What Factors Determine the Use of Volitional and Non-Volitional Devices in Vocal Interventions Performed by Brazilian Speech-Language Pathologists?

OBJECTIVE: To analyze the determining factors for using devices in vocal interventions and characterize their use by Brazilian speech-language pathologists (SLPs). METHODS: This cross-sectional observational study had a sample of 148 SLPs with clinical practice in voice. They answered an online questionnaire via Google Forms about sociodemographic data, training, work in the area, and the use of devices in vocal interventions. Data were analyzed descriptively and inferentially. RESULTS: Tubes, straws, and masks were the most commonly used devices. SLPs specializing in voice are more inclined to use thermotherapy and kinesio tapings while being less inclined to use therapeutic ultrasounds and nebulizers. Voice specialists are less likely to employ electrostimulation. The choice to use photobiomodulation and auditory monitoring devices is influenced by the years of clinical experience, whereas the speech-language therapy training duration affects the use of electrostimulation. The age of the professional also plays a role in the utilization of vibratory stimulation. Vibratory stimulation, auditory monitoring devices, thermotherapy, and nebulization are more frequently utilized among individuals who rely on their voices for occupational purposes, whereas electrostimulation is less common. The use of photobiomodulation is infrequent in children; vibratory stimulation is more common in adolescents, and thermotherapy is relatively common among older individuals. Most of these devices are typically prescribed in execution time during vocal intervention. CONCLUSION: The specialization, the time since graduation and in the occupation, and the target population of the service are the determining factors for the use of devices. They are used in vocal therapy and training, targeting vocal function.

Aspectos oromiofuncionais e fatores associados à autopercepção sobre a qualidade do sono em indivíduos com queixa de ronco / Oromyofunctional aspects and factors associated with self-perception of sleep quality in individuals with snoring complaints / Aspectos oromiofuncionales y factores asociados a la autopercepción de la calidad del sueño en individuos con quejas de ronquidos

Introdução: O sono é uma função vital e essencial para a sobrevivência humana e tem por objetivo favorecer o reparo corporal e mental. Objetivo: Investigar os fatores associados à autopercepção sobre a qualidade do sono, bem como possíveis alterações das estruturas orofaciais e funções estomatognáticas em indivíduos com queixa de ronco. Material e Método: Trata-se de estudo observacional, analítico e transversal, realizado com 30 indivíduos adultos com queixa de ronco durante o sono, com idade média de 45 anos e 5 meses. Para a avaliação de motricidade oromiofuncional foi utilizado o protocolo AMIOFE. Foram aplicados questionários para investigação do ronco e qualidade de sono dos participantes: Questionário de Berlin, Escala de Sonolência de Epworth e Questionário de qualidade de sono de Pittsburgh. Resultados: Os resultados do questionário de Pittsburgh indicaram disfunção na qualidade do sono em 66,67% dos participantes. A sonolência diurna foi evidenciada em 33,33%, por meio da Escala de Epworth. 60% dos participantes apresentaram alto risco para AOS, por meio dos escores obtidos no instrumento de Berlin. Indivíduos que não praticam exercício físico e com posição habitual de língua no assoalho bucal apresentaram maiores escores no questionário de Berlin. Houve correlação positiva estatisticamente significante e moderada entre as variáveis Índice de massa corporal (IMC) e os escores do Questionário de Berlin. Conclusão: Indivíduos com queixa de ronco apresentam dificuldades relacionadas à qualidade do sono. A autopercepção negativa de qualidade do sono teve relação com dados de motricidade orofacial, hábitos alimentares, composição corporal e hábitos de estilo de vida. (AU)

