Fonoterapia intensiva em paciente com fissura de palato submucosa - relato de caso / Intensive speech therapy in a patient with submucosal cleft palate - case report / Fonoterapia intensiva en um paciente con fisura palatina submoucosa - reporte de caso

Introdução: A fissura de palato submucosa é uma malformação craniofacial, que pode ocasionar alterações de fala, e a fonoterapia intensiva é uma possibilidade de tratamento. Objetivo: relatar o caso de uma paciente com fissura submucosa de palato sintomática não operada que participou de um programa de fonoterapia intensiva para reabilitação de fala, descrever os processos terapêuticos e comparar a produção da fala antes e depois da terapia. Metodologia: o programa de fonoterapia intensiva foi realizado com uma paciente do gênero feminino de 13 anos de idade, com fissura submucosa de palato sintomática, não operada; e constituiu de três sessões diárias de terapia fonoaudiológica durante um período de 4 semanas, resultando em um total de 60 sessões de terapia. Antes da primeira sessão, e após a última, foi realizada avaliação clínica da fala e instrumental da função velofaríngea. Resultados: sistematização do fechamento velofaríngeo, melhora na inteligibilidade de fala, correção das articulações compensatórias, da fraca pressão intraoral e hipernasalidade em fala dirigida. Conclusão: o programa de fonoterapia intensiva proporcionou resultados positivos em período curto na reabilitação da fala da paciente.

Introduction: Submucosal cleft palate is a craniofacial malformation that can cause speech disorders and intensive speech therapy is an alternative treatment. Objective: report the case of a patient with submucous cleft who participated in an intensive speech therapy program, describe the therapeutic processes and compare speech production before and after therapy. Methods: the intensive therapy program was conducted with a 13-year-old female patient with submucosal cleft and consisted of three daily speech therapy sessions over a period of 4 weeks, resulting in 60 therapy sessions. Before the first session and after the last session, clinical and instrumental assessments of velopharyngeal function were performed. Results: systematization of velopharyngeal closure, improvement of speech intelligibility, elimination of compensatory articulations, weak intraoral pressure and hypernasal resonance in monitored speech. Conclusion: The intensive speech therapy program provided positive short-term results in speech rehabilitation of a patient with submucosal cleft.

Introducción: el fissura palatina submucosa es una malformación craneofacial, por esta razón puede causar trastornos del habla y la terapia intensiva del habla es un tratamiento alternativo. Objetivo: relatar el caso de una paciente con fisura palatina submucosa que participó en un programa intensivo de terapia fonoaudiológica para la rehabilitación del habla, describir los procesos terapéuticos y comparar la producción del habla antes y después de la terapia. Metodos: el programa de cuidados intensivos se llevó a cabo con una paciente del género femenino de 13 años de edad con fisura palatina submoucosa y consistió en tres sesiones diarias de terapia fonoaudiológica durante un período de 4 semanas, lo que resultó en un total de 60 sesiones de terapia. Antes de la primera sesión y después de la última, se realizó una evaluación clínica e instrumental de la función velofaríngea. Resultados: sistematización del cierre velofaríngeo, mejor inteligibilidad del habla, eliminación de las articulaciones compensatorias, de la presión intraoral débil y de la resonancia hipernasal en el habla dirigida. Conclusión: el programa de cuidados intensivos proporcionó resultados positivos en un corto período de tiempo en la rehabilitación del habla de una paciente con fisura submucosa.

Using gradient Forest to predict climate response and adaptation in Cork oak.

Climate change is impacting locally adapted species such as the keystone tree species cork oak (Quercus suber L.). Quantifying the importance of environmental variables in explaining the species distribution can help build resilient populations in restoration projects and design forest management strategies. Using landscape genomics, we investigated the population structure and ecological adaptation of this tree species across the Mediterranean Basin. We applied genotyping by sequencing and derived 2,583 single nucleotide polymorphism markers genotyped from 81 individuals across 17 sites in the studied region. We implemented an approach based on the nearest neighbour haplotype 'coancestry' and uncovered a weak population structure along an east-west climatic gradient across the Mediterranean region. We identified genomic regions potentially involved in local adaptation and predicted differences in the genetic composition across the landscape under current and future climates. Variants associated with temperature and precipitation variables were detected, and we applied a nonlinear multivariate association method, gradient forest, to project these gene-environment relationships across space. The model allowed the identification of geographic areas within the western Mediterranean region most sensitive to climate change: south-western Iberia and northern Morocco. Our findings provide a preliminary assessment towards a potential management strategy for the conservation of cork oak in the Mediterranean Basin.

Disclosing proteins in the leaves of cork oak plants associated with the immune response to Phytophthora cinnamomi inoculation in the roots: A long-term proteomics approach.

