Voice and Swallowing in Professional Voice Users: The Effect of Therapy Methods

This study aimed to evaluate pain complaints, as well as voice and swallowing functions, in professional voice users, and to compare the effectiveness of three therapeutic approaches: vocal hygiene (VH), vocal function regulating exercises (VFRE), and transcutaneous electrical nerve stimulation (TENS).

Twenty-seven professional voice users (18 females, 9 males; mean age 45.4 ± 12.2 years) were equally allocated into three groups (VH, VH+VFRE, VH+TENS). Pre- and post-therapy assessments included videolaryngostroboscopy, acoustic analysis (F0, jitter, shimmer, HNR), maximum phonation time (MPT), and self-reported scales: Voice Handicap Index (VHI-10), Singing Voice Handicap Index (SVHI), Voice-Related Quality of Life (V-RQOL), Reflux Symptom Index (RSI), Dysphagia Handicap Index (DHI), Eating Assessment Tool (EAT-10), and Visual Analog Scale (VAS) for pain. Interventions were delivered over 8 weeks.

Across all groups, RSI scores significantly decreased from 16.5 ± 10.1 to 10.3 ± 7.8 (p = 0.028), reflecting meaningful improvement in reflux-related symptoms. However, in participants with baseline RSI >13 and concomitant laryngoscopic findings, scores remained above pathological threshold after therapy. Between-group analyses showed modality-specific effects: pain decreased most prominently in VH+TENS (p = 0.033), jitter values post-therapy were lower in VH+VFRE compared with VH+TENS (p = 0.022), and HNR was higher in VH+VFRE compared with VH (p = 0.023). EAT-10 and DHI scores did not change significantly, likely due to low baseline swallowing burden and sample size-related floor effects.

All three therapy pathways reduced reflux-related symptom burden, largely attributable to shared VH education. VFRE provided favorable effects on acoustic stability, while TENS was most effective for pain reduction. Although swallowing outcomes did not change significantly, findings support a tailored approach: VH as a universal foundation, VFRE for acoustic inefficiency, and TENS for pain/tension. Larger and longer term studies are needed to further clarify effects on swallowing.