Jeferson Sampaio D'Avila

Laryngeal and vocal evaluation in untreated growth hormone deficient adults.

OBJECTIVE: To evaluate the consequences of lifetime, severe and untreated isolated growth hormone deficiency (IGHD) on vocal and laryngeal function. STUDY DESIGN: Cross-sectional. SUBJECTS AND METHODS: A total of 23 IGHD adult subjects and 22 controls were administered a questionnaire about vocal complaints and harmful voice habits, and underwent videolaryngostroboscopic examination, voice evaluation by perceptual-auditory analysis with GRBAS scale including grade of dysphonia, roughness, breathiness, asthenia and strain items, objective voice evaluation by maximum phonation time (MPT), and acoustic analysis. RESULTS: There was no difference in vocal complaints between IGHD subjects and controls. Vocal abuse and smoking were more frequent in IGHD subjects. IGHD subjects presented higher values for roughness, breathiness, and strain. Laryngopharyngeal reflux (LPR) signs and laryngeal constriction were more frequent in IGHD individuals. MPT was similar in the two groups. Fundamental frequency was higher in IGHD females and males. Harmonic to noise ratio was higher in IGHD in both genders and shimmer was lower in IGHD females. CONCLUSIONS: IGHD subjects have higher prevalence of signs of LPR and laryngeal constriction, with high pitch in both genders, which suggests a prominent role of IGHD on these parameters.

Escolares submetidos a videonasofaringoscopia na escola: achados e aceitação

OBJECTIVE: To verify childrens acceptance of nasal fiber optic examination in a school setting and to evaluate hypertrophy of adenoid vegetation and to determine its prevalence in this population. METHODS: A survey was performed of a representative (n = 368) sample of school age children at elementary school (aged 6 to 13 years old) who had been subjected to fiber optic examination, in Aracaju (SE), Brazil. All students were subjected to the same study protocol, carried out at school and with no need for sedation or restraint. RESULTS: All of the children tolerated the nasal fiber optic examination well, making possible a good evaluation of pharynx and nasal cavities. The prevalence of adenoid hypertrophy grade I was 50.6%, of grade II 35.1% and of grade III 14.3%. Grades II and III hypertrophy were related to an increase in obstructive symptoms. CONCLUSION: As this study performed in a school setting demonstrates, nasal fiber optic examination can be performed with excellent tolerance in settings other than hospitals and outpatient clinics, indicating that its usage could be increased and made available for an extended range of populations. The prevalence of adenoid hypertrophy in Aracaju is not comparable with prevalence rates observed in earlier studies because it this was a study of children without respiratory symptoms.

Characteristics and Professional Use of Voice in Street Children in Aracaju, Brazil

The objective of the study was to evaluate voice characteristics of children engaged in street selling, which involves an essentially professional use of voice in this population. A controlled cross-sectional study was carried out. A randomly chosen sample of 200 school children with a history of street selling assisted by public social services and 400 school children without this experience was selected. Seven- to 10-year-old children of both sexes were studied. Both groups were interviewed and given vocal assessment (auditory-perceptual assessment and spectrographic acoustic measures) and otorhinolaryngological evaluation (physical and videonasolaryngoscopic examination). Children with abnormal results in both groups were compared using chi(2) (Chi-squared test). The significance level was established at 5% (P<0.05). Voice problems were detected more frequently in working children (106-53%) than in regular school children (90-22.5%). The control group achieved better school performance as more children in this group attend school regularly than street children, although age-for-grade deficit was similar. The control group had more access to medical visits (80-40%) and treatment with a doctor (34-17%). Language assessment has shown that the control group had more dysphonia (73-37%) and myofunctional orofacial disorders (20-10%). Street children had more normal voice but had more nasal disorders and greater glottal closure than the school control group. Voice disorders were present in both groups, but less frequently in street children. Although subject to inadequate living conditions, street children had better voice quality than the control group. An explanation could be that by adapting their voice professionally for selling goods in the streets, they developed adequate resilience to their difficult living conditions.

Estudo comparativo da microvascularizaçäo das pregas vocais humanas acometidas por cisto e reaçäo nodular contra-lateral sob endoscopia rígida

AIM: The aim of this study was to analyze microvascular alterations that occur in the human vocal fold (VF), when damaged by cyst and contralateral nodule reaction. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Through laryngoscope of suspension the VFs were analyzed by rigid endoscopy in anterior, medium, posterior and subglotic regions. The microvascular alterations were classified in four major groups: parallel, transversal, branched and puntiform. Theses were subdivided into twelve types. RESULT: In VFs damaged by cyst, the microvascular alterations were more frequent (93,1%) rather than in contralateral VFs damaged by nodule reaction (6,9%). In the occurrence of cyst were also observed multiple microvascular alterations (10 subtypes), having prevalence of sinuous and ectasical microvessels, while in VFs damaged by contralateral nodule reaction these microvessels alterations were less varied (3 subtypes). When straight related to nodular lesion, those were exclusively puntiform. CONCLUSION: Our findings emphasize that the presence of cyst in the blade itself interferes in the arrangements of the microvessels of the VFs, while nodular reaction that compromises the epithelium, which is more superficial than the vessels, interferes in a minor degree in the vascular architecture. Therefore in the occurrence of altered microvessels diagnosis of the cyst in more likely rather than the nodule reaction.

