Voice therapy, the behavioral treatment aimed at modifying behaviors that cause or contribute to voice disorders, is the standard of care for many people with voice disorders. Although voice therapy is effective at treating voice disorders initially; substantial limitations exist with traditional treatment paradigms. These limitations case a protracted length of time in required in treatment, as well as attrition and relapse rates approaching 70%, which contribute to the high costs associated with treating voice disorders. Traditional voice therapy builds hierarchically from breathing and relaxation exercises to production of single sounds, words, phrases, and finally, conversation. Patients report that this final step, transfer of skills to conversation, is the most difficult part of voice therapy. Motor learning theory states that training complex skills as a whole (e.g. conversation) facilitates learning and retention more-so than breaking these complexities down into simple components (e.g. single sounds). It is unknown if eliminating the therapeutic hierarchy and training target voice techniques in conversation, starting in the first session and throughout all sessions, would reduce the time spent in treatment and improve learning and retention, thereby reducing attrition and relapse. To that end, a new voice therapy approach, Conversation Training Therapy (CTT), was developed by a team of expert voice-specialized speech-language pathologists and successfully trialed on a small cohort of five patients with voice disorders. The CTT approach resulted in voice goals met in an average of 3 sessions, substantially below the number of sessions typically required in traditional therapy programs. Further, a clinically meaningful decrease in VHI-10 scores was observed for all patients. The goal of the current application is to determine the efficacy of CTT in the rehabilitation of patients with 2 common voice disorders, benign vocal fold lesions and muscle tension dysphonia. After determining initial efficacy, the long term goal of this research is to conduct multi-center comparative effectiveness trials comparing CTT to traditional voice therapy programs in people with voice disorders. This proposal is an investigation of the first voice therapy program based in theories of motor learning and neuroplasticity, developed without the use of a traditional therapeutic hierarchy, with input from patients with voice disorders and expert, clinical, speech-language pathologists. Results of the current research are potentially paradigm-shifting with regards to how voice therapy is delivered, including the necessary time spent in treatment, resulting in a potential savings of billions of dollars to the healthcare system and improved quality of life for people wit voice disorders.

Public Health Relevance

Voice therapy is the standard-of-care for the nearly 140 million people in the United States who suffer from voice disorders. Patients claim that current therapies are ineffective at meeting their voice needs, specifically voice use in conversation. The goal of the current study is to determine efficacy of a new voice therapy approach, Conversation Training Therapy (CTT), in the rehabilitation of patients with 2 common voice disorders, benign vocal fold lesions and muscle tension dysphonia.

National Institute of Health (NIH)
National Institute on Deafness and Other Communication Disorders (NIDCD)
Small Research Grants (R03)
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Communication Disorders Review Committee (CDRC)
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Shekim, Lana O
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University of Pittsburgh
Schools of Medicine
United States
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