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Mara Behlau, Glaucya Madazio, Gisele Oliveira Voice Department, Centro de Estudos da Voz – CEV, São Paulo, Brazil Abstract: Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient's perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient's recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for achieving a consensus regarding this complex problem. Keywords: voice, dysphonia, evaluation, patient-related outcomes, quality of life, voice handicap

Purpose: To compare the acoustic measurements of Cepstral Peak Prominence Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) of children with normal and altered voices, to relationship with auditory-perceptual judgment (APJ) and to establish cut-off points., Methods: Vocal recordings of the sustained vowel and number counting tasks of 185 children were selected from a database and submitted to acoustic analysis with extraction of CPPS and AVQI measurements, and to APJ. The APJ was performed individually for each task, classified as normal or altered, and for the tasks together defining whether the child would pass or fail in a situation of vocal screening., Results: Children with altered APJ and who failed the screening had lower CPPS values and higher AVQI values, than those with normal APJ and who passed the screening. The APJ of the sustained vowel task was related to CPPS and AVQI, and APJ of the number counting task was related only to AVQI and CPPS numbers. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the vowel CPPS, 7.62 for the CPPS numbers and 2.01 for the AVQI., Conclusion: Children with altered voices, have higher AVQI values and lower CPPS values, when detected in children with voices within the normal range. The acoustic measurements were related to the auditory perceptual judgment of vocal quality in the sustained vowel task, however, the number counting task was related only to the AVQI and CPPS. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the CPPS vowel, 7.62 for the CPPS numbers and 2.01 for the AVQI. The three measures were similar in identifying voices without deviation and dysphonic voices.

Purpose: To map and describe the characteristics present in the publications of the CoDAS journal in the voice segment., Research Strategies: The research was carried on the Scielo database using the descriptor voice., Selection Criteria: CoDAS publications in the field of voice., Data Analysis: Specific data collected according to delineation, summarized by descriptive analysis and analyzed in narrative format., Results: Studies published in 2019 and with cross-sectional delineation were more frequent. The most frequent result in the cross-sectional studies was the vocal self-assessment. Most intervention studies were of immediate single-session-only effect. The most frequent procedures in the validation studies were translation and transcultural adaptation., Conclusion: There was a gradual increase in the number of publications of voice studies, though these had heterogeneous characteristics.

Purpose: To compare the vowel emission and number counting tasks in perceptual-auditory differentiation among children with and without laryngeal lesions., Methods: Observational, analytical, and cross-sectional methods were used. Medical records of 44 children were selected from a database of an otorhinolaryngology service at a University Hospital and they were divided into groups: without laryngeal lesion (WOLL), and with laryngeal lesion (WLL), with 33 and 11 children. For the auditory-perceptual evaluation, the vocal samples were separated according to the type of task. They were analyzed separately by a judge who analyzed the general degree of vocal deviation and assessed whether the child would pass or fail in the face of a screening situation., Results: There was a difference between the WOLL and WLL groups in terms of the overall degree of vocal deviation for the task of number counting, with a predominance of mild deviations in WOLL and moderate in WLL. In the screening, there was a difference between the groups during the number counting task, with more failures in the WLL. The groups were similar in the sustained vowel task, both in terms of the overall degree of vocal deviation and the vocal screening. Most children in the WLL failed in both tasks during vocal screening compared to the children in the WOLL who, in general, failed in only one task., Conclusion: The task of number counting contributes to the auditory differentiation in children with and without laryngeal lesion, by identifying deviations of greater intensity in children with laryngeal lesion.

