Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The development of children s vocal apparatus reflects in their voice characteristics. Objectives: To review the characteristics of the child s voice; to assess and correlate the results of the acoustic analysis of the glottal source, maximum phonation times (MPT), body height and body mass index (BMI) of children aged 4-8 years. Methods: A sample of 484 eutrophic children without a speech-language pathology diagnosis of dysphonia; mailing of questionnaires to parents; auditory screening; BMI determination, and auditory-perceptual analysis of voice (CAPE-V scale); acoustic assessment of /a:/ using the Multi Dimensional Voice Program Advanced; /a,i,u/ MPT measurements; descriptive statistics analysis, t-test and multiple regression (SPSS, significance at 5%). Results: hoarseness and/or breathiness is expected, as well as voice instability; increased loudness, and hard glottal attack; lowered fundamental frequency (f0) as the child grows; measures of jitter, shimmer, noise-to-harmonics ratio (NHR), and voice turbulence index (VTI) tend to be higher in younger children and decrease with body growth and increasing age; due to the maturation of the structures, increased soft phonation index (SPI) is also expected; MPT in seconds parallels the child s age in years, with slightly more sustained phonation than the respective chronological age. In childhood, voice disorders are frequent and more prevalent in boys, with characteristics such as hoarseness and breathiness; lowered f0 and increased jitter and shimmer in dysphonic voices. Original papers: lower f0 as age increases; lower f0 values in girls; greater jitter, shimmer, and VTI measures in girls at six years; higher SPI in boys at seven years; negative correlations between f0, height, and BMI at four years; positive correlations between height and BMI and measures of jitter, shimmer, and VTI, as well as between height and NHR in girls at five years; variability in amplitude and height at seven years in girls; SPI and height in boys at five and seven years. Mean /a/ MPTs for boys at four, five, six and seven years, respectively: 3.77s, 5s, 5.85s, and 7.5s. Mean /a/ MPTs for girls at the same ages: 3.89s, 4.89s, 5.61s, and 6.61s, respectively. Mean /i/ MPTs for boys: 3.49s, 4.96s, 5.72s, and 6.88s. Mean /i/ MPTs for girls: 3.49s, 4.73s, 5.41s, and 6.63s. Mean /u/ MPTs for boys: 3.64s, 4.85s, 5.76s, and 7.08s. Mean /u/ MPTs for girls: 3.54s, 4.73s, 5.64s, and 6.47s. Longer /a/ MPT in boys at seven years, which correlated positively with height. Conclusion: Body height seemed to be the anthropometric measure with the greatest correlation to the acoustic measures, predominantly in girls. The age ranges showing acoustic abnormalities coincided with those rated as having mild deviance in auditory-perceptual analysis. Children s MPT increases with age; /a,i,u/ MPTs in seconds follow the age in years; at seven years, /a/ MPT was longer for boys and influenced by body height, while BMI had no influence on MPT. / O aparato vocal da criança se desenvolve com reflexos nas características acústicas da voz. Objetivo: realizar revisão sobre características da voz de crianças, verificar e correlacionar os resultados da análise acústica de fonte glótica, tempos máximos de fonação (TMF), estatura e índice de massa corporal (IMC) de crianças com voz considerada normal. Método: Amostra de 484 crianças de quatro a oito anos, eutróficas com voz considerada normal; envio de questionário aos pais, triagem auditiva, avaliação do IMC e análise vocal perceptivo-auditiva (Escala CAPE-V); análise acústica de /a:/ pelo Multi Dimensional Voice Program Advanced; obtenção dos TMF/a,i,u/; análise estatística descritiva, Teste t e regressão múltipla (SPSS, significância de 5%). Resultados: discreto grau de rouquidão e/ou soprosidade, instabilidade, loudness aumentada e ataque vocal brusco; diminuição da frequência fundamental (f0) conforme a criança cresce; medidas de Jitter, Shimmer, proporção ruído-harmônico (NHR) e índice de turbulência da voz (VTI) tendem a ser maiores em crianças jovens, diminuindo com o crescimento e aumento da idade; pela maturação das estruturas, espera-se, igualmente, aumento dos valores de índice de fonação suave (SPI); TMF em segundos gira em