A Prospective Comparative Analysis to Study the Impact on Voice Changes Following Endoscopic Thyroidectomy.

BACKGROUND: Endoscopic approach has come up as a safe and feasible procedure for thyroidectomy with better cosmetic outcomes. However, concerns over its safety in terms of nerve injury and postoperative voice changes remain. This prospective study evaluated the role of vocal cord function assessment using laryngeal examination and voice analysis in patients who underwent endoscopic hemithyroidectomy either by the trans-oral endoscopic thyroidectomy vestibular approach (TOETVA) or the bilateral axillobreast approach (BABA). METHODS: Thirty-nine consecutive patients were randomly allocated to either of the 2 groups of endoscopic hemithyroidectomy; 19 in TOETVA and 20 in the BABA groups. Vocal cord function was assessed subjectively using the GRBAS scale and objectively by acoustic analysis of parameters such as jitter, shimmer, mean frequency (F 0 ), noise-to-harmonic ratio (NHR), and maximum phonatory time (MPT) at baseline, postoperative day 10, and 3 months after surgery. RESULTS: There were no significant differences in mean GRBAS scores and values of mean frequency, jitter and shimmer between the 2 groups and on postoperative day 10 and at 3 months compared with baseline. The mean NHR and MPT showed no differences between the 2 procedures. However, there was a significant decrease in their values on day 10 postsurgery, compared with baseline. These values returned to their baseline at 3 months. The other operative parameters were comparable between the 2 groups, except for the shorter mean operative time in the TOETVA group. CONCLUSIONS: Perioperative quantitative voice parameters were comparable with no statistically significant difference between the 2 techniques of endoscopic thyroidectomy.

Voice Disorder Prevalence and Vocal Health Characteristics in Children.

Importance: Voice disorders impede communication and limit quality of life for many children. However, research demonstrating the prevalence of pediatric voice problems and associated voice use patterns is scarce. This investigation examined the prevalence of voice problems and vocal health characteristics of school-aged children. Objective: To examine the prevalence of voice problems in school-aged children throughout the US with reference to lifestyle, demographic characteristics, and voice use patterns. Design, Setting, and Participants: This study used a cross-sectional design to survey a probability sample of caregivers of children aged 4 to 12 years living throughout the US in 2023. Main Outcomes and Measures: Caregivers were surveyed regarding their children's voice use, voice symptoms, voice problems, extracurricular activities, and demographic information. Caregivers also competed the Pediatric Voice-Related Quality of Life questionnaire. The Fisher exact test, χ2 tests, and logistic regression were used to compare children with and without voice problems. Results: Overall, 6293 panelists were invited to complete screening questions for the survey, and 1789 individuals were screened for eligibility between March and April 2023. Of these, 1175 parents (65.7%) completed the survey. Twenty-one (1.8%) were excluded for a combination of either high refusal rates (n = 16), speeding (n = 2), or straight lining (n = 12). The final number of participants included in analysis was 1154 caregivers of children aged 4 to 12 years (559 female children [48.4%]; 595 male children [51.6%]; mean [SD] age, 8.02 [2.49] years). The prevalence of voice problems in children was 6.7% (n = 78), and the lifetime prevalence was 12% (n = 138). Benign vocal fold lesions was the most common diagnosis underlying voice complaints, and other causes included respiratory illness, allergies, autism-related voice issues, and other neurological conditions. Risk factors for pediatric voice problems included being male (odds ratio [OR], 1.47; 95% CI, 1.0-2.1), having more than 4 individuals living in the household (OR, 2.30; 95% CI, 1.2-4.4), poor speech intelligibility (OR, 2.26; 95% CI, 1.2-4.3), maternal history of voice problems (OR, 4.54; 95% CI, 1.2-16.4), participating in online gaming (OR, 1.56; 95% CI, 1.0-2.3), and secondhand smoke exposure (OR, 1.7; 95% CI, 1.1-2.6). Voice use-related risk factors included frequent talking, coughing, throat clearing, tantrums/crying, and vocal strain. Voice problems were associated with substantially detracted quality of life as measured by the Pediatric Voice-Related Quality of Life questionnaire, limited social/extracurricular interactions, increased school absences, and negative attention from adults. Conclusions: The results of this survey study suggest that pediatric voice problems are relatively common and detract from quality of life. Specific environmental and behaviorial factors are associated with increased risk for voice disorders.

Voice Disorders and Hearing Loss May Be Additive Risk Factors for Depression in a National Cohort.

