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Cha J, Choi SH. Extrinsic Laryngeal Muscle Activity and Vocal Economy in Professionally Trained Voices During Vocal Vibrato. J Voice 2024:S0892-1997(24)00218-2. [PMID: 39127534 DOI: 10.1016/j.jvoice.2024.07.009] [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: 04/12/2024] [Revised: 06/11/2024] [Accepted: 07/08/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE The purpose of the present study was to determine the extrinsic laryngeal muscle activity and vocal economy during two different singing conditions (straight-tone- vs vibrato singing) over a physiologically relevant singing range. METHODS Thirty professional singers or voice coaches participated in the study. The participants sang a sustained /a:/ vowel for approximately 5seconds, once in straight-tone singing conditions and once more in vibrato. The target pitches were C3, F3, A3, C4, F4, A4, and C5. Surface electromyographic (sEMG) measures were performed in the infrahyoid (IH)- and the suprahyoid (SH) muscle region. Contact quotient (CQ), sound pressure level (SPL), and fundamental frequencies were measured to derive the electroglottographic-based vocal economy parameter quasi-output cost ratio (QOCR). RESULTS sEMG measures show that IH and SH muscles significantly increased in activity with ascending pitch. IH and SH muscle activity was also significantly higher when singing in vibrato than straight-tone. Moreover, SPL also increased with ascending pitch and when sung in vibrato. CQ increased and QOCR decreased as pitch ascended but did not significantly change when sung in vibrato. CONCLUSION Singing higher pitches was generally associated with higher extrinsic laryngeal muscle activity and lower QOCR values. When comparing two singing conditions, extrinsic laryngeal muscle activity was higher during vibrato, implicating that IH and the SH muscles may contribute to rhythmic pulsations of pitch modulation. Although the QOCR value did not show significant differences between the two singing conditions, a significantly higher SPL during vibrato may offer some acoustical and physiological advantages. Results also indicate that extrinsic muscle activity may not be reliably measure vocal economy.
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Affiliation(s)
- Junseo Cha
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Seong Hee Choi
- Department of Audiology and Speech Language Pathology, Daegu Catholic University, Kyeongsan, Republic of Korea.
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Hashemnia SS, Seifpanahi MS, Baghban K, Miresmaeili A, Khazaei S. The Immediate Effect of Straw Phonation in Children With Repaired Cleft Palate. J Voice 2024:S0892-1997(24)00201-7. [PMID: 39095240 DOI: 10.1016/j.jvoice.2024.06.023] [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: 04/12/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE This study aims to investigate the immediate effect of straw phonation on the phonation of Persian-speaking children with repaired cleft palate. STUDY DESIGN Quasi-experimental preintervention and postintervention. METHODS Seventeen children with repaired cleft palate and velopharyngeal dysfunction were investigated. A control group was established comprising children without a cleft palate (control group), carefully matched in terms of age and gender. All participants underwent straw phonation and assessment. The assessments were made two times: at baseline and immediately after straw phonation. Each participant performs straw phonation (a short straw measuring 3 mm in inner diameter and 20 cm in length) once for 3 minutes. The acoustic analysis including parameters, such as jitter, shimmer, harmonics-to-noise ratio (HNR), cepstral peak prominence (CPP) parameters, as well as the electroglottography (closed quotient [CQ]) analysis were performed at pretreatment and immediately after treatment. RESULTS Compared with the pretreatment values, after-treatment observation demonstrated a significant reduction in Jitter % and Shimmer %, and a significant enhancement in HNR and CPP among children with repaired cleft palate. There is no significant difference in intragroup data in the CPP and CQ in pretreatment. CONCLUSIONS The proposed straw phonation technique results in an immediate positive change in the quality of voice in both groups. Moreover, assessments in the clinical group showed a significant decrease in shimmer and jitter perturbation, alongside elevated levels of HNR and CPP subsequent to straw phonation, irrespective of the phonatory task.
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Affiliation(s)
- Seyede Saghar Hashemnia
- Department of Speech Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Science, Hamadan, Iran.
| | - Mohammad-Sadegh Seifpanahi
- Department of Speech Therapy, School of Rehabilitation Sciences, Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Kowsar Baghban
- Department of Speech Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Science, Hamadan, Iran.
