Voice Outcomes Following Behavioral Voice Therapy in Adults With Sulcus Vocalis: A Retrospective Controlled Study.
TL;DR
Compared with vocal hygiene education with home implementation, the additional voice therapy program was associated with greater improvements in perceptual voice quality, sustained phonatory capacity, selected acoustic measures, voice-related handicap, and vocal fatigue.
Abstract
OBJECTIVE(S) To evaluate changes in voice outcomes associated with multicomponent individualized behavioral voice therapy in adults with sulcus vocalis. STUDY
Design
Retrospective controlled study.
Methods
Thirty-four patients with sulcus vocalis diagnosed by videostroboscopic examination were retrospectively categorized into a vocal hygiene group (n = 17) and a voice therapy group (n = 17). Both groups received vocal hygiene education with continued home implementation for 2 months; the voice therapy group additionally received an 8-week multicomponent individualized behavioral voice therapy program. Voice outcomes were assessed before and after the intervention. Voice outcomes included GRBAS ratings, maximum phonation time (MPT), fundamental frequency (F0), jitter, shimmer, harmonics-to-noise ratio (HNR), cepstral peak prominence for sustained vowel /a/ (CPP-a) and connected-speech (CPP-s), Voice Handicap Index (VHI), and Vocal Fatigue Index (VFI). GRBAS ratings were analyzed using ordinal logistic generalized estimating equations, whereas continuous outcomes were analyzed using repeated-measures ANOVAs, Bonferroni-corrected within-group comparisons, and baseline-adjusted analyses.
Results
For GRBAS ratings, significant group × time interactions were observed for G, B, and S, but not for R or A. G, B, and S decreased significantly in the voice therapy group, and post-intervention G and B were significantly lower than in the vocal hygiene group. For continuous outcomes, significant group × time interactions were observed for MPT, jitter, shimmer, HNR, CPP-a, VHI, and VFI, with baseline-adjusted post-intervention comparisons for these outcomes favoring the voice therapy group. No significant group × time interactions were observed for F0 or CPP-s.
Conclusions
Compared with vocal hygiene education with home implementation, the additional voice therapy program was associated with greater improvements in perceptual voice quality, sustained phonatory capacity, selected acoustic measures, voice-related handicap, and vocal fatigue. These findings suggest a potential benefit of behavioral voice therapy for adults with sulcus vocalis.