1. Can Voice therapy lead to optimal vocal fold physiology in cases with vocal nodules?
Namita Joshi*, Gauri Belsare**, Jayashree Jagtap***
*Associate professor,
BVDU’s Medical College
School of Audiology & Speech Language Pathology
Pune

2. Effect of Vocal Nodules on vocal fold physiology
Incomplete closure (hour glass pattern)
Absent (at site) or Irregular vocal fold vibration
Mucosal wave is absent at site
Symmetrical vocal fold vibration except at site
Hoarse voice
Diplophonia in cases with ventricular fold hypertrophy
Colton & Casper(2000)

3. Goals in Voice therapy
Optimal vocal fold physiology is the ultimate goal.
Physiological voice therapy-widely accepted approach
Reduction in Nodule size is secondary
Vocal hygiene program
Resonant voice therapy
(Boone, 1995, Stemple, 2001, Verdolini et al 2001,Chen et al 2007)
Effect of voice therapy in Indian scenario not much explored.
(Boominathan 2003, Savithri & Rajsudhakar 2005, 2010)

4. Aim
To explore the effect of Voice therapy on vocal fold vibration in clients with vocal nodules.
Objectives
To study the effect of voice therapy on closure of vocal folds in clients with vocal nodules.
To study the effect of voice therapy on mucosal wave of the vocal folds in clients with vocal nodules.
The study the effect of voice therapy on quality of voice of clients with vocal nodules.
Null Hypotheses
There will be no effect of voice therapy on closure of vocal folds of clients with vocal nodules.
There will be no effect of voice therapy on mucosal wave of the vocal folds of clients with vocal nodules.
There will be no effect of voice therapy on voice quality of clients with vocal nodules.

5. Method . (H/0 vocal abuse since at least six months)
Females between years of age
Pre post design
Three clients diagnosed with vocal nodules
minimum of 6 sessions
Followed structured voice therapy programme
Stoboscopy evaluation &
MDVP evaluation
GRBAS
prescribed same dosage of anti-inflammatory medicines
Clients were evaluated by same professionals
On visual analog scale
Post therapy evaluations
Voice evaluations done at regular intervals .

6. Voice therapy Hydration vocal function exercises
Resonant voice therapy
Dietary modification
Environmental modifications
Sessions were of 30 mins each thrice a week.

7. Results Objective 1: To study the effect of voice therapy on closure of vocal folds in clients with vocal nodules.
Pre therapy
Post therapy
Client 1
Client 2
Client 3
Inter rater reliablity r=0.6 ( Rating done by two SLPs and one ENT)

8. Results Objective 2: To study the effect of voice therapy on mucosal wave of vocal folds in clients with vocal nodules SN
Category
Client 1
Pre Post
Client 2
Pre Post
Client 3
Pre Post 1
Closure
Hourglass
Complete
Post chink 2
Mucosal wave
+ on right
Reduced on left
+ on both VF
-ve at site
+ both, full length VF
-ve at site
+ ve complete VF 3
Symmetry
-ve on left + 4
Periodicity
-ve on Left 5
False cords
hypertrophy
Reduced
Normal
Pre therapy video – post therapy video
(Inter rater reliability r=0.6)
kruscal Wallis test was done, significant difference was found only for Mucosal wave pattern and Closure pattern(p˂0.05)

9. Results Objective 3: To study the effect of voice therapy on quality of voice in clients with vocal nodules
Client 1
Client 2
Client 3

10. Results Objective 3: To study the effect of voice therapy on quality of voice in clients with vocal nodules
Category
Client 1
Client 2
Client 3
Pre
Post
Grade overall 2 1 3
Roughness
Breathiness
Asthenic
Strain
(Inter rater reliability r=0.6)
Significant positive correlation (r= 0.7 , (p˂0.05) was found between closure pattern and overall grade of voice quality

11. Conclusion Null hypotheses are rejected.
There was a significant effect of voice therapy in achieving optimal vocal fold vibration, in terms of improving vocal fold closure, mucosal wave pattern, and improving quality of voice.
Voice therapy should be recommended irrespective of the size of the nodule prior & post to surgery.
Efficacy of voice therapy in larger sample should be explored.

12. References
Verdolini-K,M; M.K. Burke, Lessac, A; Glaze E; Caldwell E; (1995); ‘Preliminary study of two methods of treatment for laryngeal nodules; Journal of Voice, Volume 9, Issue 1, March, Pages 74-85
Sheng Hwa Chen, Tzu-Yu Hsiao, Li-Chun Hsiao, Yu-Mei Chung, Shu-Chiung Chiang (2007); “Outcome of Resonant Voice Therapy for Female Teachers With Voice Disorders: Perceptual, Physiological, Acoustic, Aerodynamic, and Functional Measurements.Journal of Voice, Volume 21, Issue 4, Pages
Stemple J.C; (2001) “ Principles of Voice therapy” Plural Publishing ltd.
Rajsudhakar & Savithri (2010), “ Vocal load in teachers’, JISHA, vol 30.

13. THANK YOU