Terapia vocal intensiva associada à hidratação laríngea de superfície em idosas: ensaio clínico, randomizado e cego
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2020-05-08
Autores
Pereira, Maria Cecília Bayer [UNESP]
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Universidade Estadual Paulista (Unesp)
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Introdução: Diversas terapias vocais têm apresentado resultados benéficos para a qualidade vocal de idosos, dentre elas a terapia intensiva com progressão de intensidade e de frequência de voz e de duração do tempo de fonação. Um dos fatores que promovem melhora nas características biomecânicas das pregas vocais é a hidratação, a qual pode favorecer os benefícios da terapia vocal. A terapia vocal intensiva com progressão de intensidade e de frequência de voz e de duração do tempo de fonação associada à hidratação laríngea de superfície pode trazer melhores condições vocais em idosas. Objetivo: Analisar a efetividade da terapia vocal intensiva com progressão de intensidade e de frequência da voz e de duração do tempo de fonação associada e não associada à hidratação de superfície das pregas vocais em idosos. Métodos: Foram selecionadas 18 idosas com queixas vocais, divididas em: Grupo Experimental (GE), constituído de 9 participantes e média de idade de 69,22 anos; e Grupo Controle (GC), com 9 participantes e média de idade de 69,67 anos. Ambos receberam a Terapia vocal intensiva com progressão de intensidade e frequência da voz e de duração do tempo de fonação, em 12 sessões, ocorrendo em 3 semanas consecutivas. O GE foi submetido à nebulização com 3 ml de soro fisiológico (0,9%) no início das terapias. Para a verificação do efeito das terapias, foram realizadas: a análise acústica pelo MDVP (Multi Dimentional Voice Program, a análise do CPPS (Cepstral Peak Prominence-smoothed) pelo software Praat; a extração do Tempo Máximo de Fonação (TMF); a avaliação perceptivoauditiva, por meio de uma escala visual-analógica; e a autoavaliação, com o uso da Escala de Desconforto no Trato Vocal (EDTV), da Escala de Sintomas Vocais (ESV), do Protocolo de Qualidade de Vida em Voz (QVV) e da Escala de Sensação de Pigarro. Além disso, foi realizada a avaliação laríngea por meio de nasoendoscopia e videoestroboscopia. Os dados foram analisados comparando os momentos Pré-terapia (Pré) e Pós-terapia (Pós) nos grupos e, ainda, comparando os grupos GC e GE. Resultados: Em relação à comparação entre os momentos Pré e Pós de ambos os grupos, na análise acústica, houve aumento da frequência fundamental (fo) e diminuição do Jitter após a realização das propostas terapêuticas. Na avaliação perceptivoauditiva, houve redução do desvio dos parâmetros rugosidade e soprosidade na emissão sustentada de vogal e nos parâmetros grau geral, rugosidade, soprosidade, tensão e loudness na contagem de números. Na autoavaliação, a terapia vocal não provocou mudanças no QVV e no ESV. No EDTV, houve redução na frequência e na intensidade de garganta irritada e aumento dos valores da frequência de bolo na garganta no GC. Não houve mudança nos resultados do GE. Conclusão: As terapias estudadas apresentaram mudanças com relação ao momento de avaliação em parâmetros dos desfechos de análise acústica, avaliação perceptivoauditiva e EDTV; por outro lado, não foram observadas mudanças nos parâmetros de CPPs, TMF, QVV, ESV, Escala de Sensação de Pigarro e Avaliação visual laríngea. Após as terapias, a qualidade vocal dos idosos melhorou e a voz tornou-se mais aguda, tanto para os que receberam a terapia com a associação da hidratação como os que receberam apenas a terapia. Somente os idosos que não receberam a hidratação referiram aumento da intensidade da sensação de bolo na garganta, além de redução da frequência e intensidade da sensação de garganta irritada, pois a medida de base estava elevada e alcançou o mesmo valor que o GE. Não houve diferença na comparação entre os grupos. A hidratação laríngea de superfície não apresentou melhores resultados em relação à realização da mesma terapia vocal sem a hidratação, mas também não piorou.
