Vocal Therapy Research Articles

ЛЕЧЕНИЕ ХРОНИЧЕСКИХ РЕСПИРАТОРНЫХ ЗАБОЛЕВАНИЙ МЕТОДОМ ВОКАЛОТЕРАПИИ

This article is devoted to the prospects for the use of singing as an art in the treatment and rehabilitation of chronic respiratory diseases. A review of literature data is presented, demonstrating the effectiveness of this approach, shown in numerous clinical studies. At the same time, the methodological features of a more in-depth and differentiated therapeutic and prophylactic methods are presented. It is the method of Vocal Therapy, based on the principles of academic singing and developed in Russia in the early nineties of the last century. It is carried out both in groups and individually. It has a special training system, conducted both in groups and individually. The article reflects the results of many years of research on the healing mechanisms of Vocal Therapy, the results of the application of an innovative method in the treatment of patients with bronchial asthma. It also discusses the prospects for use of the singing art power in other areas of medicine.

Spectrographic Vocal Characteristics in Female Teachers: Finger Kazoo Intensive Short-term Vocal Therapy

Verify the results from intensive short-term vocal therapy using the Finger Kazoo technique about the spectrographic vocal measurements of teachers. Controlled and randomized trial. Spectrographic vocal assessment was performed by judges before and after intensive short-term vocal therapy with Finger Kazoo. Sample was composed of 41 female teachers. There were two study groups (with vocal nodules and without structural affection of the vocal folds) and the respective control groups. For the statistical analysis of the data, nonparametric tests were used (Mann-Whitney test and Wilcoxon test). After intensive short-term vocal therapy with Finger Kazoo, improvement in voice spectral parameters, such as improvement in tracing (color intensity and regularity), greater definition of formants and harmonics, increased replacement of harmonics by noise, and a greater number of harmonics, mainly in the group without structural affection of the vocal folds. There was an improvement in the spectrographic vocal parameters, showing greater stability, quality, and projection of the emission, especially in female teachers without structural affection of the vocal folds.

Factors Associated With Loss of Follow-Up in Transgender Patients Receiving Vocal Therapy.

Optimal vocal care for transgender patients necessitates regular follow-up. Factors associated with loss of follow-up in voice patients have never been investigated. In this study, we report a case series of transgender patients seeking vocal care at our institution and compare those who were and were not lost to follow-up. Charts of transgender patients diagnosed with gender dysphoria who sought vocal care at our institution from January 2018 through May 2022 were reviewed. A chronological timeline of each patient's care at our vocal clinic was recorded. Loss of follow-up was defined as instances in which patients were not yet satisfied with their vocal outcomes and expressed interest in scheduling a subsequent visit but had not yet done so. Logistic regressions were performed to identify factors associated with loss of follow-up. Of 73 patients identified, 59 (80.8%) were assigned male at birth, and 72 (98.6%) were non-Hispanic White. Loss of follow-up occurred in 35 (47.9%) patients. Patients who received vocal surgery were significantly less likely to be lost to follow-up (OR: 0.16 (0.03, 0.79); p = 0.03). The availability of telemedicine options for vocal care was protective against loss of follow-up (OR: 0.09 (0.02, 0.44); p = 0.003). Patients who received other non-voice gender-affirming treatments concomitant to their vocal care were more likely to be lost to follow-up (OR: 4.44 (1.35, 14.59); p = 0.01). Loss of follow-up in transgender patients receiving vocal care is common. Providing telemedicine options and encouraging patients to complete vocal care prior to or after receiving other non-voice gender-affirming treatments may help increase rates of follow-up. 4 Laryngoscope, 133:3061-3067, 2023.

