Prevalence and Risk Factors for Occupational Voice Disorders in Nepalese Teachers: A Cross-Sectional Study.

Introduction Teachers are a high-risk group for the development of vocal dysfunction, as they use voice extensively in their profession. Objective To know the prevalence and risk factors associated with voice strain in teachers. Methods A cross-sectional study was conducted among schoolteachers in Chitwan, Nepal. The Voice Handicap Index questionnaire was used as a survey tool. Result A total of 315 teachers were enrolled in the study. The mean age of the participants was of 36.7 years. Teachers from public schools, primary grade classes, > 50 pupils in the classroom, > 24 hours of classes per week, dust in class, and recurrent tonsil problems were associated with various degrees of vocal handicap. Conclusion There is a high prevalence of voice disorder among teachers. A holistic approach, which includes teacher education regarding voice care during their work and management of their voice handicap by taking into consideration different risk factors, must be adopted.

Automatic Voice Disorder Detection from a Practical Perspective.

Voice disorders, such as dysphonia, are common among the general population. These pathologies often remain untreated until they reach a high level of severity. Assisting the detection of voice disorders could facilitate early diagnosis and subsequent treatment. In this study, we address the practical aspects of automatic voice disorders detection (AVDD). In real-world scenarios, data annotated for voice disorders is usually scarce due to various challenges involved in the collection and annotation of such data. However, some relatively large datasets are available for a reduced number of domains. In this context, we propose the use of a combination of out-of-domain and in-domain data for training a deep neural network-based AVDD system, and offer guidance on the minimum amount of in-domain data required to achieve acceptable performance. Further, we propose the use of a cost-based metric, the normalized expected cost (EC), to evaluate performance of AVDD systems in a way that closely reflects the needs of the application. As an added benefit, optimal decisions for the EC can be made in a principled way given by Bayes decision theory. Finally, we argue that for medical applications like AVDD, the categorical decisions need to be accompanied by interpretable scores that reflect the confidence of the system. Even very accurate models often produce scores that are not suited for interpretation. Here, we show that such models can be easily improved by adding a calibration stage-trained with just a few minutes of in-domain data. The outputs of the resulting calibrated system can then better support practitioners in their decision-making process.

Factors associated with voice-related quality of life among patients with temporomandibular disorders

Abstract Research would be important for obtaining a better understanding of voice complaints among patients with temporomandibular disorders (TMD). Objective The identification of predictors of voice disorders associated with TMD pain was made according to Diagnostic Criteria for TMD (DC/TMD) Axis I. Methodology Functional limitations were measured using the Jaw Functional Limitation Scales for mastication (JFLS-M), jaw mobility (JFLS-JM), and verbal and emotional expression (JFLS-VEE). Patients also completed the Hospital Anxiety and Depression Scale (HADS). The primary outcome was social-emotional and physical functioning as indicated by scores on the Voice-Related Quality of Life (V-RQOL) questionnaire. Multiple linear regression was used to model the relationship between the domains on the V-RQOL questionnaire and scores on the HADS and JFLS after adjusting for age, gender, DC/TMD diagnosis, pain intensity, and time since pain onset. Results The HADS-D (B=-1.15; 95% CI, -1.718 to -0.587; p<.001) and JFLS-VEE (B=-0.22; 95% CI, -0.40 to -0.06; p=.008) were significant predictors of scores on the V-RQOL questionnaire. Conclusion Higher scores on depression measures and limitations in verbal and emotional expression could exacerbate voice problems among TMD pain patients. Future research should promote multidisciplinary treatments for TMD pain-related voice disorders.

The influence of listener experience, measurement scale and speech task on the reliability of auditory-perceptual evaluation of vocal quality

ABSTRACT Purpose To assess the influence of the listener experience, measurement scales and the type of speech task on the auditory-perceptual evaluation of the overall severity (OS) of voice deviation and the predominant type of voice (rough, breathy or strain). Methods 22 listeners, divided into four groups participated in the study: speech-language pathologist specialized in voice (SLP-V), SLP non specialized in voice (SLP-NV), graduate students with auditory-perceptual analysis training (GS-T), and graduate students without auditory-perceptual analysis training (GS-U). The subjects rated the OS of voice deviation and the predominant type of voice of 44 voices by visual analog scale (VAS) and the numerical scale (score "G" from GRBAS), corresponding to six speech tasks such as sustained vowel /a/ and /ɛ/, sentences, number counting, running speech, and all five previous tasks together. Results Sentences obtained the best interrater reliability in each group, using both VAS and GRBAS. SLP-NV group demonstrated the best interrater reliability in OS judgment in different speech tasks using VAS or GRBAS. Sustained vowel (/a/ and /ɛ/) and running speech obtained the best interrater reliability among the groups of listeners in judging the predominant vocal quality. GS-T group got the best result of interrater reliability in judging the predominant vocal quality. Conclusion The time of experience in the auditory-perceptual judgment of the voice, the type of training to which they were submitted, and the type of speech task influence the reliability of the auditory-perceptual evaluation of vocal quality.

