Efficacy of a behaviorally based voice therapy protocol for vocal nodules

The aim of this study was to assess the effects on vocal function of voice therapy for vocal nodules. Perceptual and physiological progressive changes were examined during a strictly structured, behaviorally based voice thera py protocol in which I I women with vocal nodules participated. Randomized audio recordings from pretherapy and from each of the therapy approaches (v ocal hygiene, respiration, direct facilitation, carryover) were used for pe rceptual evaluations. Six speech-language pathologists rated ten voice qual ity parameters. Two evaluation procedures were performed and compared. Inte r-listener reliability was sufficiently high in both tests. Significant eff ects of therapy were found for decreased overall dysphonia, press, instabil ity, gratings, roughness, vocal fry, and "scrape." Nonsignificant group eff ects were found for breathiness, aphonic instances, and lack of sonority. N o significant parameter changes occurred between baseline assessment and th e completion of the initial (vocal hygiene) phase of therapy. Significant c hanges were found following the direct facilitation and respiration phases of therapy. Video stroboscopic evaluations made by two laryngologists showe d that in no case were the nodules completely resolved. However, the nodule s had decreased in size and edema was reduced after therapy for all clients , but one. Combined results suggest: (1) Alterations in vocal function were reflected in perceptual parameters, and (2) the voice therapy had a positi ve effect on voice quality, vocal status, and vocal function for the majori ty of the vocal nodule clients.