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BACKGROUND: Inducible laryngeal obstruction (ILO) accounts for or contributes to dyspnea in a noteworthy proportion of treatment seeking populations including those misdiagnosed with asthma. Despite increasing awareness of the disorder, literature exploring patient experience is limited. The aim of this work is to report patient perspectives on ILO and the way in which it impacts quality of life. METHODS: This qualitative study utilized methods detailed in the literature on grounded theory and phenomenological research to analyze interviews collected from participants diagnosed with ILO. Interviews were conducted, audio recorded, and transcribed. Transcriptions underwent content-analysis using Burnard's 14 step method [15], which included review of content codes across multiple raters until consensus regarding analyses was reached. RESULTS: Twenty-six participants were included in the study. Most participants were female (92%). Ages ranged from 18-72 with a mean age of 45 for female participants and 37 for male participants. Without specific prompting to do so, all participants offered descriptions of the specific symptoms they experienced and the triggers for their symptoms. In the content analysis process, "descriptions of symptoms and triggers" was thus labeled a theme that was present in all interviews. Seven additional themes were shared consistently and judged to encapsulate the interview material. These themes were: 2) diagnosis and treatment, 3) emotional impact of ILO, 4) perception of health and prognosis, 5) ameliorating factors, 6) influence of ILO on lifestyle, 7) the physical impact of ILO, and 8), social consequences of ILO. In addition, 54 subthemes were identified. CONCLUSIONS: Patients appear to place particular emphasis on the emotional and psychosocial consequences of ILO as well as factors that ameliorate the condition. As such, future efforts to treat ILO and to collect outcomes measures should account for these aspects of the patient experience.

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OBJECTIVE(S)/HYPOTHESIS: Virtual therapy (teletherapy) for patients with dysphonia has become ubiquitous in the COVID-19 era. However, barriers to widespread implementation are evident, including unpredictable insurance coverage attributed to limited evidence supporting this approach. In our single-institution cohort, our objective was to show strong evidence for use and effectiveness of teletherapy for patients with dysphonia. STUDY DESIGN: Single institution, retrospective cohort study. MATERIAL AND METHODS: This was an analysis of all patients referred for speech therapy with dysphonia as primary diagnosis from 4/1/2020 to 7/1/2021 and in whom all therapy sessions were delivered in a teletherapy format. We collated and analyzed demographics and clinical characteristics and adherence to the teletherapy program. We assessed changes in perceptual assessments and vocal capabilities (GRBAS, MPT), patient-reported outcomes (V-RQOL), and metrics of session outcomes (complexity of vocal tasks, carry-over of target voice) pre- and post-teletherapy using student's t test and chi-square test. RESULTS: Our cohort included 234 patients (mean [SD] age 52 [20] years) residing a mean (SD) distance of 51.3 (67.1) miles from our institution. The most common referral diagnosis was muscle tension dysphonia (n = 145, 62.0% patients). Patients attended a mean (SD) of 4.2 (3.0) sessions; 68.0% (n = 159) of patients completed four or more sessions and/or were deemed appropriate for discharge from teletherapy program. Statistically significant improvements were seen in complexity and consistency of vocal tasks with consistent gains in carry-over of target voice for isolated tasks and connected speech. CONCLUSIONS: Teletherapy is a versatile and effective approach for treatment of patients with dysphonia of varying age, geography, and diagnoses.

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Purpose: Voice therapy is heavily reliant on patient adherence for success, and patient perceptions are an important piece of understanding adherence. Patient perceptions of voice therapy have not been studied in the pediatric population. The purpose of this study was to examine patient, parent, and speech-language pathologists' experiences and perceptions of voice therapy and how they reflect barriers to and facilitators of adherence to therapy. Method: Participants took part in semistructured interviews, which were transcribed, and content analysis was completed using established qualitative methods of content analysis to identify themes and subthemes related to voice therapy adherence. Participants: Thirty-four voice therapy patients (of ages 4-18) and their parents and 5 pediatric speech-language pathologists were included in the study. Results: Seven primary themes with multiple subthemes were identified. The primary themes identified were as follows: (a) voice therapy is fun, (b) voice therapy is easy, (c) voice therapy is worthwhile, (d) the clinician-patient match matters, (e) support systems are helpful, (f) fitting it in, and (g) changing behavior is hard. Conclusions: Adherence to voice therapy in pediatric populations is complex and depends on multiple intrinsic and extrinsic factors. Identification of themes related to adherence in voice therapy should serve to assist clinicians in planning therapy and in developing treatment programs.

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