title: Effects of voice therapy on vocal process granuloma: a phonoscopic approach.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Otolaryngology/Head and Neck Sugery, University of California, Davis, Medical School/Center, Sacramento, CA 95817, USA. rjleonard@ucdavis.edu
authors.forename: Rebecca
authors.initials: R
authors.lastname: Leonard
authors.forename: Katherine
authors.initials: K
authors.lastname: Kendall
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006099:Granuloma / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007818:Laryngeal Diseases / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013070:Speech Therapy / Q000379:methods*; D016896:Treatment Outcome; D014827:Vocal Cords / Q000503:physiopathology*; D014832:Voice Disorders / Q000209:etiology* / Q000628:therapy*; D014834:Voice Training