Débora dos Santos Queija

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...

Quality of Life in Swallowing Disorders after Nonsurgical Treatment for Head and Neck Cancer

Introduction Radiotherapy or chemoradiotherapy can result in severe swallowing disorders with potential risk for aspiration and can negatively impact the patients quality of life (QOL). Objective To assess swallowing-related QOL in patients who underwent radiotherapy/chemoradiotherapy for head and neck cancer. Methods We interviewed 110 patients (85 men and 25 women) who had undergone exclusive radiotherapy (25.5%) or concomitant chemoradiotherapy (74.5%) from 6 to 12 months before the study. The Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire was employed to evaluate dysphagia-related QOL. Results The QOL was reduced in all domains for all patients. The scores were worse among men. There was a relationship between oral cavity as the primary cancer site and the fatigue domain and also between advanced cancer stage and the impact of food selection, communication, and social function domains. Chemoradiotherapy association, the presence of nasogastric tube and tracheotomy, and the persistence of alcoholism and smoking had also a negative effect on the QOL. Conclusions According to the SWAL-QOL questionnaire, the dysphagia-related impact on QOL was observed 6 to 12 months after the treatment ended.

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.

Translation and adaptation of the Radiotherapy Edema Rating Scale to Brazilian Portuguese

INTRODUCTION Internal lymphedema is one of the sequelae of head and neck cancer treatment that can lead to varying degrees of swallowing, speech, and respiration alterations. The Radiotherapy Edema Rating Scale, developed by Patterson et al., is a tool used to evaluate pharyngeal and laryngeal edema. OBJECTIVE To translate into Brazilian Portuguese, to culturally adapt and test this scale in patients undergoing treatment for head and neck cancer. METHODS The process followed the international guidelines and translation steps by two head and neck surgeons and back-translation performed independently by two North-American natives. The final version of the test was evaluated based on the assessment of 18 patients by two head and neck surgeons and two speech therapists using the scales in Brazilian Portuguese. RESULTS The translation and cultural adaptation were satisfactorily performed by the members of the committee in charge. CONCLUSION The translation and adaptation into Brazilian Portuguese of the Radiotherapy Edema Rating Scale was successfully performed and showed to be easy to apply.

P036: Oral Communication Voice Handicap of Total Laryngecomized

collected from the storage room and immunohistochemical test performed. RESULTS: High Cyclin D1 was expressed in 59% patients and low cyclin D1 in 41% of patients. Statistically high cyclin D1 was associated with a high recurrence rate (77.1%) whereas patients with low cyclin D1 had a lower recurrence rate (49.1%) and better response to treatment (54%). Other known prognostic factors–i.e. TNM staging, grading, parapharyngeal extension, lymph node size and supraclavicular lymph nodes involvement– did not prove to be statistically significant to the level of cyclin D1 (p 0.05). An overall five years of survival was higher in patients with low cyclin D1 expression than for those with high expression of cyclin D1 (p 0.05). CONCLUSIONS: Level of cyclin D1 is a good predictor of a high risk patient developing poor response and recurrence and this knowledge will assist in selecting and planning treatment.