An Experimental Analysis on Multicepstral Projection Representation Strategies for Dysphonia Detection.

Biometrics-based authentication has become the most well-established form of user recognition in systems that demand a certain level of security. For example, the most commonplace social activities stand out, such as access to the work environment or to one's own bank account. Among all biometrics, voice receives special attention due to factors such as ease of collection, the low cost of reading devices, and the high quantity of literature and software packages available for use. However, these biometrics may have the ability to represent the individual impaired by the phenomenon known as dysphonia, which consists of a change in the sound signal due to some disease that acts on the vocal apparatus. As a consequence, for example, a user with the flu may not be properly authenticated by the recognition system. Therefore, it is important that automatic voice dysphonia detection techniques be developed. In this work, we propose a new framework based on the representation of the voice signal by the multiple projection of cepstral coefficients to promote the detection of dysphonic alterations in the voice through machine learning techniques. Most of the best-known cepstral coefficient extraction techniques in the literature are mapped and analyzed separately and together with measures related to the fundamental frequency of the voice signal, and its representation capacity is evaluated on three classifiers. Finally, the experiments on a subset of the Saarbruecken Voice Database prove the effectiveness of the proposed material in detecting the presence of dysphonia in the voice.

Significado de los trastornos de voz. Un estudio cualitativo desde la mirada de profesores de enseñanza básica / Meaning of Voice Disorders. A Qualitative Study from the Perspective of Elementary School Teachers

Objetivo. El objetivo del presente estudio fue describir el significado que le otorgan a los trastornos de voz los profesores y cuáles son las motivaciones que los llevan a no consultar con un especialista. Método. Para tal propósito, se realizó un estudio cualitativo en el que participa-ron 16 profesores de enseñanza básica. La información fue obtenida mediante una entrevista semiestructurada, la cual fue grabada y luego transcrita para su posterior análisis. El estudio contó con la aprobación del comité de ética y el consentimiento informado de cada uno de los participantes. Resultados. En cuanto a los resultados, surgieron cinco categorías: Conocimiento de los problemas de voz; Entrenamiento formal y recursos vocales; Sintomatología vocal experimentada a lo largo de la carrera docente; Afectación de la calidad de vida; Tratamiento y abordaje de los problemas de voz. Todos los participantes tienen alguna noción de los problemas de voz, asociándolos principalmente con algún síntoma o molestia experimentada. La gran mayoría declara nunca haber recibido formación en cuanto al uso de la voz y expresan sentir que su voz ha ido cambiando a lo largo de los años de ejercicio profesional, volviéndose más grave o ronca. Destaca que en cuanto al tratamiento, quince de los participantes nunca han consultado con especialistas, sino que recurren a remedios caseros o populares. Conclusión. En conclusión, los profesores corresponden a uno de los grupos donde se presenta una alta prevalencia de trastornos de voz. Sin embargo, esto contrasta con la baja preocupación y el desconocimiento respecto al abordaje de este tipo de problemas

Aim. The objective of the present study was to describe the significance teachers give to voice disorders, and the reasons that dissuade them from consulting a specialist. Method. To achieve this objective, a qualitative study was carried out with the participation of 16 elementary school teachers. The information was obtained by semi-structured interviews, which were recorded and then transcripts were prepared for analysis. The study was approved by the Ethics Committee and an informed con-sent was signed by each of the participants. Results. Five categories emerged from the results: Knowledge of voice problems; Formal training and voice resources; Vocal symptoms experienced throughout the teaching career; Effects on quality of life; Treatment of and approach to voice prob-lems. All the participants had some notion of voice problems, which they associated mainly with some symptom or discomfort experienced. The great majority stated they had never received training in voice use; they felt that their voices had changed over the years of their professional careers, becoming deeper or hoarser. A striking finding was that fifteen of the participants had never consulted a specialist, but only used home or popular remedies. Conclusion. In conclusion, teachers form a group with a high prevalence of voice disorders; however, this contrasts with a low level of concern and a lack of knowledge about addressing such problems

Performance of Acoustic Measures for the Discrimination Among Healthy, Rough, Breathy, and Strained Voices Using the Feedforward Neural Network.

OBJECTIVE: To identify and evaluate the best set of acoustic measures to discriminate among healthy, rough, breathy, and strained voices. METHODS: This study used the vocal samples of the sustained /ε/ vowel from 251 patients with the vocal complaints, among which 51, 80, 63, and 57 patients exhibited healthy, rough, breathy, and strained voices, respectively. Twenty-two acoustic measures were extracted, and feature selection was applied to reduce the number of combinations of acoustic measures and obtain an optimal subset of measures according to the information gain attribute ranking algorithm. To classify signals as a function of predominant voice quality, a feedforward neural network was applied using a Levenberg-Marquardt supervised learning algorithm. RESULTS: The best results were obtained from 11 combinations, with each combination presenting six acoustic measures. Kappa indices ranged from 0.7527 to 0.7743, the overall hit rates are 81.67%-83.27%, and the hit rates of healthy, rough, breathy, and strained voices are 74.51%-84.31%, 78.75%-90.00%, 85.71%-98.41%, and 68.42%-82.46%, respectively. CONCLUSIONS: We obtained the best results from 11 combinations, with each combination exhibiting six acoustic measures for discriminating among healthy, rough, breathy, and strained voices. These sets exhibited good Kappa performance and a good overall hit rate. The hit rate varied between acceptable and good for healthy voices, acceptable and excellent for rough voices, good and excellent for breathy voices, and poor and good for strained voices.

