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Master's Dissertation
DOI
https://doi.org/10.11606/D.25.2023.tde-07112023-183350
Document
Author
Full name
Pollyana Nascimento Diedio
Institute/School/College
Knowledge Area
Date of Defense
Published
Bauru, 2023
Supervisor
Committee
Silverio, Kelly Cristina Alves (President)
Godoy, Juliana Fernandes
Brasolotto, Alcione Ghedini
Pereira, Eliane Cristina
Title in Portuguese
Aspectos vocais e respiratórios após COVID-19
Keywords in Portuguese
Anormalidades do sistema respiratorio
Disfonia
Síndrome pós-COVID-19 aguda
Abstract in Portuguese
Introdução: O pós-COVID-19 tem causado sequelas em vários sistemas do corpo, incluindo o respiratório, nervoso central, cardíaco, metabólico e renal, além de fadiga e fraqueza muscular. No entanto, há poucos estudos sobre as características vocais e respiratórias nessa fase pós-COVID-19. Objetivo: Caracterizar os aspectos vocais e respiratórios antes, durante e após a COVID-19, levando em consideração sexo, idade, tempo de acometimento e grau de severidade da doença, e comparar esses aspectos com indivíduos não acometidos pela COVID-19. Metodologia: participaram do estudo indivíduos adultos, de ambos os sexos e que comprovadamente foram acometidos pela COVID-19 (grupo COVID); indivíduos não acometidos pela COVID, pareados de acordo com sexo e faixa etária (grupo NCOVID). Após assinarem o termo de Consentimento Livre e Esclarecido (CEP/FOB-USP: parecer 5.335.408), todos responderam a um questionário remotamente (google forms). Foram investigados: idade, sexo, presença de queixa vocal, respiratória, sintomas vocais, laringofaríngeos e respiratórios antes, durante e após COVID-19, bem como perguntas sobre a doença. Responderam também aos protocolos ITDV, ESV, IFV e IDV-10. Após responderem ao questionário e protocolos, os moradores de Bauru/SP e região foram convidados a gravar a voz (vogal /a/ e contagem) e para extração de medidas respiratórias (capacidade vital forçada- CVF, volume expiratório forçado de primeiro segundo VEF e razão de VEF/CVF). Para a análise perceptivo-auditiva, três juízes cegados em relação aos grupos, classificaram as vozes como: sem desvio e voz alterada, quanto aos parâmetros grau geral da qualidade vocal, rouquidão, soprosidade e tensão. A análise acústica foi composta pelas medidas: pico cepstral suavizada, relação alfa e diferença L1 e L0. Para a análise da amostra, foram aplicados testes estatísticos paramétricos e não paramétricos (p<0,05). Dividiu-se as análises em três fases: fase 1 - grupo COVID e NCOVID; fase 2 grupo COVID, dividido em COVID LEVE (sem hospitalização), COVID MODERADA (hospitalização) e COVID SEVERA (hospitalização e intubação); fase 3 - grupos COVID e NCOVID com avaliação de protocolos, da qualidade vocal e respiratória. Resultados: Houve predomínio do sexo feminino, faixa etária de 18 a 44 anos e 11 meses, acometidos por COVID leve, com predomínio de respostas de 2 a 4 meses após a doença, nas três fases. Fase 1 composta por 117 participantes em cada grupo (COVID e NCOVID), houve relação entre o tempo decorrido após o diagnóstico da COVID-19 e a presença de queixas vocais após a doença; hábitos de ingestão de bebida alcoólica e tabagismo estão relacionados com o não acometimento da doença. Fase 2 - contou com 145 indivíduos no grupo COVID LEVE, sete participantes no COVID MODERADA e 13 no COVID SEVERA. Encontrou-se que os sintomas vocais (ardência na garganta, perda da voz e instabilidade) e dispneia, após o acometimento da doença estão significativamente relacionados com grau de severidade da doença, predominantemente por dois a quatro meses. Participantes com queixa vocal também tiveram significativamente mais sintoma geral de cansaço autorreferido após COVID-19. A presença de sintomas vocais, fadiga vocal e distúrbio vocal está significativamente nos graus de maior acometimento da COVID-19. A presença de bronquite e DPOC impacta no grau de severidade da COVID-19. A dispneia está nos mais variados graus da doença, sendo impactada por sintomas gerais como tosse seca e cansaço. A fase 3 foi composta por 23 participantes em cada grupo (COVID e NCOVID). Após COVID-19 leve há limitação no uso da voz, com presença de fadiga vocal. Conclusão: Toda a conclusão deste estudo está baseada na amostra composta por em sua maioria de indivíduos adultos jovens, sexo feminino, acometidos por COVID-19 de grau leve e que foram investigados entre dois e quatro meses após a doença. Os sintomas vocais, principalmente relacionados à limitação no uso da voz, fadiga vocal e distúrbio vocal, assim como dispneia, estão significativamente mais presentes em graus de maior severidade da doença.