Efficacy of straw phonation exercises with breathing exercises and indirect approaches for dysphonic adults with benign vocal fold lesions

Background: The voice is essential to a people’s daily life, especially in occupational voice users who are at risk for benign vocal fold lesions. It is important to use the proper vocal therapy techniques on a dysphonic patient who has benign vocal fold lesions in order to reduce behaviors that will aggravate the voice disorder and enhance behaviors that help improve voice quality. Objectives: The purpose of this study was to evaluate the efficacy of straw phonation exercises with breathing exercises and indirect approaches in dysphonic adults with benign vocal fold lesions, including vocal nodules; vocal polyps, and vocal cysts. Materials and methods: This study was a pilot study. Twelve participants who had benign vocal fold lesions received vocal hygiene guidance, abdominal breathing exercises, muscle relaxation, and straw phonation voice therapy. All participants received 8 weekly therapy sessions: 30 minutes per session. The vocal assessment data was collected before the first voice therapy session, and immediately after the eighth session, by subjective vocal assessment, and objective vocal assessment with Dr. Speech software version 5. Results: The results after therapy showed significant improvements against the GIRBAS scales in terms of the subjective vocal assessment, in the values of SD F0, jitter, NNE, and MPT of the objective vocal assessment. Conclusion: This result indicates straw phonation with breathing exercises and indirect approaches as being a worthwhile alternative method for voice therapy in dysphonic patients with benign vocal fold lesions.

Efficacy of straw phonation exercises with breathing exercises and indirect approaches for dysphonic adults with benign vocal fold lesions

Background: The voice is essential to a people’s daily life, especially in occupational voice users who are at risk for benign vocal fold lesions. It is important to use the proper vocal therapy techniques on a dysphonic patient who has benign vocal fold lesions in order to reduce behaviors that will aggravate the voice disorder and enhance behaviors that help improve voice quality. Objectives: The purpose of this study was to evaluate the efficacy of straw phonation exercises with breathing exercises and indirect approaches in dysphonic adults with benign vocal fold lesions, including vocal nodules; vocal polyps, and vocal cysts. Materials and methods: This study was a pilot study. Twelve participants who had benign vocal fold lesions received vocal hygiene guidance, abdominal breathing exercises, muscle relaxation, and straw phonation voice therapy. All participants received 8 weekly therapy sessions: 30 minutes per session. The vocal assessment data was collected before the first voice therapy session, and immediately after the eighth session, by subjective vocal assessment, and objective vocal assessment with Dr. Speech software version 5. Results: The results after therapy showed significant improvements against the GIRBAS scales in terms of the subjective vocal assessment, in the values of SD F0, jitter, NNE, and MPT of the objective vocal assessment. Conclusion: This result indicates straw phonation with breathing exercises and indirect approaches as being a worthwhile alternative method for voice therapy in dysphonic patients with benign vocal fold lesions.

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.

Acoustic measurements of CPPS and AVQI pre and post speech therapy.

To compare the acoustic measurements of Cepstral Peak Prominence-Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) at pre- and post-voice therapy times. This is a before and after intervention study, with retrospective data collection. Twenty-two subjects with a mean age of 49.9 years participated in the study. The vocal therapy occurred between the years 2016 to 2019 in a teaching clinic, and the subjects had vocal samples collected before and after the therapeutic processes. CPPS and AVQI data extractions were performed during pre- and post-therapy. In order to characterize the sample, auditory-perceptual evaluation (APE) regarding the overall degree of vocal deviation at pre- and post-therapy moments was performed. The data were analyzed statistically. The APE data indicated a decrease in the median values of overall vocal deviation degree at the post-therapy stage for both the vowel (p=0.00) and number (p=0.00) samples. The average CPPS for the vowel was 14.53 pre-therapy and 16.37 post-therapy (p=0.01); for the number emission, it was 8.22 pre-therapy and 9.06 post-therapy (p=0.02), there was a difference in the CPPS of the vowel and numbers indicating vocal improvement at post-therapy. The average AVQI was 2.27 pre-therapy and 1.54 post-therapy (p=0.05). There was an improvement in the AVQI results, with borderline p-value. Vocal therapy produced changes in the general degree of vocal deviation, as well as in CPPS and AVQI measurements, and the results at the post-therapy moment are similar to those of vocally healthy individuals.