Coaching is one of the most common words in our modern vocabulary and has many meanings depending on the setting in which it is used. Coaching facilitates positive changes to achieve a goal, usually through indirect approaches, including improving an individual's outlook on their behaviors or attitudes. Its application has spread beyond the corporate world, and many medical specialties use coaching principles. The goals of this article are to introduce coaching as a profession, and to explore the function of a vocal coach to improve communicative and vocal performance. Moreover, differences between voice therapy and voice training are highlighted, including the principles subjacent to these interventions and the use of coaching strategies. Four strategies of professional coach practitioners adapted to the training and therapy of the voice with applications to both are described. These are: powerful questions, active listening, changing habits, and implementation intention. The use of these strategies may help individuals to achieve high voice performance. Most importantly, the speech-language pathologist voice specialist can apply these strategies particularly in cases of behavioral dysphonias, which can be resistant to traditional voice therapy., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Introduction  Musicians have an advantage over non-musicians in detecting, perceiving, and processing nonverbal (i.e., environmental sounds, tones and others) and verbal sounds (i.e., consonant, vowel, phrases and others) as well as instrumental sounds. In contrast to the high skill of musicians, there is another group of people who are tone-deaf and have difficulty in distinguishing musical sounds or singing in tune. These sounds can originate in different ways, such as a musical instrument, orchestra, or the human voice. Objective  The objective of the present work is to study frequency-following responses (FFRs) in individuals who can sing in-tune and those who sing off-tune. Methods  Electrophysiological responses were recorded in 37 individuals divided in two groups: (i) control group (CG) with professional musicians, and (ii) experimental group (EG) with non-musicians. Results  There was homogeneity between the two groups regarding age and gender. The CG had more homogeneous responses in the latency of the FFRs waves when responses between the right and left ears were compared to those of the EG. Conclusion  This study showed that monaural stimulation (right or left) in an FFR test is useful for demonstrating impairment of speech perception in individuals who sing off tune. The response of the left ear appears to present more subtlety and reliability when identifying the coding of speech sound in individuals who sing off tune., Competing Interests: Conflict of Interests The authors declare that there is no conflict of interests, (Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Purpose: To compare self-assessment when speaking in public, using the Self-Statements During Public Speaking scale, with the communicational perception and self-reported shyness of university students., Methods: This was a prospective cross-sectional observational study. University students from different areas of knowledge in Brazil were invited to participate in this study. Those who agreed to participate were included. Participants received an electronic invitation and filled out a form created on the Google Forms platform that contained sociodemographic questions, on self-perception as a good speaker, on ease of expression, on shyness, and the Self-Statements During Public Speaking scale. The means of the Self-Statements During Public Speaking scale were compared with the self-perception as a good speaker, the ease of expressing oneself, and shyness., Results: Participants who considered themselves to be good communicators, those who believed they had an ease to express themselves, and those who were not shy had better self-perception of their public speaking skills., Conclusion: positive communicational self-perception, as well as less shyness self-perception, are related to a more favorable self-assessment in relation to public presentations.

This text is the continuation of the XVIII SBFa Congress publication. In part "A" we presented the analyses on clinical vocal evaluation. Part "B" focuses on vocal rehabilitation: 4. Traditional techniques of vocal therapy; 5. Modern techniques of electrostimulation and photobiomodulation applied to vocal rehabilitation. The numerous studies on the various programs, methods, and techniques of traditional rehabilitation techniques, and many with high quality of evidence, allow us to consider such procedures relatively well described, safe, and with known effects, accounting for the treatment of various vocal disorders. The scientific evidence with traditional techniques is recognized worldwide. New fronts of evolution, with electrostimulation or photobiomodulation used to handle voice problems, seem to be promising as coadjutant approaches. There are more studies on electrostimulation in vocal rehabilitation than with photobiomodulation; however, scientific evidence for these two modern techniques is still limited. Knowledge and caution are required for the application of either technique.

During the XXVIII Brazilian Congress of SBFa, 24 specialists met and, from a leading position on scientific research as a tool for connecting laboratory and clinic, five fronts of knowledge of the voice specialty were discussed as following: Perceptual-auditory judgment of vocal quality; 2. Acoustic analysis of the vocal signal; 3. Voice self-assessment; 4. Traditional techniques of therapy; 5. Modern techniques of electrostimulation and photobiomodulation (PBMT) in voice. Part "a" of this publication was associated with the consolidation of the analyses of the first three aspects. The trend in the perceptual-auditory judgment of vocal quality was related to the use of standard protocols. The acoustic evaluation of the vocal signal is accessible and can be done descriptively or by extraction of parameters, thus preferring multiparametric measures. Finally, the analysis of the individual himself closes this triad of voice documentation, which will be the basis for the conclusion of the evaluation, reference for monitoring progress, and evaluation of treatment results.

