Iára Bittante de Oliveira

Distúrbio de voz em professores: autorreferência, avaliação perceptiva da voz e das pregas vocais

PURPOSE: To analyze the presence of voice disorders in teachers in agreement between self-report, auditory-perceptive assessment of voice quality and vocal fold assessment. METHODS: The subjects of this cross-sectional study were 60 public elementary, middle and high-school teachers. After answering a self-awareness questionnaire (Voice Production Conditions of Teachers - CPV-P) used to characterize the sample and collect self-report data regarding voice disorders, the teachers were submitted to speech sample collection procedures and laryngoscopic examination. In order to classify the voices, three speech-language pathologist judges used the GRBASI scale, and an otorhynolaryngologist described the alterations seen in the vocal folds. Data were descriptively analyzed and then submitted to association tests. RESULTS: In the questionnaire, 63.3% of the subjects reported having or having had a voice disorder, while 43.3% were diagnosed with a vocal quality deviation and 46.7% with vocal fold alteration. There was no association between self-report and voice quality assessment, or between self-report and vocal fold evaluation, with low levels of agreement between the three assessments. However, there was association between voice quality and vocal fold assessment, with intermediate level of agreement between them. CONCLUSION: There were more self-reported voice disorders than what was found in the auditory-perceptive and vocal fold assessments. The intermediate agreement between the two assessments predicts the need for the use of at least one of these techniques when performing screening procedures in teachers.

25 anos de cuidados com a voz profissional: avaliando ações

PURPOSE: to analyze the information acquired by voice professionals in preventive speech actions and check their impact in relation to vocal health. METHODS: 100 voice professionals took part in this study, men and women, between 16 and 55-year old, including teachers, announcers, singers, actors and telemarketing operators. The studied subjects answered a questionnaire on how to take care of voice, origin of received guidance and its application, and how the interviewed subjects qualify its effectiveness. RESULTS: the most cited information, considering the received guidance, was: hydration of vocal cords by 66% (N=66) of the subjects and consumption of apple by 32% (N=32) of the subjects, however, they were not the most used by them. Voice warm up exercises were used by 12% of all those that had cited them, being mostly practiced by the singers. For 66% of the subjects, the information and guidance were received from other professionals while 34% got them from the speech therapists. And 58% (N= 58) of the people who closely followed the guidance steps affirmed having noted an improvement in their voice quality. CONCLUSION: the relevant lack of knowledge on the part of the studied voice professionals in relation to the cares with the vocal health can be attributed to the little importance given to preventive speech actions. However, the subjects that affirmed following the received guidance confirmed improvements in voice quality. We may conclude that speech therapists can be considered as guidance reference when compared with different segments of professionals.

Comunicação oral de laringectomizados com prótese traqueoesofágica: análise comparativa pré e pós-treino

BACKGROUND: speech and voice training for laryngectomized patients with tracheoesophageal prosthesis. AIM: to compare the quality of oral communication of a group of laryngectomized patients with tracheoesophageal prostheses, pre and post speech and voice training. METHOD: voice and speech samples of 17 laryngectomized patients were analyzed before and after receiving speech and voice training. The voice and speech samples were mixed and presented to speech-language pathologists for assessment. RESULTS: statistically significant (Binomial Test) improvement was observed. CONCLUSION: it can be concluded that the proposed training improved the speech patterns, including melody and singing.

