Marta Assumpção de Andrada e Silva

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.

Tipologia facial aplicada à Fonoaudiologia: revisão de literatura

A face humana, com suas estruturas osseas e musculares, apresenta caracteristicas proprias e peculiares. Pode ser classificada em tres tipos basicos, os quais tem relacao com a variacao do formato e da configuracao craniofacial, tanto no sentido vertical como no horizontal e influenciam diretamente a oclusao dentaria, harmonia facial, musculatura orofacial e funcoes estomatognaticas. Por essa razao, diagnosticar o tipo facial e importante para a clinica fonoaudiologica. O objetivo deste estudo foi realizar uma revisao de literatura relacionada as caracteristicas dos tipos faciais e apresentar as pesquisas e os estudos mais recentes sobre o tema. Para atingir tal meta, fez-se um levantamento bibliografico nas bases de dados LILACS, SciELO, Web of Science e Google Academico, alem de livros, dissertacoes e teses sobre o assunto dos ultimos dez anos. Varias pesquisas em campo comprovaram algumas caracteristicas dos tipos faciais encontradas, principalmente, em referencias mais antigas. Alguns aspectos, porem, foram controversos ao se comparar os tipos faciais como a atividade eletromiografica do musculo masseter, modo respiratorio e o comprimento do labio superior e do filtro. Pode-se constatar que conhecer o tipo facial e correlaciona-lo as funcoes estomatognaticas, musculatura e oclusao e um fator importante para a pratica clinica, mas o profissional deve ser flexivel ao comparar as caracteristicas do paciente com a literatura. Dessa forma, pode-se evitar determinar uma anormalidade ou atipia quando nao for o caso, e ocorrer apenas uma variabilidade ou adaptacao.

Análise comparativa da mastigação de crianças respiradoras nasais e orais com dentição decídua

PURPOSE: to investigate the possible alterations caused by breathing modus in mastication in a group of children with complete first teething, nasal and mouth breathing. Method: 46 children took part in this investigation (23 children were nasal breathing- NB and 23 children mouth breathing- MB). Children were enrolled in two public kindergartens in Sao Caetano do Sul. Their parents were asked to fill out a form in order to collect information about their childrens breathing. This data was related with oral miofunctional evaluation to check the childrens breathing modus. NB and MB groups were formed and a mastication function evaluation was carried out by observation means and videoing the children while they were masticating French bread. RESULTS: fontal bite: NB, 91.3%; MB, 82.6%. Alternate bilateral mastication: NB, 78.3%; MB, 82.0%. Vertical and rotating movements: NB, 95.7%; MB, 100%. Average time of mastication of NB group: 24.0 sec.; average time of MB group: 15.9 sec. Symmetry of average volume taken: NB, 73.9%; MB, 73.9%. Without any residue of food: NB, 73.9%; MB, 39.1%. Absence of noise: NB, 91.3%; MB, 60.9%. Open lips: NB, 4.3%; MB, 56.5%; Symmetry of masseter and temporalis muscles: NB, 100%; MB, 100% in both groups. CONCLUSION: significant statistical difference occurred in breathing modus comparison, negatively affecting some aspects of mouth breathings mastication, which were mastication time, residue of food in the oral cavity, lips posture and noise during mastication.

Postura, tônus e mobilidade de lábios e língua de crianças respiradoras orais

PURPOSE: to characterize lips and tongue posture, tone and mobility of mouth breathing children. METHOD: the subjects of this study, conducted in Sao Paulo, SP, Brazil, were 40 mouth breathing children, 26 (65%) male and 14 (35%) female, aging between 7 and 10-year old. MBGR protocol was used to evaluate the aforementioned aspects. RESULTS: the following results were obtained for lip posture: semi-open lips (32.5%), alternating between open and closed lips (27.5%), open lip posture (22.5%) and closed lips (17.5%). With regards to the upper lip tone: 90% showed normal muscle tone, 10% lower tone, and no subjects showed a higher muscle tone. As for the tone of the lower lip, 80.0% of the children showed lower muscle tone, and 20.0% normal muscle tone. For the lips mobility variable, 100% had their mobility close to the best scores. Regarding tongue posture, 57.5% had a low-lying resting tongue posture, 32.5% did not allow for observation of this variable, and in 10.0% of the subjects the tongue was placed in an interdental resting posture. As for tongue muscle tone, 52.5% showed lowered tone, and 47.5% were considered normal. When assessing tongue mobility, 100% had mobility close to the best scores. CONCLUSION: characteristics of posture, tone and mobility of lips in this studys mouth breathing children were: semi-opened lip posture, upper lip with normal tone, lower lip with lowered tonicity and normal mobility. Regarding tongue characteristics: low-lying resting posture, lowered muscle tone and normal mobility.

