Long-Term Average Spectrum as an Outcome Measure of Vocal Projection After Resonant Voice Therapy in Carnatic Classical Singers

BACKGROUND

The current study evaluated the effects of resonant voice therapy (RVT) on the long-term average spectrum (LTAS) parameters of vocally healthy trained Carnatic classical singers. The objectives of the study were i) to understand the perceptual differences and ii) to understand the change in LTAS contour parameters and the alpha ratio of the sung voice samples of the trained Carnatic classical singers before and after RVT.

METHOD

The study used a quasi-experimental, pre post design and purposive-convenient sampling method. Nineteen vocally healthy singers (4 males and 15 females) aged 18-25 years (M = 23; standard deviation [SD] = 2.09) with minimum 10 years of formal Carnatic classical vocal music training volunteered to participate in the study. The audio recordings of the participants' sung aakaara (/a/ vowel singing) were obtained before and after the training. All participants were assigned to a 21-day-long RVT training program scheduled as 15-20 minutes sessions. The participants' pre-training and post-training singing samples were subjected to LTAS analysis. The spectral mean, SD, skewness, kurtosis, and alpha ratio were extracted from the sung samples. The mean and SD of the parameters were obtained using descriptive statistical methods. Wilcoxon signed-rank test was performed to evaluate significant differences in the obtained parameters across pre-training and post-training sung samples.

RESULTS

Though there was an increase in perceptual vocal resonance in the post-training sung samples, the difference was observed to be statistically insignificant. The results indicated a significant difference only in the alpha ratio values, which were decreased, indicating an increase in the high-frequency energies. The descriptive statistical evaluations showed a reduction in the parameters of spectral mean, SD, skewness, and kurtosis.

CONCLUSION

The observations from the current study indicated that the RVT training increased the energies of higher frequencies in the singers' voices (1-5 kHz). This high-frequency energy favored improved voice projection, imparting perceptual resonance or ringing quality of the voice.

Evaluation of the Effectiveness of Resonant Voice Therapy in Patients with Functional Voice Disorder

OBJECTIVE

This study aims to determine the effectiveness of resonant voice therapy (RVT) in patients with functional voice disorder and to examine the subjective and objective voice changes after the therapy.

STUDY DESIGN

This study adopted an experimental research design with a pretest-posttest control group.

METHOD

Thirty-four women participated in the study-17 in the experimental group and 17 in the control group. Voice hygiene training and RVT were applied to the experimental group. The Turkish version of the Voice Handicap Index (VHI-10) and GRBAS (Grade, Roughness, Breathiness, Asthenia, and Strain) scale were used for subjective voice assessment. Voice recordings were subjected to acoustic analysis on the PRAAT program. After an 8-week therapy program, the same process was repeated for post-test assessment.

RESULTS

In the voice analyses performed after RVT, which was applied to patients with functional voice disorders, the results of the acoustic analysis showed statistically significant differences in jitter, PPQ5, RAP, shimmer, APQ11, and NHR parameters. Subjective voice analysis indicated a statistically significant decrease in VHI-10 scores from 20.88 ± 5.33-9.06 ± 3.3 in the experimental group. The GRBAS score was 4.29 ± 1.2 before the therapy and 1.71 ± 1.1 after the therapy, which is a statistically significant decrease. The results point out that RVT has been effective in improving the objective and subjective parameters of patients with functional voice disorders.

CONCLUSION

RVT applied to patients with functional voice disorders provides significant improvement in acoustic and perceptual voice parameters. The RVT is an effective therapy method in the treatment of patients with functional voice disorders and should be considered as a therapeutic option.

Effects of Resonant Voice Therapy on Perceptual and Acoustic Source and Tract Parameters - A Preliminary Study on Indian Carnatic Classical Singers

PURPOSE

The aim of the study was to examine the effects of resonant voice therapy (RVT) on the vocal resonance of trained Carnatic singers. The specific objectives were to evaluate the effects of resonant voice therapy on the auditory perceptual judgments and acoustic source and tract parameters before and after RVT on phonation and sung voice samples.

METHOD

Six vocally healthy trained Carnatic singers, three males and three females aged 18-25 years (M = 23; S.D = 2.09) participated in the study. All the participants were assigned to a 21-days-long Resonance Voice Therapy (RVT) training program. The participants' pre and post training phonation and sung samples were subjected to auditory perceptual analysis and acoustic analysis.

