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Plec EMRL, Côrtes Gama AC, Souza BO, Santos MAR. Effect of Nebulization on Laryngeal Parameters: Analysis Using High-Speed Digital Videolaryngoscopy. J Voice 2024; 38:970.e1-970.e12. [PMID: 35288013 DOI: 10.1016/j.jvoice.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Superficial laryngeal hydration, obtained through nebulization, is related to the moisture level on the epithelial surfaces of the vocal folds, modifying their biomechanical and aerodynamic properties. Through high-speed videolaryngoscopy it is possible to obtain objective data for laryngeal analysis after nebulization and a better understanding of this phenomenon OBJECTIVE: To verify the effects of nebulization with saline solution on laryngeal parameters of digital videokymography obtained by high-speed videolaryngoscopy examination in women and men with and without laryngeal alterations METHOD: This is a clinical, comparative intra-subject study. Fifty-nine adults were selected, with and without laryngeal alterations, 30 females and 29 males. Digital videokymographs in the anterior, middle and posterior thirds of the vocal folds of the participants were analyzed before and after nebulization with 0.9% saline solution. RESULTS Women without laryngeal alterations showed more parameters changes after nebulization, in which there was a decrease in maximum and medium opening, amplitude of opening of the left and right vocal fold in the anterior glottal third, and an increase of the percentage of closure of the vocal folds. These results indicate a minor extent of lateral excursion of the vocal folds during phonation. In women with laryngeal alterations, the parameters that changed after nebulization were the increased frequency of opening of the left and right vocal folds in the topography of the posterior third. In men, nebulization did not change the variables studied, except for the amplitude of the right vocal fold in men with laryngeal alterations, in the analysis of the posterior glottic third. CONCLUSION The results suggest that surface hydration modifies laryngeal dynamics differently between genders. After nebulization with saline solution, women without laryngeal alterations showed a decrease in the lateralization of the vocal folds during phonation, suggesting a better phonatory efficiency.
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Affiliation(s)
- Elisa Meiti Ribeiro Lin Plec
- Department of the Faculdade de Medicina - Universidade Federal de Minas Gerais - UFMG. Av. Alfredo Balena, Otolaryngologist of the Hospital Felício Rocho Belo Horizonte, Belo Horizonte Minas Gerais, Brasil.
| | - Ana Cristina Côrtes Gama
- Universidade Federal de Minas Gerais - Postgraduate program of the Speech and Language Department of the Faculdade de Medicina - Universidade Federal de Minas Gerais - UFMG. Av. Alfredo Balena, Belo Horizonte Minas Gerais, Brasil
| | - Bárbara Oliveira Souza
- Department of the Faculdade de Medicina - Universidade Federal de Minas Gerais - UFMG. Av. Alfredo Balena, Belo Horizonte Minas Gerais, Brasil
| | - Marco Aurélio Rocha Santos
- Department of the Faculdade de Medicina - Universidade Federal de Minas Gerais - UFMG. Av. Alfredo Balena, Professor of the Universidade Federal de Minas Gerais - Otolaryngologist of the Hospital Felício Rocho - Belo Horizonte, Belo Horizonte Minas Gerais, Brasil
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Batista DDJ, Duarte JMDT, Siqueira LTD, Almeida AA, Lopes LW, Ribeiro VV. Volitional and Non-volitional Devices Used in Voice Therapy and Training: A Scoping Review-Part A. J Voice 2023:S0892-1997(23)00348-X. [PMID: 38155057 DOI: 10.1016/j.jvoice.2023.10.027] [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: 07/31/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To map the volitional and non-volitional devices used by speech and language pathologists (SLPs) in voice training and therapy and characterize their use in research on voice interventions. METHODS This scoping review is the first part of a larger study. The electronic search was carried out by mapping the references in PubMed/Medline, LILACS/BVS, Scopus, Web of Science, EMBASE, and the Cochrane Library, and the manual search was carried out in the grey literature. Two blind independent reviewers selected and extracted data; divergences were solved by consensus. The data extracted in this part of the study were the authorship and year of publication, country, study design, sample characteristics, intervention modality, ingredient, target, mechanism of action, dosage, and outcome measures. They were addressed with descriptive analysis. RESULTS Publications that use devices as ingredients are mostly from the last two decades, mainly carried out in the United States of America and Brazil, in adults of both sexes with behavioral dysphonia. Forty-two types of devices were used, many of them with similar approaches but different nomenclatures. Most devices were used voluntarily, focusing on vocal function, and aiming to increase source and filter interaction. Most studies used silicone tubes. The most reported technical specification to apply the ingredient was surface electrodes on the neck. Device dosage was time-controlled, and the most used outcomes were self-assessment and acoustic analysis. CONCLUSION Devices are currently used as ingredients in vocal interventions, with a greater focus on increasing the source and filter interaction, associated with silicone tubes (the most used devices in these studies), which have been dosed with performance time. Outcomes were measured with self-assessment instruments.
