Skip to main content
  • Original Article
  • Open access
  • Published:

Voice outcome following electrical stimulation-supported voice therapy in cases of unilateral vocal fold paralysis

En

Abstract

Introduction

The current lack of knowledge on the effects of transcutaneous electrical stimulation-supported voice therapy (TESVT) on voice production, coupled with increasing anecdotal reports of TESVT use with voice disorders, prompted this research.

Aim

The aim of this study was to compare the therapeutic value of conventional voice therapy (CVT) and TESVT on voice outcome in patients with unilateral vocal fold paralysis.

Patients and methods

The study was conducted on randomly selected 29 patients with unilateral vocal fold paralysis who were candidates for voice therapy attending to the Unit of Phoniatrics, Department of Otorhinolaryngology, Faculty of Medicine, University of Alexandria. The patients were divided into two groups: group I, which included 14 patients who were assigned to CVT, and group II, which included 15 patients who were assigned to TESVT.

Each patient was subjected to the following procedures before and after therapy to document glottis closure and voice quality changes: auditory perceptual assessment using the GRBAS scale, the Voice Problem Self-assessment Scale, videostroboscopic examination, and acoustic and aerodynamic analysis of a sample of phonation in addition to electroglottography. TESVT was applied for all participants.

Results

Statistically significant changes have been obtained for all measurers. No significant statistical difference was found between CVT and TESVT in patients with vocal fold immobility except for frequency perturbation and some electroglottographic parameters.

Conclusion

Transcutaneous electrical stimulation-supported voice therapy is as effective as CVT in improving voice parameters in cases of unilateral vocal fold immobility. Further research is warranted with a larger number of patients to assess the efficacy of electrical stimulation-supported voice therapy in cases of vocal fold immobility and to determine selective criteria for this TESVT approach.

References

  1. Kotby M. The accent method of voice therapy. San Diego, CA: Singular Publishing Group; 1995.

    Google Scholar 

  2. Stemple J, Glaze L, Klaben B. Clinical voice pathology: theory and management. 3rd ed. San Diego, CA: Singular Publishing Group; 2000.

    Google Scholar 

  3. Misono S, Merati AL. Evidence-based practice: evaluation and management of unilateral vocal fold paralysis. Otolaryngol Clin North Am 2012; 45: 1083–1108.

    Article  Google Scholar 

  4. Heuer RJ, Sataloff RT, Emerich K, Rulnick R, Baroody M, Spiegel JR et al. Unilateral recurrent laryngeal nerve paralysis: the importance of ‘preoperative’ voice therapy. J Voice 1997; 11: 88–94.

    Article  CAS  Google Scholar 

  5. Ptok M. Electralstimulation therapy in patients with unilateral vocal cord paralysis. Language Voice Hearing 2008; 32: 110–114.

    Google Scholar 

  6. Pahn J, Pahn E. The nasalized methods [German]. Rostock: Oehmke; 2000.

    Google Scholar 

  7. Ludlow CL, Humbert I, Saxon K, Poletto C, Sonies B, Crujido L. Effects of surface electrical stimulation both at rest and during swallowing in chronic pharyngeal dysphagia. Dysphagia 2007; 22: 1–10.

    Article  Google Scholar 

  8. Leelamanit V, Limsakul C, Geater A. Synchronized electrical stimulation in treating pharyngeal dysphagia. Laryngoscope 2002; 112: 2204–2210.

    Article  Google Scholar 

  9. Sun S, Hsu C, Lin H. Combined neuromuscular electrical stimulation (NMES) with fiberoptic endoscopic evaluation of swallowing (FEES) and trational swallowing rehabilitation in the treatment of stroke-related dysphagia (online). Dysphagia 2013:1–10.

  10. Blumenfeld L, Hahn Y, Lepage A, Leonard R, Belafsky PC. Transcutaneous electrical stimulation versus traditional dysphagia therapy: a nonconcurrent cohort study. Otolaryngol Head Neck Surg 2006; 135: 754–757.

    Article  Google Scholar 

  11. Mu L, Sanders I. Neuromuscular specializations within human pharyngeal constrictor muscles. Ann Otol Rhinol Laryngol 2007; 116: 604–617.

    Article  Google Scholar 

  12. Wu YZ, Baker MJ, Crumley RL, Blanks RH, Caiozzo VJ. A new concept in laryngeal muscle: multiple myosin isoform types in single muscle fibers of the lateral cricoarytenoid. Otolaryngol Head Neck Surg 1998; 118: 86–94.

    Article  CAS  Google Scholar 

  13. Malmgren LT, Fisher PJ, Jones CE, Bookman LM, Uno T. Numerical densities of myonuclei and satellite cells in muscle fiber types in the aging human thyroarytenoid muscle: an immunohistochemical and stereological study using confocal laser scanning microscopy. Otolaryngol Head Neck Surg 2000; 123: 377–384.

    Article  CAS  Google Scholar 

  14. Shaw GY, Sechtem PR, Searl J, Keller K, Rawi TA, Dowdy E. Transcutaneous neuromuscular electrical stimulation (VitalStim) curative therapy for severe dysphagia: myth or reality? Ann Otol Rhinol Laryngol 2007; 116: 36–44.

    Article  Google Scholar 

  15. Hirano M. Clinical examination of voice. Wein; New York, NY: Springer; 1981.

    Google Scholar 

  16. El-Banna M, Abou-Ras Y. Formulation of a voice problem self-assessment scale (VPSS) clinician based tool for Egyptian dysphonic population. Bull Alexandria Fac Med 2010; 46: 119–126.

