Throat Clearing, Coughing, and Alternative Behaviors

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Summary Chronic clearing behaviors are prevalent throughout the population of persons with voice disorders. Throat clearing and coughing have been deemed vocally abusive and are typically targeted to be reduced during voice therapy. The abusive behaviors are commonly replaced with less abuse clearing maneuvers inclusive of: soft throat clear, silent cough, hard swallow, and hard swallow with a fluid bolus. Although the prevalence of clearing behaviors and methods to diminish the use of the behaviors are well-known, there is a lack of scientific evidence as to the 'harmfulness' of these behaviors and their relationship with hydration. Likewise, no research has been accomplished investigating the alternative techniques taught to patients as compensatory strategies. Additionally, the effectiveness of both harmful and alternative clearing behaviors to displace mucus and to provide the patient with relief from the sensation remains unknown. The long-term aim of this research is to determine the efficacy of specific components in vocal hygiene therapy for patients with voice disorders which will increase treatment efficiency. There are two specific aims proposed to begin to reach the long-term goal. The first aim is to compare biomechanical, physiological components of phonation, phonation onset, soft throat clear, hard throat clear, silent cough, and hard cough within and between normophonic participants. This aim will focus on within participant differences of average velocity during these behaviors. The second aim is to compare pre- and post-clearing ratings of mucus aggregation and sensation removal among six clearing behaviors, soft throat clear, hard throat clear, silent cough, hard cough, hard swallow, and hard swallow with a fluid bolus. The result of both aims will be related to hydration measures. The aims will be accomplished through a research plan utilizing stroboscopy, high-speed videoendoscopy, and novel image processing techniques. Normophonic speakers and persons with voice disorders will participate in this research to allow for comparisons. It is expected that the outcome of this research will be relevant to public health by increasing our knowledge of behaviors commonly associated with voice pathology. The results of this study should provide increased knowledge to relate directly to methods of patient care. Narrative Four million and eighty thousand persons with voice disorders use habitual abusive clearing behaviors, which are considered one of the most prevalent forms of vocal abuse and linked to causing vocal fold lesions. By utilizing digital high-speed videoendoscopy, stroboscopy, hydration analysis and image analysis techniques, this research will provide objective data on the dynamics and kinematics of vocal fold movement and vibration associated with these behaviors, as well as data on alternative behaviors often advocated for in vocal hygiene education and voice therapy, and the relationship of both deleterious and ameliorative clearing behaviors with level of hydration. It is expected that the outcome of this research will be relevant to public health by increasing our knowledge of behaviors commonly associated with voice pathology and relating directly to methods of patient care.