Ana Paula Brandão Barros

Voice and vocal self-assessment after thyroidectomy

Voice alterations after thyroidectomy can be found even with preserved function of laryngeal nerves. The purpose of this study was to evaluate voice before and after thyroid surgery and the role of orotracheal intubation on voice changes.

Quality of life and depression in patients undergoing total and partial laryngectomy

PURPOSE The surgical treatment of head and neck cancer, primarily laryngeal cancer, causes sequelae and can change the patients quality of life. The purpose of this study was to investigate the impact of laryngectomy on the quality of life regarding the functional, physical, psychological, and social aspects. METHODS Fourteen patients underwent total laryngectomy and 16 underwent vertical partial laryngectomy. The Quality of Life Core Questionnaire (QLQ-C30) and Head and Neck (H&N35) questionnaire from the European Organization for Research and Treatment of Cancer (EORTC) were used for quality of life evaluation, while the Beck Depression Inventory questionnaire was used for the depression screen. RESULTS In the total laryngectomy group, reported adverse effects were worsened, social and emotional function (21.3%), olfaction and taste changes (85.6%), cough (71.3%), speech difficulty (100%), and dysphagia (64.3%). Most of the patients (85.5%) judged their quality of life to be reasonable. In the partial laryngectomy group, reported adverse effects were worsened, emotional function (71.4%), speech difficulty (100%), and dysphagia (31.3%). However, most of the patients judged their quality of life to be above the general average. CONCLUSION Despite being different surgeries, both groups experienced similar difficulties but at different levels. The quality of life was judged worse in the patients who underwent total laryngectomy.

Correlação entre os achados estroboscópicos, perceptivo-auditivos e acústicos em adultos sem queixa vocal

The great progress in understanding the vocal physiology and the scientific and technological development in the voice area allow transposing the therapeutic limit through the means for the precocious detection of vocal changes. OBJECTIVE: to evaluate subjects without vocal complaint, and to correlate possible videostroboscopic, perceptual and acoustic analysis finding. STUDY DESIGN: Observacional cohort with transversal cut. PATIENTS AND METHODS: 21 men without vocal complaints were studied. Their ages ranged from 20 to 50 with median of 33. They were neither alcohol nor smoke users. The subjects underwent the videostroboscopic, perceptual and acoustic evaluations. RESULTS: 57.15% of the subjects presented any alteration in one or more of the evaluated aspects. In the videostroboscopy it was observed posterior triangular gap in 4 subjects. Ten subjects presented a mild grade alteration in the perceptual analysis, in instability, hoarseness and breathiness parameters. Three subjects presented respectively hipernasal, cul de sac and pharyngolaryngeal resonance focus. The acoustic evaluation presented the following averages: f0 125.69 Hz; jitter 0.22%; shimmer 3.06%; NNE -12.29 dB; HNR 20.75 dB; tremor frequency 2.09 Hz; tremor amplitude 1.16 Hz. Some subjects presented shimmer% values and tremor frequency largest than the average. CONCLUSION: Alterations were detected in 57.15% of the evaluations of subjects without vocal complaints. Those changes could be variations of the normality, or they could indicate a predisposition to future glottic and vocal alterations in the course of the time. There was any acoustic aspect change in all the evaluations, which presented alteration.

Swallowing and quality of life after total laryngectomy and pharyngolaryngectomy

UNLABELLED Dysphagia can be a consequence of total laryngectomy even in the absence of symptoms and it could indeed directly or indirectly compromise quality of life. AIM To evaluate the characteristics of swallowing after total laryngectomy and pharyngolaryngectomy with pharyngeal T closure, correlating them with the Quality of Life in Swallowing Disorders questionnaire. METHODS A prospective evaluation was performed in 28 patients; fifteen undergoing total laryngectomy and thirteen undergoing total pharyngolaryngectomy. Swallowing was evaluated through videofluoroscopy regarding the preparatory, oral and pharyngeal phases of swallowing, and the quality of life related to swallowing questionnaire was employed to measure quality of life. RESULTS Anatomical and functional changes were observed under videofluoroscopic evaluation. Dysphagia was diagnosed in 18 patients (64.3%), being mild in 66.6% and moderate/severe in 33.3%. The questionnaire indicated good quality of life in almost all scales. Complaints of dysphagia were associated to the burden (p=0.036) and mental health scale (p=0.031). The questionnaire indicated impact on the mental health scale for patients with severe dysphagia (p=0.012). CONCLUSIONS High incidence of dysphagia was observed in some quality of life assessments, especially of mild degree.

Deglutição e qualidade de vida após laringectomia e faringolaringectomia total

Dysphagia can be a consequence of total laryngectomy even in the absence of symptoms and it could indeed directly or indirectly compromise quality of life. A...

