Intervention Review

Interventions for preventing voice disorders in adults

  1. Jani H Ruotsalainen1,*,
  2. Jaana Sellman2,
  3. Laura Lehto3,
  4. Leena K Isotalo4,
  5. Jos H Verbeek1

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 18 MAR 2010

DOI: 10.1002/14651858.CD006372.pub2

Database Title

Additional Information

How to Cite

Ruotsalainen JH, Sellman J, Lehto L, Isotalo LK, Verbeek JH. Interventions for preventing voice disorders in adults. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006372. DOI: 10.1002/14651858.CD006372.pub2.

Author Information

  1. 1

    Finnish Institute of Occupational Health, Cochrane Occupational Health Field, Team of Knowledge Transfer in Occupational Health and Safety, Kuopio, Finland

  2. 2

    Motivoice Ltd, Espoo, Finland

  3. 3

    Helsinki Central Hospital, Phoniatrics Department, ENT Clinic, Helsinki, Finland

  4. 4

    Finnish Institute of Occupational Health, Helsinki, Finland

*Jani H Ruotsalainen, Cochrane Occupational Health Field, Team of Knowledge Transfer in Occupational Health and Safety, Finnish Institute of Occupational Health, PO Box 310 (Neulaniementie 4), Kuopio, 70101, Finland. jani.ruotsalainen@ttl.fi.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2007.

Poor voice quality due to a voice disorder can lead to a reduced quality of life. In occupations where voice use is substantial it can lead to periods of absence from work.

Objectives

To evaluate the effectiveness of interventions to prevent voice disorders in adults.

Search methods

We searched databases including CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO and OSH Update to March 2010.

Selection criteria

Randomised controlled clinical trials (RCTs) evaluating interventions for preventing voice disorders in adults. For work-directed interventions, interrupted time-series and prospective cohort studies were also eligible.

Data collection and analysis

Two authors independently extracted data and assessed trial risk of bias. We performed meta-analysis where appropriate.

Main results

We identified six randomised controlled trials including a total of 262 participants. Four studies were conducted with primary school or kindergarten teachers, one with student teachers and one with telemarketers.

Three studies found similar self-reported vocal symptoms between those who attended direct voice training and those who were in a no intervention control group (standardised mean difference (SMD) 0.27; 95% CI -0.12 to 0.66).

Two studies found similar self-reported vocal symptoms between those who attended indirect voice training and those who were in a no intervention control group (SMD 0.44; 95% CI -0.03 to 0.92).

One study found similar scores on the Voice Handicap Index for those who had direct and indirect voice training combined and for those who had no intervention. Two studies compared a combination of direct and indirect voice training with indirect voice training only. Both studies found similar scores for self-reported phonation difficulty (mean difference -5.55; 95% CI -23.75 to 12.66) in both groups.

The evidence for all comparisons was rated as low quality.

No work-directed studies were found. No studies evaluated the effectiveness of prevention in terms of sick leave or number of diagnosed voice disorders.

Authors' conclusions

We found no evidence that either direct or indirect voice training or the two combined are effective in improving self-reported vocal functioning when compared to no intervention. The current practice of giving training to at-risk populations for preventing the development of voice disorders is therefore not supported by definitive evidence of effectiveness. Larger and methodologically better trials are needed with outcome measures that better reflect the aims of interventions.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Interventions for preventing voice disorders in adults

People in occupations where voice use is central, such as teachers, are more at risk of developing voice disorders. The definition of voice disorders and their possible causes as well as the best methods for preventing them are still being debated. There is also no consensus on the best method of evaluating the voice, although many consider auditory voice quality assessment (where an expert judge listens to a recording of a participant's voice and makes his or her own judgment of its level of abnormality) as a gold standard measure. Voice training is used to prevent voice disorders. Voice training usually consists of a combination of 'direct' and 'indirect' treatment techniques. Direct techniques focus on the underlying physiological changes needed to improve an individual's technique in using the vocal system and may aim to alter vocal fold closure (adduction), respiratory patterns or resonance, pitch or articulatory tension. In practice this means training about how to achieve correct posture, breathing techniques and making various sounds like humming, singing musical scales or yawning. Indirect techniques, on the other hand, concentrate on contributory and maintenance aspects of the voice disorder and may involve relaxation strategies, counselling, explanation of the normal anatomy and physiology of the vocal tract, explanation of the causal factors of voice disorders and voice care and conservation.

