Navegando por Palavras-chave "Dysphonia"

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    Auditory-perceptual Evaluation of Normal and Dysphonic Voices Using the Voice Deviation Scale
    (Mosby-Elsevier, 2017) Yamasaki, Rosiane; Madazio, Glaucya; Leao, Sylvia Helena de Souza; Padovani, Marina Martins Pereira; Azevedo, Renata Rangel [UNIFESP]; Behlau, Mara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective This study aims to (1) determine the cutoff values of the overall severity (OS) of vocal deviation on the visual analog scale (VAS) based on the ratings of the numerical scale (NS); and (2) verify the power of discrimination of these cutoff values according to different degrees of vocal deviation. Study Design This is a prospective study. Methods The auditory-perceptual evaluation was performed by four speech-language pathologists who used two protocols with different scalar properties: the VAS and the 4-point NS. Vocal samples from142 women and 69 men, plus 10% of repetition, with and without vocal complaints, ranging from 19 to 60 years were included. The analyzed speaking task was the counting from 1 to 10. For both protocols, the judges rated the OS. Results Based on the correspondence between the two scales, the cutoff values of the OS on the VAS obtained were 35.5, 50.5, and 90.5 points. The 35.5 value corresponds to the cutoff point between normal variability and mild/moderate vocal deviations; the 50.5 value corresponds to the cutoff point between mild/moderate and moderate vocal deviations; the 90.5 value corresponds to the cutoff point between moderate and severe deviations. Areas under the receiver operating characteristic curve for the three cutoff values were 0.918, 0.948, and 0.970, respectively. Conclusions The cutoff values of the OS on the VAS were obtained, and the areas under the ROC curve showed that all the three cutoff points had excellent accuracy that represents a higher power of discrimination of different degrees of vocal deviations
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    Behavior, Social Competence, and Voice Disorders in Childhood and Adolescence
    (Mosby-Elsevier, 2016) Krohling, Livia Lima; Pereira de Paula, Kely Maria; Behlau, Mara Suzana [UNIFESP]
    Objectives/Hypothesis. This study aimed to verify the relationships among voice change complaints, indicators of competence, and behavioral problems in children and adolescents. Study Design. This is a prospective study. Methods. A sample of 103 parents/guardians completed the Child Behavior Checklist for ages 6-18 years. The mean age and gender were very similar between the participants with and without voice complaints. Results. Regarding the competences, no differences were found between the participants with and without voice complaints. The group with voice complaints presented higher total scores and T-scores in the both anxiety/depression and somatic complaints domains and in the internalising, externalizing, and total scales. The total scores and T-scores on the internalising, externalizing, and total scales, as well as those of their domains (anxiety/depression, somatic complaints, social problems, thought problems, attention problems, rule-breaking behavior, and aggressive behavior), differed between children and adolescents with and without voice complaints. Conclusions. Children and adolescents with complaints of voice disorder demonstrate a potential risk of developing emotional/behavioral problems.
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    Characteristics and Professional Use of Voice in Street Children in Aracaju, Brazil
    (Elsevier B.V., 2010-07-01) Sales, Neuza Josina; Gurgel, Ricardo Queiroz; Rebelo Goncalves, Maria Ines [UNIFESP]; Cunha, Edilson; Prado Barreto, Valeria Maria; Todt Neto, Joao Carlos; D'Avila, Jeferson Sampaio; Univ Fed Sergipe; Universidade Federal de São Paulo (UNIFESP); Sao Lucas Hosp
    The objective of the study was to evaluate voice characteristics of children engaged in street selling, which involves an essentially professional use of voice in this population. A controlled cross-sectional study was carried out. A randomly chosen sample of 200 school children with a history of street selling assisted by public social services and 400 school children without this experience was selected. Seven- to 10-year-old children of both sexes were studied. Both groups were interviewed and given vocal assessment (auditory-perceptual assessment and spectrographic acoustic measures) and otorhinolaryngological evaluation (physical and videonasolaryngoscopic examination). Children with abnormal results in both groups were compared using chi(2) (Chi-squared test). the significance level was established at 5% (P < 0.05). Voice problems were detected more frequently in working children (106-53%) than in regular school children (90-22.5%). the control group achieved better school performance as more children in this group attend school regularly than street children, although age-for-grade deficit was similar. the control group had more access to medical visits (80-40%) and treatment with a doctor (34-17%). Language assessment has shown that the control group had more dysphonia (73-37%) and myofunctional orofacial disorders (20-10%). Street children had more normal voice but had more nasal disorders and greater glottal closure than the school control group. Voice disorders were present in both groups, but less frequently in street children. Although subject to inadequate living conditions, street children had better voice quality than the control group. An explanation could be that by adapting their voice professionally for selling goods in the streets, they developed adequate resilience to their difficult living conditions.
