Cepstral Peak Prominence Smoothed - CPPS and Acoustic Voice Quality Index - AVQI in healthy and altered children's voices: comparation, relationship with auditory-perceptual judgment and cut-off points. / Cepstral Peak Prominence Smoothed - CPPS e Acoustic Voice Quality Index - AVQI em vozes infantis saudáveis e alteradas: comparação, relação com julgamento perceptivo-auditivo e pontos de corte.

PURPOSE: To compare the acoustic measurements of Cepstral Peak Prominence Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) of children with normal and altered voices, to relationship with auditory-perceptual judgment (APJ) and to establish cut-off points. METHODS: Vocal recordings of the sustained vowel and number counting tasks of 185 children were selected from a database and submitted to acoustic analysis with extraction of CPPS and AVQI measurements, and to APJ. The APJ was performed individually for each task, classified as normal or altered, and for the tasks together defining whether the child would pass or fail in a situation of vocal screening. RESULTS: Children with altered APJ and who failed the screening had lower CPPS values and higher AVQI values, than those with normal APJ and who passed the screening. The APJ of the sustained vowel task was related to CPPS and AVQI, and APJ of the number counting task was related only to AVQI and CPPS numbers. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the vowel CPPS, 7.62 for the CPPS numbers and 2.01 for the AVQI. CONCLUSION: Children with altered voices, have higher AVQI values and lower CPPS values, when detected in children with voices within the normal range. The acoustic measurements were related to the auditory perceptual judgment of vocal quality in the sustained vowel task, however, the number counting task was related only to the AVQI and CPPS. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the CPPS vowel, 7.62 for the CPPS numbers and 2.01 for the AVQI. The three measures were similar in identifying voices without deviation and dysphonic voices.

OBJETIVO: Comparar as medidas acústicas de Cepstral Peak Prominence Smoothed (CPPS) e Acoustic Voice Quality Index (AVQI) de crianças com vozes normais e alteradas, relacionar com o julgamento perceptivo-auditivo (JPA) da voz e estabelecer pontos de corte. MÉTODO: Gravações vocais das tarefas de vogal sustentada e contagem de números de 185 crianças foram selecionadas em um banco de dados e submetidas a análise acústica com extração das medidas de CPPS e AVQI, e ao JPA. O JPA foi realizado individualmente para cada tarefa e as amostras foram classificadas posteriormente como normal ou alterada, e para as tarefas em conjunto definindo-se se a criança passaria ou falharia em uma situação de triagem vocal. RESULTADOS: Crianças com JPA alterado e que falharam na triagem apresentaram valores menores de CPPS e maiores de AVQI, do que as com JPA normal e que passaram na triagem. O JPA da tarefa de vogal sustentada se relacionou ao CPPS e AVQI, e da tarefa de contagem de números relacionou-se apenas ao AVQI e CPPS números. Os pontos de corte que diferenciam crianças com e sem desvio vocal são 14,07 para o CPPS vogal, 7,62 para o CPPS números e 2,01 para o AVQI. CONCLUSÃO: Crianças com JPA alterado apresentaram maiores valores de AVQI e menores valores de CPPs. O JPA da tarefa de vogal previu todas as medidas acústicas, porém, de contagem previu apenas as medidas extraídas dela. As três medidas foram semelhantes na identificação de vozes sem desvio e vozes disfônicas.

Immediate effect of inspiratory exercise with exerciser and respiratory encourager in women without vocal complaints. / Efeito imediato de exercício inspiratório com exercitador e incentivador respiratório em mulheres sem queixas vocais.

PURPOSE: To evaluate the immediate effect of the inspiratory exercise with a booster and a respiratory exerciser on the voice of women without vocal complaints. METHODS: 25 women with no vocal complaints, between 18 and 34 years old, with a score of 1 on the Vocal Disorder Screening Index (ITDV) participated. Data collection was performed before and after performing the inspiratory exercise and consisted of recording the sustained vowel /a/, connected speech and maximum phonatory times (MPT) of vowels, fricative phonemes and counting numbers. In the auditory-perceptual judgment, the Vocal Deviation Scale (VSD) was used to verify the general degree of vocal deviation. Acoustic evaluation was performed using the PRAAT software and the parameters fundamental frequency (f0), jitter, shimmer, harmonium-to-noise ratio (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) and Acoustic Breathiness Index (ABI). To measure the aerodynamic measurements, the time of each emission was extracted in the Audacity program. Data were statistically analyzed using the Statistica for Windows software and normality was tested using the Shapiro-Wilk test. To compare the results, Student's and Wilcoxon's t tests were applied, adopting a significance level of 5%. RESULTS: There were no significant differences between the results of the JPA and the acoustic measures, in the pre and post inspiratory exercise moments. As for the aerodynamic measures, it was possible to observe a significant increase in the value of the TMF /s/ (p=0.008). CONCLUSION: There was no change in vocal quality after the inspiratory exercise with stimulator and respiratory exerciser, but an increase in the MPT of the phoneme /s/ was observed after the exercise.

