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The effectiveness of intervention by speech therapy in vocal fold paralysis

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Oral presentation at IALP congress in 2013 - Turin, Italy.
Authors: Pedro Melo Pestana; Susana Vaz Freitas; Cecília Almeida e Sousa
PMP terapia - Esposende, Portugal

Published in: Health & Medicine
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The effectiveness of intervention by speech therapy in vocal fold paralysis

  1. 1. THE EFFECTIVENESS OF INTERVENTION BY SPEECH THERAPY IN VOCAL FOLD PARALYSIS FP45 Pedro Melo Pestana1; Susana Vaz-Freitas1, 2; Cecília Almeida e Sousa 2 1Universidade Fernando Pessoa – Faculdade de Ciências da Saúde 2Centro Hospitalar do Porto – Hospital de Santo António
  2. 2. Introduction Vocal fold paralysis (VFP) as: • Peripheral neuropathy of the recurrent laryngeal nerve and superior laryngeal nerve • Affects more the left side than the right one (> extension) introduction objectives methods results summary FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN 2 (Sulica, Cutrara and Blitzer, 2006)
  3. 3. Introduction Consequences of vocal fold paralysis 1st Dysphonia aphonia Breathiness Wet voice Dysphagia Hyper functioning Extreme and unstable pitch introduction objectives methods results summary Adapted from Verdolini et al (2005) and Simpson and Rosen (2008) 3 If dysphagia occurs: • Aspiration of liquids (> common in SLN) • Weak and ineffective cough • Difficult in swallowing solids (< common) FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  4. 4. Objectives • Analyze the results achieved by a group of patients with vocal fold paralysis using objective assessment measures, before and after intervention of Speech Language Pathology (SLP) 4introduction objectives methods results summary FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  5. 5. Methods 5introduction objectives methods results summary 1st - 69 patients with VFP •2000-2010 2nd - 38 patients due to exclusion criteria •Missing values •Signs of dysphagia •Withdrawal due to lack of attendance Male (n/%) Female (n/%) Total Gender 12 31,6% 26 68,4% 38 Mean(SD) Min Max Age 49,58 (11,3) 22 69 Etiology n=38 % Total thyroidectomy 16 42,1 Hemithyroidectomy 5 13,2 Neck surgery 5 13,2 Idiopathic 4 10,5 Esophageal surgery 2 5,3 Others 6 15,6 FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  6. 6. Methods • Retrospective analysis of the results obtained by a group of 38 patients with vocal fold paralysis underwent intervention by Speech Therapy at a Central Hospital in Portugal 6introduction objectives methods results summary FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  7. 7. Methods • Clinical history • Videostroboscopy – Storz, Germany – Conducted by Phoniatrician • Acoustic Assessment – vowel [ α ] – Sampling frequency: 44100 Hz – 16 bits – Philips SBC ME 400, unidirectional (cardioid) – Room noise level <40 dB SPL – Distance: 10cm – Dr. Speech (Tiger, DRS, Inc.) • Statistics: – SPSS v 18.0.0 (SPSS Inc, Chicago, Illinois, EUA) – Descriptive statistics – Inferential statistics: Wilcoxon test 7introduction objectives methods results summary FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  8. 8. Methods 8introduction objectives methods results summary Major therapeutic goal Complete glottal closure, using the other intrinsic and extrinsic laryngeal muscles • If UVFP, the non-injured vocal fold compensation can be used • Wrong compensations must be avoided FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  9. 9. Results 9introduction objectives methods results summary n=38 % Unilateral paralysis - paramedian 19 50,0 Unilateral paralysis - intermediate 17 44,7 Unilateral palsy - paramedian 1 2,6 Bilateral palsy - paramedian 1 2,6 Videostroboscopy Mean SD 13,29 7,95 Number of sessions FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  10. 10. Results Acoustic Analysis 10introduction objectives methods results summary Parameter Pre-therapy Post-therapy F0 (Hz) 206,74±59,86 212,72±59,80 Jitter (%) 1,023±0,98 0,44±0,70 ** Shimmer (%) 6,73±5,91 3,11±3,11 ** NNE (dB) -5,64±4,63 -9,55±6,17 ** The values are the mean+ standard deviation; ** p < 0,05 comparingpre- and post-therapymoments throughWilcoxon test 202 204 206 208 210 212 214 0,00 0,20 0,40 0,60 0,80 1,00 1,20 0,00 2,00 4,00 6,00 8,00 -12,00 -10,00 -8,00 -6,00 -4,00 -2,00 0,00 FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  11. 11. Summary • SLP in VFP started early (1 month after the onset) is effective. • Due to SLP intervention,these patients didn’t need to undergo surgery. • The type of paralysis was variable – most of them with unilateral paralysis, in paramedian position. • The average number of sessions needed was 13.29 ± 7.95. 11introduction objectives methods results summary FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  12. 12. Summary • Differences in performance parameters of jitter, shimmer and NNE were significant (p <0.05) • Jitter (local), shimmer (local) and NNE were the best acoustic measurements to reveal the SLP efficiency. Consistent with those of Schindler et al (2008) and Cantarella et al (2010) 12introduction objectives methods results summary FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  13. 13. Future research • Increase the amount of subjects involved (> VFP types; > etiologies) • Correlate type of paralysis and efficiency • Isolate different therapeutical techniques facing different types of VFP 13introduction objectives methods results summary FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  14. 14. Considerations • If evidence based guidelines were created, the decision making process will be easier and faster • Investing in SLP will allow the institutions to attain economic advantage, avoiding surgeries (13 SLP sessions are cheaper than many surgeries and are not that invasive) • The patient must not need to wait so much time for a therapeutical decision – < impact of voice disorderon quality of life 14introduction objectives methods results summary FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN
  15. 15. • Sulica, L., Cultrara, A., e Blitzer, A. Vocal Fold Paralysis: Causes, Outcomes and Clinical Aspects. In: Sulica L, Blitzer A. Vocal fold paralysis. New York: Springer; 2006. p. 33-48. • Verdolini K, Rosen CA, Branski RC, Andrews ML, American Speech-Language-Hearing Association. Special Interest Division 3 V, Disorders V. Classification manual for voice disorders-I: Lawrence Erlbaum; 2005. • SchindlerA, BotteroA, Capaccio P, Ginocchio D, Adorni F, Ottaviani F. Vocal improvement aftervoice therapy in unilateral vocal fold paralysis. J Voice. 2008 Jan;22(1):113-8. • Cantarella G, Viglione S, Forti S, Pignataro L. Voice therapy for laryngeal hemiplegia: the role of timing of initiation of therapy. J Rehabil Med. 2010 May;42(5):442-6. 15 melopestana@gmail.com FP 45 – Pestana, Vaz-Freitas and Sousa - IALP 2013, TURIN

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