Camila Queiroz de Moraes Silveira Di Ninno

Correlação entre os achados do teste de emissão de ar nasal e da nasofaringoscopia em pacientes com fissura labiopalatina operada

OBJETIVO: Verificar se as informacoes colhidas no teste de emissao de ar nasal apresentam compatibilidade com os achados da nasofaringoscopia, podendo auxiliar no julgamento da funcionalidade do mecanismo velofaringeo. METODOS: Foram analisados os achados do teste de emissao de ar nasal e nasofaringoscopia em 21 individuos operados de fissura pos-forame e transforame incisivo, de ambos os generos, com idade superior a oito anos. A correlacao foi feita observando se, diante de um gap velofaringeo (espaco entre as estruturas da regiao velofaringea) visualizado na nasofaringoscopia, notava-se embacamento do espelho de Glatzel no teste de emissao de ar nasal. Os dados foram analisados estatisticamente pelo indice de Kappa. RESULTADOS: Notou-se concordância entre os testes (p<0,05), sendo esta considerada mais alta durante o sopro, emissao de plosivos isolados e fricativos em palavras e frases (Kappa: 0,897; 0,887; 0,774 e 0,774, respectivamente), do que para a emissao de plosivos em palavras, fricativos isolados e plosivos em frases (Kappa: 0,691; 0,640 e 0,488, respectivamente). A incompatibilidade ocorreu em poucos casos, na presenca de gap pequeno, fechamento total e fechamento total com borbulha. Quanto a tendencia de fechamento velofaringeo, verificou-se predominância do tipo coronal (48%), sendo notado melhora do mesmo com o uso de prova terapeutica em 62% dos sujeitos. CONCLUSAO: Foi observada a validade do teste de emissao de ar nasal quando comparado a nasofaringoscopia. Contudo, e importante que o teste de emissao de ar nasal seja aplicado de forma criteriosa e que a realizacao deste, nao substitua a nasofaringoscopia, que e conclusiva para o planejamento cirurgico e terapeutico.

Caracterização do ceceio em pacientes de um Centro Clínico de Fonoaudiologia

PURPOSE: This study had the aim to verify and characterize the lisp occurrence, investigating its correlation with the tonicity of the syllable in which the phoneme [s] occurred, either in initial or final position. The study also had the aim to observe whether some of these contexts would facilitate the correct production of the phoneme [s] and would be indicated as a valid therapeutic resource. METHODS: From the 54 patients in speech therapy, 16 were selected through records analysis. These subjects (both male and female) had ages ranging from five to 19 years and presented lisp. Data were gathered through a speech test that had the aim to verify the production of the phoneme [s] in 79 words, in initial, middle and final syllable positions, in both stressed and unstressed syllables followed by the vowels [a], [e], [e], [i], , [o] and [u]. The productions were recorded on audio and video. Statistical analysis used the Minitab software, version 14.0, and the Z Test for comparison of ratio. RESULTS: Twelve patients (75%) presented frontal lisp and four (25%), lateral lisp. Reduction of the lisp was not observed in relation to syllable stress or coarticulation with different vowels. The initial and middle syllable positions reduced significantly the lisp, when compared to middle and final coda positions. CONCLUSION: Syllable stress and coarticulation with different vowels do not modify the incidence of lisp. Initial syllable positions, however, seem to facilitate the production of [s] and must be considered in the choice of the resource and material to be used in therapy.

