Methodological Procedures to Acquire and Analyze Ultrasound Images of Swallowing: A Scoping Review.

This scoping review aimed to identify methodological procedures for acquiring and analyzing ultrasound images related to swallowing in adults and older adults. The inclusion criteria were based on the PCC strategy (participants, concept, and context), as follows: population (adults and older adults), concept (ultrasound assessment), and context (swallowing assessment). The review included observational, experimental, descriptive, and analytical studies and excluded those that were not available in full, animal studies, in vitro studies, letters to the editor, errata, study protocols, and those that used ultrasound for purposes other than swallowing. There were no language and time restrictions. Two independent blinded professionals selected 81 articles that met the inclusion criteria from different databases. The most evaluated parameters included tongue morphology and movements, hyoid bone displacement, swallowing muscle area, and pharyngeal residue detection, such as pharyngeal wall mobility. They used convex and linear transducers (3 MHz to 8 MHz) positioned in the submental, laryngeal, and lateral regions of the neck. The subjects were seated and instructed to eat different food volumes and consistencies. The literature mapping showed that ultrasound is a promising diagnostic tool, helping clinicians understand swallowing disorders, as it provides static and dynamic images in different modes and positions. Also, patients receive real-time biofeedback of changes related to dysphagia.

Obstructive sleep apnea and orofacial myofunctional aspects in obesity.

PURPOSE: This study aimed to evaluate the quality of sleep, presence of obstructive sleep apnea (OSA), and its relationship with the presence of snoring, cephalometric characteristics, degree of collapse of the upper airways, and orofacial myofunctional profile in obese and overweight individuals. METHODS: All participants completed polysomnography, as well as sleep and snoring questionnaires. We further performed orofacial, otorhinolaryngological, and anthropometric evaluations on all participants. RESULTS: A total of 102 adults, comprising 29 obese, 21 overweight, and 52 eutrophic individuals of both sexes participated in this study. We observed a high prevalence of snoring in both obese and overweight (100%), and in 65% of eutrophic individuals. Among the obese subjects 58% had a severe degree of OSA, whereas 4% of eutrophic subjects presented a risk for OSA development. Sleep quality was related to body mass index (BMI) and cervical and abdominal circumference. All obese and overweight individuals presented with orofacial myofunctional alterations such as facial asymmetry, alteration of the maxilla-jaw relationship, inadequate tongue posture, changes in masticatory pattern and swallowing, and inadequate general orofacial myofunctional condition. Airway obstructions at the retropalatal and retrolingual levels > 75% were observed in at least 48% of the individuals. CONCLUSION: Obese and overweight individuals presented a higher risk for the development of OSA compared with eutrophic patients, and obese individuals presented a greater severity of OSA. The higher the BMI and greater the cervical and abdominal circumferences, the higher the prevalence of OSA, worse the quality of sleep, and more serious orofacial myofunctional characteristics in this population.

Proposal of a protocol for thermographic assessment of the orbicularis oris muscle.

BACKGROUND: The orbicularis oris muscle is extremely important to performing various oral functions, including mastication, swallowing and speech. Infrared thermography is a non-invasive painless technique that does not require either contrast or ionisation. It has been increasingly used in speech-language-hearing therapy in the last years. OBJECTIVE: The objective of the study was to propose a thermographic analysis method for the orbicularis oris muscle. METHODS: This is an observational, analytical, cross-sectional study. The area of the orbicularis oris muscle was defined based on its anatomy with thermographic images of 11 children and 13 adults. Then, this area was divided into four quadrants, each of which was analysed considering four different shapes: a triangle; a rectangle; a triangle with a rounded side, including the vermilion zone; and a customised shape encompassing only the region of the orbicularis oris muscle, not including the vermilion zone. Data were collected and analysed with the coefficient of variation and interrater agreement. RESULTS: Data variability for the four shapes had similar dispersions per region of the orbicularis oris muscle, in both maximum and mean temperatures and in both children and adults. The rectangle was the shape with the lowest coefficient of variation in more regions of both adults and children. Interrater agreement was excellent for all shapes, in both children and adults. CONCLUSION: Currently, the best way to analyse the orbicularis oris muscle's quadrants is to use the maximum temperature and the rectangle, based on an initial ellipsis encompassing the whole muscle.