The pathological interaction between oak trees and Phytophthora cinnamomi has implications in the cork oak decline observed over the last decades in the Iberian Peninsula. During host colonization, the phytopathogen secretes effector molecules like elicitins to increase disease effectiveness. The objective of this study was to unravel the proteome changes associated with the cork oak immune response triggered by P. cinnamomi inoculation in a long-term assay, through SWATH-MS quantitative proteomics performed in the oak leaves. Using the Arabidopis proteome database as a reference, 424 proteins were confidently quantified in cork oak leaves, of which 80 proteins showed a p-value below 0.05 or a fold-change greater than 2 or less than 0.5 in their levels between inoculated and control samples being considered as altered. The inoculation of cork oak roots with P. cinnamomi increased the levels of proteins associated with protein-DNA complex assembly, lipid oxidation, response to endoplasmic reticulum stress, and pyridine-containing compound metabolic process in the leaves. In opposition, several proteins associated with cellular metabolic compound salvage and monosaccharide catabolic process had significantly decreased abundances. The most significant abundance variations were observed for the Ribulose 1,5-Bisphosphate Carboxylase small subunit (RBCS1A), Heat Shock protein 90-1 (Hsp90-1), Lipoxygenase 2 (LOX2) and Histone superfamily protein H3.3 (A8MRLO/At4G40030) revealing a pertinent role for these proteins in the host-pathogen interaction mechanism. This work represents the first SWATH-MS analysis performed in cork oak plants inoculated with P. cinnamomi and highlights host proteins that have a relevant action in the homeostatic states that emerge from the interaction between the oomycete and the host in the long term and in a distal organ.

Systematic Review of Auditory Perceptual and Acoustic Characteristics of the Voice of Cochlear Implant Adult Users.

STATEMENT OF PROBLEM: What are the normative data available on the perceptual and acoustic characteristics of the voice of adults of both sexes who have hearing-impairment and who use cochlear implants? PURPOSE: To identify in the literature, normative data about the perceptual auditory and acoustic characteristics of the voice of hearing-impaired cochlear implant adult users. SEARCH STRATEGY: A systematic search was carried out in the Virtual Health Library, Web of Science, Science Direct, SciELO, and SCOPUS databases with no temporal restriction. SELECTION CRITERIA: The articles were selected if they led with citation to normative data of the acoustic analysis of the voice of deaf cochlear implant users. And duplicate articles, case studies, letters to the editor, reviews, and studies that were not directly related to the topic were excluded. DATA EXTRACTION: The data from each article were extracted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist: title, abstract, year of publication, journal, authors and country of origin, identification of background, purpose, study design, participants, variables, and data measurement. DATA SYNTHESIS: There were 1,052 publications that met the search criteria. After applying the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist, excluding duplicates, and reading of the full text, 10 papers were selected for further analysis. Although several voice parameters have been studied, there is a great variation in study designs, sample sizes, age of participants, voice samples analyzed, and cochlear implant specifications. CONCLUSION: The normative data available in the literature concerning the voice of cochlear implant users are consistent only in terms of fundamental frequency.

Intensive therapy for speech rehabilitation of a patient with cleft lip and palate: a case report / Terapia intensiva para a reabilitação da fala em paciente com fissura labiopalatina: relato de caso

ABSTRACT Intensive therapy is an alternative to accelerate the therapeutic process of individuals with cleft lip and palate. The purpose of this study is to describe an intensive speech therapy program and compare the results before and after the program on a child with previously operated right unilateral cleft lip and palate and velopharyngeal insufficiency, using a speech bulb. Sixty therapy sessions were carried out over a 4-week period. Before and after, anamnesis, speech assessment and evaluation of the velopharyngeal function with nasofibroscopy, were performed. The patient presented with adequate resonance and speech intelligibility, reduction of obligatory disorders and compensatory articulations, after intensive therapy with the speech bulb and reduction of velopharyngeal gap, after intensive therapy with and without the speech bulb. Progress was achieved with the intensive speech therapy.

RESUMO A terapia intensiva é uma alternativa para acelerar o processo terapêutico de indivíduos com fissura labiopalatina. O objetivo desse estudo foi descrever, aplicar um programa de terapia intensiva e comparar a evolução antes e após o programa de fonoterapia de uma criança com fissura transforame incisivo unilateral direita operada e insuficiência velofaríngea em uso de prótese de palato obturadora. Foram realizadas 60 sessões de terapia, durante 4 semanas. Antes e após, aplicou-se anamnese, avaliação da fala e nasofibroscopia. Como resultado, a paciente apresentou adequação da ressonância e da inteligibilidade de fala, diminuição dos distúrbios obrigatórios e das articulações compensatórias após terapia intensiva com prótese de palato obturadora; e redução do gap velofaríngeo após a terapia intensiva com e sem o uso da prótese. Concluiu-se que a fonoterapia intensiva proporcionou evolução do caso.

