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Immediate effects of a semi-occluded water-resistance ventilation mask on vocal outcomes in women with dysphonia
Abstract
Introduction
Semi-occluded vocal tract exercises (SOVTEs) are frequently used exercises in voice therapy. An important shortcoming to most SOVTEs is the inability to include continuous speech in these exercises. A variation of water-resistance therapy (WRT), during which a patient phonates through a resonance tube ending in water, was developed to include continuous speech: the semi-occluded water resistance ventilation mask (SOVM-WR). The current study investigated the immediate effects of this innovative technique on vocal outcomes of women with dysphonia.
Methods
A pretest-posttest randomized controlled trial was performed. Twenty female participants were randomly assigned to the experimental SOVM-WR group or the WRT (control) group. A blinded multidimensional voice assessment was conducted before and after a 30-minute therapy session with the assigned technique.
Results
No significant changes were found in acoustic or auditory-perceptual vocal outcomes in either of the groups, except for a significant increase in lowest frequency in both groups. Patient-reported outcomes (PROMs) showed significant improvements of vocal comfort, vocal effort, and voice quality in both groups, and participants indicated that they would use the techniques at home.
Conclusions
The similar results of the SOVM-WR to WRT and promising PROMs confirm its suitability as an alternative to the latter technique. Potential reasons for a lack of improvement of objective and auditory-perceptual vocal outcomes are vocal fatigue, tube dimensions and immersion, and the small sample size. Large-scale and longitudinal research is needed to examine whether the SOVM-WR has a higher transfer to spontaneous speech than WRT after a full therapy program.
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IntroductionSemi-occluded vocal tract exercises, such as water resistance therapy (WRT), are widely used in voice therapy. However, the potential positive effects of such a therapy on vocal fold oscillation patterns in patients indicating a need for phonomicrosurgery have not yet been explored. The presented study aims to analyze the effect of WRT in patients suffering from vocal fold mass lesions.Materials and methodsEight participants with vocal fold mass lesions were asked to sustain a phonation on the vowel /i/ at a comfortable loudness and a fundamental frequency of 250 Hz (females) or 125 Hz (males). During phonation the subjects were simultaneously recorded with transnasal high-speed videoendoscopy (HSV, 20.000 fps), electroglottography, and audio signals. These subjects then performed a WRT (phonation in a silicone tube of 30 cm length, 5 cm below the water surface) for 10 min. Repeated measurements of sustained phonation were performed 0, 10, and 30 min after exercising. From the HSV data the glottal area waveform (GAW) was segmented and GAW parameters were computed.ResultsDuring WRT there was an increase of the GAW related open quotient and closing quotient. Immediately after WRT, there was a drop of both values followed by a rise of these parameters up to 30 min after the intervention. Furthermore, there was no correlation between GAW and electroglottographical open quotients.Conclusions
The effects observed after a single session of WRT on participants with vocal fold mass lesions showed a similar pattern to vocal fatigue.
Purpose:
The present study aimed at observing the possible differential effects of eight semioccluded vocal tract exercises (SOVTE) on vocal economy measured by the Quasi Output Cost Ratio (QOCR).
Methods:
Thirty-six participants were included in this study. They were divided into two groups: an experimental group of subjects diagnosed with mild hyperfunctional dysphonia (n = 17) and a control group of vocally healthy subjects (n = 19). Participants were required to randomly select and produce a series of three SOVTE from a list of eight exercises. The electroglottographic based measure QOCR was used to calculate the vocal economy before and after each voice exercise.
Results:
Significant differences were found when comparing pre and poststages regardless of the vocal condition (normal voice or dysphonia) or the specific SOVTE used. Moreover, when individually comparing the effect of each SOVTE, only tube in water (10 cm) showed significant differences between pre and postconditions (QOCR values were higher after exercises).
Conclusion:
In general, semioccluded vocal tract exercises tend to increase vocal economy regardless the vocal condition (normal voice or dysphonia) or the specific SOVTE used. Phonation into a tube submerged deep into water promoted the highest increase in vocal economy. An increased acoustic output, nonproportional increase in vocal folds adduction and an effortless voice production would cause this increase in vocal economy after water resistance therapy.
Objective:
The aim of this study was to determine the immediate effect of the resonance tube technique associated with ascending and descending glissando on the vocal range profile (VRP) of amateur choristers.
Method:
The sample consisted of 40 choristers aged between 18 and 57 years (average of 26.28 ± 7.51 years) with the following voice types: soprano, contralto, tenor and bass, with no vocal symptoms. Recordings of the VRP of the choristers were made before and after performing the resonance tube technique executed in ascending and descending glissando for 3 minutes in each modality. The recordings were made in the VRP of specific software.
Results:
The VRP of the choristers increased after application of the ascending and descending technique. Stratifying by voice types showed an increase in contralto, tenor and bass after the ascending glissando technique and in tenor and bass after the descending technique.
Conclusion:
The resonance tube technique associated with ascending and descending glissando increased the VRP in contralto, tenor and bass voice types, as well as the maximum frequency and range in hertz and semitones, in all the voice types of the choristers under study, justifying its application in the vocal warm-up of this population.
Objective:
This study aimed to investigate the duration of straw phonation effects using aerodynamic, electroglottographic, and acoustic metrics.
Methods:
Twenty-four participants were recruited to perform both a 5-minute and a 10-minute straw phonation exercise. Upon completion of the exercises, phonation threshold pressure (PTP), mean airflow, contact quotient, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio were measured over a 20-minute time frame. Parameters were measured before the intervention (baseline), immediately after the intervention (m0), 5 minutes (m5), 10 minutes (m10), 15 minutes (m15), and 20 minutes (m20) after the intervention.
Results:
PTP significantly decreased immediately after 5 minutes of straw phonation and returned to initial state within 5 minutes. PTP remained decreased over 5 minutes after 10 minutes of straw phonation. Mean airflow increased immediately after both 5 minutes and 10 minutes of straw phonations and remained improved for 20 minutes. No significant changes were obtained for contact quotient and acoustic parameters over the intervention period.
Conclusions:
The results extended our knowledge of proper clinical application of straw phonation regarding the duration of exercise. This study confirmed that 10 minutes of straw phonation lead to optimal and relatively continuous effects in PTP and mean airflow. Although straw phonation did show lingering effects in aerodynamics, repeated practices were recommended to obtain optimum and therapeutic effects.
Objectives/hypothesis:
Traditional semi-occluded vocal tract therapies have the benefit of improving vocal economy but, do not allow for connected speech during rehabilitation. In this study, we introduce a semi-occluded face mask (SOFM) as an improvement upon current methods. This novel technique allows for normal speech production, and will make the transition to everyday speech more natural. We hypothesize that use of an SOFM will lead to the same gains in vocal economy seen in traditional methods.
Study design:
Repeated measures excised canine larynx bench experiment with each larynx subject to controls and a randomized series of experimental conditions.
Methods:
Aerodynamic data were collected for 30 excised canine larynges. The larynges were subjected to conditions including a control, two tube extensions (15 and 30 cm), and two tube diameters (6.5 and 17 mm) both with and without the SOFM. Results were compared between groups and between conditions within each group.
