Effects of Early Voice Therapy Intervention Using Non-Phonatory Exercises in Patients With Unilateral Vocal Fold Paralysis After Thyroidectomy: A Randomized Clinical Trial

Objectives: Aim of this study was to verify the effects of early management through non-phonatory exercises aimed at improving glottic closure in patients affected by iatrogenic unilateral vocal fold paralysis. Study design: randomized clinical trial. Methods: Between February 2024 and September 2024, 20 patients (15 F, 5 M; mean age 46.78 ± 14.34 years) with unilateral vocal fold paralysis (UVFP) after total thyroidectomy were recruited. After a first phoniatric visit (T0), all patients were randomly assigned to the Experimental group (A) (which performed non-phonatory exercises for one week in parallel with cortisone therapy) or to the Control group (B) (which undergone cortisone therapy only). At the end of the first week, all patients underwent a second phoniatric visit (T1) and started standard voice therapy. After five voice therapy sessions, a further phoniatric control was performed (T2). During each phoniatric visit, a videolaryngoscopic evaluation with attribution of a score relating to the degree of glottal gap, an acoustic analysis of the voice, a perceptual evaluation, and the collection of maximum phonatory time (MPT) were performed. Results: At the end of the first week (T1), group A achieved a significant improvement in the degree of glottal gap and in the MPT compared to those of group B (P < 0.05). Furthermore, at the end of the therapy (T2), group A obtained statistically lower values of Minimum Frequency (Fmin Hz) and a statistically significant improvement of the parameter “Instability (I)” in the perceptual assessment (Grade-Instability-Roughness-Breathiness-Asthenia-Strain scale). Conclusions: In patients affected by UVFP, the early execution of non-phonatory exercises helps the sphincter function of the larynx and improves the degree of adduction of vocal folds, reduces the phonatory effort, and may prevents the establishment of dysfunctional compensations that the patient may implement in the attempt to increase the intensity of the vocal emission.