Digital Manipulation, Pressure and Massage

1. This technique is based on the need to reduce "cramping" in the extrinsic and intrinsic laryngeal muscles which is believed to be the cause of dysphonia in many patients. The massaging of the muscles induces relaxation, and the technique promotes a lowered laryngeal position, permitting ease of phonation.
2. The clinician should exert light pressure in a circular motion to the hyoid bone of the patient.
3. The clinician then moves the fingers into the thyrohoid space and carries out the circular motion massage, moving posteriorly from the thyroid notch area.
4. With the clinician's fingers along the superior border of the thyroid cartilage the clinician begins to gently exert pressure in a downward manner in order to move the larynx down.
5. The patient is asked to phonate vowels.
6. When a positive change in the voice is noted, the focus shifts to the production of that voice with and then without manipulation.