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Affiliation(s)
- Denis de Jesus Batista
- Center for Exact and Natural Sciences, Postgraduate program in Decision Models and Health of Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil; Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil
| | - João M da Trindade Duarte
- Center for Human Sciences, Letters and Arts, Postgraduate program in Linguistics of Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Larissa T D Siqueira
- Department of Speech-Language Pathology and Audiology of the Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Anna A Almeida
- Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil; Department of Speech-Language Pathology and Audiology, Graduate Program in Linguistics, and Graduate Program in Decision Models and Health of the Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Leonardo W Lopes
- Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil; Department of Speech-Language Pathology and Audiology, Graduate Program in Linguistics, and Graduate Program in Decision Models and Health of the Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Vanessa V Ribeiro
- Health Sciences Center, Associated Postgraduate Program in Speech-Language Pathology and Audiology at the Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte, and Universidade Estadual de Ciências da Saúde de Alagoas, João Pessoa, Paraíba, Brazil; Faculty of Medicine, Speech-Language Pathology and Audiology course and the Postgraduate Program in Medical Sciences of the Universidade de Brasília, Brasília, Distrito Federal, Brazil.
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de Jesus Batista D, Lopes LW, Almeida AA, Siqueira LTD, Ribeiro VV. What Factors Determine the Use of Volitional and Non-Volitional Devices in Vocal Interventions Performed by Brazilian Speech-Language Pathologists? J Voice 2023:S0892-1997(23)00346-6. [PMID: 37957072 DOI: 10.1016/j.jvoice.2023.10.026] [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: 07/31/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE To analyze the determining factors for using devices in vocal interventions and characterize their use by Brazilian speech-language pathologists (SLPs). METHODS This cross-sectional observational study had a sample of 148 SLPs with clinical practice in voice. They answered an online questionnaire via Google Forms about sociodemographic data, training, work in the area, and the use of devices in vocal interventions. Data were analyzed descriptively and inferentially. RESULTS Tubes, straws, and masks were the most commonly used devices. SLPs specializing in voice are more inclined to use thermotherapy and kinesio tapings while being less inclined to use therapeutic ultrasounds and nebulizers. Voice specialists are less likely to employ electrostimulation. The choice to use photobiomodulation and auditory monitoring devices is influenced by the years of clinical experience, whereas the speech-language therapy training duration affects the use of electrostimulation. The age of the professional also plays a role in the utilization of vibratory stimulation. Vibratory stimulation, auditory monitoring devices, thermotherapy, and nebulization are more frequently utilized among individuals who rely on their voices for occupational purposes, whereas electrostimulation is less common. The use of photobiomodulation is infrequent in children; vibratory stimulation is more common in adolescents, and thermotherapy is relatively common among older individuals. Most of these devices are typically prescribed in execution time during vocal intervention. CONCLUSION The specialization, the time since graduation and in the occupation, and the target population of the service are the determining factors for the use of devices. They are used in vocal therapy and training, targeting vocal function.
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Affiliation(s)
- Denis de Jesus Batista
- Postgraduate Program in Decision Models and Health, Statistics Departament, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil; Associate Postgraduate Program in Speech-language Therapy, Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte and Universidade Estadual de Ciências da Saúde de Alagoas.
