Mapping of the characteristics in the CoDAS journal publications in the voice area: a scoping review

ABSTRACT

Purpose

To map and describe the characteristics present in the publications of the CoDAS journal in the voice segment.

Research strategies

The research was carried on the Scielo database using the descriptor voice.

Selection criteria

CoDAS publications in the field of voice.

Data analysis

Specific data collected according to delineation, summarized by descriptive analysis and analyzed in narrative format.

Results

Studies published in 2019 and with cross-sectional delineation were more frequent. The most frequent result in the cross-sectional studies was the vocal self-assessment. Most intervention studies were of immediate single-session-only effect. The most frequent procedures in the validation studies were translation and transcultural adaptation.

Conclusion

There was a gradual increase in the number of publications of voice studies, though these had heterogeneous characteristics.

Keywords:
Voice; Outcomes; Procedures; Dysphonia; Voice Disorders

RESUMO

Objetivo

Mapear e descrever as características das publicações da revista CoDAS na área da voz.

Estratégia de pesquisa

Foi realizada uma busca eletrônica na base de dados Scielo pelo descritor voz.

Critérios de seleção

Foram selecionados os estudos publicados na revista CoDAS, na área de voz.

Análise dos dados

Foram extraídos dados específicos por delineamento. Os dados foram sintetizados por análise descritiva, e analisados de forma narrativa.

Resultados

Foram mais frequentes estudos publicados em 2019, com delineamento transversal. Foram mais frequentes estudos com amostra na faixa etária de 18-59 anos. Nos estudos transversais, foi mais frequente a medida de resultado de autoavaliação vocal. Nos estudos de intervenção, a maioria foi de efeito imediato de uma sessão. Dentre os estudos de validação, foram mais frequentes os procedimentos de tradução e adaptação transcultural.

Conclusão

Houve aumento gradual de estudos em voz, porém, as características das publicações foram heterogêneas.

Descritores:
Voz; Desfechos; Procedimentos; Disfonia; Distúrbios da Voz

INTRODUCTION

In the contemporary healthcare world, the search for a scientific knowledge in the contemporary world of health care, the search for scientific knowledge has taken a prominent place, with the main purpose of fostering clinical practice. In this sense, the production of evidence through the publication of a scientific article is a way to transmit to the scientific and clinical community data on the development of new procedures, instruments, and interventions, as well as the analysis of risk factors and epidemiological reality in the various areas of Science(¹), such as in Speech Therapy (phonoaudiology).

In Brazil, voice is one of the phonoaudiological areas recognized as a specialty since 2006(²). Since this resolution, the voice area has advanced even more as a recognized specialty in constant evolution. The strength and recognition of a profession or area are in most part based on the quality of the articles published in peer-reviewed journals. The Brazilian scientific production in the area of voice is vast, which contributes to and strengthens the practice. Historically, the first researches in the voice area, as well as in the health and speech sciences in general, dealt with the delineation of expert opinions and case series from clinical practice. These were the first scientific steps in a young field, but the conclusions of these studies could not yet be generalized. The practice was based on the learning acquired during the clinicians' training, and their questions were answered directly with recognized experts. Over time, research has been improving, and the focus has become the availability of evidence to improve clinical practice, as well as the implementation of evidence. Currently, the challenge for vocal clinicians is to choose the best scientific evidence to support their practice(³,⁴). These changes stemmed, in large part, from a movement called Evidence Based Practice (EBP), which seeks to ensure the quality of care of health professionals, including speech therapists, aiming at better decision making for each case(⁵). The EBP consists of three practices: 1) The clinician identifies a problem or doubt in their practice; 2) The researcher transforms this problem/doubt into a research question and develops a study to answer it based on evidence; 3) The clinician searches and selects the study, and applies the evidence to their clinical practice, from a critical analysis that takes into account their practice experience and patient perspectives(⁶). Thus, the execution of EBP does not depend only on researchers, but mainly on clinicians, who must act as integrators of science and clinic, critical evaluators of data, and executors in the application of evidence in their clinical cases(⁷). It can be said that the continuous development of Speech Pathology and the field of voice is directly linked to the practice of EBP(⁸), although EBP is still not frequent in the field of voice.

Brazil currently hás four speech therapy specialized magazines that contribute to EPB, one of them is CoDAS (Communication Disorders, Audiology and Swallowing) an easy and short english abbreviation that includes the main areas of Speech Therapy. CoDAS is a journal that has been adapted to the needs of the phonoaudiological academy and clinic. Initially, it was called Pró-Fono Revista de Atualização Cientifica (2005-2010). In 2010, it was renamed Jornal da Sociedade Brasileira de Fonoaudiologia (2010-2012). The articles published from 2010 onwards are available on the Scielo platform with open access. In its last restructuring in 2013, it was renamed CoDAS, with a centralized editorial as the only publication of the Brazilian Society of Speech Therapy. The journal is indexed by Web of Science, MEDLINE/PubMed, Scopus, PsycINFO, Scientific Electronic Library Online (SciELO), Linguistics and Language Behavior Abstracts (CSA), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), SociedadIberoamericana de Información Científica (SIIC Data Bases), and the Directory of Open Access Journals (DOAJ). Considering the importance of this journal for research and clinical practice in the area of voice, it is important to map the publications in this area that have been published in it. Such data will provide a general panorama (landscape) of the scope of the publications in regards to the designs, samples, outcomes and exercise prescription. It is believed that such data will contribute to identify what has been done in the country, map the advances, point out the limitations and needs of the area and help the speech therapist in the search for evidence towards a final goal that is to provide the best care for patients in the vocal clinic. Furthermore, the mapping done by a scope review can contribute to future directions in the area and the growth of science.

Thus, the overall objective of this research was to map and describe the characteristics of CoDAS journal publications in the area of voice.

RESEARCH STRATEGY

The present study has a scoping review design and followed the recommendations of Joanna Briggs Institute Manual for Evidence Synthesis for Scoping Reviews (⁹) and PRISMA-ScR(¹⁰). The protocol of the present scope review was registered at Open Science Framework (doi:10.17605/OSF.IO/VFWN7). To elaborate the research question we used the acronym PCC: Population - dysphonic and non-dysphonic individuals; Concept - sampling and methodological characteristics; Context - CoDAS magazine. Thus, the research question that supported its development was: What are the main sampling and methodological characteristics of studies with dysphonic and non-dysphonic individuals published in CoDAS?

The search was conducted in the Scielo database, using the descriptor “voice”. Journal filters were applied, selecting only CoDAS, and publication period until December 2019. The search was performed in the month of August 2020.

The inclusion criteria used to consider the studies for this review were: articles published in the journal CoDAS (Pró-Fono Revista de Atualização Científica, Jornal da Sociedade Brasileira de Fonoaudiologia e CoDAS), period until December 2019, in the area of voice, with a population of dysphonic and non-dysphonic individuals. In June 2022 the article was updated with publications from January 2020 to December 2021. We excluded interdisciplinary studies in which the focus was not the area of voice (outcomes of other areas), and secondary studies (literature review).

The procedures used to select the studies and apply the eligibility criteria were: reading the title; reading the abstract, and reading the full articles. The selection was performed by the main author between August and November 2020.

ANALYZING DATA

Data extraction and analysis was performed by two authors. In order to facilitate data extraction and analysis, the selected studies were separated into three groups, according to the design: observational(¹¹); intervention(¹¹); and instrument validation. The data extracted from the studies were:

1. Observational (Cross-sectional, Cohort and Case-control): authors, year, country, institution, design, area, age group, gender, sample size, outcomes, self-assessment, perceptual-auditory assessment, acoustic analysis, aerodynamics.

2. Intervention (Quasi-experimental, Experimental and Intervention before and after): authors, year, country, institution, design, area, age group, gender, sample size, number of sessions, session time, session frequency.

3. Translation, cross-cultural adaptation, and validation of instruments: authors, year, country, institution, design, area, age group, gender, sample size, translation, and cross-cultural adaptation.

The synthesis of the data was presented descriptively by means of tables and graphs with frequency analysis. Data analysis was performed in narrative format.

RESULTS

Figure 1 shows that 2742 studies were identified in the Scielo database. During the first selection phase 2530 studies were excluded because they were not in the area of voice or because they were interdisciplinary studies with no voice endpoints, thus making 212 studies. During the second selection phase, 36 were excluded based on the design (secondary studies). Thus, 176 studies were selected(¹²-¹⁸⁷).

Figure 1
Search and selection flowchart

Publications in the area of voice were most frequent in the years 2019 (n=20; 11.4%) and 2013 (n=19; 10.8%), as indicated in Figure 2.

Figure 2
Descriptive analysis of the frequency of voice articles per year of publication in CoDAS

Table 1 shows that in CoDAS the articles developed in Brazil were more frequent (n=165; 93.8%), followed by the United States of America (n=3; 1.7%). The institutions that published the most were Centro de Estudos da Voz (n=46; 26.1%), Universidade de São Paulo (n=20; 11.4%), and Universidade Federal de São Paulo (n=17; 9.7%), tied with multicenter studies (n=17; 9.7%).

