Table 1 The cricothyroid visor maneuver technique steps

1.

The hyoid bone is encircled with the thumb and index finger, which is worked posteriorly until the tips of the major horns are felt

2.

Light pressure is exerted with the fingers in a circular motion over the horns of the hyoid bone

3.

The procedure (1 and 2) is repeated, beginning from the thyroid notch and working posteriorly

4.

The posterior borders of the thyroid cartilage, just medial to the sternocleidomastoid muscles, are located, and the procedure is repeated

5.

With the fingers over the superior borders of the thyroid cartilage, the larynx is worked downward, and moved laterally at times

6.

With the thumbs of both hands over both sides of the visor, the structure is pulled away from both sides for opening of the visor

7.

The patient is asked to produce the vowel /a/ in a high-pitched voice for activating the cricothyroid muscle, as the larynx is worked downward. The patient is also asked to hum or prolong vowels, and any changes in vocal quality are noted. The improved voice was progressively shaped from vowels and words (i.e., counting, stating the days of the week), to short phrases, to sentences, and finally to conversation