Treatment of vocal fold bowing using neuromuscular electrical stimulation

Arch Otolaryngol Head Neck Surg. 2010 Apr;136(4):398-403. doi: 10.1001/archoto.2010.33.


Objective: To investigate the clinical effectiveness and safety of a novel behavioral voice therapy program combining structured vocal exercise with adjunctive neuromuscular electrical stimulation for rehabilitating dysphonia secondary to vocal fold bowing.

Design: Prospective interventional clinical case series with a 3-month follow-up.

Setting: Outpatient speech and hearing clinic in an academic medical center.

Patients: Convenience sample of 7 patients diagnosed by an otolaryngologist as having chronic dysphonia for at least 3 months due to bilateral vocal fold bowing.

Intervention: A novel voice therapy program incorporating exercise principles and sustained phonations of increasing length, volume, and pitch paired with concurrent transcutaneous neuromuscular electrical stimulation.

Main outcome measures: Change in maximum phonation time, highest attainable pitch, glottal closure, supraglottic compression, and Voice Handicap Index.

Results: Maximum phonation time for /i/ increased significantly (z = -2.201, P < .03), with a modest effect demonstrated (Hedges g, 0.65; 95% confidence interval, -0.56 to 1.75). Voice Handicap Index trended toward significance (z = -1.787, P < .07). Glottal closure during phonation improved, and supraglottic compression decreased. Improvements were maintained or enhanced at the 3-month follow-up. Analysis of highest attainable pitch data was limited owing to aperiodicity in the baseline evaluations.

Conclusions: Behavioral voice therapy with adjunctive neuromuscular electrical stimulation reduced vocal fold bowing, resulting in improved acoustic, laryngeal, and patient-centered outcomes. Maximum phonation time and glottal closure results imply increased vocal fold tension secondary to enhanced thyroarytenoid or cricothyroid muscle function after voice therapy.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dysphonia / etiology
  • Dysphonia / physiopathology
  • Dysphonia / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Laryngeal Muscles
  • Male
  • Middle Aged
  • Prospective Studies
  • Speech Acoustics
  • Transcutaneous Electric Nerve Stimulation*
  • Treatment Outcome
  • Vocal Cords*
  • Voice Quality
  • Voice Training*