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Ultrasound applicability in Speech Language Pathology and Audiology

Abstracts

PURPOSE:

To present recent studies that used the ultrasound in the fields of Speech Language Pathology and Audiology, which evidence possibilities of the applicability of this technique in different subareas.

RESEARCH STRATEGY:

A bibliographic research was carried out in the PubMed database, using the keywords "ultrasonic," "speech," "phonetics," "Speech, Language and Hearing Sciences," "voice," "deglutition," and "myofunctional therapy," comprising some areas of Speech Language Pathology and Audiology Sciences. The keywords "ultrasound," "ultrasonography," "swallow," "orofacial myofunctional therapy," and "orofacial myology" were also used in the search.

SELECTION CRITERIA:

Studies in humans from the past 5 years were selected. In the preselection, duplicated studies, articles not fully available, and those that did not present direct relation between ultrasound and Speech Language Pathology and Audiology Sciences were discarded.

DATA ANALYSIS:

The data were analyzed descriptively and classified subareas of Speech Language Pathology and Audiology Sciences. The following items were considered: purposes, participants, procedures, and results.

RESULTS:

We selected 12 articles for ultrasound versus speech/phonetics subarea, 5 for ultrasound versus voice, 1 for ultrasound versus muscles of mastication, and 10 for ultrasound versus swallow. Studies relating "ultrasound" and "Speech Language Pathology and Audiology Sciences" in the past 5 years were not found.

CONCLUSION:

Different studies on the use of ultrasound in Speech Language Pathology and Audiology Sciences were found. Each of them, according to its purpose, confirms new possibilities of the use of this instrument in the several subareas, aiming at a more accurate diagnosis and new evaluative and therapeutic possibilities.


OBJETIVO:

Apresentar estudos recentes que utilizaram a ultrassonografia na área da Fonoaudiologia, os quais evidenciam possibilidades de aplicabilidade dessa técnica nas diferentes subáreas.

ESTRATÉGIA DE PESQUISA:

Foi realizada uma pesquisa bibliográfica na base de dados PubMed, utilizando como descritores "ultrasonic"; "speech"; "phonetics"; "Speech, Language and Hearing Sciences"; "voice"; "deglutition" e "myofunctional therapy", contemplando algumas das áreas da Fonoaudiologia. Foram também empregados na busca os termos "ultrasound"; "ultrasonography"; "swallow"; "orofacial myofunctional therapy" e "orofacial myology".

CRITÉRIOS DE SELEÇÃO:

Como critérios da pesquisa em base de dados, selecionaram-se: estudos dos últimos cinco anos e estudos em humanos. Na pré-seleção, foram descartados estudos duplicados, não disponibilizados na íntegra e que não apresentassem relação direta da ultrassonografia com a Fonoaudiologia.

ANÁLISE DOS DADOS:

A análise dos dados foi realizada de forma descritiva e separada para cada subárea da Fonoaudiologia. Consideraram-se os itens: objetivos; sujeitos; procedimentos e resultados.

RESULTADOS:

Foram selecionados 12 artigos para a subárea ultrassom versus fala/fonética; cinco para ultrassom versus voz; um para ultrassom versus músculos mastigatórios e dez para ultrassom versus deglutição. Não foram encontrados estudos referentes aos últimos cinco anos relacionando "ultrassom" e "Fonoaudiologia".

CONCLUSÃO:

Foram encontradas diferentes pesquisas que se voltaram ao emprego da ultrassonografia na Fonoaudiologia. Cada qual, a partir de seu objetivo, confirma novas possibilidades de uso desse instrumento nas diversas subáreas, visando a um diagnóstico mais preciso e novas possibilidades, tanto avaliativas quanto terapêuticas.


INTRODUCTION

The Speech Language Pathology and Audiology clinic uses various instruments to validate its actions. It is common to use assessment protocols, often subjective, to define the different steps and procedures of Speech Language Pathology and Audiology therapy. In recent years, there is a growing search for instruments and more direct and quantifying analysis, seeking greater accuracy of the data collected, as well as of the diagnostics and prognostics.

The auditory-perceptual analysis is used widely in the areas of speech and language and can be complemented by other instrumental evaluations, so that the participant is evaluated and treated in all respects of its communicative disorder. Acoustic analysis of speech and voice has been used for a long time as tool for analysis of altered cases, for promoting more accurate diagnoses, and as the monitoring procedure of the therapeutic process, both by speech language pathologist and by the patient( 11. Gregio FN, Camargo ZA. Dados de tempo de início do vozeamento (VOT) na avaliação do sinal vocal de indivíduos com paralisia unilateral de prega vocal. Disturb Comum. 2005;17(3):289-97.

2. Melo RM, Mota HB, Mezzomo CL, Brasil BC, Lovatto L, Arzeno L. Parâmetros acústicos do contraste de sonoridade das plosivas no desenvolvimento fonológico típico e no desviante. Rev Soc Bras Fonoaudiol. 2012;17(3):304-12.

