Joziane Padilha de Moraes Lima

Exercícios de trato vocal semiocluído: revisão de literatura

Este trabalho tem como tema os exercicios de trato vocal semiocluido (ETVSO) e procura sintetizar e organizar, por meio de revisao de literatura, informacoes sobre nocoes fisicas e de anatomofisiologia subjacentes aos ETVSO e seus diferentes tipos, com descricao, aplicabilidades clinicas, restricoes, tempo de realizacao, efeitos e eficacia. Os ETVSO sao realizados com alguma oclusao no trato vocal que modifica a impedância acustica e gera ressonância retroflexa, afastando as pregas vocais na vibracao, reduzindo os riscos de trauma e equilibrando as pressoes sub e supraglotica, com economia vocal; tipos: vibracao de labios e de lingua, sons fricativos, /b/ prolongado, humming, firmeza glotica, constricao labial e fonacao em tubos; sao utilizados em disturbios vocais, incluindo a hipernasalidade, no aquecimento e aperfeicoamento vocal; a fonacao com tubo imerso a 15cm em agua somente deve ser utilizada em disfonias hipocineticas; nao ha definicao cientifica quanto ao tempo de execucao; os efeitos positivos gerados sao a melhora da propriocepcao, dos aspectos vocais perceptivo-auditivos e acusticos e mudancas no trato vocal; os estudos realizados com ressonância magnetica e tomografia computadorizada verificaram modificacoes no trato vocal apos a tecnica de fonacao em tubos, tais como area central mais alargada, firme fechamento do esfincter velofaringeo, diminuicao da regiao do esfincter velofaringeo, epiglote em posicao vertical, lingua mais elevada posteriormente, expansao das areas transversais da orofaringe e da cavidade oral; nao foram encontrados estudos sobre eficacia dos ETVSO.

Influência do sexo, idade, profissão e diagnóstico fonoaudiológico na qualidade de vida em voz

OBJETIVO: investigar e correlacionar as respostas aos questionarios de Qualidade de Vida em Voz e Indice de Desvantagem Vocal, conforme idade, sexo, uso profissional ou nao da voz e diagnostico fonoaudiologico. METODOS: analise das respostas aos questionarios Qualidade de Vida em Voz e Indice de Desvantagem Vocal dos registros de 48 sujeitos, sendo 41 mulheres e sete homens; com idades entre 18 e 63 anos; seis profissionais da voz e 42 nao profissionais; 39 sujeitos com disfonia funcional, seis com disfonia orgânica e tres com disfonia organofuncional. Teste Qui-quadrado e coeficiente de correlacao de Spearman (p=0,05). RESULTADOS: quanto ao questionario de Qualidade de Vida em Voz, houve associacao significante entre sexo e escore emocional; faixa etaria e escore emocional; profissao e escore total, emocional e fisico. Quanto ao Indice de Desvantagem Vocal, houve associacao significante entre sexo e escore emocional; faixa etaria e escore fisico e emocional; diagnostico fonoaudiologico e escore emocional; profissao e escore funcional. Houve correlacao positiva entre os aspectos de cada protocolo separadamente e correlacao negativa entre as pontuacoes dos questionarios. CONCLUSAO: no grupo estudado, verificou-se maior qualidade de vida no sexo feminino; decrescimo da qualidade de vida e aumento da desvantagem vocal com o aumento da idade; a presenca de disfonia organofuncional gerou maior desvantagem vocal; os profissionais da voz apresentaram pior qualidade de vida e maior desvantagem vocal. Os protocolos utilizados mostraram resultados complementares e uteis para mensurar o impacto de uma disfonia na qualidade de vida dos sujeitos.

Relações entre /s/ e /z/ e entre /e/ e /e/ não vozeado ou áfono

ABSTRACTPurpose : correlate the maximum phonation time (MPT) and the relations between the fricative /s/ and /z/ (s/z) and between the vowels /ė/ and /e/ (ė/e) of women without laryngeal disorders. Method : participants were 60 women with a mean of 21.56 years old. Were collected MPT/ė/, /e/, /s/ and /z/ and calculated the relations ė/e and s/z, with normal pattern for the relationship from 0.8 to 1.2; for MPT/s/ and MPT/z/, between 15.57 and 34.17s; for the MPT/ė/, between 16 to 18s; and for the MPT/e/, between 14.04 and 26.96s. Lilliefords, Spearman, Binomial and Mann-Whitney tests with a significance level of 5%. Results: positive correlation between MPT/s/ and MPT/ė/, MPT/z/ and MPT/e/, MPT/s/ and MPT/z/, and MPT/ė/ and MPT/e/. There was no correlation between the ratios s/z and ė/e, no differences between the relative ė/e, while the relation s/z was significantly normal. MPT/ė/ and MPT/e/ significantly reduced; MPT/s/ and MPT/z/ significantly normal. MPT/ė/ significantly lower than MPT/s/; MPT/e/ significantly lower than MPT/z/.