| | - Amirfarhang Miresmaeili
- Dental Research Center, Department of Orthodontics, Faculty of Dentistry, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Salman Khazaei
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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Laukkanen AM, Radolf V, Bula V, Horáček J, Geneid A. Glottal Imaging Study Comparing Vowel Phonation with Semioccluded Vocal Tract Exercises (SOVTEs) Produced Loudly. J Voice 2024:S0892-1997(24)00200-5. [PMID: 39003213 DOI: 10.1016/j.jvoice.2024.06.019] [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: 04/08/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
OBJECTIVES This study aimed to estimate vocal loading in loud phonation of a vowel and two widely used semiocclusion voice exercises (SOVTEs). Impact stress (IS) was estimated from glottal closing speed, inertial forces from the second derivative of glottal opening and closing. STUDY DESIGN Experimental study in vivo. METHODS A vocally healthy male sustained the [o:] vowel with habitual loudness and loudly: (1) without a tube, (2) into a silicone "Lax Vox" type tube (35 cm in length, 10 mm in diameter) outer end submerged 10 cm in water, and (3) into a straw (length 12.6 cm, diameter 2.5 mm) the outer end in air. He tried to use equal effort in all loud samples. High-speed video-laryngo-endoscopy was performed with a rigid scope. Oral air pressure (Poral) was registered in a mouthpiece through which the endoscope was inserted into the larynx and to which the tubes were attached air-tightly. RESULTS Compared with vowel phonation at habitual loudness, mean of maximal glottal width (max GW) increased by 44.1% for loud tube phonation and decreased by 1.8% for loud straw phonation, and mean absolute value of minimum GW time derivative dmin increased by 57.1% for tube and by 29.5% for straw suggesting faster glottal closing. Compared with loud vowel phonation, max GW increased by 22.6% for loud tube phonation, while it decreased by 16.6% for loud straw phonation. For the tube, dmindecreased by 7.6% and for the straw by 23.8%. Maximal acceleration (ACC) and deceleration (DC) values were larger for the tube and smaller for the straw than the values for both vowel phonations. CONCLUSIONS IS, deduced from dmin, increased in loud SOVTEs compared to vowel phonation at a conversational loudness, but remained lower in loud SOVTEs than in loud vowel phonation, particularly with a narrow straw, which also reduced inertial forces, as suggested by the reduced ACC and DC.
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Affiliation(s)
| | - Vojtěch Radolf
- Institute of Thermomechanics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Vítězslav Bula
- Institute of Thermomechanics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jaromír Horáček
- Institute of Thermomechanics of the Czech Academy of Sciences, Prague, Czech Republic
| | - Ahmed Geneid
- Department of Otolaryngology and Phoniatrics-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Apfelbach CS, Sandage M, Abbott KV. Effects of Back Pressure on the Feasibility and Tolerability of Laryngeal Diadochokinetic Exercise: A Pilot Study. J Voice 2024:S0892-1997(24)00158-9. [PMID: 38969542 DOI: 10.1016/j.jvoice.2024.05.007] [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: 09/05/2023] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND The term vocal demand response refers to how speakers meet vocal demands. Vocal loading tasks with predetermined demand parameters (duration, pitch, loudness, etc) have been used in research to study the vocal demand response; these have historically consisted of loud sustained vowel and loud speech tasks. Tasks founded on laryngeal diadochokinesis (LDDK) may be viable alternatives, especially if demand parameters such as exercise-rest ratio and fluid back pressure are concurrently modulated. OBJECTIVES To explore the effects of four fluid back pressure conditions (0, 5, 10, and 15 cm H2O) on several measures of subjective participant experience, feasibility, and tolerability during intervallic laryngeal diadochokinetic exercise. METHODS Participants (n = 12) completed 15-minute trials of LDDK in 30-second rest and exercise intervals against four counterbalanced back pressure conditions: 0, 5, 10, and 15 cm H2O. The effects of back pressure on (1) ratings of perceived vocal exertion, (2) prevalence of adverse effects such as shortness of breath or lightheadedness, (3) subjective difficulty of sustaining LDDK, (4) number of exercise intervals completed, (5) rankings of participant-preferred back pressure levels, and (6) expert ratings of auditory-perceptual diadochokinetic strength were assessed descriptively. RESULTS Perceived vocal exertion, lightheadedness, and subjective laryngeal diadochokinetic difficulty increased as back pressure increased. Number of intervals completed, auditory-perceptual diadochokinetic strength, and participant rankings of back pressure conditions, by contrast, decreased as back pressure increased. 0 and 5 cm H2O were the most preferred back pressure conditions overall. DISCUSSION Fluid back pressure was feasible and broadly tolerated during 15-minute trials of vocal exercise. However, the transition from 5 → 10 cm H2O appeared to represent an inflection point in our results: a minority of participants did not tolerate exercise at 10 cm H2O, becoming a majority at 15 cm H2O. We conclude that fluid back pressure should be restricted to values between 0 and 10 cm H2O during LDDK.
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Affiliation(s)
| | - Mary Sandage
- Department of Speech, Language & Hearing Sciences, Auburn University, Auburn, Alabama
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Cha J, Kim C, Choi SH. Extrinsic Laryngeal Muscle Activity With Different Diameters and Water Depths in a Semi-Occluded Vocal Tract Exercise. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:1324-1338. [PMID: 38592964 DOI: 10.1044/2024_jslhr-23-00194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE Surface electromyography (sEMG) has been used to evaluate extrinsic laryngeal muscle activity during swallowing and phonation. In the current study, sEMG amplitudes were measured from the infrahyoid and suprahyoid muscles during phonation through a tube submerged in water. METHOD The sEMG amplitude values measured from the extrinsic laryngeal muscles and the electroglottographic contact quotient (CQ) were obtained simultaneously from 62 healthy participants (31 men, 31 women) during phonation through a tube at six different depths (2, 4, 7, 10, 15, and 20 cm) while using two tubes with different diameters (1 and 0.5 cm). RESULTS With increasing depth, the sEMG amplitude for the suprahyoid muscles increased in men and women. However, sEMG amplitudes for the infrahyoid muscles increased significantly only in men. Tube diameter had a significant effect on the suprahyoid sEMG amplitudes only for men, with higher sEMG amplitudes when phonating with a 1.0-cm tube. CQ values increased with submerged depth for both men and women. Tube diameter affected results such than CQ values were higher for men when using the wider tube and for women with the narrower tube. CONCLUSIONS Vocal fold vibratory patterns changed with the depth of tube submersion in water for both men and women, but the patterns of muscle activation differed between the sexes. This suggests that men and women use different strategies when confronted with increased intraoral pressure during semi-occluded vocal tract exercises. In this study, sEMG provided insight into the mechanism for differences between vocally normal individuals and could help detect compensatory muscle activation during tube phonation in water for people with voice disorders.
