Voice and Temporal Auditory Processing in Elderly People: A Correlation Study.

Introduction The voice and hearing can be affected to different degrees by aging, which can cause communication difficulties for elderly people. Vocal production requires effective temporal auditory processing at central levels within the nervous system, which can be compromised by the aging process. Objective To analyze the correlation between voice and temporal auditory processing in older adults. Materials and Methods A total of 40 elderly people aged 60 years or older were subdivided into 2 groups according to the presence or absence of vocal symptoms measured by the Voice Symptom Scale. All of the participants were submitted to auditory temporal tests, vocal self-assessment, and acoustic and perceptual auditory analyses of voice. Results Most of the subjects assessed had decreased voice intensity and normal variability in terms of vocal quality. The performance was normal in the Pitch Pattern Sequence test and altered in the Random Gap Detection test. In the Masking Period Pattern test, the detection thresholds for the target signal were increased in the presence of masking in different temporal target signal positions. Only pitch differed between the two groups. There were differences between the genders regarding frequency, shimmer, the overall severity of the alteration, and roughness. There was a correlation regarding temporal resolution ability and the overall severity of the alteration and roughness of the voice. Conclusion There is a central auditory impairment in temporal resolution which is correlated with vocal alterations in the elderly.

Passaggio on chorists' voice range profile: preliminary study of frequency and intensity. / Nota de passagem no perfil de extensão vocal de coristas: estudo preliminar de frequência e intensidade.

PURPOSE: To analyze the passaggio in the voice range profile of choristers, by identifying the fundamental frequencies and intensities, both in the change to the high and low registers, comparing them, by voice types. METHOD: 67 choristers participated, mean age of 27.79 (± 7.50) years old, of the following voice types: soprano (n = 20), alto (n = 17), tenor (n = 15) and bass (n = 15). For data collection and analysis, the Vocalgram software (CTS Informática) was used, which recorded the emission of the vowel / Ɛ / in ascending and descending glissando, up to the lowest and highest note in the weakest and strongest intensities possible. RESULTS: The values of frequencies and respective intensities of the passaggio were identified in ascending and descending, strong and weak emissions in all voice types. There was a higher occurrence of voice break in the high voices, compared to the low ones. The average values ​​of the frequencies found corresponded to different tones from those established in the literature for all voice types. CONCLUSION: The passaggio identified in the vocal range profile of choristers, based on their frequencies and intensities were more frequent in soprano na tenor, compared to alto and bass, in changes to the low and high registers.

OBJETIVO: Analisar a nota de passagem no perfil de extensão vocal de coristas, pela identificação das frequências fundamentais e intensidades, tanto na mudança para o registro agudo quanto para o grave, comparando-as, por naipe. MÉTODO: Participaram 67 coristas, com média de idade de 27,79 (±7,50) anos, dos naipes: soprano (n=20), contralto (n=17), tenor (n=15) e baixo (n=15). Para coleta e análise dos dados utilizou-se o software Vocalgrama (CTS Informática) no qual foi realizada a gravação da emissão da vogal /Ɛ/ em glissando ascendente e descendente, até às frequências mais grave e mais aguda, nas intensidades mais fraca e mais forte possíveis. RESULTADOS: Foram identificados os valores das frequências e respectivas intensidades das notas de passagem nas emissões ascendentes e descendentes fortes e fracas nos quatro naipes. Houve maior ocorrência de identificação de quebra nas vozes agudas, comparativamente às mais graves. Os valores médios das frequências encontradas foram correspondentes a notas diferentes das estabelecidas na literatura para todos os naipes. CONCLUSÃO: As notas de passagem identificadas no perfil de extensão vocal de coristas, a partir de suas frequências e intensidades, obtiveram maior ocorrência nos naipes soprano e tenor, comparativamente ao contralto e baixo, nas mudanças para os registros graves e agudos.

Performance of the phonatory deviation diagram in monitoring voice quality before and after voice exercise in individuals with Parkinson's Disease. / Desempenho do diagrama de desvio fonatório no monitoramento da qualidade vocal pré e pós exercício vocal em indivíduos com Doença de Parkinson.

PURPOSE: To assess the performance of the phonatory deviation diagram and its measurements in monitoring voice quality before and after voice exercise in individuals with Parkinson's Disease. METHODS: Retrospective and documentary study. A sample of 30 subjects was used, 50% male, with a mean age of 62.13 ± 9.05 years. The results of the phonatory deviation diagram were analyzed, in the moments before and after vocal exercise with the pushing technique associated with plosive sounds, considering the area, density, shape and location of the diagram in the quadrants. For comparison purposes, the acoustic parameters of jitter, shimmer, glottal to noise excitation ratio and results of the auditory-perceptual analysis, carried out in previous research, were also considered, in the pre- and post-technical moments. RESULTS: Despite the fact that there was no difference in the distribution of samples in the diagram, after performing the vocal technique, a change in the displacement of the diagram towards the area of normality was identified in the visual qualitative analysis, and there was an association between the general degree of vocal deviation in the analysis auditory perception and the area of the diagram. There was an improvement in the shimmer values after the vocal technique. CONCLUSION: The displacement of the phonatory deviation diagram towards the area of normality corroborated the results in relation to the general degree of dysphonia, evaluated by the auditory-perceptual analysis and the shimmer results, after the vocal technique. Thus, the diagram shows good performance in monitoring voice quality of individuals with Parkinson's.

