Reinaldo Jordão Gusmão

Correlação da qualidade de vida e voz com atividade profissional

As disfonias podem comprometer a qualidade da comunicacao e, por consequencia, a relacao social do individuo e assim afetar sua qualidade de vida. Existe hoje necessidade de protocolos objetivos para avaliacao da qualidade vocal que mensurem suas implicacoes na qualidade de vida do paciente. OBJETIVOS: Relacionar qualidade de vida e voz com o grau de disfonia e o uso profissional da voz em um grupo de pacientes disfonicos. MATERIAL E METODO: Realizou-se estudo clinico prospectivo aplicando-se protocolo internacional para avaliar a qualidade de vida e voz em um grupo de pacientes disfonicos. Realizou-se tratamento estatistico dos resultados considerando-se nao-distincao entre profissionais da voz e nao-profissionais da voz e, em seguida, considerando-se esta distincao profissional. RESULTADOS: A disfonia afetou a qualidade de vida em todos os individuos. Nao houve diferenca estatistica entre os grupos, profissionais da voz e nao-profissionais da voz, quanto ao grau de disfonia. Houve correlacao entre qualidade de vida e grau de disfonia, no entanto, considerando-se os grupos separadamente, esta correlacao foi significativa apenas no grupo de sujeitos nao-profissionais da voz. CONCLUSAO: A disfonia afetou a qualidade de vida em todos os sujeitos independente do uso profissional da voz.

Clinical manifestations in children with tonsillar lymphoma: A systematic review

BACKGROUND The lymphoma is the most common childhood malignancy in the head and neck. Approximately 15% of head and neck lymphomas in children affect the Waldeyers ring. Early diagnosis and treatment are of great importance in the prognosis of tonsillar lymphoma patients. OBJECTIVES To realize a systematic review of the literature on the clinical manifestations present at diagnosis of tonsillar lymphoma in pediatric patients. DATE SOURCE Articles in English, Spanish or Portuguese in the last 15 years about lymphoma in palatine tonsil in children from PubMed/Medline, LILACS, IBECS, Cochrane, SCIELO, BIREME and Scopus. STUDY ELIGIBILITY CRITERIA It was included articles and case reports that covered the pediatric age group, up to 18 years old and that contained information of the clinical manifestations of tonsillar lymphoma at diagnosis. RESULTS We found 87 articles of which 18 were included; there were 66 cases of lymphoma of palatine tonsils. The most common clinical manifestations found in children with lymphoma in palatine tonsils were unilateral tonsillar enlargement (72.7%), alteration in appearance of the tonsil (45.4%) and cervical lymphadenopathy (30.3%). The presence of B symptoms occurred in only 16% of the patients. Burkitt was the most common type of lymphoma found. CONCLUSION The most common clinical manifestations of lymphoma in palatine tonsil are the tonsils asymmetry, alteration in the appearance of the mucous and cervical lymphadenopathy. A detailed description of cases of lymphoma in palatine tonsils and the use of criteria for classification of tonsillar asymmetry are important for future revisions.

Lingual frenulum: changes after frenectomy

OBJETIVO: Descrever as mudancas ocorridas apos a frenectomia com relacao a mobilidade e funcoes da lingua. METODOS: Foram avaliados 53 sujeitos, os quais nunca haviam se submetido a fonoterapia ou a cirurgia do frenulo. Um protocolo com escores especificos para avaliacao do frenulo lingual foi utilizado para avaliar os sujeitos com evidencias de alteracao neste aspecto. Foi encontrada alteracao em dez sujeitos, que foram encaminhados a um otorrinolaringologista para frenectomia. Apos a cirurgia, esses sujeitos foram reavaliados pelo fonoaudiologo utilizando-se o mesmo protocolo. Fotos e videos foram usados para comparacao. RESULTADOS: Trinta dias apos a cirurgia, os sujeitos apresentaram a forma da ponta da lingua modificada, assim como os movimentos melhorados. O fechamento labial e a fala tambem melhoraram. CONCLUSAO: A frenectomia e eficiente para melhorar a mobilidade e a postura da lingua, assim como suas funcoes, incluindo a producao da fala.PURPOSE To describe the changes after frenectomy concerning mobility and functions of the tongue. METHODS Participants were 53 subjects who had never undergone speech therapy or lingual frenulum surgery. A specific lingual frenulum protocol with scores was used by speech-language pathologists when there was evidence of frenulum alteration. Ten subjects had abnormal frenulum and were referred to an otolaryngologist for frenectomy. After surgery, the subjects were re-evaluated using the same protocol. Photos and videos were taken for comparison. RESULTS Thirty days after surgery, the subjects had the shape of the tip of the tongue and its movements improved. Lip closure and speech were also improved. CONCLUSION Frenectomy is efficient to improve tongue posture, tongue mobility, oral functions, and oral communication.

