Evaldo Dacheux de Macedo Filho

O uso da toxina botulínica no tratamento da distonia laríngea (disfonia espasmódica): estudo preliminar com doze pacientes

Laryngeal dystonia (spasmodic dysphonia) is a movement disorder characterized by involuntary contractions of laryngeal muscles involved with vocalization. The introduction of botulinum toxin in the treatment of laryngeal dystonia had a major clinical impact due to the striking improvement of symptoms. We report the preliminary results of therapeutical use of botulinum toxin in the treatment of twelve patients with laryngeal dystonia. After an extensive clinical evaluation, the patients underwent a videostroboscopic exam for diagnostic confirmation. Botulinum toxin was injected in the cricothyreoid membrane, directed towards the thyreoaritenoid muscle, with the aid of eletromyography needles. Most of patients who underwent botulinum toxin injection had a significant improvement of their symptoms (83%), with effects lasting for four months in average and without important side effects.

Achados histológicos na parede posterior da laringe em pacientes com refluxo gastroesofageano (GERD)

Introduction: The mechanisms of the otolaryngologic manifestations of GERD are most likely the result of intermittent nocturnal gastroesophageal-pharyngeal reflux and contact or upper airway structures with refluxate. The contact of the gastric juice with the pharynx and larynx, result in edema and inflammation, even with minimal acid exposition. Although, histological findings in the posterior wall of the larynx in patients with GERD, may be a important diagnostic tool in these patients. The aim of this study is to describe the results of the biopsies of the posteiror wall of the larynx in patients with GERD. Study design: Prospective no randomized. Material and method: We performed biopsies in the laryngeal posterior wall in seven patients complaints of cronical pharyngeal symptoms with gastroesophageal reflux disease (GERD). All the patients were investigated with digestive endoscopy and all had erosive esophagitis. Laryngoscopy were performed looking for lesions sugestive of GERD. Two groups were created: group I - normal laryngoscopy; and group II - laryngoscopy with posterior laryngitis. Results: The results showed that 42.85% of the patients presented with scamous epithelim in the laryngeal posterior wall, 42.85% presented areas of scamous metaplasia among the respiratory epithelium and 28.57% of the patients presented with respiratory epithelium. 71.4% of the patients presented with histologic alterations of the GERD that are found in the mucosal esophagus. Conclusions: The results ot this study suggest that the GERD can be related to the epithelium changes in the laryngeal posterior wall and inflamatory histologic alterations in this region.

Characteristics of polypoid lesions in patients undergoing microsurgery of the larynx.

Summary Introduction: Dysphonia is the main symptom of lesions that affect the vocal tract. Many of those lesions may require surgical treatment. Polyps are one of the most common forms of vocal cord lesions and the most prevalent indication for laryngeal microsurgery. There are different types of polyps, and their different characteristics can indicate different prognosis and treatments. Aim: To conduct a comparative study of polypoid lesions (angiomatous and gelatinous) in patients undergoing laryngeal microsurgery via an electronic protocol. Method: We prospectively evaluated 93 patients diagnosed with vocal fold polyps; the polyps were classified as angiomatous or gelatinous. Results: In total, 93 patients undergoing laryngeal microsurgery were diagnosed with vocal fold polyps. Of these, 63 (64.74%) had angiomatous and 30 (32.26%) gelatinous polyps. Most patients with angiomatous polyps were men; their polyps were frequently of medium size, positioned in the middle third of the vocal fold, and accompanied by minimal structural alterations (MSA). In contrast, the majority of patients with gelatinous polyps were women; their polyps were smaller, positioned in the middle and posterior third of the vocal fold, and were not accompanied by MSA. Both types of polyps were more frequently located on the right vocal fold. Conclusion: Angiomatous polyps were more frequently encountered than gelatinous polyps. In addition, correlations between polyp type and sex, polyp size, position, location, and the presence of MSA were observed. Different surgical techniques were used, but the postoperative results were similar and satisfactory after speech therapy.

