Analysis of the immediate effect of the high-frequency oral oscillation exercise on individuals with and without vocal symptoms

Dantas, Miriã Isabela dos Santos; Gama, Ana Cristina Côrtes; Nogueira, Lorena Luiza Costa Rosa; Furlan, Renata Maria Moreira Moraes

doi:10.1590/2317-1782/e20240056pt

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Original Article • CoDAS 37 (2) • 2025 • https://doi.org/10.1590/2317-1782/e20240056en linkcopy

Analysis of the immediate effect of the high-frequency oral oscillation exercise on individuals with and without vocal symptoms

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose to verify the immediate effects of high-frequency oral oscillation using the Classic Shaker®, on acoustic, perceptual-auditory and vocal self-perception measures, in adults with and without vocal complaints.

Methods 50 individuals were allocated into four groups - men with vocal symptoms, men without vocal symptoms, women with vocal symptoms and women without vocal symptoms. The participants completed the Vocal Symptoms Scale, the self-assessment of vocal discomfort, and were subjected to voice recording before and after performing the tested exercise, which consisted of blowing the Shaker® - Classic model - mouthpiece, while emitting the vowel U, for three minutes. The recordings were submitted to acoustic analysis and perceptual-auditory analysis. Paired T-test and Wilcoxon test were used, significance level of 5%.

Results after the exercise, there was a decrease in jitter in the groups of men with symptoms and in shimmer in men without symptoms. Women with symptoms showed an increase in fundamental frequency, harmonic-to-noise ratio, CPP, and CPPS values and a decrease in jitter; women without symptoms showed an increase in GNE. The perceptual-auditory evaluation did not indicate changes after carrying out the exercise. A reduction in vocal discomfort was observed in all groups after the exercise.

Conclusion The high-frequency oral oscillation exercise using the Shaker® was able to promote improvements in acoustic parameters and a reduction in self-reported vocal discomfort in the four groups evaluated.

Keywords:
Voice; Vocal Quality; Speech Acoustics; Voice Training; Speech, Language and Hearing Sciences

Variable	Pre-exercise								Post-exercise							p-value	1-β	Effect size
Variable	Mean	SD	Median	1º quartile		3º quartile	Minimum	Maximum	Mean	SD	Median	1º quartile	3º quartile	Minimum	Maximum	p-value	1-β	Effect size
Fundamental Frequency (Hz)	108.62	16.57	113.22	99.77	118.20		70.72	130.08	117.75	12.43	116.29	110.07	126.09	96.64	134.68	0.232^(A)	0.827	-
Noise (dB)	1.68	0.79	1.61	1.17	1.79		0.53	3.54	1.38	0.65	1.34	1.00	1.84	0.45	2.52	0.106^(A)	0.415	-
GNE (dB)	0.73	0.21	0.67	0.66	0.78		0.44	1.26	0.72	0.16	0.73	0.61	0.81	0.45	0.95	0.667^(A)	0.672	-
HNR (dB)	7.89	4.83	8.52	6.21	10.82		1.04	16.31	8.54	5.66	9.91	2.45	11.27	0.52	17.6	0.711^(A)	0.736	-
Jitter (%)	5.52	10.13	1.92	1.26	3.87		0.26	38.15	4.08	7.28	2.26	0.53	3.67	0.25	27.72	0.048*^(A)	-	0.159
Shimmer (%)	33.0	26.19	23.75	19.41	36.49		12.64	114.10	20.75	9.15	23.25	11.37	24.55	6.73	36.23	0.507^(B)	0.889	-
CPP vowel	23.18	3.38	23.56	21.35	24.97		17.35	28.13	24.83	3.11	24.94	23.08	27.52	19.56	29.49	0.055^(A)	0.409	-
CPP count	19.64	1.20	19.41	19.15	20.55		17.41	21.71	19.78	1.16	19.99	18.79	20.49	17.90	21.82	0.734^(A)	0.756	-
CPPS vowel	12.12	2.55	12.74	11.22	14.09		7.26	15.94	13.45	2.56	12.95	11.75	15.83	8.91	17.47	0.061⁽A⁾	0.447	-
CPPS count	10.49	1.41	10.69	10.18	11.27		6.6	12.21	10.39	1.29	10.42	9.66	11.52	8.15	11.94	0.713^(A)	0.723	-
Vocal discomfort self-perception	2.38	2.14	2.0	0	4.0		0	6.0	0.61	0.77	0	0	1.0	0	2.0	0.009*(B⁾	-	0.943

