Wind instrumentalists' work-related vocal tract discomfort.

BACKGROUND: Wind instrumentalist use the vocal tract intensively in their professional activities, which can lead to the development work-related voice disorders. OBJECTIVE: To analyze the perception of vocal tract discomfort (VTD) by wind instrumentalists from Natal, Brazil. METHOD: Cross-sectional study with 117 professional musicians and music students from six official bands/orchestras in the city of Natal. Both the Vocal Tract Discomfort Scale and a sample characterization questionnaire were applied. The Chi-square test, Fisher's exact test, and Mann-Whitney U test were applied in the statistical analysis of the variables. RESULTS: The most frequent and intense symptoms of VTD were sensitive throat and sore throat. There was a significant difference between the values of frequency and intensity of all symptoms both before and after playing the instrument. Dryness was the most intense symptom felt after playing the instrument. Musicians who report muscle pain and gastroesophageal reflux showed more VTD symptoms. CONCLUSION: Symptoms of VTD are experienced by wind instrumentalists and can be work-related since there was a difference in their perception after playing their instruments. There was also a relationship with gastroesophageal reflux and muscle pain, indicating that, in addition to collective issues, the individual musicians' health should be taken into account.

Relationship of Food Intolerance 2 Years After Roux-en-Y Gastric Bypass Surgery for Obesity with Masticatory Efficiency and Protein Consumption.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is among the most performed bariatric surgery techniques. One known complication of RYGB surgery is food intolerance, which may limit the intake of protein. OBJECTIVE: To investigate the relationship of food intolerance after RYGB surgery with masticatory efficiency, chewing time and cycles, and consumption of protein and red meat. METHODS: A case-control study in subjects with and without food intolerance (regurgitation and/or vomiting more than once a week) aged over 18 years old who had undergone RYGB more than 2 years prior, with an absence of no more than 2 dental units and normal oral motor system evaluation. Masticatory efficiency was evaluated by the granulometry of red meat chewed by the study subject according to a predefined protocol using a sieving technique and classified from very poor to excellent. Protein and red meat consumption were evaluated by usual food recall and a 3-day dietary diary. RESULTS: The study population consisted of 24 cases (37.7 ± 7.57 years old, 79.2% females) and 68 controls (38.0 ± 8.75 years old, 61.8% females). There was a statistically significant association (p = 0.001 by the ranksum test) between food intolerance and masticatory efficiency, with 58.3% of cases and 23.5% of controls showing very poor masticatory efficiency. No evidence was found of an association of food intolerance with chewing time, chewing cycles, low protein or red meat consumption. CONCLUSION: Masticatory inefficiency is a contributing factor to food intolerance after RYGB, regardless of time and chewing cycles. No relationship was found between food intolerance and consumption of red meat and protein.

Food Tolerance and Eating Behavior After Roux-en-Y Gastric Bypass Surgery.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) surgery often leads to food intolerance, especially protein intake. AIM: This is to investigate the association of food intolerance with protein intake and chewing parameters in patients who underwent RYGB surgery 2 years prior. METHODS: An observational study was carried out in 30 patients aged between 18 and 60 years old with at least a 2-year postoperative period since undergoing RYGB surgery. A specific questionnaire was applied to obtain a food tolerance score; a masticatory efficiency, chewing cycles, and time were evaluated with a standard test based on the size of the fragmentation of almonds and of meat after a certain chewing time. Protein intake was evaluated by 24-h dietary recall. RESULTS: Mean age was 42.3 ± 11.2 years; mean body mass index was 33 ± 6 kg/m2; and mean time since surgery was 4.9 years. The food tolerance score was 23.4 ± 3.3 points. There was no evidence of an association between food tolerance and chewing efficiency for meat (p = 0.28) nor between food tolerance and protein intake (Spearman correlation coefficient 0.03, p = 0.86). Regarding chewing efficiency with almonds, tolerance was higher in patients with optimal efficiency than among those with good and acceptable efficiency (p = 0.01). CONCLUSIONS: In the evaluation of mastication using almonds, food tolerance increased with the number of chewing cycles and with greater chewing efficiency; the same association was not found in the evaluation using red meat.

Effects of Weight Loss on Acoustic Parameters After Bariatric Surgery.

BACKGROUND: Patients with morbid obesity may present vocal alterations, since large accumulation of fat in the vocal tract may interfere with voice production of these individuals. OBJECTIVE: Verify the neck circumference and the acoustic parameters of voice in obese women, before and after the bariatric surgery, and compare the results with a control group, with normal weight. METHODS: Observational, longitudinal, descriptive study with patients referred to the SCODE (Obesity Surgery and Related Disorders Center) in a university hospital. The sample consisted of 25 morbidly obese women, age range 28-43 years and 23 non-obese women, aged 21-41 years control group. To measure the neck circumference, a tape measure was used and all participants were seated upright with the head positioned in the Frankfort horizontal plane. The fundamental frequency was calculated through the sustained emission of vowel [a] at usual intensity and pitch, to measure the fundamental frequency of the voice, that is, how much the vocal fold vibrates per second. After the recording, participants were prompted to produce vowels [a], [i], and [u] sustained at usual intensity and pitch, and a stopwatch was used to measure the maximum phonation time, to verify the balance between myoelastic and dynamic forces of the larynx. After 8 months post-surgery, the patients were recruited to be re-evaluated using the same pre-surgical data collection procedures. RESULTS: There was an increase in the mean value of f0. The maximum phonation time of all vowels increased after surgery. CONCLUSION: Obese individuals with post-surgery weight loss may present neck circumference, fundamental frequency, and maximum phonation time values closer to the mean values of normal weight individuals. In this study, weight loss was sufficient to adjust the acoustic parameter measurements.

