Validação do conteúdo de um protocolo de avaliação da motricidade orofacial em lactentes / Content validation of an orofacial myofunctional assessment protocol for infants / Validación del contenido de un protocolo para la evaluación de la motricidad orofacial en bebés

Introdução: Muitos estudos têm se dedicado a compreender melhor a dinâmica da avaliação das estruturas e funções estomatognáticas de lactentes; até a presente pesquisa não foram encontrados estudos específicos para essa faixa etária, até recentemente. Objetivo: Validar o conteúdo de um instrumento fonoaudiológico de avaliação da motricidade orofacial para lactentes na faixa etária de um mês a dois anos. Metodologia: Foi elaborado o instrumento para "avaliação fonoaudiológica da motricidade orofacial de lactentes de um mês a dois anos" a partir dos dados obtidos na literatura. A validação do conteúdo do instrumento se deu por meio da avaliação de quatro juízes para clareza dos itens propostos no protocolo e da representatividade dos mesmos no processo de validação do conteúdo. Os juízes classificaram cada item quanto à clareza, a partir de uma escala tipo Likert de quatro pontos, sendo: (4) muito claro, (3) claro, (2) pouco claro, (1) sem clareza, com o propósito de realizar a validação do conteúdo por meio da aplicação da equação do Índice de Validação do Conteúdo (IVC). Resultados: O protocolo desenvolvido possui 8 itens e uma breve anamnese: Hábitos Orais; Avaliação Estrutural; Respiração; Voz; Avaliação Funcional; Alimentação e Deglutição - líquidos e alimentos em pedaços; Diagnóstico Fonoaudiológico. A etapa seguinte contou com a análise da representatividade e para clareza dos itens do protocolo pelos juízes, e após a segunda análise, a validação do conteúdo resultou na permanência dos 8 itens com Índice de Validade de Conteúdo total de 100%. Conclusão: O conteúdo do protocolo foi considerado válido para uso na avaliação do público-alvo, comprovado por profissionais com experiência na área. A versão final do Protocolo de avaliação fonoaudiológica da motricidade orofacial de bebês foi finalizada com 8 itens de avaliação. (AU)

Introduction: The instruments for evaluating the structures and functions of the stomatognathic system in babies have been lacking in studies. Objective: To validate the content of a speech-language instrument to assess orofacial motricity for babies aged between one month and two years old. Methodology: The instrument for "speech-language assessment of the orofacial motricity of babies from one month to two years old" was created based on the data obtained by the integrative review. The instrument's content was validated through the evaluation of four judges. The judges classified each item according to clarity, based on a four-point Likert scale, as follows: (4) very clear, (3) clear, (2) lightly clear, (1) unclear, to perform content validation by applying the Content Validation Index (CVI) equation. Results: The developed protocol has eight items and a brief anamnesis: Oral Habits; Structural Assessment; Breathing; Voice; Functional Assessment; Feeding and Swallowing - liquids and food in pieces; and Speech-Language Diagnosis. The next step included the analysis of the representativeness of the protocol items by the judges. After the second analysis, the validation of the content resulted in the permanence of the eight items with a total Content Validity Index of 100%. Conclusion: The content of the protocol was considered valid for use in the evaluation of the target audience, proven by people with experience in the area. The final version of the Protocol for the Speech-Language Pathology Assessment of Orofacial Motricity in Babies was completed with eight assessment items. (AU)

Introducción: Los instrumentos para la evaluación de las estructuras y funciones del sistema estomatognático en los bebés han mostrado falta de estudios. Objetivo: Validar el contenido de un instrumento de fonoaudiología para la evaluación de la motricidad orofacial en bebés de un mes a dos años de edad. Metodología: Inicialmente, se llevó a cabo la elaboración del instrumento para la "evaluación logopédica de la motricidad orofacial de bebés de un mes a dos años de edad" propiamente dicho, a partir de los datos obtenidos por la revisión integradora. La validación del contenido del instrumento se realizó a través de la evaluación de cuatro jueces. Los jueces calificaron cada ítem en términos de claridad, utilizando una escala de Likert de cuatro puntos, de la siguiente manera: (4) muy claro, (3) claro, (2) poco claro, (1) poco claro, con el propósito de realizar la validación de contenido a través de la aplicación de la ecuación del Índice de Validación de Contenido (CVI). Resultados: después de la lectura y discusión de los artículos, fue posible desarrollar el protocolo que contiene 8 ítems y una breve anamnesis, que son: Hábitos Orales; Evaluación Estructural; Respiración; Voz; Evaluación Funcional; Alimentación y deglución: líquidos y alimentos en trozos; y; Diagnóstico de Patología del Habla-Lenguaje. El siguiente paso fue el análisis de la representatividad de los ítems del protocolo por parte de los jueces, y luego del segundo análisis, la validación de contenido resultó en la permanencia de 8 ítems con un Índice de Validez de Contenido total del 100%. Conclusión: El contenido del protocolo se consideró válido para su uso en la evaluación del público objetivo, confirmado por personas con experiencia en el área. La versión final del Protocolo de evaluación de la patología del habla y el lenguaje para la motricidad orofacial en bebés se completó con 8 ítems de evaluación. (AU)

Finger Kazoo Intensive Short-term Vocal Therapy: Vocal and Aerodynamic Measurements in Female Teachers.

OBJECTIVE: to verify the effect after short-term intensive therapy with the Finger Kazoo technique on vocal and aerodynamic measures of dysphonic female teachers. METHOD: blind randomized clinical trial. Fifteen female teachers without structural disorders of vocal folds and nine with vocal nodules participated in the study groups. Yet, nine female teachers without structural disorders and eight with vocal nodules in the control groups. The following variables were measured pre and post-therapy: minimum and maximum fundamental frequency: forced vital capacity; simple phonic coefficient; compound phonic coefficient; ratio between maximum phonation time of /a/ and expected maximum phonation time. RESULTS: no statistical significance was observed in the intra and intergroup analyses in any of the measures. CONCLUSION: in this group of female teachers, it was not possible to show a positive effect of short-term and intensive therapy with the Finger Kazoo technique on the vocal measures of minimum and maximum fundamental frequency, forced vital capacity, simple phonic coefficient, compound phonic coefficient, and the relationship between maximum phonation time of /a/ and expected maximum phonation time.

