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Complementary Effect of Transcutaneous Cervical Stimulation by Interferential Current on Functional Dysphonia

Published:January 16, 2023DOI:https://doi.org/10.1016/j.jvoice.2022.12.023

      Summary

      Objectives

      Functional dysphonia (FD) varies in terms of vocal behavior and treatment efficacy. So-called hypofunctional dysphonia is characterized by insufficient subglottal pressure which causes a lack of driving power needed to vibrate the vocal folds leading to weak voice or aphonia in severe cases. While voice therapy is the initial treatment, some patients fail to respond to it. Interferential current (IFC) stimulation has been used as part of rehabilitation by physical therapists to reduce the progressive pain. IFC stimulation has also been developed as a laryngeal sensory stimulation device to modify the swallowing function by triggering swallowing reflex. Many researchers have shown recently in animal studies that laryngeal afferent inputs, such as vocal fold vibrations, subglottic pressure, flow rate, and vocal fold location affect vocal motor pattern and voice quality. However, IFC stimulation as a laryngeal afferent has not been verified. Herein, we assessed the effects of IFC stimulation to the neck on difficult functional dysphonia.

      Methods

      Six patients with refractory FD with insufficient subglottic pressure were assessed in this study. All six cases were females and two of them presented with aphonia. All cases were initially treated by voice therapy (VTx) such as flow phonation, water resistance therapy, or tube phonation for 2 months to increase subglottic pressure; however, this resulted in poor improvement in voice.
      We additionally performed VTx with concurrent application of IFC stimulation to the neck for 3 months, and the effects on voice were evaluated.

      Results

      VTx with IFC stimulation resulted in improved voice in all cases, demonstrating the improvement in maximum phonation time, subglottic pressure, and voice handicap index-10.

      Conclusions

      Results from this clinical study suggest that VTx with IFC stimulation may be useful for adjusting vocal function in patients with FD caused by insufficient subglottic pressure.

      Key Words

      Abbreviations:

      IFC (interferential current), VHI-10 (voice handicap index-10), CPG (central pattern generator), FD (functional dysphonia), SLN (superior laryngeal nerve), RLN (recurrent laryngeal nerve), MPT (maximum phonation time), NTS (nucleus tractus solitarius), RF (reticular formation), VTx (voice therapy)
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      REFERENCES