Masking level difference among brazilian military personnel: a comparison between pilots and non-pilots.

OBJECTIVES: The aims of this study were to investigate auditory habits and binaural interaction among pilot and non-pilot military personnel from the Brazilian Air Force. DESIGN: A cross-sectional study using (1) an auditory habits questionnaire to outline the groups auditory profile and (2) the masking level difference test (MLD, Auditec, Saint Louis®) to evaluate and compare the groups. STUDY SAMPLE: Forty military male personnel aged between 30-40 years old, all with normal hearing, comprising 20 pilots in the study group (SG), and 20 non-pilots, not exposed to noise, in the control group (CG). RESULTS: There was no significant difference between groups regarding auditory habits. In the MLD test, a significantly better performance under the homophasic condition (S0N0) was found in the SG. Under the antiphasic condition (SπN0) there were no differences between groups. This combination resulted in a significantly lower MLD in the SG compared to the CG. CONCLUSIONS: Repeated exposure to conditions where active pilots have to learn to recognise speech in noisy backgrounds may lead to a better performance in the MLD's homophasic condition (S0N0).

Musical Performance Anxiety and Voice Handicap in Amateur Evangelical Singers.

OBJECTIVE: To compare and correlate musical performance anxiety (MPA) and vocal self-perception among amateur evangelical singers, focusing on the interaction between anxiety and aspects of performance in this sample. METHOD: This study employed a cross-sectional and quantitative approach, involving 75 amateur gospel singers from evangelical churches, aged between 18 and 59 years. Data collection included the administration of a sample identification and characterization questionnaire, the Brazilian Portuguese version of the Kenny Music Performance Anxiety Inventory (K-MPAI), and the Singing Voice Handicap Index (S-VHI). The descriptive analysis used absolute and relative frequencies, measures of central tendency, and dispersion (mean and standard deviation [SD]). To compare the vocal self-assessment protocols and performance aspects, the Kruskal-Wallis test was applied. Spearman's correlation test was used for correlation analysis. All analyses were conducted with a significance level set at 5% (P < 0.05). RESULTS: Vocal warm-up and cool-down activities, vocal discomfort after performance, and vocal self-assessment were significantly associated with scores on S-VHI, and the variable "instruments louder than voices" was associated with the K-MPAI score. Participants exhibited a mean K-MPAI score of 85.12 points (SD ± 36.6), and the vocal handicap of the sample had a mean score of 45.22 (SD ± 32.3). There was no statistically significant correlation between the protocols. CONCLUSION: Incorporating vocal warm-up and cool-down activities was significantly associated with lower scores on S-VHI. Conversely, those experiencing postperformance vocal discomfort exhibited higher scores on S-VHI. Moreover, the absence of correlation between the assessment protocols suggests that while significant levels of voice handicap were observed, a direct link to MPA cannot be definitively established. Overall, these findings contribute to a nuanced understanding of the multifaceted factors shaping vocal health and performance among amateur evangelical singers, thereby guiding future research and interventions in this field.

A comprehensive review on frontotemporal dementia: its impact on language, speech and behavior.

Frontotemporal dementia (FTD) is a progressive neurodegenerative disorder defined by the selective deterioration of the frontal and temporal lobes of the brain. This comprehensive review explored the effect of FTD on language, speech, and behavior. Early symptoms include difficulty in word finding, reduced speech output, and comprehension deficits, often leading to aphasia. The study discussed the profound behavioral changes observed in FTD patients, including apathy, disinhibition, compulsive behaviors, and loss of empathy, the importance of an accurate and early diagnosis, and its challenges. We even reviewed the potential for targeted therapies and the essential role of multidisciplinary care in managing the language, speech, and behavioral aspects of FTD. By examining objective data and comprehensive research on the subject, this study offers valuable insights into FTD's profound effects on language, speech, and behavior, assisting in improved clinical management and potential therapeutic strategies for this devastating condition.

