Dysphonia, arterial hypertension, diabetes mellitus, thyroid diseases, and noise complaints as probable factors associated with hearing loss among teachers / Disfonia, hipertensão arterial, diabetes mellitus, doenças da tireoide e queixas de ruído como prováveis fatores associados a perda auditiva em professores

ABSTRACT Objective: to verify a possible association between hearing loss and dysphonia, arterial hypertension, diabetes mellitus, thyroid diseases, and noise complaints. Methods: a cross-sectional study involving 60 teachers, mean age 47.05 years. Pure-tone threshold audiometry was used to assess hearing, the voice questionnaire and voice acoustic evaluation were used for voice perception and quality, and the standardized questionnaire verified noise complaint and comorbidities. The statistical analysis was conducted with Mann-Whitney and Fisher's exact tests and multivariate linear regression. Results: there was a significant association between hearing loss and diabetes mellitus, hypertension, and thyroid disease (both p <0.0001), but there was no association between noise complaints and hearing loss in this population. The regression showed that dysphonia (p = 0.0311) and diabetes mellitus (p = 0.0302) are independent risk factors for hearing loss. A correlation was found between hearing loss and voice characteristics: roughness, breathiness, tension, and resonance. Conclusion: this study showed that hypertension and thyroid diseases are factors associated with hearing loss. In addition, dysphonia and diabetes mellitus are independent factors associated with hearing loss in teachers. These results show the need for policies aimed at promoting teachers' health.

RESUMO Objetivo: verificar possível associação da perda auditiva com disfonia, hipertensão arterial (HA), diabetes mellitus (DM), doenças da tireoide e queixas de ruído. Métodos: estudo transversal envolvendo 60 professores, média de idade de 47,05 anos. Foi avaliada a audição por meio da Audiometria tonal limiar, a percepção e qualidade vocal com o questionário vocal e a avaliação vocal acústica, enquanto a queixa de ruído e as comorbidades envolvidas foram investigadas com o questionário padronizado. A análise estatística utilizou os testes Ex-act de Mann Whitney, Fisher e regressão linear multivariada. Resultados: houve associação significante entre perda auditiva e DM, HA e doenças da tireoide (ambas p <0,0001), mas não foi encontrada associação entre queixa de ruído e perda auditiva nesta população. A regressão mostrou que as variáveis disfonia (p = 0,0311) e DM (p = 0,0302) são fatores de risco independentes para perda auditiva. Houve correlação entre perda auditiva e as características vocais rugosidade, soprosidade, tensão e ressonância. Conclusão: este estudo demostrou que HA e doenças da tireoide são fatores associados a perda auditiva, além disso a disfonia e DM se constituem em fatores associados independentes para a perda auditiva em professores. Estes resultados mostram a necessidade de políticas direcionadas a promoção da saúde do professor.

Processamento auditivo central em crianças com disfonia: avaliação comportamental e eletrofisiológica / Central auditory processing in children with dysphonia: behavioral and electrophysiological assessment / Procesamiento auditivo central en niños com disfonía: evaluación comportamental y electrofisiológica

Introdução: O transtorno do processamento auditivo central pode ocorrer em concomitância com outras alterações, assim como a disfonia. Objetivo: Analisar os resultados obtidos na avaliação do processamento auditivo central em crianças com disfonia. Método: Estudo comparativo e de coorte transversal, constituído por 16 crianças de oito a 11 anos reunidas em dois grupos: o Grupo Estudo composto por sete crianças com disfonia funcional ou organofuncional, e o Grupo Controle por nove crianças sem queixas e alterações vocais. Foram realizados os seguintes procedimentos: anamnese, gravação vocal, avaliação perceptivo-auditiva da voz, laringoscopia, avaliação audiológica básica, avaliação do processamento auditivo por meio de testes comportamentais e eletrofisiológicos. Resultados: Houve diferença estatisticamente significativa entre os grupos para as etapas de atenção direcionada no teste Dicótico não verbal, etapa de humming no Padrão de frequência, limiar de detecção de gap e porcentagem de acertos no Gaps in Noise e para a latência do P300. Conclusão: A partir da análise dos resultados verificou-se que o grupo com disfonia apresentou transtorno do processamento auditivo central com alteração nas habilidades auditivas de figura-fundo para sons não verbais, ordenação e resolução temporal e latência do P300 prolongada, sugerindo também um déficit no processamento cognitivo da informação acústica.

