Nair Kátia Nemr

Comparative Analysis of the Closed Quotient for Lip and Tongue Trills in Relation to the Sustained Vowel /ε/

Various types of trill exercises have been used for a long time as a tool in the treatment and preparation of the voice. Although they are reported to produce vocal benefits in most subjects, their physiology has not yet been studied in depth. The aim of this study was to compare the mean and standard deviation of the closed quotient in exercises of lip and tongue trills with the sustained vowel /ε/ in opera singers. Ten professional classical (operatic) singers, reportedly in perfect laryngeal health, served as subjects for this study and underwent electroglottography. During the examination, the subjects were instructed to deliver the sustained vowel /ε/ and lip and tongue trills in a same preestablished frequency and intensity. The mean values and standard deviation of the closed quotient were obtained using the software developed for this purpose. The comparison of the results was intrasubjects; maximum intensities were compared only among them and so were minimum intensities. The means of closed quotient were statistically significant only in the strong intensities, and the lip trill was different from the tongue trill and the sustained vowel /ε/. The standard deviation of the closed quotient distinguished the sustained vowel /ε/ from the lip and tongue trills in the two intensities. We concluded that there is oscillation of the closed quotient during the exercises of tongue and lip trills, and the closed quotient is higher during the performance of exercises of the lip trill, when compared with the two other utterances, only in the strong intensities.

Impacto de treinamento auditivo na avaliação perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia

OBJETIVO: Analisar o impacto de treino auditivo na avaliacao perceptivo-auditiva da voz realizada por estudantes de Fonoaudiologia. METODOS: Durante dois semestres, 17 estudantes que cursavam disciplinas teoricas de fonacao (Fonacao/Disturbios da Fonacao) analisaram amostras de vozes alteradas e nao alteradas (selecionadas para este estudo), por meio da escala GRBAS. Todos receberam treinamento auditivo durante um total de nove encontros semanais, com cerca de 15 minutos de duracao cada. Em cada encontro foi apresentado um parâmetro, por meio de vozes diferentes da amostra avaliada, com predominância no aspecto treinado. A avaliacao das amostras por meio da escala foi realizada pre e pos o treinamento e em outros quatro momentos ao longo dos encontros. As avaliacoes dos alunos foram comparadas com uma avaliacao de juizas, realizada previamente por tres fonoaudiologos, especialistas em voz. Para verificar a efetividade do treinamento foi usado o teste de Friedman e Indice de Concordância Kappa. RESULTADOS: O indice de acertos dos alunos no momento pre-treinamento foi considerado entre regular e bom. Observou-se manutencao do numero de acertos ao longo das avaliacoes realizadas, para a maioria dos parâmetros da escala. No momento pos-treinamento observou-se melhora na analise da astenia, parâmetro enfatizado a partir das dificuldades apresentadas pelos alunos. Houve diminuicao dos acertos no parâmetro rugosidade apos este ter sido trabalhado de maneira segmentada em rouquidao e aspereza, e associado a diferentes diagnosticos e parâmetros acusticos. CONCLUSAO: O treino auditivo potencializa as habilidades iniciais dos alunos, refinando-as para realizacao da avaliacao, alem de nortear ajustes em dinâmicas das disciplinas.

Efeito do ruído na voz de educadoras de instituições de educação infantil

OBJETIVO: Evaluar la asociacion entre niveles de ruido presentes en centros de educacion infantil y alteraciones vocales en educadoras. METODOS: Estudio transversal con 28 educadoras de tres instituciones de educacion infantil de Sao Paulo, Sureste de Brasil, en 2009. Los niveles de presion sonora se cuantificaron segun Asociacion Brasilena de Normas Tecnicas, con uso de medidor de nivel de presion sonora. Los promedios se clasificaron segun los niveles de conforto, incomodidad y dano auditivo propuestos por la Organizacion Panamericana de Salud. A las educadoras se les evaluo la voz: auto-evaluacion con escala analogica visual, evaluacion perceptivo-auditiva con escala GRBAS y analisis acustico con el programa Praat. Para analisis de asociacion entre ruido y evaluacion vocal, se utilizo estadistica descriptiva y prueba de chi-cuadrado, con 10% de significancia debido al tamano de la muestra. RESULTADOS: Las educadoras presentaban edades entre 21 y 56 anos. El promedio de ruido fue 72,7dB, considerado dano 2. La auto-evaluacion vocal de las profesionales presento promedio de 5,1 en la escala, considerada alteracion moderada. En la evaluacion perceptivo-auditiva, 74% presentaron alteracion vocal, principalmente ronquera; de estas, 52% fueron consideradas alteraciones leves. La mayor parte presento frecuencia fundamental por debajo de lo esperado en la evaluacion acustica. Promedios de jitter, shimmer y proporcion armonico-ruido estaban alterados. Presencia de ruido entre los armonicos se asocio a alteracion vocal. CONCLUSIONES: Hubo asociacion entre presencia de ruido entre armonicos y alteracion vocal, con elevados niveles de ruido. A pesar de que la mayoria de las educadoras presentaron voz alterada en grado reducido, la auto-evaluacion mostro alteracion moderada, probablemente por la dificultad de proyeccion.

