An Analysis of the Effects of Voice Therapy on Patients

With Early Vocal Fold Polyps

Pan Zhuge, Huihua You, Hanqing Wang, Yulan Zhang, and Huanle Du, Jinhua, Zhejiang Province, China
Summary: Objective. This study aimed to analyze the voice characteristics of patients with early vocal fold polyps
and to investigate the effects of voice therapy on patients.
Methods. Voice therapy was conducted on 88 patients with early vocal fold polyps in an experimental group. Laryngostroboscopy, the voice handicap index (VHI), and the dysphonia severity index (DSI) were applied to evaluate the patients voice quality before and after treatment. Thirty-one healthy volunteers also underwent evaluation of voice quality
as a control group. The intergroup and intragroup differences in the results of laryngostroboscopy, VHI, and DSI were
compared statistically.
Results. In the experimental group, 22 patients withdrew from the treatment for various reasons. After voice therapy,
the cure rate was 30.3% (20/66). All the VHI values in the experimental group before treatment were statistically worse
than the values in the control group. The P and T values of the VHI in the experimental group were still worse after
treatment than the values in the control group, although the VHI did improve after treatment in the experimental group.
The maximum phonation time (MPT), jitter, I-low, and DSI were statistically different between the control group and
the experimental group both before and after treatment. Furthermore, the MPT, jitter, F0-high, I-low, and DSI improved
after treatment in the experimental group.
Conclusions. Patients with early vocal fold polyps have some degree of subjective and objective dysphonia. Voice
therapy can improve the voice quality in these patients.
Key Words: Vocal fold polypVoice therapyDynamic laryngoscopeVoice handicap indexDysphonia severity
index.

INTRODUCTION
Vocal fold polyps are a common benign proliferative lesion of
the vocal fold that present clinically in the superficial lamina
propria of the vocal fold. Currently, the exact pathogenesis of
vocal fold polyps has not been fully illustrated. PetrovicLazic et al (2015)1 reported that all analyzed acoustic
parameters in patients with vocal fold polyps improved after
the phonomicrosurgery and voice therapy, and they tended to
approach the values of the control group. However, an investigation by physicians from the Department of Otolaryngology in
America revealed that 91% of physicians choose voice therapy
as the preferred treatment for vocal fold nodules, but only 30%
of physicians choose voice therapy as the preferred treatment
for vocal fold polyps.2 The main reason may be that few studies
have been reported on the effects of voice treatment in patients
with vocal fold polyps. Particularly, there is a lack of large-scale
case studies reflecting the subjective and objective sound quality changes in patients with vocal fold polyps before and after
voice treatment. In a multivariate analysis of 158 patients diagnosed with vocal polyps who received voice therapy, Cho et al
(2011)3 suggested that among clinical factors such as the size,
location, site of origin, and color of vocal fold polyps, as well
as the presence of hypopharynx reflux, polyp size was the
only factor associated with the sound quality. In their study,
Accepted for publication August 19, 2015.
From the Department of Otolaryngology, Jinhua Central Hospital, Jinhua, Zhejiang
Province, China.
Address correspondence and reprint requests to Huihua You, Department of Otolaryngology, Jinhua Central Hospital, No. 351 Bright Moon Street, Jinhua 321000, Zhejiang
Province, China. E-mail: pzhhcn@126.com
Journal of Voice, Vol. -, No. -, pp. 1-7
0892-1997/$36.00
2015 The Voice Foundation
http://dx.doi.org/10.1016/j.jvoice.2015.08.013

smaller polyps were associated with a better effect of voice

treatment. Dursun et al (2010)4 found that, compared to patients
with large polyps, those with small polyps had significantly less
fundamental frequency perturbation (jitter). The previously
mentioned reports suggest that patients with small early vocal
fold polyps may exhibit specificity with regard to the pathogenesis, dysphonia characteristics, treatment, and prognosis of the
polyps.
The voice, a complex multidimensional phenomenon, is both
an acoustic phenomenon of vocal fold vibration and sound generation as a result of expiratory flow and a subjective psychological auditory phenomenon. Commonly used means of
clinical assessment of dysphonia include laryngostroboscopy,
the voice handicap index (VHI), dysphonia severity index
(DSI), and so forth.513
The main purpose of this study was to evaluate changes in the
degree of dysphonia in patients with early vocal fold polyps by
laryngostroboscopy, the VHI, and the DSI before and after
voice treatment. This study aimed to address the following
questions: (1) the characteristics of subjective and objective assessments of voice in patients with early vocal fold polyps; (2)
the effects of voice treatment on patients with early vocal fold
polyps.
MATERIALS AND METHODS
Clinical data
The experimental group was composed of 88 patients with
vocal fold polyps treated in the Department of Otolaryngology,
Jinhua Central Hospital, from June 2011 to December 2012,
with an average disease course of 4.05 1.11 months. In 41 patients, the polyps were bilateral, and in the others, they were
unilateral. The inclusion criteria were as follows: chief

