Estudio preliminar para la validación de la versión chilena del Vocal Tract Discomfort-VTD en población docente / Validation of the chilean version of the Vocal Tract Discomfort-VTD on teachers: a preliminary study

Debido a la carga vocal a la que están expuestos los profesionales de la voz, como los profesores, son frecuentes los trastornos de voz y mal uso vocal en este grupo, lo que hace necesario poder contar con instrumentos de pesquisa rápidos y sencillos para un diagnóstico precoz de sintomatología vocal. El objetivo del presente estudio es realizar una adaptación y validación preliminar de la pauta "Vocal Tract Discomfort Scale (VTD)" al idioma español chileno en profesores. Se comenzó con la traducción al español del instrumento original por parte de dos expertos nativos y luego la retro-traducción por dos expertos en idioma inglés para determinar concordancias y discrepancias. Luego se continuó con la validación de apariencia y contenido realizada por valoración de grupo de expertos compuesto por dos metodólogos y cinco fonoaudiólogos con experiencia en el área vocal. La validez de criterio se obtuvo mediante la correlación entre la escala en estudio y el Voice Handicap Index en su versión validada al español como prueba gold-standard, para lo cual se aplicó en una muestra de 31 docentes. La validación de la escala VTD es fiable y deja a disposición de los fonoaudiólogos una herramienta sencilla y comprensible para el entendimiento del impacto generado en personas con disfonía, particularmente, en profesionales de la voz como los profesores.

Due to the vocal load to which voice professionals such as teachers are exposed, voice disorders and vocal misuse are frequently found in this group. This makes it necessary to have quick and simple assessment instruments that allow early detection of vocal symptoms. The objective of this study was to adapt the "Vocal Tract Discomfort Scale (VTD)" to Chilean Spanish and carry out a preliminary validation of this protocol on teachers. First, the original instrument was translated toSpanish by two native speakers, and then back-translated by two English experts, in order to determine the presence of agreements and discrepancies. Subsequently, a group of experts made up of two methodologists and five speech therapists with experience in the voice field performed an appearance and content validation. Criterion validity was obtained through the correlation between the Vocal Tract Discomfort Scale and the Spanish-validated version of the Voice Handicap Index as a gold-standard test, for which the first was appliedto a sample of 31 teachers. The validation of the VTD scale is reliable and provides speech therapists with a simple and understandable tool that allows them to comprehend the impact of dysphonia on people, particularly on voice professionals such as teachers.

Voice deviation, dysphonia risk screening and quality of life in individuals with various laryngeal diagnoses

OBJECTIVES: To characterize the voice quality of individuals with dysphonia and to investigate possible correlations between the degree of voice deviation (D) and scores on the Dysphonia Risk Screening Protocol-General (DRSP), the Voice-Related Quality of Life (V-RQOL) measure and the Voice Handicap Index, short version (VHI-10). METHODS: The sample included 200 individuals with dysphonia. Following laryngoscopy, the participants completed the DRSP, the V-RQOL measure, and the VHI-10; subsequently, voice samples were recorded for auditory-perceptual and acoustic analyses. The correlation between the score for each questionnaire and the overall degree of vocal deviation was analyzed, as was the correlation among the scores for the three questionnaires. RESULTS: Most of the participants (62%) were female, and the mean age of the sample was 49 years. The most common laryngeal diagnosis was organic dysphonia (79.5%). The mean D was 59.54, and the predominance of roughness had a mean of 54.74. All the participants exhibited at least one abnormal acoustic aspect. The mean questionnaire scores were DRSP, 44.7; V-RQOL, 57.1; and VHI-10, 16. An inverse correlation was found between the V-RQOL score and D; however, a positive correlation was found between both the VHI-10 and DRSP scores and D. CONCLUSION: A predominance of adult women, organic dysphonia, moderate voice deviation, high dysphonia risk, and low to moderate quality of life impact characterized our sample. There were correlations between the scores of each of the three questionnaires and the degree of voice deviation. It should be noted that the DRSP monitored the degree of dysphonia severity, which reinforces its applicability for patients with different laryngeal diagnoses.

