Iris Meerschman

Purpose: Treating mild passive speech errors in adults with a structurally competent velopharyngeal mechanism is challenging. Task-specific interventions that mimic speech conditions may hold potential. This study investigated the effect of semi-occluded vocal tract (SOVT) exercises, namely, water resistance tube phonation with a ventilation mask, to improve speech and health-related quality of life (HRQoL) in adults with inconsistent velopharyngeal dysfunction (VPD) and mild passive speech errors due to cleft palate. Method: Two male adults (19 and 36 years old) with inconsistent VPD and mild passive speech errors participated in a single-case study to evaluate the effects of a sham intervention (SOVT with a ventilation mask without phonation) versus an active speech intervention (SOVT with a ventilation mask with phonation). The study consisted of five consecutive phases: (1) baseline, (2) sham, (3) withdrawal, (4) active intervention, and (5) maintenance. The active intervention was administered over 2 weeks (five sessions per week, 1 hr per session). Outcomes included (a) perceptual ratings of speech, (b) instrumental nasalance scores, and (c) patient-reported HRQoL. Results: Both participants demonstrated stable baselines across all speech and HRQoL measures during the pre-intervention and sham phases, indicating no effect of the sham intervention. Marked improvements were observed following the active intervention. In both cases, speech understandability and acceptability improved to within normal limits, and passive speech errors were reduced. Additionally, both participants reported clinically meaningful improvements in HRQoL, with sustained benefits observed at the 4-week follow-up. Conclusions: This study provides preliminary evidence that water resistance tube phonation with a ventilation mask is a promising, task-specific intervention for adults with cleft palate who present with inconsistent VPD and mild passive speech errors. Future studies should examine the efficacy of this intervention in larger, randomized controlled trials; explore the role of prior surgical history in treatment responsiveness; and assess long-term outcomes using direct aerodynamic measures.

Purpose: The purpose of this study was to examine the short‐ and longer‐term effects (3‐month follow‐up) of a 1‐month intensive straw phonation (SP) therapy on the voice quality and voice‐related quality of life of female speech‐language pathology (SLP) students with mild dysphonia. Method: Thirty‐two female SLP students (mean age: 18.5 years, range: 17.8–19.8 years) with mild dysphonia were included in this study. A randomized controlled trial was used with three experimental groups and a control group. The experimental groups received a short‐term intensive voice therapy of one month with SP in air ( n = 8), SP in 2 cm water ( n = 8) or SP in 5 cm water ( n = 8). The control group ( n = 8) received a comparable voice therapy by using [u] phonation with similar soft onset and slightly pursed lips as in SP but without a straw. Three maintenance sessions were provided via telepractice in the next month. A multidimensional voice assessment was performed immediately before therapy (pre), immediately after therapy (post 1) and at 1 month (after the maintenance therapy = post 2) and 3 months follow‐up (post 3) by an assessor blinded to the group assignment and study phase. Results: No significant time‐by‐group interactions were found for any of the outcome measures, indicating no significant differences in evolution over time among the four groups. Primary outcomes: Within‐group analyses showed a significant increase (improvement) in Dysphonia Severity Index (DSI) between post 1 and post 2 in the SP in 2 cm water group. Trends of improvement were visible in DSI between pre and post 1 in the SP in air group, and between pre/post 1 and post 2 in the SP in 5 cm water group. A clinically relevant decrease (improvement) in Acoustic Voice Quality Index (AVQI) was found between pre and post 1 in the SP in 2 cm water group. Secondary outcomes: Within‐group analyses further showed a significant increase in the SP in 2 cm water group in the highest intensity between pre and post 1/post 2, a significant decrease in the lowest frequency between pre and post 3, and a significant decrease in Vocal Fatigue Index between pre and post 1/post 2. The SP in the air group showed an increase in the highest frequency between pre and post 2. The SP in 5 cm water group showed improvements in the auditory‐perceptual parameters, roughness, and strain between pre and post 1. Conclusions: Positive effects were found for the three SP interventions. The most promising results were found for SP in 2 cm water, suggesting an optimal impedance match between the glottis and the vocal tract in this specific population of female SLP students with mild dysphonia. WHAT THIS PAPER ADDS: What is already known on the subject Straw phonation (SP) exercises have shown positive effective for patients with dysphonia. However, to date, there remains a lack of clarity regarding the training conditions generating the most optimal effects, emphasizing the need for further research. For example, there is still uncertainty about a potential additional benefit of submerging the straw in water, creating extra resistance to airflow and a potential massage‐like effect. To date, most studies investigated the immediate effects of SP. Consequently, there is limited evidence regarding whether a SP intervention results in a more economical and efficient voice production in the longer term. What this paper adds to existing knowledge The purpose of this study was to examine the short‐ and longer‐term effects (3 months follow-up) of a one‐month intensive SP intervention on the voice quality and voice‐related quality of life of female speech‐language pathology (SLP) students diagnosed with mild dysphonia, using a randomized controlled trial. The effects of SP in air, SP in 2cm water and SP in 5cm water were compared. Positive effects were found for the three SP interventions. However, the most promising results were found for SP in 2cm water, suggesting an optimal impedance match between the glottis and the vocal tract in this specific population. What are the potential or actual clinical implications of this work? In line with the current state of the art, an intervention using straw phonation (with stirring straws) demonstrated positive effects on the phonation of the investigated female SLP students with mild dysphonia. Among the three conditions tested, a stirring straw submerged 2 cm in water appeared to be the most effective for this population. Further research is needed to determine whether these findings extend to other voice users. The ultimate clinical goal of such efficacy studies is to refine and individualize the selection of SP types for specific populations in clinical practice. To achieve this, future large‐scale randomized controlled trials focusing on specific patient subgroups are warranted.