Introduction: Sleep is a vital and essential function for human survival and aims to promote bodily and mental repair. Objective: To investigate factors associated with self-perception of sleep quality, as well as possible alterations in orofacial structures and stomatognathic functions in individuals with snoring complaints. Material and Method: Observational, analytical and cross-sectional study, conducted with 30 adult individuals complaining of snoring during sleep, with a mean age of 45 years and 5 months. For the evaluation of orofacial myofunctional motricity, the (AMIOFE) was used. Questionnaires were applied to investigate the snoring and sleep quality of the participants: Berlin Questionnaire, Epworth Sleepiness Scale and Pittsburg Sleep Quality Index Questionnaire. Results: The Pittsburgh questionnaire results indicated sleep quality dysfunction in 66.67% of participants. Daytime sleepiness was evidenced in 33.33%, using the Epworth Scale. 60% of the participants presented high risk for obstructive sleep apnea syndrome (OSA), through the scores obtained in the Berlin questionnaire. Individuals who do not practice physical exercise and with usual tongue position on the oral floor presented higher scores in the Berlin questionnaire. There was a statistically significant and moderate positive correlation between the variables Body Mass Index (BMI) and the Berlin questionnaire scores. Conclusion: Individuals complaining of snoring self-reported difficulties related to sleep quality. The sleep quality difficulties self-reported were related to data on orofacial motricity, eating habits, body composition and lifestyle habits. (AU)

Introducción: El sueño es uma función vital y essencial para la supervivência human, tien como objetivo promover la reparación corporal y mental. Objetivo: Investigar los factores asociados con la autopercepción de la calidad del sueño, así como posibles alteraciones en las estructuras orofaciales y funciones estomatognáticas en individuos con quejas de ronquidos. Metodo: Se trata de estudio observacional, analítico, transversal, realizado con 30 individuos adultos con queja de ronquidos durante el sueño y edad media de 45 años y 5 meses. Para la evaluación de la motricidad oromiofuncional se utilizó el protocolo (AMIOFE/OMES). Se aplicaron cuestionarios para investigar el ronquido y la calidad de sueño de los participantes: Cuestionario de Berlín; Escala de Somnolencia de Epworth; Cuestionario de Calidad del Sueño de Pittsburgh. Resultados: Los resultados del cuestionario de Pittsburgh indicaron disfunción en la calidad del sueño en 66,67%. La Escala de Epworth evidenció somnolencia diurna en 33,33%. El 60% presentaron alto riesgo de AOS, conforme las puntuaciones obtenidas en el instrumento de Berlín. Los que no practican ejercicio físico y que tienen la posición habitual de la lengua en el piso de la boca obtuvieron puntuaciones más altas en el cuestionario de Berlín. Hubo correlación positiva estadísticamente significativa y moderada entre las variables del IMC y las puntuaciones del Cuestionario de Berlín. Conclusión: Individuos con quejas de ronquidos refieren dificultades relacionadas con la calidad del sueño. Las dificultades estuvieron relacionadas con datos de motricidad orofacial, hábitos alimentarios, composición corporal y los hábitos de estilo de vida. (AU)

Vocal Self-Perception of Home Office Workers During the COVID-19 Pandemic.

OBJECTIVE: To investigate the self-perception of vocal fatigue symptoms and musculoskeletal pain in home office workers before and during the coronavirus disease (COVID-19) pandemic. MATERIALS AND METHODS: A total of 424 individuals participated in this cross-sectional, observational, and descriptive study; they were stratified into the experimental group (EG), consisting of 235 individuals working from home office during the COVID-19 pandemic; and the control group (CG), with 189 individuals who continued to work in person during this period. All participants answered the vocal fatigue index and the musculoskeletal pain investigation questionnaires. The data were analyzed in a descriptive and inferential manner. RESULTS: Participants in the EG reported more vocal fatigue symptoms and musculoskeletal pain than those in the CG before the pandemic. However, during the pandemic, the EG presented a higher frequency of pain in the posterior of the neck, shoulder, upper back, and temporal and masseter muscles, while the CG presented a higher frequency of pain in the larynx. With regard to vocal fatigue, during the pandemic, EG had an increase in scores to factors such as tiredness and voice impairment, avoidance of voice use, and total scores. No such differences were noted in the CG. CONCLUSION: Workers who migrated to home offices during the COVID-19 pandemic are at risk of developing vocal disorders.

The influence of the low-frequency transcutaneous electrical nerve stimulation application moment in vocal quality of dysphonic women.