We conducted a systematic search of the literature on preventing voice disorders in adults. We then appraised the quality of the studies found and combined their results. We found six studies which met our inclusion criteria. Four were conducted with teachers, one with student teachers and one with telemarketers.

We found no evidence that either direct or indirect voice training nor the two combined are effective in improving vocal functioning when measured using self-reported outcomes and when compared to no intervention.

All the included studies were small and of low methodological quality. Given the extent of the problem and the widespread use of voice training, further research is warranted.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

預防成人音聲異常的處理

因為音聲異常造成不良的聲音品質會破壞生活品質，且會讓在職業中需要大量用聲音的病人停止一段時間的工作

目標

預防成人音聲異常的處理之效果評估

搜尋策略

搜尋MEDLINE (PubMed, 1950 to 2006), EMBASE (1974 to 2006), CENTRAL (The Cochrane Library, Issue 2 2006), CINAHL (1983 to 2006), PsychINFO (1967 to 2006), Science Citation Index (1986 to 2006)及the Occupational Health databases OSHROM (to 2006)。最後搜尋日期為2006年4月5日

選擇標準

評估預防成人音聲異常的治療效果之隨機對照臨床試驗。對於行為指導方法的間斷時間序列研究及前瞻性群體研究也在收集標準內

資料收集與分析

兩位作者各自摘選資料並評估實驗等級，適當的資料做整合分析

主要結論

找到兩個隨機對照試驗，共包括53位參與者在實驗組，43位在對照組。一個研究由教師帶領，而另一個由學生教師帶領。兩個試驗皆設計品質不良。治療處置的分組為(1)直接音聲訓練(2)間接音聲訓練(3)合併直接與間接音聲訓練。 (1)直接音聲訓練:一個研究比較直接音聲訓練與無處置，並沒有顯示可明顯減少音聲障礙指數。 (2)間接音聲訓練:一個研究比較間接音聲訓練與無處置，沒有顯示可明顯減少音聲障礙指數。 (3)合併直接與間接音聲訓練:一個研究比較合併直接與間接音聲訓練與無處置，沒有顯示可減少音聲障礙指數。但此研究發現此種訓練與無處置比較下，可增加最長發音時間(平均 −3.18秒; 95 % CI −4.43 to −1.93)。 沒有找到關於行為指導的研究。關於處置可防止請病假的效果及診斷為音聲異常的次數上，也沒有找到評估這方面的研究

作者結論

證據顯示不論是直接、間接、或合併直接與間接音聲訓練與無處理相比，皆不能有效改善音聲功能的自我感覺。目前沒有明確的證據來支持“給予高危險族群音聲訓練以預防發生音聲異常”這個行為是有效果的。需要一些結果評量方式可反映出處置目的大型及設計較好的試驗

翻譯人

本摘要由國泰綜合醫院方德詠翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

需要大量用到聲音的工作，例如教師，是發生音聲異常的高危險群。音聲異常的定義、其可能原因、及最佳的預防方法等，仍是些爭論的議題。雖然許多人認為所聽到的音質評估是評量的黃金標準，但對於最佳的音聲評估法仍沒有共識。音聲訓練用來治療及間接預防音聲異常，其通常合併直接及間接的治療技巧。直接的技巧著重在病患利用其根本生理上的改變來使本身運用發聲系統的技巧改進；而間接的技巧注重在音聲異常的原因及保養方面(例如缺乏相關知識)。我們系統性搜尋關於預防成人音聲異常的文獻，評價研究的品質，並整合這些結果，找到兩個符合我們收集標準的研究，一個由教師領導，另一個由學生教師領導。證據顯示不論是直接、間接音聲治療、或合併這兩種治療，與無治療比較後，皆不能有效改善音聲功能。兩個研究都屬小型且設計方法品質不良。須要更多研究證明這疾病的相關問題及是否需要廣泛運用音聲訓練

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