Effect of COVID-19 Quarantine on Voice Handicap Index in Female Classical Singers.

OBJECTIVE: This study aimed to verify the impact of vocal deviation in the quality of life of classical female singers over the quarantine imposed by the COVID-19 pandemic through self-assessments. METHODS: Fifty five professional classical female singers filled out an online questionnaire including general questions such as identification, age, professional experience time, vocal classification, time of singing, and rehearsal studies. They all answered the protocol Classical Singing Handicap Index, adapted for this research, which analyses three subscales: Disability, Handicap, and Impairment. RESULTS: There was no significant difference in the perceived total handicap index score (40% of 120 points). Regarding the three domains analyzed, Disability was significantly higher than Impairment (P = 0.012). In addition, the correlation with the variables identified that Impairment subscale showed a negative correlation with the variable hours of rehearsal (r = -0.335, P = 0.040). CONCLUSIONS: The COVID-19 quarantine does not seem to cause a significant impact on the voice of professional classical female singers probably due to their degree of experience and vocal preparation.

Effects of intranasal oxytocin on the self-perception and anxiety of singers during a simulated public singing performance: A randomized, placebo-controlled trial.

Professional musicians experience intense social exposure and high levels of preoccupation with their performance and potential negative reactions from the audience, which favor anxiety. Considering that oxytocin (OXT) has a potential therapeutic effect on anxiety, cognitive processes, and decreased psychosocial stress, this study's objective was to assess the effects of a single dose of 24 UI of intranasal OXT among professional singers, during a public singing simulation test, on self-rated performance and mood. This crossover, randomized, double-blinded, placebo-controlled trial addressed 54 male singers with different levels of musical performance anxiety (42% high). The participants took part in different phases of a simulated public singing performance and completed instruments rating their performances (Self Statements During Public Performance- State version) and mood (Visual Analogue Mood Scale). Data were analyzed using ANOVA 2 × 2 for crossover trials. The results show that the use of OXT during the performance and immediate post-stress favored more positive (effect size: d > 1.04) and less negative assessments of musical performance (effect size: d > 1.86) than when placebo was used. No treatment effects were found in any VAMS subscales, indicating no direct anxiolytic effects. The conclusion is that OXT can minimizes social stress, especially during performances. This finding is exploratory and, if confirmed in future studies, may have relevance for musicians, especially those who constantly experience and recognize the impact of negative and catastrophic thoughts on performance and professional activities. Clinical Trial Registration: [https://ensaiosclinicos.gov.br/rg/RBR-5r5sc5], identifier [RBR-5r5sc5].

Vocal resistance among choir singers.

PURPOSE: The purpose of the present study was to compare the voice of choir singers before and after 60 min of singing and after an absolute rest. METHODS: Twenty-one female choir singers aged on average 26.59 years, with experience in choir singing of at least one year were instructed to emit the vowel /a/ before and after singing and after a vocal rest of 30 min for an analysis of acoustic measures, and for the evaluation of their tactile-kinesthetic self-perception. Vocal warm-up was performed for 10 min. The participants were instructed to sing the "Ave Verum" music continuously for 60 min. RESULTS: f0 (p = 0.0001) and Flo (p = 0.0002) increased after the singing test and were reduced after the vocal rest, in contrast to Fhi (p = 0.001), which continued to be increased compared to the pre-test measure even after the vocal rest. The vAm parameter (p = 0.05) was reduced after continuous singing and rest. All self-evaluation symptoms increased after the continuous singing task and were reduced after the 30 min rest, except for complaints of low voice, pain when swallowing and cough/throat clearing. CONCLUSION: 60 min of continuous use of the singing voice induced signs of vocal fatigue with an increase in f0, with improvement of symptoms and a reduction of f0 occurring after 30 min of vocal rest.

SWALLOWING IN PATIENTS WITH LARYNGITIS.

BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

Deglutição em pacientes com laringite / Swallowing in patients with laryngitis

ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

RESUMO CONTEXTO: Disfagia é uma queixa presente em 32% dos pacientes com laringite. OBJETIVO: O objetivo desta investigação foi avaliar o trânsito oral e faríngeo de pacientes com laringite, com a hipótese de que a alteração no trânsito do bolo pela boca e faringe pode estar envolvida com a queixa de disfagia. MÉTODOS: A avaliação videofluoroscópica da deglutição de bolos líquido, pastoso e sólido foi realizada em 21 pacientes com laringite, 10 deles com disfagia e 21 voluntários normais da mesma idade e sexo. Duas deglutições de 5 mL de bolo líquido, duas deglutições de bolo pastoso e duas deglutições de bolo sólido foram avaliadas em sequência casual definida por sorteio. Bolo líquido foi sulfato de bário 100%, e o bolo pastoso foi preparado com 50 mL de bário líquido e 4 g de espessante alimentar (amido e maltodextrina). O bolo sólido foi 2,2 g de uma bolacha macia embebida em bário líquido. A duração da preparação oral, trânsito oral, trânsito faríngeo, depuração da faringe, abertura do esfíncter superior do esôfago, movimento do hióide e do trânsito oral-faríngeo foram medidas. Precedendo a videofluoroscopia todos pacientes realizaram exame de pHmetria de 24 horas. RESULTADOS: O registro do pH intraesofágico distal revelou resultado anormal em 10 pacientes. Pacientes com laringite apresentaram maior duração da preparação oral para bolo pastoso e um tempo de trânsito oral mais rápido para bolo sólido. Os pacientes com laringite e disfagia tiveram uma preparação oral mais longa para bolo pastoso e sólido e tempo de trânsito oral menor com bolos líquido, pastoso e sólido. CONCLUSÃO: Preparação oral mais longa para bolos pastoso e sólido e trânsito mais rápido através da boca são situações associadas com a presença de disfagia em pacientes com laringite.

Fundamental Frequency and Formants Before and After Prolonged Voice Use in Teachers.

OBJECTIVES: This study aimed to describe and correlate the fundamental frequency behavior and the first four formants before and after exposure to usual and routinely prolonged voice use from teachers with over 4 years of experience in teaching. STUDY DESIGN: The study design is observational and transversal with quantitative and descriptive evaluations. METHODS: A total of 28 female teachers were subjected to the Screening Index for Voice Disorder (SIVD) and to recordings of the sustained vowel /a/ before and after exposure to prolonged voice use. Data were obtained about the fundamental frequency and the first four formants before and after voice use. Descriptive analysis and statistical processing were performed with P ≤ 0.05 for the general sample and in groups according to the outcome of the SIVD (normal and altered) and the evaluation period (morning or afternoon). RESULTS: The average exposure time to prolonged voice use was 176 minutes. There was no statistical difference in any of the variables studied. Correlations were positive and similar across all assessments before the class, something not observed in evaluations conducted after exposure to prolonged voice use. In the general sample, altered SIVD and afternoon period groups, the second formant from before-class measurements seems to interfere negatively in the fourth formant from after-class measurements. CONCLUSIONS: There were no changes in vocal behavior before and after exposure to prolonged voice use in the occupational environment. However, formants F1 and F2 measured before class correlated inversely with F4 after exposure to prolonged voice use.

Effect of the tracheoesophageal voice resistance test in total laryngectomees.

OBJECTIVES/HYPOTHESIS: To analyze tracheoesophageal voice resistance in laryngectomized patients by comparing the acoustic, perceptive-auditory and self-evaluation measures before and after the voice resistance test. STUDY DESIGN: An observational, experimental study with a quantitative and descriptive approach. METHODS: Nineteen total laryngectomees were submitted for capture of vocal intensity, self-assessment of signs and symptoms of voice fatigue using a visual analogue scale, and perceptive-auditory and acoustic analysis of the tracheoesophageal voice before and after the voice resistance test, which consisted of continuous repeated counting from one to 100. RESULTS: The mean time of execution of the test was 33.68 minutes. Type II sound signal, voice intensity, voice quality, degree of severity of dysphonia, and the pitch and loudness parameters were maintained after the test. There were no changes in signs and symptoms of vocal fatigue. CONCLUSIONS: Most of the total laryngectomees performed the voice resistance test for less than 30 minutes. However, the voice resistance test did not induce significant changes in the quality of tracheoesophageal voice of total laryngectomees or in the signs and symptoms of vocal fatigue. LEVEL OF EVIDENCE: 4 Laryngoscope, 2016 127:405-410, 2017.

