Combined Functional Voice Therapy in Singers With Muscle Tension Dysphonia in Singing

This paper has been based on a study that was conducted by the authors whose overall objective of study was to understand vocal tract function in singers, and the clarity of their voices after going through combined functional voice therapy. This combined voice therapy was being used in this study to eliminate the muscle tension dysphonia voice disorder the singers were experiencing.

Muscle tension dysphonia has a high correlation with the cause of voice disorders, due to the fact that it is the severe tension of both your laryngeal and paralaryngeal musculature(Journal of voice 2017). Muscle tension dysphonia also has a strong correlation to people who have high vocal demanding careers or hobbies for example singers, professors. Hence why this study was conducted primarily on singers and their own experiences and poor outcomes of having muscle tension dysphonia. Loss of voice resonance, loss of control of pitch and loudness, hoarseness, excess vocal effort and vocal fatigue, or neck tightness are the result of Muscle tension dysphonia. These results are what we associate with a voice disorder, hence the correlation of muscle tension dysphonia and voice disorders.

The conductors of the study focused on rehabilitating the vocalists voices and used several different assessment tools to identify the rehabilitation process. These assessments were videolaryngostroboscopy, palpation of the vocal tract structures, flexible fiberoptic evaluation of the pharynx and the larynx, perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, and the Voice Handicap Index. (journal of voice 2017). The overall research question these authors are seeking answers to is whether or not combined functional voice therapy can be an effective method to solving Muscle tension dysphonia in singers.

The authors conducted their research over a duration of three years with participants who had to fulfill the criteria. The criteria that applicants had to meet were that they had to have a diagnosis of Muscle tension dysphonia in singing, had to have at least one year of singing experience and had to be fully through puberty. The study ended up with 40 participants who were separated into groups, one being the Study group and another the Control group. The difference between the two groups was that the Study group received voice therapy while the control group did not. Both groups then went through multiple assessments.

Each person in either group had a full clinical evaluation done of their mouth, throat, vocal cords and lungs before their

rehabilitation treatment began. Another significant portion of the assessment is that of one’s posture in the standing position. It is necessary to see how while singing or speaking the upper body is functioning in specifically the neck, chest and abdominal walls as stated by (journal of voice 2017). As each participant was assessed they would earn a zero if they had proper movement and tension and a maximum of three points would be granted for any incorrect tension and movement. This exact assessment would be done twice, and blind of any previous results by two different examiners.

In addition to these assessments I have listed, throughout the study another assessment the participants underwent was one of their normal speaking by assessing their voices through a short conversation, as well as the assessment of their singing voice while singing a short vocal exercise. Wherever each participant displayed trouble and gained a higher score in, those areas would be where the rehabilitation would be focused moving forward in the study, each participant would vary. The rehabilitation would have a main focus on improving the participants singing voice however if there were any issues involved with their normal speech as well then some time would be spent on that as well.

Following this was the rehabilitation of ones posture however the most important remaining portion of a participants rehabilitation was to teach them to have awareness of their vocal tracts and how to manage the tension in their bodies upper region as well as their abdominal walls. The last two stages of this rehabilitation were creating positive breathing patterns, and enhancing one’s ability to consciously create an appoggio which means to create support. Furthermore, all of these assessments led to the final data.

The data in which the authors compiled was completely based on all of the assessment processes the participants went through. As mentioned earlier, each section of assessment was graded on a score basis ranging overall between zero and thirty-eight. The lower the number the better your proficiency in that specific area of assessment and the higher the number the more therapy needed to resolve the current problems in whichever area of assessment. The authors used many of other tools during their data analysis process such as Statistica 12 package (Dell Statistica Partner, the USA)(the journal), The nonparametric Wilcoxon pair test the nonparametric Mann-Whitney U test the Cronbach alpha coefficient and test-retest reliability and the r-Spearman coefficient (the journal.)

The results of some of the participants was the diagnosis of vocal nodules however the results show that with the intervention of the nodules through functional voice rehabilitation that the vocal nodules were gone. Any issues that were identified within a participants vocal tract at rest, while singing or also while speaking was completely maintained and improved after the intervention through functional rehabilitation. The participants voices when considering range and acoustics both significantly improved with rehabilitation. While the study also assessed the participants posture they noticed that with the rehabilitation correcting any posture issues, that there was a clear improvement in the amount of tension in the upper body area.