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Effect of Nebulization on Laryngeal Parameters: Analysis Using High-Speed Digital Videolaryngoscopy

  • Elisa Meiti Ribeiro Lin Plec
    Correspondence
    Address correspondence and reprint requests to Elisa Meiti Ribeiro Lin Plec, 190 - Sala 249, Santa Efigênia, Belo Horizonte Minas Gerais, Brasil, CEP: 30130-100.
    Affiliations
    Department of the Faculdade de Medicina - Universidade Federal de Minas Gerais – UFMG. Av. Alfredo Balena, Otolaryngologist of the Hospital Felício Rocho Belo Horizonte, Belo Horizonte Minas Gerais, Brasil
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  • Ana Cristina Côrtes Gama
    Affiliations
    Universidade Federal de Minas Gerais - Postgraduate program of the Speech and Language Department of the Faculdade de Medicina - Universidade Federal de Minas Gerais – UFMG. Av. Alfredo Balena, Belo Horizonte Minas Gerais, Brasil
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  • Bárbara Oliveira Souza
    Affiliations
    Department of the Faculdade de Medicina - Universidade Federal de Minas Gerais - UFMG. Av. Alfredo Balena, Belo Horizonte Minas Gerais, Brasil
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  • Marco Aurélio Rocha Santos
    Affiliations
    Department of the Faculdade de Medicina - Universidade Federal de Minas Gerais – UFMG. Av. Alfredo Balena, Professor of the Universidade Federal de Minas Gerais - Otolaryngologist of the Hospital Felício Rocho - Belo Horizonte, Belo Horizonte Minas Gerais, Brasil
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      Summary

      Introduction

      Superficial laryngeal hydration, obtained through nebulization, is related to the moisture level on the epithelial surfaces of the vocal folds, modifying their biomechanical and aerodynamic properties. Through high-speed videolaryngoscopy it is possible to obtain objective data for laryngeal analysis after nebulization and a better understanding of this phenomenon

      Objective

      To verify the effects of nebulization with saline solution on laryngeal parameters of digital videokymography obtained by high-speed videolaryngoscopy examination in women and men with and without laryngeal alterations

      Method

      This is a clinical, comparative intra-subject study. Fifty-nine adults were selected, with and without laryngeal alterations, 30 females and 29 males. Digital videokymographs in the anterior, middle and posterior thirds of the vocal folds of the participants were analyzed before and after nebulization with 0.9% saline solution.

      Results

      Women without laryngeal alterations showed more parameters changes after nebulization, in which there was a decrease in maximum and medium opening, amplitude of opening of the left and right vocal fold in the anterior glottal third, and an increase of the percentage of closure of the vocal folds. These results indicate a minor extent of lateral excursion of the vocal folds during phonation. In women with laryngeal alterations, the parameters that changed after nebulization were the increased frequency of opening of the left and right vocal folds in the topography of the posterior third. In men, nebulization did not change the variables studied, except for the amplitude of the right vocal fold in men with laryngeal alterations, in the analysis of the posterior glottic third.

      Conclusion

      The results suggest that surface hydration modifies laryngeal dynamics differently between genders. After nebulization with saline solution, women without laryngeal alterations showed a decrease in the lateralization of the vocal folds during phonation, suggesting a better phonatory efficiency.

