Risk of Dysphonia, Presence of Vocal Changes, and Vocal Self-Perception in Brazilian Transgender Women.

OBJECTIVE: To evaluate and correlate the risk of dysphonia, the presence of vocal changes and their associated factors, and the vocal self-perception of transgender women. METHOD: Observational cross-sectional study in Brazilian transgender women. The analysis addressed their age, length of experience in the gender, perceptual-auditory and acoustic vocal aspects, scores in the General Dysphonia Risk Screening Protocol (DRSP-G), and the Voice Questionnaire for Male-to-Female Transsexuals (TVQ(MtF)). The sample was divided into two groups based on the grade of vocal deviation (Consensus Auditory-Perceptual Evaluation of Voice)-with (G.W.C.) and without vocal changes (G.N.C.)-to verify the association between the presence of vocal changes and other variables. The correlation between the grade of vocal deviation and DRSP and TVQ(MtF) scores was also verified. RESULTS: The sample included 32 transgender women with a mean age of 30.1 and 11.52 years of experience as females. Over half declared themselves Black, and a third of the sample did not have a defined profession. Use of female hormones was reported by 71.9%, the majority without a medical prescription. The mean grade of vocal deviation was 22, the dysphonia risk score was 43.47, and the TVQ(MtF) score was 59.46. Nasal and pharyngeal resonance was observed in 59.4%, and the mean fundamental frequency (f0) was 156.14 Hz. G.W.C. had a shorter experience living in the redesignated genre. The participants idealized more feminine voices than they currently had. The DRSP-G and TVQ(MtF) scores had a moderate positive correlation. CONCLUSION: The study sample had characteristics compatible with some degree of social and health vulnerability. There was a moderate impact of voice on their quality of life, and despite the high risk of dysphonia, there was a low occurrence of vocal changes. There was a correlation between the DRSP-G and TVQ(MtF) scores.

Uso do método de Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares (PROMPT) no Transtorno do Espectro Autista: um estudo de caso / Use of the Prompts for Reestructuring Oral Muscular Phonetic Targets (PROMPT) in Autism Spectrum Disorder: a case study

RESUMO O Transtorno do Espectro Autista (TEA) é classificado pelo Manual de Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) como um Transtorno do Neurodesenvolvimento, sendo caracterizado, principalmente, por alterações na comunicação social e pela presença de um repertório restrito de atividades e interesses. Na literatura, há muitos estudos sobre autismo, fala e linguagem, mas poucos correlacionando fala e autismo. Este estudo teve como finalidade realizar um estudo de caso que abordou autismo, fala e PROMPT (Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares) e mensurou a melhora da fala no participante com autismo, utilizando o método. Foram definidas palavras-alvo para toda a intervenção, conforme o Sistema de Observação e Análise (SOA) e Hierarquia Motora de Fala (HMF), que fazem parte da avaliação de PROMPT. Após a avaliação, o participante foi atendido por 16 sessões, uma vez semanalmente. Após análise dos dados, observou-se melhora em todos os aspectos que foram delineados de acordo com a avaliação no pré-tratamento, como controle fonatório, controle mandibular, controle lábio-facial e controle lingual, como também no movimento sequenciado, apesar deste não ser o objetivo traçado na avaliação. Também foi possível mensurar melhora no número de vocábulos adequados, número de fonemas adequados, porcentagens de consoantes corretas - revisado (PCC-R) e inteligibilidade.

ABSTRACT Autism Spectrum Disorder (ASD) is classified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a neurodevelopmental disorder, whose characteristics are mainly deficits in social communication and a restricted range of interests. There are several studies about autism, speech, and language in the literature, but few correlate speech and autism. This study aims to carry out a case study that will address autism, speech, and PROMPT (Restructuring Oral Muscular Phonetic Targets) and also to describe the speech improvement in the participant with autism using the method. The target words were defined for the entire intervention according to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH), which are parts of the PROMPT evaluation. After the evaluation, the participant was attended for 16 sessions, once weekly, with the objective of improving their speech. After analyzing the data, it was possible to observe improvement in all aspects outlined according to the pre-treatment evaluation of the method such as phonatory control, mandibular control, lip-facial control and lingual control as well as in the sequenced movement although this was not the aim outlined in the evaluation. It was also possible to measure the improvement of an adequate number of words, an adequate number of phonemes, percentages of correct consonants - revised (PCC-R), and intelligibility.

Proposals to promote health and prevent voice disorders in occupational voice users: A scoping review / Propostas de promoção da saúde e prevenção de distúrbios vocais para profissionais da voz: revisão de escopo

ABSTRACT Purpose: to characterize the actions of vocal health promotion and/or prevention of vocal disorders applied to voice professionals. Methods: a scoping review following the PRISMA-ScR guidelines in SciELO and PubMed databases was conducted. Articles that had as participants voice professionals without concomitant vocal treatment, that described proposals for health promotion or vocal disorders prevention, published between 2010 and 2023, were included. They were grouped into categories and data were presented descriptively. Literature Review: eighteen articles with artistic and non-artistic voice professionals, mostly teachers, were included. Most of the studies focused on healthy voices, aiming at primary prevention. Many articles presented guidance on vocal hygiene and health and used resources such as vocal enhancement, voice workshop, voice amplifiers and apps. All the articles positively mentioned their results, especially with regard to self-perception in relation to voice, vocal quality and quality of life, awareness of positive and harmful practices to the voice. Conclusion: the proposals contemplated different levels of prevention, but most focused on primary prevention, including vocally healthy participants; all articles indicated positive results in voice self-perception, voice quality and quality of life, and awareness of positive and harmful voice practices.