Caracterização dos sistemas de referência e contrarreferência em um serviço de fonoaudiologia de alta complexidade na cidade de São Paulo / Effectiveness of referral and counter-referral systems in a high-complexity Speech, Language and Hearing healthcare service in the city of São Paulo

RESUMO Introdução Conhecer o fluxo de referência e contrarreferência de serviços de saúde de alta complexidade é imprescindível para o aperfeiçoamento da assistência fonoaudiológica. Objetivo Analisar o fluxo de pacientes de um serviço de Fonoaudiologia de alta complexidade no Sistema Único de Saúde (SUS). Métodos Estudo descritivo, realizado em serviço de Fonoaudiologia de hospital de alta complexidade. Foram analisados os dados de 373 usuários submetidos à triagem fonoaudiológica (consulta a prontuários). As variáveis analisadas foram: perfil sociodemográfico e fonoaudiológico; origem dos usuários (referência); tempo entre a referência e a realização da triagem; encaminhamentos após a triagem (contrarreferência); tempo entre a conclusão da triagem e o primeiro atendimento fonoaudiológico no serviço de contrarreferência; grau de satisfação com o atendimento fonoaudiológico de contrarreferência. Resultados Predominaram indivíduos com idades entre 0 e 11 anos e 11 meses, do gênero masculino, residentes na cidade de São Paulo, com ensino fundamental incompleto. A hipótese diagnóstica fonoaudiológica de disfonia foi a mais prevalente. A maioria dos usuários foi referenciada pela atenção terciária. A média de tempo de espera para a triagem foi de 56,6 dias (intervalo predominante de 51 a 60 dias). Pouco mais da metade dos sujeitos foi encaminhada para o nível terciário. O tempo de espera pelo atendimento foi maior no nível secundário. A maioria dos usuários referiu como excelente ou bom o grau de satisfação com o atendimento. Conclusão Observou-se alto grau de resolutividade no serviço analisado (atenção terciária) e necessidade de reorganização dos sistemas de referência e contrarreferência na atenção secundária e primária.

ABSTRACT Introduction For optimum quality in Speech, Language and Hearing (SLH) healthcare, it is essential to be aware of the flow of referrals and counter-referrals for high-complexity health services. Purpose To analyze the flow of patients of a high-complexity SLH service in Brazil's Unified Health System (Sistema Único de Saúde - SUS). Methods Descriptive study, made at a Speech, language and hearing (SLH) service of a high complexity hospital. Participants were 373 users who underwent SLH screening (consultation of health records). The variables analyzed were: social-demographic profile; SLH profile; origin of referral of users; time between referral and screening being carried out; referrals after screening (counter-referral); time between conclusion of screening and first SLH consultation in the counter-referred service; and degree of satisfaction with the SLH consultation of the counter-referral. Results The largest group was the age range zero to 11 years 11 months, male, resident in the city of São Paulo, who had not completed primary education. The most prevalent initial diagnosis in SLH terms was dysphonia. The majority of users were referred to tertiary care. The average waiting time for screening was 56.6 days. Just over half the subjects were referred for tertiary care. The waiting time for care was longest at the secondary level. The majority of users stated their degree of satisfaction with the care to be excellent or good. Conclusion A high degree of resolutiveness was observed in the tertiary care service analyzed; and a need was observed in secondary and primary care for reorganization of the systems of referral and counter-referral.

Analysis of possible factors of vocal interference during the teaching activity / Análise de possíveis fatores de interferência no uso da voz durante atividade docente