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Affiliation(s)
- Junseo Cha
- Department of Audiology and Speech-Language Pathology, Research Institute of Biomimetic Sensory Control, Catholic Hearing Voice Speech Center, Daegu Catholic University, Gyeongsan, South Korea
| | - Chaehyun Kim
- Department of Audiology and Speech-Language Pathology, Research Institute of Biomimetic Sensory Control, Catholic Hearing Voice Speech Center, Daegu Catholic University, Gyeongsan, South Korea
| | - Seong Hee Choi
- Department of Audiology and Speech-Language Pathology, Research Institute of Biomimetic Sensory Control, Catholic Hearing Voice Speech Center, Daegu Catholic University, Gyeongsan, South Korea
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Taguchi A, Hyodo N, Shiromoto O. A Study on Vocal Attack During Voice Therapy Exercises Using Photoglottography. J Voice 2024:S0892-1997(24)00087-0. [PMID: 38582725 DOI: 10.1016/j.jvoice.2024.03.017] [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: 10/25/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE There are various exercises for voice therapy, but current evidence is insufficient to decide the most effective training technique for each type of dysphonia. This study focused on vocal attack as one of the causes of dysphonia. Hence, vocal attack during voice therapy exercises was investigated using photoglottogram (PGG). METHODS Eighteen healthy adult subjects (10 males and 8 females) were included in this study. The first to fifth vocal waves during natural voice, hard and soft voice onset, and semi-occluded vocal tract exercises (SOVTE: humming, tubing, and lip trill) were assessed. We also calculated the 25% vocal fold open quotient (OQ) using a PGG and compared these parameters. RESULTS The 25% OQ did not show any sex-related differences. In the first wave, the 25% OQ for hard attack was significantly lower than that for soft attack, tongue-out humming, and lip trill. In contrast, the 25% OQ value for soft attack was significantly higher than that for humming, 6 mm tube phonation, and lip trill. The 25% OQ values differed between SOVTE procedures; it was higher for the 13 mm tube phonation than for the 6 mm tube phonation. The 25% OQ at voice onset in the first to fifth waves differed depending on the SOVTE technique, indicating different voice onset patterns. CONCLUSIONS These results suggest that appropriate selection of SOVTE tailored for each patient may have benefit in further voice improvement. Future research should focus on conducting a similar study on patients with dysphonia.
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Affiliation(s)
- Aki Taguchi
- Faculty of Health and Welfare, Department of Health and Welfare, Prefectural University of Hiroshima, Higashihiroshima, Hiroshima, Japan.
| | - Naoki Hyodo
- Department of Rehabilitation, Matsuyama Rehabilitation Hospital, Tokorozawa, Saitama, Japan
| | - Osamu Shiromoto
- Faculty of Health and Welfare, Department of Health and Welfare, Prefectural University of Hiroshima, Higashihiroshima, Hiroshima, Japan
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Apfelbach CS, Guzmán M. Acoustic, Aerodynamic, Morphometric, and Perceptual Changes During and After Semi-Occluded Vocal Tract Exercise: An Integrative Review. J Voice 2024; 38:404-425. [PMID: 34774370 DOI: 10.1016/j.jvoice.2021.09.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The body of literature discussing the acoustic, aerodynamic, perceptual, and morphometric changes that occur during and after semi-occluded vocal tract exercise (SOVTE) has dramatically expanded within the past 20 years. The current study integrates the literature on SOVTE from the 1990s onward, reviewing the technique's clinically relevant effects in vocally untrained adults both with and without dysphonia. The study aims to give clinicians actionable information on how SOVTEs alter vocal function in both normal and pathological states. METHODS The author queried the MEDLINE database for combinations of search terms related to semi-occluded vocal tract exercise. To improve article identification, the author also performed iterative citation webbing in which the reference lists of each article selected for full-text screening were cross-referenced against the articles returned in the initial MEDLINE search. Articles identified by iterative citation webbing that did not appear in the initial MEDLINE search were then screened individually. The second author independently verified adherence to the review's inclusion and exclusion criteria in both the initial search and data extraction phases. RESULTS The initial MEDLINE search returned 869 articles, 111 of which passed the title and abstract screening phase. Iterative citation webbing returned an additional 20 studies, resulting in a total of 131 articles that qualified for full-text screening. 53 articles passed full-text screening and were included in the current review. DISCUSSION Semi-occluded vocal tract exercise increases the inertive reactance of the glottis, vocal tract, and air column, as well as introducing flow resistance at the level of the lips or velopharyngeal port. Each of these mechanisms yields downstream acoustic, aerodynamic, morphometric, and perceptual changes, including reductions in phonation threshold pressure and perceived phonatory effort, improved spectral characteristics of the acoustic signal, attenuation of vocal fold impact stress as indexed by various metrics such as maximum area declination rate, and alterations to the physical dimensions of the vocal tract. Although few studies examined the duration of these changes post exercise, several RCTs support the assertion that SOVTE's effects can be sustained with regular practice over weeks or months, regardless of current vocal health status.