RESUMO Objetivo: caracterizar as ações de promoção de saúde vocal e/ou prevenção de distúrbios vocais aplicadas em profissionais da voz. Métodos: foi conduzida uma revisão de escopo seguindo as diretrizes do PRISMA-ScR nas bases de dados SciELO e PubMed. Foram incluídos artigos que tivessem como participantes profissionais da voz sem tratamento vocal concomitante, que descrevessem propostas de promoção da saúde ou prevenção de distúrbios vocais, publicados entre 2010 e 2023. Os artigos foram agrupados em categorias e os dados apresentados de forma descritiva. Revisão da Literatura: foram incluídos 18 artigos com profissionais da voz artística e não-artística, em sua maioria professores. A maior parte dos estudos tinha como foco vozes saudáveis, visando a prevenção primária. Muitos artigos apresentaram orientações sobre higiene e saúde vocal e utilizaram recursos como aprimoramento vocal, oficina de voz, amplificadores de voz e aplicativos. Todos os artigos mencionam resultados benéficos, principalmente no que se refere à autopercepção em relação a voz, qualidade vocal e de vida, conscientização de práticas positivas e prejudiciais à voz. Conclusão: as propostas contemplaram diferentes níveis de prevenção, mas a maioria tinha como foco a prevenção primária, incluindo participantes vocalmente saudáveis; todos os artigos indicaram resultados favoráveis na autopercepção em relação à voz, qualidade vocal e de vida e conscientização de práticas benéficas e prejudiciais à voz.

Use of the Prompts for Reestructuring Oral Muscular Phonetic Targets (PROMPT) in Autism Spectrum Disorder: a case study. / Uso do método de Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares (PROMPT) no Transtorno do Espectro Autista: um estudo de caso.

Autism Spectrum Disorder (ASD) is classified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a neurodevelopmental disorder, whose characteristics are mainly deficits in social communication and a restricted range of interests. There are several studies about autism, speech, and language in the literature, but few correlate speech and autism. This study aims to carry out a case study that will address autism, speech, and PROMPT (Restructuring Oral Muscular Phonetic Targets) and also to describe the speech improvement in the participant with autism using the method. The target words were defined for the entire intervention according to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH), which are parts of the PROMPT evaluation. After the evaluation, the participant was attended for 16 sessions, once weekly, with the objective of improving their speech. After analyzing the data, it was possible to observe improvement in all aspects outlined according to the pre-treatment evaluation of the method such as phonatory control, mandibular control, lip-facial control and lingual control as well as in the sequenced movement although this was not the aim outlined in the evaluation. It was also possible to measure the improvement of an adequate number of words, an adequate number of phonemes, percentages of correct consonants - revised (PCC-R), and intelligibility.

O Transtorno do Espectro Autista (TEA) é classificado pelo Manual de Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) como um Transtorno do Neurodesenvolvimento, sendo caracterizado, principalmente, por alterações na comunicação social e pela presença de um repertório restrito de atividades e interesses. Na literatura, há muitos estudos sobre autismo, fala e linguagem, mas poucos correlacionando fala e autismo. Este estudo teve como finalidade realizar um estudo de caso que abordou autismo, fala e PROMPT (Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares) e mensurou a melhora da fala no participante com autismo, utilizando o método. Foram definidas palavras-alvo para toda a intervenção, conforme o Sistema de Observação e Análise (SOA) e Hierarquia Motora de Fala (HMF), que fazem parte da avaliação de PROMPT. Após a avaliação, o participante foi atendido por 16 sessões, uma vez semanalmente. Após análise dos dados, observou-se melhora em todos os aspectos que foram delineados de acordo com a avaliação no pré-tratamento, como controle fonatório, controle mandibular, controle lábio-facial e controle lingual, como também no movimento sequenciado, apesar deste não ser o objetivo traçado na avaliação. Também foi possível mensurar melhora no número de vocábulos adequados, número de fonemas adequados, porcentagens de consoantes corretas ­ revisado (PCC-R) e inteligibilidade.

Risk of Dysphonia in Legal Professionals: Proposal for a Screening Protocol

Introduction: Due to the communicative requirements inherent to the profession, the legal professional benefits from speech therapy monitoring for the proper use of the voice and to avoid the occurrence of vocal disorders. The development of specific instruments will contribute with more relevant data to guide this monitoring. Objective: To verify the applicability of the General Dysphonia Risk Screening Protocol (DRSP-G) and the Specific Dysphonia Risk Screening Protocol for Legal Professionals (DRSP-LP) and to correlate the average scores of both with vocal deviation, sex, age, professional performance time, vocal signs and symptoms, and vocal self-assessment. Methods: Fifty legal professionals participated. All participants completed the DRSP-G and DRSP-LP and recorded their voices for detection of the presence of altered vocal quality. Results: Most participants presented a high risk of dysphonia, which was higher in men. Altered vocal quality was observed in 34% of the participants. The items with the highest scores in the DRSP-G were talking a lot (76%), excessive daily coffee intake (70%), contact with smokers (60%), and insufficient hydration and sleep (48%); in the DRSP-LP, alcohol consumption (68%) and exposure to air conditioning (64%). There was no correlation between risk scores and the degree of dysphonia, or with age or length of professional experience. The DRSP-G score correlated with vocal signs and symptoms and vocal self-perception. Conclusions: The joint application of the DRSP-G and the DRSP-LP enabled a quantitative and qualitative analysis of risk factors for dysphonia in legal professionals.

