Anna Alice Figueirêdo de Almeida

Severity of Voice Disorders in Children: Correlations Between Perceptual and Acoustic Data

OBJECTIVES The aims of this study were to verify whether there is correlation between perceptual and acoustic data and to verify which measures are useful to identify the severity of voice deviation in children. METHODS The participants were 71 children aged 3-9 years. The severity of voice deviation, roughness, breathiness, strain, and instability was evaluated by three speech therapists, experts on perceptual voice evaluation. A visual analog scale was used; speech material consisted of a sustained vowel sound /ε/ and the counting of numbers from one to 10. The means and standard deviations of fundamental frequency (F(0)), jitter, shimmer, and glottal-to-noise excitation (GNE) ratio were extracted from the sustained vowel, and the mean and variability of F(0) were extracted from automatic speech (counting). Perceptual and acoustic data were correlated. RESULTS Most children had mild voice deviation, with strain, instability, and breathiness as predominant voice qualities. F(0) measures correlate with strain to phonate. Shimmer and GNE correlate with general degree of voice deviation and with the roughness, breathiness, and instability parameters. GNE and F(0) mean in connected speech were the only measures that distinguished voices regarding severity of voice deviation. CONCLUSIONS There was a correlation between perceptual and acoustic measures from these childrens voices. Children with high-pitched voices had higher voice deviations. GNE is a measure that reliably distinguishes the severity of voice deviation and may be useful in the screening and evaluation of childrens voices.

Correlação entre ansiedade e performance comunicativa

Purpose: To investigate the possible existing correlations between trait anxiety, state anxiety, and vocal parameters. Methods: Participants were 24 adult subjects, 12 men and 12 women, with ages between 19 and 42 years, with no psychiatric history. The score in the State-Trait Anxiety Inventory (STAI), especially the STAI-Trait, enabled the division of participants into two groups: low anxiety (LA) and high anxiety (HA). Psychological parameters (STAI) and vocal parameters (self-assessment through the vocal signs and symptoms questionnaire and the Voice-Related Quality of Life – V-RQoL protocol; perceptual, auditory and visual assessment of vocal behavior with the description of voice, speech and body parameters; and acoustic analysis). The sustained production o the vowel /a/, counting numbers, and a discourse regarding the subjects’ greatest anxiety moments constituted the analyzed material. Results: The higher the trait anxiety indicated by STAI, the greater the evidence of anxiety in connected speech and discourse; the higher the vocal pitch, the greater the impairment in speech articulation, coordination between breathing and speech, body movement and facial expression. The higher the state anxiety, the greater the evidence of anxiety in various parameters of the speech, with imbalance in vocal resonance, alterations in the modulation and articulation of speech and in facial expression. Conclusion: The trait and state of anxiety differentiated the communicative behavior of individuals, involving changes in the body, speech and voice.

Effect of Progressive Self-Focus Meditation on Attention, Anxiety, and Depression Scores

This study evaluated the effects of Progressive Self-focus Meditation with 42 volunteers (M age = 46.0 yr., SD = 14.1) allocated to two groups: one that had weekly 1-hr. training sessions in the practice for 5 wk. and one waiting-list group. Participants were evaluated before and after 5 wk. on the Beck Anxiety Inventory, Beck Depression Inventory, the Digit Symbol subtest of the Wechsler Adult Intelligence Scale, and the Mindfulness Attention Awareness Scale. After 5 wk., a significant reduction in scores on depression was found in the Meditation group as well as an increase in attention in comparison with the waiting-list Control group.

Fatores de risco e emocionais na voz de professores com e sem queixas vocais

PURPOSE: to evaluate the effect of emotional risk factors on the voice of teachers with and without vocal complaints. METHOD: the sample comprised 44 teachers. We used a form for collecting personal and professional data, three questionnaires concerning vocal aspects, and two questionnaires for data related to emotion. Further, we recorded voices for auditory-perceptual analysis. The teachers were divided based on the number of symptoms reported: 22 volunteers in a group of Teachers Without Complaints (TWOC) and 22 in a group of Teachers With Complaints (TWC). The latter group included individuals reporting more than three vocal symptoms. RESULTS: the average number of symptoms described in the Voice Signs and Symptoms Questionnaire was 5.7 (±2.8) and 0.8 (±0.9) for the PCQ and PSQ groups, respectively. The PSQ reported better vocal self-assessment (p = 0.01) and the PCQ reported greater vocal impairment (p = 0.001). The PSQ group obtained the highest scores in the Physical Voice-related Quality of Life (P-VQL) (p = 0.0007) and Total VQL (p = 0.0006). The PCQ had higher values in the Total Voice Handicap Index (VHI) (p = 0.0003) and Organic VHI (p = 0.0006), and greater emotional impairment in the Self-Report Questionnaire [5.7 (±3.9)] and Trait-State Anxiety Inventory [42.5 (±12.7)]. Auditory-perceptual analysis showed that the PCQ had moderate vocal deviation with vocal roughness, breathiness, and tension, while the PSQ group showed slight deviation in all parameters. CONCLUSION: teachers with vocal complaints are exposed to more risk factors, and report more symptoms and vocal and emotional impairments.

