Carla Aparecida Cielo

Lesões de borda de pregas vocais e tempos máximos de fonação

PURPOSE: to compare the otorhinolaryngologic diagnosis of vocal folds edge lesions and their Maximum Phonation Times in adults and children of both genders; to check the frequency of the Maximum Phonation Times types (reduced, normal or increased) in the pathologies of vocal folds edge and the frequency of these pathologies in individuals with mature vocal fold edge (adults) and immature vocal fold edge (children) in both genders. METHODS: to recover the database of the patients that have complained about voice. They have been attended in a phonological university service office, with a medical diagnosis of the edge pathology of vocal fold. Among the 152 records displayed by the database, 54 have been passed for the inclusion criteria, being 8 cases from cysts of vocal fold and 46 from vocal fold nodules. RESULTS: the vocal fold nodules have showed the lesions with more frequency in adults and children, with higher portion in adult women and male gender children. The cysts of vocal folds have occurred in a higher portion in female gender both in children as well as in adults. There was a decrease in Maximum Phonation Times of children of both gender and of adults women. CONCLUSION: as the vocal fold edge lesions difficult the appropriate glottal closing, they tend to cause a decrease in the Maximum Phonation Times values.

Medidas acústicas de fonte glótica de vozes masculinas normais

BACKGROUND acoustic vocal characteristics of young male adults. AIM to characterize the acoustic measurements of the glottal source of young male adults with normal voices and larynx and to compare these results to the standard measurements proposed by the software used for this assessment. METHOD 25 young male individuals (20 to 40 years), who presented normal voices and larynx, were selected. All subjects had the prolonged vowel [a] emission analyzed by the Multi Dimensional Voice Program Advanced (MDVPA). The Lilliefords test, with a significance level of 5%, was used to verify the normal distribution of the results of each measurement. The parameters with normal distribution had their means compared to the standard measurements proposed by the program using the T Test (significance level of 5%). RESULTS the group was characterized by 18 means of acoustic measurements. Measurements of frequency disturbance and amplitude were the ones that most differed from the standard measurements, presenting higher values. Approximately half of the measurements presented normal distribution. CONCLUSIONS the measurements of jitter and shimmer of young male adults with normal voices and larynx were high. Measurements of fundamental frequency, noise and instability remained within the expected values. Approximately half of the measurements presented normal distribution prevailing those of jitter and shimmer, indicating that these measurements can be used as a reference.

Tempos máximos de fonação de vogais em mulheres adultas com nódulos vocais

TEMA: tempos maximos de fonacao (TMF) de vogais em mulheres adultas com presenca de nodulos vocais. OBJETIVO: verificar e correlacionar os valores de TMF de vogais em mulheres adultas jovens e de meia-idade com presenca de nodulos vocais. METODO: utilizaram-se os registros do Banco de dados de uma clinica-escola de Fonoaudiologia, totalizando um grupo de 38 sujeitos. Criterios de inclusao: adultos do sexo feminino com idades entre 20 e 53 anos e diagnostico otorrinolaringologico de nodulos vocais. Criterios de exclusao: apresentar outra patologia laringea alem dos nodulos vocais; comprometimento auditivo; respiracao oral; historico de doencas neurologicas, psiquiatricas, endocrinologicas ou gastricas; gripe ou quadros de alergias; habitos de etilismo e/ou tabagismo; tratamento fonoaudiologico e/ou otorrinolaringologico previos. Foram coletados os dados de anamnese, o diagnostico otorrinolaringologico, e as medidas de TMF das vogais /a, i, u/ de cada sujeito da amostra. A avaliacao dos TMF se deu pela medida da duracao de tres emissoes de cada vogal em estudo, em tom e intensidade habituais, ate o final da expiracao, com o paciente em pe, considerando-se o maior valor de cada vogal. Os resultados foram analisados estatisticamente ao nivel de significância de 5%. RESULTADOS: faixa de idade representativa; TMF e media menos representativos, abaixo da normalidade e com forte correlacao positiva e significativa entre si; correlacao moderada, positiva e significativa entre os TMF entre si e sua media. CONCLUSAO: na presenca de nodulos vocais em um grupo de mulheres adultas, os TMF encontraram-se reduzidos e positivamente correlacionados, o TMF da vogal /a/ apresentou menor valor quando comparado as demais vogais.

