User:H.hoangtn/sandbox

Treatment of Dysphonia: Draft 2 (after peer-review)

Thank you @Chloe.93 and @Chrissietheslp for the comments! I have incorporated some of your feedback on citations to the section. I will also look into lengthening the surgery section. As for the jargon at the beginning of the section, we will have the terms explained at the beginning of the "Dysphonia" article. I will make note that they are difficult terms to understand, and make sure that our group has a good introduction for them!

Multiple treatments have been developed to address the various organic, functional, and psychogenic causes of dysphonia. Dysphonia can be targeted through direct therapy, indirect therapy, medical treatments, and surgery. Functional dysphonias may be treated through direct and indirect voice therapies, whereas surgeries are recommended for chronic, organic dysphonias. A combination of both indirect and direct treatment methods are used.

Direct therapies address the physical aspects of vocal production. Techniques work to either modify vocal fold contact, manage breathing patterns, and/or change the tension at level of the larynx. Notable techniques include, but are not limited to, the yawn-sigh method, optimal pitch, laryngeal manipulation, humming, the accent method, and the Lee Silverman Voice Treatment. An example of a direct therapy is circumlaryngeal manual therapy, which has been used to reduce tension and massage hyoid-laryngeal muscles. This area is often tense from chronic elevation of the larynx. Pressure is applied to these areas as the patient hums or sustains a vowel. Traditional voice therapy is often used to treat muscular tension dysphonia.

Indirect therapies take into account external factors that may influence vocal production. This incorporates maintenance of vocal hygiene practices, as well as the prevention of harmful vocal behaviours. Vocal hygiene includes adequate hydration of the vocal folds, monitoring the amount of voice use and rest, avoidance of vocal abuse (e.g., shouting, clearing of the throat), and taking into consideration lifestyle choices that may affect vocal health (e.g., smoking, sleeping habits). Vocal warm-ups and cool-downs may be employed to improve muscle tension and decrease risk of injury before strenuous vocal activities. It should be taken into account that vocal hygiene practices alone are minimally effective in treating dysphonia, and thus should be paired with other therapies.

Medical and surgical treatments have been recommended to treat organic dysphonias. An effective treatment for spasmodic dysphonia (hoarseness resulting from periodic breaks in phonation due to hyperadduction of the vocal folds) is botulinum toxin injection . The toxin acts by blocking acetylcholine release at the thyro-arytenoid muscle. Although the use of botlinum toxin injections is considered relatively safe, patients' responses to treatment differ in the initial stages; some have reported experiencing swallowing problems and breathy voice quality as a side-effect to the injections. Breathiness may last for a longer period of time for males than females.

Surgeries involve myoectomies of the laryngeal muscles to reduce voice breaks, and laryngoplasties, in which laryngeal cartilage is altered to reduce tension.

H.hoangtn (talk) 12:48, 5 November 2016 (UTC)

Treatment of Dysphonia: Draft

Multiple treatments have been developed to address the various organic, functional, and psychogenic causes of dysphonia. Dysphonia can be targeted through direct therapy, indirect therapy, medical treatments, and surgery. Functional dysphonias may be treated through direct and indirect voice therapies, whereas surgeries are required for chronic, organic dysphonias. It is recommended that a combination of both indirect and direct treatment methods are used .

Direct therapies address the physical aspects of vocal production. Techniques employed by these therapies work to either modify medial compression of the vocal folds, manage breathing patterns, and/or change the tension at level of the larynx. Notable techniques include, but are not limited to, the yawn-sigh method, optimal pitch, laryngeal manipulation, humming, the accent method, and the Lee Silverman Voice Treatment. An example of a direct therapy is circumlaryngeal manual therapy, which has been used to reduce tension and massage hyoid-laryngeal musculature. This area is often tense from chronic elevation of the larynx. Pressure is applied to these areas as the patient hums or sustains a vowel. Traditional voice therapy is often used to treat muscular tension dysphonia.

