Comparison between the acoustic fundamental frequency of the voice and the vibration frequency of the vocal folds analyzed by digital kymography. / Comparação entre a frequência fundamental acústica da voz e a frequência de vibração das pregas vocais analisada pela videoquimografia digital.

PURPOSE: To compare the frequency of vocal fold opening variation, analyzed by digital kymography, with the fundamental voice frequency obtained by acoustic analysis, in individuals without laryngeal alteration. METHODS: Observational analytical cross-sectional study. The participants were forty-eight women and 38 men from 18 to 55 years of age. The evaluation was made by voice acoustic analysis, by the habitual emission of the vowel /a/ for 3 seconds, and days of the week, and digital kymography (DKG), by the habitual emission of the vowels /i/ and /ɛ/. The measurements analyzed were acoustic fundamental frequency (f0), extracted by the Computerized Speech Lab (CSL) program, and dominant frequency of the variation of right (R-freq) and left (L-freq) vocal fold opening, obtained through the KIPS image processing program. The mounting of the kymograms consisted in the manual demarcation of the region by vertical lines delimiting width and horizontal lines separating the posterior, middle and anterior thirds of the Rima glottidis. In the statistical analysis, the Anderson-Darling test was used to verify the normality of the sample. The ANOVA and Tukey tests were performed for the comparison of measurements between the groups. For the comparison of age between the groups, the Mann-Whitney test was used. RESULTS: There are no differences between the values of the frequency measurement analyzed by digital kymography, with the acoustic fundamental frequency, in individuals without laryngeal alteration. CONCLUSION: The values of the dominant frequency of the vocal folds opening variation, as assessed by digital kymography, and the acoustic fundamental frequency of the voice are similar, allowing comparison between these measurements in the multidimensional evaluation of the voice, in individuals without laryngeal alteration.

OBJETIVO: Comparar a frequência da variação da abertura das pregas vocais, analisada pela videoquimografia digital, com a frequência fundamental da voz, obtida através da análise acústica, em indivíduos sem alteração laríngea. MÉTODO: Trata-se de um estudo observacional analítico transversal. Participaram 48 mulheres e 38 homens, de 18 a 55 anos. A avaliação foi composta por análise acústica da voz, obtida pela emissão habitual da vogal /a/ durante 3 segundos, e os dias da semana, e pela videoquimografia digital (DKG), obtida pela emissão habitual das vogais /i/ e /ɛ/. As medidas analisadas foram a frequência fundamental acústica (f0), extraída pelo programa Computerized Speech Lab (CSL), e a frequência dominante da variação de abertura da prega vocal direita (D-freq) e esquerda (E-freq), obtidas através do programa de processamento de imagens KIPS. A montagem dos quimogramas constou na demarcação manual da região, compostas por linhas verticais que delimitaram largura da prega vocal e linhas horizontais que marcaram os terços posterior, médio e anterior da rima glótica. Na análise estatística, o teste Anderson-Darling foi utilizado para verificar a normalidade da amostra. Os testes ANOVA e Tukey foram realizados para a comparação das medidas entre os grupos. Para a comparação da idade entre os grupos, foi utilizado o teste Mann-Whitney. RESULTADOS: Não existem diferenças entre os valores da medida de frequência analisada pela videoquimografia digital, com a frequência fundamental acústica, em indivíduos sem alteração laríngea. CONCLUSÃO: Os valores da frequência dominante da variação de abertura das pregas vocais, avaliada pela videoquimografia digital, e a frequência fundamental acústica da voz são similares, permitindo uma comparação entre estas medidas na avaliação multidimensional da voz, em indivíduos sem alteração laríngea.

Nebulized Saline Solution: A Multidimensional Voice Analysis.

PURPOSE: To verify the effect of nebulization on the voice of dysphonic and non-dysphonic individuals on acoustic, perceptual-auditory, aerodynamic, electroglottographic, laryngeal parameters and on the self-perception of vocal discomfort. MATERIALS AND METHODS: All the research subjects were submitted to vocal evaluation, laryngeal and voice self-perception. Then, the participants remained in vocal rest for a period of 10 minutes and the analysis mentioned above were again performed. After this first stage, the participants were submitted to the nebulization for a period of 10 minutes and the all analysis above were again performed. Descriptive analysis of the variables was carried. In the comparison of the pre- and post-nebulization groups, the Paired T-Student Test was used for variables with non-dysphonic distribution and the Wilcoxon Test for variables with asymmetric distribution. When categorical variables were evaluated (perceptual-auditory evaluation and laryngeal assessment), the Pearson's Chi-square test was used. In all analysis, a significance level of 5% was considered. The intra-rater agreement in the auditory-perceptual and perceptual-visual assessment was assessed using the AC1 statistic, using the R program. For this purpose, 20% of the voice samples and laryngeal images were replicated blindly and interpreted by the evaluators at the time evaluations. RESULTS: The results of this research show that non-dysphonic individuals have more positive vocal and laryngeal effects after nebulization than dysphonic ones. It is also observed that the EGG measurement was the most sensitive to the effect of nebulization, with an increase in the Closed quotient (CQ) in all groups evaluated. Regarding acoustic measurements, it is noted that the effect of nebulization in men is more evident than in women. After nebulization, there was an increase in fundamental frequency in the group of non-dysphonic women and dysphonic and non-dysphonic men. A decrease in the amplitude perturbation quotient values is observed in all groups, besides a reduction in the pitch perturbation quotient values after nebulization in non-dysphonic men groups. There was improves aerodynamic efficiency in groups of dysphonic and non-dysphonic men and in the self-perception of vocal discomfort in all groups studied after the hydration procedure. The results of this study demonstrate a significant improvement in the mucosal wave after nebulization in the groups of women and men who are not dysphonic. CONCLUSION: The nebulization procedure with saline solution improves acoustic measurements, the electroglottographic closed quotient and vocal self-perception of dysphonic and non-dysphonic women and men. Nebulization increases the mucosal wave of the vocal folds in non-dysphonic women and men and improves the aerodynamic efficiency of men.