Reduzindo o GAP entre a ciência e a clínica: lições da academia e da prática profissional - parte A: julgamento perceptivo-auditivo da qualidade vocal, análise acústica do sinal vocal e autoavaliação em voz / Reducing the GAP between science and clinic: lessons from academia and professional practice - part A: perceptual-auditory judgment of vocal quality, acoustic vocal signal analysis and voice self-assessment

RESUMO No XXVIII Congresso Brasileiro da SBFa, 24 especialistas reuniram-se e, a partir de um posicionamento condutor sobre pesquisa científica como ferramenta de conexão entre laboratório e clínica, cinco frentes de conhecimento da especialidade de voz foram discutidas: 1. Julgamento perceptivo-auditivo da qualidade vocal; 2. Análise acústica do sinal vocal; 3. Autoavaliação em voz; 4. Técnicas tradicionais de terapia; 5. Técnicas modernas de eletroestimulação e fotobiomodulação em voz. A parte "a" desta publicação é a consolidação das análises dos três primeiros aspectos. A tendência no julgamento perceptivo-auditivo da qualidade vocal é o uso de protocolos padrão. A avaliação acústica do sinal vocal é acessível e pode ser feita de modo descritivo ou por extração de parâmetros, preferindo-se medidas multiparamétricas. Finalmente, a análise do próprio indivíduo fecha essa tríade de documentação fonoaudiológica, que será base para a conclusão da avaliação, referência para monitoramento do progresso e avaliação de resultado de tratamento.

ABSTRACT During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part "a" of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

Reduzindo o gap entre a ciência e a clínica: lições da academia e da prática profissional - parte B: técnicas tradicionais de terapia vocal e técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação vocal / Reducing the gap between science and clinic: lessons from academia and professional practice - part B: traditional vocal therapy techniques and modern electrostimulation and photobiomodulation techniques applied to vocal rehabilitation

RESUMO O presente texto é a continuação da publicação referente ao XVIII Congresso da SBFa. Na parte "A" apresentamos análises sobre avaliação clínica vocal. O foco da parte "B" são aspectos de reabilitação vocal: 4. Técnicas tradicionais de terapia vocal; 5. Técnicas modernas de eletroestimulação e fotobiomodulação aplicadas à reabilitação. Os inúmeros estudos sobre os diversos programas, métodos ou técnicas tradicionais de reabilitação, muitos de elevada qualidade de evidência, permitem considerar tais procedimentos relativamente bem descritos, seguros e com efeitos conhecidos, dando conta do tratamento de diversos distúrbios vocais. As evidências científicas com as técnicas tradicionais são reconhecidas mundialmente. Novas frentes de evolução, como o uso da eletroestimulação ou fotobiomodulação em voz parecem ser promissoras como abordagens coadjuvantes. Há mais estudos sobre eletroestimulação em voz do que com fotobiomodulação, contudo, evidências científicas para essas duas técnicas modernas são ainda limitadas. Conhecimento e cautela são necessários para a aplicação de quaisquer técnicas.

ABSTRACT This text is the continuation of the XVIII SBFa Congress publication. In part "A" we presented the analyses on clinical vocal evaluation. Part "B" focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.

Wavelet packet transform and multilayer perceptron to identify voices with a mild degree of vocal deviation / Transformada Wavelet packet y Perceptrón Multicapa para identificación de voces con grado leve de desvío vocal

Introduction. Laryngeal disorders are characterized by a change in the vibratory pattern of the vocal folds. This disorder may have an organic origin described by anatomical fold modification, or a functional origin caused by vocal abuse or misuse. The most common diagnostic methods are performed by invasive imaging features that cause patient discomfort. In addition, mild voice deviations do not stop the in-dividual from using their voices, which makes it difficult to identify the problem and increases the possibility of complications. Aim. For those reasons, the goal of the present paper was to develop a noninvasive alternative for the identification of voices with a mild degree of vocal deviation ap-plying the Wavelet Packet Transform (WPT) and Multilayer Perceptron (MLP), an Artificial Neural Network (ANN). Methods. A dataset of 74 audio files were used. Shannon energy and entropy mea-sures were extracted using the Daubechies 2 and Symlet 2 families and then the processing step was performed with the MLP ANN. Results. The Symlet 2 family was more efficient in its generalization, obtaining 99.75% and 99.56% accuracy by using Shannon energy and entropy measures, re-spectively. The Daubechies 2 family, however, obtained lower accuracy rates: 91.17% and 70.01%, respectively. Conclusion. The combination of WPT and MLP presented high accuracy for the identification of voices with a mild degree of vocal deviation

