TENS on salivary flow and voice

Martins, Vera Beatris; Cielo, Carla Aparecida; Paim, Émille Dalbem; de Oliveira Goulart, Felipe; Macagnan, Fabrício Edler

doi:10.1590/2317-6431-2024-2977pt

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Case Report • Audiol., Commun. Res. 30 • 2025 • https://doi.org/10.1590/2317-6431-2024-2977en linkcopy

TENS on salivary flow and voice

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Electrical stimulation has shown potential in improving salivary flow in patients with head and neck cancer, but its impact on post-radiotherapy voice is not yet fully understood. This is a case series involving three men and one woman with an average age of 58 years and 2.5 months, who underwent chemotherapy and radiotherapy for oropharyngeal tumors, presenting with vocal complaints and hyposalivation. All subjects underwent nasofibrolaryngoscopy, voice recording, and salivary flow measurement at the beginning and end of treatment. Perceptual-auditory and acoustic voice analyses were performed. The aim was to compare the results of salivary volume and vocal measures before and after electrical stimulation. After the intervention, there was a variable increase in salivary flow in all patients, with an average of 0.66 ml/min; however, no marked differences were observed in the perceptual-auditory voice evaluation, as they were very subtle. Nevertheless, changes were recorded in the acoustic analysis of glottal source (changes in fundamental frequency, with a more evident increase, and reduction in some parameters) and in the spectrographic analysis using Wide Band Spectrography. Improvement was observed, with a reduction in antiresonance at low and high frequencies. In Narrow Band Spectrography, there was a worsening, with a reduction in the definition and regularity of harmonics at low and mid frequencies and across the entire spectrogram, as well as a reduction in the number of harmonics at mid frequencies and across the entire spectrogram. Improvement was recorded with a reduction in noise (general) and sub-harmonics at high frequencies. Electrical stimulation demonstrated the ability to induce a variable increase in salivary flow with some acoustic vocal improvements, while the perceptual-auditory voice evaluation did not reveal differences between pre- and post-intervention moments. Despite the promising results, studies with larger samples and greater control of intervening variables are crucial to establish a causal relationship between saliva induced by electrical stimulation and the improvement of vocal quality in patients undergoing radiotherapy.

Keyword:
Transcutaneous electric nerve stimulation; Head and neck neoplasms; Xerostomia; Radiotherapy; Voice

Subjects	Gender	Age	Education	Tumor site	Surgery	RT dose (Gy)	RT method	CT	Time completed (months)	Salivary flow pre and post-intervention
Subjects	Gender	Age	Education	Tumor site	Surgery	RT dose (Gy)	RT method	CT	Time completed (months)	Start(ml/min)	Final (ml/min)	Difference(ml/min)
Subject 1	M	67	Elementary Education	oropharynx	Yes	60	2D	Yes	12	0,4	2,2	1,8
Subject 2	M	61	Elementary Education	oropharynx	No	70	2D	Yes	6	0	0,1	0,1
Subject 3	M	48	Incomplete high school	oropharynx	No	44	2D	Yes	7	0,26	0,8	0,54
Subject 4	F	57	Completed higher education	oropharynx	Yes	70	2D	Yes	2	0,4	0,6	0,2

Subjects	Moment	G	R	B	A	S	I
Subject 1	Pre	2	1	0	0	0	2
Subject 1	Post	2	1	0	0	0	1
Subject 2	Pre	2	2	1	1	0	2
Subject 2	Post	2	1	1	2	0	1
Subject 3	Pre	0	0	0	0	0	0
Subject 3	Post	1	0	0	0	1	1
Subject 4	Pre	1	1	1	0	0	0
Subject 4	Post	1	1	0	0	0	1

