Contraction of the pharyngeal constrictor muscles that surround the throat. Or, the “pharyngeal squeeze.” It is the primarily the middle and inferior constrictor muscles that contract. When these muscles contract, they tense and narrow the pharynx. This action is particularly important for swallowing.
The pharynx also contracts when a person produces voice above a certain pitch in his or her range. The threshold for pharynx contraction depends in part on a person’s sex and age, and in women with peri-menopausal voice change (a condition in which they lose some capability and comfort in their upper vocal range), the pharynx will contract at a much lower pitch than otherwise expected. Thus, a clinician trying to diagnose peri-menopausal voice change can endoscopically view a patient’s pharynx and elicit different vocal tasks to see if the voice’s “muscular ceiling”—where the pharynx begins to contract—has lowered or not.
Pharynx contraction (1 of 2)
The pharyngeal constrictor muscles are relaxed during low-pitch phonation. Notice the open pyriform sinuses.
Pharynx contraction (2 of 2)
During high-pitch phonation, the pharyngeal constrictor muscles contract (in direction of green arrows) to obscure the pyriform sinuses; the midline is now evident (blue arrow).
Example 2
Pharynx contraction (1 of 2)
At low vocal pitch, the pharynx is uncontracted; pyriform sinuses are both widely open.
Pharynx contraction (2 of 2)
At high pitch, the pharynx contracts and surrounds the larynx more closely; pyriform sinus capacity is reduced.
Example 3
Pharynx contraction (1 of 2)
Laryngopharyngeal view of a young woman, phonating at F4 (~349 Hz). Here the pharynx is relaxed: notice the broad arc of the pharyngeal wall (green dotted line) and the widely open pyriform sinuses (blue dotted lines).
Pharynx contraction (2 of 2)
Same patient, now phonating at C5 (~523 Hz). The pharynx has contracted: notice the narrower, more pointed arc of the pharyngeal wall (green dotted line) and that the pyriform sinuses (blue dotted lines) are nearly closed. In this relatively young soprano, this degree of pharyngeal contraction should not occur until she sings as high as G5 (~784 Hz) or higher. This singer is experiencing loss of expected upper range—a lowered “muscular” ceiling of the voice.
Inappropriate Pharynx Contraction Is A Component of (MTD)
Rest Position of Pharynx (1 of 6)
This talented teenaged classical singer is bothered by a sense of effort, fatigue, and discomfort when attempting her high soprano notes. Quiet breathing (seen here) establishes the rest position of pharynx (dotted lines), with wide open pyriform sinuses (P). A thin sheet of muscle is just beneath the mucosa.
Inactive Pharynx Musculature (2 of 6)
Pharynx muscle should be inactive (not contracted) until a singer reaches the top few notes of his or her range. This singer is producing voice at B3 (247 Hz), a low note for this singer. The pharynx musculature remains inactive, like in photo 1.
Contracted Pharynx (3 of 6)
At B4 (495 Hz), which is only middle voice, the pharynx begins to contract, inappropriately. Note the smaller diameter of pyriform sinuses (see lines), and the more curved pharyngeal wall contour (dotted lines).
Contracted Pharynx (4 of 6)
At E-flat 5, still far from upper range, the pharynx is contracting a lot, and again inappropriately. This degree of contraction should not be seen until much higher in her range. If she sings continually at this pitch and higher, she will experience paralaryngeal discomfort and effort, and sometimes a “reaching up” vocal quality.
Greater Contraction of Pharynx (5 of 6)
Now at “only” F#5 (740 Hz), the contraction of the pharynx is maximal and pyriform sinuses closed. For a soprano, this degree of contraction is ideally not seen before reaching C6 (1046 Hz) or higher! As the pharynx is not designed for sustained contraction, upper voice singing will be impossibly uncomfortable for her.
Phonating Larynx (6 of 6)
Close-range visualization of the phonating larynx (note the vibratory blur) shows a characteristic posterior commissure gap (arrows). This finding is also characteristic of MTD.
Pharynx Contraction at Three Different Pitches
Panoramic view, A3 (1 of 3)
Panoramic view of laryngopharynx of an older middle-aged woman singing A3 (220 Hz). Pharynx here is uncontracted and both pyriform sinuses (within dotted lines) are maximal in size.
Contraction, A4 (2 of 3)
At A4 (440 Hz), the pharynx has begun to contract, and the pyriform sinuses have begun to close.
Maximal contraction, F5 (3 of 3)
At F5 (698 Hz), the pharynx is nearly maximally contracted and pyriform sinuses nearly closed completely. Sustained singing at this pitch and above will be effortful and cause discomfort, unless this singer can learn to “de-recruit” pharynx contraction via technical changes of voice production.
Pharyngeal Paralysis, Seen with Pharynx Contraction
Pharyngeal paralysis (1 of 2)
View of the laryngopharynx. This patient has pharyngeal paralysis on one side, which is already slightly evident because the posterior pharyngeal wall's midline (dotted line) is deviating here slightly to one side, even at rest.
Pharyngeal paralysis, more obvious with pharynx contraction (2 of 2)
The pharynx is contracted, and the posterior pharyngeal wall (midline again at dotted line) now deviates dramatically toward the non-paralyzed side of the pharynx. This pharynx contraction was elicited via extremely high-pitched voicing.
Strengthen Pharynx for Swallowing by Eliciting the “Pharyngeal Squeeze” Through Voice
Low range (1 of 4)
Production of voice in low range does not contract the pharynx. Both pyriform sinuses and post-arytenoid area are widely open to produce the outlined broad and mostly horizontal "swallowing crescent."
Upper middle range (2 of 4)
When the person produces upper middle voice, the swallowing crescent becomes smaller due to the start of the "pharyngeal squeeze" as inferior constrictor muscles begin to bulge anteriorly.
Top range (3 of 4)
Now reaching near the top of the range, the pharynx is contracting to hug the larynx more vigorously.
Highest note (4 of 4)
At the highest note this person can produce, pharynx contraction is maximal. The same degree of contraction occurs if that highest pitch is only mentally produced (i.e. without actually making sound). Voila! The patient can do pharynx "calisthenics" in short bursts throughout the day, without disturbing companions.
