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Fritz W. The mechanism of action for laryngeal manual therapies: the need for an update. Curr Opin Otolaryngol Head Neck Surg 2024; 32:151-155. [PMID: 38393684 DOI: 10.1097/moo.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
PURPOSE OF REVIEW To propose a pathway for expanding the understanding of potential mechanisms of action with laryngeal-based manual therapy (LMT) for muscle tension dysphonia (MTD). This review may help determine if current LMT literature has kept up with advances in the more general manual therapy (MT) findings. RECENT FINDINGS Studies over the past thirty years, including recently published articles, have confirmed the efficacy of various manual therapy interventions in treating MTD. However, gaps exist between current LMT literature and that being presented in the more general MT field. Instead of viewing peripheral manipulation's influences as a local cause/effect process, the MT literature paints a richer tapestry of centrally mediated impacts. SUMMARY Evidence from outside the LMT field has introduced a broad tapestry of factors that may contribute to the efficacy of MT, extending beyond the local effects reported in LMT literature. To better understand the effect and mechanism of action touch-based interventions have on a patient's voice and to potentially improve outcomes, it is necessary to broaden investigations to include a broader range of perspectives.
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Franz L, Da Canal A, Tuon M, Defilippi R, Biscaro A, Pasian M, Lucchini E, Marioni G, de Filippis C. Clinical effectiveness of telerehabilitation in voice therapy programs for dysphonia. Am J Otolaryngol 2024; 45:104255. [PMID: 38471418 DOI: 10.1016/j.amjoto.2024.104255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE The main aim of this study was to investigate the clinical efficacy of speech therapy, delivered via tele-practice to patients with dysphonia. A secondary aim was to verify whether a telerehabilitation-only protocol could have a clinical efficacy similar to a combined telerehabilitation and in-person approach. METHODS Thirty-two consecutive patients undergoing telerehabilitation for dysphonia were retrospectively considered. Patients were divided into two groups: those who received combined in-person and telerehabilitation treatment, and those who underwent telerehabilitation only. RESULTS Overall, patients included in this study showed a significant improvement in their VHI-10 scores after treatment (p < 0.001). Such an improvement was also significant in both combined therapy and telerehabilitation only groups (p = 0.019, and p = 0.002, respectively). A significant reduction in general degree of dysphonia (G), roughness (R), breathiness (B) and strain (S) scores (p < 0.001, p = 0.012, p < 0.001, and p < 0.001, respectively) was noticed over the whole sample after treatment. The same parameters showed a significant improvement also in the combined therapy group, while in the telerehabilitation only group, only G, B and S scores significantly improved. Mean phonation time, Jitter and Shimmer values significantly improved in the overall sample as well as in the combined therapy group. A significantly more favorable spectrographic class relative to the vowel /a/ was found after treatment in the whole sample, as well as in both combined therapy and telerehabilitation only groups (p < 0.001, p = 0.002, p = 0.004, respectively). CONCLUSION This study's results seem to support telerehabilitation as a potentially effective tool to administer speech therapy in dysphonic patients, both as a single modality and in combination with traditional in-person sessions. To better characterize the clinical results of telerehabilitation in dysphonia treatment, large-scale prospective investigations are mandatory.
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Affiliation(s)
- Leonardo Franz
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, Treviso, Italy
| | - Arianna Da Canal
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, Treviso, Italy
| | - Martina Tuon
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, Treviso, Italy
| | - Roberta Defilippi
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, Treviso, Italy
| | - Ariella Biscaro
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, Treviso, Italy
| | - Massimo Pasian
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, Treviso, Italy
| | - Emanuela Lucchini
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, Treviso, Italy
| | - Gino Marioni
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, Treviso, Italy.
| | - Cosimo de Filippis
- Phoniatrics and Audiology Unit, Department of Neuroscience DNS, University of Padova, Treviso, Italy
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Wang F, Yiu EM. Is Surface Electromyography (sEMG) a Useful Tool in Identifying Muscle Tension Dysphonia? An Integrative Review of the Current Evidence. J Voice 2024; 38:800.e1-800.e12. [PMID: 34903394 DOI: 10.1016/j.jvoice.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This integrative review aims to determine the quality level of evidence on using surface electromyography (sEMG) as a diagnostic tool in identifying muscle tension dysphonia. METHOD Two independent reviewers used one search engine and five databases to identify sEMG studies published between January 1980 and December 2020, using a set of specified search terms related to muscle tension dysphonia. The selected articles were systematically evaluated by two independent raters using a modified critical appraisal of diagnostic evidence (m-CADE) form. RESULTS Nine articles that satisfied the inclusion criteria were selected from among 576 studies for evaluation. These nine studies showed varied methodological approaches in sEMG measurements, including electrode configuration and position, tasks used in sEMG data collection, outcome measure, and normalization procedures. Five studies showed relatively high m-CADE scores, which were indicative of "suggestive validity and compelling importance". Two studies were rated as "suggestive validity and importance", while two remaining studies were rated as "less suggestive or equivocal validity and importance". CONCLUSIONS The review found a moderate level of evidence that sEMG can be a potentially useful tool with diagnostic value in identifying muscle tension dysphonia. However, evidence is not yet available to determine the diagnostic accuracy of sEMG for muscle tension dysphonia. More studies are needed, and it is recommended that future studies involving sEMG and reference measurements should be undertaken using a blinding procedure in order to control any subjective biases. Details of the population that the sEMG has been tested on should be outlined clearly so that spectrum bias could be eliminated or minimized in the application process. Furthermore, it is suggested that a reliable and valid protocol in collecting sEMG data during speech should be developed to minimize the variability of sEMG measures in assessing muscle activities during speech.
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Affiliation(s)
- Feifan Wang
- School of Humanities, Shanghai Normal University, Shanghai, China.
| | - Edwin Ml Yiu
- Voice Research Laboratory, The University of Hong Kong, Pokfulam, Hong Kong
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Hockey K, Kennedy E. Clinical Characteristics of Individuals Presenting to Physiotherapy for Voice and Throat Care: A Retrospective Case Notes Review. J Voice 2024:S0892-1997(24)00009-2. [PMID: 38429117 DOI: 10.1016/j.jvoice.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Currently, little is known about the characteristics of individuals presenting for physiotherapy care with voice and throat problems. PURPOSE The aim of this study is to describe the demographic and clinical characteristics of individuals presenting to physiotherapy for voice and throat-related problems, and to use this information to clarify the role of physiotherapy in the management of people with voice and throat problems. METHODS A retrospective clinical case notes review was conducted of all clients who accessed physiotherapy for voice and throat problems at a private practice based in Christchurch within a 12-month period from 1st October 2020 to 1st October 2021. RESULTS Data were analyzed from 53 patient charts. The typical profile of an individual accessing physiotherapy for voice and throat problems were female (n = 37), NZ European (n = 26), singer (n = 43), with chronic problems (n = 20), of a nontraumatic origin (n = 45). Voice problems were present in 39 cases and muscle-related problems were present in 42 cases. Treatment primarily included manual therapy and various modes of exercise therapy. CONCLUSIONS The clinical characteristics described offer insight into the demographic and clinical characteristics of individuals accessing physiotherapy services for voice and throat problems. A high prevalence of muscle-related problems and wider issues were identified, consistent with the physiotherapy skill set. Physiotherapy appears to complement existing ENT or SLT services by identifying and managing muscle-related voice problems and addressing wider factors contributing to voice and throat problems.
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Daniels K, Chanda A, Berry L, Edke A, Patel P, Wun A, Krisciunas GP. A Survey of Manual Therapy Techniques and Protocols Used to Prevent or Treat Dysphagia in Head and Neck Cancer Patients During and after Radiation Therapy. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241263349. [PMID: 38903482 PMCID: PMC11189010 DOI: 10.1177/27536130241263349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
Background Authoritative research demonstrating efficacy of traditional dysphagia therapy for Head & Neck Cancer (HNC) patients is limited. A 2019 survey reported speech-language-pathologists (SLPs) have started using Manual Therapy (MT) to prevent or rehabilitate dysphagia in HNC patients. This application of MT is supported theoretically but no research has established efficacy. Further, specific contents of MT protocols employed in this setting remain unknown. Objectives In the absence of HNC dysphagia specific MT protocols, this study aimed to better understand MT protocols employed by SLPs to prevent and treat dysphagia in HNC patients during and after Radiation Therapy (RT). Methods An internet-based questionnaire for SLPs who use MT with HNC patients was developed and tested for face/content validity. It was sent to SLPs practicing in the USA, twice, through three national listservs (ASHA-SIG13, ASHA-SIG3, University of Iowa Voiceserv). Results Of 64 respondents, 44 completed the survey. Of the 44, 15(34%) provided proactive MT during RT, 37(84%) provided proactive MT after RT (to prevent dysphagia), and 44(100%) provided reactive MT after RT (to treat dysphagia). 40(91%) were trained in MT through a CE course and 25(57%) had HNC-specific MT training. The most common MT techniques were laryngeal manipulation (LM) and myofascial release (MFR). During RT, MT protocols are gentler and highly tailored, with simple home programs of mild intensity. After RT, protocols are more regimented and aggressive, but still highly customized, with more diverse home programs of at least moderate intensity. Conclusion MT for HNC patients lacks a standard protocol or approach, but MFR and LM, or components of those techniques, are used most frequently. Given the frequency with which MFR and LM are employed to treat dysphagia during and post-RT, and the lack of empirical evidence supporting or refuting their use, a collaboratively designed RCT is warranted to establish the safety and efficacy of MT for HNC patients.