Variable	Pre-exercise							Post-exercise							p-value	1-β	Effect size
Variable	Mean	SD	Median	1º quartile	3º quartile	Minimum	Maximum	Mean	SD	Median	1º quartile	3º quartile	Minimum	Maximum	p-value	1-β	Effect size
Fundamental Frequency (Hz)	104.97	39.23	116.44	103.42	122.40	77.40	162.11	102.79	42.17	108.2	97.92	123.71	72.01	177.12	0.820^(A)	0.823	-
Noise (dB)	1.61	0.77	1.88	0.69	2.22	0.55	2.49	1.51	0.90	1.21	‘0.67	2.31	0.48	2.92	0.666^(B)	0.690	-
GNE (dB)	0.64	0.17	0.59	0.50	0.72	0.46	0.92	0.69	0.22	0.76	0.50	0.89	0.35	0.94	0.388^(B)	0.532	-
HNR (dB)	12.13	8.11	10.97	8.43	18.17	3.70	26.49	12.60	7.09	11.78	10.49	16.50	0.63	23.56	0.811^(A)	0.815	-
Jitter (%)	3.19	3.80	1.33	0.70	4.3	0.34	9.84	3.02	4.16	1.00	0.59	3.43	0.2	14.38	0.290^(B)	0.295	-
Shimmer (%)	24.58	13.79	20.98	15.71	35.97	3.22	47.27	17.91	10.33	16.33	11.32	20.68	5.05	39.53	0.042*^(A)	-	0.537
CPP vowel	24.31	4.47	24.04	21.35	27.25	17.47	31.43	25.37	4.29	25.84	21.23	28.83	18.65	30.83	0.148^(A)	0.271	-
CPP count	20.0	1.60	20.36	19.01	21.21	17.10	21.92	19.86	1.27	20.04	19.36	20.61	17.55	21.58	0.695^(A)	0.710	-
CPPS vowel	13.11	3.59	12.68	10.60	15.66	7.01	18.81	14.08	3.57	14.43	10.53	17.40	8.55	18.59	0.078⁽A⁾	0.191	-
CPPS count	10.29	1.32	10.40	10.11	11.19	6.97	11.81	10.25	1.31	10.51	9.70	10.91	6.76	11.70	0.814^(B)	0.815	-
Vocal discomfort self-perception	1.17	1.19	1.0	0	2.0	0	3.0	0.25	0.45	0	0	0.25	0	1	0.022*(B⁾	-	0.884

Variable	Pre-exercise							Post-exercise							p-value	1-β	Effect size
Variable	Mean	SD	Median	1º quartile	3º quartile	Minimum	Maximum	Mean	SD	Median	1º quartile	3º quartile	Minimum	Maximum	p-value	1-β	Effect size
Fundamental Frequency (Hz)	196.51	27.16	205.94	179.58	212.67	130.37	239.88	207.97	23.93	204.72	200.14	219.72	158.24	253.04	0.010*^(A)	-	0.446
Noise (dB)	1.28	0.65	1.06	0.82	1.78	0.39	2.59	1.09	0.57	1.09	0.56	1.30	0.41	2.08	0.080^(A)	0.242	-
GNE (dB)	0.75	0.16	0.80	0.63	0.86	0.43	0.96	0.79	0.14	0.79	0.74	0.92	0.55	0.96	0.089^(A)	0.216	-
HNR (dB)	9.67	7.54	7.47	5.21	13.45	0.66	28.19	12.67	7.01	11.78	6.37	15.02	5.54	27.93	0.011*^(A)	-	0.411
Jitter (%)	3.59	4.24	2.11	0.73	5.12	0.19	14.12	1.80	2.73	1.51	0.19	2.06	0.08	10.36	0.014*^(B)	-	0.480
Shimmer (%)	16.60	12.66	12.43	9.05	16.1	2.1	49.05	10.59	6.93	8.82	5.78	13.00	2.56	24.86	0.184^(B)	0.700	-
CPP vowel	23.56	2.29	23.26	21.85	24.75	21.01	28.53	24.36	2.35	23.47	22.90	26.49	20.89	28.22	0.002*^(B)	-	0.345
CPP count	19.19	1.45	19.45	18.23	19.88	16.71	21.94	19.40	0.85	19.41	19.13	19.95	17.79	20.79	0.616^(A)	0.674	-
CPPS vowel	12.81	2.47	12.09	11.47	14.4	9.47	17.84	13.63	2.39	12.92	12.06	16.22	10.27	17.29	0.014*^(B)	-	0.337
CPPS count	9.77	0.92	9.90	9.52	10.24	7.32	11.04	10.05	0.80	9.91	9.48	10.48	8.99	11.46	0.198⁽A⁾	0.443	-
Vocal discomfort self-perception	4.15	2.54	5.0	2.0	6.0	1.0	8.0	1.61	2.06	0	0	3.0	0	5.0	0.002*(B⁾	-	1.087

