SUMMARY
Objectives
This study aimed to assess the feasibility of gastroesophageal manometry for continuously
evaluating the degree of expiratory effort by measuring the pressures in the digestive
tract during crescendo phonation.
Methods
Each of 18 healthy nondysphonic speakers had a probe with a four-channel gastroesophageal
manometer inserted through the nasal cavity to place four pressure sensors in the
hypopharynx, cervical-/thoracic esophagus, and stomach, and was asked to gradually
increase the vocal loudness during sustained phonation of the vowel /e:/ (vowel-crescendo
task), while the sound pressure level and the pressures were simultaneously recorded.
Results
50% of the successful vowel-crescendo task samples with a gradual and adequate sound
pressure level increase showed a concomitant gradual increase in both the intra-thoracic-esophageal/intra-gastric
pressure values from approximately -5 mmHg /6 mmHg to -10 mmHg/20 mmHg, respectively.
The maximum pressure value was the highest in the intra-gastric pressure followed
by the intra-thoracic-esophageal and intra-cervical-esophageal pressures in order.
However, most of the samples showed less than one of atypical pressure changes, such
as fluctuations in the intra-thoracic-esophageal and intra-gastric pressure changes
and dispersion in the intra-cervical-esophageal and intra-hypopharyngeal pressure
values (perhaps due to the peristaltic motions, and the contact of the sensors to
the membranous wall).
Conclusion
These results show that, during successful crescendo phonation, gastroesophageal manometry
reveals a gradual increase in the intra-thoracic and intra-abdominal pressures with
increasing the vocal intensity, even though showing some systematic errors, suggesting
the usefulness of gastroesophageal manometry for continuously evaluating the degree
of expiratory effort without influence by the laryngeal condition.
KEY WORDS
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Intelligibility related to loudness, Speech.Monograph. 1946; 13: 13-18https://doi.org/10.1080/03637754609374911
- Effects of vocal force on the intelligibility of speech sounds.J Acoust Soc Am. 1956; 28: 902-905https://doi.org/10.1121/1.1908510
- Benign lesions of the vocal folds: histopathology and phonotrauma.Ann Otol Rhinol Laryngol. 1995; 104: 698-703https://doi.org/10.1177/000348949510400905
- Exudative lesions of Reinke's space. An anatomopathological correlation.Acta Otorhinolaryngol Belg. 1996; 50: 253-264
- Vocal fold nodules: morphological and immunohistochemical investigations.J Voice. 2010; 24: 531-539https://doi.org/10.1016/j.jvoice.2009.01.002
- Ventricular dysphonia: new interpretation of an old observation.Laryngoscope. 1960; 70: 1608-1627https://doi.org/10.1288/00005537-196012000-00003
- Current and emerging concept in muscle tension dysphonia: a 30-month review.J Voice. 2005; 19: 261-267https://doi.org/10.1016/j.jvoice.2004.03.007
- Direct and indirect determination of mean subglottal pressure.Folia Phoniatr. 1956; 8: 1-24https://doi.org/10.1159/000262725
- Respiratory muscles in speech.J Speech Hear Res. 1959; 2: 16-27https://doi.org/10.1044/jshr.0201.16
- Expiratory pressure and airflow during speech.Brit. Med. J. 1960; 18: 1837-1843https://doi.org/10.1136/bmj.1.5189.1837
- Loudness, sound pressure, and subglottic pressure in speech.J Acoust Soc Am. 1963; 35: 454-460https://doi.org/10.1121/1.1918503
- Regulatory mechanism of voice intensity variation.J Speech Lang Hear Res. 1964; 7: 17-29https://doi.org/10.1044/jshr.0701.17
- Vocal intensity and air flow rate, Folia.Phoniatr. 1965; 17: 92-104https://doi.org/10.1159/000263031
- Vocal intensity, subglottic pressure and air flow relationship in singes.Folia Phoniatr (Basel). 1967; 19: 393-413https://doi.org/10.1159/000263170
- The Efficiency of Voice Production.State University Hospital, Groningen1980
- Relationships between vocal intensity and noninvasively obtained aerodynamic parameters in normal subjects.J Acoust Soc Am. 1983; 73: 1316-1321https://doi.org/10.1121/1.389235