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Affiliation(s)
- Christopher S Apfelbach
- Department of Communication Sciences and Disorders, University of Delaware, Newark, Delaware.
| | - Marco Guzmán
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
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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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Acevedo K, Guzman M, Ortega A, Aguirre C, Diaz S, Escudero J, Quezada C. Remote Voice Therapy With an Oscillatory Positive Expiratory Pressure Device in Subjects With Vocal Fatigue: A Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4801-4811. [PMID: 37971520 DOI: 10.1044/2023_jslhr-23-00357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
PURPOSE The present study aimed at assessing the efficacy of remote voice therapy (telepractice) implemented with Shaker Medic Plus device in subjects with vocal fatigue. METHOD Thirty-six participants were initially enrolled in this study. Twenty-four participants with vocal fatigue were finally randomly assigned to one of two treatment groups: (a) voice treatment with Shaker Medic Plus device plus vocal hygiene program (n = 12) and (b) voice treatment with water resistance therapy (WRT) plus vocal hygiene program (n = 12). Laryngoscopic assessment was conducted on all subjects. Before and after voice therapy, participants underwent (a) self-assessment of voice: Vocal Fatigue Index and Vocal Tract Discomfort Scale and (b) instrumental assessment with aerodynamic, acoustic, and electroglottographic measures. The treatment period included six voice therapy sessions within 6 weeks. Each session lasted 30 min. For both groups, exercises consisted of a sequence of nine phonatory tasks performed with Shaker Medic Plus (experimental group) and WRT (control group). Comparisons for all variables were performed between the experimental group and control group. RESULTS Significant improvements were found for self-reported variables when comparing pre- and postmeasures for both groups. No significant differences were found when comparing groups. No significant main effects or interactions were observed for any of the observed instrumental variables. CONCLUSIONS Remote physiologic voice therapy with Shaker Medic Plus device and water resistance therapy seem to be both effective to improve voice in subjects diagnosed with vocal fatigue. No differences should be expected between these therapeutic protocols when treating patients with vocal fatigue. Moreover, both are effective at reducing tiredness of voice, voice avoidance, physical discomfort associated with voicing, subjective perception of sensory discomfort in throat, and reduction of physical, emotional, and functional impact of voice problems.
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Affiliation(s)
- Karol Acevedo
- Escuela de Fonoaudiología, Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Santiago, Chile
| | - Marco Guzman
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
| | - Andrés Ortega
- Department of Ear, Nose, and Throat, Clínica las Condes, Santiago, Chile
| | - Camila Aguirre
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
| | - Sofía Diaz
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
| | - Javiera Escudero
- Department of Communication Sciences and Disorders, Universidad de los Andes, Santiago, Chile
| | - Camilo Quezada
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago
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Tsai MJ, Wang CT, Fu S, Lin FC. Effect of intensive water resistance phonation therapy for people with presbyphonia: A pilot study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023:1-9. [PMID: 37908078 DOI: 10.1080/17549507.2023.2261660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Purpose: The aim of this pilot study was to explore the efficacy of an intensive 3 week water resistance phonation (WRP) therapy program for people with presbyphonia.Method: Participants included 13 people with presbyphonia who received intensive WRP therapy. All participants completed eight sessions of therapy over 3 weeks. Auditory perceptual ratings, and acoustic and aerodynamic assessments were performed before and after treatment. Participants also completed the voice-related quality of life questionnaire before and after the treatment.Result: After 3 weeks of intensive voice therapy, significant improvements were demonstrated in acoustic, aerodynamic, and auditory perceptual parameters, as well as patient perceptions of voice-related quality of life. Acoustically, it was found there were significant decreases in shimmer (p = 0.019), noise-to-harmonic ratio (p = 0.016), and smoothed cepstral peak prominence (p = 0.001). Perceptually, the clients with presbyphonia showed significant reductions in the ratings of the overall grade, roughness, asthenia, and strain. Moreover, there was a significant increase in the total score of the Mandarin version of the Voice-Related Quality of Life measure post-therapy.Conclusion: The investigation provides preliminary evidence that people with presbyphonia can improve their vocal function and voice-related quality of life through intensive WRP therapy within a short period of time.
