Marina Padovani

Phonarticulatory diadochokinesis in young and elderly individuals

The phonoarticulatory diadochokinesis test has been recommended to evaluate neurological disorders. It is a speech task that consists of the ability to repeat at high speed a segment of speech. The purpose of this research is to analyze the diadochokinesia rate of adults from two distinct age groups. 23 young adults and 23 elderly people, both sexes participated in this study. Each participant produced the /pa/, /ta/, /ka/ syllables, the vowel /a/ and the /pataka/ sequence, as fast and as long as they could with habitual pitch and loudness. The speech samples were analyzed by using the voice and speech analysis software Visi-Pitch III/Sona-Speech, KayElemetrics. Both groups presented with reduced diadochokinesia rate as the speech production became more complex. The young adults group presented with higher diadochokinesia rate in adults in all speech tasks while the elderly adults group had a worse intensity control.

Auditory-perceptual Evaluation of Normal and Dysphonic Voices Using the Voice Deviation Scale

OBJECTIVE This study aims to (1) determine the cutoff values of the overall severity (OS) of vocal deviation on the visual analog scale (VAS) based on the ratings of the numerical scale (NS); and (2) verify the power of discrimination of these cutoff values according to different degrees of vocal deviation. STUDY DESIGN This is a prospective study. METHODS The auditory-perceptual evaluation was performed by four speech-language pathologists who used two protocols with different scalar properties: the VAS and the 4-point NS. Vocal samples from142 women and 69 men, plus 10% of repetition, with and without vocal complaints, ranging from 19 to 60 years were included. The analyzed speaking task was the counting from 1 to 10. For both protocols, the judges rated the OS. RESULTS Based on the correspondence between the two scales, the cutoff values of the OS on the VAS obtained were 35.5, 50.5, and 90.5 points. The 35.5 value corresponds to the cutoff point between normal variability and mild/moderate vocal deviations; the 50.5 value corresponds to the cutoff point between mild/moderate and moderate vocal deviations; the 90.5 value corresponds to the cutoff point between moderate and severe deviations. Areas under the receiver operating characteristic curve for the three cutoff values were 0.918, 0.948, and 0.970, respectively. CONCLUSIONS The cutoff values of the OS on the VAS were obtained, and the areas under the ROC curve showed that all the three cutoff points had excellent accuracy that represents a higher power of discrimination of different degrees of vocal deviations.

Dysphonia Severity Degree and Phonation Onset Latency in Laryngeal Adductor Dystonia

Although the latency between the initiation of thyroarytenoid electrical activity and the onset of phonation generally is increased in patients with adductor laryngeal dystonia, there is disagreement about whether there is overlap of latency values in these patients and normal subjects. The goal of this article was to compare the severity of dysphonia with the latency between electrophysiological activation of the thyroarytenoid muscle (TA) and the onset of phonation in patients with adductor laryngeal dystonia and compare the values with normal controls. Twenty-one patients with adductor dystonia and 15 control patients underwent laryngeal electromyographic (EMG) examination of the left TA. We measured the latency from initiation spike of the electric activity of the TA muscle to the onset of phonation. Three speech-pathologists/voice specialists arrived at a consensus to rate the perceptual evaluation of voice quality for the study group. The average latency measured for patients with mild dysphonia was 332 milliseconds, for moderate dysphonia was 426 milliseconds, and for the severe dysphonia was 792 milliseconds. We used the Spearmans correlation test to compare the latency time values and the dysphonias degree of severity (P<0.05). Latency was significantly and directly related to the degree of severity of dysphonia.

Comparison of clinical characteristics of patients with adductor laryngeal dystonia in the focal and segmental types

UNLABELLED Dystonia is a central motor processing neurological disorder characterized by abnormal, often action-induced, involuntary movements or uncontrolled spasms. AIM To compare patients with the diagnoses of focal and segmental adductor laryngeal dystonia at the Neurolarynx Outpatient Clinic of the Federal University of São Paulo. MATERIALS AND METHODS A clinical retrospective study of data collected from patient registries from 2003 to 2009. RESULTS Of 34 patients, 25 presented focal dystonia and 9 presented segmental dystonia. There were 30 females (88. 2%) and 4 males (11. 8%). A relation with a traumatic event was reported in 11 cases (32. 4%). Vocal tremor was observed in 21 patients (61. 8%). The mean age at onset, the age at diagnosis, and time between the onset and the diagnosis were respectively 55, 61. 3 and 6. 3 years. There was no statistical difference between patients with focal laryngeal adductor dystonia and segmental dystonia in the study data. CONCLUSIONS There were no statistical differences among patients with focal adductor laryngeal dystonia and segmental dystonia relating to age of onset, age of diagnosis, gender, time between onset and diagnosis, presence of associated tremor, and relation to trauma.