Background/Objectives: Pediatric obstructive sleep apnea (OSA) is a prevalent medical condition, affecting 1–5% of non-syndromic children and 30–90% of children with Down syndrome. Given the severity of the condition and the associated health risks, early and effective treatment is crucial. However, current treatment modalities are often invasive or suffer from poor patient adherence. Additionally, adenotonsillectomy, the first-line treatment in pediatric OSA, seems not to be effective in every child, leaving children with residual OSA postoperatively. These challenges are particularly pronounced in high-risk populations, such as children with Down syndrome, highlighting the need for alternative therapeutic strategies. Therefore, a protocol is presented to evaluate the effectiveness of orofacial myofunctional therapy (OMT) as a treatment for OSA in two pediatric populations: (1) Non-syndromic children aged 4–18 years: 10 weeks of OMT. (2) Children with Down syndrome aged 4–18 years: 20 weeks of OMT. Effects of the OMT program will be evaluated on: sleep parameters (e.g., obstructive Apnea–Hyponea Index (oAHI), snoring frequency); orofacial functions (e.g., breathing pattern, tongue position at rest); quality of life outcomes. Methods: A pretest–posttest design will be used to evaluate the effectiveness of OMT in both children with and without Down syndrome and OSA. Both objective measures and patient-reported outcomes are being collected. Results: OMT is expected to improve orofacial functions, reduce OSA severity and symptoms, and enhance quality of life in both non-syndromic and syndromic children. Conclusions: This multidisciplinary research protocol, involving collaboration between ENT specialists and speech-language pathologists, aims to provide a comprehensive understanding of the potential benefits of OMT in treating OSA.

Purpose: The aim was to determine and compare the short-term effects of two intensive semi-occluded vocal tract (SOVT) programs, “straw phonation” (SP) and “resonant voice therapy” (RVT), on the phonation of children with vocal fold nodules. Method: A pretest–posttest randomized controlled study design was used. Thirty children aged 6–12 years were randomly assigned to the SP group ( n = 11), RVT group ( n = 11), or control group receiving indirect treatment ( n = 8) for their voice problems. All participants received 11 hr of group voice therapy over four consecutive days. A multidimensional voice assessment consisting of both objective (dysphonia severity index and acoustic voice quality index) and subjective (pediatric voice handicap index and perceptual rating of overall severity) measures was performed pre- and posttherapy. Voice therapy effectiveness was evaluated using group-level analyses (linear mixed models) and individual-level analyses to investigate what proportion of participants changed to a clinically relevant degree. Results: Group-level analyses found no significant Time × Group interactions, indicating that the evolution over time did not differ among the three groups. Within-group effects of time showed a significant and equal improvement in dysphonia severity index in the SP and RVT groups and a significant improvement in perceptual rating of overall severity in the SP group. For dysphonia severity index, individual-level analyses showed that 36% and 45% of participants improved to a clinically relevant degree in the SP and RVT groups, respectively. For acoustic voice quality index, 38% improved to a clinically relevant degree in the SP group. Conclusions: Results suggest that short-term intensive SOVT programs may have a positive effect on voice quality and vocal capacities of children with vocal fold nodules. Participants seem to benefit more from a SP program than a RVT program.

