Safety of CoronaVac and ChAdOx1 vaccines against SARS-CoV-2 in patients with rheumatoid arthritis: data from the Brazilian multicentric study safer.

BACKGROUND: Patients with immune-mediated rheumatic diseases (IMRDs) have been prioritized for COVID-19 vaccination to mitigate the infection severity risks. Patients with rheumatoid arthritis (RA) are at a high risk of severe COVID-19 outcomes, especially those under immunosuppression or with associated comorbidities. However, few studies have assessed the safety of the COVID-19 vaccine in patients with RA. OBJECTIVE: To evaluate the safety of vaccines against SARS-CoV-2 in patients with RA. METHODS: This data are from the study "Safety and Efficacy on COVID-19 Vaccine in Rheumatic Diseases," a Brazilian multicentric prospective phase IV study to evaluate COVID-19 vaccine in IMRDs in Brazil. Adverse events (AEs) in patients with RA of all centers were assessed after two doses of ChAdOx1 (Oxford/AstraZeneca) or CoronaVac (Sinovac/Butantan). Stratification of postvaccination AEs was performed using a diary, filled out daily and returned at the end of 28 days for each dose. RESULTS: A total of 188 patients with RA were include, 90% female. CoronaVac was used in 109 patients and ChAdOx1 in 79. Only mild AEs were observed, mainly after the first dose. The most common AEs after the first dose were pain at the injection (46,7%), headache (39,4%), arthralgia (39,4%), myalgia (30,5%) and fatigue (26,6%), and ChAdOx1 had a higher frequency of pain at the injection (66% vs 32 %, p < 0.001) arthralgia (62% vs 22%, p < 0.001) and myalgia (45% vs 20%, p < 0.001) compared to CoronaVac. The more common AEs after the second dose were pain at the injection (37%), arthralgia (31%), myalgia (23%), headache (21%) and fatigue (18%). Arthralgia (41,4% vs 25%, p = 0.02) and pain at injection (51,4% vs 27%, p = 0.001) were more common with ChAdOx1. No serious AEs were related. With Regard to RA activity level, no significant difference was observed between the three time periods for both COVID-19 vaccines. CONCLUSION: In the comparison between the two immunizers in patients with RA, local reactions and musculoskeletal symptoms were more frequent with ChAdOx1 than with CoronaVac, especially after the first dose. In summary, the AE occurred mainly after the first dose, and were mild, like previous data from others immunizing agents in patients with rheumatoid arthritis. Vaccination did not worsen the degree of disease activity.

Nebulized Saline Solution: A Multidimensional Voice Analysis.

PURPOSE: To verify the effect of nebulization on the voice of dysphonic and non-dysphonic individuals on acoustic, perceptual-auditory, aerodynamic, electroglottographic, laryngeal parameters and on the self-perception of vocal discomfort. MATERIALS AND METHODS: All the research subjects were submitted to vocal evaluation, laryngeal and voice self-perception. Then, the participants remained in vocal rest for a period of 10 minutes and the analysis mentioned above were again performed. After this first stage, the participants were submitted to the nebulization for a period of 10 minutes and the all analysis above were again performed. Descriptive analysis of the variables was carried. In the comparison of the pre- and post-nebulization groups, the Paired T-Student Test was used for variables with non-dysphonic distribution and the Wilcoxon Test for variables with asymmetric distribution. When categorical variables were evaluated (perceptual-auditory evaluation and laryngeal assessment), the Pearson's Chi-square test was used. In all analysis, a significance level of 5% was considered. The intra-rater agreement in the auditory-perceptual and perceptual-visual assessment was assessed using the AC1 statistic, using the R program. For this purpose, 20% of the voice samples and laryngeal images were replicated blindly and interpreted by the evaluators at the time evaluations. RESULTS: The results of this research show that non-dysphonic individuals have more positive vocal and laryngeal effects after nebulization than dysphonic ones. It is also observed that the EGG measurement was the most sensitive to the effect of nebulization, with an increase in the Closed quotient (CQ) in all groups evaluated. Regarding acoustic measurements, it is noted that the effect of nebulization in men is more evident than in women. After nebulization, there was an increase in fundamental frequency in the group of non-dysphonic women and dysphonic and non-dysphonic men. A decrease in the amplitude perturbation quotient values is observed in all groups, besides a reduction in the pitch perturbation quotient values after nebulization in non-dysphonic men groups. There was improves aerodynamic efficiency in groups of dysphonic and non-dysphonic men and in the self-perception of vocal discomfort in all groups studied after the hydration procedure. The results of this study demonstrate a significant improvement in the mucosal wave after nebulization in the groups of women and men who are not dysphonic. CONCLUSION: The nebulization procedure with saline solution improves acoustic measurements, the electroglottographic closed quotient and vocal self-perception of dysphonic and non-dysphonic women and men. Nebulization increases the mucosal wave of the vocal folds in non-dysphonic women and men and improves the aerodynamic efficiency of men.

Effect of Nebulization on Laryngeal Parameters: Analysis Using High-Speed Digital Videolaryngoscopy.

INTRODUCTION: Superficial laryngeal hydration, obtained through nebulization, is related to the moisture level on the epithelial surfaces of the vocal folds, modifying their biomechanical and aerodynamic properties. Through high-speed videolaryngoscopy it is possible to obtain objective data for laryngeal analysis after nebulization and a better understanding of this phenomenon OBJECTIVE: To verify the effects of nebulization with saline solution on laryngeal parameters of digital videokymography obtained by high-speed videolaryngoscopy examination in women and men with and without laryngeal alterations METHOD: This is a clinical, comparative intra-subject study. Fifty-nine adults were selected, with and without laryngeal alterations, 30 females and 29 males. Digital videokymographs in the anterior, middle and posterior thirds of the vocal folds of the participants were analyzed before and after nebulization with 0.9% saline solution. RESULTS: Women without laryngeal alterations showed more parameters changes after nebulization, in which there was a decrease in maximum and medium opening, amplitude of opening of the left and right vocal fold in the anterior glottal third, and an increase of the percentage of closure of the vocal folds. These results indicate a minor extent of lateral excursion of the vocal folds during phonation. In women with laryngeal alterations, the parameters that changed after nebulization were the increased frequency of opening of the left and right vocal folds in the topography of the posterior third. In men, nebulization did not change the variables studied, except for the amplitude of the right vocal fold in men with laryngeal alterations, in the analysis of the posterior glottic third. CONCLUSION: The results suggest that surface hydration modifies laryngeal dynamics differently between genders. After nebulization with saline solution, women without laryngeal alterations showed a decrease in the lateralization of the vocal folds during phonation, suggesting a better phonatory efficiency.