OBJETIVO: Verificar o desempenho do diagrama de desvio fonatório e de suas medidas no monitoramento da qualidade da voz, pré e pós exercício vocal, em indivíduos com Doença de Parkinson. MÉTODO: Estudo retrospectivo e documental. Utilizou-se uma amostra de 30 sujeitos, sendo 50% do sexo masculino, com média de idade de 62,13 ± 9,05 anos. Foram analisados os resultados do diagrama de desvio fonatório, nos momentos pré e pós exercício vocal com a técnica de empuxo associada aos sons plosivos, considerando-se a área, densidade, forma e localização do diagrama nos quadrantes. Para fins de comparação, os parâmetros acústicos de jitter, shimmer, glottal to noise excitation ratio e resultados da análise perceptivo-auditiva, realizada em pesquisa anterior, também foram considerados, nos momentos pré e pós-técnica. RESULTADOS: A despeito de não ocorrer diferença na distribuição das amostras no diagrama, após realização da técnica vocal, foi identificada, na análise qualitativa visual, mudança no deslocamento do diagrama em direção à área de normalidade e houve associação entre o grau geral do desvio vocal da análise perceptivoauditiva e a área do diagrama. Houve melhora nos valores de shimmer, após a técnica vocal. CONCLUSÃO: O deslocamento do diagrama de desvio fonatório em direção à área de normalidade corroborou os resultados em relação ao grau geral de disfonia avaliado pela análise perceptivoauditiva e os resultados de shimmer, após a técnica vocal empregada. Desse modo, o diagrama de desvio fonatório apresentou bom desempenho no monitoramento da qualidade vocal de indivíduos com Parkinson.

Oropharyngeal geometry and acoustic parameters of voice in healthy and Parkinson's disease subjects. / Geometria orofaríngea e parâmetros acústicos vocais de indivíduos hígidos e com doença de Parkinson.

PURPOSE: to verify whether there are differences in acoustic measures and oropharyngeal geometry between healthy individuals and people with Parkinson's disease, according to age and sex, and to investigate whether there are correlations between oropharyngeal geometry measures in this population. METHODS: 40 individuals participated, 20 with a diagnosis of Parkinson's disease and 20 healthy individuals, matched by age, sex, and body mass index. Acoustic variables included fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, and mean intensity. Oropharyngeal geometry variables were measured with acoustic pharyngometry. RESULTS: geometry variables were smaller in the group with Parkinson's disease, and older adults with Parkinson's disease had a smaller oropharyngeal junction area than healthy older adults. Regarding acoustic parameters of voice, fundamental frequency values were lower in males with Parkinson's disease, and jitter values ​​were higher in the non-elderly subjects with Parkinson's disease. There was a moderate positive correlation between oral cavity length and volume, pharyngeal cavity length and vocal tract length, and pharyngeal cavity volume and vocal tract volume. CONCLUSION: individuals with Parkinson's disease had smaller glottal areas and oropharyngeal junction areas than healthy individuals. When distributed into sex and age groups, the fundamental frequency was lower in males with Parkinson's disease. There was a moderate positive correlation between oropharyngeal length and volume measures in the study sample.

OBJETIVO: verificar se existem diferenças nas medidas acústicas e da geometria orofaríngea entre indivíduos hígidos e pessoas com Doença de Parkinson, segundo a idade e sexo e investigar se há correlações entre as medidas geométricas orofaríngeas nessa população. MÉTODO: participaram 40 indivíduos, sendo 20 com diagnóstico de Doença de Parkinson e 20 indivíduos hígidos, pareados por faixa etária, sexo e índice de massa corporal. As variáveis acústicas estudadas foram frequência fundamental, jitter, shimmer, glottal-to-noise excitation ratio, ruído e média da intensidade. As variáveis geométricas da orofaringe foram aferidas por faringometria acústica. RESULTADOS: as variáveis geométricas foram menores no grupo com Doença de Parkinson e os idosos com Doença de Parkinson apresentaram menor área da junção orofaríngea que os idosos hígidos. Com relação aos parâmetros acústicos vocais, o valor da frequência fundamental foi menor no sexo masculino, no grupo com Doença de Parkinson e os valores de jitter foram maiores no grupo não idoso dos sujeitos com Doença de Parkinson. Houve correlação positiva moderada entre o comprimento e volume da cavidade oral, comprimento da cavidade faríngea e o comprimento do trato vocal e do volume da cavidade faríngea e o volume do trato vocal. CONCLUSÃO: indivíduos com Doença de Parkinson apresentaram menores valores de área glótica e área da junção orofaríngea, comparativamente aos hígidos. Quando distribuídos por faixa etária e sexo, a frequência fundamental foi menor no grupo com doença de Parkinson, na população masculina. Houve correlação positiva moderada entre as medidas de comprimento e volume da orofaringe, na amostra estudada.

Effect of Wendler glottoplasty on voice and quality of life of transgender women.

