Treatment of vocal fold bowing using neuromuscular electrical stimulation

Lisa A Lagorio, Giselle D Carnaby-Mann, Michael A Crary
Archives of Otolaryngology—Head & Neck Surgery 2010, 136 (4): 398-403

OBJECTIVE: To investigate the clinical effectiveness and safety of a novel behavioral voice therapy program combining structured vocal exercise with adjunctive neuromuscular electrical stimulation for rehabilitating dysphonia secondary to vocal fold bowing.

DESIGN: Prospective interventional clinical case series with a 3-month follow-up.

SETTING: Outpatient speech and hearing clinic in an academic medical center.

PATIENTS: Convenience sample of 7 patients diagnosed by an otolaryngologist as having chronic dysphonia for at least 3 months due to bilateral vocal fold bowing.

INTERVENTION: A novel voice therapy program incorporating exercise principles and sustained phonations of increasing length, volume, and pitch paired with concurrent transcutaneous neuromuscular electrical stimulation.

MAIN OUTCOME MEASURES: Change in maximum phonation time, highest attainable pitch, glottal closure, supraglottic compression, and Voice Handicap Index.

RESULTS: Maximum phonation time for /i/ increased significantly (z = -2.201, P < .03), with a modest effect demonstrated (Hedges g, 0.65; 95% confidence interval, -0.56 to 1.75). Voice Handicap Index trended toward significance (z = -1.787, P < .07). Glottal closure during phonation improved, and supraglottic compression decreased. Improvements were maintained or enhanced at the 3-month follow-up. Analysis of highest attainable pitch data was limited owing to aperiodicity in the baseline evaluations.

CONCLUSIONS: Behavioral voice therapy with adjunctive neuromuscular electrical stimulation reduced vocal fold bowing, resulting in improved acoustic, laryngeal, and patient-centered outcomes. Maximum phonation time and glottal closure results imply increased vocal fold tension secondary to enhanced thyroarytenoid or cricothyroid muscle function after voice therapy.

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