Immediate vocal effects produced by the Shaker® device in women with and without vocal complaints. / Efeitos vocais imediatos produzidos pelo dispositivo Shaker® em mulheres com e sem queixa vocal.

PURPOSE: To evaluate the acoustic and self-perception modifications obtained after the first, third, fifth and seventh minutes of voice oral high-frequency oscillation practice accomplished with the Shaker® device. METHODOLOGY: Twenty-seven women aged between 18 and 41 years with and without vocal complaint participated in the study. The sustained vowel / ε / was recorded at maximum phonation time before (pre-exercise) and after the first, third, fifth and seventh minutes of voice oral high-frequency oscillation practice accomplished with Shaker®. The acoustic analysis of the following parameters was performed: noise, fundamental frequency, glottal to noise excitation, Jitter, Shimmer and number of harmonics. RESULTS: There were no significant differences in the comparison of the acoustic parameters between the participants with and without vocal symptoms. It was observed an improvement in the self-perception of vocal discomfort in the groups of women with and without vocal symptoms, comparing the moment before the practice with the first and third minutes of practice. There was a reduction in Jitter values when comparing the time before practice with the moments after one and seven minutes and when comparing the moments after five and seven minutes of exercise in the group of women with vocal symptoms. CONCLUSION: The Shaker® technique showed positive results both in individuals with symptoms and in individuals without vocal symptoms.

OBJETIVO: Avaliar as modificações acústicas e de autopercepção obtidas após o primeiro, terceiro, quinto e sétimo minuto de prática da técnica de oscilação oral de alta frequência sonorizada, realizada com o dispositivo Shaker®. MÉTODO: Participaram do estudo 27 mulheres com idade entre 18 e 41 anos com e sem queixa vocal. A vogal sustentada /ε/ foi registrada em tempo máximo de fonação antes (pré-exercício) e após o primeiro, terceiro, quinto e o sétimo minuto de execução da técnica de oscilação oral de alta frequência sonorizada com o dispositivo Shaker®. Foi realizada a análise acústica dos seguintes parâmetros: ruído, frequência fundamental, glottal to noise excitation, Jitter, Shimmer e número de harmônicos. RESULTADOS: Não houve diferenças significativas na comparação dos parâmetros acústicos entre as participantes com e sem sintomas vocais. Observou-se melhora na autopercepção do desconforto vocal nos grupos das mulheres com e sem sintomas vocais, comparando-se o momento antes da prática com o primeiro e terceiro minutos de prática. Houve redução dos valores de Jitter, ao comparar o momento antes da prática com os momentos após um e sete minutos e ao comparar os momentos após cinco e sete minutos de exercício, no grupo de mulheres com sintomas vocais. CONCLUSÃO: A técnica com o Shaker® mostrou resultados positivos, tanto em indivíduos com sintomas quanto em indivíduos sem sintomas vocais.

The Influence of Noise on the Vocal Dose in Women.

OBJECTIVE: The objective of this study was to evaluate if noise interferes with the vocal dose in women without vocal complaints. STUDY DESIGN: This is an experimental and comparative study. METHODS: Data were collected on 27 women between 22 and 50 years of age without vocal complaints in a university classroom. Speech-language pathology evaluation was performed employing auditory-perceptual analysis and a vocal symptom questionnaire. The acoustics of the classroom were evaluated via both observation of the characteristics of the room and the quantification of background noise and reverberation time. Two distinctive acoustic conditions were created for evaluations: condition 1, a room without acoustic treatment and without noise reproduction, and condition 2, a room without acoustic treatment with noise reproduction. Each participant was evaluated individually in both acoustic conditions. To obtain vocal dose data, a vocal dosimeter was used. Subjects were asked to perform two 10-minute readings, one in each acoustic condition. The order of conditions was randomized between subjects. Subjects were instructed to complete the reading tasks at the vocal intensity deemed appropriate to be heard by a listener in the back of the room. t Tests and the Wilcoxon test were employed to compare parameters across subjects and conditions. RESULTS: Fundamental frequency, vocal intensity, percentage of phonation, and cycle dose significantly increased in the background noise condition. CONCLUSION: A positive relation between vocal dose and the presence of excessive noise in the environment was observed.

Effect of the comprehensive voice rehabilitation program in teachers with behavioral dysphonia. / Efeito do programa integral de reabilitação vocal em professoras com disfonia comportamental.

PURPOSE: Analyze the effects of the Comprehensive Vocal Rehabilitation Program (CVRP) and the motivational stages during speech therapy in teachers with behavioral dysphonia. METHODS: Retrospective, longitudinal, observational study using data from the medical records of 33 teachers regarding auditory-perceptual, acoustic, self-perception analyses and the Voice Handicap Index (VHI-10) protocol in pre- and post-speech therapy situations, and motivational stages of adherence to treatment. RESULTS: Auditory-perceptual assessment of the voice showed that 64.7% of the participants improved voice quality post-speech therapy. Comparison between the pre- and post-speech therapy moments showed that 82.4% of the teachers improved their voice according to self-perception. The VHI-10 showed no statistically significant difference between the pre- and post-speech therapy moments (p=0.879). Acoustic analysis of the voice showed improvement in the means of all evaluated parameters. Statistically significant correlation was observed in the analysis between the pre- and post-speech therapy moments only for the variables maximum phonation time and shimmer. Most of the teachers were at the stage of contemplation on the URICA-VOICE scale. No statistical significance was observed in the correlation analysis between VHI-10, auditory-perceptual assessment of the voice, maximum phonation time, and parameters of acoustic analysis with vocal self-perception of teachers and with auditory-perceptual assessment of voice. CONCLUSION: The use of CVRP for the treatment of behavioral dysphonia presented positive results in the pre- and post-speech therapy evaluation. As for motivation, the teachers strongly believed in the possibility of facing the problem, but still without much effort to change this situation.

OBJETIVO: analisar os efeitos do Programa Integral de Reabilitação Vocal (PIRV) e os estágios motivacionais durante a terapia de voz em professoras com disfonia comportamental. MÉTODO: estudo observacional longitudinal retrospectivo com dados de prontuários de 33 professoras referente à análise perceptivo-auditiva, acústica, autopercepção vocal e Protocolo de Índice de Desvantagem Vocal (IDV-10) nas situações pré e pós-fonoterapia e estágios motivacionais de adesão ao tratamento. RESULTADOS: Na avaliação perceptivo-auditiva da voz, 64,7% das participantes melhoraram a qualidade vocal pós-fonoterapia. Quando comparados os momentos pré e pós-fonoterapia, observou-se que 82,4% das professoras melhoraram a voz segundo a autopercepção. O IDV-10 não mostrou diferença entre os momentos pré e pós-fonoterapia (p=0,879). Na análise acústica da voz, observou-se melhora da média de todos os parâmetros avaliados. Houve associação estatisticamente significante na análise entre os momentos pré e pós-fonoterapia apenas nas variáveis tempo máximo de fonação e shimmer. A maioria das professoras encontrou-se no estágio de contemplação na escala URICA-VOZ. Não houve significância estatística na análise de associação entre o IDV-10, análise perceptivo-auditiva, tempo máximo de fonação e parâmetros da análise acústica com a autopercepção vocal das professoras e com a avaliação perceptivo-auditiva da voz. CONCLUSÃO: o uso do PIRV para tratamento de disfonias comportamentais promoveu resultados positivos quando comparada a avaliação vocal antes e após tratamento. Quanto à motivação, as professoras acreditavam com firmeza na possibilidade de enfrentar o problema, mas ainda sem muito esforço para mudar essa situação.

