Anete Branco

Dysphonia in Children

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 childrens 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.

Aging voice and the laryngeal muscle atrophy

To study by means of morphometric measurements the severity of vocal muscle atrophy in the elderly.

Valor e variações da freqüência fundamental no choro de dor de recém-nascidos

PURPOSE: to study the value of fundamental frequency and its variations found in newborn pain cry. METHODS: emissions of 111 healthy and term newborns were recorded, whose lifetime varied from 24 to 72 hours, during venepuncture procedures. The acoustic analysis was realized with VOXMETRIA 1.1 software, with an extract from the fundamental frequency value and GRAM 5.7, in order to verify the occurrence of fundamental frequency variations such as breaks, double harmonic breaks and higher fundamental frequency. The NIPS scale was carried out during venepuncture. The statistical analysis is descriptive with extract from the mean values, standard deviation and frequency of event occurrence. RESULTS: the newborns showed 100% of their emissions with frequency variations, in other words, breaks and double harmonic breaks. The higher fundamental frequency was found in 34.2% of the newborns. CONCLUSION: the newborn communicates pain through cry. The newborn pain emission is tense and strident with higher fundamental frequency and variations founds at the spectrographic tracing such as breaks, double harmonic breaks and higher fundamental frequency. Such characteristics are important to attract adult attention concerning as for a fast support to the newborns and to help in the evaluation of pain during a procedure.

Aging voice: presbyphonia

Presbyphonia is a physiological process of aging voice that includes morphological changes in the coverage mucosa, muscle, and cartilage. We revised the morphological, endoscopic, and vocal acoustic changes that occur in presbyphonia and discussed some treatments proposed to minimize glottal incompetence and improve vocal performance of the elderly.

Os distúrbios fonoarticulatórios na síndrome de Down e a intervenção precoce

TEMA: a crianca com Sindrome de Down apresenta um atraso na aquisicao e desenvolvimento dos aspectos fonoarticulatorios, atraso este, que tem sido atribuido a caracteristicas fisicas e ambientais que influenciam negativamente no processo de desenvolvimento. Caracterizar os aspectos fonoarticulatorios dos sujeitos com Sindrome de Down pode proporcionar uma melhor compreensao das alteracoes abordadas na reabilitacao em suas diversas modalidades e contribuir na evolucao terapeutica. Por esta razao decidiu-se focar com maior profundidade em um dos aspectos mais importantes da comunicacao, a fonoarticulacao. OBJETIVO: caracterizar as alteracoes fonoarticulatorias encontradas em individuos portadores da Sindrome de Down, por meio de uma revisao bibliografica, enfocando a importância da intervencao precoce frente a tais circunstâncias. CONCLUSAO: a falta de estimulacao e o encaminhamento tardio irao interferir no desenvolvimento fonoarticulatorio, assim, por meio da intervencao precoce, sera possivel a obtencao de melhores resultados, fazendo com que grandes problemas tornem-se alteracoes minimas.

Clinical practice: vocal nodules in dysphonic children.

Common among children, vocal symptoms are a cause of concern for parents who seek elucidation of their diagnosis and treatment. Vocal nodules are the major cause of dysphonias in children and are related to vocal abuse. We conducted a literature review considering clinical, physiopathological, epidemiological, and histological aspects of vocal nodules, as well as diagnostic methods, highlighting the main studies addressing this issue. The controversial points of treatments were also discussed.

Hyaluronic acid behavior in the lamina propria of the larynx with advancing age.

Objectives To analyze the hyaluronic acid behavior in the lamina propria of the larynx with advancing age. Study Design Prospective study. Setting UNESP-Univ Estadual Paulista, Botucatu Medical School, Brazil. Subjects and Methods Thirty vocal folds were obtained at necropsy from 10 adult males (30–50 years old) and 20 geriatric males (10: 60–75 years old; 10: over 76 years old). Midmembranous vocal fold sections were subjected to immunohistochemical reactions. Digital imaging software (ImageJ) was used to quantify the hyaluronic acid distribution over the lamina propria of vocal folds, from superficial to deep layers. Results Hyaluronic acid distribution was homogeneous for the larynges, at both superficial and deep layers (41.6 and 38.5, respectively). For both 30- to 50-year-old men geriatric age groups, hyaluronic acid level was lower at both layers. Conclusion Hyaluronic acid level in the lamina propria of the larynx of geriatric men decreases with advancing age at both layers of the lamina.

