Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time

J Voice. 2024 Nov;38(6):1525.e15-1525.e22. doi: 10.1016/j.jvoice.2022.04.005. Epub 2022 May 28.

Abstract

Objective: To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP).

Methods: Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later.

Results: Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P = 0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P = 0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P = 0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR.

Conclusions: With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.

Keywords: Telerehabilitation—Voice therapy—Thyroidectomy—Unilateral vocal fold paralysis–COVID-19–SARS-CoV-2.

MeSH terms

  • Adult
  • Aged
  • COVID-19* / complications
  • Dysphonia* / diagnosis
  • Dysphonia* / etiology
  • Dysphonia* / physiopathology
  • Dysphonia* / rehabilitation
  • Dysphonia* / surgery
  • Female
  • Humans
  • Iatrogenic Disease*
  • Laryngoscopy
  • Male
  • Middle Aged
  • Phonation
  • Recovery of Function*
  • Stroboscopy
  • Telerehabilitation*
  • Thyroidectomy* / adverse effects
  • Time Factors
  • Treatment Outcome
  • Vocal Cord Paralysis* / etiology
  • Vocal Cord Paralysis* / physiopathology
  • Vocal Cord Paralysis* / rehabilitation
  • Vocal Cord Paralysis* / surgery
  • Vocal Cords / physiopathology
  • Vocal Cords / surgery
  • Voice Quality*
  • Voice Training*