Objective: to compare the immediate effects of low-frequency TENS employment on vocal quality in women with behavioral dysphonia before and after vocal exercises.Methodology: 30 women (mean = 31.3 years old), diagnosed with behavioral dysphonia received low-frequency TENS before (TENS + VE Group) and after vocal exercises (VE + TENS Group) with a 1-week washout. They had their sustained vowel/a/and running speech recorded before and after each procedure for auditory-perceptual analysis and acoustic measures. The low-frequency TENS parameters applied were symmetrical biphasic quadratic pulse, 200 µs phase, 10 Hz frequency, intensity on the motor threshold, and the electrodes were positioned on the submandibular and superior fibers of the trapezius muscle region. The vocal exercises: tongue trill, humming, finger kazoo, and water resistance therapy were performed totalizing 20 min.Results: intragroup analysis of sustained vowel/a/showed reduction in both groups of strain parameter and increased the breathiness; only VE + TENS Group increased the instability parameter, decreased fundamental frequency, and increased in SPI values; the running speech analysis showed an increase in the overall degree, roughness, and breathiness parameters. However, in VE + TENS Group, there was a statistically significant decrease in the intensity of the strain and an increase in breathiness. The acoustic measures showed that VE + TENS Group had a higher variation than TENS + VE Group regarding NHR.Conclusion: vocal exercises followed by low-frequency TENS have more immediate positive effects on voice quality than the low-frequency TENS followed by vocal exercises. This is a preliminary immediate effects study, and these effects could be verified through long-term assessments.

Can Vocal Therapy With Transcutaneous Electrical Nerve Stimulation (TENS) Followed by Vocal Exercises Reduce Benign Laryngeal Lesions in Dysphonic Women?: Randomized, Blind Clinical Trial.

PURPOSE: To investigate the effectiveness of vocal therapy with the use of low-frequency transcutaneous electrical nerve stimulation (TENS) followed by voice exercises on vocal fold lesion size, vocal quality and quality of life in dysphonic women. METHODS: 27 women with vocal nodules participated, randomized into to: experimental group (EG)-13 women who received vocal therapy with 12 sessions of 20 min of TENS application (pulse:200µs, frequency:10Hz, motor threshold intensity, electrodes positioned in the trapezius muscle [descending fibers and submandibular region, bilaterally]). Each TENS session was followed by 30 min of vocal exercises; and the Control Group (CG)- 14 women who received 12 sessions with 20 min of application of placebo TENS (same conditions EG, but without receiving the stimulus electric), followed by 30 min of vocal exercise. Before, immediately after and one month after vocal therapy, participants underwent vocal recording for acoustic analysis, vocal self-assessment, laryngological examination and answered voice-related quality of life (V-RQOL) protocol. RESULTS: There was reduction in the size of vocal fold lesions only in the EG, immediately after treatment and one month after treatment. Acoustic analysis showed decreases in SPI values immediately after and one month after treatment in both groups. There was improvement in voice self-perception in both groups after treatment and one month after, but no significant difference in V-RQOL values. CONCLUSION: TENS followed by vocal exercises produced results similar to vocal therapy without TENS regarding voice quality, self-perception and quality of life in voice. However, vocal therapy with low-frequency TENS followed by vocal exercise was effective in reducing vocal fold lesion size in dysphonic women.

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

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

Influence of the characteristics of home office work on self-perceived vocal fatigue during the COVID-19 pandemic.

PURPOSE: To verify the influence of work characteristics and the occupational voice use on the self-perception of vocal fatigue symptoms in individuals working in the home office during the COVID-19 pandemic. METHODS: This was a cross-sectional, observational, and descriptive study. The sample consisted of 206 individuals (123 women and 83 men), with an average age of 34 years, working exclusively in a home office mode due to the pandemic. Through an online form, all participants responded to the Vocal Fatigue Index (VFI) protocol and the questionnaire on the characterization of work and the occupational voice use during the pandemic, developed by the authors of this study. Multiple linear regression using the backward elimination technique was performed. RESULTS: The variables the interlocutor does "not listen to me in home office work," "noise in the home office work environment," "the daily workload in home office," "vocal quality worsened in home office work," "increased vocal loudness in home office work" and "lack of training about voice use in home office work" are predictors of the dependent variable vocal fatigue symptoms. CONCLUSION: The characteristics of work and occupational voice use influence the self-perception of vocal fatigue symptoms in individuals working in the home office mode during the COVID-19 pandemic.

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

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

Vocal Self-Perception of Singers During COVID-19 Pandemic.

