The Influence of Auditory Feedback and Vocal Rehabilitation on Prelingual Hearing-Impaired Individuals Post Cochlear Implant.

OBJECTIVE: To verify changes in the perceptual and acoustic vocal parameters in prelingual hearing-impaired adults with cochlear implants after vocal rehabilitation. HYPOTHESIS: Auditory feedback restoration alone after cochlear implant is not enough for vocal adjustments. A targeted and specific voice therapy intervention is required. STUDY DESIGN: Prospective and pre-post repeated measures design. METHODS: Twenty literate adults with severe to profound prelingual bilateral sensorineural hearing loss participated in the study; individuals were implanted late and were fluent users of oral language. Ages ranged from 17 to 48 years. All individuals presented normal results in laryngoscopy, and hearing thresholds with the cochlear implant were over 40 dB HL. Individuals were randomly distributed into two groups: Group 1 (treatment group) and Group 2 (control group), both with ten patients each, five men and five women, matching mean age and hearing deprivation time before the cochlear implantation. Patients from Group 1 underwent a protocol of vocal therapy including 12 individual sessions with the same clinician. Group 2 only underwent vocal recordings. The vocal recordings occurred before and after the participation in the therapy protocol for Group 1 and after the same period, 3 months later, without any intervention, for Group 2. The recording sessions used the Consensus Auditory-Perceptual Evaluation of Voice protocol sentence reading and emission of sustained vowel /a/. Auditory-perceptual evaluation of voices was performed by three judges, and the acoustical analysis used the Praat program. RESULTS: Statistically significant reductions in the overall vocal degree, vocal instability, and degree of resonance change were observed after vocal rehabilitation in Group 1. Statistically, individuals from Group 1 did not differ in regard to the modification of acoustic parameters. Group 2 did not present significant changes in any of the analyzed parameters. CONCLUSIONS: The cochlear implanted adults submitted to vocal rehabilitation presented changes in the auditory-perceptual parameters, with reduction of the overall voice severity, vocal instability, and degree of resonance after vocal intervention. There were no changes in the acoustic parameters in the implanted prelingual hearing-impaired adult subjects.

Voice feature characteristic in morbid obese population.

BACKGROUND: Morbid obesity is highly prevalent in the Western World, and its consequences present a real public health challenge. Voice alterations can represent one of these consequences and represent an opportunity for interference with therapeutic methods. This particularly features of the individual's voice was the goal of the present study. METHODS: A group of 45 adult volunteers of both sexes with a BMI greater than 35 Kg/m(2) was selected among patients of the Obesity Ambulatory of the Digestive Surgery Division. The control group consisted of volunteers matched by sex, age (±1 year), and smoking habits, but with a BMI below 30 Kg/m(2). All subjects were submitted to laryngoscopic examination, audio perceptive analysis, and voice acoustics determination. Examinations were always performed by the same doctor, and diagnoses were provided by two different physician specialists in laryngology and voice. RESULTS: Obese individuals exhibit the following modifications in voice feature: hoarseness, murmuring, vocal instability, altered jitter and shimmer, and reduced maximum phonation times as well the presence of voice strangulation at the end of emission. CONCLUSION: The voices of individuals with morbid obesity are different of the voice of nonobese people and demonstrate significant changes in vocal characteristics.

The relationship between tongue trill performance duration and vocal changes in dysphonic women.

OBJECTIVE: To assess the relationship between tongue trill performance duration and auditory perception and acoustic changes in dysphonic women. STUDY DESIGN: Prospective clinical study, with intrasubject comparison. METHODS: Twenty-seven women who had vocal nodules were in the experimental group (EG) (tongue trills), and 10 were also in the control group (CG) (placebo exercises). The voices were recorded before and after experimental and placebo exercises at the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of performance. These recordings were randomized, and the auditory perception analysis was carried out by three judges trained in voice analysis. Individual recordings were analyzed using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol, the randomized pairs of recordings were compared, and the better voice was chosen. VoxMetria software (CTS, Parana, Brazil, www.ctsinformatica.com.br) was used to assess the acoustic. RESULTS: In the EG, the CAPE-V results showed a predominance of vocal improvement, statistically proven, at m5 of tongue trill exercise, with the best overall rating, the least roughness and breathiness, and increase in pitch level. At m7, strain was significantly higher. In the paired comparison analysis, voices at m5 were considered the best of all moments. There was an increase of the F(0) and glottal-to-noise excitation after m3 and a decrease in noise as in m1. In the CG, vocal changes were discrete compared with those in the EG. CONCLUSION: Tongue trill performance duration interfered with the vocal response of dysphonic women, with positive response predominance at m5. At m7, there was an increase of vocal tension and a drop in vocal quality.

Discriminação entre vozes adaptadas, levemente soprosas e tensas: diferenças entre os dois primeiros harmônicos / Distinction between adapted, slightly breathy and tense voices: differences between the first two harmonics

OBJETIVO: Verificar a eficácia dos valores da diferença entre os dois primeiros harmônicos para diferenciar vozes adaptadas de vozes levemente soprosas (B) ou tensas (S), durante a emissão da vogal -é- prolongada. MÉTODOS: Foram avaliadas 30 mulheres com vozes normais e alteradas. Foi gravada a vogal -é- de cada sujeito para posterior extração da intensidade dos dois primeiros harmônicos, por meio do gráfico FFT. Foi feita a subtração da amplitude do primeiro pelo segundo harmônico (H1-H2) e os dados foram tratados estatisticamente. RESULTADOS: A variação entre os valores de H1-H2, entre os sujeitos com grau 0 de soprosidade e tensão e os sujeitos com grau 1, também nos dois parâmetros, foi muito grande, portanto os valores não foram estatisticamente significativos. Entretanto, quando a soprosidade e tensão atingem o grau 2 a variação dos valores aproxima-se das descrições da literatura. CONCLUSÃO: A medida estudada não é eficaz para diferenciar vozes adaptadas daquelas levemente soprosas e tensas, em emissões da vogal -é- prolongada.

