Leonardo Wanderley Lopes

Severity of Voice Disorders in Children: Correlations Between Perceptual and Acoustic Data

OBJECTIVES The aims of this study were to verify whether there is correlation between perceptual and acoustic data and to verify which measures are useful to identify the severity of voice deviation in children. METHODS The participants were 71 children aged 3-9 years. The severity of voice deviation, roughness, breathiness, strain, and instability was evaluated by three speech therapists, experts on perceptual voice evaluation. A visual analog scale was used; speech material consisted of a sustained vowel sound /ε/ and the counting of numbers from one to 10. The means and standard deviations of fundamental frequency (F(0)), jitter, shimmer, and glottal-to-noise excitation (GNE) ratio were extracted from the sustained vowel, and the mean and variability of F(0) were extracted from automatic speech (counting). Perceptual and acoustic data were correlated. RESULTS Most children had mild voice deviation, with strain, instability, and breathiness as predominant voice qualities. F(0) measures correlate with strain to phonate. Shimmer and GNE correlate with general degree of voice deviation and with the roughness, breathiness, and instability parameters. GNE and F(0) mean in connected speech were the only measures that distinguished voices regarding severity of voice deviation. CONCLUSIONS There was a correlation between perceptual and acoustic measures from these childrens voices. Children with high-pitched voices had higher voice deviations. GNE is a measure that reliably distinguishes the severity of voice deviation and may be useful in the screening and evaluation of childrens voices.

Severity of voice disorders: integration of perceptual and acoustic data in dysphonic patients

PURPOSE To analyze the correlation between acoustic measures and intensity of vocal deviation, and its discriminatory power in detecting the presence of vocal change, classifying the severity of the deviation and differencing the type of predominant voice. METHODS The sample comprised 186 patients with dysphonia. The vocal deviation from the vowel/ε/was evaluated by consensus between three speech language pathologists, using a Visual Analog Scale. We extracted the mean and standard deviation (SD) of the fundamental frequency (F₀), jitter, shimmer, and Glottal-to-Noise Excitation Ratio (GNE). RESULTS Mean F₀ was negatively correlated with the degree of roughness and positively with the degree of tension. The F₀ SD was positively correlated with the overall, roughness, tension, and instability grades. The jitter and shimmer were positively correlated with all perceptual parameters. Only the GNE distinguished between healthy and dysphonic voices and rated the degree of breathiness. The shimmer separated rough voices from not rough voices. The mean F₀ was helpful to determine the degree of phonatory tension and to separate rough voices from breathy and strained voices. CONCLUSION There is a correlation between the acoustic and auditory perceptual measures. The shimmer, the GNE, and F₀ SD can be used to detect roughness, breathing, and strain, respectively. The GNE and mean F₀ are useful to classify the degree of breathiness and strain, respectively. The mean F₀ distinguished between rough, breathy, and strained voices, with rough voices more severe compared to the other two.

Fatores de risco e emocionais na voz de professores com e sem queixas vocais

PURPOSE: to evaluate the effect of emotional risk factors on the voice of teachers with and without vocal complaints. METHOD: the sample comprised 44 teachers. We used a form for collecting personal and professional data, three questionnaires concerning vocal aspects, and two questionnaires for data related to emotion. Further, we recorded voices for auditory-perceptual analysis. The teachers were divided based on the number of symptoms reported: 22 volunteers in a group of Teachers Without Complaints (TWOC) and 22 in a group of Teachers With Complaints (TWC). The latter group included individuals reporting more than three vocal symptoms. RESULTS: the average number of symptoms described in the Voice Signs and Symptoms Questionnaire was 5.7 (±2.8) and 0.8 (±0.9) for the PCQ and PSQ groups, respectively. The PSQ reported better vocal self-assessment (p = 0.01) and the PCQ reported greater vocal impairment (p = 0.001). The PSQ group obtained the highest scores in the Physical Voice-related Quality of Life (P-VQL) (p = 0.0007) and Total VQL (p = 0.0006). The PCQ had higher values in the Total Voice Handicap Index (VHI) (p = 0.0003) and Organic VHI (p = 0.0006), and greater emotional impairment in the Self-Report Questionnaire [5.7 (±3.9)] and Trait-State Anxiety Inventory [42.5 (±12.7)]. Auditory-perceptual analysis showed that the PCQ had moderate vocal deviation with vocal roughness, breathiness, and tension, while the PSQ group showed slight deviation in all parameters. CONCLUSION: teachers with vocal complaints are exposed to more risk factors, and report more symptoms and vocal and emotional impairments.

