Mara Behlau

Epidemiology of Voice Disorders in Teachers and Nonteachers in Brazil: Prevalence and Adverse Effects

PURPOSE This epidemiological study compared the frequency and adverse effects of voice disorders in Brazilian teachers and nonteachers. METHODS A standardized interview/questionnaire was administered to 3,265 participants; 1,651 teachers; and 1,614 nonteachers recruited from all 27 Brazilian states. RESULTS Prevalence of reporting a current voice disorder was 11.6% for teachers and 7.5% for nonteachers, respectively (χ2(1)=16.1, P<0.001). Sixty-three percent of teachers and 35.8% of nonteachers reported having experienced a voice problem at some point during their lifetime (χ2(1)=246.6, P<0.001). Teachers reported a higher number of current (3.7) and past (3.6) voice symptoms as compared with nonteachers (1.7 current, 2.3 past) and more often attributed these symptoms to their occupation (P<0.001). Teachers, as compared with nonteachers (1) more frequently reported that their voice limited their ability to do certain tasks within their current occupation (29.9% of teachers vs 5.4% of nonteachers; P<0.001); (2) experienced more voice-related absenteeism over the past year (12.1% of teachers missed 5 or more days of work vs 2.4% of nonteachers; P<0.001); and (3) more often considered changing occupations in the future because of voice problems (16.7% of teachers vs 0.9% of nonteachers; P<0.001). The magnitude of voice-related dysfunction among teachers was similar across Brazilian states, and regional characteristics did not appear to significantly influence the results. CONCLUSION This large epidemiological study comparing teachers and nonteachers confirms that teaching at school is a high-risk occupation for developing voice disorders. These voice disorders contribute to reduced job performance, attendance, and force many Brazilian teachers to consider changing occupations in the future because of their voice.

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.

Morphological and Functional Aspects of the Senile Larynx

Objective: To analyze the senile larynx, considering morphological aspects during respiration and functional aspects during phonation, comparing it to the young adult larynx. Patients and Methods: A retrospective study was conducted of 100 laryngeal images of adults without vocal complaints, 50 laryngeal images of young adults aged 20–45 years and 50 laryngeal images of elderly individuals aged 65–85 years, of both genders. Images were produced by means of a rigid endoscope and stroboscopy. The morphological aspects analyzed were: laryngeal symmetry, vocal fold bowing, prominence of the vocal process and glottic proportion. The functional aspects analyzed were glottic closure, laryngeal vestibule behavior, phase (timing of closure) and amplitude symmetry of mucosal wave and tremor of laryngeal structures. Results: Significant differences between the young adult larynx and the geriatric larynx were found for the following parameters: vocal fold bowing, prominence of the vocal process, glottic proportion, phase and amplitude symmetry of mucosal wave and tremor of laryngeal structures. Conclusion: The data suggests that the geriatric larynx differs from the young adult larynx in many characteristic aspects.

Quality of Life and Voice: Study of a Brazilian Population Using the Voice-Related Quality of Life Measure

Objective: The goal of the present study was to characterize a large population of Brazilian individuals using the Brazilian Portuguese version of the Voice-Related Quality of Life (V-RQOL) Measure. Patients and Methods: We studied a population of 2,214 Brazilian subjects who completed the V-RQOL questionnaire consisting of 10 questions from two domains: physical functioning and social-emotional functioning. The subjects were divided into two groups according to the presence of vocal complaints: group 1, with vocal complaints (1,304 individuals); group 2, without vocal complaints (910 individuals). Subject age ranged from 14 to 90 years in both groups. All subjects self-rated their voice quality upon a five-point categorical scale ranging from poor to excellent. Moreover, the respondents’ professions were classified into four categories according to their level of voice usage. Results: Results indicate that the worse the self-assessment of the voice, the lower the V-RQOL scores, with higher significance in the group with vocal complaints. The total V-RQOL score was 97 for excellent voices, 92 for very good, 84 for good, 65 for fair, and 45 for poor voices. Main correlations for both groups were: total and physical scores (0.96), total and social-emotional scores (0.82); physical and social-emotional scores (0.69); self-assessment of the voice and total score (0.61); self-assessment of the voice and physical score (0.58), and self-assessment of the voice and social-emotional score (0.52). Two interesting negative correlations were found between age and self-assessment of the voice (–0.271), and age and social-emotional score (–0.184). Group 1, with vocal complaints, presented lower scores than group 2. Conclusions: The relationship between self-assessment of voice quality and V-RQOL scores was very clear and statistically significant, especially when considering the group with a known voice disorder.