Psychogenic dysphonia: diversity of clinical and vocal manifestations in a case series

INTRODUCTION Psychogenic dysphonia is a functional disorder with variable clinical manifestations. OBJECTIVE To assess the clinical and vocal characteristics of patients with psychogenic dysphonia in a case series. METHODS The study included 28 adult patients with psychogenic dysphonia, evaluated at a University hospital in the last ten years. Assessed variables included gender, age, occupation, vocal symptoms, vocal characteristics, and videolaryngostroboscopic findings. RESULTS 28 patients (26 women and 2 men) were assessed. Their occupations included: housekeeper (n=17), teacher (n=4), salesclerk (n=4), nurse (n=1), retired (n=1), and psychologist (n=1). Sudden symptom onset was reported by 16 patients and progressive symptom onset was reported by 12; intermittent evolution was reported by 15; symptom duration longer than three months was reported by 21 patients. Videolaryngostroboscopy showed only functional disorders; no patient had structural lesions or changes in vocal fold mobility. Conversion aphonia, skeletal muscle tension, and intermittent voicing were the most frequent vocal emission manifestation forms. CONCLUSIONS In this case series of patients with psychogenic dysphonia, the most frequent form of clinical presentation was conversion aphonia, followed by musculoskeletal tension and intermittent voicing. The clinical and vocal aspects of 28 patients with psychogenic dysphonia, as well as the particularities of each case, are discussed.

Laryngeal and voice disorders in patients with gastroesophageal symptoms. Correlation with pH-monitoring

PURPOSE To investigate laryngeal and voice disorders in patients with gastroesophageal symptoms and their correlation with pH-monitoring. METHODS A prospective study was carried out in patients attended at the Voice Disorder Outpatient Clinics of Botucatu Medical School in a five-year period and had vocal and gastroesophagic symptoms. Patients underwent videolaryngoscopy, auditory-perceptual vocal analyses, computerized acoustic vocal analysis and dual probe pH-monitoring for 24 hours. RESULTS Fifty-seven patients were included (aged between 21 and 65 years; 45 women and 12 men), 18 had normal (31.6%) and 39 had abnormal pH-monitoring results (68.4%). Videolaryngoscopy recorded several laryngeal lesions for both patients with normal and abnormal pH-monitoring, but mostly for the latter group, highlighting posterior pachyderma. Auditory-perceptual vocal assessments identified vocal changes of several intensities for both groups but especially for patients with abnormal pH-monitoring results. All acoustic parameters, except f0, were abnormal for both groups, compared to the control population. CONCLUSION Acoustic and perceptual vocal changes and laryngeal lesions were recorded for both patients with normal pH-monitoring results and patients with abnormal pH-monitoring results, evidencing the importance of clinical history and videolaryngoscopic findings for diagnosing acid laryngitis.

Alterations in Extracellular Matrix Composition in the Aging Larynx

Objective To study by immunohistochemistry the alterations of collagens I, III, IV, and V and elastin in the aging process of the human larynx. Study Design Cadaver study. Setting Universidade Estadual Paulista, Botucatu Medical School, São Paulo State University (UNESP), Brazil. Subjects and Methods Thirty vocal folds were obtained at autopsy from 10 adult men (aged 30 to 50 years) and 20 geriatric men (10 aged 60 to 75 years and 10 aged >75 years). Mid membranous vocal fold slides were subjected to immunohistochemical reactions. Digital imaging software (ImageJ) was used to quantify the increase in brownish staining of the lamina propria structures of vocal folds, from superficial to deep layers. Results There was an increase of collagen I and III immunoexpression in the elderly larynges, in both layers. Collagens IV and V were immunoexpressed in the vessels endothelium of the lamina propria and in the basement membrane. The immunoexpression of elastin decreased in the elderly larynges, in both lamina propria layers of the vocal folds. Conclusion A clear increase of collagens I and III and a decrease of elastic fibers were observed in the lamina propria of vocal folds. The concentration of collagens IV and V was the same across age groups. These findings suggest that as men age, the density of the extracellular matrix increases, brought about by an increase in collagen, while the loss of elastin results in decreased viscoelasticity.