OBJECTIVES: Hearing loss (HL) (receptive communication impairment) is a known risk factor for depression. However, dysphonia (expressive communication impairment), has received little study. We study HL, self-reported voice disorder, and combined impairment as risk factors for depression in a large national cohort. METHODS: This was a cross-sectional epidemiologic study. Data were analyzed from the Korean National Health and Nutrition Examination Survey (KNHANES) cycles 2008-2012 and 2019-2020. KNHANES uniquely contains both audiometry and voice disorder data. HL (yes/no) was defined as ≥25 dB pure tone average. Voice disorder (yes/no) was defined by self-report. Depression (yes/no) was defined by physician diagnosis. Odds ratios for depression were calculated using multivariable logistic regressions with HL and voice disorder. RESULTS: 8,524 individuals aged 19 to 80 years old had complete data. The mean age was 57.3 years (SD = 13.4) and 64% were women. All regressions were controlled for age and sex. Those with HL, versus those without, had 1.27 times the odds (95% CI = 1.07-1.52, p = 0.007) of depression. Those with self-reported voice disorder, versus those without, had 1.48 times the odds (1.22-1.78, p < 0.001) of depression. Those with HL and self-reported voice disorder, versus those with neither, had 1.79 times the odds (1.27-2.48, p < 0.001) of depression. CONCLUSIONS: This study demonstrates independent relationships between HL and depression and self-reported voice disorder and depression. Combined HL and self-reported voice disorder had nearly 1.8 times the odds of depression. This is likely due to the grossly additive effect of difficulty with incoming and outgoing communication streams. LEVEL OF EVIDENCE: II Laryngoscope, 134:4060-4065, 2024.

Voice handicap and voice-related quality of life in COVID-19 patients.

OBJECTIVES: Identifying voice handicap and voice-related quality of life in patients presenting pulmonary impairment associated with COVID-19 infection, comparing pulmonary parameters between these patients and individuals in the control group, as well as correlating pulmonary parameters to self-assessment questionnaires (IDV-10 and QVV). METHODS: Thirty-five (35) patients presenting pulmonary impairment with COVID-19 infection were herein selected and compared to 35 individuals who were not affected by COVID-19 infection. Two self-assessment questionnaires were applied (vocal handicap index and voice quality of life protocol). Maximum phonation time Forced Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) were measured and videolaryngoscopy was performed. RESULTS: There was statistically significant difference in scores recorded in voice self-assessment questionnaires (IDV-10 and QVV), Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) between patients with pulmonary impairment associated with COVID-19 infection and those in the control group. Correlation between PEF/PIF and scores recorded in voice self-assessment questionnaires was also observed. CONCLUSION: Pulmonary impairment associated with COVID-19 infection has worsened voice handicap and voice-related quality of life in the assessed patients, as well as reduced their forced expiratory and inspiratory pressure in comparison to the control group.

Analysis of factors on voice quality in thyroidectomy patients.

OBJECTIVE: Vocal cord paralysis (VCP) is a serious complication in thyroidectomy operations; however, its management remains unclear. The present study evaluated the voice parameters of patients who underwent surgery using Intraoperative Neurophysiologic Monitoring (IONM). PATIENTS AND METHODS: A total of 52 patients (41 females and 11 males) who underwent a total thyroidectomy operation were evaluated using objective and subjective voice analysis examinations before and after surgery. Acoustic parameters, such as Fundamental Frequency (F0), Shimmer, Jitter, Noise-to-Harmonic ratio (NHR), and aerodynamic parameters, including S/Z ratio and maximum phonation time (MPT), were analyzed. Objective findings, including the VHI-10 (Voice Handicap Index) and V-RQOL (Voice-Related Quality of Life), were also analyzed. The relationship between voice parameters and IONM values was investigated. RESULTS: The objective analysis (acoustic and aerodynamic parameters) showed no difference (p>0.05). However, the subjective analysis, which involved the VHI-10 and V-RQOL measures, revealed a significant difference before and after the operation (p<0.05). The Spearman correlation analysis showed that the NHR postoperative 1st-month parameter negatively correlated (rho=-0.317, p<0.059), while the F0 postoperative 6th-month parameter positively correlated (rho=0.347) with the amplitude difference before and after dissection (Right R2-R1 difference) for the right RLN measured in IONM. CONCLUSIONS: Patients who are planning to undergo a thyroidectomy procedure should undergo voice assessment during both the preoperative and postoperative periods. IONM could improve voice quality outcomes.