ABSTRACT OBJECTIVE To measure the risk of dysphonia in teachers, as well as investigate whether the perceptual-auditory and acoustic aspects of the voice of teachers in situations of silence and noise, the signal-to-noise ratio, and the noise levels in the classroom are associated with the presence of dysphonia. METHODS This is an observational cross-sectional research with 23 primary and secondary school teachers from a private school in the municipality of São Paulo, Brazil, divided into the groups without dysphonia and with dysphonia. We performed the following procedures: general Dysphonia Risk Screening Protocol (General-DRSP) and complementary to speaking voice - teacher (Specific-DRSP), voice recording during class and in an individual situation in a silent room, and measurement of the signal-to-noise ratio and noise levels of classrooms. RESULTS We have found differences between groups regarding physical activity (General-DRSP) and particularities of the profession (Specific-DRSP), as well as in all aspects of the perceptual-auditory vocal analysis. We have found signs of voice wear in the group without dysphonia. Regarding the vocal resources in the situations of noise and silence, we have identified a difference for the production of abrupt vocal attack and the tendency of a more precise speech in the situation of noise. Both the signal-to-noise ratio and the room noise levels during class were high in both groups. CONCLUSIONS Teachers in both groups are at high risk for developing dysphonia and have negative vocal signals to a greater or lesser extent. Signal-to-noise ratio was inadequate in most classrooms, considering the standards for both children with normal hearing and with hearing loss, as well as equivalent noise levels.

RESUMO OBJETIVO Mensurar o risco de disfonia em professores, bem como investigar se os aspectos vocais perceptivo-auditivos e acústicos em situação de ruído, a relação sinal-ruído e os níveis de ruído em sala de aula estão associados à presença de disfonia. MÉTODOS Pesquisa transversal observacional com 23 professores da educação infantil e ensino fundamental de uma escola particular do município de São Paulo divididos nos grupos sem disfonia e com disfonia. Foram realizados os seguintes procedimentos: protocolo de rastreio de risco de disfonia geral (PRRD-Geral) e complementar para voz falada - professor (PRRD-Específico), gravação da voz durante aula e em situação individual em sala silenciosa, medição da relação sinal-ruído e dos níveis de ruído das salas de aula. RESULTADOS Foram encontradas diferenças entre os grupos quanto à atividade física (PRRD-Geral) e particularidades da profissão (PRRD-Específico), bem como em todos os aspectos da análise vocal perceptivo-auditiva. No grupo sem disfonia, foram encontrados sinais de desgaste da voz. Quanto aos recursos vocais nas situações de ruído e silêncio, identificamos diferença para produção de ataque vocal brusco e tendência de uma fala mais precisa na situação-ruído. Tanto a relação sinal-ruído quanto os níveis de ruído das salas durante a aula foram elevados nos dois grupos. CONCLUSÕES Os professores dos dois grupos estão expostos a riscos elevados para o desenvolvimento de disfonias e apresentam sinais vocais negativos em maior ou menor grau. A relação sinal-ruído apresentou-se inadequada em grande parte das salas de aula, considerando-se as normas tanto para crianças com audição normal quanto para aquelas com perda auditiva, assim como os níveis de ruído equivalentes.

Autoavaliação e prontidão para mudança em pacientes disfônicos / Self-assessment and readiness for change in dysphonic patients

RESUMO Objetivo Analisar se existe associação entre a autoavaliação vocal e a prontidão para mudança em pacientes disfônicos. Método Participaram 151 pacientes com queixa vocal e diagnóstico de disfonia, entre 18 e 65 anos de idade, 47 homens e 104 mulheres, atendidos no ambulatório de voz de uma instituição pública. Foram aplicados quatro instrumentos de autoavaliação, incluindo o Questionário de Qualidade de Vida em Voz (QVV), o Índice de Desvantagem Vocal (IDV) e a Escala de Sintomas Vocais (ESV), além da utilização do instrumento URICA-VOZ, para verificação do estágio de prontidão para mudança dos pacientes. Todos os instrumentos foram aplicados imediatamente antes do início da terapia vocal. As variáveis foram correlacionadas e comparadas por meio de estatística inferencial. Resultados A maioria dos pacientes encontrava-se no estágio de contemplação (76,2%, n = 115), 22 (14,6%), no estágio de pré-contemplação e 14 (9,3%), no estágio de ação. Houve correlação negativa entre o escore no URICA-VOZ e o domínio socioemocional e escore total do QVV. Ocorreu correlação positiva entre o escore do URICA-VOZ e os domínios total, emocional e funcional do IDV, assim como entre o escore do URICA-VOZ e os domínios total, de limitação e emocional da ESV. Apenas os valores do domínio socioemocional do QVV e emocional no ESV apresentaram diferenças estatisticamente significantes entre os estágios motivacionais. Conclusões Existe associação entre a autoavaliação vocal e a prontidão para mudança em pacientes disfônicos. Pacientes com maior impacto na qualidade de vida em voz no QVV e maior frequência de sintomas vocais referida na ESV apresentam maior prontidão para mudança.