Intrarater and interrater agreement and reliability of vestibular evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) for HTLV-1 associated myelopathy testing.

BACKGROUND: The vestibular evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) has been used to assess the function of the vestibulospinal motor tract and is a candidate biomarker to predict and monitor the human T-cell lymphotropic virus type 1 (HTLV-1) associated myelopathy (HAM). This study determined the agreement and reliability of this exam. METHODS: Galvanic-VEMP was performed in 96 participants, of which 24 patients presented HAM, 27 HTLV-1-asymptomatic carriers, and 45 HTLV-1-negative asymptomatic controls. Galvanic vestibular stimulation was achieved by passing a binaural and bipolar current at a 2 milliamperes (mA) intensity for 400 milliseconds (ms) between the mastoid processes. Galvanic-VEMP electromyographic wave responses of short latency (SL) and medium latency (ML) were recorded from the gastrocnemius muscle. Intrarater (test-retest) and interrater (two independent examiners) agreement and reliability were assessed by standard error of measurement (SEM), coefficient of repeatability (CR), intraclass correlation coefficient (ICC), and Kappa coefficient. RESULTS: In the total sample (n = 96), SL and ML medians were 56 ms (IQR 52-66) and 120 ms (IQR 107-130), respectively. The intrarater repeatability measures for SL and ML were, respectively: SEM of 6 and 8 ms; CR of 16 and 22 ms; ICC of 0.80 (p<0.001) and 0.91 (p<0.001); and a Kappa coefficient of 0.53 (p<0.001) and 0.82 (p<0.001). The interrater reproducibility measures for SL and ML were, respectively: SEM of 3 and 10 ms; CR of 8 and 27 ms; ICC of 0.95 (p<0.001) and 0.86 (p<0.001); and a Kappa coefficient of 0.77 (p<0.001) and 0.88 (p<0.001). CONCLUSION: Galvanic-VEMP is a reliable and reproducible method to define the integrity of the vestibulospinal tract. Longitudinal studies will clarify its validity in the clinical context, aimed at achieving an early diagnosis and the monitoring of HAM.

Vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation may reveal subclinical alterations in human T-cell lymphotropic virus type 1-associated myelopathy.

BACKGROUND: Vestibular-evoked myogenic potential triggered by galvanic vestibular stimulation (galvanic-VEMP) evaluates the motor spinal cord and identifies subclinical myelopathies. We used galvanic-VEMP to compare spinal cord function in individuals infected with human T-cell lymphotropic virus type 1 (HTLV-1) from asymptomatic status to HTLV-1-associated myelopathy (HAM). METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional study with 122 individuals included 26 HTLV-1-asymptomatic carriers, 26 individuals with possible HAM, 25 individuals with HAM, and 45 HTLV-1-seronegative individuals (controls). The groups were similar regarding gender, age, and height. Galvanic stimuli (duration: 400 ms; intensity: 2 mA) were applied bilaterally to the mastoid processes and VEMP was recorded from the gastrocnemius muscle. The electromyographic parameters investigated were the latency and amplitude of the short-latency (SL) and medium-latency (ML) responses. While SL and ML amplitudes were similar between groups, SL and ML latencies were delayed in the HTLV-1 groups compared to the control group (p<0.001). Using neurological examination as the gold standard, ROC curve showed an area under the curve of 0.83 (p<0.001) for SL and 0.86 (p<0.001) for ML to detect spinal cord injury. Sensibility and specificity were, respectively, 76% and 86% for SL and 79% and 85% for ML. Galvanic-VEMP disclosed alterations that were progressive in HTLV-1-neurological disease, ranging from SL delayed latency in HTLV-1-asymptomatic carriers, SL and ML delayed latency in possible HAM group, to absence of VEMP response in HAM group. CONCLUSIONS/SIGNIFICANCE: The worse the galvanic-VEMP response, the more severe the myelopathy. Galvanic-VEMP alteration followed a pattern of alteration and may be a prognostic marker of progression from HTLV-1-asymptomatic carrier to HAM.

Analysis of voice-related quality of life in children. / Análise da qualidade de vida relacionada à voz na população infantil.

PURPOSE: To analyze the voice-related quality of life of children with dysphonia and without voice disorders in a population sample of Belo Horizonte, Minas Gerais state, Brazil. METHODS: Study participants were 420 children, 98 with dysphonia and 322 without voice disorders, aged six to 10 years, enrolled in public and private elementary schools. The random sample was divided into two groups: dysphonic children (study group - SG) and children without vocal disorders (control group - CG). Assessment of the children's voices was performed by four voice-expert speech-language pathologists with more than 10 years of experience in this field, using the auditory-perceptual parameter of overall severity of dysphonia graded in four points. The results were analyzed based on the evaluation of children's voices conducted by the speech-language pathologist that presented the highest intra-rater agreement, using the Kappa statistical method. The Pediatric Voice-related Quality-of-Life (PVRQoL) survey was answered by the children's parents/legal guardians. Descriptive statistical analysis of the data was conducted using the Student's t-Test. RESULTS: Of the 420 children evaluated, 98 were dysphonic (SG) and 322 presented no voice alteration (CG). Analysis of the three PVRQoL scores (total, physical, and social-emotional) showed no difference between the groups tested (SG and CG). No difference was observed in PVRQoL values regarding the degree of vocal deviation. CONCLUSION: Dysphonia does not have a negative impact on the voice-related quality of life of children considering the response of secondary informants.

Quilombos e a luta contra o racismo no contexto da pandemia

Este artigo tem como objeto refletir sobre a situação vivenciada no contexto atual de pandemia causada pelo novo coronavírus nas comunidades quilombolas do Brasil. Com impactos globais bastante significativos, os efeitos da pandemia têm causado danos mais acentuados em determinados grupos populacionais no Brasil? O racismo estrutural de nossa sociedade tem aprofundado sua marca de desigualdade nessa situação de pandemia? Como os quilombos estão vivenciando essa realidade? Essas são questões que buscaremos abordar neste artigo, em diálogo com as manifestações e estratégias dos quilombolas, por meios de suas organizações, para enfrentar o racismo estrutural no Brasil, no contexto da pandemia da Covid-19.

