Objective: This paper seeks to determine the effects of ankyloglossia (‘tongue-tie’) on the singing voice, and whether treatment alters symptoms and performance outcomes.

Methods: A scoping review was undertaken with a single case study on a 34-year-old professional classical soprano with ankyloglossia. General and singing symptoms were present. Treatment protocol included pre- and post-operative orofacial myofunctional therapy, three treatments each of manual physical therapy, chiropractic, and OraLase laser therapy, over a two week period. These were followed by frenectomy with partial genioglossus myotomy using a LightScalpel Co2 laser.

Data was collected at six intervals, including same-day pre- and post-surgery. Singing was recorded between lingual frenectomy and labial/buccal frenectomies (lip/cheek ties; also present). Cone-beam computed tomography (CBCT) measured neutral position (N), peak inhalation (PI), and end of phonated expiration. Rhinometer, pharyngometer, inspirometer, spirometer, and range of motion tests were performed. Singing was recorded and analyzed by spectrogram using VoceVista Video Pro.

Results: Changes to the supraglottic structures were observed including an increase in airway volume by 18.68% (N) and 27.39% (PI), and a 54.1% increase at the minimum axial cross-section. The hyoid bone position shifted inferiorly by 3.34 mm (N) and 5.8 mm (PI), the posterior tongue lifted to the palate, and pharyngometer indicated 50.62% reduced collapsibility upon expiration.

Voice analysis demonstrated a 29.37% decrease in jitter, 20.51% decrease in shimmer, range expansion of one octave, and a 116.5% increase in dynamic variance (pianissimo to fortissimo). Peak expiratory flow rose by 9.6%, and maximum sustained note duration increased by 7.8 seconds, indicative of improved breath and phonation efficiency. Consistency over passaggi and legato singing improved, and inability to perform a lingual trill /r/ resolved. Suppleness and range of motion increased in the neck and shoulders (visible when singing), torso, and pelvic floor.

Conclusion: Ankyloglossia can restrict the vocal tract, producing singing symptoms and muscle tension dysphonia. The integrative treatment protocol was effective in reducing and/or resolving singing voice symptoms and enhancing vocal quality.