Medidas acústicas de CPPS e AVQI pré e pós terapia fonoaudiológica

ABSTRACT Purpose To compare the acoustic measurements of Cepstral Peak Prominence-Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) at pre- and post-voice therapy times. Methods This is a before and after intervention study, with retrospective data collection. Twenty-two subjects with a mean age of 49.9 years participated in the study. The vocal therapy occurred between the years 2016 to 2019 in a teaching clinic, and the subjects had vocal samples collected before and after the therapeutic processes. CPPS and AVQI data extractions were performed during pre- and post-therapy. In order to characterize the sample, auditory-perceptual evaluation (APE) regarding the overall degree of vocal deviation at pre- and post-therapy moments was performed. The data were analyzed statistically. Results The APE data indicated a decrease in the median values of overall vocal deviation degree at the post-therapy stage for both the vowel (p=0.00) and number (p=0.00) samples. The average CPPS for the vowel was 14.53 pre-therapy and 16.37 post-therapy (p=0.01); for the number emission, it was 8.22 pre-therapy and 9.06 post-therapy (p=0.02), there was a difference in the CPPS of the vowel and numbers indicating vocal improvement at post-therapy. The average AVQI was 2.27 pre-therapy and 1.54 post-therapy (p=0.05). There was an improvement in the AVQI results, with borderline p-value. Conclusion Vocal therapy produced changes in the general degree of vocal deviation, as well as in CPPS and AVQI measurements, and the results at the post-therapy moment are similar to those of vocally healthy individuals.

Effects of indirect vocal therapy via telehealth in speech-language therapy on self-assessment and vocal quality of physical education professionals

RESUMO Objetivo: este estudo objetivou verificar os efeitos da terapia vocal indireta (TVI), aplicada via telefonoaudiologia, em profissionais da educação física na autoavaliação e qualidade vocal. Métodos: 16 profissionais da Educação Física, com idades entre 18 e 50 anos, de ambos os sexos, participaram do estudo. Foram submetidos a oito sessões de TVI, duas vezes/semana, 30 minutos cada. As sessões e avaliações foram ministradas à distância. Foram trabalhados conhecimento sobre saúde vocal, para modificar hábitos vocais e de saúde geral, estratégias de enfrentamento, gerenciamento de estresse e interação terapêutica. Aplicaram-se protocolos: Índice de Triagem de Distúrbios Vocais, Escala de Sintomas Vocais (ESV), Índice de Desvantagem Vocal (IDV) e gravação vocal (/a/ e contagem), avaliando-se o grau geral da qualidade vocal, pré e pós TVI. Utilizou-se o Teste de Wilcoxon (p<0,05) nas comparações. Resultados: houve diminuição significante nos valores dos protocolos ESV (total p=0,041; limitação p=0,032), IDV (total p=0,012 e orgânico p=0,005), e no grau geral da qualidade vocal na vogal (p=0,011). Conclusão: a TVI aplicada por meio da telefonoaudiologia, em profissionais da Educação Física, tem efeitos positivos nos sintomas vocais/laringofaríngeos, melhorando a autopercepção da desvantagem vocal. A TVI melhorou significantemente o grau geral da qualidade vocal, apenas na emissão da vogal sustentada.

Efeitos da terapia vocal indireta via telefonoaudiologia na autoavaliação e qualidade vocal de profissionais da educação física

ABSTRACT Purpose: this study aimed to verify the effects of indirect vocal therapy (IVT), via telehealth, in physical education professionals in voice self-assessment, as well as vocal quality. Methods: 16 physical education professionals, aged between 18 and 50 years, both sexes, participated in the study. All participants were submitted to eight IVT sessions twice a week, 30 minutes each, remotely. The assessments happened remotely, too. Vocal health was explained to modify vocal habits and general health, coping strategies, stress management, and therapeutic interaction. The following protocols were applied: Vocal Disorders Screening Index, Voice Symptoms Scale (VoiSS), Voice Handicap Index (VHI), and vocal recording (/a/ and counting) was performed, evaluating the general degree of vocal quality, pre and post-IVT. The Wilcoxon Test (p<0.05) was applied to verify the findings. Results: there was a significant decrease in the values of the VoiSS protocol (total p=0.041; limitation p=0.032), and VHI (total p=0.012; p=0.005), and in the general degree of vocal quality in vowel /a/ (p=0.011). Conclusion: IVT applied through telehealth in physical education professionals, has positive effects on vocal and laryngopharyngeal symptoms, improving the self-perception of voice handicaps. IVT significantly improved the general degree of vocal quality, only in the emission of the sustained vowel.

