Acoustic vocal characteristics and morphometric measurements of the larynx in the elderly

• Grant number: 12/13684-2
• Support Opportunities: Regular Research Grants
• Start date: November 01, 2012
• End date: October 31, 2014
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Regina Helena Garcia Martins
• Grantee: Regina Helena Garcia Martins
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil

Abstract

Introduction: The presbyphonia correspond to the process of vocal senility. There are loss of vocal intensity, reduction of harmonics, decreased vocal range, reduction in speech rate, decrease in intensity and vocal tremor. Perceptive and acoustic vocal analyses show increase in the percentage of jitter, increasing the variety of pitch, reducing of the maximum phonation time, increased of breathiness, decreased of fundamental frequency in women and increased in men. Videolaryngoscopy exams show glottic incompetence and prominence of the vocal apophysis. Videolaryngoscopy shows decrease of the amplitude of the glottal wave and aperiodicity. Histological changes in presbyphonia include reduction in thickness of the epithelium, increase in the numbers of collagen fibers and fibroblasts, chronic inflammation, epithelial keratosis, enlargement of cell joints, edema, increase of blood vessels, muscular atrophy and thinning of the lamina propria. Researchers on morphological changes of the senile larynx can contribute to the development of new therapeutic measures which can minimize the deleterious effects of the presbiphonia. Objectives: To evaluate acoustic vocal characteristics and morphometric measurements of the larynx in the elderly. Methods: the research will be composed by two studies: clinical and histomorphometric: Clinical study - voices of 40 elderly volunteers (20 aged 60-75 years and 20 aged above 76 years) and of 30 control volunteers, aged between 30 and 50 years will be analyzed. All participants will undergo to three evaluations: vocal acoustic analysis, audiometric exam and laryngoscopy. For the vocal acoustic analysis (MDVP program) the following parameters will be studied: Fo,% jitter, PPQ, shimmer%, SPI APQ, NHR. To the videolaryngoscopy a rigid telescope (Asap), 70, 8 mm or nasofibrolaryngoscopy will used. Finally, the voluntaries will be submitted to the pure tone audiometry. Histomorphometric study - bilateral vocal folds will be removed from 15 larynx (five of patients aged between 60 and 75 years, five of patients over 76 years and five controls, aged between 30-50 years) during necropsy at the Department of Pathology, Faculty of Medicine of Botucatu - UNESP. The cause of death will be investigate and we will were exclude patients with: sepsis, prolonged intubation, systemic infectious diseases, skin diseases, autoimmune or metabolic disorders, cervical trauma of any nature or other causes that may compromise the voice or the morphology of the vocal folds. The specimens will be fixed in 10% formalin for 48 hours, embedded in paraffin, cut and stained with hematoxylin and eosin and PSA (periodic acid-Schiff). In the morphometric analyzes will be performed measurements of the thickness of the epithelium and lamina propria. For this purpose, the slides previously stained with PAS. Images will be obtained by software Axion Vision version 4.8m of the three non-overlapping fields using always the same magnification of 20X. For each scanned image will be carried 10 measures of the epithelium and lamina propria (between the basal membrane and the muscle layer), using the Image J version 4.5 program. StatisticsSamples obtained from the quantitative analysis are expressed as mean ± SD and will be evaluated according to the distribution of morphological changes of patients and controls. The descriptive analysis will be demonstrated by the ANOVA test. When necessary, we will use the test applied in Turkey to identify the differences between the measures. The significance of p d 0.05 will be established (AU)