Development and validation of the protocol for the evaluation of voice in patients with hearing impairment (PEV-SHI) / Desenvolvimento e validação do protocolo de avaliação da voz do deficiente auditivo (PAV-DA)

Abstract Introduction: The voice of individuals with hearing impairment has been widely described, and can be compromised in all levels of the phonatory system. Objective: To develop and validate an instrument for evaluating the voice of this population. Methods: The instrument underwent the validation steps suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. The study sample consisted of seventy-eight Brazilian people with cochlear implants (experimental group) and 78 individuals with normal hearing (control group), divided in groups by age range — children from 3 to 5 years; children from 6 to 10 years and adults from 18 to 46 years. The study sample participated in a voice recording of the sustained vowel /a/, connected speech and spontaneous conversation, in which three voice specialists rated using the proposed instrument. It consists of visual-analog scales of suprasegmental aspects, respiratory-phonatory coordination, resonance, phonation, additional parameters and general vocal perception. Results: Evaluation by an expert committee and a pilot test established content validity. Reliability measures showed excellent test-retest reproducibility for the majority of the parameters. Analysis with the ROC curve showed that perceptual evaluation with the sustained vowel did not strongly differentiate individuals with cochlear implants from those with normal hearing, and the parameter "speech rate" did not differentiate the groups at all. For the connected speech and spontaneous conversation, the majority of the parameters differentiated the experimental group from the control group with an area under the curve ≥0.7. The cutoff values with maximum specificity and sensitivity were 30.5 for mild, 49.0 for moderate and 69.5 for intense deviation. Conclusions: The protocol for the evaluation of voice in subjects with hearing impairment, PEV-SHI, is a reliable and useful tool for assessing the particularities of the voice of individuals with hearing impairment treated with cochlear implants and can be used in research and clinical settings to standardize evaluation and facilitate information exchange among services.

Resumo Introdução: A voz de indivíduos com deficiência auditiva tem sido amplamente descrita e pode estar comprometida em todos os níveis do sistema fonatório. Objetivo: Desenvolver e validar uma ferramenta para avaliar a voz dessa população. Método: A ferramenta foi submetida às etapas de validação sugeridas pelo Scientific Advisory Committee of the Medical Outcomes Trust. A amostra do estudo foi composta por 78 indivíduos brasileiros com implantes cocleares (grupo experimental) e 78 indivíduos com audição normal (grupo controle) divididos em grupos por faixa etária - crianças de 3 a 5 anos; crianças de 6 a 10 anos e adultos de 18 a 46 anos. Os participantes do estudo realizaram uma gravação de voz da vogal /a/ sustentada, fala encadeada e conversa espontânea, que foi avaliada por três especialistas em voz com o instrumento proposto. Este instrumento consistem em escalas visuais analógicas dos aspectos suprassegmentares da voz, coordenação pneumofonoarticulatória, ressoância, fonação, parâmetro adicional e impressão geral da qualidade vocal. Resultados: A avaliação por um comitê de especialistas e um teste-piloto estabeleceram a validade de conteúdo. Medidas de confiabilidade mostraram excelente reprodutibilidade teste-reteste para a maioria dos parâmetros. A análise com a curva ROC mostrou que a avaliação perceptivo-auditiva com a vogal sustentada não diferenciou significantemente os indivíduos com implante coclear daqueles com audição normal e o parâmetro "velocidade de fala" não diferenciou os grupos. Para a fala encadeada e conversa espontânea, a maioria dos parâmetros diferenciou o grupo experimental do grupo controle, com uma área sob a curva ≥ 0,7. Os valores de corte com máxima especificidade e sensibilidade foram 30,5 para desvio discreto, 49,0 para desvio moderado e 69,5 para desvio intenso. Conclusões: O protocolo de avaliação de voz do deficiente auditivo é uma ferramenta confiável e útil para avaliar as particularidades da voz de indivíduos com deficiência auditiva e implante coclear e pode ser utilizada em pesquisas e contextos clínicos para padronizar a avaliação e facilitar a troca de informações entre os serviços.

Development and validation of the protocol for the evaluation of voice in patients with hearing impairment (PEV-SHI).

INTRODUCTION: The voice of individuals with hearing impairment has been widely described, and can be compromised in all levels of the phonatory system. OBJECTIVE: To develop and validate an instrument for evaluating the voice of this population. METHODS: The instrument underwent the validation steps suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. The study sample consisted of seventy-eight Brazilian people with cochlear implants (experimental group) and 78 individuals with normal hearing (control group), divided in groups by age range - children from 3 to 5 years; children from 6 to 10 years and adults from 18 to 46 years. The study sample participated in a voice recording of the sustained vowel /a/, connected speech and spontaneous conversation, in which three voice specialists rated using the proposed instrument. It consists of visual-analog scales of suprasegmental aspects, respiratory-phonatory coordination, resonance, phonation, additional parameters and general vocal perception. RESULTS: Evaluation by an expert committee and a pilot test established content validity. Reliability measures showed excellent test-retest reproducibility for the majority of the parameters. Analysis with the ROC curve showed that perceptual evaluation with the sustained vowel did not strongly differentiate individuals with cochlear implants from those with normal hearing, and the parameter "speech rate" did not differentiate the groups at all. For the connected speech and spontaneous conversation, the majority of the parameters differentiated the experimental group from the control group with an area under the curve ≥0.7. The cutoff values with maximum specificity and sensitivity were 30.5 for mild, 49.0 for moderate and 69.5 for intense deviation. CONCLUSIONS: The protocol for the evaluation of voice in subjects with hearing impairment, PEV-SHI, is a reliable and useful tool for assessing the particularities of the voice of individuals with hearing impairment treated with cochlear implants and can be used in research and clinical settings to standardize evaluation and facilitate information exchange among services.

