Advertisement

Outcomes of Cricothyroid Visor Maneuver (CVM) for Treatment of Vocal Polyp: A Case Report

  • Ali Dehqan
    Correspondence
    Address correspondence and reprint requests to Ali Dehqan, Department of Speech therapy, School of Rehabilitation, Zahedan University of Medical Sciences, Zahedan, Iran.
    Affiliations
    Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran

    Department of Speech therapy, School of Rehabilitation, Zahedan University of Medical Sciences, Zahedan, Iran
    Search for articles by this author
Published:November 13, 2020DOI:https://doi.org/10.1016/j.jvoice.2020.11.002

      Objective

      The aim of the study is the clinical investigation of a patient with a vocal fold polyp, and the visual, acoustical, perceptual, and self-report changes before and after using the cricothyroid visor manoeuvre (CVM).

      Design

      A 48-year-old female university professor, gynecologist, and obstetrician with a history of laryngopharyngeal reflux and a left vocal polyp participated. Treatment was provided in 10 sessions. Pre- and post-treatment audio recordings of sustained vowels, selected sentences, and connected speech samples were submitted to auditory-perceptual and acoustical analysis to assess the effects of the two-treatment program. Also, laryngoscopic images, perceptions by the patient about her voice quality and quality of life before and after therapy were assessed.

      Results

      Improvements in acoustic parameters were obtained especially in perturbation and CCPS parameters. The overall voice quality scores on the CAPE-V were moderate before therapy and became mild after therapy. Laryngoscopy images demonstrated improvement in the glottis closure configuration in two phases (open and close) in pre- and post- CVM therapy and a decrease in polyp size. The patient had improvement in VAS, IVQLP, and VRQOL scores.

      Conclusion

      The CVM therapy used in the study resulted in positive changes in acoustic and perceptual-auditory aspects of voice production, self-report, and QOL for the patient. The CVM approach appears to have been effective for this case in decreasing the polyp size or its regression or for vocal adaptation.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bos-Clark M
        • Carding P.
        Effectiveness of voice therapy in functional dysphonia: where are we now?.
        Curr Opin Otolaryngol Head Neck Surg. 2011; 19: 160-164
        • Dehqan A
        • Ballard KJ.
        An evaluation of short-term treatment outcomes of Cricothyroid Visor Maneuver: A proof-of-concept Pilot Study.
        J Voice. 2019; (S0892-1997(19)30435-7)
        • Harris T
        • Harris S
        • Howard D
        Clinical Voice Handbook.
        2nd ed. Whurr Publishers Ltd, London2018
        • Vilkman E
        • Sonninen A
        • Hurme P
        • et al.
        External laryngeal frame function in voice production revisited: a review.
        J Voice. 1996; 10: 78-92
      1. Polyp paper

        • Toran KC
        • Vaidhya BK.
        Objective voice analysis for vocal polyps following microlaryngeal phonosurgery.
        Kathmandu Univ Med J (KUMJ). 2010; 8: 185-189https://doi.org/10.3126/kumj.v8i2.3555
        • Sulica L
        • Behrman A.
        Management of benign vocal fold lesions: a survey of current opinion and practice.
        Ann Otol Rhinol Laryngol. 2003; 112: 827-833
        • Vasconcelos D
        • Gomes AOC
        • Araújo CMT
        Vocal fold polyps: literature review.
        Int Arch Otorhinolaryngol. 2019; 23: 116-124
        • Cohen SM
        • Garrett CG.
        Utility of voice therapy in the management of vocal fold polyps and cysts.
        Otolaryngol Head Neck Surg. 2007; 136: 742-746https://doi.org/10.1016/j.otohns.2006.12.009
        • Johns MM.
        Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts.
        Curr Opin Otolaryngol Head Neck Surg. 2003; 11: 456-461
        • Yun YS
        • Kim MB
        • Son YI
        The effect of vocal hygiene education for patients with vocal polyp.
        Otolaryngol Head Neck Surg. 2007; 137: 569-575
        • Klein AM
        • Lehmann M
        • Hapner ER
        • et al.
        Spontaneous resolution of hemorrhagic polyps of the true vocal fold.
        J Voice. 2009; 23: 132-135
        • Nakagawa H
        • Miyamoto M
        • Kusuyama T
        • et al.
        Resolution of vocal fold polyps with conservative treatment.
        J Voice. 2012; 26: e107-e110
        • Cho KJ
        • Nam IC
        • Hwang YS
        • et al.
        Analysis of factors influencing voice quality and therapeutic approaches in vocal polyp patients.
        Eur Arch Otorhinolaryngol. 2011; 268: 1321-1327https://doi.org/10.1007/s00405-011-1618-7
        • Iwaki S
        • Tanabe M
        • Iida Y
        • et al.
        Effectiveness of voice therapy for vocal fold polyp.
        Japan J Logoped Phoniatr. 2011; 52: 141-148https://doi.org/10.5112/jjlp.52.141
        • Madazio G
        • Moreti F.
        Resolution of vocal fold polyps with conservative treatment.
        Rev Soc Bras Fonoaudiol. 2012; 17: 502-503https://doi.org/10.1590/S1516-80342012000400023
        • Lee YS
        • Lee DH
        • Jeong GE
        • et al.
        Treatment efficacy of voice therapy for vocal fold polyps and factors predictive of its efficacy.
        J Voice. 2017; 31: 120.e9-120.e13https://doi.org/10.1016/j.jvoice.2016.02.014
        • Schindler A
        • Mozzanica F
        • Ginocchio D
        • et al.
        Vocal improvement after voice therapy in the treatment of benign vocal fold lesions.
        Acta Otorhinolaryngol Ital. 2012; 32 (Avaliable from:) (Accessed March 1, 2015.): 304-308
        • Schindler A
        • Mozzanica F
        • Maruzzi P
        • et al.
        Multidimensional assessment of vocal changes in benign vocal fold lesions after voice therapy.
        Auris Nasus Larynx. 2013; 40: 291-297
        • Parsa V
        • Jamieson DG.
        Acoustic discrimination of pathological voice: sustained vowels versus continuous speech.
        J Speech Lang Hear Res. 2001; 44: 327-339
        • Batthyany C
        • Youri Maryn Y
        • Trauwaen I
        • et al.
        A case of specificity: how does the Acoustic Voice Quality Index perform in normophonic subjects?.
        Appl Sci. 2019; 9: 2527
        • Kempster GB
        • Gerratt BR
        • Verdolini Abbott K
        Consensus auditory perceptual evaluation of voice: development of a standardized clinical protocol.
        Am J Speech Lang Pathol. 2009; 18: 124-132
      2. Funke F. Vergleich Visueller Analogskalen mit Kategorialskalen in Offline- und Online-Design. 2004.

