Publications by authors named "Elaine Lara Mendes Tavares"

18 Publications

  • Page 1 of 1

Does Abrupt Weight Loss Caused by Bariatric Surgery Compromise the Voice in Women?

J Voice 2021 Apr 5. Epub 2021 Apr 5.

Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, São Paulo State University, Botucatu, SP, Brazil. Electronic address:

Objective: To evaluate vocal symptoms, voice characteristics and videolaryngoscopy in obese women before and after bariatric surgery.

Methods: Obese patients (18 to 59 years old), candidates for bariatric surgery were recruited. Evaluation times: T1 (preoperative), T2 (after six months), T3 (after 12 months). Evaluated parameters: weight, height, body mass index, abdominal and neck circumference, vocal self-assessment, perceptual and acoustic vocal assessment, and videolaryngoscopy.

Results: A total of 37 obese women were included, average age 40.8 years. There was a decrease in anthropometric measurements between the preoperative assessment and after 12 months: weight (121.18 ± 15.4 kg; 77.1 ± 11.6 kg), BMI (46.6 ± 6.95 kg/m; 30 ± kg/m), abdominal circumference (128 ± 16.1; 99.1 ± 12.1), and neck circumference (41.1 ± 5.85; 36.6 ± 3.02). Gastroesophageal (21.6%) and vocal symptoms (27%) prevailed. No difference was identified in vocal self-assessment between the evaluations. In the acoustic analysis, f0 increased and the soft phonation index decreased. The perceptual analysis registered lower scores for the degree of dysphonia (G) and voice instability (I). The maximum phonation time values increased without changing the s/z ratio. Videolaryngoscopies showed a posterior middle cleft and improvement in the signs of reflux.

Conclusions: Bariatric surgery led to an important and gradual decrease in anthropometric parameters. The voice became less hoarse, with higher pitch and more stable, with an improvement in maximum phonation time, however with slight breathiness. Such changes were not noticed by the patients.
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April 2021

Vocal Characteristics of Patients With Morbid Obesity.

J Voice 2021 Mar 21;35(2):329.e7-329.e11. Epub 2019 Oct 21.

Department of Surgery, São Paulo State University (Unesp), Botucatu, Sao Paulo, Brazil.

Introduction: Obesity modifies vocal characteristics, causing abnormal fat deposition in the abdominal region and upper airways. For some authors the voice of the obese is not different from nonobese and the vocal symptoms are scarce; for others dysphonia in obese is reported by 70% of them and the voice becomes hoarse, breathy, and unstable.

Objective: To characterize the voice of patients with morbid obesity.

Methods: Two groups were included: Obese (n-27), aged between 26 and 59 years, selected for bariatric surgery; Control (n-27), matched in age, with ideal weight for height.

Parameters: Vocal self-assessment (Vocal Disadvantage Index-IDV and Quality of Life and Voice-QVV); Perceptual-auditory vocal evaluation (GRBASI scale), maximum phonation time; Acoustic vocal analysis and Videolaryngoscopic exams.

Results: In obese, the most frequent symptoms were gastroesophageal and hoarseness. The vocal self-evaluation did not record any relevant complaints in both groups. In obese, the perceptual-auditory voice evaluations indicated significant changes in R (roughness), B (breathiness), I (instability), and S (tension) parameters. Acoustic vocal analysis recorded changes in the noise-harmonic ratio (NHR) and soft phonation index (SPI) parameters. The videolaryngoscopy examinations showed, in control and obese groups, respectively: normal: 92.5% and 55.5%; posterior pachydermia: 11.1% and 33.3%; mid-posterior bowing: 0% and 7.4%; edema/congestion: 0% and 7.40%.

Conclusion: The voice of the obese becomes discreetly hoarse, breathless, and unstable. The most frequent videolaryngoscopic findings in obese patients are hyperemia and edema of vocal folds and posterior pachydermia, related to acid laryngitis, secondary to gastroesophageal reflux.
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March 2021

Laryngeal and vocal alterations after thyroidectomy.