Voz e disfunção temporomandibular em professores

OBJETIVO: Verificar a presenca e possivel correlacao entre alteracao vocal e disfuncao temporomandibular (DTM), em professores, a partir de dados de avaliacao auto-referida, fonoaudiologica, otorrinolaringologica e odontologica. JUSTIFICATIVA: Esta pesquisa foi planejada partindo do pressuposto de que pode haver correlacao entre a presenca de alteracao de voz e DTM. Na presenca dessa correlacao, atividades que envolvam a promocao de saude e prevencao de alteracoes, tanto relacionadas a DTM quanto a voz, auxiliarao os professores a melhorar suas condicoes de saude e, consequentemente, de trabalho. METODO: Participaram deste estudo, de natureza transversal observacional, 29 professores de uma escola da rede publica do ensino fundamental e medio, do municipio de Sorocaba/SP. O estudo foi desenvolvido por uma equipe multidisciplinar, composta por um medico otorrinolaringologista, duas fonoaudiologas e um odontologo (especialista em cirurgia bucomaxilofacial). Todos os professores responderam questionario auto-referido (adaptado de BIANCHINI, 2000 e FERREIRA et al., 2007), que contou com questoes relativas a identificacao, aspectos concernentes a alteracoes vocais e queixas referentes a disfuncao da articulacao temporomandibular. Em seguida, passaram por quatro avaliacoes: qualidade de voz (avaliacao perceptivo-auditiva); exames de laringe (videonasolaringoscopia), motricidade orofacial e odontologico. Foi considerado como alteracao de voz e de DTM aquele que apresentou tres ou mais sinais e/ou sintomas no questionario, avaliacoes de motricidade orofacial e odontologica. Na analise estatistica dos dados, foram empregados o Teste Exato de Fisher e o de Concordância Kappa. RESULTADOS: 82,8% dos participantes fizeram auto-referencia a alteracao vocal e 62,1% de sintomas de DTM; 51,7%, alteracao de voz na otorrinolaringologica e 65,5%, alteracao de DTM na avaliacao odontologica. Na comparacao das propostas de avaliacao de alteracao de voz e DTM foi registrada tendencia significativa para a aplicacao do questionario. Por outro lado, tanto na analise da relacao, quanto na de concordância foi a avaliacao fonoaudiologica (perceptivo-auditiva da voz e de motricidade orofacial para DTM) que se mostrou significativa

O corpo do cantor: alongar, relaxar ou aquecer?

BACKGROUND: physical exercises and singing. PURPOSE: to make a reflection on the difference among stretching, relaxation and warm-up and theirs benefits for singers. CONCLUSION: warm-up and stretching exercises are complementary to preparation of singers. Warm-up prevents injuries; is favorable for stretching and provides us with better vocal folds vibration. The stretching aids to maintain posture and opening the thorax. The relaxation is not advisable to prepare the singing, because it may compromise the motor control. Vocalize is an excellent exercise for warm-up and stretching as for the vocal folds, but it must come anteceded by body warm-up, with emphasis on the extrinsic and intrinsic muscles of the larynx, without sound emission.

Caracterização vocal de pacientes com hipertireoidismo e hipotireoidismo

ABSTRACT Purpose: To characterize the vocal quality of subjects with hyperthyroidism (group A), and hypothyroidism (group B) through acomputer-aided and auditory-perceptive analysis. Methods: Twenty non-smoking women with ages between 18 and 55 years fromthe Endocrinology Ambulatory of the institution were evaluated after clinical and lab diagnosis for hyperthyroidism orhypothyroidism. The parameters investigated were: period bearing the disease, vocal complaint, maximum phonation time /a/, /s/,and /z/, fundamental frequency (F 0 ), glottal noise (GNE). The aspects evaluated in the auditory-perceptive analysis were: pneumo-phono-articulatory coordination (coordinated or uncoordinated), pitch, loudness, vocal attack, resonance, speech speed and vocalquality, that could be classified as one or two of the following: neutral, hoarse, whispered, coarse, or tense, and degree: light, moderateor severe. Data were statistically analyzed through the EPI-INFO 6.04b software, Fisher qualitative method, considering a significancelevel of 0.05.