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Journal of Voice, Vol. -, No. -, 2015

complaint of hoarseness; disease course of less than 6 months;

and a vocal fold polyp located at the junction of 1/3 of the front
and the middle of the vocal fold under a laryngoscope, presenting as a small fusiform translucent bulge with a diameter less
than 1/4 of the length of the vocal fold.3 The exclusion criteria
were as follows: vocal fold polyps with a diameter greater than
1/4 of the vocal fold length or pedunculated polyps; vocal fold
tumors; vocal nodules; or Reinke edema. During the experiment, 22 patients in the experimental group withdrew from
treatment for several reasons. The withdrawal rate was 25%
(22/88). The remaining 66 patients completed the treatment
program, including 18 men and 48 women. The mean age
was 37.52 9.17 years. In the control group, there were 31
healthy volunteers, including 9 men and 22 women, and the
mean age was 32.48 5.8 years. To ensure that the vocal folds
of the control subjects were healthy, these subjects had no
hoarseness or other clinical complaints, no chronic pharyngitis,
no chronic laryngitis, and no history of laryngopharyngeal or
esophageal reflux disease. The balancing test showed no significant difference in the age (t 0.904; P 0.369) and gender
(z 0.934, P 0.348) between the 66 patients that completed
the treatment in the experimental group and those in the control
group. Subjects in both the experimental and the control groups
signed informed consent forms. This study was conducted in
accordance with the declaration of Helsinki. This study was
conducted with approval from the Ethics Committee of Jinhua
Central Hospital. Written informed consent was obtained from
all participants.
Laryngostroboscopy
The polyps were detected using a laryngostroboscopy system
from XION, Berlin, Germany. For the examination, the subjects
sat in a quiet environment, and the pharyngeal mucosa was
anesthetized three times using 1% tetracaine spray. The subjects were asked to relax and breathe calmly. A rigid laryngoscope warmed to 70 was placed into the mouth of each
subject. The lens was closed to the posterior pharyngeal wall
and parallel to the level of the vocal fold. The subjects were instructed to produce /I/, and a designated examiner observed the
vocal fold polyp volume and location, as well as the vocal fold
vibration symmetry, period, amplitude, and closure, and the
mucosal waves on a television screen. These features were recorded on video, and the characteristics of the disease condition
were assessed.
Self-assessment of subjective dysphonia
A resident was designated to be responsible for interpreting the
significance of the investigation. Using the Chinese version of
the VHI,14 the subjects appraised themselves in three areas,
including physiology (P), function (F), and emotion (E). Each
part included 10 questions, and the responses represented the
frequency of occurrence: 0 represented never; 1 represented
very little; 2 represented sometimes; 3 represented
often; 4 represented always. The total score of each part
was the sum of the scores for the 10 questions. The scores
ranged from 0 to 40 points; the total score (T) was the sum of
the scores of the three parts, ranging from 0 to 120 points.