Voice-Related Quality of Life, Anxiety, and Depression in Female Teachers: Finger Kazoo Intensive Short-Term Vocal Therapy.

BACKGROUND: Among professional voice users, teachers are subject to higher risks of developing occupational dysphonia due to their abusive use of the voice, usually under unfavorable conditions. OBJECTIVES: Quantify the vocal self-perception, the voice-related quality of life, and the anxiety, and depression symptoms, of dysphonic female teachers, after a brief and intensive short-term voice therapy using the finger kazoo technique. METHODS: Blinded, randomized, and controlled clinical trial. Questionnaires applied to two study groups (15 subjects without structural laryngeal disorder in one group, and nine subjects with vocal nodules in the other), and to two control groups (9 subjects without structural laryngeal disorder in one group, and eight subjects with vocal nodules in the other). RESULTS: The Vocal Tract Discomfort Scale, the Voice Activity and Participation Profile, the Voice Symptom Scale, and the Voice-Related Quality of Life Protocol, showed significant improvement in both study groups. The Vocal Perception Protocol showed that negative vocal self-perception reduced significantly in subjects without structural alteration of the vocal folds in the study group. Anxiety symptoms improved significantly in subjects with vocal nodules in the study group; depression symptoms improved significantly in subjects with vocal nodules in the control group, and in subjects without structural alteration of the vocal folds in the study group. CONCLUSION: Brief and intensive short-term voice therapy using the finger kazoo technique provided improvement in the vocal self-perception, the voice-related quality of life, and in the symptoms of anxiety and depression in dysphonic teachers, more evidently in teachers with vocal nodules.

Percepção de fonoaudiólogos sobre a atuação na área de cuidados paliativos em um hospital público de Santa Catarina / Speech-language pathologists' perception on their performance in the palliative care area at a public hospital in Santa Catarina state, Brazil

RESUMO Objetivo identificar a percepção de fonoaudiólogos sobre a própria atuação em cuidados paliativos em um hospital público de Santa Catarina. Método trata-se de um estudo qualitativo, descritivo, realizado com cinco fonoaudiólogos atuantes em um hospital público de Santa Catarina. Os dados foram coletados mediante entrevista semiestruturada e submetidos à análise de conteúdo. Resultados após análise do conteúdo do discurso dos fonoaudiólogos participantes, surgiram as seguintes categorias: conceito e entendimento sobre cuidados paliativos e atuação do fonoaudiólogo; reconhecimento da Fonoaudiologia na atuação multiprofissional; relação interpessoal com o paciente e a família e dificuldades na prática de cuidados paliativos. Conclusão a percepção dos fonoaudiólogos revela o conceito de que os cuidados paliativos são prestados a pacientes que não possuem mais possibilidade de cura, mas para os quais há necessidade de tratar comorbidades e proporcionar melhor qualidade de vida. Evidenciaram-se durante as entrevistas: a percepção da atuação fonoaudiológica na área da disfagia, o reconhecimento dos demais profissionais de que a atuação fonoaudiológica tem se ampliado e de que o cuidado deve se estender a toda a família.

ABSTRACT Purpose To identify speech-language pathologists' perception on their performance in palliative care at a public hospital in Santa Catarina State, Brazil. Methods It is a descriptive, qualitative study, conducted by 5 speech-language pathologists at a public hospital in Santa Catarina State. Data were collected by means of a semi-structured interview and submitted to content analysis. Results After the content analysis of the participating speech-language pathologists, the following post-defined categories emerged: concept and understanding of palliative care and speech-language pathologists' performance; the importance of the speech-language pathologists in multidisciplinary teams; interpersonal relationship with patients and their families, and constraints in the practice of palliative care. Conclusion According to speech-language pathologists' perception, palliative care is delivered to patients without any possibility of cure, but it is necessary to treat their comorbidities, and provide them with better quality of life; the perception of the speech-language pathology performance in the field of dysphagia stood out; report of other professionals acknowledging speech-language pathologists' performance in the area of dysphagia has been expanded; and such care should be extended to the whole family.

Aerodynamic Vocal Measurements in Female Teachers: Finger Kazoo Intensive Short-Term Vocal Therapy.

OBJECTIVE: Obtain aerodynamic vocal measurements of dysphonic female teachers from two groups, before and after a brief and intensive short-term voice therapy using the finger kazoo technique, compare to the respective control groups, and compare between the two study groups. STUDY DESIGN: A randomized blind controlled clinical trial. METHODS: A randomized blind controlled clinical trial. Measurements of maximum phonation time and sound pressure level (dB SPL) were measured before and after intensive short-term vocal therapy in 24 teachers with and without structural laryngeal disorders and 17 controls with and without structural laryngeal disorder. RESULTS: There was significant reduction in the maximum phonation time of /e/ for the group with no structural laryngeal disorder, and a significant reduction of the maximum sound pressure level for the group with structural laryngeal disorder. CONCLUSIONS: Based on the observed results, a significant reduction in the maximum phonation time of /e/ for the group with no structural laryngeal disorder, and a significant reduction of the maximum sound pressure level for the group with structural laryngeal disorder, it is possible that finger kazoo reduced the glottal hyperfunction by improving the balance between the respiratory and the glottal vocal production levels during speech.

Acoustic Measurements of the Glottic Source of Female Teachers With Dysphonia.

OBJECTIVE: To verify the acoustic measurements of glottic source of dysphonic teachers of a medium-sized municipality of interior of the state. METHODS: Retrospective, cross-sectional, and quantitative study, with a composite sample of 34 dysphonic teachers, of which 21 teachers without laryngeal affections and 13 with laryngeal affections, mean age 39.1 years old and 39.5 years old, respectively. Glottic source acoustic analysis was performed with the Multi-Dimensional Voice Program Advanced. The data were analyzed statistically to verify the significance of each acoustic measure between the groups (with laryngeal affection, without laryngeal affection, and total) and in relation to the normality proposed by the software. RESULTS: In the three conditions (groups with and without affection and total) the means were statistically below normality in the measurements of maximum and minimum fundamental frequency. In the group without affection, frequency, and noise measurements presented above normality. In both groups, measurements of frequency, noise, and subharmonic segments were above normal, and number of voice breaks below normal. CONCLUSION: Acoustic parameters outside the normal pattern showed an aperiodic vocal production, with presence of noise and instability in the vocal signal, in dysphonic teachers with or without alteration at the laryngeal level.

