RESUMO
OBJECTIVE: Visual-perceptive assessment of glottic characteristics of vocal nodules by means of high-speed videoendoscopy. METHODS: Descriptive observational research with convenience sampling of five laryngeal videos of women with an average age of 25 years. The diagnosis of vocal nodules was defined by two otolaryngologists, with 100% intra-rater agreement and 53.40% inter-rater agreement and five otolaryngologists as judge assessed the laryngeal videos based on an adapted protocol. The statistical analysis calculated measures of central tendency and dispersion, as well as percentage. The AC1 coefficient was used for agreement analysis. RESULTS: In high-speed videoendoscopy imaging, vocal nodules are characterized by amplitude of the mucosal wave and muco-undulatory movement with magnitude between 50% and 60%. Non-vibrating segments of vocal folds are scarce, and the glottal cycle does not show a predominant phase, it is symmetric and periodic. Glottal closure is characterized by the presence of a mid-posterior triangular chink (double chink or isolated mid-posterior triangular chink), without movement of supraglottic laryngeal structures, with irregular contour of the free edge of vocal folds, which are vertically on-plane. CONCLUSION: Vocal nodules present mid-posterior triangular chink and irregular free edge contour. Amplitude and mucosal wave were partially reduced. LEVEL OF EVIDENCE: Level 4 (Case-series).
Assuntos
Laringoscopia , Prega Vocal , Adulto , Feminino , Humanos , Glote/diagnóstico por imagem , Laringoscopia/métodos , Pescoço , Fonação , Estroboscopia , Gravação em Vídeo , Prega Vocal/diagnóstico por imagemRESUMO
Abstract Introduction: Difficulties or limitations in producing high-pitched sounds while singing may be due to the vocal technique used or organic factor. The observation of such difficulty or limitation by singing teachers is one of the main reasons affected individuals are referred to otolaryngologists. Objective: To evaluate the laryngostroboscopic and electromyographic changes in the cricothyroid muscles of singers with difficulties or limitations producing high-pitched sounds. Methods: This is a cross-sectional study. Ten singers with difficulty producing high-pitched sounds underwent voice, laryngostroboscopic, and electromyographic evaluations. Results: None of the evaluated singers presented signs of impairment of the superior laryngeal nerve on laryngostroboscopy. The electromyographic findings for the cricothyroid muscle were normal for all singers. Six singers presented vocal fold lesions, seven had signs suggestive of laryngopharyngeal reflux, and two presented vascular changes. Conclusion: No signs suggestive of superior laryngeal nerve paresis or paralysis were observed on laryngostroboscopy and electromyography of the cricothyroid muscle in singers with difficulties or limitations producing high-pitched sounds. The presence of vocal fold lesions should be investigated in this population.
Resumo Introdução: Dificuldades ou limitações na produção de sons agudos durante o canto podem ser decorrentes da técnica vocal utilizada ou de fatores orgânicos. A observação dessa dificuldade ou limitação pelos professores de canto é uma das principais razões pelas quais os indivíduos afetados são encaminhados aos otorrinolaringologistas. Objetivo: Avaliar as alterações laringoestroboscópicas e eletromiográficas no músculo cricotireóideo de cantores com dificuldades ou limitações na produção de sons agudos. Método: Estudo de coorte transversal. Dez cantores com dificuldade de produzir sons agudos foram submetidos a avaliações de voz, laringoestroboscópicas e eletromiográficas. Resultados: Nenhum dos cantores avaliados apresentou sinais de comprometimento do nervo laríngeo superior na laringoestroboscopia. Os achados eletromiográficos para o músculo cricotireóideo foram normais para todos os cantores. Seis cantores apresentaram lesões nas pregas vocais, sete apresentaram sinais sugestivos de refluxo laringofaríngeo e dois apresentaram alterações vasculares. Conclusão: Não foram observados sinais sugestivos de paresia ou paralisia do nervo laríngeo superior na laringoestroboscopia e eletromiografia do músculo cricotireóideo em cantores com dificuldades ou limitações na produção de sons agudos. A presença de lesões nas pregas vocais deve ser investigada nessa população.
Assuntos
Humanos , Distúrbios da Voz , Canto , Qualidade da Voz , Estudos Transversais , Estroboscopia , EletromiografiaRESUMO
INTRODUCTION: Difficulties or limitations in producing high-pitched sounds while singing may be due to the vocal technique used or organic factor. The observation of such difficulty or limitation by singing teachers is one of the main reasons affected individuals are referred to otolaryngologists. OBJECTIVE: To evaluate the laryngostroboscopic and electromyographic changes in the cricothyroid muscles of singers with difficulties or limitations producing high-pitched sounds. METHODS: This is a cross-sectional study. Ten singers with difficulty producing high-pitched sounds underwent voice, laryngostroboscopic, and electromyographic evaluations. RESULTS: None of the evaluated singers presented signs of impairment of the superior laryngeal nerve on laryngostroboscopy. The electromyographic findings for the cricothyroid muscle were normal for all singers. Six singers presented vocal fold lesions, seven had signs suggestive of laryngopharyngeal reflux, and two presented vascular changes. CONCLUSION: No signs suggestive of superior laryngeal nerve paresis or paralysis were observed on laryngostroboscopy and electromyography of the cricothyroid muscle in singers with difficulties or limitations producing high-pitched sounds. The presence of vocal fold lesions should be investigated in this population.