torno número de anos de idade da criança, podendo observar-se sustentações discretamente maiores do que as idades cronológicas. Na infância os distúrbios vocais comportamentais são frequentes e prevalentes nos meninos, com características como rouquidão e soprosidade; f0 mais grave e aumento das medidas de Jitter e Shimmer nas vozes disfônicas. Observou-se: Diminuição de f0 com o aumento da idade; medidas de f0 mais graves nas meninas, Jitter, Shimmer e VTI maiores nas meninas aos seis anos; SPI maior nos meninos aos sete anos; correlação negativa: entre medidas de f0, estatura e IMC aos quatro anos; correlação positiva entre: estatura e IMC e medidas de Jitter, Shimmer e VTI, bem como entre estatura e NHR nas meninas aos cinco anos; variação da amplitude e estatura aos sete anos nas meninas; SPI e estatura nos meninos, aos cinco e sete anos. Média TMF/a/ de 3,77s aos quatro anos, 5s aos cinco, 5,85s aos seis e 7,5s aos sete nos meninos, nas meninas respectivamente de 3,89s, 4,89s, 5,61s, e 6,61s; TMF/i/ 3,49s aos quatro, 4,96s aos cinco, 5,72s aos seis e 6,88s aos sete nos meninos, nas meninas respectivamente de 3,49s, 4,73s, 5,41s, e 6,63s; TMF/u/ 3,64s aos quatro, 4,85s aos cinco, 5,76s aos seis e 7,08s aos sete nos meninos, nas meninas respectivamente de 3,54s, 4,73s, 5,64s, e 6,47s. TMF/a/ maior nos meninos aos sete anos com correlação positiva com a estatura. Conclusão: estatura pareceu ser a medida antropométrica de maior correlação com as medidas acústicas, relação observada predominantemente nas meninas. As faixas etárias que apresentaram alterações acústicas coincidiram com aquelas classificadas com alteração discreta na avaliação perceptivo-auditiva. Os TMF de crianças aumentam com a idade; TMF/a,i,u/ em segundos ficaram em torno do número de anos de idade; aos sete anos, TMF/a/ foi maior nos meninos, sendo afetado pela estatura; o IMC não mostrou influência sobre os TMF.

Litteraturen beskriver larynxmask som ett skonsamt alternativ till intubation med endotrakealtub. Tidigare studier visar dock att det inte är ovanligt med halsbesvär postoperativt, i form av halsont och/eller heshet. Syftet med studien var att undersöka förekomst och karaktär av halsbesvär postoperativt efter användning av två olika larynxmasker. Författarna genomförde en pilotstudie där nitton vuxna patienter, både män och kvinnor, som erhållit Pro-Breathe® eller I-gel® larynxmask under anestesin ingick. Patienterna intervjuades 60 minuter respektive 24 timmar efter uttagandet av larynxmasken. Intervjun bestod av två slutna frågor om halsont och heshet samt en öppen fråga om hur det kändes i halsen. Den öppna frågan visade att andra typer av halsbesvär förekommer, bland annat irritabilitet, svårigheter att svälja, torrhet och svullnadskänsla. Pilotstudiens metod lämpade sig att använda och svarade mot studiens syfte. Resultatet visade att olika typer av halsbesvär var vanligt postoperativt. Åtta av tio patienter som haft Pro-Breathe® samt sju av nio patienter som haft I-gel® hade någon typ av halsbesvär. / The literature describes the laryngeal mask as a gentle alternative to intubation with endotracheal tube. Previous studies show that it is not unusual with throat discomfort postoperatively, in terms of sore throat and/or hoarseness/dysphonia. The aim of this study was to investigate the presence and nature of throat discomfort postoperatively after the use of two different laryngeal masks. The authors conducted a pilot study in which nineteen adult patients, both men and women, who received Pro-Breathe® or I-gel® laryngeal mask during anesthesia was included. The patients were interviewed 60 minutes and 24 hours after the laryngeal mask were removed. The interview consisted of two sealed questions about sore throat and hoarseness/dysphonia and one open question about how it felt in the throat. The open question showed that other types of throat discomforts occurred, including irritability, difficulty swallowing, dryness and swelling sensation. The method of the pilot-study was suitable to use and responded to the study's purpose. The results showed that different types of throat discomfort were common postoperatively. Eight out of ten patients who received Pro-Breathe® and seven out of nine patients who received I-gel® had some type of throat discomfort.

