Analysis of Supraglottic Activity during Vocalization in Flamenco Singers.

INTRODUCTION: Flamenco is a traditional music originally from Andalusia in southern Spain. Some of the vocal resources used in Flamenco have components of voice distortion and other voice qualities that could sound like hyperfunctional voice productions. The present study aimed at observing supraglottic activity in flamenco singers while engaged in singing at various degrees of pitch and loudness and while engaged in realizing phonatory tasks. METHODS: A total of eighteen flamenco singers with at least 5 years of voice training were recruited. Flexible endoscopic voice evaluations were recorded and edited to provide samples of different pitches, loudness levels, and phonatory tasks. Sound was removed from video samples. Two blinded laryngologists were asked to assess antero-posterior compression, medial compression, pharyngeal compression, and VLP for every sample, using a visual analog scale. RESULTS: Significantly higher values were found for medial compression, anterior-posterior compression, VLP and pharyngeal compression during high loudness levels when compared to medium and low loudness. Overall, medial compression was lower than anterior-posterior compression. CONCLUSION: Supraglottic activity is present in flamenco singing in the four laryngoscopic variables. It seems to be that supraglottic activity increases with loudness level and pitch. This behavior could be a natural and necessary aspect of flamenco singing present during both sustained vowels and song.

Systematic Review of Literature on Vocal Demand Response: Understanding Physiology, Measurements, and Associated Factors.

PURPOSE: Considering the conceptual migration from vocal load and vocal loading to vocal demand and vocal demand response, this review of literature aimed to identify physiological explanations, reported measurements, and associated factors (vocal demands) reported in the literature when considering the phonatory response to a vocal demand. METHODS: A systematic review of literature, following the PRISMA Statement, was conducted using Web of Science, PubMed, Scopus, and ScienceDirect. Data were analyzed and presented in two parts. First, a bibliometric analysis, co-occurrence analysis, and content analysis were performed. Three criteria that got article inclusion were defined: (1) written in English, Spanish, and Portuguese; (2) published between 2009 and 2021; and (3) focused on vocal load and loading, vocal demand response, and voice assessment parameters. A total of 54 publications met the criteria and were included in this review. The second part included a conceptual framework based on the content analysis of three aspects of vocal demand response: (1) physiological explanations, (2) reported measurements, and (3) vocal demands. RESULTS AND CONCLUSION: As would be expected since vocal demand response is a relatively new term and not yet commonly used in literature when discussing way that the speakers respond to communicative scenarios, most of the studies reviewed (both historical and recent) still use the term of vocal load and vocal loading. Although there is a broad variety of literature discussing a wide range of vocal demands and voice parameters used to characterize the vocal demand response, results show that there is consistency across the studies. While vocal demand response is unique and intrinsic to the talker, associated factors that contribute to this response include both internal talker and external talker factors. Internal factors include muscle stiffness, viscosity in the phonatory system, vocal fold tissue damage, elevated sound pressure levels during occupational voice demands, extended periods of voice use, suboptimal body posture, difficulties in breathing technique, and sleep disturbances. Associated external factors include the working environment (noise, acoustics, temperature, humidity). In conclusion, although vocal demand response is intrinsic to the speaker, the speaker's response is affected by external vocal demands. However, due to the wide methods to evaluate vocal demand response, it has been difficult to establish its contribution to voice disorders in the general population and, specifically, among occupational voice users. This literature review identified commonly reported parameters and factors that may help clinicians and researchers define vocal demand response.

Validation of the Spanish Version of the Voice-Related Quality of Life Questionnaire: Psychometric Properties and Clinical Applications.

INTRODUCTION: The present study aimed to validate the Voice-Related Quality of Life (V-RQOL), vocal self-assessment questionnaire for Spanish. METHODS: The validation and psychometric properties were developed according to the criteria of the Scientific Advisory Committee of Medical Outcomes Trust (SAC). The Spanish translation for linguistic and cultural adaptation of the V-RQOL was used. The study involved 193 participants, including 90 vocally healthy individuals and 103 patients with voice disorders, to establish validity. To evaluate reliability, the protocol was applied to 40 participants with dysphonia, who answered it twice before the treatment. Then to determine response changes, the responses of 13 dysphonic participants to the V-RQOL for Spanish were analyzed after intervention and then compared to the initial ones. Clinicians contrasted subjects' V-RQOL results with a perceptual analysis of voice quality using the GRBAS scale. In order to determine sensitivity and specificity cut-off values, tools results were subjected to the receiver operating characteristic curve analysis. The sensitivity was obtained from the experimental group (dysphonic group) and the specificity from the control group (non-dysphonic group). RESULTS: This version of the V-RQOL questionnaire may be used as part of the standard assessment process of people with voice complaints and as an outcome of treatment efficacy in clinical trials. CONCLUSION: A validation of the V-RQOL for Spanish in Chilean population was achieved.