Braz J Otorhinolaryngol 2019 Jan - Feb;85(1):3-10. Epub 2017 Sep 21.

Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Disciplina de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Botucatu, SP, Brazil. Electronic address:

Introduction: Dysphonia is a common symptom after thyroidectomy.

Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy.

Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months).

Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy n=40, total thyroidectomy n=88, thyroidectomy+lymph node dissection n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy+isthmectomy n=6; total thyroidectomy n=17; thyroidectomy+lymph node dissection n=9) and 2 superior laryngeal nerve (lobectomy+isthmectomy n=1; Total thyroidectomy+lymph node dissection n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21).

Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.
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February 2019

Are Vocal Alterations Caused by Smoking in Reinke's Edema in Women Entirely Reversible After Microsurgery and Smoking Cessation?

J Voice 2017 May 21;31(3):380.e11-380.e14. Epub 2016 Jul 21.

Speech Therapy, Discipline of Otolaryngology, UNESP Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.

Background: Reinke's edema is a benign lesion of the vocal folds that affects chronic smokers, especially women. The voice becomes hoarse and virilized, and the treatment is microsurgery. However, even after surgery and smoking cessation, many patients remain with a deep and hoarse voice.

Objectives: The aim of the present study was to compare pre- and postoperative acoustic and perceptual-auditory vocal analyses of women with Reinke's edema and of women in the control group, who were non-smokers.

Methods: A total of 20 women with videolaryngoscopy diagnosis of Reinke's edema who underwent laryngeal microsurgery were evaluated pre- and postoperatively (6 months) by videolaryngoscopy, acoustic voice, and perceptual-auditory analyses (General degree of dysphonia, Roughness, Breathiness, Asthenia, Strain, and Instability [GRBASI] scale), and the maximum phonation times were calculated. The pre- and postoperative parameters of the women with Reinke's edema were compared with those of the control group of women with no laryngeal lesions, smoking habit, or vocal symptoms.

Results: Acoustic vocal perceptual-auditory analyses and the maximum phonation time of women with Reinke's edema improved significantly in the postoperative evaluations; nevertheless, 6 months after surgery, their voices became worse than the voices of the women from the control group.

Conclusions: Abnormalities caused by smoking in Reinke's edema in women are not fully reversible with surgery and smoking cessation. One explanation would be the presence of possible structural alterations in fibroblasts caused by the toxicity of cigarette components, resulting in the uncontrolled production of fibrous matrix in the lamina propria, and preventing complete vocal recovery.
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May 2017

Voice Disorders: Etiology and Diagnosis.

J Voice 2016 Nov 4;30(6):761.e1-761.e9. Epub 2015 Nov 4.

Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Botucatu Medical School, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.

Objectives: Voice disorders affect adults and children and have different causes in different age groups. The aim of the study is to present the etiology and diagnosis dysphonia in a large population of patients with this voice disorder.for dysphonia of a large population of dysphonic patients.

Methods: We evaluated 2019 patients with dysphonia who attended the Voice Disease ambulatories of a university hospital. Parameters assessed were age, gender, profession, associated symptoms, smoking, and videolaryngoscopy diagnoses.

Results: Of the 2019 patients with dysphonia who were included in this study, 786 were male (38.93%) and 1233 were female (61.07). The age groups were as follows: 1-6 years (n = 100); 7-12 years (n = 187); 13-18 years (n = 92); 19-39 years (n = 494); 41-60 years (n = 811); and >60 years (n = 335). Symptoms associated with dysphonia were vocal overuse (n = 677), gastroesophageal symptoms (n = 535), and nasosinusal symptoms (n = 497). The predominant professions of the patients were domestic workers, students, and teachers. Smoking was reported by 13.6% patients. With regard to the etiology of dysphonia, in children (1-18 years old), nodules (n = 225; 59.3%), cysts (n = 39; 10.3%), and acute laryngitis (n = 26; 6.8%) prevailed. In adults (19-60 years old), functional dysphonia (n = 268; 20.5%), acid laryngitis (n = 164; 12.5%), and vocal polyps (n = 156; 12%) predominated. In patients older than 60 years, presbyphonia (n = 89; 26.5%), functional dysphonia (n = 59; 17.6%), and Reinke's edema (n = 48; 14%) predominated.

