Ana L. Spina

Primary versus secondary tracheoesophageal puncture for speech rehabilitation in total laryngectomy : Long-term results with indwelling voice prosthesis

OBJECTIVE: To evaluate the long-term use of indwelling Blom-Singer voice prosthesis (VP) for vocal rehabilitation of patients submitted to total laryngectomy (TL). The influence of the timing (primary or secondary) of tracheoesophageal puncture (TEP), use of radiotherapy (xRT), patient age, and length of follow-up were studied to evaluate the success rate of VP use. STUDY DESIGN AND SETTING: Prospective clinical study in a tertiary referral center. Seventy-one patients were submitted to TL and rehabilitated with indwelling VP. All patients were evaluated for vocal functional issues by an otolaryngologist and a speech pathologist at 1 month, then at every 3 months up to 1 year, and then at every 6 months after 1 year of follow-up. The relative data on time of placement of VP, time of VP use, xRT, age, length of follow-up, and life span of each VP were recorded during the follow-up. RESULTS: Eighty-seven percent of the patients underwent primary and 13%, secondary TEP. The follow-up varied from 12 to 87 months, with an average of 38 months for primary and 51 months for secondary TEP. Fifty-nine percent of the patients were submitted to xRT. The general rate of success was 94%, with 97% for primary and 78% (P = 0.07) for secondary TEP; after 2 years, the success rate was 96% for primary and 75% for secondary (P = 0.07) TEP. The use of xRT and patient age had no influence on the success of VP use for primary and secondary TEP, independently of the length of follow-up. CONCLUSIONS: The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.

Role of margin status in recurrence after CO2 laser endoscopic resection of early glottic cancer

Conclusion. In patients with early glottic squamous cell carcinoma (SCC) submitted to CO2 laser endoscopic resection, local disease recurrence was significantly correlated with the presence of positive additional surgical margins on permanent sections. Objectives. To evaluate the rate of cancer recurrence in patients with early glottic SCC submitted to CO2 laser endoscopic resection according to margin status after resection, stage of disease and postoperative radiotherapy. The rate of larynx preservation and the length of hospital stay were also evaluated. Material and methods. Forty consecutive patients with early glottic cancer were subjected to laser endoscopic resection surgery of glottic cancer followed by frozen-section control of margins, with intraoperative enlargement of margins when positive. Adjuvant radiation therapy or enlargement of previous margins was indicated in the case of positive additional surgical margins on permanent section. Results. Local recurrence occurred in three patients (7.5%), all with positive additional surgical margins on permanent section. Positive additional surgical margins on permanent section were related to 37.5% of recurrences and negative additional surgical margins with 0% of recurrences (p=0.006). All patients spent at most 1 day at the hospital.

Correlação da qualidade de vida e voz com atividade profissional

As disfonias podem comprometer a qualidade da comunicacao e, por consequencia, a relacao social do individuo e assim afetar sua qualidade de vida. Existe hoje necessidade de protocolos objetivos para avaliacao da qualidade vocal que mensurem suas implicacoes na qualidade de vida do paciente. OBJETIVOS: Relacionar qualidade de vida e voz com o grau de disfonia e o uso profissional da voz em um grupo de pacientes disfonicos. MATERIAL E METODO: Realizou-se estudo clinico prospectivo aplicando-se protocolo internacional para avaliar a qualidade de vida e voz em um grupo de pacientes disfonicos. Realizou-se tratamento estatistico dos resultados considerando-se nao-distincao entre profissionais da voz e nao-profissionais da voz e, em seguida, considerando-se esta distincao profissional. RESULTADOS: A disfonia afetou a qualidade de vida em todos os individuos. Nao houve diferenca estatistica entre os grupos, profissionais da voz e nao-profissionais da voz, quanto ao grau de disfonia. Houve correlacao entre qualidade de vida e grau de disfonia, no entanto, considerando-se os grupos separadamente, esta correlacao foi significativa apenas no grupo de sujeitos nao-profissionais da voz. CONCLUSAO: A disfonia afetou a qualidade de vida em todos os sujeitos independente do uso profissional da voz.

