Treatment of laryngeal hyperfunction with flow phonation: A pilot study

Abstract

Context:While clinical successes and descriptions have been reported in a few texts, no data exist to define the utility of flow phonation to improve voice quality in patients with laryngeal hyperfunction. Aims: To provide pilot data regarding the utility of three exercises (gargling, cup bubble blowing, and stretch-and-flow) to improve phonatory airflow during voicing in patients with laryngeal hyperfunction. Settings and Design: Outpatient Voice and Swallowing Center in a University Medical Center. Materials and Methods: Participants received five treatment sessions and were evaluated prior to treatment and after each session using a Phonatory Aerodynamic System to measure airflow during voicing tasks. Noise-to-harmonic ratio and perceptual voice measures were also obtained, as was self-perception of voice handicap. Statistical Analysis Used: Repeated All increased airflow and decreased laryngeal airway resistance over five sessions. Measures Analysis of Variance. Results: Six participants completed the protocol. All participants decreased self-perception of voice handicap and improved on noise-to-harmonic ratio and perceptual ratings of vocal quality. Conclusions: Data derived on a small sample of patients in an exploratory investigation suggest further research into the use of these three exercises to improve airflow with voicing and improve vocal quality in patients with laryngeal hyperfunction is warranted.

Telepractice Versus In-Person Delivery of Voice Therapy for Primary Muscle Tension Dysphonia

“…Our sample size was particularly small. We determined sample size on the basis of statistical results from pilot data (McCullough et al, 2012), but those data were focused on the exercises themselves and not the use of telehealth technology. As stated, larger numbers guided by detailed power analyses are needed to more critically examine different types of MTD and changes in Rlaw in relation to phonatory airflow and tease out the effects of initial severity.…”

“…Variants of these exercises have been used with reported clinical success (Gartner-Schmidt, 2010). McCullough et al (2012) recently provided the first data-based study of this method's utility for improving airflow and decreasing symptoms of vocal hyperfunction. The authors reported data from six participants who were treated for primary MTD using flow phonation exercises for a 6-week period.…”

Evaluating the efficacy of voice therapy for functional, organic and neurological voice disorders

“…These studies provide a reasonable justification for the call for improved scientific evaluation of intervention effectiveness. However, to date, only two case series (Robey Phase 2) have examined the effects of flow phonation in a clinical population …”

“…However, to date, only two case series (Robey Phase 2) have examined the effects of flow phonation in a clinical population. 35,36 The need for careful and detailed documentation of therapy content has also received some attention in recent literature. Some key studies provide a detailed description of therapy content to allow for replication (e.g.…”

A randomized controlled trial of stretch‐and‐flow voice therapy for muscle tension Dysphonia

“…Stretch‐and‐flow (S n F) is a voice therapy program that targets attainment of a physiological balance between the vocal subsystems in patients with hyperfunctional voice disorders. S n F was first described by Stone and Casteel in the early 1980s and has also been referred to as flow phonation by a number of authors and clinicians . The fundamental target in S n F is to initiate volitional control over the vocal subsystems using voiced and unvoiced airflow stimuli while maintaining a perception of minimal muscular effort during phonation .…”