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Lewis A, Philip KEJ, Lound A, Cave P, Russell J, Hopkinson NS. The physiology of singing and implications for 'Singing for Lung Health' as a therapy for individuals with chronic obstructive pulmonary disease. BMJ Open Respir Res 2021; 8:8/1/e000996. [PMID: 34764199 PMCID: PMC8587358 DOI: 10.1136/bmjresp-2021-000996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022] Open
Abstract
Singing is an increasingly popular activity for people with chronic obstructive pulmonary disease (COPD). Research to date suggests that ‘Singing for Lung Health’ may improve various health measures, including health-related quality-of-life. Singing and breathing are closely linked processes affecting one another. In this narrative review, we explore the physiological rationale for ‘Singing for Lung Health’ as an intervention, focusing on the abnormalities of pulmonary mechanics seen in COPD and how these might be impacted by singing. The potential beneficial physiological mechanisms outlined here require further in-depth evaluation.
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Affiliation(s)
- Adam Lewis
- Department of Health Sciences, Brunel University London, London, UK
| | | | - Adam Lound
- Patient Experience Research Centre, Imperial College London, London, UK
| | - Phoene Cave
- Department of Health Sciences, Brunel University London, London, UK
| | - Juliet Russell
- Department of Health Sciences, Brunel University London, London, UK
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Yilmaz C, Bostancı Ö, Bulut S. Effect of Respiratory Muscle Training on Pitch Range and Sound Duration in Brass Instrument Players and Singers. J Voice 2020; 36:76-82. [PMID: 32451252 DOI: 10.1016/j.jvoice.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Effective use of respiratory organs is important for musicians. Therefore, the impact of Respiratory Muscle Training (RMT) on phonation is open to research. The aim of this study was to investigate the measurable effects of RMT on blowing in brass instrumental and on voice performance in singers. METHODS Thirty musicians were recruited and separated into a four groups. The brass instrumental and singers groups were further subdivided into control and RMT groups for a 4 week RMT intervention giving a total four groups: singers experimental (SE; n:10), singers control (SC; n:10), brass instrument players experimental (BIPE; n:5), and BIPC (n:5). The groups selected from the musicians of Samsun State Opera and Ballet Directorate and Samsun Metropolitan Municipality Band Team participated in the study. RESULTS After 4 weeks of RMT application in the study groups, significant increase in all parameters except Forced vital capacity/Forced expiratory volume in 1 second was observed in the values of pulmonary function tests and respiratory muscle strength in subjects with SE and BIPE (P < 0.05). The most significant results of this study are that in addition to changes in the duration of phonation (SE 36%), high-pitch (SE 79%, BIPE 27%) and low-pitch sounds (BIPE 61% and SE 42%), the SE (15%) and BIPE (3%) groups reached higher pitches in the high-pitch notes. CONCLUSIONS It was determined that performance of the highest and lowest pitch sounds within a vocal register in a single breath and phonation times can be improved by RMT.
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Affiliation(s)
- Coşkun Yilmaz
- Ondokuz Mayıs University, Graduate School of Health Sciences, Samsun, Turkey.
| | - Özgür Bostancı
- Ondokuz Mayıs University, Yasar Dogu Sport Science Faculty, Department of Physical Education and Sports, Samsun, Turkey
| | - Seyhan Bulut
- Ondokuz Mayıs University, State Conservatory, Department of Music, Samsun, Turkey
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Ray C, Trudeau MD, McCoy S. Effects of Respiratory Muscle Strength Training in Classically Trained Singers. J Voice 2018; 32:644.e25-644.e34. [DOI: 10.1016/j.jvoice.2017.08.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 11/30/2022]
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Quantifying Laryngopharyngeal Reflux in Singers: Perceptual and Objective Findings. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3918214. [PMID: 29098155 PMCID: PMC5625805 DOI: 10.1155/2017/3918214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/26/2017] [Accepted: 08/14/2017] [Indexed: 12/12/2022]
Abstract
This study examines the relationship between laryngopharyngeal reflux (LPR) symptoms and oropharyngeal pH levels in singers. We hypothesized that reported symptoms would correlate with objective measures of pH levels from the oropharynx, including the number and total duration of reflux episodes. Twenty professional/semiprofessional singers completed the Reflux Symptom Index (RSI) and underwent oropharyngeal pH monitoring. Mild, moderate, or severe pH exposure was recorded during oropharyngeal pH monitoring. Correlations were performed to examine potential relationships between reflux symptoms and duration of LPR episodes. Symptom severity did not correlate with pH levels; however, we found a number of covariances of interest. Large sample sizes are necessary to determine if true correlations exist. Our results suggest that singers may exhibit enhanced sensitivity to LPR and may therefore manifest symptoms, even in response to subtle changes in pH. This study emphasizes the importance of sensitive and objective measures of reflux severity as well as consideration of the cumulative time of reflux exposure in addition to the number of reflux episodes.
