The influence of listener experience, measurement scale and speech task on the reliability of auditory-perceptual evaluation of vocal quality.

PURPOSE: To assess the influence of the listener experience, measurement scales and the type of speech task on the auditory-perceptual evaluation of the overall severity (OS) of voice deviation and the predominant type of voice (rough, breathy or strain). METHODS: 22 listeners, divided into four groups participated in the study: speech-language pathologist specialized in voice (SLP-V), SLP non specialized in voice (SLP-NV), graduate students with auditory-perceptual analysis training (GS-T), and graduate students without auditory-perceptual analysis training (GS-U). The subjects rated the OS of voice deviation and the predominant type of voice of 44 voices by visual analog scale (VAS) and the numerical scale (score "G" from GRBAS), corresponding to six speech tasks such as sustained vowel /a/ and /ɛ/, sentences, number counting, running speech, and all five previous tasks together. RESULTS: Sentences obtained the best interrater reliability in each group, using both VAS and GRBAS. SLP-NV group demonstrated the best interrater reliability in OS judgment in different speech tasks using VAS or GRBAS. Sustained vowel (/a/ and /ɛ/) and running speech obtained the best interrater reliability among the groups of listeners in judging the predominant vocal quality. GS-T group got the best result of interrater reliability in judging the predominant vocal quality. CONCLUSION: The time of experience in the auditory-perceptual judgment of the voice, the type of training to which they were submitted, and the type of speech task influence the reliability of the auditory-perceptual evaluation of vocal quality.

The influence of listener experience, measurement scale and speech task on the reliability of auditory-perceptual evaluation of vocal quality

ABSTRACT Purpose To assess the influence of the listener experience, measurement scales and the type of speech task on the auditory-perceptual evaluation of the overall severity (OS) of voice deviation and the predominant type of voice (rough, breathy or strain). Methods 22 listeners, divided into four groups participated in the study: speech-language pathologist specialized in voice (SLP-V), SLP non specialized in voice (SLP-NV), graduate students with auditory-perceptual analysis training (GS-T), and graduate students without auditory-perceptual analysis training (GS-U). The subjects rated the OS of voice deviation and the predominant type of voice of 44 voices by visual analog scale (VAS) and the numerical scale (score "G" from GRBAS), corresponding to six speech tasks such as sustained vowel /a/ and /ɛ/, sentences, number counting, running speech, and all five previous tasks together. Results Sentences obtained the best interrater reliability in each group, using both VAS and GRBAS. SLP-NV group demonstrated the best interrater reliability in OS judgment in different speech tasks using VAS or GRBAS. Sustained vowel (/a/ and /ɛ/) and running speech obtained the best interrater reliability among the groups of listeners in judging the predominant vocal quality. GS-T group got the best result of interrater reliability in judging the predominant vocal quality. Conclusion The time of experience in the auditory-perceptual judgment of the voice, the type of training to which they were submitted, and the type of speech task influence the reliability of the auditory-perceptual evaluation of vocal quality.

Medidas espectrais e cepstrais em mulheres com disfonia comportamental / Spectral and cepstral measurements in women with behavioral dysphonia

RESUMO Objetivo Investigar se existem diferenças nas medidas acústicas cepstrais e espectrais entre mulheres com disfonia comportamental com e sem lesão laríngea, bem como verificar se existe correlação entre tais medidas e o julgamento perceptivo-auditivo da qualidade vocal. Método Participaram 78 mulheres com disfonia comportamental sem lesão laríngea (DCSL) e 68 com disfonia comportamental com lesão laríngea (nódulos vocais) (DCCL). Foram extraídas as medidas CPP (cepstral peak prominence), CPPS (cepstral peak prominence smoothed), declínio espectral e H1-H2 (diferença entre a amplitude do primeiro e do segundo harmônico), assim como o julgamento perceptivo-auditivo (JPA) do grau geral de desvio vocal (GG), graus de rugosidade (GR), de soprosidade (GS) e de tensão (GT). Resultados Mulheres com DCCL apresentaram maiores valores de H1-H2 e menores valores no CPP e CPPS, em relação às mulheres com DCSL. As vozes mais desviadas apresentaram menores valores do CPP e CPPS. As vozes soprosas apresentaram menores valores de CPP e CPPS, assim como maior valor de H1-H2 em relação às vozes rugosas. Houve correlação negativa fraca entre o CPP e o GR, negativa moderada com o GG e negativa forte com o GS. O CPPS apresentou correlação negativa moderada com o GG, GR e GS. A medida H1-H2 apresentou correlação positiva fraca com o GS. Houve correlação positiva fraca entre o declínio espectral e o GT. Conclusão As medidas acústicas H1-H2, CPP e CPPS apresentam diferenças entre mulheres com DCSL e DCCL. Além disso, há correlação entre as medidas cepstrais e espectrais e os diferentes parâmetros do JPA.