Glottal Closure in Women with No Voice Complaints or Laryngeal Disorders

Introduction: The understanding of normal vocal production is essential to guide any voice professional as it is fundamental to understand the effects of the posterior glottal gap on the vocal quality. Objective: The aim of the present study was to verify the association between glottic closure, acoustic parameters, and some characteristics of the videolaryngostroboscopy of young women without vocal complaints nor laryngeal disorders. Methods: This is a cross-sectional study with 56 women between 20 and 30 years old who underwent videolaryngostroboscopy. The acoustic parameters of the vowel /a:/ were analyzed using the Praat software, Release 4.6.10 (Paul Boersman and David Weenik, Amsterdam, Netherlands). Statistical Analysis: The chi-squared, Fischer, and Kruskall-Wallis tests were applied, with 5% significance. Results: Significant occurrence of posterior glottal gap (85.71%, p < 0.001), of normal vocal folds vibration amplitude (82.14%, p < 0.001), and of absence of significant constriction of the laryngeal vestibule (98.21%, p < 0.001); no significant association of the glottic closure with the vocal acoustic parameters; no significant association of glottic closure, vocal folds vibration amplitude, and constriction of the laryngeal vestibule. Conclusion: There was a predominance of posterior glottal gap, normal vocal folds vibration amplitude, and absence of laryngeal vestibule constriction, and no relation with the acoustic parameters, suggesting that the posterior glottal gap did not generate impact on the vocal production of the young adult women studied (AU)

Glottal Closure in Women with No Voice Complaints or Laryngeal Disorders.

Introduction The understanding of normal vocal production is essential to guide any voice professional as it is fundamental to understand the effects of the posterior glottal gap on the vocal quality. Objective The aim of the present study was to verify the association between glottic closure, acoustic parameters, and some characteristics of the videolaryngostroboscopy of young women without vocal complaints nor laryngeal disorders. Methods This is a cross-sectional study with 56 women between 20 and 30 years old who underwent videolaryngostroboscopy. The acoustic parameters of the vowel /a:/ were analyzed using the Praat software, Release 4.6.10 (Paul Boersman and David Weenik, Amsterdam, Netherlands). Statistical Analysis The chi-squared, Fischer, and Kruskall-Wallis tests were applied, with 5% significance. Results Significant occurrence of posterior glottal gap (85.71%, p < 0.001), of normal vocal folds vibration amplitude (82.14%, p < 0.001), and of absence of significant constriction of the laryngeal vestibule (98.21%, p < 0.001); no significant association of the glottic closure with the vocal acoustic parameters; no significant association of glottic closure, vocal folds vibration amplitude, and constriction of the laryngeal vestibule. Conclusion There was a predominance of posterior glottal gap, normal vocal folds vibration amplitude, and absence of laryngeal vestibule constriction, and no relation with the acoustic parameters, suggesting that the posterior glottal gap did not generate impact on the vocal production of the young adult women studied.

Maximum phonation times and vital capacity in dysphonic women / Tempos máximos de fonação e capacidade vital de mulheres disfônicas

ABSTRACT Objective: to verify the correlation between vital capacity and maximum phonation times of /ė/ (unvoiced) and /s/, as well as compare and relate them with the professional voice use and age in women with functional or organic-functional dysphonia. Methods: a retrospective research with 524 records of dysphonic patients from a school clinic, including young adult women with a speech-language diagnosis of functional or organic-functional dysphonia based on medical reports. Neurological and psychiatric alterations, previous speech therapy treatment, symptoms of flu or allergies on the day of evaluation, pulmonary disease, organic dysphonia diagnosis, and hearing loss, were excluded. The sample resulted in 14 women with functional dysphonia and 21 with organic-functional dysphonia. Data on professional voice use, as well as results for vital capacity and maximum phonation times were collected. The data were statistically analyzed at a 5% significance level. Results: There was a positive correlation for both groups of dysphonic patients between the maximum phonation times of /ė/ and of /s/, as well as the maximum phonation times of /ė/, /s/, and vital capacity. Higher values for vital capacity and maximum times of /s/ and /ė/ for voice professionals were seen. The maximum phonation times of /ė/ were lower than those of /s/. Conclusion: as the maximum phonation times of /ė/ increased, the maximum phonation times of /s/ and the vital capacity also augmented in both groups, demonstrating the interrelation among these variables; there was no relation with the other variables studied.

RESUMO Objetivo: verificar a correlação entre capacidade vital, tempos máximos de fonação de /ė/ (sem sonorização) e /s/ e comparar e relacionar com o uso profissional da voz e a idade em mulheres com disfonia funcional ou organofuncional. Métodos: pesquisa retrospectiva com 524 registros de disfônicos de uma clínica-escola. Foram incluídas: mulheres adultas jovens, diagnóstico fonoaudiológico de disfonia funcional ou organofuncional, com base no laudo médico. Foram excluídas: alterações neurológicas, psiquiátricas, tratamento fonoaudiológico prévio, quadro gripal ou alérgico no dia das avaliações, doença pulmonar, diagnóstico de disfonia orgânica, perda auditiva. A amostra resultou em 14 mulheres com disfonia funcional e 21 com disfonia organofuncional. Coletaram-se dados sobre e uso profissional da voz e resultados da capacidade vital e dos tempos máximos de fonação. Os dados foram analisados estatisticamente com nível de significância de 5%. Resultados: correlação positiva para ambos os grupos de disfônicas entre: tempo máximo de fonação de /ė/ e tempo máximo de fonação de /s/; e entre tempo máximo de fonação de /ė/, /s/ e capacidade vital. Maiores valores de capacidade vital, tempo máximo de /s/ e /ė/ nas profissionais da voz. Os valores de tempo máximo de fonação de /ė/ foram menores do que /s/. Conclusão: à medida que o tempo máximo de fonação de /ė/ aumentou, o tempo máximo de fonação de /s/ e a capacidade vital também aumentaram em ambos os grupos, evidenciando a inter-relação entre essas variáveis; não havendo relação com as demais variáveis estudadas.