Conclusions: In this population of 2019 patients with dysphonia, adults and women were predominant. Dysphonia had different etiologies in the age groups studied. Nodules and cysts were predominant in children, functional dysphonia and reflux in adults, and presbyphonia and Reinke's edema in the elderly.
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November 2016

Voice Disorders in Teachers: Clinical, Videolaryngoscopical, and Vocal Aspects.

J Voice 2015 Sep 19;29(5):564-71. Epub 2015 Feb 19.

Department of Otolaryngology, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil; Department of Ophtalmology, Otorhinolaryngology and Head and Neck Surgery, Botucatu Medical School, Univ. Estadual Paulista, Botucatu, São Paulo, Brazil. Electronic address:

Goal: Dysphonia is more prevalent in teachers than among the general population. The objective of this study was to analyze clinical, vocal, and videolaryngoscopical aspects in dysphonic teachers.

Methods: Ninety dysphonic teachers were inquired about their voice, comorbidities, and work conditions. They underwent vocal auditory-perceptual evaluation (maximum phonation time and GRBASI scale), acoustic voice analysis, and videolaryngoscopy. The results were compared with a control group consisting of 90 dysphonic nonteachers, of similar gender and ages, and with professional activities excluding teaching and singing.

Results: In both groups, there were 85 women and five men (age range 31-50 years). In the controls, the majority of subjects worked in domestic activities, whereas the majority of teachers worked in primary (42.8%) and secondary school (37.7%). Teachers and controls reported, respectively: vocal abuse (76.7%; 37.8%), weekly hours of work between 21 and 40 years (72.2%; 80%), under 10 years of practice (36%; 23%), absenteeism (23%; 0%), sinonasal (66%; 20%) and gastroesophageal symptoms (44%; 22%), hoarseness (82%; 78%), throat clearing (70%; 62%), and phonatory effort (72%; 52%). In both groups, there were decreased values of maximum phonation time, impairment of the G parameter in the GRBASI scale (82%), decrease of F0 and increase of the rest of acoustic parameters. Nodules and laryngopharyngeal reflux were predominant in teachers; laryngopharyngeal reflux, polyps, and sulcus vocalis predominated in the controls.

Conclusions: Vocal symptoms, comorbidities, and absenteeism were predominant among teachers. The vocal analyses were similar in both groups. Nodules and laryngopharyngeal reflux were predominant among teachers, whereas polyps, laryngopharyngeal reflux, and sulcus were predominant among controls.
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September 2015

Psychogenic dysphonia: diversity of clinical and vocal manifestations in a case series.

Braz J Otorhinolaryngol 2014 Nov-Dec;80(6):497-502. Epub 2014 Sep 16.

Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP, Brazil.

Introduction: Psychogenic dysphonia is a functional disorder with variable clinical manifestations.

Objective: To assess the clinical and vocal characteristics of patients with psychogenic dysphonia in a case series.

Methods: The study included 28 adult patients with psychogenic dysphonia, evaluated at a University hospital in the last ten years. Assessed variables included gender, age, occupation, vocal symptoms, vocal characteristics, and videolaryngostroboscopic findings.

Results: 28 patients (26 women and 2 men) were assessed. Their occupations included: housekeeper (n=17), teacher (n=4), salesclerk (n=4), nurse (n=1), retired (n=1), and psychologist (n=1). Sudden symptom onset was reported by 16 patients and progressive symptom onset was reported by 12; intermittent evolution was reported by 15; symptom duration longer than three months was reported by 21 patients. Videolaryngostroboscopy showed only functional disorders; no patient had structural lesions or changes in vocal fold mobility. Conversion aphonia, skeletal muscle tension, and intermittent voicing were the most frequent vocal emission manifestation forms.