Table 1
Studies characteristics

Variables and categories	n	%
Country
Brazil	165	93.8
Chile	3	1.7
United States	3	1.7
Belgium	1	0.6
Brazil & Belgium	1	0.6
Brazil & Canada	1	0.6
Netherlands	1	0.6
Italy	1	0.6
Institution
Centro de Estudos da Voz - São Paulo / SP	46	26.1
Universidade de São Paulo - São Paulo / SP	20	11.4
Multicêntricas	17	9.7
Universidade Federal de Minas Gerais - Belo Horizonte / MG	17	9.7
Universidade Federal de São Paulo - São Paulo / SP	16	9.1
Universidade Federal da Paraíba - João Pessoa / PB	10	5.7
Pontifícia Universidade Católica de São Paulo - São Paulo / SP	7	4.0
Universidade Estadual Paulista - Marília / SP	5	2.8
Universidade Federal de Santa Catarina - Florianópolis / SC	4	2.3
Universidade Federal do Espírito Santo - Vitória / ES	4	2.3
Universidade Federal de Santa Maria / RS	3	1.7
Santa Casa de Misericórdia de São Paulo - São Paulo / SP	3	1.7
Universidade Metodista de Piracicaba - Piracicaba / SP	3	1.7
Universidade Estadual do Centro-Oeste-Irati / PR	2	1.1
Universidade Federal da Sergipe - Lagarto / SE	2	1.1
Columbia University - New York (USA)	1	0.6
Hospital AG Sint-Jan - Bruges (Belgium)	1	0.6
Pontificia Universidade Católica de Goiás - Goiania / GO	1	0.6
Santa Casa de Misericórdia de Porto Alegre - ISCMPA - Porto Alegre / RS	1	0.6
Santa Casa de Misericórdia do Rio de Janeiro - Rio de Janeiro / RJ	1	0.6
Southern IIIinois University - Carbondale / IL (USA)	1	0.6
The Touro College and University System - New York (USA)	1	0.6
Universidad de Valparaiso - Valparaiso / Chile	1	0.6
Universidade Estadual de Campinas - Campinas / SP	1	0.6
Universidade Estadual de Montes Claros - Montes Claros/MG	1	0.6
Universidade Federal da Bahia - Salvador / BA	1	0.6
Universidade Federal de Ciências da Saúde de Porto Alegre - Porto Alegre / RS	1	0.6
Universidade Federal de Pernambuco - Recife/PE	1	0.6
Universidade Federal do Rio Grande do Sul - Porto Alegre / RS	1	0.6
Universidade Tuiuti do Paraná-UTP-Curitiba / PR	1	0.6
Universidade Veiga de Almeida e Ambulatório de Urologia Reconstrutura Universitário Pedro Ernesto - HUPE - Rio de Janeiro / RJ	1	0.6
Zuyd University of Applied Sciences - Heerlen (Holanda)	1	0.6
Outline
Observational-Cross-sectional	115	65.3
Quasi-experimental	27	15.3
Translation. Cross-cultural adaptation and Validation of instruments	24	13.6
Experimental	6	3.4
Intervention before and after	4	2.3

• Caption: n = Absolute frequency; % = percentage relative frequency

Most studies were cross-sectional (n=115; 59.7%), followed by quasi-experimental (n=27; 15.3%), translation, cross-cultural adaptation or validation studies (n=24; 13.6%), experimental (n=6; 3.4%) and before-and-after intervention (n=4; 2.3%).

According to Table 2, there was a higher frequency of clinical voice studies (n=105; 59.7%). There were more frequent studies with sample in the age range of 18-59 years (n=96; 54.5%), and of both genders (n=102; 58.0%).

Table 2
Characteristics of the area and sample of the studies

Variables and categories	n	%
Area
Clinical Voice	105	59.7
Professional Voice	71	40.3
Age range
18-59	96	54.5
60-103	42	23.9
0-18	21	11.9
Non informed	17	9.7
Gender
Both	102	58.04
Feminine	48	26.57
Non informed	17	9.09
Masculine	9	6.29

• Caption: n = Absolute frequency; % = percentage relative frequency

Regarding the 115 cross-sectional studies, Table 3 shows that the most frequent outcomes were vocal self-assessment (n=102; 88.7%), the perceptual-auditory voice judgment - JPA (n=92; 80%) and the acoustic voice analysis (n=61; 53%).

Table 3
Characteristics of cross-sectional studies (n=115)

Variables and categories	n	%
Outcomes (n=115)
Self-evaluation	102	88.7
JPA	92	80.0
Acoustic analysis	61	53.0
Evaluations of other areas	42	36.5
Laryngeal image	22	19.1
Aerodinamics	20	17.4
Other vocal evaluations	10	8.7
Self-evaluation (n=102)
ESV	14	13.7
QVV	10	9.8
IDV-10	7	6.9
Self-assessment elaborated by the researcher	6	5.9
IDV	6	5.9
IFV	6	5.9
CPV-P	5	4.9
EDTV	5	4.9
ITDV	5	4.9
QSHV	5	4.9
PPAV	4	3.9
URICA-VOZ	4	3.9
IDCM	4	3.9
PRRD	3	2.9
LSSV	2	2.0
SSPS	2	2.0
VcD	2	2.0
BORG CR10-BR	1	1.0
EAFV	1	1.0
IDCC	1	1.0
IDV-C	1	1.0
List of vocal signs and symptoms	1	1.0
LSU-BR	1	1.0
PDA	1	1.0
PEED	1	1.0
Vocal quality and intensity	1	1.0
QVV-P	1	1.0
RAVI	1	1.0
TVQ	1	1.0
JPA (n=92)
Scales created by researchers	26	28.3
GRBASI	28	30.4
EAV- visual analog scale	21	22.8
CAPE-V	12	13.0
EN (Numerical Scale)	1	1.1
GGDV (overall degree of voice deviation)	1	1.1
GT (degree of tension)	1	1.1
VPAS	1	1.1
Likert (scale)	1	1.1
Acoustic analysis (n=61)
Traditional acoustic analysis	52	85.2
DDF (phonatory deviation diagram)	5	8.2
DDC (diadocokinesis)	2	3.3
AVQI	1	1.6
CPPs	1	1.6
Aerodynamics (n=20)
TMF (maximum phonatory time)	19	95.0
Nasometry	1	5.0

• Caption: n = Absolute frequency; % = percentage relative frequency; JPA = Auditory Perceptual Judgment; ESV = Vocal Symptomscale QVV = Quality of Life in Voice; IDV-10 = Vocal Handicap Index; IDV = Vocal Handicap Index; IFV = Vocal Fatigue Index; CVP-P = Teacher's Vocal Production Condition; EDTV = Vocal Tract Discomfort Scale; ITDV = Hearing Index for Voice Disorder; QSHV = Health and Vocal Hygiene Questionnaire; PPAV = Participation Profile Protocol and Vocal Activities; IDCM = Modern Corner Handicap Index PRRD = Dysphonia Risk Screening Protocol; LSSV = List of Vocal Signs and Symptoms; SSPS = Scale for Self-Assessment when Speaking in Public; VcD = Questionnaire Living with Dysarthria; BORG CR10-BR = Adapted Borg CR10 For Vocal Effort Ratings; EAFV = Vocal Fatigue Self-Perception Scale; IDCC = Vocal Handicap Index in Classical Singing; IDVC = Corner Handicap Index; LSU-BR = The Levels of Speech Usage; PDA = Autonomous Dysfunction Protocol; PEED = Dysphonia Coping Strategy Protocol; QVV-P = Quality of Life in Pediatric Voice; RAVI = Vocal Alteration Screening in the Elderly; TVQ = Transgender Voice Questionnaire for Male to Female Transsexuals; GRBASI = Japanese scale for evaluation of auditory perceptual parameters; EAV = Visual Analog Scale; CAPE-V = Consensus on auditory auditory perceptual evaluation of voice; EN = Numerical Scale; GGDV = Global Degree of Voice Deviation; GT = Degree of Tension; VPAS = John Laver's Vocal Profile Analysis Protocol; LIKERT = Self-report scale; DDF = Phonatory Deviation Diagram; DDC = Diadocokinesia Review; AVQI = Acoustic Voice Quality Index; CPPS = Smoothed Cepstral Peak Prominence; TMF = Maximum Phonatory Times; Nasometria = Nasallance Assessment

In studies which analyzed the self-reported impact of a voice problem, that is, voice self-assessment (n=102), the most used instruments were the Vocal Symptoms Scale - VSS (n=14; 13,7%), Quality of Life in Voice - QLV (n=10; 9,8%) and the Vocal Disadvantage Index - VDI-10 (n=7; 6.9%). In the studies that performed JPA (n=78), the GRBASI scale (n=28; 30.4%) and self-generated scales (n=26; 28.3%) were most frequently used. In the 61 studies with acoustic analysis, traditional acoustic parameter extraction (n=52; 85.2%) and the phonation deviation diagram (POD) (n=5; 8.2%) were the most published. Finally, the few papers which did aerodynamic analysis (n=20) studied maximum phonatory time - TMF (n=19; 95%) and nasometry (n=1; 5%).

It was observed that of the 37 intervention studies, 16 (43.2%) studied immediate effects, followed by those that did six (n=3; 8.1%) or twelve intervention sessions (n=3; 8.1%).

The most frequent session time among those who reported the information was 60 minutes (n=6; 16.2%), and the absence of this information was predominant (n=10; 27%). Studies with a single session frequency (n=16; 43.2%) were the most frequent, followed by weekly frequency (n=9; 24.3%), as shown in Table 4.