INTRODUÇÃO: a laringectomia parcial supracricóide é uma possibilidade de tratamento que permite a preservação das funções laríngeas e um bom controle oncológico local da doença. Até o momento não foram localizados estudos que apontem o tempo mais indicado para execução de exercícios vocais para pacientes submetidos a essa cirurgia. OBJETIVO: avaliar a efetividade do exercício de [b] prolongado associado à vogal grave com pressão tóraco-abdominal após laringectomia supracricóide por meio da configuração laríngea e tempo de execução. MÉTODOS: a amostra foi composta por 11 pacientes submetidos à laringectomia parcial supracricóide após reestabelecimento da alimentação via oral exclusiva. Todos os participantes foram submetidos à nasofibroscopia para análise da configuração laríngea durante a execução do exercício e gravação de voz para análise perceptivo-auditiva e acústica. A gravação foi realizada em seis momentos: momento zero (M0), antes da primeira execução do exercício, e em mais cinco momentos: minuto um (M1), minuto dois (M2), minuto três (M3), minuto quatro (M4) e minuto cinco (M5) e em cada intervalo foi realizada gravação das tarefas vocais. Ao final totalizou-se a realização do exercício por cinco minutos. Para a análise da confiabilidade intra-juiz e inter-juizes foram inseridas repetições de 70% das vozes e utilizado o Coeficiente de Correlação Intraclasse. Para análise de cada juiz para a comparação entre M0, M1, M2, M3, M4 e M5 foi considerado como nível de significância p <= 0,05. A análise acústica não linear foi realizada pelo Programa MatLab® 10.0. RESULTADOS: na análise da configuração laríngea observou-se mudança da atividade supraglótica ântero-posterior e vestibular mediana durante a realização do exercício, porém sem significância estatística. Na análise perceptivo-auditiva, houve melhora nos parâmetros grau geral de desvio vocal, rugosidade, tensão e soprosidade a partir de quatro minutos considerando os dois juízes com maior índice de confiabilidade. A análise acústica não linear mostrou todos os parâmetros alterados e não foi capaz de detectar mudanças entre os diferentes momentos. CONCLUSÃO: a execução do exercício do [b] prolongado associado a vocal grave com pressão tóracoabdominal aumenta a intensidade da atividade supraglótica ântero-posterior e vestibular mediana. A realização do exercício a partir de quatro minutos de execução apresenta melhora quanto ao grau geral de desvio vocal, rugosidade, tensão e soprosidade. A análise acústica não apresentou resultados significativos, não sendo possível captar medidas ou modificações entre os momentos / INTRODUCTION: Partial supracricoid laryngectomy is a feasible treatment that allows the preservation of laryngeal functions and an appropriate local oncological disease control. Currently, we did note find studies that indicate the most appropriate time to perform vocal exercises for patients who underwent this surgery. PURPOSE: to assess the effectiveness of prolonged exercise of the consonant [b] associated to the vowel with thoracoabdominal pressure after supracricoid laryngectomy through the execution time technique. METHODS: the sample consisted of 11 patients, who underwent partial supracricoid laryngectomy after reestablishment of exclusive oral feeding. All participants underwent nasofibroscopy to analyze the laryngeal configuration during exercise and voice recording for perceptual-auditory and acoustic analysis. The recording was performed in six moments: zero moment (M0), before the first execution of the exercise, and in another five moments: minute one (M1), minute two (M2), minute three (M3), minute four(M4) and minute five (M5) and at each interval recording of the vocal tasks was performed. At the end, the exercise was completed for five minutes. For intrajudge reliability analysis and inter-judges, 70% repetitions of the voices were inserted and the Intraclass Correlation Coefficient was used. For the analysis of each judge for the comparison between M0, M1, M2, M3, M4 and M5 was considered as level of significance p <= 0.05. Non-linear acoustic analysis was performed by the MatLab® 10.0 Program. RESULTS: in the analysis of the laryngeal configuration, the supraglottic activity of the anteroposterior and medial vestibular variables was observed during the exercise, but with no statistical significance. In the perceptual-auditory analysis, there was improvement in the parameters general degree of vocal deviation, roughness, tension