Avaliação vocal e atividade eletrica dos musculos supra-hioideos e esternocleidomastoideo em individuos com desordem temporomandibular miogenica em situações de repouso e fonação

Orientador: Vanessa Monteiro-PedroTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A proposta deste estudo foi avaliar a voz e mensurar a atividade elétrica dos músculos supra-hioídeos (SH) e estemocleidomastoideo (ECM) em indivíduos portadores de desordem temporomandibular, em situações de repouso e fonação. Foram avaliados, por meio da eletromiografia de superfície os músculos esternocleidomastoideo direito e esquerdo e o grupo de músculos supra-hioídeos de 20 indivíduos do sexo feminino, subdivididos em dois grupos. Um grupo com 10 indivíduos portadores de desordem temporomandibular - grupo DTM na faixa etária de 18 a 33 anos (X=22,1; DP '+ ou ¿' 4,3) e 10 indivíduos clinicamente normais - Grupo Controle ¿ sem queixas relativas à desordem temporomandibular e a problemas vocais, com qualidade vocal equilibrada na faixa etária de 18 a 30 anos (X=22,5; DP '+ ou ¿' 4,0).Todos os indivíduos selecionados passaram por avaliação fonoaudiológica - análise perceptiva auditiva da voz e análise acústica ¿ e avaliação otorrinolaringológica - exame laringológico. As situações avaliadas foram repouso, emissão da vogal /a/, fala espontânea e contagem de números. A atividade elétrica foi mensurada por um Módulo Condicionador de sinais MCS-V2 Lynx de 16 canais, com placa conversora CAD 12/36 - Lynx, software Aqdados versão 4.18 - Lynx e eletrodos ativos diferenciais simples. O sinal eletromiográfico foi analisado pela envoltória da média com uso do software Matlab 6.0. Durante o registro do sinal eletromiográfico foi realizada a gravação das vozes dos indivíduos com uso de gravador digital - MiniDisc - Sony para posterior análise auditiva e acústica. A Análise perceptivo-auditiva foi realizada por três avaliadores em momentos diferentes e a análise acústica foi feita através do software Multi-Speech Model 3700 da Kay Elemetrics. Os dados relativos à eletromiografia foram estatisticamente tratados por meio dos testes ANOVA e Tuckey ('alfa¿=5%). Os resultados deste estudo revelaram que, quanto à análise perceptivo-auditiva, o grupo DTM apresentou grau leve de disfonia, rouquidão, soprosidade e instabilidade, porém significativamente maior que o grupo Controle. Da mesma forma, o grupo DTM apresentou uma prevalência de 51,7% de alteração ressonantal e do padrão articulatório, enquanto que o Grupo Controle apresentou 21% de alteração da ressonância e 30% de alteração da articulação. A Análise acústica do registro vocal revelou que o grupo DTM apresentou valores significativamente maiores nas medidas de Variação de Amplitude (vAm) e proporção harmônico-ruído (NHR) em relação ao grupo Controle. Quanto à atividade elétrica, os resultados mostraram que os músculos SH do grupo Controle apresentaram atividade elétrica significativamente maior do que o grupo DTM, enquanto que não houve diferença significativa entre os músculos ECM esquerdo e direito, na comparação entre grupos. No grupo Controle, os músculos SH apresentaram atividade elétrica significativamente aumentada em relação ao músculo ECM bilateralmente (p=0,0014 e p=0,0023, respectivamente), enquanto que no grupo DTM o mesmo ocorreu apenas em relação ao músculo ECM direito (p=0,0022). Houve diferença estatisticamente significativa entre as atividades de fonação e repouso apenas quanto à atividade elétrica dos músculos SH em ambos os grupos (p=0,0001).Os dados deste estudo permitem concluir que apesar da eletromiografia não ter revelado diferenças entre os grupos, indivíduos portadores de desordem temporomandibular miogênica apresentam algum tipo de queixa vocal e, embora com padrão de coaptação glótica normal!, apresentaram alterações vocais de grau leve em relação a indivíduos não portadores desse tipo de alteração. A atividade elétrica do músculo