Conclusions: In this case series of patients with psychogenic dysphonia, the most frequent form of clinical presentation was conversion aphonia, followed by musculoskeletal tension and intermittent voicing. The clinical and vocal aspects of 28 patients with psychogenic dysphonia, as well as the particularities of each case, are discussed.
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March 2015

Voice disorders in teachers. A review.

J Voice 2014 Nov 11;28(6):716-24. Epub 2014 Jun 11.

Discipline Otolaryngology, Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu, São Paulo, Brazil.

Introduction: Voice disorders are very prevalent among teachers and consequences are serious. Although the literature is extensive, there are differences in the concepts and methodology related to voice problems; most studies are restricted to analyzing the responses of teachers to questionnaires and only a few studies include vocal assessments and videolaryngoscopic examinations to obtain a definitive diagnosis.

Objective: To review demographic studies related to vocal disorders in teachers to analyze the diverse methodologies, the prevalence rates pointed out by the authors, the main risk factors, the most prevalent laryngeal lesions, and the repercussions of dysphonias on professional activities.

Materials And Methods: The available literature (from 1997 to 2013) was narratively reviewed based on Medline, PubMed, Lilacs, SciELO, and Cochrane library databases. Excluded were articles that specifically analyzed treatment modalities and those that did not make their abstracts available in those databases. The keywords included were teacher, dysphonia, voice disorders, professional voice.
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November 2014

Clinical practice: vocal nodules in dysphonic children.

Eur J Pediatr 2013 Sep 31;172(9):1161-5. Epub 2013 May 31.

Department of Otorhinolaryngology, São Paulo State University, Botucatu, São Paulo, Brazil.

Common among children, vocal symptoms are a cause of concern for parents who seek elucidation of their diagnosis and treatment. Vocal nodules are the major cause of dysphonias in children and are related to vocal abuse. We conducted a literature review considering clinical, physiopathological, epidemiological, and histological aspects of vocal nodules, as well as diagnostic methods, highlighting the main studies addressing this issue. The controversial points of treatments were also discussed.
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September 2013

Laryngeal and voice disorders in patients with gastroesophageal symptoms. Correlation with pH-monitoring.

Acta Cir Bras 2012 Nov;27(11):821-8

Division of Otolaryngology, Department of Ophthalmology, Otolaryngology, Head and Neck Surgery, FMB, UNESP, Botucatu-SP, Brazil.

Purpose: To investigate laryngeal and voice disorders in patients with gastroesophageal symptoms and their correlation with pH-monitoring.

Methods: A prospective study was carried out in patients attended at the Voice Disorder Outpatient Clinics of Botucatu Medical School in a five-year period and had vocal and gastroesophagic symptoms. Patients underwent videolaryngoscopy, auditory-perceptual vocal analyses, computerized acoustic vocal analysis and dual probe pH-monitoring for 24 hours.

Results: Fifty-seven patients were included (aged between 21 and 65 years; 45 women and 12 men), 18 had normal (31.6%) and 39 had abnormal pH-monitoring results (68.4%). Videolaryngoscopy recorded several laryngeal lesions for both patients with normal and abnormal pH-monitoring, but mostly for the latter group, highlighting posterior pachyderma. Auditory-perceptual vocal assessments identified vocal changes of several intensities for both groups but especially for patients with abnormal pH-monitoring results. All acoustic parameters, except f0, were abnormal for both groups, compared to the control population.

Conclusion: Acoustic and perceptual vocal changes and laryngeal lesions were recorded for both patients with normal pH-monitoring results and patients with abnormal pH-monitoring results, evidencing the importance of clinical history and videolaryngoscopic findings for diagnosing acid laryngitis.
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November 2012

Dysphonia in children.

J Voice 2012 Sep 15;26(5):674.e17-20. Epub 2012 Jul 15.

Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Botucatu Medical School, UNESP, São Paulo State University, Botucatu, São Paulo, Brazil.

Introduction: Vocal symptoms are common among the pediatric population and are often caused by vocal abuse. Laryngoscopy is essential for their diagnosis because it helps differentiate several laryngeal lesions, leading to a decision for suitable treatments considering each case.