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Affiliation(s)
- Kadesh Daniels
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
- Department of Medicine, AU/UGA Medical Partnership Medical College of Georgia, Augusta, GA, USA
| | - Anindita Chanda
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
- Division of Internal Medicine, UConn Health, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Lucas Berry
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Arpita Edke
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
| | - Parth Patel
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
| | - Andy Wun
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
| | - Gintas P. Krisciunas
- Department of Otolaryngology, Boston Medical Center, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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Khoddami SM, Aghadoost S, Jalaie S, Dabirmoghaddam P. The comparison between vocal facilitating techniques, manual circumlaryngeal therapy, and combined voice therapy in teachers with muscle tension dysphonia: a randomized clinical trial. Eur Arch Otorhinolaryngol 2023; 280:4543-4553. [PMID: 37341763 DOI: 10.1007/s00405-023-08042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/24/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Although voice therapy (VT) has been known effective in muscle tension dysphonia (MTD), it is not obviously clear which VT approach is more effective. This study aimed to compare the effectiveness of Vocal Facilitating Techniques (VFTs), Manual Circumlaryngeal Therapy (MCT), and combined VT in teachers with MTD. METHODS This study was a double-blind parallel randomized clinical trial. Thirty elementary female teachers with MTD were divided into three treatment groups including VFTs; MCT, and combined VT. In addition, vocal hygiene was presented to all groups. All participants received 10 individual 45-min sessions of VT twice a week. The effectiveness was assessed using Vocal Tract Discomfort (VTD) scale and Dysphonia Severity Index (DSI) before and after treatment and improvement measurement was calculated. The participants and data analyzer were blinded to the type of VT. RESULTS All groups showed significantly better results on the subscales of VTD scale and DSI score after VT (p ≤ 0.001; η2 ≥ 0.90). There was a significant difference between the three groups on the results of VTD scale and DSI score (p ≤ 0.05). The improvement measurement on the VTD severity subscale and DSI score following the combined VT was the greatest compared with other groups (η2 = 0.99 and 0.98, respectively). The significant interactive effect of treatment and time was observed on the VTD severity subscale and DSI score (p < 0.05; η2 ≥ 0.56). CONCLUSIONS This study showed that the VFTs, MCT, and combined VT were effective for MTD teachers, and the combined VT is the most effective one. It seems the combination of different approaches is recommended for the VT of MTD patients.
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Affiliation(s)
- Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Pich-E-Shemiran, Enghelab Ave., Tehran, 11489, Iran
| | - Samira Aghadoost
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Pich-E-Shemiran, Enghelab Ave., Tehran, 11489, Iran.
| | - Shohreh Jalaie
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Fuentes C, Castañón S, Roldán L. Differences between the Perilaryngeal Pressure Pain Thresholds in Asymptomatic Women, Women With Bruxism, and Women With Odynophonia. J Voice 2023:S0892-1997(23)00219-9. [PMID: 37661520 DOI: 10.1016/j.jvoice.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE This study was aimed at comparing perilaryngeal pressure pain thresholds (PPT) among asymptomatic women, women with bruxism, and women with odynophonia. DESIGN Observational cross-sectional study. METHODS Eighty-four women whose age mean was 23.75 (SD, 3.02) years were grouped according to inclusion and exclusion criteria into a group of asymptomatic women (G1), another group of women with bruxism (G2), and another of women with odynophonia (G3). Palpation was used to identify regions of interest for this study, and an analog algometer was used to evaluate perilaryngeal PPT in the previously localized regions. Each PPT evaluation was done twice. RESULTS G1 PPT mean were between 1.35 (SD, 0.20) and 2.29 (SD, 0.28) kg/cm2, G2 PPT mean were found between 0.85 (SD, 0.12) and 1.78 (SD, 0.23) kg/cm2, and G3 PPT mean were located between 0.71 (SD, 0.11) and 1.45 (SD, 0.19) kg/cm2. Differences were observed between PPT in the three groups evaluated (P < 0.05). The intra-evaluator agreement between the evaluations performed fluctuated between 60.71% (κ = 0.51) and 92.86% (κ = 0.91). CONCLUSIONS There are significant differences between the perilaryngeal PPT of asymptomatic women, women with bruxism, and women with odynophonia. Asymptomatic women had the highest PPT, while odynophonia sufferers had the lowest.
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Affiliation(s)
- Christopher Fuentes
- Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Región Metropolitana, Chile.
| | - Sebastián Castañón
- Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Región Metropolitana, Chile
| | - Lylia Roldán
- Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Región Metropolitana, Chile
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Shabani Q, ShaterzadehYazdi MJ, Soltani M, Behdarvandan A, Najarzadeh Z, Naderifar E, Dastoorpour M, Moradi N, Rahimifar P. The effects of transcutaneous electrical nerve stimulation on muscle activity pattern in professional voice users with muscle tension dysphonia using surface electromyography data: A pilot study. Am J Otolaryngol 2023; 44:103911. [PMID: 37209538 DOI: 10.1016/j.amjoto.2023.103911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/20/2023] [Accepted: 04/29/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Muscle Tension Dysphonia is a voice disorder, which results in stiffness in the laryngeal extrinsic muscles, intense collision, painful contractions, and vibrations of the vocal cords. Due to the multifactorial identity of Muscle Tension Dysphonia, its therapeutic approach must be multidisciplinary. METHODS The participants were divided into two groups: a control group (5participants) that received Circumlaryngeal Manual Therapy (CMT) + Placebo Transcutaneous Electrical Nerve Stimulation and an experimental group (5participants) that received Transcutaneous Electrical Nerve Stimulation + CMT. Both groups received 10 sessions of treatment, twice a week, for 40 min each. Before and after treatment, participants were assessed using the Dysphonia Severity Index (DSI) and surface electromyography for their ability to sustain the vowels /e& u/and count from 20 to30. RESULT After therapy, there were substantial improvements in the DSI (2.72 ± 0.55, P < 0.05) and muscle electrical activity in the control group. The DSI (3.66 ± 0.63, P < 0.05) and muscle electrical activity were also significantly improved in the experimental group after treatment. The findings of the between-group comparison after treatment revealed a significantly greater increase in the Dysphonia Severity Index in the experimental group compared with the control group (P = 0.037). Although there was no significant difference between the two groups in terms of muscle electrical activity, clinically significant changes were more noticeable in the experimental group when compared with the control group. CONCLUSIONS Positive results were seen in both groups. The results demonstrate that both approaches relax vocal tract muscles. As a result, Transcutaneous Electrical Nerve Stimulation was recommended as a complementary treatment for clients with Muscle Tension Dysphonia.
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Affiliation(s)
- Qobad Shabani
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Speech Therapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Jafar ShaterzadehYazdi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Soltani
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Speech Therapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amin Behdarvandan
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Zahra Najarzadeh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ehsan Naderifar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Speech Therapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Dastoorpour
- Department of Biostatistics and Epidemiology, Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Negin Moradi
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Speech Therapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Parvaneh Rahimifar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Speech Therapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Thomas CM, Rhodes D, Mehta M, Alexander J. Methods of Measuring Laryngeal Muscle Tension in Patients with Muscle Tension Dysphonia: A Scoping Review. J Voice 2023:S0892-1997(23)00106-6. [PMID: 37062641 DOI: 10.1016/j.jvoice.2023.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND In clinical practice and research relating to Muscle Tension Dysphonia (MTD), several laryngeal muscle tension measurement methods are used to diagnose, to identify specific muscle strengths and deficits, and to measure therapeutic outcomes. The variety and reliability of available measurement methods presents challenges within diagnosis and treatment. The lack of methodical standardization presents a barrier to homogeneous practice in this area. There is a need for a comprehensive scoping review of laryngeal muscle tension measurement methods. STUDY DESIGN Scoping review. OBJECTIVES (1) To identify current methods of laryngeal muscle measurement which have been developed or tested with people with MTD; and (2) To identify the construct/s measured, reliability, validity, ability to detect change, efficiency and accessibility of identified methods. METHOD This scoping review was conducted using the Arksey and O'Malley framework. Studies were identified through searches of 4 major databases. The reviewer independently assessed titles, abstracts, and full-text articles. RESULTS Twenty seven papers published from 2000 to 2022 that satisfied the inclusion criteria were selected from 194 studies. The papers showed a variety of approaches with regards to the measurement of laryngeal activity and tension in subjects with MTD. Just over a quarter (25.9%) were reviews of the validity of assessment methods of MTD, including surface electromyography (sEMG), while 22.2% discussed surface electromyography as a measurement of muscle activity in subjects with MTD. 96.3% used a published methodological framework. CONCLUSIONS Assessment methods for Primary MTD are multifaceted, including patient history, laryngoscopic examination, and voice-related musculoskeletal features. Potential use of objective measurement methods, including sEMG, Real Time Elastosonography, Magnetic Resonance Imaging was noted. Due to variability in assessment methods and results, there is a need for greater objective practical methodological standardization to ensure accurate diagnosis, appropriate care, and chart patient progress.
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Affiliation(s)
- Claire M Thomas
- Institute of Coaching and Performance, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK.
| | - David Rhodes
- Institute of Coaching and Performance, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Melanie Mehta
- Institute of Coaching and Performance, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
| | - Jill Alexander
- Institute of Coaching and Performance, School of Sport and Health Sciences, University of Central Lancashire, Preston, UK
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Abur D, MacPherson MK, Shembel AC, Stepp CE. Acoustic Measures of Voice and Physiologic Measures of Autonomic Arousal During Speech as a Function of Cognitive Load in Older Adults. J Voice 2023; 37:194-202. [PMID: 33509665 PMCID: PMC8310524 DOI: 10.1016/j.jvoice.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 12/01/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to determine the relationships among cognitive loading, autonomic arousal, and acoustic measures of voice in healthy older adults. STUDY DESIGN Prospective and observational. METHODS Twelve healthy older adults (six females) produced a sentence containing an embedded Stroop task in each of two cognitive load conditions: congruent and incongruent. Three physiologic measures of autonomic arousal (pulse volume amplitude, pulse period, and skin conductance response amplitude) and four acoustic measures of voice (cepstral peak prominence, low-to-high spectral energy ratio, fundamental frequency, and sound pressure level) were analyzed in each cognitive load condition. RESULTS A logistic regression model was used to predict the cognitive load condition using participant as a categorical predictor and the four acoustic measures and three autonomic measures as continuous predictors. Skin conductance response amplitude and pulse volume amplitude were both predictive of cognitive load; however, no acoustic measures of voice were statistically significant predictors of cognitive load for older adults. CONCLUSIONS These findings support the idea that increased cognitive load is associated with increased autonomic nervous system activity in older adults. The lack of changes in acoustic measures of voice with increased cognitive load may result from age-related changes in vocal quality and speech subsystems.