| | - Leonardo Wanderley Lopes
- Associate Postgraduate Program in Speech-language Therapy, Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte and Universidade Estadual de Ciências da Saúde de Alagoas; Department of Speech-Language Therapy, and Postgraduate Program in Decision Models and Health at the Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | - Anna Alice Almeida
- Associate Postgraduate Program in Speech-language Therapy, Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte and Universidade Estadual de Ciências da Saúde de Alagoas; Department of Speech-Language Therapy, and Postgraduate Program in Decision Models and Health at the Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
| | | | - Vanessa Veis Ribeiro
- Associate Postgraduate Program in Speech-language Therapy, Universidade Federal da Paraíba, Universidade Federal do Rio Grande do Norte and Universidade Estadual de Ciências da Saúde de Alagoas; Speech-language Therapy Course and Postgraduate Program in Medical Sciences, Universidade de Brasília
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González-Gamboa M, Segura-Pujol H, Oyarzún PD, Rojas S. Are Occupational Voice Disorders Accurately Measured? A Systematic Review of Prevalence and Methodologies in Schoolteachers to Report Voice Disorders. J Voice 2022:S0892-1997(22)00348-4. [PMID: 36496306 DOI: 10.1016/j.jvoice.2022.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Different measuring instruments have been described to determine the prevalence of voice disorders in schoolteachers. However, the heterogeneity of prevalence figures has made it difficult in determining the impact of voice disorders in this group. This investigation aims to review and identify scientific evidence of methodological analysis of voice disorders in teachers, the relevance of measuring instruments, the prevalence of dysphonia, and the impact on the development of vocal health prevention programs. METHODS A systematic review was conducted by searching six important scientific databases. Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were carried out. Articles were included whether they presented data related to the prevalence of dysphonia and the impact of therapy programs on teachers. RESULTS Twenty articles out of 8,998 were selected. The cross-sectional design type was predominant throughout the investigations. Differences were observed in the number of participants across studies, leading to heterogeneous prevalence figures - which ranged from 10.5% to 69.1%. The assessment instruments are not standardly used to effectively determine the disease burden. Despite the fact of the extensive evidence of the effectiveness of programs that address dysphonia in teachers, the scarcity of literature is yet evident on systematic programs promoted by either the government or educational institutions. CONCLUSION Findings suggest that future investigations should consider the consensus of a global definition for occupational dysphonia in teachers in order to develop accurately measuring instruments and to assist with voice care programs and treatment approaches in this population. This might be crucial since it could also assist with the implementation of Delphi-type studies that could support the development of further evidence-based agreements around these programs (voice care and treatment approaches) in schoolteachers.
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Affiliation(s)
| | - Hugo Segura-Pujol
- Escuela de Fonoaudiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Patricia D Oyarzún
- Escuela de Fonoaudiología, Facultad de Salud, Universidad Santo Tomás, Chile
| | - Sandra Rojas
- Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
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Ramos LDA, Ribeiro CJS, Brasil CCP, Gama ACC. The Effectiveness of Vocal Health Programs in the Prevention of Voice Disorders in Teachers: A Systematic Review and Meta-Analysis. J Voice 2022:S0892-1997(22)00290-9. [PMID: 36494244 DOI: 10.1016/j.jvoice.2022.09.017] [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: 07/19/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the effectiveness of voice disorder prevention programs and to verify the effectiveness of direct and indirect voice training on the Voice Handicap Index (VHI), Voice-Related Quality of Life (V-RQOL), maximum phonation time (MPT), fundamental frequency and shimmer, for the prevention of voice disorders in regular-school teachers. METHODS This is a literature review with meta-analysis, carried out through an electronic search in PubMed, Cochrane Central, Embase, Web of Science, Scopus and BVS, and Google Scholar, as well as ClinicalTrials.gov databases for gray literature. SELECTION CRITERIA Randomized clinical trials and quasi-experimental studies were selected. The population consisted of regular schoolteachers, adults, with no vocal complaints submitted to a vocal health education and prevention program of voice disorders classified as direct (direct vocal tract training) and indirect (vocal hygiene guidelines that influence voice production). The outcomes vocal self-assessment: fundamental frequency, aerodynamic measurements (maximum phonation time), acoustic measures (shimmer) was analyzed in comparison with other vocal interventions or no vocal intervention. DATA ANALYSIS Studies were independently assessed using the Cochrane Risk of bias and ROBINS-I tools. Effect sizes were calculated only at post-treatment. GRADE criteria were used to assess the quality of evidence. RESULTS Twenty-six studies were included but, only 12 studies were included in the meta-analysis and investigated for direct and/or indirect intervention compared to no intervention. No studies were judged to be at low risk of bias, and the quality of evidence was considered high only for the Voice Handicap Index. No evidence was found that suggested effectiveness of direct and indirect voice training for any of the outcomes: VHI -1.87 (95% CI -7.03, 3.30), maximum phonation time -1.11 (95% CI -3.40, 1.17), fundamental frequency 0.87 (-1.06, 2.79) and shimmer 0, 28 (-1.50, 2.05). CONCLUSION Results of this study were not considered significant to conclude on the effectiveness of voice training for preventing dysphonia in teachers.