Therapeutic Singing and Semi-Occluded Vocal Tract Exercises for Individuals with Parkinson's Disease: A Randomized Controlled Trial of a Single Session Intervention.

Individuals with Parkinson's disease (PD) experience speech and voice-related symptoms that diminish communication and quality of life. Semi-occluded vocal tract (SOVT) exercises are targeted interventions that, when combined with the positive psychosocial benefits of therapeutic group singing (TGS), may affect outcomes. The purpose of this study was to explore the effectiveness of SOVT exercises, specifically straw phonation combined with TGS, to improve voice quality and mood for individuals with PD. We used a true experimental pretest-posttest between-subjects design (i.e., randomized controlled trial) facilitated by a board-certified music therapist. All participants (N = 27) were randomly assigned to one of three groups (a) straw phonation combined with TGS (SP + TGS, n = 10), (b) TGS (n = 10), and (c) speaking-only control group (n = 7). Participants completed voice recordings for acoustic measures and the Visual Analogue Mood Scale for mood analysis before and after a 30-min intervention. The results demonstrated significant improvement in voice quality evidenced by decreasing Acoustic Voice Quality Index scores following a single session for both SP + TGS and TGS intervention groups when compared to the control. Happiness scores improved in the experimental groups when compared to control. Although not statistically significant, participants in the experimental groups (SP + TGS, TGS) demonstrated better mean mood scores on happiness, anxiety, and angry when compared to control, indicating a positive psychological response to the singing interventions. Overall, this study indicated the effectiveness of SP + TGS and TGS as promising therapeutic interventions for voice quality and mood in individuals with PD.

Voice self-assessment in individuals with Parkinson's Disease as compared to general voice disorders.

BACKGROUND: Individuals with Parkinson's Disease (IwPD) often fail to adjust their voice in different situations, without awareness of this limitation. Clinicians use self-report questionnaires that are typically designed for individuals with General Voice Disorders (GVD) in the vocal assessment of IwPD. However, these instruments may not consider that IwPD have a reduced self-perception of their vocal deficits. This study aimed to compare self-reported vocal symptoms and voice loudness between IwPD and GVD. METHODS: 28 IwPD and 26 with GVD completed the Voice Symptom Scale (VoiSS) questionnaire to evaluate their voice self-perception. Vocal loudness (dB) was also assessed. Univariate and multivariate analyses were used to compare the outcomes from these measures between the two groups. Principal Component Analysis and Hierarchical Clustering Analysis were applied to explore data patterns related to voice symptoms. RESULTS: IwPD reported significantly fewer vocal symptoms than those with GVD in all VoiSS questionnaire domains. Multivariate principal component analysis found no significant correlations between VoiSS scores and participant similarities in voice measures. Despite experiencing hypophonia, IwPD scored lower in all VoiSS domains but still fell in the healthy voice range. Hierarchical Clustering Analysis grouped participants into three distinct categories, primarily based on age, vocal loudness, and VoiSS domain scores, distinguishing between PD and GVD individuals. CONCLUSIONS: IwPD reported fewer vocal symptoms than GVD. The voice self-assessment seems to be unreliable to assess vocal symptoms in IwPD, at least regarding loudness. New self-report instruments tailored to PD individuals are needed due to their particular voice characteristics.

Paediatric voice disorder: who to refer and how to assess? A summary of recent literature.

PURPOSE OF REVIEW: The purpose of this review is to update the reader with recent advances and current opinion on the assessment and management of paediatric voice disorders. RECENT FINDINGS: Access to advanced multidisciplinary paediatric voice clinics has increased over the last decade. Often the assessment is combined between speech therapy/pathology and ENT surgery. Vocal fold nodules remain the most prevalent diagnosis at a paediatric voice clinic, but significant diseases will also present, for example laryngeal papilloma. Recently, more consideration of the psychosocial aspect of voice disorders and evaluation of auditory processing disorders have shown how these can have a negative impact. There also appears to be a lack of parental and teacher awareness of paediatric voice disorders and their significance. SUMMARY: We would recommend multiparametric assessment and analysis of all children with a voice disorder. Most paediatric voice conditions will respond to skilled voice therapy. However, the exact techniques and dosage requires further evaluation and research. Paediatric voice conditions are common and should not be dismissed, as they may represent significant disease, for example papilloma, vagal palsy or have a significant psychosocial impact on the child.

Characterizing Long-Term Swallowing and Voice Outcomes Following Anterior Transcervical Approach.