Objectives: This study aims to present the clinical characteristics, and the laryngoscopic diagnosis of a dysphonic child population.

Methods: The parents of 304 children, aged from 4 to 18 years and presenting prolonged hoarseness, answered a questionnaire about their children's voice, and all children were subjected to videolaryngostroboscopy.

Results: Male children aged from 7 to 12 years (64%) were predominant. Vocal abuse (n-162) and nasal obstruction symptoms (n-10) were the most frequent associated symptoms. The vocal symptoms had a chronic evolution (over 1 year) and were reported by most parents (n-200). The most commonly diagnosed lesions in the laryngoscopic exams were vocal nodules (n-175) and epidermal cysts (n-47). Furthermore, there was an association of some lesions, especially minor structural alterations.

Conclusion: In the present study, dysphonia occurred mainly in children aged from 7 to 12 years, predominantly males. Vocal abuse and nasal obstruction symptoms were frequently reported. Vocal nodules and cysts were the most commonly diagnosed laryngeal lesions in the laryngoscopic exams.
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September 2012

Maximum phonation time and s/z ratio in a large child cohort.

J Voice 2012 Sep 20;26(5):675.e1-4. Epub 2012 Jun 20.

Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University, São Paulo, Brazil.

Aim: The purpose of this study was to provide normal values for maximum phonation time (MPT) and the s/z ratio by examining 1660 children aged 4-12 years and without vocal signs or symptoms.

Methods: The technique was based on the sustained emission of the /a/ vowel and fricatives /s/ and /z/.

Results: The average of the MPT in children of the different age groups was as follows: 6.09 seconds for the age group 4-6 years (males, 5.97; female, 6.21 seconds), 7.94 seconds for the age group 7-9 years (males, 8.07; females, 7.79 seconds), and 8.98 for the age group 10-12 years (males, 9.05; females, 8.92 seconds). The overall average for males was 7.78 and females 7.64 seconds. The s/z ratio was near 1.0 in most children but above 1.2 in 133 children and below 0.8 in 133 children.

Conclusion: These values of MPT and s/z ratio can be used as normative in further pediatric studies.
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September 2012

Epidemiological study of dysphonia in 4-12 year-old children.

Braz J Otorhinolaryngol 2011 Nov-Dec;77(6):736-46

Faculdade de Medicina de Botucatu, Universidade de São Paulo, Botucatu, SP, Brasil.

Unlabelled: Children dysphonia studies have reported an incidence of 4.4 to 30.3%.

Goals: To establish the prevalence of dysphonia in children, based on the opinion of the parents, acoustic and vocal-perceptual assessments, associated symptoms, risk factors and videolaryngoscopy findings.

Materials And Methods: The parents from 2,000 children answered a questionnaire about the vocal quality of their children, and these children were submitted to perceptual vocal, acoustic and videolaryngoscopy assessments.

Results: We had 1,007 boys and 993 girls; sporadic symptoms were reported by 206 parents and permanent symptoms were reported by 123. In the perceptual assessment, the G parameter (degree of dysphonia) had a score of 0 in 694 voices; 1 in 1,065 and 2 in 228. There was f0 reduction with age and the remaining acoustic parameters were high in children with a G score of 2. Nodules, thickening and inflammation were the most common in the videolaryngoscopy exams.

Conclusions: Parental judgment indicated a prevalence of dysphonia in 6.15%, and perceptual analysis yielded a value of 11.4%. Vocal symptoms were associated with a phonatory overload. sinonasal disorders, vocal abuse and noise were considered relevant risk factors. The acoustic analysis kept a direct association with the perceptual-auditory. Laryngeal lesions were found in the videolaryngoscopy exams, stressing nodules, thickening and inflammation.
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September 2012

Consequences of chronic nasal obstruction on the laryngeal mucosa and voice quality of 4- to 12-year-old children.

J Voice 2012 Jul 25;26(4):488-92. Epub 2011 Jun 25.

Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University, São Paulo, Brazil.

