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

Abstract

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.

Índice de Desvantagem Vocal pré e pós-intervenção vocal em pacientes disfônicos

“…and "My voice "gives out" on me in the middle of speaking." These changes are related to speech therapy, which focused on proper and efficient glottal closure, proper muscle fitting, reduction in phonation effort, and better body awareness, which then allows the voice to improve as a whole (23) . In the present study, the IDV instrument proved effective to measure and characterize the patients' perception regarding the impact of dysphonia on the social, emotional, and physical domains.…”

The Effectiveness of Physiotherapy and Complementary Therapies on Voice Disorders: A Systematic Review of Randomized Controlled Trials

“…Manual therapy has been used by professionals from several different fields, such as speech-language therapists (23, 26), osteopaths (27), and physiotherapists (9–11). This variety reflects different descriptors or denominations that are used in research and clinically.…”

Exercise-induced laryngeal obstruction in athletes: Contributory factors and treatment implications

“…Secondary MTD occurs concomitant to, and is associated with, underlying organic disorder (Van Houtte et al, 2011). Both types present with symptoms including hoarseness, vocal fatigue, reduced quality of voice production and vocal range, pain connected to voice use, tight muscles and neck stiffness (Craig et al, 2015). MTD is produced by psychological and/or personality factors (Roy & Bless, 2000), incorrect vocal techniques, respiratory disturbance, previous infection(s) or as compensation for underlying disease (Van Houtte et al, 2011).…”

“…Direct approaches include vocal exercises to facilitate vocal techniques and circumlaryngeal massage to reduce extra-laryngeal muscle tension and optimize voice production. A few systematic reviews and randomized studies have established that a combination of indirect and direct approaches is the most effective intervention for treating muscle tension dysphonia when compared to no intervention (Carding, Horsley, & Docherty, 1999;Craig et al, 2015;Gillivan-Murphy, Drinnan, O'Dwyer, Ridha, & Carding, 2006;Mackenzie et al, 2001;J. Ruotsalainen, Sellman, Lehto, & Verbeek, 2008;J.…”

“…A number of authors contend that a whole body approach is imperative to optimize evaluation and treatment in order to achieve meaningful improvements in people with voice problems ( Cardoso, Meneses, & Lumini-Oliveira, 2017;Craig et al, 2015;Rubin et al, 2007;Tomlinson & Archer, 2015) and in singers (Kennard, Lieberman, Saaid, & Rolfe, 2015;Pettersen & Westgaard, 2005;Staes et al, 2011). Rubin et al (2007) discussed how a broader physical therapy approach, including evaluation of muscular tension, stability and position of the neck and upper thoracic spine, as well as the interrelatedness between these dimensions, was helpful in the management of voice problems in 26 patients.…”