High-frequency oral oscillation with phonation and sonorous blowing into a silicone tube in older adults with presbylarynx: randomized clinical trial

Bello, Jade Zaccarias; Cassol, Mauriceia

doi:10.1590/2317-6431-2025-3081pt

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Original Article • Audiol., Commun. Res. 30 • 2025 • https://doi.org/10.1590/2317-6431-2025-3081en linkcopy

High-frequency oral oscillation with phonation and sonorous blowing into a silicone tube in older adults with presbylarynx: randomized clinical trial

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose To investigate the effects of high-frequency oral oscillation with phonation (VOHFO), sonorous blowing into a silicone tube, and the combination of both techniques in older adults with presbylarynx, regarding phonation and respiration.

Methods Randomized clinical trial with 51 older adults diagnosed with presbylarynx by an otolaryngologist, allocated into three groups: G1 – VOHFO; G2 – silicone tube with sonorous blowing; G3 – combination of the techniques. Eight weekly sessions were conducted. Outcome variables were: maximum phonation time (MPT), vital capacity (VC), and perceptual-auditory vocal quality (GRBASI). Assessments included perceptual-auditory analysis, spirometry, and MPT measurements. Data were analyzed using ANOVA and Generalized Estimating Equations. The study is registered in the Brazilian Clinical Trials Registry (REBEC), number RBR-46hk7r.

Results Before the intervention, the mean MPT for the vowel /a/ was 8.1s, and after therapy, 10.1s; VC increased from 4.04L to 4.52L. These changes were statistically significant (P < 0.001). No changes were found in vocal quality by GRBASI, and no relevant differences were observed between isolated and combined techniques.

Conclusion VOHFO and sonorous blowing into a silicone tube significantly improved MPT and VC, with no perceptible effect on GRBASI. The observed aerodynamic improvement may favor vocal resistance, projection, and communicative participation in daily life, enhancing autonomy and quality of life in this population.

Keywords:
Aged; Aging; Dysphonia; Rehabilitation; Voice

Variables	Group 1	Group 2	Group 3	p-value
Variables	Mean ± SD	Mean ± SD	Mean ± SD	p-value
Age (years)	76.5 ± 10.1	73.9 ± 7.3	74.3 ± 8.8	0.645
Gender – n(%)				0.270
Female	13 (76.5)	11 (64.7)	15 (88.2)
Male	4 (23.5)	6 (35.3)	2 (11.8)

Variables	Judge 1	Judge 2	Judge 3	Agreement (Fleiss's Kappa value)
Variables	n (%)	n (%)	n (%)	J1 x J2 x J3
G				0.29 (P < 0.001)
1	50 (49.0)	53 (52.0)	55 (53.9)
2	47 (46.1)	44 (43.1)	42 (41.2)
3	5 (4.9)	5 (4.9)	5 (4.9)
R				0.25 (P < 0.001)
0	4 (3.9)	0 (0.0)	2 (2.0)
1	67 (65.7)	69 (67.6)	75 (73.5)
2	28 (27.5)	32 (31.4)	24 (23.5)
3	3 (2.9)	1 (1.0)	1 (1.0)
B				0.14 (P = 0.001)
0	13 (12.7)	11 (10.8)	14 (13.7)
1	67 (65.7)	74 (72.5)	70 (68.6)
2	21 (20.6)	15 (14.7)	16 (15.7)
3	1 (1.0)	2 (2.0)	2 (2.0)
A
0	102 (100)	102 (100)	102 (100)	-
S				0.21 (P < 0.001)
0	8 (7.8)	9 (8.8)	14 (13.7)
1	71 (69.6)	69 (67.6)	63 (61.8)
2	22 (21.6)	22 (21.6)	23 (22.5)
3	1 (1.0)	2 (2.0)	2 (2.0)
I				0.25 (P < 0.001)
0	11 (10.8)	9 (8.8)	9 (8.8)
1	70 (68.6)	73 (71.6)	73 (71.6)
2	20 (19.6)	19 (18.6)	20 (19.6)
3	1 (1.0)	1 (1.0)	0 (0.0)