Vocal and self-perception effects of straw phonation exercises / Efeitos vocais e de autopercepção da prática da fonação em canudo

ABSTRACT Purpose: to assess the acoustic and self-perceived voice changes in women with and without voice symptoms after 1, 3, 5, and 7 minutes of straw phonation exercises. Methods: a total of 30 women aged 18 to 39 years participated in the study - 17 with and 13 without voice symptoms. The participants filled in the visual analog scale on self-perceived voice discomfort. The sustained vowel /ɛ/ was recorded in maximum phonation time before (m0) and after the first, third, fifth, and seventh minute performing straw phonation exercises. The maximum phonation time was measured, and an acoustic analysis was made, encompassing the following parameters: the number of harmonics, fundamental frequency, noise, glottal-to-noise excitation ratio (GNE), jitter, and shimmer. The Friedman and Wilcoxon tests were used to compare each parameter at the different moments, and the Mann-Whitney test, to compare the groups. The 5% significance level was set for the analyses. Results: no changes were found in either the acoustic variables or the self-perception of voice comparing the moments before and after the exercises in either group. The comparison between the groups revealed that the one with voice symptoms had lower GNE and higher noise values at the second moment performing the technique. Conclusion: the straw phonation did not cause acoustic or self-perceived voice changes in women with and without voice symptoms. The comparison between the groups showed that the women with symptoms had lower GNE and higher noise values than those without symptoms, after 1 minute performing straw phonation.

RESUMO Objetivo: avaliar as modificações acústicas e na autopercepção da voz em mulheres com e sem sintomas vocais, após um, três, cinco e sete minutos da prática de fonação em canudo. Métodos: participaram do estudo 30 mulheres, com idades entre 18 e 39 anos, das quais 17 apresentavam sintomas vocais e 13 não apresentavam sintomas vocais. As participantes preencheram a Escala Visual Analógica sobre a autopercepção de desconforto vocal. Realizou-se a gravação da vogal /ɛ/ sustentada em tempo máximo de fonação antes da prática (m0) e após o primeiro, terceiro, quinto e sétimo minutos de execução do exercício de fonação em canudo. Foi obtida a medida de tempo máximo de fonação e realizada análise acústica. Os parâmetros acústicos analisados foram: número de harmônicos, frequência fundamental, ruído, glottal-to-noise excitation ratio (GNE), Jitter e Shimmer. Foram utilizados os testes de Friedman e Wilcoxon para comparar cada parâmetro nos diferentes momentos e o Teste de Mann-Whitney para comparação entre os grupos. Considerou-se o nível de 5% de significância nas análises. Resultados: não houve modificações nas variáveis acústicas ou na autopercepção da voz quando comparados os momentos pré e pós-exercício em ambos os grupos. Nas comparações entre os grupos, observou-se que o grupo com sintomas vocais apresentou menor GNE e maior ruído no segundo momento de execução da técnica. Conclusão: a fonação em canudo não proporcionou modificações acústicas ou na autopercepção da voz de mulheres com e sem sintomas vocais. Na comparação entre os grupos, as mulheres com sintomas apresentaram menor GNE e maior ruído do que as sem sintomas, após um minuto da prática de fonação em canudo.

Efeitos vocais imediatos produzidos pelo dispositivo Shaker® em mulheres com e sem queixa vocal / Immediate vocal effects produced by the Shaker® device in women with and without vocal complaints

RESUMO Objetivo Avaliar as modificações acústicas e de autopercepção obtidas após o primeiro, terceiro, quinto e sétimo minuto de prática da técnica de oscilação oral de alta frequência sonorizada, realizada com o dispositivo Shaker®. Método Participaram do estudo 27 mulheres com idade entre 18 e 41 anos com e sem queixa vocal. A vogal sustentada /ε/ foi registrada em tempo máximo de fonação antes (pré-exercício) e após o primeiro, terceiro, quinto e o sétimo minuto de execução da técnica de oscilação oral de alta frequência sonorizada com o dispositivo Shaker®. Foi realizada a análise acústica dos seguintes parâmetros: ruído, frequência fundamental, glottal to noise excitation, Jitter, Shimmer e número de harmônicos. Resultados Não houve diferenças significativas na comparação dos parâmetros acústicos entre as participantes com e sem sintomas vocais. Observou-se melhora na autopercepção do desconforto vocal nos grupos das mulheres com e sem sintomas vocais, comparando-se o momento antes da prática com o primeiro e terceiro minutos de prática. Houve redução dos valores de Jitter, ao comparar o momento antes da prática com os momentos após um e sete minutos e ao comparar os momentos após cinco e sete minutos de exercício, no grupo de mulheres com sintomas vocais. Conclusão A técnica com o Shaker® mostrou resultados positivos, tanto em indivíduos com sintomas quanto em indivíduos sem sintomas vocais.

ABSTRACT Purpose To evaluate the acoustic and self-perception modifications obtained after the first, third, fifth and seventh minutes of voice oral high-frequency oscillation practice accomplished with the Shaker® device. Methodology Twenty-seven women aged between 18 and 41 years with and without vocal complaint participated in the study. The sustained vowel / ε / was recorded at maximum phonation time before (pre-exercise) and after the first, third, fifth and seventh minutes of voice oral high-frequency oscillation practice accomplished with Shaker®. The acoustic analysis of the following parameters was performed: noise, fundamental frequency, glottal to noise excitation, Jitter, Shimmer and number of harmonics. Results There were no significant differences in the comparison of the acoustic parameters between the participants with and without vocal symptoms. It was observed an improvement in the self-perception of vocal discomfort in the groups of women with and without vocal symptoms, comparing the moment before the practice with the first and third minutes of practice. There was a reduction in Jitter values when comparing the time before practice with the moments after one and seven minutes and when comparing the moments after five and seven minutes of exercise in the group of women with vocal symptoms. Conclusion The Shaker® technique showed positive results both in individuals with symptoms and in individuals without vocal symptoms.