OBJECTIVES: (1) Assess the frequency and severity of long-term swallowing and voice complaints, follow-up care, risk factors for the development of long-term swallowing and voice complications in patients who underwent anterior transcervical approach (ACA). (2) Determine incidence of long-term swallowing and voice complications requiring follow-up otolaryngologic care and assess the frequency of otolaryngologic follow-up for postoperative swallowing and voice complaints. METHODS: Retrospective cohort study of patients between January 2017 and March 2020 who underwent ACA. Demographic information, data from preoperative evaluation, operative records, and data from postoperative visits were collected. Patients were contacted to complete the Eating Assessment Tool and the "Impairment" subset of the Voice Symptoms Scale. RESULTS: A total of 48 patients (10.6%) followed up with a head and neck surgeon for swallowing complaints and 31 patients (6.8%) for voice complaints. Otolaryngology follow-up for swallowing complaints among patients with at least 3 and 12 months of follow-up was 16.4% and 17.8%, respectively. Otolaryngology follow-up for voice complaints among patients with at least 3 and 12 months of follow-up was 11.7% and 11.9%, respectively. Swallowing function was abnormal in 40.7% at least 3 months after surgery and in 41.8% 12 months after. Voice function was abnormal in 55.7% of respondents at least 3 months after surgery and in 54.5% of respondents 12 months after. CONCLUSIONS: ACA is associated with otolaryngologic complications that include dysphagia and dysphonia. This study demonstrates that long-term swallowing and voice dysfunction appear to persist longer than what is noted by patient utilization of follow-up otolaryngologic care. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:3201-3205, 2024.

Rare Example of abnormal vocal resonance: a case from Balzac's novel.

Ungewöhnliche klinische Fälle wecken bei praktizierenden Ärzten immer wieder Interesse und ermöglichen es ihnen, ihre Wissensbasis zu erweitern und ihre Fähigkeiten zum klinischen Denken zu verbessern. Der Zweck dieser Studie besteht darin, einen klinischen Fall von Stimmresonanz beim Singen bei einem schwindsüchtigen Teenager aus dem Roman "Der Landarzt" von Honoré de Balzac unter Verwendung induktiver und deduktiver Methoden des klinischen Denkens zu analysieren. Stimmresonanzen beim Singen in Schwindsucht können als pathognomonisches Zeichen für eine kavernöse Tuberkulose gewertet werden, da nur mit dem Bronchus verbundene Hohlräume als Helmholtz-Resonator wirken. Trotz der Einzigartigkeit ist das Gehäuse durchaus realistisch, da es nicht im Widerspruch zu den Gesetzen der Akustik steht. Praktizierende Ärzte verfügen über die Kenntnisse der medizinischen Physik, Morphologie und Physiologie, die zum Verständnis der Pathogenese der klinischen Manifestation einer Lungenhöhle erforderlich sind. Dieser Fall zeigt deutlich die Vor- und Nachteile klinischer Denkmethoden, die in der Praxis eingesetzt werden. Dank der Kombination aus Originalität und Realismus kann der Fall von Stimmresonanz aus Balzacs Roman "Der Landarzt" seinen rechtmäßigen Platz in der persönlichen Sammlung klinischer Fälle eines jeden Lungenarztes einnehmen.

Polycystic Ovary Syndrome and Alteration of Vocal Function: A Systematic Review and Meta-Analysis.

INTRODUCTION: Polycystic ovary syndrome (PCOS) is a common hormonal disorder among young women, correlated with hyperandrogenism. Among the symptoms of PCOS, vocal alterations are quite unknown. Dysphonia may be related to hyperandrogenism, and there is no consensus about its prevalence and the severity of vocal disorders, which can cause noticeable discomfort. METHODS: A systematic review of the literature was conducted. Four studies on PCOS that evaluated the phonatory system were included for a total of 174 patients (96 PCOS, 78 controls), and a meta-analysis on comparable data was performed. RESULTS: Four studies evaluated parameters related to vocal symptomatology, altered audiometric examination, and findings at the laryngoscopy in patients affected by PCOS versus controls. Although the individual studies showed increased incidence of alterations and a tendency to develop speech fatigue in women with PCOS, when the results of studies were pulled in meta-analysis, the overall difference was not statistically significant. The studies themselves were very different from each other; therefore, it is hard to draw any firm conclusions. DISCUSSION: The aim of this study was to assess the prevalence of vocal alterations, the correlation with hyperandrogenism, the quality of life, and the voice changes after starting a therapy for PCOS. The present meta-analysis failed to find any difference in terms of PCOS and control cohort. However, the lack of high-quality studies makes it difficult to draw firm conclusions. New and larger studies or big population program data are therefore warranted.