ABSTRACT Purpose To investigate whether there are differences in cepstral and spectral acoustic measures between women with behavioral dysphonia with and without laryngeal lesions and verify whether there is a correlation between such measures and the auditory-perceptual evaluation of voice quality. Methods The sample comprised 78 women with behavioral dysphonia without laryngeal lesions (BDWOL) and 68 with behavioral dysphonia with laryngeal lesions (vocal nodules) (BDWL). Cepstral peak prominence (CPP), cepstral peak prominence-smoothed (CPPS), spectral decrease, and H1-H2 (difference between the amplitude of the first and second harmonics) were extracted. They were submitted to the auditory-perceptual evaluation (APE) of the grade of hoarseness (GH), roughness (RO), breathiness (BR), and strain (ST). Results BDWL women had higher H1-H2 values and lower CPP and CPPS values than BDWOL women. More deviant voices had lower CPP and CPPS values. Breathy voices had lower CPP and CPPS values and higher H1-H2 values than rough ones. There was a weak negative correlation between CPP and RO, a moderate negative correlation with GH, and a strong negative correlation with BR. CPPS had a moderate negative correlation with GH, RO, and BR. H1-H2 had a weak positive correlation with BR. There was a weak positive correlation between spectral decrease and ST. Conclusion H1-H2, CPP, and CPPS were different between BDWOL and BDWL women. Furthermore, cepstral and spectral measures were correlated with the different APE parameters.

Spectral and cepstral measurements in women with behavioral dysphonia. / Medidas espectrais e cepstrais em mulheres com disfonia comportamental.

PURPOSE: To investigate whether there are differences in cepstral and spectral acoustic measures between women with behavioral dysphonia with and without laryngeal lesions and verify whether there is a correlation between such measures and the auditory-perceptual evaluation of voice quality. METHODS: The sample comprised 78 women with behavioral dysphonia without laryngeal lesions (BDWOL) and 68 with behavioral dysphonia with laryngeal lesions (vocal nodules) (BDWL). Cepstral peak prominence (CPP), cepstral peak prominence-smoothed (CPPS), spectral decrease, and H1-H2 (difference between the amplitude of the first and second harmonics) were extracted. They were submitted to the auditory-perceptual evaluation (APE) of the grade of hoarseness (GH), roughness (RO), breathiness (BR), and strain (ST). RESULTS: BDWL women had higher H1-H2 values and lower CPP and CPPS values than BDWOL women. More deviant voices had lower CPP and CPPS values. Breathy voices had lower CPP and CPPS values and higher H1-H2 values than rough ones. There was a weak negative correlation between CPP and RO, a moderate negative correlation with GH, and a strong negative correlation with BR. CPPS had a moderate negative correlation with GH, RO, and BR. H1-H2 had a weak positive correlation with BR. There was a weak positive correlation between spectral decrease and ST. CONCLUSION: H1-H2, CPP, and CPPS were different between BDWOL and BDWL women. Furthermore, cepstral and spectral measures were correlated with the different APE parameters.

OBJETIVO: Investigar se existem diferenças nas medidas acústicas cepstrais e espectrais entre mulheres com disfonia comportamental com e sem lesão laríngea, bem como verificar se existe correlação entre tais medidas e o julgamento perceptivo-auditivo da qualidade vocal. MÉTODO: Participaram 78 mulheres com disfonia comportamental sem lesão laríngea (DCSL) e 68 com disfonia comportamental com lesão laríngea (nódulos vocais) (DCCL). Foram extraídas as medidas CPP (cepstral peak prominence), CPPS (cepstral peak prominence smoothed), declínio espectral e H1-H2 (diferença entre a amplitude do primeiro e do segundo harmônico), assim como o julgamento perceptivo-auditivo (JPA) do grau geral de desvio vocal (GG), graus de rugosidade (GR), de soprosidade (GS) e de tensão (GT). RESULTADOS: Mulheres com DCCL apresentaram maiores valores de H1-H2 e menores valores no CPP e CPPS, em relação às mulheres com DCSL. As vozes mais desviadas apresentaram menores valores do CPP e CPPS. As vozes soprosas apresentaram menores valores de CPP e CPPS, assim como maior valor de H1-H2 em relação às vozes rugosas. Houve correlação negativa fraca entre o CPP e o GR, negativa moderada com o GG e negativa forte com o GS. O CPPS apresentou correlação negativa moderada com o GG, GR e GS. A medida H1-H2 apresentou correlação positiva fraca com o GS. Houve correlação positiva fraca entre o declínio espectral e o GT. CONCLUSÃO: As medidas acústicas H1-H2, CPP e CPPS apresentam diferenças entre mulheres com DCSL e DCCL. Além disso, há correlação entre as medidas cepstrais e espectrais e os diferentes parâmetros do JPA.

Effectiveness of a Blended-Learning Intervention in Teachers' Vocal Health.

OBJECTIVE: To verify the effectiveness of a blended-learning voice assistance program for elementary school teachers. STUDY DESIGN: Nonrandomized and comparative interventional clinical trial. METHODS: A total of 59 teachers participated; 33 of the 59 teachers participated in face-to-face learning (control group-CG), and 26 of the 59 teachers participated in blended learning (experimental group-EG). The Voice Assistance Program included the following for both groups: preintervention assessment, four voice workshops and postintervention assessment. The instruments used were the Vocal Production Condition - Teacher (VPC-T) questionnaire, the Screening Index for Voice Disorder (SIVD), the Vocal Health and Hygiene Questionnaire (VHHQ) and the Voice-Related Quality of Life (V-RQOL) measure. Additionally, voice samples were collected for auditory-perceptual analysis of voice quality. The workshops included theoretical and practical content for both groups. All the workshops for the CG were conducted face-to-face, while the workshops for the EG consisted of two online workshops and two face-to-face workshops. A descriptive analysis of the data was performed, and paired Wilcoxon and Mann-Whitney tests were performed using R software, with a significance level of 0.05. RESULTS: Both groups showed improved acquisition of knowledge regarding vocal health and improved voice quality, but the improvement was greater for the EG. There was a significant decrease in the risk of voice disorder in the EG. Only the CG showed significant improvement in voice-related quality of life. CONCLUSION: The voice assistance program with blended learning is effective for increasing knowledge about vocal health, reducing the risk of voice disorder and improving the voice quality of teachers.