Background: Although psychological factors have been implicated in patients with functional dysphonia (FD), conventional voice therapy (CVT) typically targets the aberrant voice symptoms exclusively. Yet, CVT is not always successful, and in view of the significant adverse quality of life impact combined with the financial burden on the healthcare system and society, research is needed to elucidate the underlying psychophysiology of FD and improve treatment outcomes.Objectives: The first objective of this research project is to compare the occurrence and frequency of symptoms and/or disorders related to autonomic nervous system (ANS) dysfunction in patients with FD with gender‐ and age‐matched vocally healthy controls, using a case‐control study. The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (i.e., ANS therapy: heart rate variability (HRV) biofeedback) on both autonomic function and voice function versus CVT alone or in combination with ANS therapy (i.e., ANS therapy + CVT), using a randomized controlled trial (RCT).Methods: Case‐control study: Autonomic (dys)function of patients with FD will be compared with gender‐ and age‐matched vocally healthy controls, using both physiological measures (e.g., HRV, skin conductance level) and psychological patient‐reported outcome measures (PROMs, e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). RCT: The FD group will be randomly assigned to the innovative ANS therapy group, the CVT group or the ANS therapy + CVT group. All patients received 1 month of treatment with 20 min of daily practice. Both the autonomic assessment and the voice assessment will be performed pretherapy and immediately after therapy by assessors blinded to group allocation and study phase.Expected results: Higher occurrences of symptoms and/or disorders related to autonomic dysfunction are expected in patients with FD compared with vocally healthy controls. Physiological outcomes: lower HRV, lower cardiac pre‐ejection period, higher respiration rate and higher skin conductance level are hypothesized in patients with FD compared with vocally healthy controls. Psychological PROMs: higher self‐report of feelings/symptoms related to autonomic dysfunction (e.g., perceived stress, anxiety) is expected in patients with FD compared with vocally healthy controls. The autonomic function is hypothesized to improve more after the ANS therapy and the ANS therapy + CVT compared with the CVT only. Voice function is expected to improve more after the ANS therapy + CVT compared with the ANS therapy and the CVT alone.WHAT THIS PAPER ADDS: What is already known on the subject: Autonomic dysfunction is well recognized in the field of psychology but remains understudied in the area of voice. Given that the vagus nerve, innervating the larynx, also helps to regulate the ANS, and psychological symptoms commonly observed in patients with FD may reflect ANS dysregulation, research in this area is needed. There is some preliminary evidence that autonomic dysfunction might indeed be associated with FD. However, physiological ANS measures are needed, as well as validated psychological PROMs. What this paper adds to the existing knowledge: The first objective of this study is to investigate the occurrence and frequency of symptoms and/or disorders related to autonomic dysfunction in patients with FD as compared with a gender‐ and age‐matched vocally healthy control group. Autonomic (dys)function will be determined by employing both physiological measures (e.g., HRV, skin conductance level) and psychological PROMs (e.g., Neuroception of Psychological Safety Scale, Depression Anxiety and Stress Scale). The second objective is to compare the effects of a novel therapy for FD based on ANS regulation (HRV biofeedback) versus CVT alone or in combination with ANS therapy. What are the potential or actual clinical implications of this work?: Success rates of symptomatic CVT for FD are highly variable. This study is expected to lead to innovative results related to the pathogenesis and psychophysiology of FD, a prevalent voice disorder associated with a significant adverse quality of life impact and a substantial financial burden on the healthcare system and society. The results of this study will lead to crucial new insights into both the diagnosis and treatment of FD, contributing to evidence‐based practice in the field of voice.