Effects of voice therapy on vocal process granuloma: a phonoscopic approach

Purpose: This study reviewed the effects of a voice therapy program in patients who had failed other treatments for vocal process granuloma related to laryngopharyngeal reflux. The program was offered to 16 patients, all of whom demonstrated contact of the vocal processes at the site of pathology on voicing. During an initial evaluation, each patient was counseled regarding the need for voice conservation and improved vocal hygiene. Of the 16 patients, 10 agreed to undergo voice therapy and were subsequently enrolled in the treatment program. Methods: The primary therapy objective was to modify each patient's vocal fold contact pattern so that a small gap remained between the vocal processes during voicing. A phonoscopic approach to therapy was used. That is, the clinician and the patient were able to observe the larynx endoscopically while also listening to the voice. This combined aural and visual approach enabled the clinician to guide the patient toward the treatment objective with precision and provided patients with immediate feedback regarding their progress. Results: Of the 10 patients who underwent therapy, 8 were able to achieve the treatment objective, and all 8 experienced resolution of pathology or a marked reduction in its extent. Six patients who did not undergo treatment, and the 2 who were unable to achieve the treatment objective, demonstrated minimal or no improvement, or worsening of their pathology, over the same period. Conclusions: The treatment program described may be of value to similar patients with resistant granuloma related to extraesophageal reflux. (c) 2005 Elsevier Inc. All rights reserved.