Indirect Vocal Therapy as a Treatment Program for Behavioral Dysphonia: A Pilot Study.

INTRODUCTION: Indirect vocal therapy (IVT) has tools that aim to modify an individual's behavior, emotional factors, and physical environment for restoring vocal quality. Then, vocal health guidance may promote the desire for caring about the voice and prevent or treat behavioral dysphonia. However, studies that used parts of IVT have shown conflicting results. Hence, the main objective of this study was to introduce an IVT program based on the taxonomy of Van Stan et al. [Am J Speech Lang Pathol. 2015;24(2):101-25]. The second objective of this study was to analyze the preliminary effects of the IVT program on vocal comfort through the self-assessment of vocal fatigue, vocal symptoms, vocal handicap, and vocal quality in patients diagnosed with behavioral dysphonia. METHOD: This is an experimental, analytical, and prospective pilot study. Nine participants (five women; four men) aged between 18 and 50 years with behavioral dysphonia participated in this study. They underwent the IVT program with guidance about vocal health, general health, emotional factors, and motivation. The therapy was implemented twice per week, totalizing eight sessions, each lasting 35 min. Participants were assessed before therapy started (M1), after it ended (M2), and 1 month after as a follow-up (M3). As assessment, participants filled in the Vocal Fatigue Index (VFI), Voice Symptoms Scale (VoiSS), and Vocal Handicap Index-30 (VHI-30). Additionally, they had their voices recorded for acoustic measures (i.e., cepstral peak prominence-smoothed, alpha ratio, and L1-L0) and auditory-perceptual analysis using the GRBASI scale. RESULTS: The acoustic measures and auditory-perceptual analysis showed no significant differences between the assessment moments. The auditory-perceptual analysis showed a mild deviation in participants' vocal quality. The participants' scores of the VFI, VoiSS, and VHI were lower in M2 and remained lower in M3. CONCLUSION: The IVT program had positive results in voice-related self-assessment and vocal comfort. However, further studies are necessary to elucidate its effects on the vocal quality of participants with behavioral dysphonia.

An initial study of voice characteristics of children using two different sound coding strategies in comparison to normal hearing children.

OBJECTIVE: To compare some perceptual and acoustic characteristics of the voices of children who use the advanced combination encoder (ACE) or fine structure processing (FSP) speech coding strategies, and to investigate whether these characteristics differ from children with normal hearing. DESIGN: Acoustic analysis of the sustained vowel /a/ was performed using the multi-dimensional voice program (MDVP). Analyses of sequential and spontaneous speech were performed using the real time pitch. Perceptual analyses of these samples were performed using visual-analogic scales of pre-selected parameters. STUDY SAMPLE: Seventy-six children from three years to five years and 11 months of age participated. Twenty-eight were users of ACE, 23 were users of FSP, and 25 were children with normal hearing. RESULTS: Although both groups with CI presented with some deviated vocal features, the users of ACE presented with voice quality more like children with normal hearing than the users of FSP. CONCLUSIONS: Sound processing of ACE appeared to provide better conditions for auditory monitoring of the voice, and consequently, for better control of the voice production. However, these findings need to be further investigated due to the lack of comparative studies published to understand exactly which attributes of sound processing are responsible for differences in performance.

Speech Articulatory Characteristics of Individuals With Dentofacial Deformity.

PURPOSE: To analyze the speech articulatory characteristics of individuals with dentofacial deformities (DFD) and assess differences compared to individuals with dentofacial balance. METHODS: Sixty individuals participated, being 30 presenting DFD (19 with class III and 11 class II skeletal malocclusion, 18 women and 12 men, age group 18-40 years) and 30 individuals from a control group matched for gender and age. The assessment of the diadochokinesis (DDK) was evaluated using the emissions /pa/, /ta/, /ka/, /pataka/, and /i/. RESULTS: The individuals with DFD produced fewer emissions per second: at syllable "ka" and sequence "pataka" for the total of individuals; syllable "pa" and sequence "pataka" for women, individuals with class II and class III malocclusion. The parameters related to the irregularity of the cycles were higher for the group with DFD than for the control, as well as emission of the syllable "pa" for the total of individuals, group of class III malocclusion and women, during production of the syllables "ta" and "ka" for all individuals and group of class III and during emission of the vowel "ï" for women. CONCLUSIONS: Differences regarding speed and stability of oral and laryngeal DDK were found among individuals with DFD compared with the control group.