OBJECTIVE: To investigate the effect of Wendler glottoplasty on voice feminization, voice quality and voice-related quality of life. METHODS: Prospective interventional cohort of transgender women submitted to Wendler glottoplasty. Acoustic analysis of the voice included assessment of fundamental frequency, maximum phonation time formant frequencies (F1 and F2), frequency range, jitter and shimmer. Voice quality was blindly assessed through GRBAS scale. Voice-related quality of life was measured using the Trans Woman Voice Questionnaire and the self-perceived femininity of the voice. RESULTS: A total of 7 patients were included. The mean age was 35.4 years, and the mean postoperative follow-up time was 13.7 months. There was a mean increase of 47.9 ±â€¯46.6 Hz (p = 0.023) in sustained/e/F0 and a mean increase of 24.6 ±â€¯27.5 Hz (p = 0.029) in speaking F0 after glottoplasty. There was no statistical significance in the pre- and postoperative comparison of maximum phonation time, formant frequencies, frequency range, jitter, shimmer, and grade, roughness, breathiness, asthenia, and strain scale. Trans Woman Voice Questionnaire decreased following surgery from 98.3 ±â€¯9.2 to 54.1 ±â€¯25.0 (p = 0.007) and mean self-perceived femininity of the voice increased from 2.8 ±â€¯1.8 to 7.7 ±â€¯2.4 (p = 0.008). One patient (14%) presented a postoperative granuloma and there was 1 (14%) premature suture dehiscence. CONCLUSION: Glottoplasty is safe and effective for feminizing the voice of transgender women. There was an increase in fundamental frequency, without aggravating other acoustic parameters or voice quality. Voice-related quality of life improved after surgery.

Métodos utilizados na análise morfométrica do trato vocal em cantores: revisão integrativa / Methods used in morphometric analysis of singers' vocal tracts: an integrative review

RESUMO Objetivo descrever os principais métodos quantitativos utilizados para análise morfométrica do trato vocal em cantores, suas aplicações e os principais segmentos estudados. Estratégia de pesquisa trata-se de uma revisão integrativa guiada pela pergunta condutora: "Quais os principais métodos quantitativos utilizados para análise morfométrica do trato vocal, suas aplicações e os principais segmentos estudados em cantores?". Foram utilizadas as bases eletrônicas PubMed, Scopus e BVS, por meio da chave de busca Vocal tract OR Oropharynx AND Morphology OR Geometry AND Evaluation OR Diagnosis AND voice, sem restrições de ano de publicação, sendo incluídos artigos em três idiomas: português, inglês e espanhol. Critérios de seleção: a seleção se deu de forma independente, por meio da leitura por pares e posterior aplicação dos critérios de exclusão e inclusão. Resultados dos 380 estudos, foram excluídos 30 duplicados. A partir da leitura dos resumos, aplicando-se os critérios de seleção, foram selecionados 18 estudos para leitura na íntegra, dos quais, 12 foram incluídos nesta revisão. A ressonância magnética foi o principal instrumento utilizado e os segmentos analisados incluíram desde o comprimento e volume do trato vocal, como segmentos isolados e suas particularidades morfológicas. Conclusão os métodos de quantificação morfológica do trato vocal integram instrumentos importantes para a avaliação instrumental do trato vocal e de seus segmentos, colaborando na atualização tecnológica em voz para melhor compreensão e intervenções fonoaudiológicas na voz cantada

ABSTRACT Purpose To describe the main quantitative methods used for morphometric analysis of the vocal tract in singers, their applications and the main segments studied. Research strategy This is an integrative review guided by the guiding question "What are the main quantitative methods used for morphometric analysis of the vocal tract, their applications and the main segments studied in singers?". The electronic databases PubMed, Scopus and VHL were used through the search key (Vocal tract OR Oropharynx) AND (Morphology OR Geometry) AND (Evaluation OR Diagnosis) AND (voice), without restriction of years of publication, including articles in three languages: Portuguese, English and Spanish. Selection criteria The selection took place independently through reading by pairs and subsequent application of exclusion and inclusion criteria. Results Of the 380 studies, 30 duplicates were excluded. After reading the abstracts, applying the selection criteria, 18 studies were selected for full reading, of which 12 were included in this review. Magnetic resonance imaging was the main instrument used and the analyzed segments ranged from the length and volume of the vocal tract to isolated segments and their morphological particularities. Conclusion Vocal tract morphological quantification methods are important for the instrumental evaluation of the vocal tract and its segments, a technological update leading to better understanding of singers' voice and therapeutical intervention.

Nota de passagem no perfil de extensão vocal de coristas: estudo preliminar de frequência e intensidade / Passaggio on chorists' voice range profile: preliminary study of frequency and intensity

RESUMO Objetivo Analisar a nota de passagem no perfil de extensão vocal de coristas, pela identificação das frequências fundamentais e intensidades, tanto na mudança para o registro agudo quanto para o grave, comparando-as, por naipe. Método Participaram 67 coristas, com média de idade de 27,79 (±7,50) anos, dos naipes: soprano (n=20), contralto (n=17), tenor (n=15) e baixo (n=15). Para coleta e análise dos dados utilizou-se o software Vocalgrama (CTS Informática) no qual foi realizada a gravação da emissão da vogal /Ɛ/ em glissando ascendente e descendente, até às frequências mais grave e mais aguda, nas intensidades mais fraca e mais forte possíveis. Resultados Foram identificados os valores das frequências e respectivas intensidades das notas de passagem nas emissões ascendentes e descendentes fortes e fracas nos quatro naipes. Houve maior ocorrência de identificação de quebra nas vozes agudas, comparativamente às mais graves. Os valores médios das frequências encontradas foram correspondentes a notas diferentes das estabelecidas na literatura para todos os naipes. Conclusão As notas de passagem identificadas no perfil de extensão vocal de coristas, a partir de suas frequências e intensidades, obtiveram maior ocorrência nos naipes soprano e tenor, comparativamente ao contralto e baixo, nas mudanças para os registros graves e agudos.

