Os exercícios de trato vocal semiocluído (ETVSO) são técnicas vocais que têm como objetivo promover uma voz mais eficaz com o mínimo de esforço. ETVSO podem ser realizados utilizando tubos rígidos ou flexíveis imersos em água, os quais podem produzir resultados distintos e interferir na sua indicação em intervenções fonoaudiológicas. Este trabalho tem como objetivos: verificar os efeitos do exercício de fonação em diferentes tipos de tubos de ressonância em relação a aspectos vocais, laríngeos, respiratórios e de autopercepção; verificar se essas modificações ocorrem da mesma forma em indivíduos sem e com disfonia, em homens e mulheres e de diversas faixas etárias; verificar o comportamento laríngeo durante os exercícios. Para isso foram avaliados 75 indivíduos, entre 20 anos e 69 anos, sem ou com disfonias. Os participantes responderam questões sobre sintomas vocais e autopercepção do efeito do exercício, além de serem submetidos à avaliação perceptivoauditiva, acústica, respiratória e laríngea. O Índice de Concordância Kappa verificou a confiabilidade intra-avaliador nas análises perceptivas. Para comparação entre os momentos pré e pós imediatos à realização dos exercícios foram realizados Teste TStudent Pareado, Teste de Igualdade de Duas Proporções (p<0,05). Após o ETVSO com Lax Vox houve aumento de todos os parâmetros de instabilidade da frequência fundamental, principalmente para os indivíduos a partir de 50 anos e para as mulheres; aumentou o índice de fonação suave para todos os subgrupos, com exceção dos indivíduos a partir de 50 anos; aumentou o tempo máximo de fonação (TMF) de /z/ para diversos grupos, mas diminuiu o TMF do /a/ para mulheres; o volume fonatório reduziu para indivíduos a partir de 50 anos. Após o ETVSO com o tubo Finlandês, a voz se tornou mais grave, principalmente para homens, houve redução da variação de amplitude para todos os subgrupos, exceto a partir de 50 anos, aumento do TMF de /s/ e /z/, em especial para disfônicos. Com o tubo de Alta Resistência, os parâmetros de instabilidade da frequência fundamental aumentaram, principalmente para os indivíduos até 49 anos e para os não disfônicos; a variabilidade de amplitude diminuiu para indivíduos até 49 anos, não disfônicos e para mulheres; aumentou o índice de fonação suave para mulheres e aumentou TMF de z para participantes até 49 anos. Após os ETVSO com o canudo Padrão Refrigerante, os parâmetros de instabilidade de frequência aumentaram para disfônicos, mulheres, indivíduos até 49 anos; a perturbação de amplitude aumentou para mulheres; o índice de fonação suave aumentou para indivíduos a partir de 50 anos, não disfônicos e homens; aumentou TMF de /z/, principalmente para disfônicos. Considerando a somatória dos efeitos de todos os ETVSO, os disfônicos apresentaram melhora no fechamento glótico, assim como os homens. Os exercícios promoveram aumento da vibração da laringe e da mucosa, principalmente o LaxVox. Os tubos Finlandês e LaxVox foram percebidos como de efeitos mais positivos pelos participantes. Conclui-se que os efeitos dos ETVSO são distintos quando realizados com diferentes tipos de tubos e em diferentes populações, o que deve ser considerado em intervenções de reabilitação e aprimoramento vocais. / The semioccluded vocal tract exercises (SOVTE) are vocal techniques that aim to promote a more effective voice with minimal effort. SOVTE can be performed using rigid or flexible tubes immersed in water, which can produce distinct results and interfere in their indication in speech-language interventions. This study aims to: verify the effects of the phonation exercise in different types of resonance tubes in relation to vocal, laryngeal, respiratory and self-perception aspects; to verify if these modifications occur in the same way in individuals with and without dysphonia, in men and women and of diverse age groups; to verify the laryngeal behavior during the exercises. For that, 75 individuals, aged 20 years and 69 years, with or without dysphonias were tested. Participants answered questions about vocal symptoms and self-perception of the effect of the exercise, besides being submitted to auditive, acoustic, respiratory and laryngeal perceptual tests. The Kappa Concordance Index verified the intra-rater reliability in the perceptual analyzes. For the comparison between the immediate moments before and after the exercises were performed TStudent Test, Equality Test of Two Proportions (p <0.05). After the SOVTE with Lax Vox, there was an increase in all fundamental frequency instability parameters, mainly for individuals aged 50 and over, and for women; increased was the soft phonation index for all subgroups, with the exception of individuals aged 50 years and older; increased the maximum phonation time (MPT) of / z / for several groups, but decreased MPT of /a/ for women; the phonatory volume was reduced for individuals from 50 years of age. After the SOVTE with the Finnish tube, voice became deeper, especially for men, there was a reduction of the amplitude variation for all subgroups, except from 50 years, an increase in the MPT of / s / and / z /, in especially for dysphonics. With the High Resistance tube, fundamental frequency instability parameters increased, especially for individuals up to 49 years old and for nondysphonic individuals; the variability of amplitude decreased for individuals up to 49 years, non-dysphonic and for women; increased was the soft phonation index for women and increased MPT of / z / for participants up to 49 years old. After the SOVTE with the Standard Refrigerant straw, the parameters of frequency instability increased for dysphonics, women, individuals up to 49 years old; the amplitude disturbance increased for women; the soft phonation rate increased for individuals aged 50 years and older, non-dysphonic and men; increased MPT of / z /, especially for dysphonics. Considering the sum of the effects of all SOVTE, dysphonics presented improvement in glottic closure, as did men. The exercises promoted increased vibration of the larynx and mucosa, mainly LaxVox. The Finnish and LaxVox tubes were perceived as having more positive effects by the participants. It is concluded that the effects of SOVTE are different when performed with different types of tubes and in different populations, which should be considered in vocal rehabilitation and improvement interventions.

