Mary J. Sandage

Effect of hydration treatments on laryngeal nodules and polyps and related voice measures

In this study, a double-blind, placebo-controlled approach was used in assessing the effectiveness of hydration treatments in the clinical management of selected voice disorders. Six adult female patients with laryngeal nodules or polyps each received 5 consecutive days of hydration treatment and 5 consecutive days of placebo/control treatment. The combined results indicated improvements in voice and in laryngeal appearance following both placebo/control and hydration treatments as compared with baseline. However, the greatest improvements were obtained following the hydration treatment. Although caution about generalization of the effects to the typical clinical situation is emphasized, the study provides preliminary evidence of a therapeutic benefit from hydration treatments in patients with nodules or polyps. Based on previous theoretical work, hydration effects may be related to reductions in the viscosity of vocal fold tissue, although other explanations are also possible.

Vocal Function and Upper Airway Thermoregulation in Five Different Environmental Conditions

PURPOSE Phonation threshold pressure and perceived phonatory effort were hypothesized to increase and upper airway temperature to decrease following exposure to cold and/or dry air. Greater changes were expected with mouth versus nose breathing. METHOD In a within-participant repeated measures design, 15 consented participants (7 men, 8 women) completed 20-min duration trials to allow for adequate thermal equilibration for both nose and mouth breathing in 5 different environments: 3 temperatures (°C) matched for relative humidity (% RH), cold (15 °C, 40% RH), thermally neutral (25 °C, 40% RH), and hot (35 °C, 40% RH); and 2 temperatures with variable relative humidity to match vapor pressure for the neutral environment (25 °C, 40% RH), cold (15 °C, 74% RH) and hot (35 °C, 23% RH). Following each equilibration trial, measures were taken in this order: upper airway temperature (transnasal thermistor probe), phonation threshold pressure, and perceived phonatory effort. RESULTS Data were analyzed using repeated measures analysis of variance, and no significant differences were established. CONCLUSIONS The study hypotheses were not supported. Findings suggest that the upper airway is tightly regulated for temperature when challenged by a realistic range of temperature and relative humidity environments. This is the first study of its kind to include measurement of upper airway temperature in conjunction with measures of vocal function.

Voice Function Differences Following Resting Breathing Versus Submaximal Exercise

OBJECTIVES/HYPOTHESIS There is little known about how physical exercise may alter physiological parameters of voice production. In this investigation, vocal function and upper airway temperature were examined following a bout of submaximal exercise and compared with a resting breathing condition. It was hypothesized that phonation threshold pressure (PTP) and perceived phonatory effort (PPE) would increase and pharyngeal temperature would decrease following an exercise bout. STUDY DESIGN Using a within-participant repeated measures design, 18 consented participants (nine men and nine women) completed the study. METHODS A 20-minute equilibration task was immediately followed by 8 minutes of submaximal exercise on a stationary bike in a thermally neutral environment (25°C/40% RH). At the end of the equilibration trial and the exercise trial, measures were taken in the following order: pharyngeal temperature, PTP, and PPE. Data were analyzed using paired t tests with significance set at P < 0.05. RESULTS Significantly increased PTP and PPE and significantly decreased pharyngeal temperature (1.9°C) were found, supporting the initial hypotheses. CONCLUSIONS Findings from this investigation support the widely held belief that voice use associated with physical activity requires additional laryngeal effort and closure forces. The effect of the temperature reduction in the upper airway on voice function requires further study.

Influence of Vowel Selection on Determination of Phonation Threshold Pressure

OBJECTIVE/HYPOTHESIS Phonation threshold pressure values reported in the literature have largely been determined with use of one of three consonant-vowel sequences, /pi/, /pae/, and /pa/; however, it is not currently known if vowel choice influences phonation threshold pressure values. Based on the evidence that describes velopharyngeal closure variations between vowels, this research effort hypothesized that phonation threshold pressure values measured from the consonant-vowel sequence /pi/ would be significantly lower than the /pae/ and /pa/ sequences. METHODS Twelve female participants aged between 20 and 27 years produced five-syllable trains of /pi/, /pae/, and /pa/ at low, modal, and high pitches. STUDY DESIGN A within-subject repeated measures approach was conducted to compare phonation threshold pressure value differences between the three consonant-vowel sequences for three different pitches while controlling for other task elicitation variables that may also influence phonation threshold pressure values. RESULTS Repeated measures analysis of the data indicated that there was no significant difference (P<0.05) in phonation threshold pressure values between the three consonant-vowel sequences at any frequency assessed. Further, for all three consonant-vowel sequences measured, significant differences of phonation threshold pressure magnitude were observed when comparing the high frequency versus the low and modal frequencies, a finding consistent with previous publications. CONCLUSIONS The vowel selected for task elicitation for phonation threshold pressure determination does not appear to significantly affect phonation threshold values, indicating flexibility of the vowel aspect of this measure for clinical use of phonation threshold pressure.