ABSTRACT Purpose To analyze the passaggio in the voice range profile of choristers, by identifying the fundamental frequencies and intensities, both in the change to the high and low registers, comparing them, by voice types. Method 67 choristers participated, mean age of 27.79 (± 7.50) years old, of the following voice types: soprano (n = 20), alto (n = 17), tenor (n = 15) and bass (n = 15). For data collection and analysis, the Vocalgram software (CTS Informática) was used, which recorded the emission of the vowel / Ɛ / in ascending and descending glissando, up to the lowest and highest note in the weakest and strongest intensities possible. Results The values of frequencies and respective intensities of the passaggio were identified in ascending and descending, strong and weak emissions in all voice types. There was a higher occurrence of voice break in the high voices, compared to the low ones. The average values ​​of the frequencies found corresponded to different tones from those established in the literature for all voice types. Conclusion The passaggio identified in the vocal range profile of choristers, based on their frequencies and intensities were more frequent in soprano na tenor, compared to alto and bass, in changes to the low and high registers.

Voice therapy with a respiratory approach in older adults: the practice of Brazilian speech-language-hearing therapists / Terapia vocal com abordagem respiratória em idosos: prática de fonoaudiólogos brasileiros

ABSTRACT Purpose: to investigate the practice of Brazilian speech-language-hearing therapists in voice therapy for older adults focused on breathing and verify possible associations between taking specific courses and having knowledge of respiratory parameters, between using incentive spirometers and respiratory devices, and between age and the use of these instruments. Methods: the sample had 156 specialists in voice, contacted via email, who answered a form in Google Forms. Specialists in voice with 3 or more years of experience were included, whereas those who did not fill out the questionnaire completely were excluded. The analysis addressed absolute and relative frequencies and associations with the chi-square test. Significance was set at 5%. Results: most participants took courses on respiratory approach. The use of facilitating sounds, vocal function exercises, and respiratory instruments stood out, with reported vocal improvements. The use of incentive spirometers was associated with respiratory devices, and age was associated with the use of respiratory instruments. Conclusion: speech-language-hearing therapists with expertise in voice provide voice therapy for dysphonic older people focusing on a respiratory approach. Professionals who use incentive spirometers also use respiratory devices. Older therapists are the ones who most use respiratory instruments and taking specific courses was not associated with knowledge on respiratory parameters.

RESUMO Objetivo: investigar a prática de fonoaudiólogos brasileiros em terapia vocal para idosos com ênfase na respiração e verificar possíveis associações entre realização de cursos específicos e conhecimento sobre parâmetros respiratórios, entre o uso de incentivadores e dispositivos respiratórios e entre a idade e o uso destes instrumentos. Métodos: participaram 156 especialistas em voz, contatados via e-mail, que responderam um formulário na plataforma Google Forms. Foram incluídos especialistas em voz, com experiência maior ou igual a três anos e excluídos aqueles que não preencheram o questionário completamente. Analisaram-se frequências absolutas e relativas e a associação pelo teste Qui-quadrado, com significância de 5%. Resultados: a maioria realizou cursos com abordagem respiratória. Destacaram-se: uso de sons facilitadores, exercícios de função vocal e uso de instrumentos respiratórios, com relatos de melhora vocal. Houve associação entre o uso de incentivadores e dispositivos respiratórios e entre idade e o uso de instrumentos respiratórios. Conclusão: fonoaudiólogos experts em voz realizam terapia vocal para idosos disfônicos com ênfase na abordagem respiratória. Profissionais que usam incentivadores respiratórios usam também os dispositivos respiratórios. Aqueles com mais idade são os que mais utilizam instrumentos respiratórios. A realização de cursos específicos não está associada ao conhecimento sobre parâmetros respiratórios.

Geometria orofaríngea e parâmetros acústicos vocais de indivíduos hígidos e com doença de Parkinson / Oropharyngeal geometry and acoustic parameters of voice in healthy and Parkinson's disease subjects

RESUMO Objetivo verificar se existem diferenças nas medidas acústicas e da geometria orofaríngea entre indivíduos hígidos e pessoas com Doença de Parkinson, segundo a idade e sexo e investigar se há correlações entre as medidas geométricas orofaríngeas nessa população. Método participaram 40 indivíduos, sendo 20 com diagnóstico de Doença de Parkinson e 20 indivíduos hígidos, pareados por faixa etária, sexo e índice de massa corporal. As variáveis acústicas estudadas foram frequência fundamental, jitter, shimmer, glottal-to-noise excitation ratio, ruído e média da intensidade. As variáveis geométricas da orofaringe foram aferidas por faringometria acústica. Resultados as variáveis geométricas foram menores no grupo com Doença de Parkinson e os idosos com Doença de Parkinson apresentaram menor área da junção orofaríngea que os idosos hígidos. Com relação aos parâmetros acústicos vocais, o valor da frequência fundamental foi menor no sexo masculino, no grupo com Doença de Parkinson e os valores de jitter foram maiores no grupo não idoso dos sujeitos com Doença de Parkinson. Houve correlação positiva moderada entre o comprimento e volume da cavidade oral, comprimento da cavidade faríngea e o comprimento do trato vocal e do volume da cavidade faríngea e o volume do trato vocal. Conclusão indivíduos com Doença de Parkinson apresentaram menores valores de área glótica e área da junção orofaríngea, comparativamente aos hígidos. Quando distribuídos por faixa etária e sexo, a frequência fundamental foi menor no grupo com doença de Parkinson, na população masculina. Houve correlação positiva moderada entre as medidas de comprimento e volume da orofaringe, na amostra estudada.