The higher the score for each part of the evaluation, the greater
the impact of dysphonia according to the patient. The higher the
total score, the more severe the subjective assessment of
dysphonia.
Objective acoustic and aerodynamic evaluation and
DSI calculation
The evaluation was conducted in a soundproof room (in line
with the acoustical criteria of a living room),15 using DiVAS
voice analysis software from XION, Germany. The subjects
wore a headset with a microphone, with 30 cm between the
microphone probe and the mouth. The subjects were asked to
relax and breathe calmly. Testing of maximum phonation
time (MPT), jitter, F0-high, and I-low was conducted according
to requirements, and the DSI scores were calculated.
MPT test
After performing deep breathing, the subjects persistently pronounced the vowel a with a conscious and comfortable pitch
and sound intensity for as long as possible. The test was conducted three times, and the result of the longest sound sample
was used for the analysis.
Jitter test
Examinees persistently pronounced the vowel a with a
conscious and comfortable pitch and sound intensity. The duration was approximately 3 seconds, and the test was conducted
thrice. The jitter value of each sample was evaluated from 0.5
to 1.5 seconds after the start. The average value from the three
trials was used in the analysis.
F0-high and I-low test
The examinees persistently pronounced the vowel a with a
conscious and comfortable pitch and sound intensity. This
particular comfortable pitch and sound intensity was recorded.
On the basis of this, examinees gradually pronounced the sound
with a pitch and sound intensity as high as possible and with a
pitch and sound intensity as low as possible. The average values
of F0-high and I-low from the three trials were used in the
analysis.
DSI score calculation
The DSI scores were automatically calculated using DiVAS
voice analysis software on the basis of the MPT, jitter, F0high, and I-low values.
Voice therapy programs
The patients in the experimental group received approximately
3 months of voice treatment in the form of a training program.
The subjects had one therapy session every 23 weeks. Each session lasted approximately 6090 minutes. Four physicians with
knowledge and skills required for voice therapy from the Department of Otolaryngology presented brief explanations of vocal
polyps and voice therapy. The main components of the training
program were as follows: (1) relaxation training; (2) breathing exercises; (3) vocal function exercises; (4) resonant improvement
exercises; (5) carryover exercises; (6) prevention of misuse and

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Pan Zhuge, et al

Therapy on Patients With Early Vocal Fold Polyp

abuse of the voice; (7) popularization of health knowledge related

to voice use.1619 At each session, the patients practiced the
techniques of correct voice emission. All patients received
voice-treatmenttraining materials produced by us with a
repeated emphasis on individualized practices at home, and the
effects of the patients home performance were evaluated at the
beginning of the subsequent session. Meanwhile, we discussed
the subjects progress with the exercises and answered any
questions in telephone follow-up visits.
Therapeutic evaluation
After the voice therapy, the patients in the experimental group
were reexamined by laryngostroboscopy. The disappearance
vocal fold polyps on VHI evaluation was the criterion for
cure. MPT, jitter, F0-high, and I-low were tested again, and
the DSI scores were calculated.
Statistical treatment
Statistical analysis was conducted using the SPSS 15.0 statistical software (SPSS Inc., Chicago, IL). If the data were consistent with a normal distribution and homogeneity of the
variance, the results were presented as the mean standard deviation, and significant differences in the means between two
groups were analyzed by a t test analysis. If the data were not
consistent with a normal distribution and homogeneity of variance, the results were presented as the median interquartile
range, and the rank-sum test was conducted to determine the
difference in the median between the two groups. The correlation between two continuous variables was tested by a simple
correlation analysis, and P < 0.05 was considered to represent
a statistically significant difference.

RESULTS
Reasons for withdrawal from treatment in the
experimental group
The reasons for withdrawal from the study are summarized as
follows: (1) Nine patients felt that voice therapy was complex
and incomprehensible (40.9%, 9/22); (2) Six patients felt that
the therapy had no effects (27.3%, 6/22); (3) Three patients
lived far away from the hospital and felt that participation in
the study was inconvenient (13.6%, 3/22); (4) Two patients
thought the frequent sessions would impact their work (9.1%,
2/22); (5) Two patients stated that they did not have time to
participate in the study (9.1%, 2/22).
Assessment results of laryngostroboscopy of
patients in the control and experimental groups
before and after voice treatment
The 66 patients in the experimental group presented polyps
located at the junction of 1/3 of the front and middle of the vocal
fold before treatment. The polyps presented as small fusiform
translucent bulges with a diameter less than 1/4 of the length
of the vocal fold. The surface had no induration-like change,
with is consistent with the diagnosis of early vocal fold polyps.
Fifteen patients had mild incomplete glottal closure (22.7%, 15/
66). After voice therapy, the polyps had disappeared in 20 of 66
patients (30.3%, 20/66), the size decreased in 35 of 66 patients
(53%, 35/66), and the size remained unchanged in 11 of 66 patients (16.7%, 11/66) on laryngostroboscopic examination. After voice therapy, the incomplete glottal closure resolved in 11
of 15 patients (73%, 11/15) (Figure 1).
No vocal polyps were observed in the control group. Two
control subjects presented mild incomplete glottal closure
(6.5%, 2/31).

FIGURE 1. (A) Unilateral vocal fold polyp was located in the junction of 1/3 of the front and middle of the vocal fold; (B) Bilateral vocal fold
polyp was located in the junction of 1/3 of the front and middle of the vocal fold; (C) Bilateral vocal fold polyp before voice therapy; (D) Bilateral
vocal fold polyp decreased in size after voice therapy; (E) Unilateral vocal fold polyp before voice therapy; (F) Unilateral vocal fold polyp disappeared after voice therapy.