Reabilitação fonatória do laringectomizado total: utilização de toxina botulínica na voz tráqueo-esofágica com prótese fonatória

Na puncao traqueo-esofagica(PTE) e realizada miotomia do musculo constritor da faringe, mas sua necessidade e entre 9% a 79% dos pacientes. Sua realizacao pode aumentar as taxas de fistula salivar no pos-operatorio. A aplicacao da TB e ambulatorial. OBJETIVO: Analise da eficacia da aplicacao de toxina botulinica (TB), na reabilitacao do laringectomizado total com voz traqueo-esofagica(VTE) com espasmo(E) do segmento faringo-esofagico (SFE) sem miotomia. MATERIAL E METODOS: Analise de oito pacientes submetidos a laringectomia total (LT), reabilitados com VTE com protese fonatoria (PF), esforco para emissao de voz devido a E do SFE. Todos submetidos a tratamento dessa alteracao motora com injecao de 100 unidades de TB no SFE. A avaliacao constituiu-se de analise perceptiva de voz, videofluoroscopia (VF) do SFE, analise acustica de voz e manometria computadorizada (MC) do SFE, todos antes e apos aplicacao de TB. DESENHO DE ESTUDO: Estudo prospectivo. RESULTADOS: Houve diminuicao na pressao a MC do SFE, apos a injecao de TB. Analise acustica demonstrou melhora na qualidade de harmonicos apos o tratamento. Houve emissao de voz sem esforco e melhora do E apos o uso da TB. CONCLUSAO: Todos os pacientes com E do SFE apresentaram melhora vocal apos aplicacao da TB neste SFE.

Uso de manometria computadorizada para estudo do espasmo do segmento faringoesofágico em pacientes com voz traqueoesofágica inadequada antes e após aplicação de toxina botulínica

Tracheoesophageal voice (TEV) with voice prosthesis (VP) is an efficient and reproducible method used in vocal rehabilitation after total laryngectomy (TL), prevented by spasms in the pharyngoesophageal segment (PES). Computerized Manometry (CM) is a new, direct and objective method used to assess the PES. AIM: to carry out an objective analysis of the PES, with CM, before and after the injection of botulinum toxin (BT). STUDY DESIGN: clinical-prospective. MATERIALS AND METHODS: analysis of eight patients consecutively submitted to TL with TEV and VP, without vocal emission, with PES spasms seen through videofluoroscopy, considered the gold standard for spasm detection. All had their spasms treated with the injection of 100 units of BT in the PES. The assessment was based on PES videofluoroscopy and CM, before and after BT injection. RESULTS: There was a PES pressure reduction according to the CM after BT injection in all patients. The average pressure in the PES seen through the CM in eight patients before BT injection was 25.36 mmHg, and afterwards it dropped to 14.31 mmHg (p=0.004). There was vocal emission without stress and PES spasm improvement seen through the videolaryngoscopy after BT injection. CONCLUSION: We observed a reduction in PES pressure after BT injection, seen through CM in all the patients, with spasms improvement seen through videofluoroscopy.

Computerized manometry use to evaluate spasm in pharyngoesophageal segment in patients with poor tracheoesophageal speech before and after treatment with botulinum toxin

UNLABELLED Tracheoesophageal voice (TEV) with voice prosthesis (VP) is an efficient and reproducible method used in vocal rehabilitation after total laryngectomy (TL), prevented by spasms in the pharyngoesophageal segment (PES). Computerized Manometry (CM) is a new, direct and objective method used to assess the PES. AIM to carry out an objective analysis of the PES, with CM, before and after the injection of botulinum toxin (BT). STUDY DESIGN Clinical-prospective. MATERIALS AND METHODS Analysis of eight patients consecutively submitted to TL with TEV and VP, without vocal emission, with PES spasms seen through videofluoroscopy, considered the gold standard for spasm detection. All had their spasms treated with the injection of 100 units of BT in the PES. The assessment was based on PES videofluoroscopy and CM, before and after BT injection. RESULTS There was a PES pressure reduction according to the CM after BT injection in all patients. The average pressure in the PES seen through the CM in eight patients before BT injection was 25.36 mmHg, and afterwards it dropped to 14.31 mmHg (p=0.004). There was vocal emission without stress and PES spasm improvement seen through the videolaryngoscopy after BT injection. CONCLUSION We observed a reduction in PES pressure after BT injection, seen through CM in all the patients, with spasms improvement seen through videofluoroscopy.

