Terapia vocal e sons nasais: efeitos sobre disfonias hiperfuncionais

Relationship Between Oropharyngeal Geometry and Vocal Parameters in Subjects With Parkinson's Disease

OBJECTIVE

To verify whether the dimensions of different segments of the oropharyngeal cavity have different proportions between Parkinson's disease patients and vocally healthy subjects and investigate whether the measurements of these subjects' oropharyngeal geometry associate with their acoustic measurements of voice.

METHOD

Quantitative, descriptive, cross-sectional, and retrospective study with secondary data, approved by the Human Research Ethics Committee under no. 4.325.029. We used vocal samples and data from the oropharyngeal geometry of 40 subjects - 20 with Parkinson's disease stages I to III and 20 who formed the control group, matched for sex and age. Each group had 10 males and 10 females, mean age of 61 years (±6.0). Formant (F1, F2, and F3) and cepstral measures of the sustained vowel /ε/ were extracted and arranged in the database to determine their values using Praat software. The data were descriptively analyzed, with statistics generated with R software. The proportion of oropharyngeal geometry measurements was arranged by mean values and coefficients of variation. Pearson's linear correlation test was applied to relate voice parameters to oropharyngeal geometry, considering P < 0.05, and linear regression test, to justify F2.

RESULTS

The Parkinson's disease group showed a linear relationship between oral cavity length and F1 in males (P = 0.04) and between glottal area and F2 in females (P = 0.00); linear relationships were established according to age in both groups, and a regression model for F2 was estimated (R2 = 0.61). There was no difference between pathological and healthy voices; there was a difference in the proportional relationship of oropharyngeal geometry between the groups.

CONCLUSION

The proportional relationship of oropharyngeal geometry differs between the Parkinson's disease group and the control group, as well as the relationship between oropharyngeal geometry and formant and cepstral values of voice according to the subjects' sex and age.

The Role of the Vocal Tract's Acousto-Mechanical Resonance on the Mechanism of Bubble Release From Tubes Used in SOVTE

AND OBJECTIVES

Semi-occluded vocal tract exercises involving a tube with a distal end immersed in water have been used as a voice rehabilitation technique for nearly 60 years. Advantages of this technique include a constant flow resistance, which is mainly dependent on the tube's immersion depth, and an oscillatory component of the back pressure due to bubble release, which is assumed to provide relief of muscle hypertension around the laryngeal and pharyngeal regions. The goal of this study is twofold. First, to shed more light on the contribution of geometrical parameters, such as tube inner diameter and inclination, on the amplitude of the back pressure oscillation and on the bubble release frequency (BRF). The second goal aims to understand the role of vocal tract compliance on the mechanism of bubble release. We hypothesize that the low-frequency acousto-mechanical resonance of a real compliant vocal tract becomes strongly coupled with the mechanism of bubble release, thereby augmenting the back pressure oscillation and dictating the BRF.

METHODS

The BRF and the back pressure are assessed experimentally as a function of flow rate for tubes with a non-compliant upstream condition, considering different diameters and inclinations. These results are compared with theoretical predictions and the experimental data obtained with six adult subjects, from which the vocal tract acousto-mechanical resonance frequencies are also assessed.

RESULTS

The results obtained with tubes involving a non-compliant upstream condition agreed well with the theoretical results and did not indicate a significant influence of the inclination nor the inner diameter on the BRF and on the oscillatory component of the back pressure. Despite the good agreement with the theory, the results obtained from the tube with a non-compliant upstream termination diverged significantly from those obtained with human subjects. In the latter case, the back pressure fluctuation was considerably higher and the BRF measured for each subject coincided with the frequency associated their respective vocal tract acousto-mechanical resonance.

CONCLUSIONS

Results indicate that the BRF is essentially driven by the acousto-mechanical resonance of the vocal tract. Furthermore, the substantial increase on the amplitude of the oscillatory component of the back pressure suggests a strong feedback loop between the source of pressure (bubble release mechanism) and the resonator (vocal tract). The high-pressure fluctuations within the oral cavity implies that subjects need a considerable extra effort to adjust their vocal tract in order to achieve an adequate impedance match between vocal folds and vocal tractsd to produce voice.

Effect of Pompage on Teachers Self-Assessment-Clinical Trial

OBJECTIVE

To verify the results of self-assessments of teachers with vocal and musculoskeletal complaints and with the normal larynx, after myofascial release using pompage.

METHODS

Double-blind, controlled, and randomized clinical trial including 28 teachers in the study group and 28 teachers in the control group, totaling 56 participants. Anamnesis, video laryngoscopy, hearing screening, clinical and photogrammetric postural assessment, pain threshold in cervical muscles, sound pressure and maximum phonation time measurements, and manovacuometry were performed. Protocols for vocal self-assessment, neck pain, anxiety and depression, and musculoskeletal pain were filled out. Pompage therapy consisted of a total of 24 sessions (8 weeks) of 40 minutes each, three times a week. Afterward, the groups were reassessed.