3. Marino VCC, Berti LC, Lima-Gregio AM. Características acústicas da oclusiva glotal associada à sequência de Pierre Robin: estudo de caso. Rev CEFAC. 2013;15(2):466-77.
- 44. Giacchini V, Mota HB, Mezzomo CL. Variáveis relevantes no processo terapêutico para a aquisição do onset complexo na fala de crianças com desvio fonológico. Rev CEFAC (no prelo). ). The articulatory analysis in the area of speech and orofacial motricity emerges as a new possibility, especially at the national level( 55. Berti LC. Investigação da produção de fala a partir da ultrassonografia do movimento de língua. In: 19º Congresso Brasileiro de Fonoaudiologia; 2010; Curitiba. Revista da Sociedade Brasileira de Fonoaudiologia: suplemento. Curitiba: Sociedade Brasileira de Fonoaudiologia; 2010.

6. Pereira LCK, Gregio FN, Svicero MAF, Nan PC, Madureira S, Camargo ZA. Caracterização de vogais orais e nasais por dados de ultrassonografia, ressonância magnética e análise acústica. In: 19º Congresso Brasileiro e 8º Internacional de Fonoaudiologia; 2011; São Paulo. Revista da Sociedade Brasileira de Fonoaudiologia: suplemento. São Paulo: Sociedade Brasileira de Fonoaudiologia; 2011. p. 980.

7. Svicero MAF, Pereira LK, Nan PC, Isolan-Cury R, Camargo Z. Dados preliminares de análise de fala por meio da ultrassonografia. In: 19º Congresso Brasileiro e 8º Internacional de Fonoaudiologia; 2011; São Paulo. Revista da Sociedade Brasileira de Fonoaudiologia: suplemento. São Paulo: Sociedade Brasileira de Fonoaudiologia; 2011. p. 728.

8. Trawitzki LV, Dantas RO, Elias-Júnior J, Mello-Filho FV. Masseter muscle thickness three years after surgical correction of class III dentofacial deformity. Arch Oral Biol. 2011;56(8):799-803.

9. Berti LC. Investigação ultrassonográfica dos erros de fala infantil à luz da Fonologia Gestual. In: Ferreira-Gonçalves G, Brum-de-Paula M. Dinâmica dos movimentos articulatórios: sons, gestos e imagens. Pelotas (RS): Editora da UFPel; 2013. p.127-44.
- 1010. Francisco DT, Pagan-Neves LO, Wertzner HF. Aplicação da ultrassonografia de fala como ferramenta auxiliar ao diagnóstico do transtorno fonológico. In: 4º Seminário de Aquisição fonológica; 2013; Santa Maria. 4º Seminário de Aquisição fonológica: resumos e programação. Pelotas (RS): Editora da UFPel; 2013. p. 33-4. ), for integration of these analyses already mentioned, using, for example, the ultrasonography for evaluation of tongue movements( 1111. Bernhardt BM, Bacsfalvi P, Adler-Bock M, Shimizu R, Cheney A, Giesbrecht N, et al. Ultrasound as visual feedback in speech habilitation: exploring consultative use in rural British Columbia, Canada. Clin Linguist Phon. 2008;22(2):149-62.

12. Modha G, Bernhardt BM, Church R, Bacsfalvi P. Case study using ultrasound to treat /r/. Int J Lang Commun Disord. 2008;43(3):323-9.

13. Pouplier M. The role of a coda consonant as error trigger in repetition tasks. J Phon. 2008;36(1):114-40.

14. Rastadmehr O, Bressmann T, Smyth R, Irish JC. Increased midsagittal tongue velocity as indication of articulatory compensation in patients with lateral partial glossectomies. Head Neck. 2008;30(6):718-26.

15. Campbell F, Gick B, Wilson I, Vatikiotis-Bateson E. Spatial and temporal properties of gestures in North American English /r/. Lang Speech. 2010;53(1):49-69.

16. Bressmann T, Flowers H, Wong W, Irish JC. Coronal view ultrasound imaging of movement in different segments of the tongue during paced recital: findings from four normal speakers and a speaker with partial glossectomy. Clin Linguist Phon. 2010;24(8):589-601.

17. Galén S, Jost-Brinkmann PG. B-mode and M-mode ultrasonography of tongue movements during swallowing. J Orofac Orthop. 2010;71(2):125-35.

18. Zharkova N, Hewlett N, Hardcastle WJ. Coarticulation as an indicator of speech motor control development in children: an ultrasound study. Motor Control. 2011;15(1):118-40.

19. Steele C, Sasse C, Bressmann T. Tongue-pressure and hyoid movement timing in healthy liquid swallowing. Int J Lang Commun Disord. 2012;47(1):77-83.

20. Tamura F, Kikutani T, Tohara T, Yoshida M, Yaegaki K. Tongue thickness relates to nutritional status in the elderly. Dysphagia. 2012;27(4):556-61.

21. Kochetov A, Pouplier M, Truong S. A preliminary ultrasound study of Nepali lingual articulations. J Acoust Soc Am. 2013;13:1-9.
- 2222. Zharkova N. Using ultrasound to quantify tongue shape and movement characteristics. Cleft Palate Craniofac J. 2013;50(1):76-81. ), and of the hyoid bone( 1919. Steele C, Sasse C, Bressmann T. Tongue-pressure and hyoid movement timing in healthy liquid swallowing. Int J Lang Commun Disord. 2012;47(1):77-83. , 2323. Huang YL, Hsieh SF, Chang YC, Chen HC, Wang TG. Ultrasonographic evaluation of hyoid-larynx approximation in dysphagic stroke patients. Ultrasound Med Biol. 2009;35(7):1103-8.

