Behavioral Dysphonia Research Articles

Surface electromyographic biofeedback for behavioral dysphonia in adult people: a systematic review.

To review systematically the literature and to analyze the effectiveness of surface electromyographic biofeedback in the rehabilitation of adults with behavioral dysphonia. Two authors performed an independent search in the following databases: Clinical Trials, Cochrane Library, Embase, LILACS, PubMed, and Web of Science. A specific search strategy was developed for each database. The review included studies that examined the effectiveness of surface electromyographic biofeedback compared to other direct vocal therapy intervention in adults with behavioral dysphonia. There were no restrictions in regard to language or date of publication. Analysis of the risk of bias, heterogeneity, quantitative and qualitative data, sensitivity, subgroups, and publication bias. 51 studies were identified, but only two cohort studies remained as prospects for analysis. The studies showed 100% uncertain risk of selection, performance, and detection bias. There was a high degree of clinical heterogeneity. The descriptive analysis showed a reduction in muscle electrical activity and improvement in vocal self-assessment using electromyographic biofeedback; however, it was not possible to calculate the effect size of the interventions. The present study was limited by the fact that it was unable to show a consensus for the majority of data analyzed. The available literature does not support a conclusive finding about the effectiveness of surface electromyographic biofeedback compared to other direct interventions used in the rehabilitation of adults with behavioral dysphonia. The studies analyzed vary widely in their clinical procedures and methodology, making it impossible to determine the procedure's effectiveness.

Effect of the comprehensive voice rehabilitation program in teachers with behavioral dysphonia.

Analyze the effects of the Comprehensive Vocal Rehabilitation Program (CVRP) and the motivational stages during speech therapy in teachers with behavioral dysphonia. Retrospective, longitudinal, observational study using data from the medical records of 33 teachers regarding auditory-perceptual, acoustic, self-perception analyses and the Voice Handicap Index (VHI-10) protocol in pre- and post-speech therapy situations, and motivational stages of adherence to treatment. Auditory-perceptual assessment of the voice showed that 64.7% of the participants improved voice quality post-speech therapy. Comparison between the pre- and post-speech therapy moments showed that 82.4% of the teachers improved their voice according to self-perception. The VHI-10 showed no statistically significant difference between the pre- and post-speech therapy moments (p=0.879). Acoustic analysis of the voice showed improvement in the means of all evaluated parameters. Statistically significant correlation was observed in the analysis between the pre- and post-speech therapy moments only for the variables maximum phonation time and shimmer. Most of the teachers were at the stage of contemplation on the URICA-VOICE scale. No statistical significance was observed in the correlation analysis between VHI-10, auditory-perceptual assessment of the voice, maximum phonation time, and parameters of acoustic analysis with vocal self-perception of teachers and with auditory-perceptual assessment of voice. The use of CVRP for the treatment of behavioral dysphonia presented positive results in the pre- and post-speech therapy evaluation. As for motivation, the teachers strongly believed in the possibility of facing the problem, but still without much effort to change this situation.

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

To analyze the effectiveness of vocal therapy associated with electromyographic biofeedback in women with behavioral dysphonia. 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). 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. 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.

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

This study aims to propose and analyze the effect of a voice therapy program (VTP) in women with behavioral dysphonia. 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). 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. 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.

Diagrama de Desvio Fonatório em dois programas de reabilitação vocal

Objetivo: Comparar a análise perceptivo-auditiva vocal, análise acústica e diagrama de desvio fonatório (DDF) de pacientes submetidos à terapia de voz com os exercícios de função vocal (EFV) e de pacientes submetidos ao Programa Integral de Reabilitação Vocal (PIRV). Métodos: 72 profissionais da voz com queixa vocal, encaminhados para reabilitação vocal por disfonia comportamental, foram acompanhados por seis sessões de terapia de voz. Os participantes foram divididos aleatoriamente em dois grupos. Um deles foi submetido ao PIRV e o outro, ao EFV. O material de fala analisado foi a vogal /ε/, gravada no módulo qualidade vocal do programa Voxmetria (CTS Informatica), para extração do DDF, nos momentos pré e pós-terapia. Os grupos foram comparados de acordo com o grau geral do desvio vocal, aspectos acústicos e com a distribuição das amostras vocais no DDF, em relação à área de normalidade, densidade, forma e localização nos quadrantes. Resultados: Houve diferença apenas quanto à densidade do registro do DDF no pós-terapia vocal, sendo que o grupo EFV apresentou registro concentrado no pós-terapia quando comparado ao grupo PIRV. Apenas indivíduos do grupo PIRV apresentaram diferenças na avaliação perceptivo-auditiva pré e pós, sendo que mais indivíduos tiveram suas vozes avaliadas como sem desvio no pós-intervenção. Conclusões: O Programa Integral de Reabilitação Vocal promoveu melhora da qualidade vocal, porém não houve correspondência da análise perceptivo-auditiva com a análise acústica, já que o diagrama de desvio fonatório foi sensível para identificar mudanças somente na avaliação dos pacientes submetidos aos exercícios de função vocal.

