Effectiveness of voice therapy in patients with vocal fold nodules: a systematic search and narrative review
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REVIEW ARTICLE
Effectiveness of voice therapy in patients with vocal fold nodules: a systematic search and narrative review Rita Alegria1 · Susana Vaz Freitas2,3,4 · Maria Conceição Manso5,6,7 Received: 7 April 2020 / Accepted: 13 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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. Methods 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. Results 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 ( 19 years [4]. In treatment-seeking populations with dysphonia, Houtte et al. [5] reported a prevalence of 9.5% of VFNs, in a Belgian population of aged 15 years and older, whereas Coyle et al. [6] reported a prevalence of 8.2%, in a population in southwestern Ohio, USA, for the same age range. Women and type of occupation appear to be risk factors in the development of vocal fold lesions due to voice overuse, misuse or abuse that traumatizes the vocal fold tissue [5–7]. Potentially, women are at a higher risk of developing nodules because they have less amount of hyaluronic acid (HA), in their superficial layer of the lamina propria of the vocal cords, when compared with men (3:1 male:female). HA levels affect the vocal fold tissue hydration, viscosity, and thickness which influence the biomechanics of voice production and voice quality. Less HA may suggest reduced protection from vibratory trauma and overuse [8]. Another factor differentiating gender is that women have higher pitch (frequency) voices, which in theory, may result in an increase repetitive vocal fold collision and therefore, phonotrauma [9]. According to Vilkman et al. [10], some professions are considered to be at risk of developing vocal fold nodules, namely those that involve teaching activities for large groups of students and workplaces with high environmental noise (e.g. teacher). Similarly, Jones et al. [11],
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