Influence of Abusive Vocal Habits, Hydration, Mastication, and Sleep in the Occurrence of Vocal Symptoms in Teachers

Some vocal disorders in teachers are associated with occupational factors, but there are few studies that analyze the influence of vocal habits, fluid intake, mastication, and sleep on these disorders. The objective was to analyze the Occurrence of vocal fatigue, hoarseness, and dry throat in elementary and high school teachers and their association with vocal habits, fluid intake, mastication, and sleep. A sample of 422 elementary and secondary school teachers was Studied using a specific questionnaire. The multiple regression analysis showed that hoarseness was associated with absence of water intake (odds ratio (OR) = 1.7; P = 0.047), yelling/speaking loudly (OR = 1.6; P = 0.058), jaw-opening limitations (OR = 3.8; P = 0.003). average of: 6 hours of sleep/light (OR = 1.7; P = 0.039), and waking-up feeling replenished (OR = 2.0; P = 0.020). The presence of vocal fatigue was significantly associated with yelling/speaking loudly (OR = 2.2: P = 0.013), speaking excessively (OR = 2.4; P = 0.023), difficulty to open the mouth to masticate (OR = 6.6; P = 0.003), less than 6 hours of sleep (OR = 4.0; P = 0.008), and waking-up feeling replenished (sometimes OR = 2.8: P = 0.003; or never OR = 3.3 P = 0.002). The presence of dry throat was associated with being a former smoker (OR = 3.3; P = 0.011) and having jaw-opening limitations (OR = 3.9; P = 0.021). In recent years, speech and hearing interventions with teachers have focused on health-care promotion actions and prevention of vocal disorders, prioritizing issues related with hydration and healthy vocal use habits. However, the findings in the present study show the need to further focus on lifestyle habits related to sleep and eating habits.

Aquecimento e Desaquecimento Vocal em Estudantes de Pedagogia

Introduction: the voice is one of the main features of interaction between teacher and student. As teachers, future teachers are also risk population for the development of dysphonia and may be subject to protective intervention. Purpose: to evaluate the effect of a vocal warm-up and cool-down procedure at Pedagogy students. Method: A quasi-experimental study, pre-posttest without a control group, with fourteen Pedagogy students at a public university, participants of a short course. The analysis was performed by a self-assessment visual analogue scale of 10 cm, considering aspects related to the body and voice. The protocol was implemented in three steps: pre-test, post warm-up and post cool-down, and it was calculated the averages of the variables of discomfort and compared the measurements before and after performing each procedure. It was used the the Wilcoxon signed-rank statiscal test, adopting a significance level of 5%. Results: there was less discomfort with statistical significance after the vocal warm-up (p=0.002) and cool-down (p=0.001), with greater magnitude in both aspects related to voice. Conclusions: The vocal warm-up and cool-down have positive effects on the perception of students and should be taught to future teachers in order to prevent vocal disorders. The vocal cool-down, poorly researched, should not be passed over vocal health practices since its purpose showed obvious improvement in the investigated group.

Voice Disorders in Teachers. A Review

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Perturbações da voz profissional: da prevalência ao impacto económico

Dissertação apresentada à Associação de Politécnicos do Norte para obtenção do Grau de Mestre em Gestão das Organizações, Ramo de Gestão de Empresas Orientação: Prof. Doutor Jorge Ferreira Dias de Figueiredo Co-Orientação: Mestre Luís Francisco de Oliveira Marques Metello

Speech Analysis using Modern Techniques of Nonlinear Dynamics

Medical fields requires fast, simple and noninvasive methods of diagnostic techniques. Several methods are available and possible because of the growth of technology that provides the necessary means of collecting and processing signals. The present thesis details the work done in the field of voice signals. New methods of analysis have been developed to understand the complexity of voice signals, such as nonlinear dynamics aiming at the exploration of voice signals dynamic nature. The purpose of this thesis is to characterize complexities of pathological voice from healthy signals and to differentiate stuttering signals from healthy signals. Efficiency of various acoustic as well as non linear time series methods are analysed. Three groups of samples are used, one from healthy individuals, subjects with vocal pathologies and stuttering subjects. Individual vowels/ and a continuous speech data for the utterance of the sentence "iruvarum changatimaranu" the meaning in English is "Both are good friends" from Malayalam language are recorded using a microphone . The recorded audio are converted to digital signals and are subjected to analysis.Acoustic perturbation methods like fundamental frequency (FO), jitter, shimmer, Zero Crossing Rate(ZCR) were carried out and non linear measures like maximum lyapunov exponent(Lamda max), correlation dimension (D2), Kolmogorov exponent(K2), and a new measure of entropy viz., Permutation entropy (PE) are evaluated for all three groups of the subjects. Permutation Entropy is a nonlinear complexity measure which can efficiently distinguish regular and complex nature of any signal and extract information about the change in dynamics of the process by indicating sudden change in its value. The results shows that nonlinear dynamical methods seem to be a suitable technique for voice signal analysis, due to the chaotic component of the human voice. Permutation entropy is well suited due to its sensitivity to uncertainties, since the pathologies are characterized by an increase in the signal complexity and unpredictability. Pathological groups have higher entropy values compared to the normal group. The stuttering signals have lower entropy values compared to the normal signals.PE is effective in charaterising the level of improvement after two weeks of speech therapy in the case of stuttering subjects. PE is also effective in characterizing the dynamical difference between healthy and pathological subjects. This suggests that PE can improve and complement the recent voice analysis methods available for clinicians. The work establishes the application of the simple, inexpensive and fast algorithm of PE for diagnosis in vocal disorders and stuttering subjects.