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    Comparison of clinical characteristics of patients with adductor laryngeal dystonia in the focal and segmental types
    (Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2011-07-01) Korn, Gustavo Polacow [UNIFESP]; Moraes, Miriam; Pereira Vilanova, Luiz Celso [UNIFESP]; Moraes, Bruno Teixeira de [UNIFESP]; Madazio, Glaucya; Padovani, Marina Martins Pereira; De Biase, Noemi Grigoletto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Dystonia is a central motor processing neurological disorder characterized by abnormal, often action-induced, involuntary movements or uncontrolled spasms.Aim: To compare patients with the diagnoses of focal and segmental adductor laryngeal dystonia at the Neurolarynx Outpatient Clinic of the Federal University of Sao Paulo.Materials and methods: A clinical retrospective study of data collected from patient registries from 2003 to 2009.Results: Of 34 patients, 25 presented focal dystonia and 9 presented segmental dystonia. There were 30 females (88.2%) and 4 males (11.8%). A relation with a traumatic event was reported in 11 cases (32.4%). Vocal tremor was observed in 21 patients (61.8%). The mean age at onset, the age at diagnosis, and time between the onset and the diagnosis were respectively 55, 61.3 and 6.3 years. There was no statistical difference between patients with focal laryngeal adductor dystonia and segmental dystonia in the study data.Conclusion: There were no statistical differences among patients with focal adductor laryngeal dystonia and segmental dystonia relating to age of onset, age of diagnosis, gender, time between onset and diagnosis, presence of associated tremor, and relation to trauma.
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    Considerações teóricas sobre a relação entre respiração oral e disfonia
    (Sociedade Brasileira de Fonoaudiologia, 2008-01-01) Tavares, Juliana Gomes; Silva, Érika Henriques de Araújo Alves da [UNIFESP]; Faculdade Integrada do Recife; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Ciências da Saúde de Alagoas
    It is known that mouth breathing can lead to several bone, postural, muscular and functional alterations, and also changes on vocal quality and/or vocal behavior. These alterations can compromise oral communication, in which the voice cannot perform its basic role on the transmission of an individual's verbal and emotional message. Individuals with mouth breathing can present hiper or hiponasal resonance, changes on voicing features and hoarseness. From researches on LILACS and SciELO databases, books and specialized magazines about the subject, it was carried a literature review about the relationship between mouth breathing and dysphonia, analyzing the influence of alterations caused by mouth breathing on vocal quality and/or vocal behavior. It was possible observe that mouth breathing promotes several significant structural alterations, which reflect on stomatognathic functions and on phonation. However, few authors report the possible correlation between mouth breathing and dysphonia.