OBJETIVO: Avaliar o efeito imediato do exercício inspiratório com incentivador e exercitador respiratório na voz de mulheres sem queixas vocais. MÉTODO: Participaram 25 mulheres sem queixas vocais, entre 18 e 34 anos, com pontuação 1 no Índice de Triagem para Distúrbio Vocal (ITDV). A coleta de dados foi realizada nos momentos antes e após realização de exercício inspiratório e consistiu na gravação de vogal sustentada /a/, fala encadeada e tempos máximos fonatórios (TMF) de vogais, fonemas fricativos e contagem de números. No julgamento perceptivo-auditivo foi utilizada a Escala de Desvio Vocal (EDV) para verificar o grau geral do desvio vocal. Avaliação acústica foi feita no software PRAAT e foram extraídos os parâmetros frequência fundamental (f0), jitter, shimmer, proporção harmônico -ruído (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) e Acoustic Breathiness Index (ABI). Para mensuração das medidas aerodinâmicas, o tempo de emissão foi extraído no programa Audacity. Para comparar os resultados utilizou-se o teste paramétrico t de Student para amostras dependentes na análise das variáveis com distribuição normal e o teste de Wilcoxon para variáveis com distribuição não normal. RESULTADOS: Não houve diferenças entre os resultados do JPA e das medidas acústicas, nos momentos pré e pós exercício inspiratório. Quanto às medidas aerodinâmicas foi possível observar aumento significativo no valor do TMF /s/ (p=0,008). CONCLUSÃO: Não houve modificação na qualidade vocal após o exercício inspiratório com incentivador e exercitador respiratório, porém foi observado aumento do TMF do fonema /s/ após a realização do exercício.

Acoustic measurements of CPPS and AVQI pre and post speech therapy. / Medidas acústicas de CPPS e AVQI pré e pós terapia fonoaudiológica.

PURPOSE: To compare the acoustic measurements of Cepstral Peak Prominence-Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) at pre- and post-voice therapy times. METHODS: This is a before and after intervention study, with retrospective data collection. Twenty-two subjects with a mean age of 49.9 years participated in the study. The vocal therapy occurred between the years 2016 to 2019 in a teaching clinic, and the subjects had vocal samples collected before and after the therapeutic processes. CPPS and AVQI data extractions were performed during pre- and post-therapy. In order to characterize the sample, auditory-perceptual evaluation (APE) regarding the overall degree of vocal deviation at pre- and post-therapy moments was performed. The data were analyzed statistically. RESULTS: The APE data indicated a decrease in the median values of overall vocal deviation degree at the post-therapy stage for both the vowel (p=0.00) and number (p=0.00) samples. The average CPPS for the vowel was 14.53 pre-therapy and 16.37 post-therapy (p=0.01); for the number emission, it was 8.22 pre-therapy and 9.06 post-therapy (p=0.02), there was a difference in the CPPS of the vowel and numbers indicating vocal improvement at post-therapy. The average AVQI was 2.27 pre-therapy and 1.54 post-therapy (p=0.05). There was an improvement in the AVQI results, with borderline p-value. CONCLUSION: Vocal therapy produced changes in the general degree of vocal deviation, as well as in CPPS and AVQI measurements, and the results at the post-therapy moment are similar to those of vocally healthy individuals.

OBJETIVO: Comparar as medidas acústicas de Proeminência do Pico Cepstral Suavizado (CPPS) e Acoustic Voice Quality Index (AVQI) nos momentos pré e pós-terapia Vocal. MÉTODO: Trata-se de estudo de intervenção antes e após, com coleta de dados retrospectiva. Participaram do estudo 22 sujeitos com média de idade de 49,9 anos. A terapia vocal ocorreu entre os anos de 2016 a 2019 em uma clínica-escola, sendo que antes e após os processos terapêuticos, os sujeitos tiveram amostras vocais coletadas. Foram realizadas as extrações dos dados de CPPS e AVQI nos momentos pré e pós-terapia. A fim de caracterizar a amostra, foi realizado julgamento perceptivo-auditivo (JPA) referente ao grau geral do desvio vocal nos momentos pré e pós-terapia. Os dados foram analisados estatisticamente. RESULTADOS: Os dados do JPA indicaram diminuição nos valores medianos de grau geral do desvio vocal no momento pós-terapia, tanto para a amostra de vogal (p=0,00) quanto de números (p=0,00). A média do CPPS para a vogal foi de 14,53 pré-terapia e 16,37 pós-terapia (p= 0,01) e na emissão dos números foi de 8,22 pré-terapia e 9,06 pós-terapia (p=0,02), houve diferença no CPPS da vogal e dos números indicando melhora vocal pós-terapia. A média do AVQI foi de 2,27 pré-terapia e 1,54 pós-terapia (p= 0,05), houve melhora nos resultados do AVQI, com valor de p limítrofe. CONCLUSÃO: A terapia vocal produziu modificações no grau geral do desvio vocal e nas medidas de CPPS e AVQI, sendo que no momento pós terapia os resultados são semelhantes aos apresentados por indivíduos vocalmente saudáveis.

Future teachers and the self-perception of vocal symptoms and knowledge about vocal health and hygiene. / Futuros professores e a autopercepção de sintomas vocais e conhecimento em saúde e higiene vocal.

PURPOSE: To analyze responses of future teachers regarding the self-perception of vocal symptoms and knowledge about vocal health and vocal hygiene, relating them to sociodemographic and occupational variables and previous knowledge about voice. METHODS: Observational, analytical and cross-sectional study. A total of 264 undergraduate students participated and the Vocal Health and Hygiene Questionnaire (QSHV), Vocal Symptoms Scale (ESV) and a questionnaire with sociodemographic, occupational and vocal questions were applied. Data were statistically analyzed considering a 5% significance level. RESULTS: QSHV of future teachers had a total mean score of 21.89, suggestive of lack of knowledge about vocal health and hygiene. The results of the ESV are above the instrument's cutoff score, in each of the three domains and in the total score, there was greater symptomatology in first-year students when compared to other students, in the emotional, limitation and total domains. There was a difference when comparing the QSHV with the year of graduation (p=0.001), in which third and fourth year students obtained higher scores. A positive correlation was observed between the total QSHV score and the age variable (p=0.019). CONCLUSION: Future teachers present important vocal symptomatology, compatible with dysphonic individuals, and have insufficient knowledge about vocal health and hygiene. Knowledge is even lower among students in the early undergraduate years and at a younger age. Older future teachers demonstrate more knowledge about vocal health and hygiene. It is necessary to propose preventive actions with this population, even during the graduation period, aiming to reduce the risks of developing vocal problems in the medium or long term during teaching.

