Efeito da estimulação das habilidades auditivas de fonoaudiólogos para avaliação perceptiva do desvio vocal / Effect of stimulation of auditory skills of speech-language pathologists to perceptual evaluation of vocal deviation

RESUMO Objetivo Verificar se a estimulação das habilidades auditivas de fonoaudiólogos com e sem dificuldades no processamento auditivo central (PAC) interfere no desempenho da avaliação perceptivo-auditiva (APA) do desvio vocal predominante. Métodos Estudo prospectivo, quase-experimental, realizado com 26 fonoaudiólogos, desenvolvido em cinco etapas: Etapa1: Pré-intervenção - primeira APA, composta por 30 amostras da vogal sustentada /ε/, acrescidas de 20% de repetição (seis amostras repetidas), apresentadas randomicamente, na qual os participantes deveriam identificar o desvio vocal predominante; Etapa 2: Triagem das habilidades do PAC com nove testes da plataforma AudBility; Etapa 3: Treinamento perceptivo-auditivo do desvio vocal predominante e segunda APA, idêntica à anterior; Etapa 4: Intervenção - estimulação das habilidades auditivas (EHA), realizada por 14 fonoaudiólogos, sendo oito que não passaram na triagem da Etapa 2 (Grupo1) e seis que passaram na triagem e, espontaneamente, realizaram a EHA (Grupo G2a). Os outros 12 participantes não realizaram EHA e formaram o Grupo G2b; Etapa 5: Pós-intervenção - realização da terceira APA, idêntica às anteriores, por todos os fonoaudiólogos. A acurácia das respostas e confiabilidade intra-avaliadores foram verificadas ao longo das três APAs. Resultados Os três grupos apresentaram desempenhos semelhantes nas três APAs. G1 e G2a não apresentaram melhora no desempenho da análise do desvio vocal predominante pós-EHA. A confiabilidade intra-avaliador pré-intervenção no G1 foi inferior a do G2a e G2b nas APA1 e APA2, e similar a eles na APA3, pós-intervenção. Conclusão EHA proposto não impactou a acurácia da APA, mas influenciou a confiabilidade intra-avaliador dos fonoaudiólogos com dificuldades nas habilidades auditivas do PAC.

ABSTRACT Purpose To verify if the stimulation of auditory skills of speech therapists with and without difficulty in auditory processing (CAP) interferes in performance of auditory-perceptual assessment (APA) regarding predominant vocal deviation. Methods Prospective, quasi-experimental study, conducted with 26 speech therapists and developed in five stages: Stage1: Pre-intervention - APA, composed of 30 samples of sustained vowel emissions /ε/, plus 20% repetition (six repeated samples) in which participants should identify the predominant vocal deviation. Stage2: Screening of CAP skills through nine tests of AudBility web platform. Stage3: Perceptual-auditory training of predominant vocal deviation and, later, second APA, identical to previous one. Stage4: Intervention - Stimulation of auditory skills (EHA) performed by 14 participants, eight of which failed the screening from Stage2 and six who passed th e screening and spontaneously performed EHA (Group G2a ). The other 12 participants did not perform EHA and formed the G2b Group. Stage5: Post-intervention - Third execution of APA, identical to previous, by all participants. Accuracy of analysis and intra-rater reliability were assessed in all APAs. Results The three groups showed similar performances in the three APAs. G1 and G2a showed no improvement in the performance of the analysis of predominant vocal deviation after EHA. Pre-intervention intra-rater reliability in G1 was lower than in G2a and G2b in APA1 and APA2, and similar to them in APA3, post-intervention. Conclusion Proposed EHA had no impact on APA accuracy, but influenced in intra-rater reliability of speech therapists with difficulty in the hearing skills of CAP.

The Efficacy of Voice Screening Using the Thyroidectomy Related Voice Questionnaires / 대한이비인후과학회지

Most common cause of vocal dysfunction after thyroidectomy is nerve injury, but an understanding of the anatomy and surgical techniques associated with such voice problems reduces the risk of damage to these nerves. Despite these efforts, many patients still suffer from voice-related problems without obvious accidental nerve injury or vocal-cord palsy. The possible causes of vocal dysfunction without nerve injury are a strap muscle contraction due to surgery, impairment of laryngeal movement, laryngeal trauma after endotracheal intubation, modification of the vascular supply, and psychological problem. However, multiple means of assessing vocal function are time-consuming, require specific instruments and specialists, and increase costs. Thus, the authors developed the Perioperative Voice-Screening Protocol for Thyroid Surgery using the Thyroidectomy-Related Voice Questionnaire (TVQ). This questionnaire was developed at our institution and is a self-assessment tool that measures quality of voice. It consists of 20 questions; responses to each are scored from a minimum of 0 (no voice alterations or symptoms) to a maximum of 80 (highest voice impairment and multiple vocal symptoms). This questionnaire was developed based on the voice handicap index and it concern general voice complaints, representative symptoms related to LPR and vocal cord palsy, and swallowing-related symptoms associated with thyroidectomy. Based on the results of the study, we recommend that a preoperative voice work-up should be performed in patients with a high preoperative TVQ score (≥5). We also recommend that a postoperative voice work-up should be performed in patients with a high postoperative TVQ score (≥25).