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Affiliation(s)
- Ming-Jhen Tsai
- Department of Otorhinolaryngology - Head & Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Electric Engineering, Yuan-Ze University, Taoyuan, Taiwan
| | - Sherry Fu
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan
- Lower School, Taipei American School, Taipei, Taiwan
| | - Feng-Chuan Lin
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Santos SS, Christmann MK, Cielo CA. Spectrographic Vocal Characteristics in Female Teachers: Finger Kazoo Intensive Short-term Vocal Therapy. J Voice 2023:S0892-1997(23)00270-9. [PMID: 37838586 DOI: 10.1016/j.jvoice.2023.08.023] [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: 06/05/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE Verify the results from intensive short-term vocal therapy using the Finger Kazoo technique about the spectrographic vocal measurements of teachers. METHODS Controlled and randomized trial. Spectrographic vocal assessment was performed by judges before and after intensive short-term vocal therapy with Finger Kazoo. Sample was composed of 41 female teachers. There were two study groups (with vocal nodules and without structural affection of the vocal folds) and the respective control groups. For the statistical analysis of the data, nonparametric tests were used (Mann-Whitney test and Wilcoxon test). RESULTS After intensive short-term vocal therapy with Finger Kazoo, improvement in voice spectral parameters, such as improvement in tracing (color intensity and regularity), greater definition of formants and harmonics, increased replacement of harmonics by noise, and a greater number of harmonics, mainly in the group without structural affection of the vocal folds. CONCLUSION There was an improvement in the spectrographic vocal parameters, showing greater stability, quality, and projection of the emission, especially in female teachers without structural affection of the vocal folds.
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Affiliation(s)
- Sabrina S Santos
- Departamento de Fonoaudiologia, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
| | - Mara K Christmann
- Departamento de Fonoaudiologia, Universidade do Vale do Itajaí (UNIVALI), Itajaí, SC, Brazil.
| | - Carla A Cielo
- Departamento de Fonoaudiologia, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
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Tsai LYJ, Chan RW, Shen C, Chen Z, Zhuang P, Chiang YN, Tai SK, Xue K. A 4-Week Straw Phonation in Water Exercise Program for Aging-Related Vocal Fold Atrophy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:2581-2599. [PMID: 37459605 DOI: 10.1044/2023_jslhr-23-00071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
PURPOSE This study evaluated the efficacy of a 4-week straw phonation in water (SPW) exercise program on aging-related vocal fold atrophy (VFA), with a secondary objective to examine the immediate effects of SPW exercises. METHOD Thirty-eight older adults aged 60 years and above formally diagnosed with aging-related VFA were randomly assigned into an experimental group undergoing SPW exercises with an 8-cm depth of straw submersion into water for 4 weeks plus vocal hygiene practice (n = 20), and a control group with only vocal hygiene practice (n = 18). Outcome measures included laryngeal endoscopic measures of glottal gap, auditory-perceptual ratings of voice quality, acoustic measures, aerodynamic measures, and standardized self-assessment questionnaire scores. An additional round of acoustic and aerodynamic assessment following 20 min of SPW exercises was conducted to examine the immediate effects. RESULTS Significant improvements in normalized glottal gap area, perceptual rating of breathiness, smoothed cepstral peak prominence, harmonics-to-noise ratio (HNR), mean oral airflow, subglottal pressure and laryngeal airway resistance at comfortable loudness, Voice-related Quality of Life scores, and Chinese Vocal Fatigue Index Factor 3 scores were observed in the experimental group relative to the control group. There were also significant immediate effects for HNR, mean oral airflow, subglottal pressure, and laryngeal airway resistance. CONCLUSIONS These findings suggested significant immediate improvements in vocal function following SPW exercises, with additional significant improvements in vocal function as well as significant improvements in quality of life following the 4-week SPW exercise program. Further studies with more long-term follow-up are recommended to better understand the efficacy of SPW exercises with deep levels of straw submersion into water as an effective clinical option for the management of hypofunctional dysphonia associated with aging-related VFA.
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Affiliation(s)
- Lydia Yueh-Ju Tsai
- Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan
| | - Roger W Chan
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
- Department of Voice Medicine, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Cuiling Shen
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
| | - Zusen Chen
- Geriatric Care Research Center, Xiamen Medical College, Xiamen, Fujian, China
| | - Peiyun Zhuang
- Department of Voice Medicine, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
| | - Yu-Ning Chiang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shyh-Kuan Tai
- Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan
| | - Keying Xue
- Institute of Respiratory Diseases, Xiamen Medical College, China
- Department of Respiratory Medicine, Second Affiliated Hospital, Xiamen Medical College, Xiamen, Fujian, China
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13
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Titze IR, Maxfield L, Cox KT. Optimizing Diameter, Length, and Water Immersion in Flow Resistant Tube Vocalization. J Voice 2022:S0892-1997(22)00306-X. [PMID: 36357237 PMCID: PMC10164201 DOI: 10.1016/j.jvoice.2022.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective was to quantify the range of airflow resistance and oral pressure attainable with variation of length, diameter, and water immersion depth of tubes and straws. STUDY DESIGN Pressure-flow equations for tubes, determined previously for variable tube geometries, were used to calculate oral pressure ranges. Human subjects were then recruited to use the variable tube geometries to produce oral pressures, which were quantified with commercial manometers. RESULTS Nomograms for airflow resistances and oral pressures are plotted as a function of tube length, tube diameter, and water insertion depth. CONCLUSIONS It is shown that tube diameters in the range of 2.5-3.0 mm with tube lengths of 10-40 cm produce oral pressures in the range of 10-40 cm H2O. Insertion of the distal end into water adds a pressure in the amount of the depth of insertion. Maximum power transfer with different tube geometries is discussed.