and breathiness from four minutes considering the two judges with the highest reliability index. The non-linear acoustic analysis showed all altered parameters and was not able to detect changes between the different moments. CONCLUSION: the exercise execution of the prolonged [b] associated with severe vocal cords with thoraco-abdominal pressure increases the intensity of antero-posterior and medial vestibular supraglottic activity. The performance of the exercise from four minutes of execution improves the general degree of vocal deviation, roughness, tension and breathiness. The acoustic analysis did not present significant results, and it was not possible to capture measurements or modifications between moments

The research reported here deals with the early characterization of Parkinson’s disease (PD), the second most common degenerative disease of the human motor system after Alzheimer’s. PD results from the death of dopaminergic neurons in the substantia nigra region of the brain. Its occurrence is highly correlated with the aging population whose numbers increase with the healthcare benefits of a longer life. Observation of motor control symptoms associated with PD, such as gait and speech analysis, is most often used to evaluate, detect, and diagnose PD. Since speech and some delicate motor functions have provided early detection signs of PD, reliable analysis of these features is a promising objective diagnostic technique for early intervention with any remedial measures. We implement and study here three PD diagnostic methods and their correlation between each other’s results and with the motor functions in subjects diagnosed with and without PD. One initial test documented well in the literature deals with feature analysis of voice during phonation to determine dysphonia measures. Features of the motor function of two fingers were extracted in tests titled “Motor function of alternating finger tapping on a computer keyboard” and “Motor function of the index and thumb finger tapping with an accelerometer”, that we objectively scripted. The voice dysphonia measures were extracted using various software packages like PRAAT, Wavesurfer, and Matlab. In the initial test, several robust feature selection algorithms were used to obtain an optimally selected subset of features. We were able to program distance classifiers, support vector machine (SVM), and hierarchical clustering discrimination approaches for the dichotomous identification of non-PD control subjects and people with Parkinson’s (PWP). Validation tests were implemented to verify the accuracy of the classification processes. We determined the extent of functional agreement between voice and motor functions by correlating test results.

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Background: Technological advancements in speech acoustic analysis have led to the development of spectral/cepstral analyses due to questions regarding the validity of traditional time-based measures (i.e., Jitter, Shimmer, and Harmonics-to-Noise-Ratio) in objectifying perturbations in dysphonic voices. Aim: This study investigated the validity of time-based measures in discriminating those with Friedreich’s ataxia (FA) from normal voiced (NV) peers when compared to cepstral-spectral measures. Method: A total of 120 sustained vowel phonations from an existing database of 40 participants (20 FA; 20 NV) of the vowels /ɑ/, /i/, and /o/ were analyzed to determine which set of variables (i.e., time-based vs. cepstral-spectral) better predicted group membership. Four variables of time-based measures (Jitter Local %, Jitter RAP, Shimmer Local %, Shimmer APQ11, and HNR) were analyzed via the freeware program PRAAT and compared to four cepstral-spectral measures (Cepstral Peak Prominence, Cepstral Peak Prominence Standard Deviation, Low/High Ratio Standard Deviation, and the Cepstral/ Spectral Index of Dysphonia) extracted from the Analysis of Dysphonia in Speech and Voice (ADSV) software program. Results: Findings from a discriminant analysis showed sensitivity and specificity results to be better for ADSV measures; 100% of those in the FA group were classified correctly (sensitivity), and 95% of members in the NV group were correctly identified (specificity) as compared to PRAAT (70% sensitivity and 85% specificity). Conclusions: Cepstral-spectral measures are much more accurate in discriminating between those with FA and NV peers as compared to time-based estimates.