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Affiliation(s)
- Defne Abur
- Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Megan K MacPherson
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant, MI.
| | - Adrianna C Shembel
- NYU Langone Health, Department of Otolaryngology-Head and Neck Surgery, New York University, New York, NY
| | - Cara E Stepp
- Department of Speech, Language, and Hearing Sciences, Boston University, MA; Department of Biomedical Engineering, Boston University, Boston, MA; Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, MA
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11
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Moein N, Dehqan A, Scherer RC. Chronic voice disorder after coronavirus disease 2019 infection and its treatment using the cricothyroid visor maneuver: a case report. J Med Case Rep 2023; 17:67. [PMID: 36841775 PMCID: PMC9968215 DOI: 10.1186/s13256-023-03780-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/16/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Regarding human coronavirus, the severe acute respiratory syndrome coronavirus 2 pandemic, the novelty of disease, and consequently the lack of studies, the etiology of dysphonia in patients with coronavirus disease 2019 is still unknown and needs to be investigated. The purpose of the current study is to investigate the effect of a new manual therapy technique, cricothyroid visor maneuver, on muscle tension dysphonia symptoms for a patient who had experienced dysphonia symptoms due to the coronavirus disease 2019 infection. CASE PRESENTATION A 55-year-old retired Iranian teacher who was diagnosed with muscle tension dysphonia by an otolaryngologist participated in this study. Fifty days before being referred to an otolaryngologist, he was diagnosed with coronavirus disease 2019 on the basis of the results of a standard laboratory test, namely real-time polymerase chain reaction. Treatment was provided in ten sessions. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted for auditory perceptual and acoustic analysis to assess the effects of the treatment program. Also, videolaryngostroboscopy voice quality perceptions by the patient, both before and after therapy, were assessed. The reduction in all features of the Consensus Auditory-Perceptual Evaluation of Voice was observed. The results of acoustic assessment showed that jitter (35.13%) and shimmer (20.48%) decreased; moreover, the harmonics-to-noise ratio (1.17%), cepstral peak prominence smoothed (28.53%) and maximum phonation time (15.5%) increased after treatment sessions. The scores of four parameters of Stroboscopy Examination Rating Form (SERF) form changed after cricothyroid visor maneuver therapy. Also, the visual analog scales score at the pre-treatment assessment was 40, and increased to 90 at the post-treatment assessment. CONCLUSIONS The effectiveness of cricothyroid visor maneuver therapy on dysphonia associated with coronavirus disease 2019 was investigated in the current study. This case study has highlighted chronic dysphonia after coronavirus disease 2019 infection, and suggests that the cricothyroid visor maneuver therapy approach may have positive outcomes for patients with muscle tension dysphonia with this background.
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Affiliation(s)
- Narges Moein
- grid.411746.10000 0004 4911 7066Department of Speech Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Madadkaran St., Shahnazari Ave., Mirdamad Blvd., Madar Sq., Tehran, Iran
| | - Ali Dehqan
- Rehabilitation Sciences Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Ronald C. Scherer
- grid.253248.a0000 0001 0661 0035Department of Communication Disorders, Bowling Green State University, Bowling Green, OH USA
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12
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Vahid M, Mansuri B, Farzadi F, Tohidast SA, Bagheri R, Scherer RC. Immediate Effects of Combining Kinesio Tape with Voice Therapy in Patients with Muscle Tension Dysphonia. J Voice 2022:S0892-1997(22)00278-8. [PMID: 36283906 DOI: 10.1016/j.jvoice.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The present study investigated the immediate effect of adding Kinesio taping along with voice therapy for the treatment of muscle tension dysphonia patients. MATERIALS AND METHODS Twenty patients with primary muscle tension dysphonia (MTD) (12 males and 8 females) with a mean age of 36.95 ± 9.58 years participated in the study. Participants were assigned to two groups: one group (6 males and 4 females) received only traditional voice therapy (VT) and the other group (6 males and 4 females) received Kinesio taping (KT) and voice therapy (VT). The VT group received laryngeal manual therapy (LMT) (for 15 minutes) and voice therapy techniques including humming, chewing, and yawn-sigh (for 15 minutes). The VT + KT group received both KT and the same VT as the first group. KT was applied to the sternocleidomastoid, infralaryngeal, and supralaryngeal muscles of the neck. Auditory-perceptual assessments using CAPE-V, acoustic voice analysis, and assessments of vocal tract discomfort and pain were used to evaluate the effects of a single treatment session. The Wilcoxon and Mann-Whitney U tests were used for data analysis. RESULTS The results of within-group comparison of the auditory-perceptual assessment (overall severity, roughness, breathiness, and strain) in both sustained vowels and connected speech tasks showed a significant reduction in all mentioned items in both groups (P < 0.05). Acoustic voice analysis showed significant improvement of HNR in the KT + VT group for both sustained vowels and connected speech tasks, and significant improvement of jitter in the VT group for sustained vowels (P < 0.05). Regarding vocal tract discomfort, the symptom of tightness in the KT + VT group, irritability and pain in the VT group, and the overall score of vocal tract discomfort in both groups, significantly decreased (P < 0.05). A significant decrease in pain severity in the front of the neck, throat, and larynx was reported by MTD patients in both groups (P < 0.05). Between-group comparisons indicated a significant difference only in the pain item of the VTD scale (P < 0.05) with greater pain decrease for the VT group. Comparison of the mean of differences showed that the VT group reduced irritability more than the KT + VT group (P < 0.05). CONCLUSION The present study showed that voice therapy with and without Kinesio taping can improve patients' voice quality (auditory-perceptual and acoustic voice analysis) and reduce vocal tract discomfort and pain in MTD patients after one therapy session. Moreover, MTD patients treated with KT + VT did not experience more significant improvements compared to those treated with VT alone. More studies in this area are recommended to better determine the effects of KT in MTD patients especially for long term effects of KT.
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Affiliation(s)
- Maedeh Vahid
- Department of Speech Therapy, School of Rehabilitation, Semnan University of Medical Sciences, Semnan, Iran
| | - Banafshe Mansuri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran.
| | - Faezeh Farzadi
- Otorhinolaryngology Research Center, Amir A'lam Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Seyed Abolfazl Tohidast
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Rasool Bagheri
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Ronald Callaway Scherer
- Department of Communication Sciences and Disorders, Bowling Green State University, Bowling Green, Ohio
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Desjardins M, Apfelbach C, Rubino M, Verdolini Abbott K. Integrative Review and Framework of Suggested Mechanisms in Primary Muscle Tension Dysphonia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:1867-1893. [PMID: 35446683 PMCID: PMC9559660 DOI: 10.1044/2022_jslhr-21-00575] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 05/26/2023]
Abstract
PURPOSE Despite the high prevalence of primary muscle tension dysphonia (MTD-1), its underlying mechanisms and their interrelationships have yet to be fully identified. The objectives of this integrative review were (a) to describe and classify the suggested underlying mechanisms for MTD-1, (b) to appraise the empirical evidence supporting each of the proposed mechanisms, and (c) to summarize the information in an integrative model. METHOD PubMed, Scopus, and CINAHL were searched for all publications pertaining to muscle tension dysphonia. Papers were retained if they included theoretical or empirical data pertaining to underlying mechanisms of MTD-1. A total of 921 papers initially qualified for screening, of which 100 remained for consideration in this review. Underlying mechanisms of MTD-1 were extracted using a consensus approach. RESULTS Seven broad categories of putative mechanisms involved in MTD-1 were identified: psychosocial, autonomic, sensorimotor, respiratory, postural, inflammatory, and neuromuscular. These categories were further divided into 19 subcategories detailed in the body of this review article. Based on the reviewed evidence, our proposed integrative model presents MTD-1 as an idiosyncratic motor adaptation to physiological perturbation or perceived threat. Under this model, physiologically or psychologically aversive stimuli can instigate a series of motor adaptations at multiple levels of the nervous system, ultimately disturbing muscle activation patterns and their biomechanical outcomes. Importantly, these adaptations appear to have the potential to become chronic even after threatening stimuli are withdrawn. CONCLUSIONS The proposed model highlights the importance of personalized rehabilitation in MTD-1 treatment. Limitations of the literature are discussed to provide guidance for future research aimed at improving our understanding of MTD-1. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19586065.
