Randomized Controlled Trial of Supplemental Augmentative and Alternative Communication versus Voice Rest Alone after Phonomicrosurgery

Objective. This randomized trial investigated voice rest and supplemental text-to-speech communication versus voice rest alone on visual analog scale measures of communication effectiveness and magnitude of voice use. Study Design. Randomized clinical trial. Setting. Multicenter outpatient voice clinics. Subjects. Thirty-seven patients undergoing phonomicrosurgery. Methods. Patients undergoing phonomicrosurgery were randomized to voice rest and supplemental text-to-speech communication or voice rest alone. The primary outcome measure was the impact of voice rest on ability to communicate effectively over a 7-day period. Pre- and postoperative magnitude of voice use was also measured as an observational outcome. Results. Patients randomized to voice rest and supplemental text-to-speech communication reported higher median communication effectiveness on each postoperative day compared to those randomized to voice rest alone, with significantly higher median communication effectiveness on postoperative days 3 (P = .03) and 5 (P = .01). Magnitude of voice use did not differ on any preoperative (P > .05) or postoperative day (P > .05), nor did patients significantly decrease voice use as the surgery date approached (P > .05). However, there was a significant reduction in median voice use pre- to postoperatively across patients (P < .001) with median voice use ranging from 0 to 3 throughout the postoperative week. Conclusion. Supplemental text-to-speech communication increased patient-perceived communication effectiveness on postoperative days 3 and 5 over voice rest alone. With the prevalence of smartphones and the widespread use of text messaging, supplemental text-to-speech communication may provide an accessible and cost-effective communication option for patients on vocal restrictions.