Duration of Straw Phonation, TRISMUS, THE NOSE, and PYV!

Duration of Straw Phonation...

Have you ever wondered HOW LONG to perform straw phonation?! The current research normally suggests that 2-5 minutes is very effective… which makes it so easy to sneak into your day… multiple times per day.

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Buuuut a new (2023!!!) study sought to determine the ideal performance time for those with healthy voices to use straw phonation, & the study aimed to investigate the immediate effect of straw phonation after 1, 3, 5, 7, & 10 minutes—utilizing measurements of acoustic parameters, EGG parameters, auditory-perceptual general voice quality, & the participants' perceptions of vocal effort and laryngeal discomfort during the SOVTE (semi-occluded vocal tract exercise).

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The participants performed straw phonation (using a 5mm diameter straw) for 10 minutes & data was collected before starting as well as immediately after the 1st, 3rd, 5th, 7th, & 10th minute of performance. The “test” included production of a prolonged /a/ for 5 seconds & reciting of a sentence three times.


There were a lot of interesting findings, but my favorites included: auditory-perceptual general voice quality was optimal at 3mins in women & at 5mins in men, while it deteriorated at 7mins in women & at 10mins in men. Vocal effort during the exercise increased at 7mins in women & at 10mins in men. The laryngeal discomfort during the exercise increased for both groups at 10mins.

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Conclusions included that the STRAW PHONATION EXERCISE in HEALTHY individuals promoted OPTIMAL effects on VOICE QUALITY after 5 & 7 minutes for men, and 3 & 5 minutes for women. Prolongation of the exercise time caused negative effects on voice quality & an increase in vocal effort & laryngeal discomfort as perceived by the participants. The results also found that the self-assessment results were congruent with the objective and subjective evaluations.

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(Tetik-Hacitahiroglu & Düzenli-Öztürk, 2023)

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Sooooooo, STRAW away my friends, but be aware of the duration of time you spend doing so. I PERSONALLY believe there IS benefit in only one minute of straw phonation… & I often teach a protocol that is 4-5 minutes in length depending on the type of straw work being done.

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PRIORITIZE YOUR VOICE. What SOVTE work have you done today?! #letsgo

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#voxfit #voice #vocalfitness #bevocallyfit #vocalhealth #vocalwellness #vocalwarmup #prioritizeyourvoice #protectyourvoice #healthyvoice #singer #fitnessinstructor #publicspeaker #occupationalvoiceuser #speechpathologist #voicespecialist #awareness #beproactive #straw #strawphonation #sovte #research

WHAT IS TRISMUS?

I know I talk mostly about voice & airway-related things on this page :), but I also work with A LOT of patients who currently have or have had head/neck cancer (HNC). I even recently started a local chapter of @spohncusa (which is an incredible SUPPORT organization that aims to raise awareness and meet the needs of individuals with oral, head, &/or neck cancer). Helping these individuals is truly another one of my PASSIONS (as are support groups). I would love to highlight a patient of mine named Frank… (he did mention I could use this picture ;) ). Unfortunately I met him a few years after he had already completed radiation therapy (RT) & surgical-related treatment for cancer of the tongue… And when I met him, he had significant trismus (which is reduced jaw opening, most often related to radiation &/or surgical effects)…
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Trismus is serious: medical complications include compromised airway, disrupted, cancer treatments, oral hygiene & dental treatment complications, pain & joint dysfunction, and dysphagia & lung infections. It also contributes to reduced quality of life, reduced oral access & difficulty eating, denture/prosthetic insertion & removal challenges, speech problems, & reduced social interaction. A clinical diagnosis of trismus is a MIO of less than 35mm. The cause of trismus is radiation fibrosis. Major risk factors for trismus include RT (with the highest risk if the radiation field includes the masseter &/or pterygoids), & additional risk with increased dosage (+10Gy increases risk of trismus by 24%). If there is RT to the pterygoid, there is a 93.8% incidence of trismus. Pre-existing limited opening is another risk factor as are T-stage 3-4 (lose 46% more MIO), flap surgeries, age (16% increase for over age 42), &/or chemo.
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Trismus is also common, with 32-50% of all HNC patients developing it (62-85% incidence in nasopharyngeal cancer & 54% incidence with oropharyngeal cancer— the “higher” the location, the higher the risk). A 2022 study by Jia et al. found that patient reported outcome measures (EAT-10 & UWQOL) were more abnormal in HNC patients with trismus versus those without.
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AFTER surgery & radiation therapy, incidence and severity of trismus increases over time. Post radiation loss of MIO is continual & progressive; there can often be a loss of MIO over the first year (24.6% in post radiated patients with nasopharyngeal cancer).
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Trismus is preventable. Early rehabilitation is helpful to decrease the occurrence of trismus in radiated patients & improve quality of life. Because radiation fibrosis is more inelastic and resistant than regular scar tissue, it’s progressive nature requires that most patients will continue to need to mobilize & stretch the jaw region for the rest of their lives in order to prevent the negative effects of trismus.
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There are a variety of protocols, but I most often recommend the 3-5-30 protocol & the Orastretch device.
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Soooo back to Frank!… at our first visit, his maximum interincisal opening (MIO) was ~18 mm. And thanks to therapy & use of the Orastretch device by @craniorehab , he’s measuring about 26mm now and stretching to 31mm. He also can eat with his dentures in and actually fit food and utensils in his mouth. It’s a journey of daily commitment, but I am SO proud of him.
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 #voxfit #voice #headandneckcancer #hnc #spohnc #trismus #orastretch #research #radiation #support #speechpathology #speechpathologist #voicespecialist #advocacy #advocateforyourpatients 

