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What is the Voice triangle and why should we activate it?

voice triangle


The voice triangle is a medical and preventive tool to detect future voice problems. Four years ago, precisely in 2018, we conducted a clinical trial to apply this methodology to 400 participants of a speech course at UCSAR, in Caracas, Venezuela.

It consisted of evaluating the anatomical structures of the Nose, Ear and Larynx, and demonstrating the relationship that this triangle has in the formation and pathologies of the voice.

Materials: Speculum, fronto-light, Orl unit, vasoconstrictors, gauze, gloves, spatula, video voice recording during phonation were used.

For the more specialised studies, the following were used: audiological study, Rhinomanometry, video stroboscopy, voice spectrogram and computerised tomography of the nose.

Collaborators: students of the speech course, the collaboration of Dr. Ramón Hernández, a phoniatrist.


Examination of the nose: consisted of evaluating the anatomical structures that form parts of the nostrils such as the turbinates, the nasal septum, by means of anterior rhinoscopy, after placing gauze with vasoconstrictors, allowing us to evaluate the size of the turbinates, to rule out mild, moderate and severe hypertrophy that produces nasal obstruction, We also evaluated the structure of the nasal septum and ruled out ridge, nasal spur, perforation and dysfunction of the nasal valves. These alterations of the anatomical elements produce alterations in the nasal timbre of the voice, causing hyponasality or hypernasality depending on the nasal pathology.


This causes phonation to depend on oral breathing to finish phoning which is unconscious, resulting in phono-respiratory incoordination, causing the air entering through the mouth, which is not filtered and does not have the right temperature, dries out the lubrication of the vocal cords, resulting in the first functional pathology such as vocal hypotonia or glottal hyatus, if this persists the friction of the vocal cords causes an inflammatory process in the middle third of both vocal cords called Vocal Nodules.


As a complementary study, Acoustic Rhinomanometry was performed, a test that allows the measurement of nasal areas and volumes, which would be well associated with Rhinomanometry and the patient's subjective sensation of nasal obstruction.

nostril examination
inferior turbinate hypertrophy
nasal pathology
Acoustic rhinomanometry
examination of the ear
audiological study
laryngeal pathology

Ear Examination: using the auditory otoscope we can visualise the external auditory canal and the tympanic membrane, it allows us to evaluate whether the patient has a cerumen plug in the external auditory canal, and the structure of the tympanic membrane, as a complementary study is the study of tonal and vocal audiometry and impedance audiometry, This allows us to assess the degree of hearing loss of the person and the impedance of the tympanic membrane to the sound wave. Any functional or organic pathology that generates a decrease in the auditory threshold for low or high-pitched sounds causes an increase in the intensity or volume of the patient's voice, causing lesions in the vocal cords, such as chordal haemorrhage.

Examination of the vocal cordsWe use indirect laryngoscopy by means of the Garcia mirror, allowing us to observe the structures of the phonatory apparatus such as the vocal cords during breathing and phonation. For patients with an exaggerated gag reflex, flexible nasopharyngolaryngoscopy is performed through the nose, after vasoconstriction of the turbinates, allowing us to make a video of phonation, and to complete and very slowly observe the vibration of the vocal cords, Video-Estroboscopy is a scan that uses an intermittent light synchronised with the frequency of the vocal cycle to evaluate the vibratory function of the vocal cords. When the patient has an inadequate breathing pattern, he/she is forced to breathe through the mouth as well, provoking laryngeal pathology.


The activation of the voice triangle in this study allowed us to obtain a surprising result, when 9% of the participants, i.e. 36 people, were fit from the TDV point of view, to use the voice as an instrument of work, in this case as a speaker, the rest, representing 91%, had nasal pathologies 80%, auditory pathology 10% and laryngeal pathology 10%, which required surgery and at the same time phoniatric rehabilitation.


ConclusionThis method of preventive diagnosis of functional and organic pathologies of the voice allows us to select quality participants for courses in voice-over, oratory, singing, etc.

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