Speech teletherapy: new strategies for the treatment of voice disorders

Abstract

As demonstrated in the editorial by Martini A [1], technological advancements profoundly impacting the fields of Audiology and Phoniatrics had been developing over the past few years. With the challenges posed by the Coronavirus disease 2019 (COVID-19) pandemic, even greater novel demands have arisen [2]. Consequently, eHealth (i.e. mobile health, telehealth) has rapidly evolved and offered effective solutions for previously unmet patient needs during these unprecedented times. It is anticipated that as this technology improves, it will become more prevalent, reducing costs for health systems and expanding access to rural or distant areas [3]. The needs for this are great. In Italy alone, for example, approximately 2,000,000 patients require speech therapy for the treatment of speech and swallow disorders each year. Speech Therapy is a field that will likely benefit from the use of Telepractice, especially in the treatment of voice disorders, speech and language impediments, learning disabilities, facial nerve palsy, neurogenic and post-surgical dysphagia, and cochlear implant (CI) candidacy and speech perception outcomes. Voice disorders include heterogeneous pathologies often amenable to speech therapy. Examples include singing voice disorders, muscle tension dysphonia, benign laryngeal lesions (i.e. nodules, polyps), vocal fold paresis, and, sometimes, spasmodic dysphonia. All of these disorders require an integrated strategy and consistent exercise. The COVID-19 pandemic highlighted the necessity of maintaining treatment continuity to keep patients motivated while at home, while limiting their visits to the hospital and, therefore, the risk of contagion exposure. A hybrid telepractice approach, namely ‘speech teletherapy’, has been fundamental in helping our patients complete the rehabilitation process through weekly treatment sessions, consequently reducing the risk of relapse or worsening clinical status [4]. In Tables 1 and 2, we would like to introduce our proposal for the management of voice disorders via a telepractice model at our research hospital, Casa Sollievo della Sofferenza in San Giovanni Rotondo, Italy. The hybrid protocol includes ten individual sessions of laryngeal and respiratory exercises, both in an outpatient and virtual setting. Both adults and paediatric patients could benefit from this innovative approach when conducted by an appropriately trained speech therapist. During the first and fifth sessions, which are held at the clinic, a video of the treatment is recorded so that patients can correctly perform the exercises while at home. Additionally, the speech therapists communicate via phone or e-mail between all sessions to provide support and obtain validated questionnaire data both for clinical and research purposes. Although this protocol was established in the singular context of the COVID-19 pandemic, it presents several long-term advantages. Firstly, it allows support for patients in distant or underserved geographic areas. Secondly, it could allow a network between tertiary referral centres and local primary care settings with the administration of telehealth services in these settings for those without home telehealth capabilities, potentially expanding treatment options and reducing costs for health systems. Lastly, videos, recorded phone consultations, electronic consent processes, and overall technological refinements may allow for the utilisation of an