OBJETIVO: Analisar respostas de futuros professores quanto à autopercepção de sintomas vocais e conhecimento sobre saúde vocal e higiene vocal, relacionando-os às variáveis sociodemográficas, ocupacionais e conhecimento prévio sobre voz. MÉTODO: Estudo observacional, analítico e transversal. Participaram 264 alunos de licenciatura, foram aplicados Questionário de Saúde e Higiene Vocal (QSHV), Escala de Sintomas Vocais (ESV) e questionário com perguntas sociodemográficas, ocupacionais e vocais. Os dados foram analisados estatisticamente considerando nível de significância 5%. RESULTADOS: QSHV de futuros professores apresentou escore médio total de 21,89, sugestivo de conhecimento insuficiente sobre saúde e higiene vocal. Resultados da ESV estão acima da nota de corte do instrumento, nos três domínios e no escore total, observou-se maior sintomatologia em estudantes do primeiro ano quando comparados aos demais estudantes, nos domínios emocional, limitação e total. Houve diferença na comparação do QSHV com o ano da graduação (p=0,001), em que alunos dos terceiros e quartos anos obtiveram pontuações maiores. Observou-se correlação positiva entre escore total do QSHV e variável idade (p=0,019). CONCLUSÃO: Futuros professores apresentam sintomatologia vocal importante, compatível aos indivíduos disfônicos, e possuem conhecimento insuficiente sobre saúde e higiene vocal. O conhecimento é ainda menor em alunos dos anos de graduação iniciais e com menor idade. Futuros professores com mais idade demonstram ter mais conhecimento sobre saúde e higiene vocal. Faz-se necessária a proposição de ações preventivas à essa população, ainda no período da graduação, visando à diminuição dos riscos ao desenvolvimento de problemas vocais em médio ou longo prazo durante a docência.

Vocal Characteristics of Children With Short Stature Before and After Growth Hormone Treatment.

OBJECTIVE: To evaluate the vocal characteristics of children with short stature before and 12 months after growth hormone treatment. MATERIAL AND METHODS: This analytical, observational cohort study included 23 children (age 5-11 years) diagnosed with short stature. Children in the short stature group (SSG) were matched (1:1) for age and sex with children with normal growth (normal stature group; NSG). Participants in the SSG underwent assessments before and 12 months after growth hormone treatment, while those in the NSG underwent the same assessments at baseline and 12 months. The assessments included evaluation of (A) vocal characteristics (history, vocal self-assessment, auditory-perceptual evaluation, and acoustic analysis), (B) anthropometry, (C) bone age, and (D) measurement of insulin-like growth factor-1 (IGF-1) levels. RESULTS: Children in the SSG had more vocal complaints (P = 0.026) than those in the NSG. The groups were similar in terms of vocal self-assessment and auditory-perceptual evaluation (P = nonsignificant). Results of acoustic analysis were also similar for fundamental frequency (F 0) and perturbation measures (P for both = nonsignificant). F 0 and speech frequency decreased significantly at 12 months in both groups. F1 values were higher at 12 months in the NSG, while F2 values were significantly higher in the baseline evaluation in boys in the SSG. Children in the SSG compared with those in the NSG presented a greater increase in height measurements at 12 months, although the anthropometric means were lower in both evaluations (P < 0.001). CONCLUSION: Vocal characteristics in children with short stature before and after treatment with growth hormone are comparable to those in children with normal growth.

Effect of Wearing a Face Mask on Vocal Self-Perception during a Pandemic.

OBJECTIVE: To analyze the vocal self-perception of individuals who wore face masks for essential activities and those who wore them for professional and essential activities during the coronavirus disease pandemic. MATERIALS AND METHODS: This was an observational, descriptive, cross-sectional study. The study included 468 individuals who were stratified into two groups: the Working Group, comprising individuals who wore face masks for professional and essential activities during the pandemic; and the Essential Activities Group, with individuals who wore face masks only for essential activities during the pandemic. The outcome measures tested were self-perception of vocal fatigue, vocal tract discomfort, vocal effort, speech intelligibility, auditory feedback, and coordination between speech and breathing. Descriptive and inferential statistics were performed. RESULTS: Face masks increased the perception of vocal effort, difficulty in speech intelligibility, auditory feedback, and difficulty in coordinating speech and breathing, irrespective of usage. Individuals who wore face masks for professional and essential activities had a greater perception of symptoms of vocal fatigue and discomfort, vocal effort, difficulties in speech intelligibility, and in coordinating speech and breathing. CONCLUSION: Use of face masks increases the perception of vocal symptoms and discomfort, especially in individuals who wore it for professional and essential activities.

Does Shyness Influence the Self-Perception of Vocal Symptoms, Public Speaking, and Daily Communication?