Water Resistance Therapy in Individuals with Parkinson's Disease: A Session-by-Session Analysis of the Vocal Quality.

OBJECTIVES: Verify session-by-session effects of the water resistance therapy (WRT) on the vocal quality of individuals with Parkinson's disease (PD). METHODS: This is a retrospective analytical study. Then, the samples were acquired from a database composed of 10 men aged between 50 and 90 years old diagnosed with PD. The participants underwent WRT with a resonance tube; then, they were guided to perform the following phonatory tasks: comfortable pitch and loudness, high pitch, low pitch, ascending and descending glissandos, and sentence uttering. Furthermore, tube depth ranged from 2 cm to 9 cm. Finally, WRT was implemented twice per week, totaling eight sessions, each lasting 45 minutes. Participants were assessed before and after each therapy session. Hence, the data were assessed with spectrographic analysis, vocal intensity, cepstral peak prominence-smoothed, alpha ratio, L1-L0, oscillatory frequency, and auditory-perceptual assessment of overall degree, roughness, breathiness, and instability. One-way repeated measures analysis of variance and Friedman tests were applied (P < 0.05). Furthermore, Holm-Sidak and Tukey tests were used as posthoc tests. RESULTS: After the sixth session, the spectrographic analysis revealed that the tracing color intensity of medium frequencies darkened, whereas a better result could be observed after the eighth session. Regarding vocal intensity, the improvement could be observed from the third session. Additionally, L1-L0 followed the same results. The overall degree auditory-perceptual assessment revealed the best results only after the second, third, and fourth sessions; however, after the eighth session, the instability increased. CONCLUSIONS: WRT allowed better results from the third session, with some improvements in the sixth session. However, the instability increased after the eighth session; thus, it is important to review the phonatory tasks and session numbers to avoid an overload in the phonatory system.

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.

Low-Frequency TENS in Women With Behavioral Dysphonia: Preliminary Data From a Randomized Clinical Trial.

PURPOSE: To verify the effectiveness of low-frequency transcutaneous electrical nerve stimulation (TENS) simultaneously applied to the performance of vocal exercises in women with behavioral dysphonia. METHODS: This is a randomized, blinded clinical trial (Register Number: RBR-5k95vs). Twelve adult women with vocal nodules, randomly divided into three groups (G1: 4 participants - 12 sessions - application of placebo TENS simultaneously to the execution of vocal exercises; G2: 5 participants - 12 sessions - application of low-frequency TENS (frequency at 10 Hz, 200 µs duration phase, motor threshold, with electrodes placed on the thyroid cartilage lamina, bilaterally); and G3: 3 participants - 12 sessions - application of low-frequency TENS (same condition as G2) simultaneously to the execution of vocal exercises), participated in this study. The therapies were performed for 30 minutes in each session, twice a week. The participants were evaluated regarding vocal quality through acoustic voice analysis (fundamental frequency, Cesptral Peak Prominence-Smoothed (CPPs), alpha ratio, L1-L0, Acoustic Breathiness Index (ABI), and Acoustic Vocal Quality Index (AVQI)), vocal economy through electroglottography, and vocal self-assessment using the Voice-Related Quality of Life (V-RQOL) protocol. Assessments were performed before and immediately after voice therapy. Data were analyzed using the two-way repeated-measures ANOVA (variance analysis) test to compare assessment times and intervention groups. RESULTS: It was observed that G2 presented a reduction in the ABI acoustic parameter after the intervention and an increase in the values of the CPPs and L1-L0 parameter and in the scores of the physical and total V-RQOL domains. There were no differences for the other outcomes in relation to time and group. CONCLUSION: Preliminary results indicate that low-frequency TENS applied alone can reduce ABI parameter values and improve voice-related quality of life in dysphonic women.

