Use of Traditional Chinese Medicine in the treatment of vocal nodules

Elaine Kwong, Edwin Yiu, Fredrick Xie, BChiMed. Zhixiu Lin

Vocal nodules are one of the most commonly seen conditions in otolaryngological clinics (Herrington-Hall, Lee, Stemple, Niemi, & McHone, 1988). Although behavioral voice therapy has been shown to be effective in improving the voice quality of patients with vocal nodules and is used as the first-line treatment approach (Ramig & Verdolini, 1998), approximately 20% of patients did not necessarily benefit from it (Holmberg, Hillman, Hammarberg, Sodersten, & Doyle, 2001; Woo, Casper, Colton, & Brewer, 1994). In persistent cases, phonosurgery, though invasive in nature and has a potential risk of scarring, will be employed. However, it is not uncommon to find patients who exhibit recurrent vocal nodules even after surgical removal. It is therefore necessary to explore for treatment modalities beyond conventional treatment models. This paper will discuss the development of vocal nodules treatment from the Traditional Chinese Medicine (TCM) perspective. A review of the effectiveness of two major TCM treatment options, acupuncture and Chinese herbal medicine, will be discussed. Data on an acupuncture study showed that dysphonic subjects who received acupuncture on acupoints Hegu (LI4), Lieque (Lu7), Lianquan (CV23), Renying (St9) and Zhaohai (Ki6) within a six-week period showed significantly greater immediate improvements in voice range profile, auditory-perceptual voice quality, and vocal fold conditions. Convincing evidence on Chinese herbal medicine is lacking in the treatment of vocal nodules although a number of decotions and formulae have been proposed.

Acknowledgement
This study was supported by a grant from the National Centre for Complementary and Alternative Medicine (NCCAM), National Institute of Health (NIH) (1 R21 AT003879-01); Committee on Research and Conference Grant (2001-2002), The University of Hong Kong; Simon KY Lee Research Fund in Linguistics, Speech and Hearing Sciences Grant (2004-2005); and Sik Sik Yuen Education Research Fund (2005-2006), the University of Hong Kong.

Elaine Kwong, BSc., Edwin Yiu, PhD., Fredrick Xie, BChiMed. & Zhixiu Lin, PhD.
Institution: Voice Research Laboratory,
Division of Speech and Hearing Sciences, University of Hong Kong
Correspondence: Elaine Kwong, BSc.
Voice Research Laboratory
Division of Speech and Hearing Sciences,
The University of Hong Kong,
5/F Prince Philip Dental Hospital,
34 Hospital Road, Hong Kong
Tel: (852) 2859 0572 Fax: (852) 2559 0060
Email: jasperek@graduate.hku.hk

Prof Edwin Yiu, Ph.D.
Voice Research Laboratory
Division of Speech and Hearing Sciences,
The University of Hong Kong,
5/F Prince Philip Dental Hospital,
34 Hospital Road, Hong Kong
Tel: (852) 2859 0595 Fax: (852) 2559 0060
Email: eyiu@hku.hk

Frederick Tse, MSc, BChi Med.
Hospital Authority, Hong Kong SAR
Room 516N, HA Building,
147B Argyle Street. Kowloon,
Hong Kong.
Tel: (852) 23006331 Fax: (852) 28818058
Email: tfw686@ha.org.hk

Zhixiu Lin, PhD.
School of Chinese Medicine
The Chinese University of Hong Kong.
Shatin, N.T.
Hong Kong.
Tel: (852) 26096347 Fax: (852) 26037203
Email: linzx@cuhk.edu.hk

References:
Herrington-Hall, B. L., Lee, L., Stemple, J. C., Niemi, K. R., & McHone, M. M. (1988). Descriptions of laryngeal pathologies by age, sex and occupation in a treatment-seeking sample. Journal of speech and Hearing Disorders, 53, 57-64.
Holmberg, E. B., Hillman, R. E., Hammarberg, B., Sodersten, M., & Doyle, P. (2001). Efficacy of a Behaviorally Based Voice Therapy Protocol for Vocal Nodules. Journal of Voice, 15(3), 395-412.
Ramig, L. O., & Verdolini, K. (1998). Treatment Efficacy: Voice Disorders. Journal of Speech, Language and Hearing Research, 41, s101-S116.
Woo, P., Casper, J., Colton, R., & Brewer, D. (1994). Diagnosis and treatment of persistence dysphonia after laryngeal surgery: A retrospective analysis of 62 patients. Laryngoscope, 104, 1084-1091.