A demência frontotemporal (DFT) é uma doença neurodegenerativa progressiva definida pela deterioração seletiva dos lobos frontal e temporal do cérebro. Esta revisão abrangente explorou o efeito da DFT na linguagem, na fala e no comportamento. Os primeiros sintomas incluem dificuldade em encontrar palavras, redução da produção de fala e déficits de compreensão, muitas vezes levando à afasia. A revisão discutiu as profundas mudanças comportamentais observadas em pacientes com DFT, incluindo apatia, desinibição, comportamentos compulsivos e perda de empatia, a importância de um diagnóstico preciso e precoce e seus desafios. Também foi revisado o potencial para terapias direcionadas e o papel essencial do cuidado multidisciplinar no gerenciamento dos aspectos de linguagem, fala e comportamentais da DFT. Ao examinar os dados objetivos e a pesquisa abrangente sobre o assunto, esta revisão oferece insights valiosos sobre os efeitos profundos da DFT na linguagem, na fala e no comportamento, auxiliando no melhor manejo clínico e em possíveis estratégias terapêuticas para essa condição devastadora.

Spectrographic Vocal Characteristics in Female Teachers: Finger Kazoo Intensive Short-term Vocal Therapy.

OBJECTIVE: Verify the results from intensive short-term vocal therapy using the Finger Kazoo technique about the spectrographic vocal measurements of teachers. METHODS: Controlled and randomized trial. Spectrographic vocal assessment was performed by judges before and after intensive short-term vocal therapy with Finger Kazoo. Sample was composed of 41 female teachers. There were two study groups (with vocal nodules and without structural affection of the vocal folds) and the respective control groups. For the statistical analysis of the data, nonparametric tests were used (Mann-Whitney test and Wilcoxon test). RESULTS: After intensive short-term vocal therapy with Finger Kazoo, improvement in voice spectral parameters, such as improvement in tracing (color intensity and regularity), greater definition of formants and harmonics, increased replacement of harmonics by noise, and a greater number of harmonics, mainly in the group without structural affection of the vocal folds. CONCLUSION: There was an improvement in the spectrographic vocal parameters, showing greater stability, quality, and projection of the emission, especially in female teachers without structural affection of the vocal folds.

What Factors Determine the Use of Volitional and Non-Volitional Devices in Vocal Interventions Performed by Brazilian Speech-Language Pathologists?

OBJECTIVE: To analyze the determining factors for using devices in vocal interventions and characterize their use by Brazilian speech-language pathologists (SLPs). METHODS: This cross-sectional observational study had a sample of 148 SLPs with clinical practice in voice. They answered an online questionnaire via Google Forms about sociodemographic data, training, work in the area, and the use of devices in vocal interventions. Data were analyzed descriptively and inferentially. RESULTS: Tubes, straws, and masks were the most commonly used devices. SLPs specializing in voice are more inclined to use thermotherapy and kinesio tapings while being less inclined to use therapeutic ultrasounds and nebulizers. Voice specialists are less likely to employ electrostimulation. The choice to use photobiomodulation and auditory monitoring devices is influenced by the years of clinical experience, whereas the speech-language therapy training duration affects the use of electrostimulation. The age of the professional also plays a role in the utilization of vibratory stimulation. Vibratory stimulation, auditory monitoring devices, thermotherapy, and nebulization are more frequently utilized among individuals who rely on their voices for occupational purposes, whereas electrostimulation is less common. The use of photobiomodulation is infrequent in children; vibratory stimulation is more common in adolescents, and thermotherapy is relatively common among older individuals. Most of these devices are typically prescribed in execution time during vocal intervention. CONCLUSION: The specialization, the time since graduation and in the occupation, and the target population of the service are the determining factors for the use of devices. They are used in vocal therapy and training, targeting vocal function.