Atendimento fonoaudiológico intensivo em pacientes operados de fissura labiopalatina: relato de casos

Due to the lack of speech therapists at various regions of Brazil to assist patients with cleft lip and palate, new intervention programs must be developed for these individuals. Intensive speech therapy has been cited in literature as an alternative modality. This article relates the experience of four cleft lip patients, comparing their speech performances before and after the intensive intervention. The subjects, three adults and one adolescent with compensatory articulatory disorders, were engaged in an intensive summer training program. For each patient, intervention was carried out daily for three hours, during 10 days, divided into individual and group therapy. At the beginning and at the end of that period, patients were assessed by a speech therapist who did not participate in the sessions. A sample of spontaneous speech, counting from 1 to 20 and repetition of a list of words and sentences with oral occlusive and fricative phonemes were recorded on video tape. All patients showed satisfactory development with the intensive therapy program, adapting the worked phonemes in directed speech, but still requiring follow-up therapy to automatize their production. Intensive speech therapy was shown to be an efficient and possible alternative in these cases, and could also be a strategy at the beginning of conventional speech intervention.

Levantamento epidemiológico dos pacientes portadores de fissura de lábio e/ou palato de um centro especializado de Belo Horizonte

PURPOSE: to trace the epidemiological profile of patients with cleft lip and/or palate at a specialized center in Belo Horizonte. METHOD: data referring to the year of entry to the center, type of cleft, gender, city of origin and age at the time of first attendance were obtained from an Excel spreadsheet containing the records of all patients. Statistical analysis was performed by the Chi-square test at 5% significance level. RESULTS: the sample was composed of 1,219 subjects, 593 patients being registered in 2005, 273 in 2006, 222 in 2007 and 131 in 2008. Of the total sample, 49% showed complete cleft lip and palate, 26% cleft palate, 19% cleft lip, 2% incomplete cleft lip and cleft palate and 3% other types of craniofacial malformation. As for the gender, 54% were of the male gender and 46% were of the female gender. With regard to the origin, 33% were from Belo Horizonte residents, 28% were from other cities in the Metropolitan Region of Belo Horizonte, 38.5% from the inland of the State of Minas Gerais and 0.5% from other States. As for the age, 40% of the cases arrived to the center before completing 3 years of age, 45.5% between the ages of 3 and 18 years and 14.5% over the age of 18 years. CONCLUSION: at this reference center, the largest number of cases showed the complete cleft lip and palate type, those were patients of the male gender, coming from the inland of the State of Minas Gerais, and consisting of babies and children.

A prevalência do uso de sonda nasogástrica em bebês portadores de fissura de lábio e/ou palato

PURPOSE: To investigate the prevalence of the use of nasogastric tube in babies with cleft lip and/or palate, and to correlate its use with type of cleft, maternity hospital (private or public) and city of origin, and age at the first visit to a cleft center. METHODS: The sample consisted of data collected from 137 babies of both genders with cleft lip and/or palate, without any other associated anomalies, born full-term, who attended their first consultation at a specialized cleft center with ages between zero and 12 months (median=33 days). Statistical analyses used the coefficient of contingency test (p<0,05). RESULTS: From the subjects, 61% were male and 39% were female; 51% presented cleft lip and palate, 35% cleft palate, and 14% cleft lip. Regarding place of birth, 36% were born in private and 64% in public maternity hospitals; 60% were born in the city of Belo Horizonte (Minas Gerais, Brazil), 15% in other cities of the metropolitan area, and 25% in other cities at the state of Minas Gerais (Brazil). The use of nasogastric tube was reported in 23% of the cases. There was no association between the type of cleft or maternity and the use of the tube, but the later was more frequent within the metropolitan area (p=0,007). CONCLUSION: The prevalence of the use of nasogastric tube in babies with cleft lip and/or palate was considered high since they were born full-term and without any other associated anomalies that would indicate the need of the tube. The use of nasogastric tube was more frequent in babies born at the metropolitan area of Belo Horizonte, when compared to other cities in the state of Minas Gerais (Brazil).

