Quality of life and depression in patients undergoing total and partial laryngectomy.

PURPOSE: The surgical treatment of head and neck cancer, primarily laryngeal cancer, causes sequelae and can change the patient's quality of life. The purpose of this study was to investigate the impact of laryngectomy on the quality of life regarding the functional, physical, psychological, and social aspects. METHODS: Fourteen patients underwent total laryngectomy and 16 underwent vertical partial laryngectomy. The Quality of Life Core Questionnaire (QLQ-C30) and Head and Neck (H&N35) questionnaire from the European Organization for Research and Treatment of Cancer (EORTC) were used for quality of life evaluation, while the Beck Depression Inventory questionnaire was used for the depression screen. RESULTS: In the total laryngectomy group, reported adverse effects were worsened, social and emotional function (21.3%), olfaction and taste changes (85.6%), cough (71.3%), speech difficulty (100%), and dysphagia (64.3%). Most of the patients (85.5%) judged their quality of life to be reasonable. In the partial laryngectomy group, reported adverse effects were worsened, emotional function (71.4%), speech difficulty (100%), and dysphagia (31.3%). However, most of the patients judged their quality of life to be above the general average. CONCLUSION: Despite being different surgeries, both groups experienced similar difficulties but at different levels. The quality of life was judged worse in the patients who underwent total laryngectomy.

Voice and swallowing in patients enrolled in a larynx preservation trial.

BACKGROUND: The main goals of larynx preservation protocols are preservation of a functional larynx with intact voice and maintenance of normal deglutition. However, few studies have addressed functional outcomes. OBJECTIVES: To evaluate voice and swallowing in patients enrolled in a larynx preservation protocol. DESIGN AND SETTING: Acoustic analysis of 15 patients and videofluoroscopic evaluation of 14 patients who underwent chemoradiotherapy in an attempt to preserve the larynx. PATIENTS: Forty-three patients with larynx or hypopharynx squamous cell carcinomas were treated with weekly paclitaxel (30 mg/m2) and cisplatin (20 mg/m2) concurrent to radiotherapy (180-rad/d fraction [1.8 Gy] to 7040 rad [70.4 Gy]). Voice was analyzed perceptually and acoustically in 15 patients. Videofluoroscopic evaluation of swallowing was performed in 14 patients, focusing on oropharyngeal motility disorders, stasis, laryngeal penetration, aspiration, and dysphagia severity. RESULTS: Vocal analysis produced normal results in 1 patient, mild dysphonia in 4, moderate dysphonia in 6, and severe dysphonia in 4. The mean fundamental frequency for acoustic analysis was 131.4 Hz for men and 109.8 Hz for women. Acoustic measures of perturbation and noise were above the reference limits, indicating changes in the voice signal. Swallowing analysis showed inefficient bolus preparation in 13 patients and changes in the bolus propulsion in 12. Stasis was observed in all areas of the oropharynx. Five patients had reduction in laryngeal elevation, and 12 had stasis in the hypopharynx. Five patients presented with silent aspiration. We detected functional swallowing in 3 patients, mild dysphagia in 7, mild or moderate dysphagia in 2, and severe dysphagia in 2. CONCLUSIONS: Laryngeal preservation resulted in voice and swallowing abnormalities, but they tend to be mild to moderate, allowing intelligible communication and efficient swallowing in most patients.

Characterization of the communication resources used by patients in palliative care - an integrative review / Caracterização dos recursos de comunicação utilizados por pacientes em cuidados paliativos - revisão integrativa

ABSTRACT The aim of this study was to integrative review of publications concerning the role of speech and language therapists in regards to communication strategies in palliative care, as well as the characterization of the types of communication used in these cases. The search was conducted in the databases SciELO, LILACS and PubMed from 2001 to 2016. The studies selected included abstracts or full articles addressing aspects of communication in palliative care, especially those related to speech and language therapy, with an emphasis on communication. Ten articles focused on communication, and published after 2004, were selected, half being literature reviews, two, case reports, two others, quantitative exploratory studies, and one, a qualitative exploratory study, with only 3 specifically describing the communication strategies used by speech and language therapists in patients in palliative care. The descriptors found were: palliative care, communication, speech and language therapy, quality of life, dysphagia, swallowing and elderly. Four of the ten articles showed the importance of patients communication in palliative care. When described, it is up to the speech and language therapist to provide family support, evaluate the patient, favore patient-family and patient-team intervention, manage and intervene in communication and swallowing. Finally, the most used communication strategies were non-verbal communication, communication board, electronic equipment, verbal communication and speech valve. The analysis of the characterization of the communication in palliative care over the past 15 years allowed concluding that the attention to communication is recent and is only described in a few reports, includes non-verbal communication in different ways as the most frequent resource, but provides oral communication as an important factor for maintaining dignity and comfort in this scenario. Speech and language therapist are the main interlocutors for the maintenance, mediation and adaptation of communication, within the multidisciplinary team as well as among patients, their family and the care team.