Introducción: Debido a las exigencias comunicativas inherentes a la profesión, el profesional del derecho se beneficia del seguimiento logopédico para el correcto uso de la voz y para evitar la aparición de trastornos vocales. El desarrollo de instrumentos específicos contribuirá con datos más relevantes para guiar este seguimiento. Objetivo: Verificar la aplicabilidad del Protocolo General de Detección de Riesgo de Disfonía (DRSP-G) y el Protocolo de Detección de Riesgo Específico para Profesionales del Derecho (DRSP-LP) y correlacionar las puntuaciones de ambos con varias variables de interés. Metodología: Participaron 50 profesionales del derecho. Todos completaron el DRSP-G y DRSP-LP y grabaron sus voces para detectar la presencia de alteraciones en la calidad de la voz. Resultados: La mayoría presentó un alto riesgo de disfonía, que fue mayor en los hombres. Se observó alteración en la calidad de la voz en el 34% de los participantes. Los ítems con puntajes más altos en el DRSP-G fueron hablar mucho (76%), ingesta diaria excesiva de café (70%), contacto con fumadores (60%) e hidratación y sueño insuficientes (48%); y en el DRSP-LP, consumo de alcohol (68%) y exposición al aire acondicionado (64%). No hubo correlación entre las puntuaciones de riesgo y el grado de disfonía, ni con la edad o la antigüedad profesional. La puntuación DRSP-G se correlacionó con los signos y síntomas vocales y la autopercepción vocal. Conclusiones: La aplicación conjunta del DRSP-G y el DRSP-LP permitió un análisis cuantitativo y cualitativo de los factores de riesgo de disfonía en profesionales del derecho.

Risk of dysphonia and voice quality in performing arts students. / Risco de disfonia e qualidade vocal em estudantes de artes cênicas.

PURPOSE: To analyse the relationship between the risk of dysphonia and vocal quality in undergraduate performing arts students. METHODS: Observational cross-sectional study with 38 undergraduate students in Performing Arts. We applied screening protocols for general and specific risk of dysphonia for actors and made recordings of sustained emission of the vowel /a/, spontaneous speech and reading a text, used for perceptual analysis performed by three evaluators using the GRBASI scale. After intra and inter-rater reliability tests it was obtained final classification of the general degree of vocal deviation parameter for each participant. Comparisons were made considering groups that had or did not have other profession/activity with the use of voice, and the groups were formed from the general grade. RESULTS: Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild degree. Students who had another profession/activity with voice use scored higher in the specific protocol for actors, and in the sum of this protocol with the general screening protocol. There was no relationship between the degree of vocal alteration and the risk of dysphonia. Students who did not yet work professionally had more moderate or severe vocal alterations, and those who did work professionally had a higher frequency of mild vocal alterations. CONCLUSION: Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild alteration. There was no relationship between the risk of dysphonia and the degree of vocal alteration.

OBJETIVO: Analisar a relação entre o risco de disfonia e a qualidade vocal em estudantes de graduação em Artes Cênicas. MÉTODO: Estudo transversal observacional com 38 estudantes de graduação em Artes Cênicas. Foram aplicados protocolos de rastreio de risco de disfonia geral e específico para atores, e realizadas gravações da emissão sustentada da vogal /a/, fala espontânea e leitura de texto, usadas para análise perceptivo-auditiva, efetuada por três avaliadores, com o uso da escala GRBASI. Após testes de confiabilidade intra e interavaliadores chegou-se à classificação final do grau geral do desvio vocal para cada participante. Foram feitas comparações entre grupos que tinham ou não outra profissão/atividade com o uso da voz e os grupos formados a partir do grau geral. RESULTADOS: A maioria dos estudantes apresentou alto risco para disfonia. Todos apresentaram alteração vocal, com predominância de grau leve. Os estudantes que tinham outra profissão/atividade com uso da voz obtiveram maior pontuação no protocolo específico para atores, bem como na soma desse protocolo com o de rastreio geral. Não houve relação entre o grau de alteração vocal e o risco de disfonia. Os estudantes que ainda não atuavam profissionalmente apresentaram mais alterações vocais de grau moderado ou severo, e os que atuavam profissionalmente apresentaram com maior frequência alteração vocal de grau leve. CONCLUSÃO: A maior parte dos estudantes apresentou alto risco para disfonia. Todos apresentaram alteração vocal, com predomínio de grau leve. Não houve relação entre o risco de disfonia e o grau de alteração vocal.

Risk of Dysphonia in Theater Actors: Proposal for a Screening Protocol.

OBJECTIVE: To propose a Dysphonia Risk Screening Protocol for Actors (DRSP-A), test its usability in conjunction with the General Dysphonia Risk Screening Protocol (G-DRSP), determine the cut-off point for a high risk of dysphonia in actors, and compare the risk of dysphonia between actors with and without voice disorders. METHOD: Observational cross-sectional study with 77 professional actors or students. The questionnaires were applied individually and the total scores were summed to calculate the final score of the Dysphonia Risk Screening (DRS-Final). The validity of the questionnaire was verified from the area under the Receiver Operating Characteristic (ROC) curve, and cut-offs were obtained based on diagnostic criteria for screening procedures. Voice recordings were collected for auditory-perceptual analysis and subsequent division into groups with and without vocal alteration. RESULTS: The sample showed a high risk of dysphonia. Higher scores in the G-DRSP and in the DRS-Final were found in the group that presented vocal alteration. The cut-off points established for the DRSP-A and DRS-Final were 0.623 and 0.789, respectively, with higher degrees of sensitivity than specificity. Thus, above these values, the risk of dysphonia is greater. CONCLUSION: A cut-off value was calculated for the DRSP-A. This instrument was proven to be viable and applicable. The group with vocal alteration had a higher score in the G-DRSP and DRS-Final, but there was no difference in the DRSP-A.