Índice videoquimográfico da função glótica: análise da precisão diagnóstica / Videokymographic index of glottic function: an analysis of diagnostic accuracy

RESUMO Objetivo Elaborar um indicador composto denominado Índice Videoquimográfico da Função Glótica - IVFG, a partir de parâmetros da videoquimografia digital, captados pelo exame de videolaringoscopia de alta velocidade de mulheres sem e com alterações laríngeas de etiologia comportamental. Método A amostra foi composta por 92 mulheres, destas 55 apresentaram disfonia comportamental, com presença de alterações laríngeas e vocais, e 37 mulheres sem alterações laríngeas e vocais, entre 18 a 45 anos. A avaliação vocal foi realizada por consenso pela análise perceptivo-auditiva da vogal /a/ em frequência e intensidade habituais, e classificação através do grau geral da disfonia, onde G0 indicou qualidade vocal neutra e G1 a 3 qualidade vocal alterada. As imagens laríngeas foram obtidas pela gravação da emissão da vogal /i/, em frequência e intensidade habituais para análise da videoquimografia digital. A construção do IVFG se deu pela escolha do ponto médio da glote para análise e, elaboração foi realizada regressão logística pelo programa MINITAB 19. Resultados A regressão logística contou com duas etapas, sendo que a etapa 1 constou da análise de todas as variáveis, onde as variáveis abertura máxima e fechamento glótico apresentaram significância estatística (p-valor <0.05) e o modelo se encontrou bem ajustado de acordo com o teste de Hosmer-Lemeshow (p-valor=0,794); na etapa 2, as variáveis selecionadas foram novamente analisadas e o modelo também se mostrou bem ajustado (p-valor=0,198). O IVFG foi definido por IVFG=e^(8,1318-0,2941AbMax-0,0703FechGlo)/1+e^(8,1318-0,2941AbMax-0,0703FechGlo). Conclusão O IVFG apresenta valor de corte igual a 0,71. A probabilidade de acerto é de 81,5%, sensibilidade 76,4%, especificidade de 89,2%.

ABSTRACT Purpose To develop the Videokymographic Index of Glottic Function (VIGF), a composite indicator from digital videokymography parameters, captured by high-speed videolaryngoscopy exams of women with and without laryngeal alterations of behavioral etiology. Methods The sample consisted of 92 women aged between 18 and 45 years. Fifty-five (55) women with behavioral dysphonia, presenting with laryngeal and voice alterations, and thirty-seven (37) women without any laryngeal and voice alterations. Voice evaluation was performed by consensus via an auditory-perceptual analysis of the sustained vowel /a/ at a habitual pitch and loudness. Voice classification was obtained by means of a general degree of dysphonia, where G0 indicated neutral voice quality and G1 to G3 indicated altered voice quality. Laryngeal images were captured via digital videokymography analysis of a sustained vowel /i/ at a habitual pitch and loudness. The VIGF was based on the midpoint of the glottal region for analysis. Logistic regression was performed using the MINITAB 19 program. Results Logistic regression was composed of two stages: Stage 1 consisted of the analysis of all variables, where the maximum opening and closed quotient variables showed statistical significance (p-value <0.05) and the model was well adjusted according to the Hosmer-Lemeshow test (p-value=0.794). Stage 2 consisted of the re-analysis of the selected variables, also showing a well-adjusted model (p-value=0.198). The VIGF was defined as follows: VIGF=e^(8.1318-0.2941AbMax-0.0703FechGlo)/1+e^(8.1318-0.2941AbMax-0.0703FechGlo). Conclusion The VIGF demonstrated a cut-off value equal to 0.71. The probability of success was 81.5%, sensitivity 76.4%, and specificity 89.2%.

Comparação entre a frequência fundamental acústica da voz e a frequência de vibração das pregas vocais analisada pela videoquimografia digital / Comparison between the acoustic fundamental frequency of the voice and the vibration frequency of the vocal folds analyzed by digital kymography

RESUMO Objetivo Comparar a frequência da variação da abertura das pregas vocais, analisada pela videoquimografia digital, com a frequência fundamental da voz, obtida através da análise acústica, em indivíduos sem alteração laríngea. Método Trata-se de um estudo observacional analítico transversal. Participaram 48 mulheres e 38 homens, de 18 a 55 anos. A avaliação foi composta por análise acústica da voz, obtida pela emissão habitual da vogal /a/ durante 3 segundos, e os dias da semana, e pela videoquimografia digital (DKG), obtida pela emissão habitual das vogais /i/ e /ɛ/. As medidas analisadas foram a frequência fundamental acústica (f0), extraída pelo programa Computerized Speech Lab (CSL), e a frequência dominante da variação de abertura da prega vocal direita (D-freq) e esquerda (E-freq), obtidas através do programa de processamento de imagens KIPS. A montagem dos quimogramas constou na demarcação manual da região, compostas por linhas verticais que delimitaram largura da prega vocal e linhas horizontais que marcaram os terços posterior, médio e anterior da rima glótica. Na análise estatística, o teste Anderson-Darling foi utilizado para verificar a normalidade da amostra. Os testes ANOVA e Tukey foram realizados para a comparação das medidas entre os grupos. Para a comparação da idade entre os grupos, foi utilizado o teste Mann-Whitney. Resultados Não existem diferenças entre os valores da medida de frequência analisada pela videoquimografia digital, com a frequência fundamental acústica, em indivíduos sem alteração laríngea. Conclusão Os valores da frequência dominante da variação de abertura das pregas vocais, avaliada pela videoquimografia digital, e a frequência fundamental acústica da voz são similares, permitindo uma comparação entre estas medidas na avaliação multidimensional da voz, em indivíduos sem alteração laríngea.

