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Efficacy of an Eclectic Voice Therapy Protocol in Unilateral Vocal Fold Paralysis: Evidence from Multidimensional
Srirangam Vijayakumar Narasimhan1, Neha Gandhi1, Lakshmanan Lokeshwari1
1Department of Speech Language Pathology, JSS Institute of Speech and Hearing, Mysore, Karnataka, India.
Purpose:
This study aimed to evaluate the efficacy of an eclectic voice therapy protocol for individuals with unilateral vocal fold paralysis (UVFP). The eclectic voice therapy protocol integrated evidence-based facilitatory and physiological voice therapy techniques to holistically address respiratory-phonatory incoordination and glottal insufficiency. Additionally, the study sought to identify the voice parameters that are most sensitive to change following therapy using a discriminant analysis.
Method:
A one-group pretest-posttest design was adopted involving 12 participants diagnosed with UVFP of less than 2 months' duration. The eclectic voice therapy protocol, developed through a three-round Delphi process, included four techniques: cough and phonate, half-swallow boom, vocal function exercises, and abdominal breathing. The intervention spanned three weeks with biweekly 45-minute sessions. Vocal outcomes were evaluated using a comprehensive, multidimensional framework that included perceptual ratings, acoustic measures, multiparametric indices, electroglottographic (EGG) parameters, and patient-reported outcome measures (PROMs) in Kannada.
Results:
Post-intervention analyses revealed statistically significant improvements across all grades, roughness, breathiness, asthenia, and strain parameters and PROMs, with large effect sizes. Acoustic measures showed reduced perturbation and noise-related measures, and improved harmonic structure. Multiparametric measures significantly decreased, reflecting enhanced voice quality and reduced breathiness. EGG perturbation parameters also showed significant improvement. Discriminant analysis revealed the acoustic breathiness index and normalized noise energy as the strongest predictors of therapeutic change, classifying pretreatment and post-treatment conditions with 100% accuracy.
Conclusion:
The eclectic voice therapy protocol demonstrated robust efficacy in improving voice outcomes across perceptual, acoustic, EGG, and self-reported domains. The structured design of the therapy protocol and sensitivity to multidimensional voice measures make it a clinically feasible and effective option for early intervention in UVFP. Future randomized controlled trials with larger samples are warranted to validate these findings further.