Correlation between Voice and Auditory Processing

To compare and to correlate the performance of women with behavioral dysphonia and without voice disorders in auditory processing tests and in the Voice Tone Reproduction Test (VTRT). Forty women aged from 18 to 44 years participated and were divided in two groups: dysphonic (DG) and non-dysphonic (NDG). The participants underwent interview, hearing, otorhinolaryngology and voice assessments (voice record, VTRT through phonetography), and auditory processing assessment-using the Pitch Pattern Sequence (PPS) test and the Duration Pattern Sequence (DPS) test. The statistical analysis compared both groups, and there was a correlation test (P < 0.05). The NDG had a better performance in the PPS test (P = 0.000), in the VTRT test in the first attempt (P = 0.025), and in the total of correct answers (P = 0.017). There was a positive correlation between the PPS and both the first attempt of the VTRT and the total number of attempts. Regarding the DPS, there was a positive correlation for the left ear with the total number of VTRT attempts. Dysphonic women presented disorders in temporal auditory processing skills, revealing an important relation between vocal production and impairment of some central auditory functions. There was a positive correlation between the performance in the auditory processing assessment and the performance in voice tone reproduction in both groups. The VTRT may assist speech therapists and voice trainers in verifying difficulties of auditory perception of dysphonic women when the cause is due to behavioral tdysphonia.

Stage of readiness of patients with behavioral dysphonia in pre and post-group voice therapy assessments.

To verify the efficacy of group voice therapy in the stage of readiness and identify which items of the URICA-Voice range are more sensitive to post-therapy change in patients with behavioral dysphonia. An intervention study was conducted on 49 patients with behavioral dysphonia. An eclectic approach to group therapy was implemented over eight sessions, the first and last sessions consisting of assessments. The URICA-Voice range was used to evaluate the stage of readiness at pre- and post-therapy assessments. A descriptive and inferential statistical analysis was implemented for the results. Most participants were female, did not make professional use of voice, and had membranous vocal fold lesions. Most of them were in the Contemplation stage at in both moments, pre- and post-therapy. There was no significant change in the comparison of pre- and post-therapy scores. The majority of patients showed a reduction in the stage of readiness and some advanced to a higher stage. In the comparison of URICA-V range items, seven questions had equal or inferior responses in the post-therapy assessment. There was no statistical difference when comparing the pre- and post-therapy total average score of the URICA-Voice range. There were significant changes in the stage of readiness of patients in pre- and post-group speech therapy assessments.

Transcutaneous Electrical Nerve Stimulation (TENS) and Laryngeal Manual Therapy (LMT): Immediate Effects in Women With Dysphonia

This study aimed to verify the immediate effect of low-frequency transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) in musculoskeletal pain, voice quality, and self-reported signs in women with dysphonia. Thirty women with behavioral dysphonia were randomly divided into the TENS group and the LMT group. All participants fulfilled the pain survey and had their voices recorded to posterior perceptual and acoustic analysis before and after intervention. The TENS group received a unique low-frequency TENS session (20 minutes). The LMT group received LMT (20 minutes) with soft and superficial massage in the sternocleidomastoid muscle, suprahyoid muscles, and larynx. Afterward, the volunteers reported their voice, larynx, breathing, and articulatory signs. Pre and post data were compared by parametric and nonparametric tests. After TENS, a decrease in pain intensity in the posterior or anterior region of the neck, shoulders, upper or lower back, and masseter was observed. After LMT, a decrease in pain intensity in the neck anterior region, shoulders, lower back, and temporal region was observed. Also, after TENS, there was an improvement in vowel /a/ instability; after LMT, there was a general improvement in voice quality, decrease in tension, and decrease in breathiness in speech. Positive voice and laryngeal signs were reported after TENS, and positive laryngeal signs and articulation were reported after LMT. TENS and LMT may be used in voice treatment of women with behavioral dysphonia, and both may be considered important therapy resources that reduce musculoskeletal pain and cause positive laryngeal signs. Both TENS and LMT are able to partially improve voice quality, but TENS presented better results.