Medidas de efeito das intervenções em vozes saudáveis: uma revisão de escopo / Measurements of the effect of interventions on heathly voices: a scope review

RESUMO Objetivo mapear as medidas de avaliação vocal utilizadas para verificar o efeito da intervenção em indivíduos vocalmente saudáveis. Estratégia de pesquisa trata-se de uma revisão de escopo baseada na questão de pesquisa: "Quais as medidas de avaliação vocal utilizadas para verificar o efeito da intervenção em indivíduos vocalmente saudáveis?" A busca foi realizada de forma eletrônica nas bases de dados MEDLINE (PubMed), LILACS (BVS), Scopus (Elsevier), Web of Science (Clarivate), Embase e Cochrane. Critérios de seleção a seleção dos estudos foi baseada na leitura dos títulos, resumos, palavras-chave e textos completos, aplicando-se os critérios de elegibilidade. Foram extraídos os dados relacionados às informações bibliográficas da publicação, características da amostra e da intervenção, os efeitos da intervenção nas medidas de autoavaliação, perceptivo-auditivas, acústicas, aerodinâmicas, eletroglotográficas, resultado do exame laríngeo, entre outros. Os dados foram resumidos e apresentados de forma quantitativa e descritiva. Resultados foram selecionados 97 artigos, entre os 979 estudos mapeados nesta revisão. A análise acústica foi a medida mais utilizada (n=70, 72,3%) para verificar os efeitos do treinamento vocal nos estudos selecionados, seguida pela eletroglotografia (n= 55, 56,7%), autoavaliação (n= 38, 39,2%), aerodinâmica (n= 33, 34,0%), julgamento perceptivo-auditivo (n= 22, 22,7%) e exame laríngeo (n= 16, 16,5%). Conclusão a análise acústica é a medida utilizada na maioria dos estudos para verificar o efeito da intervenção em indivíduos vocalmente saudáveis.

ABSTRACT Purpose to map the vocal assessment measures used to verify the effect of the intervention in vocally healthy individuals. Research strategy This is a scope review based on the research question: What vocal assessment measures are used to verify the effect of the intervention in vocally healthy individuals? The search was carried out electronically in MEDLINE (PubMed), LILACS (BVS), Scopus (Elsevier), Web of Science (Clarivate), Embase and Cochrane databases. Selection criteria The selection of studies was based on reading the titles, abstracts, keywords and full texts, applying the eligibility criteria. Data related to the publication's bibliographic information, sample and intervention characteristics, the effects of the intervention on self-assessment, auditory-perceptual, acoustic, aerodynamic, electroglottographic measures, laryngeal examination results, among others, were extracted. The data were summarized and presented in a quantitative and descriptive way. Results 97 articles were selected, among the 979 studies mapped in this review. Acoustic analysis was the most used measure (n=70, 72.3%) to verify the effects of vocal training in the selected studies, followed by electroglottography (n= 55, 56.7%), self-assessment (n= 38, 39 .2%), aerodynamics (n= 33, 34.0%), auditory-perceptual judgment (n= 22, 22.7%) and laryngeal examination (n= 16, 16.5%). Conclusion Acoustic analysis is the measure used in most studies to verify the effect of the intervention in vocally healthy individuals.

Validation of the Self-assessment of Communication Competence (SACCom) in Brazilian Portuguese Through Item Response Theory.

OBJECTIVE: To evaluate the validity of the Self-assessment of Communication Competence - SACCom by analyzing the communication competency of adult individuals using the item response theory (IRT). METHODS: Overall, 778 individuals who responded to SACCom participated in this study. The initial version consisted of 20 polytomous items regarding communication skills. Polytomous answer keys to each item were ordered as follows: 1 - no, 2 - more or less, and 3 - yes. The IRT and the gradual response model, a 2-parameter logistic model for polytomous items, were used for validation. RESULTS: Due to problems in the preliminary analysis using the item characteristic curve (ICC), answer keys to SACCom items were reorganized in an ordinal dichotomous way. Response 1 was coded as 0 - no, while responses 2 and 3 were coded as 1 - yes. Item 9 of the ICC was problematic and did not add information to the instrument; hence, this item was excluded. SACCom, in its dichotomous format with 19 items, was unidimensional according to the eigenvalues graph and tetrachoric correlation analysis. The Cronbach's alpha coefficient showed an internal consistency value of 0.711. All item-total correlations were greater than 0.284. Item discrimination parameters ranged from a = 0.563 to a = 1.505, and the difficulty of the items ranged between b = -2.725 and b = 0.612. The likelihood ratio test showed that the model without restrictions best fit the data. ICC gleaned more information for individuals with lower communication skills. CONCLUSION: The 19-item, dichotomous SACCom is valid for the analysis of communication skills according to the IRT.

