ABSTRACT
OBJECTIVE: To map the volitional and non-volitional devices used by speech and language pathologists (SLPs) in voice training and therapy and characterize their use in research on voice interventions. METHODS: This scoping review is the first part of a larger study. The electronic search was carried out by mapping the references in PubMed/Medline, LILACS/BVS, Scopus, Web of Science, EMBASE, and the Cochrane Library, and the manual search was carried out in the grey literature. Two blind independent reviewers selected and extracted data; divergences were solved by consensus. The data extracted in this part of the study were the authorship and year of publication, country, study design, sample characteristics, intervention modality, ingredient, target, mechanism of action, dosage, and outcome measures. They were addressed with descriptive analysis. RESULTS: Publications that use devices as ingredients are mostly from the last two decades, mainly carried out in the United States of America and Brazil, in adults of both sexes with behavioral dysphonia. Forty-two types of devices were used, many of them with similar approaches but different nomenclatures. Most devices were used voluntarily, focusing on vocal function, and aiming to increase source and filter interaction. Most studies used silicone tubes. The most reported technical specification to apply the ingredient was surface electrodes on the neck. Device dosage was time-controlled, and the most used outcomes were self-assessment and acoustic analysis. CONCLUSION: Devices are currently used as ingredients in vocal interventions, with a greater focus on increasing the source and filter interaction, associated with silicone tubes (the most used devices in these studies), which have been dosed with performance time. Outcomes were measured with self-assessment instruments.
ABSTRACT
OBJECTIVE: Evaluate vocal quality in patients with OSA before and after continuous use of CPAP with a humidifier using subjective patient perception and clinical assessment. The hypothesis was that CPAP treatment with a humidifier would benefit voice quality. STUDY DESIGN: Randomized, sham-controlled, blinded clinical trial. METHODS: Forty-three natal males with obstructive sleep apnea for whom CPAP treatment was recommended following polysomnography were randomized into two therapy groups: CPAP and Sham-CPAP. Participants completed questionnaires on voice use, a voice self-assessment with the ten-item vocal handicap index (VHI-10), and complementary questionnaires: the Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), reflux symptoms index (LPRSI) and oral dryness visual analog scale (DRY). Their voices were recorded at three different times: before CPAP therapy, and after 3 and 6 months of continuous CPAP use. The acoustic voice quality index (AVQI), and an auditory-perceptual judgment (APJ) were also applied before and after the CPAP and Sham treatments. RESULTS: After 6 months of treatment, the CPAP group presented improvements in their sleep patterns; however, no statistically significant differences were observed between the groups in respect of the results of the voice-related questionnaires, the AVQI values, and the APJ of the voice quality. All of the participants had some degree of vocal deviation at baseline. CONCLUSIONS: CPAP therapy with a humidifier did not improve vocal quality as evaluated by the clinician or patient self-assessment. However, it did not have any significant negative effects on voice quality, so can be considered safe to use in male OSA patients.
ABSTRACT
The terminology and classification of voice disorders are complex topics. For this reason, developing a consensus in the scientific community regarding such a topic would bring a wide range of benefits to this field of study. The study is originally divided into parts A and B, and part A explored general propositions of voice disorder classification systems. Now, Part B of this study explores the classification of voice disorders in specific conditions and diagnoses. A scoping review was performed after an electronic and manual search, resulting in the inclusion of 20 studies in Part B. The articles were published between 1993 and 2020, most of which originated from the United States. The specific conditions covered by the studies were muscle tension dysphonia (MTD), spasmodic dysphonia, dystonias, and psychogenic voice disorders, among others. The terminology used to refer to these conditions, especially when hyper-functional aspects of the larynx are involved also varied. Six studies proposed classification systems, while another 14 studies discussed classifications and/or stressed the need for additional studies regarding laryngeal conditions such as these. Among the studies that proposed classification methods, the number of groups varied between two and six, with MTD being the most studied condition. In conclusion, recent studies seek to reduce the number of classifying categories in voice disorders, despite understanding the specificity of wide-ranging clinical profiles. Disorder etiology is the foundation for these proposals. In Part B of this study, specific diagnoses of voice and laryngeal conditions are shown to be classified with a descriptive and visual approach, such as an examination of the larynx. Technological evolution can improve voice and laryngeal semiotics and lead to more automated classification of voice disorders.