Results:
No significant differences were found between the phonation threshold pressure and phonation threshold flow measurements obtained with or without the SOFM throughout all extension and constriction levels. Significant differences in phonation threshold pressure and phonation threshold flow were observed when varying the tube diameter while the same comparison for varying the tube length at least trended toward significance.
Conclusions:
This study suggests that a SOFM can be used to elicit the same gains in vocal economy as what has been seen with traditional semi-occluded vocal tract methods. Future studies should test this novel technique in human subjects to validate its use in a clinical setting.
Objectives:
This study aimed to characterize the pressure-flow relationship of tubes used for semi-occluded vocal tract voice training/therapy, as well as to answer these major questions: (1) What is the relative importance of tube length to tube diameter? (2) What is the range of oral pressures achieved with tubes at phonation flow rates? (3) Does mouth configuration behind the tubes matter?
Methods:
Plastic tubes of various diameters and lengths were mounted in line with an upstream pipe, and the pressure drop across each tube was measured at stepwise increments in flow rate. Basic flow theory and modified flow theory equations were used to describe the pressure-flow relationship of the tubes based on diameter and length. Additionally, the upstream pipe diameter was varied to explore how mouth shape affects tube resistance.
Results:
The modified equation provided an excellent prediction of the pressure-flow relationship across all tube sizes (6% error compared with the experimental data). Variation in upstream pipe diameter yielded up to 10% deviation in pressure for tube sizes typically used in voice training/therapy.
Conclusions:
Using the presented equations, we can characterize resistance for any tube based on diameter, length, and flow rate. With regard to the original questions, we found that (1) For commonly used tubes, diameter is the critical variable for governing flow resistance; (2) For phonation flow rates, a range of tube dimensions produced pressures between 0 and 7.0 kPa; and (3) The mouth pressure behind the lips will vary slightly with different mouth shapes, but this effect can be considered relatively insignificant.
Suggests a practice exercise using a straw. Notes that the basic intent is to alter the acoustic load, which is normally very low in comparison to the glottal impedance in a vowel. Contends that phonating into a small-diameter straw establishes an overall large positive pressure throughout the vocal tract with the semi-occlusion at the lips, the vocal folds are kept apart, vibrating only with a small amplitude in a horizontal plane, and this is healthy for the tissues while the abdominal muscles get a good workout. Includes references.
To date, no instruments exist to quantify the psychosocial consequences of voice disorders. The aim of the present investigation was the development of a statistically robust Voice Handicap Index (VHI). An 85-item version of this instrument was administered to 65 consecutive patients seen in the Voice Clinic at Henry Ford Hospital. The data were subjected to measures of internal consistency reliability and the initial 85-item version was reduced to a 30-item final version. This final version was administered to 63 consecutive patients on two occasions in an attempt to assess test-retest stability, which proved to be strong. The findings of the latter analysis demonstrated that a change between two administrations of 18 points represents a significant shift in psychosocial function.
Phonation into glass tubes ('resonance tubes'), keeping the free end of the tube in water, has been a frequently used voice therapy method in Finland and more recently also in other countries. The purpose of this exploratory study was to investigate what effects tube phonation with and without water has on the larynx. Two participants were included in the study. The methods used were high-speed imaging, electroglottographic observations of vocal fold vibrations, and measurements of oral pressure during tube phonation. Results showed that the fluctuation in the back pressure during tube phonation in water altered the vocal fold vibrations. In the high-speed imaging, effects were found in the open quotient and amplitude variation of the glottal opening. The open quotient increased with increasing water depth (from 2 cm to 6 cm). A modulation effect by the water bubbles on the vocal fold vibrations was seen both in the high-speed glottal area tracings and in the electroglottography signal. A second experiment revealed that the increased average oral pressure was largely determined by the water depth. The increased open quotient can possibly be explained by an increased abduction of the vocal folds and/or a reduced transglottal pressure. The back pressure of the bubbles also modulates glottal vibrations with a possible 'massage' effect on the vocal folds. This effect and the well-defined average pressure increase due to the known water depth are different from those of other methods using a semi-occluded vocal tract.
Introduction
Semi-occluded vocal tract exercises (SOVTE) are often used in voice clinics. SOVTE change the acoustic vocal tract impedance in relation to the glottis impedance, improving voice quality. However, differences among SOVTE, such as the number of vibration sources into the vocal tract, are often disregarded by clinicians. Some SOVTE present single, whereas others double source. This study aims at investigating changes in voice production pattern for a series of SOVTE. A combined exercise (tongue-trill coupled with hand-over-mouth) was implemented to illustrate the effect of a secondary source of vibration in the vocal tract.
Method
Twenty-three healthy volunteers performed a series of SOVTE: LaxVox, straw, lip-trill, tongue-trill, hand-over-mouth, humming, and tongue-trill combined with hand-over-mouth. Comfortable phonation served as control exercise. The dependent variables were electroglottography contact quotient (CQ), contact quotient range (CQr), fundamental frequency (F0), fundamental frequency range, and difference between the first formant frequency and F0 (F1 − F0).
Results
A significant difference for CQr scores compared with comfortable phonation was found for the combined tongue-trill with hand-over-mouth, lip-trill, LaxVox, and tongue-trill exercises. The F1 − F0 acoustic analysis showed significant differences in scores for exercises with one versus two sources of vibration.
Discussion and Conclusion
The results indicate that SOVTE should be divided into two groups, as follows: (a) steady (single sourced) with lower CQr and F1 − F0 difference (hand-over-mouth, humming, and straw) and (b) fluctuating (dual source) with larger CQr and F1 − F0 difference (tongue-trill, lip-trill, and LaxVox). Because of these differences, also different therapeutic effects can be expected. Tongue-trill combined with hand-over-mouth exhibited mixed effects of both the exercise groups.
Aims:
To verify whether humming corrects supraglottic compression in muscle tension dysphonia (MTD) patients.
Methods:
We enrolled 23 MTD participants (13 male, 10 female) showing supraglottic compression. Each individual was instructed to perform 3 types of phonation under transnasal laryngofiberscopy: natural phonation, humming phonation without pitch change and subsequent um-hum phonation, i.e. humming with pitch glide up as if agreeing with someone. The degree of supraglottic compression was estimated with 2 parameters. The false vocal fold and anterior-posterior indices (the FVF and AP indices) were calculated by normalizing the lateral width and AP length of the visible vocal cords at phonation normalized to the mean vocal cord length at inspiration, respectively. These indices were compared among the tasks.
Results:
All the MTD participants but 5 females accomplished decreases in the vocal roughness scores upon the phonatory tasks. The whole MTD group showed significant increases in the FVF and AP indices even after humming without pitch change with a dominance of the AP index. The humming-responsive MTD subgroup showed greater increases in both indices than the humming-resistant subgroup.
Conclusion:
These data demonstrate that humming corrects both the lateral and AP components of supraglottic compression in most MTD patients.