RESUMO O objetivo foi realizar uma revisão integrativa das publicações referentes ao papel do fonoaudiólogo em relação às estratégias de comunicação em cuidados paliativos, bem como a caracterização das formas de comunicação utilizadas nesses casos. As buscas foram realizadas nos bancos de dados da SciELO, LILACS e PubMed no período de 2001 a 2016. Foram selecionados os estudos cujos resumos, ou textos na íntegra, abordavam aspectos da comunicação em cuidados paliativos, principalmente os relacionados com a atuação fonoaudiológica, com ênfase em comunicação. Foram selecionados 10 artigos, com enfoque em comunicação, a partir de 2004, sendo metade de revisão bibliográfica, dois relatos de caso, outros dois exploratórios quantitativos e um exploratório qualitativo, com apenas 3 deles descrevendo especificamente as estratégias de comunicação utilizadas por um fonoaudiólogo com pacientes em cuidados paliativos. Os descritores encontrados foram: cuidados paliativos (Palliative care), comunicação (communication), fonoaudiologia, qualidade de vida, disfagia, deglutição e idoso. Quatro dos dez artigos apontaram a importância da comunicação dos pacientes em cuidados paliativos. Quando descrito, compete ao fonoaudiólogo: oferecer suporte familiar, avaliar o paciente, favorecer a intervenção paciente-família e paciente-equipe, gerenciar e intervir na comunicação e deglutição. Finalmente, as estratégias de comunicação mais utilizadas foram: comunicação não verbal, prancha de comunicação, equipamentos eletrônicos, comunicação verbal e válvula de fala. A análise da caracterização da comunicação em cuidados paliativos nos últimos 15 anos permitiu concluir que a atenção à comunicação é recente, com poucos relatos ainda descritos, inclui a comunicação não verbal de diferentes maneiras como o recurso mais frequente, mas prevê a comunicação oral como um importante fator para a manutenção da dignidade e conforto nesse cenário. O fonoaudiólogo é o principal interlocutor para a manutenção, mediação e adaptação da comunicação, tanto entre equipe multiprofissional, quanto entre o paciente, sua família e a equipe de cuidado.

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.

[Swallowing after non-surgical treatment (radiation therapy / radiochemotherapy protocol) of laryngeal cancer]. / 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.

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.

Voice and swallowing disorders: functional results and quality of life following supracricoid laryngectomy with cricohyoidoepiglottopexy.

We conducted a prospective study of 11 patients with laryngeal cancer who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. Our goal was to evaluate their postoperative voice and swallowing function and to ascertain the impact that surgery had on patient-perceived quality of life. Postoperative assessments were made by auditory perception analyses, objective voice analyses, the Voice Handicap Index questionnaire, the Quality of Life in Swallowing Disorders questionnaire, and videofluoroscopy. Following surgery, 8 patients experienced severe dysphonia and 3 experienced moderate dysphonia. Also, 5 patients experienced mild to severe dysphagia whereas 6 patients experienced normal or near-normal swallowing function. Postoperative acoustic measurements were higher than expected, and spectrographic evaluation revealed the presence of high-grade noise without predominant concentration over the spectrum. Some association with the grade of dysphonia and self-perception of voice handicap was observed. With regard to swallowing, 5 patients (45.5%) showed a decrease in laryngeal remnant elevation and a slight or moderate degree of stasis in the oropharynx. Overall, patients reported good quality of life regarding both voice and swallowing. No relationship between the functional swallowing and the number of preserved arytenoid cartilages was observed.

