Alteração vocal em idosos ativos e fatores associados / Vocal alteration in active elderly and associated factors

RESUMO Objetivo Verificar a suspeição de alteração vocal em idosos ativos e a associação com aspectos sociodemográficos, hábitos de vida relacionados à voz e desvantagem vocal. Métodos Estudo observacional transversal realizado com 254 idosos usuários de academias públicas do município de Belo Horizonte (MG). A coleta de dados incluiu uma entrevista, contendo informações sociodemográficas, hábitos de vida relacionados à voz e autorrelato de rouquidão, além da aplicação dos protocolos Índice de Desvantagem Vocal (IDV-10) e Rastreamento de Alteração Vocal em Idosos (RAVI). O resultado do RAVI foi considerado a variável resposta. Os dados foram submetidos à análise descritiva e de associação, por meio dos testes Qui-quadrado de Pearson e Regressão de Poisson, com variância robusta (nível de significância de 5%). Resultados Verificou-se que a maioria dos idosos era do sexo feminino (83,5%), na faixa etária de 60 a 70 anos (65,4%), aposentada (84,9%) e sem companheiros (61,8%). Segundo o protocolo RAVI, 44,5% dos idosos apresentaram suspeição de alteração vocal. Na análise multivariada, as variáveis autorrelato de rouquidão e desvantagem vocal apresentaram associação com a suspeição de alteração vocal mensurada pelo RAVI. Conclusão Foi elevada a suspeição de alteração vocal em idosos ativos, sendo maior entre os idosos com autorrelato de rouquidão e com desvantagem vocal.

ABSTRACT Purpose To verify suspected vocal alterations in active elderly and its association with sociodemographic, voice-related lifestyle habits and vocal handicap aspects. Methods Cross-sectional observational study conducted with 254 elderly users of public health gyms in Belo Horizonte municipality. Data collection included an interview containing sociodemographic information, voice-related life habits and hoarseness self-report, in addition to the application of protocols: vocal handicap index (IDV-10) and screening for voice disorders (RAVI in Portuguese). The result of RAVI was considered the outcome variable. The data were subject to descriptive and association analysis using Pearson's Chi-square and Poisson Regression tests with Robust variance (5% significance level). Results It was found that the majority of the elderly are female (83.5%), aged 60 to 70 years (65.4%), retired (84.9%) and without a partner (61.8%). According to the RAVI protocol, 44.5% of them are suspected of voice alteration. Through multivariate analysis, the self-reported variables of hoarseness and vocal handicap showed association with suspected vocal changes measured by RAVI. Conclusion The vocal alteration suspicion was high in the elderly actives. The suspicion of vocal alteration was higher among the elderly with self-reported hoarseness and with vocal handicap.

Hoarseness and vocal tract discomfort and associated risk factors in air traffic controllers / Rouquidão, desconforto do trato vocal e fatores de risco associados em controladores de tráfego aéreo

Abstract Introduction: An air traffic controller is a professional who performs air traffic control functions in air traffic control units and is responsible for controlling the various stages of a flight. Objective: To compare hoarseness and vocal tract discomfort and their risk factors among air traffic controllers in the approach control of São Paulo. Methods: In a cross-sectional survey, a voice self-evaluation adapted from to self-evaluation prepared by the Brazilian Ministry of Labor for teachers was administered to 76 air traffic controllers at approach control of São Paulo, Brazil. Results: The percentage of hoarseness and vocal tract discomfort was 19.7% and 38.2%, respectively. In relation to air pollution, the percentages of hoarseness and vocal tract discomfort were higher among those who consider their working environment to be intolerable than among those in a comfortable or disturbing environment. The percentage of hoarseness was higher among those who seek medical advice due to vocal complaints and among those who experience difficulty using their voice at work than among those who experience mild or no difficulty. The percentage of vocal tract discomfort was higher among those in a very tense and stressful environment than among those who consider their work environment to be mild or moderately tense and stressful. The percentage of vocal tract discomfort was higher among those who describe themselves as very tense and stressed or tense and stressed than among those who describe themselves as calm. Additionally, the percentage of vocal tract discomfort was higher among those who care about their health. Conclusion: Among air traffic controllers, the percentage of vocal tract discomfort was almost twice that of hoarseness. Both symptoms are prevalent among air traffic controllers who considered their workplace intolerable in terms of air pollution. Vocal tract discomfort was related to a tense and stressful environment, and hoarseness was related to difficulty using the voice at work.