Clinical Voice Outcomes for Two Voice Rest Protocols after Phonomicrosurgery.

OBJECTIVES: Voice rest is commonly recommended for patients with benign vocal fold lesions (BVFLs) after phonomicrosurgery. The study compares the clinical voice outcomes of two protocols, 7-day complete voice rest (CVR) and 3-day CVR followed by 4-day relative voice rest (CVR + RVR), for patients with BVFLs after phonomicrosurgery. STUDY DESIGN: Prospective, randomized controlled trial. METHOD: Patients with BVFLs undergoing phonomicrosurgery were recruited prospectively and randomly assigned to either protocol. Outcomes were assessed on objective measures of acoustics (fundamental frequency, frequency range, mean intensity, cepstral peak analysis) and aerodynamics (vital capacity, airflow rate, subglottal pressure, phonation threshold pressure), as well as subjective measures, both provider-reported through the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and patient-reported through the Voice Handicap Index (VHI). Clinical measures were collected at three-time points: preoperatively, 1-week postoperatively (on voice rest), and 1-month postoperatively. In addition, adherence was estimated using a vocal dosimeter. RESULTS: Twenty-five patients were recruited and randomized to 7-day CVR (n = 13) and CVR + RVR regimen (n = 12). Statistically significant changes were found within both groups for subglottal pressure (p = 0.03) and VHI score (p < 0.001) comparing pre-operative baseline to 1-month postoperative follow-up. There were no statistically significant differences between the groups. Regardless of group assignment, a significant decrease in overall severity ratings for the CAPE-V was found by comparing the preoperative scores to postoperative scores at 1-week (p < 0.001) and 1-month (p < 0.001). CONCLUSION: Both groups improved their overall voice quality comparably 1 month after undergoing phonomicrosurgery as measured by objective and subjective parameters. LEVELS OF EVIDENCE: 2. Laryngoscope, 134:2812-2818, 2024.

The Effect of Noise on Deep Learning for Classification of Pathological Voice.

OBJECTIVE: This study aimed to evaluate the significance of background noise in machine learning models assessing the GRBAS scale for voice disorders. METHODS: A dataset of 1406 voice samples was collected from retrospective data, and a 5-layer 1D convolutional neural network (CNN) model was constructed using TensorFlow. The dataset was divided into training, validation, and test data. Gaussian noise was added to test samples at various intensities to assess the model's noise resilience. The model's performance was evaluated using accuracy, F1 score, and quadratic weighted Cohen's kappa score. RESULTS: The model's performance on the GRBAS scale generally declined with increasing noise intensities. For the G scale, accuracy dropped from 70.9% (original) to 8.5% (at the highest noise), F1 score from 69.2% to 1.3%, and Cohen's kappa from 0.679 to 0.0. Similar declines were observed for the remaining RBAS components. CONCLUSION: The model's performance was affected by background noise, with substantial decreases in evaluation metrics as noise levels intensified. Future research should explore noise-tolerant techniques, such as data augmentation, to improve the model's noise resilience in real-world settings. LEVEL OF EVIDENCE: This study evaluates a machine learning model using a single dataset without comparative controls. Given its non-comparative design and specific focus, it aligns with Level 4 evidence (Case-series) under the 2011 OCEBM guidelines Laryngoscope, 134:3537-3541, 2024.

Perceptual, aerodynamic and acoustic outcomes of surgical technique for sulcus vocalis patients: A systematic review and meta analysis.

