Asia Pacific Journal of Speech, Language and Hearing
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The efficacy of resonance method to
hyperfunctional dysphonia from physiological,
acoustic and aerodynamic aspects: the preliminary
study
Sheng Hwa Chen, Jui-Lin Huang & Wei-Shan Chang
To cite this article: Sheng Hwa Chen, Jui-Lin Huang & Wei-Shan Chang (2003) The efficacy
of resonance method to hyperfunctional dysphonia from physiological, acoustic and
aerodynamic aspects: the preliminary study, Asia Pacific Journal of Speech, Language and
Hearing, 8:3, 200-203
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Published online: 18 Jul 2013.
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Download by: [Orta Dogu Teknik Universitesi] Date: 01 April 2016, At: 19:01
200 Asia Pacific Journal of Speech, Language and Hearing, 8, 200-203 2003
The efficacy of resonance lDethod to
hyperfunctional dysphonia froID physiological,
acoustic and aerodynalDic aspects: the
Downloaded by [Orta Dogu Teknik Universitesi] at 19:01 01 April 2016
preliIninary study
Sheng Hwa Chen1, Jui-Lin Huang2 and Wei-Shan Chang1
JDepartment of Speech and Hearing Disorders and Sciences, National Taipei College of Nursing,
Taipei, Taiwan; 2Department of Otolaryngology, Veterans General Hospital-Taipei, Taipei,Taiwan
Abstract
The purpose of this study is to investigate the treatment efficacy of Resonance Voice
Therapy (RVT) to hyperfunctional dysphonic patients from physiological, acoustic
and aerodynamic aspects. Twenty-one females, age range 23 to 56 years, diagnosed
with hyperfunctional dysphonia in the Veterans General Hospital, Taipei were
equally divided into seven groups. The therapy was provided by a speech pathologist
once a week, for 90 minutes per session, for eight weeks. Laboratory tests of
videostroboscopy, auditory perceptual judgement, acoustic analysis and aerodynamic
analysis were done on all subjects before and after RVT. A paired t-test was used to
analyse test-retest reliability and significance of therapy. After RVT, there is signif-
icant improvement of vocal fold closure, vocal fold vibration and voice quality. A
significant decrease of shimmer and intra-oral pressure, and a significant increase in
speaking frequency range, physiological frequency range and intensity range quantify
subjective improvements. RVT reflects physiological changes in respiratory,
laryngeal and resonant systems. This therapy technique proves to be an effective
treatment method for hyperfunctional voice-disordered patients.
Introduction
Voice therapy is one of the most popular treatment methods for hyperfunctional
dysphonia (Carding et aI., 1999; Casper and Murry, 2000; Mackenzie et aI., 2001).
Many voice therapy techniques have been reported to successfully reduce voice
symptoms (Roy et aI., 1997; Bassiouny, 1998; Verdolini, 1998; Carding et aI., 1999;
Ramig et aI., 2001). However, few of them can maintain adequate vocal function
(Verdolini, 1995; Roy et aI., 1997; Carding et aI., 1999; Ramig et aI., 2001). The
documented treatment efficacy is mostly based on subjective description rather
than quantitative data, which makes it difficult to provide a physiological expla-
nation for vocal changes (Verdolini, 1993; Casper and Murry, 2000). Moreover, the
EFFICACY OF RESONANCE METHODTO DYSPHONIA 201
lack of specific description of voice therapy approaches makes it more difficult to
document the outcome (Aronson, 1990; Boone and McFarlane, 1993; Colton and
Casper, 1996; Pannbacker, 1998). Therefore, specific pathophysiology voice therapy
techniques have been selected to change the disordered physiology for dysphonic
patients in recent years (Kotby, 1995; Ramig et aI., 1995; Verdolini, 1998; Stemple
et aI., 2000; Ramig et aI., 2001).
Resonance Voice Therapy (RVT)is one of the specific pathophysiology voice
therapy techniques modified by resonance method in singing training (Lessac,
1997). This technique is designed to enhance the normal voice by easy phonation
with a frontal focus based on changing phonation physiology. During phonation,
the vocal folds are barely adducted and vocal loudness is increased, manifested in a
high-intensity glottal source spectrum (Verdolini, 1995; Lessac, 1997; Verdolini et
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aI., 1998). This technique was suggested to be sensitive to hyperfunctional
dysphonic patients, and is learnable as well as possible to utilize outside the clinic
(Verdolini-Marston et aI., 1995; Lessac, 1997). Although RVT has been successfully
reported by Verdolini (1993) for laryngeal nodules, the number of research subjects
is only three. Besides, the assessment methods of voice include only three measures:
self-report, auditory-perceptual ratings and stroboscopy. The small sample size and
the lack of objective measures limit the significance of clinical use."If RVT could
produce maximum vocal intensity with minimum efforts, it is important to test on a
larger amount of subjects with objective measures.
