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The Effectiveness of Eclectic Voice Therapy on Multidimensional Voice Parameters in Patients with Primary Muscle
Dilara Söylemez1, Elife Barmak2, Esma Altan1
1Department of Otolaryngology, Ankara Etlik City Hospital, Ankara, Turkey.
Background:
Primary muscle tension dysphonia (MTD) is a functional voice disorder characterized by excessive laryngeal muscle tension, resulting in various voice quality impairments and associated symptoms. While voice therapy is recognized as the primary treatment approach, there remains limited evidence regarding the multidimensional effects of eclectic therapeutic interventions combining multiple evidence-based techniques.
Aim:
To investigate the effectiveness of eclectic voice therapy on acoustic, aerodynamic, auditory-perceptual, and self-assessment voice parameters in patients diagnosed with primary MTD.
Method And Procedures:
Thirty patients (17 males, 13 females) diagnosed with primary MTD participated in this prospective cohort study. All participants underwent multidimensional pre- and post-therapy evaluations, including acoustic analysis (fundamental frequency, jitter, shimmer, noise-to-harmonics ratio [NHR], voice turbulence index, soft phonation index), respiratory and phonotary efficiency (maximum phonation time [MPT], s/z ratio), auditory-perceptual evaluation (Grade, Roughness, Breathiness, Asthenia, Strain [GRBAS]), and self-assessment scales (voice handicap index-10 [VHI-10], vocal fatigue index [VFI], vocal tract discomfort scale [VTDS]). The intervention consisted of eclectic voice therapy incorporating vocal hygiene education, head-neck relaxation exercises, tongue-out phonation, yawn-sigh technique, voice production with body movements, resonant voice therapy, and laryngeal manual therapy over eight weekly sessions.
Outcomes And Results:
Significant improvements were observed in acoustic parameters, including jitter (P = 0.009), shimmer (P < 0.001), and NHR (P = 0.022). MPT increased significantly from 11.03 seconds to 16.47 seconds (P < 0.001). All GRBAS parameters demonstrated significant improvements (P < 0.05). Self-assessment measures showed substantial reductions: VHI-10 scores decreased from 25.5 to 9.2 (P < 0.001). VFI total scores reduced from 44.9 to 18.47 (P < 0.001), and VTDS frequency and severity scores decreased significantly from 17.8 to 6.4 and 17.45 to 6.66, respectively (P < 0.001).
Conclusion And Implications:
Eclectic voice therapy demonstrated significant effectiveness across multidimensional voice parameters in patients with primary MTD. These findings support the clinical efficacy of combined therapeutic approaches that systematically integrate multiple evidence-based techniques in the management of primary MTD.