Introduction: Central auditory processing disorder may occur in parallel with other dysfunctions, such as dysphonia. Objective: To investigate auditory processing results in children with dysphonia. Methods: Comparative and cross-sectional study of 16 children aged 8 to 11 years old, who were divided into two groups: a study group of 7 children with functional or organic and functional dysphonia; and a control group of 9 children with no vocal complaints or disorders. After clinical assessment voices were recorded and children underwent perceptive voice evaluation, audiogram, and auditory processing with behavioral and electrophysiological tests. Results: A statistically significant difference was found between the groups with regard to dichotic nonverbal listening tests, humming in the frequency pattern test, and gap detection threshold, in addition to the percentage of correct answers in gap-in-noise test and for the P300 latency. Conclusion: Children with dysphonia had central auditory processing disorder with changes in listening skills for figure-ground to nonverbal sounds, ordering and temporal resolution and P300 latency suggesting a concomitant impairment in cognitive processing of acoustic information.

Introducción: El trastorno de procesamiento auditivo central puede estar en comorbilidad con otras alteraciones como la disfonía. Objetivo: Analizar los resultados obtenidos en la evaluación del procesamiento auditivo central en niños con disfonía. Métodos: Estudio comparativo y de corte transversal, constituido por 16 niños entre 8 y 11 años de edad reunidos en dos grupos: el Grupo de Estudio compuesto por siete niños con disfonía funcional u orgánico funcional y el Grupo Control compuesto por nueve niños sin quejas ni alteraciones vocales. Fueron realizados los siguientes procedimientos: Anamnesis, grabación vocal, evaluación perceptivo auditiva de la voz, laringoscopia, evaluación audiológica básica, evaluación del procesamiento auditivo por medio de tests comportamentales y electrofisiológicos. Resultados: Hubo diferencia estadísticamente significativa entre los grupos para las etapas de atención direccionada en el test Dicótico no verbal, etapa de humming en el Patrón de frecuencia, limiar de detección de gap y porcentaje de aciertos en el Gaps in Noise y para la latencia del P300. Conclusión: A partir del análisis de los resultados se verificó que el grupo con disfonía presentó trastorno de procesamiento auditivo central con alteración en las habilidades auditivas de figura-fondo para los sonidos no verbales, ordenamiento, resolución temporal y latencia del P300 prolongada; sugiriendo también un déficit en el procesamiento cognitivo de la información acústica.

Musculoskeletal Pain and Voice-related Quality of Life in Dysphonic and Non-dysphonic Subjects.

PURPOSE: This study aimed to compare and correlate musculoskeletal pain and voice-related quality of life of dysphonic and non-dysphonic individuals. METHOD: This is a retrospective case-control study. A total of 74 adults were divided into two groups: the experimental group (EG) comprising 37 individuals with vocal complaints and hyperfunctional dysphonia, and the control group (CG) comprising 37 individuals without vocal complaints and with healthy voices. Both groups presented similar gender and age (28 females and 9 males for each group; average age = 31.5). All the participants answered the protocols: Voice-Related Quality of Life and Musculoskeletal Pain Questionnaire. Statistical data were analyzed by Mann-Whitney U test (P ≤ 0.05) and Spearman correlation test (P ≤ 0.05). RESULTS: It was observed that the EG presented significantly lower scores of voice-related quality of life in the social-emotional (P < 0.001), physical (P < 0.001), and total (P < 0.001) fields. Concerning musculoskeletal pain, it was observed in the EG that there was a higher intensity in pain in the region of the larynx (P < 0.001), and a higher frequency of pain in the submandibular (P = 0.013), larynx (P < 0.001), and front of the neck (P = 0.002) regions, when compared with the CG. CONCLUSION: In the group of individuals studied, worst indexes of voice-related quality of life and higher frequency and intensity of pain in the larynx were observed, in addition to higher frequency of pain in regions near the larynx in dysphonic subjects. There was correlation between voice-related quality of life and the frequency and intensity of musculoskeletal pain.

