Correlation Between Voice, Speech, Body and
Facial Types in Young Adults
Silvana Bommarito1, Patricia Barbarini Takaki1, Angélica da Veiga Said1, Marcela Dinalli Gomes Barbosa1, Gisele da Silva Dalben2, Eduardo Kazuo Sannomiya1 and Marilena Manno Vieira1
1Speech Therapy Department, São Paulo Federal University, São Paulo, Brazil
2Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil
Submission: June 24, 2019; Published: July 16, 2019
*Corresponding author: Silvana Bommarito, Speech Therapy Department, São Paulo Federal University, São Paulo, Brazil
How to cite this article: Silvana B, Patricia B T, Angélica V S, Marcela D G B, Gisele S D, et al. Correlation Between Voice, Speech, Body and Facial Types
in Young Adults. Glob J Oto, 2019; 20(4): 556041. DOI: 10.19080/GJO.2019.20.556041
Introduction: Body proportions have been an issue since Ancient times. It started with an interest for personal aesthetics, followed by the concern for selecting the most skillful and physically prepared warriors afterwards. Measurement methods were improved over time, resulting in the emergence of biotypology and biometry, which differentiates individuals among themselves in a higher level when compared to age, gender or social factors.
Objective: To correlate voice, speech, biotype and facial type measures.
Method: The study was conducted on 124 individual’s college students, with mean age 22 years old. The sample was divided in three groups, according to biotype, and all individuals were submitted to anthropometric and vocal evaluation. The anthropometric evaluation consisted of body and facial type. Voice evaluation consisted of sustained phonation and acoustic analysis. All voice records were carried out and analyzed on an acoustic program PRAAT. Statistical analysis was performed by ANOVA and Pearson Correlation (0.05 significance level).
Results: A relationship was found in men between body type and F1 /i/ (p < 0.001, correlation -53.9%) and with F1 /a/ and F3 /u/ (p = 0.05 e p = 0.035, respectively). There was also relationship between F3 and facial types, with higher F3 values in men with short faces and women with long faces.
Conclusion: There is interference in F1 and F3 formants shaping by body type and in F3 formant shaping by facial type, concluding that body type reflects in different vocal tract shapes and in final speech product.
Body proportions have been an issue since Ancient times. It started with an interest for personal aesthetics, followed by the concern for selecting the most skillful and physically prepared warriors afterwards [1,2].
Measurement methods were improved over time, resulting in the emergence of biotypology and biometry, which “differentiates individuals among themselves in a higher level when compared to age, gender or social factors” . Biotypology provided the establishment of standards in the search for ideal and universal body proportions . Obtained by Cormic Index [3-5] and related to Facial Types (FT) , it may classify individuals into three different biotypes [2,7,8] as follows:
a) Endomorph: Presents a longer upper body compared to the extremities, has brachycephalic skull and is euryprosopic, characterized by a widened face. Such individuals present short and broad muscles, allowing them for better performance in tasks that involve strength and resistance. They also have
shortened and enlarged necks, resulting in a wider vocal tract, as well as oral and nasal cavities.
b) Ectomorph: Exhibits longitudinal development, with longer extremities than the torso, dolichocephalic skull and is leptoprosopic, characterized by a prolonged face. Their muscles are long and slim, promoting better results in speed and agility activities. They have thin necks, with slender oral and nasal cavities.
c) Mesomorph: The intermediate biotype, with more symmetric body measures. The characteristic FT described by the Italian School is mesoprosopic, which also presents more symmetry between measurements.
Therefore, it is possible to infer that, for each biotype, a different FT, larynx and vocal tract anatomy are expected, with variations in muscle diameter and length, airspace and vocal folds , as shown in Figure 1. These differences may modify muscular activities during phonation, causing changes in vocal measures [8,9] and resonance [10,11] parameters. Due to the flexibility
of the vocal tract and articulatory structures, it is still unknown
how body measures reflect on voice characteristics [12,13]. It
is only known to be influenced by age and sex, [14,15] and the
vocal tract’s characteristics and ability to change shape influence
the frequency of formants [16,17]. Since publication of these
studies and also considering the evidences of different effects
resulting from resonance tube length [10,14], articulation point,
mouth opening  and other fine adjustments on the vocal
tract, new vocal therapy methods were developed addressing
the vocal tract (e.g. Semi Occluded Vocal Tract method) .