Introduction: The Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) scale is a modern, clinical-scientific approach to voice analysis. It has been translated and culturally adapted to Brazilian Portuguese, but it still lacks validation., Objective: To validate the Brazilian Portuguese version of the CAPE-V scale using the previously translated and culturally adapted version., Method: Forty voice samples were selected (30 dysphonic, 10 nondysphonic), and the degree of vocal deviation was evaluated by a committee of three voice specialists. Nine voice specialists judged the 40 voice samples plus 20% repetition (total of 48 samples) using the CAPE-V. To ensure construct validity of the CAPE-V, its analysis was compared to the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale that was performed 48-72 hours later. Finally, the intra- and inter-rater reliability values were verified and the correlation between the nine judges and the previously defined evaluation was analyzed., Results: The Brazilian CAPE-V presented significant intra (0.860-0.997) and inter-rater reliability values (0.707-0.964) for the overall degree and strong correlation with GRBAS (above 0.828). Deviant voice quality had greater consensus among raters than normal voices. A strong correlation was observed between the analysis of the nine raters and that of the committee., Conclusion: CAPE-V is an important diagnostic instrument that contributes to the standardization of vocal quality evaluation in several languages, including Brazilian Portuguese. Thus, its usefulness is neither related to a single language nor to a single set of raters., (Copyright © 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: Verify and compare vocal deviation in quality, vocal symptoms and reflux symptom index in patients with clinical diagnosis of laryngopharyngeal reflux (LPR)., Methods: 100 individuals of both genders participated in this prospective study, aged between 18 and 60 years old, who presented signs of LPR in the nasofibrolaryngological exam. Participants answered the Reflux Symptom Index (RSI) questionnaire to determine the reflux index and the Voice Symptom Scale (VoiSS). Their voices were recorded for the auditory-perceptual assessment. Three speech therapists with voice experience were contacted and the most reliable one was maintained., Results: 100 examined voices, 34 were classified as adapted and 66 as deviated. The predominant vocal quality type was rough and a slight degree of deviation. The average score on VoiSS and RSI of individuals with deviated voice is significantly higher than the adapted voice group on both protocols (p<0.01). The symptom reported with most frequency and intensity, in both analyses, was throat clearing. There were statistically significant differences once analyzed the vocal quality types by pairs: rough-adapted (p=0.0021) and tense-adapted (p=0.0075) on VoiSS, and rough-adapted (p=0.001) on RSI., Conclusion: Individuals with deviated voice reported higher occurrence of LPR related vocal signals and symptoms measured by VoiSS and RSI. The numerous theories about the disease do not make possible a single conclusion on the subject. Further studies are needed in the area to assist the professional in the diagnosis and treatment of the RLF patient.

Purpose: This Brief Communication describes the professional coaching/coach counterpointed by the vocal coaching/coach. The aim is to introduce and explain these two coaching perspectives for a correct and specific use of the terms., Methods: Six undergraduate professors, speech language pathologists - SLP and/or professional coaches and/or vocal coaches met and shared their perceptions and experiences in professional or vocal coaching and in teaching coaching strategies to professionals working in the voice field. A chart was set encompassing the similarities and differences between the two attributions, both in terms of the intervention process and professional training., Results: Six fundamental aspects were identified to characterize the two coaching presentations, both professional and vocal, namely: credentials, performance, process, basic knowledge, partnership for results, and professional title., Conclusion: Professional coaching involved a structured process that requires certified training with individuals accredited by qualified associations aiming to facilitate positive changes in clients' lives and improve for the understanding of how personal and professional skills are developed. Conversely, vocal coaching can be characterized as an unstructured function that does not require accredited training, executable by various health or vocal pedagogy professionals for improving voice and/or communicative performance of artistic or non-artistic individuals , sung or spoken voice users. Particularly regarding vocal coaching, it is suggested that the professional is identified throughout the academic training or basic professional performance, thus adding the term vocal coach as a qualifier.

Purpose: To identify muscle tension dysphonia (MTD) signs and symptoms, as well as to analyze the results of vocal parameters, the physical clinical examination of muscle palpation, the self-perception of vocal symptoms, vocal pain, and fatigue of women with MTD and compare them with women with healthy voices., Methods: a cross-sectional study with 45 women (23 with MTD and 22 controls), similar median age between groups. The speech-language and otorhinolaryngological evaluation determined the diagnosis of MTD. All participants responded to the Voice Symptoms Scale (VoiSS), Vocal Fatigue Index (VFI), and Nordic Musculoskeletal Questionnaire (NMQ) protocols. They were also assessed by a palpatory evaluation of the perilaryngeal musculature, auditory-perceptual evaluation, and acoustic analysis of the voice fundamental frequency. The speech sample included sustained vowels "a", "i" and "e" and connected speech, recorded in a silent environment, and submitted to auditory-perceptual evaluation by three judges. In the acoustic analysis, the fundamental frequency and maximum phonation times were extracted., Results: The MTD group had worse results in VoiSS, VFI, and NMQ, in addition to greater resistance to palpation and a high vertical position of the larynx. The vocal parameters also showed greater deviation in the MTD group, except for the fundamental frequency. There was no relationship between vocal symptoms, fatigue, or pain with the general degree of dysphonia in the MTD group, indicating important symptoms in mild or moderate vocal deviations., Conclusion: women with MTD presented vocal symptoms, vocal fatigue, muscle pain, resistance to palpation and deviated vocal parameters when compared to vocally healthy women.