Voice symptoms and handicap in adults with cochlear implants / Sintomas vocais e desvantagem vocal em adultos usuários de implante coclear

ABSTRACT Purpose: to investigate the presence of vocal symptoms and handicap in adults with cochlear implants, and verify the correlation with their self-perception of the voice quality. Methods: twenty-seven adults of both genders, with cochlear implants, in the age range of 19 to 57 years participated. The participants answered the self-assessment protocols Voice Handicap Index and Voice Symptom Scale. Furthermore, the participants answered an additional question about how they rated their voices. Results: for the Voice Handicap Index, the average score was 28.74, in total, and the average score for the Voice Symptom Scale was 29.22, in total. The correlation between the scores of the Voice Handicap Index and the self-perception of the voice showed that the worse the perception, the more handicap in every domain of the protocol. For the Voice Symptoms Scale, the results showed that there is a positive and moderate correlation between the self-perception of the voice and the total scores as well as for the impairment and emotional subscales. Conclusion: this study verified the presence of handicap and symptoms related to voice, mainly, regarding physical, functional and limitation aspects for the adults with cochlear implants. There is a positive and moderate correlation between the score of the protocols applied and self-evaluation of the vocal quality of the participants.

RESUMO Objetivo: investigar a presença de desvantagem vocal e sintomas vocais em usuários adultos de implante coclear e verificar sua correlação com a autoavaliação da qualidade vocal. Métodos: participaram 27 adultos com implante coclear de ambos os sexos com idade entre 19 e 57 anos. Foram aplicados os questionários de autoavaliação Índice de Desvantagem Vocal e Escala de Sintomas Vocais. Além disso, os participantes responderam uma questão sobre autopercepção vocal. Resultados: a pontuação média para o Índice de Desvantagem Vocal foi de 28,74 no total, e a pontuação média da Escala de Sintomas Vocais foi de 29,22. A correlação entre o Índice de Desvantagem Vocal e a questão de autopercepção vocal indicaram que ao passo que a percepção da voz piora, há maior desvantagem vocal em todos os domínios do questionário. Para a Escala de Sintomas Vocais houve correlação positiva e moderada entre a autopercepção vocal e a pontuação dos domínios limitação, emocional e a pontuação total. Conclusão: foi possível verificar presença de desvantagem e sintomas relacionados à voz, no que se refere a questões funcionais, orgânicas e de limitação na população estudada. Existe correlação positiva e moderada entre a pontuação dos questionários e a autoavaliação da qualidade vocal dos participantes.

Auditory-Perceptual Evaluation of Voice Quality of Cochlear-implanted and Normal-hearing Individuals: A Reliability Study.

OBJECTIVE: This study aimed to present an experience in rating voices of adults with normal hearing and adults with cochlear implants and critically examine the outcomes, discussing pros and cons of the methodology used. STUDY DESIGN: This is a cross-sectional, prospective study. METHODS: One hundred and fifty voice samples, consisting of 50 sustained vowels, 50 samples of connected speech, and 50 samples of conversational speech, belonging to 25 adults with hearing impairment with cochlear implants and 25 adults with normal hearing, were perceptually analyzed for inter-rater agreement and intra-rater reliability. Three experienced judges rated the voice samples using visual analog scales of parameters considered relevant for cochlear-implanted population such as articulation, intonation, and resonance. The raters participated in three training sessions for calibration and had 1 month to complete the ratings individually. Twenty percent of the samples were repeated randomly to verify intra-rater reliability. The levels of agreement and reliability were verified using the interclass correlation coefficient. RESULTS: The inter-rater agreement varied widely across the parameters and speech tasks, from poor to excellent agreement. The only parameter for which the raters maintained consistently good or excellent agreement for all groups and emissions was the pitch. For intra-rater reliability, two of the raters presented excellent reliability for most parameters across all of the speech tasks, whereas one rater presented more inconsistencies. CONCLUSIONS: In this reliability study, factors such as extensive deadline for the auditory perceptual evaluation, lack of periodic recalibration, speech tasks, and familiarity with the population studied were identified as factors that contributed to inconsistent reliability results.

