[The Evaluation of Voice Quality via Signal Typing in Voice using Narrowband Spectrograms]. / Spektrografische Stimmtypenklassifizierung zur Beurteilung der Stimmqualität.

OBJECTIVE: Traditionally, voice quality is evaluated by auditory-perceptual judgment but objective-acoustic analyses are also valid tools. Spectrography is a part of objective-acoustic analyses and is used since around 50 years. Recently, Sprecher et al. (2010) designed a new classification scheme for signal typing in voice using narrowband spectrograms. The present study aimed to explore the external validation between these 2 methods in a larger dataset. MATERIALS AND METHODS: In total 300 voice samples were used based on the vowel [a:], in which n=270 had various degrees of dysphonia and n=30 were vocally normal. All voice samples were evaluated by 7 speech-language therapists using the RBH-scale and 2 judges analyzed the signal typing in voice using narrowband spectrograms. RESULTS: The intra- and inter-rater reliability of all RBH parameters was fair in average (kappa=0.234-0.383) but the rater reliability was moderate between the 2 judges rating signal typing in voice (kappa=0.457). A strong concurrent validity was identified between the signal typing in voice using narrowband spectrograms and auditory-perceptual judgment of hoarseness and breathiness (H: r=0.746, p=0.000; B: r=0.746, p=0.000) but only fair in roughness (r=0.370, p=0.000). CONCLUSION: The present results confirmed the results of Sprecher et al. (2010) and it might be meaningful to benefit signal typing in voice using narrowband spectrograms on sustained vowels as a valid complement in the evaluation of hoarseness and breathiness for clinical utility and research.

[Development of a questionnaire for the assessment of the voice self-concept]. / Entwicklung eines Fragebogens zur Erfassung des stimmlichen Selbstkonzepts.

BACKGROUND: Common self-assessment questionnaires on voice diagnostics focus mostly on functionality of the voice and the impact on the quality of life. Personal aspects such as the relationship with one's own voice and its self-perception are for the most part not taken into consideration. OBJECTIVES: In this article a questionnaire for the assessment of the voice self-concept (Fragebogen zur Erfassung des stimmlichen Selbstkonzepts, FESS) is introduced. MATERIALS AND METHODS: Reliability and validity were tested with a sample of 308 student teachers. For external validity, the scales were correlated with standardized questionnaires of vocal, physical, and mental health. The scale reliability was also retested in 94 participants. RESULTS: The principal component analysis confirmed the internal consistency of three subscales on the relationship with one's own voice, the awareness of the use of one's own voice, and the perception of the connection between voice and emotional changes. CONCLUSION: The FESS questionnaire was shown to be a reliable and valid instrument which supplements existing voice questionnaires by self-related aspects of the voice.

[How to render an expert opinion on dysphonia]. / Begutachtung der Stimmfunktionsstörung.

In Germany, parameters for medicolegal evaluation of dysphonia have to be revised against the background of communication disorders getting more important in a modern communication society. In this work, up-to-date diagnostic tools are reviewed and evaluated for medicolegal purposes. Parametrization is -performed according to the International Classification of Functioning, Disability and Health ICF. Following this schema, -dysphonia is graded as follows: 1) No dysphonia (no problem, percentile 0-4) impairment of the whole person 0%, 2) Slight, strain-induced dysphonia (slight problem, percentile 5-24) -impairment of the whole person 0-10%, 3) Moderate dysphonia (moderate problem, percentile 25-49) impairment of the whole person 20-30%, 4) Severe dysphonia (severe problem, percentile 50-95) impairment of the whole person 40-50%, 5) Complete loss of voice (extreme problem, percentile 96-100%) impairment of the whole person 50%.

[The Acoustic Voice Quality Index. Toward expanded measurement of dysphonia severity in German subjects]. / Der Acoustic Voice Quality Index in Deutsch. Ein Messverfahren zur allgemeinen Stimmqualität.