Table 4
Characteristics of intervention studies (n=37)

VARIABLES AND CATEGORIES	n	%
Number of sessions
1 (immediate effect)	16	43.2
6	3	8.1
12	3	8.1
2	2	5.4
5	2	5.4
16	2	5.4
3	1	2.7
4	1	2.7
7	1	2.7
8	1	2.7
10	1	2.7
45	1	2.7
Does not apply	3	8.1
Session time
Non informed	10	27.0
60 minutes	6	16.2
20 minutes	3	8.1
1 minute	3	8.1
Does not apply	3	8.1
30 minutes	2	5.4
3 minutes	1	2.7
5 minutes	1	2.7
10 minutes	1	2.7
15 minutes	1	2.7
16 minutes	1	2.7
40 minutes	1	2.7
45 minutes	1	2.7
64 minutes	1	2.7
90 minutes	1	2.7
1 session of 240 minutes / 4 sessions of 120 minutes	1	2.7
Session Frequency
Once (immediate effect)	16	43.2
Once a week	9	24.3
Twice a week	3	8.1
Non informed	3	8.1
2 to 3 times a week	1	2.7
4 times a week	1	2.7
Once a month	1	2.7
Does not apply	3	8.1

• Caption: n = Absolute frequency; % = percentage relative frequency

Table 5 shows that of the 24 elaboration, adaptation, and validation studies, 17 (70.8%) performed the translation and cross-cultural adaptation phase; 5 (20.8%) performed validation; and, only 2 (8.3%) elaborated a new instrument.

Table 5
Characteristics of translation studies, cross-cultural adaptation and validation (n=24)

Variables and categories	n	%
Translation and cross-cultural adaptation	17	70.8
Validation	5	20.8
Instrument development	2	8.3

• Caption: n = Absolute frequency; % = percentage relative frequency

DISCUSSION

Scientific research in Speech Therapy seeks to provide reliable evidence for the clinic(¹⁵⁹,¹⁶³,¹⁸⁵-¹⁸⁷) based on evidence-based practice(¹⁸⁸). In this practice, clinicians are faced with different results, and need to compare evidence that answers their questions and assists in decision making in search of the best results. However, this comparison is made difficult when analyzing research with different procedures or with several instruments used for the same purpose. The CoDAS journal occupies a prominent place in the national scenario of scientific research publications. In this sense, mapping procedures and analyzing their frequencies show trends, limitations, and can contribute to clinical practice, as well as to the development of other studies.

The results of the present scoping review showed that there was a non-linear upward curve of publications in the CoDAS journal in the last years analyzed, with a rise in the years 2013 and 2020. The higher number of publications in the year 2013 can be explained by changes in editorial strategies, such as the new name of the journal that began to be called CoDAS, the insertion of area editors, the greater participation of foreign colleagues and the professionalization of the editorial office. In addition, the year 2013 presented an improvement in the definition of the objectives of Brazilian studies in the designs of experiments, as well as the expansion of multicenter papers(¹⁸⁹). As for the year 2019, the journal was marked by improved indexing and internationalization of the journal.

National publications are the most frequent in CoDAS. Among the 11 international articles, the United States of America and Chile have published three, but it is worth remembering that only recently the journal has had international visibility with English as the mandatory language. The international articles are published both jointly between domestic and foreign institutions, and with only foreign authorship. It is believed that, even in the face of a journal that is still strong and recognized in Brazilian Speech Therapy publications, the increase in internationalization, such as the recent indexation of the journal in the Web of Science, will bring greater international visibility and reach, besides more growth and research data for the journal.

The Centro de Estudos da Voz - CEV was the educational institution that published the most in CoDAS in the area of voice, followed by Universidade de Sao Paulo - USP, Universidade Federal de Sao Paulo - UNIFESP and the multicenter publications. CEV is a teaching and research institution in the area of human communication that completed 40 years in 2021, that offers a Specialization Course in Voice - CECEV, whose first graduating class was in 1993 (The teacher's voice, Sinpro/CEV). In 2021, CECEV had its 24th class, and all the students are encouraged and oriented to develop a monograph to conclude the course, to be presented in congresses and published. USP is a traditional public university in the area, which has three campuses with the Speech Therapy course, in São Paulo, Ribeirão Preto, and Bauru. UNIFESP is one of the oldest universities in teaching and research, and is also recognized for its scientific effort in the area of voice. It is a public university that aims at developing interrelated teaching, research and extension activities, with emphasis on the specific field of health sciences(¹⁹⁰). The UNIFESP counts on scientific initiation programs while still in the undergraduate course, and the improvement and specialization programs are linked to scientific production and publication. In the sequence, the results pointed to multicenter publications. This is a worldwide trend and a good indication for the journal, showing that researchers from institutes and universities have been coming together for the improvement of scientific development. The expansion of multicentric works can offer a more comprehensive national geographical representation, besides being fundamental for the development of large projects.

Observational studies of the cross-sectional type, which are simple, fast, and easier to execute designs, were most commonly found in the review. They are research designs that are thought to be an excellent method for describing characteristics of a population. However, they are valid only for that particular place and time, and over time their findings can no longer be used for the clinic(¹⁹¹,¹⁹²). It is important to highlight that the design is directly related to the clinical question that is intended to be answered, and this type of study is more indicated for the description of characteristics, diagnostic accuracy and disease prevalence(³). Cross-sectional studies were followed by quasi-experimental studies, the most frequent type among intervention studies. Quasi-experimental studies are controlled interventions without sample randomization. The lack of randomization generates a risk of selection bias. Experimental studies, also known as randomized clinical trials, are considered high level of evidence studies(³) and the gold standard for efficacy analysis of interventions(¹⁹²), but only six publications with this design were observed. Although the quality of publications has increased in the last decade, being still in the process of growth and structural modifications, few researches published in specialized journals incorporated the proper methodology and answered the clinical questions satisfactorily, both in Brazilian journals and in international publications(¹⁹³).

A balance was observed between studies of clinical voice and professional voice, however, still with greater frequency in the area of clinical voice, historically more present in the area of Voice. It is important to note that both subareas have been contemplated in CoDAS’ publications journal, expanding the possibilities of searching for evidence for clinical vocal practice, professional voice training, and clinical voice therapy.

Most studies included adult participants (18-59 years), followed by the elderly (60-103 years) and children and adolescents (0-18 years). Adults also represent the majority of patients who seek vocal clinic(¹⁹⁴). The elderly population has been gaining space not only in vocal clinic, but in all studies in the health area, by demographic changes and the search for vocal longevity and quality of life, although they are still few compared to adults(¹⁹⁵,¹⁹⁶).

Children are the minority in seeking clinical care, although the prevalence data of childhood dysphonia is up to 38% of the pediatric population(¹⁵¹). It is believed that pediatric dysphonia has fewer studies by the need for parental consent that do not necessarily want their children as a research subject(¹⁵¹). The occurrence of studies with children found in this review is in line with the literature(¹⁵¹,¹⁹⁶). It is noteworthy here that some research did not report the age range of participants, although it is essential data for the applicability and interpretation of results.

Most studies included both genders in their analyses. This data is positive and relevant because the anatomical and physiological differences between the sexes lead to the need for specific studies and different interpretations, besides the different normality values for some evaluations(¹⁹⁷-¹⁹⁹).

When considering only the cross-sectional studies, it is observed that the most frequent outcome was self-assessment, followed by JPA. These two assessments are part of the non-instrumental assessments that make up the multidimensional evaluation of voice(⁶). Self-evaluation brings data that cannot be obtained in the clinical evaluation carried out by the speech therapist and is used to quantify the perception of the subject about the influence of his or her voice on different daily activities(²⁰⁰). Total wellbeing does not include only the absence of disease, but also the individual's self-perception of his condition and the impacts on several aspects of his life(²⁰¹-²⁰³).

The review showed that the most frequently used self-assessment instruments were the the Vocal Symptoms Scale - VSS, Quality of Life in Voice - QLV and the Vocal Disadvantage Index - VDI-10.

These instruments, all validated for Brazilian Portuguese(²³,³⁷,²⁰⁴) are widely used in day to day vocal clinic for being fast, easy to apply and also for presenting reliable psychometric properties, capable of classifying individuals with and without dysphonia. The VSS is one of the most robust instruments in the area of voice because of its psychometric properties and seeks to analyze the self-perception of vocal symptoms(³⁷). The IDV-10, a reduced version of the IDV-30, is a quick, practical and reliable instrument to measure vocal handicap in individuals with voice problems(⁶⁸). The QLV was the first instrument of vocal self-assessment to be validated for Brazilian Portuguese, widely applied in vocal clinic, which allows the analysis of the impact of a voice problem in the quality of life of dysphonic individuals(²⁰⁴).

When caring for a dysphonic patient, the American Speech-Language-Hearing Association (ASHA) recommends the use of self-assessment protocols, but does not cite a specific one(⁶) probably because the psychometric properties of the instruments are different between language validations and because the instruments have different objectives.

The JPA is considered the gold standard in vocal evaluation, capable of qualifying voice quality and quantifying the degree of deviation(²⁰⁵). Most cross-sectional studies used the GRBASI scale. The GRBASI is a Japanese scale, based on ISSHIKI's work on hoarseness, used internationally. Initially conceived as GRBAS, in 1996 it had the addition of the instability factor I, by the authors Dejonckere, Remacle & Fresnel-Elbaz(²⁰⁵). It is noteworthy the large presence of JPA scales created by the researchers themselves. The use of non-validated scales and instruments generates a difficulty in the comparison with other studies, in the clinical application and in the reliability of the findings, since they have no proven validity(¹⁹³), and the results cannot be reproduced.