Hearing performance and voice acoustics of cochlear implanted children / Desempenho auditivo e acústica da voz de crianças com implante coclear

ABSTRACT INTRODUCTION: The voice of hearing-impaired individuals has been described extensively, and exhibits abnormalities in quality, articulation and resonance. Having an understanding of the aspects that may have an impact on voice characteristics of cochlear implant users is important for users and for professionals in this field. OBJECTIVE: To verify the existence of correlation between age, time of device use, voice detection threshold, hearing category score and language category score with acoustic data of voices of cochlear implanted children. METHODS: Retrospective study. Fifty-one children ranging in age from 3 years to 5 years and 11 months who unilaterally used cochlear implants participated. Acoustic analysis of the sustained vowel/a/, sequential speech and spontaneous speech was performed. The results were correlated with demographic data and hearing test results. RESULTS: Children with worse voice detection threshold showed higher frequency in the sustained vowel ( p ≤ 0.001) and in the spontaneous speech ( p ≤ 0.005). CONCLUSION: There was a correlation between the voice detection threshold and the frequency values of the sustained vowel and spontaneous speech of the studied population.

RESUMO INTRODUÇÃO: A voz do indivíduo com deficiência auditiva tem sido amplamente caracterizada, estando comprometida em termos de tipo de voz, articulação e ressonância, sendo que o conhecimento dos aspectos que possam ter impacto nas características vocais de usuários de implante coclear é de suma importância para os usuários e profissionais da área. OBJETIVO: Verificar a existência de correlação entre idade, tempo de uso, limiar de detecção de voz, escore da categoria de audição e escore da categoria de linguagem com dados acústicos de vozes de crianças com implante coclear. MÉTODO: Estudo retrospectivo. Participaram 51 crianças usuárias de implante coclear com idade de 3-5 anos e 11 meses. Foi realizada análise acústica da vogal sustentada/a/, fala encadeada e conversa espontânea. Os resultados foram correlacionados com dados demográficos e resultados de testes auditivos. RESULTADOS: Crianças com pior desempenho no teste de detecção de voz apresentam voz mais aguda na vogal sustentada ( p ≤ 0,001) e na conversa espontânea ( p ≤ 0,005). CONCLUSÃO: Houve correlação entre os limiares de detecção de voz e os valores de frequência na vogal sustentada e conversa espontânea na população estudada.

Hearing performance and voice acoustics of cochlear implanted children.

INTRODUCTION: The voice of hearing-impaired individuals has been described extensively, and exhibits abnormalities in quality, articulation and resonance. Having an understanding of the aspects that may have an impact on voice characteristics of cochlear implant users is important for users and for professionals in this field. OBJECTIVE: To verify the existence of correlation between age, time of device use, voice detection threshold, hearing category score and language category score with acoustic data of voices of cochlear implanted children. METHODS: Retrospective study. Fifty-one children ranging in age from 3 years to 5 years and 11 months who unilaterally used cochlear implants participated. Acoustic analysis of the sustained vowel/a/, sequential speech and spontaneous speech was performed. The results were correlated with demographic data and hearing test results. RESULTS: Children with worse voice detection threshold showed higher frequency in the sustained vowel (p≤0.001) and in the spontaneous speech (p≤0.005). CONCLUSION: There was a correlation between the voice detection threshold and the frequency values of the sustained vowel and spontaneous speech of the studied population.

Há concordância entre pais e filhos quanto a seus comportamentos vocais? / Is there agreement between parents and children about their vocal behavior? / ?Hay acuerdo entre los padres y los niños sobre sus comportamientos vocales?

Objetivo: Investigar se os pais percebem as alterações vocais de seus filhos e se há concordância entre comportamentos vocais relatados por pais e filhos, considerando-se crianças com e sem alterações vocais. Método: Participaram 28 crianças disfônicas (grupo disfônico - GD) e 22 crianças sem alterações vocais (grupo controle - GC). A presença da alteração vocal foi detectada por avaliação perceptivo-auditiva. Todos responderam a um questionário com questões fechadas, referentes a fatores prejudiciais à voz nos últimos seis meses. O questionário dos pais continha uma questão sobre opinião que tinham a respeito da voz de seu filho. Aplicou-se o teste de Concordância Kappa para analisar a existência de concordância entre a opinião dos pais em relação às vozes de seus filhos e a classificação da voz das crianças realizadas por juízes. Analisou-se também a concordância entre comportamentos vocais relatados por pais e filhos. Resultado: No GD houve fraca concordância em relação à avaliação perceptivo-auditiva das vozes das crianças e a opinião dos pais e mães sobre as vozes de seus filhos. Porém no GC, houve concordância ótima para os pais, enquanto que para as mães a concordância foi perfeita. Quanto aos fatores prejudiciais à voz, houve concordância em ambos os grupos quanto à presença e à ausência de comportamentos relatados pelos pais e crianças. Conclusão: Os pais de crianças disfônicas têm dificuldade em perceber a alteração vocal de seus filhos. Além disso, houve concordância entre presença ou ausência de comportamentos vocais nocivos autorreferidos pelas crianças disfônicas e com vozes saudáveis e seus respectivos pais.

