Role of voice therapy in adherence to voice rest (King et al., 2021)

Purpose: Patients undergoing vocal fold procedures significantly reduce but often do not cease voice use during absolute postprocedure voice rest. We hypothesized that patients who completed preprocedure voice therapy would increase adherence to postprocedure voice rest.

Method: Eighty-six participants completed this prospective cohort study. Patients scheduled for office-based vocal fold procedures, 1–3 days of absolute postprocedure voice rest, and preprocedure speech-language pathology (SLP) care were recruited. SLP care consisted of either (a) multiple voice therapy sessions, (b) one counseling/therapy session, or (c) voice evaluation only. Participants reported talking and other specific voice behaviors on 100-mm visual analog scales for up to 3 days pre- and postprocedure as well as changes in overall voice use at follow-up at least 1 week postprocedure.

Results: Talking decreased postprocedure by 63% in the therapy group and 65% in the counseling group, both significantly more than the 35% decrease measured in the evaluation group. There were group differences in talking at baseline but not during voice rest. Coughing and throat clearing were highest in the voice evaluation group and decreased less than talking during voice rest. At follow-up, 84% of participants reported that they completed voice rest for at least as long as recommended and 39.5% reported that they never used their voices during voice rest. Participants estimated a 98% overall reduction in voice use during voice rest at follow-up.

Conclusions: Voice use before and after vocal fold procedures varies by participation in preprocedure voice therapy. Patients significantly decrease talking during postprocedure voice rest but are not perfectly adherent. Communicative voice use decreases more than noncommunicative voice use during voice rest. Patients may overestimate adherence to voice rest at follow-up.

Supplemental Material S1. Patient characteristics with significant pairwise group differences.

Supplemental Material S2. Employment-related characteristics of participants with paid employment (n = 54).

Supplemental Material S3. Mixed models for talking by measures of preprocedure dysphonia and dysphagia severity.

Supplemental Material S4. Spearman correlations (r_s) and p values between confounding variables.

Supplemental Material S5. Mixed models for talking with and without confounding variables.

Supplemental Material S6. Mixed models for whispering, coughing, and throat clearing before and during voice rest.

Supplemental Material S7. Mixed logistic models for singing, humming, and yelling before and during voice rest.

Supplemental Material S8. Effects of therapy group and voice rest on humming.

King, R. E., Dailey, S. H., & Thibeault, S. L. (2021). Role of voice therapy in adherence to voice rest after office-based vocal fold procedures. American Journal of Speech-Language Pathology. Advance online publication. https://doi.org/10.1044/2021_AJSLP-21-00082