Electrophysiological activity of the pharyngoesophageal transition of total laryngectomees.

OBJECTIVES/HYPOTHESIS: To determine the association of the electrophysiological activity of the pharyngoesophageal transition with tracheoesophageal speech proficiency in total laryngectomees. STUDY DESIGN: An observational (nonexperimental) study of the correlation type with a descriptive approach. METHODS: Thirty-four individuals (26 males), average age 62.5 years, total laryngectomees rehabilitated with the use of a tracheoesophageal prosthesis, were assessed for tracheoesophageal speech proficiency using an adapted protocol and classified as good, moderate, or poor speakers. Next they were submitted to electromyography of the muscles of the pharyngoesophageal transition with a needle electrode. The area to be examined was located by videofluoroscopy. Electromyographic analysis was characterized as normal, neurogenic injury (moderate to severe, severe, severe to total), myopathic injury, or inconclusive. The Fisher exact test was used to determine the association between the speech proficiency variables and electromyography. RESULTS: in the final rating of tracheoesophageal speech proficiency, most laryngectomees were categorized as moderate (n = 24) and a few as good (n = 3). Electromyography revealed neurogenic injury in all laryngectomees, which was severe in most cases (n = 20), followed by severe to total (n = 10), and moderate to severe injury (n = 4). There was no significant association between he electromyographic analyses of neurogenic injuries and tracheoesophageal speech proficiency. CONCLUSIONS: Whether or not the musculature of the pharyngoesophageal transition of tracheoesophageal speakers had a preserved motor unit, did not prevent voice acquisition and was not associated with tracheoesophageal speech proficiency. However, further studies are needed in this area. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:1369-1375, 2017.

Measurements of the Acoustic Speaking Voice After Vocal Warm-up and Cooldown in Choir Singers.

OBJECTIVES: The aim of this study was to evaluate the acoustic measurements of the vowel /a/ in modal recording before and after a singing voice resistance test and after 30 minutes of absolute rest in female choir singers. STUDY DESIGN: This is a prospective cohort study. METHODS: A total of 13 soprano choir singers with experience in choir singing were evaluated through analysis of acoustic voice parameters at three points in time: before continuous use of the voice, after vocal warm-up and a singing test 60 minutes in duration respecting the pauses for breathing, and after vocal cooldown and an absolute voice rest for 30 minutes. RESULTS: The fundamental frequency increased after the voice resistance test (P = 0.012) and remained elevated after the 30 minutes of voice rest (P = 0.01). The jitter decreased after the voice resistance test (P = 0.02) and after the 30 minutes of voice rest. A significant difference was detected for the acoustic voice parameters relative average perturbation (RAP), (P = 0.05), and pitch perturbation quotient (PPQ), (P = 0.04), compared with the initial time point. CONCLUSIONS: The fundamental frequency increased after 60 minutes of singing and remained elevated after vocal cooldown and absolute rest for 30 minutes, proving an efficient parameter for identifying the changes inherent to voice demand during singing.

Vocal Parameters and Self-Perception in Individuals With Adductor Spasmodic Dysphonia.