Resonance tubes are commonly used in voice therapy. These devices modify supraglottal impedance, potentially decreasing the aerodynamic power necessary for phonation. We modeled phonation with resonance tubes in excised larynges and evaluated the effects of varying tube width, tube length, and flow input on phonation threshold pressure (PTP) and phonation threshold flow (PTF). We hypothesized that the increased vocal economy observed in human subjects and several other models would be observed in excised larynges.
Repeated measures excised canine larynx bench experiment with each larynx serving as own control.
Nine conditions were evaluated, namely control, two tube diameters (17.5 and 6.5mm), three tube lengths (7.8, 15.0, and 30.0cm), and three levels of flow input (80, 114, and 200mL/s). Aerodynamic data were collected for 11 excised canine larynges attached to an artificial vocal tract, and results from each experimental configuration were compared with control.
A significant decrease in average PTP occurred compared with control for the 114- and 200-mL/s flow inputs, 30-cm extension, and 17.5- and 6.5-mm constrictions. Average PTF decreased compared with control for every configuration, although statistically significant changes were only observed for 200-mL/s flow and 6.5-mm constriction.
Knowledge regarding the effect of vocal tract alterations could be clinically useful in determining the optimal "straw" configuration for voice therapy. Further exploration of the relationships among width, length, and flow input could provide theoretical support for the development of new therapies and resonance tube devices.
Purpose
The present study aimed to assess the effectiveness of a physiologic voice therapy program based on water resistance therapy (WRT) exercises including connected speech in a group of subjects with voice complaints (vocal effort and fatigue).
Methods
Twenty-four participants with behavioral dysphonia were randomly assigned to one of two treatment groups: (1) voice treatment with WRT plus vocal hygiene program (n = 12), and (2) vocal hygiene program only (n = 12). Laryngoscopic assessment was performed in all subjects. Before and after voice therapy, participants underwent aerodynamic and electroglottographic assessment. The Voice Handicap Index (VHI) and self-assessment of resonant voice were also performed. The treatment included six voice therapy sessions. For the experimental group, the exercises consisted of a sequence of seven phonatory tasks performed with two different voice training devices (PocketVox and MaskVox). Comparison for all variables was performed between experimental group and control group.
Results
Significant differences were found for experimental group for VHI physical subscale, and self-perceived resonant voice when comparing pre-post conditions. A strong negative correlation between self-perceived resonant voice and VHI physical sub-score was also reported. No significant differences were found for instrumented variables.
Conclusion
Physiologic voice therapy based on WRT exercises including connected speech seems to be an effective tool to improve self-perceived voice in subjects diagnosed with voice complaints. Apparently, changes are more prone to occur in perceptual variables related with physical discomfort associate with voice production. A reduction in phonatory effort and perceptual aspects of vocal fatigue are the main improvements.
Purpose
The present study was designed to assess the efficacy of a six-session physiologic voice therapy program with the semioccluded ventilation mask (SOVM) in a group of subjects with voice complaints (vocal effort and fatigue).
Methods
Thirty-four participants with functional dysphonia were randomly assigned to one of two treatment groups: (1) voice treatment with physiologic voice therapy plus vocal hygiene program (n = 17), and (2) vocal hygiene program only (n = 17). Laryngoscopic assessment was performed in all subjects to confirm laryngeal diagnosis. Before and after voice therapy, participants underwent aerodynamic assessment. The Voice Handicap Index (VHI), Vocal Tract Discomfort Scale (VTDS), and self-assessment of resonant voice were also performed. The treatment included six voice therapy sessions. For the experimental group, the exercises consisted of a sequence of seven phonatory tasks performed with the SOVM. Comparison for all variables was performed between experimental group and control group.
Results
Statistical analysis showed significant improvements for experimental group for VHI (decrease), VTDS (decrease), and self-perception of resonant voice quality (increase). Significant decrease for experimental group was observed in subglottic pressure and phonation threshold pressure.
Conclusion
Physiologic voice therapy based on the SOVM with connected speech exercises seems to be an effective tool to improve voice in subjects diagnosed with voice complaints. Apparently, improvements are reflected in both subjective and objective outcomes. A reduction in phonatory effort and perceptual aspects of vocal fatigue are the main subjective improvements. A decrease in air pressure-related variables seems to be the most important objective change after voice therapy.
Objective
Semioccluded vocal tract (SOVT) exercises are routinely included in many voice therapy programs because they have been shown to improve acoustic, aerodynamic, and patient-reported voice outcomes. One limitation of the traditional SOVT exercise is that the nature of phonation through straws or semioccluded oral postures allows only for single phoneme production. A variably occluded facemask (VOFM) allows for use of articulated connected speech beyond the production of single phonemes, while still providing occlusion and, presumably, the vocal efficiency benefits that arise from it. This study reports on the effect of time duration of phonation with a variably occluded facemask on voice outcomes in patients with voice disorders.
Design
Prospective, randomized cohort study.
Methods
Fifteen patients with voice disorders phonated for 5 minutes through a VOFM with diameter openings of 3.2, 6.4, and 9.6 mm. Acoustic and aerodynamic voice measures were collected before and after each occlusion trial. These results were compared to a historical patient group that received the same phonation training for 2 minutes.
Results
Positive effect sizes were found for acoustic and aerodynamic improvements for all patients for at least one occlusion diameter. Effect sizes for aerodynamic outcomes were greater in the 5-minute conditions for both the 9.6- and 6.4-mm occlusions than the 2-minute condition. Effect sizes for acoustic outcomes were greater in the 5 minute than 2-minute trial for the 9.6- and 6.4-mm occlusion diameter, but greater in the 2 minute than 5-minute trial for 3.2-mm diameter.
Discussion
This study provides evidence that all three occlusion sizes may elicit beneficial changes for different patients; however, 5 minutes of phonation into a facemask with end occlusion of 6.4-mm diameter results in improved acoustic and aerodynamic voice outcomes for many patients with voice disorders. Future studies should further explore phonatory physiologic changes of the VOFM in a larger sample of patients and translate effects into clinical treatment for patients with voice disorders.
Purpose
The present study aimed at observing the effect of tube diameter and vocal tract configuration on frequency, amplitude, and regularity of Poral oscillation caused by bubbling during water resistance therapy (WRT). A secondary objective was to examine the degree of self-perceived sensation of massage-like effect produced by bubbles during WRT.
Methods
Forty-two participants were included in this study. Assessment protocol included: (1) self-assessment of massage-like sensation and (2) objective assessment of air pressure-related variables. In the first section, participants were instructed to select and produce a sustained-vowel like phonation into three different tubes (varying inner diameter) submerged 5 cm below the water surface. Also, two different vocal tract configurations were produced by all subjects: (1) horizontal position (regular vocal tract position), (2) vertical position (yawning position with low vertical laryngeal position). Participants were asked to self-assess their massage-like sensation. In the second section, objective measurements of air pressure-related variables were acquired during WRT exercises.
Results
Statistical differences were driven by tube inner diameter for oral pressure oscillation frequency, amplitude, jitter and shimmer and self-perceived massage-like sensation. Vocal tract position generated differences for medium-size tube and large-size tube only for self-perceived massage-like sensation.