OBJECTIVES: The present study aimed to characterize and to verify the relationship between shyness and self-assessment of vocal symptoms, public speaking, and aspects of daily communication. METHODS: This is an observational, analytical, and cross-sectional study. Two hundred and sixty-four male and female participants, with a mean age of 21 years and without any vocal disorder. To measure the outcomes, the participants' scores were measured using the following self-assessment instruments: Revised Cheek and Buss Shyness Scale, Voice Symptom Scale, Self-Statements during Public Speaking Scale, and the Daily Communication Self-evaluation Questionnaire. A descriptive and inferential analysis of the data was performed. RESULTS: Shy persons had higher vocal symptomatology scores in the limitation, emotional, and total domain. Furthermore, they scored higher on the negative aspects of public speaking and lower on its positive aspects. In addition, they showed weaker loudness and higher pitch in daily communication, compared with nonshy persons. Statistically significant correlations were found between positive shyness scores and all domains of vocal symptoms, negative aspects of public speaking, and pitch in daily communication. However, negative correlation was found between the positive aspects of public speaking and loudness in daily communication. CONCLUSION: Shy persons have a higher self-evaluation with regard to the negative and less positive aspects of public speaking and most vocal symptoms, as well as weaker loudness and higher pitch in daily communication when compared to nonshy persons. The greater the perception of shyness, the greater the self-assessment with regard to daily communication and vocal symptoms and the negative aspects of public speaking.

Self-perception of insomnia, sleep quality, and musculoskeletal pain in dysphonic women: preliminary study.

OBJECTIVE: To evaluate the association between musculoskeletal pain, insomnia indices, and sleep quality with voice functioning among women. METHODS: Thirty women aged between 18 and 50 years old participated in two groups: dysphonic group (DG) - composed of 15 women diagnosed with behavioral dysphonia; and control group (CG) - composed of 15 vocally healthy women. All participants answered the Musculoskeletal Pain Investigation Questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Insomnia Severity Index (ISI) questionnaires. Statistical tests were applied to compare groups and to relate outcome variables, with a significance of 5% (p<.05). RESULTS: Dysphonic women presented a higher frequency of musculoskeletal pain in the posterior neck, lower back, masseter, submandibular, and larynx regions. There was no statistically significant difference for the other compared variables. We observed that there was a difference in the comparison between pain in some head and neck regions and the quality of sleep and evidence of insomnia, both in DG and CG. CONCLUSIONS: Dysphonic women have a higher frequency of pain in the head and neck regions when compared to vocally healthy women. There is a difference between sleep quality, insomnia, and musculoskeletal pain, regardless of the presence of vocal and laryngeal alterations.

Vocal Signs and Symptoms Related to COVID-19 and Risk Factors for their Persistence.

OBJECTIVE: To compare the occurrence of vocal signs and symptoms before, during, and after coronavirus disease (COVID-19) and analyze possible risk factors for the persistence of these signs and symptoms after disease resolution. METHODS: This was an observational, analytical, and cross-sectional study. The participants were 45 individuals of both sexes, with a mean age of 44 years, who were previously affected by COVID-19. All participants answered a questionnaire about sociodemographic data, smoking history, disease course, vocal complaints, and the vocal signs and symptoms list (SSL), referring to three timepoints (before, during, and after COVID-19). RESULTS: The most commonly reported vocal signs and symptoms before COVID-19 were phlegm (26.67%; n=12) and dry throat (24.44%; n=11). During COVID-19, the most frequent vocal signs and symptoms were tired voice after short-term use (73.33%; n=33) and dry throat (71.11%; n=32). After the disease, the most reported vocal signs and symptoms were dry throat (57.78%; n=26) and phlegm (53.33; n=24). The self-perception of vocal signs and symptoms before COVID-19 was lower than that during and after COVID-19 (P < 0.001). Vocal complaints after COVID-19 and oxygen therapy were predictors of self-perception of vocal signs and symptoms after COVID-19. CONCLUSIONS: Individuals affected by COVID-19 had a higher frequency of vocal signs and symptoms during the disease. However, after remission, the frequency of vocal signs and symptoms was higher than that at baseline. The need for oxygen therapy may indicate a risk for a higher occurrence of vocal signs and symptoms after COVID-19.

Vocal Symptoms in Brazilian Professors: Self-Perception and Relationship Factors.

OBJECTIVE: This study aimed to investigate the self-perception of vocal symptoms and relationship factors in Brazilian academic teacher. METHODS: This was a cross-sectional study. The study sample consisted of 235 Brazilian academic teachers, of whom 103 were men and 132 women, aged between 26 and 67 years, and employed at 39 institutions. All participants filled out a questionnaire detailing the presence of vocal complaints, and occupation and sociodemographic information. The vocal symptoms were investigated using voice symptom scale. RESULTS: Academic teacher with vocal complaints showed a higher perception of vocal symptoms in all domains (P < 0.001 for all). Other factors did not result in any significant difference. CONCLUSION: The only factor that influences the self-perception of vocal symptoms in Brazilian academic teachers is the presence of vocal complaints.

Immediate Effect of Semioccluded Vocal Tract Exercises Using Resonance Tube Phonation in Water on Women Without Vocal Complaints.

OBJECTIVE: To analyze the immediate effects of semioccluded vocal tract exercises on vocal quality and vocal self-assessment using resonance tube phonation in water in women without voice complaints, and to compare these results with those obtained using tongue trills and unvoiced fricative exercises. METHODS: This was a quasi-experimental study. The participants were 30 women aged 18-39 years and without vocal complaints. All participants performed three exercises for 3 minutes: experimental exercise (EE: phonation into a resonance flexible tube in water exercise), control exercise (tongue trill exercise), and placebo exercise (PE: unvoiced fricative exercise). Three outcomes were analyzed-vocal self-assessment, auditory-perceptual evaluation, and acoustic analysis. RESULTS: The vocal self-assessment showed significantly greater improvement after EE than after the other exercises. There were no significant differences in auditory-perceptual evaluation or acoustic analyses in any of the voice exercises. CONCLUSION: The EE promoted an immediate positive effect in the subjective self-assessment, with better results compared with PE. However, the clinical vocal evaluation did not indicate immediate positive effects after 3 minutes of EE, control exercise, or PE.