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Journal of Voice, Vol. -, No. -, 2015

TABLE 1.
Spearman Correlation Coefficient of VHI and DSI in
Experimental Group Before Treatment
Parameter
MPT
Jitter
F0-high
I-low
DSI

TABLE 3.
The t Test Results of VHI Value in Control Group and
Experimental Group Before Treatment (xs)

0.222
0.028
0.258*
0.258*
0.106

0.453**
0.151
0.159
0.350*
0.009

0.517**
0.330
0.217
0.347*
0.048

0.457**
0.086
0.225
0.338*
0.027

VHI Value Experimental Group Control Group t Value

F
P
E
T

9.79 7.55
18.15 9.35
8.79 9.96
35.82 25.23

4.51 2.38
3.68 1.38
4.61 1.89
12.83 4.33

3.79**
8.55**
2.31*
5.02**

*P < 0.05, and **P < 0.01.

*P < 0.05, and **P < 0.01.

Analysis of the correlation between the VHI and DSI

in patients in the experimental group before
treatment
Before voice treatment, the 66 patients in the experimental
group had a mean function score of 9.79 7.55, a mean physiology score of 18.15 9.35, a mean emotion score of
8.79 9.96, and a mean total score of 35.82 25.23.
MPT was 17.13 3.92 seconds, jitter was 1.50 0.68%,
F0-high was 390.17 50.95 Hz, I-low was 58.30 4.45 dB,
and DSI was 0.26 1.46. The total values for the VHI showed
no significant correlation with the DSI before voice treatment
(Table 1).
Analysis of the correlation between the VHI and DSI
in patients in the experimental group after
treatment
After voice treatment, the 66 patients in the experimental group
had a mean function score of 6.29 6.07, a mean physiology
score of 12.56 7.71, a mean emotion score of 5.52 7.31,
and a mean total score of 24.25 18.81. MPT was
18.74 4.09 seconds, jitter was 1.27 0.50%, F0-high
was 408.98 46.24 Hz, I-low was 56.06 4.17 dB, and DSI
was 0.89 1.42. The total values for the VHI showed no significant correlation with the DSI after voice treatment (Table 2).
Comparison of the results of the VHI assessment
between the control group and the experimental
group before and after voice therapy
By independent sample t test analysis, the E, F, P, and T values
showed statistically significant differences between the control

TABLE 2.
Spearman Correlation Coefficient of VHI and DSI in
Experimental Group After Treatment
Parameter
MPT
Jitter
F0-high
I-low
DSI

0.115
0.033
0.113
0.238
0.086

0.162
0.134
0.000
0.198
0.014

0.429**
0.186
0.158
0.386**
0.004

0.275*
0.133
0.096
0.312*
0.039

*P < 0.05, and **P < 0.01.

group and the experimental group before treatment. Additionally, the P and T values showed statistically significant differences between the control group and the experimental group
after treatment (Tables 3 and 4).
Comparison of results of the DSI assessment
between the control group and the experimental
group before and after voice therapy
By independent sample t test analysis, MPT, jitter, I-low, and
DSI showed statistically significant differences between the
control group and the experimental group before and after treatment (Tables 5 and 6).
Evaluation of the effects of voice therapy in patients
in the experimental group
By paired sample t test analysis, the VHI- and DSI-related
values showed statistically significant differences in the experimental group before and after treatment (Tables 7 and 8).
DISCUSSION
In recent years, improved studies on the efficacy and complications of various types of microsurgeries for vocal fold polyps
(including CO2 lasers and injection of steroids) have been conducted,6,2022 confirming the important role of microsurgery in
the treatment of vocal fold polyps. However, patients must bear
the economic burden of inpatient surgery as well as the risks
associated with surgery (vocal fold scarring) and general
anesthesia. Furthermore, patients must observe strict voice
rest after surgery.23 For patients who do not want to undergo
surgical treatment for various reasons, voice therapy may be
an alternative treatment worth considering. Currently, rare
related studies on vocal fold polyps and voice treatment have
been reported. Schindler et al (2012)24 reported a study of 16

TABLE 4.
The t Test Results of VHI Value in Control Group and
Experimental Group After Treatment (xs)
VHI Value Experimental Group Control Group t Value
F
P
E
T

6.29 6.07
12.56 7.71
5.52 7.31
24.25 18.81

4.51 2.38
3.68 1.38
4.61 1.89
12.83 4.33

*P < 0.05, and **P < 0.01.