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Affiliation(s)
- Lorena de A Ramos
- Department of Speech-language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais. Belo Horizonte, MG, Brazil.
| | - Claudiane J S Ribeiro
- Postgraduate Program in Developmental Disorders at the Center for Biological and Health Sciences at Universidade Presbiteriana Mackenzie
| | | | - Ana C C Gama
- Department of Speech-language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais. Belo Horizonte, MG, Brazil
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Buckley KL, O’Halloran PD, Oates JM, Carey LB, Ruddock ML. Vocal ergonomics with sports coaches: Co-devised approaches to occupational voice. Work 2022; 73:S109-S126. [DOI: 10.3233/wor-211215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND: Work-system participation and factors are associated with occupational vocal health for vocally reliant workers, such as sports coaches. However, there is limited use of systems approaches and worker collaboration to address occupational voice. OBJECTIVE: The current research aimed to cooperatively consider coaches’ vocally reliant systems participation, including addressing vocal ergonomic factors that can create barriers for occupational vocal health and voice use. METHODS: Collaborative action inquiries explored vocal ergonomics with coaches (n = 24) from nine professional basketball teams. Across three basketball seasons, coaches and a subject matter expert identified what influenced coaches’ voices and trialed approaches to optimize vocally reliant coaching participation. Nine action inquiry methods were used, including search conferences, ergonomic approaches to enhance systems participation, and focus groups. Multi-level analyses were also undertaken. RESULTS: Participants cooperatively generated, implemented, and evaluated different strategies. A cumulative total of 57 strategies were explored within teams (team mean = 6.33, SD = 3, range = 4–14). Cross-case analysis identified 25 different strategy types. Overall, participants appraised 31.58% (18/57) strategies as supportive (i.e., enhanced facilitators for voice), 61.40% (35/57) strategies as somewhat supportive (i.e., some enhanced facilitators and some ongoing barriers), and 7.02% (4/57) strategies as unsupportive (i.e., pervasive ongoing barriers not mitigated by strategies). Further, factors across coaches’ work-systems continued to influence coaches’ voices in dynamic and complex ways. CONCLUSIONS: Collaboration with coaches enriched vocal ergonomic approaches by providing novel, context-anchored insights. Collaboration should form ‘part’ of broader mechanisms to support coaches’ voice use and vocal health at work.
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Affiliation(s)
- Katie L. Buckley
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- Human Factors/Ergonomics (HF/E) - Health and Technical Services, WorkSafe New Zealand, Wellington, Aotearoa New Zealand
| | - Paul D. O’Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Jennifer M. Oates
- Department of Speech Pathology, Orthoptics and Audiology, La Trobe University, Melbourne, VIC, Australia
| | - Lindsay B. Carey
- Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Mandy L. Ruddock
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Buckley KL, O'Halloran PD, Oates JM, Ruddock-Hudson ML. Action inquiry and vocal ergonomics: A pilot study with sports coaches. Work 2021; 70:1151-1163. [PMID: 34842203 DOI: 10.3233/wor-205040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Coaches critically rely on voice for occupational functioning, which has associated risks to vocal health. However, vocal occupational health and safety (OHS) and vocal ergonomics are not typically considered for, by, or with coaches. OBJECTIVE This study piloted a participatory approach to vocal ergonomics, aiming to collaboratively (i) understand coaches' vocally reliant occupational participation, and (ii) consider vocal ergonomic factors. METHODS This research was undertaken at an international tournament for floorball (also known as 'Innebandy', 'Salibandy', or 'Unihockey'). Three national coaches (n = 3) and the lead researcher undertook cooperative action inquiry. This piloted a participatory vocal ergonomics programme. Action inquiry methods included fieldnotes, interviews, observations, a workshop, ergonomics approaches, and a focus group. Multi-level analyses supported the findings, including categorical aggregation, direct interpretation, and reflexive thematic analysis. RESULTS Participants identified vocal ergonomic factors present at the tournament; including personal, activity, physical environmental, and organisational factors. Participants developed four vocal ergonomic approaches responsive to factors. These were: (1) player consultation, (2) ongoing feedback discussions, (3) movement and postural change, and (4) specific task adaptation. Approaches 1-2 directly supported coaches' voices. Coaches posited limitations to other strategies, but made recommendations for future use. Coaches also reflected that this collaboration provided actionable voice insights and opportunities to address vocal ergonomics. They advocated for extended engagement with coaches, increased focus on vocal health, and inclusion of early career coaches in future programmes. CONCLUSIONS These findings support engagement of coaches, and other vocally reliant workers, in addressing voice use and vocal health at work.