ABSTRACT Purpose To compare the frequency of vocal fold opening variation, analyzed by digital kymography, with the fundamental voice frequency obtained by acoustic analysis, in individuals without laryngeal alteration. Methods Observational analytical cross-sectional study. The participants were forty-eight women and 38 men from 18 to 55 years of age. The evaluation was made by voice acoustic analysis, by the habitual emission of the vowel /a/ for 3 seconds, and days of the week, and digital kymography (DKG), by the habitual emission of the vowels /i/ and /ɛ/. The measurements analyzed were acoustic fundamental frequency (f0), extracted by the Computerized Speech Lab (CSL) program, and dominant frequency of the variation of right (R-freq) and left (L-freq) vocal fold opening, obtained through the KIPS image processing program. The mounting of the kymograms consisted in the manual demarcation of the region by vertical lines delimiting width and horizontal lines separating the posterior, middle and anterior thirds of the Rima glottidis. In the statistical analysis, the Anderson-Darling test was used to verify the normality of the sample. The ANOVA and Tukey tests were performed for the comparison of measurements between the groups. For the comparison of age between the groups, the Mann-Whitney test was used. Results There are no differences between the values of the frequency measurement analyzed by digital kymography, with the acoustic fundamental frequency, in individuals without laryngeal alteration. Conclusion The values of the dominant frequency of the vocal folds opening variation, as assessed by digital kymography, and the acoustic fundamental frequency of the voice are similar, allowing comparison between these measurements in the multidimensional evaluation of the voice, in individuals without laryngeal alteration.

Vocal rehabilitation in singers with vocal complaints: a digital kymography analysis / Reabilitação vocal em cantoras com queixa vocal: análise da videoquimografia digital

ABSTRACT Purpose: to evaluate the effects of the Comprehensive Vocal Rehabilitation Program associated with the application of transcutaneous electrical nerve stimulation through digital kymography in singers with vocal complaints. Methods: an experimental intrasubject comparative study in 24 singers, who underwent the rehabilitation program associated with transcutaneous electrical nerve stimulation. They were assessed with laryngeal high-speed videoendoscopy before and after vocal rehabilitation. The paired t-test and Wilcoxon test were used to compare the two assessments. The significance level was set at 5%. Results: significant differences were found in the maximum opening, dominant amplitude of the opening variation and dominant frequency of the opening variation of the right vocal fold in the posterior glottic region, and in maximum opening, mean opening, dominant amplitude of the opening variation of the left vocal fold and dominant frequency of the opening variation of both vocal folds in the anterior glottic region. Conclusion: the results showed that the Comprehensive Vocal Rehabilitation Program associated with transcutaneous electrical stimulation decreased the opening amplitude of the vocal fold, increased the vibration frequency, and improved glottal closure in the anterior and posterior glottic regions.

RESUMO Objetivo: avaliar os efeitos do Programa Integral de Reabilitação Vocal associado à aplicação da estimulação elétrica nervosa transcutânea por meio da videoquimografia digital em cantoras com queixa vocal. Métodos: estudo experimental comparativo intrassujeitos com 24 cantoras, que realizaram o programa de reabilitação associado à estimulação elétrica nervosa transcutânea. A avaliação, por meio da videolaringoscopia de alta velocidade, foi realizada antes e após a reabilitação vocal. Os testes T pareado e de Wilcoxon foram utilizados para comparação das duas avaliações. Considerou-se o nível de significância de 5%. Resultados: diferenças significantes foram identificadas quanto aos parâmetros de abertura máxima, amplitude dominante de variação de abertura e frequência dominante de abertura da prega vocal direita na região posterior da glote, além dos parâmetros de abertura máxima, abertura média, amplitude dominante de variação de abertura da prega vocal esquerda e frequência dominante de abertura de ambas as pregas vocais na região anterior da glote. Conclusão: os resultados mostraram que o Programa Integral de Reabilitação Vocal associado à estimulação elétrica transcutânea promoveu uma diminuição da amplitude de abertura da prega vocal e aumento da frequência de vibração, além de um melhor fechamento glótico nas regiões anterior e posterior da glote.

Videokymographic index of glottic function: an analysis of diagnostic accuracy. / Índice videoquimográfico da função glótica: análise da precisão diagnóstica.

PURPOSE: To develop the Videokymographic Index of Glottic Function (VIGF), a composite indicator from digital videokymography parameters, captured by high-speed videolaryngoscopy exams of women with and without laryngeal alterations of behavioral etiology. METHODS: The sample consisted of 92 women aged between 18 and 45 years. Fifty-five (55) women with behavioral dysphonia, presenting with laryngeal and voice alterations, and thirty-seven (37) women without any laryngeal and voice alterations. Voice evaluation was performed by consensus via an auditory-perceptual analysis of the sustained vowel /a/ at a habitual pitch and loudness. Voice classification was obtained by means of a general degree of dysphonia, where G0 indicated neutral voice quality and G1 to G3 indicated altered voice quality. Laryngeal images were captured via digital videokymography analysis of a sustained vowel /i/ at a habitual pitch and loudness. The VIGF was based on the midpoint of the glottal region for analysis. Logistic regression was performed using the MINITAB 19 program. RESULTS: Logistic regression was composed of two stages: Stage 1 consisted of the analysis of all variables, where the maximum opening and closed quotient variables showed statistical significance (p-value <0.05) and the model was well adjusted according to the Hosmer-Lemeshow test (p-value=0.794). Stage 2 consisted of the re-analysis of the selected variables, also showing a well-adjusted model (p-value=0.198). The VIGF was defined as follows: VIGF=e^(8.1318-0.2941AbMax-0.0703FechGlo)/1+e^(8.1318-0.2941AbMax-0.0703FechGlo). CONCLUSION: The VIGF demonstrated a cut-off value equal to 0.71. The probability of success was 81.5%, sensitivity 76.4%, and specificity 89.2%.

OBJETIVO: Elaborar um indicador composto denominado Índice Videoquimográfico da Função Glótica ­ IVFG, a partir de parâmetros da videoquimografia digital, captados pelo exame de videolaringoscopia de alta velocidade de mulheres sem e com alterações laríngeas de etiologia comportamental. MÉTODO: A amostra foi composta por 92 mulheres, destas 55 apresentaram disfonia comportamental, com presença de alterações laríngeas e vocais, e 37 mulheres sem alterações laríngeas e vocais, entre 18 a 45 anos. A avaliação vocal foi realizada por consenso pela análise perceptivo-auditiva da vogal /a/ em frequência e intensidade habituais, e classificação através do grau geral da disfonia, onde G0 indicou qualidade vocal neutra e G1 a 3 qualidade vocal alterada. As imagens laríngeas foram obtidas pela gravação da emissão da vogal /i/, em frequência e intensidade habituais para análise da videoquimografia digital. A construção do IVFG se deu pela escolha do ponto médio da glote para análise e, elaboração foi realizada regressão logística pelo programa MINITAB 19. RESULTADOS: A regressão logística contou com duas etapas, sendo que a etapa 1 constou da análise de todas as variáveis, onde as variáveis abertura máxima e fechamento glótico apresentaram significância estatística (p-valor <0.05) e o modelo se encontrou bem ajustado de acordo com o teste de Hosmer-Lemeshow (p-valor=0,794); na etapa 2, as variáveis selecionadas foram novamente analisadas e o modelo também se mostrou bem ajustado (p-valor=0,198). O IVFG foi definido por IVFG=e

Effect of Nebulization on Laryngeal Parameters: Analysis Using High-Speed Digital Videolaryngoscopy.