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1.57*
6.34**
0.68*
3.33**

Pan Zhuge, et al

Therapy on Patients With Early Vocal Fold Polyp

TABLE 5.
The t Test Results of DSI Value in Control Group and
Experimental Group Before Treatment (xs)

TABLE 7.
The t Test Results of VHI Value in Experimental Group
Before and After Treatment (xs)

DSI Value

Experimental
Group

Control
Group

t Value

VHI Value

MPT (s)
Jitter (%)
F0-high (Hz)
I-low (dB)
DSI

17.13 3.92
1.50 0.68
390.17 50.95
58.30 4.45
0.26 1.46

25.66 6.73
0.99 0.27
371.52 125.52
54.72 2.35
2.28 0.55

7.86**
3.97**
1.04*
4.20**
9.22**

F
P
E
T

Before
Treatment

After
Treatment

t Value

9.79 7.55
18.15 9.35
8.79 9.96
35.82 25.23

6.29 6.07
12.56 7.71
5.52 7.31
24.25 18.81

10.66*
11.57*
5.46*
9.43*

*P < 0.01.

*P < 0.05, and **P < 0.01.

consecutive patients who had 10 voice therapy sessions with an

experienced speech-language pathologist for a period of
12 months and were evaluated before and at the end of the
voice therapy using a multidimensional protocol that included
self-assessment measures and videostroboscopic, perceptual,
aerodynamic, and acoustic ratings. Videostroboscopic examination did not reveal resolution of the initial pathology in any
case. No improvement was observed in the aerodynamic and
perceptual ratings. A clear and significant improvement was
found using the Wilcoxon signed rank test for the mean values
of Jitt%, the noise-to-harmonics ratio (NHR), and the VHI
scores. Our findings suggest that there is a degree of subjective
and objective dysphonia present in patients with early vocal
fold polyps; after voice therapy, the cure rate was 30.3% in
the experimental group. The subjective and objective dysphonia
assessments of the patients (VHI and DSI) were improved
compared with those before treatment, but the values did not return to normal levels. This result is consistent with the findings
of the previously mentioned report. The mechanism of polyp
healing remains unclear. It is assumed that tissue remodeling
in the polyps eventually leads to polyp absorption; another possibility is that the sustained vocal trauma narrows the polyp
base, and the shearing force during the vocalization will eventually lead to polyp avulsion from the vocal fold.25 We believe
that the popularization of vocal training and vocal hygiene education will improve the health knowledge of patients and help
them to avoid voice misuse and abuse, reducing the occurrence
of sustained vocal fold mucosavibration trauma caused by

TABLE 6.
The t Test Results of DSI Value in Control Group and
Experimental Group After Treatment (xs)

certain sound behaviors and allowing for healing and absorption of the polyps. Continued practice allows patients to cultivate correct habits for soft vocalization and coordinates the
subglottic pressure and glottal closure so that the exhaled
airflow during vocalization is completely as much as possible
converted into the vibrating waves of the vocal fold, thus
improving the objective pronunciation quality of patients.
Furthermore, voice therapy allows patients to have a clearer understanding of the problems with their own voice, it relieves the
psychological anxiety caused by the voice quality disorder, they
experience improvements in the sound of their voice and
greater vocal comfort, and they establish reasonable therapeutic
expectations, thus improving the subjective self-assessment of
their dysphonia.
Our study also found that after voice therapy, 66 patients presented normal vocal fold vibration amplitude, mucosal wave,
symmetry, and periodicity, and 15 patients presented incomplete glottal closure, which was resolved in 11 patients. In
our analysis, vocal polyp is a proliferative disease that occurs
in the superficial lamina propria of the vocal fold. Early lesions
mainly include hemorrhage, edema, and fibrin deposition,
which evolves into tissue fibrosis, amyloidosis, or hyalinization
in the late stage, thereby leading to cladding vocal fold stiffness,
increased quality, decreased softness, and reduced resilience.
This results in a decreased mucosal wave and amplitude and
can even lead to changes in the symmetry and periodicity of
the vocal fold.4,26,27 Early small polyps are mainly
manifested by hemorrhage and edema and have little effect

TABLE 8.
The t Test Results of DSI-Related Value in Experimental
Group Before and After Treatment (xs)

DSI Value

Experimental
Group

Control
Group

t Value

DSI Value

MPT (s)
Jitter (%)
F0-high (Hz)
I-low (dB)
DSI

18.74 4.09
1.27 0.50
408.98 46.24
56.06 4.17
0.89 1.42

25.66 6.73
0.99 0.27
371.52 125.52
54.72 2.35
2.28 0.55

6.27**
2.90**
2.14*
1.66*
5.28**

MPT (s)
Jitter (%)
F0-high (Hz)
I-low (dB)
DSI

*P < 0.05, and **P < 0.01.