OBJECTIVE: The study aimed to compare and correlate perceptual-auditory analysis of vocal parameters and self-perception in individuals with adductor spasmodic dysphonia before and after the application of botulinum toxin. STUDY DESIGN: This is a prospective cohort study. METHODS: Sixteen individuals with a diagnosis of adductor spasmodic dysphonia were submitted to the application of botulinum toxin in the thyroarytenoid muscle, to the recording of a voice signal, and to the Voice Handicap Index (VHI) questionnaire before the application and at two time points after application. Two judges performed a perceptual-auditory analysis of eight vocal parameters with the aid of the Praat software for the visualization of narrow band spectrography, pitch, and intensity contour. RESULTS: Comparison of the vocal parameters before toxin application and on the first return revealed a reduction of oscillation intensity (P = 0.002), voice breaks (P = 0.002), and vocal tremor (P = 0.002). The same parameters increased on the second return. The degree of severity, strained-strangled voice, roughness, breathiness, and asthenia was unchanged. The total score and the emotional domain score of the VHI were reduced on the first return. There was a moderate correlation between the degree of voice severity and the total VHI score before application and on the second return, and a weak correlation on the first return. CONCLUSIONS: Perceptual-auditory analysis and self-perception proved to be efficient in the recognition of vocal changes and of the vocal impact on individuals with adductor spasmodic dysphonia under treatment with botulinum toxin, permitting the quantitation of changes along time.

Correlation of maximum phonation time and vocal intensity with intraluminal esophageal and pharyngoesophageal pressure in total laryngectomees.

OBJECTIVE: This study aimed to correlate maximum phonation time, vocal intensity, and dynamic extension with intraluminal esophageal and pharyngoesophageal segment pressure during tracheoesophageal phonation. DESIGN: Prospective analysis. SETTING: Tertiary academic hospital. METHODS: The study was conducted on 20 total laryngectomees with alaryngeal speech and with secondary insertion of a tracheoesophageal prosthesis who were submitted to vocal recording of maximum phonation time and vocal intensity (minimum, habitual, and maximum). The participants were then submitted to manometry for the determination of the amplitude of intraluminal esophageal (proximal, middle, and distal) and pharyngoesophageal segment pressure during phonation. RESULTS: A significant positive correlation was detected between habitual vocal intensity and the middle (0.004) and distal (0.05) esophagus, in addition to a correlation of maximum intensity with the middle esophageal portion (0.03). Dynamic extension showed correlation with the amplitude of esophageal pressure. There was no significant correlation between the variables studied and pressure of the pharyngoesophageal segment or between maximum phonation time and esophageal pressure amplitude. CONCLUSION: The middle and distal regions of the esophagus were found to be compliant, permitting an adjustment of vocal intensity. There was no correlation between maximum phonation time and the amplitude of esophageal and pharyngoesophageal segment pressure.

Nasalance and nasality of tracheoesophageal speech in total laryngectomee / Nasalancia e nasalidade da voz traqueosofagica em laringectomizados totais

OBJECTIVES: The objective of this study was to determine the rates of nasalance for total laryngectomized users of a tracheoesophageal voice prosthesis and correlate them with the findings of auditory-perceptual assessment of nasality. METHODS: In this study, 25 total laryngectomized users, including 20 men and five women, with a mean age of 63 years old participated. All the participants had a tracheoesophageal voice prosthesis and underwent treatment for the rehabilitation of tracheoesophageal communication. These patients were submitted to nasalance assessment using nasometry and auditory-perceptual evaluation of nasality and were rated by trained speech therapists. RESULTS: The nasalance values obtained for nasal (59.92%) and oral (18.64%) sentences were within the normal limits for laryngeal speakers of Brazilian Portuguese language. It was possible to observe the presence of nasality in nasal sentences and its absence in oral sentences among most speakers. Specificity was found to be 100% for nasal sentences and sensitivity was 100% for oral sentences. It was not possible to calculate these values for the oral sentences. CONCLUSIONS: Total laryngectomized patients with tracheoesophageal voice prostheses have adequate vocal nasality compatible with nasometry rates. .

