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de Andrade BMR, Valença EHO, Salvatori R, Oliveira LA, Souza AHO, Oliveira AHA, Oliveira MCP, Melo EV, de Carvalho S, Sales NJ, Monteiro GC, de Lima JM, Annunziato MFH, Mannis GDB, de A Souza LE, Goes YD, Carvalho TS, de Farias C, Dos Santos MP, Cardoso GPF, Pereira Sousa CS, Santana JR, Sales EA, d'Avila JS, Aguiar-Oliveira MH. Art and science: impact of semioccluded vocal tract exercises and choral singing on quality of life in subjects with congenital GH deficiency. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2022; 66:198-205. [PMID: 35315986 PMCID: PMC9832885 DOI: 10.20945/2359-3997000000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective Currently, not much is known about the interactions between voice and growth hormone (GH). We have described large kindred with isolated GH deficiency (IGHD) due to a GHRH receptor mutation, resulting in severe short stature and high-pitched voice. These IGHD individuals have little interest in GH treatment, as they consider themselves "short long-lived people", rather than patients. Interestingly, they report normal general quality of life, but they rate their Voice-Related Quality of Life (V-RQOL) as low. Here, we assessed the social and auditory-perceptual impacts of artistic-intervention voice therapy with semioccluded vocal tract exercises (SOVTE) and choral singing, on their voices. Methods Seventeen GH-naïve adult IGHD individuals were enrolled in a single-arm interventional pre-post study with 13 weekly sessions of choir singing over 90 days. Outcome measures were V-RQOL scores, self-assessment of voice, and auditory-perceptual analysis (GRBAS scale, G: grade of the severity of dysphonia; R: roughness; B: breathiness; A: asthenia; and S: strain). Results Marked improvements in total (p = 0.0001), physical (p = 0.0002), and socioemotional (p = 0.0001) V-RQOL scores and in self-assessment of voice (p = 0.004) were found. The general grades of vocal deviation (p = 0.0001), roughness (p = 0.0001), breathiness (p = 0.0001) and strain (p = 0.0001) exhibited accentuated reductions. Conclusion Voice therapy with semioccluded vocal tract exercises and choral training improved social impact and perceptual voice assessments in IGHD subjects and markedly improved their voice-related quality of life. This is particularly important in a setting where GH replacement therapy is not widely accepted.
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Affiliation(s)
- Bruna M R de Andrade
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Eugenia H O Valença
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Roberto Salvatori
- Division of Endocrinology, Department of Medicine, The Johns Hopkins University School of Medicine Baltimore (Maryland), United States
| | - Luiz A Oliveira
- Divisão de Odontologia, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Anita H O Souza
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Alaíde H A Oliveira
- Divisão de Odontologia, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Mario C P Oliveira
- Departamento de Comunicação Social, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Enaldo V Melo
- Divisão de Odontologia, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Susana de Carvalho
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Neuza J Sales
- Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | | | | | | | | | - Lucas E de A Souza
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Yasmin D Goes
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Thayza S Carvalho
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Celiane de Farias
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Michela P Dos Santos
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Gabriela P F Cardoso
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Carla S Pereira Sousa
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Julia Rodrigues Santana
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Ester Almeida Sales
- Departamento de Fonoaudiologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Jeferson Sampaio d'Avila
- Divisão de Otorrinolaringologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil
| | - Manuel H Aguiar-Oliveira
- Divisão de Endocrinologia, Programa de Pós-graduação em Ciências da Saúde, Universidade Federal de Sergipe, Aracaju, SE, Brasil,
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Xavier CB, Dassie-Leite AP, Pereira RM, Nesi-França S, De Lacerda L. Vocal Characteristics of Children With Short Stature Before and After Growth Hormone Treatment. J Voice 2022:S0892-1997(22)00003-0. [PMID: 35090764 DOI: 10.1016/j.jvoice.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the vocal characteristics of children with short stature before and 12 months after growth hormone treatment. MATERIAL AND METHODS This analytical, observational cohort study included 23 children (age 5-11 years) diagnosed with short stature. Children in the short stature group (SSG) were matched (1:1) for age and sex with children with normal growth (normal stature group; NSG). Participants in the SSG underwent assessments before and 12 months after growth hormone treatment, while those in the NSG underwent the same assessments at baseline and 12 months. The assessments included evaluation of (A) vocal characteristics (history, vocal self-assessment, auditory-perceptual evaluation, and acoustic analysis), (B) anthropometry, (C) bone age, and (D) measurement of insulin-like growth factor-1 (IGF-1) levels. RESULTS Children in the SSG had more vocal complaints (P = 0.026) than those in the NSG. The groups were similar in terms of vocal self-assessment and auditory-perceptual evaluation (P = nonsignificant). Results of acoustic analysis were also similar for fundamental frequency (F 0) and perturbation measures (P for both = nonsignificant). F 0 and speech frequency decreased significantly at 12 months in both groups. F1 values were higher at 12 months in the NSG, while F2 values were significantly higher in the baseline evaluation in boys in the SSG. Children in the SSG compared with those in the NSG presented a greater increase in height measurements at 12 months, although the anthropometric means were lower in both evaluations (P < 0.001). CONCLUSION Vocal characteristics in children with short stature before and after treatment with growth hormone are comparable to those in children with normal growth.