Avaliação de voz e qualidade de vida após laringectomia supracricóide

PURPOSE: To evaluate subjects submitted to supracricoid laryngectomy concerning vocal self-assessment, auditory-perceptual and acoustic analysis, and the impact of dysphonia on the quality of life. METHODS: Twelve male subjects, who underwent supracricoid laryngectomy for carcinoma resection, mean age of 59.3 years, took part in this prospective observational study. The auditory-perceptual analysis was performed through GRBASI scale in double blind. The acoustic analysis used the VOXMETRIA® software to obtain the fundamental frequency (f0), jitter, shimmer, glottal to noise excitation ratio and phonatory deviation diagram. The self-assessment and the impact of organic dysphonia on the quality of life of these subjects was observed through Voice-Related Quality of Life V-RQOL and Voice Handicap Index (VHI) protocols. RESULTS: f0 ranged between 91.59 Hz and 260.05 Hz, shimmer and/or jitter measures were fairly altered confirming the results of the auditory-perceptual analysis that revealed a vocal deviation degree from moderate to intense, despite the subjects having considered their voices as good or reasonable. However the V-RQOL results showed 50.0% of the subjects presenting gross scores consistent with dysphonic voices. The Voice Handicap Index showed highest scores for the organic domain. CONCLUSION: The vocal deviation degree of subjects varied from moderate to intense, corroborating the acoustic analysis; nevertheless, subjects classified their voices as reasonable and good. Scores of V-RQOL and VHI revealed predominance of the physic and organic domains respectively, compatible with dysphonic voices. Further studies are necessary for a better understanding of the relation between vocal self-assessment and impact on quality of life of subjects with dysphonia resulting from laryngeal carcinoma.

Disfonias orgânicas por neoplasias: análise de diagramas de desvio fonatório

PURPOSE:to compare acoustic data obtained through the phonatory deviation diagram of voices of dysphonic patients submitted to partial laryngectomy with voices of subjects of the same age range, however, without vocal complaint.METHODS:the voices of 28 subjects were studied: 14 submitted to partial laryngectomy and 14 without vocal complaints, composing a control group. Both groups of males with same age and educational level. The perceptual analysis of voices was conducted by GRBASI scale double-blind; and acoustic analysis used software VOXMETRIA(r).RESULTS:voices of partial laryngectomy group (100%) were distributed outside the normality quadrant, 64,3% were located in the upper right quadrant, 100% presented horizontal deviation of jitter and shimmer and 85,7% had a vertical deviation. In the control group, 28,5% were distributed within the normality quadrant, 71,5% were located in the lower right quadrant, 57,2% presented altered shimmer and 7,2% altered jitter. Only 7,2% had a vertical deviation in the control group. Statistical significance was observed regarding the parameters of jitter, shimmer and GNE (glottal to noise excitation) and between the distribution of the voices in the upper right and left quadrants of the diagram in the presence of altered voices.CONCLUSION:the diagram allowed to analyze and discriminate the performance of normal and pathological voice differentiating them through their parameters, distribution, location and type of voice, being considered a useful resource for voice analysis.

Voice Disorder and Burnout Syndrome in Teachers

OBJECTIVE The objective of this study was to assess the association between burnout syndrome and the likely presence of voice disorders among teachers from a public elementary school in the country town of Sergipe. METHODS This is a cross-sectional study in which 208 teachers completed the following questionnaires: the Condition of Vocal Production-Teacher (CPV-P), the Screening Index for Voice Disorder (SIVD), and the Burnout Syndrome Evaluation Questionnaire (CESQT). RESULTS Of the 208 teachers, 76.9% were women, 77.9% came from rural areas, and 64.4% were likely to have a voice disorder. Teachers with a career length of over 15 years were almost twice as likely to have a voice disorder. Of the symptoms listed in the SIVD, the following were most prevalent: dry throat (88.1%), hoarseness (84.4%), and fatigue when speaking (82.1%). Among the burnout subscales, psychic exhaustion was the most common (30.3%). Analyses revealed that probable voice disorder was associated with psychic exhaustion with an odds ratio of 1.78 (P <0.001, χ2 = 84.1%). Teachers with positive scores on two to four burnout subscales had an odds ratio of 4.01 (P = 0.013, χ2 = 86.2%) for a probable voice disorder compared with those with positive scores on zero to one subscale. CONCLUSIONS The present results confirmed that burnout syndrome was associated with the presence of a probable voice disorder.

