Comparative Study of Two Semi-Occluded Vocal Tract Protocols: A Randomized Clinical Trial.

Introduction: 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 R...

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Published in:Journal of Speech, Language & Hearing Research Vol. 67; no. 11; pp. 4275 - 4288
Main Authors: Heller-Stark, Amanda, Maxfield, Lynn, Herrick, Jennifer, Smith, Marshall, Titze, Ingo
Format: Article
Published: American Speech-Language-Hearing Association Nov2024
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      dt: Nov2024
      vid: 67
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      pub: American Speech-Language-Hearing Association
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        10.1044/2024_JSLHR-22-00456
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        atl: Comparative Study of Two Semi-Occluded Vocal Tract Protocols: A Randomized Clinical Trial.
      aug:
        au:
          Heller-Stark, Amanda
          Maxfield, Lynn
          Herrick, Jennifer
          Smith, Marshall
          Titze, Ingo
        affil:
          Utah Center for Vocology, The University of Utah, Salt Lake City
          School of Music, The University of Utah, Salt Lake City
          Study Design and Biostatistics Center for Clinical and Translational Science, The University of Utah, Salt Lake City
          Department of Surgery, The University of Utah, Salt Lake City
      su:
        Self-evaluation
        Randomized controlled trials
        Medical protocols
        T-test (Statistics)
        Research funding
        Statistical sampling
        Multiple regression analysis
        Questionnaires
        Treatment effectiveness
        Descriptive statistics
        Analysis of covariance
        Chi-squared test
        Voice disorder treatment
        Physiological aspects of speech
        Statistics
        Comparative studies
        Confidence intervals
        Data analysis software
        Quality assurance
      sug:
        subj:
          Self-evaluation
          Randomized controlled trials
          Marketing Research and Public Opinion Polling
          Medical protocols
          T-test (Statistics)
          Research funding
          Statistical sampling
          Multiple regression analysis
          Questionnaires
          Treatment effectiveness
          Descriptive statistics
          Analysis of covariance
          Chi-squared test
          Voice disorder treatment
          Physiological aspects of speech
          Statistics
          Comparative studies
          Confidence intervals
          Data analysis software
          Quality assurance
      ab: Introduction: 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. Method: Sixty-seven participants with voice disorder were randomized into one of five groups: 4-week FRT (n = 14), 8-week FRT (n = 19), 4-week LMRVT (n = 15), 8-week LMRVT (n = 5), and control (n = 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. Results: A statistically significant reduction of VHI in both 8-week FRT relative to controls (-10.60, 95% CI [-19.80, -1.40], p = .025) and 8-week LMRVT (-15.74, 95% CI [-29.40, -2.08], p = .025) was found. We also found an improvement in 4-week FRT relative to controls (-10.11, 95% CI [-20.03, -0.20], p = .046), but the 4-week LMRVT result was not statistically significant (p = .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], p = .01), but not using a 5-point margin (p = .054). There were no statistically significant differences in VHI scores between 4- and 8-week sessions for either therapy. Conclusions: 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.
      pubtype: Academic Journal
      doctype: Article
      src: R
    language: English
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