Purpose: Investigate if parents observe vocal alterations of their children and if there is agreement between vocal conduct referred by parents and children with or without voice disorders, and also investigate are there are correlations between family habits and dysphonia in children. Methods: 28dysphonic children and their parents (dysphonic group) and 22 ormophonic children and their parents (control group) participated. The unhealthy factors were investigated with a self-reported questionnaire. These factors were compared among the children of both groups, among children and their mothers and among children and their fathers. To compare the two groups, we used the difference of proportion test (p<0.05). To verify the correlation between children?s and parent?s habits, the Kappa coefficient (0.00<K<1.0 and p<0.05) was used. Results: We verified that the individuals of the dysphonic group presented more unhealthy habits and reported living in a noisy household in a greater scale than the control group. Regarding the correlation analysis of the unhealthy factors, the Kappa coefficient revealed that for both groups there was a significant correlation for those factors between children and parents, both for their presence or absence. Conclusion: The presence or absence of dysphonia is correlated to family behavior of both parents and children.

Objetivos: Investigar si los padres se dan cuenta de las alteraciones vocales de sus hijos y si hay acuerdo entre los comportamientos vocales relatados por padres y hijos, teniendo en cuenta niños con y sin trastornos vocales. Método: Participaron 28 niños disfónicos (grupo disfónico-GD) y 22 niños sin trastornos de la voz (grupo control-GC) . La presencia de alteración vocal se detectó por evaluación perceptivo-auditiva. Todos contestaron a un cuestionario con preguntas cerradas, que se referían afactores nocivos para la voz, en los últimos seis meses. El cuestionario de los padres contenía una pregunta adicional sobre la opinión que tenían a respeto de la voz de su hijo. Se utilizó el Test de Concordancia de Kappa para analizar la existencia de acuerdo entrela opinión de los padres sobre las voces de sus hijos y la clasificación de la voz de los niños realizada por jueces. Se analizó también el acuerdo entre los comportamientos vocales relatados por padres e hijos .Resultado: En el GD hubo bajo acuerdo en relación a la evaluación perceptivo-auditiva de las voces de los niños y las opiniones de los padres y madres sobre las voces de sus hijos. Todavía en el GC hubo fuerte acuerdo para los padres, mientras para las madres el acuerdo fue perfecto. En cuanto a los factores nocivos para la voz, hubo acuerdo en ambos grupos en cuanto a la presencia y ausencia de comportamientos reportados por los padres y los hijos. Conclusión: Los padres de niños disfónicos tienen dificultades para percibir la alteración vocal de sus hijos. Además, hubo acuerdo entre la presencia o ausencia de comportamientos vocales autoreferidos por los niños disfónicos y con voces saludables y sus respectivos padres.

Há concordância entre pais e filhos quanto a seus comportamentos vocais? / Is there agreement between parents and children about their vocal behavior? / ?Hay acuerdo entre los padres y los niños sobre sus comportamientos vocales?

Objetivo: Investigar se os pais percebem as alterações vocais de seus filhos e se há concordância entre comportamentos vocais relatados por pais e filhos, considerando-se crianças com e sem alterações vocais.Método: Participaram 28 crianças disfônicas (grupo disfônico - GD) e 22 crianças sem alterações vocais (grupo controle - GC). A presença da alteração vocal foi detectada por avaliação perceptivo-auditiva. Todos responderam a um questionário com questões fechadas, referentes a fatores prejudiciais à voz nos últimos seis meses. O questionário dos pais continha uma questão sobre opinião que tinham a respeito da voz de seu filho. Aplicou-se o teste de Concordância Kappa para analisar a existência de concordância entre a opinião dos pais em relação às vozes de seus filhos e a classificação da voz das crianças realizadas por juízes. Analisou-se também a concordância entre comportamentos vocais relatados por pais e filhos. Resultado: No GD houve fraca concordância em relação à avaliação perceptivo-auditiva das vozes das crianças e a opinião dos pais e mães sobre as vozes de seus filhos. Porém no GC, houve concordância ótima para os pais, enquanto que para as mães a concordância foi perfeita. Quanto aos fatores prejudiciais à voz, houve concordância em ambos os grupos quanto à presença e à ausência de comportamentos relatados pelos pais e crianças. Conclusão: Os pais de crianças disfônicas têm dificuldade em perceber a alteração vocal de seus filhos. Além disso, houve concordância entre presença ou ausência de comportamentos vocais nocivos autorreferidos pelas crianças disfônicas e com vozes saudáveis e seus respectivos pais.(AU)

Purpose: Investigate if parents observe vocal alterations of their children and if there is agreement between vocal conduct referred by parents and children with or without voice disorders, and also investigate are there are correlations between family habits and dysphonia in children. Methods: 28dysphonic children and their parents (dysphonic group) and 22 ormophonic children and their parents (control group) participated. The unhealthy factors were investigated with a self-reported questionnaire. These factors were compared among the children of both groups, among children and their mothers and among children and their fathers. To compare the two groups, we used the difference of proportion test (p<0.05). To verify the correlation between children?s and parent?s habits, the Kappa coefficient (0.00