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    Coping Strategies in Teachers With Vocal Complaint
    (Elsevier B.V., 2014-05-01) Zambon, Fabiana [UNIFESP]; Moreti, Felipe [UNIFESP]; Behlau, Mara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); SINPRO SP
    Objectives. To understand the coping strategies used by teachers with vocal complaints, compare the differences between those who seek and those who do not seek voice therapy, and investigate the relationships among coping and voice perceptual analysis, coping and signs and symptoms of voice, and coping and participation restrictions and limitations in vocal activities.Study Design. Cross-sectional nonrandomized prospective study with control group.Methods. Ninety female teachers participated in the study, of similar ages, divided into three groups: group 1 (G1) comprised 30 teachers with vocal complaints who sought voice therapy, group 2 (G2) comprised 30 teachers with vocal complaints who never sought voice therapy, and group 3 (G3) comprised 30 teachers without vocal complaints. the following analysis were conducted: identification and characterization questionnaire, addressing personal and occupational description, recording speech material for voice perceptual analysis, Voice Signs and Symptoms Questionnaire, Voice Activity and Participation Profile (VAPP), and Voice Disability Coping Questionnaire (VDCQ)-Brazilian Version.Results. in relation to the voice perceptual analysis, there was statistically significant difference between the groups with vocal complaint (G1 + G2), which had showed voices with mild-to-moderate deviation, and the group without vocal complaint (G1), which showed voices within the normal variability of voice quality (mean for G1 49.9, G2 43.7, and G3 32.3, P < 0.001). G1 had higher mean of voice signs and symptoms (G1 8.6, G2 6.6, and G3 2.0, P < 0.001) and higher scores in almost all dimensions of VAPP (P < 0.001), except for the aspects effect on job and effect on social communication. Individuals with vocal complaints who looked for voice therapy (G1) tended to use more problem-focused strategies and had higher scores in VDCQ (G1 45.4, G2 38.5, and G3 9.5, P < 0.001). the aspects that were correlated with VDCQ in the three groups were degree of vocal deviation, VAPP total score, VAPP partial scores of self-perceived severity of voice problem, effect on daily communication, effect on emotion, and participation restriction for G1; VAPP total score and partial score of effect on daily communication for G2; and all VAPP scores for G3. No correlation was found between voice signs and symptoms and coping.Conclusion. Teachers with vocal complaints who looked for voice therapy use more coping strategies. Moreover, they present a tendency to use more problem-focused coping strategies. Voice symptoms prompt the teachers into seeking treatment; however, they are not correlated with the coping itself. in general, the higher the perception of limitation and restriction of participating in vocal activities, the greater the use of coping strategies.
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    Coping Strategies in Voice Disorders of a Brazilian Population
    (Elsevier B.V., 2012-03-01) Oliveira, Gisele [UNIFESP]; Hirani, Shashivadan P.; Epstein, Ruth; Yazigi, Latife [UNIFESP]; Behlau, Mara [UNIFESP]; CEV Ctr Estudos Voz; Universidade Federal de São Paulo (UNIFESP); UCL; City Univ London
    The purpose of this research is to explore coping strategies of individuals with and without vocal complaint and to examine relationships between the type of coping and vocal complaint; vocal symptoms; vocal self-assessment; perceptual analysis and states of depression, anxiety, and aspects related to self-esteem; and locus of control. One hundred seventy-eight subjects with (n = 87) and without vocal (n = 91) complaint completed the following analysis: identification and characterization questionnaire, vocal self-assessment, perceptual analysis, Voice Disability Coping Questionnaire (VDCQ)-Brazilian Version, Beck Depression Inventory, Rosenberg Self-esteem Scale, Spielberger State-Trait Anxiety Inventory, and Health Locus of Control Scale. Age (P = 0.219) and sex (P = 0.132) were similar for both groups. the groups were statistically different for the following vocal characterization: number of symptoms, voice complaint, vocal self-assessment, and perceptual analysis. Conversely, the groups did not differ on states of depression, anxiety, and aspects related to self-esteem; and locus of control. Mean coping scores for the group with vocal complaint was 51.86 and for the group without vocal complaint was 23.18. Furthermore, men and women did not differ on the coping strategies reported (P = 0.750); however, individuals with vocal complaint reported statistically more strategies than the individuals without vocal complaint (P < 0.001). Problem-focused strategies were more frequently reported by individuals with vocal complaint (46.7%). Coping results correlated (Spearman's r) positively with vocal perceptual analysis (P = 0.036), depression (P = 0.006), and anxiety (P = 0.022), and correlated negatively with locus of control (P = 0.001). No correlation was found between coping and the other variables studied. These findings indicate that people with vocal complaint use a variety of coping strategies, problem focused in particular, to deal with their voice problems. Coping results appear to be associated with perceptual characteristics of voice and some traits, such as depression, anxiety, and locus of control.