PURPOSE: To verify the efficacy of the values of the difference between the first two harmonics to distinguish adapted voices from slightly breathy (B) or tense (S), during the emission of the long vowel /é/. METHODS: Thirty women with normal and altered voices were evaluated. Each subject's vowel /é/ was recorded in order to extract the intensity of the first two harmonics, using the FFT graph. The range of the second harmonic was subtracted from the range of the first, and data were treated statistically. RESULTS: The variation between the values of H1-H2 between subjects rated 0 breathiness and tension and subjects rated 1, also in both parameters, was very high, therefore the values were not statistically significant. However, when the degrees of breathiness and tension get to 2, the variation values become more compatible with descriptions in literature. CONCLUSION: The measure studied is not efficient to distinguish adapted voices from those slightly breathy and tense, during the emission of the long vowel /é/.

Caracterização da voz do indivíduo portador de obesidade mórbida / Morbid obesity and it´s relationship to voice alterations

RACIONAL: A obesidade é doença crônica e grave com crescimento alarmante em todo o mundo e de interesse na saúde pública. Existe alteração no comportamento vocal destes pacientes e ele é pouco estudado. OBJETIVO: Caracterizar prospectivamente a voz de indivíduos portadores de obesidade mórbida comparando-a com a de não obesos. MÉTODOS: Estudo prospectivo de 45 indivíduos adultos voluntários, 14 homens e 31 mulheres com idade média de 43 anos variando de 20 a 63 anos. Todos apresentavam IMC acima de 35 Kg/m2 constituindo o grupo em estudo (GO) Para cada indivíduo do GO foi selecionado também um indivíduo adulto voluntário, proveniente da população geral do ambulatório de otorrinolaringologia com IMC abaixo de 30 Kg/m2, constituindo o grupo controle (GN). Os critérios de exclusão foram diagnóstico de lesões neoplásicas malignas em cabeça e pescoço ou operações prévias da região orofaríngea. Fooram submetidos a exame laringológico e à gravação da voz. Também submeteram-se à avaliação subjetiva perceptivo-auditiva da qualidade vocal, através da escala GIRBAS e a aspereza, o estrangulamento no final das. A análise acústica foi realizada objetivamente utilizando os softwares Vox Metria versão 4.0.47 e PRAAT, fornecendo a frequência fundamenta, jitter, shimmer, ruído e tempo máximo fonatório. RESULTADOS: Observou-se que os grupos foram homogêneos em relação ao sexo, idade, tabagismo e altura, mas significativamente diferentes em relação ao peso e IMC (P<0,001). Os achados laringoscópicos em ambos os grupos mostraram que 26,7% dos obesos tinham laringoscopia alterada contra 13,3% dos não obesos. Sinais laríngeos sugestivos de RLF foram significativos para o GO (P<0,042). A análise perceptivo-auditiva revelou que o grau da disfonia, a instabilidade, a rouquidão, a soprosidade, a astenia, a tensão e a aspereza tiveram alterações altamente significantes para o GO (P=0,001 ou 002)...

BACKGROUND: Obesity is a chronic disease with public health interest. Voice disturbance is common in this group. AIM: To compare the voice between the morbid obese patients with the non obese. METHODS: Prospective trial with 45 adult volunteers with 43 years old median age with BMI>35 Kg/m2 as study group and a control group in the same number but with BMI<30 Kg/m2. Exclusion criteria were tumor in head and neck or previous operations in oropharynx. All had laryngoscopy and voice recording. They were submitted to GIRBAS score. Acoustic analysis was done based on Vox Metria software and PRAAT. RESULTS: Laryngoscopy showed alterations in 26,7% of the obese group and 13,3% in controls. The GIRBAS score was highly significant to the obese group. Acoustic alterations were also significant in the obese group. CONCLUSION: The patients with morbid obesity have significant alterations in voice caracteristics in comparison to the ones normal in weight.

Falsete mutacional: estudo de cinco casos / Mutational falsetto: five case report

A desordem de muda vocal mais comum é o falsete mutacional. Foram estudados cinco sujeitos atendidos no Setor de Fonoaudiologia do Ambulatório de Otorrinolaringologia do Hospital de Clínicas da Faculdade de Medicina da Universidade de São Paulo, com queixa de voz fina, para constatar a eficácia da intervenção terapêutica. Três indivíduos fizeram apenas fonoterapia e outros dois, fonoterapia, tireoplasia tipo III seguida de fonoterapia novamente. A fonoterapia constou de exercícios para abaixamento laríngeo, relaxamento da musculatura laríngea e exercícios de agravamento da voz conforme citado por McFarlane (1988); Pinho et al. (1996); Pinho (1998), além da conscientização da imagem vocal e identificação com o novo registro vocal. Os resultados mostraram diminuição da freqüência fundamental, agravamento do pitch e adequação da loudness. Concluímos que as intervenções terapêuticas apresentam resultados significativos no tratamento dos casos de falsete mutacional.