Subclinical experimental infection with Taenia hydatigena in sheep is associated with production losses.

The effect of experimental infection by Taenia hydatigena metacestodes on different productive parameters in sheep was evaluated. Seventeen male Columbia lambs distributed in three groups were used. The lambs of the first group (n = 5) were orally inoculated with 1000 T. hydatigena eggs (low dose). The lambs of the second group (n = 5) were inoculated orally with all the eggs of the last proglottid of an adult cestode (high dose). The lambs of the third group (n = 7) only received a placebo and were used as a control group. All lambs were humanely euthanized at week 13 postinfection, and carcass yield and conformation were evaluated. The infection rates of the lambs from the high-dose infected group and the low-dose infected group were 100% and 40%, respectively, with a mean of 2.4 ± 0.6 and 1 ± 0.7 metacestodes of T. hydatigena in the abdominal cavity, respectively. In a first multivariate study (MANOVA) considering the under the curve (AUC) values of body condition, weight gain, and feed consumption, as well as the final feed conversion values, showed a highly significant (p < 0.0001) group effect (high dose/low dose/uninfected). In a second multivariate study (MANOVA) considering the AUC values of eosinophils blood count, packed cell volume and alkaline phosphatase showed a highly significant (p < 0.0001) group effect (high dose/low dose/uninfected). The increase in serum ALP is a consequence of liver damage that had a strong negative correlation (r = -0.63, p < 0.007) with the body condition of the lambs. Despite these findings, we did not observe obvious clinical manifestations in any of the infected lambs. In general, no differences (p > 0.1) were observed between the lambs of the control group and the lambs of the low-dose infected group in the parameters evaluated. The results of this study show that the infection of T. hydatigena metacestodes subclinically produces a decrease in productive efficiency, alterations of some hematological and biochemical values, and a slight deterioration in the general appearance of the infected lambs. The above aspects are rarely detected by most farmers, but they have a negative impact on the productivity of infected lambs.

Efficacy of ethyl-4-bromophenyl carbamate on different Rhipicephalus microplus stages implanted in cattle.

The effect of ethyl-4-bromophenyl carbamate on different Rhipicephalus microplus stages implanted in cattle was evaluated using the pen test with infestation chambers. Twelve steers were distributed into four groups (n = 3), each with four chambers (12 chambers per group), where approximately 1,000 R. microplus larvae were placed in each chamber. The chambers of the first group were sprayed with a solution of ethyl-4-bromophenyl carbamate (0.668 mg/mL) on day 2 post-infestation (PI) (exposed larvae). The chambers of the second group were sprayed with the same solution on day 8 PI (exposed nymphs), and the chambers of the third group were sprayed on day 16 PI (exposed adults) with the same solution. The chambers of the fourth group were used as controls. The percentages of engorged females, egg laying, egg production and egg hatching were evaluated in all groups. The percentage of cumulative reduction of hatched larvae was 98.3, 96.1 and 94.4% when larvae, nymph and adult stages were treated, respectively. The average cumulative reduction of hatched larvae, considering the three treated stages, was 96.3%, whereby the reproductive potential of this tick was drastically reduced. In conclusion, ethyl-4-bromophenyl carbamate acted as an ixodicide (lethal effect) when larval stages were sprayed and as a growth regulator when nymphal and adult stages were sprayed. The sum of these effects had a direct impact on the efficacy of the product in the pen test, and future studies will indicate the potential use of this product for tick control.

Taenia hydatigena larvae vesicular concentrates increase Anti-OVA IgG and the production of some cytokines in rats.