Acoustic Measurements of Speech and Voice in Men with Angle Class II, Division 1, Malocclusion

Abstract Introduction The acoustic analysis of speech (measurements of the fundamental frequency and formant frequencies) of different vowels produced by speakers with the Angle class II, division 1, malocclusion can provide information about the relationship between articulatory and phonatory mechanisms in this type of maxillomandibular disproportion. Objectives To investigate acoustic measurements related to the fundamental frequency (F0) and formant frequencies (F1 and F2) of the oral vowels of Brazilian Portuguese (BP) produced by male speakers with Angle class II, division 1, malocclusion (study group) and compare with men with Angle class I malocclusion (control group). Methods In total, 60 men (20 with class II, 40 with class I) aged between 18 and 40 years were included in the study. Measurements of F0, F1 and F2 of the seven oral vowels of BP were estimated from the audio samples containing repetitions of carrier sentences. The statistical analysis was performed using the Student t-test and the effect size was calculated. Results Significant differences (p-values) were detected for F0 values in five vowels ([e], [i], [o], [o] and [u]), and for F1 in vowels [a] and [ɔ], with high levels for class II, division 1. Conclusion Statistical differences were found in the F0 measurements with higher values in five of the seven vowels analysed in subjects with Angle class II, division 1. The formant frequencies showed differences only in F1 in two vowels with higher values in the study group. The data suggest that data on voice and speech production must be included in the protocol's assessment of patients with malocclusion.

Acoustic Measurements of Speech and Voice in Men with Angle Class II, Division 1, Malocclusion.

Introduction The acoustic analysis of speech (measurements of the fundamental frequency and formant frequencies) of different vowels produced by speakers with the Angle class II, division 1, malocclusion can provide information about the relationship between articulatory and phonatory mechanisms in this type of maxillomandibular disproportion. Objectives To investigate acoustic measurements related to the fundamental frequency (F0) and formant frequencies (F1 and F2) of the oral vowels of Brazilian Portuguese (BP) produced by male speakers with Angle class II, division 1, malocclusion (study group) and compare with men with Angle class I malocclusion (control group). Methods In total, 60 men (20 with class II, 40 with class I) aged between 18 and 40 years were included in the study. Measurements of F0, F1 and F2 of the seven oral vowels of BP were estimated from the audio samples containing repetitions of carrier sentences. The statistical analysis was performed using the Student t -test and the effect size was calculated. Results Significant differences ( p -values) were detected for F0 values in five vowels ([e], [i], [ᴐ], [o] and [u]), and for F1 in vowels [a] and [ᴐ], with high levels for class II, division 1. Conclusion Statistical differences were found in the F0 measurements with higher values in five of the seven vowels analysed in subjects with Angle class II, division 1. The formant frequencies showed differences only in F1 in two vowels with higher values in the study group. The data suggest that data on voice and speech production must be included in the protocol's assessment of patients with malocclusion.

The public health system and the place of autism / O sistema de saúde pública e o lugar do autismo

ABSTRACT Purpose: to characterize the population with autism spectrum disorder and the Psychosocial Care Network. Methods: a study conducted with patients presented with autism spectrum disorder up to 18 years old treated at the health network in Taboão da Serra, Brazil. Participants' data were collected from medical records of the Psychosocial Care Network for Children of that city, authorized by the Municipal Department of Health, and quantitatively analyzed. Results: altogether, there were 237 patients with autism spectrum disorder in the said health network by April 2019. Of these, 188 were treated at the Psychosocial Care Network for Children, 110 of them with weekly therapy. There was a predominance of males (73.63%), age range from 3 to 10 years, with a higher percentage of 5-year old (17.27%) patients, and a mean treatment time of 32 months. The youngest age was 2 years old. Half the sample (50%) had weekly therapy and received homeopathic medication; 24 users (21.81%) were referred by speech-language-hearing therapists and 19 (17.27%), by the school they attended. Final Considerations: although the Psychosocial Care Network for Children is the reference in the region, it is known that this facility alone cannot meet all needs of individuals with autism spectrum disorder. A service network coordinated according to patient's individual needs and the region's reality would ensure their expected rights, decrease public spending, and enable these users to occupy not only one but many places in society.

RESUMO Objetivo: caracterizar a população com Transtorno do Espectro Autista e a Rede de Atenção Psicossocial de Taboão da Serra-SP. Métodos: estudo realizado com usuários da rede de saúde de Taboão da Serra com Transtorno do Espectro Autista com até 18 anos. Os dados dos participantes foram coletados dos prontuários do Centro de Atenção Psicossocial Infantil de Taboão da Serra com autorização da Secretaria Municipal de Saúde e as informações coletadas foram analisadas por vertente quantitativa. Resultados: o total de usuários com Transtorno do Espectro Autista na referida rede de saúde em abril de 2019 foi de 237. Destes, 188 realizavam atendimento no Centro de Atenção Psicossocial infantil, 110 em atendimento semanal. Verificou-se predominância do sexo masculino (73,63%), faixa etária de 3 a 10 anos com maior porcentagem em 5 anos (17,27%), e tempo médio de atendimento de 32 meses. a menor idade encontrada foi 2 anos de idade. Metade da amostra (50%) concentra-se em atendimento semanal e abordagem medicamentosa da homeopatia. Foram encaminhados 24 usuários (21,81%) pelo fonoaudiólogo e 19 (17,27%) pela escola. Considerações Finais: apesar da referência do território ser o Centro de Atenção Psicossocial infantil sabe-se que este equipamento por si só não atende a todas as necessidades dos indivíduos com Transtorno do Espectro Autista. Utilizar uma rede de serviços articulada segundo a demanda individual do paciente e a realidade do território garantiria os direitos almejados, diminuição de gastos públicos e permitiria a ocupação destes usuários não mais em um único lugar, mas sim "lugares".