Videolaringoestroboscopia e avaliação vocal em pacientes portadores de artrite reumatoide / Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

A artrite pode afetar a laringe com rouquidão e fadiga vocal. OBJETIVO: Avaliar as manifestações laríngeas da artrite reumatoide. MÉTODOS: Estudo prospectivo de 27 pacientes com artrite reumatoide por meio de videolaringoestroboscopia, avaliação perceptivo-auditiva da voz por meio da escala GIRBAS, análise acústica e questionário do Índice de desvantagem vocal. RESULTADOS: Queixas laríngeas foram descritas por 19 pacientes, principalmente disfonia intermitente e sensação de corpo estranho na garganta. O achado laringoscópico mais frequente foi o cavalgamento das aritenoides. Três pacientes apresentaram pitch considerada grave. Nove tiveram o grau de disfonia e rugosidade discretos. As medianas das medidas acústicas foram: F0, 198,39 Hz; Jitter, 0,815; Shimmer, 4,915; e NHR, 0,144. Em relação ao índice de desvantagem vocal, a mediana foi zero para todos os domínios. Existiu significância estatística relacionando a queixa vocal com todos os domínios desse índice. A classe funcional teve relação estatisticamente significante com: cavalgamento de aritenoides (p = 0,001), PPQ (p = 0,0257), Shimmer (p = 0,0295), APQ (p = 0,0195) e com o domínio físico e total do IDV (p = 0,0227 e p = 0,0425). CONCLUSÃO: Queixa laríngea foi referida por 70,4% dos pacientes e alterações laringoscópicas foram verificadas em 48%. A avaliação acústica da voz e a autopercepção mostraram-se alterados.

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 / Swallowing after non-surgical treatment (radiation therapy / radiochemotherapy protocol) of laryngeal cancer

O tratamento radioterápico/ radioquimioterápico para tumores de laringe pode ocasionar sequelas na deglutição. OBJETIVO: Avaliar características da deglutição de pacientes tratados por radioterapia/ radioquimioterapia para tumores de laringe. MATERIAL E MÉTODO: Estudo prospectivo com 20 indivíduos, idade média de 62 anos, após término do tratamento oncológico. Destes, 6 (30 por cento) foram tratados por radioterapia exclusiva e 14 (70 por cento) por radioquimioterapia. O tempo médio decorrido do tratamento médico ao momento da avaliação fonoaudiológica foi de 8,5 meses. Foi realizada avaliação videofluoroscópica da deglutição orofaríngea e analisados eventos das fases preparatória, oral e faríngea da deglutição. RESULTADOS: Todos os pacientes se alimentavam com via oral exclusiva. Apenas 25 por cento da amostra apresentavam deglutição dentro dos limites da normalidade. A videofluoroscopia da deglutição identificou os seguintes eventos alterados: formação do bolo (85 por cento), ejeção do bolo (60 por cento), estases na cavidade oral (55 por cento), alteração no início da fase faríngea (100 por cento), redução da elevação da laringe (65 por cento) e estase em hipofaringe (80 por cento). A penetração laríngea foi diagnosticada em 25 por cento dos casos e 40 por cento penetrações seguidas de aspirações traqueais. O grau de penetração/ aspiração foi considerado discreto em 60 por cento, porém em 35 por cento da amostra a aspiração foi silenciosa. Embora 75 por cento da amostra apresentassem algum grau de disfagia, apenas 25 por cento dos pacientes referiam queixa de deglutição. CONCLUSÃO: Pacientes com câncer de laringe tratados com radioterapia/ radioquimioterapia podem apresentar alterações em todas as fases da deglutição, mesmo na ausência de sintomas.

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 percent) underwent radiation therapy, and 14 patients (70 percent) 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 percent of patients. The swallowing videofluoroscopic examination identified the following changes: bolus formation (85 percent), bolus ejection (60 percent), oral cavity stasis (55 percent), changes in the onset of the pharyngeal phase (100 percent), decreased laryngeal elevation (65 percent), and hypopharyngeal stasis (80 percent). Laryngeal penetration was observed in 25 percent of the cases; 40 percent presented tracheal aspiration. The grade of penetration/aspiration was mild in 60 percent of cases. Aspiration was silent in 35 percent of patients. Although 75 percent of patients had dysphagia, only 25 percent 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.

Voice and vocal self-assessment after thyroidectomy.