These evidences reinforce the need to understand the relation of
biotype to voice and speech for enhancing diagnostics precision
and therapeutic accuracy, possibly guiding the selection of
exercise type and its focus - speed and agility or resistance and
strength - besides to facilitate the definition of proper exercises
and therapeutic boundaries for each case, which is what believe.
Hence, considering the lack of studies concerning biotype and its
implications in speech, the present study is proposed, aiming to
correlate biotype, facial type, voice and speech measures.
This analytical, observational and cross-sectional study
was approved by the Institutional Review Board (No 288.430).
The study was conducted on 124 young adults (68 men and
56 women), with mean age 22 years, with normal occlusion or
Angle’s Class I malocclusion  and with no vocal complaints.
All individuals agreed to participate and signed a written consent
form and were distributed according to the biotype classification
(43 endomorph, 42 mesomorph and 39 ectomorph). Individuals
with smoking or alcoholism habits, history of occupational
vocal abuse, with syndromes or malformations, physical or
mental disabilities, that suffered cranioencephalic trauma,
submitted to head or neck surgery or intubation procedure were
excluded from the analysis. In addition, individuals with nasal
obstruction, myofunctional and vocal disorders, open or cross
bite, dental malocclusions (except for Angle’s Class I, the most
frequent occlusion in Brazil), temporomandibular dysfunction
(TD) or who had undergone orthodontic treatment in less than
two years were also excluded. All individuals underwent clinical
evaluation of the upper airways with otolaryngologist and dental
specialist of TD.
To ensure that the voice samples were within normal
variability, a perceptual evaluation of vocal quality was carried
out by impartial professionals. For this evaluation, a visual
analog scale was used according to Yamasaki’s method and
cutoff values , including voices scored up to 35.5 mm. The
voices were presented randomly and blindly, with repetition
of 10% of the sample to verify the intraexaminer reliability.
Thereafter, the intra- and interexaminer reliability was analyzed
by Cohen’s Kappa, which revealed a very low interexaminer
statistical agreement (Kappa = 0.18). Thus, evaluation by a single
examiner with the highest intraexaminer reliability (Kappa = 1)
was conducted to evaluate the vocal quality of individuals. All
participants were submitted to a personal information interview
to assess the vocal habits and orthodontic history, and the latter
was used as exclusion criteria. Then, they were submitted to
anthropometric assessment and voice and speech evaluation. All
instruments were sanitized with 70% ethyl alcohol after each
procedure. The measures were taken three times to increase
reliability, and the mean values were used for further analysis.
The heads of all individuals were positioned taking as reference
the Frankfurt Horizontal Plane and the Midsagittal Plane.
Body measures were taken to obtain the facial and Cormic
Index (CI) for subsequent body and facial type classification.
For biotype assessment, the height and torso cephalic measures
were taken using a stadiometer with 1-mm precision. All
individuals were positioned standing with their backs straight,
perpendicular to the ground, shoeless, with parallel feet and
joined heels. For torso cephalic height - the distance between
the vertex and the ischia in a straight line - individuals were
positioned sitting in a 45 cm-high standard seat with their backs
straight against the stadiometer (Figure 2). The measure consists
of the height from head to the ground, deducting the height of
the seat. The CI, created in 1907 by Giuffrida-Ruggeri (Figure
1), was calculated using a specific equation (CI = torso cephalic
height / height x 100). For males, values less than or equal to
51,0 are considered logilineos; from 51,1 to 53 are mesolineos
and up to 53,1 are brevilineos. For females values less than or equal 52,0 are logilineos, from 52,1 to 54 are mesolineos and
up to 54,1 are brevilineos. Facial eavluation was performed by
Martin´s Facial Index , by formula = face height / face width
x100, being considered hiperprosopic the individuals with
measures equal or below to 78,9; euriprosopic from 79,0 to 83,0;
mesoprosopic from 84,0 to 87,9; leptoprosopic from 88,0 to 92,9
and hyperprosopic equal or higher than 93,0. Facial height is
the distance in a straight line between the Nasion (N) and the
Gnathion (Gn), and was measured using a 500 mm CESCORF®
bone caliper, positioned perpendicular to the ground Figure 2.
Facial width is measured with the caliper parallel to the ground,
by the distance between the two most lateral points of the
zygomatic arches (bizygomatic diameter) (Figure 3).