Purpose: To evaluate the ability that in tune and out of tune individuals have to identify normal and deviated voice qualities and to compare it with their performance in auditory processing tests and perceptual judgment., Method: The study investigated 15 in tune and 15 out of tune individuals. Participants were matched for age and sex, were amateur choir singers, had normal hearing thresholds and normal vocal quality. All individuals underwent Pitch-matching scanning to be classified as in or out of tune. Next, they performed the Pitch Pattern Sequence (PPS) and the Duration Pattern Sequence (DPS) tests and the perceptual judgment of 36 voices plus 20% of repetition for reliability analysis., Results: The out of tune individuals had worse performance in the PPS and DPS for both ears (p=0.002 RE; p=0.001 LE; p=0.009 DPS); no difference was observed in the perceptual judgment and the reliability (p=0.153). However, participants with normal PPS and DPS had better performance in the perceptual judgment and better reliability (p=0.033). Thus, individuals with disorders in temporal auditory processing skills have greater difficulty in the perceptual judgment and have lower intra-rater reliability, despite being in or out of tune., Conclusion: It can be observed that voice tone is not required to guarantee good perceptual judgment. However, temporal patterns and intra-rater reliability are essential to perceptually assess normal and altered voice qualities. Therefore, auditory training should be included in programs that aim to develop voice perceptual judgment abilities.

Purpose: To identify the parameters that influences the decision of singing teachers to seek speech-language pathology (SLP) assistance for their students., Methods: The study sample comprised 48 popular-music singing teachers, male and female, aged 37.96 years on average. The participants responded to a 10 closed-question questionnaire prepared by the researchers via the SurveyMonkey platform. The questions referred to the reasons why singing teachers seek SLP assistance, as well as to the knowledge of these teachers regarding chronic hoarseness as a risk symptom to identify other lesions in the larynx., Results: Singing teachers seek SLP assistance for their students in the presence of hoarseness complaints and impaired speech sound articulation. The singing teachers assessed did not consider vocal tiredness complaint as a determining factor for referral to SLP evaluation. Most study participants were not aware that a hoarseness complaint for over 15 days can be indicative of larynx tumor. There was no influence of the variables age and time of professional experience in the referral to SLP assistance., Conclusion: Most of the singing teachers who participated in this study sought SLP assistance for their students when they presented hoarseness complaints and impaired speech sound articulation.

Purpose: To verify the relation between the self-reported shyness and perceived vocal handicap in teachers from Early childhood and Primary education (elementary and middle school)., Methods: 200 teachers (mean age 41.8 years old) without vocal complaint answered to personal identification protocol, work characterization information, the Vocal Handcap Index and the Shyness Scale., Results: From the total sample, 142 (71%) teachers had no vocal disadvantage, 42% (n = 59) were shy and 58% (n = 83) were non-shy. Among the 58 (29%) teachers with vocal disadvantage, most of them were shy (64%) instead of non-shy (26%). Considering the shy teachers, most of them worked in Early Childhood Education, were aged between 20-30 years old, had from 1 to 10 years of teaching experience and were working in a noisy classroom. The presence of upper airway affections was more frequent in shy teachers without vocal disadvantage and this was the only aspect that differentiated shy and non-shy teachers., Conclusion: Shy teachers showed higher frequency of vocal disadvantage when compared to non-shy teachers. Teachers between 20 and 30 years old, with up to 10 years of teaching experience and who teach in Early Childhood Education reported shyness, but there was no relation with vocal disadvantage.

Purpose: To investigate the learning factor during a perceptual-auditory analysis of an unusual task in three different groups., Methods: 269 listeners, divided into three groups: 73 voice specialists Speech Language Pathologists (EG), 84 voice specialists Speech Language Pathologists (NEG); and 112 non-speech pathologists in the Naive Group (NG). They all completed a listening session that included 18 synthesized and 18 human voices with different types and degrees of deviation (50% of repetition for intra-rater consistency analysis). The task was to classify the voices as human or synthesized. We analyzed the learning factor by comparing the initial error percentage, first 18 voices, with the final, last 18 voices., Results: EG presented less error towards the end of the task (25.5%) than at the beginning (28.6%) with statistical difference (p = 0.024). The error percentage of the beginning and the end of the task did not differ for the NEG and the NG (NEG beginning = 36.5%, end = 35.3%; NG beginning = 38.3%, end = 37.7%)., Conclusion: The EG was the only group to present evidence of learning factor. Therefore, it seems that professional experience positively influences the perceptual-auditory analysis, which reinforces the impact of its training to become a voice specialist. Moreover, the voice specialists seem to be more prepared and more susceptible to use learning strategies to improve their performance during a perceptual-auditory analysis task, even if unusual.

Purpose: To compare vocal and acoustic parameters of HIV-infected children and non-HIV-infected children., Methods: Vocal samples were submitted to auditory-perceptual and acoustic analysis. Samples of the sustained vowel /ε/ and continuous speech of 74 children between 6 and incomplete 12 years old were analyzed, divided into two groups: 37 HIV-infected children (GHIV) and 37 non-HIV-infected children, the control group (CG), age and gender-matched and without previous vocal evaluation; they were all prepubescent by the Tanner Stages (MS, 2014). The children had their voices recorded and analyzed by VoxMetria 5.1, in the period between 2014 and 2015. The auditory-perceptual analysis assessed the overall degree of the vocal quality and was performed using a 100-point visual analogue scale, transformed into a 4 point numerical scale (0 = no vocal deviation and 4 = severe vocal deviation). The acoustic evaluation was based on the analysis of the vocal sample distribution in the Phonatory Deviation Diagram (PDD). The research was approved by the Ethics Committee under the number 122.746., Results: In the auditory-perceptual analysis, most children of both groups were evaluated as with no vocal deviation. No difference between the groups was found in the acoustic analysis using the PDD; most voice samples were within the normality area, in the quadrant 1, with a spread density distribution and a vertical shape., Conclusion: HIV-infected children presented similar vocal quality to children without the illness, both for the perceptual-auditory and acoustic evaluation.