Conclusion
Inner diameter of tube and configuration of vocal tract affect bubble characteristics and massage-like sensation during WRT. Larger tube diameters and vocal tract volumes seem to produce more regular bubbles, lower bubble frequency, and larger bubble amplitude, causing a more evident massage-like sensation. Therefore, control of these variables is apparently relevant to obtain the best effect in patients with voice disorders.
Background
Traditional semi-occluded vocal tract exercises (SOVTEs) are restricted to single-phoneme tasks due to the semi-occlusion at the mouth, which hinders full articulation, continuous speech, and singing. Innovative SOVTEs should overcome this limitation by creating the semi-occlusion outside the oral cavity.
Purpose
The purpose of this study was to investigate the immediate effects of a semi-occluded water resistance ventilation mask, which allows for continuous speech and singing, on objective (voice range, multiparametric voice quality indices) and subjective (auditory-perceptual, self-report) vocal outcomes in musical theater students.
Method
A pre-/posttest randomized controlled trial was used. Twenty-four musical theater students (16 women and eight men, with a mean age of 21 years) were randomly assigned into a study group and a control group. The study group received a vocal warm-up session with the innovative water resistance ventilation mask (tube attached to the mask “outside” the mouth), whereas the control group received the traditional water resistance approach (tube “inside” the mouth). Both sessions lasted 30 min and were similar with respect to vocal demand tasks. A multidimensional voice assessment including objective and subjective outcomes was performed pre- and posttraining by an assessor blinded to group allocation.
Results
The Dysphonia Severity Index significantly and similarly increased (improved) in both the study and control groups, whereas the Acoustic Voice Quality Index solely decreased (improved) in the control group. The intensity range significantly decreased (worsened) and the semitone range significantly increased (improved) in the study group, whereas no differences in voice range profile were found in the control group. Auditory-perceptually, a more strenuous speaking voice was noticed after the use of the traditional water resistance approach. The subjects perceived both SOVTEs as comfortable vocal warm-up exercises that decrease the amount of effort during speaking and singing, with a slight preference for the water resistance ventilation mask.
Conclusions
Both the innovative water resistance ventilation mask and the traditional water resistance exercise seem effective vocal warm-up exercises for musical theater students. The additional articulatory freedom of the mask might increase the phonatory comfort and the practical implementation of SOVTEs in the daily vocal warm-up of (future) elite vocal performers. The hypothesis of a higher transfer to continuous speech or singing in the mask condition has not been supported by the current study. Larger scale investigation and longer term follow-up studies are needed to confirm these preliminary results.
Supplemental Material
https://doi.org/10.23641/asha.11991549
Purpose
The present study was designed to assess the immediate effects of the semi-occluded ventilation mask (SOVM) in subjects with functional dysphonia and subjects with normal voice.
Methods
Sixty-four participants were included in this study (48 women and 16 men). Thirty-one of them were diagnosed with functional dysphonia and 33 with normal voice. All subjects were randomly assigned to one of two conditions: an experimental condition using the SOVM (n = 33) and a control condition with participants not using the SOVM (n = 31). Thus, within both conditions, participants could be either dysphonic or normal-voiced. This produced a total of four different groups: (1) subjects with normal voice with SOVM (n = 17), (2) subjects with normal voice without SOVM (n = 16), (3) dysphonic subjects with SOVM (n = 16), and (4) dysphonic subjects without SOVM (n = 15). All participants underwent aerodynamic, electroglottographic (EGG), and acoustic assessments, and were also asked to assess their own voice, before and after voice exercises.
Results
Significant differences were found for aerodynamic, EGG, and acoustic variables when comparing SOVM conditions (dysphonic and normal) against control. Cepstral peak prominence and EGG contact quotient showed an increase among dysphonic participants with SOVM. L1-L0 showed an increase for all participants in SOVM condition (dysphonic and normal). Self-perceived resonant voice quality showed an increase for both groups in SOVM condition. Glottal airflow showed a decrease for the dysphonic participants in SOVM condition. Phonation threshold pressure and subglottic pressure showed a decrease for both groups in SOVM condition.
Conclusion
The present study suggests that immediate positive effect could be produced by connected speech phonatory tasks using the SOVM in both dysphonic subjects and subjects with normal voice, the change being greater among the former. SOVM seems to promote an easy voice production and a more efficient phonation.
Objective:
The objective of this study was to validate the Vocal Tract Discomfort Scale (VTD) Argentine version.
Study design:
Nonrandomized, cross-sectional prospective study with control group.
Material and methods:
The VTD Scale was culturally and linguistically adapted to Argentinian Spanish according to the recommended requirements of translation, closely observing the methodology that was suggested (translation, summary, review and back-translation). The scale Argentine version (Escala de disconfort del tracto vocal) was administered to 107 patients with muscle-tension dysphonia (MTD) (23 men and 84 women, mean ages being: 32.30 ± 9.09 years old for MTD type I, and 31.23 ± 8.45 years old for MTD type II) and 30 volunteers with no vocal pathology (9 men and 21 women, mean ages being: 44.3 ± 8.72 years old). All patients completed the Escala de disconfort del tracto vocal before and after Mathieson Laryngeal Manual Therapy. The results of the VTD Scale administered in both patients and vocally healthy subjects were initially compared; the changes arising from pre and post therapy were also compared in the second phase. The internal consistency of the VTD Scale was assessed using Cronbach alpha coefficient.
Results:
The internal consistency assessed was considered acceptable for both subscales within the VTD Scale. The values obtained for frequency, severity, and total score of the Scale were similar in patients with MTD I and MTD II, marking a difference with those obtained in the control group of healthy volunteers. A lump feeling in the throat was one of the most frequent symptoms in both MTD and vocally healthy groups.
Conclusion:
The VTD Scale shows an acceptable consistency, so it is a highly reproducible, reliable, and valuable instrument of evaluation to assess Argentinian patients with voice disorders.
Background
To date, the immediate effects of a semi‐occluded vocal tract (SOVT) configuration have been thoroughly demonstrated. However, it is not yet sufficiently confirmed whether a therapy programme (i.e. longer than one session) using SOVT exercises leads to an enhanced phonation and improved vocal quality.
Aims
The aim of this study was to investigate the effect of three SOVT therapy programmes: lip trill, water‐resistance therapy (WRT) and straw phonation, on the vocal quality, vocal capacities, psychosocial impact and vocal tract discomfort of patients with dysphonia.
Methods & Procedures
A blocked‐randomized sham‐controlled trial was used. Thirty‐five patients with dysphonia (mean age = 21 years; 33 women, two men) were assigned to either a lip trill group, a WRT group, a straw phonation group or a control group using blocked randomization. The lip trill, WRT and straw phonation groups practised their respective SOVT exercise across 3 weeks, whereas the control group received a sham treatment across the same time span. A multidimensional voice assessment consisting of both objective (multiparametric indices: Dysphonia Severity Index (DSI), Acoustic Voice Quality Index (AVQI)) and subjective (subject's self‐report, auditory–perceptual evaluation) vocal outcomes was performed by a blinded assessor pre‐ and post‐therapy.