The effect of noise on the voice of preschool institution educators

OBJETIVO: Evaluar la asociacion entre niveles de ruido presentes en centros de educacion infantil y alteraciones vocales en educadoras. METODOS: Estudio transversal con 28 educadoras de tres instituciones de educacion infantil de Sao Paulo, Sureste de Brasil, en 2009. Los niveles de presion sonora se cuantificaron segun Asociacion Brasilena de Normas Tecnicas, con uso de medidor de nivel de presion sonora. Los promedios se clasificaron segun los niveles de conforto, incomodidad y dano auditivo propuestos por la Organizacion Panamericana de Salud. A las educadoras se les evaluo la voz: auto-evaluacion con escala analogica visual, evaluacion perceptivo-auditiva con escala GRBAS y analisis acustico con el programa Praat. Para analisis de asociacion entre ruido y evaluacion vocal, se utilizo estadistica descriptiva y prueba de chi-cuadrado, con 10% de significancia debido al tamano de la muestra. RESULTADOS: Las educadoras presentaban edades entre 21 y 56 anos. El promedio de ruido fue 72,7dB, considerado dano 2. La auto-evaluacion vocal de las profesionales presento promedio de 5,1 en la escala, considerada alteracion moderada. En la evaluacion perceptivo-auditiva, 74% presentaron alteracion vocal, principalmente ronquera; de estas, 52% fueron consideradas alteraciones leves. La mayor parte presento frecuencia fundamental por debajo de lo esperado en la evaluacion acustica. Promedios de jitter, shimmer y proporcion armonico-ruido estaban alterados. Presencia de ruido entre los armonicos se asocio a alteracion vocal. CONCLUSIONES: Hubo asociacion entre presencia de ruido entre armonicos y alteracion vocal, con elevados niveles de ruido. A pesar de que la mayoria de las educadoras presentaron voz alterada en grado reducido, la auto-evaluacion mostro alteracion moderada, probablemente por la dificultad de proyeccion.

Análise vocal acústica: efeito do treinamento auditivo-visual para graduandos de Fonoaudiologia

Purpose: To verify the effectiveness of a training for acoustic voice assessment with undergraduate students of Speech-Language Pathology. Methods: Study conducted with 14 undergraduate students of Speech-Language Pathology who participated in six theoretical/practical weekly encounters, whose total duration was four hours and a half. Basic concepts of acoustic voice assessment was performed; we used spectrographic analysis to each parameter, visually and auditory. In order to verify the proposal’s effectiveness, the undergraduate students assessed before and after de training, the measures of automatic extraction of the evaluation measures and also aspects of narrowband spectrograph of 15 voices, normal and disordered in varying degrees. We considered the performance of students, before and after the training comparing their mistakes and correct scores to a previous analysis performed by a specialist with Kappa index >0.70. To compare the results obtained by the undergraduate students in the two instances McNemar test was performed. Results: For all parameters analyzed the average of correct scores was higher after the training, as well as the overall average (24.2% before and 93.0% after). Conclusion: The developed training was effective for the learning of undergraduate students, and may be included into subjects which involve concepts of voice assessment and also might be transformed into teaching material available to other groups.

