Priscila Oliveira Costa Silva

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.

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.

Relação entre os sintomas vocais, intensidade do desvio vocal e diagnóstico laríngeo em pacientes com distúrbios da voz

Purpose To investigate whether there is an association between the frequency of occurrence of vocal symptoms, the intensity of vocal deviation and laryngeal diagnosis in patients with different voice disorders. Methods The study included 330 patients with vocal complaints. The patients were divided into five groups according to the laryngeal diagnosis: G1- without laryngeal lesions; G2 -benign vocal fold lesions; G3 - voice disorder of neurological origin; G4 -incomplete glottal closure without organic or neurologic cause; and G5 - voice disorder secondary to gastroesophageal reflux. All participants responded to the Voice Symptom Scale (VoiSS) and recorded the sustained /ɛ/ vowel, which was analyzed for the intensity of vocal deviation using a visual analog scale. Results There were differences in total VoiSS scores and in scores for the impairment and physical domains among the different diagnostic groups. Patients with lesions in the membranous portion of the vocal folds presented more vocal symptoms than those in the other diagnostic groups. There was a positive correlation between the intensity of vocal deviation and the total, limitation and emotional VoiSS scores. Patients with moderate and intense vocal deviation showed a greater number of vocal symptoms than patients with healthy voices or with mild deviations. Conclusion There is an association between laryngeal diagnosis, the intensity of vocal deviation and vocal symptoms. Patients with benign vocal fold lesions and more intense vocal deviations have a higher frequency of vocal symptoms.

Relationship between working and voice conditions self-reported by telemarketers of an emergency call center

Purpose To investigate whether there is association between vocal symptoms, voice complaint, and working and voice conditions self-reported by telemarketers. Methods Study participants were 72 telemarketing operators, both genders, who work in an emergency call center. They responded to a questionnaire on personal data, voice complaints, vocal symptoms, and working conditions. Data analysis was performed using the Chi-square, Mann-Whitney, and Fishers Exact tests. Results Correlation was found between the telemarketers in the study group and voice disorder complaint for aspects of working condition, such as noisy working environment, and aspects of voice condition, such as change in the voice and workplace absence. Differences were observed between the mean of auditory vocal symptoms of participants for echo in the work room, change in voice, and workplace absence, as well as between the mean of their sensory vocal symptoms in relation to the variables stressful work rate, noisy working environment, noise from other rooms, echo in the work room, radio use, change in voice, and workplace absence. Conclusion Correlation was found between the presence of vocal complaints, number of auditory and sensory vocal symptoms, and working conditions self-reported by the telemarketers surveyed.

Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Evaluation of Patients With Voice Disorders

OBJECTIVES We aimed to correlate the Vocal Tract Discomfort Scale (VTDS) with the Voice Symptom Scale (VoiSS) for evaluation of patients with dysphonia. In addition, we aimed to compare vocal tract discomfort symptoms in patients with and without self-reported voice problem. STUDY DESIGN This is a descriptive, cross-sectional, and retrospective study. We analyzed 143 women and 62 men with voice disorders, as confirmed by endoscopic larynx examination. All patients completed the VTDS and VoiSS at vocal evaluation. Descriptive statistics and the Spearman correlation test were applied to all variables. The degree of covariance of variables was noted. The Mann-Whitney U test was used to compare the average number of discomfort symptoms among patients with and without self-reported voice problems. RESULTS A weak to moderate positive correlation was observed between the average number, frequency, and intensity of comfort symptom and the total score, physical domain score, and limitation domain score of the VoiSS. The vocal tract discomfort symptoms and the emotional domain score of the VoiSS were weakly correlated. Patients with self-reported voice problems had a higher number, frequency, and intensity of vocal tract discomfort symptoms. CONCLUSION There is correlation between the VTDS and VoiSS scales, with greater references to vocal tract discomfort symptom in patients with self-reported voice problems. Therefore, the discomfort symptoms seem to influence the perception of the impact of a voice problem.

Performance of the phonatory deviation diagram in the evaluation of rough and breathy synthesized voices