Outcomes & Results
Lip trill and straw phonation therapy led to a significant improvement in DSI. Auditory–perceptual grade and roughness significantly decreased after straw phonation. Lip trill and WRT both led to a significant decrease in Voice Handicap Index. Subjects reported a better self‐perceived vocal quality and a more comfortable voice production after WRT. No changes were found after the sham treatment in the control group.
Conclusions & Implications
Results suggest that SOVT therapy programmes including lip trill or straw phonation can improve the objective vocal quality in patients with dysphonia. Auditory–perceptual improvements were found after straw phonation therapy, whereas psychosocial improvements were found after lip trill and WRT. Patients seem to experience more comfort and a better self‐perceived vocal quality after WRT. This study supports the use of the three SOVT therapy programmes in clinical practice. They all had a positive impact on one or more outcomes of the multidimensional voice assessment. Strikingly, vocal quality outcomes were not in line with the subject's opinion. Larger‐scale investigation is needed to support these preliminary findings.
Objective:
This study reports on experiments designed to examine the effects of a variably occluded face mask (VOFM) on (a) estimated subglottal pressure (Psub) in normophonic participants and (b) aerodynamic and acoustic characteristics of voice in dysphonic participants.
Design:
A prospective design was used for experiment 1, and a prospective, randomized cohort design was used for experiment 2.
Methods:
The outlet ports of disposable anesthesia face masks were fitted with plastic caps with variable diameter drilled openings (9.6, 6.4, 3.2, and 1.6 mm) to create a series of mask openings. In experiment 1, Psub was measured in normophonic participants using the face mask during syllable repetitions in unoccluded and variable diameter opening conditions. In experiment 2, aerodynamic and acoustic measures were obtained in a group of dysphonic speakers before and after syllable and speech repetition tasks using the VOFM.
Results:
In experiment 1, mean PSub was observed to decrease while using the VOFM in all occlusion conditions versus nonocclusion, with a significant reduction in Psub observed between the baseline and the 6.4 mm condition. In experiment 2, standardized mean differences showed that many dysphonic participants produced reduced Psub, increased airflow, and improved acoustic measures after the use of the VOFM in at least one occlusion condition.
Conclusions:
Beneficial changes in both aerodynamic and acoustic characteristics of voice may be obtained in dysphonic speakers using a VOFM. By moving the place of occlusion outside of the oral cavity, therapeutic stimuli options may be extended beyond vowel and humming elicitations to syllable and speech contexts and assist with generalization of voice therapy targets to conversational speech.
The present study aimed to perform a systematic literature review to assess the effects of phonation therapy on voice quality and function in singers. The systematic search was performed in February and updated in October 2017. No restriction of year, language, or publication status was applied. The primary electronic databases searched were LILACS, SciELO, PubMed, and Cochrane. Kappa coefficient was used to assess the agreement between examiners in judging article eligibility. The eligible articles were analyzed based on their risk of bias using the tools proposed by the Joanna Briggs Institute. Mendeley Desktop 1.13.3 software package (Mendeley Ltd, London, UK) was used to standardize the references of identified articles. The general sample consisted of 1965 articles screened out of the electronic databases. Two examiners analyzed the sample in the search for eligible articles. The agreement between examiners reached excellent outcomes (kappa coefficient = 0.88). After the selection, phase 6 articles remained eligible. Together, the eligible studies accounted 141 subjects (65 men and 76 women) aged between 18 and 72 years old. Electroglottography was considered as the most common method (83.33%) of assessment of the effects of phonation therapy in singers. The most prevalent exercises within the therapies were phonation into straws and phonation into glass tubes. The phonation into glass tubes immersed in water, straws, and LaxVox tubes promoted positive effects on the voice quality in singers, such as more comfortable phonation, better voice projection, and economy in voice emission.
Purpose:
The present study reports the effects of double source of vibration semioccluded vocal tract exercises (SOVTEs) on subjective and objective variables in subjects with voice complaints.
Methods:
Eighty-four participants with voice complaints were randomly assigned to one of four treatment groups: (1) water resistance therapy, (2) tongue trills, (3) lip trills, and (4) raspberry (tongue and lip trills at the same time). Before and after voice therapy, participants underwent aerodynamic, electroglottographic, and acoustic assessments. Measures for the Vocal Tract Discomfort Scale (VTDS), self-assessment of resonant voice quality, and sensation of muscle relaxation were also obtained. Three assessment sessions were conducted: (1) before the therapy session (Pre), (2) immediately after the voice therapy session (Post 1), and (3) 1 week after home practice (Post 2).
Results:
Significant differences between baseline (Pre) and both post measures were found for the perception of muscle relaxation and resonant voice quality. No significant differences between Post 1 and Post 2 for any exercises were observed. This indicates that all voice exercises improved subjective self-perceived voice quality immediately after exercises and that improvement remained stable after 1 week of practice. Water resistance therapy and raspberry attained the highest effect. A significant decrease for all exercises was also observed for VTDS values after 1 week of practice. Although some significant changes were observed in objective variables, no clear patterns could be detected.
Conclusions:
SOVTEs with secondary source of vibration may reduce vocal symptoms related to physical discomfort in subjects with voice complaints. Objective variables apparently do not fully reflect subjective positive outcomes, or they are not sensitive enough to capture changes. No significant differences between four observed SOVTEs were observed.
The objective of the study was to analyze the outcome of the proprioceptive-elastic (PROEL) voice therapy method in patients with functional dysphonia (FD). Fifty-two patients with FD were involved in the study; they were composed of three subgroups of patients with (1) FD without glottal insufficiency (n = 28), (2) FD and glottal insufficiency (n = 9), and (3) FD, glottal insufficiency, and vocal nodules (n = 15). A multidimensional assessment protocol including videolaryngostroboscopy; maximum phonation time; perceptual evaluation of dysphonia with the Grade, Instability, Roughness, Breathiness, Asthenia, and Strain (GIRBAS) scale; and 10-item version of the Voice Handicap Index was conducted before and after 15 sessions of voice therapy. All voice therapy sessions were conducted by the same speech-language pathologist. The comparison between voice assessment before and after voice therapy with the PROEL method in patients with FD, in all the three subgroups, revealed a statistically significant improvement in periodicity and the mucosal wave in the laryngostroboscopy, maximum phonation time, GIRBAS scale scores, and VHI-10.
Voice of patients with FD improved after treatment with the PROEL method. Further studies are needed to analyze the efficacy of the PROEL method with randomized double-blind clinical trials using different methods for voice therapy. At present, the PROEL method represents an alternative tool for the speech pathologist to improve voice in patients with FD.
Phonation into a tube that lowers the acoustic vocal tract resonance frequency and increases vocal tract impedance is used in voice therapy to establish effortless voice production. Additionally, keeping the distal end of the tube in the water results in the water bubbling and a consequent oscillation of oral pressure. This may feel like a massage of the vocal tract and larynx.
Objective:
This study compares the flow resistance of Resonance tube (RT) and Lax Vox tube (LVT) when submerged 2 cm and 10 cm in water, as well as phonation into the tubes in these conditions.
