Diagrama de desvio fonatório e análise perceptivo-auditiva pré e pós-terapia vocal

Phonatory Deviation Diagram pre and post vocal rehabilitation

Resumos

OBJETIVO: Verificar se o Diagrama de Desvio Fonatório (DDF) demonstra a mudança vocal obtida por meio da terapia fonoaudiológica e se acompanha as alterações da análise perceptivo-auditiva. MÉTODOS: Foram analisadas amostras da vogal sustentada /ε/ de 34 indivíduos, com diversos tipos de disfonia, nos momentos pré e pós-terapia. As vozes foram submetidas à análise acústica pelo DDF e perceptivo-auditiva pela escala analógica visual (EAV) de 100 pontos. No DDF, as vozes foram classificadas quanto à densidade (concentrada ou ampliada), à forma (horizontal, vertical ou circular) e à localização nos quadrantes do diagrama (inferior esquerdo = 1; inferior direito = 2; superior direito = 3 e superior esquerdo = 4). Procedeu-se à análise estatística dos parâmetros acústicos, da distribuição das amostras e da correlação entre a análise acústica e a auditiva, nos momentos pré e pós-terapia. RESULTADOS: Os dados acústicos mostraram melhora na situação pós-terapia. A densidade do DDF não se diferenciou nos dois momentos. Já as formas diferenciaram-se nos dois momentos (p=0,031), sendo que a vertical caracterizou as amostras no momento pré-terapia (12; 35,29%), e a circular (7; 20,59%) no momento pós-terapia. No momento pré-terapia, as amostras estavam distribuídas em três dos quatro quadrantes; no pós-terapia, 90% localizaram-se no quadrante 1 (área de normalidade). A média da avaliação auditiva passou de grau moderado a leve-moderado (p<0,001). Houve diferença entre a localização no quadrante e a avaliação auditiva (p<0,001). CONCLUSÃO: O DDF é útil para identificar mudanças em relação à terapia vocal, correlacionando-se à avaliação perceptivo-auditiva.

Voz; Acústica da fala; Qualidade da voz; Percepção auditiva; Distúrbio da voz

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; Acoustic; Voice quality; Auditory perception; Voice disorders