RESULTS

The results revealed that the post training auditory perceptual ratings of the phonation task showed a statistically significant difference from the pre training scores (Z= 2.35; P = 0.019). While for the singing task, the post training perceptual ratings were not significantly different from the pre training perceptual rating scores (Z= 2.66; P = 0.08). A significant difference was observed between the pre and post training values for all the measured acoustic parameters of the phonation task. In singing task, though the fundamental frequency, third and fourth formant frequencies showed no significant difference in the pre and post training conditions (P > 0.05), the parameter of- difference between the first formant frequency and the fundamental frequency showed a significant decrease (P = 0.028).

CONCLUSION

The effects of resonant voice production led to a high vocal economy, as evidenced from the improved source and filter acoustic parameters. Indication for formant tuning through vocal tract modifications, probably an enlarged pharyngeal area resulting in increased resonant voice quality in both phonation and singing tasks, is inferred from these results.

Voice Therapy for Benign Voice Disorders in the Elderly: A Randomized Controlled Trial Comparing Telepractice and Conventional Face-to-Face Therapy

Purpose Previous studies have reported that voice therapy via telepractice is useful for patients with nodules and muscle tension dysphonia. Nevertheless, telepractice for elderly patients with voice disorders has not yet been investigated. We conducted this study to examine the hypothesis that voice therapy via telepractice is not inferior to conventional voice therapy. Method Eighty patients with dysphonia aged more than 55 years participated in this study from September 2016 to June 2018. After screening the inclusion and the exclusion criteria, 69 patients were randomized into telepractice (33 patients) and conventional (36 patients) groups. The outcome measurements included Voice Handicap Index-10, videolaryngostroboscopy, maximum phonation time, auditory-perceptual evaluation, and acoustic analysis. Paired t test, Wilcoxon signed-ranks test, and repeated measures analysis of variance were used to examine treatment outcomes. Results The diagnoses of voice disorders included atrophy (n = 33), unilateral vocal paralysis (n = 13), muscle tension dysphonia (n = 7), nodules (n = 6), and polyps (n = 10). No significant differences were observed in age, sex, and baseline measurements between the two groups. Twenty-five patients in the telepractice group and 24 patients in the control group completed at least four weekly sessions. Significant improvements were observed for all the outcome measures (p < .05) in both groups. Improvements in Voice Handicap Index-10 in the telepractice group (24.84 ± 5.49 to 16.80 ± 8.94) were comparable to those in the conventional group (22.17 ± 7.29 to 13.46 ± 9.95, p = .764). Other parameters also showed comparable improvements between the two groups without statistically significant differences. Conclusions This is the first randomized controlled trial comparing telepractice and conventional voice therapy in elderly patients with voice disorders. The results showed that the effectiveness of voice therapy via telepractice was not inferior to that of conventional voice therapy, indicating that telepractice can be used as an alternative to provide voice care for elderly patients with vocal disorders.

Effects of Resonance Voice Therapy on Hormone-Related Vocal Disorders in Professional Singers: A Pilot Study

BACKGROUND

Menstruation-related hormonal alteration can be detrimental to the professional singing voice of women. Resonance Voice Therapy (RVT) has been proven to improve vocal production. However, no research to date has been conducted examining the subjective, acoustic, and stroboscopic effects of RVT on professional female singers having premenstrual or postmenopausal voice disorders.

AIM

The aim of this study is to compare the vocal effects of RVT with a control cervical-thoracic intervention in healthy female singers during the premenstrual phase as well as in postmenopausal singers and to evaluate which intervention will allow singers to improve vocal performance regardless of changes in hormonal status.

DESIGN

A randomized study was designed for this research. The research subjects were 20 professional female singers from the Southern California area, USA, with 10 premenstrual subjects in one group and 10 postmenopausal subjects in the other group. Among each group, 5 subjects were randomly selected to receive RVT and the remaining subjects received cervical-thoracic-focused exercises. The therapies consisted of 1 month of daily 15-minute sessions. For premenstrual subjects, voice data were collected at days 25 to 27 of the premenstrual phase during a scheduled initial voice evaluation. Follow-up data were collected during the same phase of the menstrual cycle (days 25-27) after 1 month of exercises. For postmenopausal subjects, voice data were collected at an initial voice evaluation with follow-up after 1 month of the assigned voice treatment. Outcomes were assessed with the singer's voice handicap index (VHI), laryngeal videostroboscopic examination, maximum phonation time (MPT), relative average perturbation (RAP), and pitch range before and following completion of therapies. Alleviation or deterioration percentages were used for statistical analysis. Student t test was used for statistical comparison between therapies.