ECM esquerdo encontrou-se aumentada nos indivíduos com DTM, sugerindo problemas cervicais, o que está de acordo com a literatura. Quanto aos músculos SH, outros estudos devem ser realizados para melhor compreensão desta musculatura na fonaçãoAbstract: The aim of this study was to evaluate the voice and mesure the electrical activity of suprahyoid (SH) and esternocleidomastoid (SCM) muscles in subjects with temporomandibular joint disorder, in rest and speaking situations. By means of surface eletromyographic, were assessed the SCM left and right muscles, as well as the SH muscles of 20 female individuais, divided into two groups: one group formed by 10 subjects carrying temporomandibular joint disorder - TMJ group on average of 18 to 33 years old (X=22,1; DP '+ or ¿' 4,3) and 10 clinically normal subjects -Control Group - without complaints related to temporomandibular joint disorder as well to voice problems, with normal voice in the ages of 18 to 30 years old (X=22,5; DP '+ or ¿' 4,0). Every subjects were evaluate by perceptual and acoustical analysis of voice and otorhinolaryngologic exams. The situations analyzed were rest, production of vowel Ia/, spontaneous sequenced speech and counting. The electric activity was measured by an Analogic/Digital Converter AlD (LYNX,), a Software for Data Acquisition and simpie differential active electrodes. The electric sign was calculated by the root mean square (RMS) in 'mu¿V, processed by Matlab (version 5.0) routine and normalized by Envoltory. The voices were registers in minidiscs for perceptual and acoustical analysis. The perceptual analysis was evaluated by three speech pathologists and the acoustical analysis was measured by Multi Speech model 3700 - Kay Elemetrics software. The data were statistically analyzed by variance analysis (ANOVA) and Tukey's test, with significance levei of 0.05. The results of this study showed that, in relation to the perceptual analysis, the TMJ group presented a slight dysphonia degree, roughness, beathness and instability, yet significantly greater than the Control group. Likewise, the TMJ group showed a prevalence of 51.7% of ressonant alteration as well the articulatory pattern. In the meanwhile, the Control group showed 21% of ressonance alteration and 30% of articulation alteration. The vocal register acoustics analysis revealed that the TMJ group presented bigger significantly values in the Peak-to-peak Amplitude Variation (vAm) and Noise to Harmonic Ratio (NHR) in relation to the Control group. As for the electrical activity, the results showed that the SH muscles of the Control group presented a significantly bigger electrical activity than the TMJ group while there was a significant difference between the right and left SCM muscles, when comparing both groups. In the Control group, the SH muscles presented significantly increased electrical activity in relation to the two-sided SCM muscles (p=0.0014 and p=0.0023, respectively), as for in the TMJ group the same only occurred in relation to the right SCM muscle (p=0.0022).There just was a statistically significant difference between the pho'nation and rest activities regarding the electrical activity of the SH muscles in both groups (p=0.0001).The data of this study allow us to conclude that in spite of the lack of differences in both groups with the electromyograph, individuais carrying myogenic TMJ, present some kind of vocal complaint and, besides the normal glottal pattern, they presented vocal alterations of light degree in relation to the individuais that don't carry this kind of alteration. The electrical activity of the left SCM muscle was verified to be raised in the TMJ subjects which suggests cervical problems in agreement with the literature. As for the SH muscles, other studies need to be carried out for better comprehension of these muscles in relation to the phonationDoutoradoDoutor em Biologia Buco-Denta