Efeitos da técnica finger kazoo conforme o tempo de execução / Effects of kazoo finger technique as the time of execution / Efectos de la técnica finger kazoo conforme el tiempo de ejecución

Objetivo: Comparar o efeito da técnica de finger kazoo (FK), conforme o tempo de execução, em mulheres com voz e laringe normal. Métodos: 45 voluntárias emitiram a vogal /a:/ antes e após três séries de 15 repetições da técnica FK. Foram cronometrados e somados os tempos de todas as repetições da técnica, e os sujeitos foram divididos em grupos conforme o tempo de execução total: grupo I (até 5min de execução); grupo II (de 5,1min até 7min); grupo III (de 7,1min até 10min); e grupo IV (de 10,1min até 15min). Os grupos I, II e III ficaram com 12 sujeitos e o grupo IV, com oito. Foram realizadas medidas acústicas glóticas e espectrográficas, avaliação vocal perceptivoauditiva (escala RASATI) e autoavaliação vocal pré e pós-FK. Kruskal-Wallis e post hoc foram aplicados. Resultados: Na espectrografia de banda estreita, houve diminuição do ruído nas altas frequências no grupo IV comparado ao grupo II. Na espectrografia de banda larga, não houve diferença entre os grupos. Em todos os grupos, ocorreu melhor voz autorreferida, sem diferenças. Na RASATI, houve diminuição significativa da rouquidão e da astenia no grupo I, quando comparado aos grupos II e III. Conclusão: Não foi possível estabelecer um tempo ideal de execução do FK, mas houve diferença em relação aos efeitos gerados pela técnica nos sujeitos que realizaram o mesmo número de repetições, com melhora perceptivoauditiva da voz com até 5min de FK e melhora espectrográfica apenas a partir de 10min. Em todos os grupos, foi observada melhora qualitativa da autopercepção vocal.

Objective: Compare the effect of the technique of Finger Kazoo (FK), according to the execution time, in women with normal voice and larynx. Methods: 45 volunteers emitted the vowel /a:/ before and after three series of the 15 repetitions of FK technique. The times of all repetitions of the technique were timed and summed up, and the subjects were divided into groups according to the total execution time: group I (up to five minutes); group II (five minutes and one second to seven minutes); group III (seven minutes and one second to ten minutes); and group IV (ten minutes and one second to fifteen minutes). The groups I, II, III were 12 subjects in group IV, with eight. Were performed glottal and spectrographic acoustic analysis, auditory perceptual (RASATI scale) and vocal self-assessment. Kruskal-Wallis and post hoc tests were applied. Results: The spectrographic of narrowband had significant decrease noise in high, medium and low frequencies in group IV, compared to group II. In the spectrographic of broadband there was no difference between groups. In all groups, occurred self-reported best voice, without significance. In RASATI, there was significant decrease of hoarseness and asthenia in group I, compared to groups II and III. MDVPA without significance. Conclusion: It was not possible to find an ideal time to perform the FK, but there was a difference in the effects generated by the technique in the subjects who performed the same number of repetitions, with auditory improvement of the voice with up to 5 minutes of FK and improvement in the spectrograph only after 10 minutes. In all groups, qualitative improvement of vocal self-perception was observed.

Objetivo: Comparar el efecto de la técnica finger kazoo (FK) conforme el tiempo de ejecución en mujeres con voz y laringe normales. Métodos: 45 voluntarias emitieron la vocal / a: / antes y después de tres series de 15 repeticiones de la técnica FK. Fueron cronometrados y sumados los tiempos de todas las repeticiones y los sujetos fueron divididos en grupos de acuerdo uma el tiempo de ejecución total: grupo I (hasta 5 minutos); grupo II (de 5,1min a 7min); grupo III (7,1min a 10 min); y grupo IV (de 10,1min a 15 min). Los grupos I, II y III se quedaron con 12 sujetos y el grupo IV con ocho. Se llevaron a cabo mediciones acústicas, glóticas y espectrográficas, evaluación vocal perceptivo audiotiva (escala RASATI) y auto evaluación vocal pre y post-FK. Kruskal-Wallis e post hoc fueron aplicados. Resultados: En la espectrógrafia de banda estrecha, hubo reducción del ruído en las frecuencias altas en el grupo IV en comparación con el grupo II. En la espectroscopia de banda ancha, no hubo diferencias entre los grupos. En todos los grupos ocurrió mejor voz de auto-reporte sin diferencias. En la RASATI, hubo uma disminución significativa de la ronquera y la astenia en el grupo I, cuando comparado a los grupos II y III. Conclusión: No fue posible establecer un tiempo ideal de ejecución del FK, pero no hubo diferencias cuanto a los efectos generados por la técnica en los sujetos que realizaron el mismo número de repeticiones, con mejora perceptivo auditiva de la voz para hasta 5min del FK y mejora espectrográfica apenas desde 10min. En todos los grupos, hubo uma mejora cualitativa de la autopercepción vocal.

Terapia breve e intensiva com finger kazoo em caso de disfonia orgânica pós-intubação orotraqueal / Short and intensive therapy with finger kazoo in patient with organic dysphonia post-orotracheal intubation / Terapia breve e intensa con finger kazoo en paciente con disfonía orgánica postintubación orotraqueal

Objetivo: avaliar o efeito de um programa de Terapia Breve e Intensiva com a técnica finger kazoo em paciente adulta do sexo feminino com disfonia orgânica. Apresentação do caso clínico: realizadas medidas aerodinâmicas, acústicas, perceptivo auditivas, videolaringoestroboscópicas e autoavaliação vocal antes e após 15 sessões de terapia breve e intensiva com a técnica finger kazzo em uma mulher de 62 anos com disfonia orgânica por fibrose em prega vocal direita, fenda glótica do tipo irregular, com assimetria de fase e amplitude, além de edema da subglote e retração da porção anterior da prega vestibular direita decorrente de intubação orotraqueal. Resultados: Após a terapia, houve adequação dos tempos máximos de fonação, de medidas acústicas de frequência, perturbação de frequência, ruído, segmentos sub-harmônicos, melhor delineamento do traçado espectrográfico e de todos os parâmetros perceptivo auditivos, além de aumento dos escores de qualidade de vida, de depressão e ansiedade. Na avaliação videolaringoestroboscópica, houve melhora da amplitude de vibração da mucosa das pregas vocais e redução da constrição medial do vestíbulo laríngeo. Conclusão: houve modificações vocais positivas em nível glótico, respiratório e ressonantal, bem como no exame videolaringoestroboscópico e na autoavaliação vocal, evidenciando que essa foi uma modalidade de tratamento efetiva para o caso.