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Affiliation(s)
- Maude Desjardins
- Department of Communication Sciences & Disorders, University of Delaware, Newark
| | | | - Marianna Rubino
- Department of Communication Sciences & Disorders, University of Delaware, Newark
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14
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Ahmadi N, Moein N, Tarameshlu M, Ghelichi L, Kamali M, Jenabi MS. The effect of breathing exercises combined with manual therapy on muscle tension dysphonia in traditional singers: a blinded randomized controlled trial. Eur Arch Otorhinolaryngol 2022; 279:2989-2996. [DOI: 10.1007/s00405-021-07237-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/22/2021] [Indexed: 12/01/2022]
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15
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Cardoso R, Meneses RF, Lumini-Oliveira J, Pestana P. Myofascial Release Effects in Teachers' Posture, Muscle Tension and Voice Quality: A Randomized Controlled Trial. J Voice 2021:S0892-1997(21)00119-3. [PMID: 34024696 DOI: 10.1016/j.jvoice.2021.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Myofascial release (MFR) comprises a set of manual therapeutic techniques applied to many conditions, but specific evidence concerning its effects on body posture, muscle tension and voice has been lacking. Thus, the aim of this study was to verify the effects of MFR in teachers' posture, muscular tension and voice quality. STUDY DESIGN Randomized controlled trial - crossover. METHODS Twenty-four teachers, after completing a Sociodemographic and Clinical Questionnaire and providing written informed consent, were randomly distributed into two groups designated Group 1 (G1; n = 12; received MFR first) and Group 2 (G2; n = 12; belong to control group first). All participants received treatment and were into control group, since, after a 14 day period, procedures were switched between groups. Photogrammetry, muscle tension assessed through palpation, algometry, aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were performed before and after interventions. RESULTS Regarding voice, statistically significant differences were found when intervention was applied to both groups for maximum phonation time (MPT) (G1 P = 0.019; G2 P = 0.004). The acoustic variables did not differ. Concerning the auditory-perceptual analysis of voice statistically significant differences were found when intervention was applied in both groups for Grade in G2 (P = 0.046) and for Roughness in G1 (P = 0.025). Regarding the photogrammetry assessment statistically significant differences were found when intervention was applied to both groups in many parameters while as control group they did not. Concerning the algometry and muscle tension assessed through palpation statistically significant differences were found when intervention was applied in all muscles. CONCLUSIONS Findings indicated that MFR seems to be an effective therapy in improving MPT, two subscales (Grade and Roughness) of the GRABASH scale, muscle tension assessed through palpation and algometry. Regarding photogrammetry, MFR had an immediately effect in improvement of the posture, especially related with head.
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Affiliation(s)
- Ricardo Cardoso
- Fernando Pessoa University, Porto, Portugal; Transdisciplinary Center of Consciousness Studies of Fernando Pessoa University, Porto, Portugal.
| | - Rute F Meneses
- Fernando Pessoa University, Porto, Portugal; Transdisciplinary Center of Consciousness Studies of Fernando Pessoa University, Porto, Portugal; Longevity and Development Observatory of Fernando Pessoa University, Porto, Portugal
| | - José Lumini-Oliveira
- Fernando Pessoa University, Porto, Portugal; CIAFEL - Research Centre in Physical Activity, Health and Leisure, Porto University, Porto, Portugal; LABIOMEP - Porto Biomechanics Laboratory, Porto University, Porto
| | - Pedro Pestana
- Fernando Pessoa University, Porto, Portugal; PMP terapia, Esposende, Portugal
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16
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A Novel Laryngeal Palpatory Scale (LPS) in Patients with Muscle Tension Dysphonia. J Voice 2020; 34:488.e9-488.e27. [DOI: 10.1016/j.jvoice.2018.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 09/01/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022]
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17
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Associations between Teachers' Posture, Muscle Tension and Voice Complaints. J Voice 2020; 35:933.e23-933.e31. [PMID: 32178916 DOI: 10.1016/j.jvoice.2020.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The interaction between muscle tension, posture, and vocal use is very complex as clinical research suggests that abnormal laryngeal posture can be associated with muscle adaptive changes, although specific evidence concerning body posture and voice disorders has been lacking. Thus, the aim of this study was to verify if there were differences in posture, muscle tension and voice between teachers with and without voice complaints. STUDY DESIGN Cross-sectional study. METHODS Twenty-four teachers, 6 males and 18 females, were submitted to photogrammetry, muscle tension assessed trough palpation and algometry assessment. Aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were done. Participants were divided into without voice complaints group (WVCG; n = 11) and voice complaints group (VCG; n = 13) based on Sociodemographic and Clinical Questionnaire completion. RESULTS For auditory-perceptual analysis, VCG showed a significant higher values on GRBASH subscales Grade (p < 0.001) and Roughness (p = 0.011). The VCG showed statistically significant higher values on muscle tension of suprahyoids (p = 0.001), thyrohyoids (P = 0009) and cricothyroids muscles (p = 0.040) and statistically significant lower values on algometry of the cricothyroid (p = 0.023 left and p = 0.026 right), suprahyoids (p = 0.017 left & p = 0.018 right), thyrohyoids (p = 0.006 left and p = 0.007 right) and pharyngolaryngeal (p = 0.016 left and p = 0.021 right) muscles of both sides. Concerning the aerodynamic assessment of voice and acoustic analysis of voice, no statistically significant differences between the groups were found. CONCLUSIONS Findings indicated statistically significant differences in muscle tension in laryngeal intrinsic muscles and auditory-perceptual analysis between teachers with and without voice complaints.
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Aghadoost S, Jalaie S, Khatoonabadi AR, Dabirmoghaddam P, Khoddami SM. A Study of Vocal Facilitating Techniques Compared to Manual Circumlaryngeal Therapy in Teachers With Muscle Tension Dysphonia. J Voice 2019; 34:963.e11-963.e21. [PMID: 31353126 DOI: 10.1016/j.jvoice.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/01/2019] [Accepted: 06/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE There are several voice therapy techniques been suggested in patients with muscle tension dysphonia (MTD), however a few studies are compared between them. The purpose of present study was to compare the effect of vocal facilitating techniques (VFTs) and manual circumlaryngeal therapy (MCT) in teachers with MTD. STUDY DESIGN This is a randomized clinical trial study. METHODS Sixteen teachers with MTD (female; mean age: 38.6 ± 4.6 years) participated in this study. The participants allocated to two treatment groups: the first group received VFTs (n: 8) and MCT was presented to the second one (n: 8). In each group, the voice therapy techniques were given for 10 individual sessions twice a week. The effect of both techniques was assessed using voice handicap index (VHI) and dysphonia severity index (DSI). RESULTS Within group comparison, the VHI, DSI, and theirs components showed significantly better results after both treatment groups (P ≤ 0.05). Although, effect size was strong for all target features (η2 > 0.36); the greatest magnitude was obtained on the physical subscale of VHI following MCT and for the DSI after VFTs (η2 = 0.92 and 0.90, respectively). Moreover, the interactive effect of time and treatment groups indicated that there was significant main effect on the physical and functional subscales of VHI (P = 0.00 and 0.02, respectively) as well as I-low and DSI (P = 0.01 and 0.02, respectively). CONCLUSION VFTs and MCT are two effective techniques in voice therapy of teachers with MTD. However, the greatest improvement obtained on the DSI following VFTs and for the physical aspect of VHI after MCT demonstrated voice therapist can use appropriate technique based on the voice complaints and results of voice assessments in MTD.
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Affiliation(s)
- Samira Aghadoost
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Jalaie
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Khatoonabadi
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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Slinger C, Mehdi SB, Milan SJ, Dodd S, Matthews J, Vyas A, Marsden PA. Speech and language therapy for management of chronic cough. Cochrane Database Syst Rev 2019; 7:CD013067. [PMID: 31335963 PMCID: PMC6649889 DOI: 10.1002/14651858.cd013067.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cough both protects and clears the airway. Cough has three phases: breathing in (inspiration), closure of the glottis, and a forced expiratory effort. Chronic cough has a negative, far-reaching impact on quality of life. Few effective medical treatments for individuals with unexplained (idiopathic/refractory) chronic cough (UCC) are known. For this group, current guidelines advocate the use of gabapentin. Speech and language therapy (SLT) has been considered as a non-pharmacological option for managing UCC without the risks and side effects associated with pharmacological agents, and this review considers the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of SLT in this context. OBJECTIVES To evaluate the effectiveness of speech and language therapy for treatment of people with unexplained (idiopathic/refractory) chronic cough. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, trials registries, and reference lists of included studies. Our most recent search was 8 February 2019. SELECTION CRITERIA We included RCTs in which participants had a diagnosis of UCC having undergone a full diagnostic workup to exclude an underlying cause, as per published guidelines or local protocols, and where the intervention included speech and language therapy techniques for UCC. DATA COLLECTION AND ANALYSIS Two review authors independently screened the titles and abstracts of 94 records. Two clinical trials, represented in 10 study reports, met our predefined inclusion criteria. Two review authors independently assessed risk of bias for each study and extracted outcome data. We analysed dichotomous data as odds ratios (ORs), and continuous data as mean differences (MDs) or geometric mean differences. We used standard methods recommended by Cochrane. Our primary outcomes were health-related quality of life (HRQoL) and serious adverse events (SAEs). MAIN RESULTS We found two studies involving 162 adults that met our inclusion criteria. Neither of the two studies included children. The duration of treatment and length of sessions varied between studies from four sessions delivered weekly, to four sessions over two months. Similarly, length of sessions varied slightly from one 60-minute session and three 45-minute sessions to four 30-minute sessions. The control interventions were healthy lifestyle advice in both studies.One study contributed HRQoL data, using the Leicester Cough Questionnaire (LCQ), and we judged the quality of the evidence to be low using the GRADE approach. Data were reported as between-group difference from baseline to four weeks (MD 1.53, 95% confidence interval (CI) 0.21 to 2.85; participants = 71), revealing a statistically significant benefit for people receiving a physiotherapy and speech and language therapy intervention (PSALTI) versus control. However, the difference between PSALTI and control was not observed between week four and three months. The same study provided information on SAEs, and there were no SAEs in either the PSALTI or control arms. Using the GRADE approach we judged the quality of evidence for this outcome to be low.Data were also available for our prespecified secondary outcomes. In each case data were provided by only one study, therefore there were no opportunities for aggregation; we judged the quality of this evidence to be low for each outcome. A significant difference favouring therapy was demonstrated for: objective cough counts (ratio for mean coughs per hour on treatment was 59% (95% CI 37% to 95%) relative to control; participants = 71); symptom score (MD 9.80, 95% CI 4.50 to 15.10; participants = 87); and clinical improvement as defined by trialists (OR 48.13, 95% CI 13.53 to 171.25; participants = 87). There was no significant difference between therapy and control regarding subjective measures of cough (MD on visual analogue scale of cough severity: -9.72, 95% CI -20.80 to 1.36; participants = 71) and cough reflex sensitivity (capsaicin concentration to induce five coughs: 1.11 (95% CI 0.80 to 1.54; participants = 49) times higher on treatment than on control). One study reported data on adverse events, and there were no adverse events reported in either the therapy or control arms of the study. AUTHORS' CONCLUSIONS The paucity of data in this review highlights the need for more controlled trial data examining the efficacy of SLT interventions in the management of UCC. Although a large number of studies were found in the initial search as per protocol, we could include only two studies in the review. In addition, this review highlights that endpoints vary between published studies.The improvements in HRQoL (LCQ) and reduction in 24-hour cough frequency seen with the PSALTI intervention were statistically significant but short-lived, with the between-group difference lasting up to four weeks only. Further studies are required to replicate these findings and to investigate the effects of SLT interventions over time. It is clear that SLT interventions vary between studies. Further research is needed to understand which aspects of SLT interventions are most effective in reducing cough (both objective cough frequency and subjective measures of cough) and improving HRQoL. We consider these endpoints to be clinically important. It is also important for future studies to report information on adverse events.Because of the paucity of data, we can draw no robust conclusions regarding the efficacy of SLT interventions for improving outcomes in unexplained chronic cough. Our review identifies the need for further high-quality research, with comparable endpoints to inform robust conclusions.
