Vocal Symptoms Research Articles

Patterns of Emotional Expression and Responses to Health and Illness in Women With Functional Voice Disorders (MTVD) and a Comparison Group

To determine whether emotional expression, alexithymia, illness behavior, and coping strategies differed between women with muscle tension voice disorder (MTVD) and those without voice disorder and between women with and without mucosal pathology of the vocal folds, and to explore possible links between psychosocial constructs and clinical features in women with MTVD. A within-subjects design matched 20 women with MTVD and 20 women without voice disorder on validated self-report measures of the psychosocial constructs. The effect of mucosal pathology was assessed using between-groups analyses. Correlations assessed relationships between psychosocial constructs and clinical features. Comparisons between women with MTVD and those without voice disorder showed an elevated sense of illness identity and greater belief in the presence of somatic illness in women with MTVD. There was a trend toward women with MTVD showing lower levels of emotional awareness. Women without vocal fold pathology reported lower levels of emotional awareness than those with pathology, whereas women with pathology reported greater use of a mixed pattern of adaptive and maladaptive coping strategies than those with no pathology. Low vocal load was associated with higher scores on alexithymia, higher numbers of vocal symptoms were associated with the use of adaptive coping, and greater impact of symptoms was associated with higher levels of emotional awareness and greater belief in the presence of somatic illness. These findings encourage further investigation of relationships between emotional awareness, illness behavior, and coping in women with functional voice disorders.

Communicative aspects and coping strategies in patients with Parkinson's disease

Purpose: To investigate in patients with Parkinson's disease (PD), which are the coping strategies used and the relation between type of coping, voice symptoms and communicative aspects. Method: 73 subjects, 33 in the experimental group, with diagnosis of PD, and 40 subjects in the control group, healthy and without vocal complaints. They underwent the following procedures: application of the Voice Symptons Scale – VoiSS – Brazilian Version, Voice Disability Coping Questionnaire – VDCQ – Brazilian Version, and the questionnaire Living with Dysarthria – LwD. Results: The experimental group showed deviations in all protocols: VDCQ (p<0.001), VoiSS (p<0.001), LwD (p<0.001). The most frequently used coping strategy was self-control (p<0.001). The correlation between vocal symptoms and communicative aspects showed that the greater the impairment in communication, the greater the VoiSS emotional scores and the greater will be the amount of voice symptoms and signs. However, the vocal signs and symptoms and communicative aspects showed no correlation with coping. Conclusion: Patients with PD have a high amount of vocal signs and symptoms and the higher the occurrence, the more the patient reports being difficult to live with dysarthria, particularly when there are deviations in the emotional domain.

Efeitos de duas intervenções em professores com queixas vocais

Objetivo Comparar os efeitos da massagem manual perilaríngea e do treinamento vocal tradicional em professores com queixas vocais. Métodos Quarenta e dois professores universitários foram selecionados aleatoriamente para um dos dois grupos: grupo de massagem manual perilaríngea (G1), ou grupo de treinamento vocal (G2). Avaliações realizadas : autoavaliação vocal e da dor, relato de sintoma vocal, avaliação da tensão da musculatura cervical, análises perceptivo-auditiva e acústica da voz. Resultados Não houve diferença entre os grupos para idade, gênero e tempo de magistério. Os sintomas vocais mais referidos foram sensação de secura na garganta e rouquidão. Nos dois grupos houve redução dos sintomas vocais. Não houve diferença entre as intervenções, quanto aos escores parciais e total do questionário de autoavaliação vocal e à análise acústica. O G1 apresentou diferença intragrupo para autopercepção vocal e parâmetro acústico “energia de ruído glótico”. O G2, para os escores “efeitos na comunicação diária”, “efeitos na emoção”, “limitação das atividades”, escore total, parâmetros shimmer e “energia de ruído glótico”. O G1 apresentou diferença intragrupo para autopercepção da dor e houve redução da tensão cervical e do grau discreto de disfonia, aumentando a porcentagem de sujeitos com grau normal. O G2 manteve o resultado da análise perceptivo-auditiva da voz, após a intervenção, e não apresentou diferença na avaliação da tensão. Conclusão : As duas intervenções contribuíram para melhorar o bem-estar e a qualidade vocal dos participantes, cabendo ao profissional fonoaudiólogo decidir qual utilizará, observando as queixas e a demanda vocal do professor.

