A randomized controlled trial of the effects of flow phonation voice treatment for primary muscle tension dysphonia.

OBJECTIVE: The purpose of the study was to investigate the effects of flow phonation voice therapy on laryngeal physiology and vocal quality in persons with primary Muscle Tension Dysphonia (MTD1). METHODS: Seventeen participants with a diagnosis of MTD1 completed the study. Participants were randomized to two groups. Group 1 (9 participants) received flow phonation treatment and individualized vocal hygiene education for 12 sessions over six weeks. Group 2 (8 participants) received vocal hygiene education only for three weeks (6 sessions), followed by another three weeks (6 sessions) of both vocal hygiene instruction and flow phonation therapy. Treatment consisted of cup-bubble blowing, gargling, and stretch and flow exercises. Visual-perceptual. auditory-perceptual, acoustic, aerodynamic and voice-related quality-of-life measures were obtained at three time points: before treatment, three weeks after initiation of treatment and after completion of treatment. RESULTS: Voice quality was perceived to be significantly improved in both groups. Voice related quality-of-life trended toward improvement for both groups across time points. Changes in aerodynamic and acoustic measures did not reach statistical significance compared to baseline for both groups. Visual comparisons of laryngeal closure patterns demonstrated comparably better outcomes for Group 1. CONCLUSIONS: Results of this study indicate flow phonation exercises can potentially be favorably employed for individuals with MTD1. In particular, it appears that the exercises aid in alleviating vocal hyperfunction, as evidenced by visual perceptual stroboscopic analysis, and clinically improved auditory-perceptual measures.

"Prologues to a Bad Voice": Effect of Vocal Hygiene Knowledge and Training on Voice Quality Following Stage Performance.

PURPOSE: The purpose of this investigation was to determine the effects of intensive stage rehearsal and performance on perceptual, acoustic, and aerodynamic measures of voice, and to determine the impact of knowledge and practice of vocal hygiene on measures of voice during intensive vocal performance. METHODS: Nineteen stage actors who were participating in the Arkansas Shakespeare Theatre festival took part in the study. Each participant completed auditory-perceptual, acoustic, aerodynamic, and quality of life measures before and after 1 month of intensive rehearsals and stage performances. They also completed a questionnaire documenting their vocal use, vocal hygiene, and previous vocal training, if any. RESULTS: Subjects demonstrated statistically significant deterioration in auditory-perceptual measures and mean expiratory airflow. Other acoustic measures trended toward poorer outcomes after the performances; however, these were not statistically significant. Knowledge of vocal hygiene and vocal training did not have an impact on the change in vocal measures. CONCLUSIONS: Stage performances do impact vocal outcomes with reduction in quality and efficient use of airflow for voice production. Knowledge and practice of vocal hygiene have some impact on these changes; however, vocal hygiene may not be the best preventive strategy of potential phonotrauma in this subject population.