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.

Volitional and Non-volitional Devices Used in Voice Therapy and Training: A Scoping Review-Part A.

OBJECTIVE: To map the volitional and non-volitional devices used by speech and language pathologists (SLPs) in voice training and therapy and characterize their use in research on voice interventions. METHODS: This scoping review is the first part of a larger study. The electronic search was carried out by mapping the references in PubMed/Medline, LILACS/BVS, Scopus, Web of Science, EMBASE, and the Cochrane Library, and the manual search was carried out in the grey literature. Two blind independent reviewers selected and extracted data; divergences were solved by consensus. The data extracted in this part of the study were the authorship and year of publication, country, study design, sample characteristics, intervention modality, ingredient, target, mechanism of action, dosage, and outcome measures. They were addressed with descriptive analysis. RESULTS: Publications that use devices as ingredients are mostly from the last two decades, mainly carried out in the United States of America and Brazil, in adults of both sexes with behavioral dysphonia. Forty-two types of devices were used, many of them with similar approaches but different nomenclatures. Most devices were used voluntarily, focusing on vocal function, and aiming to increase source and filter interaction. Most studies used silicone tubes. The most reported technical specification to apply the ingredient was surface electrodes on the neck. Device dosage was time-controlled, and the most used outcomes were self-assessment and acoustic analysis. CONCLUSION: Devices are currently used as ingredients in vocal interventions, with a greater focus on increasing the source and filter interaction, associated with silicone tubes (the most used devices in these studies), which have been dosed with performance time. Outcomes were measured with self-assessment instruments.

Orofacial Myofunctional Aspects of Nursing Infants and Preschoolers.

Introduction Clinical assessment in orofacial motricity is required for the speech therapist to diagnose and treat disorders involving the stomatognathic system. Validated tools can help establish a prognosis and outline intervention methods connected to human development. Objective The goal of the present study was to examine the domains of the oromyofunctional assessment of nursing infants and preschoolers according to sex and age group, as well as the application of the MMBGR Protocol - Nursing Infants and Preschool Children. Methods A quantitative technique was used to conduct an analytical and cross-sectional investigation. The present study included a total of 214 healthy breastfeeding infants and preschoolers of both sexes. The Mann-Whitney test was used to compare the medians. The Spearman correlation of each test domain was determined. R Core Team 2021 (R Foundation, Vienna, Austria) was used, and the significance threshold was set at 5%. Results In intraoral and extraoral examinations, there was a difference between sexes for tongue scores in nursing infants (d = - 0.428; p = 0.045), worse in males. When the orofacial functions were considered in nursing infants, there were differences between the sexes for the liquid/solid/semisolid deglutition scores (d = 0.479; p = 0.031), with females performing worse. There were sex differences in solid/semisolid deglutition (d = - 0.335; p = 0.043), and speech in preschoolers (d = - 0.478; p = 0.034), including the production of phones/phonemes (d = - 0.599; p = 0.007), which were always worse in males. Conclusion The research revealed sex disparities and related the domains of oromyofunctional assessment, according to scores, of the domains of myofunctional assessment, as recorded in a standardized oromyofunctional assessment protocol by age group.

Brazilian Consensus on Sleep-Focused Speech-Language-Hearing Sciences - 2023 Brazilian Sleep Association.

Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach. Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when ⅔ (66.6%) of valid responses were on a same on a same answer (either "agree" or "disagree"). Results Participants voted on 102 items. The mean consensus rate was 89.9% ± 10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services. Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.

Voice And Gender Incongruence: Relationship Between Vocal Self-Perception And Mental Health Of Trans Women.