Episodic Laryngeal Breathing Disorders: Literature Review and Proposal of Preliminary Theoretical Framework

OBJECTIVE The purposes of this literature review were (1) to identify and assess frameworks for clinical characterization of episodic laryngeal breathing disorders (ELBD) and their subtypes, (2) to integrate concepts from these frameworks into a novel theoretical paradigm, and (3) to provide a preliminary algorithm to classify clinical features of ELBD for future study of its clinical manifestations and underlying pathophysiological mechanisms. STUDY DESIGN This is a literature review. METHODS Peer-reviewed literature from 1983 to 2015 pertaining to models for ELBD was searched using Pubmed, Ovid, Proquest, Cochrane Database of Systematic Reviews, and Google Scholar. Theoretical models for ELBD were identified, evaluated, and integrated into a novel comprehensive framework. Consensus across three salient models provided a working definition and inclusionary criteria for ELBD within the new framework. Inconsistencies and discrepancies within the models provided an analytic platform for future research. RESULTS Comparison among three conceptual models-(1) Irritable larynx syndrome, (2) Dichotomous triggers, and (3) Periodic occurrence of laryngeal obstruction-showed that the models uniformly consider ELBD to involve episodic laryngeal obstruction causing dyspnea. The models differed in their description of source of dyspnea, in their inclusion of corollary behaviors, in their inclusion of other laryngeal-based behaviors (eg, cough), and types of triggers. CONCLUSION The proposed integrated theoretical framework for ELBD provides a preliminary systematic platform for the identification of key clinical feature patterns indicative of ELBD and associated clinical subgroups. This algorithmic paradigm should evolve with better understanding of this spectrum of disorders and its underlying pathophysiological mechanisms.

Influence of Syllable Train Length and Performance End Effects on Estimation of Phonation Threshold Pressure

OBJECTIVES The purpose of this study was to determine whether the number of syllables collected and performance end effects had a significant effect on phonation threshold pressure (PTP) estimates. METHODS Ten adult females with normal voices produced five- and seven-syllable trains of /pi/ at low, modal, and high pitches. The results were analyzed using repeated-measures analysis of variance to determine whether a difference existed in PTP when a five-syllable train was collected versus when a seven-syllable train was collected and whether the typically discarded first and last syllables within a train differed from the middle syllables. RESULTS The results indicated that there was no significant difference in estimated PTP values when calculated from a five-syllable versus a seven-syllable train or between the first, middle, and last syllables within a train. CONCLUSIONS Based on these findings, it appears that a five-syllable train provides adequate information from which to estimate PTP values. Furthermore, these findings also suggest that within the five-syllable train, any three adjacent syllables could be used to estimate PTP. These findings are significant in developing a clinically standardized, effective, and efficient method for collecting PTP.

The Effect of Traditional Singing Warm-Up Versus Semioccluded Vocal Tract Exercises on the Acoustic Parameters of Singing Voice.

OBJECTIVES/HYPOTHESES This study investigated the effect of traditional vocal warm-up versus semioccluded vocal tract exercises on the acoustic parameters of voice through three questions: does vocal warm-up condition significantly alter the singing power ratio of the singing voice? Is singing power ratio dependent upon vowel? Is perceived phonatory effort affected by warm-up condition? Hypotheses were that vocal warm-up would alter the singing power ratio, and that semioccluded vocal tract warm-up would affect the singing power ratio more than no warm-up or traditional warm-up, that singing power ratio would vary across vowel, and that perceived phonatory effort would vary with warm-up condition. STUDY DESIGN This study was a within-participant repeated measures design with counterbalanced conditions. METHODS Thirteen male singers were recorded under three different conditions: no warm-up, traditional warm-up, and semioccluded vocal tract exercise warm-up. Recordings were made of these singers performing the Star Spangled Banner, and singing power ratio (SPR) was calculated from four vowels. Singers rated their perceived phonatory effort (PPE) singing the Star Spangled Banner after each warm-up condition. RESULTS Warm-up condition did not significantly affect SPR. SPR was significantly different for /i/ and /e/. PPE was not significantly different between warm-up conditions. CONCLUSIONS The present study did not find significant differences in SPR between warm-up conditions. SPR differences for /i/, support previous findings. PPE did not differ significantly across warm-up condition despite the expectation that traditional or semioccluded warm-up would cause a decrease.