Comparison of the immediate effect of voiced oral high-frequency oscillation and flow phonation with resonance tube in vocally-healthy elderly women. / Comparação do impacto imediato das técnicas de oscilação oral de alta frequência sonorizada e sopro sonorizado com tubo de ressonância em idosas vocalmente saudáveis.

PURPOSE: To verify and compare the immediate effects of the voiced oral high-frequency oscillation (VOHFO) technique and the phonation into a silicone resonance tube in the elderly self-perception of vocal and laryngeal symptoms and in their voice quality. METHODS: 14 elderly women, over 60 years old, performed the VOHFO and phonation into a resonance tube technique (35cm in length and 9mm in diameter) with one-week interval between both to avoid carry-over effect. Initially, all participants answered questions regarding the frequency and intensity of their vocal/laryngeal symptoms. Recordings of the sustained vowel /a/ and counting numbers were performed for posterior perceptual and acoustic analyses of the voice quality. The maximum phonation time (MPT) for /a/, /s/, /z/ and counting numbers were also obtained. After that, a draw lot established which technique (VOHFO or resonance tube) would be initially applied for three minutes. After the exercise performance the same procedures were carried out and the elderly women answered a self-assessment questionnaire about the effect of the techniques in her voice, larynx, breathing and articulation. Comparison pre and post each technique were analyzed using ANOVA, Wilcoxon and Mann-Whitney tests. The sensations after the techniques were assessed using the Chi-square test (p<0.05). RESULTS: The comparison of both techniques showed decrease in roughness and improvement in resonance for counting numbers after the resonance tube and same outcomes post VOHFO. There were no significant differences for the other analyzed variables between groups. CONCLUSION: The phonation into a resonance tube exercise improves the vocal quality of elderly women. In addition, both exercises are similar regarding self-perception of vocal / laryngeal symptoms and sensations post three minutes of the technique, suggesting that VOHFO can be safely applied in voice therapy for this population.

OBJETIVO: Verificar e comparar os efeitos imediatos da técnica de oscilação oral de alta frequência sonorizada (OOAFS) e sopro sonorizado com tubo de ressonância na autopercepção de sintomas vocais/laríngeos e na qualidade vocal de idosas. MÉTODO: Participaram 14 mulheres idosas que realizaram as técnicas OOAFS e sopro sonorizado com tubo de ressonância de silicone, com wash-out de uma semana. Todas responderam questões sobre frequência e intensidade dos sintomas vocais/laríngeos; foram submetidas à gravação da vogal sustentada /a/ e contagem de números, para análise perceptivo-auditiva e acústica vocal. Foram extraídos os tempos máximos de fonação (TMF). Em seguida, sorteou-se a técnica a ser realizada: OOAFS ou tubo de ressonância, por três minutos em tom habitual. Após exercício, os mesmos procedimentos da avaliação inicial foram repetidos e as idosas responderam a um questionário de autoavaliação sobre os efeitos das técnicas. Os dados foram comparados antes e após aplicação das técnicas por meio dos testes ANOVA, Wilcoxon e Mann-Whitney; para as sensações vocais após técnicas, aplicou-se teste Quiquadrado(p<0,05). RESULTADOS: Ao comparar as técnicas, verificou-se diminuição da rugosidade e melhora da ressonância na contagem dos números após tubo de ressonância e manutenção dos resultados após OOAFS. Não houve mais diferenças significantes para as demais variáveis estudadas entre os grupos. CONCLUSÃO: O sopro sonorizado com tubo de ressonância melhora a qualidade vocal de mulheres idosas. Além disso, ambos os exercícios apresentaram semelhanças na autopercepção dos sintomas vocais/laríngeos e sensações, sugerindo que a OOAFS é segura e pode ser empregada na terapia de voz nesta população.

Influence of the Body Position and Emission Number in the Results of the Maximum Phonation Times of Adults without Vocal Complaints.

OBJECTIVE: To analyze if there is an influence of the body position and emission number in the results of the maximum phonation times (MPT) of adults without vocal complaints. MATERIALS AND METHODS: This is an observational, analytical and cross-sectional study. Sixty subjects participated: 30 men and 30 women without vocal complaints. Subjects were instructed to stay in orthostatic or sitting position, according to the collection's order that was selected. The first 30 subjects were evaluated in order number 1 (sitting and orthostatic) and the other 30 subjects were evaluated in order number 2 (orthostatic and sitting), with a 5-minute interval between the emissions in the two positions. The MPT of vowels /a/, /i/, /u/, fricatives /s/ and /z/, and numbers were collected. After this, the subjects were instructed to do the same emissions mentioned above, but in another position (orthostatic or sitting). The values of MPT were statistically analyzed with both the Analysis of Variance (ANOVA) paired measures test to three criteria and the Tukey Test (P < 0.05). RESULTS: There was no difference between the MPT obtained in both positions. Males had all MPT higher than females. Regarding the emission number, there were differences for both sexes in the MPT of the vowel /a/ and the number counting. CONCLUSION: In general, it is concluded that there is no influence of body position in the results of voice temporal measures, but the sex and the number of the emissions influence the result of the MPT.

Relation Between Musculoskeletal Pain and Voice Self-Assessment in Tele-Operators.