Accuracy of Acoustic Analysis Measurements in the Evaluation of Patients With Different Laryngeal Diagnoses

OBJECTIVE This study aims to investigate the accuracy of acoustic measures in discriminating between patients with different laryngeal diagnoses. STUDY DESIGN The study design is descriptive, cross-sectional, and retrospective. METHODS A total of 279 female patients participated in the research. Acoustic measures of the mean and standard deviation (SD) values of the fundamental frequency (F0), jitter, shimmer, and glottal to noise excitation (GNE) were extracted from the emission of the vowel /ε/. RESULTS Isolated acoustic measures do not demonstrate adequate performance in discriminating patients with and without laryngeal alteration. The combination of GNE, SD of the F0, jitter, and shimmer improved the ability to classify patients with and without laryngeal alteration. In isolation, the SD of the F0, shimmer, and GNE presented acceptable performance in discriminating individuals with different laryngeal diagnoses. The combination of acoustic measurements caused discrete improvement in performance of the classifier to discriminate healthy larynx vs vocal polyp (SD of the F0, shimmer, and GNE), healthy larynx vs unilateral vocal fold paralysis (SD of the F0 and jitter), healthy larynx vs vocal nodules (SD of the F0 and jitter), healthy larynx vs sulcus vocalis (SD of the F0 and shimmer), and healthy larynx vs voice disorder due to gastroesophageal reflux (F0 mean, jitter, and shimmer). CONCLUSIONS Isolated acoustic measures do not demonstrate adequate performance in discriminating patients with and without laryngeal alteration, although they present acceptable performance in classifying different laryngeal diagnoses. Combined acoustic measures present an acceptable capacity to discriminate between the presence and the absence of laryngeal alteration and to differentiate several laryngeal diagnoses.

Relationship Between Acoustic Measurements and Self-evaluation in Patients With Voice Disorders

OBJECTIVE The study aimed to determine whether there is a relationship between acoustic measures and self-evaluation in patients with voice disorders. STUDY DESIGN This is a descriptive, transversal, and observational study. METHODS Patients (257) who answered the Voice Handicap Index protocols (VHI) and the Voice Symptoms Scale (VoiSS) and recorded the vowel /ε/ were included. Standard deviation (SD) measures of the fundamental frequency (F0), jitter, shimmer, and the glottal to noise excitation ratio (GNE) vowel /ε/ were taken. RESULTS There was a weak positive correlation between all scores of VoiSS and the SD of the F0 and jitter. The overall scores, physical limitation, and VoiSS showed weak positive correlations with shimmer. The overall scores, limitation, and emotional VoiSS showed weak negative correlations with the GNE. The VHI did not correlate with any of the acoustic measurements. There was no difference in the mean of the acoustic measures of the SD of F0, jitter, and GNE because of a voice problem detected from the cutoff points of VoiSS. There was no difference in any of the acoustic measurements when patients with and without voice problems were compared from VHI cutoffs. CONCLUSIONS There is a correlation between the scores of VoiSS and acoustic measurements. Patients with self-reported voice problems in VoiSS present greater deviations in acoustic measures, mainly in jitter. There is no correlation between the VHI scores and the acoustic measures and no difference in the averages of these measures between patients with and without voice problems detected from the VHI cutoffs.

Characteristics of voice and personality of patients with vocal fold immobility

PURPOSE To examine the voice and personality characteristics of patients diagnosed with organic dysphonia secondary to vocal fold immobility. METHODS The study comprised patients of both genders, attending the Clinic School of Speech Therapy of the Federal University of Paraíba, with otorhinolaryngological diagnosis of vocal fold immobility and speech therapy diagnosis of dysphonia. The self-assessment of voice was measured through a Vocal Screening Protocol and Voice Symptoms Scale (VoiSS), the voice was collected for auditory-perceptive evaluation, and the Factorial Personality Battery (FPB) was used. Descriptive statistical analysis was performed to determine the frequency, mean, and standard deviation of the studied variables. RESULTS Eight patients participated in the study, of both genders, with average age of 40.4 ± 16.9 years. The more frequent risk factors were the personal ones (4.7 ± 2.1). In the VoiSS, the patients presented a higher average in the limitation score (34.1 ± 15.7). From the auditory-perceptive evaluation, moderate intensity of vocal deviation was obtained, with predominant vocal roughness (57.7 ± 25.2). In the FPB, the patients had an average higher than the cutoff scores in neuroticism (3.8 ± 1.4) and accomplishment (5.2 ± 1.0). CONCLUSION The predominant vocal parameter was roughness. The patients referred to a few risk factors that compromise the vocal behavior and presented the neuroticism and realization factors as a highlight in their personality. Thus, individuals with vocal fold immobility show personality characteristics that may be a reflection of their voice disorder, not a factor that determines their dysphonia.