BACKGROUND: The purpose of this study was first to explore the cross-linguistic robustness of the Acoustic Voice Quality Index (i.e., AVQI) when administered to German continuous speech segments instead of Dutch sentences. The second aim was to define a normative AVQI threshold for distinguishing between normophonia and dysphonia in German speakers. METHODS: Sixty-one German subjects with diverse voice disorders were asked to sustain the vowel [a] and to read aloud a common text. A 3-s mid-vowel segment and the first two sentences of the text "The northwind and the sun" were edited, concatenated and analyzed according to methods described elsewhere. The voice recordings from all 61 participants were (1) auditory-perceptually rated with 'H' from the RBH system by five experienced clinicians and (2) acoustically analyzed to yield the AVQI scores. RESULTS: First, a reasonable correlation was found between the AVQI and H (i.e., r(s) = 0.79). Second, the AVQI revealed an acceptable diagnostic differentiation between normal and dysphonic voices (i.e., AUC = 0.888). These results on German material accord with the results from previous studies on Dutch material. Furthermore, in the German version, the AVQI's cutoff score of 2.70 is accompanied by sensitivity = 79% and specificity = 92%. This indicates minimal normative deviation from the AVQI's cutoff score of 2.95 in Dutch. CONCLUSION: The present and the previous studies yielded almost identical results, denoting the AVQI's cross-linguistic robustness and its feasibility to clinically measure voice quality in German.

Clinical value of acoustic voice measures: a retrospective study.

Within this study a retrospective analysis of clinical voice perturbation measures, Dysphonia Severity Index and subjective perceived hoarseness was performed to determine their value under clinical aspects. The study included the data of 580 healthy and 1,700 pathologic voices, which were investigated under the following aspects. The relevant parameters were identified and their interrelation determined. Group differences between healthy and pathologic voices were figured out and investigated if voice quality measures allowed an automatic diagnosis of voice disorders. The analysis revealed significant changes between the clinical groups, which indicate the diagnostic relevance of voice quality measures. However, an individual diagnosis of the underlying voice disorder failed due to a vast spread of the parameter values within the respective groups. Classification accuracies of 75-90% were achieved. The high misclassification rate of up to 25% implied that in voice disorder diagnosis, the individual interpretation of the parameter values has to be done carefully.

Additional Injection Laryngoplasty for Patients With Unilateral Vocal Fold Paralysis.

OBJECTIVES: In case of insufficient voice improvement after injection laryngoplasty (IL), additional IL will be one of the next option of treatments. However, little is known about the voice outcomes regarding an additional IL. STUDY DESIGN: Retrospective comparative study in single institution. METHODS: We enrolled the patients of unilateral vocal fold paralysis (UVFP), who received IL (N = 76) twice because of insufficient voice improvement. The etiologies of UVFP were related with thoracic and esophageal surgery (51.3%), neck surgery (30.3%), skull base surgery (7.9%), or unknown (10.5%). The subjective and objective voice parameters were collected before and after (mean: 5.3 months) each IL. RESULTS: Aspiration, maximum phonation time (MPT), jitter percentage, shimmer percentage, and noise to harmonic ratio (NHR) were significantly improved after both the first and second rounds of IL (P < .05). Voice handicap index (VHI)-30 was also significantly improved after both the first and second rounds of IL (P < .001). Regarding GRBAS score, overall grade of dysphonia (G), roughness (R), and breathiness (B) were significantly improved after the first IL, but only G and R after the second IL (P < .05). In comparison between postprocedural voice parameters of the first and second ILs, MPT was significantly improved from 5.5 ± 3.5 seconds to 7.3 ± 7.5 seconds (P = .001). Grade of dysphonia (1.9 ± 0.8) and breathiness (1.7 ± 0.9) of post-first IL were significantly (P < .001) improved to those of post-second IL (1.3 ± 0.7 and 1.2 ± 0.7, respectively). VHI-30 of post-first IL (72.0 ± 20) was significantly improved (P < .001) to those of the second IL (57.2 ± 23.7). CONCLUSIONS: In selected patients, additional IL could provide further improvement of voice in patient who had unsatisfactory voice results despite of initial IL. LEVEL OF EVIDENCE: 4 Laryngoscope, 2020.

Diagnostic Accuracy of Dysphonia Classification of DSI and AVQI.