Características vocais e emocionais de professores e não professores com baixa e alta ansiedade

Objetivo Comparar características vocais e emocionais em grupos de professores e não professores com baixa e alta ansiedade. Métodos Participaram do estudo 93 sujeitos, de ambos os gêneros, com idades entre 18 e 59 anos, divididos em quatro grupos: professores com baixa ansiedade (PBA), professores com alta ansiedade (PAA), não professores com baixa ansiedade (NPBA) e não professores com alta ansiedade (NPAA). Os parâmetros vocais foram mensurados por meio dos instrumentos Questionário de Sinais e Sintomas Vocais (QSSV), Protocolo de Qualidade de Vida em Voz (QVV), Índice de Desvantagem Vocal (IDV), além da gravação de fala e vogal sustentada, avaliada por três fonoaudiólogos, a partir da Escala Analógico-Visual (EAV). Para avaliação dos parâmetros emocionais, utilizou-se o Self-Report Questionnaire (SRQ) e o Inventário de Ansiedade Traço-Estado (IDATE). Resultados Constatou-se que os grupos com alta ansiedade relataram sintomas indicativos de alto nível de estresse e depressão, sendo que o grupo de professores apresentou maior número de sintomas emocionais. Quanto aos parâmetros vocais, observou-se que os professores com alta ansiedade expressaram maior número de sintomas vocais, maior comprometimento da qualidade de vida em voz, maior desvio global da qualidade vocal e alto índice de desvantagem vocal, quando comparados com os demais grupos. Conclusão Os indivíduos com alta ansiedade tiveram maior comprometimento emocional, vocal e na qualidade de vida, sobretudo aqueles que têm a voz como instrumento de trabalho, os professores.

Factores de riesgo laboral que inciden en las cualidades de voz de los docentes de la Universidad de Sucre

This study aimed to describe the occupational risk factors affecting the voice qualities of teachers at the University of Sucre. A total of 54teachers were selected through random stratified sampling. For data collection, a questionnaire was applied to detect vocal symptoms. Occupational risk factors were identified, estimated and assessed, muscular, vocal and respiratory conditions were determined, and the Anagraf test was applied in 25teachers, revealing vocal symptoms. The EPI INFO statistical package version 3.5.5 of July 30, 2012, was used for the analysis. The association between variables was assessed with the chi-square test at a significance level of P<.05. The results showed that teachers were exposed to temperatures ranging from 20-21° C and 36-37° C, relative humidity levels from 63% amd 78%, and background noise between 61dB and 70dB. Other findings were generalized muscle tension, aggravated tone, constrained timbre, vocal intensity and strong vocal attack, upper costal breathing type, maximum phonation time, expiratory breath and decreased phonatory breathing efficiency. We conclude that the longer teachers are exposed to relative humidity, the greater the changes that will occur in vocal tone and intensity.

Reported Vocal Habits of First-Year Undergraduate Musical Theater Majors in a Preprofessional Training Program: A 10-Year Retrospective Study

Collegiate-level musical theater performance students are a specialized group of vocal performers, who rely on frequent and optimal voice use for their academic advancement and ultimate livelihood. The purpose of this study was to gather information to develop a greater understanding of vocal health and practice patterns of incoming collegiate-level musical theater performers. Data obtained from questionnaires completed by freshman musical theater majors were retrospectively analyzed to gather information about baseline vocal habits of the participants. Results of a questionnaire were obtained from incoming freshman musical theater students at the Cincinnati Conservatory of Music over a period of 10 years (2002-2011). One hundred eighty-eight participants (female=90) (male=98) with an average age of 18.28years (standard deviation=0.726) were included. Results specifying participants' self-reported vocal training and practice habits, vocal health and hygiene practices, and current vocal symptoms or contributing factors to potential voice problems are provided. Data obtained from the participants revealed that the potential for vocal problems exists in this group of performers, as over half of the subjects reported at least one current negative vocal symptom. The findings from this study provide information that may be useful for individuals who are involved in the training of vocal performers.