INTRODUCTION: Superficial laryngeal hydration, obtained through nebulization, is related to the moisture level on the epithelial surfaces of the vocal folds, modifying their biomechanical and aerodynamic properties. Through high-speed videolaryngoscopy it is possible to obtain objective data for laryngeal analysis after nebulization and a better understanding of this phenomenon OBJECTIVE: To verify the effects of nebulization with saline solution on laryngeal parameters of digital videokymography obtained by high-speed videolaryngoscopy examination in women and men with and without laryngeal alterations METHOD: This is a clinical, comparative intra-subject study. Fifty-nine adults were selected, with and without laryngeal alterations, 30 females and 29 males. Digital videokymographs in the anterior, middle and posterior thirds of the vocal folds of the participants were analyzed before and after nebulization with 0.9% saline solution. RESULTS: Women without laryngeal alterations showed more parameters changes after nebulization, in which there was a decrease in maximum and medium opening, amplitude of opening of the left and right vocal fold in the anterior glottal third, and an increase of the percentage of closure of the vocal folds. These results indicate a minor extent of lateral excursion of the vocal folds during phonation. In women with laryngeal alterations, the parameters that changed after nebulization were the increased frequency of opening of the left and right vocal folds in the topography of the posterior third. In men, nebulization did not change the variables studied, except for the amplitude of the right vocal fold in men with laryngeal alterations, in the analysis of the posterior glottic third. CONCLUSION: The results suggest that surface hydration modifies laryngeal dynamics differently between genders. After nebulization with saline solution, women without laryngeal alterations showed a decrease in the lateralization of the vocal folds during phonation, suggesting a better phonatory efficiency.

Analysis of the Immediate Effects of the LaxVox Technique on Digital Videokymography Parameters in Adults With Voice Complaints.

OBJECTIVES: Digital videokymography based on high-speed videoendoscopy enables the evaluation of therapeutic techniques and voice training, such as the LaxVox technique, on vocal fold vibrations. This study investigated the immediate effects of the LaxVox technique on digital videokymographic parameters obtained through high-speed videolaryngoscopy in adults with voice complaints. STUDY DESIGN: An experimental intrasubject comparative study of adults with voice complaints was conducted. METHODS: Image processing software was used to analyze the videos and obtain digital videokymography parameters. The intraclass correlation coefficient was used to determine the intra-rater reliability of the analyzed parameters. The paired t test and Wilcoxon signed-rank test were used to compare digital videokymography parameters before and after the LaxVox technique, in sex-specific analyses. The significance level was set at 5%. RESULTS: In total, 25 laryngeal images from 15 women and 10 men were analyzed. On digital videokymography analysis, the mean vocal fold opening in the posterior glottal region was decreased immediately after using the LaxVox technique in women. In contrast, no significant changes were found in other parameters compared to pre LaxVox technique values in both men and women with voice complaints. CONCLUSION: Digital videokymography analysis revealed that the LaxVox technique reduces the mean vocal fold opening in the posterior glottal region of women with voice complaints.

Digital Videokymography: Analysis of Glottal Closure in Adults.

INTRODUCTION: High-speed videolaryngoscopy and quantitative analysis of laryngeal images are relevant in accurately diagnosing vocal fold closure patterns. OBJECTIVE: To analyze the parameters of digital videokymography obtained through high-speed videolaryngoscopy in women and men with complete and incomplete glottal closure, and posterior glottal chink. METHODS: We conducted an observational, analytical, cross-sectional study with data from 65 adults, which we divided into groups according to sex and glottal closure. Digital videokymography parameters were analyzed using an image-processing program. The Anderson-Darling and Mann-Whitney U tests were used to verify sample normality and compare videokymography parameters between groups, respectively. The significance level was set at 5%. RESULTS: Among 65 laryngeal images, 20 each were from women with complete and incomplete glottal closure, and 20 and 5 were from men with complete and incomplete glottal closure, respectively. Considering the clinical relevance of the evaluated data, groups of 11 women and 4 men with posterior glottal chink were compared with sex-similar groups with complete glottal closure. Digital videokymography showed a lower maximum and mean vocal fold opening in women with incomplete glottal closure, and a lower dominant left vocal fold-opening amplitude and higher dominant frequency of bilateral vocal fold opening in men with incomplete glottal closure. It also showed a lower closed phase percentage in the posterior region for women and men, with higher closed phase percentage in the anterior and middle regions in women. Both groups with posterior glottal chink showed similar results. CONCLUSION: Incomplete glottal closure may interfere with the results of the digital videokymography parameters, with higher impact on the posterior vocal fold region in males and the middle and anterior vocal fold regions in females.

High speed digital videolaringoscopy: evaluation of vocal nodules and cysts in women.

PURPOSE: To evaluate and compare the parameters of Digital kymography obtained through the High-speed Videolaryngoscopy of women without laryngeal disorders, of women with vocal fold nodules and of women with vocal cysts. METHODS: A cross-sectional observational study in which 60 women aged 18 years and 45 years were selected. Three study groups were formed: 20 women without laryngeal disorder forming the control group (Group 1), 20 women with diagnosis of vocal fold nodules forming Group 2 and 20 women with diagnosis of vocal cysts forming Group 3. Subsequently the participants were evaluated by High-speed Videolaryngoscopy for analysis and comparison of laryngeal images using Digital kymography. The laryngeal parameters processed by the program KIPS® were: minimum, maximum and mean opening; dominant amplitude of the left and right vocal folds; dominant frequency of the right and left vocal folds; and close. RESULTS: The analysis of Digital kymography suggests that the presence of the vocal fold nodules and the vocal cysts tend to restrict more to the maximum and minimum opening of the vocal fold and the dominant amplitude of the opening variation in the middle region of the glottis. CONCLUSION: Digital kymography parameters were similar in the presence of vocal fold nodules and vocal cysts lesions.

