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J Voice. 2017 Jan;31(1):124.e1-124.e10. doi: 10.1016/j.jvoice.2016.01.003. Epub 2016 Feb 4.

Computerized Tomography Measures During and After Artificial Lengthening of the Vocal Tract in Subjects With Voice Disorders.

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Department of Communication Sciences, University of Chile. Santiago, Chile; Department of Otolaryngology, Las Condes Clinic, Santiago, Chile. Electronic address:
Department of Radiology, University of Chile Hospital, Santiago, Chile.
Department of Otolaryngology, University of Chile Hospital, Santiago, Chile.
Department of Communication Sciences, University of Chile. Santiago, Chile.
Department of Otolaryngology, University of Chile, Santiago, Chile.



The present study aimed to observe the effect of two types of tubes on vocal tract bidimensional and tridimensional images.


Ten participants with hyperfunctional dysphonia were included. Computerized tomography was performed during production of sustained [a:], followed by sustained phonation into a drinking straw, and then repetition of sustained [a:]. A similar procedure was performed with a stirring straw after 15 minutes of vocal rest. Anatomic distances and area measures were obtained from computerized tomography midsagittal and transversal images. Vocal tract total volume was also calculated.


During tube phonation, increases were measured in the vertical length of the vocal tract, oropharyngeal area, hypopharyngeal area, outlet of the epilaryngeal tube, and inlet to the lower pharynx. Also, the larynx was lower, and more closure was noted between the velum and the nasal passage.


Tube phonation causes an increased total vocal tract volume, mostly because of the increased cross-sectional areas in the pharyngeal region. This change is more prominent when the tube offers more airflow resistance (stirring straw) compared with less airflow resistance (drinking straw). Based on our data and previous studies, it seems that vocal tract changes are not dependent on the voice condition (vocally trained, untrained, or disordered voices), but on the exercise itself and the type of instructions given to subjects. Tube phonation is a good option to reach therapeutic goals (eg, wide pharynx and low larynx) without giving biomechanical instructions, but only asking patients to feel easy voice and vibratory sensations.


functional dysphonia; semi-occluded exercises; tube phonation; vocal tract; voice therapy

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