Behavioral Therapies to Affect Tissue and Respiratory Physiology

Speech, swallowing and voice therapy is known to help patients 1) recognize and compensate for their limitations, 2) improve efficiency in voice production or swallowing, and 3) address ways to compensate for an impairment in order to improve function. However, there is a spectrum of abnormalities ranging from chronic cough to Paradoxical Vocal Fold Motion that respond to respiratory retraining therapy. Although behavioral in nature, this type of therapy takes advantage of neuroplasticity, which is also seen with dysphagia rehabilitation.

Similarly, vocal fold scarring can be a severe problem resulting in poor voice function. Behavioral therapies may also affect changes with vocal fold vibration through tissue plasticity. Investigations are underway in the following areas:

  • Treatments of chronic cough and Paradoxical Vocal Fold Motion using laryngeal desensitization therapy and respiratory retraining
  • Treatments for World Trade Center responders and others whose voices and breathing have been altered by exposure to irritants: The Grabscheid Voice Center, in conjunction with the Mount Sinai World Trade Center Program, has been treating World Trade Center responders who are continuing to have difficulties with breathing and speaking. Daniel McCabe, DMA CCC-SLP from the Grabscheid Voice Center reports that “There is an underreported group of responders who have had increasing difficulties since 9/11 with hypersensitivity to many smells, dust, smoke, and other irritants to their vocal cords. Because the vocal cords lay at the entrance to the pulmonary system, everything these responders inhaled at that time pass across the cords. Because the ability to detect irritants is so necessary to protecting the airway, they have been hypersensitized by that initial trigger on 9/11 and during clean-up. However, instead of their symptoms resolving, some of the responders’ symptoms have become worse over the past 11 years.” McCabe has been working with Rafael de la Hoz, MD and several others at Mount Sinai in developing treatments that can help de-escalate these patients’ hypersensitivities to their triggers. “We’ve had a very good response rate, and are continuing to refine our models.”
  • Combined treatments for stiff or scarred vocal cords
  • Development of new tools for measuring the singing voice (VRP) and vocal cord elasticity (device)

Publications and Presentations

  1. McCabe D, Altman KW, “Voice Therapy and Physiologic Efects: Do we do more than change behavior?,” 2013 Phonosurgery Conference: How Behavioral Treatment Can Enhance Surgical Outcomes, National Center for Voice and Speech, University of Utah, Salt Lake City, UT, July 18-19, 2012.
  2. McCabe D, Altman KW, “Prosody and voice: A review and therapeutic implications,” (poster), Annual Meeting of the Voice Foundation, Philadelphia PA, June 5-8, 2013.
  3. McCabe D, Altman KW, “Voice therapy and physiologic effects: Do we do more than change behavior?,” (poster) Fall Voice Conference, New York, NY, October 5-7, 2012.
  4. McCabe D, Altman KW, “The role of speech therapy for laryngeal desensitization and respiratory re-training in post-World Trade Center cough,” (poster) Fall Voice Conference, New York, NY, October 5-7, 2012.
  5. McCabe D, Altman KW, “Laryngeal hypersensitivity in the World Trade Center-exposed population: The role for respiratory retraining,” American Journal of Respiratory and Critical Care Medicine, 186: 402-403, 2012.
  6. Altman KW, Irwin RS, “Cough: A new frontier in otolaryngology,” Otolaryngology Head & Neck Surgery, 144: 348-52, 2011.
  7. Prufer N, Woo P, Altman KW, “Pulsed Dye and other Laser Treatment for Vocal Scar,” in Laryngology and Bronchoesophagology, PC Belafsky, ed. Current Opinion in Otolaryngology and Head & Neck Surgery, 18: 492-497, 2010.
  8. Mortenson MM, Woo P, Ivey C, Thompson C, Carroll L, Altman K, “The use of the pulse dye laser in the treatment of vocal fold scar: A preliminary study,” Laryngoscope, 118: 1884-1888, 2008.