Each individual was positioned sitting, with their heads and
backs comfortably straight. Voice recordings were achieved using
a unidirectional auricular microphone (model Karsect HT-9,
Guangdong), with condenser, plugged to an external soundboard
(USB-SA 2.0, model Andrea, Pure Audio™, Pleasant Grove – UT),
and positioned at a 5 cm distance from the individual’s mouth,
at a 45º angle with the head midline. All exercises were recorded
and stored using PRAAT software (v.5.3.85, Boersma and
Weenink, Amsterdam, Netherlands), installed in a Lenovo Yoga
2.13 notebook. The sustained phonation of vowels /a/, /ε/, /i/
and /u/ and /s/ and /z/ sounds was recorded. All individuals
were asked to breathe deeply and articulate the sounds as longer
as possible, in the same intensity of habitual speech (Figure 4).
The fricative sounds /s/ and /z/ were calculated for discard
a possible presence of glotic cleft if the difference between the
sounds was greater 1,2 seconds according Behlau, Madazio,
Oliveira . The Maximum Phonation Time (MPT) was
calculated from the recordings of the sustained /ɛ/ vowel. The
Fundamental frequency (F0) was extracted in PRAAT from
the recordings of the sustained vowel /ε/. A spectrographic
analysis was made using the emissions of vowels /a/, /i/ and
/u/. Therefore, the values of the three first formants (F1, F2 and
F3) were determined. After evaluations, data were statistically
analyzed by ANOVA test and Pearson Correlation, parametric
tests, considering a significance level of 5% and statistical
confidence of 95% (Table 1). The correlation intensity was
determined by the classification scale, according to Table 2.
The final sample distribution and descriptive statistics are
depicted in Table 1. The test results for each evaluation step is
presented in tables. Firstly, no correlation between biotype and
facial type was found (for males p = 0.529, corr = 7.8%; and for
females p = 0.532, corr = -8.5%). Analysis of the relation between
biotype and voice and speech measures (Table 3) revealed a
highly significant, inversely proportional correlation between CI
and F1 /i/ among males. When comparing the mean values by
ANOVA (Table 2), statistically significant difference was found
in males between biotypes in F1 /a/ and F3 /u/. In females, no
difference was found in any of evaluated parameters. Crossing
male’s F1 /a/ and F3 /u/ p-values, it can be inferred that the
difference found in Table 2 occurred between endomorph and
ectomorph (p = 0.004 and p = 0.034, to F1 /a/ and F3 /u/).
Similarly, a correlation test was performed to analyze FI and
voice and speech measures in males and females. Table 4 shows
that no significant relation was found among variables (Figure
Thus, the means were compared by ANOVA (Table 5)
and statistically significant difference was found between
facial types in F3 /a/ among males and females. Accordingly,
crossing of F3 /a/ p-values revealed that this difference in
men occurred between Euryprosopic and Leptoprosopic,
and between Mesoprosopic and Leptoprosopic (p = 0.049
and p = 0.048, respectively). In females, the same difference
was observed between Euryprosopic and Leptoprosopic, and
between Euryprosopic and Mesoprosopic (p= 0.032 and p =
0.033, respectively). The findings are: the longer the torso, the
lower the pharyngeal and anterior to tongue spaces (< CI, F1). Those are characteristics of narrow
cavities. The facial type is related to pharyngeal and anterior
to tongue spaces, although with inverse relationship according
to sex. It means that in male, the longer the face, the lower the
pharyngeal and anterior to tongue spaces (> FI, < F3); in female,
the longer the face, the larger is this same space (> FI, > F3).
Biotypology first started to be thoroughly studied in Italy,
with biometry, which resulted in definition of the Cormic Index
(CI) in 1907, described by Giuffrida-Ruggeri  This index is
considered the main determinant factor for bodies and functions
variables [1,9,23,24], highlighting the relevance of biotype
classification. The bio typology Italian School argues that torso
and body parts measures are proportional to the facial structures
[3,7], and, in this case, it would be a symmetry indicator. Besides,
body proportions differentiate themselves after puberty 
and determine muscles’ shape and position, which in turn plays
a role in the variation of speech, agility, resistance and strength
(SARS) . A very important finding in the present study was
that biotype did not appear to have any correlation with facial type, contradicting the symmetry theory of the Italian School
[3,5,8,9]. Nevertheless, in a more relevant sense, it agrees with
the study of Brown in 1934 , which described the population
as heterogeneous and peculiar, without any metric agreement
or symmetric measures. The significant ethnic admixture in
the Brazilian population brought about severe disordered
alterations in body proportions and therefore can be a possible
explanation for this finding. This study, along with Brown’s [2-3],
may emphasize the need to evaluate the individuals as a whole
and respect their particular characteristics.