ABSTRACT Purpose to verify whether there are differences in acoustic measures and oropharyngeal geometry between healthy individuals and people with Parkinson's disease, according to age and sex, and to investigate whether there are correlations between oropharyngeal geometry measures in this population. Methods 40 individuals participated, 20 with a diagnosis of Parkinson's disease and 20 healthy individuals, matched by age, sex, and body mass index. Acoustic variables included fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, and mean intensity. Oropharyngeal geometry variables were measured with acoustic pharyngometry. Results geometry variables were smaller in the group with Parkinson's disease, and older adults with Parkinson's disease had a smaller oropharyngeal junction area than healthy older adults. Regarding acoustic parameters of voice, fundamental frequency values were lower in males with Parkinson's disease, and jitter values ​​were higher in the non-elderly subjects with Parkinson's disease. There was a moderate positive correlation between oral cavity length and volume, pharyngeal cavity length and vocal tract length, and pharyngeal cavity volume and vocal tract volume. Conclusion individuals with Parkinson's disease had smaller glottal areas and oropharyngeal junction areas than healthy individuals. When distributed into sex and age groups, the fundamental frequency was lower in males with Parkinson's disease. There was a moderate positive correlation between oropharyngeal length and volume measures in the study sample.

Effect of Wendler glottoplasty on voice and quality of life of transgender women

Abstract Objective: To investigate the effect of Wendler glottoplasty on voice feminization, voice quality and voice-related quality of life. Methods: Prospective interventional cohort of transgender women submitted to Wendler glottoplasty. Acoustic analysis of the voice included assessment of fundamental frequency, maximum phonation time formant frequencies (F1 and F2), frequency range, jitter and shimmer. Voice quality was blindly assessed through GRBAS scale. Voice-related quality of life was measured using the Trans Woman Voice Questionnaire and the self-perceived femininity of the voice. Results: A total of 7 patients were included. The mean age was 35.4 years, and the mean postoperative follow-up time was 13.7 months. There was a mean increase of 47.9 ± 46.6 Hz (p = 0.023) in sustained/e/F0 and a mean increase of 24.6 ± 27.5 Hz (p = 0.029) in speaking F0 after glottoplasty. There was no statistical significance in the pre- and postoperative comparison of maximum phonation time, formant frequencies, frequency range, jitter, shimmer, and grade, roughness, breathiness, asthenia, and strain scale. Trans Woman Voice Questionnaire decreased following surgery from 98.3 ± 9.2 to 54.1 ± 25.0 (p = 0.007) and mean self-perceived femininity of the voice increased from 2.8 ± 1.8 to 7.7 ± 2.4 (p = 0.008). One patient (14%) presented a postoperative granuloma and there was 1 (14%) premature suture dehiscence. Conclusion: Glottoplasty is safe and effective for feminizing the voice of transgender women. There was an increase in fundamental frequency, without aggravating other acoustic parameters or voice quality. Voice-related quality of life improved after surgery.

Desempenho do diagrama de desvio fonatório no monitoramento da qualidade vocal pré e pós exercício vocal em indivíduos com Doença de Parkinson / Performance of the phonatory deviation diagram in monitoring voice quality before and after voice exercise in individuals with Parkinson's Disease

RESUMO Objetivo Verificar o desempenho do diagrama de desvio fonatório e de suas medidas no monitoramento da qualidade da voz, pré e pós exercício vocal, em indivíduos com Doença de Parkinson. Método Estudo retrospectivo e documental. Utilizou-se uma amostra de 30 sujeitos, sendo 50% do sexo masculino, com média de idade de 62,13 ± 9,05 anos. Foram analisados os resultados do diagrama de desvio fonatório, nos momentos pré e pós exercício vocal com a técnica de empuxo associada aos sons plosivos, considerando-se a área, densidade, forma e localização do diagrama nos quadrantes. Para fins de comparação, os parâmetros acústicos de jitter, shimmer, glottal to noise excitation ratio e resultados da análise perceptivo-auditiva, realizada em pesquisa anterior, também foram considerados, nos momentos pré e pós-técnica. Resultados A despeito de não ocorrer diferença na distribuição das amostras no diagrama, após realização da técnica vocal, foi identificada, na análise qualitativa visual, mudança no deslocamento do diagrama em direção à área de normalidade e houve associação entre o grau geral do desvio vocal da análise perceptivoauditiva e a área do diagrama. Houve melhora nos valores de shimmer, após a técnica vocal. Conclusão O deslocamento do diagrama de desvio fonatório em direção à área de normalidade corroborou os resultados em relação ao grau geral de disfonia avaliado pela análise perceptivoauditiva e os resultados de shimmer, após a técnica vocal empregada. Desse modo, o diagrama de desvio fonatório apresentou bom desempenho no monitoramento da qualidade vocal de indivíduos com Parkinson.