Purpose: To verify the impact that group dynamics and coaching strategies have on the PD patients voice, speech and communication, as well as the group climate., Methods: 16 individuals with mild to moderate dysarthria due to the PD were divided into two groups: the CG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 additional support sessions; and the EG (8 patients), submitted to traditional therapy with 12 regular therapy sessions plus 4 sessions with group dynamics and coaching strategies. The Living with Dysarthria questionnaire (LwD), the self-evaluation of voice, speech and communication, and the perceptual-auditory analysis of the vocal quality were assess in 3 moments: pre-traditional therapy (pre); post-traditional therapy (post 1); and post support sessions/coaching strategies (post 2); in post 1 and post 2 moments, the Group Climate Questionnaire (GCQ) was also applied., Results: CG and EG showed an improvement in the LwD from pre to post 1 and post 2 moments. Voice self-evaluation was better for the EG - when pre was compared with post 2 and when post 1 was compared with post 2 - ranging from regular to very good; both groups presented improvement in the communication self-evaluation. The perceptual-auditory evaluation of the vocal quality was better for the EG in the post 1 moment. No difference was found for the GCQ; however, the EG presented lower avoidance scores in post 2., Conclusion: All patients showed improvement in the voice, speech and communication self-evaluation; EG showed lower avoidance scores, creating a more collaborative and propitious environment for speech therapy.