Another hypothesis to this divergence with the Italian School
symmetry theory could be the manner through which the Facial
Index was obtained, whose classification does not consider
gender as a distinction factor . This distinction is important
when considering the numerous differences between males and
females, especially concerning body type and shape, muscle mass
and body functions . This difference is also noticeable in the
voice, resulting in changes of vocal measures depending on the
vocal tract length and amplitude of pharyngeal and oral cavities
[12,19,26,27]. This, emphasized by biotype classification, allows
to infer that gender is an important variable to be considered
when establishing a standard . Analyzing biotype and voice
and speech measures, it was observed that CI influenced the
shaping of F1 and F3 in men, as shown in Tables 2 & 3. Among
women, however, no relation was found between variables.
Even so, these results suggest that ectomorph individuals have
smaller posterior and anterior to tongue spaces (F3) and greater
mouth opening and vertical tongue displacement (F1), only to
name a few of the characteristics found. Facial type and voice
and analysis of speech measures did not show any correlation,
as shown in Table 4. When analyzing the difference between the
facial types means, statistical difference in F3 /a/ means was
observed both in males and females (Table 5).
However, this occurred differently between genders, which
means that F3 means were lower in men with long faces but
higher in women also with long faces. This suggests that men
and women differ according to the shapes and sizes of cavities,
even though Ávila´s classification6 considers the same facial
type for both.
This finding may be used as a guide for future studies about
facial type differences according to gender, following the bio
typology’s line [2-3]. The authors encourage further studies
to analyze if this difference is indeed relevant to facial type,
searching for greater precision in measurement, so that light
can be shed on the vocal tract’s air space, especially concerning
differences between men and women. The literature also
described that individuals with short face (endomorph) tend to
have higher formant values  when compared to elongated
facial measures (ectomorph). Table 2 presents the statistical
difference between F1 /a/ and F3 /u/ means between biotypes
(p = 0.005 and p = 0.035), specifically between endomorph and
ectomorph. These data corroborate the theory in the literature
concerning differences in cavities shape and size between those
two biotypes [2,3] and their effects on speech quality. These
findings contribute to a better understanding of differences
between biotypes, such as ectomorph compared to endomorph
individuals [6,7,9], as shown in Figure 1.
Therefore, this study confirms biotypes’ anteroposterior
dimensions (Figure 1) and their functional impact, besides
corroborating previous studies about the effect of vocal tract size
on voice and speech [6,11,12,16,18]. It is worth mentioning that
long face individuals present greater vertical dimensions of the
vocal tract than short face individuals, as well as all soft tissues,
with long and slim shape [2,3,6,7]. In clinical practice, these
findings contribute to establish the therapeutic prognostic, since
it is known that euryprosopic individuals have wide and short
oral and nasal cavities, which will favor better tongue positioning
in the oral cavity, as well as articulatory amplitude and vocal
projection. This would not occur with leptoprosopic individuals,
who have long cavities. Besides, the use of SARS concepts 
will possibly enhance therapy planning and implementation,
promoting speech and agility in endomorph and resistance and
strength in ectomorph, according to the therapist’s judgement.
The authors acknowledge that the absence of imaging exams in
our sample was an important limitation to this study, considering
that it could have provided more precise measures in oral, nasal
and pharyngeal cavities, added to the possibility to obtain
volume and air space measurements. This way, it would have
been possible to deepen the understanding of internal anatomic
differences among biotypes. Nevertheless, these differences
in speech measures were found, expressing their anatomical
distinction and their projection in speech function.
The authors concluded that biotype classification may
interfere in F1 and F3 shaping, assigning different oral, nasal
and pharyngeal cavities sizes and shapes. Facial type interfered
specifically in F3 shaping, even though more studies are required
to better understand its classification regarding gender. The
present study might suggest that biotype reflects in different
vocal tracts’ shapes and the speech final product.