Medidas vocais acústicas na doença de Parkinson: estudo de casos

TEMA: caracteristicas vocais acusticas de individuos com Doenca de Parkinson (DP). PROCEDIMENTOS: estudo de casos, estatistica descritiva; cinco pares de parkinsonianos e controle, tres masculinos e dois femininos, entre 36 e 63 anos. Avaliacao otorrinolaringologica, fonoaudiologica, voz analisada pelo Multi-Dimensional Voice Program Advanced Model 5105 da Kay Pentax®. RESULTADOS: a f0 das mulheres adultas de meia-idade com DP ficou na faixa masculina e a f0 dos controles no limite inferior da faixa feminina. Nos demais sujeitos, que eram homens de diferentes idades, a f0 foi normal; houve aumento de todas as medidas acusticas principalmente nos sujeitos com DP de todas as faixas etarias estudadas. CONCLUSAO: o processo de envelhecimento e suas consequencias parecem atuar como fator interferente nas modificacoes acusticas da voz, mas, aparentemente, a DP e a idade precoce de seu aparecimento podem acentuar tais alteracoes, repercutindo de forma negativa na fonacao.

Relação entre grau de severidade de disfunção temporomandibular e a voz

BACKGROUND Temporomandibular dysfunction is one of the most complex disorders of the body, capable of unchaining alterations in the mandibular movements which in turn can cause damage not only to speech articulation but also to the quality of voice. In the literature, the relationship between the symptomatology severity levels of this dysfunction and their influence on vocal production has been scarcely studied. AIM To verify the relationship between the symptomatology severity levels of temporomandibular dysfunction and vocal production. METHOD Participants of this study were 24 females, with ages between 16 and 56 years, who were submitted to an anamnesis index questionnaire (Fonseca et al., 1994), to odontological and otolaryngological examinations and to a hearing evaluation. Later, the participants were submitted to a voice recording, using a digital recorder, for a perceptive-auditive analysis of voice parameters such as: vocal type, resonance, quality of emission, pitch and loudness and for the analysis of the acoustic parameters of the wide and narrow band spectrography and of the Multi Dimensional Voice Program (MDVP) -- Key Elementrics Real Time software. RESULTS Considering the parameters of the perceptive-auditive evaluation, it was observed that only individuals with severe symptomatology presented a statistically significant decrease in loudness (p = 0.013). The hoarse vocal quality was the most frequent type among the participants, with severities classified as mild and severe, followed by the breathy type. In the wide band spectrography, there was a statistically significant difference for the anti-resonance increase (p = 0.013) in individuals with severe temporomandibular dysfunction. CONCLUSION It was verified that the severity level causes a decrease in loudness, an increase of noise and alterations in voice resonance, interfering in the vocal quality of these individuals.

Modificações vocais acústicas produzidas pelo som hiperagudo

OBJETIVO: descrever as modificacoes vocais acusticas apos a producao da tecnica vocal do som hiperagudo em mulheres adultas jovens, sem queixas vocais e com laringe normal. METODOS: participaram do estudo 23 sujeitos que assinaram o Termo de Consentimento Livre e Esclarecido, preencheram um questionario, realizaram avaliacao otorrinolaringologica com laringoscopia indireta, exame dos orgaos fonoarticulatorios e funcoes estomatognaticas e triagem auditiva. Realizaram o som hiperagudo em tres series de 15 repeticoes, em tempo maximo de fonacao com intervalos de 30 segundos de repouso passivo entre cada serie. A analise vocal acustica foi realizada atraves do Multi-Dimensional Voice Program, Modelo 5105, da Kay Pentax. RESULTADOS: na avaliacao acustica vocal, apos o som hiperagudo, constatou-se o aumento das medidas de frequencia fundamental e das medidas de perturbacao da frequencia fundamental, diminuicao das medidas de perturbacao da intensidade, ruido, quebra de voz, irregularidade da voz e tremor, mas nao houve significância estatistica em todas as medidas oferecidas pelo programa. CONCLUSAO: neste grupo, os sons hiperagudos nao produziram efeitos acusticos estatisticamente significantes sobre o sinal vocal.