24. Scarborough DR, Waizenhofer S, Siekemeyer L, Hughes M. Sonographically measured hyoid bone displacement during swallow in preschool children: a preliminary study. J Clin Ultrasound. 2010;38(8):430-4.

25. Macrae PR, Doeltgen SH, Jones RD, Huckabee ML. Intra- and inter-rater reliability for analysis of hyoid displacement measured with sonography. J Clin Ultrasound. 2012;40(2):74-8.

26. Yabunaka K, Sanada H, Sanada S, Konishi H, Hashimoto T, Yatake H, et al. Sonographic assessment of hyoid bone movement during swallowing: a study of normal adults with advancing age. Radiol Phys Technol. 2011;4(1):73-7.
- 2727. Hsiao MY, Chang YC, Chen WS, Chang HY, Wang TG. Application of ultrasonography in assessing oropharyngeal dysphagia in stroke patients. Ultrasound Med Biol. 2012;38(9):1522-8. ), without inserting devices within the oral cavity.

The investigation of tongue movements is one of the possibilities of using this type of articulation assessment, which is not considered invasive and is available with minimum interference in the visualization of intraoral movements( 2828. Gick B. The use of ultrasound for linguistic phonetic fieldwork. J Int Phon Assoc. 2002;32(2):113-21. , 2929. Bressmann T. Quantitative assessment of tongue shape and movement using ultrasound imaging. In: 3rd Conference on Laboratory Approaches to Spanish Phonology; 2008. Somerville (MA); 2008. p. 101-6. ), enabling research in various subareas of Speech Language Pathology and Audiology. The knowledge of speech language pathologists about the possibilities of use of ultrasound in a variety of Speech Language Pathology and Audiology alterations (the focus of this article) can affect important research in the area and consequent relevant findings. The use of ultrasound allows the speech language pathologist to perform articulatory data analysis of the participant assessed and of the patient undergoing therapeutic procedure( 1111. Bernhardt BM, Bacsfalvi P, Adler-Bock M, Shimizu R, Cheney A, Giesbrecht N, et al. Ultrasound as visual feedback in speech habilitation: exploring consultative use in rural British Columbia, Canada. Clin Linguist Phon. 2008;22(2):149-62. , 1212. Modha G, Bernhardt BM, Church R, Bacsfalvi P. Case study using ultrasound to treat /r/. Int J Lang Commun Disord. 2008;43(3):323-9. , 3030. Bacsfalvi P, Bernhardt BM. Long-term outcomes of speech therapy for seven adolescents with visual feedback technologies: ultrasound and electropalatography. Clin Linguist Phon. 2011;25(11-12):1034-43. ).

PURPOSE

To present studies of the past 5 years that used ultrasonography in the field of Speech Language Pathology and Audiology, which can show possibilities of applicability of this technique in different subareas of Speech Language Pathology and Audiology.

RESEARCH STRATEGY

A narrative review of the literature based on the question that guided this study was conducted: "In what areas and in what way the ultrasound data can contribute to the knowledge of Speech Language Pathology and Audiology?"

To answer this question, a literature review was conducted from May to July of 2013. It was performed initially in the PubMed international database, which is maintained by the National Center for Biotechnology Information (NCBI) at the National Institute of Health (NIH). This search strategy was chosen because the tool catalogs scientific articles published in journals indexed in major global scientific collections.

The keywords provided by Health Sciences Descriptors (DeCS) used in the research were "ultrasonic," "speech," "phonetics," "Speech, Language and Hearing Sciences," "voice," "deglutition," and "myofunctional therapy," covering some of the areas of the Speech Language Pathology and Audiology. The terms "ultrasound," "ultrasonography," "swallow," "orofacial myofunctional therapy," and "orofacial myology" were also researched in the examination, even though they are not descriptors provided by the Regional Library of Medicine (BIREME), because they are found several times in articles related to the area. The combinations of the descriptors and terms were as follows: ultrasonic AND speech, ultrasound AND speech, ultrasonography AND speech, and thus successively with the other terms and descriptors.

After the search for articles with the descriptors and terms quoted, the abstracts of the studies were searched and, if they were of interest to this study, the full text of the respective articles were searched.

In this way, to get some full articles not available in PubMed, the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) journals portal was also used, through the search for the topic with the job title.

The databases cited were prioritized due to the their easy access, and it was done by specific agreements made by the Universidade Federal de Santa Maria, of which the authors of this article are part of.

SELECTION CRITERIA

The following were selected as search criteria in the database: studies of the past 5 years, and studies in humans. In this way, 320 abstracts were found in the survey conducted through the PubMed database. Figure 1 shows the total number of articles for each area of the Speech Language Pathology and Audiology before the adoption of the criteria for inclusion and exclusion of articles that comprised the present literature review.

