Telemedicine Versus Traditional Treatment of Muscle Tension Dysphonia

Study Overview
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Brief Summary
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The purpose of this research is to determine whether treatment of voice disorders can be provided just as effectively using telemedicine as it can using on-site, traditional therapy. An exercise protocol for improving airflow with voicing has been demonstrated to be effective in a prior UAMS investigation (Protocol 107454). These exercises are used as part of the normal clinic routine at UAMS working with individuals with voice problems. The three exercises used are: gargling with and without voicing; cup bubble blowing with and without voicing; and, stretch and flow exercises, which involves the use of a piece of tissue to provide visual biofeedback on the ability to use proper airflow with voicing. The purpose of the exercises is to increase airflow and breathiness in the voice and reduce muscle tension. In addition, patients will be taught to use a confidential voice or gentle voice during speaking. The investigators voice patients come from all over the state and many cannot return for regular treatment. Developing a way to provide treatment to them closer to home could greatly improve quality of care and quality of life. Twenty participants will participate for 12 sessions each. All participants will be evaluated at UAMS before and after treatment as part of standard care and will, upon consent, be randomized to receive treatment via telemedicine at an AHEC site or at UAMS Medical Center. Homework will be provided along with log sheets. Results of airflow measures using an airflow-recording device (Viasys, KAY/PENTAX) pre- and post treatment will determine whether telemedicine results are equal to results of traditional, on-site treatment. The investigators hypothesize that results from treatment using telemedicine will be equivalent to results for onsite, traditional treatment.

Official Title
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Telemedicine Versus Traditional Treatment of Muscle Tension Dysphonia

Conditions
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Muscle Tension Dysphonia

Intervention / Treatment
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* Behavioral: Airflow Exercises for Voicing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Primary or Secondary Muscle Tension Dysphonia Exclusion Criteria: Head and Neck Cancer Spasmodic Dysphonia Tremor Respiratory Compromise Dysphagia

Ages Eligible for Study
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Minimum Age: 21 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
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Traditional, Onsite Treatment<br>Onsite treatment using airflow exercises. Patients will receive face-to-face treatment with the research speech pathologist two times per week. | Behavioral: Airflow Exercises for Voicing<br>* Gargling, Cup Bubble Blowing, and Stretch and Flow Exercises will be taught to reduce laryngeal closure and improve airflow through the glottis during voicing.<br>|
| Experimental: Telemedicine Treatment<br>Participants will receive treatment via telemedicine at select AHEC sites around the state of Arkansas. Treatments will occur twice per week with the research speech pathologist. | Behavioral: Airflow Exercises for Voicing<br>* Gargling, Cup Bubble Blowing, and Stretch and Flow Exercises will be taught to reduce laryngeal closure and improve airflow through the glottis during voicing.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean Expiratory Airflow During Comfortable Phonation | Measured pre- and post in liters/second using Phonatory Aerodynamic System. | 6 weeks | 
| Voicing Efficiency | Mean Airflow during voicing efficiency task, pa-pa-pa, using Phonatory Aerodynamic System. Measured in liters/second. | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Voice Handicap Index Questionnaire | Patient's perceived ratings of Voice Handicap on standardized, validated questionnaire. | 6 weeks | 
| Consensus Auditory Perceptual Evaluation of Voice | Overall perceptual rating of voice quality made by clinician on 100 point scale. | 6 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Voice, Muscle Tension Dysphonia, Hyperfunction, Treatment