Efficacy of speech language therapy intervention in unilateral vocal fold paralysis – a systematic review and a meta-analysis of visual-perceptual outcome measures

Abstract

Objective

Unilateral vocal folds paralysis is a disorder that affects a patient’s quality-of-life by disturbing their phonation, breathing, and swallowing activities. This systematic review aimed to estimate the efficacy of voice treatment on the vocal fold motility in adult patients with unilateral vocal folds paralysis.

Methods

PubMed, CINAHL, CENTRAL, and Web of Science were searched for retrospective and prospective cohort, case-control, and cross-sectional with comparative studies with adults that were published between 1 January 2008 to 31 December 2018. After applying the inclusion and exclusion criteria a total of 10 studies containing morpho-functional evaluation results were included in the analysis. Pooled data analysis of the motility of the vocal folds before and after voice therapy allowed inferring about the efficacy of voice therapy intervention in patients with unilateral vocal folds paralysis. A random-effect model was used to estimate the effect size. Publication bias was considered.

Results

The pooled data analysis of the visual-perceptual measures revealed that vocal fold motility improved in 72% (95% CI: 64.0–80.0) of all patients after the therapeutic interventions. The inconsistency index (I² = 18.35%) of the studies included in this meta-analysis revealed an extremely low heterogeneity. Funnel plot and Cochran’s Q test showed no publication bias. The systematic review was limited to only English language articles.

Conclusion

This meta-analysis supports the evidence that voice therapy intervention can have a positive effect on the vocal fold motility, that is, they can improve the glottal gap closure, irrespective of the exercises and techniques used.

Keywords:

• Unilateral laryngeal paralysis
• speech language therapy
• intervention
• meta-analysis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Rita Alegria

Rita Alegria is a doctoral student at University Fernando Pessoa, in Porto, and practicing speech-language pathologist. Her research focuses on speech therapy in an aquatic setting for patients with UVFP or with bilateral vocal fold nodules.

Susana Vaz Freitas

Susana Vaz Freitas is an Assistant Professor in the Department of Speech and Language Therapy and co-coordinator of the Doctoral Program in Language Development and Disorders of the University Fernando Pessoa. Is an external researcher of the Laboratory of Artificial Intelligence and Data Analysis (LIAAD), from INESCTEC and a Speech and Language Pathologist of the Otorhinolaryngologist Department at Centro Hospitalar Universitário do Porto (CHUP). Her research focuses on voice, voice disorders and alaryngeal speech; the dysphagia instrumental and clinical evaluation.

Maria Conceição Manso

Maria Conceição Manso is an Associate Professor in the Faculty of Health Sciences of the University Fernando Pessoa, Porto, Portugal, teaching Biostatistics and related subjects. She has research interests addressing topics across medicine, dental medicine and speech therapy areas as well as mathematical modelling of environmental and health issues.