title: The relationship between tongue trill performance duration and vocal changes in dysphonic women.
abstract: OBJECTIVE
  To assess the relationship between tongue trill performance duration and auditory perception and acoustic changes in dysphonic women.
  
  
  METHODS
  Prospective clinical study, with intrasubject comparison.
  
  
  METHODS
  Twenty-seven women who had vocal nodules were in the experimental group (EG) (tongue trills), and 10 were also in the control group (CG) (placebo exercises). The voices were recorded before and after experimental and placebo exercises at the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of performance. These recordings were randomized, and the auditory perception analysis was carried out by three judges trained in voice analysis. Individual recordings were analyzed using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol, the randomized pairs of recordings were compared, and the better voice was chosen. VoxMetria software (CTS, Parana, Brazil, www.ctsinformatica.com.br) was used to assess the acoustic.
  
  
  RESULTS
  In the EG, the CAPE-V results showed a predominance of vocal improvement, statistically proven, at m5 of tongue trill exercise, with the best overall rating, the least roughness and breathiness, and increase in pitch level. At m7, strain was significantly higher. In the paired comparison analysis, voices at m5 were considered the best of all moments. There was an increase of the F(0) and glottal-to-noise excitation after m3 and a decrease in noise as in m1. In the CG, vocal changes were discrete compared with those in the EG.
  
  
  CONCLUSIONS
  Tongue trill performance duration interfered with the vocal response of dysphonic women, with positive response predominance at m5. At m7, there was an increase of vocal tension and a drop in vocal quality.
authors.affiliation: Department of Otolaryngology, The University of São Paulo School of Medicine, São Paulo, Brazil. mmmenezes@uol.com.br
authors.forename: Marcia H M
authors.initials: MH
authors.lastname: Menezes
authors.forename: Maysa T
authors.initials: MT
authors.lastname: Ubrig-Zancanella
authors.forename: Maria Gabriela B
authors.initials: MG
authors.lastname: Cunha
authors.forename: Gislaine F
authors.initials: GF
authors.lastname: Cordeiro
authors.forename: Kátia
authors.initials: K
authors.lastname: Nemr
authors.forename: Domingos H
authors.initials: DH
authors.lastname: Tsuji
mesh_terms: D000293:Adolescent; D000328:Adult; D001307:Auditory Perception; D055154:Dysphonia / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013061:Speech Acoustics; D013997:Time Factors; D014059:Tongue / Q000502:physiology*; D016896:Treatment Outcome; D014833:Voice Quality; D055815:Young Adult