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Treating muscle tension dysphonia can be as simple as blowing bubbles, professor says

BOONE—Simple exercises like gargling or blowing bubbles in a cup of water are used by some speech pathologists to treat a serious voice disorder called muscle tension dysphonia (MTD).

They may seem like silly exercises, said Dr. Gary H. McCullough, but they reduce tension that prevents air flow through a person’s vocal cords.

McCullough is a professor and associate dean for research and graduate education in Appalachian State University’s College of Health Sciences. He and colleagues at the University of Central Arkansas (UCA), the University of Arkansas for Medical Sciences and the University of Pittsburgh are conducting research to determine who the exercises are best suited for, how the treatment impacts the voice, and the appropriate frequency of sessions using these flow phonation techniques to treat individuals with MTD.

His work is supported by a three-year grant from National Institutes of Health’s National Institute on Deafness and Other Communication Disorders. The grant, totaling nearly $309,000, was awarded while McCullough was at UCA prior to arrival at Appalachian in August.

In a pilot study at UCA where McCullough was a professor of communication sciences and disorders and a clinical speech-language pathologist, research volunteers were seen for 45 minutes twice a week for six weeks for treatment that included flow phonation and information about vocal cord hygiene.

“If your insurance covers 12 sessions, you’re lucky,” McCullough said. “Most people would get a maximum of 10 sessions a year with a speech pathologist. So we need to look at cost effectiveness. Can six sessions or three sessions be just as good?”

McCullough and his team continue to collect and analyze data from work at UCA. Next year, he plans to begin work with research volunteers at Appalachian.

MTD is the most common behavioral voice disorder seen in clinics around the country. McCullough estimates that 10 percent of the population experiences a voice disorder at some point in time and as much as 40 percent of those cases may be MTD. Particularly vulnerable are those who overuse their voice, like teachers, singers, salespeople, tour guides, the clergy and cheerleaders. But the problem can also result from gastroesophageal reflux, the common cold or emotional stress.

“Air flows through the vocal cords to make them work,” McCullough explained. “If the air flow is constricted because of tension, emotional stress or overuse, the vocal cords, which are two very delicate bands of muscle tissue, are strained.” Tension builds in supporting muscles, as well, and, eventually, “the entire larynx or voice box will shut down from the muscle tension.”

That’s when many people lose their voice entirely.

The simple, “silly” exercises, or flow phonation techniques, help patients relax their vocal cords. The technique has been used since the late 1970s after being developed by a doctor at Vanderbilt University.

The exercises’ seeming success is related to several factors. First, McCullough said, they provide immediate feedback. “If you get bubbles popping in the water, it means you have air coming out of your lungs through your vocal cords into the cup. If you can make a motor boat sound, then you’re letting the air flow through the voice box.”

Patients later transition to talking. “I think part of why this method works is that if emotions are creating this tension, then you want to do something a patient doesn’t have to think or worry about. You start with the non-speech exercises where you’re not consciously thinking about words, so you can escape the tension and get the larynx working. Then you move to speech.”

There are speech pathologists in voice centers around the country who believe the exercises work, but there has been no research conducted on the technique or the appropriate dose or frequency.

“As a researcher, I have been trained to ask questions that people have overlooked,” McCullough said. “Even though there is anecdotal evidence that this technique works, that doesn’t mean the treatment works. We need to provide data for all treatments and the gold standard is a clinical trial that focuses on treatment vs. no treatment and randomized, blind studies. Then we know if a treatment really works, and this grant allows us to do that.”