Figure 1.
Total of selected abstracts in the PubMed database as the intersection of the descriptors Caption: US = Ultrasound

As stated in the Research Strategy section, after the search in the database, there was a preselection of the material collected from the abstracts. The inclusion criteria of the work in this review were: to use ultrasound as a tool for obtaining data; to relate the ultrasound information to some of the areas of interest of the Speech Language Pathology and Audiology - speech, phonetics, voice, orofacial motricity, and swallowing; to find the availability of the full text, either in PubMed or in the CAPES journals portal.

In the preselection, duplicate studies; articles not available in its entirety; and the ones that presented no direct relation of ultrasound with the Speech Language Pathology and Audiology, for example, articles that used ultrasound to investigate biopsies, carcinomas, and esophageal swallowing, were discarded. At the end of the survey, 12 articles for the subarea ultrasound versus speech/phonetics, 5 for ultrasound versus voice; 1 for ultrasound versus masticatory muscles, and 10 for ultrasound versus swallowing were selected. Although they are descriptors used in this review, no studies were found when crossing the terms "ultrasound" and "Speech Language Pathology and Audiology" (Speech, Language and Hearing Sciences). Therefore, we selected 28 articles, being the oldest of 2008 and the latest of 2013, for this review.

DATA ANALYSIS

The data were analyzed in a descriptive manner and separately for each subarea of Speech Language Pathology and Audiology, as described earlier.

The items analyzed were the following:

  • purposes,

  • subjects considered in the study,

  • important procedures, and

  • the main results of the study.

RESULTS

Ultrasound and speech/phonetics

The studies related to the research "Ultrasound and Speech" aimed, in general,

  • to apply the ultrasound images for speech therapy( 1111. Bernhardt BM, Bacsfalvi P, Adler-Bock M, Shimizu R, Cheney A, Giesbrecht N, et al. Ultrasound as visual feedback in speech habilitation: exploring consultative use in rural British Columbia, Canada. Clin Linguist Phon. 2008;22(2):149-62. , 1212. Modha G, Bernhardt BM, Church R, Bacsfalvi P. Case study using ultrasound to treat /r/. Int J Lang Commun Disord. 2008;43(3):323-9. , 3030. Bacsfalvi P, Bernhardt BM. Long-term outcomes of speech therapy for seven adolescents with visual feedback technologies: ultrasound and electropalatography. Clin Linguist Phon. 2011;25(11-12):1034-43. );

  • to investigate the coarticulatory effects, for example, of the syllable CV (consonant-vowel) versus CVC (consonant-vowel-consonant), or vowel context( 1313. Pouplier M. The role of a coda consonant as error trigger in repetition tasks. J Phon. 2008;36(1):114-40. , 1818. Zharkova N, Hewlett N, Hardcastle WJ. Coarticulation as an indicator of speech motor control development in children: an ultrasound study. Motor Control. 2011;15(1):118-40. , 3131. McMillan CT, Corley M. Cascading influences on the production of speech: evidence from articulation. Cognition. 2010;117(3):243-60. );

  • to describe some descriptors of the tongue movements, among them, the speed and the distance covered( 1414. Rastadmehr O, Bressmann T, Smyth R, Irish JC. Increased midsagittal tongue velocity as indication of articulatory compensation in patients with lateral partial glossectomies. Head Neck. 2008;30(6):718-26. , 1616. Bressmann T, Flowers H, Wong W, Irish JC. Coronal view ultrasound imaging of movement in different segments of the tongue during paced recital: findings from four normal speakers and a speaker with partial glossectomy. Clin Linguist Phon. 2010;24(8):589-601. );

  • characterize the gestures involved in the production of consonant segments, as for instance the phoneme /r/( 1515. Campbell F, Gick B, Wilson I, Vatikiotis-Bateson E. Spatial and temporal properties of gestures in North American English /r/. Lang Speech. 2010;53(1):49-69. );

  • to describe compensatory articulatory strategies and hidden movements( 3232. Bressmann T, Radovanovic B, Kulkarni GV, Klaiman P, Fisher D. An ultrasonographic investigation of cleft-type compensatory articulations of voiceless velar stops. Clin Linguist Phon. 2011;25(11-12):1028-33. ); and

  • to propose articulatory measures via ultrasonography( 2222. Zharkova N. Using ultrasound to quantify tongue shape and movement characteristics. Cleft Palate Craniofac J. 2013;50(1):76-81. ).