Variable	Pre-exercise							Post-exercise								p-value	1-β	Effect size
Variable	Mean	SD	Median	1º quartile	3º quartile	Minimum	Maximum	Mean	SD	Median	1º quartile		3º quartile	Minimum	Maximum	p-value	1-β	Effect size
Fundamental Frequency (Hz)	237.24	89.10	212.44	189.59	229.32	184.08	273.47	214.47	22.18	209.72	201.67	232.54		181.09	253.19	0.733^(A)	0.831	-
Noise (dB)	1.30	0.71	1.30	0.75	1.65	0.42	2.87	1.02	0.40	1.03	0.67	1.25		0.49	1.67	0.085^(A)	0.400	-
GNE (dB)	0.72	0.16	0.74	0.66	0.87	0.36	0.91	0.81	0.10	0.81	0.75	0.90		0.65	0.94	0.013*^(A)	-	0.643
HNR (dB)	13.57	7.38	13.09	10.61	17.29	2.22	26.52	14.87	7.48	13.52	10.08	18.02		4.72	31.50	0.147^(A)	0.212	-
Jitter (%)	1.94	2.54	1.02	0.39	1.65	0.13	7.40	1.91	2.46	0.70	0.54	1.98		0.14	7.13	0.845^(B)	0.845	-
Shimmer (%)	10.76	4.81	11.10	7.45	14.37	2.54	16.97	12.47	6.50	12.15	9.28	15.68		2.35	25.68	0.335^(A)	0.536	-
CPP vowel	23.04	2.12	23.55	21.09	24.75	19.74	25.59	23.97	1.97	23.80	22.60	25.36		20.60	27.68	0.060^(A)	0.332	-
CPP count	18.86	2.12	18.83	17.36	20.63	15.90	21.54	18.49	1.75	18.46	17.29	20.11		15.83	20.65	0.181^(A)	0.263	-
CPPS vowel	12.71	2.07	12.82	10.79	14.26	10.04	15.62	13.48	2.06	13.73	11.97	14.58		10.13	17.47	0.066⁽A⁾	0.260	-
CPPS count	9.31	1.67	10.09	8.33	10.25	6.33	11.08	9.18	1.80	9.98	7.86	10.70		6.06	10.87	0.367^(B)	0.382	-
Vocal discomfort self-perception	2.50	1.57	2.50	2.0	3.0	0	5.0	0.83	1.40	0.5	0	1.0		0	5.0	0.009*(B⁾	-	1.119

Result	Sustained vowel		Count
Result	N	%	N	%
Males with vocal symptoms (n=13)
Improved	9	69.23	6	46.15
Unchanged	4	30.77	7	53.85
Worsened	0	0	0	0
Males without vocal symptoms (n=12)
Improved	5	41.67	3	25
Unchanged	6	50	9	75
Worsened	1	8.33	0	0
Females with vocal symptoms (n=13)
Improved	5	38.46	0	0
Unchanged	7	53.85	13	100
Worsened	1	7.69	0	0
Females without vocal symptoms (n=12)
Improved	3	25	0	0
Unchanged	7	58.33	8	66.67
Worsened	2	16.67	4	33.33

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[1] Paired T Test^(A);

[2] Wilcoxon Test^(B)

[TFN100] ^*
Significant p value (p≤ 0.05)

[4] Caption: GNE=Glottal to noise excitation; HNR=harmonic-to-noise ratio; CPP=Cepstral Peak Prominence; CPPS=Cepstral Peak Prominence-Smoothed; 1-β=Power of the test