Immediate Effects of Straw Phonation in Water Exercises on Parameters of Vocal Loading in Carnatic Classical Singers

Phonatory Tasks and Outcome Measures for Assessing Vocal Fatigue: A Scoping Review

OBJECTIVES

To map the phonatory tasks and the result measures used to evaluate vocal fatigue in vocally healthy individuals.

METHODS

This is a scoping review based on the following research question: What are the phonatory tasks and outcome measures used for the evaluation of vocal fatigue in vocally healthy individuals? The construction of the search strategy followed the PCC strategy; population: vocally healthy adult individuals; concept: phonatory tasks and vocal evaluation measures; and context: vocal fatigue. The search was performed electronically in the databases Medline (PubMed), LILACS (BVS), SCOPUS (Elsevier), Web of Science (Clarivate), EMBASE, and COCHRANE. A manual search in the references of the selected articles and in the journal with the highest number of publications was also performed. The selection of articles was based on reading the titles, abstracts, and full text, applying the eligibility criteria. The selected articles were related to the evaluation of vocal fatigue in healthy individuals from a predetermined vocal load task. Data regarding the characteristics of the publication, sample, phonatory tasks, and outcomes were extracted. The results were presented in a descriptive format, due to a frequency distribution analysis.

RESULTS

In total, 3756 studies were identified during the search, of which 60 were selected. The most used vocal load activity was the reading task, with duration ranging from 46 to 120 minutes. The (1) sustained vowel /a/ and (2) the reading of texts and phrases, both in usual intensity and frequency without the interference of the researcher, were the most used evaluation tasks. The most used outcome measures are the following: (1) acoustic parameters-fundamental frequency [fo] (mean, variance), sound pressure level (mean), local jitter (%), local shimmer (%), cepstral peak prominence (mean); (2) vocal self-assessment by the validated instruments-Perceived Phonatory Effort Scale, Visual Analog Scale, Borg-CR-10 Scale.

CONCLUSIONS

There is a diversity of phonatory tasks and outcome measures recurrently used in scientific articles to evaluate the signs of vocal fatigue in vocally healthy individuals. The most used vocal sample to evaluate vocal fatigue was the sustained vowel /a/ in habitual intensity and frequency without the interference of the researcher. The most frequently reported outcome measures for the assessment of immediate vocal fatigue effects were the acoustic analysis and vocal self-assessment.

Nasalance, Nasal Airflow and Perceived Nasality in Carnatic Singers and Non-singers

This study aims to compare the nasalance and nasal airflow between professional singers trained in Carnatic classical singing and non-singers. We also aimed to correlate perceived nasality with objective measurements of nasalance and nasal airflow. A total of 40 female participants (20 to 50 years) were involved in this study. The first group comprised 15 female professional Carnatic singers with a minimum of 10 years of classical training. The second group consisted of 25 non-singer females. These participants were compared on nasalance, nasal airflow and perceived nasality across three sets of stimuli (vowels, oral non-words, and nasal non-words) and three pitch-conditions (low, mid, and high). Correlations were also made between objective measures of nasalance and nasal airflow and perceived nasality. Mixed ANOVA showed a significant (P < 0.05) interaction in nasalance between pitch conditions and groups. Group differences were also observed in the nasalance scores of vowels, oral non-words, nasal non-words. There was a significant difference (P < 0.05) in nasalance with ascending pitch in singers and non-singers. A comparison of aerodynamic analysis of vowels, oral non-words, and nasal non-words between singers and non-singers suggested that nasal airflow was higher in singers. Perceptual nasality was significantly lower (P < 0.05) in Carnatic singers than non-singers. Correlations between objective measures of nasalance and nasal airflow and perceived nasality were not observed. Despite an increased airflow, nasality was lower in trained Carnatic singers than non-singers. Current findings suggest that vocal training impacts nasalance, nasal airflow and perceived nasality.

Volitional and Non-volitional Devices Used in Voice Therapy and Training: A Scoping Review-Part A

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.

Reducing Vocal Fatigue With Bone Conduction Devices: Comparing Forbrain and Sidetone Amplification

PURPOSE

Altered auditory feedback research aims to identify methods to strengthen speakers' awareness of their own voicing behaviors, diminish their perception of vocal fatigue, and improve their voice production. This study aims to compare the effects of two bone conduction devices that provide altered auditory feedback.

METHOD

Twenty participants (19-33 years old, age: M [SD] = 25.5 [3.85] years) participated in a vocal loading task using a standard Forbrain device that provides filtered auditory feedback via bone conduction and a modified Forbrain device that provides only sidetone amplification, and a control condition with no device was also included. They rated their vocal fatigue on a visual analog scale every 2 min during the vocal loading task. Additionally, pre- and postloading voice samples were analyzed for acoustic voice parameters.

RESULTS

Across all participants, the use of bone conduction-altered auditory feedback devices resulted in a lower vocal fatigue when compared to the condition with no feedback. During the pre- and postvoice samples, the sound pressure level decreased significantly during feedback conditions. During feedback conditions, spectral mean and standard deviation significantly decreased, and spectral skew significantly increased.

CONCLUSION

The results promote bone conduction as a possible preventative tool that may reduce self-reported vocal fatigue and compensatory voice production for healthy individuals without voice disorders.

It Sounds like It Feels: Preliminary Exploration of an Aeroacoustic Diagnostic Protocol for Singers

To date, no established protocol exists for measuring functional voice changes in singers with subclinical singing-voice complaints. Hence, these may go undiagnosed until they progress into greater severity. This exploratory study sought to (1) determine which scale items in the self-perceptual Evaluation of Ability to Sing Easily (EASE) are associated with instrumental voice measures, and (2) construct as proof-of-concept an instrumental index related to singers' perceptions of their vocal function and health status. Eighteen classical singers were acoustically recorded in a controlled environment singing an /a/ vowel using soft phonation. Aerodynamic data were collected during a softly sung /papapapapapapa/ task with the KayPENTAX Phonatory Aerodynamic System. Using multi and univariate linear regression techniques, CPPS, vibrato jitter, vibrato shimmer, and an efficiency ratio (SPL/PSub) were included in a significant model (p < 0.001) explaining 62.4% of variance in participants' composite scores of three scale items related to vocal fatigue. The instrumental index showed a significant association (p = 0.001) with the EASE vocal fatigue subscale overall. Findings illustrate that an aeroacoustic instrumental index may be useful for monitoring functional changes in the singing voice as part of a multidimensional diagnostic approach to preventative and rehabilitative voice healthcare for professional singing-voice users.

Mapping of the Execution of Resonance Tubes Phonation Immersed in Water Exercise in Adults: A Scoping Review

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.