Risco de disfonia e qualidade vocal em estudantes de artes cênicas / Risk of dysphonia and voice quality in performing arts students

RESUMO Objetivo Analisar a relação entre o risco de disfonia e a qualidade vocal em estudantes de graduação em Artes Cênicas. Método Estudo transversal observacional com 38 estudantes de graduação em Artes Cênicas. Foram aplicados protocolos de rastreio de risco de disfonia geral e específico para atores, e realizadas gravações da emissão sustentada da vogal /a/, fala espontânea e leitura de texto, usadas para análise perceptivo-auditiva, efetuada por três avaliadores, com o uso da escala GRBASI. Após testes de confiabilidade intra e interavaliadores chegou-se à classificação final do grau geral do desvio vocal para cada participante. Foram feitas comparações entre grupos que tinham ou não outra profissão/atividade com o uso da voz e os grupos formados a partir do grau geral. Resultados A maioria dos estudantes apresentou alto risco para disfonia. Todos apresentaram alteração vocal, com predominância de grau leve. Os estudantes que tinham outra profissão/atividade com uso da voz obtiveram maior pontuação no protocolo específico para atores, bem como na soma desse protocolo com o de rastreio geral. Não houve relação entre o grau de alteração vocal e o risco de disfonia. Os estudantes que ainda não atuavam profissionalmente apresentaram mais alterações vocais de grau moderado ou severo, e os que atuavam profissionalmente apresentaram com maior frequência alteração vocal de grau leve. Conclusão A maior parte dos estudantes apresentou alto risco para disfonia. Todos apresentaram alteração vocal, com predomínio de grau leve. Não houve relação entre o risco de disfonia e o grau de alteração vocal.

ABSTRACT Purpose To analyse the relationship between the risk of dysphonia and vocal quality in undergraduate performing arts students. Methods Observational cross-sectional study with 38 undergraduate students in Performing Arts. We applied screening protocols for general and specific risk of dysphonia for actors and made recordings of sustained emission of the vowel /a/, spontaneous speech and reading a text, used for perceptual analysis performed by three evaluators using the GRBASI scale. After intra and inter-rater reliability tests it was obtained final classification of the general degree of vocal deviation parameter for each participant. Comparisons were made considering groups that had or did not have other profession/activity with the use of voice, and the groups were formed from the general grade. Results Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild degree. Students who had another profession/activity with voice use scored higher in the specific protocol for actors, and in the sum of this protocol with the general screening protocol. There was no relationship between the degree of vocal alteration and the risk of dysphonia. Students who did not yet work professionally had more moderate or severe vocal alterations, and those who did work professionally had a higher frequency of mild vocal alterations. Conclusion Most students were at high risk for dysphonia. All had vocal alteration, with a predominance of mild alteration. There was no relationship between the risk of dysphonia and the degree of vocal alteration.

Acoustic voice and spectrographic measures in children with the phonological process of devoicing.

INTRODUCTION: Children with speech sound disorders (SSDs) who present the devoicing of plosive and/or fricative sounds may have difficulties with glottal respiratory control. OBJECTIVE: To analyze acoustic vocal measures, spectrographic aspects and the risk of dysphonia among children with devoicing SDDs and compare the results with those of other groups of children. METHODS: Twenty-five boys aged between six and 12 years participated. They were divided into four groups: the SSD-devoicing (PPDG), dysphonia (DG), SSDs other than devoicing (PPOG) and control groups (CG). The vocal tasks were recorded, and perceptual-auditory and acoustic voice analyses were performed. The children's parents answered questions about voice-related aspects (to determine a dysphonia risk score). All data were compared among the groups. RESULTS: Due to the sample size, an effect size analysis was considered, and the results showed possible differences between the PPDG and the other groups in measures of fundamental frequency (F0), jitter, shimmer, harmonic-to-noise ratio, maximum frequency of harmonic definition and dysphonia risk score. CONCLUSIONS: The PPDG showed a high F0 and abnormal jitter and shimmer values. Although the voices of the children in this group had more harmonics than noise, the maximum frequency for defining the harmonics was very restricted. The PPDG had the lowest dysphonia risk score among all of the groups. Variations in F0, jitter and shimmer may indicate difficulties with controlling vocal adjustments, which appear to be hyperfunctional and not to impact vocal projection or voicing.

The Actor's Voice: Vocal Performance Assessment by Different Professionals.