ABSTRACT Purpose To assess the performance of the phonatory deviation diagram and its measurements in monitoring voice quality before and after voice exercise in individuals with Parkinson's Disease. Methods Retrospective and documentary study. A sample of 30 subjects was used, 50% male, with a mean age of 62.13 ± 9.05 years. The results of the phonatory deviation diagram were analyzed, in the moments before and after vocal exercise with the pushing technique associated with plosive sounds, considering the area, density, shape and location of the diagram in the quadrants. For comparison purposes, the acoustic parameters of jitter, shimmer, glottal to noise excitation ratio and results of the auditory-perceptual analysis, carried out in previous research, were also considered, in the pre- and post-technical moments. Results Despite the fact that there was no difference in the distribution of samples in the diagram, after performing the vocal technique, a change in the displacement of the diagram towards the area of normality was identified in the visual qualitative analysis, and there was an association between the general degree of vocal deviation in the analysis auditory perception and the area of the diagram. There was an improvement in the shimmer values after the vocal technique. Conclusion The displacement of the phonatory deviation diagram towards the area of normality corroborated the results in relation to the general degree of dysphonia, evaluated by the auditory-perceptual analysis and the shimmer results, after the vocal technique. Thus, the diagram shows good performance in monitoring voice quality of individuals with Parkinson's.

Voice Therapy for Older Adults During the COVID-19 Pandemic in Brazil.

OBJECTIVE: To characterize the clinical practice of Brazilian speech-language-hearing therapists regarding voice therapy for older adults during the COVID-19 pandemic. METHODS: Cross-sectional survey conducted remotely. Data were collected through a form shared online with approximately 1.500 speech-language-hearing therapists. The form included voice therapy practice with older adults during the COVID-19 pandemic. It was responded by 155 voice experts. RESULTS: Most respondents were females with over 21 years' experience in vocal health care, working with both in-person therapy and teletherapy. Obtaining acoustic parameters and using therapy strategies for breathing and body training were the most reported changes in remote therapy during the pandemic. The main difficulties involved wearing masks in in-person therapy and assessing the voice in teletherapy. Patient adherence and goals reached were deemed positive by most participants. Associations were found between place and format of service; between patient adherence and goals reached; and between difficulties in teletherapy and use of complementary therapeutic resources. CONCLUSION: The COVID-19 pandemic led Brazilian speech-language-hearing therapists to change their clinical practice with older adults in both remote and in-person therapy. The main changes involved wearing masks in in-person therapy and assessing the voice in teletherapy. Remote therapy proved to be a safe and effective possibility.

Relationship Between Oropharyngeal Geometry and Acoustic Parameters in Singers: A Preliminary Study.

OBJECTIVE: To verify possible correlations between formant and cepstral parameters and oropharyngeal geometry in singers, stratified by sex. METHOD: Voice records and oropharyngeal measures of 31 singers - 13 females and 18 males, mean age of 28 (±5.0) years - were retrieved from a database and analyzed. The oropharyngeal geometry measures were collected with acoustic pharyngometry, and the voice records consisted of sustained vowel /Ԑ/ phonation, which were exported to Praat software and edited to obtain the formant and cepstral parameters, stratified by sex. The Pearson linear correlation test was applied to relate voice parameters to oropharyngeal geometry, at the 5% significance level; the linear regression test was used to justify the variable related to the second formant. RESULTS: Differences between the sexes were identified only in the oral cavity length (greater in males) and pharyngeal cavity length (greater in females). There was a linear correlation between the third formant and the cepstrum in the female group. In the male group, there was a linear correlation between the cepstrum and the third and fourth formants. A positive linear correlation with up to 95% confidence was also identified between the pharyngeal cavity volume and the second formant in the female group, making it possible to estimate a regression model for the second formant (R2 = 0.70). CONCLUSION: There are correlations between the oropharyngeal geometry and formant and cepstral parameters in relation to sex. The pharyngeal cavity volume showed the greatest correlation between females and the second formant.

Effects of the Voiced Tongue Trill Technique in Glissandos on the Voice Range Profile of Choir Members: A Preliminary Study.

The objective of this study was to verify the immediate effect of the voiced tongue trill technique in ascending and descending glissandos on the voice range profile of choir members. A total of 25 sopranos, mezzo-sopranos, contraltos, tenors, and baritones participated in the study. They were choir members, aged 20 to 45 years, with no voice symptoms, and able to perform the voiced tongue trill technique. Their voice range profile was analyzed before and after performing the ascending and descending technique for 2 and 5 minutes. The maximum fundamental frequency values in the study groups increased after performing the ascending and descending technique for 2 minutes (P = 0.001) and 5 minutes (P = 0.003). The range in Hz increased after 2 minutes (P = 0.010) and 5 minutes (P = 0.050) of the ascending technique and after 2 minutes (P = 0.001) of the descending technique, and the minimum fundamental frequency mean value suffered interference from the type of technique (ascending/descending). The immediate effects of VTTT in glissandos on the VRP of choir members' considering the two factors: condition and time, in ascending and descending glissandos for 2 and 5 minutes increased the maximum frequency and the range in Hz of choristers. Regarding volume levels results, no difference was found in intensity after applying the technique.

Oropharyngeal Geometry of Maxilectomized Patients Rehabilitated with Palatal Obturators in the Trans-surgical Period: Repercussions on the Voice.

