Practice and Advocacy
Consensus Statement on the Use of Voice Therapy in the Treatment of Dysphonia
This statement regarding the use of voice therapy in the treatment of dysphonia has been developed by the American Academy of Otolaryngology- Head and Neck Surgery Committee on Speech, Voice, and Swallowing and the Special Interest Division 3, Voice and Voice Disorders of the American Speech-Language-Hearing Association.
Summary
It is the consensus of these committees that voice therapy by a licensed speech language pathologist is important for effective medical and surgical treatment of the patient with dysphonia. Voice therapy should be an integral part of the treatment plan of the patient until optimal patient response is achieved.
Background
Dysphonia is defined as an impairment of the speaking or singing voice. Dysphonia arises from an abnormality of the structures and or functions of the voice production system and can cause bodily pain, a personal communication disability, or an occupational or social handicap. The cause of dysphonia is generally multifactorial. Genetic and psychological factors may predispose an individual to voice disorders.1 Chronic and acute variables may precipitate dysphonia. These include occupational vocal demands, medications, health problems, environment, trauma, and lifestyle choices. Dysphonia is as disruptive to quality of life as angina, sciatica and chronic sinusitis.2 The communicative problems associated with dysphonia can lead to social withdrawal, occupational handicaps, and depression.3
Voice disorders are a widespread and significant problem. Estimates of prevalence range from 3% to 7%of the general population. 4 Individuals with heavy occupational voice use, a significant risk factor for dysphonia, may comprise from 5-10% of the U.S. workforce.5 The largest epidemiologic study of the prevalence of voice disorders in the United States revealed that approximately 43% of adults surveyed experienced voice problems at some point during their life.6 Approximately 23% of those individuals visited a physician or speech-language pathologist for treatment for dysphonia. The cost of untreated voice disorders total billions of dollars in treatment and lost productivity costs.6 In teachers alone, the cost of dysphonia approaches $2.67 billion annually in the United States. 7
The overall goal for the dysphonic patient is optimal long-term voice quality and communication function with minimal recurrence. Treatment should be both efficient and effective. Voice therapy is an integral component of intervention and contributes to both its efficacy and efficiency. Evidence from clinical trials documents the efficacy of voice therapy for a spectrum of voice disorders. 8-14 Even in patients with a long history of dysphonia, voice therapy can be highly effective.15 Efficiency includes cost-effective and prompt intervention provided over a time period most suitable for achieving optimal outcome.
Voice therapy is the treatment of choice for muscle tension dysphonia and there is evidence to support its utility in these cases.16-22 In complex disorders such as paradoxical vocal fold motion, voice therapy prevents long-term costs of treatment by helping reduce expensive emergency room visits and hospitalizations.23 Voice therapy techniques have been shown to improve voice in individuals without voice disorders, suggesting a role for therapy in the prevention of voice disorders.24-26
Benign vocal fold lesions are a common cause of dysphonia.27 Many studies document excellent outcome after voice therapy in patients with a variety of benign lesions.28-35 In cases in which surgery is necessary, pre- and post-operative voice therapy may shorten the postoperative recovery time, allowing faster return to work and limiting scar and permanent dysphonia.36
Many laryngologists consider voice therapy essential for patients with unilateral vocal fold paralysis, as definitive treatment or as adjunctive to surgery.37-40 Evidence suggests that preoperative voice therapy improves voice outcomes for greater than 50% of patients with unilateral vocal fold paralysis and may render surgery unnecessary.41 In other neurological-based dysphonia such as Parkinson’s disease, voice therapy has yielded significant improvement in overall communication.42-45
In conclusion, research data and expert clinical experience support the use of voice therapy in the management of patients with acute and chronic voice disorders. Voice therapy contributes to increased effectiveness and efficiency in the treatment of voice disorders. When surgery is necessary, adjuvant voice therapy can improve surgical outcomes, prevent additional injury, and limit additional treatment costs.
Adopted: September 28, 2005
References
1. Gray SD, Hammond E, & Hanson DF. Benign pathologic responses of the larynx. Ann Otol Rhinol Laryngol; 104; 13-18.
2. Benninger MS, Ahuja AS, Gardner G, et al. Assessing outcomes for dysphonic patients. J Voice; 12: 540-50.
3. Smith E, Verdolini K, Gray S, et al. Effect of voice disorders on quality of life. J Med Speech Lang Path 1997;4: 223-244.
4. Healy WC, Ackerman BL, Chappell CR, et al. The Prevalence of Communicative Disorders: A Review of the Literature. American Speech-Language-Hearing Association, Rockville, MD.
5. Titze IR, Lemke J, Montequin D. Populations in the U.S. workforce who rely on voice as a primary tool of trade: A preliminary report. J Voice; 11(3): 254-259.
6. Roy N, Merrill RM, Thibeault S, Parsa RA, Gray SD, & Smith EM. (2004) Prevalence of Voice Disorders in Teachers and the General Population. J Speech Lang and Hearing Research, 47, 281-293.
7. Ramig O, Verdolini K. Treatment efficacy: voice disorders. J Speech Lang Hearing Disord 1998; 41: S101-16.
8. Verdolini K, Ramig L. Logopedics Phoniatrics Vocology; 26: 37-46.
9. Speyer R, Weineke G, Hosseini EG, Kempen PA, Kersing W, & Dejonckere PH (2002). Effects of voice therapy as objectively evaluated by digitized laryngeal stroboscopic imaging. Ann Otol Rhinol Laryngol; 111, 902-8.
10. Sellars C,