The acoustic evaluation of the voice is one of the instrumental evaluations of the clinical speech therapist and appeared in 61 studies in the review. It is known that acoustic analysis quantifies the sound signal, making vocal analysis more objective. We reiterate that JPA is still the gold standard in vocal clinic and that acoustic analysis is complementary(⁸³).

In general, the acoustic analysis practiced in vocal clinic can be performed by extraction of acoustic parameters or by visual analysis of the spectrographic tracing. The review results show that traditional measures of automatic extraction of the fundamental frequency, noise measurements, and signal perturbations are more widely studied and published. This type of acoustic analysis, until recently, was what the Brazilian vocal clinic had as knowledge and available resource. However, currently, it is understood that in dysphonic individuals, this traditional analysis is not the best measure of evaluation, since the extraction of classical measures is performed in the time domain(²⁰⁶). The signs of dysphonic voices are type 2 and 3, and do not produce reliable measurements(¹⁹⁷). In these cases, one can then opt for a descriptive analysis of the spectrographic tracing. Another option is to use multiparametric measurements that are more suitable for evaluations of dysphonic voices, offering more reliable and reliable results(¹⁴⁰).

ASHA recommends the Cepstral Peak Proeminence (CPP) for acoustic analysis of the dysphonic individual(⁶). Only one study that used this measure was included in this review. Such data indicate the need for greater investment in these measures, as well as in other multiparametric acoustic measures in Brazil.

Few studies were found that performed laryngeal imaging exams. In Brazil, laryngeal imaging exams are not part of the phonoaudiological procedures. However, this is a necessary procedure for laryngeal diagnosis, a requirement to be able to classify the type of dysphonia. The instrument recommended by the American Academy of Otolaryngology-Head and Neck Surgery is the laryngostroboscopy(²⁰⁷), in conjunction with a rigorous clinical history and complete medical evaluation(²⁰⁸).

Aerodynamic evaluation was studied in 20 articles included in the review. It is a clinical instrumental evaluation that allows noninvasive measurements of glottal parameters that make up the vocal production(¹⁹⁵). Besides the measurements of maximum phonatory time, which help in the inference of physiological data such as glottal closure and tension during phonation, other aerodynamic measurements are hardly part of clinical vocal practice.

The most commonly used measure for aerodynamic assessment in the studies analyzed in this research was maximum phonation time, which is easy to obtain and non-invasive, widely used in clinical phonoaudiological practice(²⁰⁹) to help describe vocal behavior. As for aerodynamic evaluation, ASHA recommends obtaining measurements of mean airflow rate and mean subglottic pressure. There is also an orientation to collect fundamental frequency measures and sound pressure measures, which are acoustic measures, collected simultaneously with the aerodynamic ones(⁶,²¹⁰).

With regard to intervention data, studies that measured immediate effects were more frequent. In longitudinal interventions, 6-session and 12-session interventions were more frequent. The average time of sessions most used by the researchers was 60 minutes, with a weekly frequency. It is observed that the frequency of 6-12 sessions may come from the influence of American publications, since 6 sessions correspond to the number of sessions covered by the American health insurance(²⁰⁹).

In Brazil, the SBF (Brazilian Society of Speech Therapy) and CFF (the Federal Council of Speech Therapy) therapy beacons seek to guide the frequency, duration and amounts of voice therapy sessions for various conditions. The vocal alterations range from pediatric dysphonia to the rehabilitation of laryngectomized patients. There are recommendations for a number of sessions between eight and 24 sessions, 30 to 45 minutes each session, with weekly frequency of one to three times a week, varying according to the type of alteration and age of the patient(²).

Of the studies on psychometric properties of instruments, only five were validation studies, the most frequent being translation and cross-cultural adaptation of instruments into Brazilian Portuguese. Erthal(²¹¹) states that Psychometrics is a group of techniques that enables the quantification of psychic phenomena. Among the options for instrument validation we highlight the rules of the Scientific Advisory Committee of the Medical Outcomes Trust-SAC(²¹²), frequently used in national validation studies by the Classical Test Theory in the voice area. To be used, protocols need to be formally developed and psychometrically tested, thus ensuring evidence of validity, reliability, and fairness(²⁰⁰). Translation and cross-cultural adaptation is an initial part of validation. However, only translation and cross-cultural adaptation is not sufficient for an instrument to be considered applicable and valid in a language(²¹³).

Regardless of the design, some studies did not report essential data so that their findings could be interpreted and their evidence useful for practice, which is an important opportunity to improve the description of the experiments. There were studies that did not report the age range, the sex of the subjects studied, and the time and frequency of the sessions. In addition, some studies used scales created by the researchers, which do not allow comparison of their findings. The most frequent assessment instruments in aerodynamic measures, in acoustic measures, and in self-assessment are not the instruments recommended by ASHA. However, it should be noted that the year of study selection and ASHA publication is close, and it will be necessary to review this information again in the future.

Therefore, it is necessary to reflect on the importance of a detailed and precise methodological description, as well as the standardization of procedures and measures for use in research. Evidence-based clinical practice is a necessity for the improvement of vocal clinic. However, it is necessary that some changes and standardization occur in research so that their findings are valid for clinical inference, and to be possible the implementation of evidence in practice.

CONCLUSION

The results allow us to conclude that there was a gradual increase in the number of publications in the area of voice in the journal CoDAS. The procedures and characteristics of the publications were heterogeneous. Researchers in clinical and professional voice have a preference for more cross-sectional studies and with a sample of adults and of both sexes. Cross-sectional studies with self-assessment outcomes, experimental studies of immediate effect, and studies measuring psychometric properties that performed translation and cross-cultural adaptation were more frequent. There are uninformed data on relevant parameters for the applicability of the studies such as age range, sex, and temporal parameters of interventions, besides a high index of scales created by the researchers.

• Study conducted at Centro de Estudos da Voz - CEV - São Paulo (SP), Brasil.
• Financial support: nothing to declare.