INTRODUCTION: Patients undergoing maxillectomies may present alterations in the stomatognathic functions involved in oral communication. Rehabilitative treatment should favor the rescue of these functions, through surgical flaps, obturator prostheses or both. OBJECTIVES: The present study aims to present the impact of the use of the palatal obturator on the oropharyngeal geometry and on the voice of patients undergoing maxillectomies, after adaptation to trans-surgical palatine obturators (TPO). METHODS: Twelve patients treated at a Cancer Hospital, submitted to maxillectomy and rehabilitated during surgery were evaluated. The oropharyngeal geometry was measured by acoustic pharyngometry and the vocal parameters were evaluated through auditory-perceptual and acoustic analyses. The comparison between the results with and without TPO was analyzed using the Wilcoxon test and the correlation between oropharyngeal measurements and acoustic parameters using Spearman's correlation coefficient, all with a significance level of 5%. RESULTS: There was a decrease in the following oropharyngeal measurements with the use of TPO: length of the pharyngeal cavity and vocal tract, volume of the oral cavity, pharyngeal and vocal tract and area of ​​the oropharyngeal junction. There was no difference in the length of the oral cavity and in the glottic area between situations with and without TPO. In the vocal evaluation, changes in intelligibility and resonance were observed in the situation without TPO and, in only one case, mild hypernasality was detected in the situation with TPO. CONCLUSIONS: It is concluded that the use of TPO brought the oropharyngeal measurements closer to normal values ​​and provided an improvement in speech intelligibility and vocal resonance in maxilectomized individuals.

Relationship Between Oropharyngeal Geometry and Vocal Parameters in Subjects With Parkinson's Disease.

OBJECTIVE: To verify whether the dimensions of different segments of the oropharyngeal cavity have different proportions between Parkinson's disease patients and vocally healthy subjects and investigate whether the measurements of these subjects' oropharyngeal geometry associate with their acoustic measurements of voice. METHOD: Quantitative, descriptive, cross-sectional, and retrospective study with secondary data, approved by the Human Research Ethics Committee under no. 4.325.029. We used vocal samples and data from the oropharyngeal geometry of 40 subjects - 20 with Parkinson's disease stages I to III and 20 who formed the control group, matched for sex and age. Each group had 10 males and 10 females, mean age of 61 years (±6.0). Formant (F1, F2, and F3) and cepstral measures of the sustained vowel /ε/ were extracted and arranged in the database to determine their values using Praat software. The data were descriptively analyzed, with statistics generated with R software. The proportion of oropharyngeal geometry measurements was arranged by mean values and coefficients of variation. Pearson's linear correlation test was applied to relate voice parameters to oropharyngeal geometry, considering P < 0.05, and linear regression test, to justify F2. RESULTS: The Parkinson's disease group showed a linear relationship between oral cavity length and F1 in males (P = 0.04) and between glottal area and F2 in females (P = 0.00); linear relationships were established according to age in both groups, and a regression model for F2 was estimated (R2 = 0.61). There was no difference between pathological and healthy voices; there was a difference in the proportional relationship of oropharyngeal geometry between the groups. CONCLUSION: The proportional relationship of oropharyngeal geometry differs between the Parkinson's disease group and the control group, as well as the relationship between oropharyngeal geometry and formant and cepstral values of voice according to the subjects' sex and age.

Prosodic Differences in the Voices of Transgender and Cisgender Women: Self-Perception of Voice - An Auditory and Acoustic Analysis.

INTRODUCTION: The voice is an important parameter for identifying the speaker's gender. Transgender people seek to adapt their bodies to gender identity, and transgender women have greater difficulties in achieving vocal acceptance. In this context, the evaluation of the various parameters of the voice of transgender and cisgender women is essential to make it possible to propose appropriate intervention measures. OBJECTIVES: To identify the differences in vocal characteristics of transgender and cisgender women. METHODS: An sectional study was conducted. The sample comprised 20 transgender women and 20 cisgender women who underwent evaluation of acoustic parameters, emotional prosody, self-perception, and perception of gender by lay listeners. RESULTS: The vocal characteristics of transgender and cisgender women differ in terms of the following parameters: f0, glottal noise excitation (GNE), vocal intensity, speech range profile (SRP), the first three formants of the vowel /a/, and in terms of emotional prosody, including duration and melodic contour. Higher values ​​were mostly found in the cisgender population, except for noise level and vocal intensity. In addition, in most cases lay listeners identified the voices of transgender women as belonging to the male gender. There was a negative correlation between vocal dissatisfaction and f0 among transgender women. CONCLUSIONS: Even though they perform vocal adjustments, the voices of transgender women are different from cisgender women in terms of acoustic parameters, vocal extension, and emotional prosody including duration and melodic contour. These differences have repercussions on the perception of gender by listeners.

Immediate Effect of the Finger-Kazoo Technique Associated with Glissandos in the Voice of Individuals with Parkinson's Disease.

