Gisele Oliveira

Cross-Cultural Adaptation and Validation of the Voice Handicap Index Into Brazilian Portuguese

The purpose of the present study was to culturally adapt and validate the Voice Handicap Index (VHI) to Brazilian Portuguese. Psychometric analyses were performed on the translated version as described by the Scientific Advisory Committee of the Medical Outcomes Trust. The translated version was completed by 52 individuals with vocal complaints and by a control group of 64 subjects. Validation, reliability, reproducibility, and responsiveness were evaluated. All participants also completed a self-rating vocal quality scale. Statistical analyses demonstrated high internal consistency and high test-retest reliability both for the overall VHI score and for the functional, physical, and emotional domains of the VHI. A positive correlation was found between the VHI and the self-rating vocal quality scale. The subjects in the control group had lower scores compared with the subjects with voice disorders for the overall VHI score and for the three domains. Based on these data, the Brazilian Portuguese version of VHI is a valid and reliable measure for use in the Brazilian population.

Vocal hygiene for the voice professional.

PurposeThis article presents the current state of knowledge regarding vocal hygiene for the voice professional. Recent findingsResearch regarding vocal hygiene has primarily focused on two areas: vocal hygiene as a preventive strategy, and vocal hygiene as a management technique for individuals with voice disorders. It is difficult to assess the effectiveness of vocal hygiene as a preventive tool as programs are often expensive leading to limited data. Vocal hygiene as a sole strategy for the treatment of voice disorders has shown minimal, but favorable results. As a component of a comprehensive therapeutic program, it is difficult to isolate the influence of vocal hygiene. However, limited components of vocal hygiene including hydration and vocal rest have been associated with improved therapeutic outcomes. In addition, the current literature proposes a paradigm shift away from more restrictive therapy approaches to a holistic approach to vocal well being. SummaryVocal hygiene should be considered only as a component of a broad vocal rehabilitation program. The role of vocal hygiene as a means to prevent voice disorders remains unproven. Additionally, some of the findings may be applied to both dysphonic and healthy individuals in order to facilitate vocal well being.

Validação do protocolo Perfil de Participação e Atividades Vocais no Brasil

PURPOSE: The purpose of this study was to develop the Brazilian version of the Voice Activity and Participation Profile (VAPP) protocol and to demonstrate its measure properties so that it could be used as a self-evaluation instrument about the quality of life of Brazilian patients with vocal complaints. METHODS: The translation and validation were performed following the guidelines of the Scientific Advisory Committee of Medical Outcomes Trust. The instrument was administered to 50 patients, 25 with vocal complaint and 25 without it. The instrument was submitted to linguistic/cultural adaptation, validation, reliability, reproducibility, and responsiveness. The VAPP protocol is composed of 28 questions distributed into five aspects: self-perception of the vocal problem intensity, effects at work, effects at daily communication, effects at social communication, and effects at emotion. Two additional scores are included: limitation in activities (LA) and participation restriction (PR). RESULTS: The results showed that the Portuguese version of the VAPP protocol, called Perfil de Participacao e Atividades Vocais (PPAV), is valid and reliable, presenting an acceptable reproducibility level, considering p<0.05. Responsiveness to treatment was determined by significant changes between results before and after treatment (self-awareness of the vocal problem intensity: 5.33/0.35, effects at work: 12.40/1.93, effects at daily communication: 42.55/6.75, effects at social communication: 7.05/2.42, effects at emotion: 62.5/61.9; LA: 33.3/2.81; PR: 28.7/8.28). CONCLUSION: The Brazilian version of the VAPP protocol is valid, reliable, and responsive to changes. Therefore, it can be proposed as a useful instrument to evaluate quality of life of dysphonic patients and the treatment outcomes.

Efeito imediato do exercício de sopro sonorizado na voz do idoso

PURPOSE To observe the immediate effect of the sounded blowing exercise with semi-occluded vocal tract (SOVTE) in the voices of elderly subjects. METHODS Thirty-three subjects with 65 years of age or older, with no voice or hearing disorder complaints, and with good self-perceived general health participated in the study. All participants filled in a vocal self-evaluation questionnaire. The sustained vowel /ε/ was recorded in three distinct moments: the first, denominated habitual (H), based on the subjects regular production; the second, usage (U), after one minute of continuous spontaneous conversation; the third, exercise (E), carried out after a one-minute execution of the SOVTE. After the exercise, the subjects self-evaluated the changes perceived in their voices. The recordings were edited and randomly paired, considering two moments of the same subject: H/U; H/E and U/E, for further perceptual examination of the better production by three specialized speech-language pathologists. RESULTS There were no differences between H and U (p=0.199) and between U and E (p=0.773). However, the E production was considered better than the H production (p=0.004). In the vocal self-evaluation, most subjects (n=25, 75.8%) did not observe immediate effects in their voices after the exercise. CONCLUSION The SOVTE produced positive immediate effects on the vocal quality of elderly subjects, observed only at the perceptual-auditory evaluation.