Objective/hypothesis: To assess the quality of synthesized voices through listeners' skills in discriminating human and synthesized voices., Study Design: Prospective study., Methods: Eighteen human voices with different types and degrees of deviation (roughness, breathiness, and strain, with three degrees of deviation: mild, moderate, and severe) were selected by three voice specialists. Synthesized samples with the same deviations of human voices were produced by the VoiceSim system. The manipulated parameters were vocal frequency perturbation (roughness), additive noise (breathiness), increasing tension, subglottal pressure, and decreasing vocal folds separation (strain). Two hundred sixty-nine listeners were divided in three groups: voice specialist speech language pathologists (V-SLPs), general clinician SLPs (G-SLPs), and naive listeners (NLs). The SLP listeners also indicated the type and degree of deviation., Results: The listeners misclassified 39.3% of the voices, both synthesized (42.3%) and human (36.4%) samples (P = 0.001). V-SLPs presented the lowest error percentage considering the voice nature (34.6%); G-SLPs and NLs identified almost half of the synthesized samples as human (46.9%, 45.6%). The male voices were more susceptible for misidentification. The synthesized breathy samples generated a greater perceptual confusion. The samples with severe deviation seemed to be more susceptible for errors. The synthesized female deviations were correctly classified. The male breathiness and strain were identified as roughness., Conclusion: VoiceSim produced stimuli very similar to the voices of patients with dysphonia. V-SLPs had a better ability to classify human and synthesized voices. VoiceSim is better to simulate vocal breathiness and female deviations; the male samples need adjustment., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: This study aims to (1) determine the cutoff values of the overall severity (OS) of vocal deviation on the visual analog scale (VAS) based on the ratings of the numerical scale (NS); and (2) verify the power of discrimination of these cutoff values according to different degrees of vocal deviation., Study Design: This is a prospective study., Methods: The auditory-perceptual evaluation was performed by four speech-language pathologists who used two protocols with different scalar properties: the VAS and the 4-point NS. Vocal samples from142 women and 69 men, plus 10% of repetition, with and without vocal complaints, ranging from 19 to 60 years were included. The analyzed speaking task was the counting from 1 to 10. For both protocols, the judges rated the OS., Results: Based on the correspondence between the two scales, the cutoff values of the OS on the VAS obtained were 35.5, 50.5, and 90.5 points. The 35.5 value corresponds to the cutoff point between normal variability and mild/moderate vocal deviations; the 50.5 value corresponds to the cutoff point between mild/moderate and moderate vocal deviations; the 90.5 value corresponds to the cutoff point between moderate and severe deviations. Areas under the receiver operating characteristic curve for the three cutoff values were 0.918, 0.948, and 0.970, respectively., Conclusions: The cutoff values of the OS on the VAS were obtained, and the areas under the ROC curve showed that all the three cutoff points had excellent accuracy that represents a higher power of discrimination of different degrees of vocal deviations., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives/hypothesis: To verify the discriminatory ability of human and synthesized voice samples., Study Design: This is a prospective study., Methods: A total of 70 subjects, 20 voice specialist speech-language pathologists (V-SLPs), 20 general SLPs (G-SLPs), and 30 naive listeners (NLs) participated of a listening task that was simply to classify the stimuli as human or synthesized. Samples of 36 voices, 18 human and 18 synthesized vowels, male and female (9 each), with different type and degree of deviation, were presented with 50% of repetition to verify intrarater consistency. Human voices were collected from a vocal clinic database. Voice disorders were simulated by perturbations of vocal frequency, jitter (roughness), additive noise (breathiness) and by increasing tension and decreasing separation of the vocal folds (strain)., Results: The average amount of error considering all groups was 37.8%, 31.9% for V-SLP, 39.3% for G-SLP, and 40.8% for NL. V-SLP had smaller mean percentage error for synthesized (24.7%), breathy (36.7%), synthesized breathy (30.8%), and tense (25%) and female (27.5%) voices. G-SLP and NL presented equal mean percentage error for all voices classification. All groups together presented no difference on the mean percentage error between human and synthesized voices (P value = 0.452)., Conclusions: The quality of synthesized samples was very high. V-SLP presented a lower amount of error, which allows us to infer that auditory training assists on vocal analysis tasks., (Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the efficiency of four self-assessment questionnaires that rate the impact of a voice problem on the individual's life: Voice-Related Quality of Life (V-RQOL), the original and reduced versions of the Voice Handicap Index (VHI) and VHI-10, Vocal Performance Questionnaire (VPQ), and Voice Symptom Scale (VoiSS)., Methods: Data from 975 subjects, 486 with a diagnosis of dysphonia and 489 vocally healthy individuals, were submitted to the receiver operating characteristic (ROC) curve analysis to obtain the cutoff values that determine the discriminating power of these instruments (presence of dysphonia vs healthy voice)., Results: The ROC curve analysis showed that the most efficient questionnaires were the VoiSS and the VHI. Results showed that they presented as a perfect classification based on their efficiency, specificity, and sensitivity values (all three of them = 1). The VHI-10 and the V-RQOL showed excellent classification (VHI-10: efficiency = 0.991; specificity = 1; sensitivity = 0.981; V-RQOL: efficiency = 0.914; specificity = 0.860; sensitivity = 0.967). Finally, the VPQ showed a good level of classification (efficiency = 0.828; specificity = 0.824; sensitivity = 0.831). The cutoff values for the instruments are as follows: VoiSS = 16 points, VHI = 19 points, VHI-10 = 7.5 points, V-RQOL = 91.25, and VPQ = 20.5 points. These values are important for screening large populations as well as for helping in the decision-making process of clinical management. The cutoff values for maximum sensitivity and specificity of the instruments that did not produce perfect classification are as follows: VHI-10: sensitivity = 5; specificity = 7.5, V-RQOL: sensitivity = 86.25; specificity = 98.75, and VPQ: sensitivity = 15.5; specificity = 31.5., Conclusions: Both the VoiSS and the VHI are perfect classifiers. The VHI-10 and the V-RQOL are excellent classifiers, and the VPQ is good at discriminating individuals with dysphonia from the ones without dysphonia., (Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Purpose: To present the cross-cultural equivalence of the Brazilian version of the Evaluation of the Ability to Sing Easily (EASE) protocol, through its cultural and linguistic adaptation., Methods: After the EASE was translated to Brazilian Portuguese, the back-translation into English was done. The items of the translated version were compared with the original instrument and the discrepancies were modified by consensus of a committee composed of five speech language pathologists. The Evaluation of the Ability to Sing Easily for Brazil (EASE-BR) has 22 questions with four alternatives: "no," "mildly," "moderately," and "extremely." The score is obtained by the simple sum of all answers. The three positive items (6, 12, and 21) require reverse score. For cultural equivalence, the EASE-BR was applied with 41 Brazilian singers, with an extra item in the answer key - "not applicable." The aim of this extra key was to identify issues that might not have been understood or were not appropriate for the target population and the Brazilian culture., Results: Of the 32 singers, 5 who were initially evaluated had difficulties to answer 3 of the 22 questions. Therefore, the adaptation of those sentences was necessary. Afterward, the modified EASE-BR was applied to nine singers, and no more cultural and/or conceptual barriers were found., Conclusion: Cultural equivalence was observed between EASE and its translated version to the Brazilian Portuguese, the EASE-BR. Validation of the EASE for Brazilian Portuguese is in progress.