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Introdução: A miastenia gravis (MG) é uma doença autoimune caracterizada por diminuição da força nos músculos voluntários, que se agrava com o esforço, podendo evoluir com alterações de voz e deglutição. Objetivo: Caracterizar as manifestações laríngeas da MG. Métodos: Foi realizado um estudo transversal por meio da avaliação de 37 pacientes portadores de MG, no período de maio de 2015 a novembro de 2016. Os pacientes foram recrutados no Ambulatório de Neurologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo/SP. Além dos dados clínicos e demográficos, todos os pacientes foram analizados pelo Índice de Desvantagem Vocal-10 (IDV-10), análise perceptivo-auditiva da voz, videolaringoestroboscopia e videoendoscopia da deglutição. Resultados: Na avaliação de voz, foi identificada disfonia em 89,2% dos sujeitos, sendo 59,5% de grau discreto e 29,7% moderado a grave. A autopercepção da desvantagem vocal foi significativamente maior nos pacientes diagnosticados com algum grau de disfonia. Foram identificadas alterações anatômicas em 8 pacientes à videolaringoestroboscospia. Ao comparar o grau da doença com as variáveis contração faríngea e sensibilidade laríngea na VED, observou-se maior ocorrência nos sujeitos com doença mais avançada e comprometimento bulbar. A associação entre as alterações de sensibilidade laríngea e estase indicou que os pacientes com ausência de sensibilidade tiveram estase para saliva, líquido e principalmente para purê e sólido. Conclusões: Portadores de MG apresentam alterações de voz e deglutição relacionadas à doença. A disfonia causa um impacto na vida do paciente com diagnóstico de MG. As alterções da deglutição estiveram presentes em pacientes com acometimento generalizado e maior evolução da doença / Introduction: Myasthenia gravis (MG) is an autoimmune disease characterized by a reduction in the strength of the voluntary muscles, aggravated by effort, with the possibility of developing with voice and deglutition disorders. Objective: Characterize the laryngeal manifestations of MG. Methods: A tranversal study was carried out by evaluating 37 patients with MG in the period between May 2015 and November 2016. Patients were recruited in the Neurology outpatient center at the Hospital das Clínicas, \"Faculdade de Medicina, Universidade de São Paulo\". Besides clinical and demographic data, all patients were analyzed according to the Vocal Disadvantage Index-10 (VDI-10), auditory-perceptual voice analysis, videolaryngostroboscopy and videoendoscopy of swallowing. Results: In the voice evaluation, dysphonia was identified in 89.2% of patients, 59.5% with a discreet degree and 29.7% from moderate to severe. Self-perception of the vocal disadvantage was significantly greater in patients diagnosed with some degree of dysphonia. Anatomical changes were identified in 8 patients through viodeolaryngostroboscospy. When comparing the degree of the disease with the variables pharyngeal contraction and laryngeal sensitivity in the VED, a greater incidence in patients with a more advanced disease and bulbar involvement was noticed. The association between the changes in laryngeal sensitivity and stasis showed that patients with a lack of sensitivity had stasis for saliva, liquid and mainly for purée and solids. Conclusions: MG patients present changes in voice and deglutition related to the disease. Dysphonia causes a great impact in the life of the patient diagnosed with MG. Changes in deglutition were present in patients with generalized involvement and greater progression of the disease