RESUMO
In this retrospective case study, we report the apparent clinical effectiveness of neuromuscular electrical stimulation (NMES) in combination with voice therapy (VT) for rehabilitating dysphonia secondary to suspected superior laryngeal nerve (SLN) weakness in two female patients. Both patients failed or plateaued with traditional VT but had significant improvement with the addition of NMES of the cricothyroid muscle and SLN using a VitalStim unit. Stimulation was provided simultaneously with voice exercises based on musical phonatory tasks. Both acoustic analysis and endoscopic evaluation demonstrated important improvements after treatment. In the first patient, the major change was obtained within the primo passaggio region; specifically, a decrease in voice breaks was demonstrated. In the second patient, an improvement in voice quality (less breathiness) and vocal range were the most important findings. Additionally, each patient reported a significant improvement in their voice complaints. Neuromuscular laryngeal electrical stimulation in combination with vocal exercises might be a useful tool to improve voice quality in patients with SLN injury.
Assuntos
Terapia por Estimulação Elétrica/instrumentação , Músculos Laríngeos/inervação , Nervos Laríngeos/fisiopatologia , Próteses Neurais , Fonação , Canto , Paralisia das Pregas Vocais/terapia , Qualidade da Voz , Treinamento da Voz , Acústica , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Espectrografia do Som , Fatores de Tempo , Resultado do Tratamento , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/fisiopatologiaRESUMO
In the mountains of Peru, globular colonies of Nostoc commune (Nostocales) are collected in the highland lakes by the indigenous people, who call them llullucha. They are consumed locally, traded for maize, or sold, eventually entering the folk markets of Cusco and other neighboring cities. Throughout highland Peru, Nostoc commune is highly salient as a seasonal dietary item, being eaten alone, or in picante -- a local stew -- and is said to be highly nutritious. Nostoc commune has been known to produce unusual amino acids, including those of the mycosporine group, which possibly function to prevent UV damage. We analyzed 21 different Nostoc commune spherical colonies from 7 different market collections in the Cusco area for the presence of beta-N-methylamino-L-alanine (BMAA), a neurotoxic amino acid produced by diverse taxa of cyanobacteria, using four different analytical techniques (HPLC-FD, UPLC-UV, UPLC/MS, LC/MS/MS). We found using all four techniques that BMAA was present in the samples purchased in the Peruvian markets. Since BMAA has been putatively linked to neurodegenerative illness, it would be of interest to know if the occurrence of ALS, Alzheimer's, or Parkinson's Disease is greater among individuals who consume llullucha in Peru.