Purpose of Review: Recent advances with regard to occupational voice disorders are highlighted with emphasis on issues warranting consideration when assessing, training, and treating professional voice users., Recent Findings: Findings include the many particularities between the various categories of professional voice users, the concept that the environment plays a major role in occupational voice disorders, and that biopsychosocial influences should be analyzed on an individual basis. Assessment via self-evaluation protocols to quantify the impact of these disorders is mandatory as a component of an evaluation and to document treatment outcomes. Discomfort or odynophonia has evolved as a critical symptom in this population. Clinical trials are limited and the complexity of the environment may be a limitation in experiment design., Summary: This review reinforced the need for large population studies of professional voice users; new data highlighted important factors specific to each group of voice users. Interventions directed at student teachers are necessities to not only improving the quality of future professionals, but also to avoid the frustration and limitations associated with chronic voice problems. The causative relationship between the work environment and voice disorders has not yet been established. Randomized controlled trials are lacking and must be a focus to enhance treatment paradigms for this population.

Objective: Verify whether PDD reflects vocal changes obtained by vocal rehabilitation and whether it reflects the changes in perceptual analysis., Methods: Samples of the sustained vowel / ε /, pre and post-therapy, from 34 individuals with different dysphonia diagnosis were collected. The voices were acoustically analyzed by the PDD and an auditory perceptual analysis was performed using a visual analog scale (VAS) of 100 points. The acoustic samples were classified according to PDD density (concentrate or spread), shape (horizontal, vertical or circular) and position within the quadrants of the graph (lower left = 1, = lower right = 2, upper right = 3 and upper left = 4). Statistical analysis of acoustic parameters, distribution of samples and correlation between acoustic analysis and auditory perceptual analysis were performed., Results: Acoustic data showed improvement after therapy. Density did not differ in the two moments, while shape showed differences pre and post-therapy (p = 0.031). The vertical form characterized pre-therapy samples (12, 35.29%), and the circular form was associated to post-therapy samples (7, 20.59%). In pre-treatment condition, samples were distributed in three of the four quadrants, while in post-therapy, 90% were located in the first quadrant (normality area). The average perceptual deviation reduced from moderate to mild-moderate (p <0.001). There is a relationship between quadrant location and perceptual analysis (p <0.001)., Conclusion: PDD is useful to identify changes acquired with voice therapy and correlates with perceptual voice analysis.

Voice rehabilitation is the main treatment option in cases of behavioral dysphonia, and it has the purpose of enhancing the quality of vocal production and voice-related life aspects. Several efforts have been made to offer a clinical practice that is based on evidence, including the development of specific therapeutic protocols as an option for clinical and scientific improvement. It is necessary to define the focus/objective of the dysphonia treatment, type of approach, and duration in order to establish the intervention criteria. This paper describes the organization of a program of behavioral dysphonia treatment, based on an approach that has been used for over twenty years, named Comprehensive Vocal Rehabilitation Program, and also to present its concepts, theory, and practical fundamentals. The program has an eclectic approach and associates body work, glottal source, resonance, and breathing coordination in addition to knowledge about vocal hygiene and communicative behavior. The initial proposal suggests a minimum time of intervention of six therapeutic sessions that can be adapted according to the patient's learning curve and development. The goal is to offer a rational and structured therapeutic approach that can be reproduced in other scenarios.

Unlabelled: Dystonia is a central motor processing neurological disorder characterized by abnormal, often action-induced, involuntary movements or uncontrolled spasms., Aim: To compare patients with the diagnoses of focal and segmental adductor laryngeal dystonia at the Neurolarynx Outpatient Clinic of the Federal University of São Paulo., Materials and Methods: A clinical retrospective study of data collected from patient registries from 2003 to 2009., Results: Of 34 patients, 25 presented focal dystonia and 9 presented segmental dystonia. There were 30 females (88. 2%) and 4 males (11. 8%). A relation with a traumatic event was reported in 11 cases (32. 4%). Vocal tremor was observed in 21 patients (61. 8%). The mean age at onset, the age at diagnosis, and time between the onset and the diagnosis were respectively 55, 61. 3 and 6. 3 years. There was no statistical difference between patients with focal laryngeal adductor dystonia and segmental dystonia in the study data., Conclusions: There were no statistical differences among patients with focal adductor laryngeal dystonia and segmental dystonia relating to age of onset, age of diagnosis, gender, time between onset and diagnosis, presence of associated tremor, and relation to trauma.

