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Efficacy of Voice Therapy in Rehabilitation of Muscle Tension Dysphonia in Patients of Nonlaryngeal Head and Neck Cancer: A Sequelae of Chemoradiotherapy

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Abstract

The association of voice disorders in laryngeal cancers has been studied extensively; however Dysphonia associated with chemo-radiation in non laryngeal Head and Neck cancer (HNC) is a new area of practice in voice clinics. This study thus aimed to evaluate the efficacy of voice rehabilitation among non-laryngeal HNC survivors who were treated with curative RadioTherapy (RT)/Chemoradiotherapy (CRT) in adjunct with or without surgery. This tertiary institutional assessor blinded quasi experimental study after inclusion and exclusion criteria consisted of a study cohort of 128 patients who within 1–3 months of completion of treatment for HNC reported to the laryngology clinic for voice complaints and throat discomfort. All patients underwent documentation of laryngeal endoscopic imaging, acoustics assessment, Aronson’s Laryngeal Palpatory Method (LPM) and Voice Handicap Index (VHI). Thereafter they were subjected to Vocal Rehabilitation Therapy (VRT) which constituted of Manual circumlaryngeal therapy, SOVTE, and vocal hygiene program. Re-evaluation of the vocal parameters was done at 6 weeks and 3 months from the start of the VRT. All parameters were significantly altered at 6 weeks and 3 months follow-up. Post VRT the videolaryngoscopic findings showed reduction in abnormal supraglottic MTPs with subsequent good approximation of true cords and reduction of involvement of supralaryngeal activities. The Dysphonia Severity Index (DSI) impairment levels and VHI scores showed significant improvement from the baseline to both at 6 weeks and 3 months of VRT (p < 0.001). DSI and VHI scores even showed significant improvement between 6 weeks to 3 months of therapy. There was highly significant correlation of VRT with/without surgery, with CRT and in non-smokers at 6 weeks and 3 months of VRT. In non-laryngeal head and neck malignancies, VRT offered as early as within 1–3 months of completion of treatment of HNC ameliorates surgical and chemo-radiation induced Muscle Tension Dysphonia.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India

    Vanita Sarin & Arpita Chatterjee

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  1. Vanita Sarin
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  2. Arpita Chatterjee
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Correspondence to Arpita Chatterjee.

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This study was approved by institute ethical committee. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Appendix

Appendix

See Appendix Tables

Table 4 Effect of therapy on DSI category
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Table 5 Effect of therapy on VHI severity
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Table 6 Correlation of therapy in patients without surgery (total patients without surgery = 19)
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Table 7 Correlation of therapy in patients with surgery (total patients with surgery = 109)
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7,

Table 8 Correlation of therapy in patients without CT (total patients without CT = 64)
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Table 9 Correlation of therapy in patients with CT (total patients with CT = 64)
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Table 10 Correlation of therapy with former smoker patients: (total former smokers = 5)
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10 and

Table 11 Correlation of therapy in nonsmoker patients (total nonsmokers = 123)
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11.

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Sarin, V., Chatterjee, A. Efficacy of Voice Therapy in Rehabilitation of Muscle Tension Dysphonia in Patients of Nonlaryngeal Head and Neck Cancer: A Sequelae of Chemoradiotherapy. Indian J Otolaryngol Head Neck Surg 75, 3739–3749 (2023). https://doi.org/10.1007/s12070-023-04072-x

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