Presentation and Evaluation of the Teacher's Vocal Health Guide.

OBJECTIVE: in order to contribute of the collective actions of the teacher's vocal health, the specific goal was to build a guide gathering the appliable didactic content in these actions. That being, the stages performed in the instrument elaboration of the denominated Teachers' Vocal Health Guide (TVHG) will be presented. MATERIAL AND METHODS: The elaboration process of the guide is composed of three stages: (1) parameter selection to compose the guide based on a literature review; (2) submission to a specialist examining board, with the calculation of the Content Validity Index (CVI) and the Kappa agreement coefficient; (3) content validation - the instrument was submitted to an analysis of a judges committee, and from the results the Cronbach Alfa coefficient and the CVI were calculated. RESULTS: The elaboration of the TVHG underwent three stages. In the first stage, called parameter selection, 20 didactic contents were found, consisting of 14 theoretical and six practices. In the second stage, an evaluation of the guide was performed by a specialist examining board and two contents were excluded since their CVI was below 8. The result of the Kappa Coefficient Calculation was 0.281. In the third stage, the TVHG underwent evaluation of a new group denominated judges committee, and the items were punctuated as very relevant and completely relevant. The result of the Cronbach Alfa coefficient for the instrument with 18 items was 0.721, and this value categorizes the instrument as valid. It is necessary to continue the process of instrument validation, possibly investigating the applicability of TVHG in the teachers' opinion. CONCLUSION: The current study presents the TVHG from the description of the three stages performed to elaborate a systematized instrument denominated TVHG, which suggests a gathering of didactic content that are appliable in collective actions of vocal health with this professional category.

Effects of Performance Time of the Voiced High-Frequency Oscillation and Lax Vox Technique in Vocally Healthy Subjects.

OBJECTIVES: The primary objective was to analyze and compare the effects of the voiced high-frequency oscillation (VHFO) and Lax Vox techniques in different performance times. The secondary objective was to determine if there were any differences between the exercises in men and women. METHODS: Thirty volunteers (15 male, 15 female) without vocal complaints or any history of dysphonia participated in this study. The volunteers performed the VHFO and the Lax Vox techniques with a week washout, and the performance times were 1- and 3-minute long with a 15-minute interval. They answered two questionnaires on vocal and laryngopharyngeal symptoms intensity self-assessment and had acoustic measurements (cepstral peak prominence-smoothed - CPPs - , alpha ratio, and L1-L0) obtained, before 1 minute (M0), after 1 minute (M1), and after 3 minutes (M3). They had their sustained vowel /a/ and number counting 1-10 recorded. Data were analyzed by using the repeated measures ANOVA (P < 0.05) and the post hoc Tukey's test. RESULTS: For vowel /a/, men had higher CPPs and lower alpha ratio values. For number counting, men had lower CPPs values, and for both genders there was an improvement after M1, which remained at M3. For the low-pitched voice symptom, men showed a decrease after M1, regardless of the exercise. Men had better results after VHFO, while women had better results after the Lax Vox technique for the tightness symptom. Regardless of exercise or gender, there was a decrease in tickling and irritated throat after M1, but at M3 their intensity tended to increase. The lump in the throat symptom decreased at M1 and remained at the same intensity at M3 regardless of exercise or gender. CONCLUSIONS: It is important to be aware of the voice effects and the patient reports when requesting 3 minutes of both exercises. Thus, the conclusion is that the best performance time is 1 minute. For most outcomes, there was no difference between exercises and participants' genders. However, for the low-pitched voice symptom, men benefited more from both exercises, and for tightness, men benefited more from VHFO; in contrast, women benefited more from the Lax Vox technique. Therefore, such gender differences should be considered when choosing these exercises.

Effects of Resonance Tube Voice Therapy on Parkinson's Disease: Clinical Trial.