Objective: to evaluate the effect of a program of brief and intensive therapy with finger kazoo technique in adult female patient with organic dysphonia. Presentation of the case: were realized aerodynamic, acoustic, perceptual, videolaryngostroboscopic measures and vocal self-assessment before and after 15 sessions of short and intensive therapy with finger kazzo technique in a 62 years woman with organic dysphonia by fibrosis in the right vocal fold, glottis of irregular type with phase asymmetry and amplitude, and edema of the glottis and contraction of the anterior portion of the right vestibular fold due to endotracheal intubation. Results: After therapy, there was improvement of maximum phonation time, acoustic frequency measurements, frequency of disturbance noise, sub-harmonic segments, improved stroke spectrographic and all perceptual parameters, as well as improvement of quality of life scores, depression and anxiety. In the videolaryngostroboscopy evaluation, there was improvement in range of mucosa vibration of the vocal folds and reduction of medial constriction of the laryngeal vestibule. Conclusion: there were positive vocal changes in glottic, respiratory and resonant level, videolaryngostroboscopy and vocal self-assessment, emphasizing that this was an effective treatment modality for the case.

Objetivo: evaluar los efectos de un programa de Terapia Breve e Intensa utilizando la técnica finger kazoo en una paciente adulta del sexo femenino con disfonía orgánica. Presentación del caso clínico: fueron realizadas las medidas aerodinámicas, acústicas, perceptivo auditivas, videolaringoestroboscópicas y autoevaluación vocal antes y post 15 sesiones de terapia breve e intensa con la técnica finger kazzo en una mujer de 62 años con disfonía orgánica por fibrosis en la cuerda vocal derecha, hiato glótico irregular, con asimetría de fase y amplitud, además de edema de la subglotis y retracción de la porción anterior de la cuerda vestibular derecha debido a intubación orotraqueal. Resultados: Después de la terapia, hubo adecuación en los tiempos máximos de fonación, de las medidas acústicas de frecuencia, perturbación de frecuencia, ruido, segmentos sub-armónicos, mejora del trazado espectrográfico y de todos los parámetros perceptivo auditivos, así como mejora de los puntajes de calidad de vida, depresión y ansiedad. En la evaluación videolaringoestroboscópica, hubo mejora en la amplitud de vibración da la mucosa de las cuerdas vocales y reducción da la constricción mediana del vestíbulo laríngeo. Conclusión: hubo positivos cambios vocales a nivel glótico, respiratorio y resonante, así como en el examen videolaringoestroboscópico y en la autoevaluación vocal, lo que enseña que la modalidad de tratamiento fue efectiva para el caso.

Acoustic and Auditory Perception Effects of the Voice Therapy Technique Finger Kazoo in Adult Women.

OBJECTIVE: This study aimed to verify and to correlate acoustic and auditory-perceptual measures of glottic source after the performance of finger kazoo (FK) technique. STUDY DESIGN: This is an experimental, cross-sectional, and qualitative study. METHOD: We made an analysis of the vowel [a:] in 46 adult women with neither vocal complaints nor laryngeal alterations, through the Multi-Dimensional Voice Program Advanced and RASATI scale, before and immediately after performing three series of FK and 5 minutes after a period of silence. Kappa, Friedman, Wilcoxon, and Spearman tests were used. RESULTS: We found significant increase in fundamental frequency, reduction of amplitude variation, and degree of sub-harmonics immediately after performing FK. Positive correlations were measures of frequency and its perturbation, measures of amplitude, of soft phonation index, of degree and number of unvoiced segments with aspects of RASATI. Negative correlations were voice turbulence index, measures of frequency and its perturbation, and measures of soft phonation index with aspects of RASATI. CONCLUSIONS: There was fundamental frequency increase, within normal limits, and reduction of acoustic measures related to presence of noise and instability. In general, acoustic measures, suggestive of noise and instability, were reduced according to the decrease of perceptive-auditory aspects of vocal alteration. It shows that both instruments are complementary and that the acoustic vocal effect was positive.

Ensaio clínico controlado e randomizado de terapia breve e intensiva com finger kazzo em professoras: estudo preliminar / Controlled and randomized clinical trial of intensive short-term voice therapy with finger kazzo technique in teachers

RESUMO Introdução A efetividade das técnicas vocais contribui com a prevenção/tratamento do distúrbio de voz relacionado ao trabalho. Objetivo: Verificar medidas vocais acústicas, perceptivoauditivas e videolaringoestroboscópicas em professoras disfônicas de dois grupos de estudo, antes e após um programa de terapia breve e intensiva com a técnica finger kazoo, comparando-os entre si e com respectivos grupos de controle. Métodos Estudo randomizado, pré-teste e pós-teste, com grupo controle, cego ao avaliador. Dois grupos de estudo, com e sem afecção laríngea estrutural (24 professoras disfônicas), realizaram 15 sessões de terapia breve e intensiva com finger kazoo, durante três semanas e foram comparados a dois grupos de controle (17 professoras disfônicas), que não fizeram terapia. Realizaram-se análises vocal acústica (Multi Dimensional Voice Program Advanced), perceptivoauditiva (três fonoaudiólogos) e videolaringoestroboscopia (três otorrinolaringologistas), para comparação dos resultados. Resultados Observou-se redução significativa da proporção ruído/harmônico no grupo de estudo com afecção, após a terapia. Na comparação entre o grupo de estudo sem afecção e o respectivo controle, verificou-se redução significativa de medidas de jitter, shimmer e de segmentos surdos, em favor do grupo de estudo. Constatou-se, também, redução significativa do grau da disfonia, rouquidão, soprosidade e tensão, além de menor ocorrência de fenda triangular de grau II e maior amplitude de vibração das pregas vocais, no grupo de estudo sem afecção. Conclusão A terapia breve e intensiva com finger kazoo beneficiou a voz, o fechamento glótico e a amplitude de vibração da onda mucosa das pregas vocais das professoras disfônicas com e sem afecção laríngea estrutural, sobretudo daquelas sem afecção.