      Key Words

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      REFERENCES

        • Hartley NA
        • Thibeault SL.
        Systemic hydration: relating science to clinical practice in vocal health.
        J Voice. 2014; r: 652.e1-652.e20https://doi.org/10.1016/j.jvoice.2014.01.007
        • Roy N
        • Tanner K
        • Gray SD
        • et al.
        An evaluation of the effects of three laryngeal lubricants on phonation threshold pressure (PTP).
        J Voice. 2003; 17: 331-342https://doi.org/10.1067/s0892-1997(03)00078-x
        • Alves M
        • Krüger E
        • Pillay B
        • et al.
        The effect of hydration on voice quality in adults: a systematic review.
        J Voice. 2019; 33: 125.e13-125.e28https://doi.org/10.1016/j.jvoice.2017.10.001
        • Fujita R
        • Ferreira AE
        • Sarkovas C.
        Avaliação videoquimográfica da vibração de pregas vocais no pré e pós hidratação.
        Rev Bras Otorrinolaringol. 2004; 70 ([Internet]. 2004 Dec [cited 2020 Oct 13]Available from:): 742-746https://doi.org/10.1590/S0034-72992004000600005
        • Verdolini K
        • Titze IR
        • Fennell A.
        Dependence of phonatory effort on hydration level.
        J Speech Hear Res. 1994; 37: 1001-1007https://doi.org/10.1044/jshr.3705.1001
        • Hemler RJ
        • Wieneke GH
        • Lebacq J
        • et al.
        Laryngeal mucosa elasticity and viscosity in high and low relative air humidity.
        Eur Arch Otorhinolaryngol. 2001; 258: 125-129https://doi.org/10.1007/s004050100321
        • Leydon C
        • Wroblewski M
        • Eichorn N
        • et al.
        A Meta-analysis of outcome of hydration intervention on phonation threshold pressure.
        J Voice. 2010; 24: 637-643https://doi.org/10.1016/j.jvoice.2009.06.001
        • Kavouras SA.
        Assessing hydration status.
        Curr Opin Clin Nutr Metab Care. 2002; 5: 519-524https://doi.org/10.1097/00075197-200209000-00010
        • Baron S
        • Courbebaisse M
        • Lepicard EM
        • et al.
        Assessment of hydration status in a large population.
        Br J Nutr. 2015; 113: 147-158https://doi.org/10.1017/S0007114514003213
        • Mehta DD
        • Hillman RE.
        Current role of stroboscopy in laryngeal imaging.
        Curr Opin Otolaryngol Head Neck Surg. 2012; 20: 429-436https://doi.org/10.1097/MOO.0b013e3283585f04
        • Wittenberg T
        • Tigges M
        • Mergell P
        • et al.
        Functional imaging of vocal fold vibration: digital multislice high-speed kymography.
        J Voice. 2000; 14: 422-442https://doi.org/10.1016/s0892-1997(00)80087-9
        • Deliyski DD
        • Petrushev PP
        • Bonilha HS
        • et al.
        Clinical implementation of laryngeal high-speed videoendoscopy: challenges and evolution.
        Folia Phoniatr Logop. 2008; 60: 33-44https://doi.org/10.1159/000111802
        • Mendelsohn AH
        • Remacle M
        • Courey MS
        • et al.
        The diagnostic role of high-speed vocal fold vibratory imaging.
        J Voice. 2013; 27: 627-631https://doi.org/10.1016/j.jvoice.2013.04.011
        • Deliyski D.
        Laryngeal high-speed videoendoscopy.
        in: Kendall KA Leonard RJ Laryngeal Evaluation: Indirect Laryngoscopy to High-speed Digital Imaging. Thieme Medical Publishers, New York2010: 243-270
        • Svec JG
        • Sram F
        • Schutte HK.
        Videokymography in voice disorders: what to look for?.
        Ann Otol Rhinol Laryngol. 2007; 116: 172-180https://doi.org/10.1177/000348940711600303
        • Jiang JJ
        • Chang CI
        • Raviv JR
        • et al.
        Quantitative study of mucosal wave via videokymography in canine larynges.
        Laryngoscope. 2000; 110: 1567-1573https://doi.org/10.1097/00005537-200009000-00032
        • Woo P.
        Objective measures of laryngeal imaging: what have we learned since Dr. Paul Moore.
        J Voice. 2014; 28: 69-81https://doi.org/10.1016/j.jvoice.2013.02.001
        • Patel RR