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• ⁵⁵
  Pifaia LR, Madazio G, Behlau M. Diagrama de desvio fonatório e análise perceptivo-auditiva pré e pós-terapia vocal. CoDAS. 2013;25(2):140-7. http://dx.doi.org/10.1590/S2317-17822013000200009 PMid:24408243.
  » http://dx.doi.org/10.1590/S2317-17822013000200009
• ⁵⁶
  Nemr NK, Simões-Zenari M, Ferreira TS, Fernandes HR, Mansur LL. Disfonia como principal queixa num quadro de miastenia grave: diagnóstico e fonoterapia. CoDAS. 2013;25(3):297-300. http://dx.doi.org/10.1590/S2317-17822013000300017 PMid:24408343.
  » http://dx.doi.org/10.1590/S2317-17822013000300017
• ⁵⁷
  Giannini SPP, Latorre MR, Ferreira LP. Latorre M do RD de O, Ferreira LP. Distúrbio de voz e estresse no trabalho docente: um estudo caso-controle. Cad Saude Publica. 2012;28(11):2115-24. http://dx.doi.org/10.1590/S0102-311X2012001100011 PMid:23147953.
  » http://dx.doi.org/10.1590/S0102-311X2012001100011
• ⁵⁸
  Barsties B, Verfaillie R, Roy N, Maryn Y. Do body mass index and fat volume influence vocal quality, phonatory range, and aerodynamics in females? CoDAS. 2013;25(4):310-8. http://dx.doi.org/10.1590/S2317-17822013000400003 PMid:24408481.
  » http://dx.doi.org/10.1590/S2317-17822013000400003
• ⁵⁹
  Vaiano T, Guerrieri AC, Behlau M. Dores corporais em coristas eruditos. CoDAS. 2013;25(4):303-9. http://dx.doi.org/10.1590/S2317-17822013000400002 PMid:24408480.
  » http://dx.doi.org/10.1590/S2317-17822013000400002
• ⁶⁰
  Franca MC, Simpson KO, Schuette A. Effects of caffeine on vocal acoustic and aerodynamic measures of adult females. CoDAS. 2013;25(3):250-5. http://dx.doi.org/10.1590/S2317-17822013000300010 PMid:24408336.
  » http://dx.doi.org/10.1590/S2317-17822013000300010
• ⁶¹
  Gonçalves MIR, Remaili CB, Behlau M. Cross-cultural adaptation of the Brazilian version of the Eating Assessment Tool - EAT-10. CoDAS. 2013;25(6):601-4. http://dx.doi.org/10.1590/S2317-17822013.05000012 PMid:24626972.
  » http://dx.doi.org/10.1590/S2317-17822013.05000012
• ⁶²
  Teixeira LC, Rodrigues ALV, da Silva ÁFG, Azevedo R, Gama ACC, Behlau M. Escala URICA-VOZ para identificação de estágios de adesão ao tratamento de voz. CoDAS. 2013;25(1):8-15. http://dx.doi.org/10.1590/S2317-17822013000100003 PMid:24408164.
  » http://dx.doi.org/10.1590/S2317-17822013000100003
• ⁶³
  Iqueda APD, Ricz H, Takeshita TK, dos Reis N, Aguiar-Ricz L. Nasalance and nasality of tracheoesophageal speech in total laryngectomee. CoDAS. 2013;25(5):469-74. http://dx.doi.org/10.1590/S2317-17822013000500011 PMid:24408552.
  » http://dx.doi.org/10.1590/S2317-17822013000500011
• ⁶⁴
  Pimenta RA, Dájer ME, Hachiya A, Tsuji DH, Montagnoli AN. Parameters Acoustic and High-speed kymography identified effects of voiced vibration and vocal fry exercises. CoDAS. 2013;25(6):577-83. http://dx.doi.org/10.1590/S2317-17822014000100010 PMid:24626983.
  » http://dx.doi.org/10.1590/S2317-17822014000100010
• ⁶⁵
  Cipriano F, Ferreira L, Servilha E, Marsiglia R. Relação entre distúrbio de voz e trabalho em um grupo de Agentes Comunitários de Saúde. CoDAS. 2013;25(6):548-56.
• ⁶⁶
  Lopes LW, Lima ILB, Silva EG, Almeida LNA, Almeida AAF. Accent and television journalism: evidence for the practice of speech language pathologists and audiologists. CoDAS. 2013;25(5):475-81. http://dx.doi.org/10.1590/S2317-17822013000500012 PMid:24408553.
  » http://dx.doi.org/10.1590/S2317-17822013000500012
• ⁶⁷
  Fouquet ML, Behlau M, Gonçalves AJ. A new proposal for evaluation of the pharyngoesophageal segment and its relation with the narrow-band spectrogram in tracheoesophageal speakers. CoDAS. 2013;25(6):557-65. http://dx.doi.org/10.1590/S2317-17822013.05000010 PMid:24626970.
  » http://dx.doi.org/10.1590/S2317-17822013.05000010
• ⁶⁸
  Costa T, Oliveira G, Behlau M. Validation of the Voice Handicap Index: 10 (VHI-10) to the Brazilian Portuguese. CoDAS. 2013;25(5):482-5. http://dx.doi.org/10.1590/S2317-17822013000500013 PMid:24408554.
  » http://dx.doi.org/10.1590/S2317-17822013000500013
• ⁶⁹
  Ricarte A, Oliveira G, Behlau M. Validação do protocolo perfil de participação e atividades vocais no Brasil. CoDAS. 2013;25(3):242-9. http://dx.doi.org/10.1590/S2317-17822013000300009 PMid:24408335.
  » http://dx.doi.org/10.1590/S2317-17822013000300009
• ⁷⁰
  Godoy JF, Brasolotto AG, Berretin-Félix G, Fernandes AY. Neuroradiology and voice findings in stroke. CoDAS. 2014;26(2):168-74. http://dx.doi.org/10.1590k2317-1782/2014531IN PMid:24918512.
  » http://dx.doi.org/10.1590k2317-1782/2014531IN
• ⁷¹
  de Oliveira AG, Pinho MM. Extended Neuralgic Amyotrophy Syndrome: voice therapy in one case of vocal fold paralysis. CoDAS. 2014;26(2):175-80. http://dx.doi.org/10.1590/2317-1782/2014446IN PMid:24918513.
  » http://dx.doi.org/10.1590/2317-1782/2014446IN
• ⁷²
  Dassie-Leite AP, Delazeri S, Baldissarelli B, Weber J, Lacerda L Fo. Vocal self-assessment: relation with the type of instrument, gender, age, and profession in individuals without vocal complaints. CoDAS. 2014;26(6):531-4. http://dx.doi.org/10.1590/2317-1782/20140000339 PMid:25590917.
  » http://dx.doi.org/10.1590/2317-1782/20140000339
• ⁷³
  Fava G, Paolillo NP, Oliveira G, Behlau M. Cross-cultural adaptation of the Italian version of the Voice Activity Participation Profile. CoDAS. 2014;26(3):252-5. http://dx.doi.org/10.1590/2317-1782/201420140302 PMid:25118924.
  » http://dx.doi.org/10.1590/2317-1782/201420140302
• ⁷⁴
  Santos KW, Fraga BF, Cardoso MCAF. Dysfunctions of the stomatognathic system and vocal aspects in Fahr disease: case report. CoDAS. 2014;26(2):164-7. http://dx.doi.org/10.1590/2317-1782/2014498IN PMid:24918511.
  » http://dx.doi.org/10.1590/2317-1782/2014498IN
• ⁷⁵
  Rocha BR, Moreti F, Amin E, Madazio G, Behlau M. Cross-cultural adaptation of the Brazilian version of the protocol Evaluation of the Ability to Sing Easily. CoDAS. 2014;26(6):535-9. http://dx.doi.org/10.1590/2317-1782/20142014175 PMid:25590918.
  » http://dx.doi.org/10.1590/2317-1782/20142014175
• ⁷⁶
  Lopes LW, Cavalcante DP, Costa PO. Severity of voice disorders: integration of perceptual and acoustic data in dysphonic. CoDAS. 2014;26(5):382-8. http://dx.doi.org/10.1590/2317-1782/20142013033 PMid:25388071.
  » http://dx.doi.org/10.1590/2317-1782/20142013033
• ⁷⁷
  Nemr K, Souza GVS, Simões-Zenari M, Tsuji DH, Hachiya A, Cordeiro GF, et al. Cognitive Vocal Program applied to individuals with signals presbylarynx: preliminary results. CoDAS. 2014;26(6):503-8. http://dx.doi.org/10.1590/2317-1782/20142014108 PMid:25590914.
  » http://dx.doi.org/10.1590/2317-1782/20142014108
• ⁷⁸
  Ribeiro LL, de Paula KMP, Behlau M. Voice-related quality of life in the pediatric population: validation of the Brazilian version of the Pediatric Voice-Related Quality-of Life survey. CoDAS. 2014;26(1):87-95. http://dx.doi.org/10.1590/s2317-17822014000100013 PMid:24714864.
  » http://dx.doi.org/10.1590/s2317-17822014000100013
• ⁷⁹
  Nevo L, Nevo C, Oliveira G. A comparison of vocal parameters in adult bilingual Hebrew-English speakers. CoDAS. 2015;27(5):483-91. http://dx.doi.org/10.1590/2317-1782/20152015096 PMid:26648221.
  » http://dx.doi.org/10.1590/2317-1782/20152015096
• ⁸⁰
  Moreti F, Zambon F, Behlau M. Voice symptoms and vocal deviation self-assessment in different types of dysphonia. CoDAS. 2014;26(4):331-3. http://dx.doi.org/10.1590/2317-1782/201420130036 PMid:25211694.
  » http://dx.doi.org/10.1590/2317-1782/201420130036
• ⁸¹
  Fabron EMG, Regaçone SF, Marino VCC, Mastria ML, Motonaga SM, Sebastião LT. Self-perception, complaints and vocal quality among undergraduate students enrolled in a Pedagogy course. CoDAS. 2015;27(3):285-91. http://dx.doi.org/10.1590/2317-1782/20152014178 PMid:26222947.
  » http://dx.doi.org/10.1590/2317-1782/20152014178
• ⁸²
  Ribeiro ACM, Scharlach RC, Pinheiro MMC. Avaliação dos aspectos temporais em cantores populares. CoDAS. 2015;27(6):520-5. http://dx.doi.org/10.1590/2317-1782/20152014234 PMid:26691615.
  » http://dx.doi.org/10.1590/2317-1782/20152014234
• ⁸³
  Martins PC, Couto TE, Gama ACC. Auditory-perceptual evaluation of the degree of vocal deviation: correlation between the Visual Analogue Scale and Numerical Scale. CoDAS. 2015;27(3):279-84. http://dx.doi.org/10.1590/2317-1782/20152014167 PMid:26222946.
  » http://dx.doi.org/10.1590/2317-1782/20152014167
• ⁸⁴
  Fadel CBX, Dassie-Leite AP, Santos RS, Rosa M O, Marques JM. Acoustic characteristics of the metallic voice quality. CoDAS. 2015;27(1):97-100. http://dx.doi.org/10.1590/2317-1782/20152014159
  » http://dx.doi.org/10.1590/2317-1782/20152014159