Efeito do programa integral de reabilitação vocal em professoras com disfonia comportamental / Effect of the comprehensive voice rehabilitation program in teachers with behavioral dysphonia

RESUMO Objetivo analisar os efeitos do Programa Integral de Reabilitação Vocal (PIRV) e os estágios motivacionais durante a terapia de voz em professoras com disfonia comportamental. Método estudo observacional longitudinal retrospectivo com dados de prontuários de 33 professoras referente à análise perceptivo-auditiva, acústica, autopercepção vocal e Protocolo de Índice de Desvantagem Vocal (IDV-10) nas situações pré e pós-fonoterapia e estágios motivacionais de adesão ao tratamento. Resultados Na avaliação perceptivo-auditiva da voz, 64,7% das participantes melhoraram a qualidade vocal pós-fonoterapia. Quando comparados os momentos pré e pós-fonoterapia, observou-se que 82,4% das professoras melhoraram a voz segundo a autopercepção. O IDV-10 não mostrou diferença entre os momentos pré e pós-fonoterapia (p=0,879). Na análise acústica da voz, observou-se melhora da média de todos os parâmetros avaliados. Houve associação estatisticamente significante na análise entre os momentos pré e pós-fonoterapia apenas nas variáveis tempo máximo de fonação e shimmer. A maioria das professoras encontrou-se no estágio de contemplação na escala URICA-VOZ. Não houve significância estatística na análise de associação entre o IDV-10, análise perceptivo-auditiva, tempo máximo de fonação e parâmetros da análise acústica com a autopercepção vocal das professoras e com a avaliação perceptivo-auditiva da voz. Conclusão o uso do PIRV para tratamento de disfonias comportamentais promoveu resultados positivos quando comparada a avaliação vocal antes e após tratamento. Quanto à motivação, as professoras acreditavam com firmeza na possibilidade de enfrentar o problema, mas ainda sem muito esforço para mudar essa situação.

ABSTRACT Purpose Analyze the effects of the Comprehensive Vocal Rehabilitation Program (CVRP) and the motivational stages during speech therapy in teachers with behavioral dysphonia. Methods Retrospective, longitudinal, observational study using data from the medical records of 33 teachers regarding auditory-perceptual, acoustic, self-perception analyses and the Voice Handicap Index (VHI-10) protocol in pre- and post-speech therapy situations, and motivational stages of adherence to treatment. Results Auditory-perceptual assessment of the voice showed that 64.7% of the participants improved voice quality post-speech therapy. Comparison between the pre- and post-speech therapy moments showed that 82.4% of the teachers improved their voice according to self-perception. The VHI-10 showed no statistically significant difference between the pre- and post-speech therapy moments (p=0.879). Acoustic analysis of the voice showed improvement in the means of all evaluated parameters. Statistically significant correlation was observed in the analysis between the pre- and post-speech therapy moments only for the variables maximum phonation time and shimmer. Most of the teachers were at the stage of contemplation on the URICA-VOICE scale. No statistical significance was observed in the correlation analysis between VHI-10, auditory-perceptual assessment of the voice, maximum phonation time, and parameters of acoustic analysis with vocal self-perception of teachers and with auditory-perceptual assessment of voice. Conclusion The use of CVRP for the treatment of behavioral dysphonia presented positive results in the pre- and post-speech therapy evaluation. As for motivation, the teachers strongly believed in the possibility of facing the problem, but still without much effort to change this situation.

Análise vocal na infância: uma revisão integrativa / Vocal analysis in children: an integrative review / Análisis Vocal en la infancia: una revisión integradora

Objetivo: realizar uma revisão integrativa de literatura sobre as características de vozes normais e disfônicas e a prevalência de lesões nas pregas vocais em crianças. Métodos: trata-se de uma revisão integrativa da literatura. Foi realizado o levantamento dos artigos científicos por meio das bases de dados Medline, LILACS, IBECS, PubMed e ISI Web of Science. Na busca dos artigos foram utilizados os descritores "Distúrbios da Voz", "Disfonia", "Rouquidão", "Qualidade da Voz", "Acústica da Fala", "Voz", "Fonação", "Pregas Vocais", "Pediatria", "Criança", "Pré-Escolar". Para a análise dos dados, as informações coletadas foram organizadas de maneira concisa em um banco de dados, realizado de forma descritiva, considerando as informações referentes à amostra, objetivos, metodologia e resultados principais, e organizadas por similaridade de conteúdo. Resultados: foram identificados 770 artigos, dos quais 36 estavam diretamente relacionados ao objetivo da revisão e foram analisados. Conclusões: a qualidade vocal das crianças sem alterações vocais é caracterizada por valores de frequência fundamental que decrescem com o aumento da idade e com diferenças em relação ao sexo. O tempo máximo de fonação aumenta com a idade. Em crianças disfônicas a qualidade vocal é soprosa e rugosa, com grau de alteração de leve a moderado; as medidas acústicas da voz, os valores de tempo máximo de fonação estão alterados; frequência fundamental é reduzida ou os valores de frequência fundamental observados em crianças com alteração foram mais baixos do que os valores da normalidade. A lesão de prega vocal mais prevalente até seis anos de idade é o cisto e, após esta idade, é o nódulo vocal.

Objective: to perform an integrative literature review about the characteristics of normal and dysphonic voices and the prevalence of vocal cords lesions in children. Methods: it is a literature integrative review. The survey of scientific articles was carried out through data bases Medline, LILACS, IBECS (through the VHL Search Portal), PubMed and ISI Web of Science. In the search of the articles were used the descriptors "Voice Disorders", "Dysphonia", "Hoarseness", "Voice Quality", "Speech Acoustics", "Voice", "Phonation", "Vocal Cords", "Pediatrics", "Child", "Child Preschool". For the analysis of the data, the information collected was organized in a concise manner in a database, being performed in a descriptive way, considering the information about the sample, objectives, methodology and main results, and organized by content similarity. Results: 770 articles were identified, of which 36 were directly related to objective of the review and were analyzed. Conclusions: the vocal quality of children without vocal changes is characterized by fundamental frequency values that decrease with increase of age and with differences in relation to gender. The maximum phonation time increases with age. In dysphonic children the vocal quality is blow and rough, with a grade of alteration from mild to moderate; the acoustic measures of the voice, the maximum phonation time values are altered; the fundamental frequency is severe. The cyst is vocal cords lesion most prevalent up to six years age, and after this age is the vocal nodule.

Objetivo: Realizar una revisión integradora de la literatura sobre las características de vozes normales y disfonicas y la prevalencia de lesiones de las cuerdas vocales en niños. Métodos: se realizó una investigación integrativa de la literatura a través de articulos cientificos enontrados en las bases de datos Medline, LILACS IBECS, PubMed y ISI Web of Science. En busca de artículos se utilizaron los descriptores "Trastornos de la Voz", "Disfonía", "Ronquera", "Calidad de la Voz", "Acústica del Habla", "Voz", "Fonación", "Pliegues Vocales", "Pediatría", "Niño", "Preescolar". Para el análisis de datos, la información recogida se organizó de manera concisa en una base de datos realizada de una manera descriptiva, teniendo en cuenta la información sobre la muestra, objetivos, metodología y resultados principales, organizados por la similitud del contenido. Resultados: fueron identificados 770 artículos de los cuales 36 estaban directamente relacionadas con el objetivo de la revisión y fueron analizados. Conclusiones: La calidad vocal de los niños sin trastornos vocales se caracteriza por la disminución de la frecuencia vocal fundamental con el aumento de la edad y con diferencias en relación al sexo. El tiempo máximo de fonación aumenta con la edad. Los niños con disfonía tienen una calidad de voz susurrante y rugosa, con un grado de alteración de leve a moderada; las medidas acústicas de la voz, y los valores de tiempo máximo de fonación están alterados. La frecuencia fundamental es reduzida o los valores de frecuencia fundamental obsevados en niños com alteración, fueron mas bajos que los valores de normalidad. La lesión de pliega vocal más prevalente hasta seis años de edad es el quiste. Después de esta edad son los nódulos vocales.