The effects of administration of four different fractions of T. hydatigena larvae vesicular concentrate (ThLVC) prior to immunization with ovalbumin (OVA) in rats on different parameters of the immune response were evaluated. The amount of anti-OVA IgG by ELISA, amount of blood eosinophils (BE), percentage of cell subpopulations by flow cytometry (CD3+/CD4+, CD3+/CD8+, CD3-/CD45RA+, and CD11b/c+), and production of serum cytokines by bead-based immunoassays (IL-2, IL-4, INFγ, IL-5, TNFα, GM-CSF, IL-17F, IL-17A IL-13, IL-22, and IL-6) were measured. Rats receiving total-ThLVC (p ≤ 0.05) and fraction ThLVC30-100 kDa (p < 0.001) prior to OVA administration produced higher amounts of anti-OVA IgG than rats receiving OVA alone. Rats that were only administered with OVA showed a strong increase in BE that was significantly correlated (r = 0.72, p < 0.001) with an increase in IL-5 in the blood. However, rats that received any of the ThLVC fractions prior to administration of OVA did not show these increases. In general, administration of ThLVC30-100 kDa prior to administration of OVA increased (p < 0.05) the percentage of B, CD4, and CD8 lymphocytes in the spleen and mesenteric lymph nodes. Rats that received ThLVC total fraction and OVA showed an increase (p < 0.05) in IL-2, IL17F, and IL22. The results of this study show that total-ThLVC and ThLVC30-100 kDa modify the immune response of rats in differentiated ways. Our observations suggests that both fractions of ThLVC have the potential to be used as adjuvants.

Role of Micronutrients and Gut Microbiota-Derived Metabolites in COVID-19 Recovery.

A balanced and varied diet provides diverse beneficial effects on health, such as adequate micronutrient availability and a gut microbiome in homeostasis. Besides their participation in biochemical processes as cofactors and coenzymes, vitamins and minerals have an immunoregulatory function; meanwhile, gut microbiota and its metabolites coordinate directly and indirectly the cell response through the interaction with the host receptors. Malnourishment is a crucial risk factor for several pathologies, and its involvement during the Coronavirus Disease 2019 pandemic has been reported. This pandemic has caused a significant decline in the worldwide population, especially those with chronic diseases, reduced physical activity, and elder age. Diet and gut microbiota composition are probable causes for this susceptibility, and its supplementation can play a role in reestablishing microbial homeostasis and improving immunity response against Coronavirus Disease 2019 infection and recovery. This study reviews the role of micronutrients and microbiomes in the risk of infection, the severity of disease, and the Coronavirus Disease 2019 sequelae.

Water Resistance Therapy as Vocal Warm-Up Method in Contemporary Commercial Music Singers.

BACKGROUND/AIMS: Although water resistance therapy (WRT) has been widely used in voice training, no data are supporting the effectiveness of WRT as vocal warm-up for singers. The present study aimed to determine the effects of WRT as a vocal warm-up method in contemporary commercial music (CCM) singers. METHODS: Twenty-two CCM singers were randomly assigned to one of two types of 15-min vocal warm-up: open vocal tract (OVT) warm-up and WRT. Self-perceived resonant voice quality and aerodynamic, electroglottographic, and acoustic measures were assessed before, immediately after vocal warm-up, and after 40 min of vocal loading. RESULTS: Significant results were found immediately after vocal warm-up. Subglottic pressure and inspiratory airflow duration decreased in both groups. SPL decreased for the OVT group. No changes in SPL were found for the WRT group. Significant results were observed after vocal loading. Subglottic pressure and inspiratory airflow duration decreased for both groups after vocal loading. Expiratory airflow duration and electroglottographic contact quotient decreased for the OVT group. CONCLUSION: Some objective data suggest that the WRT method is more effective as vocal warm-up than OVT exercises. Since outcomes in self-perceived resonant voice quality for both methods were similar but physiological effects were different, vocal warm-up strategies might produce a placebo effect.

Toxic effects of new ethyl-carbamates on the morphology, mortality and acetylcholinesterase activity of Eisenia foetida.

The toxicity of the ixodicidal carbamates ethyl-4-bromophenyl carbamate (LQM 919), ethyl-4-chlorophenyl carbamate (LQM 996) and propoxur on Eisenia foetida adults was evaluated to estimate their ecotoxic potential. The earthworm mortality and weight loss produced by the three evaluated carbamates showed a concentration-dependent effect (p < 0.0001) in the contact filter paper test (CFPT). In the artificial soil test (AST), mortality increased in relation to the exposure time (p < 0.0001) and the concentration (p < 0.01) of the carbamates. Only the earthworms exposed in the CFPT showed morphological alterations. According to the LC50 obtained in the CFPT, the three carbamates were classified as very toxic and, according to the LC50 obtained in the AST, the three carbamates were classified as highly toxic for E. foetida. The values of ki and kd indicated that LQM 919 and LQM 996 are weak inhibitors with lower affinity for the acetylcholinesterase of E. foetida than that of propoxur. The concentrations in the CFPT and AST at which 100% mortality was observed in E. foetida were 64- and 4-fold higher, respectively, than the egg hatching inhibitory concentration 99% reported for ticks.