Purpose: To observe the immediate effect of the sounded blowing exercise with semi-occluded vocal tract (SOVTE) in the voices of elderly subjects., Methods: Thirty-three subjects with 65 years of age or older, with no voice or hearing disorder complaints, and with good self-perceived general health participated in the study. All participants filled in a vocal self-evaluation questionnaire. The sustained vowel /ε/ was recorded in three distinct moments: the first, denominated habitual (H), based on the subject's regular production; the second, usage (U), after one minute of continuous spontaneous conversation; the third, exercise (E), carried out after a one-minute execution of the SOVTE. After the exercise, the subjects self-evaluated the changes perceived in their voices. The recordings were edited and randomly paired, considering two moments of the same subject: H/U; H/E and U/E, for further perceptual examination of the better production by three specialized speech-language pathologists., Results: There were no differences between H and U (p=0.199) and between U and E (p=0.773). However, the E production was considered better than the H production (p=0.004). In the vocal self-evaluation, most subjects (n=25, 75.8%) did not observe immediate effects in their voices after the exercise., Conclusion: The SOVTE produced positive immediate effects on the vocal quality of elderly subjects, observed only at the perceptual-auditory evaluation.

Aim: To identify the discriminative characteristics of the phonatory deviation diagram (PDD) in rough, breathy and tense voices., Methods: One hundred and ninety-six samples of normal and dysphonic voices from adults were submitted to perceptual auditory evaluation, focusing on the predominant vocal quality and the degree of deviation. Acoustic analysis was performed with the VoxMetria (CTS Informatica)., Results: Significant differences were observed between the dysphonic and normal groups (p < 0.001), and also between the breathy and rough samples (p = 0.044) and the breathy and tense samples (p < 0.001). All normal voices were positioned in the inferior left quadrant, 45% of the rough voices in the inferior right quadrant, 52.6% of the breathy voices in the superior right quadrant and 54.3% of the tense voices in the inferior left quadrant of the PDD. In the inferior left quadrant, 93.8% of voices with no deviation were located and 72.7% of voices with mild deviation; voices with moderate deviation were distributed in the inferior and superior right quadrants, the latter ones containing the most deviant voices and 80% of voices with severe deviation., Conclusion: The PDD was able to discriminate normal from dysphonic voices, and the distribution was related to the type and degree of voice alteration., (Copyright © 2011 S. Karger AG, Basel.)

Although the latency between the initiation of thyroarytenoid electrical activity and the onset of phonation generally is increased in patients with adductor laryngeal dystonia, there is disagreement about whether there is overlap of latency values in these patients and normal subjects. The goal of this article was to compare the severity of dysphonia with the latency between electrophysiological activation of the thyroarytenoid muscle (TA) and the onset of phonation in patients with adductor laryngeal dystonia and compare the values with normal controls. Twenty-one patients with adductor dystonia and 15 control patients underwent laryngeal electromyographic (EMG) examination of the left TA. We measured the latency from initiation spike of the electric activity of the TA muscle to the onset of phonation. Three speech-pathologists/voice specialists arrived at a consensus to rate the perceptual evaluation of voice quality for the study group. The average latency measured for patients with mild dysphonia was 332 milliseconds, for moderate dysphonia was 426 milliseconds, and for the severe dysphonia was 792 milliseconds. We used the Spearman's correlation test to compare the latency time values and the dysphonia's degree of severity (P<0.05). Latency was significantly and directly related to the degree of severity of dysphonia., (Copyright (c) 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.)

Unlabelled: Dystonias are organic central motor processing disorders characterized by involuntary muscular contractions or incontrollable spasms induced by task-specific movements. Adduction laryngeal dystonias present with important speech impairments, with inappropriate spasms and abrupt voice breaks. The diagnosis is based on clinical features, evaluation by a speech therapist and transnasal fiber optic laryngoscopy., Aim: Our objective is to propose and evaluate a task-oriented transnasal fiber optic laryngoscopy protocol, which shows the spasms, and propose maneuvers that reduce or make them disappear, in order to facilitate the diagnosis., Methods: transversal study. Analysis of the transnasal fiber optic laryngoscopy records of 15 patients with adductor laryngeal dystonia using the proposed protocol., Results: most of the speech and non-vocal tasks allowed us to identify the spasms and reduce or make them disappear. We propose the exclusion of two of the maneuvers that dont bring new data to the evaluation., Conclusion: the protocol was useful for the evaluation of the patients, showing changes in muscle behavior in the structure under investigation.

Videokymography is a new high-speed imaging technique to investigate vocal fold vibration. The system has been considered useful in the analysis of irregular signals, making it possible to observe left-right asymmetries, open quotient, propagation of mucosal waves, and movement of the upper and lower margins. The aim of the present study was to verify the correspondence of the videokymographic images with larynx exposition angle variation. Three Brazilian adult female subjects, with no vocal complains, were evaluated. Videokymographic images were obtained with the laryngeal endoscope 90 degrees positioned on the measuring line, perpendicular to the glottal axis-zero degree, during a sustained "ae" vowel, using habitual frequency and intensity. The procedure was repeated twice and adjusted by rotating the camera in fifteen degrees from the perpendicular line to the right and to the left. The results showed clear differences depending on the position of the endoscope, suggesting the standardization of laryngeal exposition to interpret videokymographic images correctly.