Efficacy of a Semi-occluded Mask in the Treatment of Patients With Voice Disorders

Study Overview
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Brief Summary
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Current semi-occluded vocal tract therapies limit the type of vocalizations that can be produced to single vowels, which does not promote learning of the healthy voice behavior in connected speech or generalization to conversation. However, recent preliminary results using a semi-occluded mask indicate that the use of certain mask port diameters may allow for natural speech production while increasing supraglottal pressure and impedance, and thereby result in elicitation of voice with increased efficiency. In addition, the use of a semi-occluded mask provides the possibility for a better transition from phonating single phonemes in therapy to training the target therapy techniques in connected speech.

Detailed Description
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Treatment of voice disorders varies but often involves voice therapy and/or surgical intervention. Voice therapy, a non-invasive behavioral treatment for voice disorders, helps patients develop beneficial voice habits, prevents recurrence of voice disorders, and facilitates long-lasting vocal improvement. Many voice therapy techniques involve a semi-occluded vocal tract (SOVT). SOVT treatment is often characterized by sustained (straw phonation, voiced fricatives, nasals), oral oscillatory (lip buzzes, tongue trills, raspberries) or transitory phonation (plosives and glides). Straw phonation therapy, one of the most utilized SOVT methods, was first proposed in 1904 and involved phonating at different pitches into small glass tubes with varying diameters and lengths providing simultaneous semi-occlusion and extension of the vocal tract. Voice therapy exercises involving voice production with a semi-occluded and sometimes lengthened vocal tract have demonstrated improved vocal efficiency and loudness, reduced mechanical trauma to the vocal fold mucosa, and improved source-filter interaction.Our group recently developed a semi-occluded facemask for use in patients with and without voice disorders. Recent preliminary results using this semi-occluded facemask indicated that the use of a certain mask port diameters may elicit voice with increased efficiency. A study of 5 participants without voice disorders revealed that a mask occlusion diameter of 6.4 and 3.2 mm resulted in improved vocal efficiency. A study of the immediate effects of a semi-occluded facemask in 20 patients with voice disorders revealed that occlusions diameters of 9.6, 6.4, and 3.2 mm all resulted in significant improvements in acoustic and aerodynamic voice outcomes.

Official Title
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Efficacy of a Semi-occluded Mask in the Treatment of Patients With Voice Disorders

Conditions
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Voice and Resonance Disorders, Vocal Fold Polyp, Vocal Cord Cyst, Vocal Cord Polyp, Atrophy of Vocal Cord

Intervention / Treatment
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* Device: Inclusion of semi-occluded mask in voice therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age 18 to 60 diagnosed with vocal fold lesion or polyp or cyst or atrophy or other voice condition (such as muscle tension dysphonia) recommended for voice therapy as treatment for voice disorder Exclusion Criteria: Current smoker (greater than 5 cigarettes/week)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Voice Disorder Requiring Voice Therapy<br>Individuals with a voice disorder such as muscle tension dysphonia (MTD), vocal fold atrophy or vocal fold lesions recommended for voice therapy as treatment. | Device: Inclusion of semi-occluded mask in voice therapy<br>* Patients will be given a facemask with a semi-occlusion (SOMask) for use during in person voice therapy and for use at home therapy practice.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change From Baseline in VHI-10 Score After 4 Sessions of Voice Therapy | VHI-10 is a 10 item, self reported, voice related outcome related to an individual's perception of their vocal quality and how it impacts their life. (Voice Handicap Index) Scale scores range from 0-40 where higher scores correspond to a worse vocal quality. | Baseline and approximately 6-8 weeks later; after completion of voice therapy | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change From Baseline in Cepstral Peak Prominence (dB) | CPP is an objective evaluation of voice recordings through specialized vocal analysis software. | Baseline and approximately 6-8 weeks later; after completion of voice therapy | 
| Change From Baseline in Cepstral Spectral Index of Dysphonia (CSID--a Multivariate Estimate of Dysphonia Severity) | CSID is an objective evaluation of voice recordings through specialized vocal analysis software. The CSID is a multifactorial estimate of vocal severity that correlates with the labeled visual analog scale for severity (in %). Normal cutoff range is from 19-24. Values outside of this range are considered to have varying degrees of dysphonia. The values are captured using specialized voice analysis equipment and analyzed using the specialized CSID software. Depending on the voice disorder, CSID can be calculated as both negative and positive integers with no true boundaries. | Baseline and approximately 6-8 weeks later; after completion of voice therapy | 
| Change From Baseline in Mean Airflow in Milliliters (ml) During Reading of Standardized Paragraph | mean airflow will be captured during the phonatory aerodynamic system (PAS) recording of airflow during the reading of the standardized paragraph. | Baseline and approximately 6-8 weeks later; after completion of voice therapy | 
| Change From Baseline in Mean Vocal Intensity (dB) | mean vocal intensity will be captured during the phonatory aerodynamic system (PAS) recording of airflow during the reading of the standardized paragraph. | Baseline and approximately 6-8 weeks later; after completion of voice therapy | 
| Change in the Number of Breaths Taken During Reading of Standardized Paragraph | Numeric value of the number of breaths needed to complete the reading of a paragraph. Values are positive integers | Baseline to post treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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SOVT, semi occluded vocal tract, voice disorder, voice therapy, muscle tension dysphonia, MTD, vocal fold lesions, vocal fold atrophy