Comparison of the effectiveness of tongue trill, lip trill, straw phonation, and water resistance therapy exercises in patients with primary Muscle Tension Dysphonia

Comparison of the effectiveness of tongue trill, lip trill, straw phonation, and water resistance therapy exercises in patients with primary Muscle Tension Dysphonia

A clinical trial with a control group, parallel groups, double-blind, and randomized on 30 patients

The samples will be selected among the clients of the otolaryngology clinic of Amir Alam Hospital and speech therapy clinics of Tehran University of Medical Sciences using the available sampling method

Inclusion criteria: 1) Be female, 2) The age range of 20-50 years, 3) Declare their informed consent to participate in the study, 4) Receiving the diagnosis of primary Muscle tension dysphonia Exclusion criteria: 1) Smoking cigarettes and drinking alcohol; 2) Suffering from hearing loss, hormonal diseases, and neurological diseases; 3) Having a history of laryngeal surgery or laryngeal trauma; 4) Being pregnant; 5) Being menopause; 6) Being menstruating at the time of pre-and post-treatment assessments; 7) Having an upper respiratory tract infection during the assessment days or one week before, and 8) Receiving another voice therapy program at the same time as the study is carried out

This study has five intervention groups, including four experimental groups and one control group. The experimental groups include lip trill, tongue trill, straw phonation, and water resistance therapy. The control group will receive a vocal hygiene program. All 5 groups will practice their individual treatment plan across 2 weeks with a frequency of two 45-min sessions a week.

Maximum Phonation Time; First formant; F1_F0 difference; Cepstral peak prominence; Cepstral peak prominence-smoothed; Overall Severity of Dysphonia; Frequency and Severity of Vocal Tract Discomfort; Voice Handicap Index

The studied samples will be randomly divided into five groups to receive one of the five treatments of tongue trill, lip trill, straw phonation, water resistance therapy, and vocal hygiene. Using the rule of random allocation in creating a random sequence and observing the concealment of random allocation is done by Permuted block randomization. For this purpose, 30 people in the sample size of this study are considered as six blocks of five. Each of these six blocks contains five 5 codes of the first to fifth methods. Each block is placed in a separate box containing opaque envelopes containing the codes of five treatment methods, and the blocks are used one after the other for the lottery. Patients are asked to draw one of the envelopes, take it out and open it and present it to the researcher to be placed in the relevant group

In this research, pre-and post-treatment assessments are performed by a speech therapist, and the presentation of therapeutic exercises is by another speech therapist who is the primary researcher of this study. Therefore, the outcome assessor will be blinded to the treatment group allocation, and the principal investigator will be blinded to the assessment results. From the beginning, we will explain to the participants that in this study we intend to compare the effectiveness of several voice therapy methods. We explain to them that these treatment methods have similar goals and are provided to facilitate voice production and solve their voice problems. Next, we explain that the effectiveness of these treatment methods has already been proven and we explain to them about the mechanism of these exercises that this mechanism is implemented using different voice exercises. They are supposed to be randomly placed in one of these treatment groups. Participants with knowledge of the above topics will enter the study if they declare their readiness to participate in this research through the informed consent form. Before the start of the assessment and treatment, the necessary arrangements are made so that the participants do not see each other during the entire period of treatment and assessment. Due to the fact that all participants are assessed and treated individually and will not see other patients, they will not be informed about the allocation of treatment groups.