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Advisor(s)
Abstract(s)
A reabilitação da comunicação – vocal – em indivíduos laringectomizados tem por desafio restaurar a qualidade da voz de pacientes impossibilitados de uma fonação laríngea. Quando um indivíduo apresenta cancro na laringe e o tratamento indicado é a laringectomia total, a maior alteração funcional é a ausência de fonação. Isto ocorre porque o indivíduo deixa de produzir voz laríngea e a introdução de fala alaríngea tornase imprescindível, para ultrapassar a perturbação da comunicação. Nestas situações, entre os métodos de fala existentes estão a voz esofágica (VE) e a fala com Prótese Traqueoesofágica (PTE). O estudo que se apresenta neste documento tem como objetivo principal definir padrões de medidas acústicas para VE e fala PTE em Português Europeu. Como objetivo secundário surge a contribuição com metodologias de suporte para o software LxReahb, em desenvolvimento, de aplicação de tecnologias de mHealth para o treino e recuperação vocal de laringectomizados totais. Para este estudo foram selecionados 10 sujeitos, anonimizados, da consulta de Terapia da Fala no Centro Hospitalar e Universitário do Porto – Hospital de Santo António, do sexo masculino, submetidos a laringectomia total. As vogais analisadas do português europeu foram as orais, apresentadas de forma escrita e combinadas com as consoantes /p/, /t/ e /k/ injetoras, ou seja, facilitadoras da emissão vocal alaríngea. Os sinais foram gravados a 44,1 kHz, a 16 bit, numa sala com um nível de ruído inferior a 40dB SPL, embora não acusticamente tratada. Para a realização da análise acústica das amostras foi utilizado o programa Praat, versão 6.1.03. O trabalho de investigação de campo incluiu a construção de uma base de dados constituída por 239 registos de voz, com graus de alteração diversos e devidamente anotados, em adultos com fala alaríngea do Português Europeu. O processo culminou com a análise da informação recolhida, descrição e discussão dos resultados obtidos. Definiram-se as medidas de TMF para VE e PTE (p=0,037). Além disso encontraram-se diferenças estatisticamente significativas, comparando a VE com a PTE, fo nas vogais /a/ e /i/ (p=0,004; p=0,000), 1º Formante em todas as vogais analisadas (p=0,001; p=0,016; p=0,002) e no 2º Formante na vogal /i/ (p=0,000) com 95% de confiança. Observando os resultados obtidos da relação do tamanho da prótese com as medidas acústicas encontramse diferenças estatisticamente significativas ao nível do 1º Formante (p=0,001; p=0,036; p=0,005) em todas as vogais; na vogal /a/ no 2º Formante (p=0,018) e HNR (p=0,022). Considerando os parâmetros com o tipo de tratamento acharam-se diferenças no 2ºFormante na vogal /i/ (p=0,018). Quando comparado o momento da colocação também se encontraram diferenças no 2º Formante na vogal /a/ (p=0,008).
Voice rehabilitation in laryngectomized individuals has the challenge of restoring voice quality in patients who are unable to do a laryngeal voice. When an individual has laryngeal cancer and is indicated to a total laryngectomy, the biggest change is in phonation. It happens because the individual stops producing laryngeal voice and alaryngeal speech introduction becomes indispensable to reestablish the altered function. Existing methods include esophageal speech (ES) and tracheoesophageal speech (TES). This study aims to define acoustic measures for ES and TES in European Portuguese. As a secondary objective we will: contribute to the development of a software - LxReahb - an mHealth technology application to train and achieve a total vocal recovery of laryngectomized individuals. For this study 10 male subjects with total laryngectomy who are inpatients at Centro Hospitalar e Universitário do Porto - Hospital de Santo António, were selected. The analyzed vowels where the European Portuguese oral ones, presented in written form, combined with the consonants /p/, /t/ and /k/ injectors – act as a facilitator of vocal emission. The signals were recorded at 44.1 kHz at 16 bits in a room with a noise level below 40dB SPL – although the room wasn’t acoustically treated. To perform the acoustic samples analysis, we used the Praat software (version 6.1.03). The research work included the construction of a database of 239 samples, with different alaryngeal speech degrees, of European Portuguese adult speakers. The work ends with the description and discussion of the obtained results. Definition of TMF measurements for ES and TES was done (p=0,037). Also, statistically significant differences comparing ES with TES in fo in the vowels /a/ and /i/ (p=0,004; p=0,000), 1st Formant on all vowels analyzed (p=0,001; p=0,016; p=0,002) and 2nd Formant on vowel /i/ (p=0,000) with 95% confidence. Observing the results obtained from the relationship between the size of the prosthesis and the acoustic measurements, there are statistically significant differences at the level of the 1st Formant (p=0,001; p=0,036; p=0,005) in all vowels; in the vowel /a/ in the 2nd Formant (p=0,018) and HNR (p=0,022). Considering the parameters with the type of treatment, differences were found in the 2nd Formant in the vowel /i/ (p=0,018). When comparing the moment of placement, differences were also found in the 2nd Formant in the vowel /a/ (p=0,008).
Voice rehabilitation in laryngectomized individuals has the challenge of restoring voice quality in patients who are unable to do a laryngeal voice. When an individual has laryngeal cancer and is indicated to a total laryngectomy, the biggest change is in phonation. It happens because the individual stops producing laryngeal voice and alaryngeal speech introduction becomes indispensable to reestablish the altered function. Existing methods include esophageal speech (ES) and tracheoesophageal speech (TES). This study aims to define acoustic measures for ES and TES in European Portuguese. As a secondary objective we will: contribute to the development of a software - LxReahb - an mHealth technology application to train and achieve a total vocal recovery of laryngectomized individuals. For this study 10 male subjects with total laryngectomy who are inpatients at Centro Hospitalar e Universitário do Porto - Hospital de Santo António, were selected. The analyzed vowels where the European Portuguese oral ones, presented in written form, combined with the consonants /p/, /t/ and /k/ injectors – act as a facilitator of vocal emission. The signals were recorded at 44.1 kHz at 16 bits in a room with a noise level below 40dB SPL – although the room wasn’t acoustically treated. To perform the acoustic samples analysis, we used the Praat software (version 6.1.03). The research work included the construction of a database of 239 samples, with different alaryngeal speech degrees, of European Portuguese adult speakers. The work ends with the description and discussion of the obtained results. Definition of TMF measurements for ES and TES was done (p=0,037). Also, statistically significant differences comparing ES with TES in fo in the vowels /a/ and /i/ (p=0,004; p=0,000), 1st Formant on all vowels analyzed (p=0,001; p=0,016; p=0,002) and 2nd Formant on vowel /i/ (p=0,000) with 95% confidence. Observing the results obtained from the relationship between the size of the prosthesis and the acoustic measurements, there are statistically significant differences at the level of the 1st Formant (p=0,001; p=0,036; p=0,005) in all vowels; in the vowel /a/ in the 2nd Formant (p=0,018) and HNR (p=0,022). Considering the parameters with the type of treatment, differences were found in the 2nd Formant in the vowel /i/ (p=0,018). When comparing the moment of placement, differences were also found in the 2nd Formant in the vowel /a/ (p=0,008).
Description
Keywords
Voz Laringectomia Total Fala alaríngea Avaliação Acústica Voz Esofágica Prótese Traqueoesofágica Voice Total Laryngectomy Alaryngeal Speech Acoustic Evaluation Esophageal Speech Tracheoesophageal Speech