RESULTS

The RVT decreased singer's VHI for both premenstrual and postmenopausal subjects by an average of 67%, compared with 7.8% for the cervical-thoracic therapy. The RVT also effectively decreased RAP by an average of 57% when combining the premenstrual and postmenopausal groups. The RVT increased MPT and pitch range among both premenstrual and postmenopausal subjects. The stroboscopic examination did not detect any significant differences between the 2 interventions.

CONCLUSIONS

The RVT is effective for professional female singers with hormone-related premenstrual and postmenopausal vocal changes. The RVT is suggested as one of the therapeutic approaches for vocal abnormalities in such a population. A larger cohort may be needed for future research.

LEVEL OF EVIDENCE

1b.

Facial bone vibration in resonant voice production

PURPOSE

This study investigated whether resonant voice training would enhance facial bone vibration during resonant voice production.

METHODS

Twelve normal healthy participants undertook four sessions of resonant voice training, each lasted for 30 minutes. Piezoelectric accelerometer was used to measure the vibratory level on the face (nasal bridge and upper lip) and the perilaryngeal area during the production of nasal consonant /m/ and vowels /a/, /i/, and /u/ before and after the resonant voice training. The extents of vibration of these four sounds among these three sites were compared.

RESULTS

Significant increase in facial bone vibration following resonant voice training was found. The nasal bridge showed a significantly larger magnitude of increase when compared with that at the upper lip. Different sounds were also found to facilitate different magnitude of facial bone vibration. Greater magnitude of facial bone vibration was found with the phonation of /m/, /i/, and /u/ when compared with the phonation of /a/.

CONCLUSION

Resonant voice training facilitated an increase in facial bone vibration, more so at the nasal bridge area than around the upper lip. This is hypothesized to contribute to the improved resonant voice production. Sounds that involve relatively restricted oropharyngeal cavities facilitated a greater extent of facial bone vibration during resonant voice production.

The implementation of evidence-based practice in the management of adults with functional voice disorders: a national survey of speech-language pathologists

This study examined Australian speech-language pathologists' (SLPs) use of evidence-based practice (E(3)BP) when treating adults with functional voice disorders (FVDs). It was hypothesized that SLPs would report using the available evidence to care for their clients but may be limited by time and skills. Fifty-eight SLPs completed a 26-item survey. A combination of indirect and direct voice therapy was most frequently reported, with hum and nasal consonants, pitch extension, elimination of glottal attack, and diaphragmatic breathing being the most frequently used techniques. In the absence of higher levels of evidence, 98% of respondents reported they relied on clinical experience to guide their clinical decision-making. Despite a lack of research evidence supporting this decision, SLPs also reported simultaneously using a combination of direct voice therapies to cater to the needs of their individual clients. Barriers to EBP were lack of time, specialty training and high quality evidence. To improve SLPs' management of adults with FVDs, it is suggested that SLPs need both greater access to voice training and to use practice-based evidence by actively collecting and reporting clinical data.

Vibratory and perceptual measurement of resonant voice

PURPOSE

This study set out to investigate whether there existed a correlation between auditory-perceptual judgment of resonant voice and the physical vibration in the facial bone. The magnitude of bone vibration in the facial bone during different types of voice production (resonant vs nonresonant vs strained voices) was also investigated.

METHOD

Thirty-six healthy normal subjects produced three types of phonations: resonant voice, habitual nonresonant voice, and strained voice. A piezoelectric accelerometer was used to measure the vibrations in the nasal bridge and the perilaryngeal area during the phonation. Seventy-two selected nasal sounds (/ma/) produced under the resonant voice condition by these speakers were rated by two experienced speech pathologists on the magnitude of auditory-perceptual resonance using an 11-point equal-appearing interval scale. The magnitude of bone vibration was also compared across the three voice types.

RESULTS

Significant moderate correlations were found between the physical bone vibration and the auditory-perceptual rating of resonant voice at the nasal bridge of the facial bone (0.6). Resonant voice, compared with the strained and nonresonant voice types, was also found to have a significant increase in the magnitude of facial bone vibration. Nasal stimuli, compared with nonnasal stimuli, facilitated greater bone vibration during resonant voice production.

CONCLUSION

Piezoelectric accelerometer, as an objective quantitative tool, measures reliably the extent of bone vibration in resonant voice phonation. It is a useful tool for determining the bone vibration in relation to resonant voice.