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.

Refluxo laringofaríngeo e bulimia nervosa: alterações vocais e larínegas

TEMA: Caracteristicas da bulimia nervosa (BN) e do Refluxo Laringofaringeo (RLF) e alteracoes vocais e laringeas que podem decorrer da exposicao da laringe ao acido gastrico. OBJETIVO: Descrever, por meio de revisao de literatura, as caracteristicas do RLF e da BN, relacionando-os com as alteracoes vocais e laringeas que podem se originar da exposicao da laringe ao acido gastrico que ocorre em ambas as condicoes. CONCLUSAO: A BN se caracteriza por um transtorno alimentar de causa principalmente psicologica em que ocorre ingestao compulsiva de grande quantidade de alimentos, seguida de episodios de vomitos auto-induzidos com a finalidade de evitar o ganho de peso. O RLF consiste em uma variacao clinica da DRGE, na qual o fluxo retrogrado do alimento e do acido gastrico entra em contato com a laringe e suas estruturas. Em comum, a BN e o RLF apresentam este mecanismo de regurgitacao que pode atingir a laringe. Dentre os sinais e sintomas laringeos e vocais decorrentes da regurgitacao do acido gastrico sobre a laringe estao: globus faringeo, disfonia, rouquidao, tosse seca, disfagia, halitose, lesoes inflamatorias nas pregas vocais, laringite, amigdalite, edema e eritema glotico posterior e ou de aritenoides, da regiao retrocricoidea e interaritenoidea, estenose subglotica, irregularidades na mucosa das pregas vocais, hipertrofia de mucosa laringea, leucoplasia, carcinoma, laringoespasmos, granulomas, ulcera de contato, nodulos vocais, polipos vocais, edema difuso, granuloma, fixacao uni ou bilateral de aritenoides, edema de Reinke, laringomalacia, estridor, e odinofagia.

Tempo máximo de fonação /a/, tempo máximo de fonação previsto e tipo respiratório de mulheres adultas sem afecções laríngeas

PURPOSE:to verify the differences between the maximum phonation time /a/ and maximum phonation time predicted in relation to the respiratory type, and correlate the the maximum in adult women with vital capacity within the normal range and without laryngeal affections.METHODS:cross-sectional analytic research, quantitative and retrospective, in the database, 51 female subjects with an otorhinolaryngological diagnosis of absence of laryngeal affections, aged between 18 and 44 years (mean 27.64). It was used: higher value of maximum phonation time /a/, maximum phonation time predicted, vital capacity and respiratory type. The value of maximum time predicted for women, was calculated by multiplying the vital capacity by 0.0051, and the value found was decisive for the classification of phonation time /a/ in normal, below or above expectations.RESULTS:there were significant differences between maximum time predicted and respiratory type superior (17,44s) and mixed (15,17s). No significant difference phonation time /a/ in different and respiratory type, or correlation between phonation time /a/ and maximum time predicted.CONCLUSION:there was no correlation between phonation time /a/ and maximum time predicted and the maximum time predicted was significantly higher in respiratory type superior than in mixed.

Alterações de sistema estomatognático em indivíduos disfônicos

Purpose: verifying the presence of the stomatognathic system changes and its association with gender, profession, allergies report and speech diagnosing the type of dysphonia in dysphonic individuals who sought care in a speech therapy school clinic. Methods: quantitative and retrospective study, through the database. Sample of 69 subjects records of both genders, aged between 19 and 44 years. Data were collected on age, gender, profession, report of allergies, speech therapy diagnosis of the type of dysphonia, respiratory type and data of anthroposcopic evaluation of the stomatognathic system: occlusion, horizontal and transverse bite changes, width and depth of the hard palate, breathing mode and lips, tongue and cheeks tension. Results: 28.99% (n=20) were voice professional; 33.33% (n=23) reported allergies; mixed respiratory type with 75.36% (n=52), followed by the superior with 20.29% (n=14) and diaphragmatic breathing with 4.35% (n=3); type of functional dysphonia (n=42; 66.67%), followed by organofunctional (n=19; 23.54%) and organic (n=8; 11.59%). There were not significances in the stomatognathic system changes associations with types and breathing techniques, types of dysphonia, voice professional and allergies report, there were only significances in female with no vertical bite changes. Conclusion: studied patients were predominantly women; adults; not voice professionals; with functional dysphonia; no history of allergies or stomatognathic system changes; with proper type and mode breathing, with only female association with no vertical bite changes.