OBJECTIVES: To investigate musculoskeletal pain, vocal fatigue, and voice-related quality of life of tele-operators and compare these aspects with nonvoice-related professionals; and verify if there is a relationship between musculoskeletal pain and vocal fatigue and voice-related quality of life (V-RQOL) of tele-operators and nonvoice-related professionals. METHODS: Thirty-five tele-operators (SG) and 35 nonvoice-related professionals with no vocal complaints (control group) participated in the study. All of them answered investigating questionnaires of musculoskeletal pain, vocal fatigue index, and V-RQOL. The data were statistically analyzed in aim to compare the groups and the association between variables. RESULTS: Women from SG presented higher pain frequency in their upper back than women from control group (P = 0.039). Different correlations were observed between musculoskeletal pain and vocal fatigue, just as between musculoskeletal pain and V-RQOLindex, for men and women in both groups. However, men presented a higher number or correlations between the protocols than women from both groups. CONCLUSION: Female tele-operators presented higher pain frequency on their upper back when compared to nonvoice-related professional women. Musculoskeletal pain has a negative impact on voice-related quality of life and on the increase of vocal fatigue during oral communication, regardless of the professional use of the voice.

Efeito imediato de exercício inspiratório com exercitador e incentivador respiratório em mulheres sem queixas vocais / Immediate effect of inspiratory exercise with exerciser and respiratory encourager in women without vocal complaints

RESUMO Objetivo Avaliar o efeito imediato do exercício inspiratório com incentivador e exercitador respiratório na voz de mulheres sem queixas vocais. Método Participaram 25 mulheres sem queixas vocais, entre 18 e 34 anos, com pontuação 1 no Índice de Triagem para Distúrbio Vocal (ITDV). A coleta de dados foi realizada nos momentos antes e após realização de exercício inspiratório e consistiu na gravação de vogal sustentada /a/, fala encadeada e tempos máximos fonatórios (TMF) de vogais, fonemas fricativos e contagem de números. No julgamento perceptivo-auditivo foi utilizada a Escala de Desvio Vocal (EDV) para verificar o grau geral do desvio vocal. Avaliação acústica foi feita no software PRAAT e foram extraídos os parâmetros frequência fundamental (f0), jitter, shimmer, proporção harmônico -ruído (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) e Acoustic Breathiness Index (ABI). Para mensuração das medidas aerodinâmicas, o tempo de emissão foi extraído no programa Audacity. Para comparar os resultados utilizou-se o teste paramétrico t de Student para amostras dependentes na análise das variáveis com distribuição normal e o teste de Wilcoxon para variáveis com distribuição não normal. Resultados Não houve diferenças entre os resultados do JPA e das medidas acústicas, nos momentos pré e pós exercício inspiratório. Quanto às medidas aerodinâmicas foi possível observar aumento significativo no valor do TMF /s/ (p=0,008). Conclusão Não houve modificação na qualidade vocal após o exercício inspiratório com incentivador e exercitador respiratório, porém foi observado aumento do TMF do fonema /s/ após a realização do exercício.

ABSTRACT Purpose To evaluate the immediate effect of the inspiratory exercise with a booster and a respiratory exerciser on the voice of women without vocal complaints. Methods 25 women with no vocal complaints, between 18 and 34 years old, with a score of 1 on the Vocal Disorder Screening Index (ITDV) participated. Data collection was performed before and after performing the inspiratory exercise and consisted of recording the sustained vowel /a/, connected speech and maximum phonatory times (MPT) of vowels, fricative phonemes and counting numbers. In the auditory-perceptual judgment, the Vocal Deviation Scale (VSD) was used to verify the general degree of vocal deviation. Acoustic evaluation was performed using the PRAAT software and the parameters fundamental frequency (f0), jitter, shimmer, harmonium-to-noise ratio (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) and Acoustic Breathiness Index (ABI). To measure the aerodynamic measurements, the time of each emission was extracted in the Audacity program. Data were statistically analyzed using the Statistica for Windows software and normality was tested using the Shapiro-Wilk test. To compare the results, Student's and Wilcoxon's t tests were applied, adopting a significance level of 5%. Results There were no significant differences between the results of the JPA and the acoustic measures, in the pre and post inspiratory exercise moments. As for the aerodynamic measures, it was possible to observe a significant increase in the value of the TMF /s/ (p=0.008). Conclusion There was no change in vocal quality after the inspiratory exercise with stimulator and respiratory exerciser, but an increase in the MPT of the phoneme /s/ was observed after the exercise.

Cepstral Peak Prominence Smoothed - CPPS e Acoustic Voice Quality Index - AVQI em vozes infantis saudáveis e alteradas: comparação, relação com julgamento perceptivo-auditivo e pontos de corte / Cepstral Peak Prominence Smoothed - CPPS and Acoustic Voice Quality Index - AVQI in healthy and altered children's voices: comparation, relationship with auditory-perceptual judgment and cut-off points

RESUMO Objetivo Comparar as medidas acústicas de Cepstral Peak Prominence Smoothed (CPPS) e Acoustic Voice Quality Index (AVQI) de crianças com vozes normais e alteradas, relacionar com o julgamento perceptivo-auditivo (JPA) da voz e estabelecer pontos de corte. Método Gravações vocais das tarefas de vogal sustentada e contagem de números de 185 crianças foram selecionadas em um banco de dados e submetidas a análise acústica com extração das medidas de CPPS e AVQI, e ao JPA. O JPA foi realizado individualmente para cada tarefa e as amostras foram classificadas posteriormente como normal ou alterada, e para as tarefas em conjunto definindo-se se a criança passaria ou falharia em uma situação de triagem vocal. Resultados Crianças com JPA alterado e que falharam na triagem apresentaram valores menores de CPPS e maiores de AVQI, do que as com JPA normal e que passaram na triagem. O JPA da tarefa de vogal sustentada se relacionou ao CPPS e AVQI, e da tarefa de contagem de números relacionou-se apenas ao AVQI e CPPS números. Os pontos de corte que diferenciam crianças com e sem desvio vocal são 14,07 para o CPPS vogal, 7,62 para o CPPS números e 2,01 para o AVQI. Conclusão Crianças com JPA alterado apresentaram maiores valores de AVQI e menores valores de CPPs. O JPA da tarefa de vogal previu todas as medidas acústicas, porém, de contagem previu apenas as medidas extraídas dela. As três medidas foram semelhantes na identificação de vozes sem desvio e vozes disfônicas.