OBJETIVOS: Determinar os índices de nasalância de laringectomizados totais usuários de prótese traqueoesofágica e correlacioná-los com os achados da avaliação perceptivo-auditiva da nasalidade. MÉTODOS: Participaram do estudo 25 laringectomizados totais, com idade média de 63 anos, sendo 20 do gênero masculino e cinco do feminino. Todos eram usuários de prótese traqueoesofágica e realizaram terapia fonoaudiológica para reabilitação da comunicação traqueoesofágica. Os laringectomizados foram submetidos à avaliação da nasalância, utilizando a nasometria e avaliação perceptivo-auditiva da nasalidade, por julgamento de fonoaudiólogos treinados. RESULTADOS: Os valores encontrados da nasalância para as frases nasais (59,92%) e para as orais (18,64%) estão dentro da normalidade para falantes laríngeos do português brasileiro. Foi possível perceber, na maioria dos falantes, presença de nasalidade nas frases nasais e ausência nas orais. O valor do teste de especificidade foi de 100% para as frases nasais e de sensibilidade, 100% para as frases orais. CONCLUSÃO: O laringectomizado total usuário de prótese traqueoesofágica apresenta nasalidade vocal adequada, compatível com índices nasométricos. .

Correlation of intraluminal esophageal pressure with the dynamic extension of tracheoesophageal voice in total laryngectomees.

PURPOSE: To evaluate and correlate the amplitude of esophageal contractions triggered by swallowing water with dynamic extension and habitual, strong and weak sound intensity in total laryngectomees wearing a tracheoesophageal prosthesis. METHODS: Thirty total laryngectomees using tracheoesophageal voice with a phonatory prosthesis were evaluated by measuring the amplitude of contractions in the proximal, middle and distal esophagus and the pressure of the pharyngoesophageal transition by manometry. In order to measure vocal intensity the subject was asked to emit phonation of the vowel /a/ at habitual, strong and weak intensity which was captured with a sound pressure meter. Dynamic extension was calculated by subtracting strong intensity from weak intensity. RESULTS: A positive correlation was observed between contraction amplitude and dynamic extension in the proximal (rho: 0.45; p=0.01) and distal (rho: 0.41; p=0.02) esophagus There was no correlation with other parameters.. Total laryngectomees wearing a phonatory prosthesis with a dynamic extension above 21 dBNPS had greater contraction amplitude than laryngectomees with a dynamic extension below this value. CONCLUSIONS: There was a positive correlation between pressure amplitude in the proximal and distal esophagus and increased dynamic extension. The individuals with normal dynamic extension had greater contraction amplitude in the proximal esophagus than individuals with dynamic extension lower than the expected values for age.

Correlation of intraluminal esophageal pressure with the dynamic extension of tracheoesophageal voice in total laryngectomees

PURPOSE: To evaluate and correlate the amplitude of esophageal contractions triggered by swallowing water with dynamic extension and habitual, strong and weak sound intensity in total laryngectomees wearing a tracheoesophageal prosthesis. METHODS: Thirty total laryngectomees using tracheoesophageal voice with a phonatory prosthesis were evaluated by measuring the amplitude of contractions in the proximal, middle and distal esophagus and the pressure of the pharyngoesophageal transition by manometry. In order to measure vocal intensity the subject was asked to emit phonation of the vowel /a/ at habitual, strong and weak intensity which was captured with a sound pressure meter. Dynamic extension was calculated by subtracting strong intensity from weak intensity. RESULTS: A positive correlation was observed between contraction amplitude and dynamic extension in the proximal (rho: 0.45; p=0.01) and distal (rho: 0.41; p=0.02) esophagus There was no correlation with other parameters.. Total laryngectomees wearing a phonatory prosthesis with a dynamic extension above 21 dBNPS had greater contraction amplitude than laryngectomees with a dynamic extension below this value. CONCLUSIONS: There was a positive correlation between pressure amplitude in the proximal and distal esophagus and increased dynamic extension. The individuals with normal dynamic extension had greater contraction amplitude in the proximal esophagus than individuals with dynamic extension lower than the expected values for age.

Effect of singing training on total laryngectomees wearing a tracheoesophageal voice prosthesis.

