Immediate Effectiveness of Humming on the Supraglottic Compression in Subjects with Muscle Tension Dysphonia

Abstract

Aims: To verify whether humming corrects supraglottic compression in muscle tension dysphonia (MTD) patients. Methods: We enrolled 23 MTD participants (13 male, 10 female) showing supraglottic compression. Each individual was instructed to perform 3 types of phonation under transnasal laryngofiberscopy: natural phonation, humming phonation without pitch change and subsequent um-hum phonation, i.e. humming with pitch glide up as if agreeing with someone. The degree of supraglottic compression was estimated with 2 parameters. The false vocal fold and anterior-posterior indices (the FVF and AP indices) were calculated by normalizing the lateral width and AP length of the visible vocal cords at phonation normalized to the mean vocal cord length at inspiration, respectively. These indices were compared among the tasks. Results: All the MTD participants but 5 females accomplished decreases in the vocal roughness scores upon the phonatory tasks. The whole MTD group showed significant increases in the FVF and AP indices even after humming without pitch change with a dominance of the AP index. The humming-responsive MTD subgroup showed greater increases in both indices than the humming-resistant subgroup. Conclusion: These data demonstrate that humming corrects both the lateral and AP components of supraglottic compression in most MTD patients.

Immediate Effects of Humming on Computed Electroglottographic Parameters in Patients With Muscle Tension Dysphonia

“…In our previous study, 11 to verify the former two description, we investigated the immediate effects of humming on the degree of supraglottic compression and verified that the combination of humming and subsequent um-hum phonation immediately relieves supraglottic compression by repositioning the false vocal folds, arytenoids, and petiole of the epiglottis in MTD patients as well as nondysphonic speakers. In the present study, to verify the latter two description, we investigated immediate effects of humming on the glottal condition, that is, EGG computed parameters for the degree of glottal contact as well as the irregularity of vocal fold vibration.…”

“…Concerning the first hypothesis, our previous study 11 demonstrated that supraglottic compression is immediately released in humming-responsive MTD patients. The present series of MTD patients also exhibited supraglottic compression and produced successful humming and um-hum phonation.…”

“…Our previous study also demonstrated that not all MTD patients show an improvement in vocal quality during humming and subsequent um-hum phonation. 11 Twentyeight patients were initially recruited (21 males and seven females). In the present study, we included only MTD participants who achieved the tasks successfully with a decrease of more than one point in the R score assessed by two laryngologists while performing humming and um-hum phonation.…”

“…Recently, we measured the width and length of the visible vocal folds under transnasal fiberscopy and demonstrated that humming immediately relieves supraglottic compression during phonation in MTD patients. 11 EGG is a technique used to analyze the vibratory characteristics of the vocal folds by recording impedance changes across the larynx, 12 and the waveforms of EGG signals consist of a continuum of a simple waveform caused by repeated contacts and dissociations between the bilateral vocal folds during phonation. Accordingly, EGG-period perturbation quotient (PPQ) and EGG-amplitude perturbation quotient (APQ) are generally hypothesized to reflect the period irregularity and cycle-to-cycle variability of the vocal fold contact area, respectively.…”

Effects of a Voice Therapy Program for Patients with Muscle Tension Dysphonia

“…Educational material with advice on voice care, educational videos on vocal anatomy and physiology, and incentive to attend lectures on voice health held by the hospital and teaching institution were used. The direct therapy was comprised of airflow control techniques [12, 17, 28], nasal sound exercises [17, 18, 29], laryngeal manual therapy [5, 20, 21], and semi-occluded vocal tract techniques with the use of Finnish resonance tubes and a high-resistance straw [24, 30]. …”