Primary Sjögren's syndrome in children: Is a family approach indicated?

Sjo¨grens syndrome (SS) is a chronic autoimmune diseaseprimarily affecting the lachrymal and salivary glands withvarying degrees of systemic involvement. SS can be isolated(primary SS or pSS) or associated with other autoimmunediseases, such as rheumatoid arthritis, systemic lupuserythematosus, or scleroderma (secondary SS). pSS pre-dominantly affects middle-aged women and is uncommonin childhood.

Association between unilateral tonsillar enlargement and lymphoma in children: A systematic review and meta-analysis.

Lymphoma is the most common head and neck malignancy in children, and palatine tonsils asymmetry is the most frequent clinical manifestation of tonsillar lymphoma. However, several studies with children with tonsillar asymmetry found no case of lymphoma, showing that the relationship of tonsillar asymmetry with lymphoma is unclear. In this review, we aimed to identify the association between tonsillar asymmetry and tonsillar lymphoma in children by conducting systematic reviews of the literature on children with palatine tonsil lymphoma and tonsillar asymmetry. Articles comprising the paediatric age group (up to 18 years) with information concerning clinical manifestations of tonsillar lymphoma or the diagnosis of the tonsillar asymmetry were included. The main cause of asymmetry of palatine tonsils was lymphoid hyperplasia, followed by lymphoma and nonspecific benign changes. The asymmetry of tonsils was present in 73.2% of cases of lymphoma. There was an association between asymmetric palatine tonsils and lymphoma, with a likelihood ratio of 43.5 for children with asymmetry of palatine tonsils and 8938.4 for children with asymmetry of tonsils and other signs of suspicion for malignancy. We also provide recommendations on the management of suspicious cases of palatine tonsil lymphoma.

Histological Characteristics of Altered Human Lingual Frenulum

Aim: The aim of this study was to describe the histological characteristics of altered human lingual frenulum. Materials and Methods: Between March and July, 2011, 50 children between 6 months and 4 years of age were assessed by a Speech Language Pathologist in a Public Health Care Service in Brotas - Sao Paulo, Brazil. The lingual frenulum evaluation protocol proposed by Marchesan (2010, 2012) was administered to the 50 children - 26 male and 24 female. Of the 50, 8 children had lingual frenulum alterations. The 8 children with lingual frenulum alteration underwent lingual frenectomy. The materials for analyses were taken from 7-micrometer-thick tissues sections. Staining was employed using haematoxylin paired with eosin (H&E), Massons trichrome and picrosirius red. Results: The assessment of the lingual frenulum indicated that 8 children had lingual frenulum alteration. Surgery was performed and the material collected was submitted to analyses. The histological analyses demonstrated that the lingual frenulum of children with ankyloglossia or with short frenulum had bundles of striated skeletal muscle fibers, high frequency of type I collagen in the deep layers and compact bundles of elastic fibers positioned near the epithelial lining. Bundles of muscle fibers were not observed in anterior frenulum and short frenulum with anterior fixation. Type I collagen and bundles of elastic fibers sparse and far from the epithelial lining were observed in those types of frenulum. Conclusion: The analysis of the histological sections demonstrated the characteristics of altered human lingual frenulum.

Validade e confiabilidade da triagem: “teste da linguinha”

Objetivo: verificar as propriedades psicometricas de validade e confiabilidade, bem como a sensibilidade, especificidade e valores preditivos da Triagem Neonatal proposta a partir do Protocolo de Avaliacao do Frenulo da Lingua em Bebes. Metodos: estudo experimental retrospectivo, utilizando os dados de 100 bebes. Os bebes foram avaliados nas primeiras 48 horas por meio da triagem e com 30 dias utilizando o Protocolo de Avaliacao do Frenulo da Lingua em Bebes. As imagens e dados de todos os bebes foram coletados pela fonoaudiologa (A1) e analisados pela fonoaudiologa (A2). Os casos com alteracao do frenulo foram submetidos a frenotomia, reavaliados 30 dias apos o procedimento e acompanhados ate o 6o mes. Os dados foram utilizados para as etapas de validacao: analise de concordância entre examinadores; analise de concordância intra-examinador; validade de criterio; analise da validade de construto; analise de sensibilidade, especificidade, valores preditivos positivo e negativo. Os dados foram submetidos ao tratamento estatistico. O estudo foi aprovado pelo Comite de Etica em pesquisa sob o numero CAAE 40784315.9.0000.5538. Resultados: a Triagem Neonatal identificou os bebes com alteracao do frenulo e as mudancas ocorridas apos a frenotomia e apresentou bons indices de sensibilidade, especificidade e valores preditivos. A confiabilidade entre e intra-examinadores permite afirmar que os dados obtidos com a triagem sao confiaveis e podem ser reproduzidos. Conclusao: a Triagem Neonatal do Protocolo de Avaliacao do Frenulo da Lingua em Bebes mostrou ser um instrumento valido e confiavel, assegurando acuracia no diagnostico das alteracoes do frenulo lingual em bebes.