Ocular vestibular evoked myogenic potential (VEMP) reveals mesencephalic HTLV-1-associated neurological disease.

PURPOSE: Vestibular Myogenic Evoked Potential (VEMP) evaluates vestibulo-ocular and vestibulo-collic reflexes involved in the function of the otolithic organs and their afferent pathways. We compared the results of cervical and ocular VEMP in HTLV-1 associated myelopathy (HAM) and HTLV-1-asymptomatic infection. PARTICIPANTS AND METHODS: This cross-sectional study included 52 HTLV-1-infected individuals (26 HAM and 26 asymptomatic carriers) and 26 seronegative controls. The groups were similar regarding age and gender. Participants underwent simultaneous ocular and cervical VEMP. The stimulus to generate VEMP was a low-frequency tone burst sound tone burst, with an intensity of 120 decibels normalized hearing level, bandpass filter from 10 to 1,500 Hertz (Hz), with 100 stimuli at 500 Hz and 50 milliseconds recording time. The latencies of the electrophysiological waves P13 and N23 for cervical VEMP and N10 and P15 waves for ocular VEMP were compared among the groups. The absence or delay of the electrophysiological waves were considered abnormal results. RESULTS: Ocular VEMP was similar among the groups for N10 (p = 0.375) and different for P15 (p≤0.001). Cervical VEMP was different for P13 (p = 0.001) and N23 (p = 0.003). About ocular VEMP, in the HTLV-1-asymptomatic group, normal waves were found in 23(88.5%) individuals; in HAM group, normal waves were found in 7(26.9%). About cervical VEMP, 18(69.2%) asymptomatic carriers presented normal waves and only 3(11.5%) patients with HAM presented normal waves. Abnormalities in both VEMPs were found in 1(3.8%) asymptomatic carrier and in 16(61.5%) patients with HAM. CONCLUSION: Neurological impairment in HAM was not restricted to the spinal cord. The mesencephalic connections, tested by ocular VEMP, have been also altered. Damage of the oculomotor system, responsible for eye stabilization during head and body movements, may explain why dizziness is such a frequent complaint in HAM.

Aplicações dos potenciais evocados miogênicos vestibulares: revisão sistemática de literatura / Applications of vestibular-evoked myogenic potentials: a systematic literature review

RESUMO Objetivos Revisar a literatura científica sobre as principais técnicas usadas para gerar o potencial evocado miogênico vestibular (VEMP) e suas aplicações clínicas. Estratégia de pesquisa Os artigos que descrevem os métodos de registro e as aplicações do VEMP foram localizados nas bases de dados PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. O levantamento realizado limitou-se aos artigos publicados nos idiomas Inglês, Português e Espanhol, entre janeiro de 2012 e maio de 2018. Critérios de seleção Artigos sobre os aspectos técnicos para a realização do VEMP ocular, cervical ou do músculo sóleo, com estimulação auditiva ou galvânica e artigos sobre as aplicações clínicas do VEMP foram incluídos; artigos repetidos nas bases de dados, artigos de revisão de literatura, relato de casos, cartas e editoriais foram excluídos. Resultados A estratégia de busca resultou na seleção de 28 artigos. Os estudos evidenciaram três métodos de registro do VEMP: cervical, ocular e no músculo sóleo. As aplicações clínicas do VEMP incluíram doença de Ménière, neurite vestibular, síndrome da deiscência do canal semicircular superior, doença de Parkinson, lesões centrais isquêmicas e mielopatias motoras. Conclusão Independentemente da técnica de registro, o VEMP mostrou-se útil como ferramenta complementar para o diagnóstico de doenças vestibulares periféricas e centrais.

ABSTRACT Purpose To review the scientific literature on the main techniques used to generate vestibular-evoked myogenic potential (VEMP) and its clinical applications. Research strategy A search for articles describing VEMP recording methods and applications was conducted in the PubMed, Web of Science, MEDLINE, Scopus, LILACS and SciELO databases. The search was limited to articles published in English, Portuguese, and Spanish between January 2012 and May 2018. Selection criteria Articles addressing the technical aspects for performing ocular, cervical or soleus VEMP with auditory or galvanic stimulation and articles on the clinical applications of VEMP were included in this review, whereas articles repeated in the databases, literature reviews, case reports, letters, and editorials were excluded. Results The search strategy resulted in the selection of 28 articles. The studies evidenced three methods of VEMP recording: responses from the cervical, ocular and soleus muscle. Clinical applications of VEMP included Meniere's disease, vestibular neuritis, superior semicircular canal dehiscence syndrome, Parkinson's disease, central ischemic lesions, and motor myelopathies. Conclusion Regardless of the recording technique, VEMP has proved to be useful as a complementary tool for the diagnosis of peripheral and central vestibular diseases.

Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease / Potencial evocado miogênico vestibular ocular e cervical simultâneo em indivíduos com hiporreflexia vestibular e em indivíduos com doença de Ménière

Abstract Introduction: The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response to high-intensity sounds. This study presents a combined or simultaneous technique of cervical and ocular vestibular evoked myogenic potential in individuals with changes in the vestibular system, for use in otoneurologic diagnosis. Objective: To characterize the records and analyze the results of combined cervical and ocular VEMP in individuals with vestibular hyporeflexia and in those with Ménière's disease. Methods: The study included 120 subjects: 30 subjects with vestibular hyporeflexia, 30 with Ménière's disease, and 60 individuals with normal hearing. Data collection was performed by simultaneously recording the cervical and ocular vestibular evoked myogenic potential. Results: There were differences between the study groups (individuals with vestibular hyporeflexia and individuals with Ménière's disease) and the control group for most of wave parameters in combined cervical and ocular vestibular evoked myogenic potential. For cervical vestibular evoked myogenic potential, it was observed that the prolongation of latency of the P13 and N23 waves was the most frequent finding in the group with vestibular hyporeflexia and in the group with Ménière's disease. For ocular vestibular evoked myogenic potential, prolonged latency of N10 and P15 waves was the most frequent finding in the study groups. Conclusion: Combined cervical and ocular vestibular evoked myogenic potential presented relevant results for individuals with vestibular hyporeflexia and for those with Ménière's disease. There were differences between the study groups and the control group for most of the wave parameters in combined cervical and ocular vestibular evoked myogenic potential.