OBJECTIVE: To verify the association between vocal perception and Common Mental Disorders (CMD) suspicion in trans women. METHODS: Cross-sectional observational study including 24 adult trans women with a minimum time of presentation as a woman of six months. The sampling of the subjects was supported by the "Snowball" technique. Three questionnaires were applied for data collection: sociodemographic and health data, Self-Reporting Questionnaire (SRQ-20) and Trans Woman Voice Questionnaire (TWVQ). The sociodemographic and health data collected were: age, marital status, education, smoking habits, speech therapy, use of hormones, and whether they had undergone Sex Reassignment Surgery (SRG). SRQ-20 was used for suspicion of CMD evaluation, such as depressive and anxiety symptoms. TWVQ is a vocal self-report questionnaire for trans women living the full-time gender role in which they self-identify. TWVQ has a minimum score of 30 points and a maximum of 120 points. Higher scores are associated with perceptions of a higher frequency of voice-related difficulties and psychosocial impacts. For statistical analysis, data were analyzed descriptively and statistically using Fisher's and Mann-Whitney's exact tests, both with a significance level of 5%. RESULTS: The average participants' age in this study was 28.2 years old (SD = 6.5 / minimum = 21 and maximum = 48); 83.3% were single; most (41.7%) were high school graduates; and most (95.83%) had not undergone Sex Reassignment Surgery. All subjects reported using hormones; 37.5% were smokers; 4.2% had undergone speech therapy; and the average number of years of experience in the female role was 8.8 years (SD = 7.2). The average TWVQ score was 55.4 points (SD = 4.3). Through SRQ-20, it was verified the prevalence of suspected CMD in 58.3% of the participants. The study results indicated that communicative dissatisfaction in trans women due to inconsistent voice with the recognized gender is associated with probable CMD such as depression and anxiety (P= 0.001). CONCLUSION: Trans women who reported greater difficulties and voice-related effects in their lives had more symptoms of anxiety and depression. Although more research is needed, results indicate the need for inter-professional preventive and therapeutic actions directed towards assisting trans women. This fact encourages reflection on the care of this population and the role of health professionals, enhancing scientific production, clinical practice and the inclusion of the "transsexuality" theme in Speech Language and Hearing Sciences.

Swallowing disorders in patients with obstructive sleep apnea: a critical literature review.

Patients with obstructive sleep apnea (OSA) may show signs and symptoms of altered swallowing function since repetitive episodes of OSA may cause hypoxia (decreased oxygen concentration in the blood) and hypercapnia (increased carbon dioxide concentration in the blood), as well as neuromuscular changes in the tissues involved, including the pharynx. This study aims to analyze whether patients with OSA show signs and symptoms of altered swallowing function. A literature search was performed in the PubMed, LILACS, Medline, Scopus, and SciELO databases by using the following search strategy: ("dysphagia") or ("deglutition disorders") and ("obstructive sleep apnea") or ("obstructive sleep apnea syndrome"). The included articles were sorted by authors, year, country, journal of publication, and type of study, as well as analyzed according to the objectives, case series, OSA and swallowing assessment methods, results and conclusions. After applying the inclusion and exclusion criteria, ten articles published in medicine, dentistry and physiology journals between 1999 and 2018 were selected. The analysis of the selected articles showed that the number of participants and group structuring vary according to the study and instrumental and objective exams are used to assess swallowing and sleep in most articles. Also, the results show that groups of patients with OSA can present altered swallowing reflex, altered latency time and inspiratory suppression time, and presence of premature posterior escape, residues, penetration and aspiration. Premature posterior escape was the most frequent sign found. In conclusion, patients with OSA may show signs and symptoms of altered swallowing function.

Characteristics of the Voice of Dysphonic School Children from 4:0 to 7:11 Years Old.