The effects of frenotomy on breastfeeding

Although the interference of tongue-tie with breastfeeding is a controversial subject, The use of lingual frenotomy has been widely indicated by health professionals. Objective : To observe changes in breastfeeding patterns after lingual frenotomy concerning the number of sucks, pause length between groups of sucking and mothers complaints. Material and Methods : Oral yes/no questions about breastfeeding symptoms and sucking/swallowing/breathing coordination were answered by the mothers of 109, 30 day old infants. On the same day the infants had their lingual frenulum assessed by administering a lingual frenulum protocol. After the assessment, all tongue-tied infants were referred for frenotomy; nevertheless, only 14 underwent the surgery. Of the 109 infants, 14 infants who did not have frenulum alterations were included as controls. Birth order and gender were the criteria for recruiting the control group. The tongue-tied infants underwent lingual frenotomy at 45 days of age. At the conclusion of the frenotomy, the infants were breastfed. At 75 days old, both groups – control and post-frenotomy – were reassessed. Before the reassessment the same oral yes/no questions were answered by the mothers of the 14 infants who underwent frenotomy. The mothers of the control group answered the questionnaire only at the time of the first assessment. Data were subjected to statistical analysis. Results : After frenotomy, the number of sucks increased and the pause length between sucking decreased during breastfeeding. The controls maintained the same patterns observed in the first assessment. From the questionnaire answered by the mothers of the 14 tongue-tied infants, at 30 days and 75 days, we observed that the symptoms concerning breastfeeding and sucking/swallowing/breathing coordination were improved after lingual frenotomy Conclusions : after lingual frenotomy, changes were observed in the breastfeeding patterns of the the tongue-tied infants while the control group maintained the same patterns. Moreover, all symptoms reported by the mothers of the tongue-tied infants had improved after frenotomy.

Linfoma tonsilar em crianças com assimetria tonsilar

Instituicao: Departamento de Otorrinolaringologia, Cabeca e Pescoco do Hospital da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil 1Medico Residente em Otorrinolaringologia da Disciplina de Otorrinolaringologia, Cabeca e Pescoco da Faculdade de Ciencias Medicas da Unicamp, Campinas, SP, Brasil 2Mestre em Medicina pela Faculdade de Ciencias Medicas da Universidade Nova de Lisboa, Lisboa; Medico Residente em Otorrinolaringologia da Disciplina de Otorrinolaringologia, Cabeca e Pescoco da Faculdade de Ciencias Medicas da Unicamp, Campinas, SP, Brasil 3Doutor em Ciencias Medicas pela Unicamp; Chefe do Servico de Otorrinolaringologia Pediatrica da Unicamp e do Departamento de Oftalmologia/Otorrinolaringologia da Faculdade de Ciencias Medicas da Unicamp, Campinas, SP, Brasil RESUMO

Nasolaryngoscopy or laryngotracheoscopy: which is the best exam for assessing the airways of children?

UNLABELLED It is not uncommon to find children with respiratory distress. In these cases airway endoscopy is usually required. Doubts about which examination should be used are frequent. AIM to establish which examination is the best to assess the airways of children. MATERIAL AND METHODS a retrospective study assessing 16 children with a history of respiratory distress at the Children Airway Unit of the Pediatric Otolaryngology Department at UNICAMP. All patients underwent nasolaryngoscopy and laryngotracheoscopy between March 2001 and March 2004. Data was analyzed and compared. RESULTS during this study 16 children were assessed; the most frequent indication of exams were: evaluation of prolonged tracheostomy in 10 patients (62%), and subglottic stenosis (31.3%). CONCLUSION assessing airways in children with respiratory distress is essential for a diagnosis. In our study, we concluded that all children with upper airway disease must undergo nasolaryngoscopy, an easy, economic and useful exam that provides information about larynx function. However, if subglottic or traqueal disease issuspected, or if nasolaryngoscopy findings are in conflict with the physical examination, laryngotracheoscopy should be undertaken.