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Affiliation(s)
- Congeta Bruniera Xavier
- Postgraduate Program of Childhood and Adolescence Health, Department of Pediatrics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
| | - Ana Paula Dassie-Leite
- Department of Speech-Language Pathology, Universidade Estadual do Centro-Oeste, Irati, Paraná, Brazil
| | - Rosana Marques Pereira
- Division of Pediatric Endocrinology, Department of Pediatrics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Suzana Nesi-França
- Division of Pediatric Endocrinology, Department of Pediatrics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Luiz De Lacerda
- Division of Pediatric Endocrinology, Department of Pediatrics, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
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Grisa L, Leonel ML, Gonçalves MIR, Pletsch F, Sade ER, Custódio G, Zagonel IPS, Longui CA, Figueiredo BC. Impact of early postnatal androgen exposure on voice development. PLoS One 2013; 7:e50242. [PMID: 23284635 PMCID: PMC3526601 DOI: 10.1371/journal.pone.0050242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 10/22/2012] [Indexed: 11/19/2022] Open
Abstract
Background The impact of early postnatal androgen exposure on female laryngeal tissue may depend on certain characteristics of this exposure. We assessed the impact of the dose, duration, and timing of early androgen exposure on the vocal development of female subjects who had been treated for adrenocortical tumor (ACT) in childhood. Methods The long-term effects of androgen exposure on the fundamental vocal frequency (F0), vocal pitch, and final height and the presence of virilizing signs were examined in 9 adult (age, 18.4 to 33.5 years) and 10 adolescent (13.6 to 17.8 years) female ACT patients. We also compared the current values with values obtained 0.9 years to 7.4 years after these subjects had undergone ACT surgery, a period during which they had shown normal androgen levels. Results Of the 19 subjects, 17 (89%) had been diagnosed with ACT before 4 years of age, 1 (5%) at 8.16 years, and 1 (5%) at 10.75 years. Androgen exposure (2 to 30 months) was sufficiently strong to cause pubic hair growth in all subjects and clitoromegaly in 74% (14/19) of the subjects, but did not reduce their height from the target value. Although androgen exposure induced a remarkable reduction in F0 (132 Hz) and moderate pitch virilization in 1 subject and partial F0 virilization, resulting in F0 of 165 and 169 Hz, in 2 subjects, the majority had normal F0 ranging from 189 to 245 Hz. Conclusions Female laryngeal tissue is less sensitive to androgen exposure between birth and adrenarche than during other periods. Differential larynx sensitivity to androgen exposure in childhood and F0 irreversibility in adulthood are age-, concentration-, duration-, and timing-dependent events that may also be affected by exposure to inhibitory or stimulatory hormones. Further studies are required to better characterize each of these factors.
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Affiliation(s)
- Leila Grisa
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
- Hospital Pequeno Príncipe, Curitiba, Paraná, Brazil
- Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil
| | | | - Maria I. R. Gonçalves
- Departamento de Fonoaudiologia da Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Elis R. Sade
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
- Hospital Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Gislaine Custódio
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Ivete P. S. Zagonel
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
- Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil
| | - Carlos A. Longui
- Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, São Paulo, Brazil
| | - Bonald C. Figueiredo
- Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Paraná, Brazil
- Hospital Pequeno Príncipe, Curitiba, Paraná, Brazil
- Faculdades Pequeno Príncipe, Curitiba, Paraná, Brazil
- Departmento de Saúde Comunitária, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
- * E-mail:
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Valença EHO, Souza AHO, Oliveira AHA, Valença SL, Salvatori R, Gonçalves MIR, Oliveira-Neto LA, Barros AD, Nascimento UN, Oliveira CRP, Cardoso DF, Melo VA, Aguiar-Oliveira MH. Voice quality in short stature with and without GH deficiency. J Voice 2012; 26:673.e13-9. [PMID: 22698553 DOI: 10.1016/j.jvoice.2011.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Accepted: 12/20/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the individual impact of short stature (SS) or untreated isolated growth hormone deficiency (IGHD) on voice quality and the influence of IGHD on voice aging. METHODS A cross-sectional study was carried out on 73 adults: 33 IGHD, 10 SS, and 30 normal controls (CO), by evaluating vocal perception using Voice-Related Quality-of-Life (V-RQOL) scores and fundamental frequency (ƒ0). Analysis of variance with Bonferroni post-test was used to compare groups, and the Student t test was used to verify the influence of aging. RESULTS Stature of the SS and IGHD groups was similarly reduced in comparison to CO. Cephalic perimeter (CP) in SS males was larger than CO (P<0.05), and this was larger than in IGHD (P<0.0001). CP was similar in SS and CO females, and both were larger than in IGHD (P<0.0001). V-RQOL scores were lower in IGHD than in SS and CO. ƒ0 (Hz) was similar in IGHD females and SS and higher than in CO (P<0.05). f0 of IGHD males was higher than in SS (P=0.01) and CO (P=0.001). IGHD abolished the effect of aging on ƒ0 exhibited by CO. CONCLUSIONS Lower vocal perception and higher ƒ0 were found in IGHD in comparison to CO in both genders; in comparison to SS, higher ƒ0 was only found in IGHD males. Because SS males have higher CP than IGHD, this suggests that CP and craniofacial growth can influence voice in IGHD. Finally, IGHD seems to abolish the effects of aging on voice.