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Affiliation(s)
- Ingo R Titze
- Utah Center for Vocology, The University of Utah, Salt Lake City, Utah.
| | - Lynn Maxfield
- Utah Center for Vocology, The University of Utah, Salt Lake City, Utah
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Guzman M, Ortega A, Rocha C, Salgado L, Quezada C. Efficacy of Voice Therapy With Acapella Choice ® Device in Subjects With Vocal Fatigue Delivered Via Telepractice. J Voice 2022:S0892-1997(22)00229-6. [PMID: 36153205 DOI: 10.1016/j.jvoice.2022.07.027] [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: 06/13/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The present study aimed at assessing the effectiveness of remote voice therapy (telepractice) implemented with Acapella Choice device in subjects with vocal fatigue. METHODS Thirty participants with vocal fatigue were randomly assigned to one of two treatment groups: (1) voice treatment with acapella Choice device plus vocal hygiene program (n=15), and (2) voice treatment with Water resistance therapy plus vocal hygiene program (n=15). Laryngoscopic assessment was conducted in all subjects to confirm diagnosis. Before and after voice therapy, participants underwent self-assessment of voice. Vocal Fatigue Index (VFI), Voice Handicap Index (VHI), and Vocal tract discomfort scale (VTDS) were used. Treatment period included six voice therapy sessions within 3 weeks, with a frequency of two therapy sessions per week. Each session lasted 30 minutes. For both groups, exercises consisted of a sequence of nine phonatory tasks performed with Acapella Choice (experimental group) and WRT (control group). Comparison for all variables were performed between experimental group and control group. RESULTS Significant improvements were found when comparing Pre and Post measures for both groups. No significant differences were found when comparing Acapella Choice group and WRT group. CONCLUSION Remote physiologic voice therapy with Acapella Choice device and water resistance therapy seem to be both effective to improve voice in subjects diagnosed with vocal fatigue. No differences should be expected between these therapeutic protocols when treating patients with vocal fatigue. Moreover, both are effective at reducing tiredness of voice, voice avoidance, physical discomfort associated with voicing, subjective perception of sensory discomfort in throat, and reduction of physical, emotional, and functional impact of voice problems.
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Affiliation(s)
- Marco Guzman
- Department of Communication Sciences and Disorders, Universidad de los Andes, Chile, Santiago, Chile.
| | - Andrés Ortega
- Department of Ear Nose and Throat, Clínica las Condes, Santiago, Chile
| | - Camila Rocha
- Department of Communication Sciences and Disorders, Universidad de los Andes, Chile, Santiago, Chile
| | - Lia Salgado
- Department of Communication Sciences and Disorders, Universidad de los Andes, Chile, Santiago, Chile
| | - Camilo Quezada
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
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15
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Batista DDJ, da Silva RC, Ostolin TLVDP, Behlau M, Ribeiro VV. Mapping of the Execution of Resonance Tubes Phonation Immersed in Water Exercise in Adults: A Scoping Review. J Voice 2022:S0892-1997(22)00162-X. [PMID: 35835649 DOI: 10.1016/j.jvoice.2022.06.010] [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: 02/18/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To map the execution of resonance tubes phonation immersed in water exercise in adults with healthy or altered voices. METHODS This study was a scoping review. An electronic search was performed using the following databases: MEDLINE, LILACS, SCOPUS, Web of Science, EMBASE, Cochrane Library, gray literature, and a manual search. A blinded review was performed by two authors to determine the selection and extraction procedures. Studies with adult participants with dysphonic or healthy voices who underwent intervention with phonation in a resonance tube immersed in water in the context of the vocal clinic, with an experimental intervention, quasi-experimental, or before and after the intervention were included. Data from the publication, sample, execution, and results obtained from the exercises were extracted by two blinded reviewers. Disagreements were resolved through consensus. The analysis was performed quantitatively. RESULTS A total of 44 publications were analyzed. Among these, Brazilian studies were the most frequent, with a publication peak in 2020. The characterization of the sample was variable, with a higher frequency of participants of both sexes who were not voice professionals. The most frequent studies were before and after exercise with a resonance tube immersed in water, in one session, with an exercise execution time of 3 minutes; in cases of more than one series of executions, the 30-sseconds rest time was more frequent. The most used resonance tube was a flexible silicone tube, with a wall thickness of 0.1 mm, immersion container in a 500-, 510-, or 600-mL bottle, 2/3 filled with water, and the resonance tube immersed 2 cm from the water surface. The most used phonatory task was flow phonation with rounded lips similar to the articulation of the vowel /u/. Acoustic analysis and vocal self-assessment are the most commonly used outcome measures. The best results were obtained in the self-assessment. CONCLUSION There is significant variability in the information on the execution of resonance tubes phonation immersed in water exercise influenced by vocal diagnosis and experience with previous vocal training. Studies on the effects of this exercise have been concentrated over the last decade and are of the vocal training and therapy. Acoustic and self-assessment measures were used to verify the results, with self-assessment being the outcome that most frequently indicated positive results.