RESULTS

In the study group, there was a significant improvement in the results of the following instruments: Hospital Anxiety and Depression Scale, Vocal Tract Discomfort Scale, Voice Symptoms Scale, Vocal Activity and Participation Profile, Vocal Handicap Index, Voice-Related Quality of Life, and Nordic Musculoskeletal Questionnaire.

CONCLUSIONS

After myofascial release using pompage in teachers, there was an improvement in the self-assessed aspects regarding characteristics and quality of life related to the voice, social participation related to the voice, anxiety and depression, and musculoskeletal symptoms.

Effects of Mechanical Vibration Stimulation of the Larynx on Voice Production

INTRODUCTION

Combining mechanical vibration stimulation with resistance training to improve neuromuscular performance is a method that has gained popularity in the field of sports sciences.

PURPOSE

To evaluate the immediate and mid-term effects of mechanical vibration stimulation (G-Life NL3000) of the larynx associated to vocal exercises.

METHOD

Fourteen professional voice users divided into: Experimental Group - Seven participants who performed a 20-minute exercise protocol with humming applying mechanical vibration stimulation (G-Life NL3000) of the larynx once a day for 30 days; Control Group - Seven participants who performed only the 20-minute exercise protocol with humming. For comparison purposes, the evaluation was carried out pre-stimulation, immediately after simulation (post) and 30 days after stimulation (late-post).

RESULTS

The Experimental Group showed a statistically significant progress in the post-immediate evaluation and in the post-treatment evaluation for maximum phonation time (*P = < 0.001), Jitter (*P = 0.008), Shimmer (*P = 0.005), noise-to-harmonics ratio (*P = 0.005). In the GRBASI scale, the Experimental Group showed significant results in the post-treatment evaluation for Grade (*P = 0.005), Roughness (*P = 0.008), Breathiness (*P = 0.018) and Instability (*P = 0.018). A self-perception voice questionnaire showed better voice quality (*P= 0.031) and easier phonation (*P = 0.005) in the Experimental Group.

CONCLUSION

Mechanical vibration stimulation of the larynx associated to humming produced positive changes in the vocal pattern and significantly improvement in short and mid-term vocal quality for participants in this study.

Effect of Pompage on Vocal and Respiratory Measurements from Female Teachers: A Randomized Clinical Trial

INTRODUCTION

Teachers stand out among occupational groups due to their contribution to modern societies, and their voice is the main form of interaction.

OBJECTIVE

The aim of the study was to verify the changes in vocal and respiratory measurements from teachers with vocal and musculoskeletal complaints and with normal larynx after applying a musculoskeletal manipulation protocol of myofascial release using pompage.

METHODS

Controlled and randomized clinical trial with 56 participants: 28 teachers in the study group and 28 teachers in the control group. Anamnesis, videolaryngoscopy, hearing screening, sound pressure and maximum phonation time measurements, and manovacuometry were performed. The musculoskeletal manipulation protocol of myofascial release using pompage consisted of a total of 24 sessions, 40 min for each session, three times a week, for 8 weeks.

RESULTS

There was a significant improvement in the maximum respiratory pressure in the study group after the intervention. The sound pressure level and the maximum phonation time did not change significantly.

DISCUSSION AND CONCLUSION

Musculoskeletal manipulation protocol of myofascial release using pompage had a direct effect on the respiratory measurements from female teachers, significantly increasing the maximum respiratory pressure but without affecting sound pressure level and the /a/ maximum phonation time.

Self-assessment of teachers with normal larynges and vocal and osteomuscular complaints

INTRODUCTION

Teachers face vocal problems related to long periods of speech and increased sound pressure, as well as environmental noise, inadequate posture and tension of the cervical muscles.

OBJECTIVE

To verify the results of self-assessment of teachers with normal larynges and vocal and musculoskeletal complaints, and compare them with the reference values.

METHODS

Fifty-seven teachers, aged between 21 and 60 years (average 40.14 years) participated in the study. Anamnesis, otorhinolaryngological examination, hearing screening and self-assessment protocols were performed.

RESULTS

In the Nordic musculoskeletal questionnaire, the majority of teachers had discomfort in most parts of the body and in the situations evaluated; on the voice-related quality of life, the total and physical subscores were lower than the normative values while the emotional subscore was higher; regarding voice symptoms scale and vocal tract discomfort scale, the scores were higher than the normative values; in the hospital anxiety and depression scale, there was alteration in the total score; in the Vocal Activity and Participation Profile, the effects on work and emotion were above the normative values; on the University of Rhode Island change assessment-voice and on the voice handicap index there were no significant differences.

CONCLUSION

Most of the teachers presented vocal, musculoskeletal, and emotional complaints on the self-assessment results, what suggests excessive voice use as well as overload on the body muscles, including the larynx and vocal tract, and that they presented emotional changes. These aspects had an impact on their quality of life, but they showed no action in coping with the condition.

