Effect of Resonance Tube Technique on Oropharyngeal Geometry and Voice in Individuals with Parkinson's Disease

  • Joice Maely Souza da Silva
    Correspondence
    Address correspondence and reprint requests to Joice Maely Souza da Silva, Graduate Program in Human Communication Health at the Federal University of Pernambuco, Health Sciences Center, Speech-Language Pathology and Audiology Department (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Departamento de Fonoaudiologia), Av. Prof. Artur de Sá, s/n – Cidade Universitária, Recife/PE, Brazil, CEP: 50670-420.
    Affiliations
    Graduate Program in Human Communication Health at the Federal University of Pernambuco, Health Sciences Center, Speech-Language Pathology and Audiology Department, Recife, Pernambuco, Brazil (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Departamento de Fonoaudiologia), Av. Prof. Artur de Sá, s/n – Cidade Universitária, Recife/PE, Brazil
    Search for articles by this author
  • Adriana de Oliveira Camargo Gomes
    Affiliations
    Graduate Program in Human Communication Health at the Federal University of Pernambuco, Health Sciences Center, Speech-Language Pathology and Audiology Department, Recife, Pernambuco, Brazil (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Departamento de Fonoaudiologia), Av. Prof. Artur de Sá, s/n – Cidade Universitária, Recife/PE, Brazil
    Search for articles by this author
  • Hilton Justino da Silva
    Affiliations
    Graduate Program in Human Communication Health at the Federal University of Pernambuco, Health Sciences Center, Speech-Language Pathology and Audiology Department, Recife, Pernambuco, Brazil (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Departamento de Fonoaudiologia), Av. Prof. Artur de Sá, s/n – Cidade Universitária, Recife/PE, Brazil
    Search for articles by this author
  • Silvio José de Vasconcelos
    Affiliations
    Surgery Department, Health Sciences Center, University Federal of Pernambuco, Recife, Pernambuco, Brazil, Av. Prof. Artur de Sá, s/n – Cidade Universitária, Recife/PE, Brazil
    Search for articles by this author
  • Maria das Graças Wanderley de Sales Coriolano
    Affiliations
    Graduate Program in Human Communication Health at the Federal University of Pernambuco, Health Sciences Center, Speech-Language Pathology and Audiology Department, Recife, Pernambuco, Brazil (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Departamento de Fonoaudiologia), Av. Prof. Artur de Sá, s/n – Cidade Universitária, Recife/PE, Brazil
    Search for articles by this author
  • Zulina Souza de Lira
    Affiliations
    Graduate Program in Human Communication Health at the Federal University of Pernambuco, Health Sciences Center, Speech-Language Pathology and Audiology Department, Recife, Pernambuco, Brazil (Programa de Pós-Graduação em Saúde da Comunicação Humana da Universidade Federal de Pernambuco, Centro de Ciências da Saúde, Departamento de Fonoaudiologia), Av. Prof. Artur de Sá, s/n – Cidade Universitária, Recife/PE, Brazil
    Search for articles by this author

      Summary

      Objective

      To verify the immediate effect of the flexible resonance tube vocal technique on the oropharyngeal geometry and vocal acoustic parameters of individuals with Parkinson's disease (PD) and to study the correlation between oropharyngeal geometry and the intensity and fundamental frequency (f0) parameters of the voice.

      Methods

      Forty individuals participated—20 with PD and 20 healthy individuals, with a mean age of 60.95 (± 5.69) years. There were 10 men and 10 women in each group. All underwent pharyngometric analysis of the vocal tract and voice acoustics parameters before and after use of the vocal technique with a flexible resonance tube.

      Results

      After the technique, there was a reduction in pharyngeal cavity volume only in females in the healthy group, a reduction in shimmer values in females in both groups and males in PD group and an improvement in noise parameters in females in the PD group. There was a negative correlation between vocal tract volume and intensity, between f0 and vocal tract volume, between f0 and oropharyngeal junction area, between f0 and oral cavity volume as well as a positive correlation between oral cavity length and f0.

      Conclusion

      The vocal technique with the flexible resonance tube applied to individuals with PD improved the subjects’ voice quality in the perceptual and acoustic voice parameters. Regarding the oropharyngeal geometry, it was possible to observe its correlation with the parameters of vocal intensity and frequency in the studied population.

      Key Words

      To read this article in full you will need to make a payment
      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

      1. BRASIL. Ministério da Saúde. Portaria n°10, de 31 de Outubro de 2017. Aprova o [protocolo clínico e diretrizes terapêuticas da doença de Parkinson]. Diário Oficial [da] União. 2017 out. 31; Seção 1. pp. 1–26.