Adduction laryngeal dystonia: proposal and evaluation of nasofibroscopy

UNLABELLED Dystonias are organic central motor processing disorders characterized by involuntary muscular contractions or incontrollable spasms induced by task-specific movements. Adduction laryngeal dystonias present with important speech impairments, with inappropriate spasms and abrupt voice breaks. The diagnosis is based on clinical features, evaluation by a speech therapist and transnasal fiber optic laryngoscopy. AIM Our objective is to propose and evaluate a task-oriented transnasal fiber optic laryngoscopy protocol, which shows the spasms, and propose maneuvers that reduce or make them disappear, in order to facilitate the diagnosis. METHODS transversal study. Analysis of the transnasal fiber optic laryngoscopy records of 15 patients with adductor laryngeal dystonia using the proposed protocol. RESULTS most of the speech and non-vocal tasks allowed us to identify the spasms and reduce or make them disappear. We propose the exclusion of two of the maneuvers that dont bring new data to the evaluation. CONCLUSION the protocol was useful for the evaluation of the patients, showing changes in muscle behavior in the structure under investigation.

Comparison between Essential Vocal Tremor and Dystonic Vocal Tremor Treated with Botulinum Toxin and Propranolol

Objectives: Determine and compare the response to treatment with intramuscular botulinum toxin and oral propranolol on vocal tremors, essential and dystonic. Methods: Randomized clinical trial between January 2012 and September 2013. Fifteen patients with vocal tremor were divided into 2 groups: essential and dystonic vocal tremor. Both groups were treated with botulinum toxin in thyroarytenoid muscle (15 units of Dysport unilaterally) and propranolol (80 to 120 mg daily) at different times. Time to “wash out” after injection of 6 months and after propranolol 2 months. Patients underwent self-assessment of vocal improvement, nasofibroscopy larynx, perceptual, and acoustic analysis of voice before and after each treatment. Data were compared according to the type of tremor and treatment and subjected to statistical analysis (significance level of .05). Results: There was statistically significant improvement in perceptual measure of vocal instability in patients with dystonic tremor after treatment with botulium toxin, compared with propranolol (P = .028). The acoustic measurement variabiity of fundamental frequency was also statistically significant, with a decrease in the treatment of dystonic tremor in connection with the botulinum toxin compared with propranolol (P = .05) and before treatment (P = .011). Conclusions: The dystonic and essential tremors differ in responses to treatment. The dystonic tremor responds positively to the injection of botulinum toxin into the thyroarytenoid muscle, but not to the use of oral propranolol.

Manifestações faringo-laríngeas da síndrome pós-poliomielite

INTRODUCTION: The post-polio syndrome (PPS) is characterized by a new episod of atrophy or muscle weakness in individuals previously affected by poliomyelitis. The symptoms start from an extended period of clinical stability ranging from 20 to 40 years, after the initial chart of polio. Among the pathophysiological mechanisms, the most likely is that the syndrome represents a process of attrition and neuronal metabolic exhaustion due to a continuous process of denervation reinnervation which begins after the initial acute. OBJECTIVE: Review the clinical characteristics and pathophysiological of PPS,as well as present the approach in cases with pharyngolaryngeal manifestations. CASE REPORT: We present the clinical case of a male patient with 48 years old, with main complaints of dysphonia, dysphagia and previous history of polio. The patient underwent a diagnostic investigation, in which the voice psychoacoustic findings are described. Laringoscopic, electromyographic and the videoendoscopy of swallowing compatible with PPS. The treatment consisted in phonotherapy in a total of 11 weekly sessions and guidelines for swallowing, with satisfactory improvement of the symptoms. FINAL COMMENTS: The pharyngolaryngeal manifestations of PPS are susceptible to treatment, obtaining satisfactory results, with improvement of life quality of the patients.

S196 – Phonation and Electric Activity in Adductor Dystonia

Objectives To compare the degree of dysphonias severity with the latency between the electrophysiological activation of the TA muscle and the phonation onset in patients with adductor laryngeal dystonia. Methods 21 patients with adductor dystonia and 15 controls underwent laryngeal electromyography (EMG) exam of the left TA muscle. The latency time was registered from rise of the electric activity of the TA muscle until the phonation onset. Perceptual evaluation of voice quality was performed for the study group and judged by consensus of three speech-pathologists/voice specialists. The evaluation considered 4 tasks: 1) sustained vowel /e/ in habitual pitch and loudness; 2) sustained vowel /i/ in ascending and descending glissando; 3) sustained vowel /i/ at high pitch; 4) phrases including words with voiced and voiceless phonemes. The dysphonias severity degree was classified in the following scale: 0 -; no alteration perceived; 1 -; mild degree; 2 -; moderate degree; 3 -; severe degree. The Spearmans Correlation Test was used to compare the latency time values and the dysphonias severity degree (p<0,05). Results The average latency time registered for patients with mild dysphonia was 332ms, for moderate dysphonia it was 426ms, and for the severe group was 791ms (p=0.02*). Conclusions The latency time was significantly and directly related to the degree of dysphonias severity.