BACKGROUND: Sulcus Vocalis (SV) is a voice disorder characterized by the parallel invagination of the vocal fold epithelium that adheres to the vocal ligament. This condition disrupts the vibratory function, leading to glottal incompetence, hoarseness, and vocal impairment. Despite various proposed surgical techniques, a standardized treatment approach remains elusive. METHODS: We conducted a comprehensive search across PubMed/Medline, Embase, Web of Science, Scholar, and the Cochrane Library for studies on SV treatment. The inclusion criteria comprised original studies comparing pre- and post-treatment vocal outcomes in SV patients, published in English. We excluded case reports, reviews, studies without continuous data, and patients with vocal scar/atrophy. RESULTS: Fifteen observational studies were included (361 patients, 53.73 % male, average age 41.64 years). 80 % of these studies employed self-reported outcomes, while 81.25 % analyzed acoustic/aerodynamic data. The follow-up period varied from 4 to 44 months. All techniques significantly improved Voice Handicap Index (VHI) scores (p < 0.001). Dissective and combined techniques exhibited greater reductions in VHI-30/10 (p < 0.001). Maximum Phonation Time (MPT) improved significantly across all techniques (p < 0.001), with dissective techniques demonstrating superior MPT outcomes (p < 0.001). Jitter improved significantly for dissective and injective techniques (p < 0.001), as did Shimmer for all techniques (p < 0.001). Notably, combined techniques displayed the most significant reductions (p < 0.001). CONCLUSIONS: Surgical treatments significantly improve subjective, aerodynamic, and acoustic outcomes in SV patients. Dissective and combined dissective/injective techniques appear to yield better perceptual and phonatory outcomes compared to injective techniques alone. Further research is necessary to establish the optimal treatment approach for SV.

Vocal Problems and Burnout Syndrome in Nonuniversity Teachers in Galicia, Spain.

INTRODUCTION: Voice disorders and burnout syndrome are common among teachers. This study aimed to explore the relationship among vocal problems, burnout syndrome, and some personal work factors. METHODS: This cross-sectional descriptive study enrolled 90 nonuniversity teachers who completed the Multidimensional Vocal Scale for Teachers (EVM-D) to evaluate vocal problems and an adapted Spanish version of the Maslach Burnout Inventory-Educators Survey (MBI-ES) to detect burnout syndrome. RESULTS: Overall, 16% of teachers expressed symptoms compatible with burnout, and 60% of them were in the interval above the 75th percentile of the EVM-D, i.e., they had a high risk of vocal problems. An association between burnout and more vocal problems was established among teachers, particularly between the vocal symptoms and vocal abuse dimensions with the emotional exhaustion subscale of the MBI-ES. A history of anxiety/depression and fewer years of professional experience were associated with more vocal problems. The burnout group perceived more "loss of vocal power," "vocal fatigue," "vocal effort," and "hoarseness." Vocal abuse items received the highest scores of EVM-D. However, only "shouting" in the classroom was significantly different between the groups with and without burnout. CONCLUSION: Emotional exhaustion of burnout syndrome, history of anxiety/depression, and a shorter professional experience were associated with vocal problems, which could limit the performance of teachers. Reducing classroom noise, establishing strategies to avoid shouting, or strengthening personal accomplishments in teachers could be useful in breaking the cycle of vocal problems and emotional exhaustion, particularly at the beginning of their professional experience.

Biomechanical Parameters of Voice in Parkinson's Disease Patients.

INTRODUCTION: Previous research on voice in Parkinson's disease (PD) has consistently demonstrated alterations in acoustic parameters, including fundamental frequency (F0), maximum phonation time, Shimmer, and Jitter. However, investigations into acoustic parameter alterations in individuals with PD are limited. METHODS: We conducted an experimental study involving 20 PD patients (six women and fourteen men). Subjective measures of voice (VHI-30 scale and GRBAS) and objective measures using the OnlineLAB App tool for analyzing biomechanical correlates of voice were recorded. The app analyzed a total of 22 biomechanical parameters of voice. RESULTS: The results of subjective measures were consistent with findings from previous studies. However, the results of objective measures did not align with studies that employed acoustic measures. CONCLUSIONS: The biomechanical analysis revealed alterations in various parameters according to gender. These findings open up a new avenue of research in voice analysis for patients with PD, whether through acoustic or biomechanical analysis, aiming to determine whether the observed changes in these patients' voices are attributable to age or disease progression. This line of investigation will help elucidate the relative contribution of these factors to vocal alterations in PD patients and provide a more comprehensive understanding of the underlying mechanisms.

Screening of voice disorders concerning anatomy teachers who use formaldehyde cadaveric parts in laboratory classes.