Treatment of sulcus vocalis: Auditory perceptual and acoustical analysis of the slicing mucosa surgical technique**

Sulcus vocalis is a furrow in the mucosa of the vocal folds that causes glottic insufficiency, irregular vibrations, and a distinctive dysphonia of variable severity. Treatment of sulcus vocalis needs to achieve anatomical and functional improvements that satisfy the behavior of the larynx and vocal quality. We suggest a combined approach, which includes vocal fold mucosal surgery through a technique called slicing mucosa, followed by intensive vocal rehabilitation. The aim of the surgery is to detach the mucosa of the sulcus and to interrupt the longitudinal fibrotic tension lines. The results of this procedure in 10 patients were analyzed through visual, auditory, and acoustical methods, and the data lead us to conclude that the treatment proposed offered a good anatomical result, a better vibratory pattern, and an improvement in overall vocal quality.

AVALIAÇÃO CLÍNICA E VIDEOFLUOROSCÓPICA DA DEGLUTIÇÃO EM CRIANÇAS COM PARALISIA CEREBRAL TETRAPARÉTICA ESPÁSTICA

Cerebral palsy is a condition that may be associated with swallowing disorders, that is, oropharingeal dysphagia. The aim of this study was to characterize and compare the swallowing processes of 32 children with this condition, by clinical and videofluoroscopic evaluation, with special focus on tracheal aspiration detectability. Results show an important compromise of oral phase. The most important findings during the pharyngeal phase were velopharingeal incompetence and residuals on the pharyngeal recesses. Aspiration was more common with liquids, before and after deglutition. On clinical and videofluoroscopic evaluation, cervical hyperextension was the commonest postural abnormality. Videofluoroscopy confirmed the occurrence of aspiration on most of the cases that presented suggestive signs of aspiration during clinical evaluation. We conclude that clinical and videofluoroscopic evaluations are complementary on deglutition evaluation and together may point to the most specific rehabilitation procedure.

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.

Effect of voice rehabilitation on oral communication of Parkinson's disease patients

Voice and speech disorders are common in Parkinsons disease patients and may lead to social isolation. We employed routine clinical voice therapy measures to evaluate the effect of voice rehabilitation. Twenty patients with a stable drug regimen participated in this study. The patients were assessed before and after a program of voice rehabilitation consisting of 13 group therapy sessions during 1 month, with emphasis on the increase in laryngeal sphincteric activity. Voice rehabilitation produced an increase in maximal phonation times, decrease in the values of s/z ratio and air flow, increase in vocal intensity, decrease in the complaints of weak and strained‐strangled voice and monotonous and unintelligible speech and elimination of complaints of swallowing alterations. These data indicate a greater glottic efficiency after voice rehabilitation reflecting a more functional oral communication.

Vocal Nodules and Laryngeal Morphology

Our purpose was to study the occurrence of vocal fold nodules under conditions of habitual vocal abuse associated with increased laryngeal muscle tension, to identify the existence of a relationship between vocal nodules and laryngeal morphology. We studied one group of 30 subjects with vocal nodules, 18 to 50 years old, who were compared with two control groups, one of females and one of males, consisting of 30 subjects each. The parameters evaluated were: type of vocal folds coaptation, glottic proportion (GP) and abduction angle (AA), obtained by videotelelaryngoscopy. In the nodules group, the larynges presented a mean value of GP similar to that of the female group, both of which were lower than the mean GP value of the male group. On the other hand, the mean AA was lower than the one in the female group, and closer to the one in the male group. We concluded that vocal nodules were present only in larynges with a predominantly young female morphology, with functional limitations of abduction.

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.