ABSTRACT Purpose To compare the acoustic measurements of Cepstral Peak Prominence Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) of children with normal and altered voices, to relationship with auditory-perceptual judgment (APJ) and to establish cut-off points. Methods Vocal recordings of the sustained vowel and number counting tasks of 185 children were selected from a database and submitted to acoustic analysis with extraction of CPPS and AVQI measurements, and to APJ. The APJ was performed individually for each task, classified as normal or altered, and for the tasks together defining whether the child would pass or fail in a situation of vocal screening. Results Children with altered APJ and who failed the screening had lower CPPS values and higher AVQI values, than those with normal APJ and who passed the screening. The APJ of the sustained vowel task was related to CPPS and AVQI, and APJ of the number counting task was related only to AVQI and CPPS numbers. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the vowel CPPS, 7.62 for the CPPS numbers and 2.01 for the AVQI. Conclusion Children with altered voices, have higher AVQI values and lower CPPS values, when detected in children with voices within the normal range. The acoustic measurements were related to the auditory perceptual judgment of vocal quality in the sustained vowel task, however, the number counting task was related only to the AVQI and CPPS. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the CPPS vowel, 7.62 for the CPPS numbers and 2.01 for the AVQI. The three measures were similar in identifying voices without deviation and dysphonic voices.

Phonological acquisition in children with early-treated congenital hypothyroidism: association with clinical and laboratory parameters.

PURPOSE: To evaluate the phonological characteristics of children with congenital hypothyroidism (CH). METHODS: Observational, analytical, cross-sectional, ambispective study including prepubertal children with CH (n=100; study group, SG) and controls without CH ( n=100; control group, CG). Assessments included a speech language pathology interview, the phonological evaluation of the ABFW Child Language Test, medical data, and neuropsychological tests in the first three years of life. RESULTS: On treatment onset of the SG, the median chronological age of the participants was 18.0 days and 48.4% had total T4 <2.5 µg/dL (31.75 nmol/L). At the age of 7 years, children in the SG had higher rates of consonant cluster simplification and lower rates of complete phonological system compared to those in the CG. On analysis of combined age groups (4+5 and 6+7 years), the CG had a higher frequency of complete acquisition versus the SG. On multivariate analysis, thyroid agenesis, abnormal scores on the Clinical Linguistic and Auditory Milestone Scale and developmental quotient tests were associated with the occurrence of phonological disorders. CONCLUSION: Children with CH present delay in phonological acquisition, despite early diagnosis and adequate treatment, especially between the ages of 6-7 years. The etiology of CH and the results of neuropsychological tests in the first years of life seem to be related to this delay.

Vocal Evaluation of Children with Congenital Hypothyroidism.

OBJECTIVE: To evaluate the vocal characteristics of a group of children with congenital hypothyroidism (CH) and the association of these characteristics with the children's clinical, laboratory, and therapeutic profiles. MATHERIAL AND METHODS: Observational, analytical, cross-sectional study including 200 prepubertal children, of whom 100 had CH (study group [SG]) and 100 had no CH (control group [CG]). The following parameters were evaluated: 1) history (identification, complaints, and interfering variables), 2) auditory-perceptual and acoustic evaluation (samples analyzed by a group of specialists, and objectively by a computer program), 3) self-assessment scores in the Pediatric Voice-Related Quality-of-Life (PVRQoL) survey, 4) laryngological evaluation (presence or absence of laryngeal lesions and data regarding glottal closure), and 5) medical records (CH etiology, age at treatment initiation, disease severity at diagnosis, treatment quality, and thyroid function tests on the day of the examination). RESULTS: In the perceptual assessment, 62.6% of the SG children passed, whereas 37.4% failed in the voice screening, but these results were comparable with those in the CG (P = 0.45). Both groups had mean/median acoustic measurements within the normal limits. The mean PVRQoL in the SG (99.3 ± 2.4) and CG (99.5 ± 1.7) were comparable (P = 1.00). Both SG (16.7%) and CG (15%) presented vocal cord lesions (P = 1.00). There was no association between voice/larynx characteristics and endocrinological data. CONCLUSION: Prepubescent children diagnosed with CH during neonatal screening and who have a lifelong history of adequate treatment of CH showed similar vocal and laryngeal characteristics compared with children without CH.

Futuros professores e a autopercepção de sintomas vocais e conhecimento em saúde e higiene vocal / Future teachers and the self-perception of vocal symptoms and knowledge about vocal health and hygiene