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    Cross-Cultural Adaptation, Validation, and Cutoff Values of the Brazilian Version of the Voice Symptom Scale-VoiSS
    (Elsevier B.V., 2014-07-01) Moreti, Felipe [UNIFESP]; Zambon, Fabiana [UNIFESP]; Oliveira, Gisele; Behlau, Mara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); CEV
    Objectives. the present study sought to determine the validity, reliability, and responsiveness of the Brazilian Portuguese Voice Symptom Scale (VoiSS) and also identify characteristics of efficacy and cutoff values that discriminate dysphonic from vocally healthy individuals.Study Design. Cross-sectional, nonrandomized, prospective study with controls.Methods. Thirty hundred subjects (160 with dysphonia and 140 without dysphonia) completed the Brazilian version of the VoiSS as well as a vocal self-assessment scale using a five-point rating system (excellent, very good, good, fair, and poor).Results. the Brazilian version of VoiSS, referred to as the Escala de Sintomas Vocais (ESV), was valid, reliable, and responsive. A score of 16 was determined to be highly sensitive (100%) and specific (100%) for individuals with dysphonia.Conclusions. the Brazilian version of VoiSS or ESV demonstrated a high degree of validity, reliability, and responsiveness with regard to differentiating aberrant vocal function and was valuable as an instrument to quantify the response to treatment in patients with dysphonia. the cutoff value that discriminates individuals with dysphonia from vocally healthy subjects was 16.
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    Distúrbios da voz em docentes: revisão crítica da literatura sobre a prática da vigilância em saúde do trabalhador
    (Sociedade Brasileira de Fonoaudiologia, 2012-01-01) Santana, Maria da Conceição Carneiro Pessoa de; Goulart, Bárbara Niegia Garcia de; Chiari, Brasilia Maria [UNIFESP]; Universidade Estadual de Ciências da Saúde de Alagoas Residência Multiprofissional em Saúde da Família; Universidade Estadual de Ciências da Saúde de Alagoas Departamento de Psicologia Social e Institucional; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To analyze scientific bibliographic production on the practice of occupational health surveillance related to voice disorders in teachers. Search STRATEGY: The Cochrane Handbook precepts which involves the formulation of the question to be investigated, the location, the studies selection and articles' critical evaluation were followed. SELECTION CRITERIA: The articles published between 2000 and 2011 were selected in the PubMed, LILACS, MEDLINE database, and the Cochrane Library using the descriptors voice disorders; teachers, occupational health, workers' health surveillance. DATA ANALYSIS: Texts were analyzed, using a standardized form when the following data were collected: objectives, research design, characteristics of the study group, obtained results and discussion on the practice of surveillance related to voice disorder. RESULTS: Initially, 141 studies were identified. After reviewing the titles and abstracts, considering inclusion and exclusion criteria, verifying consistency with the topic researched and eliminating the ones which were concurrently in more than one database, 32 articles were effectively analyzed for relating in the findings and/or conclusions to the practice of surveillance related to voice disorders in teachers. CONCLUSION: The practice of monitoring workers' health was evidenced in this research mainly as the identification of risk factors associated with voice disorders in teachers, aimed at the transformation of the working conditions and the assurance of quality of assistance to these workers as professionals.
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    Dysphonia Severity Degree and Phonation Onset Latency in Laryngeal Adductor Dystonia
    (Elsevier B.V., 2010-07-01) De Biase, Noemi Grigoletto [UNIFESP]; Korn, Gustavo Polacow [UNIFESP]; Lorenzon, Paula [UNIFESP]; Padovani, Marina Martins Pereira [UNIFESP]; Moraes, Miriam [UNIFESP]; Madazio, Glaucya [UNIFESP]; Vilanova, Luiz Celso Pereira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Although the latency between the initiation of thyroarytenoid electrical activity and the onset of phonation generally is increased in patients with adductor laryngeal dystonia, there is disagreement about whether there is overlap of latency values in these patients and normal subjects. the goal of this article was to compare the severity of dysphonia with the latency between electrophysiological activation of the thyroarytenoid muscle (TA) and the onset of phonation in patients with adductor laryngeal dystonia and compare the values with normal controls. Twenty-one patients with adductor dystonia and 15 control patients underwent laryngeal electromyographic (EMG) examination of the left TA. We measured the latency from initiation spike of the electric activity of the TA muscle to the onset of phonation. Three speech-pathologists/voice specialists arrived at a consensus to rate the perceptual evaluation of voice quality for the study group. the average latency measured for patients with mild dysphonia was 332 milliseconds, for moderate dysphonia was 426 milliseconds, and for the severe dysphonia was 792 milliseconds. We used the Spearman's correlation test to compare the latency time values and the dysphonia's degree of severity (P < 0.05). Latency was significantly and directly related to the degree of severity of dysphonia.