BACKGROUND: Voice alterations after thyroidectomy can be found even with preserved function of laryngeal nerves. The purpose of this study was to evaluate voice before and after thyroid surgery and the role of orotracheal intubation on voice changes. METHODS: We conducted a prospective nonrandomized study of patients who underwent thyroid surgery and compared the results with a control group of patients who underwent breast surgery. Subjects underwent a videolaryngoscopic exam, a subjective and an objective voice analysis and a Voice Handicap Index (VHI) questionnaire before and after surgery. RESULTS: A total of 100 patients who underwent thyroidectomy and 30 who underwent breast surgery were studied. Both groups were similar in demographic, clinical, and surgical variables. Postoperative videolaryngoscopy showed larynx alterations in 28% of the thyroidectomized patients, without significant alterations in the control group. There were subjective voice changes in 29.7% of the patients without vocal fold immobility after thyroid surgery and no statistically significant changes after breast surgery. Acoustic analysis showed significant increased values in the voice turbulence index (VTI) parameter in both groups, although higher in the thyroid one. In the VHI assessment, voice complaints were more frequently registered in the thyroid group rather than in the control group. CONCLUSIONS: Voice alterations are frequent after thyroidectomy even with preserved vocal fold mobility. Such alterations were more frequently detected in that group than in patients who underwent breast surgery. Orotracheal intubation is just one of the multiple factors involved.

Swallowing and quality of life after total laryngectomy and pharyngolaryngectomy / 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. 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 percent), being mild in 66.6 percent and moderate/severe in 33.3 percent. 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.

A disfagia pode ser uma das consequências após a laringectomia total mesmo na ausência de sintomas e comprometer direta ou indiretamente a qualidade vida. OBJETIVO: Avaliar as características da deglutição após a laringectomia total e faringolaringectomia com fechamento em T e correlacionar com o questionário Quality of Life in Swallowing Disorders. MATERIAL E MÉTODO: Estudo prospectivo através da avaliação de 28 pacientes, quinze submetidos à laringectomia total e treze à faringolaringectomia. A deglutição foi avaliada através da videofluoroscopia em relação às fases preparatória, oral e faríngea e o questionário de qualidade de vida relacionada à deglutição foi aplicado para mensurar a qualidade de vida. RESULTADOS: Na avaliação videofluoroscópica foram observadas alterações anatômicas e funcionais. A disfagia foi diagnosticada em 18 (64,3 por cento) dos pacientes, sendo 66,6 por cento de grau discreto e 33,3 por cento de grau moderado/severo. O questionário indicou boa qualidade de vida em quase todas as escalas. As queixas de deglutição apresentaram associação com o questionário nas escalas fardo (p=0,036) e saúde mental (p=0,031). O questionário indicou impacto na escala saúde mental para os pacientes com disfagia de grau severo (p=0,012). CONCLUSÃO: Observamos grande incidência de disfagia de grau predominantemente discreto com repercussão em algumas escalas da qualidade de vida.

Voz, deglutição e qualidade de vida de pacientes com alteração de mobilidade de prega vocal unilateral pré e pós-fonoterapia / Voice, deglutition and quality of life of patients with unilateral vocal cords mobility alteration prior and post speech therapy

OBJETIVO: Investigar as contribuições da fonoterapia na voz, na deglutição e na qualidade de vida de pacientes com alteração unilateral de mobilidade de prega vocal. MÉTODOS: Os sujeitos foram 13 pacientes, de ambos os sexos, com alteração unilateral de mobilidade de prega vocal. Foi realizado um levantamento da história clínica, dos dados de avaliação pré e pós-fonoterapia e da qualidade de vida dos mesmos a partir dos prontuários, das fitas de exame e das gravações de exames. RESULTADOS: Após a intervenção fonoaudiológica foi possível observar: nove pacientes apresentaram melhora da qualidade vocal após fonoterapia; todos os pacientes apresentaram melhora em pelo menos um parâmetro da avaliação acústica; dez pacientes apresentaram classificação dentro dos limites de normalidade em relação à escala de severidade da disfagia e nove em relação à escala de penetração/aspiração; seis pacientes referiram menor desvantagem vocal; nove pacientes referiram menor impacto da disfagia na qualidade de vida. CONCLUSÃO: Os resultados apontam melhoras na voz, na deglutição, na limitação vocal e na qualidade de vida relacionada à deglutição após fonoterapia. Pode-se dizer que a fonoterapia parece ser efetiva na melhora da voz, da deglutição, do nível de desvantagem vocal e da qualidade de vida em deglutição de pacientes com alterações na mobilidade das pregas vocais.