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Tsai YC, Huang S, Che WC, Huang YC, Liou TH, Kuo YC. The Effects of Expiratory Muscle Strength Training on Voice and Associated Factors in Medical Professionals With Voice Disorders. J Voice 2016; 30:759.e21-759.e27. [DOI: 10.1016/j.jvoice.2015.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/22/2015] [Indexed: 12/16/2022]
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Larrouy-Maestri P, Magis D, Morsomme D. Effects of Melody and Technique on Acoustical and Musical Features of Western Operatic Singing Voices. J Voice 2014; 28:332-40. [DOI: 10.1016/j.jvoice.2013.10.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 10/24/2013] [Indexed: 10/25/2022]
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Cho W, Hong J, Park H. Real-time ultrasonographic assessment of true vocal fold length in professional singers. J Voice 2013. [PMID: 23177752 DOI: 10.1016/j.jvoice.2012.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To assess changing true vocal fold (TVF) length with ultrasonography. MATERIALS Thirty-five professional singers (12 tenors and 23 sopranos) were included in this study. Each subject had a documented TVF length with laryngeal ultrasonography (SonoAce X6 scanner; Samsung Medison, Seoul, Korea) during respiration, phonation, and singing. RESULTS The average TVF lengths could be measured in each situation with real-time laryngeal ultrasonography. The mean (standard deviation [SD]) of TVF length was 1.71 cm (0.29) at inspiration, 1.56 cm (0.26) at expiration, 1.70 cm (0.21) at comfort phonation, 2.00 cm (0.22) at the highest tone, and 1.47 cm (0.19) at the lowest tone in tenors. In sopranos, the mean (SD) was 1.35 cm (0.12) at inspiration, 1.17 cm (0.12) at expiration, 1.42 cm (0.12) at comfort phonation, 1.65 cm (0.12) at the highest tone, and 1.14 cm (0.15) at the lowest tone. All variables had significant differences between both sexes (P<0.01). The lengths showed statistically significant differences in each phase (P<0.01). The differences in length between each phase were evaluated as well. When analyzed in each sex, all variables were statistically different except few of them. In both sexes, the highest tone and comfort phonation showed no difference (P=0.081 in tenors and P=0.289 in sopranos). The inspiratory phase and comfort phonation had significant difference only in sopranos (P<0.01) in contrast to tenors (P=0.905). CONCLUSION Ultrasonographic measurement of TVF could be used to assess physiological variation of TVF. To reach a high-pitched voice, the professional singers used similar range of TVF length at comfort phonation. TVF length was affected more by inspiration in tenors. In sopranos, TVF at comfort phonation was significantly lengthened than in tenors.
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Affiliation(s)
- Woojin Cho
- DAIN Ear Nose Throat Hospital Voice and Speech Center, Incheon, South Korea.
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Macdonald I, Rubin JS, Blake E, Hirani S, Epstein R. An investigation of abdominal muscle recruitment for sustained phonation in 25 healthy singers. J Voice 2013. [PMID: 23177746 DOI: 10.1016/j.jvoice.2012.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the baseline muscle thickness and recruitment patterns of the transversus abdominis muscle (TAM) and the internal oblique muscle (IOM) during semisupine phonation in a group of healthy performers. STUDY DESIGN This was a 2 × 3×2 within-group, repeated-measure study in which 25 professional vocalists--12 male and 13 female performed a series of sustained pitches in differing vocal qualities. Measurements were taken with ultrasound (Sonosite Micromaxx Ultrasound System) of the baseline thickness and % recruitment during voicing, of two deep abdominal muscles--TAM and the IOM. Correlations between TAM and IOM absolute change scores, TAM and IOM percentage change scores, and changes in muscle thickness (absolute and percentage) and age were examined using Spearman's correlations. Gender differences in the four types of change scores within each combination of pitch and quality were conducted with one-way analysis of variances. Differences in muscle thickness change 1) absolute scores and 2) percentage change in TAM and IOM, by pitch and quality (and their interactions) were analyzed using linear mixed models, using restricted maximum likelihood estimations, employing a Toeplitz variance-covariance matrix structure in SPSS (IBM, 2011). Post hoc analyses for independent variable group differences used Sidak's correction for multiple comparisons. Alpha level was set to 0.05. RESULTS In terms of absolute contractions (changes in the actual millimeter thickness of the muscle), the IOM was greater than the TAM. However in terms of percentage changes in muscles during phonation, the TAM was always greater than the IOM. The TAM as a percentage change was recruited preferentially and significantly in most vocal qualities tested. Although there were differences in muscle mass and recruitment patterns between genders, and males had thicker muscle mass at rest, differences due to muscle mass were not conclusive. CONCLUSIONS Overall this study supports the argument that the peri-abdominal muscles do indeed play a role in supporting the "performing" or athletic voice in healthy subjects, and will hopefully act as a database for further research in individuals with healthy and injured voices.