Do Professionals Who Use the Voice in a Journalistic Context Benefit from Humming as a Semi-occluded Vocal Tract Exercise?

INTRODUCTION

Many vocal enhancement and rehabilitation programs for voice professionals define vocal exercises without analyzing their effects on that specific population in which they will be applied, in the established dose and often without considering the presence and absence of vocal alteration. Journalists have sought the voice clinic due to new professional vocal demands and a vocal program is being elaborated.

OBJECTIVE

To determine the immediate effect of humming in professionals with and without voice disorders who work under high vocal demand in a journalistic context.

METHOD

Thirty-six individuals who completed the Dysphonia Risk Screening Protocol and underwent voice recording participated in the study. Three speech therapists defined the presence and/or absence of vocal changes by consensus. Subsequently, five repetitions of humming were proposed; the exercises lasted five seconds each and were separated by five seconds of complete silence, and recordings were made before and after the exercise (vowel and phrase). For the pre and post comparison between the groups with and without vocal changes, acoustic measurements and spectrogram, including the classification of the signal type, were performed.

RESULTS

The sample had a similar distribution of men and women and a mean age of 39.9 years. Most of the professionals were journalists or reporters. The risk of dysphonia was high for half of the sample, and the presence of vocal changes, predominantly mild ones, was identified in 56%. After the exercise, a decrease in noise at low frequencies and an improvement in the series of harmonics and the signal type were observed in both groups; a decrease in irregularity was observed only in the participants without vocal changes.

CONCLUSION

The proposed humming exercise had an immediate positive effect on the voice of professionals working in a journalistic context, and the changes were particularly evident in aspects of the voice that were initially altered.

Effect of Resonance Tube Technique on Oropharyngeal Geometry and Voice in Individuals with Parkinson's Disease

OBJECTIVE

To verify the immediate effect of the flexible resonance tube vocal technique on the oropharyngeal geometry and vocal acoustic parameters of individuals with Parkinson's disease (PD) and to study the correlation between oropharyngeal geometry and the intensity and fundamental frequency (f0) parameters of the voice.

METHODS

Forty individuals participated-20 with PD and 20 healthy individuals, with a mean age of 60.95 (± 5.69) years. There were 10 men and 10 women in each group. All underwent pharyngometric analysis of the vocal tract and voice acoustics parameters before and after use of the vocal technique with a flexible resonance tube.

RESULTS

After the technique, there was a reduction in pharyngeal cavity volume only in females in the healthy group, a reduction in shimmer values in females in both groups and males in PD group and an improvement in noise parameters in females in the PD group. There was a negative correlation between vocal tract volume and intensity, between f0 and vocal tract volume, between f0 and oropharyngeal junction area, between f0 and oral cavity volume as well as a positive correlation between oral cavity length and f0.

CONCLUSION

The vocal technique with the flexible resonance tube applied to individuals with PD improved the subjects' voice quality in the perceptual and acoustic voice parameters. Regarding the oropharyngeal geometry, it was possible to observe its correlation with the parameters of vocal intensity and frequency in the studied population.

Phonotherapeutic Intervention in Patients With Mucosal Leishmaniasis Sequelae

PURPOSE

To characterize the voice before and after speech-language intervention, with Humming nasal sound in patients with sequelae Mucosal Leishmaniasis (ML) and Cutaneous Leishmaniasis (CL).

METHODS

Collection of phonation /a:/ from 44 patients with ML and CL for perceptual voice analysis and computed acoustic. The Wilcoxon nonparametric test and Fisher's exact test were used, with significance level of 5%.

RESULTS

It was observed, prespeech therapy, that 27.7% of participants with ML presented asthenic vocal quality, and for the acoustics characteristics there was a statistically significant result for measures of frequency, frequency disturbance, noise, and subharmonic measurements, indicating phonatory instability, weakness, and noise emission giving the emission a feeling of vocal weakness. After therapy, the subharmonic segment measurements for the group with ML, showing reduction noise emission. Patients with CL had more grade 1 instability (36.4%), indicating tremor in vocal tract structures. After speech therapy, this group presented a reduction in the degree of roughness and reduction of the frequency disturbance measures, indicating a decrease in tension in the larynx and pharynx.

CONCLUSION

Even after completing treatment for LM, patients may experience vocal changes due to the sequelae of the disease, like vocal alterations due to nasal lesions or in other locations that interfere in the correct vocal emission. As for participants with CL, no vocal changes would be expected, since these patients present thorax, leg and arm lesions that would not cause problems for the voice. Nevertheless, the two groups of participants presented vocal changes to different degrees before vocal therapy. However, it was observed that patients with ML present vocal alterations with more severe degrees. After the speech-language intervention, the participants of both groups showed vocal improvement, but the group with CL presented more vocal benefits, possibly due to the previous vocal alterations not being so severe.