Proposed computerized protocol for epidemiological study of patients undergoing microsurgery of the larynx

Summary Introduction: The merging of medicine with information technology facilitates the retrieval of stored data, aiding the conduct of research with greater scientific rigor. Studies in the field of otorhinolaryngology, specifically in the area of laryngology and voice, are of fundamental importance, since 70% of the economically active need their voice to work. Objective: To create a computerized protocol of the diseases of the larynx, apply and validate it, and use it to evaluate patients undergoing laryngoscopic microsurgery of the larynx. Method: We created a database of ENT diseases through a literature review of textbooks and scientific articles. Next, we computerized the data and incorporated it into the SINPE©, creating a master protocol (ENT diseases) and a specific protocol (laryngeal diseases). Data were collected prospectively from patients undergoing laryngeal microsurgery in the ENT Hospital of Paraná. The collected data were analyzed with graphs through the SINPE© Analyzer module. Results: We evaluated 245 patients aged 9–79 years, and determined that 36.61% (93 patients) underwent surgery for the presence of polyps on the vocal folds, 12.6% (32) underwent surgery for papillomatosis, and 11.83% (29) underwent surgery for intracordal cysts. Conclusions: The creation of an electronic database of clinical ENT diseases was feasible. We were also able to implement and validate the protocol. The database may be released to physicians involved in clinical data collection and retrieval of information to conduct scientific research in an organized manner. The most common laryngeal disorders identified were polyps, papilloma, and intracordal cysts.

Avaliação sistematizada da dificuldade de exposição das pregas vocais na microcirurgia da laringe

INTRODUCTION: Several studies addressing preoperative factors that predict difficulty of endotracheal intubation graduated by anesthesiologists, for the scale of the Cormack-Lehane. These parameters were evaluated for the difficulty of location of the laryngoscope in microsurgery of the larynx. There is not a standard scale of difficulty targeted to surgeons of the larynx. OBJECTIVE: Create a standard scale of difficulty leasing the laryngoscope during microsurgery of the larynx, with a focus on exposure of the vocal folds (vocal cords) to evaluate which clinical parameters predict difficulty of exposure of their vocal folds and verify the improvement of laryngeal exposure with the hanger of the laryngoscope. METHOD: A prospective randomized study, 57 patients undergoing laryngeal microsurgery. The preoperative parameters were evaluated: three epidemiological data, two of history and 13 physical examination. Intraoperatively: the anesthesiologist evaluated the Cormack-Lehane score and the surgeon evaluated according to the proposed scale, before and after placement of the hanger. RESULTS AND CONCLUSION: Several parameters showed sensitivity, specificity, positive predictive value for high inadequate exposure of the larynx. But only distance hiomentual <6.05 cm (p = 0.003) and 2 classes of Cormack-Lehane (p = 0.04) with statistical significance and high sensitivity of 100% and 81% respectively. The use of the hanger of laryngoscope laryngeal exposure improved significantly (p = 0.04). The proposed scale standardizes the visualization and grades the difficulty of exposure of their vocal folds, facilitating comparisons between studies and communication between otolaryngologists.

Time for Complete Vocal Recovery in Voice Professionals Undergoing Polyp Surgery

Introduction: The voice is an important element for an individual in his personal and professional relationships. By means of it, we convey a message and are able to maintain communication. Some people use it as a working tool; they are called voice professionals and are classified into Koufman’s levels. Improper and strenuous use added to external elements, however, may cause vocal fatigue and when exertion exceeds the compensatory mechanisms, dysphonia by phonotraumatic lesions mainly polyps happen as a result. Aim: To establish a secure parameter for the required time of vocal rest for functional and professional voice recovery after laryngeal microsurgery. Methods: Through objective variables, 68 voice professionals, Koufman’s level I and II with vocal polyps, who underwent laryngeal microsurgery, were selected and compared to 100 people with healthy voice from the preoperative moment up to 3 months postoperatively, based on an acoustic analysis with the shimmer, jitter, NHR and VPQ variables. Results: All variables at 1 month postoperatively were seen to be adequate within normal limits. Conclusion: After the surgical correction of polyps, we found the need for 1 month vocal rest for complete and safe vocal recovery.