Assessment of Grade of Dysphonia and Correlation With Quality of Life Protocol

OBJECTIVE The main objective of this study is to check the correlation between vocal self-assessment and results of the Voice-Related Quality of Life (V-RQOL) protocol, and whether there is a correlation between perceptual vocal assessment made by voice therapists and the results from the V-RQOL protocol. STUDY DESIGN The study included 245 subjects with vocal complaints. This was a prospective analytical clinical study. METHODS Vocal perceptual assessment of each subject with dysphonia was made by three voice therapists, followed by self-assessment made by the subjects themselves, and the application of the V-RQOL protocol. RESULTS The results have shown poor level of agreement between vocal assessment made by the voice therapists and self-assessment made by the subjects. The statistical analysis indicated that the results of V-RQOL protocol showed significant correlation with the vocal assessment made by the voice therapists and the self-assessment by the subjects. CONCLUSIONS The agreement between the assessments was low and variable; age, gender, professional voice use, and clinical laryngoscopic diagnosis did not influence the agreement level. Protocol V-RQOL is sensitive to vocal assessment made by the voice therapists and self-assessment made by the patient.

Use of computerized manometry for the detection of pharyngoesophageal spasm in tracheoesophageal speech

Objective To evaluate the utility of computerized manometry (CM) to identify pharyngoesophageal segment (PES) spasm during tracheoesophageal speech. Study Design Prospective clinical, controlled study. Subjects and Methods Intraluminal pressures of the PES were collected in 12 tracheoesophageal speakers without spasm and 8 tracheoesophageal speakers with PES spasm before and after localized injection of botulinum toxin to the PES. All subjects underwent voice analysis and videofluoroscopy in addition to CM before and after treatment. Results All tracheoesphageal speakers with PES spasm presented with mean intraluminal pressures greater than 16 mmHg (mean, 25.36 mmHg). In contrast, mean intraluminal pressures of subjects without spasm was 11.76 mmHg (P < 0.05). The negative predictive value associated with the use of 16 mmHg as a threshold value for spasm was 100%. Conclusion CM is a clinically useful tool to aid in speech rehabilitation for tracheoesophageal speakers. Intraluminal pressures of greater than 16 mmHg was highly predictive for PES spasm.

Botulinum toxin in speech rehabilitation with voice prosthesis after total laryngectomy

UNLABELLED In tracheo esophageal puncture (TEP), we carry out a myotomy of the pharynx constrictor muscle; however, about 9 to 79% of patients need such procedure. The consequence of such procedure is an increase in salivary fistula rates in the postoperative. Botulin toxin is used in an outpatient basis. AIM analyzing the efficacy of botulin toxin (BT) use in the rehabilitation of totally laryngectomized patients with tracheo-esophageal voice (TEV) with spasms (S) of the pharyngo-esophageal segment (PES) without myotomy. MATERIALS AND METHODS We analyzed eight patients submitted to total laryngectomy (TL), rehabilitated with TEV, with speech prosthesis (SP) and struggle to utter voice because of PES spasms. They were all submitted to treatment of such motor alteration with the injection of 100 units of BT in the PES. The evaluation was based on perceptive voice analysis, video fluoroscopy (VF) of the PES, acoustic voice analysis and computerized manometry (CM) of the PES, all before and after BT injection. STUDY DESIGN prospective. RESULTS There was a reduction in PES CM pressure after BT injection. Acoustic analysis showed an improvement in harmonics quality after treatment. There was smoother voice utterance and spasm improvement after BT. CONCLUSION all patients with PES spasms presented vocal improvement after BT injection in the PES.