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Souza EVS, Bassi IB, Gama ACC. Voice amplifier: effects on dose and vocal intensity of teachers without dysphonia. Codas 2021; 33:e20200091. [PMID: 34431858 DOI: 10.1590/2317-1782/20202020091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 09/06/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Analyze the interference of using the voice amplifier in vocal dose of non-dysphonic teachers. METHODS This is an experimental study comparing people from the same ambience compound for 20 teachers from municipal elementary school in Belo Horizonte/MG. After consent, the participants were requested to answer the vocal symptom scale questionnaire (ESV) and later participated in two different moments of the study, for which they randomly selected. In the first moment, the participants used only the vocal dosimeter and in the second, they used the vocal dosimeter and the voice amplifier. The measurements were recorded by the device for 1h40m, in the classroom that the teachers taught. The time between the two measurements was one week, with the same room, the same time and the same discipline being taught, at both times. RESULTS The intensity parameter was the only one that showed difference with the use of the voice amplifier. CONCLUSION Use voice amplification while non-dysphonic teachers are teaching doesn't affect the fundamental frequency and vocal dose measure in the acoustics parameters. The vocal intensity is smaller when teacher uses the vocal amplification.
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Affiliation(s)
- Evelyn Vanessa Silva Souza
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG), Brasil
| | | | - Ana Cristina Côrtes Gama
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte, MG, Brasil
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Pereira MCB, Onofri SMM, Spazzapan EA, Carrer JDS, Silva LAD, Fabbron EMG. Immediate effect of surface laryngeal hydration associated with tongue trill technique in amateur singers. Codas 2021; 33:e20200009. [PMID: 34037159 DOI: 10.1590/2317-1782/20202020009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 05/30/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To analyze the immediate effect of laryngeal surface hydration associated with the performance of Tongue Trills (TT) on singers. METHODS Thirty singers without vocal complaints or laryngeal alterations divided into control (CG) and experimental (EG) groups. The CG performed the TT for five minutes. The EG was submitted a nebulization with 3 ml of saline solution followed by TT for five minutes. Voice self-assessment, acoustic analysis and perceptual assessment were performed at Pre (Pre TT) and post (PTT) moments in CG and pre (Pre TT), post hydration (PH) and post hydration + TT (PHTT) in GE. In the self-assessment were evaluated quality, stability, vocal intensity and hoarseness. There were extract the values of the Fundamental frequency; Jitter%; Shimmer%, Noise-to-harmonic Ratio e Cepstral Peak Prominence-Smoothed (CPPs) in the acoustic analyze. The perceptual evaluation was performed by an experienced speech therapist. RESULTS Comparing the results of self-assessment between groups showed improvement in the perception of stability and vocal intensity in the PTT (CG) in relation to PH (EG). Comparison between the EG moments showed a statistical difference in the vocal intensity perception, indicating a better results for PHTT. There was no statistical difference between the groups investigated in the perceptual assessments and acoustic analysis. CONCLUSION Surface laryngeal hydration does not potentiate the effect of TT on naturally hydrated singers with 3ml nebulization. For voice professionals with high vocal demand, surface hydration can be introduced during voice use to maintain vocal quality.