INTRODUCTION: The voice production of actors is complex and can be assessed by different professionals. The objective of this study was to measure actor's global vocal performance (GVP) based on overall voice quality (OVQ) and overall severity (OS), by consensus auditory-perceptual evaluation of voice (CAPE-V), and to investigate the possible correlation between these two analyses in actors without self-reported vocal complaints. METHODS: A total of 39 actors participated in this study, including 20 men and 19 women. Their ages ranged from 18 to 53 years (mean of 33.3 years), with a mean duration of eight years of professional experience. The referred actors were asked to perform predefined CAPE-V tasks and provide one voice sample in which they read a poem at normal loudness; all tasks were recorded. A professional speech-language therapist evaluated the OS based on CAPE-V vocal tasks; scores up to 35.5 mm represented normal parameters, while those from 35.6 to 50.5 mm represented mild deviation, 50.6 to 90.5 mm indicated moderate deviation, and 90.6 to 100 mm indicated severe deviation. A theater director and another speech-language therapist classified the voice samples using the OVQ scale. The OVQ was measured using a 200-mm visual analogue scale. The calculation of terciles allowed the division into three groups regarding the GVP: lowest score group; intermediate score group; and highest score group. The scores of both analyses were compared by sex and groups. Lastly, a correlation analysis was performed between the two analyses for the total sample. RESULTS: There was a significant difference among the three groups and a mild vocal deviation in the lowest score group. In addition, an inversely proportional correlation was observed between GVP and OS. No sex-related differences were observed in the scores for either analyses. CONCLUSION: The actors without self-reported voice complaints presented differences on GVP scores and their distribution was independent of sex and length of professional experience. Vocal deviation, although mild, on average was greater in actors who had the lowest scores in GVP, with an inversely proportional correlation between these two parameters.

Voice and Communication in News Anchors: What is the Impact of the Passage of Time?

INTRODUCTION: News anchors, as high-performance voice professionals, may be subject to voice and communication changes throughout their careers. OBJECTIVE: To compare the overall degree of vocal deviation, use of vocal and nonverbal resources, pleasantness and expressiveness of Brazilian journalists - news anchors - at 2 time points: at the beginning of their career and late in their career, when they are at an old age. METHODS: A longitudinal observational study that analyzed voice samples collected indirectly from 20 professional male journalists at 2 time points with a minimum interval of 25 years: at the beginning of the career (T1) and at present (T2). The journalists were 60 years old or older, and the samples were narratives with similar communicative content. The overall degree of vocal deviation and use of vocal resources (presence/absence of vocal alteration, vocal attack, loudness, pitch, resonance, articulation of speech sounds, speech speed and breath-speech coordination) and nonverbal resources (emphasis, pauses, rhythm and loudness and pitch variations) were analyzed. Nine judges analyzed the expressiveness and pleasantness of the participants' voices. THE RESULTS: The mean age of the participants was 38.6 years at T1 and 73.7 years at T2. Differences observed between T1 and T2 included greater overall degree of deviation at T2; greater presence of vocal alterations; and worsening of vocal attack, loudness, pitch, articulation and breath-speech coordination. A directly proportional correlation between pleasantness and expressiveness and an inversely proportional correlation between pleasantness and expressiveness and the overall degree of vocal deviation were observed. CONCLUSION: Worsening of some vocal aspects was observed; however, the participants' nonverbal characteristics, pleasantness and expressiveness were unchanged throughout their careers.

COVID-19 and Remote Learning: Predictive Factors of Perceived Improvement or Worsening of the Voice in Brazilian Teachers.

OBJECTIVES: Given the transformations in teaching modalities as a result of the COVID-19 pandemic, this study aimed to evaluate the factors associated with vocal self-perception during the pandemic and to investigate the ability of selected variables to predict changes in vocal self-perception in teachers with professional vocal demands during the investigated period. STUDY DESIGN: Cross-sectional survey. METHOD: A total of 1,126 teachers of both genders (ages 19-78 years, average 43.23 years) who were participating in remote teaching activities using their voice answered the online questionnaire. To characterize vocal changes (improvement, worsening or no change), the teachers' self-assessment of their voice quality was considered; the association between the variables reported in the questionnaire and vocal changes was analyzed, as was the capacity of these variables for predicting voice changes. RESULTS: Most of the teachers worked at a public school, reported having no previous voice changes or difficulties with their voice during online classes and indicated that they began to use their voice less often and with reduced intensity during the pandemic. Vocal demands were divided between teaching synchronous online classes, recording video lessons and participating in online meetings. Several variables were associated with voice improvement and worsening, and some had the capacity to predict voice changes: improvement in voice quality was associated with working in a public school or as an autonomous teacher, reduced voice use and, to a lesser extent, participating in online meetings, certain vocal habits and a reduction in vocal symptoms; worsening voice quality was associated with working in a private school, increased voice use, using the voice at a higher intensity, difficulty with the voice in online classes, vocal habits and vocal symptoms. CONCLUSION: The context of remote education has changed the way teachers communicate during classes, and monitoring is necessary to ensure that necessary adaptations are made to preserve the voice and ensure effective communication.

Aged voice: does advancing age generate different impacts? / Voz do idoso: o avanço da idade gera diferentes impactos?

PURPOSE: To verify if there are differences in the vocal aspects of older people from three different age groups with presbyphonia diagnosis. METHODS: Sixty older adults joined this study. They were both female and male, with an age range from 60 to 90 years old (average: 72.3) and with presbyphonia diagnosis established after otolaryngology evaluation. From their voice recordings, it was possible to make the acoustic and auditory-perceptual analysis. The data collected was compared through statistical tests considering the division of the participants into the following groups: 60-70 years old, 71-80 years old, and 81-90 years old. RESULTS: Even though the older people from all of the three groups have presented deviation in multiple vocal aspects such as instability and vocal noise in low frequencies, those with more than 80 years old have presented a higher deviation of the general grade of dysphonia, roughness, breathiness, and pitch. In this group, it was also observed higher deviations in jitter, shimmer, vocal breaks, and the GNE measure on the edge of normality. All the differences were statistically significant. The majority of the older participants from that group presented even a deviation in the phonatory deviation diagram and frequency break. CONCLUSION: Various acoustic and auditory-perceptual aspects had a higher deviation in the older adults over 80 years old, which reinforces the need to consider those specificities in the evaluation of the vocal aging impacts and also in the development of actions to minimize vocal declination.