ABSTRACT Purpose To examine whether there is an association between vocal self-assessment and readiness for change in dysphonic patients. Methods 151 patients with vocal complaints and diagnosis of dysphonia, between 18 and 65 years of age, 47 men and 104 women treated at the voice clinic of a public institution participated in the study. Four self-assessment instruments were applied, including the Voice-Related Quality of Life (V-RQOL), the Voice Handicap Index (VHI) and the Voice Symptom Scale (VoiSS), and the use of URICA-VOICE instrument to verify the patients stage of readiness for change. All instruments were applied immediately before the start of vocal therapy. The variables were correlated and compared using inferential statistics. Results Most patients were in the contemplation stage (76.2%, n = 115), 22 (14.6%) were in the pre-contemplation stage and 14 (9.3%) in the action stage. There was a negative correlation between the score in URICA-VOICE and the socio-emotional domain and total score V-RQOL. There was a positive correlation between the score URICA-VOICE and full social, emotional and functional VHI, as well as between the score URICA-VOICE and full fields, limitation and emotional VoiSS. Only the social-emotional domain V-RQOL and emotional in VoiSS values showed statistically significant differences between the motivational stages. Conclusion There is association between vocal self-assessment and readiness for change in dysphonic patients. Patients with major impact on quality of life in voice in V-RQOL and higher frequency of vocal symptoms mentioned in the VoiSS show greater readiness for change.

Dysphonia risk screening protocol

OBJECTIVE: To propose and test the applicability of a dysphonia risk screening protocol with score calculation in individuals with and without dysphonia. METHOD: This descriptive cross-sectional study included 365 individuals (41 children, 142 adult women, 91 adult men and 91 seniors) divided into a dysphonic group and a non-dysphonic group. The protocol consisted of 18 questions and a score was calculated using a 10-cm visual analog scale. The measured value on the visual analog scale was added to the overall score, along with other partial scores. Speech samples allowed for analysis/assessment of the overall degree of vocal deviation and initial definition of the respective groups and after six months, the separation of the groups was confirmed using an acoustic analysis. RESULTS: The mean total scores were different between the groups in all samples. Values ranged between 37.0 and 57.85 in the dysphonic group and between 12.95 and 19.28 in the non-dysphonic group, with overall means of 46.09 and 15.55, respectively. High sensitivity and specificity were demonstrated when discriminating between the groups with the following cut-off points: 22.50 (children), 29.25 (adult women), 22.75 (adult men), and 27.10 (seniors). CONCLUSION: The protocol demonstrated high sensitivity and specificity in differentiating groups of individuals with and without dysphonia in different sample groups and is thus an effective instrument for use in voice clinics.

Prevalencia de disfonía en profesores de colegios de la comuna de Santiago y factores de riesgo asociados / Prevalence of Dysphonia in school teachers in the district of Santiago and associated risk factors

OJETIVOS: Determinar prevalência de disfonia y factores de riesgo asociados en profesores de establecimientos educacionales de la comuna de Santiago. METODOLOGÍA: Estudio descriptivo transversal en el que 402 profesores fueron evaluados mediante Protocolo Vocal y Cuestionario RPS (SUSESO-ISTAS 21). Se caracterizaron parámetros de voz de cada profesor mediante escala RASAT por 3 fonoaudiólogos especialistas, para conformar grupos de análisis de acuerdo al grado de afectación vocal presentado. Cada muestra de audio se analizó mediante software Praat. Los resultados se analizaron mediante el programa estadistico Systat. Se aplicó el Test Shapiro-Wilk, regresión logistica entre información de parámetros acústicos, resultados de protocolos SUSESO, y estadística descriptiva del Protocolo Vocal. RESULTADOS: La prevalencia de disfonía en el grupo estudiado corresponde al 75,5% de la muestra, incluyendo alteraciones leves y moderadas. Los principales factores de riesgo asociados son: edades sobre los 45 años, profesores de educación básica, tiempo de uso de voz sobre 5 horas diarias, presencia de RGE y consumo de cigarrillos. CONCLUSIONES: Existe alta prevalencia de disfonía en profesores. Éstos no tienen conciencia del problema y consultan tardíamente. Se presentan múltiples factores asociados a disfonía, relacionados al quehacer profesional y a conductas nocivas de profesores.