Dosage dependent effect of high-resistance straw exercise in dysphonic and non-dysphonic women.

to study the dosage dependent effect of high-resistance straw exercise in women with behavioral dysphonia and in vocally healthy women. 25 dysphonic women (DG), with average age of 35 years (SD = 10.5) and 30 vocally healthy women (VHG), with average age of 31.6 years (SD = 10.3). The participants produced a continuous sound into a thin high-resistance straw for seven minutes, being interrupted after the first, third, fifth and seventh minute. At each interval, speech samples were recorded (sustained vowel and counting up to 20) and subsequently acoustically analyzed. Each participant reported the effort necessary to perform exercise and to speak, indicating their ratings on visual analog scales (VAS). with regard to the DG, the exercise caused positive vocal changes, especially between the third and fifth minute: less phonatory effort, increase in MPT, and reduction of F0 variability; these voice parameters deteriorated after five minutes. This fact associated with the increased effort to perform the exercise indicates a possible overload of the phonatory system. As to the VHG, MPT improved after one minute of exercise, while the other parameters did not change over time, probably due to the fact that the voices were not deviant; seven minutes did not seem to impose an overload in this population. positive vocal changes were observed with the high-resistance straw exercise; however, there are dosage restrictions, especially for dysphonic women.

Association between the adherence to voice therapy and voice activity profile in patients with behavioral dysphony.

To analyze the association between adherence to voice therapy and voice activity profile in patients with behavioral dysphonia and possible associated factors. The study included eighteen individuals with behavioral dysphonia who were on regular treatment at the institution Hearing and Speech Therapy Service. The participants of this study responded to the Voice Activity and Participation Profile Protocol (VAPP) and URICA-VOICE scale. The associated variables (number of sessions, age, type of behavioral dysphonia, gender and previous speech therapy) were collected through interviews with patients and analysis of their medical records. The data were submitted to inferential statistical analysis. Most patients were in the action stage. There was a statistically significant association between the aspect of the VAPP Effects on Emotion and stages of readiness for adherence to voice therapy, but other VAPP aspects were not associated with the URICA-VOICE scale. Regarding the associated variables, the number of sessions, age and type of behavioral dysphonia were associated with the adherence to voice therapy. There was a statistically significant difference between the type of behavioral dysphonia and VAPP scores. The aspect of VAPP Effects on Emotion and variables such as number of sessions, age and type of dysphonia were associated to the URICA-VOICE scale adherence stage. Individuals with organic dysphonia had greater impact of vocal disorders in their daily activities.

Efficacy of Water Resistance Therapy in Subjects Diagnosed With Behavioral Dysphonia: A Randomized Controlled Trial

The purpose of the present study was to determine the efficacy of water resistance therapy (WRT) in a long-term period of voice treatment in subjects diagnosed with voice disorders. Twenty participants, with behavioral dysphonia, were randomly assigned to one of two treatment groups: (1) voice treatment with WRT, and (2) voice treatment with tube phonation with the distal end in air (TPA). Before and after voice therapy, participants underwent aerodynamic, electroglottographic, acoustic, and auditory-perceptual assessments. The Voice Handicap Index and self-assessment of resonant voice quality were also performed. The treatment included eight voice therapy sessions. For the WRT group, the exercises consisted of a sequence of five phonatory tasks performed with a drinking straw submerged 5 cm into water. For the TPA, the exercises consisted of the same phonatory tasks, and all of them were performed into the same straw but the distal end was in air. Wilcoxon test showed significant improvements for both groups for Voice Handicap Index (decrease), subglottic pressure (decrease), phonation threshold pressure (decrease), and self-perception of resonant voice quality (increase). Improvement in auditory-perceptual assessment was found only for the TPA group. No significant differences were found for any acoustic or electroglottographic variables. No significant differences were found between WRT and TPA groups for any variable. WRT and TPA may improve voice function and self-perceived voice quality in individuals with behavioral dysphonia. No differences between these therapy protocols should be expected.