OBJETIVO: Verificar se existem diferenças em aspectos vocais entre idosos com presbifonia, divididos em três faixas etárias. MÉTODO: Participaram 60 idosos de ambos os sexos com idades entre 60 e 90 anos (média=72,3), com diagnóstico de presbifonia estabelecido em avaliação otorrinolaringológica. A partir da gravação das vozes foi realizada análise perceptivo-auditiva e acústica e os dados foram comparados por meio dos testes estatísticos com os participantes divididos nos grupos etários 60-70 anos, 71-80 anos e 81-90 anos. RESULTADOS: Ainda que os idosos dos três grupos tenham apresentado alterações em aspectos vocais variados, como instabilidade e ruído em frequências graves, aqueles com mais de 80 anos apresentaram maior grau de disfonia, rugosidade, soprosidade e pitch. Também foram observados neste grupo maiores desvios em jitter, shimmer e irregularidade e a medida GNE no limite da normalidade. Todas as diferenças foram estatisticamente significativas. A maioria dos idosos dessa faixa etária apresentou ainda alteração no diagrama de desvio fonatório e quebra de frequência. CONCLUSÃO: Diversos aspectos perceptivo-auditivos e acústicos se apresentaram mais desviados nos idosos mais velhos, o que reforça a necessidade de serem consideradas essas especificidades tanto na avaliação dos efeitos do envelhecimento na voz quanto no desenvolvimento de ações para minimizar o declínio vocal.

Functional electrostimulation associated with phonation in women without vocal disorders. / Eletroestimulação funcional associada à fonação em mulheres sem alterações vocais.

PURPOSE: To verify the immediate effect of the Excitomotor Electrical Current, called Functional Electrical Stimulation (FES), on vocal quality, Maximum Phonation Time (MPT) and possible discomfort, in women without vocal alteration, with application at Maximum Supported Intensity (MSI) and associated with phonation. METHODS: Experimental study with 20 normophonic adult women. They emitted the sustained vowel / a / and then it was applied to FES during emission of the same vowel. There were five series with three minutes of emission each, interspersed with passive rest. The electrical stimulus was at the MSI by the participant, adjusted by series. Before and after the emissions the voices were recorded and the MPT and the intensity of the stimuli were collected. The vocal quality was rated by judges. Statistical analysis made it possible to compare pre and post emission / electrostimulation data in each phase. Qualitative analysis was performed based on self-reported symptoms. RESULTS: There was no difference in vocal quality and MPT between pre and post moments in both phases. The difference between MSI and stimulus perception intensity was greater in series 1 than in series 2. There was an increase in MSI in series 5 compared to series 1. No significant negative symptoms or within 48h after procedures were reported. CONCLUSION: The FES at MSI, associated with phonation, did not generate an immediate change in vocal quality, in the MPT or self-reported discomforts by women without vocal alteration, even with a gradual increase in the stimulus, series by series.

OBJETIVO: Verificar o efeito imediato da corrente elétrica excitomotora, denominada FES, na qualidade vocal e no tempo máximo de fonação (TMF), e possíveis desconfortos, em mulheres sem alteração vocal, com aplicação em intensidade máxima suportada (IMS) e associada à fonação. MÉTODO: Estudo experimental com 20 mulheres adultas normofônicas. Elas emitiram a vogal /a/ sustentada e depois foi aplicada a FES durante emissão da mesma vogal. Foram cinco séries com três minutos de emissão cada, intercaladas com descanso passivo; o estímulo elétrico foi na IMS pela participante, ajustado por série. Antes e após as emissões as vozes foram gravadas e coletados os TMF e a intensidade dos estímulos. A qualidade vocal foi classificada por juízes. Foram comparados os dados pré e pós emissão/eletroestimulação em cada fase. A análise qualitativa foi realizada a partir de sintomas autorreferidos. RESULTADOS: Não houve diferença na qualidade vocal e nos TMF entre os momentos pré e pós nas duas fases. A diferença entre a IMS e a intensidade de percepção do estímulo foi maior na série 1 em relação à série 2. Houve aumento da IMS na série 5 em relação à série 1. Não foram relatados sintomas negativos imediatos ou em até 48 horas após os procedimentos. CONCLUSÃO: A corrente FES em IMS, associada à fonação, não gerou mudança imediata na qualidade vocal, nos TMF ou desconfortos autorreferidos pelas mulheres sem alteração vocal, mesmo com aumento gradual do estímulo.

Dysphonia Risk Screening Protocol for Musical Theatre Actors: a preliminary study. / Protocolo de Rastreio do Risco de Disfonia para Atores de Teatro Musical: resultados preliminares.

