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Multidimensional Effectiveness of Eclectic Voice Therapy in Patients with Unilateral Vocal Fold Paralysis Following
Çağla Eliküçük1, Bünyamin Çıldır1, Elvan Evrim Tuna2
1Department of Speech and Language Therapy, Ankara Yildirim Beyazit University, Ankara, Turkey.
Objectives:
To evaluate the multidimensional effectiveness of a structured 8-week voice therapy program on voice, swallowing, and thyroid-related quality of life in adults with unilateral vocal fold paralysis (UVFP) following thyroidectomy.
Study Design:
Prospective, single-arm pre-post interventional study with blinded outcome assessment.
Methods:
Forty-five adults with post-thyroidectomy UVFP (≤12 months duration) received an 8-week (once-weekly), face-to-face voice therapy program based on Lessac-Madsen Resonant Voice Therapy, semi-occluded vocal tract exercises, push-pull maneuvers, manual laryngeal techniques, postural/relaxation work, and targeted swallowing exercises when indicated. Standardized assessments were performed before (T0) and after therapy (T1), including acoustic measures (fundamental frequency, jitter, shimmer, noise-to-harmonics ratio, cepstral peak prominence), perceptual ratings (consensus auditory-perceptual evaluation of voice [CAPE-V]), patient-reported outcomes (voice handicap index-10 [VHI-10], voice-related quality of life, vocal fatigue index, Swallowing Quality of Life Questionnaire [SWAL-QOL], thyroid-related patient-reported outcome [ThyPRO]), and aerodynamic measures (maximum phonation time [MPT], S/Z ratio).
Results:
All 45 participants completed the program. VHI-10 scores improved from 27.2 ± 3.2 to 12.4 ± 4.8 (P < 0.001), and CAPE-V overall voice severity decreased from 69.5 ± 10.1 to 28.4 ± 15.3 (P < 0.001). Jitter and shimmer decreased (from 5.6% to 3.7%, and 18.9% to 3.7%, respectively; both P < 0.001), while smoothed cepstral peak prominence increased from 2.23 ± 0.72 to 5.03 ± 1.20 dB (P < 0.001). MPT nearly doubled (8.16 ± 1.31 to 18.42 ± 1.36 seconds; P < 0.001), and the median S/Z ratio improved from 3.66 to 1.70 (P < 0.001). SWAL-QOL total score increased from 119.8 ± 10.9 to 162.7 ± 10.7 (P < 0.001), indicating better swallowing-related quality of life. ThyPRO Voice/Speech, Social Life, and Daily Life domain scores showed significant improvements, whereas physical symptom and cosmetic domains were largely unchanged.
Conclusions:
In adults with post-thyroidectomy UVFP, an 8-week structured, therapist-led voice therapy program produced large, clinically meaningful gains in acoustic and aerodynamic voice parameters, swallowing function, and thyroid-specific quality of life. These findings support early, multidimensional voice therapy as an effective first-line conservative management strategy in this population.