The definition of the sample was restricted to the purposes of the searches. Therefore, the articles that applied ultrasound data for the investigation of speech focused on participants with typical( 1313. Pouplier M. The role of a coda consonant as error trigger in repetition tasks. J Phon. 2008;36(1):114-40. , 1515. Campbell F, Gick B, Wilson I, Vatikiotis-Bateson E. Spatial and temporal properties of gestures in North American English /r/. Lang Speech. 2010;53(1):49-69. , 1616. Bressmann T, Flowers H, Wong W, Irish JC. Coronal view ultrasound imaging of movement in different segments of the tongue during paced recital: findings from four normal speakers and a speaker with partial glossectomy. Clin Linguist Phon. 2010;24(8):589-601. , 1818. Zharkova N, Hewlett N, Hardcastle WJ. Coarticulation as an indicator of speech motor control development in children: an ultrasound study. Motor Control. 2011;15(1):118-40. , 3131. McMillan CT, Corley M. Cascading influences on the production of speech: evidence from articulation. Cognition. 2010;117(3):243-60. ) and atypical( 1111. Bernhardt BM, Bacsfalvi P, Adler-Bock M, Shimizu R, Cheney A, Giesbrecht N, et al. Ultrasound as visual feedback in speech habilitation: exploring consultative use in rural British Columbia, Canada. Clin Linguist Phon. 2008;22(2):149-62. , 1212. Modha G, Bernhardt BM, Church R, Bacsfalvi P. Case study using ultrasound to treat /r/. Int J Lang Commun Disord. 2008;43(3):323-9. , 1414. Rastadmehr O, Bressmann T, Smyth R, Irish JC. Increased midsagittal tongue velocity as indication of articulatory compensation in patients with lateral partial glossectomies. Head Neck. 2008;30(6):718-26. , 1616. Bressmann T, Flowers H, Wong W, Irish JC. Coronal view ultrasound imaging of movement in different segments of the tongue during paced recital: findings from four normal speakers and a speaker with partial glossectomy. Clin Linguist Phon. 2010;24(8):589-601. , 3030. Bacsfalvi P, Bernhardt BM. Long-term outcomes of speech therapy for seven adolescents with visual feedback technologies: ultrasound and electropalatography. Clin Linguist Phon. 2011;25(11-12):1034-43. , 3232. Bressmann T, Radovanovic B, Kulkarni GV, Klaiman P, Fisher D. An ultrasonographic investigation of cleft-type compensatory articulations of voiceless velar stops. Clin Linguist Phon. 2011;25(11-12):1028-33. ) speech. Speech alterations were due to speech disorder (11,12), glossectomy( 1414. Rastadmehr O, Bressmann T, Smyth R, Irish JC. Increased midsagittal tongue velocity as indication of articulatory compensation in patients with lateral partial glossectomies. Head Neck. 2008;30(6):718-26. , 1616. Bressmann T, Flowers H, Wong W, Irish JC. Coronal view ultrasound imaging of movement in different segments of the tongue during paced recital: findings from four normal speakers and a speaker with partial glossectomy. Clin Linguist Phon. 2010;24(8):589-601. ), hearing loss( 3030. Bacsfalvi P, Bernhardt BM. Long-term outcomes of speech therapy for seven adolescents with visual feedback technologies: ultrasound and electropalatography. Clin Linguist Phon. 2011;25(11-12):1034-43. ), and cleft palate( 3232. Bressmann T, Radovanovic B, Kulkarni GV, Klaiman P, Fisher D. An ultrasonographic investigation of cleft-type compensatory articulations of voiceless velar stops. Clin Linguist Phon. 2011;25(11-12):1028-33. ). The search for this subarea had on average 8.5 participants; of these, 64.9% were adults and 35.1% children.

As the characterization of the group of subjects, the observed methodological aspects are quite heterogeneous, also restricted to the research proposal (Chart 1).

Chart 1.
Studies that have addressed the application of ultrasound in speech Caption: US = ultrasound; VOT = voice onset time

The main results of the articles are also presented in Chart 1. The various possibilities of application of tongue ultrasound images in the speech subarea can be observed, because the identification of gestural patterns in an evaluative procedure to the insertion of this technology as a therapeutic procedure is available to the Speech Language Pathology and Audiology Clinic.

With the crossing of the descriptors related to "ultrasound" and "phonetic," a study( 2121. Kochetov A, Pouplier M, Truong S. A preliminary ultrasound study of Nepali lingual articulations. J Acoust Soc Am. 2013;13:1-9. ) directed to the research of speech segments was found. The article aims to analyze the images of the forms of the tongue of an individual, native speaker of a dialect of Nepal, during the production of plosives and affricates, voiced and voiceless, dental, retroflexes, and palatals. In this study, the authors believe that the spatial and dynamic information obtained via ultrasound image of the tongue can supplement the data obtained with the static electropalatography, related to the location and type of constriction of the tongue on the palate.

The results showed differences in the forms of the tongue, even if some were discreet, between location of the constriction of the devoiced and voiced consonant, of the consonant at the beginning and at the end of a syllable, and between different articulation points of the dialect investigated( 2121. Kochetov A, Pouplier M, Truong S. A preliminary ultrasound study of Nepali lingual articulations. J Acoust Soc Am. 2013;13:1-9. ).

The association between ultrasound and phonetic (Chart 2), although still small, as this bibliographic research shows, already allowed us to verify that the ultrasound images are able to provide specifics of a given language, based on the analysis of the dynamics of the sounds in real time. Such manipulation can also stimulate research in phonetics on the organization of syllabic sequences, coarticulation, and structural organizations of sounds.

Chart 2.
Study that considered the application of ultrasound in the phonetics Caption: US = ultrasound

Ultrasound and voice

The studies found and highlighted in Chart 3 showed well-differentiated goals, investigating from the tone and length of muscles, measurement of mucosal wave, adaptation of speech valves, to literature review. Many studies have sought to compare and discuss the advantages, disadvantages, and the applicability of instruments such as ultrasound to electroglottography, video fluoroscopy, and computerized tomography( 3333. Krausert CR, Olszewski AE, Taylor LN, McMurray JS, Dailey SH, Jiang JJ. Mucosal wave measurement and visualization techniques. J Voice. 2011;25(4):395-405.