Therefore, the purpose of this study is to investigate the treatment efficacy of
Resonance Voice Therapy to hyperfunctional dysphonic patients on a larger
sample size from physiological, acoustic and aerodynamic aspects.
Methods
Twenty-one females, age range 23 to 56 years, diagnosed with hyperfunctional
dysphonia in the Veterans General Hospital, Taipei, were used as research subjects.
Subjects were equally divided into seven groups for Resonance Voice Therapy.
Each group consisted of three subjects. The therapy was provided by a qualified
speech pathologist once a week, for 90 minutes per session, for eight consecutive
weeks.
The hierarchy of the therapy was relaxation, breathing exercise, frontal focus, a
one-syllable word starting with fh/, five-syllable words containing Ihl and Iml,
sentence, reading and conversation. Easy phonation and oral-alveolar vibratory
sensation were emphasized during therapy sessions to get the barely adducted vocal
folds and maximum vocal intensity.
Laboratory tests of videostroboscopy, auditory perceptual judgment, acoustic
analysis and aerodynamic analysis were done on all subjects before and one week
after voice therapy for assessment of vocal fold closure, vocal fold vibration, voice
quality, perturbation, speaking flexibility, physiological phonational range and the
ease of phonation. The first 10 subjects were used for test-retest reliability by the
otolaryngologist and speech pathologists in the study.
Videostroboscopic examination was performed by an otolaryngologist with Kay
RLS 9100 light source and Olympus OTV-SX video camera. Glottic closure, phase
closure, amplitude, mucosal wave, ventricular folds and supraglottic activity were
detected in this measurement. The severity of each parameter was rated on a five-
202 CHEN ET AL
point scale for assessment of vocal fold closure, vocal fold vibration and laryngeal
activity.
One speech pathologist performed auditory perceptual judgement for all
subjects on pitch, loudness, breathiness, roughness, diplophonia, strain, monotone,
resonance, hard attack and glottal fry from live voice of sustained vowel/a/,
counting and conversational speech, by using a seven-point rating scale for
subjective evaluation of voice quality.
Acoustic data of sustained vowel/al and reading passage were recorded using a
professional tape recorder, Nakamichi CR-5. Data of maximum vocal performance
were recorded on a phonetogram, Kay VRP-8000. The Kay 4300 main program was
used to analyse jitter, shimmer, H/N ratio and HI-H2 on vowel/al for perturbation.
The same program was used again to analyse mean speaking Fo, highest and lowest
speaking Fo, maximum range of speaking Fo, mean speaking intensity, highest and
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lowest speaking intensity, and maximum range of speaking intensity on reading
passage for speaking flexibility. The highest and lowest frequency, maximum
dynamic frequency range, loudest and softest voice, and dynamic intensity range in
phonetogram were analysed for physiological phonational range.
Aerodynamic measurement was done on sustained vowel/al and repetition of
Ipipipipipil with the Kay Aerophone II. Airflow rate and intra-oral pressure were
then analysed for laryngeal valving efficiency and phonation effort.
A paired (-test was used to analyse test-retest reliability and clinical significance
of RVT.
Results
The results revealed that test-retest reliability for all laboratory tests was 0.9. After
RVT, most of the videostroboscopic, auditory perceptual judgement, acoustic and
aerodynamic data revealed positive changes. A significant improvement in vocal
fold closure, mucosal wave and amplitude (p < 0.05) was noted in videostroboscopic
e"xaminations. Auditory perceptual judgement data of roughness, breathiness,
diplophonia, vocal strain, monotone, hard attack and glottal fry were significantly
decreased (p < 0.05) after RVT. The descriptive improvement of vocal fold closure,
vocal fold vibration and voice quality was quantified by acoustic and aerodynamic
analysis. In acoustic data, a significant decrease of shimmer value (p < 0.05),
increase of speaking frequency range, maximum dynamic frequency range and
dynamic intensity range (p < 0.05) after therapy were noted. Aerodynamic data on
intra-oral pressure wer~ significantly decreased after therapy (p < 0.05).