Assuntos
Canto , Distúrbios da Voz , Estudos Transversais , Eletromiografia , Humanos , Estroboscopia , Qualidade da VozRESUMO
Introducción: Los quistes de cuerda vocal son una causa relativamente frecuente de disfonía. Su origen es aún controversial, y su diagnóstico y manejo continúan siendo un desafío clínico. Objetivo: Exponer y analizar las características clínicas de los quistes de cuerda vocal en nuestra serie de pacientes. Material y método: Estudio retrospectivo descriptivo de los pacientes con diagnóstico de quiste de cuerda vocal atendidos en nuestro centro entre junio de 2012 y diciembre de 2015. Resultados: Se atendieron 44 pacientes con diagnóstico de quiste de cuerda vocal, lo que representa el 4,32% de las consultas en nuestro Centro de Voz. La mayoría de los pacientes fueron adultos, y de ellos el 68,29% correspondió a mujeres. El 34,1% de los pacientes fueron sometidos a tratamíento quirúrgico con técnica de microfonocirugía. El 75% de los pacientes operados presentó mejoría en patrón de onda mucosa videolaringoestroboscópica. Todos los pacientes en los que se disponía de encuestas de valoración subjetiva de la voz pre y posoperatorias demostraron mejoría vocal significativa. Conclusión: Los quistes de cuerda vocal son lesiones que afectan a niños y adultos. La videolaringoestroboscopía es clave en el diagnóstico de estas lesiones, y el tratamiento quirúrgico con microfonocirugía es efectiva en cuanto a resultados vocales desde el punto de vista anatómico y funcional.
Introduction: Vocal cord cysts are a relatively frequent cause of dysphonia. Their origin is still controversial, and their diagnosis and management continue to be a clinical challenge. Aim: To describe and analyze the clinical characteristics of vocal cord cysts in our series of patients. Material and method: Descriptive retrospective study of patients with diagnosis of vocal cord cyst attended in our center between June 2012 and December 2015. Results: 44 patients had the diagnosis of vocal cord cyst, which represents 4.32% of the patients that attended our Voice Center during that period. Most of the patients were adults, and among them 68.29% corresponded to women. 34.1% of the patients were submitted to surgical treatment with microphonosurgery technique. 75% of the surgical patients presented an improvement in the pattern of the videolaryngostroboscopic mucosal wave. All the patients in which pre and postsurgical subjective voice assessment polls were available, showed a significant voice improvement. Conclusion: Vocal cord cysts are lesions that affect both children and adults. The videolaryngostroboscopy evaluation is key in the diagnosis of these lesions, and the surgical treatment with microphonosurgery is effective in terms of anatomical and functional vocal results.
Assuntos
Humanos , Masculino , Feminino , Criança , Adulto , Prega Vocal/cirurgia , Prega Vocal/patologia , Doenças da Laringe/cirurgia , Doenças da Laringe/patologia , Cistos/cirurgia , Cistos/patologia , Doenças da Laringe/diagnóstico , Estudos Retrospectivos , Cistos/diagnóstico , Estroboscopia , Disfonia/etiologia , Laringoscopia , Microcirurgia/métodosRESUMO
OBJECTIVE: To analyze the relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux (LPR) and voice disorder (VD) in teachers. METHODS: this is a cross-sectional study with convenience sample and inclusion criteria as subjects 18 years or older, be a teacher female, seek care with complaint of VD and/or LPR. The exclusion criteria included smoking and presence of respiratory changes. All subjects concluded the following instruments: Vocal Production Condition - Teacher (VPC-T), including the Screening Index for Voice Disorder (SIVD); and Voice Handicap Index (VHI). Speech samples were collected for voice perceptual assessment and all of them were submitted to otorhinolaryngology review. RESULTS: We evaluated 121 teachers, with a mean age of 43 years and 7.8 class hours per day. Only 24.0% of the teachers did not have vocal cord lesions and 42.1% had videolaryngoscopic signs suggestive of LPR. In the group of teachers with presence of Signs suggestive of LPR, the most common symptoms of SIVD were dry throat, hoarseness, throat clearing; the average VHI was 17.9 points. There was no association between voice disorder and presence of videolaryngoscopic signs suggestive of LPR. The independent factors for the LPR in the multiple binary logistic regression analysis were age and VHI score (tertile: 13-20). CONCLUSION: There was no association between VD and LPR, but between age and VHI score.