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Affiliation(s)
- Maria Cecilia Bayer Pereira
- Programa de Pós-graduação em Fonoaudiologia, Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências - UNESP - Marília (SP), Brasil
| | - Suely Mayumi Motonaga Onofri
- Programa de Pós-graduação em Fonoaudiologia, Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências - UNESP - Marília (SP), Brasil
| | - Evelyn Alves Spazzapan
- Programa de Pós-graduação em Fonoaudiologia, Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências - UNESP - Marília (SP), Brasil
| | - Joyra da Silva Carrer
- Programa de Pós-graduação em Fonoaudiologia, Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências - UNESP - Marília (SP), Brasil
| | - Luana Alves da Silva
- Programa de Pós-graduação em Fonoaudiologia, Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências - UNESP - Marília (SP), Brasil
| | - Eliana Maria Gradim Fabbron
- Programa de Pós-graduação em Fonoaudiologia, Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências - UNESP - Marília (SP), Brasil
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Souza BO, Santos MAR, Plec EMRL, Diniz ML, Gama ACC. Nebulized Saline Solution: A Multidimensional Voice Analysis. J Voice 2021:S0892-1997(21)00083-7. [PMID: 33849762 DOI: 10.1016/j.jvoice.2021.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To verify the effect of nebulization on the voice of dysphonic and non-dysphonic individuals on acoustic, perceptual-auditory, aerodynamic, electroglottographic, laryngeal parameters and on the self-perception of vocal discomfort. MATERIALS AND METHODS All the research subjects were submitted to vocal evaluation, laryngeal and voice self-perception. Then, the participants remained in vocal rest for a period of 10 minutes and the analysis mentioned above were again performed. After this first stage, the participants were submitted to the nebulization for a period of 10 minutes and the all analysis above were again performed. Descriptive analysis of the variables was carried. In the comparison of the pre- and post-nebulization groups, the Paired T-Student Test was used for variables with non-dysphonic distribution and the Wilcoxon Test for variables with asymmetric distribution. When categorical variables were evaluated (perceptual-auditory evaluation and laryngeal assessment), the Pearson's Chi-square test was used. In all analysis, a significance level of 5% was considered. The intra-rater agreement in the auditory-perceptual and perceptual-visual assessment was assessed using the AC1 statistic, using the R program. For this purpose, 20% of the voice samples and laryngeal images were replicated blindly and interpreted by the evaluators at the time evaluations. RESULTS The results of this research show that non-dysphonic individuals have more positive vocal and laryngeal effects after nebulization than dysphonic ones. It is also observed that the EGG measurement was the most sensitive to the effect of nebulization, with an increase in the Closed quotient (CQ) in all groups evaluated. Regarding acoustic measurements, it is noted that the effect of nebulization in men is more evident than in women. After nebulization, there was an increase in fundamental frequency in the group of non-dysphonic women and dysphonic and non-dysphonic men. A decrease in the amplitude perturbation quotient values is observed in all groups, besides a reduction in the pitch perturbation quotient values after nebulization in non-dysphonic men groups. There was improves aerodynamic efficiency in groups of dysphonic and non-dysphonic men and in the self-perception of vocal discomfort in all groups studied after the hydration procedure. The results of this study demonstrate a significant improvement in the mucosal wave after nebulization in the groups of women and men who are not dysphonic. CONCLUSION The nebulization procedure with saline solution improves acoustic measurements, the electroglottographic closed quotient and vocal self-perception of dysphonic and non-dysphonic women and men. Nebulization increases the mucosal wave of the vocal folds in non-dysphonic women and men and improves the aerodynamic efficiency of men.
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Affiliation(s)
- Bárbara Oliveira Souza
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | | | - Elisa Meiti Ribeiro Lin Plec
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Luiza Diniz
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Cristina Côrtes Gama
- Department of Speech-Language Pathology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Liu M, Zhang T, Zang C, Cui X, Li J, Wang G. Preparation, optimization, and in vivo evaluation of an inhaled solution of total saponins of Panax notoginseng and its protective effect against idiopathic pulmonary fibrosis. Drug Deliv 2020; 27:1718-1728. [PMID: 33307846 PMCID: PMC7738294 DOI: 10.1080/10717544.2020.1856222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive pulmonary disease that can cause fibrotic remodeling of the surrounding lung, thus leading to respiratory failure. Although IPF is the most common form of idiopathic interstitial pneumonia, the precise mechanisms underlying this condition remain unknown. In this study, we used total saponins of Panax notoginseng inhalation solution (TIS) to induce idiopathic bleomycin-induced pulmonary fibrosis in rats. The uniformity of delivery dose was investigated by analyzing the aerodynamic particle size distribution and drug stability. The potential of hydrogen potential of hydrogen (pH) of the inhalation solution was 7.0 and the solvent 0.9% NaCl solution, thus meeting physiological requirements for pulmonary drug administration. The delivery rate was 1.94 ± 0.16 mg·min-1 and the total dose was 17.40 ± 0.04 mg. TIS was composed of five key components: notoginsenoside R1, ginsenosides Rg1, ginsenosides Re, ginsenosides Rb1, and ginsenosides Rd. The mass median aerodynamic diameter (MMAD) for these five components were 3.62 ± 0.05 µm, 3.62 ± 0.06 µm, 3.65 ± 0.10 µm, 3.62 ± 0.06 µm, and 3.61 ± 0.05 µm, respectively. Fine particle fraction (FPF) was 66.24 ± 0.73%, 66.20 ± 0.89%, 66.07 ± 1.42%, 66.18 ± 0.79%, and 66.29 ± 0.70%, respectively. The MMAD for inhalation solutions needs to be 1-5 µm, which indicates that the components of TIS are suitable for inhalation. It is important to control the particle size of targeted drugs to ensure that the drug is delivered to the appropriate target tissue. In vitro experiments indicated that TIS exhibited high rates of deposition in lung tissue, thus indicating that pulmonary delivery systems may represent a good therapeutic option for patients.