OBJECTIVE: to compare the self-perception of vocal fatigue and use of singing voice during the COVID-19 pandemic between professional and amateur singers and to relate this self-perception with vocal use characteristics during this period. METHODOLOGY: Participants were 121 singers divided into professional singers group (PSG) (12 men and 20 women) comprising singers who depended exclusively on singing as a profession and an amateur singers group (ASG) (37 men and 52 women) of singers who did not depend exclusively on singing for their livelihood. All answered online questionnaires through Google Forms ®. Sociodemographic and vocal characteristics were investigated before and during the pandemic; symptoms of vocal fatigue were assessed through the vocal fatigue index (VFI); and self-perception of use of singing voice through the evaluation of the ability to sing easily protocol for Brazil (EASE-Br). RESULTS: In the comparison between groups, the PSG presented higher scores of vocal fatigue in fatigue and vocal limitation (P = 0.045), vocal restriction (P = 0.002), and recovery with vocal rest (P = 0.008) domains than did the ASG. There was no difference between the groups regarding the use of singing voice. Based on the relationship between self-perception and vocal use characteristics during the pandemic, it was observed that the presence of vocal complaint was the only factor associated with self-perception of fatigue symptomatology in both groups. Regarding the self-perception of the current status of the singing voice, singing time, the presence of vocal complaints, the need to increase visual concentration, and the perception of vocal worsening during the pandemic were considered predictive for amateur singers. For professional singers, vocal complaints and vocal training were predictors for self-perception of the current status of the singing voice. CONCLUSION: Professional singers presented with higher scores of vocal fatigue than did amateur singers. The symptomatology of vocal fatigue was associated with the presence of vocal complaints in both groups. However, self-perception of the current status of the singing voice was different between the groups and was associated with vocal training for professional singers and characteristics of vocal demand of singing voice during the pandemic period for amateur singers.

Influence of vocal and aerodynamics aspects on the voice-related quality of life of older adults.

The pursuit for quality of life urged a better understanding of aspects involved in ageing to minimize its consequences. Although many studies investigated older adults' voice, aspects affecting this population voice-related quality of life have not yet been explored. Objective To investigate how aerodynamics and vocal aspects are associated with voice-related quality of life in older adults. Methodology fifty-six older adults aged 60 years or above - 39 women and 17 men - were evaluated. The following procedures were performed: application of the Voice-Related Quality of Life (V-RQOL) protocol; vocal assessment, including auditory-perceptual and acoustic analysis, from which we obtained fundamental frequency (F 0 ), standard deviation of fundamental frequency (SDF 0 ), shimmer, amplitude perturbation quotient (APQ), jitter, pitch period perturbation quotient (PPQ), and harmonics to noise ratio (HNR); aerodynamic assessment using a spirometer; and maximum phonation time (MPT) for /a/, /s/, /z/ and number counting. Results older adults tend to present high V-RQOL scores. Among women, roughness, APQ, and HNR parameters were negatively correlated with V-RQOL, whereas F 0 was positively. We found no correlation between spirometry measurements and V-RQOL. MPT for /a/, /z/, and number counting was positively correlated with V-RQOL solely among men. Conclusion Vocal roughness and acoustic parameters have a negative impact on the quality of life of older women. Respiratory aspects related to the available air support for speaking affected the most the voice-related quality of life of older men.

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

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

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

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

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

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

Influence of vocal and aerodynamics aspects on the voice-related quality of life of older adults

Abstract The pursuit for quality of life urged a better understanding of aspects involved in ageing to minimize its consequences. Although many studies investigated older adults' voice, aspects affecting this population voice-related quality of life have not yet been explored. Objective To investigate how aerodynamics and vocal aspects are associated with voice-related quality of life in older adults. Methodology fifty-six older adults aged 60 years or above - 39 women and 17 men - were evaluated. The following procedures were performed: application of the Voice-Related Quality of Life (V-RQOL) protocol; vocal assessment, including auditory-perceptual and acoustic analysis, from which we obtained fundamental frequency (F 0 ), standard deviation of fundamental frequency (SDF 0 ), shimmer, amplitude perturbation quotient (APQ), jitter, pitch period perturbation quotient (PPQ), and harmonics to noise ratio (HNR); aerodynamic assessment using a spirometer; and maximum phonation time (MPT) for /a/, /s/, /z/ and number counting. Results older adults tend to present high V-RQOL scores. Among women, roughness, APQ, and HNR parameters were negatively correlated with V-RQOL, whereas F 0 was positively. We found no correlation between spirometry measurements and V-RQOL. MPT for /a/, /z/, and number counting was positively correlated with V-RQOL solely among men. Conclusion Vocal roughness and acoustic parameters have a negative impact on the quality of life of older women. Respiratory aspects related to the available air support for speaking affected the most the voice-related quality of life of older men.