OBJECTIVE: The Dysphonia Severity Index (DSI) and the Acoustic Voice Quality Index (AVQI) have been successfully investigated to quantify voice quality. The aim of the present study was to evaluate the diagnostic accuracy of both measurements in comparison with the dysphonia classification. METHODS: In total, 264 subjects with vocally healthy voices (n = 105) and with various voice disorders (n = 159) were included in the study. To determine the dysphonia classification, all subjects underwent a videolaryngostroboscopy and, if necessary, a direct microlaryngoscopy plus a clinical examination to diagnose a voice disorder. Patients with a vocally healthy voice had no actual voice complaints, no history of chronic laryngeal diseases or voice disorders, no hearing problems and were determined as healthy voices by clinical voice specialists. To evaluate the diagnostic accuracy, receiver operating characteristic statistics and correct classification rate (CCR) were used. RESULTS: The diagnostic accuracy of DSI and AVQI showed strong sensitivity and specificity in the determination of dysphonia classification. A DSI threshold of 3.05 obtained a high sensitivity of 94.3% and specificity of 84.3%. An CCR of 88% was determined for DSI. Also, an AVQI threshold of 3.31 showed reasonable sensitivity of 71.7% and specificity of 88%. The CCR for AVQI was 79%. CONCLUSION: Although DSI and AVQI were developed to quantify voice quality, the present results showed that both measurements can evaluate the dysphonia classification as well. Particularly, the DSI might have higher potential in the evaluation of dysphonia classification. LEVEL OF EVIDENCE: 2C Laryngoscope, 129:692-698, 2019.

Voice outcome after unilateral ELS type III or bilateral type II resections for T1-T2 glottic carcinoma: Results after 1 year.

BACKGROUND: Voice outcome was assessed in patients with extended T1 and limited T2 glottic carcinoma, treated with a unilateral type III or a bilateral type II resection according to the European Laryngological Society (ELS) classification. METHODS: Objective evaluation (acoustic and aerodynamic parameters), perceptual evaluation (GRBAS), and patients' self-assessment (voice handicap index [VHI]) were performed before and 1 year after treatment. Results were evaluated according to ELS resection type and the involvement of the anterior commissure. RESULTS: The majority of voice parameters in all resection subgroups showed an improvement of the mean score 1 year postoperatively. Grade of dysphonia varied between 1.15 and 1.66 postoperatively and VHI score varied from 23.3 to 24.5. CONCLUSION: Voice outcome after ELS unilateral type III or a bilateral type II resection for extended T1 and limited T2 glottic carcinoma is good with mild to very moderate perceptive dysphonia and low self-reported voice impairment.

Muscle Tension Dysphonia: Which Laryngoscopic Features Can We Rely on for Diagnosis?

OBJECTIVES: Muscle tension dysphonia (MTD) is generally diagnosed through clinical history and physical examination. Several diagnostic or classification systems exist, such as those of Van Lawrence, Morrison-Rammage, and Koufman, that delineate MTD and distinguish subtypes on the basis of laryngoscopic features. The aim of this study is to determine which of the clinical features included in these classifications are most related to the aerodynamic profile of MTD. STUDY DESIGN: This is an analytic retrospective study. MATERIAL AND METHODS: This study evaluates a series of 30 consecutive patients, all over 18 years old, who attended the voice clinic consult of our department and were diagnosed with MTD. All subjects underwent fiberoptic nasal endoscopy, acoustic voice assessment, and aerodynamic voice assessment. The study only includes patients with a pathological aerodynamic profile. Presence or absence of each laryngoscopic feature in the full range of features in the Van Lawrence, Morrison-Rammage, and Koufman classification systems was evaluated independently by three experts. Cohen's kappa coefficient was calculated to indicate the degree of concordance between the experts. The chi-squared test was used to determine the degree of association between clinical features and mean value of the subglottic pressure peak (mmH2O). RESULTS: Clinical parameters that were found to have a statistically significant association (P < 0.05) with an alteration in mean subglottic pressure peak were those related to anteroposterior and lateral compression of the larynx in Van Lawrence, Morrison-Rammage, and Koufman classification systems. CONCLUSIONS: While several studies have sought to clarify the laryngoscopic features of MTD, the current study is the first to evaluate these features in subjects who have been objectively diagnosed by means of aerodynamic voice assessment. The laryngoscopic features most strongly related to an aerodynamic profile of MTD were anteroposterior compression of the larynx, lateral compression of the larynx, and vestibular fold contribution to phonation.

[Voice quality evaluation in patients with obstructive sleep apnea syndrome treated with uvulopalatopharyngoplasty (UPPP)]. / Ocena jakosci glosu u chorych z obturacyjnym zespolem snu z bezdechami leczonych operacyjnie metoda UPPP.