Influence of vocal and aerodynamics aspects on the voice-related quality of life of older adults

The pursuit for quality of life urged a better understanding of aspects involved in ageing to minimize its consequences. Although many studies investigated older adults’ voice, aspects affecting this population voice-related quality of life have not yet been explored. Objective: To investigate how aerodynamics and vocal aspects are associated with voice-related quality of life in older adults. Methodology: fifty-six older adults aged 60 years or above – 39 women and 17 men – were evaluated. The following procedures were performed: application of the Voice-Related Quality of Life (V-RQOL) protocol; vocal assessment, including auditory-perceptual and acoustic analysis, from which we obtained fundamental frequency (F 0 ), standard deviation of fundamental frequency (SDF 0 ), shimmer, amplitude perturbation quotient (APQ), jitter, pitch period perturbation quotient (PPQ), and harmonics to noise ratio (HNR); aerodynamic assessment using a spirometer; and maximum phonation time (MPT) for /a/, /s/, /z/ and number counting. Results: older adults tend to present high V-RQOL scores. Among women, roughness, APQ, and HNR parameters were negatively correlated with V-RQOL, whereas F 0 was positively. We found no correlation between spirometry measurements and V-RQOL. MPT for /a/, /z/, and number counting was positively correlated with V-RQOL solely among men. Conclusion: Vocal roughness and acoustic parameters have a negative impact on the quality of life of older women. Respiratory aspects related to the available air support for speaking affected the most the voice-related quality of life of older men

O Que os Estudantes Consideram na Escolha do Curso de Graduação?

O objetivo do presente estudo é conhecer o perfil dos estudantes com interesse de ingressar em um curso de graduação, quanto à idade, nível socioeconômico e preferências de áreas de estudo. Participaram do estudo 101 estudantes do ensino médio e cursinho pré-vestibular com idades entre 14 e 44 anos (média de 18 anos) pertencentes a duas instituições de ensino públicas e três particulares do município de Bauru, Estado de São Paulo, a maioria estudantes do 3º ano do ensino médio, com uma renda familiar entre dois e cinco salários mínimos e com preferência de estudo na área de Humanas. Os fatores que mais influenciam na escolha da profissão são: gostar da área de atuação, piso salarial e a afinidade com a disciplina no ensino médio. Na escolha do curso de graduação, os fatores que mais influenciam são: pertencer a uma instituição pública, se identificar com a área e o mercado de trabalho.The objective of the present study is to know the profile of students interested in joining one undergraduate course, regarding age, socioeconomic level and preferences of study areas. A total of 101 high school and pre-college students aged 14-44 years (mean age 18 years) belonging to two public institutions and three private institutions in the city of Bauru, State of São Paulo, participated in the study, most of them students of the 3rd year of high school, with a family income between two and five minimum wages and with a preference of study in the area of Humanities. The factors that most influence the choice of the profession are: to like the area of action, salary floor and the affinity with the discipline at high school. In choosing the undergraduate course, the factors that most influence are: belonging to a public institution, identifying with the area and the job market

Videofluoroscopic evaluation of mastication and swallowing in individuals with TMD

To study mastication and swallowing disorders in patients with temporomanclibular disorders (TMD). Objective: To investigate mastication and swallowing disorders in patients with severe TMD referred to surgery. Materials and Methods: Clinical and experimental study involving ten individuals with TMD submitted to deglutition videofluoroscopy. These patients did not have posterior teeth, mastication pain and food replacement in favor of pasty consistence food. The assessment of the oral and pharyngeal phases approached the following aspects: side of onset and preferential side for chewing, premature escape, remains of food residues in the oral cavity or in the pharyngeal recesses, number of necessary swallowing efforts, laryngeal penetration and/or tracheal aspiration. Results: During mastication and the oral phase we observed tongue compensatory movements upon chewing (n = 7; 70%), premature escape (n = 4; 40%), food remains in the cavity after swallowing (n = 5; 50%) and an excessive number of deglutition efforts (n = 5; 50%). On the pharyngeal phase we observed food remains in the valleculae (n = 6; 60%), in the pyriform sinuses (n = 4; 40%); laryngeal penetration (n = 1; 10%) and tracheal aspiration (n = 4; 40%). Conclusion: TMD patients may have alterations in their chewing and swallowing patterns, with laryngeal penetration and/or tracheal aspiration. The study indicates the need for a multidisciplinary assessment because of dysphagia in TMD patients

Amateur choir singers: self-image, difficulties and symptoms of the singing voice