• ¹
  Takahashi H, Koike Y. Some perceptual dimensions and acoustical correlates of pathologic voices. Acta Otolaryngol. 1976;338:2-22.
• ²
  Carding PN, Steen IN, Webb A, Mackenzie K, Deary IJ, Wilson JA. The reliability and sensitivity to change of acoustic measures of voice quality. Clin Otolaryngol. 2004;29(5):538-44.
• ³
  Oates,J. Auditory-perceptual evaluation of disordered voice quality: pros, cons and future directions. Folia Phoniatr Logop. 2009;61(1):49-56.
• ⁴
  Behlau M, Madazio G, Feijó D, Pontes P. Avaliação de voz. In: Behlau M, Voz: o livro do especialista. v.1. Rio de Janeiro: Revinter; 2001. p. 85-246.
• ⁵
  Speyer R, Wieneke GH, Dejonckere PH. Documentation of progress in voice therapy: perceptual, acoustic, and laryngostroboscopic findings pretherapy and posttherapy. J Voice. 2004;18(3):325-40.
• ⁶
  Patel S, Shrivastav R. Perception of dysphonic vocal quality: some thoughts and research update. Perspectives on Voice and Voice Disorders. 2007;17(2):3-6.
• ⁷
  Fröhlich M, Michaelis D, Strube, HW, Kruse E. Acoustic voice analysis by means of the hoarseness diagram. J Speech Lang Hear Res. 2000;43(3):706-20.
• ⁸
  Madazio G, Leão S, Behlau M. The phonatory deviation diagram: a novel objective measurement of vocal function. Folia Phoniatr Logop. 2011;63(6):305-311.
• ⁹
  Michaelis D, Gramss T, Strube HW. Glottal-to-noise excitation ratio – a new measure for describing pathological voices. Acta Acustica. 1997;83:700-6.
• ¹⁰
  Fröhlich M, Michaelis D, Strube HW, Kruse E. Acoustic voice quality description: Case studies for different regions of the hoarseness diagram. In: Wittenberg T, Mergell P, Tigges M, Eysholdt U. (Eds). Advances in quantative laryngoscopy, 2 nd "Round Table". Erlangen; 1997. p. 143-150.
• ¹¹
  Werth K, Voigt D, Döllinger M, Eysholdt U, Lohscheller J. Clinical value of acoustic voice measures: a retrospective study. Eur Arch Otorhinolaryngol. 2010;267(8):1261-71.
• ¹²
  Roy N, Weinrich B, Gray SD, Tanner K, Stemple JC, Sapienza CM. Three treatments for teachers with voice disorders: a randomized clinical trial. J Speech Lang Hear Res. 2003;46(3):670-88.
• ¹³
  Lessac A. The use and training of the human voice: a Bio-Dynamic approach to vocal life. Mountain View, Mayfield; 1997.
• ¹⁴
  Roy N, Leeper HA. Effects of the manual laryngeal musculoskeletal tension reduction technique as a treatment for functional voice disorders: perceptual and acoustic measures. J Voice. 1993;7(3):242-9.
• ¹⁵
  Roy N, Weinrich B, Gray SD, Tanner K, Stemple JC, Sapienza CM. Three treatments for teachers with voice disorders: a randomized clinical trial. J. Speech Lang Hear Res. 2003;46(3):670-88.
• ¹⁶
  Behlau M, Madazio G, Feijó D, Azevedo R, Gielow I, Rehder MI. Aperfeiçoamento vocal e Tratamento fonoaudiológico das disfonias. In: Behlau M, organizador. Voz: o livro do especialista. v.2. Rio de Janeiro: Revinter; 2005. p. 409-528.
• ¹⁷
  Behlau M. Consensus auditory – perceptual evaluation of voice (CAPE-V), ASHA 2003. Rev Soc Bras Fonoaudiol. 2004;9(3):187-9.
• ¹⁸
  Yamasaki R, Leão S, Madazio G, Padovani M, Azevedo R, Behlau M. Correspondência entre escala analógico-visual e escala numérica na avaliação perceptivo-auditiva de vozes. Rev Soc Bras Fonoaudiol. 2008;13(Suppl):1080.
• ¹⁹
  Simberg S, Laine A, Sala E, Rönnemaa AM. Prevalence of voice disorders among future teachers. J Voice. 2000;14(2):231-5.
• ²⁰
  Eskenazi L, Childers DG, Hicks DM. Acoustic correlates of vocal quality. J Speech Lang Hear Res. 1990;33(2):298-306.
• ²¹
  Madazio G, Leão S, Behlau M. Hoarseness diagram in voice predominantly rough, breath and strain. In: The Voice Foundation; 2006; Philadelphia. Abstract.
• ²²
  Titze I, Liang, H. Comparison of F0 extraction methods for high precision voice perturbation measurement. J Speech Hear Res 1993;36(6):1120-33
• ²³
  Kreiman J, Gerrat BR, Kempster GB, Erman A, Berke GS. Perceptual evaluation of voice quality: review, tutorial and a framework for future research. J Speech Lang Hear Res 1993;36(1):21-40.
• ²⁴
  Dejonckere PH. Principal components in voice pathology. J Voice. 1995;4:96-105.
• ²⁵
  Dejonckere PH, Lebacq J. Acoustic, perceptual, aerodynamic and anatomical correlations in voice pathology. ORL J Otorhinolaryngol Relat Spec. 1996;58(6):326-32.
• ²⁶
  Kreiman J, Gerrat B, Ito M. When and why listeners disagree in voice quality assessment tasks. J Acoust Soc Am. 2007;122(4):2354-64.
• ²⁷
  Frölich M, Michaelis D, Strube HW. Acoustic breathiness measures in the description of pathological voices. In: Proceedings ICASSP 1998, Seattle, WA; 1998. p. 937-40.
• ²⁸
  Rabinov CR, Kreiman J, Gerrat BR, Bielamowicz S. Comparing reliability of perceptual ratings of roughness and acoustic measures of jitter. J Speech Lang Hear Res. 1995;38(1):26-32.
• ²⁹
  Bielamowicz S, Kreiman J, Gerratt BR, Dauer MS, Berke, GS. Comparison of voice analysis systems for perturbation measurement. J Speech Lang Hear Res. 1996;39(1):126-34.
• ³⁰
  Schneider B, Denk DM, Bigenzahn W. Acoustic assessment of the voice quality before and after medialization thyroplasty using the titanium vocal fold medialization implant (TVFMI). Otolaryngol Head Neck Surg. 2003;128(6):815-22.

Datas de Publicação

• Publicação nesta coleção
  25 Jun 2015
• Data do Fascículo
  2013

Histórico

• Recebido
  24 Dez 2010
• Aceito
  22 Set 2011