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    Efficiency and Cutoff Values of Self-Assessment Instruments on the Impact of a Voice Problem
    (Mosby-Elsevier, 2016) Behlau, Mara; Madazio, Glaucya; Moreti, Felipe [UNIFESP]; Oliveira, Gisele; Alves dos Santos, Luciana de Moraes; Paulinelli, Bruna Rabelo; Couto Junior, Euro de Barros
    Objectives. To evaluate the efficiency of four self-assessment questionnaires that rate the impact of a voice problem on the individual's life: Voice-Related Quality of Life (V-RQOL), the original and reduced versions of the Voice Handicap Index (VHI) and VHI-10, Vocal Performance Questionnaire (VPQ), and Voice Symptom Scale (VoiSS). Methods. Data from 975 subjects, 486 with a diagnosis of dysphonia and 489 vocally healthy individuals, were submitted to the receiver operating characteristic (ROC) curve analysis to obtain the cutoff values that determine the discriminating power of these instruments (presence of dysphonia vs healthy voice). Results. The ROC curve analysis showed that the most efficient questionnaires were the VoiSS and the VHI. Results showed that they presented as a perfect classification based on their efficiency, specificity, and sensitivity values (all three of them = 1). The VHI-10 and the V-RQOL showed excellent classification (VHI-10: efficiency = 0.991
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    Equivalência cultural da versão Brasileira da Voice Symptom Scale: VoiSS
    (Sociedade Brasileira de Fonoaudiologia, 2011-12-01) Moreti, Felipe Thiago Gomes [UNIFESP]; Zambon, Fabiana [UNIFESP]; Oliveira, Gisele [UNIFESP]; Behlau, Mara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Centro de Estudos da Voz
    PURPOSE: To present the cultural equivalence of the Brazilian version of the Voice Symptom Scale - VoiSS. METHODS: The questionnaire was translated into Portuguese by two Brazilian bilingual speech-language pathologists, who were informed about the purpose of this research. The back translation was performed by a third bilingual Brazilian speech-language pathologist, who was also an English teacher, and had not participated in the previous stage. After the comparison of translations, a final version of the questionnaire was produced and called Escala de Sintomas Vocais - ESV, which was administered to 15 individuals with vocal complaint. The inclusion criterion was the presence of dysphonia, regardless of type or degree. The option not applicable was added to each item of the protocol. RESULTS: During the process of translation and cultural adaptation, no item was changed and/or eliminated from the questions. The ESV kept the same structure as the original British version with 30 questions, 15 regarding the impairment domain (functionality), eight the emotional domain (psychological effect), and seven the physical domain (organic symptoms). CONCLUSION: The cultural equivalence of the Brazilian version of the VoiSS, entitled ESV, was demonstrated. The ESV validation is currently being concluded.
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    Impacto imediato após demanda vocal no cantor de teatro musical
    (Universidade Federal de São Paulo (UNIFESP), 2017-02-24) Pacheco, Claudia de Oliveira Lima Camargo [UNIFESP]; Behlau, Mara Suzana [UNIFESP]; http://lattes.cnpq.br/2274436726620746; http://lattes.cnpq.br/7485525730547312; Universidade Federal de São Paulo (UNIFESP)
    Objectives: Evaluate the immediate impact of vocal demand in musical theatre singers and explore its relation with the presence of vocal signs and symptoms. Methods: 264 singers/actors with ages from 18 to 72 and mean age of 33 years old took part in this research. 126 were female and 138 were male. All participants were currently performing musical theatre singers when the data was collected. All of them answered two questionnaires immediately after the performance. The first questionnaire was composed by 24 questions and was designed with the purpose of collecting information about identification, voice self-assessment and detailed explanation of the actors' characteristics, besides finding out the existence of vocal symptoms. The second one, Evaluation of the Ability to Sing Easily - EASE translated and culturally adapted to Brazilian Portuguese as EASE-BR. EASE-BR explores vocal fatigue features, pathologic-risk indicators and vocal concern after using the voice professionally. We have studied the relationship between the demographic data and the vocal use with the answers from EASE-BR. Results: Singers showed a low mean of 1.56 vocal symptoms being frequent throat clearing (50,76%) and chronic throat dryness (26.52%) the most mentioned ones. There was no significant difference in relation to age, number of practicing hours, singing lessons according to the total scores and subscales of EASE-BR. Artists with longer singing practice showed lower values at total scores and subscales of EASE-BR. Singers who have been singing opera and vocal solo besides musical theater presented lower values at total scores and subscales of EASE-BR. The ones with a higher number of vocal symptoms obtained higher scores both EASE-BR and subscales’. There was a fragile correlation between EASE-BR and vocal symptoms. The test-retest showed good reproduction. Conclusion: The data showed that singers evaluate the impact of vocal demand positively and considered their voices apt to a new performance. EASE-BR proved to be useful to identify vocal changes and it has a weak association with the presence of vocal symptoms.