Purpose: to evaluate vocal self-perception, difficulties and presence of negative symptoms after singing of amateur choir singers of different vocal classifications, age and experience. Method: one hundred and twenty five singers answered a questionnaire containing identification data, information about self-perception of the singing voice, difficulties with singing and negative symptoms after singing. Results: the comparison considering vocal classification evidenced greater difficulties with high notes for altos and basses, greater difficulty regarding the transition to high notes for basses and greater vocal fatigue for altos. Comparing the singers by age, both adults and young adults referred more breathiness than the elderly. The adults referred better vocal intensity than the young adults. The young adults referred better timbre than adults. Regarding the experience, the less experienced singers reported self-perception of hoarseness and presence of hoarseness after singing in greater number than the experienced singers. Conclusion: the difficulties with singing are connected to the vocal classification and do not depend on age or experience. Vocal symptoms are related to the vocal classification and to the experience with singing. Negative self-perception is also related the vocal classification and to the experience with singing, and positive self-perception was more reported by experienced singers.Objetivo: conhecer a auto-imagem, dificuldades e presença de sintomas negativos após o canto em coralistas amadores com diferentes classificações vocais, idades e experiência. Método: cento e vinte e cinco cantores responderam a um questionário que abordou dados de identificação, informações sobre a auto-imagem da voz cantada, dificuldades apresentadas no canto e ocorrência ou não de sintomas vocais após o canto. Resultados: a comparação por naipes evidenciou maior dificuldade na emissão de sons agudos para os contraltos e baixos, maior dificuldade na emissão graves para os sopranos, maior dificuldade na transição de registro grave para agudo para os baixos, e maior cansaço vocal para os contraltos. Na divisão por idade, tanto adultos jovens e adultos referiram maior soprosidade do que os idosos. Os adultos referiram melhor intensidade vocal do que adultos jovens. Os adultos jovens consideraram seu timbre de voz adequado mais frequentemente do que adultos. Em relação à experiência, os cantores menos experientes referiram percepção de voz rouca em maior número do que os cantores mais experientes, que referiram apresentar intensidade adequada durante o canto em maior número do que os demais. Cantores menos experientes referiram maior ocorrência de rouquidão após o canto do que cantores mais experientes. Conclusão: as dificuldades encontradas no canto estão atreladas ao naipe, e não dependem da idade e nem da experiência. Sintomas estão relacionados ao naipe e ao grau de experiência com o canto. A auto-imagem vocal negativa também está relacionada ao naipe e ao nível de experiência, sendo que a auto-imagem positiva é mais comum em cantores experientes

Muscleskeletal pain in dysphonic women

Objective:To investigate the location, frequency and intensity of muscle pain in dysphonic functional/organofunctional women in comparison to women with healthy voices.Methods:Sixty women, ranging in age from 18 to 45 years, divided into two groups: Dysphonic Group (DG) – 30 women with functional or organofunctional dysphonia; Non-Dysphonic Group (NDG) – 30 women without vocal complaints, and with adapted voices. All answered a protocol, marking the localization, frequency and intensity symptoms of pain on the temporal area, masseters, submandibular areas, larynx/pharynx, front and back of the neck, shoulders, upper back, lower back, elbows, fists/hands/fingers, hip/this, knees and ankles/feet. The volunteer should report the frequency in which pain was present in the last 12 months: no, rarely, frequently or always. The intensity of pain was measured by visual-analogue scales. The DG and NDG groups were compared using the Mann-Whitney test (p<0.05).Results:The women of the DG reported significantly greater frequency of submandibular area (p=0.008), laryngeal pain (p<0.001), front of the neck (p=0.015), back of the neck (p=0.001), shoulder pain (p=0.027), upper back (p=0.027) and also reported significant greater intensity of pain in the larynx/pharynx (p=0.022) and back of the neck (p=0.003).Conclusion:The frequency and intensity of musculoskeletal pain was more frequent and more intense in dysphonic women than in women without vocal complaints, showing that pain may be related to functional and organofunctional dysphonia in women