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Affiliation(s)
- Claire Slinger
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | - Syed B Mehdi
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | | | - Steven Dodd
- Lancaster UniversityFaculty of Health and MedicineLancasterUK
| | - Jessica Matthews
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | - Aashish Vyas
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
| | - Paul A Marsden
- Lancashire Teaching Hospitals TrustDepartment of Respiratory MedicinePrestonUK
- Wythenshawe Hospital, Manchester University NHS Foundation TrustNorth West Lung CentreManchesterUK
- School of Biological Sciences, University of ManchesterDivision of Infection, Immunity and Respiratory MedicineManchesterUK
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Krisciunas GP, Vakharia A, Lazarus C, Taborda SG, Martino R, Hutcheson K, McCulloch T, Langmore SE. Application of Manual Therapy for Dysphagia in Head and Neck Cancer Patients: A Preliminary National Survey of Treatment Trends and Adverse Events. Glob Adv Health Med 2019; 8:2164956119844151. [PMID: 31041144 PMCID: PMC6482656 DOI: 10.1177/2164956119844151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/24/2019] [Accepted: 03/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Radiation-associated dysphagia is a common and debilitating consequence of treatment for head and neck cancer (HNC). Since commonly employed dysphagia therapy programs for HNC patients still lack authoritative efficacy, some speech-language pathologists (SLPs) have started employing manual therapy (MT) techniques in an attempt to prevent or rehabilitate dysphagia in this patient population. However, exceptionally little is known about the use of MT in this patient population. OBJECTIVES The purpose of this study was to describe practice patterns as well as the rate, type, and severity of adverse events associated with SLP provision of MT to HNC patients. METHODS An Internet-based questionnaire geared toward SLPs who practice MT was developed and sent to SLPs practicing in the United States, 3 times, through 3 national listservs (American Speech Language Hearing Association [ASHA] Special Interest Division 13, ASHA Special Interest Division 3, and University of Iowa Voiceserv), over the course of 4 weeks. RESULTS Of the 255 respondents, 116 (45.5%) performed MT on HNC patients. Of these 116 SLPs, 27.6% provided proactive MT during radiation, 62.1% provided 1 to 2 sessions per week, and 94.8% prescribed a MT home program. The rate, type, and severity of reported adverse events were similar between HNC and non-HNC patients. CONCLUSION This preliminary survey demonstrated that SLPs provide MT to HNC patients during and after cancer treatment, and that reported adverse events paralleled those experienced by noncancer patients. However, these results should be taken with caution, and a well-designed prospective study is needed to formally establish the safety and the preliminary efficacy of this novel clinical intervention.
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Affiliation(s)
- Gintas P Krisciunas
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts
| | - Aneri Vakharia
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts
- Aneri Vakharia, Boston University Medical Center, BCD Building, 800 Harrison Avenue, Boston, MA 02218, USA.
| | - Cathy Lazarus
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Rosemary Martino
- Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Hutcheson
- Department of Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Timothy McCulloch
- Department of Otolaryngology, University of Wisconsin, Madison, Wisconsin
| | - Susan E Langmore
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts
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21
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Cardoso R, Lumini-Oliveira J, Meneses RF. Associations between Posture, Voice, and Dysphonia: A Systematic Review. J Voice 2019; 33:124.e1-124.e12. [DOI: 10.1016/j.jvoice.2017.08.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022]
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22
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Ribeiro VV, Pedrosa V, Silverio KCA, Behlau M. Laryngeal Manual Therapies for Behavioral Dysphonia: A Systematic Review and Meta-analysis. J Voice 2018; 32:553-563. [DOI: 10.1016/j.jvoice.2017.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/21/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
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McGarey PO, Barone NA, Freeman M, Daniero JJ. Comorbid Dysphagia and Dyspnea in Muscle Tension Dysphonia: A Global Laryngeal Musculoskeletal Problem. OTO Open 2018; 2:2473974X18795671. [PMID: 31535069 PMCID: PMC6737875 DOI: 10.1177/2473974x18795671] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 06/20/2018] [Accepted: 07/31/2018] [Indexed: 11/30/2022] Open
Abstract
Objective To characterize the associated symptoms of dysphagia and dyspnea among patients presenting with muscle tension dysphonia (MTD). Study Design Retrospective chart review performed over a 14-month period from October 2014 to December 2015. Setting Voice and swallowing center of a tertiary academic medical center. Subjects and Methods Thirty-eight patients with MTD were included for analysis. Clinical data were collected and analyzed, including perceptual voice evaluation and patient-reported outcomes measures. Results Among patients with a diagnosis of MTD, the incidence of reported dysphagia during clinical history and examination was 44.7%. Among patients with MTD, 60.5% had an EAT-10 (10-item Eating Assessment Tool) score ≥3 (ie, abnormal). Patients who reported dysphagia and/or had abnormal EAT-10 score (≥3) had significantly greater voice impairment than that of patients without dysphagia (P = .02). Patients who reported dysphagia also had significantly higher Clinical COPD Questionnaire scores than those of patients who reported only dysphonia (P = .002). Conclusions Patients presenting for dysphonia who are diagnosed with MTD have a high rate of comorbid dysphagia. Patients who reported dysphagia had significantly higher self-reported voice impairment and greater severity of breathing dysfunction as measured by the Clinical COPD Questionnaire. The coincidence of these symptoms in this patient cohort may suggest an underlying pathophysiology that has yet to be elucidated. Further prospective studies are needed to clarify the underlying cause of dysphagia and breathing dysfunction in the setting of MTD and to investigate diagnostic and therapeutic paradigms.
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Affiliation(s)
- Patrick O McGarey
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Nicholas A Barone
- Curry School of Education, Department of Human Services, University of Virginia, Charlottesville, Virginia, USA
| | - Michael Freeman
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James J Daniero
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Slinger C, Mehdi SB, Milan SJ, Dodd S, Blakemore J, Vyas A, Marsden PA. Speech and language therapy for management of chronic cough. Hippokratia 2018. [DOI: 10.1002/14651858.cd013067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Claire Slinger
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | - Syed B Mehdi
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | | | - Steven Dodd
- Lancaster University; Faculty of Health and Medicine; Lancaster UK
| | - Jessica Blakemore
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | - Aashish Vyas
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
| | - Paul A Marsden
- Lancashire Teaching Hospitals Trust; Department of Respiratory Medicine; Preston UK
- Lancaster University; Faculty of Health and Medicine; Lancaster UK
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de Oliveira Lemos I, da Cunha Pereira G, Druck SantAnna G, Cassol M. Effects of a Voice Therapy Program for Patients with Muscle Tension Dysphonia. Folia Phoniatr Logop 2018; 69:239-245. [DOI: 10.1159/000487942] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/23/2018] [Indexed: 11/19/2022] Open
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DePietro JD, Rubin S, Stein DJ, Golan H, Noordzij JP. Laryngeal Manipulation for Dysphagia with Muscle Tension Dysphonia. Dysphagia 2018; 33:468-473. [PMID: 29372358 DOI: 10.1007/s00455-018-9875-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/05/2018] [Indexed: 11/29/2022]
Abstract
The purpose of the article is to describe the use of laryngeal manipulation as a treatment for dysphagia resulting from excessive paralaryngeal muscle tension and to identify the patients likely to have symptomatic improvement. This is a retrospective single-center case series. A retrospective review identified patients from 2007 to 2013 with laryngeal manipulation for muscle tension dysphagia in an academic Otolaryngology practice. Subjects with dysphagia not attributable to an anatomic cause who attended therapy at least one time were included in the study. The primary outcome of the study was subjective improvement in dysphagia symptoms (yes/no) during follow-up. Symptoms, demographic information, treatment, and response to therapy were recorded. The Kruskal-Wallis test was used for analysis of continuous variables, while a Chi-squared test or fisher's exact test was used for analysis of all categorical variables. Forty-four subjects were included, consisting of 37 women and 7 men. Subjective improvement in dysphagia was seen in 34 subjects (77.3%). No significant differences were seen in improvement based on gender (p = 0.3223), race (p = 0.4317), number of sessions with a speech pathologist (p = 0.3198), or presenting symptoms including hoarseness (p = 0.0853), pain (p = 1.000), globus (p = 0.2834), and cough (p = 1.000). We found subjective improvement with laryngeal manipulation as reported during follow-up visits to clinic among individuals with muscle tension dysphagia. Patient age, presenting symptoms, and number of therapy sessions were not found to be significantly associated with resolution of symptoms.
