Vanessa Pedrosa Vieira

Transfer function of Brazilian Portuguese oral vowels: a comparative acoustic analysis

The vocal tract transfers its characteristics onto the sounds produced at the glottis, depending on its tridimensional configuration. Aim: this study aims to...

Configuracão das pregas vestibulares à fonacão em adultos com e sem disfonia

The real participation of the vestibular folds during phonation mechanism is unknown. How vestibular folds change their configuration during phonation is still unclear. Learning about these changes in the functional mechanism of vestibular fold would be helpful for the evaluation of pathological conditions. AIM: The objective of the present study was to analyze the configuration of laryngeal vestibular folds during phonation (sustained emission of vowel /µ/) by comparing exams of individuals without vocal complaints (the normal voice group) with those with vocal complaints. STUDY DESIGN: Transversal simple study. MATERIAL AND METHOD: 120 images of larynges were analyzed, 60 of normal voice individuals and 60 of dysphonic subjects, with equal gender distribution. The position of the free margin of the vestibular fold was identified in relation to a straight line that brought together the anterior and posterior insertions. Regarding this position, three types of configurations were described: concave, when it was in a lateral position, convex when it was in a medial position, and linear when it overlapped. RESULTS: Out of the 240 vestibular folds, 158 were concave, 41 convex and 31 linear. The concave form was predominant in both groups in relation to the other two forms, although the number of convex and linear forms increased in the dysphonic group. Analyzing the behavior of these forms in each gender we noticed that among women, the linear form was significantly increased in the dysphonic group, whereas among men there was significant increase in convex form. CONCLUSION: We concluded that there were differences in behavior of vestibular folds in the dysphonic group in relation to the normal voice group, and that the differences occurred differently in both gender groups.

Presentation of the Comprehensive Vocal Rehabilitation Program for the treatment of behavioral dysphonia

Voice rehabilitation is the main treatment option in cases of behavioral dysphonia, and it has the purpose of enhancing the quality of vocal production and voice-related life aspects. Several efforts have been made to offer a clinical practice that is based on evidence, including the development of specific therapeutic protocols as an option for clinical and scientific improvement. It is necessary to define the focus/objective of the dysphonia treatment, type of approach, and duration in order to establish the intervention criteria. This paper describes the organization of a program of behavioral dysphonia treatment, based on an approach that has been used for over twenty years, named Comprehensive Vocal Rehabilitation Program, and also to present its concepts, theory, and practical fundamentals. The program has an eclectic approach and associates body work, glottal source, resonance, and breathing coordination in addition to knowledge about vocal hygiene and communicative behavior. The initial proposal suggests a minimum time of intervention of six therapeutic sessions that can be adapted according to the patients learning curve and development. The goal is to offer a rational and structured therapeutic approach that can be reproduced in other scenarios.

The research questions and methodological adequacy of clinical studies of the voice and larynx published in Brazilian and international journals

OBJECTIVE To evaluate the methodological adequacy of voice and laryngeal study designs published in speech-language pathology and otorhinolaryngology journals indexed for the ISI Web of Knowledge (ISI Web) and the MEDLINE database. METHODS A cross-sectional study conducted at the Universidade Federal de São Paulo (Federal University of São Paulo). Two Brazilian speech-language pathology and otorhinolaryngology journals (Pró-Fono and Revista Brasileira de Otorrinolaringologia) and two international speech-language pathology and otorhinolaryngology journals (Journal of Voice, Laryngoscope), all dated between 2000 and 2004, were hand-searched by specialists. Subsequently, voice and larynx publications were separated, and a speech-language pathologist and otorhinolaryngologist classified 374 articles from the four journals according to objective and study design. RESULTS The predominant objective contained in the articles was that of primary diagnostic evaluation (27%), and the most frequent study design was case series (33.7%). A mere 7.8% of the studies were designed adequately with respect to the stated objectives. There was no statistical difference in the methodological quality of studies indexed for the ISI Web and the MEDLINE database. CONCLUSION The studies published in both national journals, indexed for the MEDLINE database, and international journals, indexed for the ISI Web, demonstrate weak methodology, with research poorly designed to meet the proposed objectives. There is much scientific work to be done in order to decrease uncertainty in the field analysed.

O modo de coaptação glótica em crianças no diagnóstico diferencial de alteração estrutural mínima

The glottal closure varies during phonation, even in subjects who bears no vocal complaints and no alterations on medical examination, according to age, sex, vocal register, fundamental frequency, tension and lesions. There has been noticed complete or incomplete junction of the vocal fold free boarder; when incomplete there are formation of chinks presenting different formats. AIM: Our point is to find in the glottal coaptation mode, during sustained phonation of the vowel /e/, in children having minor structural alterations, components that allow us to set them apart from subjects having vocal nodule or from subjects presenting no vocal complaints. MATERIAL AND METHOD: We have used a retrospective study of childrens data assisted from 1996 to 2001, composed of childrens larynx images that presented diagnosis of minor structural alterations, vocal nodule and also of children not showing any vocal complaints. From these images there has been analyzed the glottal configuration during phonation of the vowel /e/ and there has been realized statistical analysis to compare the three groups. RESULTS:The triangular chinks are found in the three groups, while the spindle chink only occurred in minor structural alterations. CONCLUSION: The use of glottal coaptation mode in children as a diagnosis criterion to set the minimal structural alteration apart from the vocal nodule and regular larynx is important when we observe spindle chink, a situation found only in the minimal structural alterations. The triangular chinks were not meaningful to differentiate minimal structural alterations from vocal nodule and from regular larynx.