• ⁸⁵
  Almeida AAF, Fernandes LR, Azevedo EHM, Pinheiro RSA, Lopes LW. Characteristics of voice and personality of patients with vocal fold immobility. CoDAS. 2015;27(2):178-85. http://dx.doi.org/10.1590/2317-1782/20152014144 PMid:26107084.
  » http://dx.doi.org/10.1590/2317-1782/20152014144
• ⁸⁶
  Dornelas R, Giannini SPP, Ferreira LP. Dia Mundial da Voz em notícia: análise das reportagens sobre a Campanha da Voz no Brasil. CoDAS. 2015;27(5):492-7. http://dx.doi.org/10.1590/2317-1782/20152014204 PMid:26648222.
  » http://dx.doi.org/10.1590/2317-1782/20152014204
• ⁸⁷
  Santos ACM, Borrego MCM, Behlau M. Effect of direct and indirect voice training in Speech-Language Pathology and Audiology students. CoDAS. 2015;27(4):384-91. http://dx.doi.org/10.1590/2317-1782/20152014232 PMid:26398263.
  » http://dx.doi.org/10.1590/2317-1782/20152014232
• ⁸⁸
  Zambon F, Moreti F, Vargas ACT, Behlau M. Eficiência e valores de corte do Perfil de Participação e Atividades Vocais para não professores e professores. CoDAS. 2015;27(6):598-603. http://dx.doi.org/10.1590/2317-1782/20152015028 PMid:26691625.
  » http://dx.doi.org/10.1590/2317-1782/20152015028
• ⁸⁹
  Marquezin DMSS, Viola I, Ghirardi ACAM, Madureira S, Ferreira LP. Executives’ speech expressiveness: analysis of perceptive and acoustic aspects of vocal dynamics. CoDAS. 2015;27(2):160-9. http://dx.doi.org/10.1590/2317-1782/20152014188 PMid:26107082.
  » http://dx.doi.org/10.1590/2317-1782/20152014188
• ⁹⁰
  Pellicani AD, Ricz HMA, Ricz LNA. Phonatory function after prolonged voice use in brazilian woman. CoDAS. 2015;27(4):392-9. http://dx.doi.org/10.1590/2317-1782/20152014201 PMid:26398264.
  » http://dx.doi.org/10.1590/2317-1782/20152014201
• ⁹¹
  Santos HHANM, Aguiar AGO, Baeck HE, Van Borsel J. Translation and preliminary evaluation of the Brazilian Portuguese version of the Transgender Voice Questionnaire for male-to-female transsexuals. CoDAS. 2015;27(1):89-96. http://dx.doi.org/10.1590/2317-1782/20152014093 PMid:25885202.
  » http://dx.doi.org/10.1590/2317-1782/20152014093
• ⁹²
  Penteado RZ, da Silva NB, Montebello MIL. Voz, estresse, trabalho e qualidade de vida de técnicos e preparadores físicos de futebol. CoDAS. 2015;27(6):588-97. http://dx.doi.org/10.1590/2317-1782/20152015021 PMid:26691624.
  » http://dx.doi.org/10.1590/2317-1782/20152015021
• ⁹³
  Baravieira PB, Brasolotto AG, Montagnoli AN, Silvério KCA, Yamasaki R, Behlau M. Análise perceptivo-auditiva de vozes rugosas e soprosas: correspondência entre a escala visual analógica e a escala numérica. CoDAS. 2016;28(2):163-7. http://dx.doi.org/10.1590/2317-1782/20162015098 PMid:27191880.
  » http://dx.doi.org/10.1590/2317-1782/20162015098
• ⁹⁴
  Costa FP, Diaféria G, Behlau M. Aspectos comunicativos e enfrentamento da disfonia em pacientes com doença de Parkinson. CoDAS. 2016;28(1):46-52. http://dx.doi.org/10.1590/2317-1782/20162015054 PMid:27074189.
  » http://dx.doi.org/10.1590/2317-1782/20162015054
• ⁹⁵
  Aquino FS, Silva MAA, Teles LCS, Ferreira LP. Características da voz falada de idosas com prática de canto coral. CoDAS. 2016;28(4):446-53. http://dx.doi.org/10.1590/2317-1782/20162015109 PMid:27652927.
  » http://dx.doi.org/10.1590/2317-1782/20162015109
• ⁹⁶
  Lopes LW, Vilela EG. Autoavaliação e prontidão para mudança em pacientes disfônicos. CoDAS. 2016;28(3):295-301. http://dx.doi.org/10.1590/2317-1782/20162015111
  » http://dx.doi.org/10.1590/2317-1782/20162015111
• ⁹⁷
  Oliveira G, Zambon F, Vaiano T, Costa F, Behlau M. Versões reduzidas para protocolo clínico de enfrentamento das disfonias. CoDAS. 2016;28(6):828-32. http://dx.doi.org/10.1590/2317-1782/20162015177 PMid:27982248.
  » http://dx.doi.org/10.1590/2317-1782/20162015177
• ⁹⁸
  Moreti F, Zambon F, Behlau M. Conhecimento em cuidados vocais por indivíduos disfônicos e saudáveis de diferentes gerações. CoDAS. 2016;28(4):463-9. http://dx.doi.org/10.1590/2317-1782/20162015162 PMid:27652928.
  » http://dx.doi.org/10.1590/2317-1782/20162015162
• ⁹⁹
  Krohling LL, Paula KMP, Behlau M. Curva ROC do Protocolo Qualidade de Vida em Voz Pediátrico (QVV-P). CoDAS. 2016;28(3):311-3. http://dx.doi.org/10.1590/2317-1782/20162015103 PMid:27253227.
  » http://dx.doi.org/10.1590/2317-1782/20162015103
• ¹⁰⁰
  Gama ACC, Santos JN, Pedra EFP, Rabelo ATV, Magalhães MC, Casas EBL. Dose vocal em professores: correlação com a presença de disfonia. CoDAS. 2016;28(2):190-2. http://dx.doi.org/10.1590/2317-1782/20162015156 PMid:27191884.
  » http://dx.doi.org/10.1590/2317-1782/20162015156
• ¹⁰¹
  Reimann AP, Siqueira LTD, Rondon AV, Brasolotto AG, Silverio KCA. Efeito imediato da terapia manual laríngea em indivíduos disfônicos. CoDAS. 2016;28(1):59-65. http://dx.doi.org/10.1590/2317-1782/20162015089 PMid:27074191.
  » http://dx.doi.org/10.1590/2317-1782/20162015089
• ¹⁰²
  Krohling LL, Behlau M, Verduyckt I. Equivalência cultural da versão brasileira do Questionnaire des Symptômes Vocaux. CoDAS. 2016;28(4):454-8. http://dx.doi.org/10.1590/2317-1782/20162015124 PMid:27409418.
  » http://dx.doi.org/10.1590/2317-1782/20162015124
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  Giannini SPP, Latorre MRDO, Ferreira LP. Latorre M do RD de O, Ferreira LP. Questionário Condição de Produção Vocal - Professor: comparação entre respostas em escala Likert e em escala visual analógica. CoDAS. 2016;28(1):53-8. http://dx.doi.org/10.1590/2317-1782/20162015030 PMid:27074190.
  » http://dx.doi.org/10.1590/2317-1782/20162015030
• ¹⁰⁴
  Andrade BMR, Giannini SPP, Duprat AC, Ferreira LP. Relação entre a presença de sinais videolaringoscópicos sugestivos de refluxo laringofaríngeo e distúrbio de voz em professoras. CoDAS. 2016;28(3):302-10. http://dx.doi.org/10.1590/2317-1782/20162015122
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• ¹⁰⁵
  Lopes LW, Silva HF, Evangelista D, Silva JD, Simões LB, Costa e Silva PO, et al. Relação entre os sintomas vocais, intensidade do desvio vocal e diagnóstico laríngeo em pacientes com distúrbios da voz. CoDAS. 2016;28(4):439-45. http://dx.doi.org/10.1590/2317-1782/20162015062 PMid:27356190.
  » http://dx.doi.org/10.1590/2317-1782/20162015062
• ¹⁰⁶
  Dias AE, Limongi JCP, Barbosa ER, Hsing WT. Telerreabilitação vocal na doença de Parkinson. CoDAS. 2016;28(2):176-81. http://dx.doi.org/10.1590/2317-1782/20162015161 PMid:27191882.
  » http://dx.doi.org/10.1590/2317-1782/20162015161
• ¹⁰⁷
  Mendes ALF, Lucena BTL, Araújo AMGD, Melo LPF, Lopes LW, Silva MFBL. Voz do professor: sintomas de desconforto do trato vocal, intensidade vocal e ruído em sala de aula. CoDAS. 2016;28(2):168-75. http://dx.doi.org/10.1590/2317-1782/20162015027 PMid:27191881.
  » http://dx.doi.org/10.1590/2317-1782/20162015027
• ¹⁰⁸
  Almeida AA, Behlau M. Adaptação cultural do Questionário Reduzido de Autorregulação: sugestões de aplicação para área de voz. CoDAS. 2017;29(5):1. http://dx.doi.org/10.1590/2317-1782/20172016199
  » http://dx.doi.org/10.1590/2317-1782/20172016199
• ¹⁰⁹
  Fattore IM, Uhde RM, Oliveira LD, Roth AM, Souza APR. Análise comparativa das vocalizações iniciais de bebês prematuros e a termo, com e sem risco ao desenvolvimento. CoDAS. 2017;29(4):1. http://dx.doi.org/10.1590/2317-1782/20172016075 PMid:28902228.
  » http://dx.doi.org/10.1590/2317-1782/20172016075
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  Souza BO, Nunes RB, Friche AAL, Gama ACC. Análise da qualidade de vida relacionada à voz na população infantil. CoDAS. 2017;29(2):e20160009. http://dx.doi.org/10.1590/2317-1782/20172016009 PMid:28300937.
  » http://dx.doi.org/10.1590/2317-1782/20172016009
• ¹¹¹
  Pereira EC, Rodrigues CO, Silvério KCA, Madazio G, Behlau M. Análises perceptivo-auditiva e acústica das vozes de crianças infectadas pelo HIV. CoDAS. 2017;29(6):e20170022. http://dx.doi.org/10.1590/2317-1782/201720170022 PMid:29236906.
  » http://dx.doi.org/10.1590/2317-1782/201720170022
• ¹¹²
  Diaféria G, Madazio G, Pacheco C, Takaki PB, Behlau M. Clima de grupo na terapia vocal de pacientes com Doença de Parkinson. CoDAS. 2017;29(4):e20170051. http://dx.doi.org/10.1590/2317-1782/20172017051 PMid:28876371.
  » http://dx.doi.org/10.1590/2317-1782/20172017051
• ¹¹³
  Amaral AC, Zambon F, Moreti F, Behlau M. Desconforto do trato vocal em professores após atividade letiva. CoDAS. 2017;29(2):e20160045. http://dx.doi.org/10.1590/2317-1782/20172016045
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• ¹¹⁴
  Moreira FS, Gama ACC. Efeito do tempo de execução do exercício vocal sopro e som agudo na voz de mulheres. CoDAS. 2017;29(1):e20160005. http://dx.doi.org/10.1590/2317-1782/20172016005 PMid:28225849.