Relação entre cefalometria e análise facial na determinação do tipo de face

PURPOSE: to correlate the cephalometrical findings with the ones from facial analysis performed by means of photographs to classify facial type, according to the gender. METHODS: 105 leukoderm adults took part, 34 male (32.4%) and 71 female (67.6%) with ages between 20 and 40 years old, in a private orthodontic clinic in Belo Horizonte, MG - Brazil. The cephalometrics analysis findings for determining facial type from the Ricketts VERT index were compared with the facial classification performed by means of clinical facial analysis based on observation of two photographs. For this analysis, three Speech and Language Pathologists specialized in orofacial myology were involved. RESULTS: there was no satisfactory correspondence when comparing the two forms of facial type classification presented in this study. Most of the dolichofacial males were classified as medium face by means of facial analysis, meaning four among seven subjects (57.14%). The eleven mesofacial subjects were identified as medium face (N=5; 45.45%) or short (N=4; 36.36%) and the 16 braquifacial subjects as medium face (N=9; 56.25%) or short (N=7; 43.75%). With females, it was observed that 11 among 20, meaning 55% of the dolichofacial individuals were appointed as medium face. Among the 26 mesofacial subjects, 16 (61.53%) were also classified as medium face. Regarding the 25 braquifacial subjects, 12 (48%) were identified as short face and 11 (44%), as medium. CONCLUSION: facial type classification based only on facial analysis performed by means of photographs was not considered trustworthy, if used independently, when compared with cephalometrics analysis findings.

Proposta para determinação do tipo facial a partir da antropometria

PURPOSE To describe orofacial indexes and proportions in adults, according to facial type and gender, and to verify the possibility to establish a way of classifying face based on anthropometry. METHODS Participants were 105 leukoderm adults, 34 male (32.4%) and 71 female (67.6%), with ages between 20 and 40 years old, patients in a private orthodontic clinic in Belo Horizonte, Minas Gerais, Brazil. The findings from the cephalometric analysis contained in their orthodontic records were used for determination of facial type. Subjects were divided according to gender and facial type, and were submitted to anthropometric facial measures obtained directly through a caliper rule. These measures were compared to six variables: facial index, lower face index, upper face index, chin-face height proportion, chin height proportion, and mandibular height proportion. RESULTS The average values obtained by the subjects divided into genders and facial types that presented significant differences were: facial index, lower face index, upper face index, and mandibular height proportion for males, and mandibular height proportion, for females. To predict facial types, the following parameters were considered significant: facial index, upper face index and mandibular height proportion for the dolichofacial type, for males; and mandibular height proportion for the dolichofacial and lower face index for the brachyfacial type, for females. CONCLUSION Some indexes and orofacial proportions present variations according to facial types and genders. In general, the anthropometric variables in this study are not good predictors to determine facial types.

Apoio respiratório na voz cantada: perspectiva de professores de canto e fonoaudiólogos

PURPOSE: to analyze the definition of breath support, as well as the strategies used to achieve it and their benefits according to both singing teachers and Speech Language Pathologists (SLP). METHODS: six professionals experienced in singing voice answered an interview on issues pertaining to singing breath support. The answers were submitted to content analysis from where four categories were derived: definition of breathing support, type of support, strategies and benefits. RESULTS: the aspects that were most often reported by the professionals are: the definition of breath support is related to the participation of the diaphragm and intercostal muscles; the most adequate type of support is intercostal and diaphragmatic; among the strategies used to improve breathing support, the most commonly mentioned were body perception, awareness of the muscles involved in the process, air flow balance, tension relief and posture alignment. There are discrepancies as for the abdominal contraction, use of different objects as guidelines, mental imagery, and use of singing exercises - vocalizes. According to the interviewed subjects, the greatest benefit of breath support lies in the relief of laryngeal tensions and improvement of respiratory coordination. There was a low level of agreement about the benefits of support, especially with regards to the improvement of the singing voice. CONCLUSION: the results point out to a convergence of opinions as for most of the interviewed subjects when considering the definition, approach strategies and benefits of breathing support, however, still with no consensus on the subject.