The Efficacy of Different Voice Treatments for Vocal Fold Polyps: A Systematic Review and Meta-Analysis
Journal of Clinical Medicine
Barsties V Latoszek, B., Watts, C. R., et al. (2023).
Journal of Clinical Medicine, 12(10), 3451.
This systematic review and meta-analysis investigates the effects of phonosurgery, behavioral voice therapy, and combine treatments in individuals with vocal polyps.
No funding received
From database inception to October 26, 2022
Intervention studies with pre- and post-test measures
31
<div>For individuals with vocal polyps, behavioral voice treatment (VT), phonosurgery, and combined treatments (CT) (i.e., phonosurgery followed by behavioral voice therapy) were highly effective in improving almost all voice parameters. However, phonosurgery and CT resulted in improved outcomes when compared to VT in isolation. Specific auditory perceptual and acoustic findings were as follows:</div>
<ul>
<li><span style="color: #333333;"><strong>Grade of dysphonia</strong>: CT resulted in the greatest improvements for grade of dysphonia at 1-2 weeks follow-up (ES = -1.64) when compared to phonosurgery or VT. </span></li>
<li><span style="color: #333333;"><strong>Roughness</strong>: Phonosurgery was associated with the greatest improvements in roughness (MD = -1.89) versus CT (MD = -1.04). VT (MD = -0.52) had no significant impact on roughness. </span></li>
<li><span style="color: #333333;"><strong>Breathiness</strong>: Phonosurgery (MD = -1.08) and CT (MD = -1.06) were equally as effective in reducing breathiness, while VT (MD = -0.22) had a small, but significant effect. </span></li>
<li><span style="color: #333333;"><strong>Jitter</strong>: CT (MD = 1.46%) demonstrated greater improvements in jitter versus phonosurgery (MD = 1.27%) or VT (MD = - 0.49%). </span></li>
<li><span style="color: #333333;"><strong>Shimmer</strong>: CT (MD = -3.18%) demonstrated greater improvements in shimmer versus phonosurgery (MD = -2.30%) or VT (MD = -1.49%).</span></li>
<li><span style="color: #333333;"><strong>Noise to harmonics ratio (NHR)</strong>: Phonosurgery (MD = -0.09 dB) demonstrated the greatest improvements in NHR when compared to VT (MD = -0.07 dB), and CT (MD = -0.08 dB).</span></li>
<li><span style="color: #333333;"><strong> Maximum Phonation Time (MPT)</strong>: CT (MD = 4.07 seconds) demonstrated the greatest impact on MPT versus phonosurgery (MD = 3.26 seconds) or VT (MD = 2.56 seconds). </span></li>
</ul>
<div><span style="color: #333333;">At 3+ month follow-up, the mean gains in auditory perceptual judgements were largest for phonosurgery (jitter MD= -2.166%, NHR MD= -0.339, shimmer MD= -2.646%).</span></div>
<div>VT, phonosurgery, and CT had the following effects on Voice Handicap Index (VHI) scores in adults with vocal polyps:</div>
<ul>
<li><strong><span style="color: #333333;">Voice Handicap Index 30 (VHI-30) Total:</span></strong><span style="color: #333333;"> Equal outcomes were noted for phonosurgery (MD = -22.75) and CT (MD = -22.90). VT had no significant effect on VHI total score (MD= -18.89).</span></li>
<li><span style="color: #333333;"><strong>VHI Emotional and Functional subscales</strong>: The greatest gains for the emotional (E) and functional (F) subscales were seen for phonosurgery (E MD = -7.07; F MD = -7.44) versus VT (E MD = </span><span style="color: #333333;">-3.09; F MD= -2.73) and CT (E MD = -6.24; F MD = -5.24).</span></li>
<li><span style="color: #333333;"><strong>VHI Physical subscale: </strong>CT (P MD = -12.20) demonstrated the greatest gains for the physical (P) subscale when compared to phonosurgery (P MD = -10.46) or VT (P MD = -5.022).</span></li>
<li><span style="color: #333333;"><strong>At 1-2 month follow-up: </strong>Mean gains in VHI scores were largest for phonosurgery (E subscale MD = -11.11; F subscale MD = -11.88; P subscale = -17.37; Total score = -35.67).</span></li>
</ul>