Resumo Introdução: O potencial evocado miogênico vestibular é um potencial de média latência que avalia a resposta muscular decorrente de estimulação auditiva. Pode ser gerado a partir da contração do músculo esternocleidomastóideo e também a partir da contração de músculos extraoculares em resposta a sons de elevada intensidade. Este estudo apresenta uma técnica combinada ou simultânea de potencial evocado miogênico vestibular cervical e ocular em indivíduos com alterações no sistema vestibular para que possa ser usada no diagnóstico otoneurológico. Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos com hiporreflexia vestibular e em indivíduos com doença de Ménière. Método: Participaram do estudo 120 indivíduos, 30 com hiporreflexia vestibular, 30 com doença de Ménière e 60 com audição dentro dos padrões de normalidade. A coleta de dados foi feita por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre o grupo de estudo (indivíduos com hiporreflexia vestibular e indivíduos com doença de Ménière) e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado. Para o potencial evocado miogênico vestibular cervical observou-se que o prolongamento da latência das ondas P13 e N23 foi a alteração mais encontrada no grupo de indivíduos com hiporreflexia vestibular e no grupo de indivíduos com doença de Ménière. Para o potencial evocado miogênico vestibular ocular o prolongamento da latência das ondas N10 e P15 foi a alteração mais encontrada no grupo de estudo. Conclusão: O potencial evocado miogênico vestibular cervical e ocular combinado apresentou resultados relevantes para os indivíduos com hiporreflexia vestibular e para os indivíduos com doença de Ménière. Houve diferença entre o grupo de estudo e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado.

Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease.

INTRODUCTION: The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response to high-intensity sounds. This study presents a combined or simultaneous technique of cervical and ocular vestibular evoked myogenic potential in individuals with changes in the vestibular system, for use in otoneurologic diagnosis. OBJECTIVE: To characterize the records and analyze the results of combined cervical and ocular VEMP in individuals with vestibular hyporeflexia and in those with Ménière's disease. METHODS: The study included 120 subjects: 30 subjects with vestibular hyporeflexia, 30 with Ménière's disease, and 60 individuals with normal hearing. Data collection was performed by simultaneously recording the cervical and ocular vestibular evoked myogenic potential. RESULTS: There were differences between the study groups (individuals with vestibular hyporeflexia and individuals with Ménière's disease) and the control group for most of wave parameters in combined cervical and ocular vestibular evoked myogenic potential. For cervical vestibular evoked myogenic potential, it was observed that the prolongation of latency of the P13 and N23 waves was the most frequent finding in the group with vestibular hyporeflexia and in the group with Ménière's disease. For ocular vestibular evoked myogenic potential, prolonged latency of N10 and P15 waves was the most frequent finding in the study groups. CONCLUSION: Combined cervical and ocular vestibular evoked myogenic potential presented relevant results for individuals with vestibular hyporeflexia and for those with Ménière's disease. There were differences between the study groups and the control group for most of the wave parameters in combined cervical and ocular vestibular evoked myogenic potential.

Análise biomecânica do deslocamento hiolaríngeo: revisão integrativa / Biomechanical analysis of hyolaryngeal displacement: integrative review / Análisis biomecánico del desplazamiento hyolaryngeal: revisión integradora

Objetivo: realizar revisão integrativa da literatura sobre procedimentos de avaliação quantitativa do deslocamento hiolaríngeo na videofluoroscopia. Método: Foram utilizadas as bases de dados Lilacs, Scielo, Medline via Pubmed, Biblioteca Cochrane e Web of Science/ISI, com inclusão de 15 estudos, publicados entre os anos 2000 e 2014, nos idiomas inglês e português. Resultados: A maioria utilizou o programa ImageJ, considerou a quarta vértebra cervical como o ponto de origem, utilizou moeda no queixo dos sujeitos para calibração do sistema, avaliou deglutição de 5 e 10ml de líquido, não descreveu o número de deglutições avaliadas e utilizou dois avaliadores na análise. Os principais pontos anatômicos foram região anterior-superior e anterior-inferior de hioide e posterior-superior da coluna de ar subglótica como referência da laringe. Conclusão: Há uma variabilidade de descrição da amplitude de deslocamento hiolaríngeo entre gêneros, faixas etárias, sujeitos saudáveis e disfágicos e nos procedimentos para análise da biomecânica da deglutição.

Objetive: to conduct an integrative review of the literature on quantitative assessment procedures of the hyolaryngeal desplacement in the videofluoroscopy. Methods: Databases Lilacs, Scielo, Medline via Pubmed, Cochrane Library and Web of Science/ISI were used, with the inclusion of 15 studies, published between 2000 and 2014, in the English and Portuguese languages. Results: Most of the researchers used the ImageJ program, considered the fourth cervical vertebra as the point of origin, used coin in the chin of the subject to system calibration, evaluated swallowing of 5 and 10ml of liquid, did not describe the number of evaluated swallowing and used two evaluators in the analysis. The main anatomical points were anterior-upper and anterior-lower regions of hyoid and posterior-upper of the subglottic air column as a reference of the larynx. Conclusion: There is a description of the amplitude variation of hyolaryngeal displacement between genders, age groups, and dysphagia healthy subjects and procedures for analysis of the biomechanics of swallowing.

Objetivo revisión integradora de la literatura sobre los procedimientos de evaluación cuantitativos del desplazamiento hyolaryngeal en la videofluoroscopia. Método: Se utilizaron las bases de datos Lilacs, Scielo, Medline a través de Pubmed, Biblioteca Cochrane y la Web of Science/ISI, con la inclusión de 15 estudios, publicados entre 2000 y 2014, en los idiomas Inglés y Portugués. Resultados: La mayoría utilizó el programa ImageJ, consideró la cuarta vértebra cervical como el punto de origen, utilizó moneda en el mentón de temas para calibración del sistema, evaluó deglución de 5 y 10 ml de líquido, no describió el número de degluciones evaluadas y utilizó dos evaluadores en el análisis. Los principales puntos anatómicos fueron región anterior-superior y anterior-inferior del hioides y posterior-superior de la columna de aire subglótica como referencia de la laringe. Conclusion: Hay una descripción de la variación de la amplitud del desplazamiento hyolaryngeal entre sexos, grupos de edad, y disfagia en sujetos sanos como los procedimientos para el análisis de la biomecánica de la deglución.