INTRODUCTION Voice disorders alter the sound signal in several ways, combining several types of vocal emission disturbances and noise. The phonatory deviation diagram is a two-dimensional chart that allows the evaluation of the vocal signal based on the combination of periodicity (jitter, shimmer, and correlation coefficient) and noise (Glottal to Noise Excitation) measurements. The use of synthesized signals, where one has a greater control and knowledge of the production conditions, may allow a better understanding of the physiological and acoustic mechanisms underlying the vocal emission and its main perceptual-auditory correlates regarding the intensity of the deviation and types of vocal quality. OBJECTIVE To analyze the performance of the phonatory deviation diagram in the discrimination of the presence and degree of roughness and breathiness in synthesized voices. METHODS 871 synthesized vocal signals were used corresponding to the vowel /ɛ/. The perceptual-auditory analysis of the degree of roughness and breathiness of the synthesized signals was performed using visual analogue scale. Subsequently, the signals were categorized regarding the presence/absence of these parameters based on the visual analogue scale cutoff values. Acoustic analysis was performed by assessing the distribution of vocal signals according to the phonatory deviation diagram area, quadrant, shape, and density. The equality of proportions and the chi-square tests were performed to compare the variables. RESULTS Rough and breathy vocal signals were located predominantly outside the normal range and in the lower right quadrant of the phonatory deviation diagram. Voices with higher degrees of roughness and breathiness were located outside the area of normality in the lower right quadrant and had concentrated density. CONCLUSION The normality area and the phonatory deviation diagram quadrant can discriminate healthy voices from rough and breathy ones. Voices with higher degrees of roughness and breathiness are proportionally located outside the area of normality, in the lower right quadrant and with concentrated density.

Performance of Phonatory Deviation Diagrams in Synthesized Voice Analysis

Objective: To analyze the performance of a phonatory deviation diagram (PDD) in discriminating the presence and severity of voice deviation and the predominant voice quality of synthesized voices. Method: A speech-language pathologist performed the auditory-perceptual analysis of the synthesized voice (n = 871). The PDD distribution of voice signals was analyzed according to area, quadrant, shape, and density. Results: Differences in signal distribution regarding the PDD area and quadrant were detected when differentiating the signals with and without voice deviation and with different predominant voice quality. Differences in signal distribution were found in all PDD parameters as a function of the severity of voice disorder. Conclusion: The PDD area and quadrant can differentiate normal voices from deviant synthesized voices. There are differences in signal distribution in PDD area and quadrant as a function of the severity of voice disorder and the predominant voice quality. However, the PDD area and quadrant do not differentiate the signals as a function of severity of voice disorder and differentiated only the breathy and rough voices from the normal and strained voices. PDD density is able to differentiate only signals with moderate and severe deviation. PDD shape shows differences between signals with different severities of voice deviation.

Estágio de prontidão de pacientes com disfonia comportamental pré e pós-terapia de voz de grupo.

Purpose To verify the efficacy of group voice therapy in the stage of readiness and identify which items of the URICA-Voice range are more sensitive to post-therapy change in patients with behavioral dysphonia. Methods An intervention study was conducted on 49 patients with behavioral dysphonia. An eclectic approach to group therapy was implemented over eight sessions, the first and last sessions consisting of assessments. The URICA-Voice range was used to evaluate the stage of readiness at pre- and post-therapy assessments. A descriptive and inferential statistical analysis was implemented for the results. Results Most participants were female, did not make professional use of voice, and had membranous vocal fold lesions. Most of them were in the Contemplation stage at in both moments, pre- and post-therapy. There was no significant change in the comparison of pre- and post-therapy scores. The majority of patients showed a reduction in the stage of readiness and some advanced to a higher stage. In the comparison of URICA-V range items, seven questions had equal or inferior responses in the post-therapy assessment. Conclusion There was no statistical difference when comparing the pre- and post-therapy total average score of the URICA-Voice range. There were significant changes in the stage of readiness of patients in pre- and post-group speech therapy assessments.

Sintomas sensoriais em pacientes submetidos à tireoidectomia

Purpose To verify the occurrence of sensory symptoms in thyroidectomy patients pre- and post-operatively. Methods This is a prospective, quantitative, descriptive study conducted with a sample of twelve patients undergoing thyroidectomy. The participants underwent visual laryngeal examination and responded to the Upper Aerodigestive Symptoms (UADS) and Vocal Tract Discomfort Scale (VTDS) questionnaires before and after the surgery. Results There was higher occurrence of vocal fatigue, hoarseness, pharyngeal bolus, dry throat, and throat clearing preoperatively, whereas higher occurrence of hoarseness, vocal fatigue, cough, and pharyngeal bolus was observed postoperatively for the UADS. Regarding the VTDS sensory symptoms, higher frequency and severity of throat dryness were observed preoperatively, whereas more frequent tickling throat and more severe irritable and sore throat and lump in the throat were observed postoperatively. There was reduction in the choke symptom and in the frequency and severity of the throat dryness symptom pre- and post-operatively. With respect to the frequency and severity of vocal tract discomfort sensory symptoms, reduction in throat dryness was observed at both assessment times. Conclusion The patients presented sensory symptoms of upper aerodigestive tract and vocal tract discomfort pre- and post-operatively characterized by self-reference of hoarseness, vocal fatigue, pharyngeal bolus, and cough, as well as dry, sore, and irritable throat. Reduction in the sensory symptom of choke and in the frequency and severity of throat dryness was self-reported by thyroidectomy patients postoperatively.