Assuntos
Refluxo Laringofaríngeo/diagnóstico por imagem , Professores Escolares , Distúrbios da Voz/diagnóstico por imagem , Adulto , Fatores Etários , Estudos Transversais , Feminino , Rouquidão/etiologia , Humanos , Refluxo Laringofaríngeo/complicações , Laringoscopia , Pessoa de Meia-Idade , Estroboscopia , Inquéritos e Questionários , Distúrbios da Voz/complicações , Qualidade da Voz/fisiologia , Adulto JovemRESUMO
RESUMO Objetivo Analisar a relação entre a presença de sinais videolaringoscópicos sugestivos de refluxo laringofaríngeo (RLF) e distúrbio de voz (DV) em professoras. Métodos Pesquisa de natureza transversal, com amostra por conveniência que teve, como critérios de inclusão, ter mais de 18 anos, ser professor do sexo feminino, procurar atendimento com queixa de DV e/ou de RLF. Os fatores de exclusão foram: ser fumante e apresentar alterações respiratórias. Todos os sujeitos preencheram os seguintes instrumentos: Condição de Produção Vocal – Professor (CPV-P), inclusive o Índice de Triagem para Distúrbio de Voz (ITDV), e o Índice de Desvantagem Vocal (IDV). Fez-se coleta de amostra de fala para avaliação perceptivo-auditiva da voz e todas foram submetidas à avaliação otorrinolaringológica. Resultados Foram avaliadas 121 professoras, com média de idade de 43 anos e de 7,8 horas-aula por dia. Somente 24% das professoras não apresentaram lesões em pregas vocais e 42,1% apresentaram sinais videolaringoscópicos sugestivos de RLF. No grupo de professoras com presença de sinais de RLF, os sintomas do ITDV mais relatados foram garganta seca, rouquidão, pigarro, e a média do IDV foi de 17,9 pontos. Não houve associação entre distúrbio de voz e presença de sinais videolaringoscópicos sugestivos de RLF. Na análise de regressão logística binária múltipla, os fatores independentes para o RLF foram idade e escore (tercil: 13-20) do IDV. Conclusão Não houve associação entre o DV e o RLF e sim entre idade e escore IDV.
ABSTRACT Objective To analyze the relationship between the presence of videolaryngoscopic signs suggestive of laryngopharyngeal reflux (LPR) and voice disorder (VD) in teachers. Methods this is a cross-sectional study with convenience sample and inclusion criteria as subjects 18 years or older, be a teacher female, seek care with complaint of VD and/or LPR. The exclusion criteria included smoking and presence of respiratory changes. All subjects concluded the following instruments: Vocal Production Condition - Teacher (VPC-T), including the Screening Index for Voice Disorder (SIVD); and Voice Handicap Index (VHI). Speech samples were collected for voice perceptual assessment and all of them were submitted to otorhinolaryngology review. Results We evaluated 121 teachers, with a mean age of 43 years and 7.8 class hours per day. Only 24.0% of the teachers did not have vocal cord lesions and 42.1% had videolaryngoscopic signs suggestive of LPR. In the group of teachers with presence of Signs suggestive of LPR, the most common symptoms of SIVD were dry throat, hoarseness, throat clearing; the average VHI was 17.9 points. There was no association between voice disorder and presence of videolaryngoscopic signs suggestive of LPR. The independent factors for the LPR in the multiple binary logistic regression analysis were age and VHI score (tertile: 13-20). Conclusion There was no association between VD and LPR, but between age and VHI score.
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Distúrbios da Voz/diagnóstico por imagem , Refluxo Laringofaríngeo/diagnóstico por imagem , Professores Escolares , Qualidade da Voz/fisiologia , Distúrbios da Voz/complicações , Rouquidão/etiologia , Estudos Transversais , Inquéritos e Questionários , Fatores Etários , Estroboscopia , Refluxo Laringofaríngeo/complicações , Laringoscopia , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: This study aims to analyze the Dysphonia Severity Index (DSI) in Brazilians with or without voice disorders and investigate DSI's correlation with gender and auditory-perceptual evaluation data obtained via the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol. STUDY DESIGN: A total of 66 Brazilian adults from both genders participated in the study, including 24 patients with dysphonia confirmed on laryngeal examination (dysphonic group [DG]) and 42 volunteers without voice or hearing complaints and without auditory-perceptual voice disorders (nondysphonic group [NDG]). METHODS: The vocal tasks included in CAPE-V and DSI were performed and recorded. Data were analyzed by means of the independent t test, the Mann-Whitney U test, and Pearson correlation at the 5% significance level. RESULTS: Differences were found in the mean DSI values between the DG and the NDG. Differences were also found in all DSI items between the groups, except for the highest frequency parameter. In the DG, a moderate negative correlation was detected between overall dysphonia severity (CAPE-V) and DSI value, and between breathiness and DSI value, and a weak negative correlation was detected between DSI value and roughness. In the NDG, the maximum phonation time was higher among males. In both groups, the highest frequency parameter was higher among females. CONCLUSIONS: The DSI discriminated among Brazilians with or without voice disorders. A correlation was found between some aspects of the DSI and the CAPE-V but not between DSI and gender.
Assuntos
Acústica , Disfonia/diagnóstico , Acústica da Fala , Percepção da Fala , Medida da Produção da Fala/métodos , Qualidade da Voz , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos de Casos e Controles , Disfonia/fisiopatologia , Disfonia/psicologia , Feminino , Humanos , Julgamento , Laringoscopia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Fatores Sexuais , Estroboscopia , Adulto JovemRESUMO
PURPOSE: To characterize the voice of elderly people engaged in aerobics. METHODS: Collection of phonation /a:/ from 58 elderly people engaged in aerobics for perceptual voice analysis (RASATI scale) and computed acoustics (Multi Dimensional Voice Program Advanced, software of Kay Pentax®, that analyzes up to 33 measures, proposing normal ranges according to sex). The Spearman correlation test was used, with significance level of 5%. RESULTS: The association between auditory-perceptual assessment of voice and acoustic parameters was not statistically significant but showed less vocal quality deviations. The association between acoustic measures and age was only statistically significant result for the measurement of fundamental frequency (f0) and maximum f0 (fhi). There was no correlation between time of aerobics and acoustic measures, but there was correlation of those measurements with age. There was a statistically significant positive correlation between f0 and fhi with minimal roughness and standard deviation of f0 with hoarseness, breathiness, and asthenia; jitter and shimmer measures with hoarseness, breathiness, and asthenia; noise measurements with hoarseness, breathiness, and harshness; measures of breaking voice hoarseness and breathiness; measures of voiceless segments with hoarseness and asthenia; measures of subharmonic with hoarseness; and measures of vocal tremor with breathiness, asthenia, and instability. There was a significant negative correlation between minimum f0 with breathiness; jitter measures with tension; and soft phonation index with roughness and instability. CONCLUSIONS: Elderly women engaged in aerobics showed mostly normal voice, with most values of acoustic measures within normal and positive correlations between perceptual and auditory vocals and acoustic aspects that suggest instability, noise, and vocal tremor.
Assuntos
Exercício Físico , Setor Privado , Acústica da Fala , Distúrbios da Voz/fisiopatologia , Qualidade da Voz , Acústica , Fatores Etários , Envelhecimento , Brasil , Estudos Transversais , Feminino , Humanos , Laringoscopia , Fonação , Espectrografia do Som , Percepção da Fala , Medida da Produção da Fala , Estroboscopia , Fatores de Tempo , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/etiologiaRESUMO
Introduction The study of the dynamic properties of vocal fold vibration is important for understanding the vocal production mechanism and the impact of organic and functional changes. The advent of high-speed videolaryngoscopy (HSV) has provided the possibility of seeing the real cycle of vocal fold vibration in detail through high sampling rate of successive frames and adequate spatial resolution. Objective To describe the technique, advantages, and limitations of using HSV and digital videokymography in the diagnosis of vocal pathologies. Methods We used HSV and digital videokymography to evaluate one normophonic individual and four patients with vocal fold pathologies (nodules, unilateral paralysis of the left vocal fold, intracordal cyst, and adductor spasmodic dysphonia). The vocal fold vibration parameters (glottic closure, vibrational symmetry, periodicity, mucosal wave, amplitude, and glottal cycle phases) were assessed. Results Differences in the vocal vibration parameters were observed and correlated with the pathophysiology. Conclusion HSV is the latest diagnostic tool in visual examination of vocal behavior and has considerable potential to refine our knowledge regarding the vocal fold vibration and voice production, as well as regarding the impact of pathologic conditions have on the mechanism of phonation...
Assuntos
Humanos , Distúrbios da Voz/diagnóstico , Laringoscopia , Estroboscopia , Disfonia , Cisto Epidérmico , Prega VocalRESUMO
Los continuos desarrollos tecnológicos, en los años recientes, han permitido un mejor entendimiento de la anatomía y fisiología de los pliegues vocales y del tracto digestivo superior. Técnicas de diagnóstico como la laringoscopia de alta velocidad, la videoquimografía, la laringoscopia de acercamiento de alta resolución en la oficina y la impedanciometría esofágica con manometría, son herramientas muy importantes en la práctica clínica moderna. En lo que respecta a tratamiento, el desarrollo de equipos de láser acoplados a sistemas robóticos, fibras para la aplicación de rayos láser de diferentes longitudes de onda a sitios específicos, e instrumentos para ser usados a través de endoscopios flexibles, ampliaron las posibilidades terapéuticas, y, en casos seleccionados, las perspectivas para la ejecución de procedimientos mínimamente invasivos sin necesidad de hospitalización. El proposito de este estudio es realizar una revision y un análisis de los avances tecnológicos dirigidos al diagnóstico y tratamiento de las enfermedades del tracto aerodigestivo superior, sus posibles aplicaciones y limitaciones. Es un estudio descriptivo de una revisión de la literatura concerniente al tema. Se presenta una monografía y una revisión de la literatura relevante, disponible en publicaciones indexadas, con respecto a los diferentes métodos actualmente disponibles para el estudio de las enfermedades del tracto aerodigestivo superior, así como de las nuevas alternativas desde el punto de vista de posibilidades terapéuticas. Se hace un análisis de los aspectos técnicos importantes de cada una de las opciones, tanto diagnósticas como terapéuticas, con el fin de tener claridad sobre sus posibles aplicaciones clínicas, ventajas, desventajas y contraindicaciones.
Continuous technological developments in recent years have allowed a better understanding of the anatomy and physiology of the vocal folds and the upper digestive tract. Diagnostic techniques such as high speed laryngoscopy, videokymography, in office high resolution close up laryngoscopy and esophageal impedance with manometry are very important tools in modern day clinical practice. As far as treatment is concerned, development of laser equipments coupled to robotic systems, fibers to deliver different laser wavelengths to specific places, and instruments to be used through flexible scopes, broadened therapeutic possibilities and, in selected cases, have made it possible to perform minimally invasive procedures with no need for hospitalization. The purpose of this study is to review and analyze technological advancements for diagnosis and treatment of the diseases of the upper aerodigestive tract, their feasible applications and limitations. It is a descriptive study of literature review regarding the topic. A monograph and a revision of relevant literature accessible on indexed publications related to different currently available methods for studying the upper aerodigestive tract diseases, as well as new alternatives from the therapeutic point of view are presented. An analysis of important technical aspects of each option, either diagnostic or therapeutic is performed with the aim of elucidating their possible clinical applications, advantages, disadvantages and contraindications.
Os contínuos desenvolvimentos tecnológicos, nos anos recentes, permitiram um melhor entendimento da anatomia fisiologia das pregas vocais e do trato digestivo superior. Técnicas de diagnóstico como a laringoscopia de alta velocidade, a vídeoquimografia, a laringoscopia de aproximação de alta resolução e a impedânciometria esofágica com manometria, são ferramentas muito importantes na prática clínica moderna. No que diz respeito ao tratamento, o desenvolvimento de equipamentos de laser acoplados a sistemas robóticos, fibras para a aplicação de raios laser de diferentes longitudes de onda em locais específicos, e instrumentos para ser usados através de endoscópios flexíveis, ampliaram as possibilidades terapêuticas, e, em casos selecionados, as perspectivas para a execução de procedimentos minimamente invasivos sem a necessidade de hospitalização. O propósito deste estudo é realizar uma revisão e uma análise dos avanços tecnológicos dirigidos ao diagnóstico e tratamento das doenças do trato aerodigestivo superior, suas possíveis aplicações e limitações. É um estudo descritivo de uma revisão da literatura concernente ao tema. Apresenta-se uma monografia e una revisão da literatura relevante, disponível em publicações indexadas, com respeito aos diferentes métodos disponíveis atualmente para o estudo das doenças do trato aerodigestivo superior, bem como das novas alternativas desde o ponto de vista de possibilidades terapêuticas. É feita uma análise dos aspectos técnicos importantes de cada uma das opções, tanto diagnósticas como terapêuticas, com o fim de ter claridade sobre suas possíveis aplicações clínicas, vantagens, desvantagens e contraindicações.
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Humanos , Laringoscopia , Estroboscopia , Quimografia , ManometriaRESUMO
INTRODUCTION: Vocal symptoms are common among the pediatric population and are often caused by vocal abuse. Laryngoscopy is essential for their diagnosis because it helps differentiate several laryngeal lesions, leading to a decision for suitable treatments considering each case. OBJECTIVES: This study aims to present the clinical characteristics, and the laryngoscopic diagnosis of a dysphonic child population. METHODS: The parents of 304 children, aged from 4 to 18 years and presenting prolonged hoarseness, answered a questionnaire about their children's voice, and all children were subjected to videolaryngostroboscopy. RESULTS: Male children aged from 7 to 12 years (64%) were predominant. Vocal abuse (n-162) and nasal obstruction symptoms (n-10) were the most frequent associated symptoms. The vocal symptoms had a chronic evolution (over 1 year) and were reported by most parents (n-200). The most commonly diagnosed lesions in the laryngoscopic exams were vocal nodules (n-175) and epidermal cysts (n-47). Furthermore, there was an association of some lesions, especially minor structural alterations. CONCLUSION: In the present study, dysphonia occurred mainly in children aged from 7 to 12 years, predominantly males. Vocal abuse and nasal obstruction symptoms were frequently reported. Vocal nodules and cysts were the most commonly diagnosed laryngeal lesions in the laryngoscopic exams.
Assuntos
Disfonia/diagnóstico , Laringoscopia , Qualidade da Voz , Adolescente , Fatores Etários , Criança , Pré-Escolar , Disfonia/etiologia , Disfonia/fisiopatologia , Feminino , Rouquidão/diagnóstico , Rouquidão/fisiopatologia , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Estroboscopia , Inquéritos e Questionários , Fatores de Tempo , Gravação em VídeoRESUMO
BACKGROUND: Parkinson's disease (PD) has a high incidence in Mexico and is estimated at approximately 500,000 patients. One of the main clinical manifestations of PD is dysphagia, which is the difficult passage of food from the mouth to the stomach. The aim of this study was to assess oropharyngeal dysphagia through fibroendoscopy evaluation of swallowing in patients with PD. METHODS: We conducted a census sample of patients with PD: 17 males and 10 females, aged >49 years. Clinical history, physical examination and neurological evaluation of swallowing fibroendoscopy were carried out. RESULTS: Of the symptomatic patients, 16 patients (59.25%) reported dysphagia. Fibroendoscopic evaluation demonstrated swallowing disorders in 25 patients (92.59%). The main findings were poor bolus control in 19 patients (70.37%), deficits in bolus propulsion in 25 patients (92.59%), impaired swallowing in 14 patients (51.85%), fractional swallowing in 11 patients (40.74%), reduced epiglottic tilting in 11 patients (48.14%), food residue in vallecula in 24 patients (88.88%) and piriform sinus in 19 patients (70.37%). There was no correlation between duration of PD and degree of involvement of oropharyngeal dysphagia. CONCLUSIONS: Oropharyngeal dysphagia in patients with PD is a common symptom and can range from the oral cavity to the upper esophageal sphincter. Early onset of severe dysphagia is exceptional in this disease and should alert the clinician to the diagnostic possibility of parkinsonism.
Assuntos
Transtornos de Deglutição/etiologia , Esofagoscopia/métodos , Orofaringe/fisiopatologia , Doença de Parkinson/complicações , Estroboscopia/métodos , Adulto , Deglutição , Transtornos de Deglutição/fisiopatologia , Feminino , Tecnologia de Fibra Óptica , Alimentos , Humanos , Laringe/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nasofaringe/fisiopatologia , Doença de Parkinson/fisiopatologia , Músculos Faríngeos/fisiopatologiaRESUMO
INTRODUCTION: We indicate the exclusive radiation therapy as initial approach for T1a glottic tumors, and the frontolateral laryngectomy for the tumors staged as T1b and selected T2 glottic tumors. The videolaryngostroboscopy is a useful tool to analyze the laryngeal structural changes and compensatory motion after the therapeutic approach. OBJECTIVES: To evaluate the endolaryngeal structures of patients who participate in the vibratory sound source after the early glottic cancer treatment through the videolaryngostroboscopy. METHODS: It was a retrospective transversal study in which 20 patients who underwent exclusive radiation therapy and 25 patients who underwent frontolateral laryngectomy were analyzed by means of videolaryngostroboscopy. The radiation doses ranged from 5000 to 7020 cGy in the radiation therapy group. The mucosal wave and the vibratory source components were evaluated. RESULTS: All of the irradiated patients presented vibratory behavior, and hyperfunction was occasionally observed in four cases. The mucosal wave source was glottic in 18 cases and mixed in two cases. In the laryngectomy group, 10 supraglottic sources, 10 glottic sources, and five mixed sources were identified. Among the 10 cases of supraglottic source, eight patients presented global constriction and two patients presented medial constriction. Among the five cases of mixed source, two patients presented global constriction, one patient presented medial constriction, and one patient presented anteroposterior constriction. Regarding the number of anatomical structures presenting vibratory pattern, five patients had two structures, four patients had three structures, and one patient had four structures. CONCLUSION: Patients who underwent radiation therapy recruit less supraglottic structures as vibratory source than the patients undergoing vertical laryngectomy.
Assuntos
Glote/efeitos da radiação , Glote/cirurgia , Neoplasias Laríngeas/terapia , Laringectomia , Fonação , Voz , Idoso , Fenômenos Biomecânicos , Feminino , Glote/patologia , Glote/fisiopatologia , Humanos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/fisiopatologia , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Estroboscopia , Fatores de Tempo , Traqueotomia , Resultado do Tratamento , Vibração , Gravação em VídeoRESUMO
OBJECTIVE: To evaluate the consequences of lifetime, severe and untreated isolated growth hormone deficiency (IGHD) on vocal and laryngeal function. STUDY DESIGN: Cross-sectional. SUBJECTS AND METHODS: A total of 23 IGHD adult subjects and 22 controls were administered a questionnaire about vocal complaints and harmful voice habits, and underwent videolaryngostroboscopic examination, voice evaluation by perceptual-auditory analysis with GRBAS scale including grade of dysphonia, roughness, breathiness, asthenia and strain items, objective voice evaluation by maximum phonation time (MPT), and acoustic analysis. RESULTS: There was no difference in vocal complaints between IGHD subjects and controls. Vocal abuse and smoking were more frequent in IGHD subjects. IGHD subjects presented higher values for roughness, breathiness, and strain. Laryngopharyngeal reflux (LPR) signs and laryngeal constriction were more frequent in IGHD individuals. MPT was similar in the two groups. Fundamental frequency was higher in IGHD females and males. Harmonic to noise ratio was higher in IGHD in both genders and shimmer was lower in IGHD females. CONCLUSIONS: IGHD subjects have higher prevalence of signs of LPR and laryngeal constriction, with high pitch in both genders, which suggests a prominent role of IGHD on these parameters.
Assuntos
Nanismo Hipofisário/fisiopatologia , Laringe/fisiopatologia , Voz/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estroboscopia , Distúrbios da Voz/etiologiaRESUMO
OBJECTIVE: To analyze and compare the incidence and visual characteristics of blood vessels on the superior surface of vocal folds with polyps, nodules, and minimal structural alterations (ie, sulci, cysts, and mucosal bridges). DESIGN: Cross-sectional study. SETTING: Academic research. PATIENTS: A total of 280 videolaryngoscopic images were randomly selected and classified into the following 4 groups of 70 patients each: the vocal nodule (VN) group, the polyp group, the minimal structural alterations (MSA) group, and the control group. MAIN OUTCOME MEASURES: Laryngoscopic images were assessed for visible blood vessels and for the orientation and characteristics of the vessels. Isolated ectasias with clear boundaries were excluded. RESULTS: The highest incidence of visible vessels was observed in the MSA group (91.4%), followed by the polyp (77.1%), VN (44.7%), and control (31.4%) groups. Longitudinal and transverse vessels were found more frequently in the MSA (74.3% and 37.1%) and polyp (65.7% and 22.9%) groups than in the VN (34.3% and 12.9%) and control (25.7% and 5.7%) groups. Tangled vessels were found only in the MSA group (8.6%). Abrupt changes in the caliber of the vessels and sinuous vessels were observed only in the polyp (21.4% and 5.7%) and MSA (61.4% and 27.1%) groups. CONCLUSIONS: The main differences in the incidence and characteristics of visible blood vessels occurred between 2 pairs of groups: MSA-polyp and VN-control. The incidence was significantly higher in the MSA group than in the polyp group, and the incidence in both the MSA group and the polyp group was also significantly higher than that in the VN and control groups. The greatest variations were found in the MSA group, including the presence of tangled blood vessels (which was observed only in this group).
Assuntos
Capilares/patologia , Doenças da Laringe/patologia , Laringoscopia , Estroboscopia , Gravação em Vídeo , Prega Vocal/irrigação sanguínea , Adulto , Estudos Transversais , Dilatação Patológica/patologia , Feminino , Granuloma Laríngeo/patologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pólipos/patologia , Valores de Referência , Distúrbios da Voz/patologiaRESUMO
OBJECTIVES: To obtain complete glottal closure, and evaluate improvement of vocal fold vibration amplitude and vocal quality in patients with sulcus vocalis. METHODS: Autogenous fat and/or fascia augmentation was used in 34 patients with sulcus vocalis. Mean follow-up time was 1 year. The perceptual acoustic and phonatory functions and videolaryngostroboscopic data were evaluated before and after the procedure. RESULTS: Most of the individuals reported an improvement of vocal quality, a complete glottal closure, an enhancement of mucosal wave excursion, and significant results of acoustic perceptual and phonatory functions after the surgery. CONCLUSION: Fat and fascia injections are effective autogenous implants and should be considered options in the treatment of patients with sulcus vocalis and vocal fold atrophy.
Assuntos
Tecido Adiposo/transplante , Fáscia/transplante , Prega Vocal/patologia , Prega Vocal/cirurgia , Adolescente , Adulto , Atrofia , Feminino , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Estroboscopia , Transplante Autólogo , Resultado do Tratamento , Gravação em Vídeo , Qualidade da VozRESUMO
UNLABELLED: Work-related laryngopathy may have negative consequences for voice professionals. AIM: To analyze the profile of voice professionals seen in a tertiary level hospital. STUDY DESIGN: a longitudinal historical cohort. METHODS: A retrospective analysis of patient files. Diagnosis was reached using videostroboscopy. RESULTS: 163 patients (119 females and 44 males) were seen. The mean age was 36.5 years. Professionals included spoken voice users (salesman, teachers, telemarketers, receptionists, health professionals) and singers. The most frequent diagnoses were: minor structural changes (33%), nodules (22%), Reinkes edema (10%), and polyps (6%). A correlation was observed between smoking, age and gender; there was an association between smoking and Reinkes edema, leucoplasia and tabagism, females and Reinkes edema, nodules and minor structural changes, and also between patients aged over 40 years and Reinkes edema, and patients under 40 with nodules, laryngitis, and minor structural changes. Symptoms lasted more than 6 months in 74% of patients. CONCLUSION: The profile of voice professionals seen in a tertiary hospital included spoken voice patients and singers. In our study minor structural changes predominated, followed by nodules, Reinke edema and polyps.
Assuntos
Doenças da Laringe/complicações , Doenças Profissionais/etiologia , Ocupações/estatística & dados numéricos , Distúrbios da Voz/etiologia , Adolescente , Adulto , Idoso , Métodos Epidemiológicos , Feminino , Humanos , Doenças da Laringe/diagnóstico , Laringoscopia , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Fumar/efeitos adversos , Estroboscopia , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/epidemiologiaRESUMO
As laringopatias relacionadas ao trabalho acarretam conseqüências para os profissionais da voz. OBJETIVO: Analisar o perfil destes profissionais atendidos em um hospital terciário. FORMA DE ESTUDO: Estudo de coorte histórica longitudinal. MATERIAL E MÉTODOS: Análise retrospectiva de prontuários. Os diagnósticos foram fornecidos através de videoestrobolaringoscopia. RESULTADOS: Foram atendidos 163 pacientes (119 do sexo feminino, 44 do sexo masculino), idade média de 36,5 anos. Em relação aos grupos profissionais, encontramos profissionais da voz falada (vendedores, professores, telemarketing, recepcionistas, atores e profissionais de saúde) e da voz cantada. Os diagnósticos foram: alteração estrutural mínima (33 por cento), nódulos (22 por cento), edema de Reinke (10 por cento) e pólipos (6 por cento). Foi observada correlação com tabagismo (p=0,002), sexo (p=0,004) e idade (p<0,001), com tendência para associação do tabagismo com edema de Reinke e leucoplasia; sexo feminino com AEM, nódulos e edema de Reinke; pacientes acima de 40 anos com edema de Reinke, e dos mais jovens com nódulos, cordite e AEM. O tempo de queixa foi superior a 6 meses em 74 por cento dos casos. CONCLUSÃO: Este perfil inclui profissionais da voz falada e cantada. Houve predomínio das AEMs, seguida por nódulos, edema de Reinke e pólipos.
Work-related laryngopathy may have negative consequences for voice professionals. AIM: To analyze the profile of voice professionals seen in a tertiary level hospital. STUDY DESIGN: a longitudinal historical cohort. METHODS: A retrospective analysis of patient files. Diagnosis was reached using videostroboscopy. RESULTS: 163 patients (119 females and 44 males) were seen. The mean age was 36.5 years. Professionals included spoken voice users (salesman, teachers, telemarketers, receptionists, health professionals) and singers. The most frequent diagnoses were: minor structural changes (33 percent), nodules (22 percent), ReinkeÆs edema (10 percent), and polyps (6 percent). A correlation was observed between smoking, age and gender; there was an association between smoking and ReinkeÆs edema, leucoplasia and tabagism, females and ReinkeÆs edema, nodules and minor structural changes, and also between patients aged over 40 years and ReinkeÆs edema, and patients under 40 with nodules, laryngitis, and minor structural changes. Symptoms lasted more than 6 months in 74 percent of patients. CONCLUSION: The profile of voice professionals seen in a tertiary hospital included spoken voice patients and singers. In our study minor structural changes predominated, followed by nodules, Reinke edema and polyps.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Doenças da Laringe/complicações , Doenças Profissionais/etiologia , Ocupações/estatística & dados numéricos , Distúrbios da Voz/etiologia , Métodos Epidemiológicos , Laringoscopia , Doenças da Laringe/diagnóstico , Doenças Profissionais/diagnóstico , Doenças Profissionais/epidemiologia , Fumar , Estroboscopia , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/epidemiologiaRESUMO
Excited fluorophores produce reactive oxygen species that are toxic toward many live cells (phototoxicity) and accelerate bleaching of the fluorophores during the course of extended or repeated measurements (photobleaching). We recently developed an illumination system for fluorescence microscopy using a high power light-emitting diode (LED), which can emit short pulses of light (0.5-2 ms) to excite fluorophores. This system minimizes illumination time, thus reducing phototoxicity and photobleaching artifacts. To demonstrate the usefulness of the new system, we compared images of human sperm loaded with various fluorescent indicators and excited with either a conventional mercury lamp as a continuous excitation light source or the LED as a source of pulsed illumination. We found that sperm motility decreased rapidly and photobleaching was relatively rapid under continuous illumination, whereas under pulsed LED illumination, motility was maintained and photobleaching was much reduced. Therefore, fluorescence microscopy using LED-based pulsed illumination offers significant advantages for long-term live cell imaging, reducing the degree of phototoxicity, and extending the effective lifetime of fluorophores.
Assuntos
Corantes Fluorescentes/toxicidade , Luz , Fotodegradação/efeitos da radiação , Espermatozoides/fisiologia , Estroboscopia , Cálcio/metabolismo , Humanos , Cinética , Masculino , Sêmen/citologiaRESUMO
Objetivo: traçar o perfil epidemiológico/clínico de uma população portadora de nódulos vocais diagnosticados e comparar os tipos de fendas glóticas à fonação. Métodos: foram avaliados os registros de 70 pacientes portadores de nódulos vocais diagnosticados através de exame videolaringoestroboscópico no período de junho de 2003 a maio de 2004. As imagens arquivadas foram analisadas por quatro fonoaudiólogos e dois otorrinolaringologistas, conforme os seguintes parâmetros: simetria laríngea, aspecto da lesão, tipo de fenda, onda mucosa, movimento muco-ondulatório, amplitude de vibração, presença de sinais de refluxo e constrição supraglótica. Resultados: os dadosencontrados apontam maior incidência de nódulos vocais em mulheres adultas que utilizavam a voz profissionalmente. Clinicamente, não houve associação significativa entre pacientes fumantes com queixa de refluxo e pacientes portadores de nódulos. Ao exame videolaringoestroboscópico observamos:87,4% de lesões bilaterais e 12,6% unilaterais. O fechamento supraglótico medial ocorreu em apenas 01 caso, sendo caracterizado como unilateral e não participando da fonação. Em 3 pacientes identificou-se a presença de microweb. Todos os pacientes apresentaram fenda glótica, sendo 90,9% delas classificadas como dupla. Conclusão: a amostra foi composta predominantemente por mulheres,com idade média de 34,64 anos, não fumantes, professoras, trabalhando em três turnos, cuja queixa de rouquidão teve duração média de 5,68 meses, apresentando ao exame laringe simétricacom nódulos bilaterais, de igual tamanho. Houve significância estatística apontando proporção maior de fendas duplas.
Purpose: to determine the epidemiological/clinical profile of patients with vocal nodules, and comparetheir glottic closure during phonation. Methods: seventy vocal nodules patients were evaluated by videolaryngostroboscopy at Instituto de Otorrinolaringologia de Minas Gerais, from June 2003 to May 2004. The video images were analyzed by 4 speech therapists and 2 otorhinolaryngologists, according to the following criteria: laryngeal symmetry, lesion aspect, kind of glottic closure, mucous wave, vocalfold vibration ,vibratory amplitude, gastroesophageal reflux signals and supraglottalconstriction. Results: Data showed that the highest incidence was found with adult professional voice user females. Clinically, it was observed that there was no meaningful relationship among smoking patients or the ones withgastroesophageal reflux and those with vocal nodules. The videolaryngostroboscopy showed: 87.4% bilateral lesions and 12.6% unilateral lesions. We noted that medial supraglottal closure was found injust one case, characterized as an unilateral lesion and with no participation during phonation. Threesubjects presented a Microweb. All patients had incomplete glottal closure and 90.9% of them were classified as double. Conclusion: the sample was composed mainly by non- smoking female teachers, about 34 years old, involved in a three journey workday with a 5.68 moths hoarseness complaintpresenting laryngeal symmetry, and bilateral nodules same size. There was a statistically significant proportion of incomplete glottal closure.