SUMMARY
Objective(s)/Hypothesis
Virtual therapy (teletherapy) for patients with dysphonia has become ubiquitous in
the COVID-19 era. However, barriers to widespread implementation are evident, including
unpredictable insurance coverage attributed to limited evidence supporting this approach.
In our single-institution cohort, our objective was to show strong evidence for use
and effectiveness of teletherapy for patients with dysphonia.
Study Design
Single institution, retrospective cohort study.
Material and Methods
This was an analysis of all patients referred for speech therapy with dysphonia as
primary diagnosis from 4/1/2020 to 7/1/2021 and in whom all therapy sessions were
delivered in a teletherapy format. We collated and analyzed demographics and clinical
characteristics and adherence to the teletherapy program. We assessed changes in perceptual
assessments and vocal capabilities (GRBAS, MPT), patient-reported outcomes (V-RQOL),
and metrics of session outcomes (complexity of vocal tasks, carry-over of target voice)
pre- and post-teletherapy using student's t test and chi-square test.
Results
Our cohort included 234 patients (mean [SD] age 52 [20] years) residing a mean (SD)
distance of 51.3 (67.1) miles from our institution. The most common referral diagnosis
was muscle tension dysphonia (n = 145, 62.0% patients). Patients attended a mean (SD)
of 4.2 (3.0) sessions; 68.0% (n = 159) of patients completed four or more sessions
and/or were deemed appropriate for discharge from teletherapy program. Statistically
significant improvements were seen in complexity and consistency of vocal tasks with
consistent gains in carry-over of target voice for isolated tasks and connected speech.
Conclusions
Teletherapy is a versatile and effective approach for treatment of patients with dysphonia
of varying age, geography, and diagnoses.
Key Words
Abbreviations:
GRBAS (grade, roughness, breathiness, asthenia, strain), IRB (institutional review board), MPT (maximum phonation time), PPE (personal protective equipment), SLP (speech-language pathologist), VHI (voice handicap index), V-RQOL (voice-related quality of life)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 accessOne-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 VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of voice disorders in the general population based on the Stockholm Public Health Cohort.J Voice. 2019; 33: 900-905
- Prevalence and occupation of patients presenting with dysphonia in the United States.J Voice. 2017; 31: 594-600
- Voice disorders in the general population: prevalence, risk factors and occupational impact.Laryngoscope. 2005; 115: 1988-1995
- A systematic review of voice therapy: what “effectiveness” really implies.J Voice. 2017; 31: 392
- Aerodynamic and acoustic voice measurements of patients with vocal nodules: variation in baseline and changes across voice therapy.J Voice. 2003; 17: 262-282
- Delivery of intensive voice therapy for vocal fold nodules via telepractice: a pilot feasibility and efficacy study.J Voice. 2015; 29: 696-706
- Telehealth for treatment of pediatric dysphonia.J Voice. 2021; (Published online ahead of print)https://doi.org/10.1016/j.jvoice.2021.11.007
- Implementation of telemedicine in a laryngology practice during the COVID-19 pandemic: lessons learned, experiences shared.J Voice. 2020; 36: 396-402
- COVID-19 and the resurgence of telehealth in otolaryngology.Oper Tech Otolaryngol Head Neck Surg. 2022; 33: 158-164
- Telemedicine and the diagnosis of speech and language disorders.Mayo Clin Proc. 1997; 72: 1116-1122
- Telehealth: voice therapy using telecommunications technology.Am J Speech Lang Pathol. 2003; 12: 432-439
- Assessing acquired language disorders in adults via the Internet.Telemed J E Health. 2008; 14: 552-559
- A systematic review of the use of telehealth in speech, language and hearing sciences.J Telemed Telecare. 2015; 21: 367-376
- The challenge of virtual voice therapy during the COVID-19 pandemic.J Voice. 2021; 35: 336-337
- Clinical practice guideline: hoarseness (dysphonia).Otolaryngol Head Neck Surg. 2018; 158: S1-S42
- Validation of an instrument to measure voice-related quality of life (V-RQOL).J Voice. 1999; 13: 557-569
- Clinical Examination of Voice.Springer-Verlag, New York, NY1981
- The S/Z ratio as an indicator of laryngeal pathology.J Speech Hear Disord. 1981; 46: 147-149
- Clinical Voice Pathology: Theory and Management.Plural Publishing Inc, San Diego2014
- Carryover Techniques in Articulation and Phonological Therapy.Marshalla Speech and Language, Mill Creek, WA2010
- The effect of stretch-and-flow voice therapy on measures of vocal function and handicap.J Voice. 2015; 29: 191-199
CMS. Trump administration finalizes permanent expansion of Medicare telehealth services and improved payment for time doctors spend with patients. Available at:https://www.cms.gov/newsroom/press-releases/trump-administration-finalizes-permanent-expansion-medicare-telehealth-services-and-improved-payment. Accessed July 19, 2022
Editors FPM Cigna institutes new reimbursement policy for virtual care. Available at: https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/cigna_virtual_reimbursement.html. Accessed July 19, 2022
- Telemedicine in otolaryngology during COVID-19: patient and physician satisfaction.Otolaryngol Head Neck Surg. 2022; 167: 56-64
American Speech-Language-Hearing Association. Providing telehealth services under medicare during the COVID-19 pandemic. Available at:https://www.asha.org/practice/reimbursement/payment-and-coverage-considerations-for-telepractice-services-during-coronavirus/#PHE. Accessed January 10, 2023
- A review of patient adherence to the recommendation for voice therapy.J Voice. 2008; 22: 192-196
- Differences in temporal variables between voice therapy completers and dropouts.J Voice. 2011; 25: 62-66
- Barriers to voice therapy in dysphonic children.J Voice. 2021; (Published online ahead of print)https://doi.org/10.1016/j.jvoice.2021.01.008
- Voice therapy improves quality of life in age-related dysphonia: a case-control study.J Voice. 2008; 22: 70-74
- Applications of telemedicine in speech-language pathology: evaluation of patient satisfaction.Laryngoscope. 2022; (Published online ahead of print)https://doi.org/10.1002/lary.30303
- Voice-related quality of life (V-RQOL) following type I thyroplasty for unilateral vocal fold paralysis.J Voice. 2000; 14: 378-386
- A randomized controlled trial with female teachers: are there differences between and within the outcomes in voice therapy groups with and without carryover strategies?.J Voice. 2022; (Published online ahead of print)https://doi.org/10.1016/j.voice.2022.06.029
- Effects of voice therapy: a systematic review.J Voice. 2008; 22: 565-580
- Remote management of voice and swallowing disorders.Otolaryngol Clin N Am. 2011; 44: 1305-1316
- Patient perceptions of voice therapy adherence.J Voice. 2010; 24: 458-469
Article info
Publication history
Published online: February 28, 2023
Accepted:
January 27,
2023
Publication stage
In Press Corrected ProofFootnotes
Conflicts of Interest: The authors declare no potential conflicts of interest relevant to this work.
Funding: No specific funding source supported this work.
Meeting Information: This work was presented at The Fall Voice Conference, October 6-8th, 2022 in San Francisco, CA.
Identification
Copyright
© 2023 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