PURPOSE: To verify the effect of resonance tube voice therapy on the vocal aspects of patients with Parkinson's Disease (PD). METHOD: Intra-subject comparative controlled clinical trial with a single group assignment. Fourteen individuals with PD (10 men, mean age 66.1 years; four women, mean age 73.75 years) received eight 45-minute sessions of voice therapy, twice a week for 4 weeks. The therapy consisted of semi-occluded vocal tract exercises - phonation method in a resonance tube (glass, 27 cm x 9 mm) in water. Tube depth in water ranged from 2 cm to 9 cm, as the difficulty in carrying out the exercises increased (usual pitch, high pitch, low pitch, ascending/descending glissandos), followed by sentence production. The assessments were made three times: at baseline (Time0), after 30 days without intervention (Time1), and 1 day after eight intervention sessions (Time2). The following aspects were assessed: vocal intensity; acoustic parameters (Smoothed Cepstral Peak Prominence - CPPs, alpha ratio, and L1-L0 difference); auditory-perceptual analysis of the overall degree of vocal quality deviation; voice symptoms (Voice Symptom Scale protocol - VoiSS) and voice-related quality of life (Voice-Related Quality of Life Protocol - V-RQOL). The results were compared at the three times of assessment Time0/Time1/Time2 using one-way repeated measures ANOVA test and Tukey test (5% significance). RESULTS: intervention significantly increased: vocal intensity, L1-L0 value of vowel /a/ and counting, CPP value in counting, and decreased: the overall degree of vocal quality deviation in 78% of participants, the total score of VoiSS protocol, the limitation, and emotional subscales. In addition, the intervention increased the score of all the domains of V-RQOL protocol - physical, socio-emotional, and total. CONCLUSION: Resonance tube phonation in voice therapy was effective in increasing vocal intensity and long-term acoustic parameters, the improved overall degree of vocal quality, reducing voice symptoms, and increasing voice-related quality of life in individuals with PD.

Voiced High-Frequency Oscillation or Lax Vox Technique? Immediate Effects in Dysphonic Individuals.

OBJECTIVES: To analyze the immediate effects of voiced high-frequency oscillation (VHFO) and Lax Vox technique on vocal quality and self-reported intensity of vocal and laryngeal symptoms in individuals with behavioral dysphonia. METHODS: This experimental, prospective, randomized cross-over study, investigated thirty adults (15 women and 15 men) with behavioral dysphonia (vocal complaints, altered voice on auditory-perceptual evaluation, vocal nodules or mucosal thickening, and incomplete glottic closure). The outcome variables analyzed were auditory-perceptual analysis, acoustic analysis (voice quality characteristics), and self-reported intensities of vocal and laryngeal symptoms. Each participant performed two exercises-VHFO and Lax Vox technique-in a random sequence for 3 minutes. A 7-day washout period was provided between the exercises. The data were analyzed using the paired t-test and Wilcoxon test (P < 0.05). RESULTS: After VHFO, no significant difference was observed on auditory-perceptual evaluation in all participants, whereas the Lax Vox technique worsened breathiness among women (P = 0.027). VHFO significantly increased the fundamental frequency (P = 0.014) and decreased the noise harmonic ratios for women (P = 0.026). Among men, there was a decrease in shimmer parameter (P = 0.035). Moreover, symptoms such as "lump in the throat" (P = 0.005), "voice loss" (P = 0.017), and "high-pitched voice" (P = 0.023) decreased in women after VHFO, whereas in men, "itchiness" and "hoarseness" (P < 0.001) decreased after VHFO. The Lax Vox technique decreased "hoarseness" (P = 0.003) in women, without any effect in men. CONCLUSION: The VHFO exercise provided more positive immediate effects results than the Lax Vox technique regarding vocal quality and self-reported symptom intensity in participants with behavioral dysphonia.

Can Vocal Therapy With Transcutaneous Electrical Nerve Stimulation (TENS) Followed by Vocal Exercises Reduce Benign Laryngeal Lesions in Dysphonic Women?: Randomized, Blind Clinical Trial.

