Beyond Clinical Measures: A Mixed-Methods Study of a Systematized Voice Therapy Protocol for Perioperative Rehabilitation of Benign Vocal Fold Lesions

Voice disorders affect approximately 17.9 million U.S. adults annually, yet attrition rates in voice therapy remain high, with up to 65% of patients discontinuing treatment. Patients undergoing phonomicrosurgery for benign vocal fold lesions (BVFLs) face a postoperative period in which adherence to voice rest and rehabilitation protocols is critical to wound healing and recovery. Despite this, no systematized perioperative voice therapy protocol exists, and the patient experience during this recovery period remains largely unexplored. This dissertation employed a convergent mixed-methods design to evaluate a systematized voice therapy protocol grounded in the Rehabilitation Treatment Specification System for Voice (RTSS-Voice) framework. The protocol combined vocal hygiene education and resonant voice therapy delivered during a preoperative teletherapy session and patient-implemented during the initial 7 postoperative days. A quasi-experimental, pre-posttest design compared a prospective treatment group (n = 17) to a frequency-matched retrospective control group (n = 17) on aerodynamic, acoustic, and perceptual voice measures. Semi-structured interviews with treatment group participants were analyzed using reflexive thematic analysis, and the findings were integrated with quantitative results through joint display methodology. Quantitative analyses revealed significant Time × Group interactions for subglottal pressure and phonation threshold pressure; however, the direction of effects favored the retrospective control group, likely attributable to baseline asymmetry. No significant interactions emerged for acoustic or perceptual measures. A supplementary analysis indicated lower postoperative perceptual severity ratings in the treatment group after controlling for baseline. Qualitative analysis identified four themes: Preoperative Session as Foundation, Structure as Safety, Moderators of Adherence, and Navigating Uncertainty in Self-Guided Recovery. Integration revealed predominantly expansion meta-inferences with qualitative data capturing psychological and behavioral dimensions of the protocol’s impact that clinical voice measures were not designed to detect. This dissertation is the first mixed-methods study examining a systematized, RTSS-Voice-grounded perioperative voice therapy protocol for patients with BVFLs. Findings demonstrate that the clinical value of preoperative voice therapy extends beyond measurable changes in voice production to encompass patient readiness, self-efficacy, and emotional well-being. Results underscore the need for broader outcome measurement in voice rehabilitation research, including patient-reported outcome measures and mixed-method designs capable of capturing what standard clinical measures cannot.

Name thesis:degree_name

Doctor of Philosophy

Discipline thesis:degree_discipline

Communication Science and Disorders

Grantor

University of Houston

Year dc:date.issued

2026

Author dc:creator

• Dueppen, Abigail Jean

Advisor dc:contributor.advisor

• Joshi, Ashwini

Committee members dc:contributor.committeemember

• Gorniak, Stacey L.
• Daniels, Stephanie K.
• Kulesz, Paulina A.
• Thiessen, Amber L.

• Preoperative rehabilitation
• Benign vocal fold lesions
• Voice therapy
• Phonomicrosurgery
• RTSS-Voice
• Mixed methods

Language dc:language.iso

English

Handle dc:identifier.uri

https://hdl.handle.net/10657/21586

OAI identifier oai:identifier

oai:uh-ir.tdl.org:10657/21586