PURPOSE: To investigate the contributions of speech therapy in voice, deglutition and quality of life of participants with unilateral vocal cords mobility alteration. METHODS: The subjects were 13 patients, both genders, with unilateral vocal cords mobility alteration. A research of clinical history, evaluation prior and post speech therapy and quality of life was carried out based on protocols, exam tapes and recordings from the participants' files. RESULTS: After speech therapy, it was possible to observe that: nine participants had better vocal quality at the end of the intervention process; all participants showed improvement of at least one parameter of the acoustic evaluation; ten participants were classified as within normality regarding the dysphagia severity scale and nine regarding the penetration/aspiration scale; six patients referred less vocal disadvantage; nine subjects referred less impact of dysphagia in quality of life. CONCLUSION: Results showed improvements in voice, deglutition, vocal handicap and quality of life related to the deglutition after speech therapy. It can be concluded that speech therapy seems to be effective for voice, deglutition, vocal handicap and quality of life improvement of patients with vocal cords mobility alteration.

An Evaluation of Speech Therapist Quality of Care at Oncology Hospitals

Introduction: Although speech pathology work becomes ever more representative of different perspectives, it has not implementedthe routine of service quality evaluation. Objective: To evaluate the speech patology quality of care in oncology hospitals afterdefining parameters associated to it. Materials and Methods: The study is a sur vey of clinical and rehabilitation data in voiceand/or swallowing treatment protocols and patients histories evaluated and submitted to speech therapy from 2000 to 2005.With the purpose of measuring the quality of care given to 551 selected patients, subjective parameters for evaluation ofspeech therapy rehabilitation were established. Results: The evolution of the patients voice and/or swallowing condition wasclassified from good to excellent in 62.7% of patients even so only 17.6% have received therapy discharge; 61.8% of the 374patients who had abandoned treatment had a satisfactory evolution in rehabilitation. Factors like sex, age, marital status,staging, and tumor localization are predictive as regards rehabilitation adherence as well as the evolution of the condition.Conclusion: Results gave a measure of the speech therapy quality of care in oncology hospitals and indicated associatedpredictive factors.

Alaryngeal Communication Effectiveness And Long-term Quality Of Life

Background: Primary or salvage total laryngectomy is a surgical procedure used to treat patients with advanced-stage larynxand hypopharynx cancer. The resultant alaryngeal communication is usually considered unsatisfactory and a profound impairment.Objectives: The purpose of this study was to evaluate the efficacy of alaryngeal communication after total laryngectomy andits association with long-term quality of life evaluation. Material and Methods: 82 patients with squamous cell carcinoma ofthe larynx and hypopharynx underwent a total laryngectomy associated or not with irradiation therapy. The type of alaryngealcommunication was 18 (21.9%) tracheoesophageal voice, 12 (14.6%) esophageal speech, 11 (13.4%) electrolarynx and 41(50%) non-vocal. Communication effectiveness was judged according perceptual, acoustic and temporal parameters. TheEuropean Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC QLQ-C30) was used tomeasure quality of life. Results: Tracheoesophageal voice was considered good in 13 cases (72.2%), moderate in 4 (22.2%)and poor in 1 (5.6%); esophageal speech, good in 2 (16.7%), moderate in 8 (66.6%) and poor in 2 (16.7%); electrolarynx, goodin 1 (9.1%), moderate in 9 (81.8%) and poor in 1 (9.1%); non-vocal communication, 100% poor. Total range of QLQ score variedfrom 8.3 to 100 (median, 75). Total QLQ scores were not associated with the effectiveness of communication (p=0.2512).Conclusion: Tracheoesophageal voice was more effective than esophageal speech or electrolarynx, but surprisingly alaryngealcommunication was not considered by the patients essential to maintain or improve long- term quality of life.

Quality of life and depression in patients undergoing total and partial laryngectomy

OBJETIVO: O tratamento cirúrgico para o câncer de cabeça e pescoço, especificamente para o câncer de laringe, deixa seqüelas nos pacientes podendo alterar sua qualidade de vida. O objetivo deste estudo foi pesquisar o impacto na qualidade de vida, no que diz respeito aos aspectos funcionais, físicos, psicológicos, sociais e o rastreamento da depressão. MÉTODO: Foram estudados 14 pacientes submetidos a laringectomia total e 16 pacientes submetidos a laringectomia parcial vertical. Para a avaliação da qualidade de vida utilizamos os questionários da Organização Européia de Pesquisa e Tratamento do Câncer (EORTC), Quality of Life Core Questionnarie (QLQ-C30) e Head and Neck 35 (H&N35) e, para o rastreamento da depressão, o questionário Beck Depression. RESULTADOS: As funções social e emocional foram as mais afetadas no grupo de laringectomia total. 21,3% dos pacientes julgaram mediana sua qualidade de vida global. Dentro dos sintomas específicos, 85,5% referiram alteração no olfato e paladar, 71,3% tosse, 100% algum grau de dificuldade na fala e 64,3% dificuldades com a deglutição. No grupo de laringectomia parcial encontramos a função emocional afetada em 71,4%, a maioria julgou sua qualidade de vida global acima da média, 100% demonstraram algum grau de dificuldade com a fala e 31,3% referiram disfagia. CONCLUSAO: Embora sendo cirurgias diferentes, ambos os grupos passaram por dificuldades similares em maior ou menor grau. Os resultados demonstraram piora nos parâmetros de qualidade de vida dos pacientes submetidos a laringectomia total.