PURPOSE: To assess the effect of a program of singing training on the voice of total laryngectomees wearing tracheoesophageal voice prosthesis, considering the quality of alaryngeal phonation, vocal extension and the musical elements of tunning and legato. METHODS: Five laryngectomees wearing tracheoesophageal voice prosthesis completed the singing training program over a period of three months, with exploration of the strengthening of the respiratory muscles and vocalization and with evaluation of perceptive-auditory and singing voice being performed before and after 12 sessions of singing therapy. RESULTS: After the program of singing voice training, the quality of tracheoesophageal voice showed improvement or the persistence of the general degree of dysphonia for the emitted vowels and for the parameters of roughness and breathiness. For the vowel "a", the pitch was displaced to grave in two participants and to acute in one, and remained adequate in the others. A similar situation was observed also for the vowel "i". After the singing program, all participants presented tunning and most of them showed a greater presence of legato. The vocal extension improved in all participants. CONCLUSION: Singing training seems to have a favorable effect on the quality of tracheoesophageal phonation and on singing voice.

Effect of singing training on total laryngectomees wearing a tracheoesophageal voice prosthesis

PURPOSE: To assess the effect of a program of singing training on the voice of total laryngectomees wearing tracheoesophageal voice prosthesis, considering the quality of alaryngeal phonation, vocal extension and the musical elements of tunning and legato. METHODS: Five laryngectomees wearing tracheoesophageal voice prosthesis completed the singing training program over a period of three months, with exploration of the strengthening of the respiratory muscles and vocalization and with evaluation of perceptive-auditory and singing voice being performed before and after 12 sessions of singing therapy. RESULTS: After the program of singing voice training, the quality of tracheoesophageal voice showed improvement or the persistence of the general degree of dysphonia for the emitted vowels and for the parameters of roughness and breathiness. For the vowel "a", the pitch was displaced to grave in two participants and to acute in one, and remained adequate in the others. A similar situation was observed also for the vowel "i". After the singing program, all participants presented tunning and most of them showed a greater presence of legato. The vocal extension improved in all participants. CONCLUSION: Singing training seems to have a favorable effect on the quality of tracheoesophageal phonation and on singing voice.

Relation between the dimensions and intraluminal pressure of the pharyngoesophageal segment and tracheoesophageal voice and speech proficiency.

BACKGROUND: The objective of the present study was to relate the dimensions and the intraluminal pressure of the pharyngoesophageal segment (PES) to the voice and speech proficiency of total laryngectomees with a tracheoesophageal prosthesis (TEP). METHODS: Twenty total laryngectomees with secondary TEP insertion underwent evaluation of voice and speech, manometry, and videofluoroscopy. RESULTS: Most laryngectomees (65%) were moderate speakers. The poorer speakers presented a lower intraluminal pressure in the PES at rest (4.44 mmHg) and a higher value (40.46 mmHg) during phonation. Good speakers presented a significant difference in the anteroposterior distance between prominence of the PES and the posterior pharyngeal wall (PPES-PPW) in the rest (6.09 mm) to phonation (3.24 mm). CONCLUSIONS: The poorer speakers presented a lower intraluminal pressure in the PES at rest and a higher value during phonation compared with moderate speakers. Good speakers showed a significant difference in the PPES-PPW dimension.

Nasalance and nasality of tracheoesophageal speech in total laryngectomee.

OBJECTIVES: The objective of this study was to determine the rates of nasalance for total laryngectomized users of a tracheoesophageal voice prosthesis and correlate them with the findings of auditory-perceptual assessment of nasality. METHODS: In this study, 25 total laryngectomized users, including 20 men and five women, with a mean age of 63 years old participated. All the participants had a tracheoesophageal voice prosthesis and underwent treatment for the rehabilitation of tracheoesophageal communication. These patients were submitted to nasalance assessment using nasometry and auditory-perceptual evaluation of nasality and were rated by trained speech therapists. RESULTS: The nasalance values obtained for nasal (59.92%) and oral (18.64%) sentences were within the normal limits for laryngeal speakers of Brazilian Portuguese language. It was possible to observe the presence of nasality in nasal sentences and its absence in oral sentences among most speakers. Specificity was found to be 100% for nasal sentences and sensitivity was 100% for oral sentences. It was not possible to calculate these values for the oral sentences. CONCLUSIONS: Total laryngectomized patients with tracheoesophageal voice prostheses have adequate vocal nasality compatible with nasometry rates.

