The effect of stretch-and-flow voice therapy on measures of vocal function and handicap

Summary Objectives To investigate the efficacy of stretch-and-flow voice therapy as a primary physiological treatment for patients with hyperfunctional voice disorders. Study Design Prospective case series. Methods Participants with a diagnosis of primary muscle tension dysphonia or phonotraumatic lesions due to hyperfunctional vocal behaviors were included. Participants received stretch-and-flow voice therapy structured once weekly for 6 weeks. Outcome variables consisted of two physiologic measures (s/z ratio and maximum phonation time), an acoustic measure (cepstral peak prominence [CPP]), and a measure of vocal handicap (voice handicap index [VHI]). All measures were obtained at baseline before treatment and within 2 weeks posttreatment. Results The s/z ratio, maximum phonation time, sentence CPP, and VHI showed statistically significant ( P d  = 1.25 and 1.96 respectively), and moderate for maximum phonation time and sentence CPP ( d  = 0.79 and 0.74, respectively). Conclusions This study provides supporting evidence for preliminary efficacy of stretch-and-flow voice therapy in a small sample of patients. The treatment effect was large or moderate for multiple outcome measures. The data provide justification for larger, controlled clinical trials on the application of stretch-and-flow voice therapy in the treatment of hyperfunctional voice disorders.