OBJECTIVE: To verify the immediate effect of the Finger Kazoo technique associated with glissandos in the voice of individuals with Parkinson's disease. METHOD: Thirty subjects with Parkinson's Disease comprised of 15 men and 15 women with a mean age of 63.8 years (± 6.88) and mean time of diagnosis of 97.33 (± 63.53) months, all with preserved cognition. The subjects' voice range profile (VRP), speech range profile (SRP), and the maximum phonation time were assessed, before and after applying the Finger Kazoo technique associated with ascending and descending glissando. After the technique, a vocal satisfaction questionnaire was completed. RESULTS: After the applied technique there was an increase in the minimum and maximum fundamental frequency recorded respectively in the SRP and in the VRP; there was an increase in the vocal range (measured in Hertz and semitones) of the women, recorded in the VRP; in the male population, there was an increase in maximum phonation time. A higher percentage of positive references to vocal improvement was observed after the exercise. CONCLUSION: In patients with Parkinson's Disease, the Finger Kazoo with glissando technique promoted an increase in the minimum fundamental frequency of the SRP and in the vocal extensions of women, as well as increasing the maximum phonatory time of men. In addition, patients reported satisfaction with the use of the technique and its results.

Oropharyngeal Geometry and the Singing Voice: Immediate Effect of Two Semi-Occluded Vocal Tract Exercises.

PURPOSE: The aim of this study was to verify the immediate effect of a flexible resonance tube in water and of lip trill on oropharyngeal geometry and vocal acoustic parameters of singers without vocal symptoms. METHODS: Twenty-two adult singers participated in the study. They had an average age of 27 (±4.8) years. Participants were split into two groups: a group composed of 12 singers who performed the flexible resonance tube (FRT) exercise and a group of 10 singers who performed the Lip Trill technique (LTT). Acoustic pharyngometry and acoustic analysis of the voice were used to assess oropharyngeal geometry before and after the exercises. RESULTS: After performing the techniques, the vocal tract length was longer in the group that performed the FRT, compared to the one that performed the LTT. In the acoustic evaluation, there was an improvement in the glottal to noise excitation ratio and a decrease in noise in the group of singers who performed the LTT. In the analysis by sex men had a longer oral cavity compared to women and after application of the techniques greater volume of the vocal tract. CONCLUSION: There was variation in the oropharyngeal geometry with the FRT, while the LTT had a positive effect on the vocal acoustic parameters related to glottal noise.

Efeitos dos exercícios vocais no tratamento da disfagia: revisão integrativa / Effects of vocal exercises on the treatment of dysphagia: integrative review

RESUMO Objetivo verificar as evidências disponíveis sobre o efeito dos exercícios vocais no tratamento da disfagia. Estratégia de pesquisa foi realizado levantamento bibliográfico nas bases de dados PubMed, LILACS, SciELO e MEDLINE, sem restrições quanto ao período de publicação. Critérios de seleção artigos originais, estudos de caso e/ou revisões de literatura publicados nos idiomas português e/ou inglês, disponíveis eletronicamente na íntegra e que abordassem o tratamento clínico com exercícios vocais em adultos e idosos com disfagia. Foram excluídas publicações repetidas nas bases de dados, com população de crianças, com indivíduos que não apresentassem o diagnóstico de disfagia, com exercícios vocais sem especificação, com exercícios exclusivos de deglutição, artigos e/ou resumos sem possibilidade de acesso pelas plataformas institucionais e estudos com modelo animal. Resultados foram encontrados 2.356 artigos, dos quais, após aplicados os critérios de elegibilidade, foram selecionados 8 para a amostra final. Para avaliar os efeitos dos exercícios vocais, os estudos utilizaram avaliação clínica, videofluoroscopia, videoendoscopia e eletromiografia. Quanto aos efeitos dos exercícios vocais na deglutição, observou-se que as técnicas de som plosivo, empuxo, trato vocal semiocluído, som basal, modulação vocal, sobrearticulação, o método Lee Silverman Voice Treatment® e o uso de exercícios de treino de força muscular expiratória apresentaram efeitos positivos na reabilitação da disfagia. Conclusão os estudos com treino de força muscular expiratória, o método Lee Silverman e os exercícios vocais tradicionais demonstraram efeitos positivos no tratamento da disfagia. No entanto, ainda não foi possível comprovar o nível de evidências de todos os estudos.

ABSTRACT Purpose To verify the available evidence on the effect of vocal exercises on the treatment of dysphagia. Research strategy A bibliographic survey was carried out in the PubMed, LILACS, SciELO and MEDLINE databases, with no restrictions on the publication period. Selection criteria Original articles, case studies and/or literature reviews published in Portuguese and/or English, available electronically in full and addressing clinical treatment with vocal exercises in adults and elderly with dysphagia. Publications repeated by the databases, with a population of children, individuals who did not present the diagnosis of dysphagia, with vocal exercises without specification, with exclusive swallowing exercises, articles and/or abstracts without the possibility of access by institutional platforms, and studies with animal model were excluded. Results A total of 2,356 articles were found, of which, after the eligibility criteria were applied, 08 were selected for the final sample. To evaluate the effects of vocal exercises, the studies used clinical evaluation, videofluoroscopy, videoendoscopy and electromyography. Regarding the effects of vocal exercises on swallowing, it was observed that the techniques of plosive sound, buoyancy, semi-occluded vocal tract, basal sound, vocal modulation, overarticulation, the Lee Silverman Voice Treatment method® and the use of expiratory muscle strength training exercises showed positive effects in the rehabilitation of dysphagia. Conclusion It was observed that studies with expiratory muscle strength training (EMST), Lee Silverman method (LSVT®) and traditional vocal exercises demonstrated positive effects in the treatment of dysphagia. However, it has not yet been possible to prove the level of evidence in all studies.