Behavioral Dysphonia and Depression in Elementary School Teachers.

OBJECTIVE/HYPOTHESIS: To verify the relationship between behavioral dysphonia and current depressive episodes in municipal elementary school teachers. We hypothesize that teachers with behavioral dysphonia will be more susceptible to psychiatric disorders. DESIGN: Cross-sectional study, quantitative, conducted across municipal schools in both rural and urban regions of Pelotas. METHOD: Five-hundred seventy-five teachers from urban and rural areas of the same Brazilian state were included. The full version of the Voice Handicap Index validated into Brazilian Portuguese was used to determine the presence of behavioral dysphonia. A profile of vocal behaviors was also used to quantify the number of phonotraumatic events. In addition, the Mini-International Neuropsychiatric Interview was used to determine current episodes of depression. Data were analyzed via correlative studies using chi-square and Poisson regression analyses. RESULTS: Across all teachers, the prevalence of dysphonia was 33.9% and 55% reported that they had already taken a leave because of their voice. Those teachers with a current depressive episode had a higher rate of dysphonia compared with those without depression (prevalence ratio [PR] 1.66; P < 0.000). Teachers who presented with a risk of serious vocal problems had a prevalence ratio of 2.58, indicating a greater proportion of dysphonia, whereas teachers classified as champions of abuse were five times more likely compared with those teachers with behaved or candidates for voice problems. CONCLUSIONS: There is an association between behavioral dysphonia and current depressive episodes in elementary school teachers.

Medición de la discapacidad vocal en los pacientes con disfonías funcionales / Measurement of the vocal handicap in patients with functional dysphonia

Introducción: La medición de la discapacidad vocal en los pacientes con disfonía funcional es un tema de gran relevancia. Objetivo: Analizar los resultados de dos medidas subjetivas (el índice de discapacidad vocal (VHI) y el índice de calidad de vida (QLI)) y calcular el grado de discapacidad que suponen las disfonías funcionales para los pacientes. Material y método: Sesenta y cinco pacientes diagnosticados de disfonías funcionales contestaron un cuestionario que incluye el índice de discapacidad vocal y el índice de calidad de vida. Resultados: Encontramos un grado importante de discapacidad reflejado por unos valores elevados del VHI (55,74), sus tres subescalas (orgánica (24,82), funcional (19,28) y emocional (11,65) y del QLI (11,42). Discusión: Se realiza una revisión exhaustiva de la literatura, constatando la escasez de estudios sobre la discapacidad que producen los trastronos vocales y se comparan nuestros resultados con los de otros autores. Conclusión: La presencia de disfonías funcionales supone una discapacidad importante a nivel de las actividades sociales y laborales del paciente y un impacto emocional considerable.

Introduction: Functional dysphonia is a major issue. Aim: To analyse the results of two subjective measures (Vocal Handicap Index (VHI) and Quality Life Index (QLI)) and to calculate the impact that functional dysphonias suppose for the patients. Material and Method: 65 patients diagnosed of functional dysphonia answered a questionnaire that includes the Vocal Handicap Index and the Quality Life Index. Results: We found an important degree of handicap indicated by high values of the VHI (55,74), of its three subscales (organic (24,82), functional (19,28) and emotional (11,65)) and of the QLI (11,42). Discussion: We made a wide literature review, noting that there are a few studies of the handicap of voice disorders; and compared our results with those of other authors. Conclusion: The presence of functional dysphonias supposes an important level of handicap in the patient's social and laboral activities and a considerable emotional impact.

Auditory processing in dysphonic children.

UNLABELLED: Contemporary cross-sectional cohort study. There is evidence of the auditory perception influence on the development of oral and written language, as well as on the self-perception of vocal conditions. The auditory system maturation can impact on this process. OBJECTIVE: To characterize the auditory skills of temporal ordering and localization in dysphonic children. MATERIALS AND METHODS: We assessed 42 children (4 to 8 years). STUDY GROUP: 31 dysphonic children; Comparison group: 11 children without vocal change complaints. They all had normal auditory thresholds and also normal cochleo-eyelid reflexes. They were submitted to a Simplified assessment of the auditory process (Pereira, 1993). In order to compare the groups, we used the Mann-Whitney and Kruskal-Wallis statistical tests. Level of significance: 0.05 (5%). RESULTS: Upon simplified assessment, 100% of the Control Group and 61.29% of the Study Group had normal results. The groups were similar in the localization and verbal sequential memory tests. The nonverbal sequential memory showed worse results on dysphonic children. In this group, the performance was worse among the four to six years. CONCLUSION: The dysphonic children showed changes on the localization or temporal ordering skills, the skill of non-verbal temporal ordering differentiated the dysphonic group. In this group, the Sound Location improved with age.