34. Cho W, Hong J, Park H. Real-time ultrasonographic assessment of true vocal fold length in professional singers. J Voice. 2012;26(6):819.e1-6.

35. Ticac R, Candrlic B, Juranic J, Pavelic G, Pedisic D, Pusic M, et al. The role of videofluoroscopy and ultrasound in assessing pharyngoesophageal muscle tone after laryngectomy. Coll Antropol. 2012;36(Suppl 2):125-8.
- 3636. Pedisic D, Ticac R, Candrlic B, Marijic B, Sepic T, Malvic G, et al. The use of ultrasound in determining the length of the Provox II voice prosthesis. Coll Antropol. 2012;36(Suppl 2):103-6. ). Many of these techniques are widely used in the medical field and by speech language pathologists, but the ultrasound, for example, is a method that requires study and has been recruited on a larger scale for research in the field of Speech Language Pathology and Audiology.

Chart 3.
Studies that have addressed the application of ultrasound in the voice Caption: US = ultrasound

The studies had an average of 49 participants( 3434. Cho W, Hong J, Park H. Real-time ultrasonographic assessment of true vocal fold length in professional singers. J Voice. 2012;26(6):819.e1-6.

35. Ticac R, Candrlic B, Juranic J, Pavelic G, Pedisic D, Pusic M, et al. The role of videofluoroscopy and ultrasound in assessing pharyngoesophageal muscle tone after laryngectomy. Coll Antropol. 2012;36(Suppl 2):125-8.
- 3636. Pedisic D, Ticac R, Candrlic B, Marijic B, Sepic T, Malvic G, et al. The use of ultrasound in determining the length of the Provox II voice prosthesis. Coll Antropol. 2012;36(Suppl 2):103-6. ); the results showed improvements to the field and helped to spread the use of new techniques, improve them, and validate them.

The five studies reported the importance of using the method of ultrasound combined with other techniques, what could decrease the risk of postoperative complications( 3636. Pedisic D, Ticac R, Candrlic B, Marijic B, Sepic T, Malvic G, et al. The use of ultrasound in determining the length of the Provox II voice prosthesis. Coll Antropol. 2012;36(Suppl 2):103-6. ), determine laryngeal segments with better accuracy( 3535. Ticac R, Candrlic B, Juranic J, Pavelic G, Pedisic D, Pusic M, et al. The role of videofluoroscopy and ultrasound in assessing pharyngoesophageal muscle tone after laryngectomy. Coll Antropol. 2012;36(Suppl 2):125-8. ), determine variations in muscle length( 3434. Cho W, Hong J, Park H. Real-time ultrasonographic assessment of true vocal fold length in professional singers. J Voice. 2012;26(6):819.e1-6. ), as well as contribute to diagnosis and to an effective treatment plan( 3333. Krausert CR, Olszewski AE, Taylor LN, McMurray JS, Dailey SH, Jiang JJ. Mucosal wave measurement and visualization techniques. J Voice. 2011;25(4):395-405. , 3737. Setlur J, Hartnick CJ. Management of unilateral true vocal cord paralysis in children. Curr Opin Otolaryngol Head Neck Surg. 2012;20(6):497-501. ).

Ultrasound and masticatory muscles

The only study found( 88. Trawitzki LV, Dantas RO, Elias-Júnior J, Mello-Filho FV. Masseter muscle thickness three years after surgical correction of class III dentofacial deformity. Arch Oral Biol. 2011;56(8):799-803. ) (Chart 4) relating the ultrasound technique and masticatory muscles (even though descriptors related, in general terms, to the orofacial motricity were used) presents an interdisciplinary work and the proposal of an integrated treatment for common disorders in Speech Language Pathology and Audiology Clinical Therapy - muscle changes resulting from occlusal disorders.

Chart 4.
Study that considered the application of ultrasound in the evaluation of a masticatory muscle

The ultrasound technique allowed the measurement of the thickness of the masseter muscle as well as the diagnosis, the treatment plan, and the interdisciplinary prognosis - orthodontic, orthognathic, and Speech Language Pathology and Audiology. The technique proved to be efficient for measurements, and enabled the monitoring and setting discharge criteria for patients( 88. Trawitzki LV, Dantas RO, Elias-Júnior J, Mello-Filho FV. Masseter muscle thickness three years after surgical correction of class III dentofacial deformity. Arch Oral Biol. 2011;56(8):799-803. ).

It is believed that there are studies from other areas (e.g., dental) that are also used to search the masticatory muscles using ultrasound images, which could also be of particular interest to the Speech Language Pathology and Audiology. However, these were not included in this article, because they have not been located through the search strategies considered here.

Ultrasound and swallowing

From the search of the descriptors ultrasound versus swallowing, papers that are presented in Chart 5, the investigation of the displacement of the hyoid bone during the act of swallowing was frequent( 1919. Steele C, Sasse C, Bressmann T. Tongue-pressure and hyoid movement timing in healthy liquid swallowing. Int J Lang Commun Disord. 2012;47(1):77-83. , 2323. Huang YL, Hsieh SF, Chang YC, Chen HC, Wang TG. Ultrasonographic evaluation of hyoid-larynx approximation in dysphagic stroke patients. Ultrasound Med Biol. 2009;35(7):1103-8.