Premalignant Laryngeal Lesions: Twenty-Year Experience in Specialized Service

Introduction Premalignant lesions are considered both a hyperplastic and dysplastic stage of epithelial lesions in the glottic larynx that may or may not progress into an invasive carcinoma. The evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies. Objective The goal of this study was to determine the accuracy of the preoperative exam for diagnosis of premalignant laryngeal lesions and their connection with benign diseases of the vocal folds, as well as to assess their epidemiologic characteristics. Methods This is a retrospective and longitudinal cohort study performed through the review of surgical records of patients who underwent laryngeal microsurgery performed by a single surgeon from 1990 to 2009. Results Preoperative assessment of outpatients was 64.4% accurate. Vocal fold cysts were the most frequently associated benign lesions. The patients who apparently had premalignant lesions represented 10.57% of those who underwent laryngeal microsurgery. Premalignant lesions prevailed in men (69.49%) age from 41 to 50 years (32.20%). Conclusion Although the evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies, about one-third of premalignant lesions are diagnosed just during the laryngeal microsurgery. Cysts were the most prevalent concomitant benign lesion of the vocal folds. Males were more prevalent than females and the predominant age bracket was between 41 and 50 years.

[Schoolchildren submitted to video nasopharyngoscopy examination at school: findings and tolerance].

OBJECTIVE To verify childrens acceptance of nasal fiber optic examination in a school setting and to evaluate hypertrophy of adenoid vegetation and to determine its prevalence in this population. METHOD A survey was performed of a representative (n = 368) sample of school age children at elementary school (aged 6 to 13 years old) who had been subjected to fiber optic examination, in Aracaju (SE), Brazil. All students were subjected to the same study protocol, carried out at school and with no need for sedation or restraint. RESULTS All of the children tolerated the nasal fiber optic examination well, making possible a good evaluation of pharynx and nasal cavities. The prevalence of adenoid hypertrophy grade I was 50.6%, of grade II 35.1% and of grade III 14.3%. Grades II and III hypertrophy were related to an increase in obstructive symptoms. CONCLUSION As this study performed in a school setting demonstrates, nasal fiber optic examination can be performed with excellent tolerance in settings other than hospitals and outpatient clinics, indicating that its usage could be increased and made available for an extended range of populations. The prevalence of adenoid hypertrophy in Aracaju is not comparable with prevalence rates observed in earlier studies because it this was a study of children without respiratory symptoms.

National Voice-Care Campaign and its importance in voice-care outreach activities

I am pleased and honored to make some remarks about Laryngology in Brazil. In recent decades, thanks to the hard work of our medical scientists, Brazil reached an unprecedented international prestige. This has also been true for laryngology. Initially, by developing and upholding a high internal standard, Brazilian laryngology not only was upgraded in relation to the rest of the world, but improved itself in such a way that it is today well regarded and respected in all continents, thanks to the relevance of our research as well as the excellent representativeness from our team of laryngologists. In these specific grounds, our Brazilian Academy of Laryngology and Voice (ABLV) carried a large responsibility. Always very well chaired along all these years, the academy has been able to convey a high level of credibility both in the country and abroad, which created this elevated social and medical acknowledgement. Starting from this base, and being an integral part of this development, the Voice-Care Campaign started 10 years ago. Based on information disclosure, the campaign has been able to alert the general population about the causes of laryngeal diseases, how to avoid and treat them, providing the Brazilian population a deeper awareness on the topic. Ultimately, this resulted not only in a greater number of visits to specialized services, but also in earlier diagnoses of throat diseases, especially those associated with the vocal folds. This campaign also served to bring Brazilians a greater awareness of Otorhinolaryngology. In order to toast to this excellent ABLV work, the World Voice-Care Day was created, which is internationally held every April 16. In our present administration the Voice-Care Campaign has finally become permanent, a fact that celebrates the 10th Campaign and the 6th World Voice-Care Day. With this action, the disclosure results became more evident and we believe that at the 2009 World Convention, Brazilian representativeness in the world, through the ABLV, will represent a historical landmark for Brazilian Otorhinolaryngology.

Variant of the Technique for Laryngeal Microsurgery in Cases of Difficult Laryngoscopy

Introduction  Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical tools. Objective  To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure. Methods  This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015. Results  The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures. Conclusion  The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution.

Adenotonsillar Hypertrophy in Pre-School Children with Sickle Cell Disease and Diagnostic Accuracy of the Sleep Disturbance Scale for Children

Introduction  Adenotonsillar hypertrophy is more common in children with sickle cell disease, and can lead to sleep-disordered breathing. Objectives  To determine the frequency of adenotonsillar hypertrophy in pre-school children with sickle cell disease and assess the diagnostic accuracy of the sleep-disordered breathing subscale in the Sleep Disturbance Scale for Children. Method  Observational study with a group of 48 children with sickle cell disease and a control group of 35 children without the disease. The children underwent oropharingoscopy and video nasal endoscopy. The parents and/or guardians answered the questions of the subscale. Results  Adenotonsillar hypertrophy was observed in 25% of the children in the study group, and in 20% of the children in the control group, with no statistical difference between the groups. The subscale score ranged from 3 to 11 in both groups. There was a statistical significance in the study group. The average was 4.79 (standard deviation [SD] ± 2.50), with 4.19 (SD ± 1.72) among the children without adenotonsillar hypertrophy, and 6.5 (SD ± 3.40) among the children with adenotonsillar hypertrophy. There was also a statistical significance in the control group. The average was 5.23 (SD ± 2.81), with 4.44 (SD ± 2.2) among the children without adenotonsillar hypertrophy, and 7.87 (SD ± 2.89) among the children with adenotonsillar hypertrophy. Conclusion  Adenotonsillar hypertrophy was not associated with sickle cell disease in pre-school children. The subscale of sleep-disordered breathing in the Sleep Disturbance Scale for Children was a useful tool for the diagnostic suspicion of adenotonsillar hypertrophy in children in this age group.