Prosodic Differences in the Voices of Transgender and Cisgender Women: Self-Perception of Voice - An Auditory and Acoustic Analysis.

INTRODUCTION: The voice is an important parameter for identifying the speaker's gender. Transgender people seek to adapt their bodies to gender identity, and transgender women have greater difficulties in achieving vocal acceptance. In this context, the evaluation of the various parameters of the voice of transgender and cisgender women is essential to make it possible to propose appropriate intervention measures. OBJECTIVES: To identify the differences in vocal characteristics of transgender and cisgender women. METHODS: An sectional study was conducted. The sample comprised 20 transgender women and 20 cisgender women who underwent evaluation of acoustic parameters, emotional prosody, self-perception, and perception of gender by lay listeners. RESULTS: The vocal characteristics of transgender and cisgender women differ in terms of the following parameters: f0, glottal noise excitation (GNE), vocal intensity, speech range profile (SRP), the first three formants of the vowel /a/, and in terms of emotional prosody, including duration and melodic contour. Higher values ​​were mostly found in the cisgender population, except for noise level and vocal intensity. In addition, in most cases lay listeners identified the voices of transgender women as belonging to the male gender. There was a negative correlation between vocal dissatisfaction and f0 among transgender women. CONCLUSIONS: Even though they perform vocal adjustments, the voices of transgender women are different from cisgender women in terms of acoustic parameters, vocal extension, and emotional prosody including duration and melodic contour. These differences have repercussions on the perception of gender by listeners.

Auditory Perception of Roughness and Breathiness by Dysphonic Women.

OBJECTIVE: To investigate the auditory perception of roughness and breathiness by dysphonic women. METHODS: Twenty-two dysphonic native Brazilian Portuguese women participated in this research. All participants underwent audiological evaluation and laryngeal examination to confirm the diagnosis. During the tests, they recorded the sustained vowel /Ɛ/. A speech-language pathologist performed the auditory-perceptual judgment of voice quality for these vocal samples, categorizing the general degree of vocal deviation (mild, moderate, and severe degree) and the predominant type of deviation (roughness or breathiness). Thirty-two (32) stimuli were selected from a voice database, including twenty-four (24) dysphonic voice samples and eight (8) voice samples from vocally healthy women. The authors conducted five perception experiments, being three categorization tasks (normal vs. deviated, breathy vs. nonbreathy, rough vs. nonrough) and two tasks for discriminating the degree of deviation (roughness degree and breathiness degree). RESULTS: The experiments showed a difference between the answers for presence/absence of deviation, presence/absence of breathiness, and presence/absence of roughness in the stimuli, and a difference in the proportion of similar answers of dysphonic women (P < 0.001) regarding the identification of the deviation. Participants classified a large part of the deviated (57.9%), breathy (63.13%), and rough (65.31%) voices as normal. The degree of vocal deviation (P = 0.008) and the degree of roughness in the stimuli correlated positively with the proportion of similar answers of the participants. As for the discrimination of breathiness degrees, less deviated (normal and mild) voices were less discriminated, and more deviated (moderate and severe) voices were better discriminated. Regarding the discrimination of roughness degrees, only the voices with severe deviations showed good discrimination. CONCLUSION: Dysphonic women had a high rate of not similar answers in the identification of normal and deviated voices. They identified more than half of the deviated voices as normal. Samples with more severe deviations were proportionally more identified as deviated by the participants. The greater the vocal deviation of the participants' voices, the smallest the number of similar answers. Participants had a high rate of not similar answers in the identification of normal and breathy voices. Dysphonic women show less ability to perceive mildly and moderately breathy voices in the breathy category. Participants had a high rate of similar answers in the identification of normal and rough voices. Dysphonic women show less ability to perceive mildly and moderately breathy voices in the breathy category. Participants show less ability to perceive only mildly roughness voices with similar responses. Dysphonic women could discriminate between voices with adjacent degrees of roughness but had a low percentage of similar answers for discrimination between voices with adjacent degrees of breathiness.

Hormones and Auditory Perception: Study of Dichotic Listening in Women during the Menstrual Cycle

Abstract Introduction Dichotic listening refers to the ability to hear different sounds presented to each ear simultaneously. Objective The aim of the present study was to assess dichotic listening in women throughout the menstrual cycle. Methods The volunteers who met the eligibility criteria participated in a dichotic listening assessment composed of three tests: 1) staggered spondaic word test; 2) dichotic digits test; and 3) consonant-vowel test. The female participants were tested during two different phases of the menstrual cycle: the follicular (days 11 to 13) and luteal (days 23 to 26) phases. The phases were confirmed by measuring serum levels of the hormone estradiol. Results A total of 20 volunteers aged 18 to 49 years participated in the study (9 females and 11 males). In test 1, only the right ear of females showed better performance during the follicular phase (high estrogen levels), compared with the luteal phase (low estrogen levels); in test 2, there were no significant differences for any of the groups; and in test 3, both males and females showed significantly better performance in their right ear compared with their left ear. Conclusion The better performance of females during the follicular phase of the cycle may indicate that estrogen levels might have an influence on dichotic listening in women. (AU)

Hormones and Auditory Perception: Study of Dichotic Listening in Women during the Menstrual Cycle.