        • Dias AE
        • Limongi JCP
        • Hsing WT
        • et al.
        Telerehabilitation in Parkinson's disease: influence of cognitive status.
        Dement Neuropsycol. 2016; 10: 327-332
        • Behlau M
        • Madazio G
        • Azevedo R
        • et al.
        Disfonias neurológicas.
        in: Voz Belhlau M. O Livro do Especialista II. Revinter, Rio de Janeiro2005: 111-162
        • Tripoliti E
        • Zrinzo L
        • Martinez-torres I
        • et al.
        Effects of subthalamic stimulation on speech of consecutive patients with Parkinson disease.
        Neurology. 2011; 76: 80-86
        • Hammer MJ
        • Barlow SM
        • Lyons KE
        • et al.
        Subthalamic nucleus deep brain stimulation changes velopharyngeal control in Parkinson's disease.
        J Commun Disord. 2011; 44: 37-48
        • Pinheiro RSA
        • Alves NT
        • Almeida AAF
        Effectiveness and limitations of vocal therapy in Parkinson’s disease: a literature review.
        Rev CEFAC. 2016; 18: 758-765
        • Tyrmi J
        • Radolf V
        • Horácek J
        • et al.
        Resonance tube or Lax Vox?.
        J Voice. 2017; 35: 430-437
        • Cielo CA
        • Lima JPM
        • Christmann MK
        • et al.
        Semioccluded vocal tract exercises: literature review.
        Rev CEFAC. 2013; 15: 1679-1689
        • Santos SB
        • Rodrigues SR
        • Gadenz CD
        • et al.
        Verifying the effectiveness of using resonance tubes in voice therapy with elderly people.
        Audio Commun Res. 2014; 19: 81-87
        • Sihvo M
        Lax Vox tube.
        in: 7th Pan European Voice Conference – PEVOC; 2007 Aug 29-Spt 1; Groningen. Proceedings. Groningen: Pan European Voice Conferences. 2007 ([citado em 2017 Abril 20]. Disponível em)
        • Guzman M
        • Laukkanen A
        • Krupa P
        • et al.
        Vocal tract and glottal function during and after vocal exercising with resonance tube and straw.
        J Voice. 2013; 27: 523e.19-523e.34
        • Fadel CBX
        • Dassie-Leite AP
        • Santos RS
        • et al.
        Immediate effects of the semi-occluded vocal tract exercise with Lax Vox tube in singers.
        Codas. 2016; 28: 618-625
        • Andrade SR
        • Cielo CA
        • Schwarz K
        • et al.
        Vocal therapy and nasal sounds: effects on hyperfunctional dysphonia.
        Rev CEFAC. 2016; 18: 263-272
        • Boutet C
        • Abdirahman SMM
        • Celle S
        • et al.
        Supraepiglottic upper airway volume in elderly patients with obstructive sleep apnea.
        PlosOne. 2016; 11: 1-10
        • Vizza P
        • Tradigo G
        • Mirarchi D
        • et al.
        Methodologies of speech analysis for neurodegenerative diseases evaluation.
        International Journal of Medical Informatics. 2019; 122: 45-59
        • Bruki SMD
        • Nitrini R
        • Caramelli P
        • et al.
        Suggestions for using the mini mental state examination in Brasil.
        Arq. Neuropsiquiatr. 2003; 61: 777-781
        • Gonçalves MIR
        • Pontes PAL
        • Vieira VP
        • et al.
        Transfer function of Brazilian Portuguese oral vowels: a comparative acoustic analysis.
        Braz J Otorhinolaryngol. 2009; 75: 680-684
        • Lopes LW
        • Freitas JA
        • Almeida AA
        • et al.
        Performance of the phonatory deviation diagram in the evaluation of rough and breathy synthesized voices.
        Braz J Otorhinolaryngol. 2018; 84: 460-472
        • Baravieira PP
        • Brasolotto AG
        • Montagnoli AN
        • et al.
        Auditory-perceptual evaluation of rough and breathy voices: correspondencebetween analogical visual and numerical scale.
        Codas. 2016; 28: 163-167
        • Martins PC
        • Couto TE
        Gama ACC auditory-perceptual evaluation of the degree of vocal deviation: correlation between the visual analogue scale and numerical scale.
        Codas. 2015; 27: 279-284
        • Barbosa ER
        • Sallem FAS
        Parkinson disease – diagnosis.
        Neurociências. 2005; 133: 158-165
        • Leddy AL
        • Crowner BE
        • Earhart GM
        Functional gait assessment and balance evaluation system test: reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall.
        Physical Ther. 2011; 91: 102-113
        • Ng ML
        • Yan N
        • Chan V
        • et al.
