Karen has spoken to a number of colleagues in the Speech Therapy and ENT departments, and they have come up with a lot of ideas for research that would be beneficial in voice and healthcare. 

I will present several ideas here but Karen notes that if there is anything else health related that isn’t mentioned, the chances are that there will be somebody at the hospital who is really keen to help out with investigating any and all areas of research into communication and voice in a healthcare setting, and will be happy to put you in touch with the right people.

Here are a few of the ideas that Karen and her colleagues would be interested in exploring.

Idea 1: an interactive virtual reality model of the larynx

In order to help rehabilitate an impaired voice, the medical staff and the patient both need to have a good understanding of how the normal voice functions. Currently we have detailed anatomical models to help illustrate this, but these models do not move and are not interactive.

It would be wonderful to have a virtual or physical model of the larynx that accurately reflects the muscle movements that happen to make a voice, and that precisely replicates the gestures we make to change characteristics of the voice (e.g. pitch and volume changes). Many of the existing models reflect isolated gestures but in reality vocal movements are highly interdependent.

If it was possible to develop an accurate model to illustrate this, it would help enormously with patient understanding of the impact of certain lifestyle behaviours on the voice and the impact of certain vocal gestures.

Ideally, this model would be interactive so that we can replicate what is happening in our patient’s individual vocal tracts. For example, we would love to be able to paralyse a virtual vocal cord and arytenoid, or to add nodules to vocal cords to replicate what may be happening to a real patient.

Such a model would also be invaluable in providing a resource for surgeons to practise difficult techniques in phonosurgery. Virtual reality surgical models exist for other areas of the body. Is it possible to create a model like this in the larynx?

Idea 2: Non-invasive feedback device

When patients practise voice exercises, therapists have subjective feedback in the form of the sound of the voice, the appearance of the patient, patient reports on the sensations in the throat during phonation, and for some exercises we are able to obtain rudimentary feedback on breath support.

To obtain more detailed feedback on how a patient is making a voice, an invasive nasendoscopy procedure is required which requires a separate visit to hospital and a snapshot view of the muscles involved in phonation. This is limited by the fact that there is a camera inserted into the patient’s nose during this assessment which is uncomfortable and can lead to deviation from the patient’s normal phonation for the duration of the assessment. Some conditions (e.g. spasmodic dysphonia) are known to be greatly reduced during nasendoscopy which can make them very difficult to diagnose.

It would be great to investigate the possibility of developing a non-invasive device which can be used in the home to provide feedback on muscle activity, breath support, and optimum phonation threshold pressures to provide patients with accurate feedback on how efficiently they are able to produce a voice. Such a device could prevent patients from practising exercises ‘incorrectly’ or inefficiently, thereby dramatically reducing the time it takes to rehabilitate the voice. 

A longer-term goal would be to link a feedback device to a virtual reality model, thereby enabling a patient’s own vocal gestures to be replicated by the model. This could have huge implications for voice therapy as it would:

• enable a quicker and more accurate diagnosis through a 3D assessment of phonation instead of the top-down view we currently have;

• provide live biofeedback to enable patients to alter their technique in therapy exercises; and

• enable the therapist to gain a thorough understanding of what is happening in the vocal tract, instead of relying on subjective feedback and describing sensations during phonation (which is notoriously difficult for many people).

Idea 3: The Impact of Vaping on the Voice

The risk profile of smoking on the voice is well documented and includes Reinke’s Odema, cancer, irritation, and swelling in the vocal tract. We are seeing increasing numbers of people vaping and asking what the impacts of vaping are on the voice. Currently, there is no consensus as to whether vaping is better or worse than smoking and we do not understand the risks to the voice caused by vaping. This would be very valuable information that could inform us how to advise patients regarding this popular habit.

Idea 4: Laryngeal papilloma

There are various surgical and medical techniques used for treating viral laryngeal papilloma. This is a recurrent disease that often requires multiple surgeries throughout a patient’s lifetime. Current treatments include surgery with laser CO2, surgery with microdebrider, and vaccination. Is there an optimum combination of treatments that can reduce the severity and frequency of recurrence of this disease?

Idea 5: Steroid treatments of vocal cord palsy

Currently vocal cord palsies are treated with speech therapy or minor surgery (injection thyroplasty). Other conditions involving palsies (Bells Palsy/sudden sensorineural hearing loss) can be treated with steroid injections if caught early enough. Is there a role for steroid injections in the treatment of vocal cord palsy?

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These are just a few of the ideas, and we can put you in touch with the team if you would like further information about any of them. There were many other suggestions, including:

• The impact of mood and psychological influences on voice production and rehabilitation, in particular psychological barriers to rehabilitate the voice to an acceptable level.

• Patient perception of their voice disorder and the impacts of this on recovery.

• Possible links between hearing loss in spouses and the development of dysphonia.

• The impact of nasal pathology on voice.

• The impact of slow progress in voice therapy, and the frustrations associated with slow progress on recovery.

We are happy to put you in touch with Karen and her colleagues if you want to know more or if you have any other healthcare related ideas that you think they might be able to help with.