Original ArticleVideolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

UNLABELLED Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. OBJECTIVE This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. METHODS This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. RESULTS Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). CONCLUSION Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

UNLABELLED Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. OBJECTIVE This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. METHODS This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. RESULTS Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). CONCLUSION Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

Deglutição após tratamento não cirúrgico (radioterápico/ radioquimioterápico) do câncer de laringe

UNLABELLED Radiation therapy and radiochemotherapy protocols can cause swallowing difficulties. AIM To evaluate swallowing in patients undergoing radiation therapy and radiochemotherapy protocol only for the treatment of laryngeal tumors. METHODS A prospective study of 20 patients, with a mean age of 62 years, at the end of oncological therapy. Six patients (30%) underwent radiation therapy, and 14 patients (70%) underwent combined therapy. The mean time between treatment and an evaluation of swallowing was 8.5 months. Videofluoroscopy was done to assess the preparatory, oral and pharyngeal phases of swallowing. RESULTS All patients had only an oral diet. Normal swallowing was present in only 25% of patients. The swallowing videofluoroscopic examination identified the following changes: bolus formation (85%), bolus ejection (60%), oral cavity stasis (55%), changes in the onset of the pharyngeal phase (100%), decreased laryngeal elevation (65%), and hypopharyngeal stasis (80%). Laryngeal penetration was observed in 25% of the cases; 40% presented tracheal aspiration. The grade of penetration/aspiration was mild in 60% of cases. Aspiration was silent in 35% of patients. Although 75% of patients had dysphagia, only 25% complained of swallowing difficulties. CONCLUSION Patients with laryngeal cancer that underwent radiation therapy/combined treatment can present changes in all swallowing phases, or may be asymptomatic.

The Relationship Between the Glottic Configuration After Frontolateral Laryngectomy and the Acoustic Voice Analysis

The relative measurement of the anterior commissure synechia (S) is a crucial factor worsening voice quality and the perceptual analysis score has a strong correlation to the synechias impact. The aim of this study is to correlate the laryngeal configuration regarding the anterior commissure synechia and its relationship with the acoustic vocal parameters. Fifteen male patients underwent frontolateral partial vertical laryngectomy and reconstruction with bipedicle sternohyoid muscle flap for the treatment of T1b/T2 glottic cancer. The patients were free of disease, and the evaluation was performed after a minimum postoperative period of 12 months. Measurements of the anterior commissure synechia and the free border of both the preserved and the reconstructed vocal folds were simultaneously performed with the acoustic analysis of the voice. We calculated the mathematical proportion between the midsagital dimension of the synechia of the anterior commissure and the measurement of the free border of the intermembranous region of each vocal fold-the preserved one and that reconstructed with the bipedicle sternohyoid muscle flap. The acoustic evaluation showed an important increase in the fundamental frequency, and the values of all parameters were changed regardless of the anterior commissure synechia findings. These results suggest that the acoustic voice parameters are always changed because of the aperiodic pattern regardless of the anterior commissure synechia findings.

Laryngostroboscopy: Perceptual and acoustic evaluation of male smokers

Objectives: The objective of this study was to evaluate the conventional laryngoscopy, laryngostroboscopy, perceptual and acoustic evaluation of 28 male chronic smokers. Methods: Volunteer sample of 28 male smokers whose ages averaged 53 years. Smoking habit varied from 96 to 720 months. Standard transoral rigid videolaryngoscopy with stroboscopy was performed. The examinations were recorded on videotape (video home system format). The recorded material was analyzed by a physician according to Hirano & Bless protocol (1993). A grading system described by Yonekawa (1983) was used in order to assess the severity of the Reinke edema (RE). The subjective judgment of the voice quality was carried out by 5 experienced speech-language pathologists. The GRBAS system was used to describe the voice quality. For the acoustic assessment, the following factors were analyzed: fundamental frequency; jitter; shimmer; NNE; and HNR. Results: The conventional laryngoscopy was able to identify RE in 9 patients. In the laryngostroboscopy, RE was identified in 16 examinations with prevalence of type II. Besides it, 1 polyp, 1 leucoplakia; 1 bilateral angiodisgenesia and 1 vocal fold scar were described. The perceptual evaluation presented revealed prevalence of strainless and roughness. The acoustic analysis demonstrated higher rates of fundamental frequency, shimmer, and HNR. The jitter rates were lower than the normal. Conclusion: A rate of 57% of chronicle male smokers presented RE with no significant vocal repercussion. The perceptual evaluation showed alterations in larger scale related to the vocal tract ressonance and all the acoustic rates alterated.