Características vocais e emocionais de professores e não professores com baixa e alta ansiedade

Purpose Compare vocal symptoms and emotional features in groups of teachers and non-teachers with low and high anxiety. Methods A total of 93 male and female participants aged between 18 and 59 years participated in the study and were divided into four groups: teachers with low anxiety, teachers with high anxiety, non-teachers with low anxiety, and non-teachers with high anxiety. Vocal parameters were measured by the instruments Vocal Signs and Symptoms Questionnaire, Voice-Related Quality of Life, Voice Handicap Index; and recorded speech and sustained vowels from the Visual Analog Scale were assessed by three speech-language pathologists. To assess emotional parameters, the Self-Report Questionnaire and the State-Trait Anxiety Inventory were used. Results Groups with high anxiety reported high levels of stress and depression symptoms, and teachers had symptoms that were more emotional. Teachers with high anxiety expressed a greater number of vocal symptoms, greater impairment of voice quality of life, greater overall change in voice quality, and higher voice handicap index when compared with the other groups. Conclusion Individuals with high anxiety displayed more emotional symptoms related to voice and vocal quality of life, especially if the voice was a work instrument, such as for teachers.

Reduction of Risk Factors in Patients with Behavioral Dysphonia After Vocal Group Therapy.

OBJECTIVES The origin and development of dysphonia, particularly behavioral dysphonia, is associated with several risk factors. Here, we verified the effectiveness of group therapy in reducing the risk factors, and established the association between risk factors and sex, age, profession, and diagnosis of laryngeal disorders in patients with behavioral dysphonia. STUDY DESIGN This is a descriptive, quantitative, field intervention study. METHODS Participants (n = 26, adult patients of both sexes), with a diagnosis of behavioral dysphonia, received group therapy intervention. Data for risk factors were collected pre- and posttherapy using the Vocal Screening Protocol. The data were analyzed using descriptive and inferential statistics (Student t test, chi-squared test or Spearman correlation test). RESULTS The majority (80.8%, n = 21) of patients were female, 65.4% (n = 17) were not in a vocal profession, and 42.3% (n = 11) presented with a lesion in the membranous portion of the vocal fold. The number of personal risk factors decreased after group therapy (P = 0.04). In addition, age was correlated with total (P = 0.001), environmental (P = 0.002), and personal (P = 0.003) vocal risk factors posttherapy. CONCLUSIONS This study revealed an association between the reduction of personal risk factors and vocal group therapy, and a correlation between age and total, environmental, and personal vocal risk factors posttherapy. Thus, maintenance and origins of the behaviors that modify the behavioral aspects of the participants directly influence the production of individual vocal habits.

Autoavaliação e prontidão para mudança em pacientes disfônicos

PURPOSE To examine whether there is an association between vocal self-assessment and readiness for change in dysphonic patients. METHODS 151 patients with vocal complaints and diagnosis of dysphonia, between 18 and 65 years of age, 47 men and 104 women treated at the voice clinic of a public institution participated in the study. Four self-assessment instruments were applied, including the Voice-Related Quality of Life (V-RQOL), the Voice Handicap Index (VHI) and the Voice Symptom Scale (VoiSS), and the use of URICA-VOICE instrument to verify the patients stage of readiness for change. All instruments were applied immediately before the start of vocal therapy. The variables were correlated and compared using inferential statistics. RESULTS Most patients were in the contemplation stage (76.2%, n = 115), 22 (14.6%) were in the pre-contemplation stage and 14 (9.3%) in the action stage. There was a negative correlation between the score in URICA-VOICE and the socio-emotional domain and total score V-RQOL. There was a positive correlation between the score URICA-VOICE and full social, emotional and functional VHI, as well as between the score URICA-VOICE and full fields, limitation and emotional VoiSS. Only the social-emotional domain V-RQOL and emotional in VoiSS values showed statistically significant differences between the motivational stages. CONCLUSION There is association between vocal self-assessment and readiness for change in dysphonic patients. Patients with major impact on quality of life in voice in V-RQOL and higher frequency of vocal symptoms mentioned in the VoiSS show greater readiness for change.

Análise acústica de vozes infantis: contribuições do diagrama de desvio fonatório

PURPOSE:to analyze the discriminating power of the phonatory deviation diagram (PDD) in assessing the predominant voice type and severity of voice deviance in children.METHODS:samples of the sustained vowel /e/ were collected from 93 children. The severity of voice deviance and vocal quality were assessed with the aid of a visual analog scale. The PDD was used in the acoustic analysis, with an assessment of the distribution of the voice signals according to the area, quadrant, shape, and density in the diagram. The results were obtained from the statistical analysis of the variables using the test for equality of proportions, chi-squared test (Χ(2)), and Spearmans correlation. The level of statistical significance was set at ≤ 5% across analyses.RESULTS:a positive and statistically significant correlation was found between the classification based on the PDD quadrants and the severity of voice deviance for all the parameters analyzed except strain, which showed a negative correlation. Statistically significant differences were also noted in the proportion of children with voice roughness, breathiness, strain, and instability in relation to the area, quadrant, and shape in the PDD. There were no significant differences between the proportion of children with and without voice deviation for the evaluated parameters regarding the distribution of the voice samples in the quadrants.CONCLUSION:the PDD was capable of distinguishing the predominant vocal quality based on the distribution of the signals in the quadrants, although it could not discriminate between healthy and disordered childrens voices.