  » http://dx.doi.org/10.1590/2317-1782/20172016005
• ¹¹⁵
  Paes SM, Behlau M. Efeito do tempo de realização do exercício de canudo de alta resistência em mulheres disfônicas e não disfônicas. CoDAS. 2017;29(1):1. http://dx.doi.org/10.1590/2317-1782/20172016048 PMid:28300957.
  » http://dx.doi.org/10.1590/2317-1782/20172016048
• ¹¹⁶
  Siqueira LTD, Silverio KCA, Brasolotto AG, Guirro RRJ, Carneiro CG, Behlau M. Efeitos da terapia manual laríngea e da estimulação elétrica nervosa transcutânea (TENS) na diadococinesia laríngea em mulheres disfônicas: estudo clínico randomizado. CoDAS. 2017;29(3):e20160191". http://dx.doi.org/10.1590/2317-1782/20172016191 PMid:28538831.
  » http://dx.doi.org/10.1590/2317-1782/20172016191
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  Fabron EMG, Petrini AS, Cardoso VM, Batista JCT, Motonaga SM, Marino VCC. Efeitos imediatos da técnica de vibração sonorizada de língua associada à estimulação nervosa elétrica transcutânea (TENS). CoDAS. 2017;29(3):e20150311. http://dx.doi.org/10.1590/2317-1782/20172015311 PMid:28614457.
  » http://dx.doi.org/10.1590/2317-1782/20172015311
• ¹¹⁸
  Zambon F, Moreti F, Nanjundeswaran C, Behlau M. Equivalência cultural da versão brasileira do Vocal Fatigue Index - VFI. CoDAS. 2017;29(2):e20150261. http://dx.doi.org/10.1590/2317-1782/20172015261 PMid:28300936.
  » http://dx.doi.org/10.1590/2317-1782/20172015261
• ¹¹⁹
  Costa BOI, Silva POC, Pinheiro RSA, Silva HF, Almeida AAF. Estágio de prontidão de pacientes com disfonia comportamental pré e pós-terapia de voz de grupo. CoDAS. 2017;29(4):e20160198. http://dx.doi.org/10.1590/2317-1782/20172016198 PMid:28813072.
  » http://dx.doi.org/10.1590/2317-1782/20172016198
• ¹²⁰
  Santos KW, Scheeren B, Maciel AC, Cassol M. Modificação da voz após deglutição: compatibilidade com achados da videofluoroscopia. CoDAS. 2017;29(6):e20170004. http://dx.doi.org/10.1590/2317-1782/20172017004
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  Lavaissiéri P, Melo PED. Protótipo de aplicativo para terapia vocal: análise por pares. CoDAS. 2017;29(1):e20150300. http://dx.doi.org/10.1590/2317-1782/20172015300
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  Dornelas R, Santos TA, Oliveira DS, Irineu RA, Brito A, Silva K. Situações de violência na escola e a voz do professor. CoDAS. 2017;29(4):e20170053. http://dx.doi.org/10.1590/2317-1782/20172017053 PMid:28813075.
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  Spazzapan EA, Cardoso VM, Fabron EMG, Berti LC, Brasolotto AG, Marino VCC. Características acústicas de vozes saudáveis de adultos: da idade jovem à meia-idade. CoDAS. 2018;30(5):e20170225. http://dx.doi.org/10.1590/2317-1782/20182017225 PMid:30365649.
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  da Rosa ME, Mituuti CT, Ghirardi ACAM. Correlação da desvantagem vocal e qualidade de vida em deglutição de pacientes com câncer de laringe submetidos à quimiorradioterapia. CoDAS. 2018;30(2). http://dx.doi.org/10.1590/2317-1782/20182017060
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  Cavalcanti NR, Souza BO, Gama ACC, Medeiros AM. Efeito do programa integral de reabilitação vocal em professoras com disfonia comportamental. CoDAS. 2018;30(4):e20170182. http://dx.doi.org/10.1590/2317-1782/20182017182 PMid:30088521.
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  Correa S, Contreras F, Castillo A, Moreti F, Behlau M. Equivalencia cultural de la versión Chilena del Modern Singing Handicap Index: MSHI. CoDAS. 2018;30(3):e20170156. http://dx.doi.org/10.1590/2317-1782/20182017065 PMid:29972469.
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  Borrego MCM, Behlau M. Mapeamento do eixo condutor da prática fonoaudiológica em expressividade verbal no trabalho de competência comunicativa. CoDAS. 2018;30(6):e20180054. http://dx.doi.org/10.1590/2317-1782/20182018054 PMid:30517272.
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  Hashimoto PT, Pagan-Neves LO, de Jesus LMT, Wertzner HF. Medidas aerodinâmicas, eletroglotográficas e acústicas na produção da fricativa pós-alveolar vozeada. CoDAS. 2018;30(3):e20170177. http://dx.doi.org/10.1590/2317-1782/20182017177 PMid:29972470.
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  Genilhú PFL, Gama ACC. Medidas acústicas e aerodinâmicas em cantores: comparação entre homens e mulheres. CoDAS. 2018;30(5):e20170240. http://dx.doi.org/10.1590/2317-1782/20182017240 PMid:30304128.
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  Pereira AM, Dassie-Leite AP, Pereira EC, Cavichiolo JB, Rosa MO, Fugmann EA. Percepção auditiva de juízes leigos quanto ao gênero de mulheres com edema de Reinke. CoDAS. 2018;30(4). http://dx.doi.org/10.1590/2317-1782/20182017046
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  Lobo BPL, Madazio GMV, Badaró FAR, Behlau MS. Risco vocal em pastores: quantidade de fala, intensidade vocal e conhecimentos sobre saúde e higiene vocal. CoDAS. 2018;30(2):e20170089. http://dx.doi.org/10.1590/2317-1782/20182017089 PMid:29723332.
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  Fabron EMG, Silvério KCA, Berretin-Felix G, Andrade EC, Salles PF, Moreira PAM, et al. Terapia vocal para idosos com progressão de intensidade, frequência e duração do tempo de fonação: estudo de casos. CoDAS. 2018;30(6):e20170224. http://dx.doi.org/10.1590/2317-1782/20182017224 PMid:30379196.
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  Gimenez SRML, Madazio G, Zambon F, Behlau M. Análise da timidez na desvantagem vocal percebida em professores. CoDAS. 2019;31(3):e20180149. http://dx.doi.org/10.1590/2317-1782/20182018149 PMid:31271582.
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  Masson MLV, Fabbron EMG, Loiola-Barreiro CM. Aquecimento e desaquecimento vocal em professores: estudo quase-experimental controlado. CoDAS. 2019;31(4):e20180143. http://dx.doi.org/10.1590/2317-1782/20182018143 PMid:31531555.
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  Lira AAM, Borrego MC, Behlau M. Autoavaliação dos recursos comunicativos por representantes comerciais e sua relação com o desempenho em vendas. CoDAS. 2019;31(6):e20190067. http://dx.doi.org/10.1590/2317-1782/20192019067 PMid:31721891.
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  Englert M, Lima L, Constantini AC, Latoszek BBV, Maryn Y, Behlau M. Acoustic Voice Quality Index - AVQI para o português brasileiro: análise de diferentes materiais de fala. CoDAS. 2019;31(1):e20180082. http://dx.doi.org/10.1590/2317-1782/20182018082 PMid:30758396.
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  Limoeiro FMH, Ferreira AEM, Zambon F, Behlau M. Comparação da ocorrência de sinais e sintomas de alteração vocal e de desconforto no trato vocal em professores de diferentes níveis de ensino. CoDAS. 2019;31(2):e20180115. http://dx.doi.org/10.1590/2317-1782/20182018115 PMid:30892420.
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  França FP, de Almeida AA, Lopes LW. Configuração acústico-articulatória das vogais de mulheres com nódulos vocais e vocalmente saudáveis. CoDAS. 2019;31(6):e20180241. http://dx.doi.org/10.1590/2317-1782/20192018241 PMid:31751443.
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  Roza AP, Gielow I, Vaiano T, Behlau M. Desenvolvimento e aplicação de um game sobre saúde e higiene vocal em adultos. CoDAS. 2019;31(4):e20180184. http://dx.doi.org/10.1590/2317-1782/20182018184 PMid:31483041.
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  Gonçalves DMR, Odagima RKY, Vaiano TCG, Amin E, Behlau M. Efeito imediato da fonação em tubo de silicone em cantores gospel. CoDAS. 2019;31(6):e20180117. http://dx.doi.org/10.1590/2317-1782/20192018117 PMid:31800878.
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  Contreras F, Gonzalez N, Vivero M, Guzman M. Equivalencia cultural de la Versión Chilena del Voice-Related Quality of Life (V-RQOL). CoDAS. 2019;31(3):e20180213. http://dx.doi.org/10.1590/2317-1782/20192018213 PMid:31038543.
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  Yotoko A, Moreti F, Vaiano T, Behlau M. Equivalência cultural da versão Brasileira do protocolo The Levels of Speech Usage. CoDAS. 2019;31(4):e20180169. http://dx.doi.org/10.1590/2317-1782/20182018169 PMid:31482996.
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  Cruz MRSA, Yamasaki R, Pacheco C, Borrego MCM, Behlau M. Yamasaki R, Pacheco C, Borrego MC de M, Behlau M. Estudantes de teatro com e sem queixa de voz: dados sobre saúde e higiene vocal, sintomas e desvantagem vocal. CoDAS. 2019;31(5):e20180319. http://dx.doi.org/10.1590/2317-1782/20192018319 PMid:31691747.