Ocular and cervical vestibular evoked myogenic potential simultaneous in normal individuals.

PURPOSE: To characterize the recording and analyze the results of the combined cervical and ocular vestibular evoked myogenic potential in individuals without hearing and vestibular complaints. METHODS: In this study, 30 individuals without hearing complaints and hearing within normal limits were evaluated. Data were collected through the simultaneous recording of cervical and ocular vestibular evoked myogenic potential. RESULTS: Differences were observed between the right and left ears for the amplitude of waves P13 and N23 of the cervical vestibular evoked myogenic potential and the latency of wave N10 of the ocular vestibular evoked myogenic potential. For female subjects, there was no difference between the right and left ears for the amplitude of waves P13, N23, N10, and P15; interamplitude in cervical vestibular evoked myogenic potential and interamplitude in ocular vestibular evoked myogenic potential; and latency in waves P13, N23, N10, and P15. For male subjects, there was a difference between the right and left ears for the amplitude of wave P13. CONCLUSION: The results of the combined cervical and ocular vestibular evoked myogenic potentials were consistent, because the responses generated by the vestibular evoked myogenic potentials presented an adequate morphology, latency, and amplitude, allowing for the evaluation of the ipsilateral descending vestibular pathways and the contralateral ascending vestibular pathways.

Potencial evocado miogênico vestibular ocular e cervical simultâneo em indivíduos normais / Ocular and cervical vestibular evoked myogenic potential simultaneous in normal individuals

RESUMO Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos sem queixas auditivas e vestibulares. Métodos: Participaram da pesquisa 30 indivíduos sem queixa auditiva e com audição dentro dos padrões de normalidade. A coleta de dados foi realizada por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13 e N23 do potencial evocado miogênico vestibular cervical e para a latência da onda N10 do potencial evocado miogênico vestibular ocular. No gênero feminino não houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13, N23, N10, P15, interamplitude no potencial evocado miogênico vestibular cervical e interamplitude no potencial evocado miogênico vestibular ocular e para a latência das ondas P13, N23, N10 e P15. No gênero masculino houve diferença entre as orelhas direita e esquerda para a amplitude da onda P13. Conclusão: Os resultados do potencial evocado miogênico vestibular cervical e ocular combinado foram consistentes, uma vez que as respostas geradas pelos potenciais evocados miogênicos vestibulares apresentaram morfologia, latência e amplitude adequadas, o que permite a avaliação da via vestibular ipsilateral descendente e da via vestibular contralateral ascendente.

ABSTRACT Purpose: To characterize the recording and analyze the results of the combined cervical and ocular vestibular evoked myogenic potential in individuals without hearing and vestibular complaints. Methods: In this study, 30 individuals without hearing complaints and hearing within normal limits were evaluated. Data were collected through the simultaneous recording of cervical and ocular vestibular evoked myogenic potential. Results: Differences were observed between the right and left ears for the amplitude of waves P13 and N23 of the cervical vestibular evoked myogenic potential and the latency of wave N10 of the ocular vestibular evoked myogenic potential. For female subjects, there was no difference between the right and left ears for the amplitude of waves P13, N23, N10, and P15; interamplitude in cervical vestibular evoked myogenic potential and interamplitude in ocular vestibular evoked myogenic potential; and latency in waves P13, N23, N10, and P15. For male subjects, there was a difference between the right and left ears for the amplitude of wave P13. Conclusion: The results of the combined cervical and ocular vestibular evoked myogenic potentials were consistent, because the responses generated by the vestibular evoked myogenic potentials presented an adequate morphology, latency, and amplitude, allowing for the evaluation of the ipsilateral descending vestibular pathways and the contralateral ascending vestibular pathways.

Potencial evocado miogênico vestibular ocular: revisão de literatura / Ocular vestibular evoked myogenic potential: literature review

RESUMO Objetivo Identificar e sistematizar os principais estudos sobre o potencial evocado miogênico vestibular ocular e suas aplicações no diagnóstico das diversas doenças vestibulares. Estratégia de pesquisa Foram localizados artigos que descrevem a utilização do potencial evocado miogênico vestibular ocular na avaliação de doenças vestibulares nas bases PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. Critérios de seleção Foram incluídos estudos originais, com resumo disponível, publicados no período de janeiro de 2010 a março de 2016. Análise dos dados Foi realizada a descrição do delineamento do estudo e elencados os achados para a avaliação de potencial evocado miogênico vestibular ocular. Resultados Foram encontrados 265 estudos, dos quais 14 contemplaram os critérios de seleção propostos. Em relação à população/amostra de pacientes com alterações vestibulares incluída nos estudos, observou-se que as doenças mais investigadas foram a neurite vestibular, a vertigem posicional paroxística benigna, o Schwanoma vestibular e a doença de Ménière. Conclusão A maior parte das pesquisas realizadas nos últimos anos e publicadas nas bases de dados PubMed, Web of Science, MEDLINE e Scopus revelou que o potencial evocado miogênico vestibular ocular representa um método eficaz para avaliar a função utricular nas mais diversas doenças vestibulares.

ABSTRACT Purpose To identify and systematize the main studies on the ocular vestibular evoked myogenic potentials and their applications in the diagnosis of various vestibular diseases. Research strategy Articles that describe the use of ocular vestibular evoked myogenic potentials the evaluation of vestibular diseases were located in PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. Selection criteria Original studies, with available abstract, published in the period 2010 to March 2016 were included. Data analysis The study design was described, and the characteristics for the evaluation of ocular vestibular evoked myogenic potentials were listed. Results 265 studies were found, but just 14 contemplated the proposed selection criteria. In relation to the population / sample of patients with vestibular disorders included in the study, it was observed that the most researched diseases were the vestibular neuritis, benign paroxysmal positional vertigo, vestibular Schwanoma and Meniere's disease. Conclusion The most of the research realized in recent years and published in the databases PubMed, Web of Science, MEDLINE and Scopus revealed that the ocular vestibular evoked myogenic potentials is an effective method to evaluate the utricular function in various vestibular disorders.