Efeitos imediatos do exercício vocal sopro e som agudo

OBJETIVO: Investigar os efeitos imediatos do exercício vocal sopro e som agudo. MÉTODOS: Trata-se de estudo tipo observacional comparativo. Participaram 46 mulheres com idades entre 25 a 45 anos que foram divididas em dois grupos: 23 com queixa vocal (GQ) e 23 sem queixa vocal (GSQ). Foram realizadas a avaliação perceptivo-auditiva da qualidade vocal, análise acústica, videolaringoestroboscopia e autoavaliação da voz antes e após a execução do exercício sopro e som agudo em dez repetições. A avaliação perceptivo-auditiva e das imagens da configuração laríngea foram realizadas por três fonoaudiólogas especialistas em voz, que deveriam analisar dois trechos de cada sujeito, sem a identificação do momento do registro, assinalando o melhor trecho. Os parâmetros acústicos avaliados foram frequência fundamental, jitter e shimmer na vogal sustentada e frequência fundamental na fala encadeada. Na autoavaliação vocal, todos os participantes deveriam responder à pergunta: "Como você avalia a sua voz após a realização do exercício?". RESULTADOS: Na avaliação perceptivo-auditiva, ambos os grupos apresentaram melhor qualidade vocal no pós-exercício. Quanto à avaliação acústica, após o exercício houve diminuição dos valores shimmer, em ambos os grupos e nas medidas de jitter no GSQ. Observou-se aumento da frequência fundamental no GQ na vogal sustentada. A avaliação videolaringoestroboscópica mostrou melhor coaptação glótica e menor envolvimento do vestíbulo em ambos os grupos pós-exercício. A autoavaliação vocal indicou melhora na emissão da voz no GQ. CONCLUSÃO: O exercício vocal sopro e som agudo produz efeitos imediatos positivos nas avaliações perceptivo-auditiva, acústica, laríngea e na autoavaliação vocal.

Assessment and treatment of musculoskeletal tension in hyperfunctional voice disorders

Poorly regulated activity of the perilaryngeal muscles affects phonatory function and contributes to a class of disorders known as hyperfunctional or musculoskeletal tension voice disorders. Recognizing the signs and symptoms of excess or dysregulated laryngeal muscle activity is critical to proper diagnosis and selection of appropriate treatment(s). Although numerous approaches exist to manage such hyperfunctional syndromes, manual circumlaryngeal techniques have recently received attention as valuable tools in both assessment and treatment. Therefore, the purpose of this article is to: (1) describe common phenomenological features of dysregulated laryngeal muscle tension, thereby facilitating its recognition, (2) highlight the role of manual circumlaryngeal techniques in assessment and management, (3) survey additional treatment approaches for laryngeal hyperfunction, and explore the evidence to support their effectiveness, and (4) identify unresolved issues and controversies surrounding tension-based voice disorders. A series of pre- and post-treatment audio examples are provided on the journal website at www.informaworld.com/ijslp .

Outcome of Resonant Voice Therapy for Female Teachers With Voice Disorders: Perceptual, Physiological, Acoustic, Aerodynamic, and Functional Measurements

Teachers have a high percentage of voice problems. For voice disordered teachers, resonant voice therapy is hypothesized to reduce voice problems. No research has been done on the physiological, acoustic, and aerodynamic effects of resonant voice therapy for school teachers. The purpose of this study is to investigate resonant voice therapy outcome from perceptual, physiological, acoustic, aerodynamic, and functional aspects for female teachers with voice disorders. A prospective study was designed for this research. The research subjects were 24 female teachers in Taipei. All subjects received resonant voice therapy in groups of 4 subjects, 90 minutes per session, and 1 session per week for 8 weeks. The outcome of resonant voice therapy was assessed from auditory perceptual judgment, videostroboscopic examination, acoustic measurements, aerodynamic measurements, and functional measurements before and after therapy. After therapy the severity of roughness, strain, monotone, resonance, hard attack, and glottal fry in auditory perceptual judgments, the severity of vocal fold pathology, mucosal wave, amplitude, and vocal fold closure in videostroboscopic examinations, phonation threshold pressure, and the score of physical scale in the Voice Handicap Index were significantly reduced. The speaking Fo, maximum range of speaking Fo, and maximum range of speaking intensity were significantly increased after therapy. No significant change was found in perturbation and breathiness measurements after therapy. Resonant voice therapy is effective for school teachers and is suggested as one of the therapy approaches in clinics for this population.