RESUMEN
OBJECTIVES: Positive expiratory pressure (PEP) devices have become an additional therapeutic approach for treating voice disorders. Similar to water resistance therapy (WRT), phonation in a PEP device introduces a secondary source of vibration within the vocal tract. This investigation aimed to compare the effects of phonation using a PEP device and silicone tube phonation (STP) commonly used in WRT on the vocal mechanism during phonation. METHODS: Three normophonic subjects participated in the study. High-speed videoendoscopy, pressure, airflow, electroglottography, and acoustic recordings were collected. RESULTS: The results demonstrated that phonation using both the PEP device and silicone tube induced alterations in glottal behavior. The PEP device produced more pronounced and consistent pressure oscillations, impacting the glottal cycle and influencing parameters including contact quotient (CQ), fundamental frequency, glottal area, pressure, and airflow. The regular vibratory mechanism of the PEP device systematically modified the glottal cycle. In STP, regular bubbling at lower depths of submersion produced higher CQ values, supporting the efficacy of deep bubbling exercises for inducing glottal adduction. CONCLUSIONS: The findings suggest that phonation using PEP devices has a more pronounced impact on the vocal tract and glottis. It also provides a stronger massage effect that directly affects the glottal source. Phonation with a silicone tube produces similar results, although to a lesser extent and with lower regularity. These findings offer guidance in the selection of voice therapy devices.
RESUMEN
INTRODUCTION: Vibratory positive expiratory pressure (PEP) devices are now commonly used as a resource for voice therapy. PEP devices promote improved vocal economy with the added benefit of producing a massage effect in the vocal tract. Although the benefits of PEP devices for voice have already been demonstrated, their impact on the vocal source is still not very clear. This study assesses the impact of phonation into the Acapella Choice (a type of PEP device) on the voice. METHODS: Three normophonic subjects underwent high-speed videoendoscopy assessment while pressure, flow and electroglottographic data was collected. RESULTS: Phonation into the Acapella device produces large changes in the pressure and flow profiles consequently affecting the voice source. In specific, when intraoral pressure increases as a consequence of the downward movement of the rocker arm in the Acapella device (reduction of the airflow outlet), phonation is hindered, demonstrated by the lower amplitude of vibration of the vocal folds and weaker modulation of the pressure and flow values by the glottal cycle. When the rocker arm in the Acapella device opens (increasing the airflow outlet), the opposite trend is observed where vocal fold vibration is aided and the modulation of pressure and flow by the vocal cycle increases. Based on the pressure and flow signals, we can assume that the impedance of the vocal tract alternates between two dominant regimes: increased inertive reactance (aided vibration) and increased resistance (hindered vibration). CONCLUSIONS: PEP devices, such as the Acapella device, are efficient in modulating the pressure and flow profiles in the vocal tract leading to the alternation of glottal vibration from aided to hindered. These changes in the glottal vibration can be considered an additional consequence of the massage effect caused by the Acapella device.