Análise da qualidade vocal antes e após o uso profissional e social da voz / Voice quality assessment before and after social and professional voice use

Objetivo Analisar, do ponto de vista perceptivo-auditivo, os efeitos do uso profissional e social da voz na qualidade vocal de mulheres, em um intervalo de tempo de duas horas e 30 minutos. Métodos Pesquisa do tipo caso-controle, formada por dois grupos: grupo de uso profissional da voz, com 31 professoras, faixa etária de 28 a 59 anos e grupo de uso social da voz, com 42 mulheres, faixa etária de 31 a 59 anos, sem o uso profissional da voz e sem queixa vocal. A coleta foi realizada pela manhã, em dois momentos - antes da primeira aula e após duas horas e 30 minutos -, na própria escola em que as professoras lecionavam e consistiu em leitura de frases. O grupo de uso social seguiu os mesmos padrões de gravação, com uso da voz na residência de cada participante. As vozes foram avaliadas de forma perceptivo-auditiva por dois avaliadores experientes, comparando-se as emissões antes e após o uso e classificação de melhora, piora ou similaridade entre os momentos. Resultados Os grupos não apresentaram diferenças entre as vozes, comparando-se os momentos antes e após o uso da voz. Nos casos em que houve modificação do padrão vocal, a rugosidade foi o parâmetro perceptivo-auditivo mais frequente nos dois grupos, porém com baixo grau de alteração. Conclusão O uso social e o uso profissional da voz, decorrente da atividade letiva, no período de duas horas e 30 minutos, não causaram alterações na qualidade vocal, analisada de forma perceptivo-auditiva. .

Purpose To analyze the effects of social and professional voice use in the voice quality of women in a time frame of two hours and 30 minutes using auditory-perceptual evaluation. Methods A case-control study with two groups: professional voice users, with 31 Belo Horizonte school teachers aged 28-59 years; social voice users, with 42 females aged 31-59 years with no occupational voice use. The data was collected at two time points, in the morning period, before starting the use of voice and after two hours and thirty minutes. The subjects were instructed to read sentences in their normal speaking voice. The same recording scheme was used for the group of social voice use, with normal use of the voice in the home of each participant. The voices were evaluated through an auditory-perceptual assessment by two experienced raters who compared the emissions before and after voice use and determined whether there was improvement, deterioration or similarity between time points. Results Both groups had a higher frequency of similarity between the voices before and after the vocal loading according to the auditory-perceptual evaluation. In subjects with changes in their vocal patterns, roughness was the auditory-perceptual parameter that changed the most for both groups, albeit with a low degree of deviance. Conclusion The social voice use and the professional voice use resulting from the teaching activity, both during two hours and thirty minutes, caused no changes in voice quality as evaluated by auditory-perceptual analysis. .

Analysis of aspects of quality of life in teachers' voice after discharged: longitudinal study / Analise dos aspectos de qualidade de vida em voz em professores apos alta fonoaudiologica: estudo longitudinal

PURPOSE: To evaluate the long-term effects of voice therapy on the life quality of teachers who were discharged or abandoned the voice therapy for dysphonia. METHODS: This was a longitudinal study based on analysis of assessments with teachers of municipal schools in Belo Horizonte, who were referred to voice therapy and were discharged or abandoned the speech-language therapy for more than six months. A total of 33 teachers in the discharged group and 20 teachers in the abandoned group were contacted by phone and invited to participate in the study by answering the Voice activity and participation profile, which was forwarded to the researchers and sent via letter. RESULTS: At the moment of the pre speech therapy, the discharged and abandoned groups were homogeneous, except in relation to daily communication parameter. Comparing the discharged group in the pre and post speech-language therapy, it was showed improvements in social communication parameter as well as in the total score. The discharged group presented worsening in self-perception parameter when comparing the average values in the post therapy and current moments, and the group abandoned presented worsening in work, social communication and total score when comparing to the average values in the pre therapy and current moments. The discharged and abandoned groups differ in the present moment in all investigated parameters. CONCLUSION: Speech-language therapy for dysphonia have long term positive effects on life quality and voice of teachers who were soon discharged from the therapy and in a period of two years on average. Teachers who have abandoned treatment and did not obtain improvement in the voice showed negative impact in life quality and voice in a time of 2 years and 2 months on average. .

OBJETIVO: Avaliar os efeitos em longo prazo da fonoterapia na qualidade de vida de professoras que receberam alta ou abandonaram o tratamento fonoaudiológico para disfonia. MÉTODOS: Tratou-se de um estudo longitudinal baseado na análise das avaliações realizadas com docentes da rede municipal de ensino de Belo Horizonte, encaminhados para fonoterapia, que tiveram alta ou abandonaram o tratamento fonoaudiológico há mais de seis meses. Participaram 33 professoras no grupo alta e 20 no grupo abandono que foram contatadas, por meio de ligações telefônicas, e convidadas a responder ao protocolo Perfil de participação em atividades vocais, enviado e reencaminhado às pesquisadoras por meio de carta. RESULTADOS: No momento pré-fonoterapia, os grupos alta e abandono eram homogêneos, exceto em relação ao parâmetro comunicação diária. Na comparação do grupo alta nos momentos pré e pós-fonoterapia observou-se melhora no parâmetro comunicação social e no escore total. O grupo alta apresentou piora no parâmetro autopercepção na comparação das médias nos momentos pós-fonoterapia e atual, e no grupo abandono houve piora nos parâmetros trabalho, comunicação social e no escore total na comparação das médias pré-fonoterapia e atual. Os grupos alta e abandono apresentaram diferença no momento atual em todos os parâmetro pesquisados. CONCLUSÃO: O tratamento fonoterápico para professoras disfônicas impacta positivamente na qualidade de vida relacionada à voz, logo após a alta e em um seguimento de dois anos em média. Em professores que abandonaram o tratamento, e consequentemente não obtiveram melhora do quadro vocal, o impacto na qualidade de vida e voz se torna mais negativo em um seguimento ...