Title in English
Vocal and respiratory aspects after COVID-19
Keywords in English
Dysphonia
Post-acute COVID-19 syndrome
Respiratory system abnormalities
Abstract in English
Introduction: Post-COVID-19 has caused sequelae in various body systems, including behavioral, central nervous, cardiac, metabolic and renal, in addition to fatigue and muscle weakness. However, there are few studies on vocal and respiratory characteristics in this post-COVID-19 phase. Objective: To characterize the vocal aspects observed before, during and after COVID-19, taking into account gender, age, time of onset and degree of severity of the disease, and compare these aspects with individuals not affected by COVID-19. Methodology: the study included adult individuals of both sexes who have been proven to have been affected by COVID-19 (COVID group); individuals not affected by COVID, matched according to gender and age group (NCOVID group). After signing the Free and Informed Consent Form (CEP/FOB-USP: opinion 5,335,408), all responded to a remote conversation (google forms). The following were investigated: age, sex, presence of vocal and respiratory complaints, vocal, laryngopharyngeal symptoms and those observed before, during and after COVID-19, as well as questions about the disease. They also responded to the ITDV, ESV, IFV and IDV-10 protocols. After responding to the protocols and protocols, residents of Bauru/SP and region were invited to record their voices (vowel /a/ and count) and for respiratory measures pneumonia (forced vital capacity - FVC, forced expiratory volume in one second - FEV and FEV/FVC ratio). For an auditory-perceptual analysis, three judges who were blinded in relation to the groups classified the voices as: without deviation and altered voice, regarding the parameters general degree of vocal quality, hoarseness, breathiness and tension. The acoustic analysis consisted of the measures: smoothed cepstral peak, alpha ratio and L1 and L0 difference. For sample analysis, parametric and non-parametric statistical tests were applied (p<0.05). The analyzes were divided into three phases: phase 1 - COVID and NCOVID group; phase 2 COVID group, divided into MILD COVID (no hospitalization), MODERATE COVID (hospitalization) and SEVERE COVID (hospitalization and intubation); phase 3 - COVID and NCOVID groups with assessment of protocols, vocal and respiratory quality. Results: There was a predominance of females, aged 18 to 44 years and 11 months, affected by mild COVID, with a predominance of responses from 2 to 4 months after the disease, in the three phases. Phase 1 composed of 117 participants in each group (COVID and NCOVID), there was a relationship between the time elapsed after the diagnosis of COVID-19 and the presence of vocal complaints after the disease; drinking habits and smoking are related to the non-commitment of the disease. Phase 2 - outline with 145 individuals in the MILD COVID group, seven participants in MODERATE COVID and 13 in SEVERE COVID. It was found that vocal symptoms (burning in the throat, loss of voice and instability) and dyspnea after the onset of the disease are significantly related to the degree of severity of the disease, predominantly for two to four months. Participants with vocal complaints also had significantly more general symptoms of self-reported tiredness after COVID-19. The presence of vocal symptoms, vocal fatigue and vocal disorder are significantly in the degrees of greater involvement of COVID-19. The presence of bronchitis and COPD impacts the degree of severity of COVID-19. Dyspnea is in the most varied degrees of the disease, being impacted by general symptoms such as dry cough and tiredness. Phase 3 consisted of 23 participants in each group (COVID and NCOVID). After mild COVID-19, there is limitation in the use of the voice, with the presence of vocal fatigue. Conclusion: The entire conclusion of this study is based on the sample composed mostly of young adult individuals, female, affected by mild COVID-19 and who were investigated between two and four months after the disease. Vocal symptoms, mainly related to limitation in voice use, vocal fatigue and voice disorder, as well as dyspnea, are significantly more present in degrees of greater severity of the disease.
 
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Release Date
2025-06-29
Publishing Date
2023-11-09
 
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