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    Influência de alterações do sono na qualidade vocal
    (Universidade Federal de São Paulo (UNIFESP), 2017-02-24) Rocha, Bruna Rainho [UNIFESP]; Behlau, Mara Suzana [UNIFESP]; http://lattes.cnpq.br/2274436726620746; http://lattes.cnpq.br/7664517668044679; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To verify the influence of the sleep quality on the voice. Methods: Self-assessment of the vocal quality, sleep pattern and related data, were collected by an on-line or printed survey. The survey was divided in 3 parts: 1. Demographic data and vocal health aspects, 2. Self-assessment of sleep and vocal quality and the influence that sleep has on voice, 3. Sleep and voice self-assessment tools, which included the Epworth Sleepiness Scale - ESS, Pittsburgh Sleep Quality Index - PSQI and Voice Handicap Index reduced version – VHI-10. 862 people were included (493 women; 369 men), with a mean age of 32 years old (maximum age of 79 years and minimum of 18). Results: The perception of the influence that sleep has on voice showed difference (p<0.050) between sleep and voice self-assessment. In other words, if sleep was self-rated as poor, the voice was also self-rated as bad for individuals who perceived the influence of sleep on voice. There is more risk of presenting alteration on the ESS, PSQI and VHI-10 protocols if sleep and vocal self-assessment are worst, what shows the influence that self-assessment has on the results of these specific tools. The influence of sleep on voice impacts only the VHI-10 score: the greater the perception of this influence, the larger the perceived vocal disadvantage. Sex was not a determinant factor on the outcome regarding the self-assessment instruments. A total of 73 individuals (8.5%) presented deviations for all protocols: ESS, PSQI and VHI-10, while 134 subjects (15.5%) had no deviation for anyone of them. No relationship was found for presence of snoring and vocal quality. The aspects that influence a vocal disadvantage are: voice self-assessment, ESS total score and self-assessment of the influence that sleep has on voice. The absence of daytime sleepiness is a protective factor (OR>1) against vocal disadvantage, meanwhile the presence of daytime somnolence is a damaging factor (OR<1). Conclusion: The sleep quality influences the vocal quality. A bad sleep quality is related to a bad vocal quality. Individuals with vocal disadvantages perceive a greater influence of sleep on voice; the variables that influence these vocal disadvantages are vocal self-assessment, ESS total score, and self-assessment that sleep has on voice. Individuals with daytime somnolence are more likely to have a vocal disadvantage.
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    Morfometria do trato vocal de indivíduos disfônicos com nódulos vocais em postura de repouso: um estudo com ressonância magnética
    (Universidade Federal de São Paulo (UNIFESP), 2009-02-18) Yamasaki, Rosiane Kimiko [UNIFESP]; Behlau, Mara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To analyze the morphology of the vocal tract of individuals with vocal nodules compared with that of normal subjects by means of MNR imaging at high field in rest position. Methods: Twenty young adult women, 18 to 40 years old, 10 normal and 10 with vocal nodules diagnosis participated in the present research. All participants were tested for high-field MNR to achieve images in the median sagital and transverse sections. Eighteen measurements of the vocal tract: 15 in the median sagital section and three transversal were performed. Results: Of the measurements performed in the median sagital section, it was observed that the extent of the laryngeal vestibule area was statistically lower in the dysphonic group with vocal nodules, p = 0.012. The measure of the hard palate junction point with the soft palate (PJPDM) to the top of the hyoid bone tended to be lower in the group with nodes, p = 0.085. In the cross section, the distance between the right and left vocal processes of arytenoids’ cartilages, and the distance between the anterior commissure of the glottis to the lamina of the cricoid cartilage, were also significantly lower in the dysphonic group, with p values of 0.036 and 0.010, respectively. Conclusion: Based on these results, it is concluded that patients with vocal nodules show laryngeal vestibule constriction and reduction in the opening of the vocal folds in rest position. Although the sample is too small to allow any kind of generalization of the results, the findings show that, probably, patients with vocal nodules uphold laryngeal muscle tension even at rest. Additionally, provide evidences that the surgery, as a unique treatment of vocal nodules, may not be enough.
