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Effectiveness of voice therapy in patients with vocal fold nodules: a systematic search and narrative review

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Abstract

Background/objective

An adult with vocal fold nodules can suffer from hoarseness, breathiness and vocal fatigue, which, in turn, significantly affects their vocal participation as well as activities. A well-designed voice therapy program improves the quality of life and vocal functionality. This is a narrative review with a systematic search of the current literature about the effectiveness of voice therapy interventions in adults with vocal fold nodules.

Methods

Several key terms were used for the database electronic search of articles. Strict inclusion criteria were used and a broad evaluation of the studies was performed. This included the level of evidence based on the National Health and Medical Research Council levels of evidence, assessment, and critical appraisal.

Results

Nine out of 30 reviewed articles met the criteria of inclusion and reported positive effects of voice therapy intervention on adult patients with vocal fold nodules. The vast majority of the reviewed studies reported multidimensional voice measures outcome data, most of them containing visual-perceptual, auditory-perceptual, acoustic and self-assessment results. Regardless of receiving direct or indirect or a combination of both voice therapy contents, nearly all voice quality parameters were found to improve after treatment. Short-term treatment (< 3 weeks) may be as beneficial as longer traditional voice therapy programs, and using telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy. The study design and the evidence levels of the included studies were low (≤ III-2) and the risk of bias of the comparative studies was moderate.

Conclusion

This narrative review cannot conclude the general effectiveness of voice therapy programs. Further research and understanding of what specific parameters (exercise and techniques) of a therapy’s content will improve voice outcome measures. More studies are required to investigate whether or not voice therapy benefits are sustainable 6 months after ending the therapy. However, improved evidence is required to suggest that short period treatments are as beneficial as traditional therapy programs. Telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy.

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Acknowledgements

The last author acknowledges the support of FP-ENAS.

Funding

This study was not funded by any company or any other source of funding.

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Authors and Affiliations

  1. Fernando Pessoa College of Health, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal

    Rita Alegria

  2. Faculty of Health Sciences, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal

    Susana Vaz Freitas

  3. Speech Pathology Unit of Otoryngology Service, Centro Hospitalar e Universitário do Porto, Porto, Portugal

    Susana Vaz Freitas

  4. LIAAD - INESC TEC, Porto, Portugal

    Susana Vaz Freitas

  5. Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal

    Maria Conceição Manso

  6. Fernando Pessoa Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa, Porto, Portugal

    Maria Conceição Manso

  7. LAQV, REQUIMTE, University of Porto, Porto, Portugal

    Maria Conceição Manso

Authors
  1. Rita Alegria
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  2. Susana Vaz Freitas
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  3. Maria Conceição Manso
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Correspondence to Rita Alegria.

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Not applicable as the article is a Systematic Search and Narrative Review.

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Alegria, R., Vaz Freitas, S. & Manso, M.C. Effectiveness of voice therapy in patients with vocal fold nodules: a systematic search and narrative review. Eur Arch Otorhinolaryngol 277, 2951–2966 (2020). https://doi.org/10.1007/s00405-020-06059-8

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  • DOI: https://doi.org/10.1007/s00405-020-06059-8

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