PURPOSE: To investigate the effectiveness of vocal therapy with the use of low-frequency transcutaneous electrical nerve stimulation (TENS) followed by voice exercises on vocal fold lesion size, vocal quality and quality of life in dysphonic women. METHODS: 27 women with vocal nodules participated, randomized into to: experimental group (EG)-13 women who received vocal therapy with 12 sessions of 20 min of TENS application (pulse:200µs, frequency:10Hz, motor threshold intensity, electrodes positioned in the trapezius muscle [descending fibers and submandibular region, bilaterally]). Each TENS session was followed by 30 min of vocal exercises; and the Control Group (CG)- 14 women who received 12 sessions with 20 min of application of placebo TENS (same conditions EG, but without receiving the stimulus electric), followed by 30 min of vocal exercise. Before, immediately after and one month after vocal therapy, participants underwent vocal recording for acoustic analysis, vocal self-assessment, laryngological examination and answered voice-related quality of life (V-RQOL) protocol. RESULTS: There was reduction in the size of vocal fold lesions only in the EG, immediately after treatment and one month after treatment. Acoustic analysis showed decreases in SPI values immediately after and one month after treatment in both groups. There was improvement in voice self-perception in both groups after treatment and one month after, but no significant difference in V-RQOL values. CONCLUSION: TENS followed by vocal exercises produced results similar to vocal therapy without TENS regarding voice quality, self-perception and quality of life in voice. However, vocal therapy with low-frequency TENS followed by vocal exercise was effective in reducing vocal fold lesion size in dysphonic women.

The influence of the low-frequency transcutaneous electrical nerve stimulation application moment in vocal quality of dysphonic women.

Objective: to compare the immediate effects of low-frequency TENS employment on vocal quality in women with behavioral dysphonia before and after vocal exercises.Methodology: 30 women (mean = 31.3 years old), diagnosed with behavioral dysphonia received low-frequency TENS before (TENS + VE Group) and after vocal exercises (VE + TENS Group) with a 1-week washout. They had their sustained vowel/a/and running speech recorded before and after each procedure for auditory-perceptual analysis and acoustic measures. The low-frequency TENS parameters applied were symmetrical biphasic quadratic pulse, 200 µs phase, 10 Hz frequency, intensity on the motor threshold, and the electrodes were positioned on the submandibular and superior fibers of the trapezius muscle region. The vocal exercises: tongue trill, humming, finger kazoo, and water resistance therapy were performed totalizing 20 min.Results: intragroup analysis of sustained vowel/a/showed reduction in both groups of strain parameter and increased the breathiness; only VE + TENS Group increased the instability parameter, decreased fundamental frequency, and increased in SPI values; the running speech analysis showed an increase in the overall degree, roughness, and breathiness parameters. However, in VE + TENS Group, there was a statistically significant decrease in the intensity of the strain and an increase in breathiness. The acoustic measures showed that VE + TENS Group had a higher variation than TENS + VE Group regarding NHR.Conclusion: vocal exercises followed by low-frequency TENS have more immediate positive effects on voice quality than the low-frequency TENS followed by vocal exercises. This is a preliminary immediate effects study, and these effects could be verified through long-term assessments.

Oral and vocal fold diadochokinesis in children.

AIM: To establish reference values concerning the results of oral and vocal fold diadochokinesis (DDK) assessment, as well as to analyze the differences among gender and age. METHODS: One hundred and fifty Brazilian-Portuguese-speaking children from 8 to 10 years old were assessed. The DDK was assessed through the repetition of 'pa', 'ta', 'ka', 'pataka', 'a' and 'i'. RESULTS: As age increased there was a rise in the average DDK rate, a rise in the coefficient of variation of period for syllable 'ka' and a rise in the coefficient of variation of the peak intensity for the syllable 'ta'. The number of utterances per second of 'ta' was higher for girls than for boys. In trisyllables, 8-year-old girls presented a lower number of utterances than the other subgroups. As age increased, there was a rise in the average DDK rate of the vowel 'i' for girls; there was also a smaller standard deviation and perturbations of the period for this same vowel. CONCLUSION: Oral and vocal fold DDK reference values were established and differences as to gender and age were observed.

Development and validation of the protocol for the evaluation of voice in patients with hearing impairment (PEV-SHI).