A study of classroom acoustics and school teachers’ noise exposure, voice load and speaking time during teaching, and the effects on vocal and mental fatigue development

The study investigated the noise exposure in a group of Danish school teachers. The aims were to investigate if noise posed a risk of impairment of hearing and to study the association between classroom acoustical conditions, noise exposure, vocal symptoms, and cognitive fatigue. Background noise levels, vocal load and speaking time were measured on 35 teachers during actual classroom teaching. The classrooms were characterized acoustically by measurements of reverberation time. Before and after the workday, the teachers answered a questionnaire on fatigue symptoms and carried out two cognitive test tasks sensitive to mental fatigue. The average noise level during the lessons was 72 dB(A), but during indoor sports activities the average noise level increased 6.6 dB(A). Room reverberation time (range 0.39-0.83 s) had no significant effect on the noise level. The teachers were talking with a raised voice in 61% of the time, and the vocal load increased 0.65 dB(A) per dB(A) increase in the average lesson noise level. An increase in voice symptoms during the workday correlated significantly with individual average noise exposure, and a decrease in performance in the two-back test correlated significantly with individual average vocal load. Noise exposure in general classrooms posed no risk of noise-induced hearing impairment in school teachers. However, the results provide evidence for an association between noise exposure and vocal load and development of vocal symptoms and cognitive fatigue after work.

Asymptomatic Benign Cervical Vagal Schwannoma: Is there a Role for Initial Observational Management?

Asymptomatic Benign Cervical Vagal Schwannoma: Is there a Role for Initial Observational Management? Background: Benign cervical vagal schwannoma is an uncommon neoplasm ideally treated by subcapsular enucleation and neural preservation when possible. Despite this, vocal immobility and dysphonia is often reported postoperatively. The current study retrospectively reviews the existing English literature and correlates subsite location and tumor size with vocal outcomes in this selective group. Methods: There were 20 cases of lower cervical and 14 cases of parapharyngeal space vagal schwannoma treated by subcapsular enucleation which met the inclusion criteria and were used for cumulative vocal outcome analyses. 73 patients treated by excision or enucleation at both sites were used for pretreatment symptom analyses. Logistic regression models were used to associate vocal outcomes and pretreatment symptoms, with tumor size and location, respectively.

Long-term Voice Handicap Index after type II thyroplasty using titanium bridges for adductor spasmodic dysphonia

To determine the long-term functional outcomes of type II thyroplasty using titanium bridges for adductor spasmodic dysphonia (AdSD) by perceptual analysis using the Voice Handicap Index-10 (VHI-10) and by acoustic analysis. Fifteen patients with AdSD underwent type II thyroplasty using titanium brides between August 2006 and February 2011. VHI-10 scores, a patient-based survey that quantifies a patient's perception of his or her vocal handicap, were determined before and at least 2 years after surgery. Concurrent with the VHI-10 evaluation, acoustic parameters were assessed, including jitter, shimmer, harmonic-to-noise ratio (HNR), standard deviation of F0 (SDF0), and degree of voice breaks (DVB). The average follow-up interval was 30.1 months. No patient had strangulation of the voice, and all were satisfied with the voice postoperatively. In the perceptual analysis, the mean VHI-10 score improved significantly, from 26.7 to 4.1 two years after surgery. All patients had significantly improved each score of three different aspects of VHI-10, representing improved functional, physical, and emotional well-being. All acoustic parameters improved significantly 2 years after surgery. The treatment of AdSD with type II thyroplasty significantly improved the voice-related quality of life and acoustic parameters 2 years after surgery. The results of the study suggest that type II thyroplasty using titanium bridges provides long-term relief of vocal symptoms in patients with AdSD.