Neck Circumference and Vocal Parameters in Women Before and After Bariatric Surgery.

BACKGROUND: Morbidly obese patients may suffer from vocal disorders, as vocal production is directly related to the volume of the vocal tract, and the large-scale accumulation of fat in this region may interfere with voice production. The aim of this study was to analyze the neck circumference, fundamental frequency, and maximum phonation time of a group of morbidly obese women before and after bariatric surgery. METHODS: An observational, longitudinal, and descriptive study was performed with patients of the Obesity and Related Diseases Surgery Unit of a university hospital. A total of 21 morbidly obese women aged 28-68 years, with a mean age of 41.33 years, participated in the study. Neck circumference was measured using a tape measure. To obtain fundamental frequency values, the patient was asked to produce the vowel [a] at normal intensity and pitch for an average period of 3 s. After recording, the participants were asked to produce the sustained vowels [a], [i], and [u] at normal intensity and pitch, with a stopwatch used to measure maximum phonation time. Eight months after surgery, patients were reassessed using the same data collecting procedures as were carried out prior to surgery. RESULTS: After surgery, there was an increase in the average value of fundamental frequency and maximum phonation time for all the vowels and a reduction in neck circumference. The differences were statistically significant. CONCLUSIONS: Weight reduction and a consequent decrease in neck circumference affected the changes in maximum phonation time and fundamental frequency values in the voices of these patients, after weight loss.

VOCAL COMPLAINT, AUDITORY-PERCEPTUAL ASSESSMENT OF VOICE AND VOCAL SELF-ASSESSMENT IN WOMEN WITH MORBID OBESITY.

BACKGROUND: Obese people often have altered breathing patterns and therefore may experience difficulties in voice production. AIM: To verify the presence of vocal complaints and the correlation between the auditory-perceptual analysis of voice and vocal self-assessment of a group of women with morbid obesity before and after bariatric surgery. METHODS: A longitudinal, exploratory, descriptive study of 21 morbidly obese women aged between 28 and 68 years, assessed before and after bariatric surgery, was performed. The women filled out a form containing identification data and type of vocal complaint. Perceptual evaluation of voice and vocal self-assessment were performed using a visual analog scale. For perceptual assessment of voice the women were asked to say three sentences from the Consensus Auditory-Perceptual Evaluation of Voice. RESULTS: Of the 21 patients, 14 (66.6%) reported vocal complaints, of which 10 (71%) vocal fatigue, eight (57.14%) voice failures and seven (50%) vocal effort. All participants reported improvements in the voice after surgery, irrespective of having reported vocal complaints before surgery. There was no correlation between vocal self-assessment and auditory-perceptual assessment of the voice before or after the procedure. There was no correlation between vocal self-assessment and perceptual evaluation of the voice before surgery. CONCLUSION: Obesity interfered with voice production and influenced negative perception and therefore vocal complaints. Complaints about vocal production cannot be perceived by a speech therapist with the same impact as by patients, as both employ different criteria for vocal evaluation. Vocal self-assessment is an important tool in voice evaluation.

Cochlear implanted children present vocal parameters within normal standards.

OBJECTIVE: to compare acoustic and perceptual parameters regarding the voice of cochlear implanted children, with normal hearing children. METHOD: this is a cross-sectional, quantitative and qualitative study. METHODS: Thirty six cochlear implanted children aged between 3 y and 3 m to 5 y and 9 m and 25 children with normal hearing, aged between 3 y and 11 m and 6 y and 6 m, participated in this study. The recordings and the acoustics analysis of the sustained vowel/a/and spontaneous speech were performed using the PRAAT program. The parameters analyzed for the sustained vowel were the mean of the fundamental frequency, jitter, shimmer and harmonic-to-noise ratio (HNR). For the spontaneous speech, the minimum and maximum frequencies and the number of semitones were extracted. The perceptual analysis of the speech material was analyzed using visual-analogical scales of 100 points, composing the aspects related to the overall severity of the vocal deviation, roughness, breathiness, strain, pitch, loudness and resonance deviation, and instability. This last parameter was only analyzed for the sustained vowel. RESULTS: The results demonstrated that the majority of the vocal parameters analyzed in the samples of the implanted children disclosed values similar to those obtained by the group of children with normal hearing. CONCLUSION: implanted children who participate in a (re) habilitation and follow-up program, can present vocal characteristics similar to those vocal characteristics of children with normal hearing.