BACKGROUND: Childhood dysphonia is frequent and has many origins, with the most common initial symptom being the altered vocal quality. OBJECTIVE: Describe and correlate the auditory-perceptual and acoustic characteristics of the voice, and the maximum phonation time (MPT), of dysphonic schoolchildren from private and public schools from 4:0 to 7:11 years old, female and male. METHODS: MPT, acoustic (Multi-Dimensional Voice Program Advanced and Real Time Spectrogram), and auditory-perceptual (Consensus Auditory-Perceptual Evaluation of Voice) evaluations of 115 schoolchildren were statistically analyzed. RESULTS: Auditory-perceptual parameters values were classified as mild, and MPT values were reduced, in most children. Fundamental frequency and Jitt values decreased significantly with age; MPT/i/ increased significantly with age. Relative average perturbation, voice turbulence index (VTI), and number of sub-harmonic segments values were significantly higher in 4:0 years old children. The number of unvoiced segments was higher in 6:0 years old children. Shimmer percent was higher in 7:0 years old children. There were negative correlations between the high frequency spectrographic tracing color intensity and the vocal strain; the VTI and the MPT; the degree of unvoiced segments and the MPT. There was a positive correlation between the smoothed pitch period perturbation quotient and the roughness. CONCLUSION: In dysphonic schoolchildren, auditory-perceptual parameters were moderate, MPT was reduced, several acoustic parameters were altered, and these vocal characteristics improved with age.

Maximum Phonation Time and Body Mass Index in Nondysphonic Eutrophic Children.

BACKGROUND: Literature presents controversial maximum phonation time values in children. OBJECTIVE: Verify and correlate the maximum phonation time of vowels /a, i, u/ and the body mass index of children. METHOD: Evaluation of 484 children, eutrophic and without dysphonia, aged from 4:00 to 7:11 years. SAMPLING: questionnaire, audiometric screening, auditory-perceptual evaluation of voice, and assessment of the body mass index. DATA COLLECTION: measurement of the maximum phonation time of /a, i, u/. Descriptive statistics, t test, and multiple regression at 5% significance. RESULTS: /a:/ = 3.77 seconds at age 4:00 years, 5 seconds at 5:00, 5.85 seconds at 6:00, and 7.5 seconds at 7:00 for boys, and 3.89 seconds, 4.89 seconds, 5.61 seconds, and 6.61 seconds for girls, respectively; /i:/ = 3.49 seconds at age 4:00 years, 4.96 seconds at 5:00, 5.72 seconds at 6:00, and 6.88 seconds at 7:00 for boys, and 3.49 seconds, 4.73 seconds, 5.41 seconds, and 6.63 seconds for girls, respectively; /u:/ = 3.64 seconds at age 4:00 years, 4.85 seconds at 5:00, 5.76 seconds at 6:00, and 7.08 seconds at 7:00 for boys, and 3.54 seconds, 4.73 seconds, 5.64 seconds, and 6.47 seconds for girls, respectively. There were no significant differences between genders, except for /a:/ at age 7:00 years. The correlations were not significant. CONCLUSION: Maximum phonation time of /a, i, u/ increased with age and its value in seconds was approximately equal to the age in years. At the age 7:00 years, /a:/ from boys was longer. The body mass index did not show influence on the maximum phonation times.

Immediate Effects of Performance Time of the Voiced High-frequency Oscillation With Two Types of Breathing Devices in Vocally Healthy Individuals.

OBJECTIVE: To verify safety and compare the immediate effects of voiced high-frequency oscillation (VHFO) using two types of breathing devices on self-perception and vocal quality according to performance time in vocally healthy individuals. METHOD: Thirty individuals (15 women and 15 men) without vocal complaints or any history of dysphonia participated. Each participant performed the VHFO technique with the New Shaker and Shaker Plus devices for 3 (T3), 5 (T5), and 7 minutes (T7). All answered a questionnaire that investigated the intensity of laryngopharyngeal and vocal symptoms before and after performing the VHFO with each device and at different times. After VHFO, at each time, the voice was recorded for further analysis of vocal quality. The participants also answered a self-assessment questionnaire about vocal, laryngeal, breathing, and articulatory sensations. RESULTS: T3 showed a decrease in the laryngopharyngeal symptoms "pain when swallowing," "secretion in the throat," and "phlegm" for both genders and both devices. T7 showed an increase in "dry throat" for both genders and both devices. There was an increase in the symptom "fatigue when speaking" in T3 for both genders after VHFO with the New Shaker device. We also observed a decrease in the symptoms "voice failure" and "dry cough" after VHFO with the Shaker Plus for men in T3, and "voice failure" after VHFO with the New Shaker for women in T5. We found a decrease in the acoustic parameter shimmer for women in T5 and the NHR parameter in T7 for both genders, regardless of the breathing device. There were no changes in the auditory-perceptual analysis of the voice and self-assessment of sensations after VHFO with both devices and for both genders. CONCLUSION: VHFO performed with New Shaker and Shaker Plus is safe and can be used in clinical vocal practice in vocally healthy individuals.