    Google Scholar 

  17. Fowler LP, Gorham-Rowan M, Hapner ER. An exploratory study of voice change associated with healthy speakers after transcutaneous electrical stimulation to laryngeal muscles. J Voice 2011; 25: 54–61.

    Article  Google Scholar 

  18. Carding PN, Horsley IA, Docherty GJ. A study of the effectiveness of voice therapy in the treatment of 45 patients with nonorganic dysphonia. J Voice 1999; 13: 72–104.

    Article  CAS  Google Scholar 

  19. Chae J, Sheffler L, Knutson J. Neuromuscular electrical stimulation for motor restoration in hemiplegia. Top Stroke Rehabil 2008; 15: 412–426.

    Article  Google Scholar 

  20. Maffiuletti NA, Dugnani S, Folz M, di Pierno E, Mauro F. Effect of combined electrostimulation and plyometric training on vertical jump height. Med Sci Sports Exerc 2002; 34: 1638–1644.

    Article  Google Scholar 

  21. Valli P, Boldrini L, Bianchedi D, Brizzi G, Miserocchi G. Effect of low intensity electrical stimulation on quadriceps muscle voluntary maximal strength. J Sports Med Phys Fitness 2002; 42: 425–430.

    CAS  PubMed  Google Scholar 

  22. Schindler A, Bottero A, Capaccio P, Ginocchio D, Adorni F, Ottaviani F. Vocal improvement after voice therapy in unilateral vocal fold paralysis. J Voice 2008; 22: 113–118.

    Article  Google Scholar 

  23. Mattioli F, Bergamini G, Alicandri-Ciufelli M, Molteni G, Luppi MP, Nizzoli F et al. The role of early voice therapy in the incidence of motility recovery in unilateral vocal fold paralysis. Logoped Phoniatr Vocol 2011; 36: 40–47.

    Article  Google Scholar 

  24. Humbert IA, Poletto CJ, Saxon KG, Kearney PR, Ludlow CL. The effect of surface electrical stimulation on vocal fold position. Laryngoscope 2008; 118: 14–19.

    Article  Google Scholar 

  25. Ptok M, Strack D. Electrical stimulation-supported voice exercises are superior to voice exercise therapy alone in patients with unilateral recurrent laryngeal nerve paresis: results from a prospective, randomized clinical trial. Muscle Nerve 2008; 38: 1005–1011.

    Article  Google Scholar 

  26. Dahl R, Witt G. Analysis of voice parameters after conservatively Treating laryngeal paralysis with conventional vocal exercise or electrophonic neuromuscular stimulation. Folia Phoniatrica et Logopaedica 2006; 58: 415–426.

    Article  Google Scholar 

  27. Ptok M, Starck D. Classical voice Therapy Versus electrostimulation therapy in unilateral vocal fold paralysis. HNO 2005; 53: 1092–1097.

    Article  CAS  Google Scholar 

  28. Guzman M, Rubin A, Cox P, Landini F, Jackson-Menaldi C. Neuromuscular electrical stimulation of the cricothyroid muscle in patients with suspected superior laryngeal nerve weakness. J Voice 2014; 28: 216–225.

    Article  Google Scholar 

  29. Abdelfattah H, El-Banna M. Voice quality after laser cordectomy and vertical hemilaryngectomy. Alexandria J Med 2012; 48: 19–28.

    Article  Google Scholar 

  30. Koreman J, Putzer M. Finding correlates of vocal fold adduction deficiencies. Phonus 1997; 3: 155–178.

    Google Scholar 

  31. Mathew MM, Bhat JS. Soft phonation index − a sensitive parameter? Indian J Otolaryngol Head Neck Surg 2009; 61: 127–130

    Article  Google Scholar 

  32. Belafsky PC, Postma GN, Reulbach TR, Holland BW, Koufman JA. Muscle tension dysphonia as a sign of underlying glottal insufficiency. Otolaryngol Head Neck Surg 2002; 127: 448–451.

    Article  Google Scholar 

  33. LaGorio LA, Carnaby-Mann GD, Crary MA. Cross-system effects of dysphagia treatment on dysphonia: a case report. Cases J 2008; 1: 67.

    Article  Google Scholar 

  34. LaGorio LA, Carnaby-Mann GD, Crary MA. Treatment of vocal fold bowing using neuromuscular electrical stimulation. Arch Otolaryngol Head Neck Surg 2010; 136: 398–403.

    Article  Google Scholar 

  35. Schönweiler R, Mergardt D, Raap M. Pilot study on the effectiveness of Vocal exercise therapy using NMEPS stimulation current and the nasalized methods. LOGOS Interdisciplinary 2005; 13: 36–42.

    Google Scholar 

  36. Humbert IA, Poletto CJ, Saxon KG, Kearney PR, Crujido L, Wright-Harp W et al. The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing. J Appl Physiol (1985) 2006; 101:1657–1663.

    Article  Google Scholar 

  37. Hapner E, Gorham-Rowan M, Morris R, Fowler L. S190-voice spectral analysis after surface electrical stimulation. Otolaryngol Head Neck Surg 2008; 139(Suppl):139.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Manal M. El-Banna.

Additional information

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Rights and permissions

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work noncommercially, as long as the author is credited and the new creations are licensed under the identical terms.

To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ras, Y.A., Imam, M., El-Banna, M.M. et al. Voice outcome following electrical stimulation-supported voice therapy in cases of unilateral vocal fold paralysis. Egypt J Otolaryngol 32, 322–334 (2016). https://doi.org/10.4103/1012-5574.192543

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1012-5574.192543

Keywords