- Vocal intensity in speakers and singers.J Acoust Soc Am. 1992; 91: 2936-2946https://doi.org/10.1121/1.402929
- Relationship between subglottal pressure and sound pressure level in untrained voice.J Voice. 2015; 30: 15-20https://doi.org/10.1016/j.jvoice.2015.03.006S
- Glottal adjustment for regulating vocal intensity. An experimental study.Acta Otolaryngol (Stockh). 1986; 102: 315-324https://doi.org/10.1016/j.jvoice.2015.03.006
- Effective airway resistance and vocal sound pressure levels in cheerleaders with a history of dysphonic episodes.Folia Phoniatr. 1985; 37: 223-231https://doi.org/10.1159/000265802
- Respiratory and laryngeal function of women and men during vocal intensity variation.J Speech Lang Hear Res. 1993; 36: 64-75https://doi.org/10.1044/jshr.3601.64
- Aerodynamic and acoustic effects of false vocal folds and epiglottic in excised larynx models.Ann Otol Rhinol Laryngol. 2007; 116: 135-144https://doi.org/10.1177/000348940711600210
- On the acoustic effects of the supraglottic structures in excised larynges.J Acoustic Soc Am. 2013; 133: 2984-2992https://doi.org/10.1121/1.4796109
- Evaluation of methods of estimating sub-glottal air pressure.J Speech Hear Res. 1964; 7: 151-164https://doi.org/10.1044/jshr.0702.151
- Direct comparison of subglottal and esophageal pressure during speech.J Acoust Soc Am. 1968; 43: 1157-1164https://doi.org/10.1121/1.1910950
- Application of miniaturized pressure transducer for experimental speech research.Folia Phoniatr (Basel). 1968; 20: 360-368https://doi.org/10.1159/000263213
- Subglottal oral air pressures during phonation—preliminary investigation using miniature transducer system.Med Biol Eng. 1975; 13: 644-648https://doi.org/10.1007/BF02477320
- A clinical method for estimating laryngeal airway resistance during vowel production.J Speech Hear Res. 1981; 46: 138-146https://doi.org/10.1044/jshd.4602.138
- Initial validation of an indirect measure of subglottal pressure during vowels.J Acoust Soc Am. 1982; 72: 633-635https://doi.org/10.1121/1.388046
- Indirect measuring method of the subglottic pressure in the voice production. —Intraesophageal method and interruption method—.Jibi to Rinsho. 1964; 10: 264-270https://doi.org/10.11334/jibi1954.10.4_264
- The airway interruption techniques for measuring expiratory air pressure during phonation.Ann Bull Res Inst Logoped Phoniatr. 1983; 17: 23-32
- Phonation threshold pressure measurement during phonation by airflow interruption.Laryngoscope. 1999; 109: 425-432https://doi.org/10.1097/00005537-199903000-00016
- Estimating subglottal pressure from neck-surface acceleration during normal voice production.J Speech Lang Hear Res. 2016; 59: 1335-1345https://doi.org/10.1044/2016_JSLHR-S-15-0430
- Magnitude of neck-surface vibration as an estimate of subglottal pressure during modulations of vocal effort and intensity in healthy speakers.J Speech Lang Hear Res. 2017; 60: 3404-3416https://doi.org/10.1044/2017_JSLHR-S-17-0180
- Impact of nonmodal phonation on estimates of subglottal pressure from neck-surface acceleration in healthy speakers.J Speech Lang Hear Res. 2019; 62 (3339-335)https://doi.org/10.1044/2019_JSLHR-S-19-0067
- Estimation of sound pressure levels of voiced speech from skin vibration of the neck.J Acoust Soc Am. 2005; 117: 1386-1394https://doi.org/10.1121/1.1850074
M Umatani, M Ogawa, T Iwahashi, et al., The feasibility of a neck-surface accelerometer for estimating the amount of acoustic output during phonation regardless of the difference in the mouth configuration, J Voice. https://doi.org/10.1016/j.jvoice.2020.06.002
- Abdominal muscle activity during speech production.J Appl Physiol. 1988; 65: 2656-2664https://doi.org/10.1152/jappl.1988.65.6.2656
- Control of static pressure by expiratory muscles during expiratory effort and phonation.J Voice. 1990; 4: 256-263https://doi.org/10.1016/S0892-1997(05)80021-9
