Karine Schwarz

Modificações laríngeas e vocais produzidas pela técnica de vibração sonorizada de língua

BACKGROUND effectiveness of the sonorous tongue vibration technique (STVT). AIM to investigate the sensations and the vocal and laryngeal impact produced by the sonorous tongue vibration technique. METHOD The STVT was performed in three sets of fifteen repetitions, in maximum phonatory duration using a normal tone and intensity - with 30 seconds intervals of passive rest between each set. Twenty-four women aged between 20 and 30 years and with no vocal complaints participated in the study. All participants were submitted to a larynx evaluation through videolaryngostroboscopy examination; auditory perceptual and acoustic analysis of the voice, before and after using the STVT, by means of the Multi-Dimensional Voice Program (MDVP), Model 5105 and Real Time Spectrogram, from Key Elemetrics. RESULTS after using the STVT, a statistically significant difference was observed in terms of: improvement of voice type; focus of vertical resonance; vocal quality; predominance of positive sensations; maintenance of the larynx images parameters (glottis closure, laryngeal vestibule constriction, symmetry and amplitude of vocal folds vibration); increase in fundamental frequency; improvement of spectrographic evaluation parameters, in Broadband and Narrowband filters; and improvement of medial vestibule constriction according to increase in STVT duration. CONCLUSION the STVT modifies the glottal source and the resonant filter.

Medidas vocais acústicas de mulheres sem queixas de voz e com laringe normal

It is important to establish normal voice standards in order to help guide voice professionals. Aim: to describe acoustic voice measures of adult young women...

Voz e posição de prega vocal em homens com paralisia unilateral de prega vocal

UNLABELLED The paralyzed vocal fold positioning and the degree of dysphonia are important inputs when one is deciding upon treatment options for unilateral vocal fold paralysis (UVFP). OBJECTIVE To check voice characteristics and paralyzed vocal fold position in men with UVFP. MATERIALS AND METHODS This is a retrospective historical cross-sectional cohort study, with data from 24 men with UVFP with mean age of 60.7 years, submitted to voice assessment by three speech therapists and three ENT physicians used laryngeal images to classify the position of the paralyzed vocal fold. RESULTS The paralyzed vocal fold was found in the paramedian position in 45.83% of the cases; in the intermediary position in 25%; lateral in 20.83%, and it was in the median position in 4.16%; the dysphonia resulting from the UVFP was characterized by moderate hoarseness, roughness and stress in the voice; breathiness (most had severe breathiness); weakness and instability(mostly mild); the position of the paralyzed vocal fold had a significant influence on the general degree of vocal deviation. CONCLUSION The general degree of dysphonia is associated with the paralyzed vocal fold position; dysphonia is characterized by hoarseness, breathiness, roughness and stress of moderate to severe levels.

WHOQOL-100 Before and After Sex Reassignment Surgery in Brazilian Male-to-Female Transsexual Individuals

INTRODUCTION The 100-item World Health Organization Quality of Life Assessment (WHOQOL-100) evaluates quality of life as a subjective and multidimensional construct. Currently, particularly in Brazil, there are controversies concerning quality of life after sex reassignment surgery (SRS). AIM To assess the impact of surgical interventions on quality of life of 47 Brazilian male-to-female transsexual individuals using the WHOQOL-100. METHODS This was a prospective cohort study using the WHOQOL-100 and sociodemographic questions for individuals diagnosed with gender identity disorder according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The protocol was used when a transsexual person entered the ambulatory clinic and at least 12 months after SRS. MAIN OUTCOME MEASURES Initially, improvement or worsening of quality of life was assessed using 6 domains and 24 facets. Subsequently, quality of life was assessed for individuals who underwent new surgical interventions and those who did not undergo these procedures 1 year after SRS. RESULTS The participants showed significant improvement after SRS in domains II (psychological) and IV (social relationships) of the WHOQOL-100. In contrast, domains I (physical health) and III (level of independence) were significantly worse after SRS. Individuals who underwent additional surgery had a decrease in quality of life reflected in domains II and IV. During statistical analysis, all results were controlled for variations in demographic characteristics, without significant results. CONCLUSION The WHOQOL-100 is an important instrument to evaluate the quality of life of male-to-female transsexuals during different stages of treatment. SRS promotes the improvement of psychological aspects and social relationships. However, even 1 year after SRS, male-to-female transsexuals continue to report problems in physical health and difficulty in recovering their independence.

Voice and laryngeal configuration of men with unilateral vocal fold paralysis before and after medialization.

AIM To describe the laryngeal configuration and the voice of male patients diagnosed with unilateral vocal fold paralysis (UVFP) before and after medialization. METHODS A retrospective study involving the collection of data from medical records of 142 patients diagnosed with UVFP from January 2003 to April 2009, submitted to auditory-perceptual assessment of voices and visual perception of laryngeal images before and after medialization. RESULTS The study included data from 24 male patients, with an average of 60.7 years, who underwent three surgical medialization techniques (injection of hyaluronic acid, type I thyroplasty, and injection of Teflon). Before treatment, the position of the paralyzed vocal fold was seen to have a significant influence to the passing of the healthy vocal fold beyond the midline and on the overall degree of dysphonia. After treatment, the complete glottic closure; the free margin of the linear vocal fold; paralyzed vocal fold in the median position, reduction of hoarseness, roughness and breathiness (more frequently mild), and asthenia (more frequently normal and mild); tension and instability (more frequency normal); and a decrease in the overall degree of dysphonia were found to be significant. CONCLUSION The position of the paralyzed vocal fold influences the position of the healthy vocal fold in relation to the midline and the overall degree of dysphonia. All three treatments improved the glottic configuration and the voice of patients with UVFP.