        A volumetric analysis of the vocal tract associated with laryngectomees using acoustic reflection technology.
        Folia Phoninatr Logop. 2018; 70: 44-49
        • Patel SR
        • Frame JM
        • Larkin EK
        • et al.
        Heritability of upper airway dimensions derived using acoustic pharyngometry.
        Eur Resp J. 2008; 32: 1304-1308
        • Guzman M
        • Higueras D
        • Fincheira C
        • et al.
        Immediate acoustic effects of straw phonation exercises in subjects with dysphonic voices.
        Logoped Phoniatr Vocol. 2013; 38: 35-45
        • Guzman M
        • Castro C
        • Testart A
        • et al.
        Laryngeal and pharyngeal activity during semioccluded vocal tract postures in subjects diagnosed with hyperfunctional dysphonia.
        J Voice. 2013; 27: 709-716
        • Gelardi M
        • Maselli del Giudice A
        • Cariti F
        • et al.
        Acoustic pharyngometry: clinical and instrumental correlations in sleep disorders.
        Braz J Otorhinolaryngol. 2007; 73: 257-265
        • Fabron EMG
        • Silvério KCA
        • Berrentin-Felix G
        • et al.
        Voice therapy for the elderly with progression of intensity, frequency, and phonation time: case reports.
        Codas. 2018; 30: 1-7
        • Kamal I
        Normal standard curve for acoustic pharyngometry.
        Otolaryngol Head Neck Surg. 2001; 124: 323-330
        • Souza LBR
        • Pereira RM
        • Santos MM
        • et al.
        Fundamental frequency, phonation maximum time and vocal complaints in morbidly obese women.
        ABCD Arq Bras Cir Dig. 2014; 27: 43-46
        • Fahn S
        • Przedborski S
        Parkinsonismo.
        in: Rowland LP Tratado de Neurologia. Guanabara Koogan, Rio de Janeiro2007: 768-784
        • Garcia LZ
        • Yahashita HH
        • Garcia DV
        • et al.
        Applicability of cone beam computed tomography to the assessment of the vocal tract before and after vocal exercises in normal subjects.
        Folia Phoniatr Logop. 2017; 68: 183-188
        • Scarpell RD
        • Fonseca MDL
        Acoustic parameters of voices of women in post-menopause.
        Rev Bras Geriatr Gerontol. 2014; 17: 741-750
        • Ferreira FV
        • Cielo CA
        • Trevisan ME
        Vocal acoustic measures in Parkinson disease: case study.
        Rev CEFAC. 2010; 12: 889-898
        • Clark JP
        • Adams SG
        • Dykstra AD
        • et al.
        Loudness perception and speech intensity control in Parkinson's disease.
        J Comumun Dis. 2014; 51: 1-12
        • Rosa JC
        • Cielo CA
        • Cechella C
        Phonatory function in Parkinson’s disease patients: use of wind instrument.
        Rev CEFAC. 2009; 11: 305-313
        • Beber BC
        • Cielo CA
        Vocal acoustic characteristic in men with normal voice and laryngeal.
        Rev CEFAC. 2011; 13: 340-351
        • Sarpi TMFC
        • Fieri M
        • Chamouton CS
        • et al.
        Voice and swallowing effects after expiratory muscle strength training program in Parkinson's disease.
        Rev Distúrbios da Comum. 2017; 29: 274-283
        • Menezes LN
        • Vicente LCC
        Vocal aging of institutionalized elderly people.
        CEFAC. 2007; 9: 90-92
        • Carrillo L
        • Ortiz KZ
        Comparison between auditory-perceptual and acoustic analyses in dysarthrias.
        Rev Soc Bras Fonoaudiologia. 2008; 13: 325-331
        • Lee SH
        • Hsieh YH
        • Lee GS
        Relationships between formant frequencies of sustained vowels and tongue contours measured by ultrasonography.
        Am J Speech-Pathol. 2015; 24: 739-749
        • Magri A
        • Stamato T
        • Camargo ZA
        Formant bandwidth Influences in voice quality.
        Rev CEFAC. 2009; 11: 296-304
        • Xue SA
        • Hao GJP
        • Mayo R
        Volumetric measurements of vocal tracts for male speakers from different races.
        Clin Linguist Phon. 2006; 20: 691-702
        • Lopes LW
        • Cavalcante DP
        • Costa PO
        Severity of voice disorders: integration of perceptual and acoustic data in dysphonic patients.
        Codas. 2014; 26: 382-388
        • Van Houtte E
        • Van Lierde K
        • Claeys S
        Pathophysiology and treatment of muscle tension dysphonia: a review of the current knowledge.
        J Voice. 2011; 25: 202-207