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OBJECTIVE: To verify the immediate effects of voiced gargling on the electrical activity of extrinsic laryngeal muscles and vocal self-assessment. METHODS: A sample of 20 individuals of both sexes, mean age of 31.95 (±11.57) years, were equally divided in two groups according to the presence or absence of vocal complaint. Both groups were evaluated by surface electromyography of the suprahyoid (SH) and infrahyoid (IH) muscle areas during rest, phonation of the sustained vowel [Ɛ] in habitual and strong intensities; phonation of rising and falling glissando; and counting from 1 to 10. Surface electromyography was assessed before and after the voiced gargling exercise, which lasted 1 minute. All participants self-rated their voice and phonatory comfort after the exercise. Wilcoxon and Mann-Whitney tests were applied, as well as Fisher's exact test and linear-to-linear test. The level of significance was 5%. RESULTS: The percentage of electrical activity of the SH muscle area decreased in the glissando and counting tasks in the group with vocal complaint, as well as in phonation of sustained vowel in strong intensity in the group without complaint. Decrease was also observed in the right IH muscle area at rest and during sustained vowel phonation at habitual and strong intensities. Percentage of muscular electrical activity was lower in the group with complaint in the following situations: IH muscle area on both sides, at rest and during habitual phonation of sustained vowel and glissando before and after the exercise; right IH muscle area, during counting and strong phonation of sustained vowel before and after exercise; left IH muscle area, in the counting task, just after intervention. Most participants noticed improvement in voice (70%) and phonatory comfort (65%). CONCLUSIONS: Voiced gargling during 1 minute promotes immediate effects on the electrical activity of the extrinsic laryngeal muscles in individuals with or without vocal complaint. Most individuals reported improved voice and phonatory comfort after exercise.

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Abstract Introduction There is evidence that all the complex machinery involved in speech acts along with the auditory system, and their adjustments can be altered. Objective To present the evidence of biofeedback application for treatment of vocal disorders, emphasizing the muscle tension dysphonia. Methods A systematic review was conducted in Scielo, Lilacs, PubMed and Web of Sciences databases, using the combination of descriptors, and admitting as inclusion criteria: articles published in journals with editorial committee, reporting cases or experimental or quasi-experimental research on the use of biofeedback in real time as additional source of treatment monitoring of muscle tension dysphonia or for vocal training. Results Thirty-three articles were identified in databases, and seven were included in the qualitative synthesis. The beginning of electromyographic biofeedback studies applied to speech therapy were promising and pointed to a new method that enabled good results in muscle tension dysphonia. Nonetheless, the discussion of the results lacked physiological evidence that could serve as their basis. The search for such explanations has become a challenge for speech therapists, and determined two research lines: one dedicated to the improvement of the electromyographic biofeedback methodology for voice disorders, to reduce confounding variables, and the other dedicated to the research of neural processes involved in changing the muscle engram of normal and dysphonic patients. Conclusion There is evidence that the electromyographic biofeedback promotes changes in the neural networks responsible for speech, and can change behavior for vocal emissions with quality.

Resumo Introdução Há evidências de que o complexo aparato envolvido no ato da fala, juntamente com o sistema auditivo, e seus ajustes podem ser alterados. Objetivo Apresentar evidências da aplicação de biofeedback (biorretroalimentação) para tratamento de distúrbios vocais, enfatizar a disfonia de tensão muscular. Método Realizou-se uma revisão sistemática nas bases de dados de Scielo, Lilacs, PubMed e Web of Sciences, utilizando a combinação de descritores e admitindo como critérios de inclusão: artigos publicados em revistas com comitê editorial, relatos de casos ou pesquisas experimentais ou quase experimentais sobre o uso debiofeedbackem tempo real como fonte adicional de monitoração de tratamento de disfonia de tensão muscular ou para treinamento vocal. Resultados Trinta e três artigos foram identificados em bases de dados, e sete foram incluídos na síntese qualitativa. O início dos estudos de biofeedbackeletromiográficos aplicados à terapia fonoaudiológica foram promissores e indicaram um novo método que permitiu bons resultados na disfonia de tensão muscular. No entanto, a discussão dos resultados carecia de evidências fisiológicas que pudessem servir de base. A busca por tais explicações tornou-se um desafio para os fonoaudiólogos e determinou duas linhas de pesquisa: uma dedicada à melhoria da metodologia de biofeedbackeletromiográfico para distúrbios da voz, para reduzir as variáveis de confusão e outra dedicada à pesquisa de processos neurais envolvidos na alteração do engrama muscular de pacientes normais e disfônicos. Conclusão Há evidências de que o biofeedback eletromiográfico promove mudanças nas redes neurais responsáveis pela fala e pode mudar o comportamento para emissões vocais com qualidade.