Effects of transcutaneous electrical nervous stimulation (TENS) associated with vocal therapy on musculoskeletal pain of women with behavioral dysphonia: A randomized, placebo-controlled double-blind clinical trial.

Recently, electrical stimulation in vocal rehabilitation has been the subject of studies. This treatment has shown promising results regarding the decrease of vocal/laryngeal symptoms, pain and the improvement of vocal tension. In addition to decreasing pain symptoms, TENS treatments may lead to muscle relaxation. There is no data on the effects of this resource as a vocal therapy in women with behavioral dysphonia. Research in this area may provide evidence to assist the clinical decision related to the treatment of women with complaints of behavioral dysphonia and musculoskeletal pain. OBJECTIVE: To verify the effects of low-frequency TENS in association with vocal therapy on musculoskeletal pain in women with behavioral dysphonia. METHODS: Participants included 27 women with vocal nodules randomized into two groups. The experimental group (EG) - 13 women received 12 sessions of TENS (pulse of 200 µs, frequency at 10 Hz, in motor threshold) with electrodes placed bilaterally on the trapezius muscle and submandibular area for 20 min followed by 30 min of vocal therapy, and the control group (CG) - 14 women received 12 sessions of 20 min of a placebo TENS followed by 30 min of vocal therapy. We investigated the frequency and intensity of the musculoskeletal pain in several body regions, as well as the intensity of pain at rest and in the application of pressure with an algometer applied to the descending fibers of the trapezius muscle. The pressure-pain threshold (PPT) was also investigated. All evaluations occurred before, immediately after, and at one and three months after treatment in both groups. RESULTS: We observed a reduction in the frequency of pain in the larynx after treatment of both groups, but only the EG showed a decrease in pain intensity in this region. It was verified with an algometer to the trapezius muscle that the electrical stimulation associated with the vocal therapy decreased the intensity of pain during the application of pressure and increased the PPT. There were no significant differences with regard to variables investigated in the comparison between the interventions. On the other hand, there was decreased pain in the trapezius muscle for the EG in comparison to the pre- and post-intervention. CONCLUSION: The vocal therapyprogram reduced the frequency and intensity of the musculoskeletal pain in the regions proximal to the larynx of women with behavioral dysphonia. In addition, TENS followed by vocal therapy increased the threshold of sensitivity to muscular pain in the trapezius, demonstrating that it is a good resource to use in conjunction with traditional vocal therapy in cases of behavioral dysphonia associated with pain and muscle tension.

The Effect of a Voice Therapy Program Based on the Taxonomy of Vocal Therapy in Women with Behavioral Dysphonia.

OBJECTIVE: This study aims to propose and analyze the effect of a voice therapy program (VTP) in women with behavioral dysphonia. MATERIALS AND METHODS: This is a controlled, blinded, and nonrandomized cohort study. Participants of this study were 22 women with behavioral dysphonia divided into two groups: G1, 11 women with behavioral dysphonia who received the VTP, and G2, 11 women with behavioral dysphonia who did not receive any intervention. Before and after 6 weeks, the outcome variables evaluated in both groups were auditory-perceptual evaluation of the global degree of vocal quality (vowel /a/ and counting), instrumental acoustic parameters, Voice-Related Quality of Life, vocal and larynx symptoms, and musculoskeletal pain. The statistical analysis used the Wilcoxon, chi-square, and Mann-Whitney tests (P < 0.05). RESULTS: After 6 weeks, we observed a significantly higher improvement in the general degree of vocal deviation in vowels, a reduced F0 and symptom of "fatigue while talking" in G1, and an increased "shoulder" pain intensity in G2. Both groups showed improvement in the socioemotional domain of Voice-Related Quality of Life. In addition, the comparison between the groups showed a significantly greater reduction in fundamental frequency and the "voice loss" symptom in G1 compared with G2. CONCLUSIONS: The VTP using semioccluded vocal tract exercises obtained a positive effect on voice quality, symptoms, and musculoskeletal pain in women with behavioral dysphonia. The proposal, based on the taxonomy of voice therapy, seems to have promoted a phonatory balance, muscle relaxation, and improvement in the vocal resistance of this population.