PURPOSE: To propose the Dysphonia Risk Screening Protocol for Musical Theatre Actors (DRSP-MTA), to verify its applicability in association with the General Dysphonia Risk Screening Protocol (G-DRSP), to correlate the final scores of both, and these with the total risk score, and to compare the risk of dysphonia measured in musical theater actors with and without vocal complaint. METHODS: An observational cross-sectional study with 34 musical theater actors, adults, of both genders, with and without vocal complaints and regardless of whether they are professionals or students. The questionnaires were applied individually. Statistical analysis made it possible to verify the correlation between the dysphonia risk scores and to compare the groups with and without vocal complaint. RESULTS: Most of the participants were male, young adults, professional actors and without vocal complaint. There was a high risk of dysphonia, evidenced by the application of G-DRSP, with means scores compatible with values found in individuals with dysphonia, and reinforced by the indices found with DRSP-MTA application. There was a moderate and directly proportional correlation between the two questionnaire scores; and a correlation of both with the total risk score. Higher G-DRSP scores were observed in the vocal complaint group. CONCLUSION: DRSP-MTA was feasible and easy to apply and was positively correlated with the total score and G-DRSP score. A high risk of dysphonia was evidenced in individuals with vocal complaints. Although the specific DRSP-MTA score did not differentiate musical theatre actors with and without vocal complaints, the G-DRSP score and the total risk score performed such differentiation.

OBJETIVO: Propor o Protocolo de Rastreio do Risco de Disfonia para Atores do Teatro Musical (PRRD-TM), verificar sua aplicabilidade em associação ao Protocolo de Rastreio do Risco de Disfonia Geral (PRRD-G), correlacionar escores finais de ambos, e desses com o escore total, e comparar o risco de disfonia entre atores com e sem queixa vocal. MÉTODO: Estudo transversal observacional com 34 atores de teatro musical adultos, ambos os sexos, com e sem queixa vocal, profissionais ou estudantes. Os questionários foram aplicados individualmente. A análise estatística possibilitou verificar a correlação entre os escores de risco de disfonia e para comparação entre os grupos com e sem queixa vocal. RESULTADOS: A maioria dos participantes era do gênero masculino, jovens adultos, atores profissionais e sem queixa vocal. Observou-se elevado risco de disfonia, evidenciado pela aplicação do PRRD-G, com escores médios compatíveis com valores encontrados em indivíduos com disfonia, e reforçado pelos índices encontrados com aplicação do PRRD-TM. Observou-se correlação moderada e diretamente proporcional entre os escores dos dois questionários e desses com o escore total. Escores mais elevados do PRRD-G foram encontrados no grupo que apresentou queixa vocal. CONCLUSÃO: O PRRD-TM mostrou-se viável e de fácil aplicabilidade e apresentou correlação positiva com o escore do PRRD-G e com o escore total. Elevado risco de disfonia foi evidenciado em indivíduos com queixa vocal. Apesar do escore específico do PRRD-TM não diferenciar atores de teatro musical com e sem queixa vocal, tanto o escore do PRRD-G quanto o escore total realizaram tal diferenciação.

COVID-19 and the teacher's voice: self-perception and contributions of speech therapy to voice and communication during the pandemic.

OBJECTIVES: We aimed to analyze the vocal self-perception of Brazilian teachers and their communication needs, vocal signs and symptoms, and voice-related lifestyles during the coronavirus disease (COVID-19) pandemic and, based on this information, to develop guidance materials intended for dissemination to these teachers and the general community. METHODS: An online questionnaire designed for this survey was distributed via the researchers' networks and was available for completion by any teacher, except those who were not working at the time. There were 1,253 teachers from all over Brazil, of both sexes, covering a wide age range, working at different levels of education, and most with more than ten years of experience. Descriptive and inferential analyses of the data were performed. RESULTS: On comparing the prepandemic period with the current one, participants indicated voice improvements. In contrast, they presented symptoms such as dry throat, effort in addressing remote classes, hoarseness after classes, and difficulties with the use of headphones, among others. They further indicated stress, general fatigue, impact of the pandemic on mental health, and the overlapping of many home tasks with professional tasks. Some smoked, and others hydrated insufficiently. CONCLUSION: Although teachers generally noticed voice improvements during the pandemic, a proportion of them perceived worsening of voices. Many indicated several factors in which speech-language pathologists could guide them with the aim of improving performance and comfort during remote and hybrid classes, an initiative that will positively impact not only their voice and communication but also their quality of life.

Acoustic Analysis of Voice and Speech in Men with Skeletal Class III Malocclusion: A Pilot Study.

OBJECTIVES: To assess the fundamental (f0) and first third formant (F1, F2, F3) frequencies of the 7 oral vowels of Brazilian Portuguese in men with skeletal class III malocclusion and to compare these measures with a control group of individuals with Angle's class I. METHODS: Sixty men aged 18-40 years, 20 with Angle's class III skeletal malocclusion and 40 with Angle's class I malocclusion were selected by speech therapists and dentists. The speech signals were obtained from sustained vowels, and the values of f0 and frequencies of F1, F2 and F3 were estimated. The differences were verified through Student's t test, and the effect size calculation was performed. RESULTS: In the class III group, more acute f0 values were observed in all vowels, higher values of F1 in the vowels [a] and [ε] and in F2 in the vowels [a], [e] and [i] and lower F1 and F3 values of the vowel [u]. CONCLUSION: More acute f0 values were found in all vowels investigated in the class III group, which showed a higher laryngeal position in the production of these sounds. The frequencies of the first 3 formants showed punctual differences, with higher values of F1 in the vowels [a] and [ε] and of F2 in [a], [e] and [i], and lower values of F1 and F3 in the vowel [u] in the experimental group. Thus, it is concluded that the fundamental frequency of the voice was the main parameter that differentiated the studied group from the control.