ntroducción. Los trastornos laríngeos se caracterizan por un cambio en el patrón vibratorio de los pliegues vocales. Este trastorno puede tener un origen orgánico, descrito como la modificación anatómica de los pliegues vocales, o de origen fun-cional, provocado por abuso o mal uso de la voz. Los métodos de diagnóstico más comunes se realizan mediante procedimientos invasivos que causan malestar al pa-ciente. Además, los desvíos vocales de grado leve no impiden que el individuo utilice la voz, lo que dificulta la identificación del problema y aumenta la posibilidad de complicaciones futuras.Objetivo. Por esas razones, el objetivo de esta investigación es desarrollar una he-rramienta alternativa, no invasiva para la identificación de voces con grado leve de desvío vocal aplicando Transformada Wavelet Packet (WPT) y la red neuronal artifi-cial del tipo Perceptrón Mutlicapa (PMC). Métodos. Fue utilizado un banco de datos con 78 voces. Fueron extraídas las me-didas de energía y entropía de Shannon usando las familias Daubechies 2 y Symlet 2 para después aplicar la red neuronal PMC. Resultados. La familia Symlet 2 fue más eficiente en su generalización, obteniendo un 99.75% y un 99.56% de precisión mediante el uso de medidas de energía y en-tropía de Shannon, respectivamente. La familia Daubechies 2, sin embargo, obtuvo menores índices de precisión: 91.17% y 70.01%, respectivamente. Conclusión. La combinación de WPT y PMC presentó alta precisión para la iden-tificación de voces con grado leve de desvío vocal

Relationship Between Sleep Quality and Stress with Voice Functioning among College Professors: A Systematic Review and Meta-analysis.

BACKGROUND: Sleeping is the most critical stage in the psychological and somatic recovery process. Sleep deficiency can lead to changes in the breath pattern that might contribute to the appearance and development of voice disorders. Sleep can also compromise the individual's communicative competence. Work-related stress is a risk factor for serious health and mental issues, including voice and sleep disorders. Recovery from stress is fundamental in order to preserve health, wellbeing, and work performance. No systematic review of the literature or meta-analysis concerning this relationship has been performed yet. OBJECTIVE: To define the association of voice disorders with sleep quality and stress among teachers. METHODS: A systematic review of literature and meta-analysis were performed. Three computerized databases were used to characterize the relationship between voice disorders among teachers with sleep quality and stress. Information such as year of publication, study population, sample size, stress/sleep exposure, voice outcome, and prevalence were extracted from each paper. All the included articles were measured in terms of their methodological quality. RESULTS: In total, 10 publications met the criteria for inclusion. The point prevalence of voice disorders ranged widely for both sleep quality (12% to 81%), and for stress (17% to 81%). Teachers who reported stress at work were more likely to report voice disorders. Additionally, teachers who reported having slept more than 6 hours per day were less likely to report a voice disorder. CONCLUSION: This study provides evidence about the relationship between sleep quality and work-related stress with voice functioning. Although, included studies had low quality and the number of studies was low, our results suggest that the increased occurrence of voice disorders among teachers with high stress and work and less than 6 hours/day of sleep. Future investigation should aim to identify how sleep quality and stress interact in relation to voice functioning.

The Influence of Noise on the Vocal Dose in Women.

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

Medidas cepstrais na avaliação da intensidade do desvio vocal / Cepstral measures in the assessment of severity of voice disorders

RESUMO Objetivo Analisar se existe associação entre a presença, a intensidade e o tipo de desvio vocal e as medidas cepstrais em amostras de indivíduos com queixa vocal. Método Foram utilizadas 376 amostras da vogal /ε/ de indivíduos de ambos os gêneros, com queixa vocal. Utilizou-se uma escala analógico-visual para análise perceptivo-auditiva das vozes quanto à intensidade do desvio vocal (GG), graus de rugosidade (GR), soprosidade (GS) e tensão (GT), incluindo-se a determinação da qualidade vocal predominante (rugosa, soprosa ou tensa). Foram extraídas as medidas relacionadas ao Cepstral Peak Prominence-Smoothed (CPPS) e o declínio espectral das amostras vocais. Resultados Houve diferença dos valores do CPPS entre os grupos com e sem desvio vocal, assim como entre as diferentes intensidades e tipos de desvio vocal. Os valores do CPPS foram mais reduzidos em função da presença e intensidade do desvio vocal. Os valores do CPPS diferenciaram vozes rugosas x soprosas, rugosas x tensas e soprosas x tensas. O declínio espectral apenas diferenciou vozes soprosas x tensas. O CPPS se correlacionou de modo positivo e forte com os GG e GS, de modo negativo moderado com o GR, e de forma negativa fraca com o GT. O declínio espectral apresentou correlação positiva moderada com o GT e correlação negativa fraca com o GS. Conclusão Existe associação entre a presença de desvio vocal, o GG, a qualidade vocal predominante e o CPPS. De modo especial, o GG é fortemente correlacionado ao CPPS. O declínio espectral está associado apenas aos parâmetros de soprosidade e tensão.