Aerodynamic, Electroglottographic, and Acoustic Outcomes after Tube Phonation in Water in Elderly Subjects.

OBJECTIVE: The present study aimed at observing the influence of tube phonation into water on objective voice characteristics in elderly subjects. METHODS: Thirty elderly subjects with presbyphonia were randomly assigned to one of two voice exercise groups: (1) voice exercises with water resistance therapy at 4 and 8 cm of water depth (experimental group), and (2) voice exercises with vowel [a:]. Aerodynamic, electroglottographic, and acoustic voice assessments were conducted before and after exercises. RESULTS: The experimental group showed a significant increase in contact quotient, subglottic pressure (Psub), glottal resistance, and sound pressure level (SPL) when comparing the pre-post 8 cm and the post 4 cm-post 8 cm conditions. No significant differences were found for the control group. Moreover, significant differences for all variables (except for glottal airflow) when comparing condition post (for the control group) and condition post 8 cm (for the experimental group) were found. CONCLUSION: Tube phonation into water might improve vocal function in the geriatric population. This semioccluded vocal tract exercise seems to promote an increase in Psub and vocal fold adduction immediately after exercise. This in turn might cause an increase in SPL. The effect should become manifest when a deep level of submersion (e.g., 8 cm water) is used. Shallower submersion produced negligible or no effects.

Do Different Semi-Occluded Voice Exercises Affect Vocal Fold Adduction Differently in Subjects Diagnosed with Hyperfunctional Dysphonia?

OBJECTIVE: To observe the possible differential effects of 8 different semi-occluded vocal tract exercises on glottal contact quotient (CQ) as a measure of vocal fold impact stress. PATIENTS AND METHODS: Eighty participants were divided into two groups: an experimental group with hyperfunctional dysphonia and a control group of vocally healthy subjects. The participants were recorded before, during and after the exercises. Electroglottographic samples were analyzed to obtain CQ. RESULTS: For the experimental group, all exercises, except lip trills and tongue trills, had an overall significant effect when conditions before, during and after the exercises were compared. The CQ presented differently across the 8 semi-occluded postures during exercise for both groups. For the experimental group, most exercises increased the CQ during practice. Only lip and tongue trills demonstrated lower CQ during exercise. CONCLUSIONS: Different semi-occluded exercises differentially affect vocal fold adduction. Lip and tongue trills produced the lowest CQ. Therefore, they may be recommended for decreasing glottal adduction. A straw submerged 10 cm below the water surface presented the greatest CQ. A shallower depth led to a lower CQ, while deeper submersion produced a higher CQ.

Growth hormone stimulates the in vitro development and establishment of Haemonchus contortus in sheep.

The physiologic increase in some sex hormones has been associated with an increase in the parasite load caused by Haemonchus contortus in ewes, especially prolactin. In lambs that are especially susceptible to hemonchosis, the levels of sex hormones are low; in contrast, the levels of another pituitary hormone, growth hormone (GH), which is structurally very similar to prolactin, are high. In this study, the in vitro and in vivo effects of GH on H. contortus larvae development and establishment were evaluated. The addition of 20 ng/mL GH for 5 and 10 days to cultures of H. contortus larvae induced an enlargement (p<0.01) and an L3/L4 molting rate (p<0.03) greater than that of untreated larvae or those treated with other concentrations of the hormone. Flow cytometry showed that 3.8% of the largest and most complex cells of newly obtained larvae of H. contortus were positive for the GH receptor, and by immunofluorescence with confocal microscopy, it was observed that these receptors are located in the intestinal region larvae. In the in vivo assay, the administration of recombinant GH to gonadectomized lambs produced an increase in FEC (p<0.03), the number of female adult worms in the abomasum (p<0.05) and the levels of specific antibodies (p<0.04) in relation to the control lambs; however, it did not affect the fertility of H. contortus females. Although many factors affect the development and implantation of H. contortus in the abomasum of sheep, the results of this study strongly suggest that GH participates in the development and establishment of the parasite in sheep, mainly in young sheep.

