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Treatment and management strategies
Published in Stephanie Martin, Working with Voice Disorders, 2020
While this approach is clinically robust it is important to remember that in certain instances the ideal is not always easily achieved. For example, funding restrictions may prevent access to objective assessment resources or to further phonosurgery or psychological services, or indeed the patient may present with a complex disorder that requires a number of interventions. Despite this, however, the clinician can be encouraged by the fact that voice therapy has been shown to be effective with a number of different voice disorders (Dejardins et al., 2016; Carding et al., 2017) and clinicians do have access to many different treatment strategies which can effect change in voice disorders.
Structural Disorders of the Vocal Cords
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Yakubu Gadzama Karagama, Julian A. McGlashan
The decision to treat a patient with Reinke’s oedema depends on their symptoms, the severity of the oedema and the presence of leukoplakia. In most cases, conservative measures, such as reassurance, an explanation of their condition and vocal hygiene advice, including smoking cessation, should be tried initially. Hypothyroidism, upper airway infections and allergies and extraoesophageal reflux should be treated to reduce the throat symptoms associated with these conditions. The role of voice therapy is controversial but may be indicated if vocal hygiene issues and excessive MTD are prominent in a well-motivated patient. It certainly has a role in restoring voice function after surgical treatment.
Paediatric Voice Disorders
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
The traditional view, based on clinical experience, was that most vocal nodules in children could be expected to improve at puberty.23 Puberty is a time of great change in the larynx, with tremendous growth of the membranous vocal fold in the male and, to a lesser extent, in the female. One can see how the dynamics of vocalization might change with potential improvement in the nodules. Mori,24 however, reported that 12% of nodules did not improve at puberty. In the same study it was found that those treated with vocal hygiene alone (i.e. general advice regarding voice care) did not improve. Those given voice therapy under the supervision of a speech and language therapist did tend to improve and the degree of improvement was related to the number of therapy sessions. The essentials of voice therapy include reduction of vocal strain. Various techniques can be employed to reduce shouting, whispering, coughing and throat clearing and to encourage the use of a smooth easy voice. Periods of quiet play are recommended after noisy activity (e.g. football) to allow vocal fold recovery.
The impact of living with transfeminine vocal gender dysphoria: Health utility outcomes assessment
Published in International Journal of Transgender Health, 2023
Brian Nuyen, Cherian Kandathil, Daniella McDonald, James Thomas, Sam P. Most
Upon Institutional Review Board approval of study design, recruitment for a transfeminine patient volunteer was conducted at the vocal gender dysphoria clinic of our coauthor (J.T.). All patient volunteers in consideration were managed per transgender voice and communication treatment guidelines per World Professional Association for Transgender Health (WPATH, 2016), had pretreatment/pre-operative and post-treatment/post-operative phonometrics, underwent vocal feminization which included feminization laryngoplasty with perioperative voice therapy by a speech-language pathologist. Voice therapy included conversation therapy training, nonverbal communication strategies, and resonant voice therapy. Perioperative phonometrics included standardized speaking passages (“Long ago, men found it easier to travel on water than on land. They needed a cleared path or road when traveling on land, but on water, a log of wood or any large object that would float became a man’s boat”; see ESupplement). Based on previously-published data about feminization laryngoplasty outcomes, a volunteer with median phonometric outcomes observed (Thomas & MacMillan, 2013) was selected for use of peri-treatment speaking passages for this study; the volunteer’s pronouns were she/her/hers.
Diagnostic vocal fold injection as an intervention for secondary muscle tension dysphonia
Published in Hearing, Balance and Communication, 2021
Christopher D. Dwyer, Thomas L. Carroll
This distinction between MTD-1 and MTD-2 is paramount. For the primary type, voice therapy remains the cornerstone of treatment, and is generally quite successful in treating the patient’s voice and laryngeal related complaints [8]. On the other hand, treatment of MTD-2 can be more complicated. Recognising and concurrently addressing the underlying contributing laryngeal pathology is essential to formulating a treatment plan. This can involve behavioural therapy, medical management, surgical intervention, or a combination thereof. To that end, increasing attention to identifying and treating glottic insuffiency has arose. It can be challenging to identify due to the excessive supraglottic constriction present during laryngeal examination and lack of use/availability of stroboscopy in the clinical setting.
Voice therapy in paediatric dysphonia
Published in Hearing, Balance and Communication, 2020
Mattia Gambalonga, Davide Brotto, Niccolò Favaretto
Valadez et al. [33] described measurements of vocal parameters including fundamental frequency, shimmer, and jitter, videonasolaryngoscopy examination and clinical perceptual assessment, before and after voice therapy in children with vocal nodules. Voice therapy sessions were provided twice a week, 45 min in each session. Voice therapy was provided using the Speech Viewer III (SV-III-IBM) software, in a Gateway computer, GT 3010. The software provided visual support of acoustic parameters during voice therapy. All patients were subjected to the same therapy protocol, including voice presence and awareness, phonation duration and vocal attack. Each item was practiced for 10 min for a total time of 30 min per session. The remaining 15 min of each session were used for talking to the family about the characteristics of the voice problem and basic vocal hygiene education. Voice therapy with visual support provided by computerized images seems to be a safe, reliable and effective procedure in these patients. The results of the study showed that voice therapy using visual support provided by Speech-viewer software appears to be useful for helping children to recognize their voice characteristics and disorders. With the visual cues provided by the software used in this study, children may learn to produce relaxed phonation.