Voice in the lyric singers. Protocol for clinical and acoustic assessment

El objetivo de esta investigación es elaborar un protocolo clínico y acústico con diversas técnicas para evaluar la voz de los cantantes líricos.Se seleccionaron 18 cantantes líricos, que se consideraban sanos, clasificados como soprano, mezzosoprano, contralto, tenor, barítono y bajo. A todos se les realizó la anamnesis, el S-VHI y una serie de estudios aerodinámicos (TMF, índice s/e y cociente de fonación) y acústicos (F0, intensidad, HNR, Jitter, Shimmer, espectrograma, fonetograma y LTAS), así como una exploración clínica e instrumental estroboscópica. El 33% eran fumadores, siendo este hábito más frecuente en hombres. El S-VHI detectó 20 puntos sobre 144 posibles, puntuación relativamente alta de su grado de incapacidad. Casi la mitad obtuvieron valores fuera del rango de normalidad en el TMF, índice s/e y cociente de fonación. Las características acústicas de su voz y los rangos vocales y dinámicos estaban, en la mayoría de los casos, dentro de la normalidad. En el 55% se observó algún tipo de patología laríngea. Los cantantes deberían evitar el uso del tabaco, así como hacer revisiones frecuentes para detectar patologías laríngeas que pasan desapercibidas. Los valores aerodinámicos y acústicos muestran alteraciones con respecto a los valores normales de referencia. La presencia de vibrato y formante del cantante puede verse en el espectrograma y el LAST, así como el rango dinámico y vocal con el fonetograma. El uso del protocolo clínico y acústico proporciona importante información que completa la obtenida por el terapeuta vocal o el profesor de técnica vocal en el análisis perceptual de la voz profesional.The goal of this study is to develop a clinical and acoustic protocol with several techniques to evaluate lyrical singers voice.18 lyrical singers, considered themselves as healthy, were selected including soprano, mezzo-soprano, contralto, tenor, baritone and bass. All of them were submitted to anamnesis, S-VHI and to a series of aerodynamics (TMF, index s/e and phonation quotient) and acoustic (F0, intensity, HNR, Jitter, Shimmer, spectrogram, phoneme and LTAS) studies, as well as to a clinical exploration and stroboscopic instrumentation.33% were smokers, this habit being more frequent in men. By means of S-VHI, 20 points out of 144 possible were detected, a relatively high score about their degree of disability. Almost half of them obtained values in the TMF, index s/e and phonation quotient within the normal range. In most cases, the acoustics characteristics and vocal and dynamic ranges were within normal limits. In 55%, some type of laryngeal pathology was observed.In order to detect unnoticed laryngeal pathologies singers should avoid the use of tobacco, and be checked periodically by doctors. The aerodynamic and acoustic values show alterations with respect to normal reference values. The presence of vibrato and formant of the singer can be seen by means of the spectrogram, as well as and the LAST, as well as vocal and dynamic ranges is seen with the phonogram. Use of the clinical and acoustic protocol provides important information to complete that obtained by the vocal therapist or technique teacher in the perceptual analysis of the professional voice

Predictors of mean arterial pressure morning rate of rise and power function in subjects undergoing ambulatory blood pressure recording

Background: We determined clinical predictors of the rate of rise (RoR) in blood pressure in the morning as well as a novel measure of the power of the BP surge (BPpower) derived from ambulatory blood pressure recordings. Methods: BPpower and RoR were calculated from 409 ambulatory blood pressure (ABP) recordings from subjects attending a cardiovascular risk clinic. Anthropometric data, blood biochemistry, and history were recorded. The 409 subjects were 20-82 years old (average 57, SD = 13), 46% male, 9% with hypertension but not on medication and 34% on antihypertensive medication. Results: Average RoR was 11.1 mmHg/hour (SD = 8) and BPpower was 273 mmHg2/hour (SD = 235). Only cholesterol, low density lipoprotein and body mass index (BMI) were associated with higher BPpower and RoR (P<0.05) from 25 variables assessed. BPpower was lower in those taking beta-blockers or diuretics. Multivariate analysis identified that only BMI was associated with RoR (4.2% increase/unit BMI, P = 0.020) while cholesterol was the only remaining associated variable with BPpower (17.5% increase/mmol/L cholesterol, P = 0.047). A follow up of 213 subjects with repeated ABP after an average 1.8 years identified that baseline cholesterol was the only predictor for an increasing RoR and BPpower (P<0.05). 37 patients who commenced statin subsequently had lower BPpower whereas 90 age and weight matched controls had similar BPpower on follow-up. Conclusions: Cholesterol is an independent predictor of a greater and more rapid rise in morning BP as well as of further increases over several years. Reduction of cholesterol with statin therapy is very effective in reducing the morning blood pressure surge. © 2014 Head et al