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Affiliation(s)
- Denis de Jesus Batista
- Associate Program in Speech-Language Pathology 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; Specialization Course in Exercise Physiology Applied to Clinics, Universidade Federal de São Paulo, Santos, São Paulo, Brazil.
| | - Rebeca Cardoso da Silva
- Speech-Language Pathology Department, Universidade Federal de Sergipe, Lagarto, Sergipe, Brazil
| | | | - Mara Behlau
- Speech-Language Pathology Department, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil; Centro de Estudos da Voz, São Paulo, São Paulo, Brazil
| | - Vanessa Veis Ribeiro
- Associate Program in Speech-Language Pathology 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; Speech-Language Pathology Course, Universidade de Brasília, Brasília, Distrito Federal, Brazil
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Köberlein MC, Hermann L, Gantner S, Tur B, Westphalen C, Kuranova L, Döllinger M, Kniesburges S, Kruse SA, Echternach M. The Effect of Water Resistance Therapy on the Impulse Dispersion of Aerosols During Sustained Phonation. J Voice 2022:S0892-1997(22)00153-9. [PMID: 35803772 PMCID: PMC9256517 DOI: 10.1016/j.jvoice.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Group singing has been associated with higher transmission risks via exhaled and spread aerosols in the CoVID19 pandemic. For this reason, many musical activities, such as rehearsals and lessons, but also voice therapy sessions, have been restricted in many countries. Consequently, transmission risks and pathways have been studied, such as aerosol amounts generated by exhalation tasks, convectional flows in rooms, or the impulse dispersion of different kinds of phonation. The use of water resistance exercises such as those utilizing LAX VOX®, are common in voice lessons and as vocal warm-ups. With this context, this study investigates the impulse dispersion characteristics of aerosols during a voiced water resistance exercise in comparison to normal singing. METHODS Twelve professional singers (six male, six female) were asked to phonate a stable pitch through a silicone tube into a bottle filled with water, holding the end of the tube 5 cm below the surface. Before performing the tasks, the singers inhaled the vapor consisting of 0.5 L base liquid from an e-cigarette. The exhaled gas cloud coming out of the bottle was recorded in all three spatial directions and the dispersion was measured as a function of time. RESULTS At the end of the phonation task, the median distance to the front was 0.55 m and the median of the lateral expansion of the cloud was 0.89 m, the maximum to the front reached 0.88 m, and the maximum of lateral expansion 1.05 m. For the upwards direction of the clouds a median of 1.00 m and a maximum of 1.34 m from the mouth were measured. Three seconds after the end of the task, the medians were declining. CONCLUSION The exhaled aerosol cloud can expand despite the obstacle of the water when using LAX VOX® during phonation.
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Affiliation(s)
- Marie Christine Köberlein
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany.
| | - Laila Hermann
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Sophia Gantner
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Bogac Tur
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Caroline Westphalen
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Liudmila Kuranova
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | | | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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Cangi ME, Yılmaz G, Tabak E, Nur Duran A, Kaya T. Effect of Varied Tube Phonation in Water Exercises on Nasometric and Electroglottographic parameters: Modification in Terms of Fluid Density and Tube Submerged Depth. J Voice 2022:S0892-1997(22)00119-9. [PMID: 35623981 DOI: 10.1016/j.jvoice.2022.04.013] [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: 12/28/2021] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Within the scope of semi-occluded vocal tract exercises (SOVTEs), we aimed to examine the effects of four exercise combinations, which involved various fluid densities and tube submersion depths, on acoustic and electroglottographic (EGG) parameters. METHODS Four procedures (P) were applied consecutively to 30 female participants with normal voices using different tube submersion depths and fluid densities, including P1 (2 cm, water), P2 (2 cm, nectar), P3 (10 cm, water), and P4 (10 cm, nectar). Nasometric (Nasometer II model 6450) and EGG (Electroglottograph model 6103) measurements were taken before the procedures were initiated (pre-test) and at the end of each procedure. In addition, EGG measurements were taken for each procedure during the application. RESULTS For all three velar positions (oral passage, oro-nasal passage, nasal passage), the only procedure that caused a significant change compared to the pre-test stage in regard to nasalance score was P2 (2 cm nectar) in common. All other procedures except P1 (2 cm water) significantly increased velar closure compared to pre-test levels. However, when the differences between the exercises were examined, the least velar closure, compared to the other procedures, was obtained after P4 (10 cm nectar). While there was no significant difference between the procedures in the EGG measurements during the exercise, a significantly higher tendency to contact was observed after the procedures with a denser consistency, and an increase in the fundamental frequency (fo) values occurred in the pairwise comparisons of the procedures in the measurements after the exercises. CONCLUSION In SOVTEs in which water phonation is performed with a tube, the use of a fluid with a consistency denser than water can be considered a particularly promising approach. In addition, exercises performed with increasing consistencies in 2 cm depth can provide more vocal cord and velopharyngeal port closure by increasing EGG-CQ and nasalance score values. However, more care should be taken while increasing the consistency at a submersion depth of 10 cm.