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

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

Análise acústica da voz: comparação entre dois tipos de microfones / Acoustic voice analysis: comparison between two types of microphones

RESUMO Objetivo Comparar os valores das medidas acústicas da voz, extraídas de gravações vocais realizadas com dois tipos de microfones. Métodos Participaram da pesquisa 103 pessoas do sexo feminino, com idades entre 18 e 54 anos. Foram coletadas amostras da vogal sustentada /e/, captadas por dois microfones, simultaneamente: Shure SM58 e Karsect HT-9. Foi realizada a análise acústica das vozes, com a extração de valores de frequência fundamental (F0), variação da frequência (Jitter) e variação de amplitude dos segmentos fundamentais da voz (Shimmer) e proporção Glottal to Noise Excitation (GNE). Resultados Houve diferenças entre os microfones apenas na medida de Shimmer, com predomínio de valores mais altos captados pelo Karsect HT-9. Porém, os resultados de ambos os microfones estiveram dentro dos padrões de normalidade do software utilizado. Conclusão Os resultados da análise acústica extraídos a partir da gravação de voz realizada com os microfones Shure SM58 e Karsect HT-9 foram semelhantes, concluindo-se que ambos os microfones podem ser utilizados para gravação do sinal sonoro na análise acústica.

ABSTRACT Purpose To compare acoustic measurements of voice recorded by two types of microphones. Methods The study counted with 103 women from 18 to 54 years old. The recorded sample was the sustained vowel /ɛ/. The acoustic signal was picked up simultaneously by two unidirectional microphones: the Shure SM58 and the Karsect HT-9. The acoustic analysis was performed on these edited vocal samples. The measured parameters were F0, Jitter, Shimmer and Glottal to Noise Excitation (GNE) ratio. Results Recurrent differences between the microphones were observed only in Shimmer measurement (p=0.026); the Karsect HT-9 presented higher values. However, the acoustic measures were within the normal range for healthy voices, despite of the microphone used. Conclusion The acoustic analysis results extracted from the voice recording performed with the Shure SM58 and the Karsect HT-9 microphones were similar. Hence, it can be deduced that, connected to a high-quality interface, both microphones can be used in the acoustic analysis to record the sound signal.

Influence of the speech-language pathologist's orientation on maximum phonation times / Influência da orientação do fonoaudiólogo nos tempos máximos de fonação

ABSTRACT Purpose: to compare the results of maximum phonation times (MPTs) under two different forms of speech-language pathology orientation to extract these measures. Methods: 60 women between 17 and 23 years divided equally into two groups participated: Study Group (SG) - that performed the task under the two forms of orientation (traditional orientation and with control request of the air outlet); and the Control Group (CG) - which carried out the task in a single form of orientation (traditional one). The procedures performed comprised the extraction of MPT in the vowels /a/, /i/ and /u/, the fricatives /s/ and /z/ and numbers counting. The data were tabulated and statistically analyzed (p<0.05). Results: by comparing the two groups at the first instant of the MPT emissions, no statistically significant differences were found. However, when the second instant was compared, there were differences in most emissions, which indicates that the air control request promotes the increase of MPTs. Conclusion: the way the speech-language pathologist guides the performance of the maximum phonation times, during the evaluation of these measures, requesting the individual tomaximally control air exit, modifies the result of the extraction of the temporal measures of the voice, which must be considered in the daily vocal clinical practice.