Methods:
In the in vitro experiment, the air pressure for flow rates of 60-600 mL/s was measured at the tube inlet, when the outer end of the tube was submerged 2 cm and 10 cm below water surface in 30°, 45°, and 90° angle. In the in vivo experiment, 14 subjects phonated in habitual loudness and loudly into both tubes, with the outer end 2 cm and 10 cm in water. RT was immersed in a 45° angle and LVT in a 90° angle in water. Oral pressure, contact quotient from electroglottographic signal, and sound pressure level were studied. Sensations during phonation were reported in an interview.
Results:
Flow resistance was slightly lower with LVT than with RT, and slightly lower for smaller immersion angles. In habitual loudness, transglottic pressure and frequency of oral pressure variation were lower for LVT phonation and amplitude of oral pressure variation was higher for LVT 2 cm in water. Some subjects preferred RT, whereas others preferred LVT or reported no differences between them.
Conclusions:
The tubes differed slightly in flow resistance. Higher oral pressure oscillation with LVT 2 cm in water may offer stronger massage effect on vocal folds.
Purpose:
The purpose of the present study was to determine the efficacy of water resistance therapy (WRT) in a long-term period of voice treatment in subjects diagnosed with voice disorders.
Methods:
Twenty participants, with behavioral dysphonia, were randomly assigned to one of two treatment groups: (1) voice treatment with WRT, and (2) voice treatment with tube phonation with the distal end in air (TPA). Before and after voice therapy, participants underwent aerodynamic, electroglottographic, acoustic, and auditory-perceptual assessments. The Voice Handicap Index and self-assessment of resonant voice quality were also performed. The treatment included eight voice therapy sessions. For the WRT group, the exercises consisted of a sequence of five phonatory tasks performed with a drinking straw submerged 5 cm into water. For the TPA, the exercises consisted of the same phonatory tasks, and all of them were performed into the same straw but the distal end was in air.
Results:
Wilcoxon test showed significant improvements for both groups for Voice Handicap Index (decrease), subglottic pressure (decrease), phonation threshold pressure (decrease), and self-perception of resonant voice quality (increase). Improvement in auditory-perceptual assessment was found only for the TPA group. No significant differences were found for any acoustic or electroglottographic variables. No significant differences were found between WRT and TPA groups for any variable.
Conclusions:
WRT and TPA may improve voice function and self-perceived voice quality in individuals with behavioral dysphonia. No differences between these therapy protocols should be expected.
Objectives:
The objective of this study was to explore the effectiveness of a 3-week training program with the voice therapy "Lax Vox" for teachers.
Methods:
Four healthy female teachers participated as volunteers for the study. Several voice measurements of perception, acoustics, aerodynamics, and self-evaluation were investigated. Furthermore, a survey to rate the applicability of Lax Vox was also part of the study. To assess the treatment effects of the Lax Vox training, an effect size analysis (dunb) was conducted.
Results:
After 3 weeks of training, medium and large improvements were found in some parameters of perceptual and acoustic voice quality assessments (dunb >0.50 and dunb >0.80, respectively). Furthermore, medium improvements were revealed in some parameters of self-evaluation (ie, physical and total scale of the Voice Handicap Index) and aerodynamic (ie, maximum phonation time) assessments (all dunb >0.50). Additionally, acoustic measures of vocal function showed an expansion in the upper contour of voice range profiles after training. Particularly, the main improvements in the voice range profile was found in the modal and the beginning of the falsetto voice registers. There was an increase of the intensity levels of about 4.6 dB. No changes were revealed in some acoustic measures of the voice range profile, self-evaluation measurements, and the perception of breathy voice quality (all dunb <0.20). Finally, the applicability of Lax Vox perceptually showed clear support in training success, learning process, and transfer to the daily routine.
Conclusions:
Lax Vox training for teachers appears to improve select measures of voice quality, maximum phonation time, vocal function, self-evaluation, and perceived applicability.
Purpose:
This study investigated the influence of tube phonation into water on vocal fold vibration.
Method:
Eight participants were analyzed via high-speed digital imaging while phonating into a silicon tube with the free end submerged into water. Two test sequences were studied: (1) phonation pre, during, and post tube submerged 5 cm into water; and (2) phonation into tube submerged 5 cm, 10 cm, and 18 cm into water. Several glottal area parameters were calculated using phonovibrograms.
Results:
The results showed individual differences. However, certain trends were possible to identify based on similar results found for the majority of participants. Amplitude-to-length ratio, harmonic-to-noise ratio, and spectral flatness (derived from glottal area) decreased for all tube immersion depths, while glottal closing quotient increased for 10 cm immersion and contact quotient for 18 cm immersion. Closed quotient decreased during phonation into the tube at 5 cm depth, and jitter decreased during and after it.
Conclusion:
Results suggest that the depth of tube submersion appears to have an effect on phonation. Shallow immersion seems to promote smoother and more stable phonation, while deeper immersion may involve increased respiratory and glottal effort to compensate for the increased supraglottal resistance. This disparity, which is dependent upon the degree of flow resistance, should be considered when choosing treatment exercises for patients with various diagnoses, namely hyperfunctional or hypofunctional dysphonia.
Objective:
The current study aimed at investigating the immediate effects of a semi-occluded vocal tract exercise with a ventilation mask in a group of contemporary commercial singers.
Study design:
A randomized controlled study was carried out.
Methods:
Thirty professional or semi-professional singers with no voice complaints were randomly divided into two groups on recruitment: an experimental group and a control group. The same warm-up exercise was performed by the experimental group with an occluded ventilation mask placed over the nose and the mouth and by the control group without the ventilation mask. Voice was recorded before and after the exercise. Acoustic and self-assessment analysis were accomplished. The acoustic parameters of the voice samples recorded before and after training were compared, as well as the parameters' variations between the experimental and the control group. Self-assessment results of the experimental and the control group were compared too.
Results:
Significant changes after the warm-up exercise included jitter, shimmer, and singing power ratio (SPR) in the experimental group. No significant changes were recorded in the control group. Significant differences between the experimental and the control group were found for ΔShimmer and ΔSPR. Self-assessment analysis confirmed a significantly higher phonatory comfort and voice quality perception for the experimental group.
Conclusions:
The results of the present study support the immediate advantageous effects on singing voice of a semi-occluded vocal tract exercise with a ventilation mask in terms of acoustic quality, phonatory comfort, and voice quality perception in contemporary commercial singers. Long-term effects still remain to be studied.
Objective:
Intraclass correlation coefficient (ICC) is a widely used reliability index in test-retest, intrarater, and interrater reliability analyses. This article introduces the basic concept of ICC in the content of reliability analysis.
Discussion for researchers:
There are 10 forms of ICCs. Because each form involves distinct assumptions in their calculation and will lead to different interpretations, researchers should explicitly specify the ICC form they used in their calculation. A thorough review of the research design is needed in selecting the appropriate form of ICC to evaluate reliability. The best practice of reporting ICC should include software information, "model," "type," and "definition" selections.
Discussion for readers:
When coming across an article that includes ICC, readers should first check whether information about the ICC form has been reported and if an appropriate ICC form was used. Based on the 95% confident interval of the ICC estimate, values less than 0.5, between 0.5 and 0.75, between 0.75 and 0.9, and greater than 0.90 are indicative of poor, moderate, good, and excellent reliability, respectively.
