Efficacy of vocal training program with perceptual analysis, high-speed and electroglottography

Abstract

Dysphonia arise when there is a change in the pattern of vocal fold vibration, whether by improper functional adjustments or damages to the mucous membrane of the vocal folds, resulting in changes in vocal quality. Thus, tools capable to visualize the mechanism of speech is of paramount importance in vocal assessment.The inappropriate vocal behavior caused by vocal misuse and abuse would be the main reason to cause vocal and laryngeal disturbances, the most common being the formation of vocal nodules. The main vocal alterations are: using voice at high intensity for a long time in adverse acoustic conditions, with very grave fundamental frequency; using voice with intense physical movement, increased speech rate, sudden vocal spasms and low focus resonance.The speech therapy for vocal hyperfunctioning with or without visible vocal folds nodules has been much discussed in the literature, suggesting better outcomes with direct therapy associated with the approach to vocal hygiene/health/well-being.Voice perceptual-auditory assessment is an important tool in the speech therapy clinic and CAPE-V (Consensus Auditory Perceptual Evaluation - Voice) protocol proposed by ASHA (American Speech-Language-Hearing Association) has been increasingly used in research and clinical practice. High Speed Videolaryngoscopy (HSV) is a powerful new tool for investigating the dynamics of the vocal folds, providing key information for the effective, visual, quantitative, and physiologically interpretable clinical diagnosis. Because it is an indirect technique for assessing the mucosal wave, electroglottography (EGG) can not isolate the movement of each vocal fold, therefore, concomitant use of HSV characterizes glottic cycle more reliably, and the two exams are commentary. Thus, EGG determines the onset of the open phase and HSV can view the injury and differentiate the vibrating phase variations between the vocal folds, and both tests together may determine more accurately the extent of the injury and the causes for variation in the mucosal wave .In addition to a more accurate diagnosis, it is possible to get clinical control of speech therapy, as well as post-surgical follow-ups for the vocal folds. It is noteworthy that HSV is a recent instrument in Brazil and there are few national studies in course; we do not likely found studies associating this instrument to EGG for assessing therapeutic efficacy. The development of this study is based on the interest for understanding the dynamics of vocal production, in addition to expanding the capacity for diagnostic accuracy of the laryngeal diseases for clinical use and benefit of the population.The aim will be to propose and test a program of speech therapy intervention for individuals diagnosed with hyperfunctioning nodules with or without vocal nodules by comparing the patterns of glottal vibration and perceptual-auditory assessment, pre and post-intervention program. This is a longitudinal prospective study involving 20 patients with dysphonia evaluated by the Voice Group of the Otolaryngology Clinic, Hospital das Clinicas of Faculdade de Medicina da USP (HC-FMUSP).The subjects will be invited to take part in the Cognitive Vocal Program - Vocal Hyperfunctioning (CVP - VH), which will consist of 10 therapy sessions and two feedback sessions, one pre and one post program. From the acceptance they will be referred to take HSV and EGG. Afterwards, they will be referred to voice recording. The same procedures will be repeated at the end of the program. In order to check the vocal program effectiveness in this population, the results of the pre and post-treatment (CPV-VH) will be compared and each patient considered by his / her own control. Data collected from HSV, EGG and CAPE-V will be statistically analyzed. (AU)