Efeito do estímulo de vibração mecânica na laringe nos parâmetros perceptivo-auditivos, acústicos e laríngeos
Data
2023
Autores
Nascimento, Anderson 
Orientadores
Azevedo, Renata Rangel
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: avaliar os efeitos do estímulo de vibração mecânica (aparelho G-Life NL 3000) aplicado na região da laringe, concomitante à execução do som nasal, imediatamente após uma sessão de intervenção em indivíduos vocalmente saudáveis. Métodos: participaram 62 sujeitos de ambos os sexos, entre 18 e 45 anos, que não apresentavam disfonias ou diagnóstico de alterações laríngeas. Os sujeitos foram divididos em dois grupos: Grupo Experimental (GE), que realizou os exercícios de som nasal associado ao estímulo vibratório por 6 minutos; e Grupo Controle (GC), que realizou somente o protocolo de exercícios de som nasal por 6 minutos. A vibração mecânica foi transmitida por um dispositivo portátil – marca G-Life modelo NL3000 (frequência em torno de 120 Hz e amplitude de deslocamento em cerca de 1mm) – encostado externamente sobre o pescoço, na região da ala direita e esquerda da cartilagem tireóidea da laringe. Todos os sujeitos participantes foram submetidos à avaliação laríngea, perceptivo-auditiva e acústica pré e pós-aplicação do protocolo de intervenção descrito. Em ambos os momentos foram utilizados para avaliação: 1) a avaliação perceptivo-auditiva – GRBASI; 2) o tempo máximo fonatório (TMF); 3) a extensão vocal em Hz; 4) a extração dos parâmetros acústicos: frequência fundamental, jitter, shimmer, harmonic to noise ratio (HNR) e noise to harmonic ratio (NHR); 5) as imagens dos espectrogramas para análise perceptivo visual; e 6) a gravação dos vídeos de exame de telelaringoscopia com estroboscopia. Para análise estatística, o valor de significância foi p-valor < 0,05. Resultados: Na avaliação perceptivo-auditiva – GRBASI – não houve diferença significativa entre os grupos (p-valor 0,183). O tempo máximo fonátorio apresentou aumento significativo para ambos os sexos (homens: p-valor 0,000 e mulheres: p-valor 0,008) do GE. A extensão vocal amplia significativamente para o GE nos homens (p-valor: 0,000) e nas mulheres (p-valor:0,000). Nos parâmetros acústicos, observa-se redução significativa em jitter (homens p-valor 0,000 e mulheres p-valor 0,000) e shimmer (homens p-valor 0,000 e mulheres p-valor 0,000) em ambos os sexos do GE. Nota-se, também, aumento de F0 para os homens de ambos os grupos (GE p-valor 0,000 e GC p-valor 0,033). Embora se observe vantagem para o GE na avaliação dos espectrogramas, não foi significativa (p-valor 0,093). A avaliação dos vídeos dos exames de laringe evidenciou uma diferença estatisticamente significativa de melhoria para o grupo experimental nos parâmetros de amplitude de onda de mucosa e coaptação glótica (p-valor: 0.002). Conclusões: os efeitos imediatos do estímulo de vibração mecânica associados aos exercícios vocais de som nasal foram capazes de melhorar a flexibilidade e a qualidade da produção vocal, aumentando o tempo fonatório, a extensão vocal, reduzindo as irregularidades dos ciclos glóticos e melhorando os parâmetros laríngeos de amplitude de onda de mucosa e fechamento glótico.
