Liuzijue Qigong, a New Method of Voice Training after Thyroidectomy Due to Unilateral Vocal Fold Paralysis: A Case Study

Background: Liuzijue Qigong (LQG), a traditional Chinese health exercise (TCHE), is often speculated to help improve respiratory function but few studies support this for improving vocal function. Case presentation: We studied LQG for individuals who experienced unilateral vocal fold paralysis (UVFP) after thyroidectomy and we noted some benefits. Videostroboscopy revealed the primary cause of hoarseness—paralytic vocal fold (VF) was fixed in a midline position, with a glottal flow leakage in the closing phases and irregular vibrations of the 2 VFs. Overcompensation was present in the normal side, followed by high pitch and phonotrauma. The vibration frequency of the 2 VFs varied when the fundamental frequency (F0) was changed, leading to diplophonia. We hoped to observe promotion of glottal closure using LQG to establish the correct breathing mode, with pitch inflection (lower pitch) relaxing intrinsic laryngeal muscles and improving breathiness (diplophonia appeared as F0 dropped from 191 to 124 Hz). We also hoped to see improvement of overall voice quality, specifically, pitch that reached a similar vibration frequency between both VFs, with LQG training relaxing the VFs and eliminating diplophonia. Four voice parameters were measured-normalized noise energy (NNE), jitter, shimmer and F0. Two perceptual parameters were measured, including diplophonia and grade of hoarseness (G). Conclusion: After LQG training, jitter, shimmer and NNE decreased significantly (p<0.01); F0 decreased dramatically (p<0.001); and diplophonia and G improved significantly (p<0.001). LQG training may help with regulating breath, establishing patterns of articulation, eliminating intensive voice, restoring regularity of VF movements and promoting glottal closure. Pitch regulation can be combined with LQG training to obtain proper tone and pronunciation and acquisition of similar vibration frequency between VFs eliminating hoarseness and diplophonia. The study has been approved by the clinical ethics committee of NO.7 hospital in Shanghai. The patient voluntarily joined the trial with informed consents and we promised that his legitimate rights and interests would not be violated. The results of the study were published on the premise of patient’s agreement for scientific purposes.