Conclusion:
This article provides a practical guideline for clinical researchers to choose the correct form of ICC and suggests the best practice of reporting ICC parameters in scientific publications. This article also gives readers an appreciation for what to look for when coming across ICC while reading an article.
The main aim of this study was to assess the prevalence of Vocal Tract Discomfort (VTD) in the Flemish population without self-perceived voice disorders using the VTD scale and to examine the relationship between vocal load and VTD symptoms. In addition, consistency between the VTD scale and the Voice Handicap Index (VHI) and the Corporal Pain scale was evaluated.
A total of 333 participants completed the VTD scale, the VHI, and the Corporal Pain scale. Patient information about study and voice-related hobbies (for students), state of (non)professional voice user (for employees), smoking, shouting, allergy, and voice therapy was taken into account.
A median number of three VTD symptoms was reported, and 88% of the participants showed at least one symptom of VTD. Dryness (70%), tickling (62%), and lump in the throat (54%) were the most frequently occurring symptoms. The frequency and severity of VTD were significantly higher in participants who followed voice-related studies, played a team sport, were part of a youth movement, shouted frequently, and received voice therapy in the past (P < 0.05). Finally, low correlations were obtained between frequency and severity of the VTD scale and total VHI score (r = 0.226-0.411) or frequency and intensity of the Corporal Pain scale (r = 0.016-0.408).
The prevalence of VTD is relatively high in the Flemish population without self-perceived voice disorders, although the frequency and severity of the symptoms are rather low. Vocal load seems to influence the frequency and severity of VTD. Finally, the VTD scale seems to reveal clinically important information that cannot be gathered from any other protocol.
Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
This experimental study investigated the back pressure (Pback) versus flow (U) relationship for 10 different tubes commonly used for semi-occluded vocal tract exercises, that is, eight straws of different lengths and diameters, a resonance tube, and a silicone tube similar to a Lax Vox tube. All tubes were assessed with the free end in air. The resonance tube and silicone tube were further assessed with the free end under water at the depths from 1 to 7 cm in steps of 1 cm. The results showed that relative changes in the diameter of straws affect Pback considerably more compared with the same amount of relative change in length. Additionally, once tubes are submerged into water, Pback needs to overcome the pressure generated by the water depth before flow can start. Under this condition, only a small increase in Pback was observed as the flow was increased. Therefore, the wider tubes submerged into water produced an almost constant Pback determined by the water depth, whereas the thinner straws in air produced relatively large changes to Pback as flow was changed. These differences may be taken advantage of when customizing exercises for different users and diagnoses and optimizing the therapy outcome.
Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Semi-occluded vocal tract (SOVT) exercises have long been used by voice trainers and pedagogues and have been particularly popular in Scandinavia dating as far back as the 1800s. Titze (1988, 1994, 2006; Titze, Riede, & Popolo, 2008; Titze & Verdolini-Abbot, 2012) has contributed significantly to the exploration of the SOVT and impact on voice production, and these types of exercise have become ubiquitous in the clinical voice arena. Although SOVT exercises are commonly used, there continue to be questions about the exact nature of how they impact phonation and improved vocal economy. This article aims to explore the physiology of a SOVT on vocal fold vibration and vocal output. Several variations are described within context of recent research.
Objective:
The purpose of this study was to describe changes in aerodynamic and electroglottographic (EGG) measures immediately after completing three semi-occluded vocal tract (SOVT) exercises.
Study design:
Prospective case series.
Methods:
Aerodynamic and EGG measurements were obtained before and immediately after performing three SOVTs (straw phonation, lip trill, and tongue trill) in four singers for prepost comparisons to evaluate laryngeal changes persisting beyond the execution of SOVTs.
Results:
Mean air flow, sound pressure level, and EGG closed quotient tended to increase after completing SOVTs. The magnitude of change and consistency of change in measures across the SOVTs varied from subject-to-subject.
Conclusions:
Aerodynamic and EGG changes did occur during and immediately after completing SOVTs. However, there was marked variability within and across participants. Further investigation is needed to better understand which SOVTs are likely to benefit a particular individual.
A typical goal of voice therapy is a behavioral change in the patient's everyday speech. The SLP's plan for voice therapy should therefore optimally include strategies for automatization. The aim of the present study was to identify and describe factors that promote behavioral learning and habit change in voice behavior and have the potential to affect patient compliance and thus therapy outcome. Research literature from the areas of motor and behavioral learning, habit formation, and habit change was consulted. Also, specific elements from personal experience of clinical voice therapy are described and discussed from a learning theory perspective. Nine factors that seem to be relevant to facilitate behavioral learning and habit change in voice therapy are presented, together with related practical strategies and theoretical underpinnings. These are: 1) Cue-altering; 2) Attention exercises; 3) Repetition; 4) Cognitive activation; 5) Negative practice; 6) Inhibition through interruption; 7) Decomposing complex behavior; 8) The 'each time-every time' principle; and 9) Successive implementation of automaticity.
The use of semi-occluded vocal tract (SOVT) exercises as habilitative and rehabilitative tools has grown substantially in the past two decades. As the use of these exercises has grown, so too has the number of variations of the phonatory gestures used to create oral semi-occlusions. While much of the research on SOVT exercises to this point has been conducted using straw phonation, there has been little discussion or investigation regarding how other phonatory gestures that are considered to be SOVT compare to one another. The current study sought to measure the intraoral pressure produced by 13 phonatory gestures generally thought of as oral semi-occlusions. Twenty subjects (10 male, 10 female) produced three tokens of each gesture, and intraoral pressure was recorded via a thin, flexible-cannula pressure transducer. Pressures ranged between 0.1 and 1.0 kPa, but varied significantly between gestures and between subjects.
Hintergrund
Ziel dieser Studie war es, die Test-Retest-Variabilität des Acoustic Voice Quality Index (AVQI) sowie die Gewichtung seiner beiden Bestandteile (gehaltener Vokal und fortlaufende Sprache) für das Endergebnis des AVQI zu ermitteln.
Patienten und Methoden
In dieser Studie wurden 43 Probanden mit unterschiedlichen Heiserkeitsgraden untersucht. Jeder Proband unterzog sich 2-mal der AVQI-Untersuchungsprozedur.
Ergebnisse
Die 2 AVQI-Analysen wiesen keinen statistisch signifikanten Unterscheid im Endergebnis auf (t = 1,205; p = 0,235). Eine geringe Messvariabilität beim AVQI bestätigt sich mit einem Wert von 0,54 im Test-Retest-Verfahren. Überwiegend wird das Endergebnis des AVQI durch den gehaltenen Vokal /a/ beeinflusst (r2 = 0,88) und unterscheidet sich in der Gewichtung signifikant von der fortlaufenden Sprache (z = − 3,34; p < 0,01). Die fortlaufende Sprache trägt dennoch einen hohen Anteil (r2 = 0,55) am Endergebnis.