Introduction Dichotic listening refers to the ability to hear different sounds presented to each ear simultaneously. Objective The aim of the present study was to assess dichotic listening in women throughout the menstrual cycle. Methods The volunteers who met the eligibility criteria participated in a dichotic listening assessment composed of three tests: 1) staggered spondaic word test; 2) dichotic digits test; and 3) consonant-vowel test. The female participants were tested during two different phases of the menstrual cycle: the follicular (days 11 to 13) and luteal (days 23 to 26) phases. The phases were confirmed by measuring serum levels of the hormone estradiol. Results A total of 20 volunteers aged 18 to 49 years participated in the study (9 females and 11 males). In test 1, only the right ear of females showed better performance during the follicular phase (high estrogen levels), compared with the luteal phase (low estrogen levels); in test 2, there were no significant differences for any of the groups; and in test 3, both males and females showed significantly better performance in their right ear compared with their left ear. Conclusion The better performance of females during the follicular phase of the cycle may indicate that estrogen levels might have an influence on dichotic listening in women.

Avaliação da percepção auditiva em mulheres durante ciclo menstrual: revisão sistemática / Evaluation of auditory perception in women during menstrual cycle: a systematic review / Percepción de evaluación de audiencia sobre la mujer durante el ciclo menstrual: revisión sistemática

Introdução: As flutuações hormonais que ocorrem normalmente durante o ciclo menstrual podem interferir no sistema auditivo. A alteração mais encontrada neste período é a diminuição da acuidade auditiva, que parece estar mais associada à flutuação dos níveis de estrogênio, quando este se encontra reduzido na fase lútea final do período menstrual. Objetivo: Investigar por meio de uma revisão sistemática a percepção auditiva de mulheres durante as fases do ciclo menstrual. Método: Foi realizada uma busca nas bases de dados eletrônicas, nacionais e internacionais, LILACS, MEDLINE, PubMed e SciELO, através da consulta pelos seguintes descritores: "percepção auditiva" AND "ciclo menstrual", "percepção de fala" AND "ciclo menstrual", "percepção de fala" AND "hormônios" e seus correspondentes na língua inglesa. Resultados: Dos 293 artigos encontrados, foram selecionados apenas 7 artigos, após os critérios de inclusão e exclusão. A caracterização da amostra dos artigos selecionados variou entre 15 a 39 mulheres, com idade variando entre 17 e 46 anos. Na maioria dos artigos, nenhum tipo de procedimento clínico para estimar as fases do ciclo menstrual foi utilizado. Foi observada a realização de testes de percepção auditiva nos sete artigos selecionados, tendo destaque os testes dicóticos. Conclusão: Há necessidade da realização de mais pesquisas sobre o assunto, exigindo-se também maior rigor metodológico na elaboração desses estudos, através de procedimentos clínicos seguros e padronizados para mensuração dos níveis hormonais.

Introduction: Hormonal fluctuations that normally occur during the menstrual cycle can interfere with the audio system. The change most found in this period is the reduction of auditory acuity, which seems to be more related to fluctuating estrogen levels, when it is reduced in the luteal phase of the menstrual period end. Objective: Investigate through a systematic review hearing in women during the menstrual cycle phases. Method: A search was made in the electronic databases, national and international, LILACS, MEDLINE, PubMed and SciELO, by consulting the following descriptors: "auditory perception" and "menstrual cycle", "speech perception" and "menstrual cycle", "speech perception" and "hormones" and their corresponding in Portuguese. Results: Twenty-two articles were found, but only 7 articles were chosen after the criteria for inclusion and exclusion. The amount of the sample of selected articles ranged between 15 and 39 women, aged between 17 and 46 years old. In most articles, any type of medical procedure to estimate the phases of the menstrual cycle was used. The performance of auditory perception tests in the seven selected articles was observed, highlighted with the dichotic tests. Conclusion: There is a need of further research on the subject, demanding a greater methodological rigor in the preparation of these studies, through clinical safe and standardized to measure hormone levels procedures.

Introducción: Las fluctuaciones hormonales que ocurren normalmente durante el ciclo menstrual puede interferir con el sistema de audio. El hallazgo más frecuente en este periodo es la reducción de la agudeza auditiva, lo que parece estar más relacionado con la fluctuación de los niveles de estrógenos, cuando se reduce en la fase lútea del final del periodo menstrual. Objetivos: Investigar a través de una revisión sistemática de la percepción auditiva de la mujer durante las fases del ciclo menstrual. Métodos: Se realizó una búsqueda en bases de datos electrónicas, nacionales e internacionales, LILACS, MEDLINE, PubMed y SciELO, mediante la consulta de los siguientes descriptores: "la percepción auditiva" Y "ciclo menstrual", "la percepción del habla" Y "ciclo menstrual", "la percepción del habla" y "hormonas" y sus homólogos en el idioma Inglés. Resultados: De los 293 artículos encontrados, se seleccionaron sólo 7 artículos, después de que los criterios de inclusión y exclusión. La caracterización de la muestra de los artículos seleccionados osciló entre 15 y 39 mujeres, con edades comprendidas entre los 17 y 46 años. En la mayoría de los artículos, cualquier tipo de procedimiento médico para estimación se utilizan las fases del ciclo menstrual. el rendimiento de la prueba de percepción auditiva se observó en los siete elementos seleccionados, resalte que tiene dicóticos. Conclusión: Existe la necesidad de más investigación sobre el tema, lo que requiere también mayor rigor metodológico en la elaboración de estos estudios, através de procedimientos clínicos segura y estandarizada para medir los niveles hormonales.