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Affiliation(s)
- Joseph D DePietro
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Samuel Rubin
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Daniel J Stein
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Hadas Golan
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - J Pieter Noordzij
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, 820 Harrison Avenue, Boston, MA, 02118, USA.
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Kryshtopava M, Van Lierde K, Meerschman I, D'Haeseleer E, Vandemaele P, Vingerhoets G, Claeys S. Brain Activity During Phonation in Women With Muscle Tension Dysphonia: An fMRI Study. J Voice 2017; 31:675-690. [DOI: 10.1016/j.jvoice.2017.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/13/2017] [Accepted: 03/16/2017] [Indexed: 11/26/2022]
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Sielska-Badurek E, Osuch-Wójcikiewicz E, Sobol M, Kazanecka E, Rzepakowska A, Niemczyk K. Combined Functional Voice Therapy in Singers With Muscle Tension Dysphonia in Singing. J Voice 2017; 31:509.e23-509.e31. [DOI: 10.1016/j.jvoice.2016.10.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 10/27/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
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Kim SJ, Lee KE, Oh BM, Oh EM, Bae DS, Choi JY, Myong JP, Youn YK. Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during robotic thyroid surgery: a preliminary prospective study. Ann Surg Treat Res 2015; 89:233-9. [PMID: 26576402 PMCID: PMC4644903 DOI: 10.4174/astr.2015.89.5.233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose The aim of this study was to evaluate the feasibility of monitoring external branch of the superior laryngeal nerve (EBSLN) during robotic thyroid surgery. Methods A total of 10 patients undergoing bilateral axillo-breast approach (BABA) robotic thyroid surgery were enrolled. The nerve integrity monitor (NIM Response 2.0 System) was used for EBSLN monitoring. We performed voice assessments preoperatively and at 1 and 3 months postoperatively using Voice Handicap Index-10 (VHI-10), maximal phonation time (MPT), phonation efficient index (PEI), and laryngeal electromyography (EMG). Results A total of 19 EBSLNs were at risk and 14 EBSLNs (73.7%) were identified using neuromonitoring. VHI-10 showed a change of voice over time (0.1 vs. 3.6 vs. 1.3); however, this was not statistically significant. VHI-10 scores normalized at 3 months postoperatively compared to the preoperative scores. MPT (a) (16.0 vs. 15.6 vs. 15.4), and MPT (e) (20.1 vs. 15.4 vs. 18.5) showed no significant differences preoperatively compared to the values obtained 1 and 3 months postoperatively. There was a significant change of PEI over time (4.8 vs. 1.1 vs. 4.6) (P = 0.036); however, the values normalized at 3 months postoperatively. Laryngeal EMG results showed 4 cases (21.2%) of neuropathy of EBSLNs at 1 month postoperatively, and electrodiagnostic studies revealed nearly complete recovery of the function of EBSLNs in 4 patients at 3 months postoperatively Conclusion It is suggested that neuromonitoring of EBSLNs during BABA robotic thyroid surgery is feasible and might be helpful to preserve voice quality.
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Affiliation(s)
- Su-Jin Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Mee Oh
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Sik Bae
- Department of Surgery, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jun Pyo Myong
- Department of Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, The Catholic University College of Medicine, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Khoddami SM, Ansari NN, Jalaie S. Review on Laryngeal Palpation Methods in Muscle Tension Dysphonia: Validity and Reliability Issues. J Voice 2015; 29:459-68. [PMID: 25795346 DOI: 10.1016/j.jvoice.2014.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/16/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laryngeal palpation is a common clinical method for the assessment of neck and laryngeal muscles in muscle tension dysphonia (MTD). OBJECTIVE To review the available laryngeal palpation methods used in patients with MTD for the assessment, diagnosis, or document of treatment outcomes. STUDY DESIGN (METHOD) A systematic review of the literature concerning palpatory methods in MTD was conducted using the databases MEDLINE (PubMed), ScienceDirect, Scopus, Web of science, Web of knowledge and Cochrane Library between July and October 2013. Relevant studies were identified by one reviewer based on screened titles/abstracts and full texts. Manual searching was also used to track the source literature. RESULTS There were five main as well as miscellaneous palpation methods that were different according to target anatomical structures, judgment or grading system, and using tasks. There were only a few scales available, and the majority of the palpatory methods were qualitative. Most of the palpatory methods evaluate the tension at both static and dynamic tasks. There was little information about the validity and reliability of the available methods. CONCLUSION The literature on the scientific evidence of muscle tension indicators perceived by laryngeal palpation in MTD is scarce. Future studies should be conducted to investigate the validity and reliability of palpation methods.
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Affiliation(s)
- Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Jalaie
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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Consorti F, Mancuso R, Mingarelli V, Pretore E, Antonaci A. Frequency and severity of globus pharyngeus symptoms in patients undergoing thyroidectomy: a pre-post short term cross-sectional study. BMC Surg 2015; 15:53. [PMID: 25928173 PMCID: PMC4419479 DOI: 10.1186/s12893-015-0037-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 04/20/2015] [Indexed: 01/28/2023] Open
Abstract
Background Globus pharyngeus is a sensation of a lump or foreign body in the throat, sometimes associated with thyroid diseases and surgery. Previous studies investigated this condition with contradictory results, mainly because not standardized instruments of measure were used. The aim of this study was to evaluate the prevalence and severity of globus pattern symptoms in a population of patients three months after a thyroidectomy, and the reduction or increase of pre-existing symptoms or the onset of new symptoms. Methods Ninety-five patients (65 women, 30 men, mean age 56.03 ± 12.45) were assessed for globus pattern symptoms before and three months after thyroid surgery (72 patients: benign goiter, 23 patients: papillary cancer). The Glasgow-Edinburgh Throat Scale (GETS) was translated into Italian and used as a validated instrument of measure of the severity of globus pattern symptoms. Results The Italian version of the GETS was reliable (Cronbach alpha = 0.85) and valid. Normative data were used to classify patients into 4 groups of severity. A significant decrease of the mean GETS score was observed at the postoperative assessment (13.02 ± 11.84 vs 8.00 ± 11.26; p < 0.01), but beside symptomatic patients who improved we could observe also two other significant groups of patients: asymptomatic patients who developed symptoms and symptomatic patients who remained symptomatic. Conclusions The significant decrease of the mean GETS postoperative score was mainly due to the improvement of strongly symptomatic patients. Two other significant outcomes exist and further studies are needed to understand their pathophysiological mechanism.
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Affiliation(s)
- Fabrizio Consorti
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy.
| | - Rosaria Mancuso
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy
| | - Valentina Mingarelli
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy
| | - Eugenio Pretore
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy
| | - Alfredo Antonaci
- Department of Surgical Sciences, University "Sapienza" of Rome, Viale del Policlinico, 00161, Roma, Italy
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Spencer ML. Muscle Tension Dysphonia: A Rationale for Symptomatic Subtypes, Expedited Treatment, and Increased Therapy Compliance. ACTA ACUST UNITED AC 2015. [DOI: 10.1044/vvd25.1.5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article will briefly identify the variable nature of muscle tension dysphonia (MTD). Causes such as psychogenicity and maladaptive “vocal posture” will be described and questioned. Special Interest Group (SIG) 3 members may benefit from identification of the strengths and weaknesses of an ongoing movement towards a symptomatically generic “MTD.” More specific subtyping of MTD into 9 categories will be proposed, as well as description of associated therapy methods. Increased patient awareness that some subtypes may be self-correctable could simplify intervention, increase compliance, and improve clinician and researcher effectiveness.
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Is the sagittal postural alignment different in normal and dysphonic adult speakers? J Voice 2014; 28:523.e1-8. [PMID: 24836364 DOI: 10.1016/j.jvoice.2014.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/08/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Clinical research in the field of voice disorders, in particular functional dysphonia, has suggested abnormal laryngeal posture due to muscle adaptive changes, although specific evidence regarding body posture has been lacking. The aim of our study was to verify if there were significant differences in sagittal spine alignment between normal (41 subjects) and dysphonic speakers (33 subjects). STUDY DESIGN Cross-sectional study. METHODS Seventy-four adults, 35 males and 39 females, were submitted to sagittal plane photographs so that spine alignment could be analyzed through the Digimizer-MedCalc Software Ltd program. Perceptual and acoustic evaluation and nasoendoscopy were used for dysphonic judgments: normal and dysphonic speakers. RESULTS For thoracic length curvature (TL) and for the kyphosis index (KI), a significant effect of dysphonia was observed with mean TL and KI significantly higher for the dysphonic speakers than for the normal speakers. Concerning the TL variable, a significant effect of sex was found, in which the mean of the TL was higher for males than females. The interaction between dysphonia and sex did not have a significant effect on TL and KI variables. For the lumbar length curvature variable, a significant main effect of sex was demonstrated; there was no significant main effect of dysphonia or significant sex×dysphonia interaction. CONCLUSIONS Findings indicated significant differences in some sagittal spine posture measures between normal and dysphonic speakers. Postural measures can add useful information to voice assessment protocols and should be taken into account when considering particular treatment strategies.
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Abstract
“America’s high schools are obsolete […] designed 50 years ago to meet the needs of another age.” – Bill Gates, National Governors’ Conference, 2005.
Obsolete and designed for another time—the same could be said for our existing health care system, treatment approaches, and service delivery models. The emergence of outcome-based payment by Accountable Care Organizations, severe restrictions in funding, and limited or absent insurance coverage for voice treatment are powerful drivers for more effective voice therapy treatment. Findings reported from the Voice and Swallowing Center of Maine support significant cost reductions to payers when telepractice is used in voice treatment (Towey, 2012a). This article describes three distinct applications of voice telepractice that expands conventional thinking about voice therapy and voice therapy telepractice. It is believed these presented cases are the first published examples that demonstrate the efficacy of voice telepractice to: (1) assess and fit a device for a laryngectomee; (2) complete virtual musculoskeletal assessment of a voice patient; and (3) provide virtual simultaneous co-treatment in voice therapy.
