Utah Center for Vocology, The University of Utah, Salt Lake City.
School of Music, The University of Utah, Salt Lake City.
J Speech Lang Hear Res. 2024 Nov 7;67(11):4275-4287. doi: 10.1044/2024_JSLHR-22-00456. Epub 2024 Oct 22.
Semi-occluded vocal tract exercises (SOVTEs) are widely used as a therapeutic tool to create flow resistance in the upper airway. The current study was a randomized controlled clinical trial to establish the efficacy of two SOVTE protocols, flow-resistant tube (FRT) and Lessac-Madsen Resonant Voice Therapy (LMRVT). Exploratory investigations included a noninferiority analysis of FRT to the widely adopted therapy protocol (LMRVT), as well as examining the dosing required to improve acoustic measures and subjective ratings.
Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT ( = 14), 8-week FRT ( = 19), 4-week LMRVT ( = 15), 8-week LMRVT ( = 5), and control ( = 14). Voice Handicap Index (VHI) and Vocal Fatigue Index scores were collected pre- and posttreatment. Acoustic analysis using the Acoustic Voice Quality Index was completed. We compared VHI between controls and 8-week FRT and LMRVT, adjusting for pre-VHI using linear regression. We examined the efficacy of 4-week protocols relative to controls and conducted a noninferiority comparison of FRT (4 and 8 weeks) to LMRVT (4 and 8 weeks) using 5- and 10-point margins. Finally, we compared the 4- versus 8-week sessions for both therapies.
A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], = .046), but the 4-week LMRVT result was not statistically significant ( = .057). FRT was found to be noninferior to LMRVT in terms of VHI using a 10-point margin (FRT - LMRVT: 0.69, 95% CI [-5.76, 7.15], = .01), but not using a 5-point margin ( = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy.
Both FRT and LMRVT improved VHI scores relative to controls. FRT was noninferior to LMRVT in terms of VHI scores. There were no statistically significant differences in VHI scores between 4- and 8-week therapy sessions.
半封闭声道练习（SOVTEs）被广泛用作在上气道中产生流动阻力的治疗工具。本研究是一项随机对照临床试验，旨在确定两种 SOVTE 方案（限流管[FRT]和 Lessac-Madsen 共振语音治疗[LMRVT]）的疗效。探索性研究包括 FRT 与广泛采用的治疗方案（LMRVT）的非劣效性分析，以及检查改善声学测量和主观评分所需的剂量。
67 名患有语音障碍的参与者被随机分为五组之一：4 周 FRT（n=14）、8 周 FRT（n=19）、4 周 LMRVT（n=15）、8 周 LMRVT（n=5）和对照组（n=14）。在治疗前后收集嗓音障碍指数（VHI）和嗓音疲劳指数评分。使用声学语音质量指数完成声学分析。我们比较了对照组和 8 周 FRT 之间的 VHI，使用线性回归调整 VHI 前值。我们研究了 4 周方案相对于对照组的疗效，并使用 5 分和 10 分的差值比较了 FRT（4 周和 8 周）与 LMRVT（4 周和 8 周）的非劣效性。最后，我们比较了两种治疗方法的 4 周和 8 周治疗。
我们发现，8 周 FRT 与对照组相比（-10.60，95%置信区间[-19.80，-1.40]， =.025）和 8 周 LMRVT（-15.74，95%置信区间[-29.40，-2.08]， =.025），VHI 显著降低。我们还发现，4 周 FRT 与对照组相比（-10.11，95%置信区间[-20.03，-0.20]， =.046）也有所改善，但 4 周 LMRVT 的结果无统计学意义（ =.057）。使用 10 分差值，FRT 在 VHI 方面被发现不劣于 LMRVT（FRT-LMRVT：0.69，95%置信区间[-5.76，7.15]， =.01），但使用 5 分差值则不然（ =.054）。两种治疗方法的 4 周和 8 周治疗的 VHI 评分均无统计学差异。
FRT 和 LMRVT 均与对照组相比提高了 VHI 评分。FRT 在 VHI 评分方面不劣于 LMRVT。两种治疗方法的 4 周和 8 周治疗的 VHI 评分均无统计学差异。