Tube phonation is a voice treatment method for patients with voice disorders. The purpose of this study was to map speech language pathologist’s (SLPs) use of tube phonation in Sweden and to investigate the underlying factors for how the method is realized. The study consisted of a web-based questionnaire survey which 54 voice SLPs participated in. The survey consisted of closed end, open end and a combination of both. The open-end questions were partially analyzed quantatively, partially through a qualitative categorization method and were presented descriptively. The main results show that there is a strong consensus among SLPs in Sweden regarding materials used during tube phonation. The majority responded that they use glass tubes that are 27 cm long with a diameter of 9 mm, and an open bowl. These results are consistent with the recommendations in Simberg and Laine’s (2007) study where they analysed the method. In the present study, tube phonation was most commonly used to treat phonastenia, vocal nodules and vocal fold paralysis. Future treatment studies are warranted where Simberg och Laine’s (2007) recommendations are compared with other voice treatments. It would also be of interest to investigate the treatment effect of tube phonation on different voice disorders, and to investigate how SLPs should realize the treatment to achieve best possible effect. / Rörfonation är en röstbehandlingsmetod som används för patienter med röststörningar. Syftet med denna studie var att kartlägga hur röstlogopeder i Sverige använder rörfonation, samt att undersöka bakomliggande faktorer till hur metoden utförs. Studien bestod av en webbaserad enkätundersökning där 54 röstlogopeder deltog. Undersökningen bestod av slutna frågor, öppna frågor samt en kombination av båda. De öppna frågorna analyserades dels kvantitativt, dels genom en kvalitativ kategoriseringsmetod och presenterades deskriptivt. De centrala resultaten i denna studie är att röstlogopeder i Sverige är överens om vilka material som används vid rörfonation. Majoriteten av logopederna i studien använder sig av glasrör som är 27 cm långa med en diameter på 9 mm, samt en öppen skål. Dessa resultat stämmer överens med rekommendationer som Simberg och Laine (2007) ger efter att ha undersökt metoden. I föreliggande studie användes rörfonation i störst utsträckning till att behandla fonasteni, stämbandsknutor och stämbandspares. Framtida behandlingsstudier är nödvändiga för att jämföra rörfonation enligt Simberg och Laines (2007) rekommendationer med andra röstbehandlingsmetoder. Det skulle även vara intressant att undersöka utfallet/effekten av rörfonation vid olika röststörningar och hur logopeder bör utföra behandlingen för att uppnå bäst effekt.

Rörfonation och traditionell svensk röstbehandling är två av de vanligaste behandlingsalternativen inom svensk röstlogopedi idag. Som forskare är det viktigt att kontinuerligt utvärdera de behandlingar som erbjuds för att göra vården mer kvalitativ och kostnadseffektiv. Finns det skillnader i behandlingseffekt mellan dessa två röstbehandlingar? Är skillnaderna så tydliga att det går att fastslå att den ena behandlingen är att föredra framför den andra? Med analyser av ett patientmaterial, före och efter behandling, i form av akustisk analys, perceptuella bedömningar av en grupp erfarna logopeder samt patienternas självskattningar syftar föreliggande uppsats till att besvara vad behandlingsformerna har för effekt inom dessa områden. Patientmaterialet bestod av totalt 28 patienter varav 23 fullföljde behandling. Tolv av dessa erhöll behandling med rörfonation medan resterande elva patienter erhöll traditionell svensk röstbehandling.. Utöver röstinspelningar bestod materialet av patienternas självskattningar, i form av RHI- och Swe-VAPP-formulär. Gällande behandlingseffekt på akustiska parametrar kunde inga slutsatser dras. De perceptuella parametrarna afoni, hyperfunktion och knarr förbättrades sett till hela urvalet, oavsett typ av röstbehandling. Tydliga förbättringar sågs i patienternas självskattningar efter båda behandlingsmetoderna. Röstbehandling ger således positiva resultat, men några skillnader i behandlingseffekt mellan de två olika metoderna för röstbehandling kunde inte påvisas. / Tube phonation and traditional Swedish voice therapy are two of the most common voice therapy options in Sweden today. As a researcher, it is important to continually evaluate available therapy options to make health care more qualitative and cost effective. Are there differences in treatment effect between these two voice treatments? If so, are the differences so obvious that it is possible to conclude that one treatment should be preferred over the other? Analyses of a patient material, before and after treatment, which included acoustic analysis, perceptual analysis by a group of experienced speech-language therapists and patients' selfassessments were made aiming to answer what effect the two treatment options have in these areas. The patient material consisted of 28 patients, of whom 23 completed the therapy. Twelve of them received treatment with tube phonation while the remaining eleven patients received traditional Swedish voice therapy. Besides audio recordings, the material consisted of patients' self-assessments pre- and post-therapy, including VHI and Swe-VAPP forms. The treatment effect on acoustic parameters was inconclusive. The perceptual parameters aphonia, hyper function, and creaking improved over the entire sample, regardless of the type of voice therapy. Clear improvements were seen in the patients' self-assessments after both therapy methods. Voice therapy thus gives positive results, but no differences in treatment effect between the two different methods of voice therapy were seen.