Auditory processing in dysphonic children / Processamento auditivo em crianças disfônicas

Contemporary cross-sectional cohort study. There is evidence of the auditory perception influence on the development of oral and written language, as well as on the self-perception of vocal conditions. The auditory system maturation can impact on this process. OBJECTIVE: To characterize the auditory skills of temporal ordering and localization in dysphonic children. MATERIALS AND METHODS: We assessed 42 children (4 to 8 years). Study group: 31 dysphonic children; Comparison group: 11 children without vocal change complaints. They all had normal auditory thresholds and also normal cochleo-eyelid reflexes. They were submitted to a Simplified assessment of the auditory process (Pereira, 1993). In order to compare the groups, we used the Mann-Whitney and Kruskal-Wallis statistical tests. Level of significance: 0.05 (5 percent). RESULTS: Upon simplified assessment, 100 percent of the Control Group and 61.29 percent of the Study Group had normal results. The groups were similar in the localization and verbal sequential memory tests. The nonverbal sequential memory showed worse results on dysphonic children. In this group, the performance was worse among the four to six years. CONCLUSION: The dysphonic children showed changes on the localization or temporal ordering skills, the skill of non-verbal temporal ordering differentiated the dysphonic group. In this group, the Sound Location improved with age.

Estudo de coorte contemporânea com corte transversal. Há evidências da influência da percepção auditiva sobre o desenvolvimento da linguagem oral e escrita e da autopercepção das condições vocais. A maturação do sistema auditivo pode interferir nesse processo. OBJETIVO: Caracterizar habilidades auditivas de Localização e de Ordenação Temporal em crianças disfônicas. MATERIAL E MÉTODO: Avaliaram-se 42 crianças (4 a 8 anos). Grupo Pesquisa: 31 crianças disfônicas, Grupo de Comparação: 11 crianças sem queixas de alterações vocais. Todas apresentaram limiares auditivos normais e reflexo cócleo-palpebral. Foram submetidas à Avaliação Simplificada do Processamento Auditivo (Pereira, 1993). Para comparar os grupos utilizaram-se os testes estatísticos de Mann-Whitney e Kruskal-Wallis. Nível de significância: 0,05 (5 por cento). RESULTADOS: À Avaliação Simplificada, 100 por cento do Grupo Controle e 61,29 por cento do Grupo Pesquisa apresentaram resultados normais. Nas provas de Localização e Memória Sequencial Verbal, os grupos mostraram-se semelhantes. A Memória Sequencial Não Verbal mostrou piores resultados nas crianças disfônicas. Nesse grupo, o desempenho foi pior dos quatro aos seis anos. CONCLUSÃO: As crianças disfônicas apresentaram alterações das habilidades de localização ou ordenação temporal, a habilidade de ordenação temporal de sons não verbais diferenciou o grupo disfônico. Nesse grupo, a Localização Sonora melhorou com a idade.

Transcutaneous electrical nerve stimulation in dysphonic women.