Tempo ideal de vibração sonorizada de língua em crianças disfônicas / Ideal time of sonorous tongue vibration of dysphonic children / Tiempo ideal de la vibración sonora del lengua en niños disfónicas

Objetivo: verificar o tempo ideal do exercício de vibração sonorizada de língua (EVSL) na voz de crianças disfônicas. Método: participaram vinte e sete crianças, entre 04 e 11 anos, com diagnóstico de nódulo ou cisto de pregas vocais. Dessas crianças, onze fizeram parte do grupo experimental (GE) e 16 do grupo controle (GC). A vogal sustentada /ε/ e a contagem de 1 a 10 foram registradas antes (m0) e após o primeiro (m1), terceiro (m3), quinto (m5) e o sétimo (m7) minuto de execução do EVSL. As gravações foram apresentadas a três fonoaudiólogas, que julgaram se houve modificação da qualidade vocal. Os parâmetros acústicos avaliados na vogal sustentada foram frequência fundamental, jitter, shimmer, glotal to noise excitation (GNE) e ruído. Resultados: na avaliação perceptivo-auditiva, não houve modificações significativas entre os momentos de execução do EVSL. Na análise acústica, observou-se que o parâmetro ruído diminuiu e o parâmetro GNE aumentou após três minutos de realização do exercício no GE, em comparação com o GC. Conclusão: não houve melhora em nenhum dos tempos na avaliação perceptivoauditiva da voz de crianças disfônicas com o EVSL. A análise acústica indicou melhora da qualidade vocal aos três minutos de execução do exercício.

Purpose: verify the ideal time of the sonorous tongue vibration exercise (STVE) in the voice of dysphonic children. Method: participated twenty-seven children, from four to 11 years, diagnosed with nodules or cysts of vocal folds. Eleven children were part of the experimental group (GE) and 16 were part of the control group (GC). A sustained vowel /ε/ and count one to 10 were recorded before (m0) and after the first (m1), third (m3), fifth (m5) and the seventh (m7) minute of execution of the STVE. The recordings have been presented to three speech therapists that judged whether there was change in voice quality. The acoustic parameters evaluated in sustained vowel were fundamental frequency, jitter, shimmer, glottal to noise excitation (GNE) and noise. Results: there were no significant changes in the auditory perception evaluation between the moments of STVE execution. In the acoustic analysis, it was observed that the noise parameter decreased and the GNE parameter increased after three minutes of performing the exercise in GE, compared to the GC. Conclusion: there was no improvement in any of the times in the auditory perceptual analysis in the voice of dysphonic children with the STVE. The acoustic analysis indicated improvement in vocal quality in the third minute of exercise performance.

Objetivo: comprobar el momento ideal del ejercicio de vibración sonora del lengua (EVSL) en la voz de niños disfónicas. Método: participado veinte y siete niños, de 04 a 11 años, con diagnóstico de nódulos o quistes de los pliegues vocales. De estos niños, once eran parte del grupo experimental (GE) y 16 parte del grupo de control (GE). El sostenido vocal /ε/ y el recuento de 1 a 10 se registraron antes (m0) y después de la primero (m1), tercero (m3), quinto (m5) y séptimo (m7) minuto del ejecución de EVSL. Las grabaciones se presentaron a tres logopedas, que juzgaron si había modificación de la calidad vocal. Los parámetros acústicos evaluado en vocal sostenida fueron frecuencia fundamental, jitter, shimmer, glotal to noise excitation (GNE) y ruido. Resultado: en la evaluación perceptual, no hubo modificaciones significativos entre los momentos de ejecución de EVSL. En el análisis acústico, se observó que el parámetro de ruido disminuye y parámetro GNE aumentó después de tres minutos de ejecución del ejercicio en GE, en comparación con el GC. Conclusión: no hubo mejoría en cualquier de las tiempos en la evaluación perceptual de la voz de los niños disfónicas con EVSL. El análisis acústico indica mejoría en la calidad de la voz después de tres minutos de ejecución del ejercicio.

Análise da qualidade de vida relacionada à voz na população infantil / Analysis of voice-related quality of life in children

RESUMO Objetivo analisar o impacto na qualidade de vida relacionado à voz de crianças disfônicas e sem alteração vocal, com uma amostra populacional da grande Belo Horizonte – Minas Gerais. Método participaram do estudo 420 indivíduos na faixa etária de seis a 10 anos de idade, cursando o ensino fundamental nas escolas públicas e privadas da cidade. A amostragem foi aleatória, e as crianças, divididas em dois grupos: disfônicas (GD) e sem alteração vocal (G0). A avaliação das vozes das crianças foi realizada por quatro fonoaudiólogas especialistas em voz e com experiência de mais de 10 anos nesta análise, utilizando o parâmetro perceptivo-auditivo de grau geral de disfonia, graduado em quatro pontos. Foi considerada, para a análise dos resultados, a avaliação das vozes das crianças realizada pela fonoaudióloga que apresentou maior concordância intra-avaliador, analisada pela estatística Kappa. O protocolo Qualidade de Vida em Voz Pediátrico (QVV-P) foi respondido pelos responsáveis das crianças. Para análise inferencial, foi realizada a análise descritiva dos dados e utilizado o Teste-T de Student. Resultados das crianças avaliadas, 98 eram disfônicas (GD) e 322 não tinham alteração vocal (G0). A análise dos três Escores do QVV-P não apresentou diferença para os grupos testados (GD e G0). Também não foi observada diferença nos valores do QVV-P, considerando-se o grau de desvio vocal. Conclusão crianças disfônicas não apresentam impacto negativo na qualidade de vida relacionada à voz, considerando-se a resposta do informante secundário.