Capacidade vital e tempos máximos de fonação de /e/ áfono e de /s/ em mulheres adultas

PURPOSE: to check the relation among the values of vital capacity (CV), maximum phonation times (MPT) of closed voiceless /e/ (/ė/) and of /s/ and height in adult normal women. METHOD: 48 females, between 18 and 44 years, with no intervening factors in measures of interest (smoking, sport practicing, singing, lung disorder, articulation disorder) collected their measures of VC, MPT/ė/ and MPT/s/, three times each, and the highest produced values for each variable were selected for analysis, beyond the self-reported height. All four variables were compared. Spearmans correlation coefficient was used to check the relationship; Wilcoxon test for related samples was used to compare MPT/s/ and MPT/ė/, such as the coefficient of variation calculation, in order to compare their homogeneity. RESULTS: positive significant correlation between: VC and MPT/s/ (r=0.326; P=0.024); VC and MPT/ė/ (r=0.379; P=0.008); MPT/s/ and MPT/ė/ (r=0.360; P=0.012); and VC and height (r=0.432; P=0.002); not presenting significant correlation between height and MPT. MPT/s/ significantly higher than MPT/ė/. MPT/ė/ of the sample (10.43s) significantly lower than reference values (P<0.001). In the homogeneity of MPT, its variation coefficients were very close: 35.60% (MPT/s/) and 39.11% (MPT/ė/), respectively. CONCLUSION: there was positive significant correlation between VC and MPT and among the MPT themselves, and VC and height. There was no correlation between height and MPT. Values of MPT/ė/ were significantly lower than MPT/s/, due to the absence of articulatory control, allowing for an accurate assessment of the respiratory level control.RESUMOObjetivo: verificar a relacao entre capacidade vital (CV), tempos maximos de fonacao de /e/ fechado emitido de forma afona (TMF/ė/) e de /s/ (TMF/s/) e estatura em mulheres adultas. Metodo: 48 indi-viduos do sexo feminino, entre 18 e 44 anos, com ausencia de fatores intervenientes nas medidas de interesse (tabagistas, atletas, cantores, alteracoes pulmonares, articulatorias), tiveram suas medidas de CV, TMF/ė/ e TMF/s/ coletadas, tres vezes cada, selecionando-se o maior valor obtido para cada variavel, alem da estatura auto-referida. Os valores das quatro variaveis do grupo foram comparados entre si por meio de analise estatistica. Utilizou-se o coeficiente de correlacao de Spearman para verificar sua relacao; o teste de Wilcoxon para amostras relacionadas para comparar os TMF/s/ e TMF/ė/, alem do calculo do coeficiente de variacao para comparar a homogeneidade dessas vari-aveis. Resultados: correlacao positiva significante entre: CV e TMF/s/ (r=0,326; P=0,024); CV e TMF/ė/ (r=0,379; P=0,008); TMF/s/ e TMF/ė/ (r=0,360; P=0,012); e CV e estatura (r=0,432; P=0,002). TMF/s/ significantemente maior do que TMF/ė/. TMF/ė/ da amostra (10,43s) significantemente menor que os valores de referencia (P<0,001). Na homogeneidade dos TMF, seus coeficientes de variacao foram muito proximos: 35,60% (TMF/s/) e 39,11% (TMF/ė/). Conclusao: verificou-se correlacao posi-tiva entre CV e os TMF, entre os TMF entre si, e entre CV e estatura. Nao houve correlacao signifi -. Nao houve correlacao signifi -ao houve correlacao signifi-cante entre estatura e os TMF. Os valores dos TMF/ė/ foram significantemente menores que TMF/s/, devido a ausencia de controle articulatorio, permitindo uma avaliacao adequada do controle do nivel respiratorio.DESCRITORES: Capacidade Vital; Fonacao; Voz; Avaliacao em SaudePURPOSE: to check the vital capacity (VC) and the maximum time values of phonation (MTP) as for the voiceless /e/ (represented by /e/) and the /s/ in adult women, comparing it with the proposed normality pattern. METHOD: collecting VC, MTP/e/, MTP/s/ values and self-reported stature of 48 women between 18 and 44-year old, normal condition according to otorhinolaryngological, myofunctional, vocal, breathing and hearing ratings. We applied descriptive statistical analysis, Shapiro-Wilk normality test and calculated the coefficient variation; we adopted a 5% significance level. RESULTS: mean values: 3.206ml as for VC, 17.49s as for MTP/s/ and 1.65m as for height, with normal distribution, MTP/e/ did not have a normal distribution and whose 10.43s average was significantly lower than the literature values (P<0.001). However, MTP/e/ showed quite close medium and median values (10.43 and 10.25s) and coefficient variation very similar to the MTP/s/. CONCLUSION: for the analyzed group, we found medium VC and MTP values compatible with those reported in the literature. and medium MTP/e/ values below those proposed in the literature. The average values of MTP/e/ were found to be below the one proposed by the existing theoretical framework, showing the need for more similar studies - to investigate the field of measuring MTP/ė/ - in order to set up the normal range according to gender and more scientific data on what appears to be the most suitable for the separate evaluation of respiratory control during emission.