Prospective Study of the Surgical Techniques Used in Primary Rhinoplasty on the Caucasian Nose and Comparison of the Preoperative and Postoperative Anthropometric Nose Measurements

Introduction The knowledge and study of surgical techniques and anthropometric measurements of the nose make possible a qualitative and quantitative analysis of surgical results. Objective Study the main technique used in rhinoplasty on Caucasian noses and compare preoperative and postoperative anthropometric measurements of the nose. Methods A prospective study with 170 patients was performed at a private hospital. Data were collected using the Electronic System Integrated of Protocols software (Sistema Integrado de Protocolos Eletrônicos, SINPE©). The surgical techniques used in the nasal dorsum and tip were evaluated. Preoperative and 12-month follow-up photos as well as the measurements compared with the ideal aesthetic standard of a Caucasian nose were analyzed objectively. Student t test and standard deviation test were applied. Results There was a predominance of endonasal access (94.4%). The most common dorsum technique was hump removal (33.33%), and the predominance of sutures (24.76%) was observed on the nasal tip, with the lateral intercrural the most frequent (32.39%). Comparison between preoperative and postoperative photos found statistically significant alterations on the anthropometric measurements of the noses. Conclusion The main surgical techniques on Caucasian noses were evaluated, and a great variety was found. The evaluation of anthropometric measurements of the nose proved the efficiency of the performed procedures.

UM NOVO MÉTODO DE ANÁLISE VOCAL ATRAVÉS DA TERMOMETRIA DA FALA: ESPERANÇA DE DIAGNÓSTICO PRECOCE DE LESÕES DAS PREGAS VOCAIS ?

A voz e um fenomeno complexo que exige diversas medidas para a descricao de suas caracteristicas porque inumeras grandezas fisicas estao envolvidas na sua producao. Os varios equipamentos existentes para analise vocal medem: vibracao das pregas vocais, fluxo aereo glotico, volume do ar que passa atraves das pregas vocais, pressao subglotica, area de contato da mucosa das pregas vocais e sinal sonoro vocal. Apos a entrevista do falante, observacao e descricao de sua voz, dados obtidos do laboratorio de voz devem ser integrados a analise vocal para proporcionar avaliacao vocal completa. As medidas de analise vocal encaixam-se como pecas de um quebra-cabecas, cada qual levando a conexao natural da peca seguinte e, juntas, fornecem um quadro que nao pode ser visualizado com dados somente de uma das pecas. Nenhum metodo instrumental de analise vocal consegue fornecer todas as informacoes da fisiologia e fisiopatologia vocal, que sao importantes para o diagnostico e manejo dos problemas vocais. READ (1992) relatou que o numero de sistemas de avaliacao da voz humana disponiveis ja e bastante grande e cada um deles apresenta vantagens e desvantagens, nao existindo nenhum sistema perfeito e insubstituivel capaz de realizar avaliacao vocal completa. Novos estudos e instrumentos que avaliem a funcao da laringe devem ser testados e desenvolvidos para o melhor entendimento e aprimoramento do seu produto: a voz humana. Este artigo relata o uso de um novo instrumento de analise vocal baseado na aplicacao de fundamentos da transferencia de calor, fenomeno fisico jamais explorado anteriormente na analise da producao da voz. Atraves da distribuicao de temperatura na cavidade oral, o metodo explora diferencas entre o padrao de fluxo aereo e o fechamento das pregas vocais de individuos com voz normal e tem potencial para utilizacao em individuos disfonicos para a deteccao de doencas precoces das pregas vocais.