Implicações da traqueostomia na comunicação e na deglutição: [revisão] / Trcheotomy implication upon communication and swallowing: [review]

Nas últimas duas décadas, pesquisadores e clínicos têm-se preocupado com o impacto da traqueostomia na respiração, comunicação e deglutição. A traqueostomia está associada ao aumento do risco da aspiração e a decanulação irá melhorar a qualidade das funções. Nos casos de fácil oclusão da traqueostomia, é necessário gradativamente aumentar o tempo de oclusão e observar o quadro clínico respiratório. A sequência irá variar de acordo com a doença de base e as condições respiratórias. O impacto da traqueostomia na fisiologia da deglutição pode ser mecânico e/ou funcional.

In the last two decades, researchers and clinicians have been concerned to the impact of tracheotomy upon the respiration, communication and swallowing. The tracheotomy is associated to the increased risk of aspiration, and the decanulization can improve the functions quality. In those cases with easy occlusion of the tracheotomy, it is necessary gradually increasing the occlusion time and to observe the respiratory clinical condition. The sequence will vary according to the basic disease and the respiratory situation. The impact of the tracheotomy on the swallowing physiology can be both mechanical and/or functional.

Sintomas e sinais de alterações da deglutição após a tireoidectomia / Symptoms and signs of swallowing changes after thyroidectomy

Introdução: Sintomas e sinais clínicos de alteração de deglutição podem manifestar-se em pacientes com doença da tireóide. Objetivo: Caracterizar os sintomas e sinais de deglutição pré e pós-tireoidectomias. Métodos: Estudo prospectivo com 40 pacientes agendados para cirurgia de tireóide, submetidos à avaliação clínica da deglutição em três momentos: pré-operatório, pós-operatório imediato e pós-operatório tardio. Foi realizada anamnese para estudo dos sintomas e aplicada avaliação clínica da deglutição com 200mL de líquido contínuo e sólido. Resultados: Participaram 40 pacientes submetidos à tireoidectomia, sendo que 35 (87,5%) foram submetidos à tireoidectomia total e cinco à tireoidectomia parcial (12,5%). Na anamnese, os sintomas foram referidos nos três momentos do estudo, sendo 19 (47,5%) no pré-operatório, 26 (65%) no pós-imediato e 17 (48,5%) no pós-operatório tardio. A avaliação clínica da deglutição detectou a presença de alterações em dez (25%) no período pré-operatório, oito (20%) no pós-operatório imediato e cinco (14%) no pós-operatório tardio. Pacientes com nódulo de tamanho ? 3cm apresentaram maior ocorrência de sintomas e sinais clínicos de alteração de deglutição em todos os momentos do estudo. Conclusões: Pacientes com doença da tireóide podem apresentar sintomas e sinais clínicos desde o pré-operatório, com uma tendência a reduzir até o pós-operatório tardio.

Introduction: Clinical symptoms and signals of deglutition changes can be referred to by patients with thyroid diseases. Objectives: To characterize the swallowing symptoms and signals before and after the thyroidectomy. Methods: Prospective study with 40 patients undergoing thyroid surgery, submitted to the clinical evaluation of the deglutition in 3 moments: preoperative, early and late postoperative periods. The anamnesis and the clinical evaluation of the continuous swallowing of 200mL of liquid and solid consistence were applied. Results: Among the 40 patients, 35 patients (87.5%) underwent total thyroidectomy and 5 underwent partial thyroidectomy (12.5%). The symptoms were referred to in the 3 periods of the study, being 19 (47.5%) in the preoperative, 26 (65%) in the early postoperative and 17 (48.5%) in the late postoperative. The clinical evaluation of the deglutition detected the presence oh changes in 10 (25%) in the preoperative, 8 (20%) in the early postoperative and 5 (14%) the late postoperative periods. Patients with nodule larger than 3cm presented higher occurrence of clinical symptoms and signals of deglutition changes in all moments. Conclusion: Patients with thyroid diseases can present clinical symptoms and signals since the preoperative period, with some trend of decreasing till the late postoperative period.