Stage of readiness of patients with behavioral dysphonia in pre and post-group voice therapy assessments. / 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.

Reduction of Risk Factors in Patients with Behavioral Dysphonia After Vocal Group Therapy.

OBJECTIVES: The origin and development of dysphonia, particularly behavioral dysphonia, is associated with several risk factors. Here, we verified the effectiveness of group therapy in reducing the risk factors, and established the association between risk factors and sex, age, profession, and diagnosis of laryngeal disorders in patients with behavioral dysphonia. STUDY DESIGN: This is a descriptive, quantitative, field intervention study. METHODS: Participants (n = 26, adult patients of both sexes), with a diagnosis of behavioral dysphonia, received group therapy intervention. Data for risk factors were collected pre- and posttherapy using the Vocal Screening Protocol. The data were analyzed using descriptive and inferential statistics (Student t test, chi-squared test or Spearman correlation test). RESULTS: The majority (80.8%, n = 21) of patients were female, 65.4% (n = 17) were not in a vocal profession, and 42.3% (n = 11) presented with a lesion in the membranous portion of the vocal fold. The number of personal risk factors decreased after group therapy (P = 0.04). In addition, age was correlated with total (P = 0.001), environmental (P = 0.002), and personal (P = 0.003) vocal risk factors posttherapy. CONCLUSIONS: This study revealed an association between the reduction of personal risk factors and vocal group therapy, and a correlation between age and total, environmental, and personal vocal risk factors posttherapy. Thus, maintenance and origins of the behaviors that modify the behavioral aspects of the participants directly influence the production of individual vocal habits.

Estágio de prontidão de pacientes com disfonia comportamental pré e pós-terapia de voz de grupo / Stage of readiness of patients with behavioral dysphonia in pre and post-group voice therapy assessments

RESUMO Objetivo Verificar a efetividade da terapia de grupo no estágio de prontidão de pacientes com disfonia comportamental, bem como identificar que itens da Escala URICA-Voz são mais sensíveis a mudanças pós-terapia de grupo em pacientes com disfonia comportamental. Método Trata-se de um estudo de intervenção realizado com 49 pacientes com disfonia comportamental. A terapia de grupo ocorreu em oito sessões, sendo a primeira e a última de avaliação e as outras seis terapêuticas, com abordagem eclética. A escala URICA-Voz foi utilizada para avaliar o estágio de prontidão em que o paciente se encontra nos momentos pré e pós-terapia de grupo para voz. Foi realizada uma análise estatística descritiva e inferencial para a análise dos resultados. Resultados A maioria dos pacientes que participaram deste estudo era do gênero feminino, não faziam uso profissional da voz e tinham lesão membranosa da prega vocal. A maior parte estava no estágio de Contemplação tanto no momento pré quanto pós-terapia. Houve mudança significativa na comparação do pré e pós-terapia, a maioria dos pacientes apresentou redução no estágio de prontidão e poucos avançaram para um estágio maior. Na comparação dos itens da Escala URICA-V, sete questões apresentaram respostas iguais ou inferiores no momento pós-terapia. Conclusão Não houve diferença estatística ao se comparar as médias do escore total URICA-V no pré e pós-terapia de grupo. Houve mudanças significativas dos estágios de prontidão dos pacientes nos momentos pré e pós-terapia fonoaudiológica de grupo. Sete itens da URICA-V tiveram número igual ou menor no momento pós-intervenção entre os pacientes avaliados.

ABSTRACT 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 vocais auditivos e proprioceptivos pré e pós-terapia de grupo de pacientes com disfonia / Auditory and proprioceptive vocal symptoms in patients with dysphonia pre- and post- group therapy

RESUMO Objetivo: comparar os sintomas auditivos, proprioceptivos e os totais pré e pós-terapia de grupo de pacientes com disfonia, além de associar o número de sintomas vocais às variáveis sexo, faixa etária, uso profissional da voz e diagnóstico laríngeo. Métodos: participaram 27 pacientes inseridos em grupos terapêuticos. Todos responderam aos sintomas vocais auditivos, proprioceptivos e totais do Protocolo de Triagem Vocal (PTV) pré e pós-terapia de grupo, que constou de oito encontros, sendo o primeiro e último para aplicação do PTV; do segundo ao sétimo foram realizadas sessões terapêuticas fonoaudiológicas de abordagem eclética. Resultados: os participantes eram adultos, maioria do sexo feminino e diagnóstico laríngeo predominante de lesão na porção membranosa das pregas vocais. Pôde-se perceber que houve redução significante dos sintomas vocais proprioceptivos e totais quando se comparou pré e pós-terapia. Minimizaram significantemente pós-terapia os sintomas vocais: fadiga vocal, garganta seca, bolo na garganta, esforço e desconforto ao falar. Houve associação entre sintomas vocais (proprioceptivos, auditivos e totais) pós-terapia de grupo com as variáveis sexo feminino e diagnóstico laríngeo lesão de massa na porção membranosa das pregas vocais. Não houve associação dos sintomas vocais pós-terapia com faixa etária e nem uso profissional da voz. Conclusão: houve redução dos sintomas vocais totais e proprioceptivos relatados pelos pacientes ao comparar o pré e o pós-terapia. Houve associação entre sexo feminino e diagnóstico de lesão de massa na porção membranosa das pregas vocais com sintomas totais, proprioceptivos e auditivos pós-terapia de voz. A faixa etária e o uso profissional da voz não foram associados à redução dos sintomas vocais.

