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Is there an improvement on acoustic voice parameters in patients with bilateral vocal fold nodules after voice therapy? a meta-analysis

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Abstract

Background/objective

The aim of this study is to estimate the effect of voice therapy intervention in adults with vocal fold nodules, on three acoustic voice parameters (fundamental frequency, jitter and shimmer). The purpose of this meta-analysis is to present evidence based on literature regarding objective acoustic voice parameters changes, after voice therapy, in patients with bilateral VFNs. A pooled statistical analysis comparing pre- and post-therapy measurements of three acoustic voice parameters (average F0, % jitter and % shimmer) were performed.

Methods

A literature review was performed by searching studies in adults, with bilateral vocal fold nodules who received voice therapy, and where voice quality was evaluated quantitatively using acoustic analysis, before and after treatment. Meta-analysis was performed using random-effects model. PubMed, CINAHL, CENTRAL and Web of Science were searched for retrospective and prospective cohort, cross-sectional and case–control with comparative studies in adults published between January/1995 and March/2019 and English written. Search terms used were: intervention, therapy, vocal, voice, nodules, bilateral, multidimensional assessment, acoustic and analysis.

Results

Overall 1950 articles were identified. After removing repeated articles and conducting screening stages using inclusion and exclusion criteria, a total of four studies were selected with 147 participants for the meta-analysis. The pooled results analysis showed a statistically significant effect in two acoustic parameters after voice therapy: (1) F0 [increased mean difference post-therapy was 33.00 Hz (95% CI 20.26–45.74, p < 0.001)] and (2) jitter (%) [decreased mean difference post-therapy was 0.59% (95% CI 0.23–0.94%, p = 0.001)]. In addition, a non-statistically significant effect in shimmer (%) [decreased mean difference post-therapy was 2.98% (95% CI − 0.03–6.00, p = 0.052)].

Conclusion

Acoustic analysis has a clinical role in patients with vocal fold nodules, by objectively assessing and providing data on the effect of voice therapy in voice acoustic parameters. This meta-analysis has shown that patients with vocal fold nodules improved their acoustic voice parameters after receiving voice therapy.

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Acknowledgements

The last author acknowledges the support of FP-ENAS.

Funding

This study was not funded by any company or any other source of funding.

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Authors and Affiliations

  1. Fernando Pessoa College of Health, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal

    Rita Alegria

  2. Faculty of Health Sciences, Speech Therapy Department, University Fernando Pessoa, Porto, Portugal

    Susana Vaz Freitas

  3. Speech Pathology Unit of Otolaryngology Service, Centro Hospitalar e Universitário do Porto, Porto, Portugal

    Susana Vaz Freitas

  4. LIAAD - INESC TEC, Porto, Portugal

    Susana Vaz Freitas

  5. Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal

    Maria Conceição Manso

  6. Fernando Pessoa Energy, Environment and Health Research Unit (FP-ENAS), University Fernando Pessoa, Porto, Portugal

    Maria Conceição Manso

  7. LAQV, REQUIMTE, University of Porto, Porto, Portugal

    Maria Conceição Manso

Authors
  1. Rita Alegria
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  2. Susana Vaz Freitas
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  3. Maria Conceição Manso
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Corresponding author

Correspondence to Rita Alegria.

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Not applicable as article is a meta-analysis.

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Alegria, R., Freitas, S.V. & Manso, M.C. Is there an improvement on acoustic voice parameters in patients with bilateral vocal fold nodules after voice therapy? a meta-analysis. Eur Arch Otorhinolaryngol 277, 2163–2172 (2020). https://doi.org/10.1007/s00405-020-05956-2

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  • DOI: https://doi.org/10.1007/s00405-020-05956-2

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