Laringectomias supracricóides: revisão de literatura em protocolos de qualidade de vida

Supracricoid Partial Laryngectomy (SCPL) is indicated for treatment of tumors staging 1 and 2, and some cases of advanced tumors. Literature considers that it presents satisfactory results for the preservation of larynx and its functionality. This study aimed at a systematic review of literature on voice related quality of life in patients submitted to SCPL, identifying protocols of quality of life regarding head and neck cancer. The following database was consulted for the systematic exploratory literature review: MEDLINE, SCIELO, LILACS; PUBMED. Portuguese, English and Spanish-language descriptors (DeCS) were used. The selection of articles followed inclusion criteria with the application of Relevance Test. This literature review revealed that the protocols used specifically with head and neck oncologic patients, were mainly EORTC-C30/H&N35, UW-QOL and HNQOL. Although SCPL is considered a surgical technique that allows the preservation of swallowing and phonation functions, possible complaints regarding these functions are pointed in literature. Literature affirms that patients were satisfied with their own voices, having little difficulty to communicate with intelligibility. Studies report patients with breathing difficulties after SCPL, including obstructive sleep apnea. It was concluded that further researches aiming at pointing the difficulties resultant from SCPL and using more specific head and neck protocols are necessary, which may better reveal the impact of SCPL on quality of life.

Disfagia orofaríngea neurogênica: análise de protocolos de videofluoroscopia brasileiros e norte-americanos

The aim of this study is to analyze and compare the use of Brazilian and North American protocols for videofluoroscopy in patients with stroke. A literature review of Brazilian and North American articles was conducted. Articles containing the description of procedures for videofluoroscopy of swallowing in subjects who had stroke published between 2003 and 2013 were selected. Qualitative and quantitative analysis of the procedures for videofluoroscopy was performed. The following variables were considered: positioning for the exam, consistency and quantity of the bolus, types of tools and use of protocols. Sixteen studies were included, nine (56.25%) North American and 7 (43.75%) Brazilian. It was observed that four of the national studies (57.14%) did not report the quantity offered, while all American ones detailed it between 2 and 15 mL; the types of food and their consistencies were detailed in all national and North American studies, but national studies did it generically, without identification of foods. Regarding the position of the patient during the examination, 57.14% of the national articles did not report it, while all American articles did. Equipment used to offer the bolus are mentioned in 55.55% of Americans articles and in just 14.28% of the national ones. As for the use of protocols, only 33% of American articles did not mention it, while 71.42% of national articles failed to mention it. There is a need to standardization of procedures and terminologies in videofluoroscopy, both in Brazilian as North American publications.

Sintomas vocais e sensações laríngeas em trabalhadores de uma usina de álcool e açúcar expostos a riscos ocupacionais

Purpose: To investigate vocal symptoms and laryngeal sensations among workers of an ethanol and sugar mill exposed to noise and/ or chemical substances. Methods: Participants were 289 workers of an ethanol and sugar mill distributed into five exposure groups (I – noise; II – noise, oil, grease, petroleum derivatives; III – noise, acids, sulfates, chlorides, nitrates; IV – noise, breathable dust and free crystalline silica; V – oil, grease, petroleum derivatives) and a control group, who answered the questionnaire Conditions of Vocal Production – Teacher adapted to the professional category. The groups were compared regarding vocal symptoms, laryngeal sensations, smoking habits, and exposure to physical and chemical risks. This comparison was conducted using statistical analyses. Results: The most reported vocal symptom and laryngeal sensation were low-pitched voice and cough with phlegm, respectively. Considering the physical risk in the work environment, groups I and IV were the ones that most reported exposure to noise. Because of this exposure, they increase voice intensity (Effect of Lombard-Tarneaud) and, thus, also reported vocal symptoms. Regarding chemical risks in the occupational environment, group IV was the one that most referred presence of dust and smoke, which were composed by breathable dust and silica. Such exposures lead to vocal symptoms and laryngeal sensations and, consequently, to vocal alterations. Conclusion: Vocal symptoms and laryngeal sensations can be related to professional activities where workers are exposed to physical and/or chemical risks.