Barbara H. Jacobson

The Voice Handicap Index (VHI)Development and Validation

To date, no instruments exist to quantify the psychosocial consequences of voice disorders. The aim of the present investigation was the development of a statistically robust Voice Handicap Index (...

Acoustic analysis of voice in individuals with amyotrophic lateral sclerosis and perceptually normal vocal quality

Currently, early phonatory changes in amyotrophic lateral sclerosis (ALS) are not well understood. The aim of this study was to compare acoustic parameters of voice in ALS subjects who demonstrated perceptually normal vocal quality on sustained phonation with a control group. We hypothesized that objective analysis of voice would reveal significant differences on specific acoustic parameters of voice compared to the control group. Results revealed statistically significant differences between the two groups on measures related to frequency range and phonatory stability. The findings suggest that early bulbar signs affecting the laryngeal system may be present in patients with ALS before the occurrence of perceptually aberrant vocal characteristics.

Vocal nodules, microwebs, and surgery.

Successful treatment of vocal nodules is primarily accomplished through the direction of voice-language pathologists and teachers of music and speech. Rarely is surgical treatment necessary, although recent reports have suggested a correlation between vocal nodules and failed voice training with anterior commissure microwebs. One hundred fifteen consecutive patients with vocal nodules were evaluated. Eight anterior commissure microwebs were identified (7%), four of these in performers. Of the 96 patients with sufficient follow-up, 65 (68%) had complete resolution of their nodules and 17 (18%) had sufficient improvement to return to normal vocalization without surgical treatment. Nine patients required surgery, two of these with anterior commissure microwebs. All eight patients with microwebs had resolution of their nodules with either nonsurgical or surgical therapy. In total, 94% of patients were able to return to normal voice function, while the 6% of failures either did not receive or were noncompliant with voice therapy. Microwebs were found to be uncommon in patients with vocal nodules. Microwebs and other laryngeal pathologies in patients with nodules may be associated with a higher incidence of patients failing conservative voice therapy treatment.

Combining voice therapy and physical therapy: A novel approach to treating muscle tension dysphonia.

OBJECTIVE This study investigated the role of a specialized physical therapy program for muscle tension dysphonia patients as an adjunct to standard of care voice therapy. STUDY DESIGN Retrospective Cohort Study Methods Adult MTD patients seen between 2007 and 2012 were identified from the clinical database. They were prescribed voice therapy and, if concomitant neck pain, adjunctive physical therapy. In a pragmatic observational cohort design, patients underwent one of four potential treatment approaches: voice therapy alone (VT), voice therapy and physical therapy (VT+PT), physical therapy alone (PT), or incomplete/no treatment. Voice handicap outcomes were compared between treatment approaches. RESULTS Of 153 patients meeting criteria (Median age 48 years, 68% female, and 30% had fibromyalgia, chronic pain, chronic fatigue, depression, and/or anxiety), there was a similar distribution of patients with moderate or severe pre-treatment VHI scores across treatment groups (VT 45.5%, VT+PT 43.8%, PT 50%, no treatment 59.1%; p=0.45). Patients treated with VT alone had significantly greater median improvement in VHI than those not treated: 10-point vs. 2-point (p=0.02). Interestingly, median VHI improvement in patients with baseline moderate-severe VHI scores was no different between VT (10), VT+PT (8) and PT alone (10; p=0.99). CONCLUSIONS Findings show voice therapy to be an effective approach to treating MTD. Importantly, other treatment modalities incorporating physical therapy had a similar, albeit not significant, improvement in VHI. This preliminary study suggests that physical therapy techniques may have a role in the treatment of a subset of MTD patients. Larger, comparative studies are needed to better characterize the role of physical therapy in this population. LEARNING OUTCOMES The reader will describe symptoms associated with muscle tension dysphonia and current treatment. The reader will describe the systematic adjunctive physical therapy approach and understand the rationale to consider incorporation of physical therapy into the current treatment regimen.