ABSTRACT Purpose To analyze whether there is an association between the presence, intensity and type of voice disorder and the cepstral measures in samples of individuals with voice complaints. Methods We used 376 vowel /Ɛ/ samples from individuals of both genders that had voice complaints. An analogue-visual scale was used for the auditory-perceptual analysis of voices regarding the overall grade of dysphonia (G) and the grades of roughness (R), breathiness (B), and strain (S), including a determination of voice quality (rough, breathy or strained). Measures related to cepstral peak prominence smoothed (CPPS) and spectral decline of vocal samples were extracted. Results There were differences in the CPPS values between the groups with or without voice disorders as well as between the different intensities and types of voice disorder. CPPS values were lower because of the presence and intensity of voice disorders. The CPPS values differentiated the following voices: rough x breathy, rough x strained, and breathy x strained. The spectral decline only differentiated breathy x strained voices. CPPS correlated positively and strongly with G and B; moderately and negatively with R, and negatively and weakly with S. The spectral decline had a moderate positive correlation with S and a weak negative correlation with B. Conclusion There is association between voice disorder, G, predominant voice quality, and CPPS. In particular, G is strongly correlated with CPPS. Spectral decline is associated only with the parameters B and S.

Vocal Tract Discomfort and Voice-Related Quality of Life in Wind Instrumentalists.

OBJECTIVE: This study aimed to investigate vocal tract discomfort and quality of life in the voice of wind instrumentalists. METHOD: It is a cross-sectional study. The sample was composed of 37 musicians of the orchestra of Caxias do Sul city, RS, Brazil. The participants answered a nonstandard questionnaire about demographic and professional information, the Voice-Related Quality of Life (V-RQOL), the Vocal Tract Discomfort (VTD) scale, and additional items about fatigue after playing the instrument and pain in the cervical muscles. Correlation analyses were performed using Spearman correlation test. RESULTS: The most frequent symptoms mentioned by musicians in the VTD, for both frequency and intensity of occurrence, were dryness, ache, irritability, and cervical muscle pain, in addition to the frequency of occurrence of fatigue after playing. The musicians showed high scores in the V-RQOL survey. Several symptoms evaluated by the VTD had a negative correlation with the musicians' years of orchestra membership and with V-RQOL scores. CONCLUSION: Symptoms of vocal tract discomfort are present in wind instrumentalists in low frequency and intensity of occurrence. However, these symptoms affect the musicians' voice-related quality of life, and they occur more in musicians with fewer years of orchestra membership.

Relação entre medidas perceptivo-auditivas e de autoavaliação em pacientes com esclerose múltipla / Relationship between auditory-perceptual and self-assessment measures in patients with multiple sclerosis

RESUMO Objetivo Verificar se existe relação entre medidas perceptivo-auditivas e de autoavaliação em pacientes portadores de esclerose múltipla, com e sem queixa vocal. Métodos Participaram 18 sujeitos com diagnóstico de esclerose múltipla, com idades entre 21 e 67 anos, sendo 12 mulheres e seis homens. Foram aplicados uma breve anamnese, a Escala de Sintomas Vocais e o protocolo Vivendo com Disartria, seguidos da gravação da vogal /ԑ/ sustentada. A intensidade do desvio vocal e os graus de rugosidade, soprosidade, tensão e instabilidade foram avaliados por três fonoaudiólogos, utilizando-se uma escala analógico-visual de 100 mm. Resultados Os pacientes com esclerose múltipla com queixa vocal apresentaram maiores escores nos domínios total (p= 0,026) e limitação (p= 0,042) da Escala de Sintomas Vocais; na seção um (p= 0,041), seção quatro (p= 0,030) e seção dez (p= 0,050) do protocolo Vivendo com Disartria. Houve correlação positiva forte entre os escores da Escala de Sintomas Vocais, domínios total e limitação e os escores da seção um, quatro e nove do protocolo Vivendo com Disartria. Conclusão Pacientes com esclerose múltipla com queixa vocal possuem maior frequência de ocorrência de sintomas e maior impacto da disartria na comunicação. Não há relação entre as medidas perceptivo-auditivas e de autoavaliação em pacientes portadores de esclerose múltipla. No entanto, os escores dos dois instrumentos de autoavaliação utilizados são fortemente correlacionados.