24. Scarborough DR, Waizenhofer S, Siekemeyer L, Hughes M. Sonographically measured hyoid bone displacement during swallow in preschool children: a preliminary study. J Clin Ultrasound. 2010;38(8):430-4.

25. Macrae PR, Doeltgen SH, Jones RD, Huckabee ML. Intra- and inter-rater reliability for analysis of hyoid displacement measured with sonography. J Clin Ultrasound. 2012;40(2):74-8.
- 2626. Yabunaka K, Sanada H, Sanada S, Konishi H, Hashimoto T, Yatake H, et al. Sonographic assessment of hyoid bone movement during swallowing: a study of normal adults with advancing age. Radiol Phys Technol. 2011;4(1):73-7. ). In addition to this, three other papers further investigated the thickness of the lingual musculature( 2020. Tamura F, Kikutani T, Tohara T, Yoshida M, Yaegaki K. Tongue thickness relates to nutritional status in the elderly. Dysphagia. 2012;27(4):556-61. , 2727. Hsiao MY, Chang YC, Chen WS, Chang HY, Wang TG. Application of ultrasonography in assessing oropharyngeal dysphagia in stroke patients. Ultrasound Med Biol. 2012;38(9):1522-8. ) and the pressure exerted by the tongue on the palate( 1919. Steele C, Sasse C, Bressmann T. Tongue-pressure and hyoid movement timing in healthy liquid swallowing. Int J Lang Commun Disord. 2012;47(1):77-83. ).

Chart 5.
Studies that have addressed the application of ultrasonography in swallowing Caption: US = ultrasound; CVA = cerebral vascular accident

The other objectives of the studies were concerned with the comparison of ultrasound and techniques already established for the investigation of swallowing, such as videofluoroscopy and endoscopy( 2323. Huang YL, Hsieh SF, Chang YC, Chen HC, Wang TG. Ultrasonographic evaluation of hyoid-larynx approximation in dysphagic stroke patients. Ultrasound Med Biol. 2009;35(7):1103-8. , 2727. Hsiao MY, Chang YC, Chen WS, Chang HY, Wang TG. Application of ultrasonography in assessing oropharyngeal dysphagia in stroke patients. Ultrasound Med Biol. 2012;38(9):1522-8. , 3838. Komori M, Hyodo M, Gyo K. A swallowing evaluation with simultaneous videoendoscopy, ultrasonography and videofluorography in healthy controls. J Otorhinolaryngol Relat Spec. 2008;70(6):393-8. ), and also with the differentiation pattern of somatic and visceral swallowing( 1717. Galén S, Jost-Brinkmann PG. B-mode and M-mode ultrasonography of tongue movements during swallowing. J Orofac Orthop. 2010;71(2):125-35. ) and, finally, with research movement patterns of geniohyoid muscles( 3939. Yabunaka K, Konishi H, Nakagami G, Sanada H, Iizaka S, Sanada S, et al. Ultrasonographic evaluation of geniohyoid muscle movement during swallowing: a study on healthy adults of various ages. Radiol Phys Technol. 2012;5(1):34-9. ).

As for the sample evaluated in the mentioned papers( 1717. Galén S, Jost-Brinkmann PG. B-mode and M-mode ultrasonography of tongue movements during swallowing. J Orofac Orthop. 2010;71(2):125-35. , 1919. Steele C, Sasse C, Bressmann T. Tongue-pressure and hyoid movement timing in healthy liquid swallowing. Int J Lang Commun Disord. 2012;47(1):77-83. , 2020. Tamura F, Kikutani T, Tohara T, Yoshida M, Yaegaki K. Tongue thickness relates to nutritional status in the elderly. Dysphagia. 2012;27(4):556-61. , 2323. Huang YL, Hsieh SF, Chang YC, Chen HC, Wang TG. Ultrasonographic evaluation of hyoid-larynx approximation in dysphagic stroke patients. Ultrasound Med Biol. 2009;35(7):1103-8.

24. Scarborough DR, Waizenhofer S, Siekemeyer L, Hughes M. Sonographically measured hyoid bone displacement during swallow in preschool children: a preliminary study. J Clin Ultrasound. 2010;38(8):430-4.

25. Macrae PR, Doeltgen SH, Jones RD, Huckabee ML. Intra- and inter-rater reliability for analysis of hyoid displacement measured with sonography. J Clin Ultrasound. 2012;40(2):74-8.

26. Yabunaka K, Sanada H, Sanada S, Konishi H, Hashimoto T, Yatake H, et al. Sonographic assessment of hyoid bone movement during swallowing: a study of normal adults with advancing age. Radiol Phys Technol. 2011;4(1):73-7.
- 2727. Hsiao MY, Chang YC, Chen WS, Chang HY, Wang TG. Application of ultrasonography in assessing oropharyngeal dysphagia in stroke patients. Ultrasound Med Biol. 2012;38(9):1522-8. , 3838. Komori M, Hyodo M, Gyo K. A swallowing evaluation with simultaneous videoendoscopy, ultrasonography and videofluorography in healthy controls. J Otorhinolaryngol Relat Spec. 2008;70(6):393-8. , 3939. Yabunaka K, Konishi H, Nakagami G, Sanada H, Iizaka S, Sanada S, et al. Ultrasonographic evaluation of geniohyoid muscle movement during swallowing: a study on healthy adults of various ages. Radiol Phys Technol. 2012;5(1):34-9. ), the groups comprised individuals with typical swallowing (from children to the elderly) and with altered swallowing, due to some underlying diseases, such as cerebral vascular accident (CVA). The number of participants varied considerably from 5 to 104 among the articles, with an average of 42.5 participants.