Voice Self-assessment Protocols: Different Trends Among Organic and Behavioral Dysphonias

This study aimed to correlate the results of five self-assessment instruments for patients with behavioral or organic dysphonia (OD), and to analyze their relationship with listeners' judgments of degree of voice severity and predominant type of voice deviation. This is a cross-sectional prospective study. A total of 103 patients (77 with behavioral dysphonia, 26 with OD) completed the Brazilian validated versions of five instruments: Voice Handicap Index (VHI), Voice-Related Quality of Life, Vocal Performance Questionnaire, Voice Symptom Scale (VoiSS), and Vocal Tract Discomfort Scale. Voice samples were collected for auditory-perceptual analysis. Correlations were made among protocols, and between these instruments and the perceptual analysis. None of the instruments correctly identified 100% of the dysphonic individuals. The VoiSS identified 100 of the 103 subjects. Numerous correlations were found with variable strength. The strongest correlation was between frequency and severity scales of the Vocal Tract Discomfort Scale (r = 0.946) and the total score of the VHI and VoiSS (r = 0.917). Correlations between the instruments and the perceptual analysis achieved only moderate strength; the VHI, the Voice-Related Quality of Life, and the VoiSS showed the highest correlations with counting numbers task, particularly for OD. The predominant type of voice deviation did not influence the score of the protocols. None of the self-assessment instruments is capable of identifying all cases of dysphonia. However, they are important in assessing the impact of voice problem on quality of life. Patient self-assessment and clinician perceptual evaluation share only moderate correlations, with higher strength for counting numbers task in comparison with sustained vowel.

Reduction of Risk Factors in Patients with Behavioral Dysphonia After Vocal Group Therapy

The origin and development of dysphonia, particularly behavioral dysphonia, is associated with several risk factors. Here, we verified the effectiveness of group therapy in reducing the risk factors, and established the association between risk factors and sex, age, profession, and diagnosis of laryngeal disorders in patients with behavioral dysphonia. This is a descriptive, quantitative, field intervention study. Participants (n = 26, adult patients of both sexes), with a diagnosis of behavioral dysphonia, received group therapy intervention. Data for risk factors were collected pre- and posttherapy using the Vocal Screening Protocol. The data were analyzed using descriptive and inferential statistics (Student t test, chi-squared test or Spearman correlation test). The majority (80.8%, n = 21) of patients were female, 65.4% (n = 17) were not in a vocal profession, and 42.3% (n = 11) presented with a lesion in the membranous portion of the vocal fold. The number of personal risk factors decreased after group therapy (P = 0.04). In addition, age was correlated with total (P = 0.001), environmental (P = 0.002), and personal (P = 0.003) vocal risk factors posttherapy. This study revealed an association between the reduction of personal risk factors and vocal group therapy, and a correlation between age and total, environmental, and personal vocal risk factors posttherapy. Thus, maintenance and origins of the behaviors that modify the behavioral aspects of the participants directly influence the production of individual vocal habits.

Immediate effect of laryngeal manual therapy in dysphonic individuals.

To investigate the immediate effect of Laryngeal Manual Therapy (LMT) in musculoskeletal pain, in voice and sensations referred to individuals with behavioral dysphonia and individuals without it. 30 individuals ranging from 18 to 45 years old were selected and sorted into two groups: the dysphonic group (DG) - 15 individuals with functional or organofunctional dysphonia, and the control group (CG) - 15 individuals without vocal complaints and with non-impaired voices. The individuals answered a pain questionnaire and their voices were subsequently registered. The initial evaluation was repeated after the LMT. The LMT was applied for 20 minutes. After the LMT, the individuals were self-evaluated in terms of sensations in their voices, larynxes, articulations and respiration. After the application of LMT, the DG reported significant improvement of pain in the following areas: temporal, larynx, posterior neck, wrists/hands/fingers, upper and lower back, hip/thigh, which did not occur in CG. The perceptual analysis of the vowel /a/ revealed no significant difference in any parameter in both groups after the LMT. The analysis of the speech showed that there was an increase of the roughness parameter after the application of LMT just in the DG. The DG individuals reported better sensations in the larynx and articulations after the submission to LMT, which did not occur in CG. this study clarified that TML immediately reduces the intensity of corporal pain in dysphonic individuals, which did not occur in individuals without any vocal impairments. Although the perceptual analysis reveals an increase of the roughness in the quality of the voice, positive sensation in the larynx and articulation were reported by dysphonic individuals after the application of TML.