BACKGROUND: studies indicate correlation between dysphonia and muscle tension. AIM: to evaluate bilaterally the electrical activity of the suprahyoid muscles (SH), sternocleidomastoid (SCM), and trapezius (T), the presence of pain and the voice, after applying transcutaneous electrical nerve stimulation (TENS). METHOD: ten (10) women with nodules or bilateral mucus thickening, and phonation fissure. Volunteers were submitted to 10 TENS sessions (200 micros and 10 Hz) for 30 minutes. Pain was evaluated using an analogical visual scale; the voice was evaluated through laryngoscopy and through a perceptive-auditory and acoustic analysis; and the myoelectric signal was converted using the Root Media Square (RMS). Voice and EMG data gathering was performed during the production of the E/vowel and during spontaneous speech (SS). STATISTICAL ANALYSIS: Shapiro-Wilk Test followed by the Wilcoxon Test, or t Student, or Friedman Test (p < 0.05). RESULTS: It was observed that the TENS decreased the RMS readings, pre and pos treatment, for the Right T (RT) (2.80 +/- 1.36 to 1.77 +/- 0.93), the Left T (LT) (3.62 +/- 2.10 to 2.10 +/- 1.06), the Left SCM (LSCM) (2.64 +/- 0.69 to 1.94 +/- 0.95), and the SH (11.59 +/- 7.72 to 7.82 +/- 5.95) during the production of the E/vowel; and for the RT (3.56 +/- 2.77 to 1.93 +/- 1.13), the LT (4.68 +/- 2.56 to 3.09 +/- 2.31), the Right SCM (RSCM) (3.94 +/- 2.04 to 2.51 +/- 1.87), and the LSCM (3.54 +/- 1.04 to 3.12 +/- 3.00) during SS. A relieve in pain was also observed. Regarding the voice analysis, there was a decrease in level of laryngeal injuries; no difference was observed during the production of the E/vowel in the perceptive-auditory analysis; there was a decrease in the level of dysphonia and hoarseness during SS. CONCLUSION: TENS is effective in improving the clinical and functional signs of dysphonic women.

Estimulação elétrica nervosa transcutânea em mulheres disfônicas / Transcutaneous electrical nerve stimulation in dysphonic women

TEMA: estudos mostram correlação entre disfonia e tensão muscular. OBJETIVO: avaliar a atividade elétrica dos músculos supra-hióideos (SH), esternocleidomastóideo (ECM) e trapézio (T) bilateralmente, a dor e a voz, após aplicação da estimulação elétrica nervosa transcutânea (TENS). MÉTODO: participaram dez mulheres com nódulos ou espessamento mucoso bilateral e fenda à fonação. As voluntárias receberam dez sessões de TENS (200µs e 10Hz) por 30 minutos. A dor foi avaliada pela escala visual analógica, a voz por meio de laringoscopia, análise perceptivo-auditiva e acústica e o sinal mioelétrico pela raiz quadrada da média (RMS). A coleta dos dados de voz e EMG deu-se por emissão da vogal /E/ e fala espontânea. A análise estatística constou do teste de Shapiro-Wilk, seguido do teste de Wilcoxon ou t Student ou de Friedman (p < 0,05). RESULTADOS: observou-se que a TENS diminuiu o RMS, pré e pós-tratamento, para TD (2,80 ± 1,36 para 1,77 ± 0,93), TE (3,62 ± 2,10 para 2,10 ± 1,06), ECME (2,64 ± 0,69 para 1,94 ± 0,95) e SH (11,59 ± 7,72 para 7,82 ± 5,95) durante a emissão da vogal /E/, e TD (3,56 ± 2,77 para 1,93 ± 1,13), TE (4,68 ± 2,56 para 3,09 ± 2,31), ECMD (3,94 ± 2,04 para 2,51 ± 1,87) e ECME (3,54 ± 1,04 para 3,12 ± 3,00) durante a fala espontânea (FE), além da diminuição da dor. Quanto à voz, ocorreu diminuição do grau das lesões laríngeas e, na análise perceptivo-auditiva, não houve diferença durante a emissão da vogal /E/, porém durante a FE ocorreu diminuição do grau de disfonia e rouquidão. CONCLUSÃO: a TENS é eficaz na melhora do quadro clínico e funcional de mulheres disfônicas.