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INTRODUCTION: There is evidence that all the complex machinery involved in speech acts along with the auditory system, and their adjustments can be altered. OBJECTIVE: To present the evidence of biofeedback application for treatment of vocal disorders, emphasizing the muscle tension dysphonia. METHODS: A systematic review was conducted in Scielo, Lilacs, PubMed and Web of Sciences databases, using the combination of descriptors, and admitting as inclusion criteria: articles published in journals with editorial committee, reporting cases or experimental or quasi-experimental research on the use of biofeedback in real time as additional source of treatment monitoring of muscle tension dysphonia or for vocal training. RESULTS: Thirty-three articles were identified in databases, and seven were included in the qualitative synthesis. The beginning of electromyographic biofeedback studies applied to speech therapy were promising and pointed to a new method that enabled good results in muscle tension dysphonia. Nonetheless, the discussion of the results lacked physiological evidence that could serve as their basis. The search for such explanations has become a challenge for speech therapists, and determined two research lines: one dedicated to the improvement of the electromyographic biofeedback methodology for voice disorders, to reduce confounding variables, and the other dedicated to the research of neural processes involved in changing the muscle engram of normal and dysphonic patients. CONCLUSION: There is evidence that the electromyographic biofeedback promotes changes in the neural networks responsible for speech, and can change behavior for vocal emissions with quality.

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ABSTRACT It is assumed that singing is a highly complex activity, which requires the activation and interconnection of sensorimotor areas. The aim of the current research was to present the evidence from neuroimaging studies in the performance of the motor and sensory system in the process of singing. Research articles on the characteristics of human singing analyzed by neuroimaging, which were published between 1990 and 2016, and indexed and listed in databases such as PubMed, BIREME, Lilacs, Web of Science, Scopus, and EBSCO were chosen for this systematic review. A total of 9 articles, employing magnetoencephalography, functional magnetic resonance imaging, positron emission tomography, and electrocorticography were chosen. These neuroimaging approaches enabled the identification of a neural network interconnecting the spoken and singing voice, to identify, modulate, and correct pitch. This network changed with the singer's training, variations in melodic structure and harmonized singing, amusia, and the relationship among the brain areas that are responsible for speech, singing, and the persistence of musicality. Since knowledge of the neural networks that control singing is still scarce, the use of neuroimaging methods to elucidate these pathways should be a focus of future research.

RESUMO Admite-se que o canto seja uma atividade de alta complexidade pois requer ativação e interconexão de áreas sensório-motoras. Esta pesquisa teve como objetivo apresentar as evidências originadas por estudos de neuroimagem sobre a atuação do sistema motor e sensitivo na produção do canto. Na construção da revisão sistemática, foram premissas o período de publicação entre 1990 e 2016, artigos publicados em periódicos indexados e constantes nas bases de dados PubMed, BIREME, Lilacs, Web of Science, Scopus ou EBSCO, referentes a estudos sobre características do canto humano analisadas por neuroimagem. Os nove artigos analisados, com emprego de magnetoencefalografia, imagem por ressonância magnética funcional, tomografia por emissão de pósitrons ou eletrocorticografia, possibilitaram comprovar existência de uma rede neuronal interligada entre a modalidade falada e cantada para identificação, modulação e correção de violações de pitch, que podem ser alteradas com o treinamento do cantor, bem como alteração da estrutura melódica e harmonização do canto, amusia, relação entre áreas cerebrais responsáveis pela fala, canto e persistência da musicalidade. Assim, o conhecimento das áreas cerebrais e das interconexões necessárias ao canto ainda é escasso e deve ser um tema de pesquisas no futuro, empregando métodos de neuroimagem.