Introduction: Dysphonia affects 6% to 23% of children, and chronic nasal obstruction may participate in its pathophysiology.

Objectives: To study the effects of chronic nasal obstruction on children's vocal quality.

Subjects And Methods: Two study groups were formed: nasal obstruction group (NOG), consisting of 60 children aged 4-12 years with important symptoms of chronic nasal obstruction; and a control group (CG), similar in gender and age range, consisting of healthy students without nasal, vocal, or auditory symptoms. The parents answered a questionnaire containing questions concerning their children's vocal qualities. All the children were submitted to perceptual auditory analysis, acoustic vocal analysis, auditory acuity assessment (transient otoacoustic emissions and/or threshold tone audiometry), and videoendoscopic assessment (flexible laryngoscopy and rigid laryngoscopy).

Results: The groups were similar in age and gender. Parents reported a dysphonia rate of 76.6% in NOG and a vocal abuse rate of 68.3%. Eight children from NOG (13.34%) showed mild conductive hypoacusia. Laryngeal lesions were detected in 35 children from NOG (58%): inflammatory processes (n=19), mucosal thickening (n=10), nodules (n=5), and cyst (n=1). In children from the NOG were observed higher scores for the Grade, Roughness, Breathiness, Aesthenia, Strain, Instability (GRBAS) perceptual scale (P<0.05), lower maximum phonation time values, and higher values to the s/z ratio, insufficient nasal resonance.

Conclusions: Relevant changes in perceptual auditory and acoustic vocal analyses and in the videolaryngoscopy were detected in children with nasal obstruction. These results showed the importance of the assessment of nasal obstruction in dysphonic children.
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July 2012

Mucosal bridge of the vocal fold: difficulties in the diagnosis and treatment.

J Voice 2012 Jan 25;26(1):127-31. Epub 2011 Feb 25.

Department of Otorhinolaryngology, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.

Summary: Mucosal bridges are rare laryngeal lesions probably of genetic origin. They may cause dysphonia of varying degrees, especially when associated with other laryngeal lesions such as vocal sulci and cysts. Reports on mucosal bridges are rare, and the better treatment is inconclusive.

Aim: To report the authors' experience in 14 cases of mucosal bridge showing details on endoscopic examinations and treatment.

Study Design: Retrospective study.

Methods: We reviewed the medical records of 14 patients with a diagnosis of mucosal bridge confirmed by videolaryngostroboscopy and direct laryngoscopy who attended the Outpatient Clinic of Voice Disorders of the Discipline of Otorhinolaryngology, Botucatu Medical School, São Paulo State University, São Paulo. Data collected included information on gender, age, symptoms, time of onset, history of intubation, smoking status, alcohol intake, associated laryngeal lesions, treatment, and GRBAS (grade of hoarseness, roughness, breathiness, asthenia, and stress) scale ratings.

Results: Of 14 patients, 10 were females and four were males. There was a prevalence of adults (n=12), with only two of the patients being younger than 13 years (10 and 13 years). Mucosal bridges showed no correlations with smoking, alcohol intake, or gastroesophageal and sinonasal symptoms. Voice abuse was reported in 50% of the cases that consisted of patients who had high-voice demand occupations. In seven cases, mucosal bridges were associated with other laryngeal lesions, particularly vocal cysts and sulci. All patients who underwent surgery and phonotherapy showed improved vocal quality.

Conclusions: We documented 14 patients with dysphonia caused by mucosal bridge. Promising results were obtained with surgery.
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January 2012

Normative study of vocal acoustic parameters from children from 4 to 12 years of age without vocal symptoms: a pilot study.

Braz J Otorhinolaryngol 2010 Jul-Aug;76(4):485-90

Graduate Program of General Basis of Surgery, UNESP, Botucatu.

Unlabelled: Acoustic vocal analysis is a simple and fast method that allows to differentiate normal from changed voices. There are few studies that analyze normal acoustic vocal parameters at different age ranges in children.

Aims: To establish normative acoustic parameters of children's voice aged 4 to 12 years.