Competência glótica na doença pulmonar obstrutiva crônica / Glottal competence in chronic obstructive pulmonary disease

OBJETIVO: Correlacionar a medida do tempo máximo de fonação (TMF) com o volume de ar pulmonar expirado no primeiro segundo do sopro (VEF1) e comparar o TMF, emissão do "s", "z" e relação s/z em indivíduos saudáveis e indivíduos com doença pulmonar obstrutiva crônica (DPOC). MÉTODOS: Foram avaliados 14 voluntários saudáveis, com média de idade de 65 anos, e 16 indivíduos com DPOC, com média de idade de 68 anos. O diagnóstico da doença foi clínico e também obtido por exames da função pulmonar. Os participantes foram submetidos à espirometria para apreciação dos parâmetros VEF1, capacidade vital forçada (CVF) e o índice de Tiffeneau (VEF1/CVF). Registrou-se a emissão prolongada das vogais "a", "i", "u" para análise do tempo máximo de fonação na condição normal e forçada e aferiu-se a relação s/z após a sustentação dos fonemas /s/ e /z/. RESULTADOS: Nos dois grupos, o TMF com a fonação normal foi menor do que o tempo máximo de fonação, com a fonação forçada. A mediana do TMF do grupo controle foi maior do que a do grupo com DPOC, com a fonação normal e a fonação forçada. Não houve correlação entre o tempo máximo de fonação e os valores de VEF1 nos grupos. CONCLUSÃO: Pacientes com DPOC tem diminuição do tempo máximo de fonação e a relação s/z sugere falta de coaptação glótica. Não houve correlação do TMF e a medida do VEF1.

PURPOSE: This study correlates the extent of maximum phonation time (MPT) with the volume of air exhaled in the first second pulmonary (FEV1) and compares the MPT emission of /s/, /z/ and s/z ratio in healthy subjects and those with chronic obstructive pulmonary disease (COPD). METHODS: We studied 14 normal volunteers (control group), mean age 65 years, and 16 patients with COPD, mean age 68 years. The diagnosis of COPD was done by clinical and pulmonary function evaluation. Participants underwent spirometry for analysis of the parameters FEV1, forced vital capacity (FVC) and Tiffeneau index (FEV1/FVC). The maximum phonation time, along with phonemes /s/ and /z/, s/z ratio correlation, and maximum phonation time in both normal and forced phonation were collected and recorded. RESULTS: In both groups, the maximum phonation time with normal phonation was lower than the maximum phonation time with forced phonation. The median of the maximum phonation time in the control group was higher than in the COPD group. There was no correlation between the maximum phonation time and FEV1, in normal volunteers and patients with COPD. CONCLUSION: Patients with COPD have decreased maximum phonation time, while the s/z ratio does not suggest changes in the level of the vocal folds, since the values found were within the normal range. There was no correlation of the TMF and the measure of FEV1.

Intraluminal esophageal pressures in speaking laryngectomees.

OBJECTIVES: The objective of the present study was to evaluate intraluminal esophageal pressure during voice and speech emission in speaking laryngectomees with a tracheoesophageal prosthesis. METHODS: In our prospective analysis in a tertiary-care academic hospital, 25 laryngectomees were divided into 2 groups: 11 speaking individuals with a tracheoesophageal prosthesis and a control group of 14 nonspeaking laryngectomees. All patients were subjected to manometry during voice and speech emission tests. We determined the pressures achieved in the distal, middle, and proximal parts of the esophagus. RESULTS: Statistical analysis revealed that the amplitude of pressure in the distal esophagus during sound emission was higher in speaking laryngectomees; in the middle esophagus, intraluminal pressure during emission of the sentence was higher in speaking subjects, and in the proximal esophagus there was no difference between the groups. CONCLUSIONS: During the manometric evaluation of the distal and middle esophagus in the presence of voice and speech emission, the intraluminal pressure revealed a significant difference for the speaking laryngectomees with a tracheoesophageal prosthesis. The proximal esophagus behaved similarly in the groups of speakers and nonspeakers. Speaking laryngectomees with a tracheoesophageal prosthesis depend on a differentiated performance of the middle and distal parts of the esophagus.