Objectives: to evaluate the effects of the mechanical vibration stimulus (G-Life NL 3000 device) applied in the larynx region, concomitantly with the execution of the nasal sound, immediately after an intervention session in vocally healthy individuals. Methods: Methods: 62 subjects of both sexes, between 18 and 45 years old, who did not present dysphonia or diagnosis of laryngeal alterations, participated. The subjects were divided into two groups: Experimental Group (EG), which performed nasal sound exercises associated with vibratory stimulus for 6 minutes; and the Control Group (CG), which performed only the nasal sound exercise protocol for 6 minutes. The mechanical vibration was transmitted by a portable device – brand G-Life model NL3000 (frequency around 120 Hz and amplitude of displacement around 1mm) – placed externally on the neck, in the region of the right and left wing of the thyroid cartilage of the larynx. All participating subjects were submitted to laryngeal, auditory-perceptual and acoustic evaluation before and after application of the described intervention protocol. In both moments, the following were used for evaluation: 1) the auditory-perceptual evaluation – GRBASI; 2) the maximum phonation time (MPT); 3) vocal range in Hz; 4) extraction of acoustic parameters: fundamental frequency, jitter, shimmer, harmonic to noise ratio (HNR) and noise to harmonic ratio (NHR); 5) spectrogram images for visual perceptual analysis; and 6) video recording of telelaryngoscopy with stroboscopy. For statistical analysis, the significance value was p-value < 0.05. Results: In the auditory-perceptual assessment – GRBASI – there was no significant difference between groups (p-value 0.183). The maximum phonation time showed a significant increase for both sexes (men: p-value 0.000 and women: p-value 0.008) of the EG. Vocal range significantly increases for EG in men (p-value: 0.000) and in women (p-value: 0.000). In the acoustic parameters, there is a significant reduction in jitter (men p-value 0.000 and women p-value 0.000) and shimmer (men p-value 0.000 and women p-value 0.000) in both genders of the EG. There is also an increase in F0 for men in both groups (EG p-value 0.000 and GC p-value 0.033). Although there is an advantage for the EG in the evaluation of the spectrograms, it was not significant (p-value 0.093). The evaluation of the videos of the laryngeal exams showed a statistically significant difference in improvement for the experimental group in the parameters of mucosal wave amplitude and glottic coaptation (p-value: 0.002). Conclusions: the immediate effects of the mechanical vibration stimulus associated with nasal sound vocal exercises were able to improve the flexibility and quality of vocal production, increasing phonation time, vocal range, reducing glottic cycle irregularities and improving laryngeal parameters of mucosal wave amplitude and glottic closure.
Objectives: to evaluate the effects of the mechanical vibration stimulus (G-Life NL 3000 device) applied in the larynx region, concomitantly with the execution of the nasal sound, immediately after an intervention session in vocally healthy individuals. Methods: Methods: 62 subjects of both sexes, between 18 and 45 years old, who did not present dysphonia or diagnosis of laryngeal alterations, participated. The subjects were divided into two groups: Experimental Group (EG), which performed nasal sound exercises associated with vibratory stimulus for 6 minutes; and the Control Group (CG), which performed only the nasal sound exercise protocol for 6 minutes. The mechanical vibration was transmitted by a portable device – brand G-Life model NL3000 (frequency around 120 Hz and amplitude of displacement around 1mm) – placed externally on the neck, in the region of the right and left wing of the thyroid cartilage of the larynx. All participating subjects were submitted to laryngeal, auditory-perceptual and acoustic evaluation before and after application of the described intervention protocol. In both moments, the following were used for evaluation: 1) the auditory-perceptual evaluation – GRBASI; 2) the maximum phonation time (MPT); 3) vocal range in Hz; 4) extraction of acoustic parameters: fundamental frequency, jitter, shimmer, harmonic to noise ratio (HNR) and noise to harmonic ratio (NHR); 5) spectrogram images for visual perceptual analysis; and 6) video recording of telelaryngoscopy with stroboscopy. For statistical analysis, the significance value was p-value < 0.05. Results: In the auditory-perceptual assessment – GRBASI – there was no significant difference between groups (p-value 0.183). The maximum phonation time showed a significant increase for both sexes (men: p-value 0.000 and women: p-value 0.008) of the EG. Vocal range significantly increases for EG in men (p-value: 0.000) and in women (p-value: 0.000). In the acoustic parameters, there is a significant reduction in jitter (men p-value 0.000 and women p-value 0.000) and shimmer (men p-value 0.000 and women p-value 0.000) in both genders of the EG. There is also an increase in F0 for men in both groups (EG p-value 0.000 and GC p-value 0.033). Although there is an advantage for the EG in the evaluation of the spectrograms, it was not significant (p-value 0.093). The evaluation of the videos of the laryngeal exams showed a statistically significant difference in improvement for the experimental group in the parameters of mucosal wave amplitude and glottic coaptation (p-value: 0.002). Conclusions: the immediate effects of the mechanical vibration stimulus associated with nasal sound vocal exercises were able to improve the flexibility and quality of vocal production, increasing phonation time, vocal range, reducing glottic cycle irregularities and improving laryngeal parameters of mucosal wave amplitude and glottic closure.