        • Davis PJ
        • Zhang SP
        • Bandler R.
        Pulmonary and upper airway afferent influences on the motor pattern of vocalization evoked by excitation of the midbrain periaqueductal gray of the cat.
        Brain Res. 1993; 607: 61-80https://doi.org/10.1016/0006-8993(93)91490-j
        • Sakamoto T
        • Yamanaka Y
        • Wada K
        • et al.
        Effects of tracheostomy on electrically induced vocalization in decerebrate cats.
        Neurosci Lett. 1993; 158: 92-96https://doi.org/10.1016/0304-3940(93)90620-z
        • Shiba K
        • Yoshida K
        • Miura T.
        Functional roles of the superior laryngeal nerve afferents in electrically induced vocalization in anesthetized cats.
        Neurosci Res. 1995; 22: 23-30https://doi.org/10.1016/0168-0102(95)00877-v
        • Thoms G
        • Jürgens U.
        Role of the internal laryngeal nerve in phonation: an experimental study in the squirrel monkey.
        Exp Neurol. 1981; 74: 187-203https://doi.org/10.1016/0014-4886(81)90158-8
        • Jürgens U
        • Kirzinger A.
        The laryngeal sensory pathway and its role in phonation. A brain lesioning study in the squirrel monkey.
        Exp Brain Res. 1985; 59: 118-124https://doi.org/10.1007/BF00237672
        • Shiba K
        • Yoshida K
        • Nakajima Y
        • et al.
        Influences of laryngeal afferent inputs on intralaryngeal muscle activity during vocalization in the cat.
        Neurosci Res. 1997; 27: 85-92https://doi.org/10.1016/s0168-0102(96)01136-4
        • Patrickson JW
        • Smith TE
        • Zhou SS.
        Afferent projections of the superior and recurrent laryngeal nerves.
        Brain Res. 1991; 539: 169-174https://doi.org/10.1016/0006-8993(91)90702-w
        • Altschuler SM
        • Bao XM
        • Bieger D
        • et al.
        Viscerotopic representation of the upper alimentary tract in the rat: sensory ganglia and nuclei of the solitary and spinal trigeminal tracts.
        J Comp Neurol. 1989; 283: 248-268https://doi.org/10.1002/cne.902830207
        • Jean A.
        Brain stem control of swallowing: neuronal network and cellular mechanisms.
        Physiol Rev. 2001; 81: 929-969
        • Bianchi AL
        • Denavit-Saubié M
        • Champagnat J.
        Central control of breathing in mammals: neuronal circuitry, membrane properties, and neurotransmitters.
        Physiol Rev. 1995; 75: 1-45https://doi.org/10.1152/physrev.2001.81.2.929
        • Smotherman MS.
        Sensory feedback control of mammalian vocalizations.
        Behav Brain Res. 2007; 182: 315-326https://doi.org/10.1016/j.bbr.2007.03.008
        • Ootani S
        • Umezaki T
        • Shin T
        • et al.
        Convergence of afferents from the SLN and GPN in cat medullary swallowing neurons.
        Brain Res Bull. 1995; 37: 397-404https://doi.org/10.1016/0361-9230(95)00018-6
        • Ward AR.
        Electrical stimulation using kilohertz-frequency alternating current.
        Phys Ther. 2009; 89 (Epub 2008 Dec 18): 181-190https://doi.org/10.2522/ptj.20080060
        • Palmer ST
        • Martin DJ
        • Steedman WM
        • et al.
        Alteration of interferential current and transcutaneous electrical nerve stimulation frequency: effects on nerve excitation.
        Arch Phys Med Rehabil. 1999; 80: 1065-1071https://doi.org/10.1016/s0003-9993(99)90062-x
        • Ward AR
        • Chuen WL.
        Lowering of sensory, motor, and pain-tolerance thresholds with burst duration using kilohertz-frequency alternating current electric stimulation: part II.
        Arch Phys Med Rehabil. 2009; 90: 1619-1627https://doi.org/10.1016/j.apmr.2009.02.022
        • Furuta T
        • Takemura M
        • Tsujita J
        • et al.
        Interferential electric stimulation applied to the neck increases swallowing frequency.
        Dysphagia. 2012; 27: 94-100https://doi.org/10.1007/s00455-011-9344-2
        • Oku Y
        • Sugishita S
        • Imai T
        • et al.
        Effects of short term interferential current stimulation on swallowing reflex in dysphagic patients.
        Intl J Speech Lang Pathol Audiol. 2015; 3: 1-8
        • Umezaki T
        • Sugiyama Y
        • Fuse S
        • et al.
        Supportive effect of interferential current stimulation on susceptibility of swallowing in guinea pigs.
        Exp Brain Res. 2018; 236 (Epub 2018 Jul 4): 2661-2676https://doi.org/10.1007/s00221-018-5325-0
        • Cesari U
        • Apisa P.
        Aerodynamic analysis in quantitative evaluation of voice disorders.
        J Otol Rhinol. 2016; 05: 1-4
        • Gartner-Schmidt J.
        Flow phonation.
        Plural Publishing, San Diego2006
        • Gartner-Schmidt J.
        Flow phonation.
        (FL)in: Stemple JC Voice Therapy: Clinical Case Studies. 3rd. Plural Publishing, Abingdon2010
        • Watts CR
        • Diviney SS
        • Hamilton A
        • et al.
        The effect of stretch-and-flow voice therapy on measures of vocal function and handicap.
        J. Voice. 2015; 29 (Epub 2014 Oct 12): 191-199https://doi.org/10.1016/j.jvoice.2014.05.008
        • Ertekin C.
        Voluntary versus spontaneous swallowing in man.
        Dysphagia. 2011; 26 (Epub 2010 Dec 15): 183-192https://doi.org/10.1007/s00455-010-9319-8
        • Ward AR
        • Robertson VJ.
        Sensory, motor, and pain thresholds for stimulation with medium frequency alternating current.
        Arch Phys Med Rehabil. 1998; 79: 273-278https://doi.org/10.1016/s0003-9993(98)90006-5
        • Hillman RE
        • Stepp CE
        • Van Stan JH
        • et al.
        An updated theoretical framework for vocal hyperfunction.
        Am J Speech Lang Pathol. 2020; 29: 2254-2260https://doi.org/10.1044/2020_AJSLP-20-00104
        • Abur D
        • Subaciute A
        • Kapsner-Smith M
        • et al.
        Impaired auditory discrimination and auditory-motor integration in hyperfunctional voice disorders.
        Sci Rep. 2021; 11: 13123https://doi.org/10.1038/s41598-021-92250-8
        • Stepp CE
        • Lester-Smith RA
        • Abur D
        • et al.
        Evidence for auditory-motor impairment in individuals with hyperfunctional voice disorders.
        J Speech Lang Hear Res. 2017; 60: 1545-1550https://doi.org/10.1044/2017_JSLHR-S-16-0282
        • Miyaji H
        • Hironaga N
        • Umezaki T
        • et al.
        Neuromagnetic detection of the laryngeal area: sensory-evoked fields to air-puff stimulation.
        Neuroimage. 2014; 88 (Epub 2013 Nov 15): 162-169https://doi.org/10.1016/j.neuroimage.2013.11.008