Variables	Group 1	Group 2	Group 3	p-value	Group interaction x time (p-value)
	Median	Median	Median
	(P25 – P75)	(P25 – P75)	(P25 – P75)
G					0.465
Pre	1 (1 – 2)	2 (1 – 2)	2 (1 – 2)	0.278
Post	1 (1 – 2)	1 (1 – 2)	2 (1 – 2)	0.945
P	0.238	1,000	0.653
R					0.580
Pre	1 (1 – 1.5)	1 (1 – 1)	1 (1 – 2)	0.463
Post	1 (1 – 2)	1 (1 −1.5)	1 (1 – 2)	0.720
P	0.303	0.560	0.653
B					0.901
Pre	1 (1 – 1)	1 (1 – 1)	1 (1 – 1.5)	0.605
Post	1 (1 – 1)	1 (1 – 1)	1 (1 – 1.5)	0.525
P	0.560	1,000	1,000
A					*
Pre	0 (0 – 0)	0 (0 – 0)	0 (0 – 0)	*
Post	0 (0 – 0)	0 (0 – 0)	0 (0 – 0)	*
P	*	*	*
S					0.826
Pre	1 (1 – 1)	1 (1 – 1.5)	1 (1 – 2)	0.296
Post	1 (1 – 1)	1 (1 – 1)	1 (1 – 2)	0.238
P	0.653	1,000	0.653
I					0.931
Pre	1 (1 – 1)	1 (1 – 1.5)	1 (1 – 1)	1,000
Post	1 (1 – 1)	1 (1 – 1.5)	1 (1 – 1.5)	0.964
P	0.653	1,000	1,000

Variables	Group 1	Group 2	Group 3	p-value	Group interaction x time (p-value)
	Median	Median	Median
	(P25 – P75)	(P25 – P75)	(P25 – P75)
Vowel A					0.056
Pre	8.1 (4.4 – 9.6)	8.1 (3.6 – 10.4)	4.8 (2.7 – 8.9)	0.102
Post	10.1 (8.0 – 12.8)	9.8 (8.2 – 12.9)	8.1 (7.1 – 11.8)	0.254
P	<0.001	<0.001	<0.001
Sound Z					0.372
Pre	7.5 (5.8 – 9.9)	8.4 (6.3 – 10.1)	5.9 (4.4 – 7.5)	0.109
Post	9.7 (8.2 – 11.3)	10.1 (8.8 – 12.1)	7.9 (6.7 – 10.1)	0.076
P	<0.001	<0.001	<0.001
S/Z					0.068
Pre	1.0 (0.8 – 1.3)	0.9 (0.8 – 1.1)	1.1 (0.8 – 1.1)	0.169
Post	0.9 (0.8 – 0.9)	0.8 (0.8 – 1.1)	0.9 (0.8 – 1.2)	0.212
P	0.024	0.988	0.983

Variables	Group 1	Group 2	Group 3	p-value
Variables	Mean ± SD	Mean ± SD	Mean ± SD	p-value
VC
Pre	4.04 ± 0.58	4.34 ± 0.49	4.15 ± 0.55	0.254
Post	4.52 ± 0.40	4.65 ± 0.48	4.57 ± 0.45	0.647
Difference (95% CI)	0.47 (0.33 a 0.61)	0.31 (0.22 a 0.40)	0.42 (0.31 a 0.52)	0.113
P	<0.001	<0.001	<0.001

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Academia Brasileira de Audiologia Rua Itapeva, 202, conjunto 61, CEP 01332-000, Tel.: (11) 3253-8711 - São Paulo - SP - Brazil
E-mail: revista@audiologiabrasil.org.br

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[1] Subtitle: SD = standard deviation; n = number of participants; % = percentage