- Intra-abdominal pressures during voluntary and reflex cough.Cough. 2008; 4: 2https://doi.org/10.1186/1745-9974-4-2
- The intensity of voluntary, induced, and spontaneous cough.Chest. 2015; 148: 1259-1267https://doi.org/10.1378/chest.15-0138
- Breathing, Speech, and Song. Softcover Reprint of the Original.1st ed. Springer-Verlag Wien GmbH, Wien1980
- Oesophageal high-resolution manometry: moving from research into clinical practice.Gut. 2008; 57: 405-423https://doi.org/10.1136/gut.2007.127993
- Measurements of vibrato parameters in long sustained crescendo notes as sung by ten sopranos.J Voice. 2003; 17: 343-352https://doi.org/10.1067/S0892-1997(03)00006-7
- Messa di voce: an investigation of the symmetry of crescendo and decrescendo in a singing exercise.J Acoust Soc Am. 1999; 105: 2933-2940https://doi.org/10.1121/1.426906
T de Hoop, M Ogawa, T Iwahashi, et al., Humming facilitates a gradual increase in vocal intensity by alleviating the enhancement of vocal fold contact and supraglottic constriction. J Voice (in press) doi:10.1016/j.voice.2019.05.004
- Sound pressure level and spectral balance linearity and symmetry in the messa di voce of female classical singers.J Acoust Soc Am. 2007; 121: 1728-1736https://doi.org/10.1121/1.2436639
- Automated tracking of quantitative parameters from single scanning of vocal folds: a case study of the ‘messa di voce’ exercise.Logoped Phoniatr Vocol. 2015; 40: 44-54https://doi.org/10.3109/14015439.2013.861014
- Assessing linearity in the loudness envelop of the Messa di voce singing exercise through acoustic signal analysis.J Voice. 2015; 29: 646.e21-646.e31https://doi.org/10.1016/j.jvoice.2014.10.015
- Anatomy of the normal diaphragm.Thorac Surg Clin. 2011; 21: 273-279https://doi.org/10.1016/j.thorsurg.2011.01.001
- Mechanics of the respiratory muscles.Compr Physiol. 2011; 1: 1273-1300https://doi.org/10.1002/cphy.c100009
- Respiratory effect of the lower rib displacement produced by the diaphragm.J Appl Physiol. 2012; 112: 529-534https://doi.org/10.1152/japplphysiol.01067.2011
- Mechanisms of the increased rib cage expansion produced by the diaphragm with abdominal support.J Appl Physiol. 2015; 118: 989-995https://doi.org/10.1152/japplphysiol.00016.2015
- Fluid Flow in Respiratory Airways (Breathing), Principles of Voice Production.Prentice Hall, Englewood Cliffs1994: 53-79
- Measurement of intraesophageal pressure.J App Physiol. 1955; 7: 491-495https://doi.org/10.1152/jappl.1955.7.5.491
- Mechanics of Breathing.West’s Respiratory Physiology. The Essentials. Wolters Kluwer, Philadelphia2016: 117-131
- Sphincter action of the larynx.Arch Otolaryngol. 1941; 33: 351-377https://doi.org/10.1001/archotol.1941.00660030355002
- An analysis of cough at the level the larynx.Arch Otolaryngol. 1965; 81: 616-625https://doi.org/10.1001/archotol.1965.00750050631016
- Intra-abdominal pressure measurement: validation of intragastric pressure as a measure of intra-abdominal pressure.Br J Anaesth. 2007; 98: 628-634https://doi.org/10.1093/bja/aem060
- Semicontinuous intra-abdominal pressure measurement using a intragastric compliance catheter.Intensive Care Med. 2007; 33: 1297-1300https://doi.org/10.1007/s00134-007-0682-3
- Expiratory muscle strength training evaluated with simultaneous high-resolution manometry and electromyography.Laryngoscope. 2017; 127: 797-804https://doi.org/10.1002/lary.26397
- Comparison of pleural pressure measuring instruments.Chest. 2014; 146: 1007-1012https://doi.org/10.1378/chest.13-3004
- Estimation of intra-abdominal pressure by bladder pressure measurement: validity and methodology.J Trauma. 2001; 50: 297-302https://doi.org/10.1097/00005373-200102000-00016
Article info
Publication history
Published online: March 08, 2021
Accepted:
February 1,
2021
Footnotes
Declaration of interest: None.
Disclosure: The authors alone are responsible for the content and writing of the paper.
Identification
Copyright
© 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