Perceptual and acoustic parameters of vocal nodules in children

Vocal nodules constitute the major cause of dysphonia during childhood. Auditory-perceptual and acoustic vocal analyses have been used to differentiate vocal nodules from normal voice in children. PurposeTo study the value of auditory-perceptual and acoustic vocal analyses in assessments of children with nodules. DesignDiagnostic test study. Patients and interventionsA comparative study was carried out including 100 children with videolaryngoscopic diagnosis of vocal nodules (nodule group-NG); and 100 children without vocal symptoms and with normal videolaryngoscopic exams (control group-CG). The age range of both groups was between 4 and 11 years. All children underwent auditory-perceptual vocal analyses (GRBASI scale); maximum phonation time and s/z ratio were calculated, and acoustic vocal analysis (MDVP software) were carried out. ResultsThere was no difference in the values of maximum phonation time and s/z ratio between groups. Auditory-perceptual analysis indicated greater compromising of voice parameters for NG, compared to CG: G (79 versus 24), R (53 versus 3), B (67 versus 23) and S (35 versus 1). The values of acoustic parameters jitter, PPQ, shimmer, APQ, NHR and SPI were higher for NG for CG. The parameter f0 did not differ between groups. ConclusionCompromising of auditory-perceptual (G, R, B and S) and acoustic vocal parameters (jitter, PPQ, shimmer, APQ, NHR and SPI) was greater for children with nodules than for those of the control group, which makes them important methods for assessing child dysphonia.

Clinical and Acoustic Vocal Profile in Children With Attention Deficit Hyperactivity Disorder

The objective of this study was to evaluate the presence of etiologic factors, symptoms, and vocal acoustic alterations related to vocal hyperfunction in children with attention deficit hyperactivity disorder (ADHD). In 23 children with ADHD and 28 control children, vocal acoustic exploration was performed to analyze the F₀, jitter %, and voice turbulence index for the sustained vowels /a/ and /i/ and the average tone and intensity and tonal modulation in tests of continuous speech. The children's parents completed a specific questionnaire aimed at detecting etiologic factors and vocal symptoms. Children with ADHD displayed more vocal symptoms (hoarseness, neck strain, and shortness of breath while talking) and more etiologic factors (they shouted more, spoke louder and faster, and became angry more easily) than did children in the Control group. Likewise, children in the ADHD group exhibited a greater % jitter and a lower average intensity in the continuous speech tests. These results indicate that children with ADHD display greater vocal hyperfunction as compared with children in the Control group and suggest a higher risk of developing dysphonia. The results of this study could be useful for designing vocal programs focusing on vocal education and hygiene to prevent and decrease vocal risks and on promoting vocal health in children with ADHD.

Fatores de risco e emocionais na voz de professores com e sem queixas vocais

OBJETIVO: analisar a interferência dos fatores de riscos e emocionais na voz de professores com e sem queixa. MÉTODO: a amostra foi composta de 44 professores. Utilizou-se uma ficha com dados pessoais e profissionais, três questionários referentes aos aspectos vocais e dois questionários para dados relacionados à emoção, sobretudo ansiedade, além da coleta de voz para análise perceptivo-auditiva. Os grupos foram divididos a partir do número de sintomas relatados, estabelecendo um número de 22 voluntários no grupo de Professores Sem Queixa (PSQ) e 22 no grupo Professores Com Queixas (PCQ), sendo deste grupo, os indivíduos que relataram mais de três sintomas vocais. Os dados foram analisados estatisticamente. RESULTADOS: a média do número de sintomas descritos no QSSV foi de 5,7 (±2,8) para os PCQ e de 0,8 (±0,9) para os PSQ. Os PSQ referiram uma melhor autoavaliação vocal (p= 0,01) e os PCQ afirmaram possuir um maior comprometimento em sua voz (p= 0,001). O grupo PSQ obteve os maiores valores nos escores do QVV-Físico (p=0,0007) e QVV-Total (p= 0,0006). Os PCQ obtiveram maiores valores no IDV-Total (p=0,0003) e IDV-Orgânico (p=0,0006), e um maior comprometimento emocional, com SRQ de 5,7 (±3,9) e IDATE 42,5 (±12,7). A partir da avaliação perceptivo-auditiva, os PCQ apresentaram um desvio vocal moderado com presença de rugosidade, soprosidade e tensão na voz, enquanto os PSQ evidenciam um desvio leve em todos os parâmetros. CONCLUSÃO: os professores com queixas vocais estão expostos a mais fatores de riscos, além de relatarem mais sintomas e comprometimento vocais, bem como emocionais.

