Advertisement

Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time

  • Giorgia Mari
    Affiliations
    Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
    Search for articles by this author
  • Maria Raffaella Marchese
    Correspondence
    Address correspondence and reprint requests to Maria Raffaella Marchese, Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo “A. Gemelli”, 8, 00168 Roma, Italia.
    Affiliations
    Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
    Search for articles by this author
  • Ylenia Longobardi
    Affiliations
    Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
    Search for articles by this author
  • Ilaria Proietti
    Affiliations
    Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
    Search for articles by this author
  • Maria Elisabetta Marenda
    Affiliations
    Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
    Search for articles by this author
  • Tiziana Di Cesare
    Affiliations
    Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Roma, Italia
    Search for articles by this author
  • Lucia D'Alatri
    Affiliations
    Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia

    Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Roma, Italia
    Search for articles by this author

      Summary

      Objective

      To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP).

      Methods

      Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later.

      Results

      Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P = 0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P = 0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P = 0.04). Grade, Breathiness, and Asthenia parameters of the Grade–Roughness–Breathiness–Asthenia–Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR.

      Conclusions

      With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.

      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

        • Joliat GR
        • Guarnero V
        • Demartines N
        • et al.
        Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Incidence and postoperative evolution assessment.
        Medicine (Baltimore). 2017; 96: e6674https://doi.org/10.1097/MD.0000000000006674
        • Miller S
        Voice therapy for vocal fold paralysis.
        Otolaryngol Clin North Am. 2004; 37: 105-119https://doi.org/10.1016/S0030-6665(03)00163-4
        • Lombardi CP
        • Raffaelli M
        • D'Alatri L
        • et al.
        Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries.
        Surgery. 2006; 140: 1026-1034https://doi.org/10.1016/j.surg.2006.08.008
        • Marchese MR
        • Galli J
        • D'Alatri L
        • et al.
        Neck complaints before and after uncomplicated thyroidectomy:prevalence, postoperative outcome and relationships with thyroid weight and reflux like symptoms.
        Endocrine. 2021; 73: 98-106https://doi.org/10.1007/s12020-020-02568-y
        • Miyata E
        • Miyamoto M
        • Shiromoto O
        • et al.
        Early voice therapy for unilateral vocal fold paralysis improves subglottal pressure and glottal closure.
        Am J Otolaryngol. 2020; 41102727https://doi.org/10.1016/j.amjoto.2020.102727
        • Walton C
        • Carding P
        • Conway E
        • et al.
        Voice outcome measures for adult patients with unilateral vocal fold paralysis: a systematic review.
        Laryngoscope. 2019; 129: 187-197https://doi.org/10.1002/lary.27434
        • D'Alatri L
        • Galla S
        • Rigante M
        • et al.
        Role of early voice therapy in patients affected by unilateral vocal fold paralysis.
        J Laryngol Otol. 2008; 122: 936-941https://doi.org/10.1017/S0022215107000679
        • Ruoppolo G
        • Mariani L
        • Quaglieri S
        • et al.
        Unilateral vocal fold paralysis post-thyroidectomy: does early intervention allow for better voice recovery?.
        Eur Rev Med Pharmacol Sci. 2021; 25: 1177-1184https://doi.org/10.26355/eurrev_202102_24820
        • Ananthakrishnan AN
        • Singh S
        The doctor will call you now! Telemedicine in the midst of a pandemic.
        Clin Gastroenterol Hepatol. 2020; 18: 1688-1690https://doi.org/10.1016/j.cgh.2020.04.031
        • Grillo EU
        Building a successful voice telepractice program.
        Perspect ASHA Spec Interest Groups. 2019; 4: 100-110https://doi.org/10.1044/2018_PERS-SIG3-2018-0014
        • Fu S
        • Theodoros DG
        • Ward EC
        Delivery of intensive voice therapy for vocal fold nodules via telepractice: A pilot feasibility and efficacy study.
        J Voice. 2015; 29: 696-706https://doi.org/10.1016/j.jvoice.2014.12.003
        • Rangarathnam B
        • McCullough GH
        • Pickett H
        • et al.
        Telepractice versus in-person delivery of voice therapy for primary muscle tension dysphonia.
        Am J Speech-Lang Pathol. 2015; 24: 386-399https://doi.org/10.1044/2015_AJSLP-14-0017
        • Lin FC
        • Chien HY
        • Chen SH
        • et al.
        Voice therapy for benign voice disorders in the elderly: A randomized controlled trial comparing telepractice and conventional face-to-face therapy.
        J Speech Lang Hear Res. 2020; 20 (63): 2132-2140https://doi.org/10.1044/2020_JSLHR-19-00364
        • Mattioli F
        • Menichetti M
        • Bergamini G
        • et al.
        Results of early vs intermediate or delayed voice therapy in patients with unilateral vocal fold paralysis: our experience in 171 patients.
        J Voice. 2015; 29: 455-458https://doi.org/10.1016/j.jvoice.2014.09.027
        • Gartner-Schmidt JL
        • Roth DF
        • Zullo TG
        • et al.
        Quantifyng component part of indirect and direct voice therapy related to different voice disorders.
        J Voice. 2013; 27: 210-216https://doi.org/10.1016/j.jvoice.2012.11.007
        • McGowan RS
        Tongue-tip trills and vocal-tract wall compliance.
        J Acoust Soc Am. 1992; 91: 2903-2910https://doi.org/10.1121/1.402927
        • Titze I
        Workshop on Acoustic Voice Analysis: Summary Statement.
        National Center for Voice and Speech, Denver, CO1995
        • Isshiki N
        • Okamura H
        • Tanabe M
        • et al.
        Differential diagnosis of hoarseness.
        Folia Phoniatrica (Basel). 1969; 21: 9-19https://doi.org/10.1159/000263230
        • Schindler O
        Breviario di Patologia della Comunicazione. Vol 2. Omega, Torino1985
        • Schindler A
        • Ottaviani F
        • Mozzanica F
        • et al.
        Cross-cultural adaptation and validation of the Voice Handicap Index into Italian.
        Voice. 2010; 24: 708-714https://doi.org/10.1016/j.jvoice.2009.05.006
        • Dias AE
        • Limongi JC
        • Barbosa ER
        • et al.
        Voice telerehabilitation in Parkinson's disease.
        Codas. 2016; 28: 176-181https://doi.org/10.1590/2317-1782/20162015161
        • Schindler A
        • Bottero A
        • Capaccio P
        • et al.
        Vocal improvement after voice therapy in unilateral vocal fold paralysis.
        J Voice. 2008; 22: 113-118https://doi.org/10.1016/j.jvoice.2006.08.004
        • Valentino WL
        • Park J
        • Alnouri G
        • et al.
        Diagnostic value of acoustic and aerodynamic measurements in vocal fold movement disorders and their correlation with laryngeal electromyography and voice handicap index.
        J Voice. 2021; 35: 497.e1-497.e4https://doi.org/10.1016/j.jvoice.2019.10.008
      1. Rosen CA, Murry T, Zinn A, et al. Voice handicap index change following treatment of voice disorders J Voice. 2000; 14:619-623. https://doi.org/10.1016/s0892-1997(00)80017-x

        • Desuter G
        • Dedry M
        • Schaar B
        • et al.
        Voice outcome indicators for unilateral vocal fold paralysis surgery: a review of the literature.
        Eur Arch Otorhinolaryngol. 2018; 275: 459-468https://doi.org/10.1007/s00405-017-4844-9