BACKGROUND: studies indicate correlation between dysphonia and muscle tension. AIM: to evaluate bilaterally the electrical activity of the suprahyoid muscles (SH), sternocleidomastoid (SCM), and trapezius (T), the presence of pain and the voice, after applying transcutaneous electrical nerve stimulation (TENS). METHOD: ten (10) women with nodules or bilateral mucus thickening, and phonation fissure. Volunteers were submitted to 10 TENS sessions (200µs and 10Hz) for 30 minutes. Pain was evaluated using an analogical visual scale; the voice was evaluated through laryngoscopy and through a perceptive-auditory and acoustic analysis; and the myoelectric signal was converted using the Root Media Square (RMS). Voice and EMG data gathering was performed during the production of the E/vowel and during spontaneous speech (SS). STATISTICAL ANALYSIS: Shapiro-Wilk Test followed by the Wilcoxon Test, or t Student, or Friedman Test (p < 0.05). RESULTS: It was observed that the TENS decreased the RMS readings, pre and pos treatment, for the Right T (RT) (2.80 ± 1.36 to 1.77 ± 0.93), the Left T (LT) (3.62 ± 2.10 to 2.10 ± 1.06), the Left SCM (LSCM) (2.64 ± 0.69 to 1.94 ± 0.95), and the SH (11.59 ± 7.72 to 7.82 ± 5.95) during the production of the E/vowel; and for the RT (3.56 ± 2.77 to 1.93 ± 1.13), the LT (4.68 ± 2.56 to 3.09 ± 2.31), the Right SCM (RSCM) (3.94 ± 2.04 to 2.51 ± 1.87), and the LSCM (3.54 ± 1.04 to 3.12 ± 3.00) during SS. A relieve in pain was also observed. Regarding the voice analysis, there was a decrease in level of laryngeal injuries; no difference was observed during the production of the E/vowel in the perceptive-auditory analysis; there was a decrease in the level of dysphonia and hoarseness during SS. CONCLUSION: TENS is effective in improving the clinical and functional signs of dysphonic women.

Disfonia Crônica na infância e Adolecência: Estudo Retrospectivo / Chronic Voice Disorders in Children and Teenagers: A retrospective Study

Disfonia é um distúrbio da comunicação humana, no qual a voz não consegue cumprir seu papel básico de transmissão da mensagem verbal e emocional do indivíduo. Não é um sintoma incomum em crianças, com a maior parte dos estudos epidemiológicos referindo uma prevalência entre 6 e 9% de disfonia e problemas articulatórios na população geral infantil. Objetivo: Este estudo tem por objetivo discutir as principais causas de disfonia entre crianças e adolescentes atendidos em um ambulatório especializado de hospital terciário. Material e método: Foram avaliados, de forma retrospectiva, 49 pacientes (32 meninos e 17 meninas) com queixa de alteração de voz, atendidos no ambulatório da Disciplina de Otorrinolaringologia Pediátrica da Universidade Federal de São Paulo (UNIFESP/ EPM). Resultados: A idade variou de 3 a 16 anos, com um predomínio na faixa etária de 4 a 11 arcos. As lesões mais freqüentes foram os nódulos vocais (44,89%) e as alterações estruturais mínimas de laringe (36,73%). Alterações estruturais mínimas (AEM) estiveram relacionadas predominantemente a uma qualidade vocal do tipo áspero - soprosa; enquanto que nódulos vocais, a uma voz do tipo rouco - soprosa. Conclusões: Nódulos vocais são as lesões mais freqüentemente diagnosticadas entre crianças e adolescentes com queixa de disfonia, predominando em meninos menores de 12 anos de idade, e em meninas a partir dessa idade.

Dysphonia is a human communication disturb in which the voice fail in carry out its basic role of transmission of the verbal and emotional message of a person. It's not an uncommon symptom in children. The prevalence of dysphonia and articulatory problems in general population of children related in most of epidemic studies, ranges from 6 to 9%. Objective: The purpose of the present study is to discuss the main causes of dysphonia in children and teenagers seen in an outpatient department of a tertiary hospital. Material and method: Forty nine patients (32 boys and 17 girls) attended at division of pediatric otorhinolaryngology of Universidade Federal de São Paulo (UNIFESP/ EPM), with complaint of voice disorder, were evaluated retrospectively. Results: The age range from 3 to 16 years old, with predominance between 4 and 11 years old. The most frequent lesions were vocal nodules (44,89%) and minimal structural alterations (36,73%). Minimal structural alterations were related mainly to harsh breathy vocal quality while vocal nodules to hoarse breathy. Conclusions: Vocal nodules are the lesions more frequently diagnosed between children and teenagers with complain of dysphonia, prevailing in boys under 12 years old, and girls from this age.