ABSTRACT Purpose To determine the relationships between auditory-perceptual and self-assessment measures in patients with multiple sclerosis with and without vocal complaints. Methods Eighteen subjects diagnosed with multiple sclerosis, including 12 women and 6 men aged between 21 to 67 years, participated in the study. A brief anamnesis, the Voice Symptom Scale and the Living with Dysarthria questionnaire were completed, followed by recording of the sustained /ԑ/ vowel. The overall severity of vocal deviation and the degrees of roughness, breathiness, strain and instability were assessed by three speech therapists using a 100-mm visual analogue scale. Results Patients with multiple sclerosis and vocal complaints had higher Total (p= 0.026) and Limitation (p= 0.042) scores on the Voice Symptom Scale and on sections one (p= 0.041), four (p= 0.030) and ten (p= 0.050) of the Living with Dysarthria questionnaire. Strong positive correlations were found between the Total and Limitation scores of the Voice Symptom Scale and the scores of sections one, four and nine of the Living with Dysarthria questionnaire. Conclusion Patients with multiple sclerosis and vocal complaints have higher frequencies of symptom occurrence and emotional and speech effects. No relationship was found between auditory-perceptual and self-assessment measures in patients with multiple sclerosis. However, the scores on the two self-assessment instruments used are strongly correlated.

Uso del análisis acústico en el seguimiento de pacientes con patología vocal: estudio preliminar / Use of acoustic analysis in patients with voice pathologyfollow-up: a preliminary study / Uso da análise acústica no seguimento de pacientes compatologia vocal: estudo preliminar

Introducción: la evaluación vocal es multiparamétrica. En la dimensión acústica, los índices de perturbación y la relación armónico-ruido han sido cuestionados. La espectrografía acústica permite realizar representaciones visuales de la voz. El propósito de este trabajo es analizar si los índices de perturbación y la relación armónico-ruido mejoran en pacientes que presentaron una buena evolución vocal y describir la utilidad del espectrograma de banda angosta. Material y método: Estudio retrospectivo de una serie de casos. Se realizaron evaluaciones perceptuales y se obtuvieron informes otorrinolaringológicos pre y post-tratamiento en pacientes que presentaron buena evolución vocal post-tratamiento. Se grabó una vocal /a/ sostenida. Se analizaron los índices de perturbación y armónico-ruido generando un espectrograma de banda angosta. Resultados: Se incluyeron ocho pacientes entre 10 y 62 años. El jitter mejoró en cinco pacientes, el shimmer en siete y el armónico–ruido en la totalidad. El promedio mejoró en todos los parámetros estudiados luego del tratamiento. La diferencia pre y post-tratamiento no resultó significativa. En el espectrograma de banda angosta se observó mejor definición de la estructura armónica y disminución del componente de ruido en todos los casos. Conclusiones: Cuatro de los ocho pacientes presentaron evolución favorable en todos los parámetros. El promedio de los índices de perturbación y armónico-ruido fue mejor luego del tratamiento, si bien la diferencia encontrada no fue significativa. El espectrograma de banda angosta es un complemento que permitiría mejorar la interpretación de los índices de perturbación y armónico-ruido dentro de una evaluación vocal multidimensional y multiparamétrica.

Introduction: voice assessment is multiparametrical. In the acoustic dimension, the perturbation measures and the harmonics-to-noise ratio have been questioned. Sound spectrography allows visual representations of voice. The purpose of this paper is to analyze if perturbation measures and harmonics-to-noise ratio improve in a group of patients who showed good vocal evolution and to describe narrow band spectrogram usefulness. Material and method: Retrospective study of a series of cases. Pre and post-treatment auditoryperceptual evaluations were carried out and otorhinolaryngological reports were obtained in patients who featured vocal improvement. A sustained /a/ vowel was recorded. Perturbation measures and harmonics-to-noise ratio were analyzed, generating a narrow-band spectrogram. Results: Eight patients between the ages of 10 and 62 were included. Jitter improved in five patients, shimmer did in seven, and the harmonics-to-noise ratio improved in all of them. After treatment, the average improved in all the studied parameters. Pre- and post-treatment difference was not significant. In the narrow-band spectrogram, better harmonic structure and noise component reduction was observed in all cases. Conclusiones: Four out of said eight patients showed favorable evolution in all the studied acoustic parameters. The perturbation measures and harmonics-to-noise ratio average was better after treatment, although the difference found was not significant. Narrow-band spectrogram is a complement which would improve the interpretation of the acoustic measures within a multidimensional and multiparametrical voice assessment.