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Affiliation(s)
- Eugenia H O Valença
- Division of Speech Therapy, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Abstract
AIM The aim of researches was estimation of quality of voice after operations correcting of the nasal septum deviation. MATERIALS AND METHODS With researches one embraced 40 men in two groups (group I: 20-30 of years old, group II--above 50 of year old). Voice one priced before operation of corrective nose and 6 of months after executed intervention. In researches one used with scale GRBAS, with estimation laryngostroboskopy of function of vocal folds, with acoustic analysis created of voice, with measurement of maximum phonation time and with Polish version of VHI. Patency of nose priced patients at subjective help of five--gradual of scale. RESULTS After 6 months all ill favourably priced effect executed of operation improving patency of nose. In scale GRBAS in group I examined voice one priced as normal at 12 ill (60%), instead in group II only at 3 men (15%). Above--regularity refers also of roughness of voice. In stroboscope research executed before operation at almost all ill one ascertained diminution of amplitude of twitches of folds vocal and mucosal wave. After 6 months after operation in group I both amplitude of twitches of vocal folds as and mucosal wave at mostly examined surrendered of normalization. In group II profitable changes we observed only at several of persons. Maximum phonation time of vowel "a" after operation of nose surrendered to extension in both groups examined, however men of group I reached significantly better results, with average value approaching to norms. In acoustic analysis to distinct improvement, but only in group I examined surrendered parameter NHR. In estimation with test VHI six months after operation sense of disturbances of voice in both groups surrendered to diminution, in proportion to qualities created of voice. CONCLUSIONS Operating--restoration physiological air passage at all ill causes diminution or liquidation earlier stepping out of disturbances of voice. From passed researches results, that improvement of health, manifesting itself voice euphonious is in considerable percentage possible only at young persons. At ill in middle age and older to entire liquidation of disturbances of voice will reach in single chances.
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Barreto VMP, D'Avila JS, Sales NJ, Gonçalves MIR, Seabra JD, Salvatori R, Aguiar-Oliveira MH. Laryngeal and vocal evaluation in untreated growth hormone deficient adults. Otolaryngol Head Neck Surg 2009; 140:37-42. [PMID: 19130959 DOI: 10.1016/j.otohns.2008.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 10/06/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the consequences of lifetime, severe and untreated isolated growth hormone deficiency (IGHD) on vocal and laryngeal function. STUDY DESIGN Cross-sectional. SUBJECTS AND METHODS A total of 23 IGHD adult subjects and 22 controls were administered a questionnaire about vocal complaints and harmful voice habits, and underwent videolaryngostroboscopic examination, voice evaluation by perceptual-auditory analysis with GRBAS scale including grade of dysphonia, roughness, breathiness, asthenia and strain items, objective voice evaluation by maximum phonation time (MPT), and acoustic analysis. RESULTS There was no difference in vocal complaints between IGHD subjects and controls. Vocal abuse and smoking were more frequent in IGHD subjects. IGHD subjects presented higher values for roughness, breathiness, and strain. Laryngopharyngeal reflux (LPR) signs and laryngeal constriction were more frequent in IGHD individuals. MPT was similar in the two groups. Fundamental frequency was higher in IGHD females and males. Harmonic to noise ratio was higher in IGHD in both genders and shimmer was lower in IGHD females. CONCLUSIONS IGHD subjects have higher prevalence of signs of LPR and laryngeal constriction, with high pitch in both genders, which suggests a prominent role of IGHD on these parameters.
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Affiliation(s)
- Valéria M P Barreto
- Division of Otorhinolaryngology, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
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