ABSTRACT Purpose: to compare auditory, proprioceptive and total symptoms in dysphonia patients pre- and post- group therapy, and associate the number of vocal symptoms with gender, age, professional use of voice, and laryngeal diagnosis variables. Methods: the sample included 27 patients enrolled in therapeutic groups. All had auditory, proprioceptive, and total vocal symptoms from the Vocal Screening Protocol (VSP), pre- and post- group therapy, which consisted of eight meetings, with the first and last being for the implementation of the VSP; in the second to seventh, speech therapy sessions were performed using an eclectic approach. Results: the participants were adults, mostly female, and predominantly with laryngeal diagnoses involving lesions in the membranous portion of the vocal folds. There was a significant reduction in proprioceptive and total vocal symptoms when pre- and post- therapy was compared. The following vocal symptoms were significantly minimized post-therapy: vocal fatigue, dry throat, lumps in the throat, effort and discomfort when speaking. There was a connection between post group therapy (proprioceptive, auditory, and total) vocal symptoms and the female and laryngeal diagnosis involving mass lesions in the membranous portion of the vocal folds variables. There was no connection between post-therapy vocal symptoms and age or professional use of voice. Conclusion: there was a reduction in total and proprioceptive vocal symptoms reported by patients, comparing pre- and post- therapy. There was a connection between females and diagnoses of mass lesions in the membranous portion of the vocal folds and total, proprioceptive, and auditory symptoms post- voice therapy. Age and professional use of voice were not associated with reduced vocal symptoms.

Níveis de ansiedade e impactos na voz: uma revisão da literatura / Levels of anxiety and impacts on voice: a literature review / Niveles de ansiedad e impacto en la voz: una revisión de literatura

O objetivo deste artigo é realizar uma revisão da literatura sobre a ansiedade e seus impactos na voz. A pesquisa foi realizada em três bases de dados: PubMed, SciELO e LILACS. Para tanto, foram utilizados os descritores: "Anxiety", "Voice", "Voice Disorders" e "Dysphonia", bem como os seus correspondentes em português, no período de janeiro a março de 2015. Foi encontrado um total de 382 artigos e apenas oito atenderam aos critérios de elegibilidade. Os estudos foram analisados quanto aos objetivos; tipo de estudo; métodos de avaliação da ansiedade; métodos de avaliação da voz; análise estatística dos dados; principais resultados encontrados; associação entre voz e ansiedade; características da população estudada; ano de publicação e país onde foi desenvolvido o estudo. Os estudos selecionados apresentaram a predominância de tipo transversal, publicados na língua portuguesa e no ano de 2007. De acordo com os métodos utilizados para avaliação de ansiedade e vocal, foram empregados nove tipos de avaliação diferentes para voz e nove para ansiedade. Por fim, todos os artigos apresentaram associação entre voz e ansiedade. É importante destacar o crescente aumento das pesquisas que envolvem voz e ansiedade em produções científicas, sobretudo brasileiras. Observou-se, ainda, que a alta ansiedade influencia as características vocais e a qualidade de vida da população dos indivíduos pesquisados.

The aim of this article is to perform a systematic review about anxiety and its impacts on voice. The research was conducted in three databases: PubMed, SciELO and LILACS. To this end, we used the descriptors: "Anxiety", "Voice", "Voice Disorders" and "Dysphonia", as well as their equivalents in Portuguese, in the period from January to March 2015. We found 382 articles and only eight met the eligibility criteria. The studies were analyzed in relation to objectives, type of study, methods of evaluation of anxiety, methods of evaluation of voice, statistical analysis of the data, the main results found, association between voice and anxiety, characteristics of the study population, year of publication and country where there was developed the study. The selected studies showed the predominance of crosssectional study, published in Portuguese and in the year 2007. In accordance with the methods used for evaluation of anxiety and vocals, there were employed nine different types of evaluation for voice and nine for anxiety. Finally, all the articles presented an association between voice and anxiety. It is important to highlight the increased number of researches involving voice and anxiety in scientific productions, especially in Brazil. It was also observed that the high anxiety influences on the vocal characteristics and the quality of life of the population surveyed.