Introduction: Several vocal therapies have shown beneficial results for the vocal quality of the elderly, including an intensive voice therapy for the elderly with progression of intensity, frequency, and phonation time. One of the factors that promote improvement in the biomechanical characteristics of the vocal folds is hydration, which can favor the benefits of vocal therapy. Intensive vocal therapy with progression of intensity and frequency of voice and duration of phonation time associated with laryngeal surface hydration can bring better vocal conditions in elderly women. Objective: To analyze the effectiveness of intensive vocal therapy with progression of intensity and frequency of the voice and duration of phonation time associated and not associated with vocal fold surface hydration in the elderly. Methods: Eighteen elderly women with vocal complaints were selected, divided into: Experimental Group (EG), consisting of 9 participants and an average age of 69.22 years; and Control Group (CG), with 9 participants and a mean age of 69.67 years. Both received intensive voice therapy for the elderly with progression of intensity, frequency, and phonation time, in 12 sessions, occurring in 3 consecutive weeks. EG performed a nebulization with 3 ml of saline (0.9%) at the beginning of therapies. To verify the effect of the therapies, the following evaluations were performed: acoustic analysis by MDVP (Multi Dimentional Voice Program) and CPPS (Cepstral Peak Prominence-smoothed) analysis by Praat software; extraction of Maximum Phonation Time (MPT); auditory-perceptual, using a visual-analog scale; and self-assessment, using the Voice Tract Discomfort Scale (VTD), the Voice Symptoms Scale (VoiSS), the Voice-Related Quality of Life Protocol (V-RQOL) and the Throat Clearing Sensation Scale. In addition, laryngeal evaluation was performed using nasoendoscopy and video stroboscopy. The data were analyzed by comparing the Pre-therapy (Pre) and Post-therapy (Post) moments in the groups and also comparing the CG and GE groups. Results: In relation to the comparison between the Pre and Post moments of both groups, in the acoustic analysis, there was an increase in the fundamental frequency (fo) and a decrease in the Jitter after the realization of the therapeutic proposals. In the auditory-perceptual evaluation, there was a reduction in the deviation of the roughness and breathiness parameters in the sustained vowel emission and in the overall degree of voice deviation, roughness, breathiness, tension and loudness parameters in the counting numbers. In self-assessment, vocal therapy did not cause changes in V-RQOL and VoiSS. In VTD, there was a reduction in the frequency and intensity of irritated throat and an increase in the frequency of bolus in the throat in the CG. There was no change in the results of the GE. Conclusion: The studied therapies showed changes in relation to the moment of evaluation in the outcomes of acoustic analysis, auditory-perceptual evaluation and VTD; on the other hand, no changes were observed in the parameters of CPPs, MPT, V-RQOL, VoiSS, Throat Clearing Sensation Scale and Visual laryngeal assessment. After the therapies, the vocal quality of the elderly improved and the voice became higher, both for those who received therapy with the combination of hydration and those who received only therapy. Only the elderly who did not receive hydration reported an increase in the intensity of the sensation of the throat bolus and also a reduction in the frequency and intensity of the sensation of an irritated throat, as the baseline measure was higher and reached the same value as the EG. There was no difference in the comparison between the groups. Laryngeal surface hydration did not show better results when compared to the same vocal therapy without hydration, but it also didn't get worse.
Introduction: Several vocal therapies have shown beneficial results for the vocal quality of the elderly, including an intensive voice therapy for the elderly with progression of intensity, frequency, and phonation time. One of the factors that promote improvement in the biomechanical characteristics of the vocal folds is hydration, which can favor the benefits of vocal therapy. Intensive vocal therapy with progression of intensity and frequency of voice and duration of phonation time associated with laryngeal surface hydration can bring better vocal conditions in elderly women. Objective: To analyze the effectiveness of intensive vocal therapy with progression of intensity and frequency of the voice and duration of phonation time associated and not associated with vocal fold surface hydration in the elderly. Methods: Eighteen elderly women with vocal complaints were selected, divided into: Experimental Group (EG), consisting of 9 participants and an average age of 69.22 years; and Control Group (CG), with 9 participants and a mean age of 69.67 years. Both received intensive voice therapy for the elderly with progression of intensity, frequency, and phonation time, in 12 sessions, occurring in 3 consecutive weeks. EG performed a nebulization with 3 ml of saline (0.9%) at the beginning of therapies. To verify the effect of the therapies, the following evaluations were performed: acoustic analysis by MDVP (Multi Dimentional Voice Program) and CPPS (Cepstral Peak Prominence-smoothed) analysis by Praat software; extraction of Maximum Phonation Time (MPT); auditory-perceptual, using a visual-analog scale; and self-assessment, using the Voice Tract Discomfort Scale (VTD), the Voice Symptoms Scale (VoiSS), the Voice-Related Quality of Life Protocol (V-RQOL) and the Throat Clearing Sensation Scale. In addition, laryngeal evaluation was performed using nasoendoscopy and video stroboscopy. The data were analyzed by comparing the Pre-therapy (Pre) and Post-therapy (Post) moments in the groups and also comparing the CG and GE groups. Results: In relation to the comparison between the Pre and Post moments of both groups, in the acoustic analysis, there was an increase in the fundamental frequency (fo) and a decrease in the Jitter after the realization of the therapeutic proposals. In the auditory-perceptual evaluation, there was a reduction in the deviation of the roughness and breathiness parameters in the sustained vowel emission and in the overall degree of voice deviation, roughness, breathiness, tension and loudness parameters in the counting numbers. In self-assessment, vocal therapy did not cause changes in V-RQOL and VoiSS. In VTD, there was a reduction in the frequency and intensity of irritated throat and an increase in the frequency of bolus in the throat in the CG. There was no change in the results of the GE. Conclusion: The studied therapies showed changes in relation to the moment of evaluation in the outcomes of acoustic analysis, auditory-perceptual evaluation and VTD; on the other hand, no changes were observed in the parameters of CPPs, MPT, V-RQOL, VoiSS, Throat Clearing Sensation Scale and Visual laryngeal assessment. After the therapies, the vocal quality of the elderly improved and the voice became higher, both for those who received therapy with the combination of hydration and those who received only therapy. Only the elderly who did not receive hydration reported an increase in the intensity of the sensation of the throat bolus and also a reduction in the frequency and intensity of the sensation of an irritated throat, as the baseline measure was higher and reached the same value as the EG. There was no difference in the comparison between the groups. Laryngeal surface hydration did not show better results when compared to the same vocal therapy without hydration, but it also didn't get worse.
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Palavras-chave
Voz, Treinamento da voz, Idosos, Nebulização, Voice, Voice training, Elderly, Nebulization