BIRTH ORDER AND ANDROPHILIC MALE-TO-FEMALE TRANSSEXUALISM IN BRAZIL

Previous research has indicated that biological older brothers increase the odds of androphilia in males. This finding has been termed the fraternal birth order effect. The maternal immune hypothesis suggests that this effect reflects the progressive immunization of some mothers to male-specific antigens involved in fetal male brain masculinization. Exposure to these antigens, as a result of carrying earlier-born sons, is hypothesized to produce maternal immune responses towards later-born sons, thus leading to female-typical neural development of brain regions underlying sexual orientation. Because this hypothesis posits mechanisms that have the potential to be active in any situation where a mother gestates repeated male fetuses, a key prediction is that the fraternal birth order effect should be observable in diverse populations. The present study assessed the association between sexual orientation and birth order in androphilic male-to-female transsexuals in Brazil, a previously unexamined population. Male-to-female transsexuals who reported attraction to males were recruited from a specialty gender identity service in southern Brazil (n=118) and a comparison group of gynephilic non-transsexual men (n=143) was recruited at the same hospital. Logistic regression showed that the transsexual group had significantly more older brothers and other siblings. These effects were independent of one another and consistent with previous studies of birth order and male sexual orientation. The presence of the fraternal birth order effect in the present sample provides further evidence of the ubiquity of this effect and, therefore, lends support to the maternal immune hypothesis as an explanation of androphilic sexual orientation in some male-to-female transsexuals.

Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People

Transgender and gender diverse people (TGD) have specific healthcare needs and struggles with access barriers that should be addressed by public health systems. Our study aimed to address this topic in the Brazilian context. A hospital and web-based cross-sectional survey built with input from the medical and transgender communities was developed to assess TGD healthcare needs of and access barriers in two Brazilian states. Although services that assist this population have existed in Brazil since the 1990s, TGD have difficulty accessing these services due to discrimination, lack of information and a policy design that does not meet the needs of TGD. A history of discrimination was associated with a 6.72-fold increase in the frequency of health service avoidance [95% CI (4.5, 10.1)]. This article discusses the urgent necessity for adequate health policies and for the training of professionals regarding the needs of Brazilian TGD.

Laryngeal surgical treatment in transgender women: A systematic review and meta-analysis

To identify the effects of laryngeal surgical treatment in the voice of transgender women, especially on the fundamental frequency (f0).

Terapia vocal e sons nasais: efeitos sobre disfonias hiperfuncionais

We sought to verify the effects of a phonotherapy program that included vocal and postural orientation, adequacy of respiratory function and the technique of nasal sounds in hyperfunctional dysphonia. We carried out a clinical case, observational, longitudinal, non-controlled study with quantitative approach that analyzed three female subjects with mean age of 31.33 years who presented hyperfunctional dysphonia. The subjects were submitted to: laryngoscopy, vocal, perceptive-auditory and acoustic assessments, collection of maximum phonation time, postural screening and determination of the respiratory tract during speech before and after a therapeutic program which consisted of orientation, awareness and vocal training with nasal sounds during 16 speech therapy sessions, once a week with training at home. The data were analyzed by using the non-parametric Mann-Whitney and Chi-square, with 5% significance level. Post-therapy, we observed that the posture passed from aligned and misaligned and the respiratory type from the upper to the costodiaphragmatic-abdominal; there was a decrease of the acoustic measurements in relation to the degree and to the number of subharmonics in most subjects, besides tissue improvements and reduction of edema in the mucosa of the vocal folds and arytenoid region, as well as glottal closure improvement. After performing the phonotherapy program with vocal and postural orientation, adequacy of respiratory function and use of the technique of nasal sounds in hyperfunctional dysphonia, we observed significant improvement in body posture, the respiratory tract, the acoustic measurements suggestive of noise to vocal emission and positive effects on the tissue and the closure of the vocal folds.

Gender incongruence: a comparative study using ICD-10 and DSM-5 diagnostic criteria

Objective: To compare the presence of criteria listed in the DSM-5 and ICD-10 diagnostic manuals in a Brazilian sample of transgender persons seeking health services specifically for physical transition. Methods: This multicenter cross-sectional study included a sample of 103 subjects who sought services for gender identity disorder in two main reference centers in Brazil. The method involved a structured interview encompassing the diagnostic criteria in the two manuals. Results: The results revealed that despite theoretical disagreement about the criteria, the manuals overlap regarding diagnosis confirmation; the DSM-5 was more inclusive (97.1%) than the ICD-10 (93.2%) in this population. Conclusions: Although there is no consensus on diagnostic criteria on transgenderism in the diversity of social and cultural contexts, more comprehensive diagnostic criteria are evolving due to society’s increasing inclusivity.