Spectrographic Vocal Assessment Protocol (SVAP): Reliability and Criterion Validity.

OBJECTIVE: To present evidence of the reliability and validity in the Spectrographic Vocal Assessment Protocol. METHODS: The sample consisted of 50 female participants, aged 25-62 years old, 24 with a otorhinolaryngological diagnosis of the normal larynx or posterior glottal gap, and 26 diagnosed with vocal fold disturbances. The emission of the vowel /a:/ was analyzed by the Real Time Spectrogram software. The spectrographs were analyzed with a protocol by two speech therapist judges. For reliability analysis, inter- and intrajudge analysis were performed using the Kendall coefficient. For criterion validity, the t test for matched samples with Bonferroni correction was used to compare the average performance of the protocol between the two groups of subjects. RESULTS: Protocol reliability: for broadband items, the agreement between judges ranged from moderate (0.462) to almost perfect (0.888), and it is significant for all items, and an intrajudge agreement was almost perfect and significant (0.865-1.000) for all items. For narrowband items, the agreement between judges ranged from moderate (0.469) to almost perfect (0.922), and it is significant for all items except for the presence of "subharmonics in high frequencies" where agreement was moderate (0.504), but not significant, and the intrajudge agreement was almost perfect (0.874-1.000) and significant for all items. Criterion validity: for most broadband and narrowband items, the groups with normal or altered diagnosis differed statistically. CONCLUSION: The Spectrographic Vocal Assessment Protocol presented adequate evidence in reliability and validity.

Development and Evidence of Content Validity of the Spectrographic Vocal Assessment Protocol (SVAP).

OBJECTIVE: To develop and seek evidence of content validity of a spectrographic vocal assessment protocol. METHODS: Methodological study for development and validation of an assessment instrument. A broad literature search was conducted to develop and substantiate a spectrographic vocal assessment protocol. The protocol items were sent to five expert judges, speech therapists, nonauthors of the research, doctors, and clinicians, with experience in the field of voice and spectrographic acoustic analysis, who individually analyzed the protocol items. For data analysis, the Gwet analysis and the Content Validity Ratio formula were used. RESULTS: The Spectrographic Vocal Assessment Protocol was developed, subdivided into Broadband and Narrowband. Twenty-four protocol items had Content Validity Ratio 1.0 and 25 items had 0.6. Gwet analysis indicated substantial agreement (0.656) for broadband and almost perfect (0.848) for narrowband items. CONCLUSION: Evidence of satisfactory content validity was obtained in the development of the protocol.

Burnout syndrome in speech-language pathologists and audiologists: a review.

Speech pathologists and audiologists work with the provision of health care, and as such, are susceptible to burnout syndrome. The objective of this study was to discuss scientific studies of burnout syndrome in speech pathologists and audiologists. A search was conducted across electronic databases using the following keywords: "burnout syndrome" and "speech pathologists/ audiologists." The search retrieved 11 articles addressing burnout in this occupational category. Prevalence estimates of burnout syndrome in speech pathologists varied widely across studies. The scarcity of the literature and high methodological variability prevented a deeper analysis of the topic. Future studies are encouraged to pay closer attention to occupational stress and mental health in speech pathologists and audiologists in order to provide these professionals with specialized care.