Permutation Entropy Based Analysis of Complex Signals for Characterising Change in System Dynamics

Timely detection of sudden change in dynamics that adversely affect the performance of systems and quality of products has great scientific relevance. This work focuses on effective detection of dynamical changes of real time signals from mechanical as well as biological systems using a fast and robust technique of permutation entropy (PE). The results are used in detecting chatter onset in machine turning and identifying vocal disorders from speech signal.Permutation Entropy is a nonlinear complexity measure which can efficiently distinguish regular and complex nature of any signal and extract information about the change in dynamics of the process by indicating sudden change in its value. Here we propose the use of permutation entropy (PE), to detect the dynamical changes in two non linear processes, turning under mechanical system and speech under biological system.Effectiveness of PE in detecting the change in dynamics in turning process from the time series generated with samples of audio and current signals is studied. Experiments are carried out on a lathe machine for sudden increase in depth of cut and continuous increase in depth of cut on mild steel work pieces keeping the speed and feed rate constant. The results are applied to detect chatter onset in machining. These results are verified using frequency spectra of the signals and the non linear measure, normalized coarse-grained information rate (NCIR).PE analysis is carried out to investigate the variation in surface texture caused by chatter on the machined work piece. Statistical parameter from the optical grey level intensity histogram of laser speckle pattern recorded using a charge coupled device (CCD) camera is used to generate the time series required for PE analysis. Standard optical roughness parameter is used to confirm the results.Application of PE in identifying the vocal disorders is studied from speech signal recorded using microphone. Here analysis is carried out using speech signals of subjects with different pathological conditions and normal subjects, and the results are used for identifying vocal disorders. Standard linear technique of FFT is used to substantiate thc results.The results of PE analysis in all three cases clearly indicate that this complexity measure is sensitive to change in regularity of a signal and hence can suitably be used for detection of dynamical changes in real world systems. This work establishes the application of the simple, inexpensive and fast algorithm of PE for the benefit of advanced manufacturing process as well as clinical diagnosis in vocal disorders.

Sistema inteligente para diagnóstico de patologias na laringe utilizando máquinas de vetor de suporte

The human voice is an important communication tool and any disorder of the voice can have profound implications for social and professional life of an individual. Techniques of digital signal processing have been used by acoustic analysis of vocal disorders caused by pathologies in the larynx, due to its simplicity and noninvasive nature. This work deals with the acoustic analysis of voice signals affected by pathologies in the larynx, specifically, edema, and nodules on the vocal folds. The purpose of this work is to develop a classification system of voices to help pre-diagnosis of pathologies in the larynx, as well as monitoring pharmacological treatments and after surgery. Linear Prediction Coefficients (LPC), Mel Frequency cepstral coefficients (MFCC) and the coefficients obtained through the Wavelet Packet Transform (WPT) are applied to extract relevant characteristics of the voice signal. For the classification task is used the Support Vector Machine (SVM), which aims to build optimal hyperplanes that maximize the margin of separation between the classes involved. The hyperplane generated is determined by the support vectors, which are subsets of points in these classes. According to the database used in this work, the results showed a good performance, with a hit rate of 98.46% for classification of normal and pathological voices in general, and 98.75% in the classification of diseases together: edema and nodules