OBJECTIVES: To determine prevalence of dysphonia and associated risk factors in teachers of educational establishments in the municipality of Santiago. METHODOLOGY: A cross sectional study in which 402 teachers were evaluated by questionnaire Vocal Protocol and RPS (SUSESO-ISTAS 21). Voice parameters of each teacher were characterized by scale RASAT 3 by audiologists specialists, to form discussion groups according to the degree of vocal damage presented. Each sample was analyzed by Praat audio software. The results were analyzed using Systat statistical program. The Shapiro-Wilk test, logistic regression information acoustic parameters, results SUSESO protocols, and descriptive statistics was applied Vocal Protocol. RESULTS: The prevalence of dysphonia in the studied group corresponds to 75,5% of the sample, including mild and moderate alterations. The main risk factors associated are: age over 45 years, basic education teachers, airtime voice over 5 hours a day, presence of GER and smoking. CONCLUSIONS: There is high prevalence of dysphonia in teachers. They are not aware of the problem and consult late. Multiple factors associated with dysphonia, professional work related to harmful behaviors and teachers are presented.

Perceived dysphonia by the clinician's and patient's viewpoint / Disfonia na percepção do clínico e do paciente

PURPOSE: To verify the relationship between the clinician's vocal evaluation and vocal self-assessment and voice-related quality of life. METHODS: Participants were 96 individuals: 48 with vocal complaints and voice deviation (VCG), mean age of 51 years, with diagnosis and indication of voice therapy; and 48 with no vocal complaints and healthy voices (NVCG), mean age of 46 years. All participants answered the Voice-Related Quality of Life (V-RQOL) questionnaire, performed a vocal self-assessment and were submitted to auditory-perceptual analysis of voice. RESULTS: Mean V-RQOL scores were different between groups for all domains. Self-assessment results also showed differences between groups, which was not the case in the auditory-perceptual analysis of sustained vowel and connected speech, showing that the patient's perception was worse than the clinician's. There was correlation between the V-RQOL domains (Socio-emotional and Physical: 76.8%; Socio-emotional and Total: 90.8%; Physical and Total: 95.8%), as well as between the Socio-emotional (-52.9%), Physical (-43.1%) and Total (-52.2%) domains and the self-assessment. However, no correlation was found between auditory-perceptual analysis and self-assessment measures, except for a weak correlation between vocal self-assessment and auditory-perceptual analysis of the sustained vowel (33.3%). CONCLUSION: The clinician's perception does correspond to the individual's self-perception of his/her vocal quality and the impact of a voice deviation on his/her quality of life, but not directly. The individual's perception about his/her vocal quality and voice-related quality of life complements the clinician's perception regarding the overall degree of the voice deviation.

