Disfonía por tensión muscular: concepto y criterios diagnósticos. Artículo de revisión

Introducción. La disfonía por tensión muscular fue definida, desde 1983, como un desorden que ocasiona un desbalance en las fuerzas de tensión muscular laríngea sin evidencia de patología estructural o neurológica. Denominado también disfonía por tensión muscular, tipo 1, este desorden aún no tiene estandarizadas las características que en la práctica han sido consideradas parte de su diagnóstico. Objetivo. Revisar la información actual, no mayor a cinco años, sobre disfonía por tensión muscular para unificar criterios y diagnósticos actuales. Metodología. Se realizó una búsqueda sistemática a través de las bases de datos PubMed, Google Scholar y Cochrane. Los términos MESH utilizados fueron: disfonía por tensión muscular, disfonía funcional, disfonía hipercinética y fatiga vocal. Criterios de inclusión: artículos publicados en revistas arbitradas, sin importancia del diseño y antigüedad no mayor a cinco años. Criterios de exclusión: artículos cuyo enfoque principal no fuera disfonía por tensión muscular y con idioma diferente al inglés o español. Resultados. Dos estudios refieren mayor patología en mujeres que hombres; cuatro investigaciones reportan presión subglótica aumentada (>90 mmHg); tres trabajos reportaron medidas fonatorias; un trabajo propone video de alta resolución como demostración de hiperfunción vocal; una investigación evaluó onda mucosa por electroglotografía; una investigación estudió el uso de resonancia magnética funcional; otro trabajo propuso un estudio piloto de evaluación de flujo sanguíneo de músculos infrahioideos. Otro trabajo hace una revisión del uso de métodos diagnósticos. Conclusiones. Los parámetros de mayor peso fueron pico cepstral y presión subglótica. Aún es necesario ampliar el conocimiento con nuevas investigaciones que permitan criterios universales.

Can a natural singing voice be enhanced through digital processing? Implications of voice training and vocology in singers

Introduction. The traditional way of facilitating a good singing voice has been achieved through rigorous voice training. In the modern days, however, there are some aspects of the singing voice that can be enhanced through digital processing. Although in the past, the frequency or intensity manipulations had to be achieved through the various singing techniques of the singer, technology today allows the singing voice to be enhanced from the instruments within recording studios. In essence, the traditional voice pedagogy and the evolution of digital audio processing both strive to achieve a better quality of the singing voice, but with different methods. Nevertheless, the major aspects of how the singing voice can be manipulated are not communicated among the professionals in each field. Objective. This paper offers insights as to how the quality of the singing voice can be changed physiologically through the traditional ways of voice training, and also digitally through various instruments that are now available in recording studios. Reflection. The ways in which singers train their voice must be mediated with the audio technology that is available today. Although there are aspects in which the digital technology can aid the singer’s voice, there remain areas in which the singers must train their singing system in a physiological level to produce a better singing voice.

Pansori today: aesthetic demands vs. vocal health

Introduction: Pansori is a traditional Korean dramatic art form, which likely appeared in the mid-eighteenth century in the southern region of Korea. In pansori, there is a strong inclination toward preserving tradition, especially in regard to training, which is generally considered particularly demanding in terms of risks to vocal health. Nevertheless —as highlighted by recent studies— some innovations took place in pansori characteristics and performances in the last few decades. Objective: We hypothesize that these innovations have impacted the attitudes of singers and teachers towards pansori training and vocal health issues and that a new approach to voice training in pansori might be recommended. Method: Starting with recent evolutions of pansori and considering previous studies, we discuss how these changes might produce innovations —or at least a demand for innovation— in pansori’s training. We also try to capture the viewpoint of pansori students and performers, through an anonymous survey. Results: Although further investigation is required, the results suggest that a new approach in teaching pansori is emerging and it is increasingly requested by the trainee performers, despite some criticisms from traditionalists. Conclusion: Unlike previously thought, perhaps a more scientific and health-conscious approach to pansori voice training will be something from which many pansori singers can benefit.

Vocal Pedagogy and the Alexander Technique: a reflection

This article is a reflection about the role of the Alexander Technique and its application and influence in vocal pedagogy. It is based on more than seventeen years of active teaching as a qualified Alexander Technique Teacher and as a professional singer, working alongside vocal pedagogues, teachers, students and professionals. Its objective is to reflect upon the role of body awareness, psychophysical and emotional consciousness, and wellbeing in the realms of vocal pedagogy and singing.

Dictamen médico legal de un análisis de voz, ¿cómo hacerlo?

La acústica forense es una disciplina de la criminalística que ha alcanzado una madurez analítica que obliga a que el perito en análisis de voz se especialice en adquirir conocimientos en fonética, tecnologías de sonido, habla, voz, lenguaje, patologías del habla y la voz, así como procesamiento de la señal sonora. Cuando un dictamen deba ser realizado por un profesional de la salud completamente ajeno a la técnica legal, se tropieza con una falta de protocolos, métodos y procedimientos de trabajo que le permitan entregar un informe técnico, válido y validado para la realización de una entrevista y su posterior análisis comparativo de voces, lo que promueve la necesidad de elaborar una ruta o guía metodológica a través de medios académicos físicos o electrónicos para el desarrollo de este conocimiento y su difusión profesional y científica.