Laryngoscopic, acoustic, perceptual, and functional assessment of voice in rock singers.

OBJECTIVE: The present study aimed to vocally assess a group of rock singers who use growl voice and reinforced falsetto. METHOD: A group of 21 rock singers and a control group of 18 pop singers were included. Singing and speaking voice was assessed through acoustic, perceptual, functional and laryngoscopic analysis. RESULTS: No significant differences were observed between groups in most of the analyses. Acoustic and perceptual analysis of the experimental group demonstrated normality of speaking voice. Endoscopic evaluation showed that most rock singers presented during singing voice a high vertical laryngeal position, pharyngeal compression and laryngeal supraglottic compression. Supraglottic activity during speaking voice tasks was also observed. However, overall vocal fold integrity was demonstrated in most of the participants. Slightly abnormal observations were demonstrated in few of them. Singing voice handicap index revealed that the most affected variable was the physical sphere, followed by the social and emotional spheres. CONCLUSIONS: Although growl voice and reinforced falsetto represent laryngeal and pharyngeal hyperfunctional activity, they did not seem to contribute to the presence of any major vocal fold disorder in our subjects. Nevertheless, we cannot rule out the possibility that more evident vocal fold disorders could be found in singers who use these techniques more often and during a longer period of time.

A Voice Rehabilitation Protocol With the Semioccluded Ventilation Mask in Subjects With Symptoms of Vocal Fatigue and Phonatory Effort.

PURPOSE: The present study was designed to assess the efficacy of a six-session physiologic voice therapy program with the semioccluded ventilation mask (SOVM) in a group of subjects with voice complaints (vocal effort and fatigue). METHODS: Thirty-four participants with functional dysphonia were randomly assigned to one of two treatment groups: (1) voice treatment with physiologic voice therapy plus vocal hygiene program (n = 17), and (2) vocal hygiene program only (n = 17). Laryngoscopic assessment was performed in all subjects to confirm laryngeal diagnosis. Before and after voice therapy, participants underwent aerodynamic assessment. The Voice Handicap Index (VHI), Vocal Tract Discomfort Scale (VTDS), and self-assessment of resonant voice were also performed. The treatment included six voice therapy sessions. For the experimental group, the exercises consisted of a sequence of seven phonatory tasks performed with the SOVM. Comparison for all variables was performed between experimental group and control group. RESULTS: Statistical analysis showed significant improvements for experimental group for VHI (decrease), VTDS (decrease), and self-perception of resonant voice quality (increase). Significant decrease for experimental group was observed in subglottic pressure and phonation threshold pressure. CONCLUSION: Physiologic voice therapy based on the SOVM with connected speech exercises seems to be an effective tool to improve voice in subjects diagnosed with voice complaints. Apparently, improvements are reflected in both subjective and objective outcomes. A reduction in phonatory effort and perceptual aspects of vocal fatigue are the main subjective improvements. A decrease in air pressure-related variables seems to be the most important objective change after voice therapy.

Remote Voice Therapy With an Oscillatory Positive Expiratory Pressure Device in Subjects With Vocal Fatigue: A Randomized Controlled Trial.

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.

Efficacy of a Semi-Occluded Vocal Tract Exercises-Therapeutic Program in Behavioral Dysphonia: A Randomized and Blinded Clinical Trial.

PURPOSE: Semi-occluded vocal tract exercises (SOVTE) may improve the source and filter interaction by changing the acoustic characteristics and the impedance of the vocal tract, both in dysphonic and vocally healthy populations. However, there are a few studies that verify the effects of these exercises in a clinical trial. Thus, this study's purpose was to analyze the effectiveness of the SOVTE-Therapeutic Program (SOVTE-TP) in vocal quality and self-assessment, comparing it with Vocal Function Exercises. METHOD: Eighteen (eight men; 10 women), ages 18-50, with behavioral dysphonia participated in this randomized and blinded clinical trial. The participants were equally randomized into two groups: Experimental Group and Vocal Function Exercises Group. They were assessed at three moments: before the treatment, after finishing it, and one month after finishing the treatment--follow up. Acoustic measures (ie, fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, cepstral peak-smoothed, alpha ratio, and L1-L0), auditory-perceptual analysis, vocal fatigue index (VFI), self-perceived resonant voice, and vocal handicap index-30 (VHI-30) were measured at all assessment moments. For the two groups, the interventions happened twice per week (four weeks) and lasted 35 minutes. It was applied the repeated-measures ANOVA test (P< 0.05) and Tukey Test. RESULTS: The acoustic measures and auditory-perceptual had no differences between the groups and moments, respectively, which means that SOVTE-TP did not cause any harm. The auditory-perceptual analysis showed a mild deviation of participants' vocal quality. All groups reduced the VFI and VHI-30 scores in M2 and kept these results at M3 also, the vocal economy sensation increased in M2, decreasing slightly in M3. CONCLUSION: SOVTE-TP has positive effects regarding self-assessment (VFI, VHI, and resonant voice quality) on patients with mild behavioral dysphonia, and it provides the same effects as VFE.