Políticas públicas e voz do professor: caracterização das leis brasileiras

OBJETIVO: Caracterizar as leis sobre saúde vocal publicadas em todo território nacional até o ano de 2006. MÉTODOS: Foram feitas buscas da documentação em sites oficiais, assim como um questionário elaborado pelas autoras foi divulgado no meio fonoaudiológico, por correio eletrônico, para captar o maior número de leis possível. Obtiveram-se 22 documentos que foram analisados quanto ao raio de abrangência, ações propostas, natureza dessas ações, público-alvo, secretarias envolvidas, iniciativa e promulgação das leis. Tais dados foram analisados de maneira absoluta (numérica) e relativa (percentualmente). RESULTADOS: Os documentos são, em sua maioria, leis de abrangência estadual, mais numerosas na região sudeste, propostas pelo poder legislativo, cuja viabilização compete a uma parceria entre secretarias de saúde e educação estaduais. As ações propostas, de modo geral, preconizam a implementação de assistência preventiva por meio de cursos teórico-práticos (90,91%), com periodicidade anual, ministrados por fonoaudiólogos, com a ressalva de que será oferecido, ao professor com distúrbio vocal, acesso ao tratamento fonoaudiológico e/ou médico (77,27%). em apenas três documentos (13,64%) avança-se para além de cursos, com propostas de ações de promoção à reabilitação, inclusive com menção ao ambiente de trabalho. Dois deles (9,09%) consideram os direitos do professor trabalhador. CONCLUSÃO: Levando-se em conta o grande número de casas legislativas no Brasil, poucas são as leis propostas a favor da saúde do professor, especialmente em relação à voz. Além disso, para que sejam aplicadas e transformadas em programas de saúde vocal, tais iniciativas devem partir de competência constitucional própria, a fim de garantir os recursos financeiros necessários para a sua viabilização.

Laryngeal malformation in Richieri-Costa Pereira syndrome: New findings

Laryngeal structural anomalies were described in 13 cases of Richieri-Costa Pereira syndrome, and four previously reported cases were reviewed. The 17 individuals examined had the typical laryngeal anomalies and vocal disorders previously described. The new findings are the laryngeal microweb observed in three cases and arytenoid anteriorization movement observed in 14 cases. (C) 2012 Wiley Periodicals, Inc.

The effect of noise on the voice of preschool institution educators

OBJECTIVE: To analyze the association between noise levels present in preschool institutions and vocal disorders among educators. METHODS: Cross-sectional study conducted in 2009 with 28 teachers from three preschool institutions located in the city of Sao Paulo (Southeastern Brazil). Sound pressure levels were measured according to Brazilian Technical Standards Association, with the use of a sound level meter. The averages were classified according to the levels of comfort, discomfort, and auditory damage proposed by the Pan American Health Organization. The educators underwent voice evaluation: self-assessment with visual analogue scale, auditory perceptual evaluation using the GRBAS scale, and acoustic analysis utilizing the Praat program. To analyze the association between noise and voice evaluation, descriptive statistics and the chi-square test were employed, with significance of 10% due to sample size. RESULTS: The teachers' age ranged between 21 and 56 years. The noise average was 72.7 dB, considered as damage 2. The professionals' vocal self-assessment ranked an average of 5.1 on the scale, being considered as moderate alteration. In the auditory-perceptual assessment, 74% presented vocal alteration, especially hoarseness; of these, 52% were considered mild alterations. In the acoustic assessment the majority presented fundamental frequency below the expected level. Averages for jitter, shimmer and harmonic-noise ratio showed alterations. An association between the presence of noise between the harmonics and vocal disorders was observed. CONCLUSIONS: There is an association between presence of noise between the harmonics and vocal alteration, with high noise levels. Although most teachers presented mild voice alteration, the self-evaluation showed moderate alteration, probably due to the difficulty in projection.

Voice disorders in teachers: clinical, videolaryngoscopical, and vocal aspects

Dysphonia is more prevalent in teachers than among the general population. The objective of this study was to analyze clinical, vocal, and videolaryngoscopical aspects in dysphonic teachers. Ninety dysphonic teachers were inquired about their voice, comorbidities, and work conditions. They underwent vocal auditory-perceptual evaluation (maximum phonation time and GRBASI scale), acoustic voice analysis, and videolaryngoscopy. The results were compared with a control group consisting of 90 dysphonic nonteachers, of similar gender and ages, and with professional activities excluding teaching and singing. In both groups, there were 85 women and five men (age range 31-50 years). In the controls, the majority of subjects worked in domestic activities, whereas the majority of teachers worked in primary (42.8%) and secondary school (37.7%). Teachers and controls reported, respectively: vocal abuse (76.7%; 37.8%), weekly hours of work between 21 and 40 years (72.2%; 80%), under 10 years of practice (36%; 23%), absenteeism (23%; 0%), sinonasal (66%; 20%) and gastroesophageal symptoms (44%; 22%), hoarseness (82%; 78%), throat clearing (70%; 62%), and phonatory effort (72%; 52%). In both groups, there were decreased values of maximum phonation time, impairment of the G parameter in the GRBASI scale (82%), decrease of F0 and increase of the rest of acoustic parameters. Nodules and laryngopharyngeal reflux were predominant in teachers; laryngopharyngeal reflux, polyps, and sulcus vocalis predominated in the controls. Vocal symptoms, comorbidities, and absenteeism were predominant among teachers. The vocal analyses were similar in both groups. Nodules and laryngopharyngeal reflux were predominant among teachers, whereas polyps, laryngopharyngeal reflux, and sulcus were predominant among controls.