Indirect therapies take into account external factors that may influence vocal production. This incorporates maintenance of vocal hygiene practices, as well as the prevention of harmful vocal behaviours. Vocal hygiene includes adequate hydration of the vocal folds, monitoring the amount of voice use and rest, avoidance of vocal abuse (e.g., shouting, clearing of the throat), and taking into consideration lifestyle choices that may affect vocal health (e.g., smoking, sleeping habits). Vocal warm-ups and cool-downs may be employed to improve muscle tension and decrease risk of injury before strenuous vocal activities. It should be taken into account that vocal hygiene practices alone are minimally effective in treating dysphonia, and thus should be paired with other therapies.

Medical and surgical treatments have been recommended to treat organic dysphonias. An effective treatment for spasmodic dysphonia (hoarseness resulting from periodic breaks in phonation due to hyperadduction of the vocal folds) is botulinum toxin injection . The toxin acts by blocking acetylcholine release at the thyro-arytenoid muscle. As a result, new innervation occurs and completes after 4-5 months. Although the use of botlinum toxin injections is considered relatively safe, patients' responses to treatment differ in the initial stages. Some patients have reported experiencing swallowing problems and breathy voice quality as a side-effect to the injections. Breathiness may last for a longer period of time for males than females.

Surgeries involve myoectomies of the laryngeal muscles to reduce voice breaks, and laryngoplasties, in which laryngeal cartilage is altered to reduce tension.

H.hoangtn (talk) 16:09, 22 October 2016 (UTC)

Treatment of Dysphonia: Outline

A clear weakness of this article is it's lack of content and elaboration on the subject of dysphonia treatment. Firstly, the article requires a thorough explanation of the etiology of the different types of dysphonia (e.g. functional vs. organic), and what some associated conditions might look like. At the moment, the article only describes the voice quality as "hoarse, breathy, harsh, or rough". However, the articles lists many types of dysphonia that differ in quality. Thus, this vague description is insufficient in describing the nuances between the different types. Once the associated conditions of each type of dysphonia are described, treatment methods targeting each condition can be highlighted. This treatment section will include systematic reviews and meta-analyses of the effectiveness of indirect/direct voice therapy and interventions.

The following articles will be used to edit this section:

1. Cohen, S. M., Kim, J., Roy, N., Asche, C. & Courey, M. (2012), Prevalence and causes of dysphonia in a large treatment-seeking population. The Laryngoscope, 122, 343–348.
2. Ruotsalainen, J., Sellman, J., Lehto, L., & Verbeek, J. (2008). Systematic review of the treatment of functional dysphonia and prevention of voice disorders. Otolaryngology-Head and Neck Surgery, 138, 557-565.
3. Ulis, J. M., & Yanagisawa, E. (2009). What's new in differential diagnosis and treatment of hoarseness?. Current opinion in otolaryngology & head and neck surgery, 17, 209-215.Y
4. Van Houtte, E., Van Lierde, K., & Claeys, S. (2011). Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge. Journal of Voice, 25, 202-207.Y
5. Whurr, R., Nye, C. & Lorch, M. (1998), Meta-analysis of botulinum toxin treatment of spasmodic dysphonia: A review of 22 studies. International Journal of Language & Communication Disorders, 33, 327–329.

Please feel free to add/comment on this section.

H.hoangtn (talk) 20:55, 16 October 2016 (UTC)

Great article! I like how you highlighted certain topics so the reader could learn more about them from a different article (e.g. The Lee Silverman Voice Treatment)! Your sources all look great too, all from reviews or meta-analyses. Just a couple things to consider: make sure every sentence is followed by a citation, and maybe try to simplify some of the complicated terms used if possible!. I was advised not to put spaces between my references and to only have 2-3 references after a given sentence just to keep the article flowing more smoothly. I'm not sure if references are to come before or after the periods but just make sure you're consistent with which one you choose, I think there was one instance where the reference came after but for the most part the references were before the periods. Great job keeping an objective tone to the article though! Great balance of sources throughout the article, there was no one article that was heavily cited in comparison to any other. You could expand more on the surgical treatments just to balance out the information you provide by types of treatment, unless it's another section of the article. Overall great work! I enjoyed reading up on this subject.Chloe.93 (talk) 00:22, 29 October 2016 (UTC)