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Affiliation(s)
- Michael Towey
- Fellow: American Speech Language Hearing AssociationVoice & Swallowing Center of MaineWaldo County General HospitalBelfast, ME
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Van Houtte E, Claeys S, D’haeseleer E, Wuyts F, Van Lierde K. An Examination of Surface EMG for the Assessment of Muscle Tension Dysphonia. J Voice 2013; 27:177-86. [DOI: 10.1016/j.jvoice.2011.06.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Accepted: 06/30/2011] [Indexed: 10/17/2022]
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Izadi F, Salehi A. Comparison between palpatory findings of the hyoid position and their acoustic, videostroboscopic, and perceptual attributes in patients with muscle tension dysphonia (with and without organic lesions). J Voice 2012; 27:78-83. [PMID: 23123201 DOI: 10.1016/j.jvoice.2012.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 06/19/2012] [Indexed: 10/27/2022]
Abstract
SUMMARY The direction in which the hyoid is pulled may change as a result of muscle tension dysphonia (MTD). The disposition usually occurs owing to paralaryngeal muscular imbalance (decompensation), which can create laryngeal dysfunction and consequently deteriorating the voice quality. This study aimed at reporting on a comparison between palpatory findings of hyoid position and their acoustic and perceptual and stroboscopic attributes among patients with MTD. DESIGN Cross-sectional random triple-blinded study. METHOD Palpatory, acoustic, audioperceptual, and stroboscopic findings of 39 patients with MTD were analyzed descriptively and using independent sample t test. RESULTS Dominant perceptual vocal characteristic of patients with pulled-up hyoid position was rough and the degrees of jitter and shimmer were higher in patients with pulled-up hyoid position than in patients with pulled-down hyoid position (jitter, P=0.019; shimmer, P=0.004), whereas signal-to-noise (S/N) ratio was lower in patients with pulled-up hyoid position than in pulled-down hyoid patients, but not significantly (S/N ratio, P=0.56). The dominant perceptual characteristic of patients with pulled-up hyoid position was rough voice, whereas that for pulled-down hyoid patients was strained voice. On the other hand, the dominant observable pattern in patients with pulled-up hyoid was MTD type II (lateral constriction), whereas that in patients with pulled-down hyoid was MTD type III (moderate anteroposterior constriction). CONCLUSION There is a general congruence between the hyoid pulled direction and its perceptual, acoustic, and videostroboscopic findings in patients with MTD.
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Affiliation(s)
- Farzad Izadi
- Department of Speech and Language, Ear, Nose, Throat, Head and Neck Research Center, Hazrat-e-Rasoul Hospital, Tehran, Iran
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Kosztyła-Hojna B, Moskal D, Rogowski M, Falkowski D, Kasperuk J, Othman J. [The usage of modern physioterapeutic methods of rehabilitation in treatment of chosen kinds of dysphonia]. Otolaryngol Pol 2012; 66:328-36. [PMID: 23036122 DOI: 10.1016/j.otpol.2012.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 06/25/2012] [Indexed: 11/26/2022]
Abstract
UNLABELLED Voice quality disorders--dysphonias are the significant problem from therapeutic, social and economic point of view. The routine therapy does not always bring spectacular effects. The important role play the innovative methods supporting therapy of voice quality disorders. PURPOSE The aim of the study is to assess the effects of vibratory therapy of the larynx (Medical VR) in patients with hyperfunctional dysphonia and stimulating currents in phonatory exercises (VocaStim-Master) in paralytic dysphonia based on the analysis of parameters of objective assessment of voice quality. MATERIAL AND METHODS Forty patients with hyperfunctional dysphonia treated routinely were included in the study. 20 patients apart from the routine therapy were additionally treated using the vibratory therapy of regions of the larynx (Medical VR, CyberBioMed LLC). In group of 40 patients with paralytic dysphonia, in 20 patients the adjuvant therapy by stimulating currents in phonatory exercises (VocaStim-Master, Physiomed) was used. The results of treatment and adjuvant therapy in hyperfunctional and paralytic dysphonia were analyzed based on: MPT, parameters of stroboscopic and acoustic evaluation (F(0), Jitter, Shimmer, NHR) and narrow-band spectrography. RESULTS AND CONCLUSIONS : The analysis of the results indicated the usefulness of used parameters of objective assessment of voice quality taking into consideration the diagnostic and therapeutic aspect in hyperfunctional and paralytic dysphonia. Adjuvant vibratory therapy of the larynx in hyperfunctional dysphonia and stimulating currents in phonatory exercises in paralytic dysphonia improved the effectiveness of the therapy, what was confirmed by the analysis of parameters of objective assessment of voice quality.
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Affiliation(s)
- Bożena Kosztyła-Hojna
- Zakład Fonoaudiologii Klinicznej i Logopedii Uniwersytetu Medycznego w Białymstoku, Poland.
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Kosztyła-Hojna B, Kuryliszyn-Moskal A, Rogowski M, Moskal D, Dakowicz A, Falkowski D, Kasperuk J. Wpływ wibracyjnej terapii stymulującej na jakość głosu w postaci hiperfunkcjonalnej dysfonii zawodowej. Otolaryngol Pol 2012; 66:219-26. [DOI: 10.1016/s0030-6657(12)70773-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 12/05/2012] [Indexed: 10/28/2022]
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Niebudek-Bogusz E, Woźnicka E, Wiktorowicz J, Śliwińska-Kowalska M. Applicability of the Polish Vocal Tract Discomfort (VTD) scale in the diagnostics of occupational dysphonia. LOGOP PHONIATR VOCO 2012; 37:151-7. [DOI: 10.3109/14015439.2012.671358] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lowell SY, Kelley RT, Colton RH, Smith PB, Portnoy JE. Position of the hyoid and larynx in people with muscle tension dysphonia. Laryngoscope 2012; 122:370-7. [DOI: 10.1002/lary.22482] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/21/2011] [Accepted: 11/04/2011] [Indexed: 11/11/2022]
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Assessment of the influence of osteopathic myofascial techniques on normalization of the vocal tract functions in patients with occupational dysphonia. Int J Occup Med Environ Health 2012; 25:225-35. [DOI: 10.2478/s13382-012-0041-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 04/11/2012] [Indexed: 11/20/2022] Open
Abstract
Abstract
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Morphological changes of the vocal fold mucosa in hyperfunctional dysphonia diagnosed by psychoacoustic and videostroboscopic methods. Adv Med Sci 2011; 56:343-51. [PMID: 21983452 DOI: 10.2478/v10039-011-0036-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The aim of the study was to provide a morphological assessment of the laryngeal mucosa in patients with hyperfunctional dysphonia diagnosed by psychoacoustic and videostroboscopic methods. MATERIAL AND METHODS Forty patients with voice quality disorders of hyperfunctional dysphonia were recruited for participation in the study. The diagnosis of dysphonia was based on the Voice Rating Scale GRBAS, and endoscopic and stroboscopic assessment of the vocal folds. Acoustic assessment was carried out using following parameters: fundamental frequency, Jitter, Shimmer, Noise to Harmonic Rate and Yanagihara (YG) scale. In order to evaluate the morphology of the vocal fold mucosa transmission electron microscopy was performed using postoperative material obtained from the larynx. Results of clinical and morphological analysis were compared with the reference group. The morphological material was obtained from patients with hypopharyngeal cancer without pathological changes of the vocal folds. RESULTS The psychoacoustic assessment using the perceptual GRBAS scale enables the appropriate diagnostics of hyperfunctional dysphonia, which was confirmed by evaluation of acoustic parameters and YG scale analysis. In 40 patients with voice quality disorders causing by hyperfunctional dysphonia, in morphological assessment of the laryngeal mucosa, 4 (10%) patients demonstrated the presence of oedema and signs of intensive dysphonia in psychoacoustic and stroboscopic examination. CONCLUSIONS Oedema of the laryngeal mucosa confirmed by stroboscopic and ultramorphological examination may coexist with hyperfunctional dysphonia. The presence of the laryngeal oedema in patients with hyperfunctional dysphonia has the negative impact on voice quality in psychoacoustic assessment with the use of the GRBAS and YG scales.
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The evidence for laryngeal manual therapies in the treatment of muscle tension dysphonia. Curr Opin Otolaryngol Head Neck Surg 2011; 19:171-6. [PMID: 21358333 DOI: 10.1097/moo.0b013e3283448f6c] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Clinicians involved in treating patients with voice disorders are showing an increasing interest in manual therapies aimed at reducing excessive tension in the perilaryngeal area. Studies investigating the effects of this treatment have been appearing in the literature since the early 1990s, but the evidence base remains extremely small. The purpose of this review is to provide the reader with current information about the types of laryngeal manual therapy in clinical use internationally and the evidence base for their use. RECENT FINDINGS The results of studies undertaken recently reinforce the results of earlier studies, most of which have been conducted using individuals with muscle tension dysphonia. The various types of laryngeal manual therapy have all been shown to have positive effects. SUMMARY There is evidence that laryngeal manual therapy, in various forms, can be a useful primary intervention in cases of muscle tension dysphonia, although this is based on very few studies. A higher level of evidence is required, including randomized controlled trials, to investigate its role in comparison with other interventions. Studies are also needed to verify or refute the clinical observation that it is also an effective treatment for all voice disorders, including those of organic aetiology, when phonatory hyperfunction is a feature.