Comparison Between Vocal Function Exercises and Voice Amplification

To compare the effectiveness of vocal function exercises (VFEs) versus voice amplification (VA) after a 6-week therapy for teachers diagnosed with behavioral dysphonia. A total of 162 teachers with behavioral dysphonia were randomly allocated into two intervention groups and one control group (CG). Outcomes were assessed using auditory-perceptual evaluation of voice, laryngeal status assessment, self-ratings of the impact of dysphonia, and acoustic analysis. The VFE group showed effective changes across treatment outcome measures: overall severity of dysphonia relative to the CG, laryngeal evaluation, and self-perceived dysphonia. The VA group showed positive outcomes in some measures of self-rated dysphonia. The CG had poorer outcomes across self-assessment dimensions. The VFE method is effective in treating the behavioral dysphonia of teachers, can change the overall severity and the self-perception of the impact of dysphonia, and the laryngeal evaluation outcomes. The use of a voice amplifier is effective as a preventive measure because it results in an improved self-perception of dysphonia, especially in the work-related dimension. One case of dysphonia aggravation can be prevented in every three patients with behavioral dysphonia engaged in VFE, and one case in every five patients using VA. The lack of a therapeutic intervention worsens teachers' behavioral dysphonia in a period of 6 weeks.

Behavioral Dysphonia and Depression in Elementary School Teachers

To verify the relationship between behavioral dysphonia and current depressive episodes in municipal elementary school teachers. We hypothesize that teachers with behavioral dysphonia will be more susceptible to psychiatric disorders. Cross-sectional study, quantitative, conducted across municipal schools in both rural and urban regions of Pelotas. Five-hundred seventy-five teachers from urban and rural areas of the same Brazilian state were included. The full version of the Voice Handicap Index validated into Brazilian Portuguese was used to determine the presence of behavioral dysphonia. A profile of vocal behaviors was also used to quantify the number of phonotraumatic events. In addition, the Mini-International Neuropsychiatric Interview was used to determine current episodes of depression. Data were analyzed via correlative studies using chi-square and Poisson regression analyses. Across all teachers, the prevalence of dysphonia was 33.9% and 55% reported that they had already taken a leave because of their voice. Those teachers with a current depressive episode had a higher rate of dysphonia compared with those without depression (prevalence ratio [PR] 1.66; P < 0.000). Teachers who presented with a risk of serious vocal problems had a prevalence ratio of 2.58, indicating a greater proportion of dysphonia, whereas teachers classified as champions of abuse were five times more likely compared with those teachers with behaved or candidates for voice problems. There is an association between behavioral dysphonia and current depressive episodes in elementary school teachers.

The Effectiveness of the Comprehensive Voice Rehabilitation Program Compared With the Vocal Function Exercises Method in Behavioral Dysphonia: A Randomized Clinical Trial

To evaluate the effectiveness of the Comprehensive Voice Rehabilitation Program (CVRP) compared with Vocal Function Exercises (VFEs) to treat functional dysphonia. This is a randomized blinded clinical trial. Eighty voice professionals presented with voice complaints for more than 6months with a functional dysphonia diagnosis. Subjects were randomized into two voice treatment groups: CVRP and VFE. The rehabilitation program consisted of six voice treatment sessions and three assessment sessions performed before, immediately after, and 1month after treatment. The outcome measures were self-assessment protocols (Voice-Related Quality of Life [V-RQOL] and Voice Handicap Index [VHI]), perceptual evaluation of vocal quality, and a visual examination of the larynx, both blinded. The randomization process produced comparable groups in terms of age, gender, signs, and symptoms. Both groups had positive outcome measures. The CVRP effect size was 1.09 for the V-RQOL, 1.17 for the VHI, 0.79 for vocal perceptual evaluation, and 1.01 for larynx visual examination. The VFE effect size was 0.86 for the V-RQOL, 0.62 for the VHI, 0.48 for the vocal perceptual evaluation, and 0.51 for larynx visual examination. Only 10% of the patients were lost over the study. Both treatment programs were effective. The probability of a patient improving because of the CVRP treatment was similar to that of the VFE treatment.