RESUMO Objetivo: comparar os resultados dos tempos máximos de fonação (TMF) sob duas formas distintas de orientação fonoaudiológica para extração dessas medidas. Métodos: participaram 60 mulheres com idades entre 17 e 23 anos que foram divididas igualmente em: Grupo Estudo (GE) - que realizaram a tarefa sob as duas formas de orientação (orientação tradicional e com solicitação de controle na saída do ar); e Grupo Controle (GC) - que realizaram a tarefa sob uma única forma de orientação por duas vezes (orientação tradicional). Os procedimentos realizados compreenderam a extração do TMF das vogais /a/, /i/ e /u/, das fricativas /s/ e /z/ e da contagem de números. Os dados foram analisados estatisticamente. Resultados: ao comparar os dois grupos no primeiro momento das emissões dos TMFs, observou-se que não há diferenças estatisticamente significantes entre eles. No entanto, quando o segundo momento foi comparado, houve diferenças na maioria das emissões, indicando que a solicitação do controle do ar promoveu o aumento dos TMFs. Conclusão: a forma do fonoaudiólogo orientar a realização dos tempos máximos de fonação, solicitando ao indivíduo o controle máximo da saída do ar, modifica o resultado da extração das medidas temporais da voz, o que deve ser considerado na prática clínica vocal diária.

Transcutaneous Electrical Nerve Stimulation (TENS) and Laryngeal Manual Therapy (LMT): Immediate Effects in Women With Dysphonia.

PURPOSE: This study aimed to verify the immediate effect of low-frequency transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) in musculoskeletal pain, voice quality, and self-reported signs in women with dysphonia. METHOD: Thirty women with behavioral dysphonia were randomly divided into the TENS group and the LMT group. All participants fulfilled the pain survey and had their voices recorded to posterior perceptual and acoustic analysis before and after intervention. The TENS group received a unique low-frequency TENS session (20 minutes). The LMT group received LMT (20 minutes) with soft and superficial massage in the sternocleidomastoid muscle, suprahyoid muscles, and larynx. Afterward, the volunteers reported their voice, larynx, breathing, and articulatory signs. Pre and post data were compared by parametric and nonparametric tests. RESULTS: After TENS, a decrease in pain intensity in the posterior or anterior region of the neck, shoulders, upper or lower back, and masseter was observed. After LMT, a decrease in pain intensity in the neck anterior region, shoulders, lower back, and temporal region was observed. Also, after TENS, there was an improvement in vowel /a/ instability; after LMT, there was a general improvement in voice quality, decrease in tension, and decrease in breathiness in speech. Positive voice and laryngeal signs were reported after TENS, and positive laryngeal signs and articulation were reported after LMT. CONCLUSION: TENS and LMT may be used in voice treatment of women with behavioral dysphonia, and both may be considered important therapy resources that reduce musculoskeletal pain and cause positive laryngeal signs. Both TENS and LMT are able to partially improve voice quality, but TENS presented better results.

The Voiced Oral High-frequency Oscillation Technique's Immediate Effect on Individuals With Dysphonic and Normal Voices.

OBJECTIVE: The aim of this study was to verify the effect of the voiced oral high-frequency oscillation (VOHFO) on voice quality in acoustic voice symptoms and self-reported sensations in individuals with voice complaints and dysphonic voices, and in individuals with normal voices. METHODS: The participants, which included 60 individuals from 18 to 45 years of age, both genders, were divided into two groups: G1, 30 individuals without voice complaints and normal voices; and G2, 30 individuals with voice complaints and dysphonic voices. We used the following measures: acoustic analysis, voice and larynx symptom investigation, and phonation time before and after 3 minutes of performing the VOHFO technique. The sensations were reported only after the VOHFO technique. Data were analyzed using the Wilcoxon test (P ≤ 0.05), paired t test (P ≤ 0.05), and the Mann-Whitney test (P ≤ 0.05). RESULTS: After the VOHFO, in G1, there was an increased fundamental frequency (both genders), a higher voice turbulence index, and a decrease in dryness symptoms (women); in G2, there was a decrease in the following symptoms: strong voice, dryness and lump in the throat, sensitive throat (women), and roughness and weak voice (men). The phonation measures and sensations did not present differences. The soft phonation index decreased in G1 and increased in G2 (women), in addition to a significant decrease in strong voice and sensitive throat (women) and roughness (men) in G2. CONCLUSIONS: The VOHFO technique improves the source-filter relationship and the severity of voice and larynx symptoms in dysphonic and normal individuals. Women improved more in terms of larynx symptoms, whereas men improved more in terms of voice symptoms.