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  Abou-Rafée M, Zambon F, Badaró F, Behlau M. Fadiga vocal em professores disfônicos que procuram atendimento fonoaudiológico. CoDAS. 2019;31(3):e20180120. http://dx.doi.org/10.1590/2317-1782/20182018120 PMid:31188907.
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  Blanco ESDV, Imbrizi JM. Percepção da voz em professoras: narrativas de vida entre os espaços do trabalho e do coro cênico. CoDAS. 2019;31(2):e20180200. http://dx.doi.org/10.1590/2317-1782/20182018200 PMid:31038575.
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  Marinho ACF, de Medeiros AM, Lima EP, Pantuza JJ, Teixeira LC. Prevalência e fatores associados ao medo de falar público. CoDAS. 2019;31(6):e20180266. http://dx.doi.org/10.1590/2317-1782/20192018266 PMid:31644711.
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  Ribeiro LL, Verduyckt I, Behlau M. Sintomas vocais na população pediátrica: validação da versão brasileira do Questionário de Sintomas Vocais Pediátrico. CoDAS. 2019;31(5):e20180225. http://dx.doi.org/10.1590/2317-1782/20192018225 PMid:31644718.
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  Camargo MRMC, Zambon F, Moreti F, Behlau M. Tradução e adaptação cultural e linguística da Adapted Borg CR10 for Vocal Effort Ratings para o português brasileiro. CoDAS. 2019;31(5):e20180112. http://dx.doi.org/10.1590/2317-1782/20192018112 PMid:31691744.
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  Souza MK, Nascimento CMB, Lucena JA, Lira ZS, Araújo ANB. O uso da voz em artistas de rua. CoDAS. 2019;31(2):e20180063. http://dx.doi.org/10.1590/2317-1782/20182018063 PMid:30892419.
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  dos Santos TD, Ferreira LP. Expressividade do profissional da voz: processo de construção de um roteiro fonoaudiológico de observação. CoDAS. 2020;32(2):e20190121. http://dx.doi.org/10.1590/2317-1782/20192019121 PMid:32215472.
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  Alves ACS, Gama ACC, Magalhães MC, Genilhú PFL, Oliveira RC. Análise das medidas eletroglotográficas da voz: padrões de normalidade para cantores por meio do programa CSL da Kay Pentax®. CoDAS. 2020;32(5):e2019022. http://dx.doi.org/10.1590/2317-1782/20202019022 PMid:33053081.
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  Santos TL, Herbella FAM, Azevedo RR. The applicability of high resolution manometry in total laryngectomy. CoDAS. 2020;32(6):e20190006. http://dx.doi.org/10.1590/2317-1782/20202019006 PMid:33237186.
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  Coelho JS, Moreti F, Pacheco C, Behlau M. Autopercepção de sintomas vocais e conhecimento em saúde e higiene vocal em cantores populares e eruditos. CoDAS. 2020;32(3):e20180304. http://dx.doi.org/10.1590/2317-1782/20202018304 PMid:32638826.
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  Marinho ACF, de Medeiros AM, Pantuza JJ, Teixeira LC. Autopercepção de timidez e sua relação com aspectos da fala em público. CoDAS. 2020;32(5):e20190097. http://dx.doi.org/10.1590/2317-1782/20202019097 PMid:33053085.
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  Piragibe PC, Silverio KCA, Dassie-Leite AP, Hencke D, Falbot L, Santos K, et al. Comparação do impacto imediato das técnicas de oscilação oral de alta frequência sonorizada e sopro sonorizado com tubo de ressonância em idosas vocalmente saudáveis. CoDAS. 2020;32(4):e20190074. http://dx.doi.org/10.1590/2317-1782/20192019074 PMid:32049106.
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  Correa S, Leiva JPC, Ramírez DO, Farías NC. Equivalencia cultural de la versión Chilena del Evaluation of Ability to Sing Easily: EASE. CoDAS. 2020;32(5):e20190204. http://dx.doi.org/10.1590/2317-1782/20192019204 PMid:33174989.
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  Martinho DHC, Constantini AC. Efeitos imediatos de exercícios de trato vocal semiocluído em vozes graves e agudas: estudo sobre a autopercepção. CoDAS. 2020;32(5):e20190079. http://dx.doi.org/10.1590/2317-1782/20202019079 PMid:33053084.
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  Takishima M, Gielow I, Madazio G, Behlau M. O impacto da afinação vocal na análise perceptivo-auditiva de vozes normais e alteradas. CoDAS. 2020;32(4):e20190135. http://dx.doi.org/10.1590/2317-1782/20202019135 PMid:32813819.
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  Tonon IG, Gomes NR, Teixeira LC, de Medeiros AM. Perfil de comportamento pessoal autorreferido por professores universitários: associação com a autoavaliação comunicativa e vocal. CoDAS. 2020;32(2):e20180141. http://dx.doi.org/10.1590/2317-1782/20192018141 PMid:32049096.
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  Ricci G, Wolf AE, Barbosa AP, Moreti F, Gielow I, Behlau M. Sinais e sintomas de refluxo laringofaríngeo e sua relação com queixas e qualidade vocal. CoDAS. 2020;32(5):e20180052. http://dx.doi.org/10.1590/2317-1782/20202018052 PMid:33174981.
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  Delgado-Pinheiro EMC, Bonbonati JC, Santos FR, Fabron EMG. Voz de crianças e adolescentes deficientes auditivos e pares ouvintes: influência da percepção auditiva da fala na produção vocal. CoDAS. 2020;32(4):e20180227. http://dx.doi.org/10.1590/2317-1782/20202018227 PMid:32756851.
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  Souza EVS, Bassi IB, Gama ACC. Amplificador de voz: efeitos na dose e na intensidade vocal de professoras sem disfonia. CoDAS. 2021;33(5):e20200091. http://dx.doi.org/10.1590/2317-1782/20202020091 PMid:34431858.
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  Dornelas R, Silva K, Pellicani AD. Atendimento vocal à pessoa trans: uma apresentação do Protocolo de Atendimento Vocal do Ambulatório Trans e do Programa de Redesignação Vocal Trans (PRV-Trans). CoDAS. 2021;33(1):e20190188. http://dx.doi.org/10.1590/2317-1782/20202019188 PMid:34431858.
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  Carvalho CGO, Ribeiro MFM. Correlação entre desvantagem vocal e qualidade de vida de cantores populares. CoDAS. 2021;33(4):e20190136. http://dx.doi.org/10.1590/2317-1782/20202019136 PMid:34431859.
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  dos Santos PCM, Vieira MN, Sansão JPH, Gama ACC. Efeito de emissões âncoras de vozes sintetizadas na avaliação perceptivo-auditiva da voz. CoDAS. 2021;33(1):e20190197. http://dx.doi.org/10.1590/2317-1782/20202019197 PMid:33950146.
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  Pereira MCB, Onofri SMM, Spazzapan EA, Carrer J, Silva LA, Fabbron EMG. Efeito imediato da hidratação laríngea de superfície associada à técnica de vibração sonorizada de língua em cantores amadores. CoDAS. 2021;33(3):e20200009. http://dx.doi.org/10.1590/2317-1782/20202020009 PMid:34037159.
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  de Siqueira ACO, dos Santos NEP, Souza BO, Nogueira LLCR, Furlan RMMM. Efeitos vocais imediatos produzidos pelo dispositivo Shaker® em mulheres com e sem queixa vocal. CoDAS. 2021;33(3):e20200155. http://dx.doi.org/10.1590/2317-1782/20202020155 PMid:34133581.
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  Porto VFA, Bezerra TT, Zambon F, Behlau M. Fadiga, esforço e desconforto vocal em professores após atividade letiva. CoDAS. 2021;33(4):e20200067. http://dx.doi.org/10.1590/2317-1782/20202020067 PMid:34231711.
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  Oliveira RCCD, Gama ACC, Genilhú PFL, Santos MAR. High speed digital videolaringoscopy: evaluation of vocal nodules and cysts in women. CoDAS. 2021;33(3):e20200095. http://dx.doi.org/10.1590/2317-1782/20202020095 PMid:34008770.
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  Jesus JDS, Ferreira FR, Andrade ACS, Medeiros AM. Idosos de uma antiga colônia brasileira de hanseníase: vulnerabilidade clínico-funcional e autopercepção vocal e auditiva. CoDAS. 2021;33(5):e20200058. http://dx.doi.org/10.1590/2317-1782/20202020058 PMid:34524350.
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  Neves PCR, Toralles MBP, Scarpel RD. Perfil vocal de indivíduos 46,XX com hiperplasia adrenal congênita. CoDAS. 2021;33(5):e20180260. http://dx.doi.org/10.1590/2317-1782/20202018260 PMid:34190756.
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Publication Dates

• Publication in this collection
  05 June 2023
• Date of issue
  2023

History

• Received
  23 Mar 2022
• Accepted
  28 July 2022