MATERIAL AND METHODS: The evaluation of voice quality of 22 patients with obstructive sleep apnea syndrome (OSAS), who underwent uvulopalatopharyngoplasty (UPPP), was performed. The voice quality was assessed before the operation, and 1 month and 6-months after the procedure. The grade of dysphonia was determined on a six-grade dysphonia scale according to the Union of European Phoniatricians. Maximum phonation time (MPT) was analyzed. The acoustic examination of voice was performed determining fundamental frequency (F0) value and shimmer, jitter and NHR acoustic parameters. Formants analysis of voice was made estimating the level of F1, F2, F3 and F4 formants. RESULTS: Registered hearing dysphonia directly after the surgery was transient. The surgery did not significantly change F0 and jitter parameters that decrease the grade intensification of dysphonia. The reduction of maximum phonation time, changes in jitter and NHR acoustic parameters as well as the reduction of F3 and F4 formants confirmed the occurrence of open nasality directly after UPPP. CONCLUSION: Registered voice quality and timbre disturbance after UPPP were periodic.

Pressure and Flow Comparisons Across Vocal Pathologies.

OBJECTIVE: The aim of this study was to aid in the distinction among hyperadductive dysphonias by evaluating peak glottal pressure, release burst, and mid and final airflow values across repeated /pa/ syllable trains. METHODS: Sixty subjects were assessed for aerodynamic patterns during onset-offset for the /papapapapa/ task in modal voice. Subject groups included adductory spasmodic dysphonia (AdSD), benign vocal fold lesion, primary muscle tension dysphonia (MTD-1), secondary muscle tension dysphonia with an identifiable primary benign vocal fold lesion (MTD-2), vocal fold paresis or paralysis, and normal controls. RESULTS: Increased peak pressure (PP) was found for AdSD and MTD-2 subjects compared with controls. Release burst and mid airflow were not significantly different among groups. Final airflow was significantly higher for AdSD compared with the other groups. Final airflow was significantly lower for MTD-1. CONCLUSIONS: Significant differences in aerodynamics are seen in subjects with AdSD compared to MTD. AdSD was characterized by higher PP and higher final airflow. MTD-1 was characterized by lower final airflow, whereas MTD-2 was characterized by higher PP. Aerodynamic evaluation may aid in differential diagnosis for those patients in whom distinction among hyperadductive disorders is challenging.

Auditory-Perceptual Evaluation of Dysphonia: A Comparison Between Narrow and Broad Terminology Systems.

OBJECTIVE: In auditory-perceptual voice analysis, a multiparameter approach and a more reductionist approach may be compared with narrow and broad phonetic transcription and used interchangeably, depending on the purpose. The aim of this study was to investigate the perspectives of a translation of the terminology used in the multiparameter Danish Dysphonia Assessment (DDA) approach into the five-parameter GRBAS system. METHODS: Voice samples illustrating type and grade of the voice qualities included in DDA were rated by five speech language pathologists using the GRBAS system with the aim of estimating inter- and intrarater reliability. The same samples were then rated using the DDA terminology. RESULTS: Both inter- and intrarater reliability were found to be very high for the GRBAS parameters grade, rough, and breathy, but somewhat lower for asthenic and strained. Further, strong and clear associations were found between the DDA and GRBAS rating for grade, rough, breathy, and strained, whereas the relation between DDA ratings and asthenic was weaker and less clear. CONCLUSION: The data strongly support that the DDA system can be translated into the GRBAS system for auditory-perceptual voice analysis. The consensus discussion prior to the listening test is believed to have contributed to the high degree of inter- and intrarater reliability. We suggest for future use of the GRBAS system that rater reliability for asthenic and strained can increase, if these parameters are defined as behavioral terms and antagonists, reflecting muscular hypo- and hyperfunction.

The Effect of Information and Severity on Perception of Speakers With Adductor Spasmodic Dysphonia.

PURPOSE: The purpose of this study was to examine the effect of severity of adductor spasmodic dysphonia (ADSD) and information about it on unfamiliar listeners' attitudes about speakers' personal characteristics, perceived vocal effort, and listener comfort on the basis of ratings of speech recordings. METHOD: Fifteen women with ADSD and 5 controls provided speech samples. Forty-five unfamiliar listeners were randomized into 3 groups. Listeners in Group 1 received no information, listeners in Group 2 were told that some speakers had voice disorders or had no voice concerns, and listeners in Group 3 were provided diagnostic labels for each speaker and information about ADSD. Listeners then rated speech samples for attitudes, perceived vocal effort, and listener comfort. RESULTS: Speakers with ADSD were judged significantly worse than controls for attitudes related to "social desirability" and "intellect." There was no effect of severity on "personality" attributes. However, provision of a diagnostic label resulted in significantly more favorable personality ratings than when no label was provided. Perceived vocal effort and comfort became significantly more negative as ADSD severity increased. Finally, most listener ratings were unaffected by provision of additional information about ADSD. CONCLUSIONS: Listeners' perceptions about speakers with ADSD are difficult to change. Directions for counseling and public education need future study.

