Submitted by TATIANA MARIA GONÇALVES null (tati_unesp@hotmail.com) on 2016-04-01T01:09:37Z No. of bitstreams: 1 Dissertação TATIANA HOMOLOGAÇAO (2) pdf.pdf: 2109094 bytes, checksum: 0a330bb6e84a7dbf2b6ff2f896c7189d (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-04-05T14:49:04Z (GMT) No. of bitstreams: 1 goncalves_tm_me_bot.pdf: 2109094 bytes, checksum: 0a330bb6e84a7dbf2b6ff2f896c7189d (MD5) / Made available in DSpace on 2016-04-05T14:49:04Z (GMT). No. of bitstreams: 1 goncalves_tm_me_bot.pdf: 2109094 bytes, checksum: 0a330bb6e84a7dbf2b6ff2f896c7189d (MD5) Previous issue date: 2016-02-19 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Introdução: denomina-se presbifonia o conjunto de alterações nos padrões vocais consequentes ao envelhecimento da laringe, podendo cursar com sintomas de disfonia, voz fraca, trêmula e baixa. Estudos histológicos e imunohistoquímicos da presbilaringe demonstram atrofia do epitélio, da lâmina própria e do músculo vocal, além de aumento de fibras colágenas e diminuição de fibras elásticas e das proteínas não fibrosas da matriz extracelular. Os estudos de microscopia eletrônica da presbilaringe são escassos e podem acrescentar detalhes ultraestruturais importantes e auxiliar na compreensão da fisiopatologia da presbifonia. Objetivos: descrever os achados de microscopia eletrônica de varredura e transmissão da prega vocal senil. Casuística e métodos: Foram removidas 16 laringes humanas durante necrópsia e distribuídas em dois grupos: controle (n-8; idade 30 - 50 anos; 6F e 2M) e idoso (n-8; idade 75- 92 anos; 6F e 2M). As porções medianas de ambas as pregas vocais foram dissecadas, fixadas em glutaraldeído 2,5% e preparadas para exames de microscopia eletrônica de varredura e transmissão. A espessura do epitélio foi medida nas fotografias de microscopia eletrônica de varredura, com aumentos semelhantes, utilizando-se o programa de morfometria digital Scandium. Resultados: Microscopia eletrônica de varredura: Grupo controle: epitélio composto por 5 a 7 camadas de células sobrepostas, raras células em descamação, e discreta ondulação. Lâmina própria com rede uniforme de fibras colágenas e elásticas, correndo paralelamente à membrana basal. Grupo idosos: epitélio atrófico, composto por 2 a 3 células, maior número de células em descamação, junções intercelulares demarcadas por sulcos profundos. As medidas da espessura do epitélio foram menores nos grupos de idosos do que nos controles (22163.91 ± SD 14590.41nm versus 41783.73 ± SD 2139.314 nm, respectivamente). Lâmina própria com rede densa de fibras colágenas e elásticas formando emaranhados e com distribuição irregular. Nas camadas profundas as fibras colágenas formavam verdadeira carapaça fibrótica e rígida. Microscopia eletrônica de transmissão: Grupo Controle: epitélio íntegro, com células justapostas e desmossomos entre as junções intercelulares. Membrana basal contínua e uniforme e lâmina própria contendo fibras colágenas e elásticas em arranjo frouxo e regular, e alguns fibroblastos de diferentes formatos. Grupo Idosos: células epiteliais distanciadas umas das outras e junções intercelulares alargadas. Membrana basal sem alterações, lâmina própria com predomínio de fibroblastos de formato alongado e citoplasma contendo vacúolos. Na lâmina própria havia densa rede de fibras colágenas, na qual alguns fibroblastos estavam mergulhados. Conclusões: neste estudo de microscopia eletrônica foram identificadas algumas alterações estruturais restritas às laringes dos idosos, tanto no epitélio como na lâmina própria, algumas delas com provável participação dos fibroblastos, o que reforça a importância de estudos adicionais voltados a essas células, tanto ultraestruturais como moleculares, por serem os principais precursores dos componentes da matriz extracelular. / Introduction: Presbyphonia is called the set of changes in vocal patterns consequent aging of the larynx, which can present with symptoms of dysphonia, weak voice, trembling and low. Histological and immunohistochemical studies of presbylarynx show atrophy of the epithelium, lamina propria and the vocal muscle, and increase of collagen fibers and diminution of elastic fibers and non-fibrous proteins of the extracellular matrix. The studies of electron microscopy