El objetivo de este artículo es realizar una revisión de literatura acerca de la ansiedad y sus efectos en la voz. La investigación se realizó en tres bases de datos: PubMed, LILACS y SciELO. Con este fin, se utilizaron los descriptores: "Anxiety", "Voice", "Voice Disorders" y "Dysphonia", así como sus equivalentes en portugués, en el período de enero a marzo de 2015. Se encontró un total de 382 artículos y sólo 8 cumplieron con los criterios de elegibilidad. Los estudios fueron analizados en relación a los objetivos, el tipo de estudio, los métodos de evaluación de la ansiedad, métodos de evaluación de la voz, análisis estadístico de los datos, principales resultados encontrados, asociación entre voz y ansiedad, características de la población estudiada, año de publicación y país donde se desarrolló el estudio. Los estudios seleccionados mostraron el predominio de estudio transversal, publicado en portugués y en el año 2007. De acuerdo con los métodos utilizados para la evaluación de la ansiedad y de las voces, fueron empleados nueve tipos de evaluaciones diferentes para voz y nueve para ansiedad. Por fin, todos los artículos presentan una asociación entre la voz y la ansiedad. Es importante destacar el creciente aumento de las investigaciones que involucran la voz y la ansiedad en la producción científica, especialmente en Brasil. También se observó que la fuerte ansiedad influye en las características vocales y calidad de vida de la población investigada.

Relação entre os sintomas vocais, intensidade do desvio vocal e diagnóstico laríngeo em pacientes com distúrbios da voz / Relationship between vocal symptoms, severity of voice disorders, and laryngeal diagnosis in patients with voice disorders

RESUMO Objetivo investigar se existe associação entre a frequência de ocorrência dos sintomas vocais, a intensidade do desvio vocal e o diagnóstico laríngeo em pacientes com diferentes distúrbios da voz. Métodos Participaram do estudo 330 pacientes com queixa vocal, distribuídos em cinco grupos de acordo com o diagnóstico laringológico: G1-sem lesão laríngea, G2-lesões benignas das pregas vocais, G3-distúrbio neurológico da voz, G4-fenda glótica sem causa orgânica ou neurológica e G5-distúrbio de voz secundário a refluxo gastroesofágico. Foram alocados em cinco grupos, de acordo com o diagnóstico laríngeo. Todos os participantes responderam à Escala de Sintomas Vocais (ESV) e gravaram a vogal /ɛ/ sustentada, que foi analisada quanto à intensidade do desvio vocal por meio de uma escala analógico-visual. Resultados Houve diferença nos escores total, de limitação e físico da ESV entre diferentes grupos diagnósticos. Pacientes com lesão na porção membranosa das pregas vocais apresentaram maior número de sintomas vocais em relação aos outros grupos diagnósticos. Observou-se correlação positiva entre a intensidade do desvio vocal e os escores total, de limitação e emocional da ESV. Pacientes com desvio vocal moderado e intenso apresentaram maior número de sintomas vocais que pacientes com vozes saudáveis ou com desvio leve. Conclusão Existe associação entre o diagnóstico laríngeo, a intensidade do desvio vocal e a frequência de ocorrência dos sintomas vocais. Pacientes com lesão benigna nas pregas vocais e com desvio vocal mais intenso apresentam maior frequência de sintomas vocais.

ABSTRACT 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.

Eficácia e limitação da terapia vocal na doença de Parkinson: revisão de literatura / Effectiveness and limitations of vocal therapy in Parkinson's disease: a literature review

RESUMO: O objetivo desta revisão de literatura foi verificar as evidências científicas e restrições dos diferentes tipos de tratamentos para voz na Doença de Parkinson. O levantamento dos artigos foi realizado nas bases de dados PubMed/MEDLINE, SciELO e Lilacs. Utilizou-se como estratégia de busca as combinações com os seguintes descritores: "Parkinson disease and vocal therapy"; "Parkinson disease and speech acoustic"; "Parkinson disease and voice". Os critérios de inclusão foram: idioma em português ou inglês; artigos dos anos 2003-2013; e estudos de intervenção. Adotou-se como critérios de exclusão: os repetidos nas bases de dados; pesquisas com animais. Durante a busca foram localizados 351 artigos, dos quais apenas 18 deles preenchiam os critérios de inclusão adotados no estudo. Os resultados foram apresentados considerando os diferentes tipos de tratamento para a voz na Doença de Parkinson, de acordo com a técnica de intervenção: medicamentoso, cirúrgico e reabilitação, identificando os autores e ano de publicação, características da amostra, o tipo de tratamento, o método utilizado e a conclusão do estudo. Nesta pesquisa observou-se reduzida produção científica no tratamento da voz na doença de Parkinson. A maioria dos artigos abordou as técnicas de tratamento para a voz de alto custo, ou que necessitam de habilitação/certificação no método para a realização da terapia de voz.

ABSTRACT: The aim of this review was to assess the scientific evidences and restrictions of the different kinds of voice treatments in Parkinson's disease. The survey of articles was conducted in the databases PubMed/MEDLINE, SciELO and Lilacs. As a search strategy, combinations with the following descriptors were used: "Parkinson disease and vocal therapy"; "Parkinson disease and speech acoustic"; "Parkinson disease and voice". Inclusion criteria were: Portuguese or English language; articles from 2003-2013; and intervention studies. The following exclusion criteria were adopted: those repeated in the databases; animal research. During the search, 351 articles were found, of which only 18 met the inclusion criteria in the study. The results were presented considering the various types of voice treatment in Parkinson's disease, according to the intervention technique: pharmacological, surgical and rehabilitation, identifying authors and the year of publication, the sample characteristics, the type of treatment, the method used and the conclusion of the study. In this study, it was observed reduced scientific literature for voice treatment in Parkinson's disease. Most articles addressed high-cost treatment techniques for voice, or in need of qualification/certification in the method for carrying out the speech therapy.