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Zastosowanie manualnych technik fizjoterapeutycznych w rehabilitacji dysfonii pourazowej. Otolaryngol Pol 2011; 65:285-8. [DOI: 10.1016/s0030-6657(11)70692-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 05/29/2011] [Indexed: 11/21/2022]
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Van Houtte E, Van Lierde K, Claeys S. Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. J Voice 2010; 25:202-7. [PMID: 20400263 DOI: 10.1016/j.jvoice.2009.10.009] [Citation(s) in RCA: 209] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 10/21/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Muscle tension dysphonia (MTD) is a clinical and diagnostic term describing a spectrum of disturbed vocal fold behavior caused by increased tension of the (para)laryngeal musculature. Recent knowledge introduced MTD as a bridge between functional and organic disorders. This review addresses the causal and contributing factors of MTD and evaluates the different treatment options. METHODS We searched MEDLINE (Pubmed, 1950-2009) and CENTRAL (The Cochrane Library, Issue 2, 2009). Studies were included if they reviewed the classification of functional dysphonia or the pathophysiology of MTD. Etiology and pathophysiology of MTD and circumlaryngeal manual therapy (CMT) were obligatory based on reviews and prospective cohort studies because randomized controlled trials (RCTs) are nonexisting. Concerning the treatment options of voice therapy and vocal hygiene, selection was based on RCTs and systematic reviews. RESULTS Etiological factors can be categorized into three new subgroups: (1) psychological and/or personality factors, (2) vocal misuse and abuse, and (3) compensation for underlying disease. The effective treatment options for MTD are (1) indirect therapy: vocal hygiene and patient education; (2) direct therapy: voice therapy and CMT; (3) medical treatment; and (4) surgery for secondary organic lesions. CONCLUSIONS MTD is the pathological condition in which an excessive tension of the (para)laryngeal musculature, caused by a diverse number of etiological factors, leads to a disturbed voice. Etiological factors range from psychological/personality disorders and vocal misuse/abuse to compensatory vocal habits in case of laryngopharyngeal reflux, upper airway infections, and organic lesions. MTD needs to be approached in a multidisciplinary setting where close cooperation between a laryngologist and a speech language pathologist is possible.
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Affiliation(s)
- Evelyne Van Houtte
- Department of Otolaryngology and Head and Neck Surgery, University Hospital Ghent, Belgium
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Rubin JS, Macdonald I, Blake E. The putative involvement of the transabdominal muscles in dysphonia: a preliminary study and thoughts. J Voice 2010; 25:218-22. [PMID: 20381309 DOI: 10.1016/j.jvoice.2009.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 09/03/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Real-time ultrasound was used as an adjunct to assess patterns of periabdominal musculature in 14 individual with dysphonia and muscle tension dysphonia. MATERIALS Fourteen individuals with muscle tension dysphonia were evaluated with real-time ultrasound as a part of their initial evaluation and management. RESULTS In 13 of 14 individuals, there was an imbalance found during phonation between the transversus abdominis muscles (TAs) and internal oblique muscles (IOs), whereby the IOs were found to be overactive and the TAs underactive. After physiotherapy, this pattern was reversed. CONCLUSION The abdominal muscle pattern of overactivity of the internal oblique and underactivity of the TA during phonation was found to be present in the large majority of patients in this pilot sample who had presented with muscle tension dysphonia. The significance of this is unclear but deserves further review.
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Affiliation(s)
- J S Rubin
- Royal National Throat Nose and Ear Hospital, Royal Free Hampstead NHS Trust, London, UK.
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Roy N, Nissen SL, Dromey C, Sapir S. Articulatory changes in muscle tension dysphonia: evidence of vowel space expansion following manual circumlaryngeal therapy. JOURNAL OF COMMUNICATION DISORDERS 2009; 42:124-135. [PMID: 19054525 DOI: 10.1016/j.jcomdis.2008.10.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 10/01/2008] [Accepted: 10/08/2008] [Indexed: 05/27/2023]
Abstract
UNLABELLED In a preliminary study, we documented significant changes in formant transitions associated with successful manual circumlaryngeal treatment (MCT) of muscle tension dysphonia (MTD), suggesting improvement in speech articulation. The present study explores further the effects of MTD on vowel articulation by means of additional vowel acoustic measures. Pre- and post-treatment audio recordings of 111 women with MTD were analyzed acoustically using two measures: vowel space area (VSA) and vowel articulation index (VAI), constructed using the first (F1) and second (F2) formants of 4 point vowels/ a, i, ae, u/, extracted from eight words within a standard reading passage. Pairwise t-tests revealed significant increases in both VSA and VAI, confirming that successful treatment of MTD is associated with vowel space expansion. Although MTD is considered a voice disorder, its treatment with MCT appears to positively affect vocal tract dynamics. While the precise mechanism underlying vowel space expansion remains unknown, improvements may be related to lowering of the larynx, expanding oropharyngeal space, and improving articulatory movements. LEARNING OUTCOMES The reader will be able to: (1) describe possible articulatory changes associated with successful treatment of muscle tension dysphonia; (2) describe two acoustic methods to assess vowel centralization and decentralization, and; (3) understand the basis for viewing muscle tension dysphonia as a disorder not solely confined to the larynx.
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Affiliation(s)
- Nelson Roy
- Department of Communication Sciences & Disorders, The University of Utah, Salt Lake City, UT 84112-0252, USA.
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Marszałek S, Zebryk-Stopa A, Kraśny J, Obrebowski A, Golusiński W. [An influence of myofascial release techniques on the esophagus pressure for patients after total laryngectomy]. Otolaryngol Pol 2009; 62:686-90. [PMID: 19205512 DOI: 10.1016/s0030-6657(08)70340-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED The increase of patients after total laryngectomy myofascial neck and arms area tension might be observed. Via fascial continuity it has an adverse impact on superior oesophageal constrictor, forming the "mouth of oesophagus", which hinders learning oesophagus speech. THE AIM The assessment of manual myofascial release techniques influence on the patients' oesophagus pressure after total laryngectomy. MATERIAL 40 patients (12 F, 28 M), aged 43-75 (middle 56, 8 years), 9 months to 13 years (average 3 years) after total laryngectomy, 35 patients (87.5%) after neck lymph node's resection, 38 patients (95%) after radiotherapy. METHODS The oesophagus pressure was checked by modified Seeman's method. Manual myofascial release techniques were applied within head, neck, arms, upper trunk and upper limbs area. Wilcoxon and Shapiro-Wilk's test was used for the purpose of statistical analysis. RESULTS A statistical significant decrease of the mean of oesophagus pressure was observed after physiotherapy treatment. The average pressure among the examined group decreased from 37.9 to 26.6 mm Hg. CONCLUSIONS The application of myofascial manual techniques decreased an oesophagus pressure which allows patients to obtain faster oesophagus speech.
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Marszałek S, Zebryk-Stopa A, Kraśny J, Obrebowski A, Golusiński W. Estimation of influence of myofascial release techniques on esophageal pressure in patients after total laryngectomy. Eur Arch Otorhinolaryngol 2008; 266:1305-8. [PMID: 19023585 DOI: 10.1007/s00405-008-0861-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 10/26/2008] [Indexed: 10/21/2022]
Abstract
In patients after total laryngectomy, increased tension in myofascial neck and arm areas might be observed. Via fascial continuity it has an adverse impact on the superior esophageal constrictor forming the "mouth of the oesophagus", which hinders learning of esophageal speech. The aim is to assess the effect of manual myofascial release techniques on esophageal pressure in patients after total laryngectomy. Forty patients (12 F, 28 M), aged 43-75 (mean 56.8 years), 9 months to 13 years (average 3 years) after total laryngectomy, 35 patients (87.5%) after neck lymph node resection, 38 patients (95%) after radiotherapy. Esophageal pressure was assessed using modified Seeman's method. Manual myofascial release techniques were applied within head, neck, arms, upper trunk and upper limb areas. Wilcoxon and Shapiro-Wilk's test was used for the purpose of statistical analysis. Statistically significant decrease of the mean esophageal pressure was observed after the physiotherapy treatment. The average pressure among the examined patients decreased from 37.9 to 26.6 mmHg. The application of myofascial manual techniques decreases esophageal pressure, thus allowing patients to learn esophagus speech at a faster pace.
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Affiliation(s)
- Sławomir Marszałek
- Department of Athletics, University School of Physical Education, Poznan, Poland.
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Dromey C, Nissen SL, Roy N, Merrill RM. Articulatory changes following treatment of muscle tension dysphonia: preliminary acoustic evidence. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2008; 51:196-208. [PMID: 18230866 DOI: 10.1044/1092-4388(2008/015)] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
PURPOSE Primary muscle tension dysphonia (MTD), a voice disturbance that occurs in the absence of structural or neurological pathology, may respond to manual circumlaryngeal techniques, which ostensibly alter the posture of the larynx and/or the configuration of the vocal folds without directly targeting supralaryngeal articulatory structures. Although the phonatory benefits of these techniques have been documented previously, this investigation examined whether acoustic evidence exists for articulatory changes accompanying successful management. METHOD In this retrospective study of a clinical database, pre- and post-treatment speech samples from 111 women with MTD were analyzed for acoustic evidence of supraglottal vocal tract changes associated with voice improvement, which was confirmed by perceptual ratings of dysphonia severity. The slopes of the first and second formants in diphthongs, as well as global measures of speech timing were acquired. Twenty younger females with normal voices were recorded twice, across a similar time-span to the disordered speakers, to allow comparisons in performance. RESULTS Repeated measures analysis of variance was used to evaluate changes accompanying treatment. Significant time by group interactions for /I/ F2 slope, /eI/ F2 slope, sample duration, and speaking time ratio were observed. As compared to the controls, diphthong second formant transitions increased in slope, and timing measures showed increases in speech continuity for the speakers with MTD. CONCLUSIONS Collectively, these preliminary findings suggest that individuals with MTD experience changes in both articulatory and phonatory behavior following successful treatment that targets the larynx.
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