OBJETIVO: Verificar a relação entre a avaliação do fonoaudiólogo e a autoavaliação vocal e o impacto da disfonia na qualidade de vida do paciente. MÉTODOS: Participaram 96 indivíduos, 48 com queixa e alteração vocal (GQ), média de idade de 51 anos, com diagnóstico e indicação de fonoterapia, e 48 sem queixa vocal e voz saudável (GSQ), média de idade de 46 anos. Todos responderam ao protocolo Qualidade de Vida em Voz (QVV), realizaram autoavaliação e foram submetidos à avaliação perceptivo-auditiva da voz. RESULTADOS: Os escores médios do QVV dos grupos foram diferentes para todos os domínios. A autoavaliação mostrou valores bem distintos para os grupos, diferentemente dos obtidos na perceptivo-auditiva da vogal sustentada e da fala encadeada, mostrando que a percepção do paciente foi pior que a do clínico. Observou-se correlação entre os domínios do protocolo QVV (Sócio-emocional e Físico: 76,8%; Sócio-emocional e Total: 90,8%; Físico e Total: 95,8%), assim como entre os domínios Sócio-emocional (-52,9%), físico (-43,1%) e total (-52,2%) com a autoavaliação. Entretanto, não se observou correlação entre a análise perceptivo-auditiva e as medidas de autoavaliação, com exceção de uma baixa correlação entre autoavaliação vocal e a análise perceptivo-auditiva da vogal sustentada (33,3%). CONCLUSÃO: A percepção do clínico corresponde à percepção que o indivíduo tem da sua qualidade vocal e do impacto da alteração de voz na sua qualidade de vida, contudo não de forma direta. A percepção do indivíduo sobre a própria voz e sobre o impacto da disfonia na sua qualidade de vida complementa a percepção do clínico quanto ao grau geral desta alteração.

Correlação entre dados perceptivo-auditivos e qualidade de vida em voz de idosas / Correlation between acoustic-perceptual data and voice-related quality of life in elderly women

BACKGROUND: vocal quality and voice-related quality of life in elderly women AIM: to assess the vocal quality and voice-related quality of life in elderly women, as well as verify if the presence of dysphonia has an influence on the life quality of these women. METHODS: one hundred and three elderly women, with ages ranging from 60 to 103 years, were recruited. The V-RQOL was answered by the participants and their voices were registered and analyzed perceptually by five experienced speech pathologists, using the GRBASI scale. After the intra-rater reliability analysis, three speech pathologists were selected with whom a single GRBASI scale was built for each of the participant's voice. Later, this single assessment was compared to the physical, socio-emotional and total V-RQOL scores. RESULTS: most of the elderly women presented V-RQOL total scores between 70 and 100. They also presented a mild to moderate vocal disorder in the overall scores related to dysphonia, roughness, breathiness and instability in the GRBASI scale and did not present scores related to asthenia or strain. The G, R, B and I parameters of the GRBASI scale were statistically correlated to the physical and total V-RQOL scores. CONCLUSIONS: although most of the elderly women presented some level of dysphonia, the vocal disorders did not have an influence on their life quality. However, the physical and total V-RQOL scores were correlated to dysphonia severity, indicating that the more sever the dysphonia, the lower the voice-related quality of life.

TEMA: qualidade da voz e qualidade de vida em idosas. OBJETIVO: avaliar a qualidade vocal e a qualidade de vida relacionada à voz em idosas, bem como verificar se a presença ou não da disfonia influi na qualidade de vida dessas mulheres. MÉTODOS: trata-se de um estudo realizado com 103 idosas de 60 a 103 anos. As participantes responderam ao Questionário de Qualidade de Vida Relacionada à Voz (QVV), suas vozes foram registradas e analisadas perceptivo-auditivamente, por meio da escala GRBASI, por 5 fonoaudiólogas. Após a análise estatística da confiabilidade intra-examinadoras, foram selecionadas 3 avaliações, com as quais foi construída uma escala GRBASI única para a voz de cada idosa. Posteriormente, essa avaliação única foi comparada aos escores físico, sócio-emocional e total do QVV. RESULTADOS: a maioria das idosas apresentou escores do QVV entre 70 e 100. As senhoras apresentaram grau de alteração leve a moderado nos parâmetros grau geral de disfonia, rugosidade, soprosidade e instabilidade da escala GRBASI e não apresentaram nenhum grau de alteração nos parâmetros astenia e tensão. Os parâmetros G, R, B e I da escala GRBASI aparecem estatisticamente correlacionados aos escores físico e total do QVV. CONCLUSÃO: Apesar da maioria das idosas apresentarem algum grau de disfonia, a alteração vocal não impactou a qualidade de vida das idosas. No entanto, os valores dos escores físico e total do QVV se correlacionaram com o grau de severidade da disfonia, indicando que quanto mais severa é a disfonia, menor é a qualidade de vida relacionada à voz.