Tempos máximos de fonação e características vocais acústicas de mulheres com nódulos vocais

PURPOSE: to describe maximum phonation time (MPT) and vocal acoustic characteristics for young adult women with vocal fold nodules. METHODS: collection of MPT of the vowels /a/, /i/ and /u/; s/z ratio and acoustic measures of the glottal source (Multi Dimensional Voice Program Advanced from Kay PENTAX) of 20 female subjects, aged between 20 and 40 year old, being ten with otorhinolaryngologic diagnosis of vocal fold nodules and ten with normal larynx diagnosis. RESULTS: regarding the MPT, the group with normal larynx (GNL) showed 90% of normal values and 10% reduced, while the group with nodules (GWN) showed 70% of normal values and 30% reduced; the s/z ratio showed results within normal patterns, for the whole GNL, while the GWN showed 70% of normal results and 30% increased; both the groups had all the vocal acoustic measures within normality range, except for the GNL which showed increased vf0. CONCLUSION: young women with vocal nodules showed MPT and s/z ratio measures with no significant differences in relation to the same measures for women with no laryngeal affection. The acoustic measures of glottal source were similar and within normal limits for both groups, except the quotient of variation of fundamental frequency (vf0) measure which was increased in GNL, suggesting pneumophonoarticulatory incoordination. The MPT and s/z ratio measures, even without significant differences, seemed to be more sensitive to the presence of aerodynamic prevalence of vocal nodules than the acoustic measures.

Vocabulário expressivo e consciência fonológica: correlações destas variáveis em crianças com desvio fonológico

PURPOSE: To investigate the correlation between the performance of children with phonological disorder in tests of expressive vocabulary and phonological awareness, and to analyze the influence of age. METHODS: Participants were 24 children between 5 and 7 years old, diagnosed with phonological disorder and divided into three groups according to age range. These subjects were assessed in their phonological awareness and expressive vocabulary abilities. Data from the groups were statistically analyzed in order to verify the correlation between the performances on both tests, and to compare numerical variables between age groups. RESULTS: The 5-year-old group presented 18 significant correlations between phonological awareness sub-tasks and expressive vocabulary semantic fields. Seventeen of these correlations were positive and one was negative. The 6-year-old group presented ten correlations, nine positive and one negative. The 7-year-old group presented 11 correlations, six negative and five positive. In both tests, higher scores were reached by older subjects. CONCLUSION: A correlation was found between some phonological awareness abilities and the expressive vocabulary of the children with phonological disorder in this study, in different ages. Performance in both tasks improved with age.

