Effect of postoperative proton pump inhibitor therapy on voice outcomes following phonomicrosurgery for vocal fold polyp: a randomized controlled study

Pre and Post-operative Voice Therapy Intervention for Benign Vocal Fold Lesions: A Systematic Review

Benign vocal fold lesions cause dysphonia by preventing vocal fold closure, causing irregular vibration and increasing compensatory muscle tension. Voice therapy delivered in addition to phonosurgery may improve voice and quality of life outcomes but the evidence base is lacking and what constitutes voice therapy for this population is not defined. The purpose of this systematic review is to critically evaluate the evidence for pre and post-operative voice therapy to inform the development of an evidence based intervention.

STUDY DESIGN

Systematic Review.

METHODS

Electronic databases were searched using key terms including dysphonia, phonosurgery, voice therapy and outcomes. Eligible articles were extracted and reviewed by the authors for risk of bias and for information regarding the content, timing and intensity of any pre and post-operative voice therapy intervention.

RESULTS

Of the 432 articles identified, 35 met the inclusion criteria and were included in the review. 5 were RCTs, 2 were individual cohort studies, 1 was a case control study and 26 were case series. There was considerable heterogeneity in participant characteristics. Information was frequently lacking regarding the content timing and intensity of the reported voice therapy intervention, and where present, interventions were highly variable.

CONCLUSION

Reporting in relevant literature is limited in all aspects of content, timing and intensity of intervention. Further intervention development work is required to develop a robust voice therapy treatment intervention for this population, before effectiveness work can commence.

The Efficacy of Different Voice Treatments for Vocal Fold Polyps: A Systematic Review and Meta-Analysis

BACKGROUND

Vocal fold polyps (VFP) are a common cause of voice disorders and laryngeal discomfort. They are usually treated by behavioral voice therapy (VT) or phonosurgery, or a combination (CT) of both. However, the superiority of either of these treatments has not been clearly established.

METHODS

Three databases were searched from inception to October 2022 and a manual search was performed. All clinical trials of VFP treatment were included that reported at least auditory-perceptual judgment, aerodynamics, acoustics, and the patient-perceived handicap.

RESULTS

We identified 31 eligible studies (VT: n = 47-194; phonosurgery: n = 404-1039; CT: n = 237-350). All treatment approaches were highly effective, with large effect sizes (d > 0.8) and significant improvements in almost all voice parameters (p-values < 0.05). Phonosurgery reduced roughness and NHR, and the emotional and functional subscales of the VHI-30 were the most compared to behavioral voice therapy and combined treatment (p-values < 0.001). Combined treatment improved hoarseness, jitter, shimmer, MPT, and the physical subscale of the VHI-30 more than phonosurgery and behavioral voice therapy (p-values < 0.001).

CONCLUSIONS

All three treatment approaches were effective in eliminating vocal fold polyps or their negative sequelae, with phonosurgery and combined treatment providing the greatest improvement. These results may inform future treatment decisions for patients with vocal fold polyps.

The Effect of Platelet-Rich Plasma Injection on Short Term Vocal Outcomes Following Phonosurgery-A Pilot Study

Background and Objectives: The efficiency and optimal voice rest period following phonosurgery remains debatable. Platelet-rich plasma (PRP) is a safe and cheap alternative to many bioactive agents being studied on animal models, and is already in use in many medical areas. We investigate the short-term effects of PRP and voice rest on voice outcomes following phonosurgery as an alternative to voice rest alone. Materials and Methods: A prospective single-blinded pilot study was conducted. Sixteen patients with a diagnosis of vocal fold cyst and polyps were included, forming equal groups (PRP and voice rest vs. voice rest alone). Voice analysis was carried out on the preoperative day, day three, and week three following surgery. The measured parameters were fundamental frequency (F0), noise–signal ratio (NSR), harmonic poverty (HP), attack alteration (AL), pitch instability (PI), and amplitude instability (AI).VHI(Voice Handicap Index)-30 questionnaires were carried out before surgery and three weeks following surgery to assess the impact of subjective voice change on quality of life. PRP was obtained using commercial kits with separator gel. Results: An average 3.68-fold increase in platelets was obtained with PRP. No side effects were noted after injection. All voice parameters improved on day three and week three following surgery. Statistical significance was noted only in the fundamental frequency of male patients (p = 0.048) in favor of the PRP-voice rest group. In addition, the VHI- 30 questionnaire results between preoperative and postoperative assessments showed statistically significant differences in total VHI score (p = 0.02) as well as the physical (p = 0.05) and emotional (p = 0.02) scale in favor of the PRP-voice rest group. Conclusions: PRP presents short term safety in patients who undergo phonosurgery, although long-term outcomes are unknown. PRP and voice rest are superior to voice rest alone when considering subjective assessment of the voice. When analyzing acoustic parameters, PRP and voice rest are not superior to voice rest alone.

Effect of Proton Pump Inhibitor on the Outcome of Laryngeal Microsurgery in Patients With Vocal Fold Mucosal Disease With Reflux Symptoms

OBJECTIVES

To evaluate the effect of proton pump inhibitor (PPI) after laryngeal microsurgery (LMS) in patients with benign vocal fold (VF) mucosal disease and in patients with overt reflux symptom according to subjective and objective voice assessment.

METHODS

The improvement of voice handicap index-10 (VHI-10) score, reflux symptom index (RSI) score, grade, roughness, breathiness, asthenia, and strain (GRBAS) score, Jitter, Shimmer, noise to harmonics ratio (NHR), maximum phonation time of acoustic voice analysis RESULTS: A total of 47 patients (PPI group [n = 24] and non-PPI group [n = 23]) completed the study. The scores for VHI-10, RSI, GRBAS, and acoustic parameters significantly improved in both groups after surgery. In the subgroup analysis of patients with overt reflux symptoms (RSI ≥ 13; non-PPI group [n = 12], PPI group [n = 15]), significant between-group differences were observed in terms of the improvement in NHR and the strain factor.

CONCLUSION

Postoperative PPI administration in patients with VF benign mucosal disease with reflux symptoms might improve subjective and objective voice outcomes after LMS.

Management of benign vocal fold lesions: current perspectives on the role for voice therapy

PURPOSE OF REVIEW

Benign vocal fold lesions (BVFLs) cause dysphonia by preventing full vocal fold closure, interrupting vibratory characteristics and increasing compensatory muscle tension. Management includes phonosurgery, voice therapy, pharmacological treatment or more commonly a combination of these interventions. This review aims to present current perspectives on the management of BVFLs, particularly exploring the role of voice therapy.

RECENT FINDINGS

The review highlights variation in the management of BVFLs. There is evidence that phonosurgery is a well tolerated and effective intervention for BVFLs. Primary voice therapy can frequently prevent surgery in vocal fold nodules and some types of polyps. Used as an adjunct to phonosurgery, preoperative and postoperative voice therapy can improve patient-reported outcomes and acoustic parameters of the voice. However, heterogeneity of studies and poor descriptions of intervention components prevent a robust analysis of the impact of voice therapy.

SUMMARY

The current evidence consists of low-level studies using mixed aetiology groups, which compromises internal and external validity. There are a few exceptions to this. Poor reporting and heterogeneous methodologies lead to difficulties determining the components of a voice therapy intervention for this population. Consequently, we are unable to evaluate, which intervention elements are beneficial to patients.