Análise das modificações vocais de repórteres na situação de ruído

PURPOSE: To investigate and compare the occurrence of vocal changes in the presence of masking noise between reporters and other professionals. METHODS: Participants were 46 subjects with normal hearing, 23 reporters (study group) and 23 non-reporters (control group). Participants read an excerpt from a TV news broadcast in three listening situations: without masking noise, with 50 dB white noise, and with 90 dB white noise. The narrations were recorded and then submitted to auditory-perceptual and acoustic analyses. The auditory-perceptual analysis was performed by a speech-language pathologist specialized in voice. The acoustic analysis used the software Voxmetria (CTS Informatica) to perform the acoustic measurements. RESULTS: In the situation with 50 dB masking noise, individuals in the control group had higher increase of the following parameters, when compared to the group of reporters: pitch (82.6%), loudness (91.3%), and strain (82.6%). The same occurred in the situation with 90 dB masking noise for the same parameters: pitch (95.7%), loudness (100%) and strain (91.3%). CONCLUSION: The negative consequences of the Lombard effect occur in both groups; however, reporters showed the ability to partially inhibit the negative impact of noise situations, probably due to the stability of the professional speech production and activation of other feedback pathways.

Modifications of vestibular fold shape from respiration to phonation in unilateral vocal fold paralysis.

The diversity of vestibular fold (VeF) behavior during phonation, as well as the lack of insight regarding both the anatomy and muscle fiber composition hinder our understanding of their role during phonation. The concave shape of the free margin of VeF appears to be standard, but little is known regarding the variability of this shape. We, therefore, sought to determine the laryngoscopic features related to changes in the free margin of the VeFs during phonation in patients with unilateral vocal fold paralysis. Laryngeal images from 39 patients with unilateral paralysis associated with recurrent laryngeal nerve damage were evaluated with regard to variations in length and shape of the VeFs (concave, straight, or convex) during both respiration and phonation. The VeFs on both the paralyzed and unaffected sides were analyzed during both phonation and respiration resulting in 156 total images. During phonation, all VeFs on the nonparalyzed side were straight or convex, whereas on the paralyzed side, only 20 of the 39 were straight or convex during phonation. During respiration, significant differences in the shape of the nonparalyzed side were observed. During phonation, a nonconcave appearance on the paralyzed side usually correlated with a similar appearance during respiration. VeF length decreased during phonation in 30 nonparalyzed VeFs in contrast to only 13 paralyzed folds. When subjects switched from respiration to phonation, the VeFs were typically nonconcave on the nonparalyzed side. In contrast, on the paralyzed side, nonconcave VeFs were consistent across both tasks. In patients with unilateral vocal fold paralysis, VeF conformation is likely determined from extralaryngeal than intrinsic muscle. These findings have important theoretical considerations for laryngeal treatment.

Aplicações de Gelfoam® como tratamento de emergência na insuficiência glótica em cantora

Gelfoam® , a product referred to patients presenting unilateral vocal fold paralysis, was applied to a female singer who showed glottic insufficiency by vocal fold atrophy and who needed urgently to proceed with her professional activities. The product was applied through percutaneous and translumination viae, in clinic, and followed by vocal assessments to confirm the efficacy of the treatment. There were realized two series with one year of interval, both with two applications, respectively 28 and 30 days. The result was positive allowing the patient to return to her activities and to conclude her work during the period that Gelfoam®, that was in progressive absorption, permitted a glottic coaptation compatible with the necessities of the voice use.

Vestibular fold configuration during phonation in adults with and without dysphonia

UNLABELLED The real participation of the vestibular folds during phonation mechanism is unknown. How vestibular folds change their configuration during phonation is still unclear. Learning about these changes in the functional mechanism of vestibular fold would be helpful for the evaluation of pathological conditions. AIM The objective of the present study was to analyze the configuration of laryngeal vestibular folds during phonation (sustained emission of vowel /mu/) by comparing exams of individuals without vocal complaints (the normal voice group) with those with vocal complaints. STUDY DESIGN Transversal simple study. MATERIAL AND METHOD 120 images of larynges were analyzed, 60 of normal voice individuals and 60 of dysphonic subjects, with equal gender distribution. The position of the free margin of the vestibular fold was identified in relation to a straight line that brought together the anterior and posterior insertions. Regarding this position, three types of configurations were described: concave, when it was in a lateral position, convex when it was in a medial position, and linear when it overlapped. RESULTS Out of the 240 vestibular folds, 158 were concave, 41 convex and 31 linear. The concave form was predominant in both groups in relation to the other two forms, although the number of convex and linear forms increased in the dysphonic group. Analyzing the behavior of these forms in each gender we noticed that among women, the linear form was significantly increased in the dysphonic group, whereas among men there was significant increase in convex form. CONCLUSION We concluded that there were differences in behavior of vestibular folds in the dysphonic group in relation to the normal voice group, and that the differences occurred differently in both gender groups.

The difficult management of patients with respiratory segmental dystonia

UNLABELLED Respiratory dystonia is a rare and difficult to diagnose disorder, that causes breathing restriction of various degrees. The objective of the study is to report the case of a patient with respiratory dystonia involving the larynx and the pharynx and its evolution concerning spasms intensity and control. CASE REPORT A 24 year-old-man has been followed for 5 years. The diagnosis was made by means of nasofibroscopy and electromyography. Treatment was carried out with laryngeal and pharyngeal Botulin toxin injections, as it became necessary for symptoms control. CONCLUSION The difficult management can be secondary to the lack of knowledge on the etiology and physiopathology of the impairment, and because of the limitations in the treatment of associated respiratory symptoms.