of presbylarynx are scarce and can add significant ultrastructural details contribute to further understanding of the pathophysiology of presbyphonia. Objectives: To describe the findings of scanning and transmission electron microscopy of senile vocal folds. Methods: 16 human larynx were removed during autopsy and distributed into two groups: control (n-8; age 30-50 years; 6F and 2M) and elderly (n-8, age 75- 92 years; 6F and 2M). The median portions of the right and left vocal folds were dissected, fixed in 2.5% glutaraldehyde and prepared for examination using scanning and transmission electron microscopy respectively. The thickness of the epithelium was analyzed in the pictures of the scanning electron microscopy with similar magnification, using the Scandium morphometric digital program. Results: Scanning electron microscopy: Control Group: epithelium composed of 5-7 layers of overlapping cells, rare cells in flaking and slight ripple. Lamina propria with uniform network of collagen and elastic fibers running parallel to the basement membrane. Group Elderly: atrophic epithelium, 2 to 3 cells, with more flaking cells and intercellular junctions marked by deep grooves. The epithelial thickness was lower in elderly than controls (22163.91 ± SD 14590.41nm versus 41783.73 ± SD 2139.314 nm, respectively). Lamina propria with dense network of collagen and elastic fibers forming tangles with irregular distribution. In the deep layers of collagen fibers formed shell true fibrotic and stiff. Transmission electron microscopy: Control Group: intact epithelium, with overlapping cells and desmosomes between intercellular junctions. Continuous and smooth basement membrane and lamina propria containing collagen and elastic fibers in loose and regular arrangement, and fibroblasts of different formats. Group Elderly: epithelial cells apart from one another enlarged intercellular junctions. Basement membrane unchanged lamina propria predominantly with fibroblasts with elongated shape and cytoplasm containing vacuoles. In the lamina propria was dense network of collagen fibers, in which some fibroblasts were plunged. Conclusions: In this study of electron microscopy identified some structural changes restricted to the larynx of the elderly in both the epithelium and lamina propria, some of them with possible participation of fibroblasts. This reinforces the importance of additional studies, both ultrastructural and molecular, facing fibroblasts, because these are the main precursors of extracellular matrix components. / FAPESP: 2014/13741-1

Orientador: Regina Helena Garcia Martins / Resumo: Introdução: denomina-se presbifonia o conjunto de alterações nos padrões vocais consequentes ao envelhecimento da laringe, podendo cursar com sintomas de disfonia, voz fraca, trêmula e baixa. Estudos histológicos e imunohistoquímicos da presbilaringe demonstram atrofia do epitélio, da lâmina própria e do músculo vocal, além de aumento de fibras colágenas e diminuição de fibras elásticas e das proteínas não fibrosas da matriz extracelular. Os estudos de microscopia eletrônica da presbilaringe são escassos e podem acrescentar detalhes ultraestruturais importantes e auxiliar na compreensão da fisiopatologia da presbifonia. Objetivos: descrever os achados de microscopia eletrônica de varredura e transmissão da prega vocal senil. Casuística e métodos: Foram removidas 16 laringes humanas durante necrópsia e distribuídas em dois grupos: controle (n-8; idade 30 - 50 anos; 6F e 2M) e idoso (n-8; idade 75- 92 anos; 6F e 2M). As porções medianas de ambas as pregas vocais foram dissecadas, fixadas em glutaraldeído 2,5% e preparadas para exames de microscopia eletrônica de varredura e transmissão. A espessura do epitélio foi medida nas fotografias de microscopia eletrônica de varredura, com aumentos semelhantes, utilizando-se o programa de morfometria digital Scandium. Resultados: Microscopia eletrônica de varredura: Grupo controle: epitélio composto por 5 a 7 camadas de células sobrepostas, raras células em descamação, e discreta ondulação. Lâmina própria com rede uniforme de fibras col... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Presbyphonia is called the set of changes in vocal patterns consequent aging of the larynx, which can present with symptoms of dysphonia, weak voice, trembling and low. Histological and immunohistochemical studies of presbylarynx show atrophy of the epithelium, lamina propria and the vocal muscle, and increase of collagen fibers and diminution of elastic fibers and non-fibrous proteins of the extracellular matrix. The studies of electron microscopy of presbylarynx are scarce and can add significant ultrastructural details contribute to further understanding of the pathophysiology of presbyphonia. Objectives: To describe the findings of scanning and transmission electron microscopy of senile vocal folds. Methods: 16 human larynx were removed during autopsy and distributed into two groups: control (n-8; age 30-50 years; 6F and 2M) and elderly (n-8, age 75- 92 years; 6F and 2M). The median portions of the right and left vocal folds were dissected, fixed in 2.5% glutaraldehyde and prepared for examination using scanning and transmission electron microscopy respectively. The thickness of the epithelium was analyzed in the pictures of the scanning electron microscopy with similar magnification, using the Scandium morphometric digital program. Results: Scanning electron microscopy: Control Group: epithelium composed of 5-7 layers of overlapping cells, rare cells in flaking and slight ripple. Lamina propria with uniform network of collagen and elastic fibers running pa... (Complete abstract click electronic access below) / Mestre

This dissertation focuses on the aging voice - specifically the aging elite vocal athlete. It is comprised of four components; a series of research studies and a viewpoint piece designed to explore the awareness, struggles, and vocal compensations of aging singers dealing with age related vocal and performance problems. The overarching goal of these studies is to inform the development of a voice care protocol for the aging rock star to guide customized intervention for these elite vocal athletes that is focused on optimizing both vocal output and performance. First, the dissertation introduces and identifies characteristics of the exceptional voice. This involves a new vocal continuum that includes the normal voice, the trained voice, and the exceptional voice. The second component is a qualitative study of older contemporary commercial music (CCM) singers adjustments and accommodations associated with their aging. From this, four overarching themes are identified: modest self-perception of their vocal prowess and its relationship to performance, acute sensitivity to changes in vocal quality, recognition of the critical association of voice quality with their identity as a performer, and an array of accommodations to aging-related vocal changes. The third component of the dissertation is a randomized control trial examining the efficacy of Vocal Function Exercises as a treatment modality for presbyphonia. Analysis revealed that the experimental group improved in select outcome measures including decreased glottic gap, increased upper range, and maximum phonation time at the 6-week post-treatment re-evaluation with no such changes in the control group. The final study investigated the vocal and performing trajectories of six CCM male singers through analysis of video performances across their career. Singers were shown to make accommodations consistent with the reported findings from component two. Such accommodations include decreased total time singing for some singers, accommodations for range changes, and changes to performance. From this study, the Exceptional Voice Protocol was created to provide a customized vocal and performance blueprint for each artist that meets their unique needs for their exceptional voices. Overall, this research indicates that aging CCM singers appear to be experiencing age and performance related vocal changes and are making detectable accommodations to their performance. Additional findings show that Vocal Function Exercises appear to be an efficacious treatment modality for aging voice. Findings from these studies confirm the need for continued research on age-related vocal and performance changes for these performers and guidelines for appropriate habilitation and rehabilitation so these rock stars can continue performing for as long as they desire.