Anxiolytic Effect of Citrus aurantium L. on Patients with Chronic Myeloid Leukemia.

The bone marrow aspiration procedure is used in hematological diseases and consists of a painful, invasive procedure causing anxiety‐associated symptoms. The present study assessed the effect of Citrus aurantium L. essential oil on the treatment of anxiety, in the moment that precedes the collection of medullary material in patients with chronic myeloid leukemia (CML). Volunteers from both sexes were divided into groups receiving either the C. aurantium essential oil through inhalation, diazepam (10 mg), or the placebo. The evaluation was performed through psychometric scales [State‐Trait Anxiety Inventory (STAI)] and physiological measurements (blood pressure and cardiac and respiratory frequency). Inhalation of C. aurantium was associated with a decrease in the STAI‐S scores, suggesting an anxiolytic effect. In support of these results, a change in all the physiological measurements was observed in the group exposed to C. aurantium. In the diazepam group, only the diastolic pressure decreased, and no effect was observed in the placebo group. Therefore, the results showed that C. aurantium exhibits an anxiolytic effect and reduces the signs and symptoms associated with anxiety in patients with CML. Copyright

Relationship Between Acoustic Measurements and Self-evaluation in Patients With Voice Disorders

OBJECTIVE The study aimed to determine whether there is a relationship between acoustic measures and self-evaluation in patients with voice disorders. STUDY DESIGN This is a descriptive, transversal, and observational study. METHODS Patients (257) who answered the Voice Handicap Index protocols (VHI) and the Voice Symptoms Scale (VoiSS) and recorded the vowel /ε/ were included. Standard deviation (SD) measures of the fundamental frequency (F0), jitter, shimmer, and the glottal to noise excitation ratio (GNE) vowel /ε/ were taken. RESULTS There was a weak positive correlation between all scores of VoiSS and the SD of the F0 and jitter. The overall scores, physical limitation, and VoiSS showed weak positive correlations with shimmer. The overall scores, limitation, and emotional VoiSS showed weak negative correlations with the GNE. The VHI did not correlate with any of the acoustic measurements. There was no difference in the mean of the acoustic measures of the SD of F0, jitter, and GNE because of a voice problem detected from the cutoff points of VoiSS. There was no difference in any of the acoustic measurements when patients with and without voice problems were compared from VHI cutoffs. CONCLUSIONS There is a correlation between the scores of VoiSS and acoustic measurements. Patients with self-reported voice problems in VoiSS present greater deviations in acoustic measures, mainly in jitter. There is no correlation between the VHI scores and the acoustic measures and no difference in the averages of these measures between patients with and without voice problems detected from the VHI cutoffs.

Characteristics of voice and personality of patients with vocal fold immobility

PURPOSE To examine the voice and personality characteristics of patients diagnosed with organic dysphonia secondary to vocal fold immobility. METHODS The study comprised patients of both genders, attending the Clinic School of Speech Therapy of the Federal University of Paraíba, with otorhinolaryngological diagnosis of vocal fold immobility and speech therapy diagnosis of dysphonia. The self-assessment of voice was measured through a Vocal Screening Protocol and Voice Symptoms Scale (VoiSS), the voice was collected for auditory-perceptive evaluation, and the Factorial Personality Battery (FPB) was used. Descriptive statistical analysis was performed to determine the frequency, mean, and standard deviation of the studied variables. RESULTS Eight patients participated in the study, of both genders, with average age of 40.4 ± 16.9 years. The more frequent risk factors were the personal ones (4.7 ± 2.1). In the VoiSS, the patients presented a higher average in the limitation score (34.1 ± 15.7). From the auditory-perceptive evaluation, moderate intensity of vocal deviation was obtained, with predominant vocal roughness (57.7 ± 25.2). In the FPB, the patients had an average higher than the cutoff scores in neuroticism (3.8 ± 1.4) and accomplishment (5.2 ± 1.0). CONCLUSION The predominant vocal parameter was roughness. The patients referred to a few risk factors that compromise the vocal behavior and presented the neuroticism and realization factors as a highlight in their personality. Thus, individuals with vocal fold immobility show personality characteristics that may be a reflection of their voice disorder, not a factor that determines their dysphonia.