Fazit
Es bestätigt sich eine geringe Messvariabilität im AVQI. Die Zusammensetzung der Sprachelemente zeigt einen höheren Einfluss der gehaltenen Phonation auf das Endergebnis.
The voiced bilabial fricative /β:/ has been used as a vocal exercise. The present study investigated the effects of the exercise on voice production and voice source. This study compared vowel phonation on the syllable /a:p/ with the production of the exercise and vowel phonation before and immediately after the exercise. The methods were (a) dual-channel electroglottography, from which the vertical laryngeal position was derived, (b) electromyography using surface electrodes, and (c) inverse filtering of the acoustic signal to obtain an estimate of the voice source. In the production of /β:/ as compared with vowel phonation in most of the cases, the vertical laryngeal position seemed to be higher, the muscular activity of the larynx lower, and the slope of the voice source spectrum steeper. In vowel phonation after the exercise, the muscular activity seemed to be lower in most cases, although the voice source remained unchanged. This seems to indicate improved vocal economy.
Objective:
The present study aimed to investigate the vocal tract and glottal function during and after phonation into a tube and a stirring straw.
Methods:
A male classically trained singer was assessed. Computerized tomography (CT) was performed when the subject produced [a:] at comfortable speaking pitch, phonated into the resonance tube and when repeating [a:] after the exercise. Similar procedure was performed with a narrow straw after 15 minutes silence. Anatomic distances and area measures were obtained from CT midsagittal and transversal images. Acoustic, perceptual, electroglottographic (EGG), and subglottic pressure measures were also obtained.
Results:
During and after phonation into the tube or straw, the velum closed the nasal passage better, the larynx position lowered, and hypopharynx area widened. Moreover, the ratio between the inlet of the lower pharynx and the outlet of the epilaryngeal tube became larger during and after tube/straw phonation. Acoustic results revealed a stronger spectral prominence in the singer/speaker's formant cluster region after exercising. Listening test demonstrated better voice quality after straw/tube than before. Contact quotient derived from EGG decreased during both tube and straw and remained lower after exercising. Subglottic pressure increased during straw and remained somewhat higher after it.
Conclusion:
CT and acoustic results indicated that vocal exercises with increased vocal tract impedance lead to increased vocal efficiency and economy. One of the major changes was the more prominent singer's/speaker's formant cluster. Vocal tract and glottal modifications were more prominent during and after straw exercising compared with tube phonation.
This study sought to measure any acoustic changes in the speaking voice immediately after phonation exercises involving plastic straws versus phonation exercises with the open vowel /a/. Forty-one primary school teachers with slightly dysphonic voices were asked to participate in four phonatory tasks. Phonetically balanced text at habitual intensity level and speaking fundamental frequency was recorded. Acoustical analysis with long-term average spectrum was performed. Significant changes after therapy for the experimental group include the alpha ratio, L1-L0 ratio and ratio between 1-5 kHz and 5-8 kHz. The results indicate that the use of phonatory tasks with straw exercises can have immediate therapeutic acoustic effects in dysphonic voices. Long-term effects were not assessed in this study.
Dysphonia can affect social life and employment, but formal studies of its general health impact are lacking. The aims of this study were (i) to compare self-rated general health status as measured by the SF-36 in a large cohort of dysphonic patients with those from normative groups; and (ii) to examine the differential impact of dysphonia on the various health status domains. The 163 dysphonic voice clinic attendees (38 men, 125 women) were drawn from recruits to a prospective trial of speech therapy efficacy. The Short-Form 36 (SF-36) scores were compared with published data on 744 age-matched healthy controls. Patients with dysphonia had significantly poorer self-reported health than the controls on all eight SF-36 subscales (limitation of physical activity P < 0.05; other seven, all P < 0.001, Student's t-test). We thus conclude that dysphonia in patients without obvious laryngeal disease has an adverse impact on all health status subscales as measured by the SF-36. The study provides further evidence for the inclusion quality of life measures in otolaryngology baseline and outcome assessments.
Various types of trill exercises have been used for a long time as a tool in the treatment and preparation of the voice. Although they are reported to produce vocal benefits in most subjects, their physiology has not yet been studied in depth. The aim of this study was to compare the mean and standard deviation of the closed quotient in exercises of lip and tongue trills with the sustained vowel /ε/ in opera singers. Ten professional classical (operatic) singers, reportedly in perfect laryngeal health, served as subjects for this study and underwent electroglottography. During the examination, the subjects were instructed to deliver the sustained vowel /ε/ and lip and tongue trills in a same preestablished frequency and intensity. The mean values and standard deviation of the closed quotient were obtained using the software developed for this purpose. The comparison of the results was intrasubjects; maximum intensities were compared only among them and so were minimum intensities. The means of closed quotient were statistically significant only in the strong intensities, and the lip trill was different from the tongue trill and the sustained vowel /ε/. The standard deviation of the closed quotient distinguished the sustained vowel /ε/ from the lip and tongue trills in the two intensities. We concluded that there is oscillation of the closed quotient during the exercises of tongue and lip trills, and the closed quotient is higher during the performance of exercises of the lip trill, when compared with the two other utterances, only in the strong intensities.
To assess the relationship between tongue trill performance duration and auditory perception and acoustic changes in dysphonic women.
Prospective clinical study, with intrasubject comparison.
Twenty-seven women who had vocal nodules were in the experimental group (EG) (tongue trills), and 10 were also in the control group (CG) (placebo exercises). The voices were recorded before and after experimental and placebo exercises at the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of performance. These recordings were randomized, and the auditory perception analysis was carried out by three judges trained in voice analysis. Individual recordings were analyzed using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol, the randomized pairs of recordings were compared, and the better voice was chosen. VoxMetria software (CTS, Parana, Brazil, www.ctsinformatica.com.br) was used to assess the acoustic.
In the EG, the CAPE-V results showed a predominance of vocal improvement, statistically proven, at m5 of tongue trill exercise, with the best overall rating, the least roughness and breathiness, and increase in pitch level. At m7, strain was significantly higher. In the paired comparison analysis, voices at m5 were considered the best of all moments. There was an increase of the F(0) and glottal-to-noise excitation after m3 and a decrease in noise as in m1. In the CG, vocal changes were discrete compared with those in the EG.
Tongue trill performance duration interfered with the vocal response of dysphonic women, with positive response predominance at m5. At m7, there was an increase of vocal tension and a drop in vocal quality.
It is well known in the disciplines of neurobiology, exercise physiology, motor learning, and psychotherapy that desirable learning and behavior changes occur primarily from practice that involves high-intensity overload, variability, and specificity of training. We propose a novel treatment approach called intensive short-term voice therapy that uses these practice parameters for recalcitrant dysphonia. Intensive short-term voice therapy involves multiple sessions with a variety of clinicians, incorporating multiple simultaneous therapeutic approaches. The intensive short-term voice therapy approach is characterized by voice therapy for 1-4 successive days each with an average of 5 hours of therapy and five clinicians. This form of intensive voice therapy provides rigorous practice, involving not only overload but also opportunities for specificity and individuality thereby facilitating better transfer of learned skills. This article discusses the conceptual, theoretical, and practical foundations of this novel therapy approach.