 THE NOSE...

Most of this information comes from an excellent book, called BREATH by James Nestor.  <3
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Mouth breathing has so many negative effects on us/our bodies…but did you know it alters our mental clarity/capacity? I’m not obsessed with animal studies, but a recent Japanese study showed that rats who had their nostrils obstructed and were forced to breathe through their mouth developed fever brain cells and took twice as long to make their way through a maze than nasal breathing controls.
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Another Japanese study on humans found that mouth breathing delivered a disturbance of oxygen to the prefrontal cortex, the area of the brain associated with ADHD, and nasal breathing had no such effects.
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Mouth breathing negatively impacts our jaw position, facial structure, dental health and hygiene, and airway patency. It also negatively impacts our blood pressure, mental/emotional state, immune function, sleep patterns, digestion, and allergy/sinus symptoms. It can cause headaches and put the body into a state of stress that can make us more quickly fatigued, and dramatically reduce athletic performance.
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“Mouth breathing changes the physical body and transforms airways for the worse. Inhaling air through the mouth decreases pressure which causes a soft tissues in the back of the mouth to become loose and flex inward, creating less space, and making breathing more difficult. Mouth breathing begets more mouth breathing. Inhaling from the nose has the opposite effect; it forces air against all those floppy tissues at the back of the throat, making the airways wider and breathing easier. After a while, these tissues and muscles get “toned” to stay in this open and wide position. Nasal breathing begets more nasal breathing.”
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The nasal cavity responds to whatever inputs it receives. When the nose is denied, regular use, it will atrophy. Keeping the nose constantly in use, however, changes the tissues inside the nasal cavity and throat to flex and stay open.
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There are SO MANY BENEFITS of nasal breathing… check out my posts from the past. Nasal breathing alone can boost nitric oxide SIXFOLD, which is one of the reasons we can absorb about 18% MORE oxygen than by just breathing through the mouth. 
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“Shut your mouth and save your life” (George Catlin)

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#voxfit #voice #breath #nasalbreathing #prioritizeyourvoice #healthyvoice #vocalwellness #vocalefficiency #vocaldynamics #speechpathologist #speechpathology #voicespecialist #fitnessinstructor #prioritizeyourhealth #vocalinstrument #occupationalvoiceuser #shutyourmouthandsaveyourlife

PYV: Anddd of course, always REMEMBER to PRIORITIZE YOUR VOICE! ... 

How are YOU prioritizing your voice today? And everyday? As an OCCUPATIONAL VOICE USER, it SHOULD be one of your top priorities! 

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What do you need to know to keep your voice healthy?  You should understand how the voice works, how to protect and care for your voice, and how to use your voice and entire vocal mechanism in the most efficient, effective, and dynamic ways possible.  
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I’m super PASSIONATE about this population of voice users (I’m one and most of you are too!), and am HERE TO HELP! Reach out with any questions, concerns, or if you’d like to work together. Email me at [email protected]