ABSTRACT Introduction Knowledge about effective vocal techniques will contributes to the prevention/treatment of work-related voice disorder. Purpose Verifying acoustic vocal, auditory-perceptive and videolaryngostroboscopic measures in dysphonic teachers of two groups before and after a brief and intensive therapy program with finger kazoo technique, comparing to their control groups, and comparing the study groups between themselves. Methods Randomized study, pre-test and post-test, with control group, blind to the evaluator. Two study groups, with and without structural laryngeal affection (24 dysphonic teachers) performed15 sessions of a brief and intensive care with finger kazoo over three weeks and they were compared to two control groups (17 dysphonic teachers), who did not do therapy, in a total of 41 subjects. We carried out vocal acoustic analysis (Multi-Dimensional Voice Program Advanced), perceptual analysis (by three speech therapists) and videolaryngostroboscopy analysis (by three otolaryngologists) to compare the results obtained by each group. Results Significant reduction in harmonic-noise ratio in the study group with alteration after therapy was observed. In the comparison between the study group without affection with the respective control, there was a significant decrease in jitter, shimmer and voiceless segments in favor of the study group. It was also observed a significant reduction in dysphonia, hoarseness, breathiness and tension levels, as well as a lower incidence of triangular slit - level II - and higher amplitude of vibration of the vocal folds in the study group with alteration. Conclusion The brief and intensive care with finger kazoo provided voice, glottal closure and amplitude of mucosal wave vibration of the vocal folds improvements in dysphonic teachers with and without structural alterations of the vocal folds, especially in teachers without structural alterations.

Fonoterapia com fonação em tubos em paciente com paralisia de prega vocal medializada cirurgicamente: estudo de caso / Speech therapy with phonation into tubes in a patient with vocal fold paralysis surgically medialized: a case study

RESUMO O objetivo deste estudo foi verificar as modificações vocais perceptivo-auditivas e acústicas ocorridas após um método de fonoterapia breve usando três modalidades de fonação em tubos em um sujeito do gênero masculino com paralisia unilateral de prega vocal medializada cirurgicamente. Paciente do gênero masculino, 29 anos e um mês de idade, com diagnóstico otorrinolaringológico de paralisia de prega vocal esquerda em abdução e encaminhado para cirurgia de medialização da prega vocal esquerda (Tiroplastia tipo I) e fonoterapia. Foram realizadas cinco coletas da emissão da vogal /a:/ em momentos distintos, sendo eles: antes da cirurgia; após dez dias da cirurgia (antes da fonoterapia); após seis dias de execução da técnica de fonação em tubo de látex imerso em água; após seis dias de execução de fonação em tubo de vidro imerso em água; após seis dias de execução da fonação em tubo de menor diâmetro. Foi realizada avaliação acústica de fonte glótica, espectrográfica e perceptivo-auditiva. A fonoterapia com os três diferentes exercícios de fonação em tubo, durante 18 dias de tratamento condensado, proporcionou na análise acústica, melhora da maioria das medidas de perturbação de frequência e de componentes surdos ou não sonorizados; da intensidade da cor do traçado da espectrografia de banda larga, da regularidade dos traçados espectrográficos e da definição dos formantes; na análise perceptivo-auditiva, houve redução de tensão, aspereza e soprosidade.

ABSTRACT The purpose of this study is to verify the perceptive-auditory and acoustic voice changes after speech therapy with phonation into tubes in a male subject with unilateral vocal fold paralysis, medialized surgically. The patient was a male, twenty nine years and one month, with otorhinolaryngological diagnosis of left vocal fold paralysis in abduction. The subject was referred to medialization surgery of the left vocal fold (Thyroplasty type I) and to speech therapy. Five collections of the vowel /a:/ occurred at different times, as follows: before surgery; ten days after surgery (before speech therapy); six days after the performance of the technique of phonation into latex tube immersed in water; six days after the performance of the technique of phonation into glass tube immersed in water; six days after the performance of the technique of phonation into tube of smaller diameter. There was acoustic analysis of glottal source, spectrographic analysis and perceptive-auditory analysis. Final comments: The speech therapy with three different exercises of phonation, for 18 days, provided, in the acoustic analysis, improvement of most frequency perturbation measures and measures of voiceless or not sounded components; improvement of the intensity of the tracing color of the wide-band spectroscopy; improvement of the regularity of the spectrographic tracing and of the definition of formants; in the perceptive-auditory analysis, there was reduction of tension, roughness and breathiness.

Saúde geral, sensações vocais, diagnóstico otorrinolaringológico e tempo de uso vocal de professores / Health, vocal sensations, otorhynolaryngologic diagnosis and teachers' time of vocal use / Salud, sensaciones vocales, diagnóstico otorrinolaringológico y tiempo del uso vocal en el trabajo de profesores

Objetivo: Verificar e correlacionar dados de saúde geral, sensações vocais, diagnóstico otorrinolaringológico e tempo de uso vocal no trabalho de um grupo de professores de uma cidade de porte médio do interior do estado. Método: Participaram 25 professores de ambos os sexos (22 mulheres e três homens) com idades entre 24 e 61 anos. Analisaram-se as respostas aos questionários de identificação, anamnese e de autoavaliação vocal e os diagnósticos otorrinolaringológicos através de análises estatísticas. Resultados: Houve predomínio de: sensações vocais negativas - secreção na garganta e/ou pigarro (60%), falhas na voz (52%), secura na boca e/ou garganta (48%) e fadiga (44%); presença de afecção laríngea - nódulos vocais (20%), vasculodisgenesia (12%), fendas triangulares grau II (12%), fendas fusiformes (8%) e hiperconstrição supraglótica (8%); referência de rinite e sinusite, principalmente em professores com afecção laríngea. Não houve correlação entre as variáveis estudadas. Conclusão: Predominaram as sensações vocais negativas, a presença de afecção laríngea e a referência à presença de rinite e sinusite; não havendo relação entre a presença de sensações vocais, idade e/ ou tempo de uso da voz no trabalho