Methods: Two hundred and forty children were divided into four sub-groups by age: G1 (n-60; 4-5 years), G2 (n-60; 6-7 years), G3 (n-60; 8-9 years) and G4 (n-60; 10-12 years). The children's parents answered a questionnaire and the children were submitted to auditory acuity evaluation (Assessment of Transient Otoacoustic Emissions), acoustic vocal analyses, otorhinolaryngological and videolaryngoscopy exams.

Results: The normal values for the acoustic vocal parameters studied were established according to age range and gender. As age increased, there was a decrease of f0 and APQ and an increased in SPI with statistical difference of these parameters. The vocal parameters did not differ between genders until the age of 12.

Conclusions: the characterization of the normative vocal patterns of children is an important reference for future studies. Some of the changes showed a direct relationship between age and a reduction of f0 and of APQ, and increase in SPI, with no difference between genders.
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March 2011

Vocal cysts: clinical, endoscopic, and surgical aspects.

J Voice 2011 Jan 19;25(1):107-10. Epub 2010 Feb 19.

Department of Otorhinolaryngology, Ophthalmology and Head and Neck Surgery, School of Medicine, São Paulo State University, Botucatu, São Paulo, Brazil.

Summary: Vocal cysts are benign laryngeal lesions, which affect children and adults. They can be classified as epidermic or mucous-retention cyst.

Objective: The objective was to study the clinical, endoscopic, and surgical aspects of vocal cysts.

Methods: We reviewed the medical charts of 72 patients with vocal cysts, considering age, gender, occupation, time of vocal symptoms, nasosinusal and gastroesophageal symptoms, vocal abuse, tabagism, alcoholism, associated lesions, treatment, and histological details.

Results: Of the 72 cases, 46 were adults (36 females and 10 male) and 26 were children (eight girls and 18 boys). As far as occupation is concerned, there was a higher incidence of students and teachers. All the patients had symptoms of chronic hoarseness. Nasosinusal (27.77%) and gastroesophageal (32%) symptoms were not relevant. Vocal abuse was reported by 45.83%, smoking by 18%, and alcoholism by 8.4% of the patients. Unilateral cysts were seen in 93% of the cases, 22 patients had associated lesions, such as bridge, sulcus vocalis, and microweb. Surgical treatment was performed in 46 cases. Histological analysis of the epidermic cysts revealed a cavity with caseous content, covered by stratified squamous epithelium, often keratinized. Mucous cysts presented mucous content, and the walls were coated by a cylindrical ciliated epithelium.

Conclusion: Vocal cysts are benign vocal fold lesions that affect children and adults, being often associated with vocal overuse, which frequently affects people who use their voices professionally. Vocal symptoms are chronic in course, often times since childhood, and the treatment of choice is surgical removal. A careful examination of the vocal folds is necessary during surgery, because other laryngeal lesions may be associated with vocal cysts.
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January 2011

Occupational hearing loss in teachers: a probable diagnosis.

Braz J Otorhinolaryngol 2007 Mar-Apr;73(2):239-44

Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu.

Unlabelled: Teachers frequently report auditory symptoms and excessive noise in classrooms, but noise level measurements are not done routinely. Study model - a prospective clinical trial.

Aim: To study auditory symptoms and audiometric exams of teachers and classroom noise levels.

Material And Method: Data from two groups, GI (40 teachers) and GII (40 voluntaries) were studied as follows: age, gender, working conditions, audiometric exams, and classroom noise levels.

Results: In GI there were more females (86%), working in basic teaching (75%), in classes with 21-40 students (70%), with workloads between 26 and 40 hours per week (47%), and variable professional teaching time. Most teachers in GI reported excessive classroom noise (93.5%) and auditory symptoms (65%). In GI, 25% of teachers presented audiometric alterations (versus 10% of controls), with an acoustic notch predominating (11.25%; p<0.05). Noise levels close to 87dBA were recorded in classes at all teaching levels.

Conclusions: occupational hearing loss may occur in teachers. Further studies are needed to confirm this proposition.
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January 2008