Correlação entre os achados estroboscópicos, perceptivo-auditivos e acústicos em adultos sem queixa vocal / Correlation among stroboscopic, perceptual and acoustic analysis findings in adult subjects without vocal complaint

Os grandes avanços na compreensão da fisiologia vocal e o desenvolvimento científico e tecnológico na área de voz permitiram transpor o limite terapêutico através dos meios para a detecção precoce de alterações vocais. OBJETIVO: Avaliar indivíduos sem queixa vocal e correlacionar possíveis achados telelaringo-estroboscópicos, perceptivo-auditivos e acústicos. FORMA DE ESTUDO: Observacional coorte com corte transversal. CASUíSTICA E MÉTODO: Foram avaliados 21 indivíduos do sexo masculino, com idade variando de 20 a 50 e mediana de 33 anos, sem queixas vocais, que não faziam uso de tabaco nem de destilados. Os sujeitos foram submetidos às avaliações telelaringo-estroboscópica, perceptivo-auditiva e acústica da voz. RESULTADOS: Do total de sujeitos avaliados, 57,15 por cento apresentaram alteração em uma ou mais das avaliações realizadas. A telelaringo-estroboscopia, observou-se fenda vocal triangular posterior em 4 sujeitos. Dez apresentaram alteração na análise perceptivo-auditiva, observando-se os seguintes parâmetros: instabilidade, rouquidão e soprosidade, todos em grau discreto. Na avaliação da ressonância, três apresentaram cada foco hipernasal, cul de sac e laringo-faríngea. A avaliação acústica apresentou as seguintes médias: f0 - 125,69 Hz; jitter - 0,22 por cento; shimmer - 3,06 por cento; NNE -12,29 dB; HNR - 20,75 dB; freqüência do tremor - 2,09 Hz; amplitude do tremor - 1,16 Hz. Alguns sujeitos apresentaram valores de shimmer por cento e freqüência do tremor maiores do que a média. CONCLUSÃO: Foram detectadas alterações em 57,15 por cento das avaliações realizadas em indivíduos sem queixas vocais. Esses achados podem ser indicativos de uma variação da normalidade ou representar uma predisposição a alterações glóticas e vocais que, com o passar do tempo, podem desenvolver-se. Em todas as avaliações alteradas houve alteração de parâmetro acústico.

Achados perceptivo-auditivos e acústicos em pacientes submetidos à laringectomia fronto-lateral / Perceptual and acoustic analysis findings in patients undergone frontolateral laryngectomy

Introdução: a análise dos parâmetros vocais é importante na caracterização funcional após realização da laringectomia fronto-lateral. Objetivo: realizar a avaliação perceptivo-auditiva e acústica da voz nesse grupo de pacientes. Métodos: Foram avaliados 20 pacientes, sendo 18 do gênero masculino, com idade média de 61 anos. A avaliação perceptivo-auditiva foi realizada através da escala GIRBAS, enquanto a análise acústica foi feita pelo CSL modelo 4300B e pelo programa de análise vocal MDVP, Kay Elemetrics Corp. Resultados: A análise perceptivo-auditiva da voz revelou que todos os pacientes apresentaram algum grau de disfonia, caracterizado principalmente por rugosidade. Considerando os parâmetros acústicos, observou-se um importante incremento da freqüência fundamental e os valores de todos os parâmetros apresentaram-se alterados. Conclusão: A análise perceptivo-auditiva da voz indicou que todos os pacientes submetidos à laringectomia fronto-lateral apresentaram algum grau de disfonia, caracterizada principalmente pela presença de rugosidade e tensão. Na análise acústica da voz, observou-se incremento da freqüência fundamental e medidas acústicas alteradas.

Introduction: the vocal parameters analysis is important for the functional characterization after the frontolateral laryngectomy. Objective: to evaluate the perceptual and acoustic analysis finding in such patients. Methods: 20 patients were evaluated, being 18 men, and with age average of 61. The voice perceptual evaluation was performed through the GIRBAS scale, whereas the voice acoustic analysis was done through CSL-4300B and the voice analysis through the software MDVP, Kay Elemetrics Corp. Results: Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough voices. The acoustic evaluation showed an important increase in the fundamental frequency, and the values of all parameters were changed. Conclusion: In the voice perceptual evaluation, all patients presented some grade of dysphonia, mainly characterized for the presence of roughness and tension. The voice acoustic analysis showed increased fundamental frequency and altered acoustic measures.