Disfonia como principal queixa num quadro de miastenia grave: diagnóstico e fonoterapia

Myasthenia gravis is an autoimmune disease, manifested by progressive muscular weakness and fatigue. There are frequent ocular and bulbar symptoms, among them, dysphonia. This article reports a case of dysphonia that contributed to the diagnosis of myasthenia gravis through a speech evaluation. The patient sought speech therapy with the ENT diagnosis of presbyphonia. The perceptual voice assessment and acoustic analysis pointed out respiration, glottal voice source and resonance affections. Considering that some of the data obtained from anamnesis and vocal assessments were not directly related to presbyphonia, the speech therapist discussed the case with the physician and they both concluded it was necessary to refer the patient to a neurological evaluation. The neurologist then raised the diagnostic hypotheses of myasthenia gravis and requested further examinations. The patient underwent speech therapy and drug treatment. A vocal reassessment, which occurred two months after the initial treatment, showed improvement in voice quality, with great impact on quality of life. This article shows the importance of detailed clinical speech evaluation and participation of a speech therapist in an interdisciplinary team.

A PERCEPÇÃO DO ACOMPANHANTE E DO INDIVÍDUO COM RONCO/SAOS ANTES E APÓS FONOTERAPIA

Purposes the purpose of this study was to evaluate the perception of bed partners, auto-evaluate individuals with snoring/obstructive sleep apnea syndrome, collect cervical and abdominal circumferences before and after speech therapy, and conduct a myofunctional evaluation to associate the results with the severity of sleep disorder. Methods eleven patients between ages 25 and 75 years, of both genders presenting a recent polysomnographic diagnosis of obstructive sleep apnea syndrome of mild to severe and/or primary snoring were selected as subjects. All patients were subjected to speech therapy, myofunctional clinical assessment, and Berlin (adapted) and Epworth questionnaires before and after therapy. Results the data obtained were statistically analyzed with the Wilcoxon test (α = 0.05). Two individuals did not adhere to the treatment. No significant difference was observed between the initial and the final cervical and abdominal circumferences (cervical p = 0.069 / abdominal p = 0.789). All the patients improved their suprahyoid muscles tonus, lowering of the back of tongue, soft palate, bilateral chewing, speech, and nasal breathing. The results of the Berlin questionnaire showed a reduction in the perception of the bed partner in snoring intensity (p = 0.005) more so than frequency (p = 0.05). Significant reductions of the excessive diurnal somnolence were observed in all the patients (p = 0.000). Conclusions considering the limitations of this study, it could be concluded that after speech therapy the perceptions of the patients with obstructive sleep apnea syndrome/snoring and their bed partners was that their sleep and life quality was improved, there was a reduction of snoring intensity, and an improved in their daily activities due to the excessive diurnal somnolence reduction.

Efecto del ruido en la voz de las educadoras de instituciones de educación infantil

OBJETIVO: Evaluar la asociacion entre niveles de ruido presentes en centros de educacion infantil y alteraciones vocales en educadoras. METODOS: Estudio transversal con 28 educadoras de tres instituciones de educacion infantil de Sao Paulo, Sureste de Brasil, en 2009. Los niveles de presion sonora se cuantificaron segun Asociacion Brasilena de Normas Tecnicas, con uso de medidor de nivel de presion sonora. Los promedios se clasificaron segun los niveles de conforto, incomodidad y dano auditivo propuestos por la Organizacion Panamericana de Salud. A las educadoras se les evaluo la voz: auto-evaluacion con escala analogica visual, evaluacion perceptivo-auditiva con escala GRBAS y analisis acustico con el programa Praat. Para analisis de asociacion entre ruido y evaluacion vocal, se utilizo estadistica descriptiva y prueba de chi-cuadrado, con 10% de significancia debido al tamano de la muestra. RESULTADOS: Las educadoras presentaban edades entre 21 y 56 anos. El promedio de ruido fue 72,7dB, considerado dano 2. La auto-evaluacion vocal de las profesionales presento promedio de 5,1 en la escala, considerada alteracion moderada. En la evaluacion perceptivo-auditiva, 74% presentaron alteracion vocal, principalmente ronquera; de estas, 52% fueron consideradas alteraciones leves. La mayor parte presento frecuencia fundamental por debajo de lo esperado en la evaluacion acustica. Promedios de jitter, shimmer y proporcion armonico-ruido estaban alterados. Presencia de ruido entre los armonicos se asocio a alteracion vocal. CONCLUSIONES: Hubo asociacion entre presencia de ruido entre armonicos y alteracion vocal, con elevados niveles de ruido. A pesar de que la mayoria de las educadoras presentaron voz alterada en grado reducido, la auto-evaluacion mostro alteracion moderada, probablemente por la dificultad de proyeccion.