Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. Objective: This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. Methods: This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. Results: Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). Conclusion: Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

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.

Cochlear implanted children present vocal parameters within normal standards

Objective: to compare acoustic and perceptual parameters regarding the voice of cochlear implanted children, with normal hearing children. Method: this is a cross-sectional, quantitative and qualitative study. Methods: Thirty six cochlear implanted children aged between 3y and 3 m to 5y and 9 m and 25 children with normal hearing, aged between 3y and 11 m and 6y and 6 m, participated in this study. The recordings and the acoustics analysis of the sustained vowel/a/and spontaneous speech were performed using the PRAAT program. The parameters analyzed for the sustained vowel were the mean of the fundamental frequency, jitter, shimmer and harmonic-to-noise ratio (HNR). For the spontaneous speech, the minimum and maximum frequencies and the number of semitones were extracted. The perceptual analysis of the speech material was analyzed using visual-analogical scales of 100 points, composing the aspects related to the overall severity of the vocal deviation, roughness, breathiness, strain, pitch, loudness and resonance deviation, and instability. This last parameter was only analyzed for the sustained vowel. Results: The results demonstrated that the majority of the vocal parameters analyzed in the samples of the implanted children disclosed values similar to those obtained by the group of children with normal hearing. Conclusion: implanted children who participate in a (re) habilitation and follow-up program, can present vocal characteristics similar to those vocal characteristics of children with normal hearing. (C) 2012 Elsevier Ireland Ltd. All rights reserved.