Resumo Introdução: O controlador de tráfego aéreo é um profissional que executa funções de controle de tráfego aéreo em unidades de controle de tráfego aéreo e são responsáveis por controlar as várias fases de um voo. Objetivo: Comparar a rouquidão e o desconforto no trato vocal e seus fatores de risco em controladores de tráfego aéreo no centro de controle de aproximação de São Paulo. Método: Em um estudo transversal, uma autoavaliação de voz adaptada da autoavaliação preparada pelo Ministério do Trabalho para professores foi administrada a 76 profissionais do centro de controle de aproximação de São Paulo, Brasil. Resultados: A porcentagem de rouquidão e desconforto no trato vocal foi de 19,7% e 38,2%, respectivamente. Em relação à poluição do ar, as porcentagens de rouquidão e desconforto no trato vocal foram maiores entre aqueles que consideram seu ambiente de trabalho como intolerável do que entre aqueles em um ambiente confortável ou incômodo. A porcentagem de rouquidão foi maior entre aqueles que procuram assistência médica devido a queixas vocais e entre aqueles que têm dificuldade de usar a voz no trabalho do que entre aqueles que experimentam dificuldade leve ou não apresentam dificuldades. A porcentagem de desconforto no trato vocal foi maior entre aqueles em um ambiente muito tenso e estressante do que entre aqueles que consideram seu ambiente de trabalho leve ou moderadamente tenso e estressante. A porcentagem de desconforto no trato vocal foi maior entre aqueles que se descrevem como muito tensos e estressados ou tensos e estressados do que entre aqueles que se descrevem como calmos. Além disso, a porcentagem de desconforto no trato vocal foi maior entre aqueles que se preocupam com sua saúde. Conclusão: Entre os controladores de tráfego aéreo, a porcentagem de desconforto no trato vocal foi quase o dobro da rouquidão. Ambos os sintomas são prevalentes entre os controladores de tráfego aéreo que consideram o seu local de trabalho intolerável em termos de poluição do ar. O desconforto no trato vocal foi associado a um ambiente tenso e estressante e a rouquidão foi associada à dificuldade de usar a voz no trabalho.

Epidemiología de los trastornos respiratorios del sueño en pediatría / Epidemiology of pediatric respiratory sleep disorders

Pediatric sleep medicine has shown a considerable development during the last decades; however, sleep disorders epidemiology is varied and limited, mainly by the various definitions used. This articucle refers to prevalence data obtained by studies that include medical history, questionnaires and/or sleep studies. It includes the analysis of factors that may influence its epidemiology: age, gender, obesity, prenatal factores, ethnicity, socieconomic status and influence of some respiratory diseses susch as asthma and rhinitis. In addiction, aspects related to the natural evolution of respiratorty sleep disorders are described

La medicina del sueño pediátrica ha avanzado considerablemente durante las últimas décadas; sin embargo la evidencia epidemiológica es variada y limitada, principalmente por las diversas definiciones empleadas. El presente artículo profundiza sobre aspectos de prvalencia mediante estudios de anamnesis, cuestionarios y/o estudios de sueño; se incluye el análisis de factores que pueden influir en su epidemiología; edad, género, obesidad, factores prenatales, etnia genética, nivel socioeconómico e influencia de algunas enfermedades respiratorias como asma y rinitis. Adicionalmente, se describen aspectos relacionados con la evolución natural de los trastornos respiratorios del sueño

Factores ambientales y hábitos vocales en docentes y funcionarios de pre-escolar con alteraciones de voz / Environmental factors and vocal habits regarding pre-school teachers and functionaries suffering voice disorders

Objetivo Determinar la relación existente entre los hábitos vocales y condiciones ambientales/ ocupacionales, con la presencia de alteraciones vocales (disfonía) en docentes y funcionarios de centros sociales de educación inicial. Método Estudio descriptivo transversal en una población de 198 sujetos, que se llevó a cabo en tres fases. Fase 1: Identificación de los sujetos con mayor riesgo de presentar una alteración vocal. Fase 2: Observación-análisis del uso de la voz y los hábitos vocales de los sujetos identificados en la fase 1. Fase 3: Evaluación perceptual y computarizada de la voz, a través del Perfil Vocal de Wilson y el Multidimensional Voice Program, respectivamente. Resultados Se encontró que sujetos con quiebres tonales, carraspera, intensidad de la voz aumentada y reflujo gastroesofágico presentaron una frecuencia fundamental (Fo) por debajo de la norma. Aquellos con respiración alterada e intensidad de la voz aumentada, mostraron tener los valores acústicos de Shimmer y Jitter por encima de la norma. Conclusiones Existe un alto índice de incapacidad laboral a causa de alteraciones vocales. Se sugiere relación entre los hábitos laborales a los que están expuestas las educadoras iniciales y la existencia de alteraciones vocales.