Objetivos: Investigar si los padres se dan cuenta de las alteraciones vocales de sus hijos y si hay acuerdo entre los comportamientos vocales relatados por padres y hijos, teniendo en cuenta niños con y sin trastornos vocales. Método: Participaron 28 niños disfónicos (grupo disfónico-GD) y 22 niños sin trastornos de la voz (grupo control-GC) . La presencia de alteración vocal se detectó por evaluación perceptivo-auditiva. Todos contestaron a un cuestionario con preguntas cerradas, que se referían afactores nocivos para la voz, en los últimos seis meses. El cuestionario de los padres contenía una pregunta adicional sobre la opinión que tenían a respeto de la voz de su hijo. Se utilizó el Test de Concordancia de Kappa para analizar la existencia de acuerdo entrela opinión de los padres sobre las voces de sus hijos y la clasificación de la voz de los niños realizada por jueces. Se analizó también el acuerdo entre los comportamientos vocales relatados por padres e hijos .Resultado: En el GD hubo bajo acuerdo en relación a la evaluación perceptivo-auditiva de las voces de los niños y las opiniones de los padres y madres sobre las voces de sus hijos. Todavía en el GC hubo fuerte acuerdo para los padres, mientras para las madres el acuerdo fue perfecto. En cuanto a los factores nocivos para la voz, hubo acuerdo en ambos grupos en cuanto a la presencia y ausencia de comportamientos reportados por los padres y los hijos. Conclusión: Los padres de niños disfónicos tienen dificultades para percibir la alteración vocal de sus hijos. Además, hubo acuerdo entre la presencia o ausencia de comportamientos vocales autoreferidos por los niños disfónicos y con voces saludables y sus respectivos padres.(AU)

An initial study of voice characteristics of children using two different sound coding strategies in comparison to normal hearing children.

OBJECTIVE: To compare some perceptual and acoustic characteristics of the voices of children who use the advanced combination encoder (ACE) or fine structure processing (FSP) speech coding strategies, and to investigate whether these characteristics differ from children with normal hearing. DESIGN: Acoustic analysis of the sustained vowel /a/ was performed using the multi-dimensional voice program (MDVP). Analyses of sequential and spontaneous speech were performed using the real time pitch. Perceptual analyses of these samples were performed using visual-analogic scales of pre-selected parameters. STUDY SAMPLE: Seventy-six children from three years to five years and 11 months of age participated. Twenty-eight were users of ACE, 23 were users of FSP, and 25 were children with normal hearing. RESULTS: Although both groups with CI presented with some deviated vocal features, the users of ACE presented with voice quality more like children with normal hearing than the users of FSP. CONCLUSIONS: Sound processing of ACE appeared to provide better conditions for auditory monitoring of the voice, and consequently, for better control of the voice production. However, these findings need to be further investigated due to the lack of comparative studies published to understand exactly which attributes of sound processing are responsible for differences in performance.

A comprehensive assessment of the transcriptome of cork oak (Quercus suber) through EST sequencing.

BACKGROUND: Cork oak (Quercus suber) is one of the rare trees with the ability to produce cork, a material widely used to make wine bottle stoppers, flooring and insulation materials, among many other uses. The molecular mechanisms of cork formation are still poorly understood, in great part due to the difficulty in studying a species with a long life-cycle and for which there is scarce molecular/genomic information. Cork oak forests are of great ecological importance and represent a major economic and social resource in Southern Europe and Northern Africa. However, global warming is threatening the cork oak forests by imposing thermal, hydric and many types of novel biotic stresses. Despite the economic and social value of the Q. suber species, few genomic resources have been developed, useful for biotechnological applications and improved forest management. RESULTS: We generated in excess of 7 million sequence reads, by pyrosequencing 21 normalized cDNA libraries derived from multiple Q. suber tissues and organs, developmental stages and physiological conditions. We deployed a stringent sequence processing and assembly pipeline that resulted in the identification of ~159,000 unigenes. These were annotated according to their similarity to known plant genes, to known Interpro domains, GO classes and E.C. numbers. The phylogenetic extent of this ESTs set was investigated, and we found that cork oak revealed a significant new gene space that is not covered by other model species or EST sequencing projects. The raw data, as well as the full annotated assembly, are now available to the community in a dedicated web portal at http://www.corkoakdb.org. CONCLUSIONS: This genomic resource represents the first trancriptome study in a cork producing species. It can be explored to develop new tools and approaches to understand stress responses and developmental processes in forest trees, as well as the molecular cascades underlying cork differentiation and disease response.

