SpeechPathology.com Phone: 800-242-5183

New master brand. Same great company. Introducing continued! Read Our Story

CRA Therapy Careers

Voice Therapy Post Surgical Removal of Polyps

Bridget Russell, Ph.D

August 20, 2007

Share:

Question

I have a patient who is going to have surgery to remove a polyp from the vocal cords. How soon after the surgery can she receive voice treatment? And do you have any suggestions about exercises? I am considering soft gliding/phonation and nasal sounds.

Answer

Physicians vary greatly in their post-surgical recommendations for any microlaryngeal or laser removal procedure that involves the vocal folds. The majority of sources recommend one week of strict vocal rest, meaning absolutely no talking or whispering. During this time, your patient should also avoid coughing or throat clearing, however, if they absolutely must, then tell them to use a breathy cough or throat clear. Avoid alcohol and keep well hydrated by drinking at least 64 ounces of fluids per day. Do not gargle with mouthwash; if they feel a need to gargle, use warm salt water. It should be clarified that although the recommendation for voice rest is about seven days, there are no adequate prospective trials comparing surgery with and without voice rest. Although, it seems likely that reducing traumatic forces at the surgical site would reduce the risk of scar formation. Certainly, when we make an incision elsewhere on the body, we discourage traumatizing it while healing. Phonation should be avoided until the epithelium has healed and can provide protection for the underlying lamina propria.

After the week of voice rest is complete, begin the patient talking quietly - absolutely no screaming or yelling should occur. Also, the patient should have a follow up strobovideolaryngoscopic examination. Continue the patient using only a breathy cough or throat clear and only when absolutely necessary. Limit milk products, as they tend to increase mucous so that the patient does not feel a need to clear their throat. Voice therapy with a speech pathologist is helpful in facilitating post-surgical healing.

Typically the SLP will gradually increase the patient's voice use over the next 2-6 weeks. After 6 weeks of therapy and gradual increase of vocal use, another strobovideolaryngoscopic examination should be performed. Ideally, individuals who opt for surgical removal of a vocal cord polyp should receive pre- and post-operative voice therapy. Pre-operative voice therapy is helpful in establishing a comprehensive vocal hygiene program to encourage optimal post-surgical recovery, including education as to post-surgical vocal guidelines. Post-surgical voice therapy typically involves vocal exercises designed to encourage healing, improve vocal quality, and prevent future lesions from occurring. Specifically soft vocal onset (i.e. easy onset voicing practice) is encouraged as an early mode of voice production using the typical /h/ sound to initiate words and then voicing after he initial easy contact of the vocal folds. Another technique used post-operatively is finding the patient's optimal pitch and loudness through the use of biofeedback techniques such as the Visipitch (Kay-Pentax Inc.). The patient will ultimately improve directly after surgery and voice rest, but the patient must be strongly advised of the causal link between the abusive behavior and the resultant polyp. Future changes in vocal behavior are necessary to maintain adequate vocal fold health.

Bridget A. Russell is an Associate Professor at the State University of New York Fredonia and directs the Speech Production Laboratory in the Youngerman Centers for Communicative Disorders at the University. She has published in the Journal of Speech, Hearing and Language (JSHLR), Speech and Voice Review. She has presented over 70 peer reviewed presentations at national and international conferences on voice and respiratory disorders. Dr. Russell also has served as an editorial consultant for JSHLR, National Science Foundation (NSF) and DelMar Publishing Group. Dr. Russell's research interests include voice disorders in children and adults, professional voice, and respiratory disorders of speech production.

Related Courses

Introduction to Tracheoesophageal Voice
Presented by Julie Bishop-Leone, M.A., CCC-SLP
Video

Presenter

Julie Bishop-Leone, M.A., CCC-SLP
Course: #6232 1 Hour
  'Course was very informative'   Read Reviews
This course is designed to give attendees the basic understanding of what tracheoesophageal (TE) voice restoration is and the role of the SLP in the rehabilitation process. Other topics to be reviewed are: determining who is a candidate, sizing the TE tract, the various types of TE voice prostheses and how they are placed, considerations for prosthesis selection, and how to initiate voice rehabilitation.

Trach Talk: Current Clinical Trends and Patient Perspectives
Presented by Kim Appel, MS, CCC-SLP, Meggin Nunamaker, MS
Video

Presenters

Kim Appel, MS, CCC-SLPMeggin Nunamaker, MS
Course: #6634 1 Hour
  'Great personal experience stories! This course covered a wide range of content'   Read Reviews
This course is designed for clinicians with varying levels of experience working with tracheostomy tubes. Indications for, and methodologies used to perform a tracheotomy, as well as applications for various trach styles, sizes, features, and communication options will be discussed. Best practices in assessment and treatment will be emphasized including documentation, subglottic suction, manometry, and upper airway auscultation. Unique perspectives and tips for practitioners will also be shared by a trach user.

Assessment of Speech Sound Disorders in Children with Cleft Palate &/or VPD
Presented by Angela Dixon, MA, CCC-SLP
Video

Presenter

Angela Dixon, MA, CCC-SLP
Course: #6723 1 Hour
  'Information was presented in a concrete and easy to follow manner'   Read Reviews
(This is the 1st course in a 4-part series, SSD in Children with Cleft Palate and/or VPD.) This course will review the primary components involved in assessing speech sound disorders in children with cleft palate and/or velopharyngeal dysfunction (VPD). Functional tools/techniques will be highlighted with the goal of determining when speech therapy is beneficial and when further medical referrals are necessary.

Therapy for the Child with Cleft Palate or Velopharyngeal Dysfunction
Presented by Lynn Marty Grames, MA, CCC-SLP
Video

Presenter

Lynn Marty Grames, MA, CCC-SLP
Course: #6734 1 Hour
  'The information shared will be useful for me but the presenter ran out of time'   Read Reviews
(This is the 3rd course in a 4-part series, SSD in Children with Cleft Palate and/or VPD.) This course will focus on speech therapy techniques for the child with articulation disorder related to cleft palate or velopharyngeal dysfunction. Practical therapy techniques that can be adapted for children aged 2 through the teen years are included.

Cleft Palate - What do I hear? What do I do?
Presented by Mary O'Gara, MA, CCC-SLP
Video

Presenter

Mary O'Gara, MA, CCC-SLP
Course: #6733 1 Hour
  'A great deal of information/examples'   Read Reviews
(This is the 4th course in a 4-part series, SSD in Children with Cleft Palate and/or VPD.) Case studies will be presented to discuss assessment and therapy techniques for individuals with cleft and craniofacial conditions. Audiovisual recordings will be provided to demonstrate speech resonance, airflow control and articulation problems in this population. Therapy goal setting will be discussed, with specific techniques for compensatory articulation strategies.