Aerodynamic Outcomes of Four Common Voice Disorders: Moving Toward Disorder-Specific Assessment.

OBJECTIVES: The two goals of the present study were to (1) determine the ability of commonly used aerodynamic voice measures to capture change as a function of known interventions and (2) determine if certain aerodynamic measures demonstrate better responsiveness to change in specific disorder types than others. STUDY DESIGN: This is a retrospective, longitudinal, single-blinded, cross-sectional study. METHODS: Patients (n = 70) with a single voice disorder diagnosis of benign vocal fold lesions (lesions), unilateral vocal fold paralysis (UVFP), primary muscle tension dysphonia (MTD-1), or vocal fold atrophy (atrophy) underwent baseline testing, a single intervention (phonosurgery or voice therapy), and follow-up testing. Common aerodynamic measurements were completed in repeated syllables and an all-voiced sentence. RESULTS: Statistically significant improvements were observed for two outcome measures, average airflow in syllables, and average airflow in the all-voiced sentence. Patients with lesions, UVFP, and MTD-1 improved in average airflow in the all-voiced sentence. Patients with UVFP also improved in airflow in syllables. CONCLUSIONS: Average airflow in the all-voiced sentence changed as a function of treatment for the lesion, MTD-1, and UVFP groups, demonstrating a disorder-specific pattern. Laryngeal airway resistance, and estimates of average subglottal pressure did not show significant change. Average airflow in the all-voiced sentence measurements is recommended as a routine voice measure, and further investigation of other aerodynamic measures' sensitivity to change is warranted.

Perceptual evaluation of dysphonic voices: can a training protocol lead to the development of perceptual categories?

The purpose of this study was to develop and test a training protocol for the perceptual evaluation of dysphonia. A group of 38 inexperienced listeners participated in a three-phase experiment: a pretest to evaluate their initial performance on categorization of dysphonic voices, a training phase, and a posttest to detect training-related changes in performance. In parallel, a different group of 14 listeners who were experts in voice assessment took a test that was identical to the posttest taken by the inexperienced subjects. The corpus used for the tests was made up of recordings of 142 voices of women reading aloud, with a sampling of voice qualities ranging from normal to severely degraded. The learners' performance on judgments of moderate and severe dysphonia improved between the pretest and the posttest. No improvement was observed for normal voices, whose initial detection was already good, nor for slight dysphonias, which appear to be the most difficult to learn. The improvements were still present on a delayed posttest taken a week later. Unexpectedly, the inexperienced listeners' initial performance was similar to that of the experts. After the training phase, their scores for severely deteriorated voices were even better than the experts'. In conclusion, our training protocol seems to be effective and could therefore be proposed to voice therapists. However, judging intermediate degrees of dysphonia remains fragile and therefore needs to be reinforced by repeated training.

Exploring the relationship between spectral and cepstral measures of voice and the Voice Handicap Index (VHI).

OBJECTIVES: The purpose of this study was to examine the strength of relationship between impairment-level acoustic measures derived from spectral- and cepstral-based analyses (including the cepstral peak prominence [CPP]; ratios of low vs high frequency spectral energy; and the respective standard deviations [SDs] for these measures) and a disablement measure (the total Voice Handicap Index [VHI] score) in a large and diverse group of voice-disordered and control subjects. The relationship between total VHI and the Cepstral Spectral Index of Dysphonia (CSID-a multivariate estimate of dysphonia severity) was also examined. METHODS: Subjects were 332 adults (116 males and 216 females) comprised of voice-disordered subjects who presented to a physician with a voice-related complaint (n=258) and a group of nonvoice-disordered control subjects (n=74). A VHI 30-item score and speech/voice samples including the second and third sentences of The Rainbow Passage and productions of the sustained vowel /ɑ/ were obtained for each subject. Sentence and sustained vowel samples were analyzed using the Analysis of Dysphonia in Speech and Voice (ADSV) program (ADSV model 5109 v.3.4.2; KayPENTAX, Montvale, NJ). RESULTS: Across all subjects, low-to-moderate strength Spearman rho (rs) correlations were observed between the total VHI and the CPP and the CSID in both speech and vowel contexts and for the CPP SD from continuous speech (rs's ranging from -0.45 to -0.49 for VHI vs CPP; 0.47 for VHI vs CSID; -0.44 for VHI vs CPP SD). Several other measures obtained from spectral or cepstral analyses also were observed to correlate with total VHI, although increased variability in the strength, direction, and overall significance of these other variables was observed depending on gender and elicited context. CONCLUSIONS: Voice-related disablement occurs within a context. In contrast, impairment-level measures of phonatory function (like the spectral and cepstral measures included in this study) are by nature decontextualized and appear to correlate low-to-moderately with quality of life measures like the VHI. Therefore, spectral and cepstral acoustic measures and the VHI should be viewed as providing relatively unique, meaningful, and complementary information.