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OBJETIVO: Verificar os cuidados vocais adotados por coralistas que nunca foram submetidos a curso de orientação vocal. MATERIAIS E MÉTODO: Foram entrevistados 23 coralistas de três empresas da cidade de Recife/PE, que possuíam, no mínimo, um ano de atuação em canto coral. RESULTADOS: A partir dos resultados analisados, percebeu-se que a queixa vocal mais ocorrente referiu-se à falha da voz nas notas agudas (56,52%), enquanto que o abuso vocal mais referido foi o ato de pigarrear (65,22%). Além disso, 30,43% dos coralistas afirmaram fazer uso de pastilhas como paliativo para a disfonia. A respiração foi relatada como inadequada ao canto por 65,21% dos sujeitos. Apenas 34,78% dos coralistas realizam hidratação em quantidade satisfatória. O aquecimento vocal é realizado por 95,65% dos coralistas, todavia, apenas 13,04% realizam o desaquecimento vocal. CONCLUSÃO: Foram identificados diversos fatores que dificultam a manutenção da saúde vocal, apesar de haver a realização de cuidados vocais importantes, como o aquecimento vocal

OBJECTIVE: To check vocal care adopted by chorus singers who have never attended a course on vocal guidelines. METHODS: Twenty-three chorus singers have been researched. They take part in three different companies from Recife, and have been in chorus singing for at least one year. RESULTS: From the results analyzed, it was possible to conclude that the most occurring complaint was hoarseness after performances (56.52%), and the most occurring vocal abuse was the act of hawking (65.22%). In addition, 30.43% of singers reported making use of drops as a palliative for dysphonia. Breathing was reported by 65.21% of singers as inadequate to singing. Only 34.78% perform hydration satisfactorily. Almost all the singers (95.65%) perform vocal warm-up, however, many do not realize the vocal cool-down (13.04%). CONCLUSION: Were identified several factors that hinder the maintenance of vocal health, in spite of taking some important aids such as vocal warm-up

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PURPOSE: To evaluate the vocal behavior of receptive telemarketing operators in pre- and post-work shift moments, and to relate the results to the variable gender. METHODS: Participants were 55 telemarketing operators (11 men and 44 women) working in a receptive mode in the city of Maceió (Alagoas, Brazil). A questionnaire was applied before the work shift to initially identify the vocal complaints. After that, vocal samples were recorded, comprising sustained emissions and connected speech produced 10 minutes before and 10 minutes after the workday to be later evaluated. Auditory-perceptual and acoustic analyses of voice were conducted. RESULTS: Vocal complaints and symptoms reported by the operators after the work shift were: dry throat (64%); neck and cervix pain (33%); hoarseness (31%); voice failure (26%); and vocal fatigue (22%).Telemarketing operators presented reduced maximum phonation time before and after the day of work (p=0.645). Data from the auditory-perceptual assessment of voice were similar in pre- and post-shift moments (p=0.645). No difference was found between moments also on acoustic analysis data (p=0.738). CONCLUSION: Telemarketing operators have high indexes of vocal symptoms after the work shift, and there are no differences between pre- and post-work shift in auditory-perceptual and acoustic assessments of voice.

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OBJETIVO: Investigar o perfil de saúde vocal de cantores amadores de louvores evangélicos com relação a queixas, hábitos e dificuldades vocais vivenciados durante a prática do canto em indivíduos dos gêneros masculino e feminino. MÉTODOS: Participaram 55 sujeitos, com idade entre 18 e 50 anos, os quais responderam a um questionário auto-aplicável sobre identificação de hábitos vocais e possíveis queixas de voz falada e cantada. RESULTADOS: Os cantores religiosos evangélicos amadores relataram queixas relacionadas à voz, tais como rouquidão constante (43,6 por cento), pigarro constante (43,6 por cento), falhas na voz (34,5 por cento), perda de voz (18,1 por cento), garganta seca (18,1 por cento), voz fraca (14,5 por cento) e dor no pescoço e na nuca (12,7 por cento). Durante a atividade de canto, as queixas mais reportadas foram as de dificuldades de alcançar notas agudas (45,4 por cento), rouquidão (30,9 por cento) e falhas na voz (29 por cento). Os hábitos vocais expostos pelos cantores foram os relativos a falar muito (63,6 por cento), ingerir gelado habitualmente em excesso (43,6 por cento), falar alto (40 por cento) e gritar com frequência (20 por cento). Com relação à variável gênero, foram observadas diferenças significativas entre os grupos, relacionadas às variáveis falhas na voz, consumo de gelados e falar alto. CONCLUSÃO: Os cantores religiosos amadores, de ambos os gêneros, apresentam percentual expressivo de queixas e hábitos vocais que podem estar associados à falta de informações sobre os hábitos saudáveis de produção vocal e que podem contribuir para o desenvolvimento de alterações laríngeas e disfonia.