INTRODUCTION: The voice of individuals with hearing impairment has been widely described, and can be compromised in all levels of the phonatory system. OBJECTIVE: To develop and validate an instrument for evaluating the voice of this population. METHODS: The instrument underwent the validation steps suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. The study sample consisted of seventy-eight Brazilian people with cochlear implants (experimental group) and 78 individuals with normal hearing (control group), divided in groups by age range - children from 3 to 5 years; children from 6 to 10 years and adults from 18 to 46 years. The study sample participated in a voice recording of the sustained vowel /a/, connected speech and spontaneous conversation, in which three voice specialists rated using the proposed instrument. It consists of visual-analog scales of suprasegmental aspects, respiratory-phonatory coordination, resonance, phonation, additional parameters and general vocal perception. RESULTS: Evaluation by an expert committee and a pilot test established content validity. Reliability measures showed excellent test-retest reproducibility for the majority of the parameters. Analysis with the ROC curve showed that perceptual evaluation with the sustained vowel did not strongly differentiate individuals with cochlear implants from those with normal hearing, and the parameter "speech rate" did not differentiate the groups at all. For the connected speech and spontaneous conversation, the majority of the parameters differentiated the experimental group from the control group with an area under the curve ≥0.7. The cutoff values with maximum specificity and sensitivity were 30.5 for mild, 49.0 for moderate and 69.5 for intense deviation. CONCLUSIONS: The protocol for the evaluation of voice in subjects with hearing impairment, PEV-SHI, is a reliable and useful tool for assessing the particularities of the voice of individuals with hearing impairment treated with cochlear implants and can be used in research and clinical settings to standardize evaluation and facilitate information exchange among services.

Influence of vocal and aerodynamics aspects on the voice-related quality of life of older adults.

The pursuit for quality of life urged a better understanding of aspects involved in ageing to minimize its consequences. Although many studies investigated older adults' voice, aspects affecting this population voice-related quality of life have not yet been explored. Objective To investigate how aerodynamics and vocal aspects are associated with voice-related quality of life in older adults. Methodology fifty-six older adults aged 60 years or above - 39 women and 17 men - were evaluated. The following procedures were performed: application of the Voice-Related Quality of Life (V-RQOL) protocol; vocal assessment, including auditory-perceptual and acoustic analysis, from which we obtained fundamental frequency (F 0 ), standard deviation of fundamental frequency (SDF 0 ), shimmer, amplitude perturbation quotient (APQ), jitter, pitch period perturbation quotient (PPQ), and harmonics to noise ratio (HNR); aerodynamic assessment using a spirometer; and maximum phonation time (MPT) for /a/, /s/, /z/ and number counting. Results older adults tend to present high V-RQOL scores. Among women, roughness, APQ, and HNR parameters were negatively correlated with V-RQOL, whereas F 0 was positively. We found no correlation between spirometry measurements and V-RQOL. MPT for /a/, /z/, and number counting was positively correlated with V-RQOL solely among men. Conclusion Vocal roughness and acoustic parameters have a negative impact on the quality of life of older women. Respiratory aspects related to the available air support for speaking affected the most the voice-related quality of life of older men.

Tongue function and swallowing in individuals with temporomandibular disorders.

BACKGROUND: The tongue participates in the oral phase of swallowing by pushing the food bolus toward the oropharynx. This relationship between tongue function and swallowing is little addressed addressed in individuals with temporomandibular dysfunction (TMD). OBJECTIVE: To analyze the association of functional tongue conditions on swallowing in individuals with TMD. METHODOLOGY: After approval by the Institutional Review Board, the study was conducted on 30 individuals of both sexes, aged 18 to 28 years, with TMD, and not treated for the disorder. Tongue function was assessed as to the mobility, pressure, and oral motor control. Swallowing was analyzed by clinical assessment during ingestion of solid (wafer biscuit) and liquid (water). Data regarding mobility and swallowing were collected using the orofacial myofunctional evaluation protocol. Tongue pressure was measured by the Iowa Oral Performance Instrument, during elevation, protrusion, swallowing, and resistance test. The oral motor control was assessed by the oral diadochokinesis (DDK) test by rapid and repeated emissions of syllables "ta" and "ka". Data were statistically analyzed by the Spearman correlation coefficient, at a significance level of 5%. RESULTS: Relationships were found between tongue function and swallowing for the following aspects: mobility (r=0.741), pressure in protrusion (r=-0.366), swallowing of saliva (r=-0.499), mean DDK rate in emissions "ta" (r=-0.424) and "ka" (r=-0.446), and mean DDK period in emissions "ta" (r=0.424) and "ka" (r=0.446). Thus, the greater the change in tongue mobility, the lower the tongue pressure in protrusion and swallowing of saliva, the lower the emissions per second, the longer the mean time between vocalizations, and the worse the swallowing of individuals with TMD. CONCLUSION: The functional conditions of the tongue regarding mobility, pressure, and oral DDK were associated with swallowing in individuals with TMD.