Efeitos da reabilitação fonoaudiológica na desvantagem vocal de cantores populares profissionais

Objetivo Verificar o efeito de um programa de reabilitação de voz na desvantagem vocal autorrelatada por um questionário, em cantores populares profissionais com disfonia. Métodos Quarenta e nove cantores populares profissionais, entre 18 e 45 anos, avaliados pelo otorrinolaringologista e diagnosticados como portadores de disfonia comportamental, com ou sem lesão de massa, relacionada, em maior ou menor grau, ao comportamento vocal, foram encaminhados para fonoterapia. Os cantores foram distribuídos em dois grupos: Experimental (GE), com 29 cantores submetidos à fonoterapia imediata e Controle (GC), com 20 cantores aguardando em fila de espera do serviço para terapia fonoaudiológica, atendidos após a finalização da pesquisa. Todos os participantes responderam ao protocolo de Índice de Desvantagem para o Canto Moderno (IDCM) e autoavaliaram suas vozes falada e cantada, na primeira e na última sessão de atendimento (avaliação e reavaliação). Resultados Houve diferença entre o GE e o GC no momento pós-terapia, para todos os escores do protocolo IDCM. Não houve mudanças em relação ao número de aulas de canto, após a intervenção. O GE relatou melhoria na qualidade da voz falada e cantada. Conclusão Cantores populares profissionais que realizaram terapia fonoaudiológica apresentaram redução na desvantagem vocal autorrelatada no canto, quando comparados aos cantores com queixas vocais e sem tratamento.

Immediate Effects of the Finnish Resonance Tube Method on Behavioral Dysphonia

To investigate the immediate effects of the Finnish resonance tube method for teachers with behavioral dysphonia. Twenty-five female teachers (m=39.9 years of age) with at least a 5-year history of dysphonia were included. Additional inclusion criteria were the diagnosis of chronic behavioral dysphonia with an indication for speech therapy and the absence of any prior speech therapy. Subjects produced three sets of 10 tokens of sustained phonation with a 1-minute rest interval between tokens into a 27-cm glass tube immersed in at least 2 cm of water. Voice samples were recorded before and after these sets. The effects of these exercises were evaluated by self-assessment, auditory perceptual analysis, and acoustic evaluation involving extraction of fundamental frequency and visual spectrographic analysis. Sixty-eight percent of the teachers reported increased phonatory comfort and 52% reported improved voice quality after performing the exercises. Perceptual analysis indicated improved voice quality in the samples of counting numbers, confirmed by decreased instability, subharmonics, noise in high frequencies, and the tendency for reduced low frequency noise on spectrographic evaluation. Additionally, mean fundamental frequency decreased. The Finnish resonance tube method increased phonatory comfort and vocal changes suggestive diminished hyperfunction.

Presentation of the Comprehensive Vocal Rehabilitation Program for the treatment of behavioral dysphonia

Voice rehabilitation is the main treatment option in cases of behavioral dysphonia, and it has the purpose of enhancing the quality of vocal production and voice-related life aspects. Several efforts have been made to offer a clinical practice that is based on evidence, including the development of specific therapeutic protocols as an option for clinical and scientific improvement. It is necessary to define the focus/objective of the dysphonia treatment, type of approach, and duration in order to establish the intervention criteria. This paper describes the organization of a program of behavioral dysphonia treatment, based on an approach that has been used for over twenty years, named Comprehensive Vocal Rehabilitation Program, and also to present its concepts, theory, and practical fundamentals. The program has an eclectic approach and associates body work, glottal source, resonance, and breathing coordination in addition to knowledge about vocal hygiene and communicative behavior. The initial proposal suggests a minimum time of intervention of six therapeutic sessions that can be adapted according to the patient's learning curve and development. The goal is to offer a rational and structured therapeutic approach that can be reproduced in other scenarios.