ABSTRACT Purpose To analyze the voice-related quality of life of children with dysphonia and without voice disorders in a population sample of Belo Horizonte, Minas Gerais state, Brazil. Methods Study participants were 420 children, 98 with dysphonia and 322 without voice disorders, aged six to 10 years, enrolled in public and private elementary schools. The random sample was divided into two groups: dysphonic children (study group - SG) and children without vocal disorders (control group - CG). Assessment of the children's voices was performed by four voice-expert speech-language pathologists with more than 10 years of experience in this field, using the auditory-perceptual parameter of overall severity of dysphonia graded in four points. The results were analyzed based on the evaluation of children’s voices conducted by the speech-language pathologist that presented the highest intra-rater agreement, using the Kappa statistical method. The Pediatric Voice-related Quality-of-Life (PVRQoL) survey was answered by the children’s parents/legal guardians. Descriptive statistical analysis of the data was conducted using the Student’s t-Test. Results Of the 420 children evaluated, 98 were dysphonic (SG) and 322 presented no voice alteration (CG). Analysis of the three PVRQoL scores (total, physical, and social-emotional) showed no difference between the groups tested (SG and CG). No difference was observed in PVRQoL values regarding the degree of vocal deviation. Conclusion Dysphonia does not have a negative impact on the voice-related quality of life of children considering the response of secondary informants.

Adesão e satisfação de professores participantes do Programa Integral de Reabilitação Vocal / Adherence and satisfaction of teachers participants of the Comprehensive Vocal Rehabilitation Program / Adherencia y satisfacción de maestros participantes del Programa Integral de Rehabilitación Vocal

Objetivo: analisar a adesão e a satisfação de professores participantes de um Programa Integral de Reabilitação Vocal ­ PIRV. Método: estudo realizado com prontuários de 31 professores da rede municipal de ensino de Belo Horizonte - MG, atendidos em um projeto de extensão universitária. Foram analisadas as variáveis: idade, sexo, tempo de profissão, ciclo de ensino, turnos de trabalho, número de vezes em que os exercícios foram realizados em casa, frequência de participação dos professores e opinião/satisfação sobre o PIRV. Foi realizada a análise descritiva dos dados e medidas de associação entre as variáveis utilizando o teste Qui-Quadrado de Pearson ou Exato de Fisher. Resultados: observou-se um número reduzido de média de faltas (0,37) durante o período de execução do PIRV. Quanto à opinião dada pelos participantes, a maioria foi excelente (74,19%). Nenhum professor executou em casa a quantidade de exercícios recomendados pelo treinamento (84 repetições). 48,4% dos participantes realizaram os exercícios entre 41 a 69 repetições no total. Não houve significância estatística na análise da associação entre as variáveis utilizadas no estudo e o número de exercícios realizados em casa. Conclusão: os professores apresentaram boa adesão ao PIRV quanto à presença nas sessões e dificuldade na realização dos exercícios em casa conforme a recomendação. Quanto à opinião dos participantes, observou-se satisfação em relação ao programa.

Objective: to analyze adherence and satisfaction of teachers participating in a Comprehensive Vocal Rehabilitation Program - PIRV. Methods: study carried out with medical records of 31 teachers of the municipal schools of Belo Horizonte - MG, attending in a university extension project. Were analyzed the variables: age, sex, profession time, education cycle, work shifts, number of times the exercises were performed at home, frequency of teacher's participation in the program and opinion/satisfaction about the PIRV. A descriptive analysis of the data and association measures between variables was made using Chi-Square Test or Fisher's Exact Test. Results: small number of lacks (0,37) was observed during the program execution period of the PIRV. The most given opinions by the participants were excellent (74,19%). None teacher trained at home the amount of training recommended (84 repetitions). 48.4% of the participants performed the exercises between 41 to 69 repetitions in total. There was no statistical significance in the analysis of association between the variables used in the study and the total number of exercises performed at home. Conclusion: the teachers presented good adherence to the PIRV regarding the presence in the sessions and difficulty in accomplish the exercises at home, according to the recommendation. As for the opinion of the participants, there was satisfaction with the program.

Objetivo: analizar la adherencia y satisfaccíon de los maestros participantes de un Programa Integral de Rehabilitacíon Vocal ­ PIRV. Método: estudio realizado con prontuarios de 31 maestros del sistema escolar municipal de enzeãnza de Belo Horizonte - MG, que asisten a un proyecto de extensión universitaria. Fueron analizadas las variables: edad, sexo, tiempo de ocupación, ciclo de enseñanza, turnos de trabajo, número de veces que se realizó los ejercicios en casa, frecuencia de participación de los maestros y opinión/satisfacción sobre el PIRV. Se realizó un análisis descriptivo de los datos y medidas de asociación entre las variables utilizando la prueba de Chi-Cuadrado de Pearson o Exacto de Fisher. Resultado: Fue comprobado que había un pequeño número promedio de fallos (0,37) durante el período de ejecución del PIRV. Sobre la opinión dada por los participantes, la mayoría fue excelente (74,19%). Ningún maestro entreno en casa la cantidad de exercicios recomendada (84 repeticiones). El 48,4% de los participantes realizo los ejercicios entre 41 a 69 repeticiones en total. No hubo significación estadística en el análisis de la asociación entre las variables utilizadas en el estudio y el número de ejercicios realizados en casa. Conclusión: los maestros mostraron una buena adherencia a PIRV en cuanto a la presencia en las sesiones y dificultad en la realización de los ejercicios en casa, de acuerdo con la recomendación. Cuanto a la opinión de los participantes, se obsevo satisfacción con el programa.

Apoio visual do traçado espectrográfico: impacto na confiabilidade da análise perceptivo-auditiva da voz por avaliadores inexperientes / Spectrographic trace visual support: impact on reliability analysis of auditory-perceptualvoice by inexperienced evaluators / Apoyo visual del trazado espectrográfico: impacto en la fiabilidad del análisis audioperceptivo de la voz por evaluadores inexpertos

Introdução: são vários os recursos que podem ser utilizados para expressão do pensamento, dentre eles o desenho, que mediado e organizado pela linguagem, torna-se um instrumento de grande valia para análise da autopercepção vocal. Objetivo: analisar a autopercepção vocal de crianças disfônicas a partir de desenhos. Material e Método: trata-se de um relato de caso clínico, com análise microgenética de desenhos elaborados por três crianças, com faixa etária entre 8 a 9 anos e diagnóstico de disfonia. Resultados: para análise dos desenhos foram usadas duas categorias: o modo de grafia utilizado para elaboração do desenho e a significação da produção gráfica em relação à autopercepção vocal. Quanto ao modo de grafia, todos os sujeitos utilizaram caneta, não havendo variação de cores durante a elaboração. Em relação à autopercepção vocal, os parâmetros expostos foram os hábitos vocais, loudness e qualidade vocal. Conclusões: os desenhos se mostraram como recursos eficazes para a representação dos pensamentos, ainda que na criança o conteúdo psíquico esteja em formação. Nesse sentido, a representação gráfica pode ser utilizada como um instrumento de análise da autopercepção vocal infantil.

