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.

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.

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.

Medications Adverse Effects on Voice: Comparison Between Different Sources of Information.

INTRODUCTION: The analysis of drugs with adverse effects on voice provides relevant data for the vocal clinic. It is essential that professionals involved in voice care are aligned on the topic of voice pharmacovigilance in order to understand adverse effects from safe and reliable sources. OBJECTIVES: To compare the voice adverse effects of self-reported medications by dysphonic individuals in different sources of information. METHODS: Descriptive and analytical study based on self-reported active ingredients by dysphonic individuals and their adverse effects on voice listed in Electronic Database of the National Health Surveillance Agency of Brazil (Anvisa). Adverse effects were comparatively analyzed between the Anvisa's Electronic Database and information from the Micromedex and UpToDate databases. Data were analyzed using descriptive and inferential statistics that compared the three sources researched in relation to the number of adverse effects and in relation to the occurrence of adverse effects to the voice. RESULTS: There was a statistically significant difference between the databases regarding the occurrence of adverse effects of cough, dyspnea, xerostomia, vomiting and hoarseness, with a higher occurrence in the UpToDate database. The UpToDate database showed a statistically significant difference in the amount of drug effects compared to the Anvisa database (P < 0.001, d = 0.744) and compared to the Micromedex database (P < 0.001, d = 0.598), and in the two cases the mean number of drug effects was higher for the UpToDate database. CONCLUSIONS: UpToDate proved to be the most suitable source to complement the data from the medication package inserts at the time of the speech-language pathology assessment. It is recommended that professionals from all countries involved in voice care seek additional evidence-based sources of information to gain access to accurate and up-to-date data on adverse effects of drugs on voice.

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.

Do Professionals Who Use the Voice in a Journalistic Context Benefit from Humming as a Semi-occluded Vocal Tract Exercise?

INTRODUCTION: Many vocal enhancement and rehabilitation programs for voice professionals define vocal exercises without analyzing their effects on that specific population in which they will be applied, in the established dose and often without considering the presence and absence of vocal alteration. Journalists have sought the voice clinic due to new professional vocal demands and a vocal program is being elaborated. OBJECTIVE: To determine the immediate effect of humming in professionals with and without voice disorders who work under high vocal demand in a journalistic context. METHOD: Thirty-six individuals who completed the Dysphonia Risk Screening Protocol and underwent voice recording participated in the study. Three speech therapists defined the presence and/or absence of vocal changes by consensus. Subsequently, five repetitions of humming were proposed; the exercises lasted five seconds each and were separated by five seconds of complete silence, and recordings were made before and after the exercise (vowel and phrase). For the pre and post comparison between the groups with and without vocal changes, acoustic measurements and spectrogram, including the classification of the signal type, were performed. RESULTS: The sample had a similar distribution of men and women and a mean age of 39.9 years. Most of the professionals were journalists or reporters. The risk of dysphonia was high for half of the sample, and the presence of vocal changes, predominantly mild ones, was identified in 56%. After the exercise, a decrease in noise at low frequencies and an improvement in the series of harmonics and the signal type were observed in both groups; a decrease in irregularity was observed only in the participants without vocal changes. CONCLUSION: The proposed humming exercise had an immediate positive effect on the voice of professionals working in a journalistic context, and the changes were particularly evident in aspects of the voice that were initially altered.

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.

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

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

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

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

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

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

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.

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

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

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

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

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

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

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.