Made available in DSpace on 2016-04-27T18:12:29Z (GMT). No. of bitstreams: 1 Maria Fabiana Bonfim de Lima.pdf: 1593015 bytes, checksum: e57dc52778589cdbd734a964991ba81c (MD5) Previous issue date: 2008-02-26 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / INTRODUCTION: Among voice professionals, teachers have been the focus of most studies in this area, probably due to the fact that this professional category represents, approximately 2.5 million people in Brazil, and also because these are the professionals who have been seeking Speech Therapy services for the longest period of time. Researches mention constant vocal illness in this professional group, which is pointed out as one of those with higher risk of developing functional vocal disorders. There are many researches from different regions of Brazil which dealt with profile tracing and risk factors for teachers, and used the questionnaire as the main instrument. In this manner, the perception of the vocal disorder is part of the teacher s own responsibility. However, few studies include a Speech Therapy and ENT doctor evaluations in order to relate this data. AIM: To identify the occurrence of vocal disorders, correlating aspects from self-perceptual, vocal quality and laryngeal evaluations of teachers of two public primary and secondary schools of the city of Sorocaba SP. METHODS: 60 teachers from both schools participated in this transverse observational-type study. The teachers filled out a self-perception questionnaire (adapted from FERREIRA et al., 2007), with questions regarding personal identification, functional status, and vocal aspects. Secondly, speech samples were collected (sustained vowel /a/, scaled vowel /a/ and spontaneous speech). Teachers also went through an endoscopic laryngeal evaluation. Three experienced Speech Therapists performed a vocal quality evaluation of the subjects using the GIRBAS scale to classify the voices as normal or altered, and to specify the degree of alteration. The ENT doctor used an evaluation protocol adapted from Oliveira (1999) to describe the presence or absence of laryngeal disorders. The chisquared association test and the Kappa agreement test were used for statistic evaluation of the collected data. RESULTS: 63,3% of the subject reported having vocal disorders in the present or past in self-perception evaluation; 43,3% were diagnosed with such disorder in Speech Therapy vocal quality evaluation and 46,7% received this diagnosis from the doctor s laryngeal examination. There was no association between self-perceptive and speech therapy or ENT evaluations. Furthermore, agreement was low amongst the three evaluations. However, there was statistic association between voice quality evaluation performed by the Speech Therapists and the laryngeal evaluation performed by the ENT doctor, with intermediate agreement between them. CONCLUSION: The prevalence levels of vocal disorders found in this population are alarming. The self-perception questionnaire showed greater sensibility to indicate prevalence of these disorders, and Speech Therapy evaluation proved itself to be more specific. To obtain a real diagnosis of the needs of the population receiving treatment, we suggest combining both instruments when implementing prevention programs with focus on this health issue / INTRODUÇÃO: Entre os profissionais da voz, o professor tem sido alvo da maioria das pesquisas na área, provavelmente por representar, aproximadamente, dois milhões e quinhentos mil, no Brasil, e por ser aquele que há mais tempo procura tratamento fonoaudiológico. As pesquisas citam o adoecimento vocal constante dessa categoria, que muitas vezes é apontada como uma das que apresenta maior risco de desenvolvimento de distúrbios de voz de base funcional. Em várias regiões brasileiras, há diversos estudos sobre a identificação de perfis e fatores de risco para os professores, e esses utilizaram como instrumento um questionário. Dessa forma, a percepção do problema é de responsabilidade do próprio docente. Poucos trabalhos, contudo, incluem protocolo fonoaudiológico e otorrinolaringológico que relacione esses dados. OBJETIVO: Identificar a ocorrência de distúrbio vocal, correlacionando os aspectos de avaliação autoperceptiva, de qualidade vocal e de laringe, em professores de duas escolas da rede pública do ensino fundamental e médio do município de Sorocaba - SP. MÉTODOS: Deste estudo, do tipo transversal observacional, participaram 60 professores dessas duas escolas. Eles responderam um questionário de autopercepção (adaptado de FERREIRA et al., 2007), e dele foram consideradas as questões relacionadas à identificação, situação funcional e aspectos vocais. Em seguida, passaram por uma coleta de amostra de fala (vogal /a/ sustentada e em escala e trechos de fala espontânea) e por um exame de nasofibrolaringoscopia. Para a avaliação da qualidade vocal, três juízes fonoaudiólogos, com experiência na área de voz, utilizaram a escala GIRBAS, para classificar as vozes em alteradas ou não, e especificar o grau da alteração. Para descrever a presença ou ausência de alteração de laringe, o otorrinolaringologista utilizou o protocolo adaptado de Oliveira (1999). Na análise estatística dos dados, foram empregados o teste de associação qui-quadrado e o de concordância Kappa. RESULTADOS: 63,3% dos participantes referiram ter, no presente ou no passado, distúrbio vocal na avaliação autoperceptiva; 43,3% foram diagnosticados com esse distúrbio na avaliação fonoaudiológica de qualidade vocal e 46,7% pelo otorrinolaringologista no exame de laringe. Não houve associação entre a avaliação autoperceptiva e a avaliação fonoaudiológica, nem entre a avaliação autoperceptiva e a avaliação otorrinolaringológica. Além disso, a concordância foi baixa entre as três avaliações. Porém, houve associação estatística entre a avaliação de qualidade vocal, feita pelo fonoaudiólogo e a laringe, feita pelo otorrinolaringologista, com concordância intermediária entre as avaliações. CONCLUSÃO: Os índices de prevalência de distúrbios de voz encontrados nesta população são preocupantes. O questionário de autopercepção mostrou maior sensibilidade para indicar a prevalência desses distúrbios e a avaliação fonoaudiológica, maior especificidade. Para um real diagnóstico das necessidades da população a ser tratada, sugere-se a combinação dos dois instrumentos na implantação de programas de prevenção desse agravo à saúde

The purpose of this essay is to compile a list of symptoms to aid voice teachers in the early detection of vocal problems resulting from bulimic behavior. Bulimia nervosa (BN) is an eating disorder characterized by bingeing and purging and has a high rate of occurrence among the college population. Entertainers form a high risk group for development of BN yet the effects of BN on the voice are largely ignored in vocal literature. The study begins with a literature review which links several factors that can influence the development of BN with "the singer’s personality." The two main character traits that appear most frequently are perfectionism and anxiety. The study continues with a narrative presentation of interviews by the author with three voice specialists in different fields of voice research and treatment. The research questions on which the interview portion of the study were based are: 1) Are otolaryngologists seeing an increase in vocal problems associated with eating disorders?; 2) Is there a belief among voice specialists that singer-actors are a high risk group for the development of eating disorders?; 3) What vocal symptoms should voice teachers watch and listen for if they suspect a student is bulimic?; 4) How should the voice teacher approach the recommendation of treatment, care, and use of the bulimic voice? This portion of the paper includes a clear and concise list of symptoms associated with BN that are easily identifiable by sight or sound. The paper concludes with a summary of the study results, suggestions for voice teachers training singers with the disorder, and ideas for further research.