        • Pickering J
        • Stemple J
        • et al.
        A case report in changes in phonatory physiology following voice therapy: application of high-speed imaging.
        J Voice. 2012; 26: 734-741https://doi.org/10.1016/j.jvoice.2012.01.001
        • Miri AK
        • Barthelat F
        • Mongeau L.
        Effects of dehydration on the viscoelastic properties of vocal folds in large deformations.
        J Voice. 2012; 26: 688-697https://doi.org/10.1016/j.jvoice.2011.09.003
        • Schwartz SR
        • Cohen SM
        • Dailey SH
        • et al.
        Clinical practice guideline: hoarseness (dysphonia).
        Otolaryngol Head Neck Surg. 2009; 141: S1-S31https://doi.org/10.1016/j.otohns.2009.06.744
        • Cielo CA
        • Schwarz K
        • Finger LS
        • et al.
        Glottal closure in women with no voice complaints or laryngeal disorders.
        Int Arch Otorhinolaryngol. 2019; 23: e384-e388https://doi.org/10.1055/s-0038-1676108
        • Koo TK
        • Li MY.
        A guideline of selecting and reporting intraclass correlation coefficients for reliability research.
        J Chiropr Med. 2016; 15: 155-163https://doi.org/10.1016/j.jcm.2016.02.012
        • Santana ÉR
        • Masson MLV
        • Araújo TM.
        The effect of surface hydration on teachers' voice quality: an intervention study.
        J Voice. 2017; 31: 383.e5-383.e11https://doi.org/10.1016/j.jvoice.2016.08.019
        • Masson MLV
        • de Araújo TM.
        Protective strategies against dysphonia in teachers: preliminary results comparing voice amplification and 0.9% NaCl nebulization.
        J Voice. 2018; 32 (257): e1-257.e10https://doi.org/10.1016/j.jvoice.2017.04.013
        • Nakagawa H
        • Fukuda H
        • Kawaida M
        • et al.
        Lubrication mechanism of the larynx during phonation: an experiment in excised canine larynges.
        Folia Phoniatr Logop. 1998; 50: 183-194https://doi.org/10.1159/000021460
        • Hunter EJ
        • Tanner K
        • Smith ME
        Gender differences affecting vocal health of women in vocally demanding careers.
        Logoped Phoniatr Vocol. 2011; 36: 128-136https://doi.org/10.3109/14015439.2011.587447
        • Korn GP
        • Martins JR
        • Park SW
        • et al.
        Concentration of hyaluronic acid in human vocal folds in young and old subjects.
        Otolaryngol Head Neck Surg. 2011; 145: 981-986https://doi.org/10.1177/0194599811419457
        • Butler JE
        • Hammond TH
        • Gray SD.
        Gender-related differences of hyaluronic acid distribution in the human vocal fold.
        Laryngoscope. 2001; 111: 907-911https://doi.org/10.1097/00005537-200105000-00029
        • Tanner K
        • Fujiki RB
        • Dromey C
        • et al.
        Laryngeal desiccation challenge and nebulized isotonic saline in healthy male singers and nonsingers: effects on acoustic, aerodynamic, and self-perceived effort and dryness measures.
        J Voice. 2016; 30: 670-676https://doi.org/10.1016/j.jvoice.2015.08.016
        • Hamdan AL
        • Sibai A
        • Rameh C.
        Effect of fasting on voice in women.
        J Voice. 2007; 21: 495-501https://doi.org/10.1016/j.jvoice.2006.01.009
        • Hamdan AL
        • Ashkar J
        • Sibai A
        • et al.
        Effect of fasting on voice in males.
        Am J Otolaryngol. 2011; 32: 124-129https://doi.org/10.1016/j.amjoto.2009.12.001
        • Phadke KV
        • Vydrová J
        • Domagalská R
        • et al.
        Evaluation of clinical value of videokymography for diagnosis and treatment of voice disorders.
        Eur Arch Otorhinolaryngol. 2017; 274: 3941-3949https://doi.org/10.1007/s00405-017-4726-1
        • Powell ME
        • Deliyski DD
        • Zeitels SM
        • et al.
        Efficacy of videostroboscopy and high-speed videoendoscopy to obtain functional outcomes from perioperative ratings in patients with vocal fold mass lesions.
        J Voice. 2020; 34: 769-782https://doi.org/10.1016/j.jvoice.2019.03.012