Introduction: there are several resources that can be used to express thoughts, including the design, which mediated and organized by language, becomes a valuable tool for analysis of vocal perception. Objective: To analyze the vocal self-perception of dysphonic children from drawings. Material and Method: This is a case report, with analysis of microgenetic designs prepared by three children, aged 8-9 years old diagnosed with dysphonia. Results: Analyses of the drawings were categorized into two: the spelling mode used for the preparation of the design and the significance of graphic production in relation to vocal self-perception. As for the spelling mode all subjects used for designing a pen, with no color variation during development. Regarding the exposed self perception vocalparameters were vocal habits, loudness and voice quality. Conclusions: The designs proved to be effective for the representation of thought resources, even though the child?s psychic content is in training. In this sense, the graphical representation can be used as a tool to analyze children?s vocal self perception.

Introducción: existen varios recursos que pueden ser usados para expresar pensamientos, incluyendo el diseño, que mediado y organizado por el lenguaje, se convierte en una valiosa herramienta para el análisis de la autopercepción vocal. Objetivo: Analizar la autopercepción vocal de los niños disfónicos por medio de dibujos. Material y Método: Se trata de un reporte de caso clínico, con análisis microgenéticos de dibujos desarrollados por tres niños con edades entre los 8 y 9 años, con diagnóstico de disfonía. Resultados: Para el análisis de los dibujosseusaron dos categorías: el modográfico utilizado para la preparación del diseño y la significación de la producción gráfica en relación con la autopercepción vocal. En cuanto al modográfico todos los sujetos utilizan la pluma, sin variación de color durante el desarrollo. En cuanto a la auto percepción vocal los parámetros expuestosfueron: hábitos vocales, loudness y calidad de voz. Conclusiones: Los diseños demostraron ser recursoseficaces para la representación de los pensamientos, a pesar de que el contenido psíquico del niño está en formación. En este sentido,la representación gráfica se puede utilizar como una herramienta para analizar la autopercepción vocal de niños.

Apoio visual do traçado espectrográfico: impacto na confiabilidade da análiseperceptivo-auditiva da voz por avaliadores inexperientes / Spectrographic trace visual support: impact on reliability analysis of auditory-perceptualvoice by inexperienced evaluators / Apoyo visual del trazado espectrográfico: impacto en la fiabilidad del análisis audioperceptivo de la voz por evaluadores inexpertos

Introdução: avaliação clínica é uma ferramenta eficaz para a análise de alterações vocais, devido ao fato de que podemos descrever o perfil vocal de um indivíduo e identificar os fatores que desencadeiam e mantêm a disfonia. Os tipos de avaliação que são mais usados na terapia fonoaudiológica são a análise perceptivo-auditiva e acústica da voz. Objetivo: verificar se a apresentação simultânea de vozes e traçadoespectrográfico melhora a confiabilidade da análise perceptivo-auditiva da instabilidade (I) e o grau geral de desvio vocal (G) parâmetros realizados por avaliadores inexperientes. Material e Métodos: Este foi um estudo longitudinal no qual 14 estudantes de Fonoaudiologia avaliaram de forma perceptivo-auditiva, em dois momentos diferentes, 48 amostras vocais com e sem apoio visual de rastreamento espectrográfico. A fim de analisar a concordância inter e intra-avaliadores, vinte por cento das vozes foram repetidas aleatoriamente em dois estágios. Na análise das concordâncias, foi utilizado o índice Kappa estatística. Resultados: houve diferenças entre as avaliações perceptivo-auditivasinter e intra-avaliadores com e sem apoio visual de traçado espectrográfico do parâmetro da instabilidade (I). Em relação ao parâmetro de grau geral de desvio vocal (G), houve diferença estatística entre as avaliações perceptivo-auditivas apenas na concordância intra-avaliador. Conclusão: o apoio visual do traçado espectrográfico aumenta a confiabilidade da avaliação perceptivo-auditiva da voz.(AU)

Introduction: clinical assessment is an effective tool for voice disorders analysis, due to it we can describe the vocal profile of an individual and identify the factors that trigger and maintain dysphonia. The types of evaluation that are used the most in speech therapy are the auditory-perceptual and acoustic analysis of voice. Objective: To verify if the simultaneous presentation of voices and spectrographic trace improves the reliability of auditory-perceptual analysis of the instability (I) and the general degree of vocal deviation (G) parameters carried out by inexperienced evaluators. Material and Methodology: This was a longitudinal study in which 14 Speech-Language Pathology undergraduate students evaluated in an auditory-perceptual form, at two different moments, 48 vocal samples with and without visual support of spectrographic trace. In order to analyze the inter- and intra-raters concordance, twenty percent of the voices were repeated randomly in two stages. In the analysis of the concordances, the Kappa statistical index was used. Results: there were differences between the inter- and intra-raters auditory-perceptual evaluations with and without visual support of spectrographic trace of the parameter instability (I). In relation togeneral degree of vocal deviation (G) parameter, there was statistical difference between the auditory-perceptual evaluations only in intra-rater agreement. Conclusion: the visual support of spectrographic trace increases the reliability of the auditory-perceptual evaluation of voice.(AU)

Introducción: la evaluación fonoaudiológica es un instrumento eficaz para el análisis de trastornos vocales, puesto que permite elaborar el perfil vocal del individuo e identificar los factores desencadenantes que instalan y mantener la disfonía. Los dos tipos de evaluación frecuentemente utilizados en clínicas de fonoaudiología son el análisis audio-perceptivo y análisis acústico de la voz. Objetivo: verificar si la presentación simultánea de las voces, asociada al apoyo del trazado espectrográfico, aumenta la fiabilidad del análisis audio-perceptivo de los parámetros de inestabilidad (I) y del grado global de desviación vocal (G) realizada por evaluadores inexpertos. Material y método: Se trata de un estudio longitudinal ejecutado por 14 estudiantes del Licenciatura en Fonoaudiología. Elanálisis se realiza en dos diferentes etapas por medio de la evaluación audio-perceptiva de 48 muestras vocales con y sin el apoyo visual del espectrógrafo. Con el propósito de analizar las correlaciones inter e entra- evaluadores, el veinte por ciento de las voces fueron repetidas aleatoriamente en las dos etapas antes mencionadas. Para el análisis de las correlaciones se utilizó el índice estadístico Kappa. Resultados: Se ha observado diferencia entre las evaluaciones audio-perceptivas inter e entra-evaluadores con y sin el apoyo visual de la espectrografía en el parámetro inestabilidad (I). En el parámetro grado global de desviación vocal (G), se ha encontrado diferencia estadística apenas entre las evaluaciones audio-perceptivas en la correlación entra-evaluadores. Conclusión: el apoyo visual del trazado espectrográfico aumenta significativamente la fiabilidad de la evaluación audio-perceptiva de la voz.(AU)