Efficacy of Conversation Training Therapy (CTT)
Condition: Voice Disorders
MeSH terms: Voice Disorders
Study type: Observational

Summary: 
      Voice therapy is the standard-of-care for many of the nearly 140 million people in the United
      States who suffer from voice disorders,1 yet patients claim that current therapies are
      ineffective at meeting their voice needs.2 Published data by our research team indicate that
      patients think that transfer of target voice techniques to every day voice use (i.e.
      conversation) is the most difficult aspect of therapy,2 and that training techniques in
      conversation is the most useful aspect of voice therapy.2 Unfortunately, traditional voice
      therapy programs spend little, if any, time training voice techniques in conversation.3 This
      lack of functional specificity in voice therapy may contribute to the estimated 65% attrition
      rate.4 Even after some form of treatment, patients are still struggling with daily
      conversational voice use, and voice disorders continue to cause serious disability, stress
      and depression, which negatively affects social functioning and job performance.5 A new voice
      therapy program, Conversation Training Therapy (CTT), based on published patient reports on
      dissatisfaction with traditional therapy, was developed by the Investigators. It was honed
      with recommendations from expert clinical voice-specialized speech-language pathologists, and
      successfully piloted in a small case series of patients with voice problems. The
      investigators objective in this application is to test CTT in the rehabilitation of patients
      with voice disorders. The investigators hypothesize that, as demonstrated in the
      investigators preliminary case studies, these methods will result in early treatment success,
      and reduce the time required to reach therapeutic goals, thereby reducing costs associated
      with voice treatment.
    

Detailed description: 
      Two common voice disorders, vocal fold lesions (lesions) and muscle tension dysphonia (MTD)
      constitute over 60% of voice clinic caseloads. Over 80% of patients with lesions and nearly
      100% of those with MTD are treated exclusively with voice therapy.7,8 Traditional, bottom-up
      hierarchical, non-conversation based voice therapy is the established standard of care used
      most widely by speech-language pathologists (SLP) in clinical practice.e.g.3,9,10 However,
      the investigators group's published research indicated a clear need to target conversational
      voice use in treatment.2 Currently, no treatment program exists with a focus on voice use in
      conversation. Most voice therapy techniques are based in hierarchical, programmatic
      approaches aimed at manipulating phonatory physiology for voice improvement. These
      hierarchies necessitate that the final step in therapy is generalization of the target voice
      techniques to spontaneous, conversational speech.3 Three major problems exist with this
      approach to voice therapy, which the current proposal aims to address.

      First, A hierarchical non-conversational approach to therapy builds treatment from unvoiced
      breathing to single sounds and rote phrases to connected speech to spontaneous every day
      conversation last, if at all, and patients are often discharged from therapy unable to
      generalize therapy techniques to conversation. Second, the use of a hierarchical, bottom-up
      approach necessitates a protracted time in treatment. Third, attrition rates for behavioral
      voice therapy are estimated between 16-65%,4,17 and voice problem relapse rates are between
      51-68%.
    

Intervention name(s): Conversation Training Therapy
Intervention type(s): Behavioral
Intervention description(s): Conversational speech as the primary focus of voice therapy in individuals with muscle tension dysphonia or vocal fold lesions.
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Individuals diagnosed with either muscle tension dysphonia (MTD) or vocal fold lesion who
        are candidates for voice therapy.
      
Keywords: Voice Therapy; Muscle Tension Dysphonia; Lesions