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    MRI Anatomical and Morphological Differences in the Vocal Tract Between Dysphonic and Normal Adult Women
    (Elsevier B.V., 2011-11-01) Yamasaki, Rosiane Kimiko [UNIFESP]; Behlau, Mara [UNIFESP]; Brasil, Osíris de Oliveira Camponês do [UNIFESP]; Yamashita, Helio Kiitiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); CEV
    Objective. To analyze the vocal tract morphometry of women with vocal nodules (VN) compared with normal subjects by means of magnetic resonance imaging (MRI) at rest position.Study Design. Prospective study.Methods. the present research included 20 young adult women, aged 18-40 years: 10 dysphonic patients with VN and 10 normal subjects. All participants were tested using MRI; 12 measurements of the vocal tract were performed: nine in median sagittal section and three in axial section.Results. the 12 measurements were smaller in the dysphonic group; statistical significance was obtained for three parameters: in the sagittal plane, the laryngeal vestibule area was significantly smaller in the dysphonic group, with P = 0.012* (* = statistical significance); in the axial section, the distance between the right and left vocal processes of the arytenoids' cartilages and the distance between the anterior commissure of the glottis and the laryngeal posterior wall were also significantly lower in the dysphonic group, with P = 0.036* and 0.010*, respectively. Significant differences in the vocal tract morphometry of individuals with VN were observed compared with normal subjects, at rest position.Conclusions. Results obtained from this study suggest that patients with VN may present a constantly increased tension of the laryngeal muscles, even at rest; moreover, reduced anterior-posterior dimension of the larynx may be a morphological characteristic of patients with VN.
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    Opinião dos pais sobre a voz, características de comportamento e de personalidade de seus filhos
    (CEFAC Saúde e Educação, 2011-02-01) Von Fritsch, Angela; Oliveira, Gisele [UNIFESP]; Behlau, Mara [UNIFESP]; Centro de Estudos da Voz; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: to check how parents perceive and describe their children with 'regard to their voice and behavior and personality traits. METHODS: the study involved the participation of 66 parents of children between 6 and 9 year old, from both genders, who answered a questionnaire with 28 questions addressing voice, behavior and personality traits of their children. RESULTS: results indicated that the majority of the parents (90.9%) perceived themselves satisfied with the sound of their child's voice. Only 9.1% of the parents characterized the voice of their child as being worse than other children and 31.8% felt that their child speaks more compared to his/her friends. Approximately a quarter (22.7%) of the parents observed that the voice volume used by their children is higher. The parents that characterized their children as being more talkative also perceived their voices as having a higher pitch (p=0.013). The increased voice volume showed a positive correlation with agitation (0.044), restlessness (0.005), sociability (0.021), less hours of sleep (0.013) and extroversion (0.014). Children characterized as being calmer (p=0.011) and less argumentative (p=0.044) were also seen as less talkative compared to other children. CONCLUSION: in general, the parents seem to notice vocal traits in their children, they have a strong trend to consider their children as sensitive, observant and demanding in relation to themselves, in addition to noting a relationship among voice volume and behavior and personality traits.