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Affiliation(s)
- Mengjiao Liu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tianyi Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chen Zang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaolan Cui
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianliang Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guohua Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, China
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Occupational voice is a work in progress: active risk management, habilitation and rehabilitation. Curr Opin Otolaryngol Head Neck Surg 2020; 27:439-447. [PMID: 31651425 PMCID: PMC6867679 DOI: 10.1097/moo.0000000000000584] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current article reviews recent literature examining occupational voice use and occupational voice disorders (January 2018–July 2019).
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Araújo TMD, Pinho PDS, Masson MLV. Teachers' work and health in Brazil: thoughts on the history of research, strides, and challenges. CAD SAUDE PUBLICA 2019; 35Suppl 1:e00087318. [PMID: 31166380 DOI: 10.1590/0102-311x00087318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 03/26/2019] [Indexed: 11/22/2022] Open
Abstract
This Essay discusses the theme of teachers' work and health in Brazil. The objectives are to describe the initial history of research on teachers' health, discuss elements leading to a consensus on the characterization of the group's work and principal health problems, and systematize the main strides and challenges. The Essay draws on more than two decades of research and practice in this field. Based on this experience, the authors identify the movements, the accumulated evidence, and prospects for future development. The elements brought to the discussion point to substantial growth in the field: the number of studies, the diversity and scope of topics, the groups of men and women teachers studied, and the experiences with application of the knowledge (programs and interventions). Despite these strides, the studies and practices still emphasize the individual and the disease, with little or no attention to work factors (work process and management) in the health/disease process. Issues pertaining to gender differences (in work and in health status) also remain invisible. There is little linkage between researchers and teachers' movements (a relevant characteristic of the first initiatives in the field). There are no public policies to regulate the workplace and work management. The contributions to the discussion provide insight for thought to assist the identification of critical nodes and analytical scenarios with the potential for progress in this field of research and intervention.
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Santana ER, Araújo TMD, Masson MLV. Self-perception of surface hydration effect on teachers’ voice quality: an intervention study. REVISTA CEFAC 2018. [DOI: 10.1590/1982-021620182068418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: to assess the effects of surface hydration on vocal quality according to teachers’ self-perception. Methods: an examiner-blinded pre-test and post-test intervention study carried out with a single group of 27 teachers. Sociodemographic characteristics and work questionnaire, Screening Index for Voice Disorder, Vocal Severity Rating Scale, Expected Effects Pre-intervention, Perceived Effects Post-intervention and Post-intervention Perception instruments, were applied. The intervention lasted 4 weeks and consisted of 5 minutes of nebulization with saline solution (sodium chloride 0.9%), after 10 minutes of mouth dehydration, prior to teaching. Results: screening Index for Voice Disorder scores demonstrated a statistically significant reduction (p=0.001). Frequency of voice disorders in the Vocal Severity Rating Scale was reduced without a statistical significance (p= 0.172). Expected Effects, Pre-intervention, and Perceived Effects, Post-intervention, showed improvement in vocal quality (40.7%), vocal comfort (40.7%) and vocal folds hydration (37%). Post-intervention perception form showed moderate improvement of the symptoms (59.3%), cleared voice (55.6%) and ease speaking (48.1%) as well as intense belief in the intervention (74.1%) and intense compliance to the intervention (74.1%). Conclusion: surface hydration with saline solution promoted self-perceived improvement in vocal quality.
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