PURPOSE: To investigate the vocal health profile of male and female gospel amateur singers regarding vocal complaints, habits and difficulties during singing practice. METHODS: Participants were 55 subjects with ages between 18 and 50 years, who answered a self-assessment questionnaire regarding the identification of vocal habits and possible complaints of spoken and sung voice. RESULTS: Amateur gospel singers reported vocal complaints, such as continuous hoarseness (43.6 percent), constant throat clearing (43.6 percent), voice failure (34.5 percent), voice loss (18.1 percent), dry throat (18.1 percent), weak voice (14.5 percent), and neck and cervix pain (12.7 percent). During singing activity, the most reported complaints were difficulties in reaching high notes (45.4 percent), hoarseness (30.9 percent) and voice failure (29 percent). The vocal habits the singers reported regarded excessive talking (63.6 percent), immoderate icy beverages intake (43.6 percent), loud talking (40 percent), and repeatedly shouting (20 percent). Significant differences were found between genders regarding the variables voice failure, icy beverages intake, and loud talking. CONCLUSION: Amateur religious singers of both genders showed an expressive percentage of vocal complaints and habits that might be associated to lack of information about healthy vocal habits, which can contribute to the development of laryngeal alterations and voice disorders.

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OBJETIVO: Avaliar o comportamento vocal de teleoperadores receptivos em momento pré e pós-jornada de trabalho e relacionar os resultados à variável gênero. MÉTODOS: Participaram 55 teleoperadores de uma empresa de teleatendimento na cidade de Maceió (AL), sendo 11 homens e 44 mulheres, com atuação no modo receptivo. Inicialmente, foi aplicado um questionário antes da jornada de trabalho para identificação das queixas vocais. Em seguida foi feita gravação de amostras vocais compostas por emissões sustentadas e fala encadeada 10 minutos antes e 10 minutos após a jornada de trabalho para serem posteriormente avaliadas. Foram realizadas avaliações perceptivo-auditiva e acústica da voz. RESULTADOS: Os sintomas e queixas vocais referidos pelos teleoperadores após a jornada de trabalho foram: garganta seca (64 por cento); dores na região de nuca e pescoço (33 por cento); rouquidão (31 por cento); falhas na voz (26 por cento) e cansaço vocal (22 por cento). Os teleoperadores apresentaram tempos máximos fonatórios reduzidos antes e após a jornada de trabalho (p=0,645). Os dados da avaliação perceptivo-auditiva da voz foram semelhantes nos momentos pré e pós-jornada (p=0,645). Também não houve diferença nos dados de análise acústica no início e ao final da jornada de trabalho (p=0,738). CONCLUSÃO: Os teleoperadores apresentam elevado índice de sintomas vocais após a jornada de trabalho, e não há diferenças entre a pré e pós-jornada de trabalho nas avaliações perceptivo-auditiva e acústica da voz.

PURPOSE: To evaluate the vocal behavior of receptive telemarketing operators in pre- and post-work shift moments, and to relate the results to the variable gender. METHODS: Participants were 55 telemarketing operators (11 men and 44 women) working in a receptive mode in the city of Maceió (Alagoas, Brazil). A questionnaire was applied before the work shift to initially identify the vocal complaints. After that, vocal samples were recorded, comprising sustained emissions and connected speech produced 10 minutes before and 10 minutes after the workday to be later evaluated. Auditory-perceptual and acoustic analyses of voice were conducted. RESULTS: Vocal complaints and symptoms reported by the operators after the work shift were: dry throat (64 percent); neck and cervix pain (33 percent); hoarseness (31 percent); voice failure (26 percent); and vocal fatigue (22 percent).Telemarketing operators presented reduced maximum phonation time before and after the day of work (p=0.645). Data from the auditory-perceptual assessment of voice were similar in pre- and post-shift moments (p=0.645). No difference was found between moments also on acoustic analysis data (p=0.738). CONCLUSION: Telemarketing operators have high indexes of vocal symptoms after the work shift, and there are no differences between pre- and post-work shift in auditory-perceptual and acoustic assessments of voice.

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