Perceived dysphonia by the clinician's and patient's viewpoint

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

Qualidade de vida em voz: o impacto de uma disfonia de acordo com gênero, idade e uso vocal profissional

OBJETIVO: Verificar o impacto auto-relatado de uma alteracao vocal na qualidade de vida de individuos com queixa de voz, de acordo com genero, idade e uso vocal profissional. METODOS: Foram analisados 1304 questionarios - Qualidade de Vida em Voz (QVV) - respondidos por brasileiros com queixa vocal variada, sendo 996 mulheres e 308 homens. No tratamento estatistico foram feitas comparacoes entre genero, idade e nivel de uso vocal profissional. RESULTADOS: Os resultados totais foram similares nos tres dominios para homens (total 75,5; fisico 71,3; socio-emocional 82,3) e mulheres (total 74,9; fisico 70,7; socio-emocional 82,1). Observaram-se maiores escores do QVV nos individuos entre 20 e 29 anos (total 82,2; fisico 77,8; socio-emocional 89,2). De acordo com o nivel de uso da voz, profissionais do nivel I apresentaram os maiores indices (total 80,93 e fisico 80,97). CONCLUSAO: O impacto auto-relatado na qualidade de vida relacionado a uma alteracao vocal foi percebido de maneira semelhante por homens e mulheres. Os individuos de 20 a 29 anos perceberam o impacto da disfonia na sua qualidade de vida diferente dos individuos das outras faixas etarias. Os profissionais com grande demanda de voz falada artistica relataram sofrer o menor impacto de um problema de voz na qualidade de vida.

Immediate effects of the phonation into a straw exercise

UNLABELLED Immediate effects of an exercise with the vocal tract semi-closed. OBJECTIVE To investigate the immediate effects of the phonation exercise in a straw in individuals with and without vocal fold lesions. MATERIALS AND METHODS Prospective study. 48 individuals, aged between 18 and 55 years participated in the study, and they were distributed into two groups: GL- with a benign vocal fold lesion; GSL- without a lesion. The following analyses were carried out before and after the straw phonation exercises: voice self-analysis, [ε] vowel auditory-perception analysis, selected parameters acoustics (VoxMetria 2. 6) and videolaryngoscopy. RESULTS The vocal self assessment indicated a statistically significant improvement on voice emission in GL individuals (p = 0. 015). There were no statistically significant differences before and after the exercise and between the groups, in the videolaryngoscopy, acoustic and auditory-perception assessments. CONCLUSIONS The straw phonation exercise caused positive effects, seen upon voice self-assessment, indicating an easier and better voice upon phonation.

Índice de desvantagem vocal no canto clássico (IDCC) em cantores eruditos

BACKGROUND self-assessment of the impact of vocal deviation in the quality of life of erudite singers. AIM to verify whether the presence of vocal complaints in erudite singers produces quality of life handicap in the use of singing voice and whether this handicap is related to gender, age, vocal classification or time of singing. METHOD fifty-nine professional erudite choir singers answered the questionnaire including general questions such as identification, vocal classification, gender, time of study and dedication to classical singing. The choir singers were categorized into two groups, according to the presence of vocal complaints. They all answered the protocol Classical Singing Handicap Index (CSHI), which analyzes the impact of abnormal voice on singing voice in three subscales: Disability, Handicap and Impairment. RESULTS subscales Impairment (6.39) and Disability (5.39) presented higher scores than subscale Handicap (3.34) for all singers. Moreover, there was statistically significant correlation between presence of vocal complaint and higher score of CSHI (p > 0.001 to all subscales). In the group with complaints, women had higher score in subscale Disability than men. In the group without complaints, older subjects and those who had sung longer presented lower CSHI scores. CONCLUSION singers with vocal complaints and/or symptoms had higher handicap index in singing, expressed in subscales Impairment and Disability, without relationship with vocal classification.

Functional dysphonia: strategies to improve patient outcomes.

Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for achieving a consensus regarding this complex problem.

Validation of the Voice Handicap Index: 10 (VHI-10) to the Brazilian Portuguese

PURPOSE To validate the Voice Handicap Index-10 (VHI-10) into Brazilian Portuguese and to check its psychometric measures. METHODS The validation was performed following the guidelines suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. A hundred ten individuals participated, 60 with vocal complaint, 6 males and 54 females, with age ranging from 21 to 82 years; and 50 without vocal complaint, 6 males and 44 females, age ranging from 18 to 87 years. The procedures performed were a voice self-assessment and the VHI-10. For the self-assessment, the individuals evaluated their vocal quality by means of a five-point scale: excellent, very good, good, fair and poor. The VHI-10 was administered twice to 30 of the 60 individuals with vocal complaint to determine the test-retest reproducibility. For checking the sensitivity, the VHI-10 was administered to 21 patients that underwent voice rehabilitation. RESULTS The validity was determined by comparing the total score with the self-assessment results. Individuals that classified their voice as poor had a total score of 28.2 (standard deviation=8). Internal consistence was determined with high values of coefficient (p<0.001). Results showed a high level of reproducibility (p=0.0114). Sensitivity was demonstrated with a significant difference between pre and post-rehabilitation results (p<0.005). CONCLUSION The VHI-10 is an instrument validated into Brazilian Portuguese, with psychometric measures of validity, reliability and sensibility proven and can be applied to individuals with voice problems.