Características vocais e emocionais de professores e não professores com baixa e alta ansiedade

Purpose Compare vocal symptoms and emotional features in groups of teachers and non-teachers with low and high anxiety. Methods A total of 93 male and female participants aged between 18 and 59 years participated in the study and were divided into four groups: teachers with low anxiety, teachers with high anxiety, non-teachers with low anxiety, and non-teachers with high anxiety. Vocal parameters were measured by the instruments Vocal Signs and Symptoms Questionnaire, Voice-Related Quality of Life, Voice Handicap Index; and recorded speech and sustained vowels from the Visual Analog Scale were assessed by three speech-language pathologists. To assess emotional parameters, the Self-Report Questionnaire and the State-Trait Anxiety Inventory were used. Results Groups with high anxiety reported high levels of stress and depression symptoms, and teachers had symptoms that were more emotional. Teachers with high anxiety expressed a greater number of vocal symptoms, greater impairment of voice quality of life, greater overall change in voice quality, and higher voice handicap index when compared with the other groups. Conclusion Individuals with high anxiety displayed more emotional symptoms related to voice and vocal quality of life, especially if the voice was a work instrument, such as for teachers.

Reduction of Risk Factors in Patients with Behavioral Dysphonia After Vocal Group Therapy.

OBJECTIVES The origin and development of dysphonia, particularly behavioral dysphonia, is associated with several risk factors. Here, we verified the effectiveness of group therapy in reducing the risk factors, and established the association between risk factors and sex, age, profession, and diagnosis of laryngeal disorders in patients with behavioral dysphonia. STUDY DESIGN This is a descriptive, quantitative, field intervention study. METHODS Participants (n = 26, adult patients of both sexes), with a diagnosis of behavioral dysphonia, received group therapy intervention. Data for risk factors were collected pre- and posttherapy using the Vocal Screening Protocol. The data were analyzed using descriptive and inferential statistics (Student t test, chi-squared test or Spearman correlation test). RESULTS The majority (80.8%, n = 21) of patients were female, 65.4% (n = 17) were not in a vocal profession, and 42.3% (n = 11) presented with a lesion in the membranous portion of the vocal fold. The number of personal risk factors decreased after group therapy (P = 0.04). In addition, age was correlated with total (P = 0.001), environmental (P = 0.002), and personal (P = 0.003) vocal risk factors posttherapy. CONCLUSIONS This study revealed an association between the reduction of personal risk factors and vocal group therapy, and a correlation between age and total, environmental, and personal vocal risk factors posttherapy. Thus, maintenance and origins of the behaviors that modify the behavioral aspects of the participants directly influence the production of individual vocal habits.

Zumbido e ansiedade: uma revisão da literatura

Tinnitus is a sound perceived without external stimulus, and results from the dynamic interaction of the centers in the central nervous system, including non-auditory and auditory ways. The result of this interaction, especially with the limbic system and autonomic nervous system, would be responsible for triggering negative emotional associations and distress in patients with tinnitus. Anxiety, a physiological condition inherent to human beings, when exacerbated, generates a mood disorder, affecting thinking, behavior and physiological activity. If an inner or outer stimulus is interpreted as dangerous or threatening, it may trigger an emotional reaction characterized as a state of anxiety. This work aims to review the relationship between tinnitus and anxiety. The tinnitus sound is perceived can be altered by anxiety, thereby, sharpening the sensitivity in detecting sounds that seem a potential threat, because for many people, tinnitus is synonymous with a serious illness. The etiology for the development of depression and anxiety may be related to tinnitus. Many people acquire this symptom by physical problems and hence develop depression and anxiety. Others with different degrees of distress due to tinnitus acquire emotional problems. Thus, there is a probable link between tinnitus and emotional problems, but it is not always easy to identify which one occurs first. Studies show that patients affected by tinnitus have a greater trend for suicide, depression and anxiety. They also refer to the additive cumulative effects of anxiety and depression on the quality of life of tinnitus sufferers.