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Affiliation(s)
- Mehmet Emrah Cangi
- University of Health Sciences, Speech and Language Therapy, İstanbul, Turkey.
| | - Göksu Yılmaz
- Uskudar University, Speech and Language Therapy, İstanbul, Turkey
| | - Emine Tabak
- Uskudar University, Speech and Language Therapy, İstanbul, Turkey
| | - Ayşe Nur Duran
- Uskudar University, Speech and Language Therapy, İstanbul, Turkey
| | - Tuğba Kaya
- University of Health Sciences, Speech and Language Therapy, İstanbul, Turkey
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18
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Titze IR, Palaparthi A, Cox K, Stark A, Maxfield L, Manternach B. Vocalization with semi-occluded airways is favorable for optimizing sound production. PLoS Comput Biol 2021; 17:e1008744. [PMID: 33780433 PMCID: PMC8031921 DOI: 10.1371/journal.pcbi.1008744] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/08/2021] [Accepted: 01/26/2021] [Indexed: 01/25/2023] Open
Abstract
Vocalization in mammals, birds, reptiles, and amphibians occurs with airways that have wide openings to free-space for efficient sound radiation, but sound is also produced with occluded or semi-occluded airways that have small openings to free-space. It is hypothesized that pressures produced inside the airway with semi-occluded vocalizations have an overall widening effect on the airway. This overall widening then provides more opportunity to produce wide-narrow contrasts along the airway for variation in sound quality and loudness. For human vocalization described here, special emphasis is placed on the epilaryngeal airway, which can be adjusted for optimal aerodynamic power transfer and for optimal acoustic source-airway interaction. The methodology is three-fold, (1) geometric measurement of airway dimensions from CT scans, (2) aerodynamic and acoustic impedance calculation of the airways, and (3) simulation of acoustic signals with a self-oscillating computational model of the sound source and wave propagation.
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Affiliation(s)
- Ingo R. Titze
- National Center for Voice and Speech University of Utah, Salt Lake City, Utah, United States of America
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States of America
- National Center for Voice and Speech.Org, Salt Lake City, Utah, United States of America
| | - Anil Palaparthi
- National Center for Voice and Speech University of Utah, Salt Lake City, Utah, United States of America
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, United States of America
- National Center for Voice and Speech.Org, Salt Lake City, Utah, United States of America
| | - Karin Cox
- National Center for Voice and Speech.Org, Salt Lake City, Utah, United States of America
| | - Amanda Stark
- National Center for Voice and Speech University of Utah, Salt Lake City, Utah, United States of America
| | - Lynn Maxfield
- National Center for Voice and Speech University of Utah, Salt Lake City, Utah, United States of America
| | - Brian Manternach
- National Center for Voice and Speech University of Utah, Salt Lake City, Utah, United States of America
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Kang CH, Zhang N, Lott DG. Muscle Tension Dysphagia: Contributing Factors and Treatment Efficacy. Ann Otol Rhinol Laryngol 2020; 130:674-681. [PMID: 33090008 DOI: 10.1177/0003489420966339] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine factors contributing to disease etiology and treatment efficacy. STUDY DESIGN Original Report. SETTING Tertiary academic center. METHODS IRB approved prospective study of 20 patients with reported dysphagia who exhibited normal oropharyngeal and esophageal swallowing function as evidenced by videofluoroscopic swallow study, esophagogastroduodenoscopy, high-resolution esophageal manometry with stationary impedance, and Bravo pH probe off proton pump inhibitor. Patients underwent speech-language pathology intervention. RESULTS Atypical laryngeal muscle tension was present in 100% of patients. Forty percent of patients had diagnosed positive gastroesophageal reflux disease. Sixty-five percent of patients showed signs of non-specific laryngeal inflammation and laryngeal hyperresponsiveness during strobolaryngoscopy. All patients reported a mean of 90% recovery by the completion of voice therapy directed toward unloading muscle tension. CONCLUSION The study results suggest an association between laryngeal muscle tension and these patients' dysphagia symptoms regardless of associated conditions. Speech-language pathology intervention showed high treatment efficacy. LEVEL OF EVIDENCE 2c- Outcomes research.
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Affiliation(s)
- Christina H Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Nan Zhang
- Department of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - David G Lott
- Department of Otorhinolaryngology-Head and Neck Surgery, Division of Laryngology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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The Feasibility of a Neck-Surface Accelerometer for Estimating the Amount of Acoustic Output During Phonation Regardless of the Difference in the Mouth Configuration. J Voice 2020; 36:297-308. [DOI: 10.1016/j.jvoice.2020.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 11/23/2022]
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