Influence of the sexual steroids on the voice speak in women of the climacteric

São freqüentes as queixas entre as mulheres, particularmente entre as cantoras, de que ocorrem alterações na voz após a menopausa. Há relatos na literatura de que a freqüência fundamental da voz da mulher se altera nesta fase da vida. Como a prega vocal possui receptores para os esteróides sexuais, é possível que essas alterações sejam decorrentes da deficiência estrogênica observada no climatério. O presente trabalho teve como objetivo comparar a freqüência fundamental da voz (F0) de mulheres na pós-menopausa usuárias e não usuárias de terapia de reposição hormonal (TRH) com mulheres no menacme. Foram estudadas 45 pacientes: grupo-controle (15 mulheres de 20 a 40 anos, não usuárias de anticoncepcional hormonal, não fumantes, com ciclos menstruais regulares), grupo com TRH (15 mulheres de 45 a 60 anos, menopausadas há mais de 2 anos, usuárias de valerato de estradiol 1mg/norgestimato 90 mcg há no mínimo 6 meses) e grupo sem TRH (15 mulheres com idade de 45 a 60 anos, menopausadas há mais de 2 anos sem TRH há no mínimo 6 meses). Todas as pacientes foram submetidas à avaliação otorrinolaringológica e videolaringoscopia para confirmar a integridade da laringe. Posteriormente, avaliou-se a F0 com a emissão das vogais e" e i" na altura de fala habitual da paciente. A F0 foi analisada através do programa Dr.Speech 3.0®. Foi utilizado o teste ANOVA para comparação das médias de F0 entre os grupos. A média da idade dos grupos controle, com TRH e sem TRH foi respectivamente 30,3 anos, 54,5 anos e 56,5 anos. A média da F0 dos grupos foram respectivamente: vogal e": 215,97 Hz; 206,21 Hz e 200,71 Hz, e vogal i": 229,89 Hz; 221,79 Hz e 212,79 Hz. Os resultados mostraram uma tendência de agravamento da F0 em menopausadas, sendo a média do grupo com TRH mais próxima do grupo-controle que do grupo sem TRH. Entretanto não houve diferença estatisticamente significativa na F0 da voz para as vogais e" (p=0,2127) e i" (p=0,193), comparando os três grupos entre si. De acordo com esses resultados, parece não haver diferença clinicamente relevante na F0 da voz falada entre mulheres no menacme, menopausadas usuárias e não usuárias de TRH. A tendência à diminuição de F0 nas pacientes hipoestrogênicas sugere a possibilidade de que pequenas diferenças, decorrentes da influência hormonal sobre a laringe, que não tenham sido detectadas neste estudo, possam atingir maiores níveis de significância, quando os grupos forem analisados para a voz cantada.The complaints between the women are frequent, particularly between the singers, of whom alterations in the voice occur after the menopause. It has been reported, in literature, that woman fundamental frequency is altered in this phase of the life. As the vocal fold possess receivers for the sexual steroids are possible that these alterations are decurrent of the observed hypoestrogenism in the climacteric. To compare the voice fundamental frequency (F0) of postmenopausal women, users and non-users of HRT with women in menache. Forty-five patients have been trialed, divided into the following groups: control group (15 women of 20 to 40 years of age, non-users of hormonal contraceptives, non smokers, with regular menstrual cycles), group with HRT (15 women of 45 to 60 years of age, menopaused for over 2 years, users of estradiol valerate 1mg/norgestimato 90mcg for a minimum period of 6 months) and the group without HRT (15 women of 45 to 60 years of age, menopaused for over 2 years, without HRT for a minimum period of 6 months). All patients had been submitted to the otolaryngological evaluation and videolaryngoscopy in order to confirm the integrity of the larynx. Afterwards F0 has been evaluated by emitting the vowels [e] and [i] in the patients habitual voice pitch. The F0 was analyzed using the Dr.Speech Pro. 3 software. The ANOVA test was used in order to compare the averages of F0 between the groups. The average ages of the groups control, with HRT and without HRT were respectively 30,3 years, 54,5 years and 56,5 years. The average F0 of the groups control, with HRT and without HRT were respectively: vowel [e]: 215,97Hz; 206,21Hz and 200,71Hz and vowel [i]: 229,89Hz; 221,79Hz and 212,79Hz. The results showed a trend of aggravation of the F0 in postmenopausal women, once the F0 average of the group with HRT was closer to the group control than the group without HRT. However, in a comparison between those three groups, there were no significant statistical difference in the voice F0 for the vowels [e] (p=0,2127) and [i] (p=0,193). There were no differences in F0, in the speaking voice, between women in menache and postmenopausal users and non-users of HRT. However its been recorded a trend in the aggravation of F0 in the postmenopausal women, mainly amongst the without HRT users. In accordance with these results seem not to have significant clinical difference in the F0 of the voice said between women in menacme, postmenopausal users and non-users of HRT. The trend the reduction of F0 in the hypoestrogenism patients suggests the possibility of that small decurrent differences of the hormonal influence on the larynx, that they have not been detected in this study, can reach greaters levels of significance when the groups will be analyzed for the sung voice

