Fernando Pessoa College of Health, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal.
Faculty of Health Sciences, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal.
Eur Arch Otorhinolaryngol. 2020 Nov;277(11):2951-2966. doi: 10.1007/s00405-020-06059-8. Epub 2020 May 22.
BACKGROUND/OBJECTIVE: An adult with vocal fold nodules can suffer from hoarseness, breathiness and vocal fatigue, which, in turn, significantly affects their vocal participation as well as activities. A well-designed voice therapy program improves the quality of life and vocal functionality. This is a narrative review with a systematic search of the current literature about the effectiveness of voice therapy interventions in adults with vocal fold nodules.
Several key terms were used for the database electronic search of articles. Strict inclusion criteria were used and a broad evaluation of the studies was performed. This included the level of evidence based on the National Health and Medical Research Council levels of evidence, assessment, and critical appraisal.
Nine out of 30 reviewed articles met the criteria of inclusion and reported positive effects of voice therapy intervention on adult patients with vocal fold nodules. The vast majority of the reviewed studies reported multidimensional voice measures outcome data, most of them containing visual-perceptual, auditory-perceptual, acoustic and self-assessment results. Regardless of receiving direct or indirect or a combination of both voice therapy contents, nearly all voice quality parameters were found to improve after treatment. Short-term treatment (< 3 weeks) may be as beneficial as longer traditional voice therapy programs, and using telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy. The study design and the evidence levels of the included studies were low (≤ III-2) and the risk of bias of the comparative studies was moderate.
This narrative review cannot conclude the general effectiveness of voice therapy programs. Further research and understanding of what specific parameters (exercise and techniques) of a therapy's content will improve voice outcome measures. More studies are required to investigate whether or not voice therapy benefits are sustainable 6 months after ending the therapy. However, improved evidence is required to suggest that short period treatments are as beneficial as traditional therapy programs. Telepractice voice therapy may be an achievable and practical way of delivering treatment and enhance adherence to therapy.
背景/目的：患有声带小结的成年人可能会出现声音嘶哑、气息声和发声疲劳，这反过来又会显著影响他们的发声参与和活动。精心设计的语音治疗方案可以提高生活质量和语音功能。这是一篇叙述性综述，对当前关于声带小结成人患者语音治疗干预效果的文献进行了系统搜索。
使用几个关键术语对文章进行数据库电子搜索。严格使用纳入标准对研究进行广泛评估。这包括基于澳大利亚国家卫生与医疗研究委员会证据水平、评估和批判性评价的证据水平。
在 30 篇综述文章中，有 9 篇符合纳入标准，并报告了语音治疗干预对声带小结成年患者的积极效果。绝大多数综述研究报告了多维语音测量结果数据，其中大多数包含了视觉感知、听觉感知、声学和自我评估结果。无论接受直接、间接或两者结合的语音治疗内容，治疗后几乎所有的语音质量参数都有所改善。短期治疗（<3 周）可能与传统的语音治疗方案一样有益，而使用远程实践语音治疗可能是一种可行且实用的治疗方式，可以提高治疗的依从性。纳入研究的研究设计和证据水平较低（≤ III-2），且比较研究的偏倚风险为中度。
本叙述性综述不能得出一般语音治疗方案的有效性结论。进一步的研究和理解治疗内容中哪些特定参数（练习和技术）将改善语音预后指标。需要更多的研究来调查语音治疗的益处是否在治疗结束后 6 个月仍然可持续。然而，需要提供更多的证据来表明短期治疗与传统治疗方案一样有益。远程实践语音治疗可能是一种可行且实用的治疗方式，可以提高治疗的依从性。