Effectiveness of using the resonant vocal techniques in singing voice disorders

Singing voice disorders are an important segment of vocal pathology, targeting a niche of professional and amateur singers of all musical genres. The aim of this study is to evaluate the effectiveness of using the principles of vocal hygiene and the eclectic vocal therapy model by combining three resonant vocal techniques: humming, the method of disguised yawning and the chewing technique, in the corrective-recuperative vocal therapy program. The positive effects of the vocal therapy used in all five case studies were observed. If the initial assessment relates to altered vocal parameters, pain in the laryngeal muscles and a negative influence of vocal problems on quality of life, the final assessment found normalization of vocal parameters, decreased pain and improved the quality of life.

Transgender women

Introduction: the transgender woman, a person who identifies and performs in femininity, has increasingly looked for vocal therapy due to gender incongruence. Objective: to know the experiences and perceptions of these women about health, gender dysphoria, voice and society, to identify possible triggering factors of their discomforts and reflect on the speech therapy performance in this context, since health, in a broad view, is biopsychosocial, while voice, is a subjective construction. Method: Cross-sectional qualitative approach, with semi-structured interviews. Participants were found by the snowball technique and evaluation of the data was obtained by content analysis. Results: participants from the State of São Paulo, most of them study and/or work. They use hormones unsupervised due to the urgency of aligning with their gender identity. Negative social experiences generate discomfort and insecurity, showing that the other’s point of view impairs self-perception. Thus, they seek passability to avoid harassment. The voice was seen as a trigger to have their bodies and gender questioned, and vocal therapy is seen as positive, for working on vocal potentialities, self-perception, and self-acceptance. Having peer support and positive transgender references provide greater self-confidence, acceptance, and reassurance in gender confirmation. Final considerations: psychosocial aspects, cisheteronormativity and demands of transgender people should be considered in transgender health care, including vocal therapy, as well as discussion about the demands of this public should be proposed in society in order to promote health and inclusion to this population.

Finger Kazoo Intensive Short-term Vocal Therapy: Vocal and Aerodynamic Measurements in Female Teachers

Objectiveto verify the effect after short-term intensive therapy with the Finger Kazoo technique on vocal and aerodynamic measures of dysphonic female teachers. Methodblind randomized clinical trial. Fifteen female teachers without structural disorders of vocal folds and nine with vocal nodules participated in the study groups. Yet, nine female teachers without structural disorders and eight with vocal nodules in the control groups. The following variables were measured pre and post-therapy: minimum and maximum fundamental frequency: forced vital capacity; simple phonic coefficient; compound phonic coefficient; ratio between maximum phonation time of /a/ and expected maximum phonation time. Resultsno statistical significance was observed in the intra and intergroup analyses in any of the measures. Conclusionin this group of female teachers, it was not possible to show a positive effect of short-term and intensive therapy with the Finger Kazoo technique on the vocal measures of minimum and maximum fundamental frequency, forced vital capacity, simple phonic coefficient, compound phonic coefficient, and the relationship between maximum phonation time of /a/ and expected maximum phonation time.

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

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. 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. 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. 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 Effect of Vocal Intonation Therapy on Vocal Dysfunction in Patients With Cervical Spinal Cord Injury: A Randomized Control Trial.

In this study, the vocal intonation therapy (VIT) was compared with the standard respiratory therapy for people suffering from respiratory dysfunction as a result of cervical spinal cord injury (CSCI) to observe its effect on vocal quality. Thirty patients with vocal dysfunction after CSCI with the injury time of more than 3 months were screened for inclusion in the trial, and 18 patients completed the 12-weeks, each participant had 60 sessions in total in the clinical trial. All patients were allocated to the intervention group or the control group. The intervention group received VIT training and the control group received respiratory phonation therapy. Both groups were trained by professional therapists, and the training time was 30 min/day, 5 days/week, for 60 sessions for each group in a total of 12 weeks. In the Baseline (T0), mid-intervention period (after 6 weeks, T1), and after intervention (after 12 weeks, T2), the vocal quality of the two groups of patients was tested with a computer-aided real-time audio analyzer 2.1.6 (Adobe Systems, United States) for Sing-SPL (p < 0.0001), Speech-SPL (p < 0.0001), SNL (p < 0.0001), and F0 (p < 0.0001) of the intervention group were significantly improved compared with the control group. In comparing the spectrometry analysis of vocal quality for the 2 groups of participants, there was a significant difference in the results of Sing-SPL and Speech-SPL acoustic analysis in the intervention group of patients at T2 (after 12 weeks) compared to the control group. Vocal intonation therapy—music therapy can improve the speech sound quality of cervical CSCI patients and provide CSCI patients with a practical, highly operable treatment that has both functional training effects and can bring a pleasant experience that can be promoted in the medical field. This study was approved by the Ethics Committee of China Rehabilitation Research Center (CRRC) (approval No. 2019-83-1) on May 20th, 2019. It was registered with the National Health Security Information Platform, medical research registration, and filing information system (Registration No. MR-11-21-011802) on January 28th, 2021.