The Association Between Possible Stress Markers and Vocal Symptoms

Stress reaction provokes changes in the body involving cardiovascular alterations, autonomic reactions, neuroendocrine and immunologic as well as psychoneuroimmunologic changes. Both the primary and secondary effect of stress reaction may be of consequence for vocal function. The purpose of this questionnaire study was to determine the effect of stress symptoms on the occurrence of vocal symptoms. The study also aimed at investigating whether a possible effect was different for men and women. A total number of 1728 participants completed a questionnaire concerning speech, language, and voice. Six vocal symptoms and four possible stress symptoms were included in the questionnaire. There was a significant association between stress symptoms and the occurrence of vocal symptoms. The occurrence of muscle tension or a lump in the throat was significant regarding all the four possible stress symptoms. There were also significant results concerning gender difference. All vocal symptoms and two of four stress symptoms were more common among women. Physical changes caused by the stress reaction may result in vocal symptoms as those presented in the study. Both vocal symptoms and stress symptoms were more common among women. Stress should preferably be acknowledged as a risk factor containing and possibly entailing a number of physiological, psychological, and behavioral symptoms affecting the voice negatively.

SAT0050 Voice Impairment in Rheumatoid Arthritis Patients: A Disease Activity Marker Often Overlooked

BackgroundRheumatoid arthritis (RA) may lead to voice impairment through several anatomical and functional alterations.ObjectivesTo evaluate the prevalence of voice impairment in RA patients and to determine the correlation with disease...

Clinical Practice: Vocal nodules in dysphonic children

Common among children, vocal symptoms are a cause of concern for parents who seek elucidation of their diagnosis and treatment. Vocal nodules are the major cause of dysphonias in children and are related to vocal abuse. We conducted a literature review considering clinical, physiopathological, epidemiological, and histological aspects of vocal nodules, as well as diagnostic methods, highlighting the main studies addressing this issue. The controversial points of treatments were also discussed.

Coralistas amadores: auto-imagem, dificuldades e sintomas na voz cantada

OBJETIVO: conhecer a auto-imagem, dificuldades e presença de sintomas negativos após o canto em coralistas amadores com diferentes classificações vocais, idades e experiência. MÉTODO: cento e vinte e cinco cantores responderam a um questionário que abordou dados de identificação, informações sobre a auto-imagem da voz cantada, dificuldades apresentadas no canto e ocorrência ou não de sintomas vocais após o canto. RESULTADOS: a comparação por naipes evidenciou maior dificuldade na emissão de sons agudos para os contraltos e baixos, maior dificuldade na emissão graves para os sopranos, maior dificuldade na transição de registro grave para agudo para os baixos, e maior cansaço vocal para os contraltos. Na divisão por idade, tanto adultos jovens e adultos referiram maior soprosidade do que os idosos. Os adultos referiram melhor intensidade vocal do que adultos jovens. Os adultos jovens consideraram seu timbre de voz adequado mais frequentemente do que adultos. Em relação à experiência, os cantores menos experientes referiram percepção de voz rouca em maior número do que os cantores mais experientes, que referiram apresentar intensidade adequada durante o canto em maior número do que os demais. Cantores menos experientes referiram maior ocorrência de rouquidão após o canto do que cantores mais experientes. CONCLUSÃO: as dificuldades encontradas no canto estão atreladas ao naipe, e não dependem da idade e nem da experiência. Sintomas estão relacionados ao naipe e ao grau de experiência com o canto. A auto-imagem vocal negativa também está relacionada ao naipe e ao nível de experiência, sendo que a auto-imagem positiva é mais comum em cantores experientes.