Voiced High-frequency Oscillation and LaxVox: Analysis of Their Immediate Effects in Subjects With Healthy Voice.

OBJECTIVES: The aim of this study was to analyze the immediate effects of voiced high-frequency oscillation (VHFO) and LaxVox exercises in vocally healthy subjects. METHODS: Thirty adult subjects (15 women, 15 men) with no history of dysphonia or vocal complaints participated in the study. The subjects performed VHFO and LaxVox techniques for 3 minutes in a random order, with a washout period of 7 days. They answered a questionnaire for vocal/laryngeal intensity symptoms, and had maximum phonation time (MPT) /a/, /s/, /z/, and number counting measured. The vowel /a/ was also recorded before and after both techniques for acoustic analysis. After both techniques, the subjects answered a questionnaire about vocal, laryngeal, respiratory, and articulatory sensations. Data were analyzed using the Wilcoxon, and paired t and chi-square tests were used (P < 0.05), as required. RESULTS: There was an increase in high loudness symptom after LaxVox in women, whereas there was a decrease in painful throat, irritated throat, and low loudness symptoms after VHFO in men. After LaxVox, the MPT of /z/ increased in women and after VHFO, the MPT of /s/, /z/, and number counting increased in men. The fundamental frequency variability increased in women after VHFO. The sensations remained unchanged in both groups following the two exercises in women and men. CONCLUSIONS: VHFO and LaxVox techniques had similar effects on vocal and laryngeal symptoms, as a matter of fact, in terms of phonatory and acoustic measures. With regard to vocal symptoms, VHFO showed better immediate effects in men than in women. As a result, the hypothesis H0 is partially refuted.

The Effect of a Voice Therapy Program Based on the Taxonomy of Vocal Therapy in Women with Behavioral Dysphonia.

OBJECTIVE: This study aims to propose and analyze the effect of a voice therapy program (VTP) in women with behavioral dysphonia. MATERIALS AND METHODS: This is a controlled, blinded, and nonrandomized cohort study. Participants of this study were 22 women with behavioral dysphonia divided into two groups: G1, 11 women with behavioral dysphonia who received the VTP, and G2, 11 women with behavioral dysphonia who did not receive any intervention. Before and after 6 weeks, the outcome variables evaluated in both groups were auditory-perceptual evaluation of the global degree of vocal quality (vowel /a/ and counting), instrumental acoustic parameters, Voice-Related Quality of Life, vocal and larynx symptoms, and musculoskeletal pain. The statistical analysis used the Wilcoxon, chi-square, and Mann-Whitney tests (P < 0.05). RESULTS: After 6 weeks, we observed a significantly higher improvement in the general degree of vocal deviation in vowels, a reduced F0 and symptom of "fatigue while talking" in G1, and an increased "shoulder" pain intensity in G2. Both groups showed improvement in the socioemotional domain of Voice-Related Quality of Life. In addition, the comparison between the groups showed a significantly greater reduction in fundamental frequency and the "voice loss" symptom in G1 compared with G2. CONCLUSIONS: The VTP using semioccluded vocal tract exercises obtained a positive effect on voice quality, symptoms, and musculoskeletal pain in women with behavioral dysphonia. The proposal, based on the taxonomy of voice therapy, seems to have promoted a phonatory balance, muscle relaxation, and improvement in the vocal resistance of this population.