Introdução: a avaliação vocal é multiparamétrica. Na dimensão acústica, os índices de perturbação e a relação harmônico-ruído já foram questionados. A espectrografia acústica nos permite realizar representações visuais da voz. O propósito deste trabalho é analisar se os índices de perturbação e a relação harmônico-ruído melhoram em pacientes que apresentaram uma boa evolução vocal e descrever a utilidade do espectrograma de banda estreita. Material e método: Estudo retrospectivo de uma série de casos. Foram realizadas avaliações perceptuais, obtendo-se laudos otorrinolaringológicos pré e pós-tratamento em pacientes que apresentaram boa evolução vocal pós-tratamento. Com a gravação da vogal /a/ sustentada, foi feita a análise dos índices de perturbação e harmônico-ruído, gerando um espectrograma de banda estreita. Resultados: O estudo envolveu oito pacientes de entre 10 e 62 anos. O jitter indicou melhora em cinco pacientes, o shimmer em sete e o harmônico-ruído, na totalidade. A média melhorou em todos os parâmetros estudados após o tratamento. A diferença pré e pós-tratamento não resultou significativa. O espectrograma de banda estreita mostrou uma melhor definição da estrutura harmônica e diminuição do componente de ruído em todos os casos. Conclusões: Quatro dos oito pacientes apresentaram evolução favorável em todos os parâmetros. A média dos índices de perturbação e harmônico ruído foi melhor após o tratamento, embora a diferença encontrada não tenha sido significativa. O espectrograma de banda estreita é um complemento que permitiria melhorar a interpretação dos índices de perturbação e harmônico-ruído dentro de uma avaliação vocal multidimensional e multiparamétrica.

Distúrbio de voz e trabalho docente / Voice disorder and teaching work ability

RESUMO Objetivo: analisar a associação entre distúrbio de voz e capacidade para o trabalho em docentes da rede municipal de ensino de São Paulo. Métodos: professoras que buscaram atendimento fonoaudiológico, com queixa de alteração vocal; e professoras selecionadas sem queixa, expostas ao mesmo ambiente de trabalho, passaram por avaliação perceptivo-auditiva da voz; preenchimento dos protocolos Índice de Capacidade para o trabalho e Condição de Produção Vocal do Professor; e avaliação perceptivo-visual da laringe. Foram classificadas como Caso as que tinham alteração na avaliação perceptivo-auditiva e em pregas vocais (167) e Controle as sem alterações nas avaliações (105). Resultados: a capacidade para o trabalho esteve entre baixa e moderada entre os casos (67,4%) e entre boa e ótima (66,6%) nas professoras do controle (escore total). Houve associação estatística em duas dimensões do ICT, apontando que as docentes com distúrbio de voz apresentaram quase três vezes mais chance de perder capacidade para o trabalho e que quanto pior a perda da capacidade, mais forte é a associação com o distúrbio de voz. Conclusão: há associação entre o distúrbio de voz e as dimensões capacidade atual para o trabalho comparada com a melhor de toda vida, indicando que os sujeitos que apresentaram distúrbio de voz estavam em sua pior capacidade para trabalhar, e perda estimada para o trabalho por causa de doenças, indicando que quanto maior a perda da capacidade para o trabalho, mais forte é a relação com o distúrbio de voz, independente da idade.

ABSTRACT Purpose: to analyze the association between voice disorder and work ability in teachers of public schools of São Paulo. Methods: teachers who searched for speech therapy, with voice alteration complaint; and selected teachers with no complaint who were exposed to the work environment and submitted to the auditory voice perception; completing the Work Ability Index and the Conditions of Vocal Production of Teachers protocols; and perceptive visual larynx evaluation. Those with changes in perceptual evaluation and vocal folds were classified as Case (167) and those without changes in evaluations (105) were classified as Control. Results: the work ability was from low to moderate among the cases (67.4%) and between good and great (66.6%) in the control teachers (total score). There was a statistical association in two WAI dimensions, pointing out that teachers with voice disorders were nearly three times more likely to lose their work ability and the worst the loss of ability, the stronger is the association with the voice disorder. Conclusion: there is an association between the voice disorder and the dimensions for current work ability compared with the best of lifetime, indicating that subjects who had a voice disorder were at their worst conditions regarding their work ability, and estimated loss for work due to illnesses, indicating that the greater the loss of work ability, the stronger is the relationship with the voice disorder, regardless of age.

Factores ambientales y hábitos vocales en docentes y funcionarios de pre-escolar con alteraciones de voz / Environmental factors and vocal habits regarding pre-school teachers and functionaries suffering voice disorders

Objetivo Determinar la relación existente entre los hábitos vocales y condiciones ambientales/ ocupacionales, con la presencia de alteraciones vocales (disfonía) en docentes y funcionarios de centros sociales de educación inicial. Método Estudio descriptivo transversal en una población de 198 sujetos, que se llevó a cabo en tres fases. Fase 1: Identificación de los sujetos con mayor riesgo de presentar una alteración vocal. Fase 2: Observación-análisis del uso de la voz y los hábitos vocales de los sujetos identificados en la fase 1. Fase 3: Evaluación perceptual y computarizada de la voz, a través del Perfil Vocal de Wilson y el Multidimensional Voice Program, respectivamente. Resultados Se encontró que sujetos con quiebres tonales, carraspera, intensidad de la voz aumentada y reflujo gastroesofágico presentaron una frecuencia fundamental (Fo) por debajo de la norma. Aquellos con respiración alterada e intensidad de la voz aumentada, mostraron tener los valores acústicos de Shimmer y Jitter por encima de la norma. Conclusiones Existe un alto índice de incapacidad laboral a causa de alteraciones vocales. Se sugiere relación entre los hábitos laborales a los que están expuestas las educadoras iniciales y la existencia de alteraciones vocales.