Voice disorders are common among teachers and, in particular, anatomy teachers are exposed to a potential enemy for dysphonia, irritating chemicals, that is, formaldehyde. We seek to verify the association between: (1) teaching time, (2) type of cadaveric conservation to which the teacher is exposed and (3) hours of exposure to cadaveric preservative related to the different categories of voice disorders screening (ITDV). The sample consisted of 111 teachers who answered to 02 data collection instruments: I - Sociodemographic Data; II - ITDV. Among participating teachers there were 71 male and 40 female, with an average age of 43 years and 11 months and an average teaching time of 16 years and 5 months. Association tests between teaching time and ITDV demonstrate a significant result in the relationship between voice failure and teaching time (p<0.05). All 111 teachers use their voices in laboratory classes and use cadaveric material. From those, 107 teachers are exposed to formaldehyde as cadaveric parts' conservative solution. There was a significant association (p<0.05) between voice failure and the type of cadaveric conservative solution but non-significant relationship (p>0.05) between ITDV and the time of exposure to formaldehyde preservative. Teachers' ITDV showed vocal signs and symptoms. In particular, voice loss due to time of teaching in anatomy, and voice failure, due to exposure to formaldehyde and combinations used in anatomical parts and cadavers, were significant.

Self-perception of the Immediate Impact on the Voice of Gospel Singers after a one-hour Presentation. / Autopercepção do Impacto Imediato na Voz de Cantores Gospel após uma Apresentação de uma hora.

PURPOSE: To investigate the immediate impact on the voice of gospel singers with and without vocal complaints after a one-hour individual presentation. METHODS: Application of an online questionnaire that addressed the following aspects: 1 - Sociodemographic data; 2 - Self-assessment of the ability to sing using the Evaluation of the Ability to Sing Easily (EASE-BR) protocol; 3 - Self-assessment of vocal fatigue symptoms using the Vocal Fatigue Index (VFI) protocol; and 4 - Self-assessment of voice handicap using the Voice Handicap Index 10 (VHI-10) protocol. Participants were divided into two groups: Group with Vocal Complaint (WVC) and Group with no Vocal Complaint (WnVC) based on the total score of the IDV-10. Data underwent descriptive and inferential statistical analysis with a significance level of 5%. RESULTS: The study included 43 gospel singers with a median age of 34 years: 32 were in the WnVC group and 11 were in the WVC group. The WVC group reported hoarseness and experienced more difficulty while singing in the EASE, resulting in higher scores in both the VHI-10 and VFI protocols. A positive correlation was observed between singing difficulty and vocal handicap due to fatigue in amateur gospel singers, with this correlation being stronger within the WnVC group. CONCLUSION: After one hour of performance, singers with vocal complaints exhibited higher rates of vocal fatigue, vocal disadvantage, and greater difficulty in singing. Singers without complaints may have their ability to sing impaired by vocal fatigue. Variations in singing ability and vocal handicaps in amateur gospel singers may be directly related to vocal fatigue.

OBJETIVO: Investigar o impacto imediato na voz de cantores gospel com e sem queixa vocal após uma apresentação individual de uma hora. MÉTODO: Aplicação de um questionário online que abordou os seguintes aspectos: 1 - Dados sociodemográficos; 2 ­ Autoavaliação da habilidade de cantar pelo protocolo Evaluation of the Ability to Sing Easily (EASE-BR); 3 - Autoavaliação de sintomas de fadiga vocal pelo Índice de Fadiga Vocal (IFV); e 4 - Autoavaliação da desvantagem vocal pelo protocolo Índice de Desvantagem Vocal 10 (IDV-10). Os participantes foram divididos em dois grupos: Grupo Com Queixa (CQ) e Grupo Sem Queixa (SQ) com base no escore total do IDV-10. Os dados passaram por análise estatística descritiva e inferencial considerando o nível de significância de 5%. RESULTADOS: Participaram 43 cantores gospel com idade mediana de 34 anos, divididos entre 32 do grupo SQ e 11 do grupo CQ. O grupo CQ autorrelatou rouquidão e maior dificuldade ao cantar no EASE e maiores escores nos protocolos IDV-10 e IFV. Foi evidenciada correlação positiva entre a dificuldade ao cantar e a desvantagem vocal com a fadiga de cantores amadores gospel, sendo que essa correlação foi maior para o grupo SQ. CONCLUSÃO: Cantores com queixa vocal apresentaram maiores índices de fadiga vocal, desvantagem vocal e maior dificuldade para cantar após uma hora de apresentação. Cantores sem queixa podem ter a habilidade de cantar prejudicada pela fadiga vocal. Variações na habilidade ao cantar e desvantagens vocais de cantores amadores gospel podem ter relação direta com a fadiga vocal.