        • Flynn D
        • van Schaik P
        • van Wersch A
        A comparison of multi-item likert and visual analogue scales for the assessment of transactionally defined coping.
        Eur J Psychol Assess. 2004; 20: 49-58
        • Aitken RC.
        Measurement of feelings using visual analogue scales.
        Proc R Soc Med. 1969; 62: 989-993
        • Murphy DF
        • McDonald A
        • Power C
        • et al.
        Measurement of pain: a comparison of the visual analogue with a nonvisual analogue scale.
        Clin J Pain. 1987; 3: 197-199
        • Konnai RM
        • Jayaram M
        • Scherer RC
        Development and validation of a voice disorder outcome profile for an Indian population.
        J Voice. 2010; 24: 206-220
        • Dehqan A
        • Yadegari F
        • Asgari A
        • et al.
        Correlation of VHI-30 to acoustic measurements across three common voice disorders.
        J Voice. 2017; 31: 34-40
        • Dehqan A
        • Yadegari F
        • Asgari A
        • et al.
        Conceptualization and Exploring the Factor Structure of the Quality of Life in Iranian with Voice disorders. 2016; ([unpublished Ph.D dissertation])
        • Krischke S
        • Weigelt S
        • Hoppe U
        • et al.
        Quality of life in dysphonic patients.
        J Voice. 2005; 19: 132-137
        • Dehqan A
        • Yadegari F
        • Asgari A
        • et al.
        Development and validation of an Iranian Voice Quality of Life Profile (IVQLP) based on a classic and Rasch Rating Scale Model (RSM).
        J Voice. 2017; 31: 113.e19-113.e29
        • Dehqan A
        • Yadegari F
        • Asgari A
        • et al.
        Iranian Voice Quality of Life Profile (IVQLP): factor analysis.
        J Voice. 2017; 31: 576-582
        • Dehqan A
        • Scherer RC
        • Yadegari F
        Correlation of Iranian Voice Quality of Life Profile (IVQLP) to VHI-30 and VRQOL: construct validity evidence.
        J Voice. 2018; 32: 38-44
        • Dehqan A
        • Scherer RC
        • Yadegari F
        • et al.
        Correlation of the Iranian Voice Quality of Life Profile (IVQLP) with Acoustic Measurements across Three Common Voice Disorders.
        J Voice. 2018; 32: 514.e7-514.e11
        • Hogikyan ND
        • Sethuraman G.
        Validation of an instrument to measure Voice-Related Quality of Life (VRQOL).
        J Voice. 1999; 13: 557-569
        • Moradi N
        • Saki N
        • Aghadoost O
        • et al.
        Cross-cultural adaptation and validation of the voice-related quality of life into Persian.
        J Voice. 2014; 28 (842): e1-e9
        • Sataloff T.
        Treatment of voice Disorders.
        Plural Publishing, London2017
        • Roy N.
        Assessment and treatment of musculoskeletal tension in hyperfunctional voice disorders.
        Int J Speech Lang Pathol. 2008; 10: 195-209
        • Cielo CA
        • Christmann MK
        • Ribeiro VV
        • et al.
        Síndrome da tens»ao muscoesqueletica, musculatura laríngea extrínseca e postura corporal: considerac¸coes teoricas.
        CEFAC. 2014; 16: 1639-1649
        • Boone DR
        • McFarlane SC
        Functional disorders.
        in: Booned McFarlane Von Berg Zraick The Voice and Voice Therapy. 9th ed. Pearson, Boston2013: 113-133