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    Perceptual Error Identification of Human and Synthesized Voices
    (Mosby-Elsevier, 2016) Englert, Marina [UNIFESP]; Madazio, Glaucya; Gielow, Ingrid; Lucero, Jorge; Behlau, Mara [UNIFESP]
    Objectives/Hypothesis. To verify the discriminatory ability of human and synthesized voice samples. Study Design. This is a prospective study. Methods. A total of 70 subjects, 20 voice specialist speech-language pathologists (V-SLPs), 20 general SLPs (G-SLPs), and 30 naive listeners (NLs) participated of a listening task that was simply to classify the stimuli as human or synthesized. Samples of 36 voices, 18 human and 18 synthesized vowels, male and female (9 each), with different type and degree of deviation, were presented with 50% of repetition to verify intrarater consistency. Human voices were collected froma vocal clinic database. Voice disorders were simulated by perturbations of vocal frequency, jitter (roughness), additive noise (breathiness) and by increasing tension and decreasing separation of the vocal folds (strain). Results. The average amount of error considering all groups was 37.8%, 31.9% for V-SLP, 39.3% for G-SLP, and 40.8% for NL. V-SLP had smaller mean percentage error for synthesized (24.7%), breathy (36.7%), synthesized breathy (30.8%), and tense (25%) and female (27.5%) voices. G-SLP and NL presented equal mean percentage error for all voices classification. All groups together presented no difference on the mean percentage error between human and synthesized voices (P value = 0.452). Conclusions. The quality of synthesized samples was very high. V-SLP presented a lower amount of error, which allows us to infer that auditory training assists on vocal analysis tasks.
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    Perda da voz em professores e não professores
    (Sociedade Brasileira de Fonoaudiologia, 2009-01-01) Park, Kelly [UNIFESP]; Behlau, Mara [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Centro de Estudos da Voz
    PURPOSE: To investigate teachers' and non-teachers' perception regarding the implications of an eventual loss of voice. METHODS: Participated in the study 205 individuals (106 women and 99 men), 105 teachers and 100 non-teachers, with ages varying from 23 to 65 years old. The participants were asked to answer a questionnaire with four questions regarding an eventual loss of vision, hearing, voice and deambulation, and the inferred impact degree (from 0 to 4). RESULTS: For the teachers group, not being able to see caused the most negative impact (mean of 3.8), followed by not being able to walk (mean of 3.7), loss of voice (mean of 3.7) and hearing loss (mean of 3.6). For the non-teachers group, loss of sight also caused the most negative impact (mean of 3.4), followed by not being able to walk (3.0), hearing loss (2.2), and loss of voice (2.0). Regarding the impact of an eventual voice loss, the teachers group indicated negative consequences at work, in their social relationships and in their daily routines. The non-teachers group indicated negative consequences to their daily routine, at work, in their social relationships and in their emotional manifestations. CONCLUSION: The teachers showed to value their voices differently from the non-teachers group. Both groups agreed that voice loss would not bring the most negative consequences. Although teachers noticed more the impact of an eventual loss of voice than non-teachers, the feelings towards this hypothetical situation were similar in both groups.
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    Presentation of the Comprehensive Vocal Rehabilitation Program for the treatment of behavioral dysphonia
    (Sociedade Brasileira de Fonoaudiologia, 2013-10-01) Behlau, Mara [UNIFESP]; Pontes, Paulo; Vieira, Vanessa Pedrosa; Yamasaki, Rosiane Kimiko [UNIFESP]; Madazio, Glaucya [UNIFESP]; Centro de Estudos da Voz; Universidade Federal de São Paulo (UNIFESP); Instituto da Laringe
    Voice rehabilitation is the main treatment option in cases of behavioral dysphonia, and it has the purpose of enhancing the quality of vocal production and voice-related life aspects. Several efforts have been made to offer a clinical practice that is based on evidence, including the development of specific therapeutic protocols as an option for clinical and scientific improvement. It is necessary to define the focus/objective of the dysphonia treatment, type of approach, and duration in order to establish the intervention criteria. This paper describes the organization of a program of behavioral dysphonia treatment, based on an approach that has been used for over twenty years, named Comprehensive Vocal Rehabilitation Program, and also to present its concepts, theory, and practical fundamentals. The program has an eclectic approach and associates body work, glottal source, resonance, and breathing coordination in addition to knowledge about vocal hygiene and communicative behavior. The initial proposal suggests a minimum time of intervention of six therapeutic sessions that can be adapted according to the patient' s learning curve and development. The goal is to offer a rational and structured therapeutic approach that can be reproduced in other scenarios.