A randomized controlled trial of stretch-and-flow voice therapy for muscle tension dysphonia

Laryngoscope. 2015 Jun;125(6):1420-5. doi: 10.1002/lary.25155. Epub 2015 Jan 30.


Objectives: To investigate the effect of stretch-and-flow voice therapy on vocal function and handicap.

Study design: Randomized controlled trial.

Methods: Participants with primary muscle tension dysphonia were randomly assigned to experimental or control groups. Experimental participants received vocal hygiene education followed by 6 weeks of stretch-and-flow voice therapy. Control participants received vocal hygiene education only. Outcome variables consisted of a measure of vocal handicap (Voice Handicap Index [VHI]), maximum phonation time, s/z ratio, and acoustic measures. All measures were obtained at baseline prior to treatment and within 2 weeks posttreatment or at the end of the control period. The pre- to posttreatment measurement change (delta Δ) was applied to statistical analyses.

Results: A multivariate analysis of variance revealed significant group differences in pre-to-post changes on measures of VHI, maximum phonation time, and cepstral peak prominence (CPP) in connected speech and vowels (P = 0.003, 0.013, 0.025, and 0.017 respectively), with a significant reduction of VHI (Cohen's d = 1.6), increase in maximum phonation time (Cohen's d = 1.2), increase of CPP in connected speech (Cohen's d = 1.2), and increase of CPP in vowels (Cohen's d = 1.1) in the experimental group compared to the control group.

Conclusions: This preliminary small sample randomized controlled trial found significantly greater improvement in vocal handicap, maximum phonation time, and acoustic measures of vocal function after participants received stretch-and-flow voice therapy compared to participants receiving vocal hygiene education alone. Additional research incorporating larger samples will be needed to confirm and further investigate these findings.

Level of evidence: 1b.

Keywords: Dysphonia; flow phonation; muscle tension dysphonia; stretch-and-flow; vocal handicap; voice handicap index; voice therapy.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Dysphonia / physiopathology
  • Dysphonia / rehabilitation*
  • Female
  • Humans
  • Male
  • Multivariate Analysis
  • Phonation / physiology
  • Treatment Outcome
  • Voice Training*