Voice disorders in children and its relationship with auditory, acoustic and vocal behavior parameters

Objective: Parameters to distinguish normal from deviant voices in early childhood have not been established. The current study sought to auditorily and acoustically characterize voices of children, and to study the relationship between vocal behavior reported by teachers and the presence of vocal aberrations. Methods: One hundred children between four and 6 years and 11 months, who attended early childhood educational institutions, were included. The sample comprised 50 children with normal voices (NVG) and 50 with deviant voices (DVG) matched by gender and age. All participants were submitted to auditory and acoustic analysis of vocal quality and had their vocal behaviors assessed by teachers through a specific protocol. Results: DVG had a higher incidence of breathiness (p < 0.001) and roughness (p < 0.001), but not vocal strain (p = 0.546), which was similar in both groups. The average F-0 was lower in the DVG and a higher noise component was observed in this group as well. Regarding the protocol used "Aspects Related to Phonotrauma - Children's Protocol", higher means were observed for children from DVG in all analyzed aspects and also on the overall means (DVG = 2.15; NVG = 1.12, p < 0.001). In NVG, a higher incidence of vocal behavior without alterations or with discrete alterations was observed, whereas a higher incidence of moderate, severe or extreme alterations of vocal behavior was observed in DVG. Conclusions: Perceptual assessment of voice, vocal acoustic parameters (F-0, noise and GNE), and aspects related to vocal trauma and vocal behavior differentiated the groups of children with normal voice and deviant voice. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

Mucosal Bridge of the Vocal Fold: Difficulties in the Diagnosis and Treatment

Mucosal bridges are rare laryngeal lesions probably of genetic origin. They may cause dysphonia of varying degrees, especially when associated with other laryngeal lesions such as vocal sulci and cysts. Reports on mucosal bridges are rare, and the better treatment is inconclusive.Aim. To report the authors' experience in 14 cases of mucosal bridge showing details on endoscopic examinations and treatment.Study Design. Retrospective study.Methods. We reviewed the medical records of 14 patients with a diagnosis of mucosal bridge confirmed by video-laryngostroboscopy and direct laryngoscopy who attended the Outpatient Clinic of Voice Disorders of the Discipline of Otorhinolaryngology, Botucatu Medical School, São Paulo State University, São Paulo. Data collected included information on gender, age, symptoms, time of onset, history of intubation, smoking status, alcohol intake, associated laryngeal lesions, treatment, and GRBAS (grade of hoarseness, roughness, breathiness, asthenia, and stress) scale ratings.Results. of 14 patients, 10 were females and four were males. There was a prevalence of adults (n = 12), with only two of the patients being younger than 13 years (10 and 13 years). Mucosal bridges showed no correlations with smoking, alcohol intake, or gastroesophageal and sinonasal symptoms. Voice abuse was reported in 50% of the cases that consisted of patients who had high-voice demand occupations. In seven cases, mucosal bridges were associated with other laryngeal lesions, particularly vocal cysts and sulci. All patients who underwent surgery and phonotherapy showed improved vocal quality.Conclusions. We documented 14 patients with dysphonia caused by mucosal bridge. Promising results were obtained with surgery.

Laryngeal and voice disorders in patients with gastroesophageal symptoms. Correlation with pH-monitoring

OBJETIVO: Investigar as alterações laríngeas e vocais em pacientes com sintomas de refluxo gastroesofágico e correlacioná-las com o exame de phmetria. MÉTODOS: Estudo prospectivo que incluiu os pacientes atendidos nos ambulatórios de Distúrbios da Voz da Faculdade de Medicina de Botucatu no período de cinco anos com sintomas vocais e gastroesofágicos. Os pacientes foram submetidos à videolaringoscopia, às análises vocais perceptivo-auditivas, a analise vocal acústica computadorizada e ao exame de pHmetria de dois canais com monitorização durante 24 horas. RESULTADOS: Foram incluídos 57 pacientes (entre 21 a 65 anos; 45 mulheres e 12 homens). Desses, 18 apresentavam pHmetria normal (31,6%) e 39 alterada (68,4%). As videolaringoscopias registraram diversas lesões laríngeas tanto nos pacientes com pHmetria normal como alterada, sendo mais relevantes neste último grupo, destacando-se a paquidermia posterior. As avaliações vocais perceptivo-auditivas identificaram alterações vocais de diversas intensidades em ambos os grupos, mais importantes nos pacientes com pHmetria alterada. Todos os parâmetros acústicos, exceto Fo, mostraram-se alterados em ambos os grupos, quando comparados aos controles. CONCLUSÕES: Alterações vocais perceptivas e acústicas, e lesões laríngeas foram registradas tanto nos pacientes com phmetria normal como alterada, sinalizando para a importância da historia clínica e dos achados videolaringoscópicos no diagnóstico das laringites ácidas.