Alterations in the tessitura of the voice sung in woman of the climacteric

As flutuações nos níveis dos hormônios sexuais, ao longo da vida do ser humano, trazem modificações anátomo-fisiológicas. Esses hormônios exercem papéis determinantes no desenvolvimento anatômico da laringe e na fisiologia vocal diferindo significativamente entre os sexos o que torna a voz uma característica sexual secundária. Estudos já documentaram a presença e, mais especificamente a localização dos receptores dos hormônios sexuais na laringe e pregas vocais, evidenciando que estes órgãos podem ser responsivos aos hormônios sexuais e sofrerem as conseqüências das flutuações hormonais. Existem algumas divergências quanto ao efeito hormonal sobre a qualidade vocal. Alguns estudos afirmam que ocorrem mudanças na voz relacionadas à menopausa, enquanto outros divergem desses resultados. Tal fato nos leva a questionar se as metodologias utilizadas foram realmente as mais adequadas, uma vez que existem evidências clínicas destas mudanças. São freqüentes as queixas entre as mulheres de alterações vocais após a menopausa, particularmente entre as mulheres cantoras, que enfatizam perdas dos tons agudos. O objetivo deste trabalho foi verificar se há influência dos hormônios sexuais sobre a qualidade vocal da voz cantada de mulheres menopausadas cantoras de coral, através da avaliação da tessitura e do tempo máximo de fonação (TMF). A tessitura corresponde ao número de notas da mais grave até a mais aguda que o indivíduo consegue produzir com qualidade vocal. O tempo máximo de fonação (TMF) avalia a habilidade do paciente em forças aerodinâmicas da corrente pulmonar e as forças mioelásticas da laringe. As voluntárias foram divididas em dois grupos. Grupo jovem (n=8) mulheres com idade entre 20 e 40 anos, que apresentavam ciclos menstruais regulares que não estivessem grávidas ou amamentando durante o estudo. Grupo menopausada (n=22) mulheres com idade de 45 a 60 anos, menopausadas há no mínimo 2 anos que não faziam uso de terapia hormonal (TH). Para mensuração do TMF, foi dada a instrução de inspirar e produzir isoladamente as vogais /a/, /i/ e /u/ e as consoantes fricativas /s/ e /z/ em altura e tons habituais de fala. Para avaliar a tessitura foi escolhida uma música conhecida do folclore brasileiro que exigia as variações de freqüência da mais grave a mais aguda. Os valores de cada nota musical e sua freqüência correspondente em hertz (Hz) foram escritos manualmente. Foram comparados para o grupo jovem e menopausada os valores máximos (F2) e os valores mínimos (F1) e a diferença entre o valor máximo e mínimo (F2-F1) entre os grupos medidos em freqüência (Hz) e em semitons (St), e foram encontradas diferenças significativas entre os grupos. Não foi encontrada diferença significativa entre o grupo jovem e menopausada quando foram comparados o tempo máximo de fonação das vogais /a/, /i/, /u/ e as consoantes /s/ e /z/. Os resultados do presente estudo demonstraram haver diferença significativa na tessitura da voz cantada entre mulheres cantoras de coral jovens e pós-menopausa. Estes resultados sugerem que as alterações na tessitura da voz cantada podem ser decorrentes de modificações fonatórias da articulação, respiração e fonação realizadas durante o canto, influenciadas pelos hormônios sexuais. E não serem atribuídas às alterações nas pregas vocais como edemas, espessamentos e a hiperemia, as quais não foram encontradas ao exame videolaringoscópico e tampouco no TMF quando comparados os grupos jovem e menopausada.Fluctuations in the levels of sexual hormones, throughout the life of the human being, bring anatomic physiological modifications. These hormones exert determinative papers in the anatomical development of the larynx and in the vocal physiology differing significantly between the sexes becoming the voice a secondary sexual characteristic. Studies already had registered the presence and, more specifically the vocal localization of the receivers of sexual hormones in the larynx and vocal folds, evidencing that these agencies can be responsive to sex hormones and suffer the consequences of the hormonal fluctuations. Some divergences how much the hormonal effect exist on the vocal quality. Some studies affirm that changes in the voice related to the menopause occur, but others had demonstrated different results. Such fact takes in them to question if the used methodologies really had been adjusted a time that exist practical clinical evidences of these changes. The complaints between the women of vocal alterations are after the menopause, particularly between the women singers, who emphasize losses of the acute tones. In literature, however, we do not find references to this fact that are of clinical comment and stories, and for this reason we decide to study this phenomenon. The objective of this work was to verify if it has influence of sexual hormones on the vocal quality of the sung voice of menopausadas women chorale singers, through the evaluation of the tessitura and the maximum phonation time (MPT). The vocal tessitura corresponds to the number of notes from the lowest to the highest that an individual is able to produce with vocal quality. Maximum phonation time (MPT) is used to assess clinically the respiratory and phonatory components of the mechanism of speech production and to demonstrate the efficiency of vocal fold vibration. The volunteers had been divided in two groups. Young group (n=8) women aged 20 to 40 years, with regular menstrual cycles who were not pregnant or breast-feeding during the study. Menopausal group (n=22) women aged 45 to 60 years, who had been in menopause for at least 2 years and who did not use hormonal therapy. For MPT measurement, the women were instructed to inspire and to produce separately the vowels /a/, /i/ and /u/ and the fricative consonants /s/ and /z/ at habitual speech loudness and tones. The voice tessitura profile was obtained evaluation a well known Brazilian folk song which required variations in frequency from the lowest to the highest. The values of each musical note and its corresponding frequency in Hertz (Hz) and semitones (St) were written manually. The maximum (F2) and minimum (F1) values and the difference between them (F2-F1) were compared for the two groups in frequency (Hz) and semitones (St) and significant difference was detected between them. No significant difference was observed between groups when they had been compared for the vowels /a/, /i/ and /u/ and the consonants /s/ and /z/. The results of the present study had demonstrated with there was significant difference in tessitura between young and menopausal women. These results suggest that the alterations in the tessitura of the sung voice can be decurrently of phonatory modifications of the joint, breath and phonation during the sing influenced for sexual hormones. And not attributed to the alterations in the vocal folds as edemas, thicken and the hyperemia, which had not been found to the otorhinolaryngologic evaluation and neither in the MPT when compared young and menopausal women