Percepção de professores quanto ao impacto do ruído no ambiente escolar / Teachers' perception of the impact of noise in the school environment / Percepción del docente sobre el impacto del ruido en el entorno escolar

Introdução: a poluição sonora está presente na escola, sendo assim, é importante conhecer as fontes de ruído, o impacto na saúde do professor e no ensino. Objetivo: avaliar a percepção de professores do ensino fundamental I quanto ao impacto do ruído no ambiente escolar, bem como seus sintomas vocais. Método: estudo observacional, descritivo, analítico, transversal. Aplicou-se inventário, do qual participaram 26 professoras da rede municipal da cidade de Santo Amaro da Imperatriz, SC. Aplicou-se um questionário com questões referentes à idade, sexo, tempo de trabalho, carga horária diária, impacto e percepção do ruído no ambiente escolar. Utilizou-se o Índice de Triagem para Distúrbios da Voz, uma triagem para identificação de risco para distúrbio de voz em professores. Para a análise de associação dos resultados foi utilizado o teste de Qui Quadrado, com nível de significância de 5%. Resultados: 53,57% das professoras responderam que há excesso de ruído na escola e 57,14% consideram que o ruído dentro da sala prejudica as atividades. As fontes externas e internas de ruído que mais atrapalham são: pátio, corredor, conversas paralelas e ventilador. Quanto aos sintomas vocais referidos, destacaram-se: garganta seca, cansaço ao falar, pigarro e rouquidão. Professoras que lecionam em período integral apresentaram mais queixas para o pigarro. Conclusão: os sujeitos têm a percepção de que o ambiente escolar é excessivamente ruidoso e causa prejuízos no desenvolvimento das atividades. As participantes têm poucas queixas relacionadas à voz, sendo a mais frequente, garganta seca. Além disso, professoras que lecionam em período integral apresentaram, significativamente, mais queixas de pigarro. (AU)

Introducción: la contaminación acústica está presente en la escuela, entonces es importante conocer las fuentes del ruido, el impacto en la salud del docente y en la enseñanza. Propósito: evaluar la percepción de docentes sobre el impacto del ruido en el ambiente escolar, así como sus síntomas vocales. Método: estudio observacional, descriptivo, analítico, transversal. Se aplicó un inventario, en el que participaron 26 docentes de la red municipal de la ciudad de Santo Amaro da Imperatriz, (SC). con preguntas relacionadas con edad, género, tiempo de trabajo, carga diaria de trabajo, impacto y percepción del ruido en el ambiente escolar. Se utilizó el Índice de Detección de Trastornos de la Voz para identificar el riesgo de trastornos de la voz. Para el análisis de asociación se utilizó la prueba de chi-cuadrado, con un nivel de significación del 5%. Resultados: 53,57% respondió que en la escuela hay exceso de ruido y 57,14% consideram que el ruido dentro del salón perjudica las actividades. Las fuentes de ruido más molestas son: patio, pasillo, conversaciones paralelas y ventilador. En cuanto a los síntomas vocales reportados destacan sequedad de garganta, cansancio al hablar, carraspeo y ronquera. Los maestros de tiempo completo se quejaron más de carraspear. Conclusión: los sujetos tienen la percepción de que el ambiente escolar es excesivamente ruidoso y provoca perjuicios para el desarrollo de las actividades. Los participantes tienen pocas quejas relacionadas con la voz, siendo la garganta seca la más frecuente. Además, los maestros que enseñan a tiempo completo tenían muchas más quejas de carraspeo. (AU)

Introduction: noise pollution is present at school; therefore, it is important to know the sources of noise, the impact on the teacher's health and on teaching. Purpose: to evaluate the perception of elementary school teachers regarding the impact of noise in the school environment, as well as their vocal symptoms. Method: observational, descriptive, analytical, cross-sectional study. An inventory was applied, in which 26 teachers from the municipal network of the city of Santo Amaro da Imperatriz, (SC). participated. A questionnaire was applied with questions related to age, gender, working time, daily workload, impact and perception of noise in the school environment. The Voice Disorders Screening Index was used, a screening to identify risk for voice disorders in teachers. For the analysis of the association of results, the chi-square test was used, with a significance level of 5%. Results: 53.57% of the teachers answered that there is excessive noise in the school and 57.14% consider that the noise inside the room harms the activities. The most disturbing external and internal sources of noise are courtyard, corridor, parallel conversations and fan. As for the reported vocal symptoms, the following stand out: dry throat, tiredness when speaking, throat clearing and hoarseness. Full-time teachers complained more about throat clearing. Conclusion: the subjects have the perception that the school environment is excessively noisy and causes damage to the development of activities. The participants have few voice-related complaints, the most frequent being dry throat. In addition, teachers who teach full-time had significantly more complaints of throat clearing. (AU)