Self-Perception of Vocal Effort in Response to Modeled Communication Demands

The optimization of vocal effort given a response to a voice demand is a common clinical and vocal performance goal. Increases in vocal effort are often in response to communication limitations from both the interlocutors and the communication environment. This study investigates the relationship between vocal effort and vocal demands from changes and limitations imposed by the communication environment. Thirty-seven participants rated their vocal effort associated with a map description task in a range of communication demands. These demands included communication distance (from 1 m to 4 m), loudness goal (54 dB-66 dB), and excess background noise (53 dBA-71 dBA). The vocal effort ratings were compared across the different types and extents of vocal demand conditions. As would be expected, there were significant increases in vocal effort levels from the control condition to the extremes of the distance and loudness goal vocal demands. Each increase in background noise resulted in distinct increases in vocal effort level. Participants were able to use the vocal effort scale to efficiently quantify expected increases in vocal demands. Increases of vocal effort level accompany increases to vocal demands that exceed the habitual or expected communication. While voice training and vocal therapy are essential for reducing internal vocal demands, clients with a goal to reduce vocal effort should also consider external vocal demands such as communication distance and background noise.

ВОКАЛ КАК ФОРМА ПРОДУКТИВНОЙ ДЕЯТЕЛЬНОСТИ В ОТЕЧЕСТВЕННОЙ ЛОГОПЕДИИ

The authors use the terms "vocal", "productive vocal activity", "voice therapy", "vocal therapy", "vocal means" as synonyms in scientific research, which is a relevant technological technique in speech therapy, as an advanced pedagogical experience supplementing speech therapy science and practice. The article describes the therapeutic potential of vocal activity and the long-term experience of the leading Russian speech therapists in the practical application of elements of productive vocal activity for correctional and speech therapy work. The evolutionary-historical relationship between colloquial speech and singing and the high corrective potential of vocals laid the foundation for the diffusion of vocal elements into speech therapy practice as early as the middle of the XXth century. Successful long-term experience of application of vocal elements, primarily in the field of medical speech therapy, outlines a tangible resource for practical and scientific-theoretical research in this direction. The use of the components of vocal-pedagogical practice in the implementation of rehabilitation measures in patients with speech pathologies makes it possible to enhance noticeably the correctional speech therapy impact. It is also very important that vocals, in one form or another, can be successfully used to develop and automate the correct formation of complex supersegmental speech properties, acting as extra components in relation to the main pronunciation of words and sounds, that is, in other words, speech prosodic.

Reducing the gap between science and clinic: lessons from academia and professional practice - part B: traditional vocal therapy techniques and modern electrostimulation and photobiomodulation techniques applied to vocal rehabilitation.

This text is the continuation of the XVIII SBFa Congress publication. In part "A" we presented the analyses on clinical vocal evaluation. Part "B" focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.

Reduzindo o gap entre a ciência e a clínica: lições da academia e da prática profissional – parte B: técnicas tradicionais de terapia vocal e técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação vocal

ABSTRACT This text is the continuation of the XVIII SBFa Congress publication. In part “A” we presented the analyses on clinical vocal evaluation. Part “B” focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.

Acoustic and perceptual analysis of voice quality in patients with puberphonia before and after vocal therapy

Acoustic and perceptual analysis of voice quality in patients with puberphonia before and after vocal therapy