Laryngeal disorders, maximum phonation times and vital capacity in women with organofunctional dysphonia

PURPOSE: to determine and to correlate the maximum phonation times (MPT) of vowels, vital capacity (VC) and laryngeal disorders (LD) for women with benign organic lesions resulting from vocal misuse or abuse (BOL). METHOD: retrospective, transverse, exploratory, non-experimental, quantitative study, with measurement database of MPT [a, i, u], VC and LD of women with BOL, and Chi-Square statistic and exact tests of Fisher in order to investigate the differences between the variables and their relationships and a binomial test in order to check the significance of proportion or percentage of descriptive analysis, with p<0.05. RESULTS: the majority (22; 75.86%) showed MPT significantly reduced (p = 0.0053) and seven (24.14%) normal MPT. The normal VC was statistically significant (p = 0.0001) (26; 89.66%), but three women (10.34%) showed it to be reduced. There was significant dominance of vocal nodules (p = 0.0016) (22; 75.86%), followed by Reinkes edema (6, 20.69%) and vocal polyp (1; 3.45%). Among the 22 woman (75.86%) which showed reduced MPT, there was a predominance with normal VC (19; 86.36%), although no statistical significance (p = 0,558). All the individuals with normal MPT showed VC normal (7; 100%). The majority with BOL showed normal VC, although not statistically significant (p=0,199). There was a predominance of vocal nodules and reduced MPT (16; 72.73%), although not statistically significant (p=0.086). In the correlation of the three variables, most of the subjects presented vocal nodules associated with MPT reduced and normal VC (15; 68.18%), although not statistically significant. CONCLUSION: in women with BOL in this study, the reduced MPT, the normal VC and the presence of vocal nodules were significant and there was no relationship between the MPT, VC and LD.Purpose: to determine and to correlate the maximum phonation times (MPT) of vowels, vital capacity (VC) and laryngeal disorders (LD) for women with benign organic lesions resulting from vocal misuse or abuse (BOL). Method: retrospective, transverse, exploratory, non-experimental, quantitative study, with measurement database of MPT [a, i, u], VC and LD of women with BOL, and Chi-Square statistic and exact tests of Fisher in order to investigate the differences between the variables and their relationships and a binomial test in order to check the significance of proportion or percentage of descriptive analysis, with p<0.05. Results: the majority (22; 75.86%) showed MPT significantly reduced (p = 0.0053) and seven (24.14%) normal MPT. The normal VC was statistically significant (p = 0.0001) (26; 89.66%), but three women (10.34%) showed it to be reduced. There was significant dominance of vocal nodules (p = 0.0016) (22; 75.86%), followed by Reinke’s edema (6, 20.69%) and vocal polyp (1; 3.45%). Among the 22 woman (75.86%) which showed reduced MPT, there was a predominance with normal VC (19; 86.36%), although no statistical significance (p = 0,558). All the individuals with normal MPT showed VC normal (7; 100%). The majority with BOL showed normal VC, although not statistically significant (p=0,199). There was a predominance of vocal nodules and reduced MPT (16; 72.73%), although not statistically significant (p=0.086). In the correlation of the three variables, most of the subjects presented vocal nodules associated with MPT reduced and normal VC (15; 68.18%), although not statistically significant. Conclusion: in women with BOL in this study, the reduced MPT, the normal VC and the presence of vocal nodules were significant and there was no relationship between the MPT, VC and LD.