Before
Treatment

After
Treatment

t Value

17.13 3.92
1.50 0.68
390.17 50.95
58.30 4.45
0.26 1.46

18.74 4.09
1.27 0.50
408.98 46.24
56.06 4.17
0.89 1.42

6.32*
5.54*
7.45*
9.07*
9.63*

*P < 0.01.

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Journal of Voice, Vol. -, No. -, 2015

on the vocal fold vibration amplitude, mucosal wave,

symmetry, and periodicity of the patients. Incomplete glottal
closure is mostly caused by reduced function of the muscles
of the throat. Patients with incomplete glottal closure present
a partial loss of air during pronunciation, which affects the
voice strength. We believe that effective voice therapy can
help patients improve the incomplete glottal closure caused
by straining the throat muscles, which cannot be achieved
through microsurgical resection of vocal polyps alone.
As treatment, voice therapy takes longer than surgery. The
implementation of treatment and compliance of dysphonia patients can affect the results. Similar reports summarize clinical
factors that render patients unable to adhere to the treatment,
including physician inexperience, lack of compassion, lack of
adequate training time and effective follow-up visits, lengthy
appointments, inconvenience due to travel, and conflicts related
to training time and work.2830 Owing to cultural differences
and differences in customs, as well as differences in the level
of health care among different regions and countries, factors
affecting compliance with voice treatment may vary. Our
results show that 22 patients withdrew from the treatment,
and the main reasons included the feeling that the treatment
was complex, the feeling that the treatment had no effect, and
that travel for the treatment was inconvenient. These factors
may be related to our work experience, education, and the
health knowledge of patients, expectations for treatment, and
other factors. We have summarized the following aspects of
voice therapy, according to our experience: (1) the
development of detailed and reasonable arrangements for
training programs; (2) the stable involvement of three to four
experienced physicians in Otorhinolaryngology; (3) the use of
voice therapy training materials that are popular and easy to
understand; (4) the use of follow-up visits and good communication between the physician and the patient and between patients; and (5) the importance of reasonable expectations
among patients who are willing to accept voice therapy.
Voice is a complex and multidimensional phenomenon, and
voice quality requires a combination of a several subjective
and objective assessment methods. In recent years, studies on
the correlation between the VHI and DSI with regard to the
voice have been increasingly reported. The VHI has been
shown to have a high negative correlation with the DSI
(r 0.79, P < 0.001),31 but there are also reports that the
VHI is only weakly correlated with or not correlated with the
DSI.3235 Our results show that the VHI and DSI were not
significantly correlated in patients in the experimental group
before or after the voice treatment. The DSI is a
multiparameter assessment method for overall dysphonia in
patients, reflecting the objective physical acoustic
characteristics of vocal fold vibration in patients. The VHI is
a questionnaire composed of physical, functional, and
emotional areas to evaluate the effect of dysphonia in daily
life, emotional reactions caused by voice disorders, patient
perception of throat discomfort and sound changes, and other
subjective characteristics. Assessment results are affected
mostly by patient characteristics, disease course, social status,
level of education, the demand for professional sound use,

and social interaction sound use.34,36 Although the subjective

and objective voice qualities of the patients improved to some
extent after voice therapy, the different properties and
characteristics of the two assessment methods determine the
uncertainty of the relationship between the results. The VHI
and the DSI can evaluate different aspects of the voice, and
their combination provides a more comprehensive test to
evaluate the degree of dysphonia in patients with early vocal
fold polyps.
In summary, the voice is a complex multidimensional phenomenon. A single method cannot comprehensively assess
the overall effects of dysphonia in patients. Although the cure
rate of voice therapy was not high in the experimental group,
our results demonstrate that patients can achieve a voice quality
that is suitable for professional and social interaction through
vocal education and voice care learning. Therefore, voice therapy may be an important treatment option.
Acknowledgments
This article was supported by the grant of Zhejiang Provincial
Science Fund (No.2011C23129) and Jinhua Municipal Key
Project (No.2011-3-009).
All the authors declare that they have no conflicts of interest
regarding this article.
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