Coralistas amadores: auto-imagem, dificuldades e sintomas na voz cantada / Amateur choir singers: self-image, difficulties and symptoms of the singing voice

OBJETIVO: conhecer a auto-imagem, dificuldades e presença de sintomas negativos após o canto em coralistas amadores com diferentes classificações vocais, idades e experiência. MÉTODO: cento e vinte e cinco cantores responderam a um questionário que abordou dados de identificação, informações sobre a auto-imagem da voz cantada, dificuldades apresentadas no canto e ocorrência ou não de sintomas vocais após o canto. RESULTADOS: a comparação por naipes evidenciou maior dificuldade na emissão de sons agudos para os contraltos e baixos, maior dificuldade na emissão graves para os sopranos, maior dificuldade na transição de registro grave para agudo para os baixos, e maior cansaço vocal para os contraltos. Na divisão por idade, tanto adultos jovens e adultos referiram maior soprosidade do que os idosos. Os adultos referiram melhor intensidade vocal do que adultos jovens. Os adultos jovens consideraram seu timbre de voz adequado mais frequentemente do que adultos. Em relação à experiência, os cantores menos experientes referiram percepção de voz rouca em maior número do que os cantores mais experientes, que referiram apresentar intensidade adequada durante o canto em maior número do que os demais. Cantores menos experientes referiram maior ocorrência de rouquidão após o canto do que cantores mais experientes. CONCLUSÃO: as dificuldades encontradas no canto estão atreladas ao naipe, e não dependem da idade e nem da experiência. Sintomas estão relacionados ao naipe e ao grau de experiência com o canto. A auto-imagem vocal negativa também está relacionada ao naipe e ao nível de experiência, sendo que a auto-imagem positiva é mais comum em cantores experientes.

PURPOSE: to evaluate vocal self-perception, difficulties and presence of negative symptoms after singing of amateur choir singers of different vocal classifications, age and experience. METHOD: one hundred and twenty five singers answered a questionnaire containing identification data, information about self-perception of the singing voice, difficulties with singing and negative symptoms after singing. RESULTS: the comparison considering vocal classification evidenced greater difficulties with high notes for altos and basses, greater difficulty regarding the transition to high notes for basses and greater vocal fatigue for altos. Comparing the singers by age, both adults and young adults referred more breathiness than the elderly. The adults referred better vocal intensity than the young adults. The young adults referred better timbre than adults. Regarding the experience, the less experienced singers reported self-perception of hoarseness and presence of hoarseness after singing in greater number than the experienced singers. CONCLUSION: the difficulties with singing are connected to the vocal classification and do not depend on age or experience. Vocal symptoms are related to the vocal classification and to the experience with singing. Negative self-perception is also related the vocal classification and to the experience with singing, and positive self-perception was more reported by experienced singers.

Cochlear implanted children present vocal parameters within normal standards.

OBJECTIVE: to compare acoustic and perceptual parameters regarding the voice of cochlear implanted children, with normal hearing children. METHOD: this is a cross-sectional, quantitative and qualitative study. METHODS: Thirty six cochlear implanted children aged between 3 y and 3 m to 5 y and 9 m and 25 children with normal hearing, aged between 3 y and 11 m and 6 y and 6 m, participated in this study. The recordings and the acoustics analysis of the sustained vowel/a/and spontaneous speech were performed using the PRAAT program. The parameters analyzed for the sustained vowel were the mean of the fundamental frequency, jitter, shimmer and harmonic-to-noise ratio (HNR). For the spontaneous speech, the minimum and maximum frequencies and the number of semitones were extracted. The perceptual analysis of the speech material was analyzed using visual-analogical scales of 100 points, composing the aspects related to the overall severity of the vocal deviation, roughness, breathiness, strain, pitch, loudness and resonance deviation, and instability. This last parameter was only analyzed for the sustained vowel. RESULTS: The results demonstrated that the majority of the vocal parameters analyzed in the samples of the implanted children disclosed values similar to those obtained by the group of children with normal hearing. CONCLUSION: implanted children who participate in a (re) habilitation and follow-up program, can present vocal characteristics similar to those vocal characteristics of children with normal hearing.

Systematic analysis of the benefits of cochlear implants on voice production.

PURPOSE: To perform a systematic analysis of the research regarding vocal characteristics of hearing impaired children or adults with cochlear implants. RESEARCH STRATEGY: A literature search was conducted in the databases Web of Science, Bireme, and Universidade de São Paulo's and CAPES' thesis and dissertations databases using the keywords voice, voice quality, and cochlear implantation, and their respective correspondents in Brazilian Portuguese. SELECTION CRITERIA: The selection criteria included: title consistent with the purpose of this review; participants necessarily being children or adults with severe to profound pre-lingual or post-lingual hearing loss using cochlear implants; and data regarding participants' performance on perception and/or acoustic analysis of the voice. RESULTS: Twenty seven papers were classified according to the levels of evidence and quality indicators recommended by the American Speech-Language-Hearing Association (ASHA). The designs of the studies were considered of low and medium levels of evidence. Six papers were classified as IIb, 20 as III, and one as IV. CONCLUSION: The voice of hearing impaired children and adults with cochlear implants has been little studied. There is not an effective number of studies with high evidence levels which precisely show the effects of the cochlear implantation on the quality of voice of these individuals.