Objective: Verify and correlate health data, vocal sensations, otorhynolaryngologic diagnosis and time of vocal use at work of a group of teachers from a medium-sized city in the state. Methods: Participated 25 teachers of both genders (22 women and three men) aged between 24 and 61 years. The responses to the identification questionnaires, anamnesis and vocal self-assessment and otorhynolaryngologic diagnosis were analyzed through statistical analysis. Results: Prevalence of: negative vocal sensations - secretion in the throat and / or phlegm (60%), voice failures (52%), dry mouth and / or throat (48%) and fatigue (44%); presence of laryngeal disease - vocal nodules (20%), varicosity (12%), triangular glottic slit grade II (12%), fusiform slit (8%) and supraglottic hyperconstriction (8%); rhinitis and sinusitis reference, especially in teachers with laryngeal disease. There was no correlation among variables. Conclusion: The negative vocal sensations, the presence of laryngeal disease and the presence of the rhinitis and sinusitis reference predominated; there is no relationship among the vocal sensations, age and or time vocal use at work.

Objetivo: Comprobar y correlacionar los datos de salud general, sensaciones vocales, diagnóstico otorrinolaringológico y tiempo de uso vocal en el trabajo de un grupo de profesores de una ciudad de tamaño mediano en el estado. Métodos: Participaron 25 profesores de ambos sexos (22 mujeres y tres hombres) con edades entre 24 y 61 años. Se analizaron las respuestas de los cuestionarios de identificación, anamnesis y autoevaluación vocal, y el diagnóstico otorrinolaringológico, a través del análisis estadístico. Resultados: Hubo predominación de: sensaciones vocales negativas - secreción en la garganta y / o carraspera (60%), fallos de voz (52%), sequedad de boca y / o de garganta (48%) y fatiga (44%); presencia de enfermedad de laringe - nódulos vocales (20%), vasculodysgenesia (12%), ranuras triangulares grado II (12%), ranuras en forma de huso (8%) y hyperconstriction supraglótica (8%); referencia de rinitis y sinusitis, principalmente en los profesores con enfermedad de laringe. No hubo correlación entre las variables estudiadas. Conclusión: Predominaron las sensaciones vocales negativas, la presencia de enfermedad de laringe y la referencia a la presencia de rinitis y sinusitis; no existe relación entre la presencia de sensaciones vocales, edad o tiempo de uso de la voz en el trabajo.

Alterações de sistema estomatognático em indivíduos disfônicos / Stomatognatic system changes in dysphonic individuals

RESUMO: Objetivo: verificar a presença de alterações do sistema estomatognático e sua associação com o sexo, profissão, relato de alergias e diagnóstico fonoaudiológico do tipo de disfonia em indivíduos disfônicos que procuraram atendimento em uma clínica-escola fonoaudiológica. Métodos: estudo quantitativo e retrospectivo, por meio de banco de dados. Amostra de 69 prontuários de sujeitos de ambos os sexos, com idades entre 19 e 44 anos. Coletaram-se dados sobre faixa etária, sexo, profissão, relato de alergias, diagnóstico fonoaudiológico do tipo de disfonia, tipo respiratório e dados da avaliação antroposcópica do sistema estomatognático: oclusão, alterações horizontais e transversais de mordida, largura e profundidade do palato duro, modo respiratório e tensão de lábios, língua e bochechas. Resultados: 28,99% (n=20) eram profissionais da voz; 33,33% (n=23) relataram alergias; tipo respiratório misto com 75,36% (n=52), seguido pelo superior com 20,29% (n=14) e costodiafragmaticoabdominal com 4,35% (n=3); tipo de disfonia funcional (n=42; 66,67%), seguido pelo organofuncional (n=19; 23,54%) e orgânico (n=8; 11,59%). Nas associações de alterações do sistema estomatognático com tipos e modos respiratórios, tipos de disfonia, profissionais da voz e relato de alergias não houve significâncias, apenas do sexo feminino com ausência de alterações verticais de mordida. Conclusão: os pacientes estudados eram predominantemente mulheres; adultos; não profissionais da voz; com disfonia funcional; sem relato de alergias ou alterações de sistema estomatognático; com tipo e modo respiratórios adequados, havendo associação apenas do sexo feminino com ausência de alterações verticais de mordida.

ABSTRACT: Purpose: verifying the presence of the stomatognathic system changes and its association with gender, profession, allergies report and speech diagnosing the type of dysphonia in dysphonic individuals who sought care in a speech therapy school clinic. Methods: quantitative and retrospective study, through the database. Sample of 69 subjects records of both genders, aged between 19 and 44 years. Data were collected on age, gender, profession, report of allergies, speech therapy diagnosis of the type of dysphonia, respiratory type and data of anthroposcopic evaluation of the stomatognathic system: occlusion, horizontal and transverse bite changes, width and depth of the hard palate, breathing mode and lips, tongue and cheeks tension. Results: 28.99% (n=20) were voice professional; 33.33% (n=23) reported allergies; mixed respiratory type with 75.36% (n=52), followed by the superior with 20.29% (n=14) and diaphragmatic breathing with 4.35% (n=3); type of functional dysphonia (n=42; 66.67%), followed by organofunctional (n=19; 23.54%) and organic (n=8; 11.59%). There were not significances in the stomatognathic system changes associations with types and breathing techniques, types of dysphonia, voice professional and allergies report, there were only significances in female with no vertical bite changes. Conclusion: studied patients were predominantly women; adults; not voice professionals; with functional dysphonia; no history of allergies or stomatognathic system changes; with proper type and mode breathing, with only female association with no vertical bite changes.

Effect of Vocal Fry on Voice and on Velopharyngeal Sphincter

Abstract Introduction It is known that the basal sound promotes shortening and adduction of the vocal folds and leaves the mucosa looser. However there are few studies that address the supralaryngeal physiological findings obtained using the technique. Objective To check the effectiveness of using vocal fry on the voice and velopharingeal port closure of five adult subjects, whose cleft palate has been corrected with surgery. Methods Case study with five subjects who underwent otolaryngology examination by means of nasopharyngoscopy for imaging and measurement of the region of velopharyngeal port closure before and after using the vocal fry technique for three minutes. During the exam, the subjects sustained the isolated vowel /a:/ in their usual pitch and loudness. The emission of the vowel /a:/ was also used for perceptual analysis and spectrographic evaluation of their voices. Results Four subjects had an improvement in the region of velopharyngeal port closure; the results of the spectrographic evaluation were indicative of decreased hypernasality, and the results of the auditory-perceptual analysis suggested improved overall vocal quality, adequacy of loudness, decreased hypernasality, improvement of type of voice and decreased hoarseness. Conclusion This study showed a positive effect of vocal fry on voice and greater velopharyngeal port closure.

