Journal of voice : official journal of the Voice Foundation · 2026
Multidimensional Effectiveness of Eclectic Voice Therapy in Patients with Unilateral Vocal Fold Paralysis Following Thyroidectomy: A Prospective Clinical Study.
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Eliküçük Çağla, Çıldır Bünyamin, Tuna Elvan Evrim
Аннотация
OBJECTIVES: To evaluate the multidimensional effectiveness of a structured 8-week voice therapy program on voice, swallowing, and thyroid-related quality of life in adults with unilateral vocal fold paralysis (UVFP) following thyroidectomy.
STUDY DESIGN: Prospective, single-arm pre-post interventional study with blinded outcome assessment.
METHODS: Forty-five adults with post-thyroidectomy UVFP (≤12 months duration) received an 8-week (once-weekly), face-to-face voice therapy program based on Lessac-Madsen Resonant Voice Therapy, semi-occluded vocal tract exercises, push-pull maneuvers, manual laryngeal techniques, postural/relaxation work, and targeted swallowing exercises when indicated. Standardized assessments were performed before (T0) and after therapy (T1), including acoustic measures (fundamental frequency, jitter, shimmer, noise-to-harmonics ratio, cepstral peak prominence), perceptual ratings (consensus auditory-perceptual evaluation of voice [CAPE-V]), patient-reported outcomes (voice handicap index-10 [VHI-10], voice-related quality of life, vocal fatigue index, Swallowing Quality of Life Questionnaire [SWAL-QOL], thyroid-related patient-reported outcome [ThyPRO]), and aerodynamic measures (maximum phonation time [MPT], S/Z ratio).
RESULTS: All 45 participants completed the program. VHI-10 scores improved from 27.2 ± 3.2 to 12.4 ± 4.8 (P < 0.001), and CAPE-V overall voice severity decreased from 69.5 ± 10.1 to 28.4 ± 15.3 (P < 0.001). Jitter and shimmer decreased (from 5.6% to 3.7%, and 18.9% to 3.7%, respectively; both P < 0.001), while smoothed cepstral peak prominence increased from 2.23 ± 0.72 to 5.03 ± 1.20 dB (P < 0.001). MPT nearly doubled (8.16 ± 1.31 to 18.42 ± 1.36 seconds; P < 0.001), and the median S/Z ratio improved from 3.66 to 1.70 (P < 0.001). SWAL-QOL total score increased from 119.8 ± 10.9 to 162.7 ± 10.7 (P < 0.001), indicating better swallowing-related quality of life. ThyPRO Voice/Speech, Social Life, and Daily Life domain scores showed significant improvements, whereas physical symptom and cosmetic domains were largely unchanged.
CONCLUSIONS: In adults with post-thyroidectomy UVFP, an 8-week structured, therapist-led voice therapy program produced large, clinically meaningful gains in acoustic and aerodynamic voice parameters, swallowing function, and thyroid-specific quality of life. These findings support early, multidimensional voice therapy as an effective first-line conservative management strategy in this population.
STUDY DESIGN: Prospective, single-arm pre-post interventional study with blinded outcome assessment.
METHODS: Forty-five adults with post-thyroidectomy UVFP (≤12 months duration) received an 8-week (once-weekly), face-to-face voice therapy program based on Lessac-Madsen Resonant Voice Therapy, semi-occluded vocal tract exercises, push-pull maneuvers, manual laryngeal techniques, postural/relaxation work, and targeted swallowing exercises when indicated. Standardized assessments were performed before (T0) and after therapy (T1), including acoustic measures (fundamental frequency, jitter, shimmer, noise-to-harmonics ratio, cepstral peak prominence), perceptual ratings (consensus auditory-perceptual evaluation of voice [CAPE-V]), patient-reported outcomes (voice handicap index-10 [VHI-10], voice-related quality of life, vocal fatigue index, Swallowing Quality of Life Questionnaire [SWAL-QOL], thyroid-related patient-reported outcome [ThyPRO]), and aerodynamic measures (maximum phonation time [MPT], S/Z ratio).
RESULTS: All 45 participants completed the program. VHI-10 scores improved from 27.2 ± 3.2 to 12.4 ± 4.8 (P < 0.001), and CAPE-V overall voice severity decreased from 69.5 ± 10.1 to 28.4 ± 15.3 (P < 0.001). Jitter and shimmer decreased (from 5.6% to 3.7%, and 18.9% to 3.7%, respectively; both P < 0.001), while smoothed cepstral peak prominence increased from 2.23 ± 0.72 to 5.03 ± 1.20 dB (P < 0.001). MPT nearly doubled (8.16 ± 1.31 to 18.42 ± 1.36 seconds; P < 0.001), and the median S/Z ratio improved from 3.66 to 1.70 (P < 0.001). SWAL-QOL total score increased from 119.8 ± 10.9 to 162.7 ± 10.7 (P < 0.001), indicating better swallowing-related quality of life. ThyPRO Voice/Speech, Social Life, and Daily Life domain scores showed significant improvements, whereas physical symptom and cosmetic domains were largely unchanged.
CONCLUSIONS: In adults with post-thyroidectomy UVFP, an 8-week structured, therapist-led voice therapy program produced large, clinically meaningful gains in acoustic and aerodynamic voice parameters, swallowing function, and thyroid-specific quality of life. These findings support early, multidimensional voice therapy as an effective first-line conservative management strategy in this population.