Voice therapy in the treatment of dyspnea and dysphonia

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The role of voice therapy in the treatment of dyspnea and dysphonia in a patient with a vagal nerve stimulation device.

Gillespie AI, Helou LB, Ingle JW, Baldwin M, Rosen CA.

J Voice. 2014 Jan;28(1):59-61. doi: 10.1016/j.jvoice.2013.08.007. Epub 2013 Sep 23.

Purpose:

To demonstrate efficacy of voice and respiratory training for the treatment of VNS induces dysphonia and dyspnea

Methods:

Case report regarding a 59-year old male, 4 years post-VNS implantation with complaints of dysphonia coinciding with VNS implantation and dyspnea originating approximately 2 years after implantation. Laryngoscopy revealed immobile left vocal cord and normal range of motion of the right vocal cord. When the VNS was turned on, there was pronounced contraction of the left hemilarynx, including medial contraction of the left false vocal fold. With the VNS on, the glottic opening at rest became narrowed. The right vocal fold, which had normal range of motion with the VNS off, exhibited hypomobility with decreased abductory range of motion when the VNS was on. After deactivation complaints of dyspnea and dysphonia persisted.

Results:

Voice  and respiratory retraining therapy was described, initially for the ongoing period of VNS deactivation. Therapy continued after reactivation of VNS therapy. At long-term follow-up, 13 months after completion of therapy and VNS reactivation, the patient reported ongoing dyspneic symptoms, which he was able to manage through the use of respiratory retraining therapy techniques. Use of the same therapy techniques not only attenuated tonic symptoms of dyspnea but reportedly were preventative to the extent that the patient no longer experienced breathing ‘‘attacks.’’

http://www.ncbi.nlm.nih.gov/pubmed/24070591

Comments reviewer, Prof Van Nieuwenhuizen:

this case report is important because it focus attention on the possibility to relieve complaints of dysphonia and dyspnea in patients with VNS. This might enable continuation of VNS in patients who have shown efficacy of VNS but who suffer from severe side-effects.

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