Effect of Vocal Fry on Voice and on Velopharyngeal Sphincter.

Introduction It is known that the basal sound promotes shortening and adduction of the vocal folds and leaves the mucosa looser. However there are few studies that address the supralaryngeal physiological findings obtained using the technique. Objective To check the effectiveness of using vocal fry on the voice and velopharingeal port closure of five adult subjects, whose cleft palate has been corrected with surgery. Methods Case study with five subjects who underwent otolaryngology examination by means of nasopharyngoscopy for imaging and measurement of the region of velopharyngeal port closure before and after using the vocal fry technique for three minutes. During the exam, the subjects sustained the isolated vowel /a:/ in their usual pitch and loudness. The emission of the vowel /a:/ was also used for perceptual analysis and spectrographic evaluation of their voices. Results Four subjects had an improvement in the region of velopharyngeal port closure; the results of the spectrographic evaluation were indicative of decreased hypernasality, and the results of the auditory-perceptual analysis suggested improved overall vocal quality, adequacy of loudness, decreased hypernasality, improvement of type of voice and decreased hoarseness. Conclusion This study showed a positive effect of vocal fry on voice and greater velopharyngeal port closure.

Tempo máximo fonatório de /e/ e /ė/ não-vozeado e sua relação com índice de massa corporal e sexo em crianças / Maximum phonation time of /e/ and voiceless /ė/ and their relationship with body mass index and gender in children

RESUMO Objetivo: caracterizar e associar tempo máximo fonatório do /e/ vozeado e de /e/ não vozeado (/ė/), índice de massa corporal e sexo em crianças. Métodos: estudo transversal observacional analítico de campo e quantitativo do qual participaram 102 crianças com idades entre oito e 12 anos (média de 9,66 anos), sendo 53 (51,96%) meninas e 49 (48,04%) meninos. Os sujeitos passaram por triagem auditiva, avaliação antropométrica e coleta dos tempos máximos fonatórios de /e/ e /ė/. Os dados foram analisados por meio dos testes não-paramétricos Mann-Whitney e Correlação de Spearman, com nível de significância de 5%. Resultados: não houve diferença dos tempos máximos fonatórios de /e/, /ė/ e relação ė/e em função do índice de massa corporal e faixa etária, porém crianças do sexo masculino apresentaram tempo máximo fonatório de /e/ significantemente maior do que as meninas. Não foi encontrada correlação entre tempo máximo fonatório e índice de massa corporal. Conclusão: não houve diferença entre tempo máximo fonatório de /ė/, /e/ e relação ė/e, conforme faixa etária e índice de massa corporal, bem como o índice de massa corporal e os tempos máximos fonatórios não se correlacionaram, evidenciando homogeneidade entre as medidas dentro do grupo, sem influência do índice de massa corporal sobre os tempos máximos fonatórios. Em relação ao sexo, os meninos apresentaram tempo máximo fonatório de /e/ maior do que as meninas e apenas as crianças de oito anos apresentaram os TMF tempo máximo fonatório dentro do esperado.

ABSTRACT Purpose: to characterize and associate children's maximum phonation time of voiced /e/ and voiceless /e/ (/ė/), body mass index and gender. Methods: field and quantitative analytical observational cross-sectional study attended by 102 children aged between eight and 12 years (mean 9.66 years), being 53 (51.96%) girls and 49 (48.04%) boys. The subjects have gone through hearing screening, anthropometric assessment and collection of the maximum phonation times of /e/, /ė/. Data were analyzed using non-parametric Mann-Whitney and Spearman's rank correlation coefficient tests, with 5% significance level. Results: there was no difference of maximum phonation times of /e/, /ė/, or the relationship between them as a function of body mass index and age, but male children showed maximum phonation time significantly of /e/ higher than girls. No correlation was found between maximum phonation time and body mass index. Conclusion: there was no difference between maximum phonation time of /ė/, /e/ and ė/e ratio, according to age and body mass index, and body mass index and maximum phonation time were not correlated, showing homogeneity between measures within the group without influence of body mass index on the maximum phonation time. As for gender, boys presented maximum phonation time of /e/ higher than girls and only children aged eight years had maximum phonation time as expected.

Respiratory Muscle Strength, Sound Pressure Level, and Vocal Acoustic Parameters and Waist Circumference of Children With Different Nutritional Status.

OBJECTIVE: Relate respiratory muscle strength (RMS), sound pressure (SP) level, and vocal acoustic parameters to the abdominal circumference (AC) and nutritional status of children. STUDY DESIGN: This is a cross-sectional study. METHODS: Eighty-two school children aged between 8 and 10 years, grouped by nutritional states (eutrophic, overweight, or obese) and AC percentile (≤25, 25-75, and ≥75), were included in the study. Evaluations of maximal inspiratory pressure (IPmax) and maximal expiratory pressure (EPmax) were conducted using the manometer and SP and acoustic parameters through the Multi-Dimensional Voice Program Advanced (KayPENTAX, Montvale, New Jersey). RESULTS: There were significant differences (P < 0.05) in the EPmax of children with AC between the 25th and 75th percentiles (72.4) and those less than or equal to the 25th percentile (61.9) and in the SP of those greater than or equal to the 75th percentile (73.4) and less than or equal to the 25th percentile (66.6). The IPmax, EPmax, SP levels, and acoustic variables were not different in relation to the nutritional states of the children. There was a strong and positive correlation between the coefficient of amplitude perturbations (shimmer), the harmonics-to-noise ratio and the variation of the fundamental frequency, respectively, 0.79 and 0.71. CONCLUSIONS: RMS and acoustic voice characteristics in children do not appear to be influenced by nutritional states, and respiratory pressure does not interfere with acoustic voice characteristics. However, localized fat, represented by the AC, alters the EPmax and the SP, each of which increases as the AC increases.