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Aim: To identify the discriminative characteristics of the phonatory deviation diagram (PDD) in rough, breathy and tense voices. Methods: One hundred and ninety-six samples of normal and dysphonic voices from adults were submitted to perceptual auditory evaluation, focusing on the predominant vocal quality and the degree of deviation. Acoustic analysis was performed with the VoxMetria (CTS Informatica). Results: Significant differences were observed between the dysphonic and normal groups (p < 0.001), and also between the breathy and rough samples (p = 0.044) and the breathy and tense samples (p < 0.001). All normal voices were positioned in the inferior left quadrant, 45% of the rough voices in the inferior right quadrant, 52.6% of the breathy voices in the superior right quadrant and 54.3% of the tense voices in the inferior left quadrant of the PDD. In the inferior left quadrant, 93.8% of voices with no deviation were located and 72.7% of voices with mild deviation; voices with moderate deviation were distributed in the inferior and superior right quadrants, the latter ones containing the most deviant voices and 80% of voices with severe deviation. Conclusion: The PDD was able to discriminate normal from dysphonic voices, and the distribution was related to the type and degree of voice alteration.

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Keywords Presentation of the Comprehensive Vocal RehabilitationProgram for the treatment of behavioral dysphonia Apresentação do Programa Integral de Reabilitação Vocal para o tratamento das disfonias comportamentais ABSTRACTVoice rehabilitation is the main treatment option in cases of behavioral dysphonia, and it has the purpose of enhancing the quality of vocal production and voice-related life aspects. Several efforts have been made to offer a clinical practice that is based on evidence, including the development of specific therapeutic protocols as an option for clinical and scientific improvement. It is necessary to define the focus/objective of the dysphonia treatment, type of approach, and duration in order to establish the intervention criteria. This paper describes the organization of a program of behavioral dysphonia treatment, based on an approach that has been used for over twenty years, named Comprehensive Vocal Rehabilitation Program, and also to present its concepts, theory, and practical fundamentals. The program has an eclectic approach and associates body work, glottal source, resonance, and breathing coordination in addition to knowledge about vocal hygiene and communicative behavior. The initial proposal suggests a minimum time of intervention of six therapeutic sessions that can be adapted according to the patient's learning curve and development. The goal is to offer a rational and structured therapeutic approach that can be reproduced in other scenarios. RESUMOA reabilitação vocal é a primeira opção de tratamento nos quadros de disfonia comportamental e tem como objetivo a melhoria da produção vocal e da qualidade de vida nos aspectos relacionados à voz. Muitos esforços estão sendo feitos para que a prática clínica fonoaudiológica seja baseada em evidências, o que inclui o desenvolvimento de protocolos terapêuticos específicos como opção para o aprimoramento clínico e científico.É necessário definir o foco/objetivo, tipo de abordagens e tempo de tratamento para estabelecer critérios de intervenção nas disfonias. Este artigo registra a organização de um programa de tratamento da disfonia comportamental, que consiste em abordagens utilizadas há mais de duas décadas na clínica vocal, denominado Programa Integral de Reabilitação Vocal, e apresenta os seus conceitos, teoria e fundamentos práticos.O programa tem abordagem eclética e associa trabalhos de corpo, fonte glótica, ressonância e coordenação pneumofônica, aliados aos conhecimentos de higiene vocal e atitude comunicativa. A proposta inicial sugere intervenção mínima com seis sessões de terapia, que podem ser adaptadas ao tempo de aprendizado e desenvolvimento do paciente. A intenção é oferecer uma prática terapêutica racional e estruturada, que possa ser reproduzida em outros cenários.

OBJETIVO: Observar o efeito imediato da realização do exercício de sopro sonorizado com o trato vocal semiocluído (ETVSO) na voz de indivíduos idosos. MÉTODOS: Participaram 33 indivíduos, com idade igual ou superior a 65 anos, sem queixa de distúrbio de voz e audição e boa saúde geral auto-referida. Todos responderam a questionário de autoavaliação vocal. Foi realizada gravação da vogal /ε/ sustentada em três momentos distintos: a primeira, denominada habitual (H), a partir da emissão regular do indivíduo; a segunda, uso (U), após um minuto de conversa espontânea, continuada; a terceira, exercício (E), realizada após um minuto de execução do ETVSO. Após a realização do exercício, foi solicitada uma autoavaliação do idoso quanto às mudanças percebidas na voz. As gravações foram editadas e pareadas, aleatoriamente, considerando dois momentos de um mesmo sujeito: H/U; H/E e U/E, para posterior julgamento auditivo da melhor emissão, por três fonoaudiólogos. RESULTADOS: Não houve diferença entre H e U (p=0,199) e U e E (p=0,773). Entretanto, a emissão E foi considerada melhor do que a H (p=0,004). Quanto à autoavaliação vocal, a maior parte dos idosos (n=25; 75,8%) não observou modificações na voz após a realização do exercício. CONCLUSÃO: O ETVSO produziu efeito imediato positivo na qualidade vocal dos idosos, observado apenas na avaliação perceptivo-auditiva

Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for achieving a consensus regarding this complex problem.

This review reinforced the need for large population studies of professional voice users; new data highlighted important factors specific to each group of voice users. Interventions directed at student teachers are necessities to not only improving the quality of future professionals, but also to avoid the frustration and limitations associated with chronic voice problems. The causative relationship between the work environment and voice disorders has not yet been established. Randomized controlled trials are lacking and must be a focus to enhance treatment paradigms for this population.

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