RESUMO Objetivo Analisar respostas de futuros professores quanto à autopercepção de sintomas vocais e conhecimento sobre saúde vocal e higiene vocal, relacionando-os às variáveis sociodemográficas, ocupacionais e conhecimento prévio sobre voz. Método Estudo observacional, analítico e transversal. Participaram 264 alunos de licenciatura, foram aplicados Questionário de Saúde e Higiene Vocal (QSHV), Escala de Sintomas Vocais (ESV) e questionário com perguntas sociodemográficas, ocupacionais e vocais. Os dados foram analisados estatisticamente considerando nível de significância 5%. Resultados QSHV de futuros professores apresentou escore médio total de 21,89, sugestivo de conhecimento insuficiente sobre saúde e higiene vocal. Resultados da ESV estão acima da nota de corte do instrumento, nos três domínios e no escore total, observou-se maior sintomatologia em estudantes do primeiro ano quando comparados aos demais estudantes, nos domínios emocional, limitação e total. Houve diferença na comparação do QSHV com o ano da graduação (p=0,001), em que alunos dos terceiros e quartos anos obtiveram pontuações maiores. Observou-se correlação positiva entre escore total do QSHV e variável idade (p=0,019). Conclusão Futuros professores apresentam sintomatologia vocal importante, compatível aos indivíduos disfônicos, e possuem conhecimento insuficiente sobre saúde e higiene vocal. O conhecimento é ainda menor em alunos dos anos de graduação iniciais e com menor idade. Futuros professores com mais idade demonstram ter mais conhecimento sobre saúde e higiene vocal. Faz-se necessária a proposição de ações preventivas à essa população, ainda no período da graduação, visando à diminuição dos riscos ao desenvolvimento de problemas vocais em médio ou longo prazo durante a docência.

ABSTRACT Purpose To analyze responses of future teachers regarding the self-perception of vocal symptoms and knowledge about vocal health and vocal hygiene, relating them to sociodemographic and occupational variables and previous knowledge about voice. Methods Observational, analytical and cross-sectional study. A total of 264 undergraduate students participated and the Vocal Health and Hygiene Questionnaire (QSHV), Vocal Symptoms Scale (ESV) and a questionnaire with sociodemographic, occupational and vocal questions were applied. Data were statistically analyzed considering a 5% significance level. Results QSHV of future teachers had a total mean score of 21.89, suggestive of lack of knowledge about vocal health and hygiene. The results of the ESV are above the instrument's cutoff score, in each of the three domains and in the total score, there was greater symptomatology in first-year students when compared to other students, in the emotional, limitation and total domains. There was a difference when comparing the QSHV with the year of graduation (p=0.001), in which third and fourth year students obtained higher scores. A positive correlation was observed between the total QSHV score and the age variable (p=0.019). Conclusion Future teachers present important vocal symptomatology, compatible with dysphonic individuals, and have insufficient knowledge about vocal health and hygiene. Knowledge is even lower among students in the early undergraduate years and at a younger age. Older future teachers demonstrate more knowledge about vocal health and hygiene. It is necessary to propose preventive actions with this population, even during the graduation period, aiming to reduce the risks of developing vocal problems in the medium or long term during teaching.

Medidas acústicas de CPPS e AVQI pré e pós terapia fonoaudiológica / Acoustic measurements of CPPS and AVQI pre and post speech therapy

RESUMO Objetivo Comparar as medidas acústicas de Proeminência do Pico Cepstral Suavizado (CPPS) e Acoustic Voice Quality Index (AVQI) nos momentos pré e pós-terapia Vocal. Método Trata-se de estudo de intervenção antes e após, com coleta de dados retrospectiva. Participaram do estudo 22 sujeitos com média de idade de 49,9 anos. A terapia vocal ocorreu entre os anos de 2016 a 2019 em uma clínica-escola, sendo que antes e após os processos terapêuticos, os sujeitos tiveram amostras vocais coletadas. Foram realizadas as extrações dos dados de CPPS e AVQI nos momentos pré e pós-terapia. A fim de caracterizar a amostra, foi realizado julgamento perceptivo-auditivo (JPA) referente ao grau geral do desvio vocal nos momentos pré e pós-terapia. Os dados foram analisados estatisticamente. Resultados Os dados do JPA indicaram diminuição nos valores medianos de grau geral do desvio vocal no momento pós-terapia, tanto para a amostra de vogal (p=0,00) quanto de números (p=0,00). A média do CPPS para a vogal foi de 14,53 pré-terapia e 16,37 pós-terapia (p= 0,01) e na emissão dos números foi de 8,22 pré-terapia e 9,06 pós-terapia (p=0,02), houve diferença no CPPS da vogal e dos números indicando melhora vocal pós-terapia. A média do AVQI foi de 2,27 pré-terapia e 1,54 pós-terapia (p= 0,05), houve melhora nos resultados do AVQI, com valor de p limítrofe. Conclusão A terapia vocal produziu modificações no grau geral do desvio vocal e nas medidas de CPPS e AVQI, sendo que no momento pós terapia os resultados são semelhantes aos apresentados por indivíduos vocalmente saudáveis.

ABSTRACT Purpose To compare the acoustic measurements of Cepstral Peak Prominence-Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) at pre- and post-voice therapy times. Methods This is a before and after intervention study, with retrospective data collection. Twenty-two subjects with a mean age of 49.9 years participated in the study. The vocal therapy occurred between the years 2016 to 2019 in a teaching clinic, and the subjects had vocal samples collected before and after the therapeutic processes. CPPS and AVQI data extractions were performed during pre- and post-therapy. In order to characterize the sample, auditory-perceptual evaluation (APE) regarding the overall degree of vocal deviation at pre- and post-therapy moments was performed. The data were analyzed statistically. Results The APE data indicated a decrease in the median values of overall vocal deviation degree at the post-therapy stage for both the vowel (p=0.00) and number (p=0.00) samples. The average CPPS for the vowel was 14.53 pre-therapy and 16.37 post-therapy (p=0.01); for the number emission, it was 8.22 pre-therapy and 9.06 post-therapy (p=0.02), there was a difference in the CPPS of the vowel and numbers indicating vocal improvement at post-therapy. The average AVQI was 2.27 pre-therapy and 1.54 post-therapy (p=0.05). There was an improvement in the AVQI results, with borderline p-value. Conclusion Vocal therapy produced changes in the general degree of vocal deviation, as well as in CPPS and AVQI measurements, and the results at the post-therapy moment are similar to those of vocally healthy individuals.