Bilateral vocal cord paralysis detected incidentally during direct laryngoscopy on general anesthesia

Bilateral vocal cord paralysis detected incidentally during direct laryngoscopy on general anesthesia

Screening Index for Voice Disorder (SIVD): Development and Validation

To develop and validate a score that can serve as a screening index for voice disorders in teachers. The subjects of this study were 252 female teachers, with and without voice disorders (WVD and WOVD) from the public school system of São Paulo, Brazil. All subjects underwent medical and vocal evaluations and completed a questionnaire about experienced vocal symptoms. They were then randomly divided into samples A and B. Sample A was used to develop and sample B to validate a screening index for voice disorder (SIVD). The development was done using a factorial analysis, and a cutoff point to predict the risk of having a voice disorder was defined using a receiver operating characteristic curve. The validation was done by calculating sensitivity and specificity values for the cutoff, comparing mean scores of subjects WVD and WOVD, calculating correlation between SIVD and Voice Handicap Index (VHI), and the association between the risk and presence of voice disorder. The SIVD comprised 12 symptoms and each accounts for 1 point on the scale. The cutoff to identify risk of voice disorder is five symptoms. Analyzing sample B, it was found that SIVD has good internal consistency (α=.82) and sensitivity (94%), a strong correlation to VHI, significant association between risk of having and actual presence of voice disorder, and people WVD had higher mean SIVD. The SIVD proved to be a reliable valid tool for the identification of voice disorders in teachers, especially for use in screenings, acting as an instrument of epidemiologic vigilance.

Distúrbio de voz e estresse no trabalho docente: um estudo caso-controle

This case-control study aimed to test the association between voice disorders and job stress among public schoolteachers in São Paulo, Brazil. The groups consisted of teachers with (n = 165) and without (n = 105) voice-related complaints. Both groups answered the questionnaires Conditions of Vocal Production and Job Stress Scale. Analysis of cases and controls showed comparable samples, differing only by vocal symptoms. There was a statistically significant difference between cases and controls in relation to job stress involving high strain (OR = 2.1; 95%CI: 1.1-3.9), which places high demands combined with low job control. High strain in cases in this study represents the highest risk of physical and mental disorders for teachers. Loss of voice prevents teachers from continuing in their professional role, eliminates their professional identity, and jeopardizes their career.

Vocal Changes in Patients With Prostate Cancer Following Androgen Ablation

To compare the prevalence of vocal symptoms and parameters in patients with prostate cancer treated with androgen deprivation therapy (ADT). Thirty-two male patients aged 60-83 years were recruited for this study. The subjects were divided into two groups: one group consisted of 18 patients with prostate cancer treated with ADT using gonadotropin-releasing hormone agonists and the other group consisted of 14 controls matched according to age. Demographic data included age, history of smoking, reflux, and duration of therapy. The reported phonatory symptoms were hoarseness, inability to project the voice, and vocal fatigue. Patients also underwent acoustic analysis, and the following acoustic variables were measured: fundamental frequency, relative average perturbation, shimmer, noise-to-harmonic ratio, and voice turbulence index. Compared with the control group, there was no statistical difference in any of the phonatory symptoms. The habitual pitch was significantly higher in the prostate cancer group compared with the controls (131.76 vs 114.11 Hz), with a P value of 0.021. There was also a significant increase in all the perturbation parameters, namely, relative average perturbation and shimmer, with a significant difference with respect to the latter (P value=0.014). There was also a significant increase in the noise-to-harmonic ratio (P value=0.014). The administration of ADT for patients with prostate cancer can affect the habitual pitch. However, there are no noticeable vocal changes reported by the patients.