Impacto en la calidad de vida del tratamiento de disfonía espasmódica aductora con toxina botulínica A

Introducción. La distonía laríngea o disfonía espasmódica se caracteriza por contracciones involuntarias de los músculos laríngeos internos que se desencadenan al hablar, siendo la forma aductora la más frecuente. La inyección de toxina botulínica es el manejo de elección. Para evaluar la respuesta a la terapia existen varios instrumentos validados, uno de ellos es el cuestionario Voice Handicap Index-10 (VHI-10). El objetivo de este estudio es caracterizar a los pacientes con disfonía espasmódica aductora y evaluar el impacto de la toxina en su calidad de vida. Método. Éste se centró en un estudio retrospectivo descriptivo en pacientes adultos con diagnóstico de disfonía espasmódica aductora tratados con toxina botulínica A, en el Hospital Clínico Universidad de Chile (HCUC), en el periodo comprendido entre 2013 y 2021. El mismo permitió la obtención de los datos epidemiológicos de los pacientes, a quienes se les solicitó responder la encuesta VHI-10 previo y posterior a un mes de cada inyección de la toxina. Resultados. Se incluyeron 55 pacientes (218 procedimientos). La dosis promedio utilizada fue de 9,18 UI con un intervalo promedio de 7,4 meses. El puntaje VHI-10 promedio en la evaluación inicial fue de 29,4 y posinfiltración de 14,96, siendo esta diferencia significativa (p < 0,000001). En nuestra serie casi un tercio tiene asociada alguna patología neurológica, y se reportó un 3,67% de complicaciones leves y transitorias. Conclusión. La disfonía espasmódica aductora tiene un gran impacto en la calidad de vida de los pacientes, que se reduce significativamente mediante la inyección de toxina botulínica A, procedimiento que ha demostrado ser seguro y eficaz.

Singing Voice Therapy Revisited

Introduction. Singing is a type of sportive activity and, like sports medicine, professional voice medicine is interested in the habilitation and rehabilitation of the vocal performer. The vocal needs of the professional vocal performer may not be similar to other professional or non-professional voice users. Like a professional athlete, a vocal performer’s ability to perform for many decades at a high level will be enhanced by basing artistic and lifestyle decisions on a scientifically sound foundation. Objective. The aim of this study is to present a multidimensional introduction to the methods of SVT, incorporating the principles of sport and exercise medicine, and physical therapy and rehabilitation. Reflection. Singing voice therapy needs to provide answers to “what”, “why”, “how”, and “when” questions. SVT must first correctly identify the problem, leading to the “how to do” solutions for a wide variety of cases, followed by a schedule of prescribed activities including answers to the “why” question (which exercise relates to which muscle). The periodization and motor learning principles provide a temporal answer to the “when” question when developing habilitation and/or rehabilitative protocols. Conclusion. Singing is not only an artistic expression, but also a sportive performance. The clinical approach to professional voice is a multidimensional and multi-layered team effort. All practices are structured by blending scientific and pedagogical knowledge.

Auditory-vocal integration impairment: New challenges and opportunities for voice assessment and therapy

This reflection paper addresses the importance of the interaction between voice perception and voice production, emphasizing the processes of auditory-vocal integration that are not yet widely reported in the context of voice clinicians. Given the above, this article seeks to 1) highlight the important link between voice production and voice perception and 2) consider whether this relationship might be exploited clinically for diagnostic purposes and therapeutic benefit. Existing theories on speech production and its interaction with auditory perception provide context for discussing why the evaluation of auditory-vocal processes could help identify associated origins of dysphonia and inform the clinician around appropriate management strategies. Incorporating auditory-vocal integration assessment through sensorimotor adaptation paradigm testing could prove to be an important addition to voice assessment protocols at the clinical level. Further, if future studies can specify the means to manipulate and enhance a person’s auditory-vocal integration, the efficiency of voice therapy could be increased, leading to improved quality of life for people with voice disorders.

What is vocology?

In its broadest definition, Vocology is the study of vocalization, much like audiology is the study of hearing. Vocology includes the exploration of the full capability of human and animal sound production, some of which is embedded in human speech. For professional practice, a secondary definition of Vocology is the science and practice of voice habilitation, concept that has been in existence for more than two decades. The emphasis is on habilitation rather than re-habilitation, so that the field does not infringe on speech-language pathology. Besides, it does include the important area of animal vocalization.

Vocal tract physiology and its MRI evaluation

Introduction. The rapid technological evolution in Magnetic Resonance Imaging (MRI) has recently offered a great opportunity for the analysis of voice production. Objectives. This article is aimed to describe main physiological principles at the base of voice production (in particular of vocal tract), and an overview about literature on MRI of the vocal tract. This is presented in order to analyze both present results and future perspectives. Method. A narrative review was performed by searching the MeSH terms “vocal tract” and “MRI” in PubMed database. Then, the obtained studies were subsequently selected by relevancy. Results. Main fields described in literature concern technical feasibility and optimization of MRI sequences, modifications of vocal tract in vowel or articulatory phonetics, modifications of vocal tract in singing, 3D reproduction of vocal tract and segmentation, and describing vocal tract in pathological conditions. Conclusions. MRI is potentially the best method to study the vocal tract physiology during voice production. Most recent studies have achieved good results in representation of changes in the vocal tract during emission of vowels and singing. Further developments in MR technique are necessary to allow an equally detailed study of faster movements that participate in the articulation of speaking, which will allow fascinating perspectives in clinical use.