Comparação dos efeitos do finger kazoo e da fonação em tubo em mulheres com voz normal

Purpose To compare the voice before and after the finger kazoo and phonation into a glass tube immersed in water in women without vocal complaints or laryngeal affections. Methods Forty-six women participated of the group that performed the finger kazoo and 12 of the group performed the phonation into a glass tube immersed in water. It was collected the vowel /a:/, before and after the techniques, for acoustic analysis through the Multi-Dimensional Voice Program Advanced and the Real Time Spectrogram; and auditory perceptual with RASATI scale. The techniques were performed on three series of the 15 repetitions, with 30 seconds of rest between them. Results In comparison, phonation into a glass tube immersed in water showed significant improvement: definition of the first formant, subharmonic presence, smoothed pitch perturbation, variation of f0 and voice turbulence index; and the finger kazoo showed a significant reduction in the standard deviation of f0. The auditory perceptual analysis had no significant difference between groups. Conclusion In comparison, phonation into a glass tube immersed in water provided more noticeable improvement in acoustic vocal aspects related to resonance, noise and stability than the finger kazoo.

Fonação em tubo de vidro imerso em água: análise vocal perceptivoauditiva e videolaringoestroboscópica de mulheres sem afecções laríngeas, queixas ou alterações vocais

Purpose: to check and correlate measures of vocal acoustic of the glottal source and laryngeal characteristics of women without laryngeal disorders and without vocal complaints, after the phonation in a glass tube immersed in water. Methods: twenty-four women, between 18 and 40 years, were available and allocated in two groups, being 12 in the study group and 12 in the control group. Were performed collect the vowel /a:/ and videolaryngostroboscopy before and after the execution of technique, in the study group, and before and after a period of silence in the control. Was performed an analysis vocal acoustics and hearing perceptual and statistical analysis with Wilcoxon, Chi-square and Spearman (p<0,05). Results: SG: improvement of the smoothed pitch perturbation quotient, voice turbulence index, Shimmer percentage and Shimmer in dB; improvement of breathiness in RASATI; in the videolaryngostroboscopy, the laryngeal vestibule constriction did not change significantly. CONCLUSION: the technique phonation in a glass tube immersed in water reduced of vibration glottal aperiodicity and the noise, with increased energy harmonic and consequent improvement of the glottal signal. In videolaryngostroboscopy, the laryngeal vestibule constriction did not change significantly, this suggests that the technique does not cause laryngeal hypertension.

Fonoterapia com fonação em tubos em paciente com paralisia de prega vocal medializada cirurgicamente: estudo de caso

The purpose of this study is to verify the perceptive-auditory and acoustic voice changes after speech therapy with phonation into tubes in a male subject with unilateral vocal fold paralysis, medialized surgically. The patient was a male, twenty nine years and one month, with otorhinolaryngological diagnosis of left vocal fold paralysis in abduction. The subject was referred to medialization surgery of the left vocal fold (Thyroplasty type I) and to speech therapy. Five collections of the vowel /a:/ occurred at different times, as follows: before surgery; ten days after surgery (before speech therapy); six days after the performance of the technique of phonation into latex tube immersed in water; six days after the performance of the technique of phonation into glass tube immersed in water; six days after the performance of the technique of phonation into tube of smaller diameter. There was acoustic analysis of glottal source, spectrographic analysis and perceptive-auditory analysis. Final comments: The speech therapy with three different exercises of phonation, for 18 days, provided, in the acoustic analysis, improvement of most frequency perturbation measures and measures of voiceless or not sounded components; improvement of the intensity of the tracing color of the wide-band spectroscopy; improvement of the regularity of the spectrographic tracing and of the definition of formants; in the perceptive-auditory analysis, there was reduction of tension, roughness and breathiness.