Lip and Tongue Trills: Effective Treatment for Vocal Polyps Journal of Voice, March  2017

Daniela de Vasconcelos, Adriana de Oliveira Camargo Gomes and Claudia Marina Tavares de Araujo

This interesting research study recently published in the Journal of Voice explores the benefits of lip and tongue trills in the treatment of vocal polyps. These exercises, long practiced by singing teachers are classed as semi-occluded vocal tract exercises and this study provides further confirmation of their healing capabilities through the reduction of vocal loading and vocal fold collision. This study questions the traditional treatment methods of vocal polyps which is laryngeal microsurgery followed by post-operative speech therapy. This research argues the case for speech therapy as the initial treatment for vocal polyps and it provides small-scale evidence to support this new concept. The treatment of vocal fold polyps through speech therapy is a ‘non-invasive process that avoids the risks of laryngeal surgery.’

The research study consisted of 10 participants who had been diagnosed with polyps on the vocal folds and this group was divided into a control group and a treatment group. Each group consisted of two male and three female participants. The control group consisted of those participants who opted for surgery rather than treatment. All of the participants underwent an initial evaluation and were then re-evaluated after a three month period.

Treatment took place once a week for 45 minutes maximum over a ten week period. The vocal exercises were all performed in a seated position with hands resting on legs. The participants were asked to perform different variations of the ‘sonorous lip or tongue trill technique.’ Each variation lasted for three minutes and it began with a ‘comfortable, continuous production (without variation of frequency or intensity.)’ This means that there was no variation in pitch or loudness. This process was then repeated with pitch variations that resembled a lullaby followed by an ambulance siren requiring a modulation between two notes culminating in the tune of Happy Birthday. The participants performed each of these exercises for three minutes each. In between each three minute exercise, the participants drank water, noted down any physical symptoms and asked any questions considered necessary to the performance of the task. They were then asked to carry out these exercises three to five times per day and the average output across all five participants was 3.2 times daily.

The impact of the treatment was then assessed via a laryngoscopy, a perceptual and acoustic voice assessment, a questionnaire of vocal symptoms and a vocal self-assessment. The results showed a positive impact on three of the five participants. They reported a significant reduction of symptoms. This was substantiated by the acoustic evaluation which showed improvements in noise values and jitter. The size of the polyp and the degree of dysphonia also showed significant reduction post-treatment and participants were less hoarse and breathy. Of the remaining two participants one opted out of laryngeal surgery as they were satisfied with the improvements made. The study concludes that lip and tongue trill exercises were effective in 60% of the participants and it enabled surgery to be avoided in 80% of them. The study concludes by recommending speech therapy as a treatment option for vocal polyps.

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