Objective Determining the relationship between vocal habits and environmental/ occupational conditions with the presence of vocal disturbance (dysphonia) in teachers and functionaries working at community-based, initial childhood education centres (kindergartens). Method This was a descriptive study which adopted across-sectional approach using 198 participants which was developed in three phases. Phase 1: consisted of identifying participants having the highest risk of presenting vocal disturbance. Phase 2consisted of observation-analysis concerning the voice use and vocal habits of participants who had been identified in phase 1. Phase 3consisted of perceptual and computational assessment of participants' voices using Wilson's vocal profile and the multidimensional voice program. Results Individuals having pitch breaks, throat clearing, increased voice intensity, and gastro-oesophageal reflux were found to present below standard fundamental frequency (FF). Subjects having altered breathing and increased voice intensity were identified as having above standard shimmer and jitter acoustic values. Conclusions A high rate of inability to work was found due to vocal disturbance. It is thus suggested that there is a correlation between vocal habits and vocal disorders presented by preschool teachers in kindergarten settings.

Síndrome disfônica ocupacional: novos aspectos desta entidade nosológica / Dysphonic occupational syndrome: new aspects of this nosological entity

Introdução: Professores apresentam frequentemente disfunções fonatórias que se beneficiam de medidas preventivas. Objetivo: Determinar a prevalência da síndrome disfônica em professores e verificar a evolução deste índice com técnicas de prevenção primária. Método: Foi realizado um estudo de corte transversal em professores em duas épocas distintas: na fase 1 participaram 101 professores e, na fase 2, 148 professores. A estes dois grupos foi aplicado o questionário elaborado pela Comissão Tripartite de Normatização da Voz Profissional. Resultados: A prevalência da síndrome disfônica na primeira fase foi de 70,3%, enquanto que na segunda fase foi de 57,59%. Conclusão: 1ª a prevalência da síndrome disfônica sofreu redução significativa com a implementação do controle médico preventivo e da organização do trabalho. 2ª a síndrome disfônica é uma nova entidade nosológica. Estudo epidemiológico de corte transversal. Estudo de série.

Introduction: Teachers often have vocal disorders that benefit from preventive measures. Objective: To determine the prevalence of the syndrome in dysphonic teachers and check the evolution of this index with the techniques of primary prevention. Method: We performed a cross-sectional study of teachers in two different periods: in the first 101 teachers and participated in phase 2, 148 teachers. These two groups was administered the questionnaire prepared by the tripartite commission on regulation of the professional voice. Results: The prevalence of the syndrome dysphonic in the first phase was 70.3%, while the second stage was 57.59%. Conclusion: 1st dysphonic the prevalence of the syndrome was significantly decreased with the implementation of preventive and medical control of work organization. 2nd dysphonic syndrome is a new nosological entity. Cross-sectional epidemiological study. Study series.

Incidência de rouquidão em alunos do último ano dos cursos de licenciatura / Incidence of hoarseness in students of the last year of degree courses

Introdução: Os professores representam um dos grupo mais freqüentemente acometido por alterações vocais, sob a pena do surgimento de sintomas disfônicos, prejudiciais ao prosseguimento do magistério. Objetivo: Avaliar a ocorrência de rouquidão em alunos do último ano dos cursos de licenciatura de uma Instituição de Ensino Superior. Método: Realizou-se estudo prospectivo, individuado, observacional e transversal, entrevistando-se 100 alunos quanto a aspectos clínicos, pessoais e profissionais,através de questionário próprio. Resultados: Dos 100 alunos 65% já lecionam em pelo menos uma instituição de ensino. Do total dos alunos que já lecionam 83,08% apresentam algum tipo de sintoma relacionado ao uso inadequado da voz. Dentre os alunos que já lecionam em instituições, apenas 26,15% relatam manter habitualmente algum cuidado com a voz enquanto 73,85% dizem não ter esse hábito. 83,33% dos estudantes ao apresentarem algum sintoma relacionado a voz não buscam atendimento médico. Dentre as queixas a tríade: dor ou irritação (27,33%), pigarro (21,33%) e rouquidão (21,33%) foram constatados como as de maior freqüência. A sintomatologia foi de 27% nos que usam pouca água, contrastando com os 8% dos que fazem o uso de muita água. Conclusão: Mais da metade dos alunos pesquisados já trabalhavam como professor e apresentavam queixa de rouquidão. É fundamental que orientações vocais sejam fornecidas durante esses cursos de graduação