Voice symptoms and vocal deviation self-assessment in different types of dysphonia.

PURPOSE: To identify the relationship among the type of dysphonia, vocal deviation self-assessed and the presence of voice symptoms in adults. METHODS: One hundred sixty-four subjects of both genders (58 males and 106 females, mean age 42.89 years) diagnosis of dysphonia, divided into three groups according to the type of dysphonia: 87 individuals with functional dysphonia, 35 individuals with organofunctional dysphonia and 42 individuals with organic dysphonia, answered the Brazilian validated version of Voice Symptom Scale (VoiSS) (Escala de Sintomas Vocais - ESV), that consists of 30 questions with four scores: Impairment, Emotional, Physical and Total, and self-assessed their voices as excellent, very good, good, fair or poor. RESULTS: According to the dysphonia type, there were differences in ESV Impairment, Emotional and Total mean scores, which was not found in the Physical score. The Impairment, Emotional and Total mean scores were higher in organic dysphonia, followed by organofunctional dysphonia and finally functional dysphonia. When the vocal self-assessment is poor, the higher are the deviations in the Impairment, Emotional and Total ESV scores. CONCLUSIONS: Individuals with organic dysphonia reported higher perception of voice symptoms, followed by subjects with organofunctional dysphonia and finally individuals with functional dysphonia. In general, individuals with dysphonia presented physical voice symptoms, regardless of the type of the dysphonia. Finally, there are direct correlations between Impairment, Emotional and Total ESV scores and the vocal self-assessment.

A new hybrid intelligent system for accurate detection of Parkinson's disease.

Elderly people are commonly affected by Parkinson's disease (PD) which is one of the most common neurodegenerative disorders due to the loss of dopamine-producing brain cells. People with PD's (PWP) may have difficulty in walking, talking or completing other simple tasks. Variety of medications is available to treat PD. Recently, researchers have found that voice signals recorded from the PWP is becoming a useful tool to differentiate them from healthy controls. Several dysphonia features, feature reduction/selection techniques and classification algorithms were proposed by researchers in the literature to detect PD. In this paper, hybrid intelligent system is proposed which includes feature pre-processing using Model-based clustering (Gaussian mixture model), feature reduction/selection using principal component analysis (PCA), linear discriminant analysis (LDA), sequential forward selection (SFS) and sequential backward selection (SBS), and classification using three supervised classifiers such as least-square support vector machine (LS-SVM), probabilistic neural network (PNN) and general regression neural network (GRNN). PD dataset was used from University of California-Irvine (UCI) machine learning database. The strength of the proposed method has been evaluated through several performance measures. The experimental results show that the combination of feature pre-processing, feature reduction/selection methods and classification gives a maximum classification accuracy of 100% for the Parkinson's dataset.

Adherence of the dysphonic teachers in speech therapy.

PURPOSE: To study the possible factors associated with adherence to the speech-language pathology treatment of dysphonia in female teachers of municipal schools of Belo Horizonte. METHODS: This was a retrospective study that analyzed the medical records of 251 teachers treated at the Voice Ambulatory Speech Language Pathology Service, Hospital das Clínicas da Universidade Federal de Minas Gerais (AV-UFMG) from August 2007 to December 2009. The collected data included age, number of scheduled sessions, number of absences, number of children, type of dysphonia, degree of dysphonia, monthly family income, and education. We calculated the distance, in kilometers, of the residence to the place of treatment and the workplace to place of treatment. We also analyzed the social vulnerability index of the workplace. RESULTS: The results of this research indicated that of the 135 records that were included in the study, 89 (65.93%) corresponded to the discharged group and 46 (34.07%) corresponded to the abandonment group. In comparison with all the variables studied, only the number of faults and the type of dysphonia were associated with poor adherence to voice therapy. CONCLUSION: Results showed that the number of absences in sessions, treatment-related factor, organofuncional dysphonia type, and clinical-related factor were all associated with the abandonment of voice therapy.

Section four: laryngitis and dysphonia.

Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged.