RESUMO
Many voice disorders are linked to imbalanced muscle activity and known to exhibit asymmetric vocal fold vibration. However, the relation between imbalanced muscle activation and asymmetric vocal fold vibration is not well understood. This study introduces an asymmetric triangular body-cover model of the vocal folds, controlled by the activation of bilateral intrinsic laryngeal muscles, to investigate the effects of muscle imbalance on vocal fold oscillation. Various scenarios were considered, encompassing imbalance in individual muscles and muscle pairs, as well as accounting for asymmetry in lumped element parameters. Measurements of amplitude and phase asymmetries were employed to match the oscillatory behavior of two pathological cases: unilateral paralysis and muscle tension dysphonia. The resulting simulations exhibit muscle imbalance consistent with expectations in the composition of these voice disorders, yielding asymmetries exceeding 30% for paralysis and below 5% for dysphonia. This underscores the relevance of muscle imbalance in representing phonatory scenarios and its potential for characterizing asymmetry in vocal fold vibration.
Assuntos
Músculos Laríngeos , Fonação , Vibração , Prega Vocal , Prega Vocal/fisiologia , Prega Vocal/fisiopatologia , Humanos , Músculos Laríngeos/fisiologia , Músculos Laríngeos/fisiopatologia , Simulação por Computador , Disfonia/fisiopatologia , Paralisia das Pregas Vocais/fisiopatologia , Modelos Biológicos , Fenômenos BiomecânicosRESUMO
Background: Acoustic neuroma (AN) is a well-recognized cause of neurological morbidity, peripheral facial paralysis being one of the most prevalent. Phonatory dysfunction in the late post-operative term has not been properly addressed so far.Objective: The objective of this study is to describe the outcomes of phonatory function on the long-term follow-up of AN surgery and identify its prognostic factors.Material and methods: This cohort study included patients submitted to AN surgery from 1999 to 2014, with a mean follow up of 6.4 ± 4.5 years. To evaluate the phonatory function, we performed a combination of noninvasive acoustic and aerodynamic measurements including vocal intensity and stability, maximum declination rate of the glottal airflow (MDR) and transglottal pressure scale (TP).Results: 101 patients were studied. 25 (24.7%) presented a deficit in phonatory function. Women comprised 56% and the mean age was 42.4 ± 13.8 years (range19-80). 100% presented reduced expiratory airflow capacity with excessive manifestation of the laryngeal musculature (TP > 1,23s ;MDR/z/Assuntos
Disfonia/etiologia
, Neuroma Acústico/cirurgia
, Fonação
, Complicações Pós-Operatórias/diagnóstico
, Adulto
, Idoso
, Idoso de 80 Anos ou mais
, Análise de Variância
, Disfonia/diagnóstico
, Disfonia/epidemiologia
, Feminino
, Seguimentos
, Humanos
, Músculos Laríngeos/fisiopatologia
, Masculino
, Pessoa de Meia-Idade
, Neuroma Acústico/fisiopatologia
, Qualidade de Vida
, Adulto Jovem
RESUMO
BACKGROUND: Bulbar involvement is a hallmark of amyotrophic lateral sclerosis (ALS), but surprisingly very few studies have addressed the frequency, pattern and clinical relevance of laryngeal involvement in the disease. METHODS: Twenty-six patients with spinal-onset ALS underwent nasofibroscopy (NF), followed by laryngeal electromyography (LEMG). We also studied resting activity and motor unit potentials of the genioglossus and masseter muscles. RESULTS: Twenty-four patients presented neurogenic changes in at least one laryngeal muscle. There were fibrillation and/or fasciculation potentials associated with chronic neurogenic changes in the same muscle in 16 patients; of these, 9 had no alteration in the genioglossus. We found no patient with tongue neurogenic changes and normal LEMG. NF was abnormal in 14 patients; in the remaining 12, LEMG identified neurogenic changes in 11 of them. CONCLUSION: LEMG is able to identify laryngeal denervation in patients with ALS, sometimes before clinical manifestations are noticed. This technique may be a useful diagnostic tool for selected patients with suspicion of ALS.
Assuntos
Esclerose Lateral Amiotrófica/fisiopatologia , Músculos Laríngeos/fisiopatologia , Adulto , Idoso , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurônios Motores/fisiologiaRESUMO
Purpose: Research suggests that abnormal levels of intrinsic laryngeal muscle (ILM) contraction is a potential causal factor in stress-induced voice disorders. This study seeks to characterize the ILM stress response in a cohort of vocally healthy women. Method: The authors used an unblinded, nonrandomized, repeated-measures design. Forty vocally healthy female adults were subjected to a stressful speech preparation task. Measurements of heart rate, blood pressure, trapezius muscle (positive control) activation, and tibialis muscle (negative control) activation were obtained from 37 participants before and during stressor exposure, in a nonvoice and nonspeaking task paradigm, to confirm physiological stress response compared to baseline. Fine wire electromyography of the ILMs (posterior cricoarytenoid, thyroarytenoid/lateral cricoarytenoid muscle complex, and cricothyroid) was performed simultaneously so that the activity of these muscles could be measured prior to and during stressor exposure. Results: The protocol successfully elicited the typical and expected physiological stress responses. Findings supported the hypothesis that, in some individuals, the ILMs significantly increase in activity during stress reactions compared to baseline, as do the control muscles. Conclusions: This study characterizes ILM responses to psychological stress in vocally healthy participants. Some of the female adults in this study appeared to be "laryngeal stress responders," as evidenced by increased activity of the ILMs during a silent (i.e., nonvocal, nonspeech) speech preparation task that they considered to be stressful.
Assuntos
Músculos Laríngeos/fisiopatologia , Fala/fisiologia , Estresse Psicológico/fisiopatologia , Distúrbios da Voz/fisiopatologia , Adulto , Ansiedade/fisiopatologia , Estudos de Coortes , Eletromiografia , Feminino , Humanos , Respiração , Comportamento Social , Estresse Psicológico/complicações , Distúrbios da Voz/etiologia , Adulto JovemRESUMO
Purpose: Our goal was to test prevailing assumptions about the underlying biomechanical and aeroacoustic mechanisms associated with phonotraumatic lesions of the vocal folds using a numerical lumped-element model of voice production. Method: A numerical model with a triangular glottis, posterior glottal opening, and arytenoid posturing is proposed. Normal voice is altered by introducing various prephonatory configurations. Potential compensatory mechanisms (increased subglottal pressure, muscle activation, and supraglottal constriction) are adjusted to restore an acoustic target output through a control loop that mimics a simplified version of auditory feedback. Results: The degree of incomplete glottal closure in both the membranous and posterior portions of the folds consistently leads to a reduction in sound pressure level, fundamental frequency, harmonic richness, and harmonics-to-noise ratio. The compensatory mechanisms lead to significantly increased vocal-fold collision forces, maximum flow-declination rate, and amplitude of unsteady flow, without significantly altering the acoustic output. Conclusion: Modeling provided potentially important insights into the pathophysiology of phonotraumatic vocal hyperfunction by demonstrating that compensatory mechanisms can counteract deterioration in the voice acoustic signal due to incomplete glottal closure, but this also leads to high vocal-fold collision forces (reflected in aerodynamic measures), which significantly increases the risk of developing phonotrauma.
Assuntos
Simulação por Computador , Glote/patologia , Glote/fisiopatologia , Modelos Biológicos , Distúrbios da Voz/patologia , Distúrbios da Voz/fisiopatologia , Acústica , Algoritmos , Percepção Auditiva , Retroalimentação Sensorial , Humanos , Músculos Laríngeos/fisiopatologia , Masculino , Voz/fisiologiaRESUMO
PURPOSE: To verify and compare the effect of transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) on laryngeal diadochokinesis (DDK) of dysphonic women. METHODS: Twenty women with bilateral vocal nodules participated and were equally divided into: LMT Group - LMT application; TENS Group - TENS application; both groups received 12 sessions of treatment, twice a week, with a duration of 20 minutes each, applied by the same therapist. The women were evaluated as to laryngeal DDK at three moments: diagnostic, pre-treatment, and post-treatment, which produced three groups of measurements. The DDK recording was performed with intersected repetition of vowels /a/ and / i/. The analysis of vowels was performed by the program Motor Speech Profile Advanced (MSP)-KayPentax. The DDK parameters of the three evaluations were compared by means of the paired t-test (p≤0.05). RESULTS: The measurements of laryngeal DDK parameters were similar in the phase without treatment, indicating no individual variability over time. There was no change with respect to the speed of DDK after intervention, but after LMT, DDK of the vowel /i/ was more stable in terms of the duration of the emissions and intensity of emissions repeated. These results show improved coordination of vocal folds movement during phonation. There were no changes in the DDK parameters following TENS. CONCLUSION: LMT provides greater regularity of movement during laryngeal diadochokinesis in dysphonic women, which extends knowledge on the effect of rebalancing the larynx muscles during phonation, although TENS does not impact laryngeal diadochokinesis.
Assuntos
Disfonia/terapia , Manipulações Musculoesqueléticas/métodos , Estimulação Elétrica Nervosa Transcutânea , Adolescente , Adulto , Disfonia/fisiopatologia , Feminino , Humanos , Músculos Laríngeos/fisiopatologia , Nervos Laríngeos/fisiopatologia , Pessoa de Meia-Idade , Resultado do Tratamento , Qualidade da Voz , Adulto JovemRESUMO
BACKGROUND: Vocal impairment is one of the main debilitating symptoms of Parkinson disease (PD). The effect of levodopa on vocal function remains unclear. OBJECTIVE: This study aimed to determine the effect of levodopa on electromyographic patterns of the laryngeal muscle in patients with PD. STUDY DESIGN: This is a prospective interventional trial. METHODS: Nineteen patients with PD-diagnosed by laryngeal electromyography-were enrolled. Cricothyroid and thyroarytenoid (TA) muscle activities were measured at rest and during muscle contraction (phonation), when participants were on and off medication (12 hours after the last levodopa dose). RESULTS: Prevalence of resting hypertonia in the cricothyroid muscle was similar in the off and on states (7 of 19, P = 1.00). Eight patients off medication and four patients on medication had hypertonic TA muscle at rest (P = 0.289). No electromyographic alterations were observed during phonation for either medication states. CONCLUSION: Despite a tendency for increased rest tracings in the TA muscle when participants were on medication, no association was found between laryngeal electromyography findings and levodopa + carbidopa administration.
Assuntos
Antiparkinsonianos/administração & dosagem , Carbidopa/administração & dosagem , Eletromiografia , Músculos Laríngeos/efeitos dos fármacos , Levodopa/administração & dosagem , Doença de Parkinson/tratamento farmacológico , Fonação/efeitos dos fármacos , Qualidade da Voz/efeitos dos fármacos , Idoso , Antiparkinsonianos/efeitos adversos , Brasil , Carbidopa/efeitos adversos , Esquema de Medicação , Combinação de Medicamentos , Feminino , Humanos , Músculos Laríngeos/fisiopatologia , Levodopa/efeitos adversos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVE: The study aimed to compare and correlate perceptual-auditory analysis of vocal parameters and self-perception in individuals with adductor spasmodic dysphonia before and after the application of botulinum toxin. STUDY DESIGN: This is a prospective cohort study. METHODS: Sixteen individuals with a diagnosis of adductor spasmodic dysphonia were submitted to the application of botulinum toxin in the thyroarytenoid muscle, to the recording of a voice signal, and to the Voice Handicap Index (VHI) questionnaire before the application and at two time points after application. Two judges performed a perceptual-auditory analysis of eight vocal parameters with the aid of the Praat software for the visualization of narrow band spectrography, pitch, and intensity contour. RESULTS: Comparison of the vocal parameters before toxin application and on the first return revealed a reduction of oscillation intensity (P = 0.002), voice breaks (P = 0.002), and vocal tremor (P = 0.002). The same parameters increased on the second return. The degree of severity, strained-strangled voice, roughness, breathiness, and asthenia was unchanged. The total score and the emotional domain score of the VHI were reduced on the first return. There was a moderate correlation between the degree of voice severity and the total VHI score before application and on the second return, and a weak correlation on the first return. CONCLUSIONS: Perceptual-auditory analysis and self-perception proved to be efficient in the recognition of vocal changes and of the vocal impact on individuals with adductor spasmodic dysphonia under treatment with botulinum toxin, permitting the quantitation of changes along time.
Assuntos
Acústica , Percepção Auditiva , Disfonia/fisiopatologia , Disfonia/psicologia , Músculos Laríngeos/fisiopatologia , Fonação , Autoimagem , Qualidade da Voz , Inibidores da Liberação da Acetilcolina/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Botulínicas/administração & dosagem , Avaliação da Deficiência , Disfonia/diagnóstico , Disfonia/tratamento farmacológico , Emoções , Feminino , Humanos , Julgamento , Músculos Laríngeos/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Fonação/efeitos dos fármacos , Valor Preditivo dos Testes , Estudos Prospectivos , Processamento de Sinais Assistido por Computador , Software , Espectrografia do Som , Inquéritos e Questionários , Resultado do Tratamento , Qualidade da Voz/efeitos dos fármacosRESUMO
RESUMO Objetivo Verificar e comparar os efeitos da terapia manual laríngea (TML) e da estimulação elétrica nervosa transcutânea (TENS) na diadococinesia laríngea de mulheres disfônicas. Método Participaram 20 mulheres com nódulos vocais, divididas igualmente por sorteio em: Grupo TML–aplicação de TML; Grupo TENS–aplicação de TENS; ambos receberam 12 sessões de tratamento, duas vezes por semana, 20 minutos cada, pelo mesmo terapeuta. As mulheres foram avaliadas quanto à diadococinesia (DDC) laríngea em três momentos, diagnóstico, pré-tratamento e pós-tratamento, o que produziu três grupos de medidas. A gravação da DDC foi realizada por meio da repetição entrecortada das vogais: /a/ e /i/. A análise da DDC foi realizada pelo programa Motor Speech Profile Advanced (MSP)-KayPentax. Os parâmetros da DDC das três avaliações foram comparados entre si pelo teste t pareado (p≤0,05). Resultados Parâmetros DDC se apresentaram semelhantes na fase sem tratamento, indicando que não houve variabilidade individual ao longo do tempo. Não houve modificação em relação à velocidade da DDC após intervenções, mas após TML, a DDC da vogal /i/ se apresentou mais estável em relação à duração do período e à intensidade das emissões. Estes resultados indicam que TML melhorou a coordenação de movimentos das pregas vocais à fonação. Não houve modificações dos parâmetros da DDC em relação à estabilidade das emissões após TENS. Conclusão TML promove maior regularidade de movimentos diadococinéticos das pregas vocais em mulheres disfônicas, o que amplia o conhecimento sobre o efeito do reequilíbrio da musculatura laríngea na função fonatória, já TENS não proporciona efeitos na diadococinesia laríngea.
ABSTRACT Purpose To verify and compare the effect of transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) on laryngeal diadochokinesis (DDK) of dysphonic women. Methods Twenty women with bilateral vocal nodules participated and were equally divided into: LMT Group – LMT application; TENS Group – TENS application; both groups received 12 sessions of treatment, twice a week, with a duration of 20 minutes each, applied by the same therapist. The women were evaluated as to laryngeal DDK at three moments: diagnostic, pre-treatment, and post-treatment, which produced three groups of measurements. The DDK recording was performed with intersected repetition of vowels /a/ and / i/. The analysis of vowels was performed by the program Motor Speech Profile Advanced (MSP)-KayPentax. The DDK parameters of the three evaluations were compared by means of the paired t-test (p≤0.05). Results The measurements of laryngeal DDK parameters were similar in the phase without treatment, indicating no individual variability over time. There was no change with respect to the speed of DDK after intervention, but after LMT, DDK of the vowel /i/ was more stable in terms of the duration of the emissions and intensity of emissions repeated. These results show improved coordination of vocal folds movement during phonation. There were no changes in the DDK parameters following TENS. Conclusion LMT provides greater regularity of movement during laryngeal diadochokinesis in dysphonic women, which extends knowledge on the effect of rebalancing the larynx muscles during phonation, although TENS does not impact laryngeal diadochokinesis.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Adulto Jovem , Estimulação Elétrica Nervosa Transcutânea , Manipulações Musculoesqueléticas/métodos , Disfonia/terapia , Qualidade da Voz , Resultado do Tratamento , Disfonia/fisiopatologia , Músculos Laríngeos/fisiopatologia , Nervos Laríngeos/fisiopatologia , Pessoa de Meia-IdadeRESUMO
Laryngeal electromyography is considered a valuable diagnostic tool for voice disorders. The technique, described almost 70 years ago, evolved 3 decades later, mainly because of the growing interest of laryngologists and speech pathologists. In the authors' opinion, the reduced number of neurophysiologists involved in laryngeal electromyography groups is, at some instance, related to the difficulty to start the learning process and the multidisciplinary approach the field requires. This review highlights the anatomy and physiology needed to perform laryngeal electromyography and its clinical usefulness in the new field known as neurolaryngology.
Assuntos
Eletromiografia/métodos , Músculos Laríngeos/fisiopatologia , Laringe/patologia , Distúrbios da Voz/diagnóstico , Humanos , Laringe/fisiopatologiaRESUMO
OBJECTIVES/HYPOTHESIS: To study the laryngeal electromyography pattern in patients with Parkinson's disease (PD) and vocal complaints at different stages of the disease. STUDY DESIGN: Cross-sectional cohort study. METHODS: Ninety-four adults with PD and vocal complaints at different stages of the disease (according to the Hoehn and Yahr scale) underwent laryngeal electromyography. RESULTS: Tremors were not detected on laryngeal electromyography of the cricothyroid and thyroarytenoid muscles even in patients with clinical tremor. Laryngeal electromyography hypercontractility during voice rest was the typical result observed in 91.5% of patients regardless of disease severity. Gender and age of subjects did not correlate with laryngeal electromyography results. Patients with PD presented spontaneous intrinsic laryngeal muscle activity during voice rest, regardless of disease severity. CONCLUSIONS: This study was significant because it reported on the use of laryngeal electromyography in a large number of patients with PD and vocal complaints grouped according to PD severity. The patterns observed suggest that laryngeal electromyography is a valuable diagnostic tool for PD even at early phases of the disease.
Assuntos
Eletromiografia/métodos , Músculos Laríngeos/fisiopatologia , Doença de Parkinson/diagnóstico , Distúrbios da Voz/diagnóstico , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Muscular/fisiologia , Relaxamento Muscular/fisiologia , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Valor Preditivo dos Testes , Medição de Risco , Índice de Gravidade de Doença , Tremor/diagnóstico , Tremor/tratamento farmacológico , Distúrbios da Voz/etiologia , Distúrbios da Voz/terapiaRESUMO
O diagnóstico de comprometimento do nervo laríngeo superior e de ramos do laríngeo recorrente demanda eletromiografia, pois as alterações à laringoscopia são inespecíficas. OBJETIVO: Avaliar eletrofisiologicamente a função dos nervos laríngeo superior e inferior por meio da atividade elétrica dos músculos por eles inervados, em pacientes com disfonia com coaptação incompleta das pregas vocais à fonação. MÉTODO: Estudo prospectivo; 39 indivíduos com disfonia e fechamento glótico incompleto foram submetidos à eletromiografia dos músculos tireoaritenóideo, cricotireóideo e cricoaritenóideo lateral bilateralmente. Foram avaliadas atividade de inserção, no repouso (fibrilação, onda positiva e fasciculação) e durante contração voluntária dos músculos (recrutamento, amplitude e duração do potencial e latência entre início da atividade elétrica e a sonorização). RESULTADOS: Não observamos alteração na atividade de inserção e no repouso. Nenhum paciente apresentou recrutamento alterado. A média da amplitude dos potenciais elétricos esteve compatível com a normalidade nos músculos testados, assim como a duração do potencial e o tempo de latência entre o início da atividade elétrica e a sonorização. CONCLUSÃO: Não observamos sinais de desnervação nos músculos tireoaritenóideo, cricotireóideo e cricoaritenóideo lateral bilateralmente nos pacientes estudados.
The lack of specificity in laryngoscopical examination requires that the diagnosis of superior laryngeal and recurrent laryngeal nerve involvement be carried out with the aid of electromyography. OBJECTIVE: This study aims to assess the electrophysiological function of the superior and inferior laryngeal nerves by measuring the electrical activity of the muscles they innervate in dysphonic patients with incomplete closure of the vocal folds during phonation. METHOD: Thirty-nine patients with incomplete glottic closure were enrolled in a prospective study and had their cricothyroid, thyroarytenoid, and lateral cricoarytenoid muscles examined bilaterally through electromyography. Insertion activity, electrical activity at rest (fibrillation, positive wave and fasciculation) and during muscle voluntary contraction (recruitment, amplitude, potential length and latency between electrical activity and phonation) were measured. RESULTS: No altered test results were observed for parameters insertion activity and electrical activity at rest. None of the patients had recruitment dysfunction. The mean electrical potential amplitude values were within normal range for the tested muscles, as were potential durations and latency times between the onset of electrical activity and phonation. CONCLUSION: No signs of denervation were seen in the thyroarytenoid, cricothyroid, and lateral cricoarytenoid muscles of the studied patients.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Disfonia/fisiopatologia , Músculos Laríngeos/fisiopatologia , Nervos Laríngeos/fisiopatologia , Estudos Transversais , Disfonia/etiologia , Eletromiografia , Glote/fisiopatologia , Laringoscopia , Estudos Prospectivos , Gravação em VídeoRESUMO
INTRODUCTION: Muscle tension dysphonia (MTD) is a voice disorder in the absence of current organic laryngeal pathology, without obvious psychogenic or neurological aetiology. The laryngeal features of MTD include a posterior glottal gap and supraglottic hyperfunctional activities; however, it remains unclear if these features are specific to MTD. This report aims to compare the laryngeal features in telemarketer patients with MTD versus non-dysphonic control subjects. METHODS: We reported on an observational, analytic and transversal study. Fiberoptic nasal endoscopy was performed on 57 patients (28 telemarketers with MTD and 29 control subjects). These random-sequence videotapes were independently rated by an expert laryngologist according to the modified Morrison and Rammage classification. In addition, a questionnaire about vocal symptoms and other details was completed. RESULTS: The posterior glottal gap was the most common feature in telemarketers with MTD, while incomplete glottal gap was observed more frequently in non-dysphonic patients. More than 70% of the videotapes were rated as pathologic. There was no statistical difference in the prevalence of normal features or bowing glottal gap between patients and control subjects. Anterior-posterior supraglottic contraction was more frequent in the control group. The major symptoms found were: voice gets tired quickly, increased vocal effort and neck tension. CONCLUSIONS: The heterogeneity in the laryngeal features in telemarketers with MTD seen under fibroscopy and their presence among the non-dysphonic population suggest that they cannot determine by themselves the diagnosis of MTD.
Assuntos
Disfonia/diagnóstico , Tecnologia de Fibra Óptica , Laringoscopia/métodos , Marketing , Rigidez Muscular/diagnóstico , Tono Muscular , Doenças Profissionais/diagnóstico , Telefone , Qualidade da Voz , Adulto , Estudos Transversais , Disfonia/etiologia , Disfonia/fisiopatologia , Feminino , Glote/patologia , Humanos , Músculos Laríngeos/fisiopatologia , Masculino , Rigidez Muscular/etiologia , Rigidez Muscular/fisiopatologia , Músculos do Pescoço/fisiopatologia , Doenças Profissionais/fisiopatologia , Inquéritos e Questionários , Gravação de Videoteipe , Treinamento da Voz , Adulto JovemRESUMO
UNLABELLED: The lack of specificity in laryngoscopical examination requires that the diagnosis of superior laryngeal and recurrent laryngeal nerve involvement be carried out with the aid of electromyography. OBJECTIVE: This study aims to assess the electrophysiological function of the superior and inferior laryngeal nerves by measuring the electrical activity of the muscles they innervate in dysphonic patients with incomplete closure of the vocal folds during phonation. METHOD: Thirty-nine patients with incomplete glottic closure were enrolled in a prospective study and had their cricothyroid, thyroarytenoid, and lateral cricoarytenoid muscles examined bilaterally through electromyography. Insertion activity, electrical activity at rest (fibrillation, positive wave and fasciculation) and during muscle voluntary contraction (recruitment, amplitude, potential length and latency between electrical activity and phonation) were measured. RESULTS: No altered test results were observed for parameters insertion activity and electrical activity at rest. None of the patients had recruitment dysfunction. The mean electrical potential amplitude values were within normal range for the tested muscles, as were potential durations and latency times between the onset of electrical activity and phonation. CONCLUSION: No signs of denervation were seen in the thyroarytenoid, cricothyroid, and lateral cricoarytenoid muscles of the studied patients.
Assuntos
Disfonia/fisiopatologia , Músculos Laríngeos/fisiopatologia , Nervos Laríngeos/fisiopatologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Disfonia/etiologia , Eletromiografia , Feminino , Glote/fisiopatologia , Humanos , Laringoscopia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Gravação em Vídeo , Adulto JovemRESUMO
OBJECTIVES: Adductor spasmodic dysphonia (ADSD) is a focal laryngeal dystonia, which compromises greatly the quality of life of the patients involved. It is a severe vocal disorder characterized by spasms of laryngeal muscles during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms result from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold to strain, pressing each vocal fold against the other and increasing glottic resistance. Botulinum toxin injection remains the gold-standard treatment. However, as injections should be repeated periodically leading to voice quality instability, a more definitive procedure would be desirable. In this pilot study we report the long-term vocal quality results of endoscopic laser thyroarytenoid myoneurectomy. STUDY DESIGN: Prospective study. METHODS: Surgery was performed in 15 patients (11 females and four males), aged between 29 and 73 years, diagnosed with ADSD. Voice Handicap Index (VHI) was obtained before and after surgery (median 31 months postoperatively). RESULTS: A significant improvement in VHI was observed after surgery, as compared with baseline values (P=0.001). The median and interquartile range for preoperative VHI was 99 and 13, respectively and 24 and 42, for postoperative VHI. Subjective improvement of voice as assessed by the patients showed median improvement of 80%. CONCLUSIONS: Because long-term follow-up showed significant improvement of voice quality, this innovative surgical technique seems a satisfactory alternative treatment of ADSD patients who seek a definite improvement of their condition.
Assuntos
Disfonia/cirurgia , Músculos Laríngeos/cirurgia , Laringoscopia , Terapia a Laser , Denervação Muscular , Nervo Laríngeo Recorrente/cirurgia , Qualidade da Voz , Adulto , Idoso , Avaliação da Deficiência , Disfonia/diagnóstico , Disfonia/fisiopatologia , Feminino , Humanos , Músculos Laríngeos/inervação , Músculos Laríngeos/fisiopatologia , Laringoscopia/instrumentação , Terapia a Laser/instrumentação , Lasers de Gás , Masculino , Pessoa de Meia-Idade , Denervação Muscular/instrumentação , Fonação , Projetos Piloto , Estudos Prospectivos , Recuperação de Função Fisiológica , Nervo Laríngeo Recorrente/fisiopatologia , Fala , Medida da Produção da Fala , Fatores de Tempo , Resultado do TratamentoAssuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Laríngeos/fisiopatologia , Doença de Parkinson/fisiopatologia , Distúrbios da Voz/fisiopatologia , Eletromiografia , Estudos Prospectivos , Doença de Parkinson/complicações , Distúrbios da Voz/etiologiaRESUMO
OBJECTIVE: Treatment of obstructive sleep apnea (OSA) using methods for increasing upper airway muscle tonus has been controversial and poorly reported. Thus, a review of the evidence is needed to evaluate the effectiveness of these methods. DESIGN: The design used was a systematic review of randomized controlled trials. DATA SOURCES: Data sources are from the Cochrane Library, Medline, Embase and Scielo, registries of ongoing trials, theses indexed at Biblioteca Regional de Medicina/Pan-American Health Organization of the World Health Organization and the reference lists of all the trials retrieved. REVIEW METHODS: This was a review of randomized or quasi-randomized double-blind trials on OSA. Two reviewers independently applied eligibility criteria. One reviewer assessed study quality and extracted data, and these processes were checked by a second reviewer. The primary outcome was a decrease in the apnea/hypopnea index (AHI) of below five episodes per hour. Other outcomes were subjective sleep quality, sleep quality measured by night polysomnography, quality of life measured subjectively and adverse events associated with the treatments. DATA SYNTHESIS: Three eligible trials were included. Two studies showed improvements through the objective and subjective analyses, and one study showed improvement of snoring, but not of AHI while the subjective analyses showed no improvement. The adverse events were reported and they were not significant. CONCLUSIONS: There is no accepted scientific evidence that methods aiming to increase muscle tonus of the stomatognathic system are effective in reducing AHI to below five events per hour. Well-designed randomized controlled trials are needed to assess the efficacy of such methods.
Assuntos
Músculos Laríngeos/fisiopatologia , Tono Muscular/fisiologia , Músculos Palatinos/fisiopatologia , Músculos Faríngeos/fisiopatologia , Apneia Obstrutiva do Sono/reabilitação , Língua/fisiopatologia , Resistência das Vias Respiratórias/fisiologia , Estudos Cross-Over , Método Duplo-Cego , Terapia por Estimulação Elétrica , Medicina Baseada em Evidências , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Apneia Obstrutiva do Sono/fisiopatologiaRESUMO
UNLABELLED: Parkinson's disease (PD) involves a progressive depletion of dopamine in the basal ganglia leading to motor alterations. Oral communication impairment occurs in 75% to 90% of patients and has been poorly studied. AIM: to asses laryngeal electromyography (LEMG) patterns and correlate them to vocal analysis in patients with Parkinson's disease. MATERIALS AND METHODS: This is a prospective study. Twenty six adults with PD underwent laryngeal electromyography. Rest and phonation potentials were analyzed. VOXMETRIA and GRAM 5.1.6. were used in acoustic analysis. RESULTS: The main electromyographic pattern observed in the PD group was rest hypertonicity meaning that patients with PD presented with spontaneous intrinsic laryngeal muscle activity during voice rest, which occurred in 73% of the individuals. Not a case of laryngeal tremor was detected by electromyography, although vocal tremor was detected by VOXMETRIA in 69.5% of the individuals and in 61% of them by perceptive-auditive analysis. CONCLUSION: Vocal tremor was the main acoustic change in the PD group, with no correlation to LEMG findings.
Assuntos
Músculos Laríngeos/fisiopatologia , Doença de Parkinson/fisiopatologia , Distúrbios da Voz/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Estudos Prospectivos , Distúrbios da Voz/etiologiaRESUMO
A doença ou Mal de Parkinson se deve à deficiência dopaminérgica nos núcleos da base que geram alterações motoras. Comprometimento da comunicação verbal ocorre em 70 a 90 por cento dos doentes. Existem poucas referências da aplicação da eletromiografia no estudo dos músculos laríngeos em pacientes com a doença de Parkinson. Objetivos: Definir o padrão contrátil da musculatura intrínseca da laringe e sua correlação com a análise acústica vocal nos parkinsonianos. Casuística e método: Estudo prospectivo onde 26 adultos com o diagnóstico de Mal de Parkinson foram submetidos à eletromiografia laríngea e análise acústica vocal. Foram coletados potenciais de ação, tanto em repouso vocal quanto em fonação. Para a análise acústica da voz foram utilizados os programas VOXMETRIA® e GRAM 5.1.6®. Resultados: O padrão eletromiográfico predominante no grupo estudo foi o de hipercontratibilidade (ou recrutamento aumentado) durante repouso vocal que ocorreu em 73 por cento dos indivíduos, sem que houvesse registro eletromiográfico de tremor. Quanto às características vocais, detectou-se a presença de tremor vocal no traçado do espectrograma (VOXMETRIA E GRAM) e na avaliação perceptivo-auditiva em 69,5 por cento e 61 por cento dos sujeitos, respectivamente. Conclusão: O tremor vocal foi a característica acústica predominante no grupo estudado, sem que houvesse correlação eletromiográfica.
Parkinson's disease (PD) involves a progressive depletion of dopamine in the basal ganglia leading to motor alterations. Oral communication impairment occurs in 75 percent to 90 percent of patients and has been poorly studied. AIM: to asses laryngeal electromyography (LEMG) patterns and correlate them to vocal analysis in patients with Parkinson's disease. Materials and methods: This is a prospective study. Twenty six adults with PD underwent laryngeal electromyography. Rest and phonation potentials were analyzed. VOXMETRIA® and GRAM 5.1.6. ® were used in acoustic analysis. Results: The main electromyographic pattern observed in the PD group was rest hypertonicity meaning that patients with PD presented with spontaneous intrinsic laryngeal muscle activity during voice rest, which occurred in 73 percent of the individuals. Not a case of laryngeal tremor was detected by electromyography, although vocal tremor was detected by VOXMETRIA in 69.5 percent of the individuals and in 61 percent of them by perceptive-auditive analysis. Conclusion: Vocal tremor was the main acoustic change in the PD group, with no correlation to LEMG findings.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Laríngeos/fisiopatologia , Doença de Parkinson/fisiopatologia , Distúrbios da Voz/fisiopatologia , Eletromiografia , Estudos Prospectivos , Doença de Parkinson/complicações , Distúrbios da Voz/etiologiaRESUMO
OBJECTIVE: To study the laryngeal electromyography (LEMG) pattern in patients with Parkinson's disease (PD) and vocal complaints. STUDY DESIGN AND SETTING: Twenty-six adults with PD and vocal complaints and 26 controls with presbyphonia underwent videolaryngoscopy (VL) and LEMG. RESULTS: No tremor was found on LEMG of the cricothyroid and thyroarytenoid muscles, even in cases with clinical and VL tremor. LEMG hypertonicity during voice rest was the typical feature observed in 73% of the patients with PD versus 23% of the controls. This difference was statistically significant. The severity of the disease, diagnosis, and the time of treatment did not correlate with LEMG findings. CONCLUSION: This is the first study reporting the use of LEMG in a large series of patients with PD and vocal complaints. Patients with PD presented spontaneous intrinsic laryngeal muscle activity during voice rest. SIGNIFICANCE: The typical patterns in LEMG suggest this to be a valuable diagnostic tool in PD.