Multidimensional effects of voice therapy in patients affected by unilateral vocal fold paralysis due to cancer

Abstract Introduction: Patients with unilateral vocal fold paralysis may demonstrate different degrees of voice perturbation depending on the position of the paralyzed vocal fold. Understanding the effectiveness of voice therapy in this population may be an important coefficient to define the therapeutic approach. Objective: To evaluate the voice therapy effectiveness in the short, medium and long-term in patients with unilateral vocal fold paralysis and determine the risk factors for voice rehabilitation failure. Methods: Prospective study with 61 patients affected by unilateral vocal fold paralysis enrolled. Each subject had voice therapy with an experienced speech pathologist twice a week. A multidimensional assessment protocol was used pre-treatment and in three different times after voice treatment initiation: short-term (1-3 months), medium-term (4-6 months) and long-term (12 months); it included videoendoscopy, maximum phonation time, GRBASI scale, acoustic voice analysis and the portuguese version of the voice handicap index. Results: Multiple comparisons for GRBASI scale and VHI revealed statistically significant differences, except between medium and long term (p < 0.005). The data suggest that there is vocal improvement over time with stabilization results after 6 months (medium term). From the 28 patients with permanent unilateral vocal fold paralysis, 18 (69.2%) reached complete glottal closure following vocal therapy (p = 0.001). The logistic regression method indicated that the Jitter entered the final model as a risk factor for partial improvement. For every unit of increased Jitter, there was an increase of 0.1% (1.001) of the chance for partial improvement, which means an increase on no full improvement chance during rehabilitation. Conclusion: Vocal rehabilitation improves perceptual and acoustic voice parameters and voice handicap index, besides favor glottal closure in patients with unilateral vocal fold paralysis. The results were also permanent during the period of 1 year. The Jitter value, when elevated, is a risk factor for the voice therapy success.

摘要 引言：单侧声带麻痹患者的嗓音扰动程度可因麻痹声带的位置不同而存在差异。明确嗓音治疗在该人群中的疗效，是确定治疗方案的重要参考依据。
研究目的：评估嗓音治疗对单侧声带麻痹患者的短期、中期及长期疗效，并明确嗓音康复失败的危险因素。
研究方法：本研究为前瞻性研究，共纳入61例单侧声带麻痹患者。所有受试者均由经验丰富的言语治疗师每周开展2次嗓音治疗。在治疗前及嗓音治疗启动后的三个时间点——短期（1~3个月）、中期（4~6个月）与长期（12个月）——采用多维度评估方案进行检测，评估内容涵盖视频喉镜检查、最长发声时间、GRBASI量表、声学嗓音分析，以及葡萄牙语版嗓音障碍指数量表（Voice Handicap Index, VHI）。
研究结果：针对GRBASI量表与嗓音障碍指数量表（VHI）的多重比较结果显示，除中期与长期阶段外，其余各组间差异均具有统计学意义（p<0.005）。数据表明，患者嗓音功能随时间推移逐步改善，并在6个月（中期）后趋于稳定。在28例永久性单侧声带麻痹患者中，18例（69.2%）在接受嗓音治疗后实现了完全声门闭合（p=0.001）。Logistic回归分析显示，基频微扰（Jitter）作为仅获得部分改善的危险因素进入最终模型。基频微扰每升高1个单位，患者获得部分改善的概率即增加0.1%（优势比OR=1.001），意味着康复过程中无法获得完全改善的概率上升。
研究结论：嗓音康复可改善单侧声带麻痹患者的感知与声学嗓音参数，降低嗓音障碍指数，同时有助于实现声门闭合。上述疗效在1年随访周期内保持稳定。基频微扰水平升高是影响嗓音治疗成功的危险因素。