Prevalência de fissura de palato submucosa associada à fissura labial

ABSTRACT Purpose: To investigate the prevalence of submucous cleft palate associated with cleft lip, and its correlation with gender, type of cleft lip, signs and symptoms. Methods: Study based on the data of 132 consecutive patients with cleft lip at a specialized cleft lip and palate center, of both genders, collected by the same speech-language pathologist during the patients’ first consultation at the center. Palpation of the hard palate, visual assessment of the soft palate and uvula, and an interview with patients or their parents regarding the presence of associated symptoms were performed. Results: From the total sample, most patients were male and had left-sided cleft lip. Eleven percent of the cases presented signs of submucous cleft palate. Among them, nasal reflux was found in some cases (21%), history of otitis in half of the subjects, and none of them presented speech with hypernasality signs. Conclusion: Eleven per-cent of the patients with cleft lip presented signs of submucous cleft palate, with higher prevalence in males and in left-sided cleft lip.

Obstrução nasal total: estudo morfofuncional de um caso de sinéquia de palato mole e paredes faríngeas pós blastomicose

BACKGROUND: to identify the consequences that arising from fifteen years of total nasal obstruction in a case of post blastomicose palato and pharynxs lesion. PROCEDURES: this article was based on a case report of a 26-years-old female subject, who came to a specialized center on craniofacial deformities, complaining about her mouth breathing. Her respiratory difficulty stems from a total tack of palate and pharynx, as a blastomicose sequel that she had when 11-year-old. RESULTS: during the interview, the patient said that she had poor physical conditioning, daytime sleepiness, slow chewing and choking during the swallowing process. At evaluation, it was noted exclusive oral breath of the superior type, alternate chew on both sides, adapted swallowing and serious hyponasal resonance. we also noted long face, with convex profile, retruded jaw and dark circles under the eyes. Her lips were half-opened and dried up, with the upper one thinner and the lower part turned round and augmented. The patients palate is atresic, strait and deep. CONCLUSION: the patients characteristics are compatible with Oral Breath Syndrome and anatomic-functional consequences of a total nasal obstruction.

A eficácia de exercícios para disfunção da tuba auditiva

PURPOSE: To assess the effectiveness of blowing, suction, and nasal breathing exercises, associated with nose cleaning and Valsalvas maneuver, for Eustachian tube dysfunctions and preventing recurrent otitis media. METHODS: Twenty-two children of both genders, with ages between three and six years, who had a history of recurrent otitis media and, at the moment of the exam, types A and C tympanometric curves participated in the study. The subjects were submitted daily to the above-mentioned procedures for 3 months. RESULTS: At the end of the study, the last immitance audiometry of the 22 analyzed children showed that 18 of them had bilateral type A curves and no otitis episodes during this interval. CONCLUSION: In the studied sample, these procedures proved to be effective for preventing tube dysfunction and recurrent otitis media, and may be used preventively in children at day care centers.

Cleft palate: regional prevalence in the State of Minas Gerais in a specialized reference center

Objective: to identify the origin and some clinical, epidemiological parameters of patients seeking a cleft lip and palate specialized center in Belo Horizonte and who reside within the State of Minas Gerais. Material and methods: the sample was composed of 308 patients residing in Minas Gerais who arrived at the center without prior surgical treatment. The information was obtained from a secondary database containing the medical records of these patients. Data were analyzed according to the meso-region of the Minas Gerais State and the patients’ city of origin (Campo das Vertentes, Central Mineira, Jequitinhonha, Noroeste de Minas, Norte de Minas, Oeste de Minas, Sul/Sudoeste de Minas, Triângulo Mineiro/Alto Paranaiba, Vale do Mucuri, Vale do Rio Doce, and Zona da Mata). The following variables were analyzed: gender, age at the time of treatment, and type of cleft. Results: no statistical predominance was observed in any gender. We observed a statistically significant occurrence for “up to one year” (69%) in relation to the age when treatment was sought. Cleft lip was the most frequent type of cleft (36%). Among the 308 patients from meso-regions in Minas Gerais, the majority was concentrated in the Central region while the Triângulo Mineiro/Alto Paranaiba region comprised the smallest number of patients. Conclusion: the origin of the largest number of patients seeking a cleft lip and palate specialized center care in Belo Horizonte is in the Central region of Minas Gerais.