Objective Determining the relationship between vocal habits and environmental/ occupational conditions with the presence of vocal disturbance (dysphonia) in teachers and functionaries working at community-based, initial childhood education centres (kindergartens). Method This was a descriptive study which adopted across-sectional approach using 198 participants which was developed in three phases. Phase 1: consisted of identifying participants having the highest risk of presenting vocal disturbance. Phase 2consisted of observation-analysis concerning the voice use and vocal habits of participants who had been identified in phase 1. Phase 3consisted of perceptual and computational assessment of participants' voices using Wilson's vocal profile and the multidimensional voice program. Results Individuals having pitch breaks, throat clearing, increased voice intensity, and gastro-oesophageal reflux were found to present below standard fundamental frequency (FF). Subjects having altered breathing and increased voice intensity were identified as having above standard shimmer and jitter acoustic values. Conclusions A high rate of inability to work was found due to vocal disturbance. It is thus suggested that there is a correlation between vocal habits and vocal disorders presented by preschool teachers in kindergarten settings.

Voz e deglutição de pacientes com e sem mobilidade laríngea após tireoidectomia / Voice and deglutition in patients with or without laryngeal mobility

INTRODUÇÃO: As queixas vocais e de deglutição podem ser apresentadas após o tratamento cirúrgico da doença de tireóide em pacientes com ou sem a mobilidade laríngea preservada. O objetivo do presente estudo foi avaliar e comparar a voz e a deglutição de pacientes com e sem mobilidade laríngea alterada após a tireoidectomia. MÉTODOS: Estudo prospectivo no qual foram avaliados pacientes com doença de tireóide divididos em dois grupos: GA, com mobilidade laríngea alterada após a tireoidectomia e GB, preservada. O protocolo de avaliação vocal perceptivo-auditiva e acústica e nasofibroscopia da deglutição foi aplicado no pré, pós-operatório recente e tardio. Ambos apresentaram percentual maior de mulheres, da faixa etária entre 46 a 65 anos e de tireoidectomia total. O número reduzido de tabagistas e da indicação de esvaziamento cervical também foi comum aos dois grupos. O carcinoma papilífero foi mais freqüente no GA e o bócio, no GB; e o volume do tecido ressecado foi menor no GA em relação ao GB. RESULTADOS: A avaliação da deglutição revelou que no GA, não houve alteração no pré-operatório (PRE). No pósoperatório recente (POR) foi observada em 87% e no pós-operatório tardio (POT), em 67%. Houve diferença estatística entre os períodos PRE e POR e PRE e POT (p<0,001). A penetração e aspiração com líquido foram identificadas em 33% da amostra no POR (p=0,014). A estase de alimento ocorreu em 87% no POR e 60% no POT(p<0,001). No GB, somente os resultados entre PRE e POR tiveram significância estatística para deglutição, com aumento de 44% no número de indivíduos com disfagia, apresentando estase e escape prematuro do alimento. Os resultados de voz indicaram que a disfonia em grau discreto caracterizada pela rugosidade esteve presente em 67% da amostra do GA no PRE. Houve diferença significativa entre PRE e POR, no grau geral, tensão, instabilidade, pitch, loudness e foco ressonantal. Entre PRE e POT, a significância ocorreu apenas no pitch e loudness...

INTRODUCTION: The vocal and deglutition complaints can be presented after surgical treatment of thyroid disease in patients with or without preserved laryngeal mobility. The objective of this study was to evaluate and to compare the voice and swallowing function of patients with and without laryngeal mobility after thyroidectomy. METHODS: This prospective study evaluated patients with thyroid disease divided in two groups: GA with laryngeal mobility modified after surgery and GB, preserved. The perceptual and acoustical analysis and fiberoptic endoscope of swallowing evaluation protocol were applied at preoperatory, recent and late post operatory. Both groups had presented bigger percentage of women, with age between 46 and 65 years, and total thyroidectomy. Reduced numbers of smokers and indication of neck dissection was common to the two groups. Papillary carcinoma was more frequent in the GA, and the benign tumor in the GB; and resected tissue volume was smaller in the GA in relation to GB. RESULTS: The evaluation of the deglutition indicated that the GA did not have alteration at preoperatory (PRE). At recent postoperative (POR) it was observed in 87% and at late period (POT), in 67%. There was statistical difference between PRE and POR, and PRE and POT (p< 0,001). Penetration and aspiration with liquid had been identified in 33% of the sample at POR (p=0,014). Residue of food occurred in 87% at POR and 60% at POT (p< 0,001). In the GB, the results between PRE and POR had significance only for deglutition, with increase of 44% in the number of individuals with dysphagia, presenting residue and premature escape of the food. Voice results had indicated light degree dysphonia characterized by the roughness in 67% of the sample of the GA at PRE. There was significant difference between PRE and POR, in the global grade, strain, instability, pitch, loudness and resonance focus. Between PRE and POT, the significance it occurred only in pitch...