Introduction: Teachers are the group most affected by vocal problems, under penalty of the appearance of dysphonia symptoms, more or less early, damaging the continuation of the teaching. Aim: The authors intended to assess the occurrence of hoarseness in the last year students of the degrees courses. Method: Prospective, individual, observational and cross study, interviewed 100 students collecting clinical, personal and business information. Results: Among the 100 students 65% already teaches in at least one institution of education. Of the total of students who already teaches 83.08% have some type of symptom related to the misuse of the voice. Among the students who already teaches, only 26.15% reported usually maintain some care with the voice, while 73.85% do not have.83.33% of the students when present a symptom related to the voice do not look for medical attention. Among the complaints the triad:pain or irritation (27.33%), hawk (21.33%) and hoarseness (21.33%) were identified as those of higher frequency.The symptoms was 27% for that one who usually drink less water, contrasting with 8% of those who drink more. Conclusion: More than half of students surveyed had been working as a teacher and presented complaints of hoarseness. It is essential that guidelines are provided vocal during those courses for graduation.

Comparitive study between different types and sizes of laryngeal mask in spontaneous ventilation as regard to postoperative morbidity

The aim of this study was to identify the relationship between laryngeal mask airway [LMA] size and shape and pharyngolaryngeal morbidity after the use of a large [size 5 in males and size 4 in females] or small [size 4 in males and size 3 in females] and the use of proseal laryngeal mask.One hundred and fifty patients were included in this study. One hundred patients were allocated to insertion of a large or small LMA while breathing spontaneously during general anaesthesia. Another 50 patients [25 male and 25 femal] were allocated to insertion of the streamlined pharynx airway [proseal LMA]. The 2- and 24-h postoperative incidence of sore throat, pain, hoarseness, dysphagia, nausea and vomiting were assessed. After LMA removal, complications, as body movement, coughing, retching, regurgitation, vomiting, biting on the LMA, bronchospasm, laryngospasm, or the presence of blood on the LMA, were recorded. The use of a large LMA was associated with a higher incidence of sore throat in both sexes [20%vs. 7% in men, 21%vs. 5% in women; P < 0.05] 2 hour postoperative and at 24 h postoperatively a higher incidence of sore throat occurred in male patients [26%vs. 12%, P < 0.05]. Also a higher incidence of hoarseness occurred in male patients at 2 h postoperatively [21%vs. 9%, P < 0.05]. There were no difference in the incidence of complications of LMA removal such as difficulty swallowing, drinking, and eating, or nausea and vomiting, between male or female groups at any time period with the use of a large LMA.The use of the proseal larynx geal mask was without complaining of sore throat nor presence of blood on it upon removal. Insertion of this airway proved to be no more difficult than inserting a LMA. On conclusion; the use of a small laryngeal mask airway [size 4] in spontaneously breathing male patients and [size 3] in female patients and the proseal LMA may be more appropriate to decrease the incidence of sore throat on the first postoperative day

effect of local heat on incidence of sore throat and hoarseness after endotracheal intubation

Sore-throat and hoarseness are the most common complication after endotracheal intubation which take place 12-24 hr after operation. Different studies have reported the incidence of these complications between 24-90%. Increase of heat on the trachea will raise the blood pressure in the local capillaries and therefore induce better blood supplementation to the local tissues. This study aimed to evaluate the effect of local heat on the incidence of sore- throat and hoarseness after endotracheal intubations. One hundred and sixty patients aging 15 -50 years old, candidate for elective surgeries under general anesthesia, were randomly divided into two groups. Patients for head and neck surgeries were excluded from the study. Methods of intubation, type, size, cuff pressure of ETT, method of anesthesia and time of operation were the same for all patients. During the operation time, local heat was applied on the external surface of trachea [up to 40 [oc] by using electrical blanket for the patients in the study group. 24 hr after operation all the patients were visited by anesthesiologist for evaluating the sore- throat and hoarseness. The incidence of sore-throat in the control group was 65% versus 40% in the study group [p<0.05]. Moreover the incidence of hoarseness was 66.2% in the control group versus 10% in the case group. Application of local heat [40[oc] on the external surface of trachea can effectively decreases the incidence of postoperative sore - throat and hoarseness

Gastro-esophageal reflux disease in northwestern Tabriz, Iran.

OBJECTIVE: To determine the prevalence of gastroesophageal reflux disease (GERD), diagnosed based on the presence of frequent heartburn, in the general population in northwest area of Tabriz, Iran. METHODS: In this cross-sectional study performed during May 2000. 4207 persons were chosen by systematic randomized sampling from a total population of approximately 230,000 persons. Heartburn occurring at least thrice in the recent two weeks was taken as evidence of GERD. Symptoms were correlated with the individual's diet. RESULTS: The prevalence of GERD was 2.7%. In 80% of them, specific types of food aggravated heartburn. Waterbrash (42.8%) was the most common associated symptom. CONCLUSION: The prevalence of GERD in Tabriz is less than that reported from Western countries but is similar to that in other Asian countries.