Discussion
The significant improvement of voice quality, vocal fold vibration, speaking flexi-
bility, maximum vocal performance and phonation efforts after RVT reflects
physiological changes in respiratory, laryngeal and resonant systems, which support
the rationale of RVT (Verdolini, 1995; Lessac, 1997). This therapy technique
proves to be an effective treatment method for hyperfunctional voice-disordered
patients at a frequency and workload of once-weekly, 90 minutes per session group
therapy for eight weeks. Because RVT improves vocal fold closure for hyperfunc-
tional patients in this study, its rationale for a barely adducted vocal fold may
equally help hypofunctional voice-disordered patients.
EFFICACY OF RESONANCE METHOD TO DYSPHONIA 203
Further research needs at least one-year follow up of these patients to document
long-term effects; a self-rating report to evaluate the functional outcome of commu-
nication disorders is also needed. An increase in sample size in the follow-up study
will add to the power of therapy effects. The efficacy of this method for hypofunc-
tional voice-disordered patients is worthy of study.
References
Aronson AE. Clinical voice disorders. New York: Thieme-Stratton, 1990.
Bassiouny S. Efficacy of the Accent Method of voice therapy. Folia Phoniatrica et Logopaedica 1998; 50:
146-164.
Boone DR, McFarlane SC. A critical view of the yawn-sigh as a voice therapy technique. J Voice 1993; 7:
75-80.
Carding PN, Horsley lA, Docherty GJ. A study of the effectiveness of voice therapy in the treatment of 45
patients with nonorganic dysphona. J Voice 1999; 12(1): 72-104.
Downloaded by [Orta Dogu Teknik Universitesi] at 19:01 01 April 2016
Casper JK, Murry T. Voice therapy methods in dysphonia. Otolaryngologic Clinics of North America
2000;33(5):983-1002.
Colton RH, Casper JK. Understanding voice problems: a physiological perspective for diagnosis and
treatment. Baltimore, Williams & Wilkins, 1996: 303-304.
Kotby MN. The Accent Method of voice therapy. San Diego: Singular Publishing Group, 1995.
Lessac A. The use and training of the human voice: a biodynamic approach to vocal life. Mountain View,
CA: Mayfield Publishing, 1997.
Mackenzie K, Millar A, Wilson JA, Sellars C, Deary IJ. Is voice therapy an effective treatment for
dysphonia? A randomized controlled trial. BMJ 2001; 323(22): 658-661.
Pannbacker M. Voice treatment techniques: a review and recommendations for outcome studies. Am J
Speech-Language Pathology 1998; 7: 49-64.
Ramig LO, Sapir S, Fox C, Countryman S. Changes in vocal loudness following intensive voice treatment
(LSVT) in individuals with Parkinson's disease: a comparison with untreated patients and normal age-
matched controls. J Movement Disorder Society 2001; 16(1): 79-83.
Ramig LO, Pawlas AA, Countryman S. The Lee Silverman Voice Treatment: a practical guide for treating
the voice and speech disorders in Parkinson's disease. Iowa City: National Center for Voice and
Speech, 1995.
Roy N, Bless DM, Heisey D, Ford CN. Manual circumlaryngeal therapy for functional dysphonia: an
evaluation of short- and long-term treatment outcomes. J Voice 1997; 11(3): 321-331.
Stemple JC, Glaze LE, Klaben BG. Clinical voice pathology: theory and management, 3rd edn. San
Diego, CA: Singular Publishing Group, Thomas Learning, 2000: 331-340.
Verdolini K. Voice therapy and its effectiveness: overview of newsletter and special challenges in formal
research. Am Speech-Lang-Hearing Special Interest Divisions Newsletter: Voice and Voice Disorders
1993; 3: 1-4.
Verdolini K. Resonant voice therapy. In: Verdolini K (Ed) National Center for Voice and Speech's guide
to vocology. Iowa City: National Center for Voice and Speech, 1998: 34-35.
Verdolini K, Drucker D, Palmer P, Samawi H. Laryngeal adduction in resonant voice. J Voice 1998;
12: 315-327.
Verdolini-Marston K, Burke MK, Lessac A, et al. A preliminary study on two methods of treatment for
laryngeal nodules. J Voice 1995; 9: 74-85.