The research( 1919. Steele C, Sasse C, Bressmann T. Tongue-pressure and hyoid movement timing in healthy liquid swallowing. Int J Lang Commun Disord. 2012;47(1):77-83. , 2323. Huang YL, Hsieh SF, Chang YC, Chen HC, Wang TG. Ultrasonographic evaluation of hyoid-larynx approximation in dysphagic stroke patients. Ultrasound Med Biol. 2009;35(7):1103-8.

24. Scarborough DR, Waizenhofer S, Siekemeyer L, Hughes M. Sonographically measured hyoid bone displacement during swallow in preschool children: a preliminary study. J Clin Ultrasound. 2010;38(8):430-4.

25. Macrae PR, Doeltgen SH, Jones RD, Huckabee ML. Intra- and inter-rater reliability for analysis of hyoid displacement measured with sonography. J Clin Ultrasound. 2012;40(2):74-8.
- 2626. Yabunaka K, Sanada H, Sanada S, Konishi H, Hashimoto T, Yatake H, et al. Sonographic assessment of hyoid bone movement during swallowing: a study of normal adults with advancing age. Radiol Phys Technol. 2011;4(1):73-7. ) highlighted the ultrasound as an important tool for evaluating the displacement of the hyoid bone in swallowing research. Reducing the movement of the hyoid bone has been associated with the increased risk for intrusion of waste in the larynx and the air passages. Comparing the ultrasound image with other assessment tools( 2323. Huang YL, Hsieh SF, Chang YC, Chen HC, Wang TG. Ultrasonographic evaluation of hyoid-larynx approximation in dysphagic stroke patients. Ultrasound Med Biol. 2009;35(7):1103-8. , 2727. Hsiao MY, Chang YC, Chen WS, Chang HY, Wang TG. Application of ultrasonography in assessing oropharyngeal dysphagia in stroke patients. Ultrasound Med Biol. 2012;38(9):1522-8. , 3838. Komori M, Hyodo M, Gyo K. A swallowing evaluation with simultaneous videoendoscopy, ultrasonography and videofluorography in healthy controls. J Otorhinolaryngol Relat Spec. 2008;70(6):393-8. ), ultrasound image was considered as a reliable, relatively inexpensive, and noninvasive method of research, although it has received little attention in the literature.

Through the use of ultrasound, some authors were able to verify that the pressure of the tongue on the palate and the hyoid movement are distinct phenomena as a result of swallowing( 1919. Steele C, Sasse C, Bressmann T. Tongue-pressure and hyoid movement timing in healthy liquid swallowing. Int J Lang Commun Disord. 2012;47(1):77-83. ). However, correlation was observed between the thickness of the tongue, verified by ultrasound images, and the nutritional status of stroke patients with dysphagia. Thus, malnutrition can induce sarcopenia (decreased muscle mass and strength) and the dysfunction and abnormality of the tongue may also be an indicator of dysphagia( 2020. Tamura F, Kikutani T, Tohara T, Yoshida M, Yaegaki K. Tongue thickness relates to nutritional status in the elderly. Dysphagia. 2012;27(4):556-61. ).

As ultrasound still is underused in studies of dysphagia, in most papers further research involving this technique in the standardization of reliable measures is suggested to assess swallowing. However, most studies already confirmed the ultrasound images as a possibility in assessing the dynamics of swallowing.

CONCLUSION

Studies that investigated the use of the ultrasound technique in the field of Speech Language Pathology and Audiology in the past 5 years were found. These studies confirmed the new possibilities of the use of ultrasound in all subareas of Speech Language Pathology and Audiology considered in the present literature review, striving for a more accurate diagnosis, more detailed assessments, differentiated therapeutic processes, and greater cost-effectiveness.

The majority (27 of 28 articles selected for this literature review) of the studies found were carried out in other countries, highlighting the field need to update itself and the necessity to practice the search through the use of new instruments in the researches and in Speech Language Pathology and Audiology Clinical Therapy in Brazil.

ACKNOWLEDGMENT

We thank the Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS) and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) for providing two PhD scholarships, for the first and to the third author of this work, during this study.

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  • Financial support: Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul - FAPERGS - e Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES.
  • *LSB, BCB, and RMM were jointly responsible for the delimitation of the study, literature search, and its writing; MKS, CLM, and HBM supervised the data collection, tabulation and analysis, and provided guidance during all stages of the study elaboration. Study carried out at the Graduate Program in Human Communication Disorders, Universidade Federal de Santa Maria - UFSM - Santa Maria (RS), Brazil.

Publication Dates

  • Publication in this collection
    Dec 2014

History

  • Received
    23 Dec 2013
  • Accepted
    01 Sept 2014
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