Problems of rehabilitation and comprehensive treatment of patients with dysphonia in modern conditions

Authors:

Makhotkina Nina Nugzarovna – PhD in Medical sciences (Cand. Med. Sci.), researcher of the Department of Voice and Speech Pathophysiology, St. Petersburg Research Institute of Ear, Throat, Nose and Speech, 9 Bronnitskaya Street, 190013 St. Petersburg, Russian Federation; Associate Professor of the Department of Physical Medicine and Rehabilitation, I.I. Mechnikov Northwestern State Medical University, 41 Kirochnaya Street, 191015 St. Petersburg, Russian Federation; phone: +7 (812) 409-09-17, e-mail: n.makhotkina@niilor.ru; https://orcid.org/ 0000-0003-4479-3295.

Stepanova Yuliya Evgenievna – Grand PhD in Medical sciences (Dr. Med. Sci.), Associate Professor, Head of the Department of Voice and Speech Pathophysiology, St. Petersburg Research Institute of Ear, Throat, Nose and Speech, 9 Bronnitskaya Street, 190013 St. Petersburg, Russian Federation; e-mail: y.stepanova@niilor.ru; https://orcid.org/0000-0003-1502-6337.

Annotation:

Introduction. Currently, the problem of rehabilitation of patients with voice disorders remains unresolved: there is no rehabilitation routing scale for patients with dysphonia; speech therapists – phonopedists – without whom voice restoration is impossible, are not provided at all stages of rehabilitation; the absence of a multidisciplinary rehabilitation team working with these patients does not allow considering the existing voice restoration practice as rehabilitation, but only as complex treatment. The results of voice function restoration in patients with dysphonia in various medical settings (inpatient and outpatient) have not been analyzed.

Aim. To compare the effectiveness of complex patient and complex outpatient treatment of patients with voice disorders.

Materials and methods. 30 inpatient patients (observation group) and 20 outpatient patients (comparison group) with unilateral laryngeal paresis after thyroid surgery, aged 21 to 67 years (mean age 39 ± years), were examined. Complex treatment included neuromuscular electrophonopedagogical stimulation of the larynx, sessions with a speech therapist-phonopedist, psychotherapy, and medication treatment (as indicated). Treatment results were evaluated using videoendostroboscopy of the larynx, acoustic voice analysis, subjective scoring of complaints, and psychological testing.

Results. The analysis of the treatment effectiveness showed that the complex treatment was highly effective and allowed for the complete restoration of laryngeal mobility in 13% (4) of observation group patients and in 5% (1) of comparison group patients. In 74% (22) of observation group patients and 75% (15) of comparison group patients, the treatment course was also effective, but the mobility of the paralyzed half of the larynx was not restored. Low treatment efficacy was found in 13% (4) of patients in observation group and in 20% (4) of patients in comparison group (p <0.05). They noted voice improvement, but it was insufficient for long-term communication and professional activity. More significant were changes in observation group compared to comparison group (p<0.05).

Discussion. Treatment results for inpatients were better than those for outpatients. In observation group, this result was achieved on average three times faster than in comparison group due to increased frequency and intensity of physiotherapy procedures, phonopedic, and psychotherapeutic sessions.

Conclusion. Based on the results of the study, the Department of Voice and Speech Pathology at the St. Petersburg Research Institute of Ear, Throat, Nose and Speech with a staff of doctors necessary for multidisciplinary rehabilitation team can be considered as a clinical model of the second stage of medical rehabilitation for patients with dysphonia.

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