Physiologic Voice Rehabilitation Based on Water Resistance Therapy With Connected Speech in Subjects With Vocal Fatigue.

PURPOSE: The present study aimed to assess the effectiveness of a physiologic voice therapy program based on water resistance therapy (WRT) exercises including connected speech in a group of subjects with voice complaints (vocal effort and fatigue). METHODS: Twenty-four participants with behavioral dysphonia were randomly assigned to one of two treatment groups: (1) voice treatment with WRT plus vocal hygiene program (n = 12), and (2) vocal hygiene program only (n = 12). Laryngoscopic assessment was performed in all subjects. Before and after voice therapy, participants underwent aerodynamic and electroglottographic assessment. The Voice Handicap Index (VHI) and self-assessment of resonant voice were also performed. The treatment included six voice therapy sessions. For the experimental group, the exercises consisted of a sequence of seven phonatory tasks performed with two different voice training devices (PocketVox and MaskVox). Comparison for all variables was performed between experimental group and control group. RESULTS: Significant differences were found for experimental group for VHI physical subscale, and self-perceived resonant voice when comparing pre-post conditions. A strong negative correlation between self-perceived resonant voice and VHI physical sub-score was also reported. No significant differences were found for instrumented variables. CONCLUSION: Physiologic voice therapy based on WRT exercises including connected speech seems to be an effective tool to improve self-perceived voice in subjects diagnosed with voice complaints. Apparently, changes are more prone to occur in perceptual variables related with physical discomfort associate with voice production. A reduction in phonatory effort and perceptual aspects of vocal fatigue are the main improvements.

Efficacy of Voice Therapy With Acapella Choice ® Device in Subjects With Vocal Fatigue Delivered Via Telepractice.

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.

H2O2 Concentration in Exhaled Breath Condensate Increases After Phonotrauma: A Promise of Noninvasive Monitoring?

PURPOSE: The present study was designed to observe the concentration of hydrogen peroxide (H2O2) in exhaled breath condensate (EBC) after induced phonotrauma. METHODS: Thirty-five participants were randomly assigned to one of two conditions (1) Vocal demand and (2) Control. Participants in the experimental group (vocal demand) were asked to read aloud some texts during 1 hour, at 85-90 dB. Inflammation (H2O2 from exhaled breath condensate), acoustic, aerodynamic, and subjective measures were obtained at four time points: before vocal demand (baseline), immediately after baseline, 4-hour after baseline, and 24 hours after baseline. The same acquisition process was implemented for subjects in control group, except that they were not asked to engage in any vocal demand tasks at all. RESULTS: As for biological samples, a significant effect for group was observed. Higher values were found for participants in experimental condition. Significant differences were observed for within contrasts in the experimental group, namely 4 hours against baseline, 4 hours against immediately post, and 24 hours against 4 hours. Instrumental outcomes did not show significant differences across the different conditions at any time points. Self-reported measures (vocal fatigue and sensation of muscle tension) showed a significant main effect for group and main effect for condition. CONCLUSIONS: Intense vocal demand causes an increase in the concentration of H2O2 obtained from EBC at four hours after baseline, which is compatible with the generation of an inflammatory process in the vocal folds (phonotrauma). Moreover, the increase in the sensation of vocal fatigue and muscle tension after demand tasks seems to be an immediate reaction that did not match in time with the increment of H2O2 concentration.

Acoustic, Aerodynamic, Morphometric, and Perceptual Changes During and After Semi-Occluded Vocal Tract Exercise: An Integrative Review.

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.