Content area
Full text
Editorial by Carding
Introduction
Many patients have transient, self limiting changes in voice, but those who have been hoarse for more than three weeks need specialist assessment to exclude underlying laryngopharyngeal pathology. Once conditions that need surgery have been excluded, patients are usually referred to a speech and language therapist for voice therapy. Up to 40 000 patients with dysphonia are referred for voice therapy annually in the United Kingdom. 1 At the time of referral, many patients with vocal dysfunction have entered a vicious cycle in which psychological factors exacerbate voice pathology and poor voice quality adversely affects psychological wellbeing. 2-9 The relation between these factors is complex, and the relative influence of each factor varies from individual to individual.
No study has yet examined the overall effectiveness of voice therapy for dysphonia in terms of either changes in voice quality or changes in psychological distress or laryngoscopic findings. We aimed to examine the efficacy of voice therapy in patients with dysphonia and to identify those patients for whom voice therapy might be most beneficial.
Participants and methods
We recruited consecutive outpatients attending the department of otorhinolaryngology and head and neck surgery of Glasgow Royal Infirmary with a primary complaint of dysphonia (hoarseness) present for a minimum of two months and without any relevant organic pathology (for example, polyp, papilloma, tumour, vocal cord palsy) or need for surgery.
The inclusion criteria were age greater than 16 years, motivation to resolve the voice problem, and willingness to enter into regular voice therapy sessions. The exclusion criteria were previously treated dysphonia, neurological disease, or upper aerodigestive tract malignancy; marked hearing impairment; acid reflux; multiple medical complaints; professional voice user requiring urgent intervention; puberphonia; and transsexual conflict.
The 204 patients (51 men, 153 women) who gave informed consent for inclusion were new referrals typical of patients referred for voice therapy. At entry to the study, 100 patients were randomised to voice therapy and 104 to no treatment. By completion of the study 12-14 weeks later, about a third of participants had dropped out or been excluded, leaving 70 patients in the treatment group and 63 patients in the observation group (figure). This attrition was mostly a result of patients defaulting. In addition to failure to reattend, some...