Effectiveness of Voice Therapy Associated With Electromyographic Biofeedback in Women With Behavioral Dysphonia: Randomized Placebo-Controlled Double-Blind Clinical Trial.

OBJECTIVE: To analyze the effectiveness of vocal therapy associated with electromyographic biofeedback in women with behavioral dysphonia. MATERIALS AND METHODS: This is a randomized placebo-controlled double-blind clinical trial. Twenty-two adult women with behavioral dysphonia were randomly divided into two groups: Experimental Group-11 women participated in vocal therapy associated with the application of electromyographic biofeedback; Placebo Group-11 women participated in vocal therapy associated with the application of placebo electromyographic biofeedback. Both groups performed eight therapy sessions, twice a week, lasting 30 minutes. The vocal therapy of both groups was composed of semioccluded vocal tract exercises (trill, humming, and fricative). The evaluations were performed at four time points-before, after, one, and three months after the vocal therapy-and will consist of the following assessments: auditory-perceptual evaluation of voice, acoustic evaluation of voice, and surface electromyographic. The data were analyzed statistically comparing the groups and the time of evaluation (P < 0.05). RESULTS: The proposed vocal therapy promoted positive results in vocal quality and muscular electrical activity during rest in women with behavioral dysphonia for both groups. Electromyographic biofeedback promoted additional positive results in muscle electrical activity during phonatory tasks in women with behavioral dysphonia. CONCLUSION: In this study, the vocal therapy associated with electromyographic biofeedback had equivalent efficacy to traditional therapy in the voice. The biofeedback was more effective than traditional therapy on muscular electrical activity and had effects that remained for a longer time in women with behavioral dysphonia.

Effects of transcutaneous electrical nervous stimulation (TENS) associated with vocal therapy on musculoskeletal pain of women with behavioral dysphonia: A randomized, placebo-controlled double-blind clinical trial.

Recently, electrical stimulation in vocal rehabilitation has been the subject of studies. This treatment has shown promising results regarding the decrease of vocal/laryngeal symptoms, pain and the improvement of vocal tension. In addition to decreasing pain symptoms, TENS treatments may lead to muscle relaxation. There is no data on the effects of this resource as a vocal therapy in women with behavioral dysphonia. Research in this area may provide evidence to assist the clinical decision related to the treatment of women with complaints of behavioral dysphonia and musculoskeletal pain. OBJECTIVE: To verify the effects of low-frequency TENS in association with vocal therapy on musculoskeletal pain in women with behavioral dysphonia. METHODS: Participants included 27 women with vocal nodules randomized into two groups. The experimental group (EG) - 13 women received 12 sessions of TENS (pulse of 200 µs, frequency at 10 Hz, in motor threshold) with electrodes placed bilaterally on the trapezius muscle and submandibular area for 20 min followed by 30 min of vocal therapy, and the control group (CG) - 14 women received 12 sessions of 20 min of a placebo TENS followed by 30 min of vocal therapy. We investigated the frequency and intensity of the musculoskeletal pain in several body regions, as well as the intensity of pain at rest and in the application of pressure with an algometer applied to the descending fibers of the trapezius muscle. The pressure-pain threshold (PPT) was also investigated. All evaluations occurred before, immediately after, and at one and three months after treatment in both groups. RESULTS: We observed a reduction in the frequency of pain in the larynx after treatment of both groups, but only the EG showed a decrease in pain intensity in this region. It was verified with an algometer to the trapezius muscle that the electrical stimulation associated with the vocal therapy decreased the intensity of pain during the application of pressure and increased the PPT. There were no significant differences with regard to variables investigated in the comparison between the interventions. On the other hand, there was decreased pain in the trapezius muscle for the EG in comparison to the pre- and post-intervention. CONCLUSION: The vocal therapyprogram reduced the frequency and intensity of the musculoskeletal pain in the regions proximal to the larynx of women with behavioral dysphonia. In addition, TENS followed by vocal therapy increased the threshold of sensitivity to muscular pain in the trapezius, demonstrating that it is a good resource to use in conjunction with traditional vocal therapy in cases of behavioral dysphonia associated with pain and muscle tension.