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Affiliation(s)
- Ian Macdonald
- Royal National Throat, Nose, & Ear Hospital, London, United Kingdom
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Kelleher JE, Siegmund T, Du M, Naseri E, Chan RW. The anisotropic hyperelastic biomechanical response of the vocal ligament and implications for frequency regulation: a case study. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2013; 133:1625-36. [PMID: 23464032 PMCID: PMC3606228 DOI: 10.1121/1.4776204] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
One of the primary mechanisms to vary one's vocal frequency is through vocal fold length changes. As stress and deformation are linked to each other, it is hypothesized that the anisotropy in the biomechanical properties of the vocal fold tissue would affect the phonation characteristics. A biomechanical model of vibrational frequency rise during vocal fold elongation is developed which combines an advanced biomechanical characterization protocol of the vocal fold tissue with continuum beam models. Biomechanical response of the tissue is related to a microstructurally informed, anisotropic, nonlinear hyperelastic constitutive model. A microstructural characteristic (the dispersion of collagen) was represented through a statistical orientation function acquired from a second harmonic generation image of the vocal ligament. Continuum models of vibration were constructed based upon Euler-Bernoulli and Timoshenko beam theories, and applied to the study of the vibration of a vocal ligament specimen. From the natural frequency predictions in dependence of elongation, two competing processes in frequency control emerged, i.e., the applied tension raises the frequency while simultaneously shear deformation lowers the frequency. Shear becomes much more substantial at higher modes of vibration and for highly anisotropic tissues. The analysis was developed as a case study based on a human vocal ligament specimen.
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Affiliation(s)
- Jordan E Kelleher
- Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, Indiana 47907, USA
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García-López I, Gavilán Bouzas J. La voz cantada. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2010; 61:441-51. [DOI: 10.1016/j.otorri.2009.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 12/10/2009] [Indexed: 11/27/2022]
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Gava Júnior W, Ferreira LP, Andrada e Silva MAD. Apoio respiratório na voz cantada: perspectiva de professores de canto e fonoaudiólogos. REVISTA CEFAC 2010. [DOI: 10.1590/s1516-18462010005000047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: analisar a definição de apoio respiratório, assim como as estratégias de trabalho e benefícios de sua aplicação, segundo a perspectiva de professores de canto e fonoaudiólogos. MÉTODOS: seis profissionais com experiência em voz cantada foram entrevistados sobre questões relacionadas ao apoio respiratório no canto. As respostas foram submetidas à análise de conteúdo e definidas quatro categorias: definição de apoio respiratório, tipo de apoio, estratégias e benefícios. RESULTADOS: os aspectos mais mencionados pelos entrevistados foram: a definição de apoio está relacionada com a participação do músculo diafragma e dos intercostais; o tipo de apoio mais adequado é o intercostal e diafragmático; dentre as estratégias de trabalho, utilizadas para a adequação do apoio respiratório, as mais citadas foram propriocepção corporal, conscientização da musculatura envolvida, equilíbrio do fluxo aéreo, alívio de tensões e correção da postura. Há discrepâncias com relação à utilização da contração abdominal, do uso de objetos de apoio, de imagens mentais e realização de vocalizes. Para os entrevistados, o maior benefício do apoio respiratório está no alívio das tensões laríngeas e melhoria na coordenação pneumofonoarticulatória. Houve pouca concordância sobre a ação benéfica do apoio, principalmente quanto à sua melhoria na emissão cantada. CONCLUSÃO: os resultados apontam para uma convergência da maioria dos entrevistados quanto à definição, estratégias de trabalho e benefícios do apoio respiratório, porém ainda sem consenso.
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Silva EGFD, Luna CLCD. Análise perceptivo-auditiva de parâmetros vocais em cantores da noite do estilo musical brega da cidade do Recife. REVISTA CEFAC 2009. [DOI: 10.1590/s1516-18462009000300013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: avaliar de forma perceptivo-auditiva a voz dos cantores da noite do estilo musical Brega da cidade do Recife. MÉTODOS: pesquisa realizada na clínica-escola do curso de Fonoaudiologia da Universidade Federal de Pernambuco e na emissora de TV Rede Estação canal 14, ambos localizados na cidade do Recife. Trata-se de estudo observacional, transversal e descritivo. Com anuência de 13 cantores, maiores de 18 anos, houve gravação da voz falada na emissão sustentada de vogais e durante a música "parabéns pra você"; na voz cantada realizou-se a gravação de trecho de música pertencente ao repertório do cantor. RESULTADOS: tempos de fonação reduzidos; modificações no pitch e loudness, comparando voz falada e cantada, ambos passando de adequados para, respectivamente, agudo e elevada; mudanças na ressonância, que era laringofaríngea e tornou-se equilibrada com compensação nasal. Houve manutenção do ataque vocal brusco; mudança do registro modal misto na voz habitual para o modal cabeça na voz profissional; predominância da qualidade vocal clara na voz falada e padrões adequados para modulação, projeção e articulação na voz cantada. CONCLUSÃO: os cantores da noite do estilo musical Brega da cidade do Recife apresentaram tempos de fonação reduzidos e tiveram, da voz falada para a voz cantada, mudanças no pitch, loudness e ressonância e manutenção das características vocais para ataque e registro. A qualidade vocal clara na voz falada foi predominante, assim como a modulação adequada, boa projeção e articulação precisa estavam entre os padrões vocais mais frequentes na voz cantada.
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