Influence of Glottal Fry on Acoustic Voice Assessment: A Preliminary Study

PURPOSE This preliminary study examined the influence of glottal fry on measurement of speaking fundamental frequency (SF0) and whether sex differences influence the impact glottal fry has on SF0 and cepstral peak prominence (CPP). It was hypothesized that SF0 and CPP would decrease as percent glottal fry in the sample increased, with larger changes observed in the female voice. METHODS Twenty-six participants (13 men, 13 women) completed the study. Participants were recorded reading the Rainbow Passage. SF0 and CPP were determined from the original sample. Percent glottal fry SF0 was determined and semitone change was recalculated after removal of glottal fry from the sample. Regression analysis was used to determine the impact of glottal fry and sex on semitone change and CPP differences in SF0. RESULTS Significant differences were found for both sex and percent glottal fry on semitone change in SF0. A significant relationship was not found between CPP and semitone change when sex was accounted for. CONCLUSIONS Findings from this study indicate that the measurement of SF0 for women will decline as percent of glottal fry increases. These findings have clinical implications for interpretation of SF0 measurement and evidence-based outcomes for voice therapy.

Muscle Bioenergetic Considerations for Intrinsic Laryngeal Skeletal Muscle Physiology

Purpose Intrinsic laryngeal skeletal muscle bioenergetics, the means by which muscles produce fuel for muscle metabolism, is an understudied aspect of laryngeal physiology with direct implications for voice habilitation and rehabilitation. The purpose of this review is to describe bioenergetic pathways identified in limb skeletal muscle and introduce bioenergetic physiology as a necessary parameter for theoretical models of laryngeal skeletal muscle function. Method A comprehensive review of the human intrinsic laryngeal skeletal muscle physiology literature was conducted. Findings regarding intrinsic laryngeal muscle fiber complement and muscle metabolism in human models are summarized and exercise physiology methodology is applied to identify probable bioenergetic pathways used for voice function. Results Intrinsic laryngeal skeletal muscle fibers described in human models support the fast, high-intensity physiological requirements of these muscles for biological functions of airway protection. Inclusion of muscle bioenergetic constructs in theoretical modeling of voice training, detraining, fatigue, and voice loading have been limited. Conclusions Muscle bioenergetics, a key component for muscle training, detraining, and fatigue models in exercise science, is a little-considered aspect of intrinsic laryngeal skeletal muscle physiology. Partnered with knowledge of occupation-specific voice requirements, application of bioenergetics may inform novel considerations for voice habilitation and rehabilitation.

Evaluating the effects of stress reduction techniques and Fitzmaurice Voicework® on physiologic markers and mental states related to performance anxiety in student actors

Abstract This preliminary study investigated the effects of training in Fitzmaurice Voicework® (FV) and Mindfulness-Based Stress Reduction (MBSR) Techniques on the physiological stress markers and mental states of student actors preparing to perform. Twelve participants were recruited from an undergraduate program in theatre and music theatre. Six students received training in both meditative/mindfulness techniques and FV as part of their BFA Performance curriculum for two semesters. Six non-BFA students were wait-listed for the training as a control group. Both groups were offered three hours of outside meditative practice during the academic year. Physiologic measures included readings in heart rate and respiration at four time points before an audition or performance over the course of an academic year. In addition, self-report questionnaires that evaluated the student’s psycho-physical state at baseline and at the final data collection time points were used qualitatively. The study hypotheses were as follows: (1) the intervention group would demonstrate lower heart rate and respiratory rate than the control group; (2) the intervention group would report lower perceived stress than the control group by the end of the study. Results of this preliminary investigation indicated that the experimental group experienced less perceived stress around performing, but findings from the physiologic measures did not support the hypotheses.