Intervention Review

Interventions for treating functional dysphonia in adults

  1. Jani H Ruotsalainen1,*,
  2. Jaana Sellman2,
  3. Laura Lehto3,
  4. Merja Jauhiainen4,
  5. Jos H Verbeek5

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 21 MAY 2007

DOI: 10.1002/14651858.CD006373.pub2

Database Title

Additional Information

How to Cite

Ruotsalainen JH, Sellman J, Lehto L, Jauhiainen M, Verbeek JH. Interventions for treating functional dysphonia in adults. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD006373. DOI: 10.1002/14651858.CD006373.pub2.

Author Information

  1. 1

    Finnish Institute of Occupational Health, Cochrane Occupational Health Field, Kuopio, Finland

  2. 2

    University of Helsinki, Department of Speech Sciences, Helsinki, Finland

  3. 3

    Helsinki University of Technology, Laboratory of Acoustics and Audio Signal Processing, HUT, Finland

  4. 4

    Finnish Institute of Occupational Health, Knowledge Transfer Team, Helsinki, Finland

  5. 5

    Cochrane Occupational Health Field, Finnish Institute of Occupational Health, Center of Expertise for Good Practices and Competence, Team of Knowledge Transfer in Occupational Health and Safety, Kuopio, Finland

*Jani H Ruotsalainen, Cochrane Occupational Health Field, Finnish Institute of Occupational Health, Neulaniementie 4, Kuopio, 70701, Finland. jani.ruotsalainen@ttl.fi.

Publication History

  1. Publication Status: Edited (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

Poor voice quality due to functional dysphonia can lead to a reduced quality of life. In occupations where voice use is substantial it can lead to a loss of employment.

Objectives

To evaluate the effectiveness of interventions to treat functional dysphonia in adults.

Search methods

We searched 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) and the Occupational Health databases OSH-ROM (to 2006). The date of the last search was 5th April 2006.

Selection criteria

Randomised controlled trials (RCTs) of interventions evaluating the effectiveness of treatments targeted at adults with functional dysphonia. 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 quality. Meta-analysis was performed where appropriate.

Main results

We identified six randomised controlled trials including a total of 163 participants in intervention groups and 141 controls. One trial was high quality. Interventions were grouped into 1) Direct voice therapy 2) Indirect voice therapy 3) Combination of direct and indirect voice therapy and 4) Other treatments: pharmacological treatment and vocal hygiene instructions given by phoniatrist.

No studies were found evaluating direct voice therapy on its own. One study did not show indirect voice therapy on its own to be effective when compared to no intervention. There is evidence from three studies for the effectiveness of a combination of direct and indirect voice therapy on self-reported vocal functioning (SMD -1.07; 95% CI -1.94 to -0.19), on observer-rated vocal functioning (WMD -13.00; 95% CI -17.92 to -8.08) and on instrumental assessment of vocal functioning (WMD -1.20; 95% CI -2.37 to -0.03) when compared to no intervention. The results of one study also show that the remedial effect remains significant for at least 14 weeks on self-reported vocal functioning (SMD -0.51; 95% CI -0.87 to -0.14) and on observer-rated vocal functioning (Buffalo Voice Profile) (WMD -0.80; 95% CI -1.14 to -0.46). There is also limited evidence from one study that the number of symptoms may remain lower for a year. The combined therapy with biofeedback was not shown to be more effective than combined therapy alone in one study nor was pharmacological treatment found to be more effective than vocal hygiene instructions given by phoniatrist in one study. Publication bias may have influenced the results.

Authors' conclusions

Evidence is available for the effectiveness of comprehensive voice therapy comprising both direct and indirect therapy elements. Effects are similar in patients and in teachers and student teachers screened for voice problems. Larger and methodologically better studies are needed with outcome measures that match treatment aims.

 

Plain language summary

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

Interventions for treating functional dysphonia in adults

Functional dysphonia is characterised by an abnormal quality of voice in the absence of an identifiable lesion. People in occupations where voice use is central, like teachers, are more at risk of developing functional dysphonia. The causes of voice disorders are still being debated. There is also no consensus on the best method of evaluating voice, although many consider auditory voice quality assessment as a gold standard measure. Because functional dysphonia is a non-organic voice disorder there is no indication for surgical or medical interventions, and it is treated with behavioural (i.e. voice) therapy. Voice therapy 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 whereas indirect techniques concentrate on contributory and maintenance aspects of the voice disorder (such as lack of knowledge).

We conducted a systematic search of the literature on treating functional dysphonia in adults. We then appraised the quality of the studies found and combined their results.

A combination of direct and indirect voice therapy is effective in improving vocal functioning when compared to no intervention. The achieved results may still be apparent after a year.

Most of the studies are small and of low methodological quality and further research is warranted.

 

摘要

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

背景

治療成人功能性音聲障礙的處置

因為功能性音聲障礙造成不良的聲音音質會破壞生活品質，且會讓在職業中需要大量用聲音的病人失去工作

目標

評估治療成人功能性音聲障礙的處置效果

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) and 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

評估治療成人功能性音聲障礙的效果之隨機對照試驗。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６個隨機對照試驗,共包含１６３位參與者在實驗組及１４１位在對照組,其中１個試驗的設計品質優良。處置的方法分組成(１)直接音聲治療(２)間接音聲治療(３)合併直接與間接音聲治療(４)其他治療方式：藥物治療及由語言治療師教導聲音保健法。沒有找到只單獨直接音聲治療的研究。其中一個研究比較單獨間接音聲治療與無治療,沒有顯示出其效果。３個研究比較合併直接／間接音聲治療與無治療,證據顯示有其治療效果,包括在聲音功能的自我感覺上(SMD −1.07; 95% CI −1.94 to −0.19)、觀察者評分上(WMD −13.00; 95% CI −17.92 to −8.08)、及儀器測量上(WMD −1.20; 95% CI −2.37 to −0.03)。1個研究的結果也顯示治療後的作用可明顯持續至少14周,包括在聲音功能的自我感覺上(SMD −0.51; 95% CI −0.87 to −0.14)及觀察者評分上(利用Buffalo Voice Profile) (WMD −0.80; 95% CI −1.14 to −0.46)。也有一個研究的有限證據指出治療後可持續一年的時間讓症狀數目較少。一個研究利用生物回饋法來做合併直接／間接音聲治療，發現並沒有比單獨合併直接／間接音聲治療有效; 另一個研究也顯示藥物治療沒有比語言治療師教導聲音保健法有效。發表文章中的誤差可能會影響這些結果

作者結論

全面性的音聲治療,包括直接與間接治療方式,證據顯示有其效果。其效果在有聲音問題的病人,教師,及學者教師中都是相似的。需要更多結果評量方式符合治療目標的大型及設計較好的研究

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

治療成人功能性音聲障礙的處置:異常的聲音品質卻找不到病變，是功能性音聲障礙的特色。需要大量用到聲音的職業,例如教師,是會發生功能性音聲障礙的高危險群，而音聲異常的原因仍是個受爭論的議題。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方法仍沒有共識。由於功能性音聲障礙是個非器質性的音聲異常,並不需要作手術及內科治療,而利用行為(即音聲)療法來治療。音聲治療通常合併直接及間接治療技巧。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治療成人功能性音聲障礙的文獻，評價研究的品質，並整合這些結果。證據顯示合併直接／間接音聲治療在改善聲音功能上，比無治療有效。這些得到的效果在一年後仍非常顯著。多數研究都屬小型且設計方法品質不良，所以須要更多研究來證明

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