Variables	MALE						FEMALE
	S1		S2		S3		S4
	Pre	Post	Pre	Post	Pre	Post	Pre	Post
f_o (Hz)	111,021	135,66	119,92	110,203	99,566	91,1	173,522	193,62
fhi (Hz)	122,423	140,53	124,28	115,352	103,29	121,81	290,427	486,25
flo (Hz)	96,073	129,18	116,03	106,151	96,457	87,898	97,216	67,764
STD (Hz)	6,729	2,27	1,463	1,485	1,195	1,889	61,446	52,923
Jita (us)	43,647	35,275	60,401	87,165	54,04	64,903	283,45	410,43
Jitt (%)	0,483	0,478	0,724	0,96	0,538	0,591	4,441	7,635
RAP (%)	0,279	0,28	0,403	0,565	0,262	0,282	2,692	4,503
PPQ (%)	0,272	0,284	0,46	0,557	0,299	0,345	2,853	4,996
sPPQ (%)	0,733	0,506	0,632	0,913	0,812	0,805	7,045	5,102
vf _o (%)	6,061	1,673	1,22	1,348	1,2	2,074	35,411	27,333
ShdB (dB)	0,589	0,334	0,731	0,7	0,456	0,546	1,835	1,131
Shim (%)	6,63	3,818	8,257	7,989	5,21	6,046	19,814	11,604
APQ (%)	5,548	3,706	6,697	5,726	4,431	4,943	14,063	7,995
sAPQ (%)	8,296	6,256	7,352	7,605	7,053	12,578	16,977	11,736
vAm (%)	25,551	12,444	11,025	11,495	16,829	22,545	30,724	23,574
NHR (%)	0,152	0,129	0,171	0,152	0,131	0,159	0,338	0,297
VTI	0,073	0,035	0,056	0,052	0,041	0,046	0,074	0,062
SPI	11,142	14,498	11,355	17,072	13,667	12,214	3,929	19,333
DVB (%)	0	0	0	0	0	0	8,42	41,008
DSH (%)	0	0	0	0	0	0	5,882	46,825
DUV (%)	0	0	0,826	0,826	0	1,653	61,364	4,545
NVB (%)	0	0	0	0	0	0	2	4
NSH (%)	0	0	0	0	0	0	3	59
NUV (%)	0	0	1	1	0	2	81	6

Parameters	Intensity	S1		S2		S3		S4
Parameters	Intensity	Pre	Post	Pre	Post	Pre	Post	Pre	Post
F trace color intensity (%)	F1	84	70	72	85	53	52	33	62
	F2	84	51	54	72	36	36	30	40
	F3	48	42	47	41	19	25	21	25
	F4	37	25	41	33	14	19	17	25
Trace color intensity (%)	LF	85	66	68	75	46	43	41	52
	MF	65	49	42	49	30	25	25	36
	HF	46	33	46	48	17	17	19	28
	Spectrogram as a whole	73	58	60	62	40	36	36	45
Definition and regularity of F (%)	F1	94	79	81	80	45	40	31	50
	F2	85	52	64	73	38	35	26	41
	F3	63	49	44	43	17	17	18	31
	F4	46	28	48	40	13	14	15	26
Regularity of the line (%)	From vertical striations at low frequencies	58	50	59	66	38	40	30	28
	From vertical striations in the medium frequencies	48	40	43	45	35	34	28	28
	From vertical striations at high frequencies	39	28	46	35	29	30	24	24
	In the vocal spectrogram as a whole	53	39	46	39	39	39	29	24
Bandwidth (%)	F1	51	57	48	50	55	51	38	51
	F2	48	43	43	46	46	39	35	39
	F3	37	40	36	36	16	16	26	38
	F4	33	20	45	49	14	19	26	37
Antiresonance/damping/damping/intensity decay/negative resonance (%)	Immediately above F1	16	3	0	2	3	1	6	0,60
	LF	5	3	0	3	3	1	9	5
	MF	3	10	0	8	44	30	10	7
	HF	10	4	0	4	47	32	21	2
	Spectrogram as a whole	9	10	0	9	39	30	21	9

Parameters	Intensity	S1		S2		S3		S4
Parameters	Intensity	Pre	Post	Pre	Post	Pre	Post	Pre	Post
Trace color intensity (%)	LF	79	71	67	67	60	56	57	59
	MF	62	65	37	57	49	24	41	40
	HF	36	34	50	51	19	9	12	34
	Spectrogram as a whole	58	62	53	52	41	33	38	49
Presence of noise (%)	LF	40	28	30	31	31	22	46	22
	MF	40	47	38	37	26	23	44	36
	HF	40	47	38	37	26	23	44	36
	Spectrogram as a whole	41	44	43	41	34	30	49	35
Replacement of harmonics by noise (%)	LF	34	30	36	34	5	5	8	16
	MF	32	45	35	25	13	24	24	23
	HF	43	51	30	25	27	31	20	21
	Spectrogram as a whole	37	37	37	28	19	30	28	29
Definition and regularity of harmonics (%)	LF	52	51	56	55	45	42	38	58
	MF	51	36	44	37	40	23	31	33
	HF	34	30	36	34	5	5	8	16
	Spectrogram as a whole	45	41	45	35	28	25	29	39
Number of harmonics (%)	LF	46	51	60	57	60	55	41	61
	MF	49	38	46	39	36	26	25	34
	HF	26	32	45	40	5	5	9	20
	Spectrogram as a whole	45	42	51	46	34	35	25	34
Presence of subharmonics (%)	LF	16	16	16	20	11	12	25	10
	MF	16	21	24	18	11	11	26	26
	HF	19	14	16	13	11	7	12	18
	Spectrogram as a whole	18	22	19	20	11	6	26	18

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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: M=male; F= female; RT= radiotherapy; 2D = conventional radiotherapy; Gy=Grays; CT= chemotherapy; ml = milliliter; min = minute