Frequently Asked Questions
Most frequent questions and answers
Usually, we use the 4-7 cmH2O backpressure level. This is the phonation threshold pressure (PTP) range which is an easy level for vocal fold vibration. We assume that the primary vibration (glottic wave) and secondary vibration (bubbling water) are in a kind of balance in the PTP range. To treat the glottic closure deficiencies, we use the high backpressure (which means between 10-35 cmH2O) in our therapy regimes. The lab research showed us that it is not possible to sustain glottic vibrations over 45 cmH2O. Of course, these numbers are to be considered within personal changes. The water bubbling provides a continuous (DC) backpressure with the water level and an additional vibratory (AC- alternant) backpressure by bubbling. To increase the DC backpressure it is possible to increase the water level, but it is not practical and hard to find a long bottle. The phonation tube should also be elongated. So this was the start for the DC-Valve devising process: Need is the mother of innovation.
During (DoctorVox Voice Therapy (DVT) sessions, we have discovered that the vertical glottic closure increases when we increased the backpressure. We made some experiments and made a research about the higher backpressure (higher than the PTP levels). Then used the high back pressure (up to 25cmH2O) in mutational falsetto patients. It worked efficiently for them and possibly; the vocalis segment of the thyroarytenoid muscle contraction was provoked by the high backpressure. We continued to use the high backpressure in glottic closure deficiencies, and the clinical studies go on. Higher back pressure levels also helped us for the vocal nodules (possible effect of mechanotransduction increased with high backpressure) and so on (coming soon!).
First of all, try to find professional help from an expert. The best way to apply the backpressure, in the beginning, is to choose a level in the PTP range. So, don’t rush, try to develop a pneumophonic concordance. Then gradually, you can increase the backpressure to develop the muscles. Tissues never lie: Believe in your feelings and do not try hard. Blowing without phonation may increase the risk of supraglottic hyperfunction. Please be careful not to contract your false vocal folds. We generally start with the basic DVT exercises (sostenuto and glissando especially). Then we increase the difficulty with combined DVT exercises. When we pass to the mask, we decrease the backpressure to the PTP range again. The DC-valve is easy to assemble/disassemble and you can switch between high-normal backpressure anytime. If you wish, you can also use the DC-only backpressure without water (DC-valve mounted maskVOX).
The answer can be given only after the vocological examination. But in general, voice therapy is a must. Surgery, if needed, maybe a therapy of choice.
Laryngeal dystonia (Spasmodic dysphonia, laryngeal tremor) is primarily a neurological disorder and beyond surgical interventions, Botox injection and, deep brain stimulation; voice therapy may be beneficial to some extent. Voice therapy, including DVT, has not yet been shown to be a primary choice of treatment. We use the DVT program and devices after Botox injection to increase the duration of effects; but again, we cannot give statistical data for the clinical results.
The DVT program and devices are quite useful for providing pneumophonic concordance to the user. Especially, the professional voice users including singers, speakers, theatre artists benefit from the DVT system.
The DoctorVox Method can be used for Unilateral VFP, also in pediatric cases. I would recommend starting with DVT preset exercise and then sostenuto- glissando- staccato. In advance, you can use maskVOX by reading and singing exercises. It would take at least 3 months to reach a chest register in general.
The oral mask is the main device that helps to transfer the primal sound skill to new vocal behavior. It is not easy to shift from the tube phonation to outside-speaking phonation. This was a missing step for me to defeat. The maskVOX was devised with this need. So you can go with the free articulatory movements plus resonance tube and backpressure at the same time. In time, the LAX VOX tube exercise (by Marketta Sihvo) and the DoctorVox Method has been separated in methodology and devices being used for.
Voice therapy and vocal training require personal contact to understand your vocal pattern and seek for solutions. In this way, problem-specific and person-specific therapy patterns can be constructed. If you are interested in semi occluded vocal patterns, then you can use the DoctorVox devices in this way. But solving a specific problem needs professional assistance, personal contact and, a thorough vocological examination, for sure.