The effects of breath-holding on vocal fold adduction: implications for safe swallowing.

OBJECTIVE To determine the effects, if any, of 3 different breath-holding techniques on a person's ability to attain vocal fold closure (VFC) to successfully complete swallowing maneuvers. DESIGN Prospective, randomized study. SETTING Private practice. PATIENTS A total of 150 healthy volunteers recruited from private practice patients and community volunteers. Intervention Group 1 received the easy breath-hold instruction; group 2 received the inhale/easy breath-hold instruction; and group 3 received the hard breath-hold instruction. MAIN OUTCOME MEASURE Closure of true and false vocal folds following the breath-hold instruction. RESULTS In the easy breath-hold group, true VFC occurred in 82% of the subjects, and closure of both the true and false vocal folds occurred in 30%. In the inhale/easy breath-hold group, true VFC occurred in 62%, and closure of both folds occurred in 46%. In the hard breath-hold group, true VFC occurred in 86%, and closure of both folds occurred in 64%. The differences among the 3 groups were significant for true VFC (chi2=9.242; P=.01) and for closure of both folds (chi2=11.625; P=.003). CONCLUSIONS The hard breath-hold instruction was the most effective method to attain full laryngeal closure, and the inhale/easy breath-hold instruction was the least effective method to attain true VFC for safe swallowing.