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PAPERS: Kenneth MacKenzie, Audrey Millar, Janet A Wilson, Cameron Sellars, and Ian J Deary Is voice therapy an effective treatment for dysphonia? A randomised controlled trial BMJ 2001; 323: 658 [Abstract] [Full text]

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how to cure some dysphonia

Wendy McLean   (22 September 2001)

Suitable controls in voice therapy RCTs.

Neil Davidson Kelly   (18 October 2001)

how to cure some dysphonia 22 September 2001
Wendy McLean, retired home Send response to journal: Re: how to cure some dysphonia	As a recent patient with dysphonia I can testify to the considerable distress this causes. Voice therapy was ineffective. My problems improved considerably when treated with lansoprazone 30mg for two months - for the first month once daily in the morning and the second (at my suggestion) once a day at night. I had few symptoms of reflux when my dysphonia began although a barium X-ray later revealed a minor hiatus hernia. The consultant felt this was not the cause of my voice problems. As these improved when the head of my bed was raised by 5 inches with wooden blocks a trial of lansoprazole seemed reasonable. I would urge all those treating patients with dysphonia to suggest that they sleep on a slope to see if this improves their voice problems. If it does lansoprazole may be appropriate.
Suitable controls in voice therapy RCTs. 18 October 2001
Neil Davidson Kelly, 4th Year Medical Student Newcastle Medical School Send response to journal: Re: Suitable controls in voice therapy RCTs.	EDITOR- MacKenzie and colleagues(1) showed voice therapy was an effective treatment for dysphonia, based on self-reported and objective data. However, we would like to raise some issues concerning the methods. These may have implications for the validity of the authors’ conclusions. People with depression may be less likely to report improvements in their condition. Although both groups experienced depression, there was a significantly higher level in the control group at the start of the study. The authors recognise the vicious cycle of psychological factors and worsening dysphonia, and we wonder whether this might have affected their results. The difference in the improvement of dysphonia between the study groups was not controlled for depression. Improvement in the controls may have been underreported due to depression, resulting in a greater relative improvement in the treatment group. The social interaction experienced by the treatment group could give rise to a placebo effect, and we feel a purely observational control group may not have been appropriate. This possible effect could have been balanced by providing similar social contact to the observational group. Because of this, it is difficult to ascertain whether the improvement in voice experienced by the treatment group is a placebo effect or due to the complex intervention. Drop out rates were a major problem and the original target of 100 patients in each group could not be met. Although the authors state that they had 70 complete data sets in the treatment group, this does not correspond with the seemingly incomplete data in tables 2 and 3 of the full version found on the BMJ website. We think the initial number of controls in the flow chart on page 2 of the full version should read 104. We agree that this study is both relevant and important in the absence of an evidence base. We feel that further research is required to reinforce the authors’ conclusions, using a suitable control intervention and a greater number of subjects. Yours Faithfully, Neil Davidson Kelly fourth year medical student n.a.davidson-kelly@ncl.ac.uk Emma Bradshaw fourth year medical student Katy Edmonds fourth year medical student James Shawcross fourth year medical student 1: MacKenzie K, Audrey Millar, Janet A Wilson, Cameron Sellars, Ian J Deary. Is voice therapy an effective treatment for dysphonia? A randomised control trial. BMJ 2001; 323: 658-661. (see www.bmj.com for full version)