Title: Physical Therapy Treatment of Muscle Tension Dysphonia

Title: Physical therapy treatment of muscle tension dysphonia Authors: Carey A Tomlinson, Jennifer Craig, David Francis, Kristin R. Archer

Background: Muscle Tension Dysphonia (MTD) is a voice disorder characterized by increased laryngeal musculoskeletal tension with excessive muscular recruitment in the larynx and pharynx and co-occurs with disruption of efficient vibratory parameters resulting in an aberrant vocal quality (Boone, McFarlane, VonBerg, & Zraick, 2010). In primary MTD, no lesion is seen on visualization of the larynx. Speech therapy typically is the only treatment of this disorder.

Purpose: The purpose of this Randomized Control Trial (RCT) is to determine if the addition of physical therapy to standard of care speech therapy is beneficial in the treatment of patients with MTD.

Design: RCT of 40 subjects with diagnosed MTD will be randomized into 2 groups: the control group receiving speech language pathology (SLP) and the experimental group (SLP + PT). Subjects will be randomized into the two groups at their physician visit where they are diagnosed with MTD.

Methods: Both groups will receive 4 sessions of voice therapy by a Speech Language Pathologist. The experimental group will receive 12 PT visits in addition to the 4 sessions of voice therapy. The PT sessions will follow the established PT guidelines as established in a preliminary cohort study. All subjects will receive two outcome measurements: Voice Handicapped Index (VHI) to assess subjective assessment of the voice and the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) to objectively assess the voice quality. Each measure will take place at the initial assessment with the speech language pathologist and at the 3 month follow up with a physician. Pre- and post-assessment will be completed by personnel blinded to group SLP

Results: Wilcoxon Signed-Rank and Fisher’s exact tests will assess difference in pretest and posttest measurements. Analyses will be intent-to-treat.

Conclusion: The outcome of this study will be to establish that physical in conjunction with speech therapy is beneficial to patients at 3 months follow-up. Future research will be performed to see if outcomes are maintained over a year’s time and in a larger RCT.