Emulating the perceptual capabilities of a human evaluator to map the GRB scale for the assessment of voice disorders

This paper presents the design of an automatic voice quality analysis system for the assessment of voice pathologies, which emulates the perceptual capabilities of a human evaluator according the GRB scale. For this purpose, a novel methodology based on multiple sets of characteristics, ordinal classification and Gaussian regression is proposed. In particular, a reduced subset of characteristics is identified, and the regressor is used to convert the discrete perceptual scale to a continuum, more in agreement to the nature of the problem under study. The robustness of the system is evaluated in several cross-dataset experiments. Similarly, a clinical evaluation of the predictions provided by the system is carried out. Results indicate that the proposed methodology is proficient in modelling the perceptual capabilities of the human evaluator. They also show that it is possible to extend the GRB scale to a continuum through regression techniques while maintaining the consistency of the results. On average, the deviation between the labels assessed by the expert and the ones provided by the system is of about 0.5 units (in a scale from 0 to 3) for G and B, and of 0.7 units for R. Similarly, the deviation of the labels predicted by the system in the clinical assessment trials is about 0.3 units for G, 0.4 units for B, and 0.5 units for

Emulating the perceptual capabilities of a human evaluator to map the GRB scale for the assessment of voice disorders

This paper presents the design of an automatic voice quality analysis system for the assessment of voice pathologies, which emulates the perceptual capabilities of a human evaluator according the GRB scale. For this purpose, a novel methodology based on multiple sets of characteristics, ordinal classification and Gaussian regression is proposed. In particular, a reduced subset of characteristics is identified, and the regressor is used to convert the discrete perceptual scale to a continuum, more in agreement to the nature of the problem under study. The robustness of the system is evaluated in several cross-dataset experiments. Similarly, a clinical evaluation of the predictions provided by the system is carried out. Results indicate that the proposed methodology is proficient in modelling the perceptual capabilities of the human evaluator. They also show that it is possible to extend the GRB scale to a continuum through regression techniques while maintaining the consistency of the results. On average, the deviation between the labels assessed by the expert and the ones provided by the system is of about 0.5 units (in a scale from 0 to 3) for G and B, and of 0.7 units for R. Similarly, the deviation of the labels predicted by the system in the clinical assessment trials is about 0.3 units for G, 0.4 units for B, and 0.5 units for