Efetividade da reabilitação fonoaudiológica na comunicação oral e na deglutição em pacientes irradiados devido ao câncer de cabeça e pescoço / The efficacy of voice and swallowing therapy in the voice and swallowing in patients submitted to radiotherapy due to head and neck cancer

OBJETIVO: O objetivo deste estudo foi avaliar os resultados da reabilitação fonoaudiológica, antes, durante e após a radioterapia, na voz e na deglutição de pacientes tratados para câncer de cabeça e pescoço. PACIENTES E MÉTODOS: Foi um estudo prospectivo, onde foram analisados 25 pacientes que foram submetidos à radioterapia exclusiva ou associada à quimioterapia. ... RESULTADOS: Para as variáveis perceptivas, no grupo SF o subgrupo PVE apresentou tendência de permanecer igual ou apresentar melhora em relação ao grau da disfonia, rouquidão e articulação. O subgrupo PVP apresentou, pelo menos em 1 momento de análise, piora de alguma variável. No grupo CF, ambos os subgrupos demonstraram resultados semelhantes ao do grupo SF, embora se observe piora em quase todas as variáveis. Quanto às medidas acústicas no grupo SF, o subgrupo PVE, apresentou as medidas alteradas no primeiro momento com melhora no decorrer do tratamento. O grupo CF manteve as medidas alteradas (shimmer (%), APQ e VTI) nos três momentos de análise. Em relação ao VHI, os pacientes do grupo CF referiram pior desvantagem vocal quando comparados ao grupo SF. Em relação à deglutição, para as fases preparatória e oral, os pacientes do grupo CF pioraram menos do que os pacientes do grupo SF. Quanto à fase faríngea, não foi observado diferença entre os grupos. Quanto à qualidade de vida relaciona à deglutição, os pacientes do grupo CF apresentaram melhores resultados. CONCLUSÕES: Os resultados obtidos neste estudo indicam que a terapia vocal antes, durante e logo após a radioterapia, não contribui para melhores resultados vocais. Em relação à deglutição a intervenção fonoaudiológica pode ser útil na redução da incidência das alterações no decorrer do tratamento radioterápico...

OBJECTIVE: The objective of this study was to evaluate the results of voice and swallowing therapy before, during and after radiation therapy, in voice and swallowing in patients treated for head and neck cancer. PATIENTS AND METHODS: It was a prospective study of the series of cases, in which 25 patients, who have been submitted to radiation therapy alone, or in concomitant with chemotherapy, were analyzed. The patients were distributing into two groups according to admission in the hospital: without therapy (W/OT) and with therapy (WT), and underwent vocal function and swallowing evaluations at three distinct moments: 1. pre-radiation therapy, 2. immediately post-therapy and 3. one month after the end of therapy. To evaluate the results of voice therapy, the patients were classified according to the vocal folds exposure to radiation (EVF = exposed vocal fold and PVF = protected vocal cord). In order to analyze the results of the voice therapy, the following evaluations were performed: 1. perceptual-auditory analysis, voice-objective acoustic analysis, and 3. voice-handicap index (VHI). The following tools were carried out to evaluate the results of the swallowing therapy: 1. videofluoroscopic evaluation of swallowing and 2. quality-of-life related to swallowing (SWAL-QOL) questionnaire. RESULTS: Regarding the perceptive variables the EVF subgroup of the group W/OT presented a trend to remain the same or to improve in relation to the level of dysphonia, hoarseness and articulation. The PVF subgroup presented, at least at one moment of the analysis, a worse result in some variable. In the group WT, both subgroups showed results similar to the group W/OT, although almost all variables showed worse results. As to the acoustic measurement in the group W/OT, the EVF subgroup presented measurement changes at the first moment, improving during the treatment. The group WT presented altered measurement (shimmer (%), APQ and VTI) at the three moments of the analysis. In relation to VHI, the patients in the group WT referred to a worse voice disadvantage when compared to the group W/OT. Regarding the swallowing, the patients in the group WT were not as affected as those in the group W/OT in the preparatory and oral phases. On the other hand, no differences were observed between the groups in the pharyngeal phase. The patients in the group WT presented better results regarding the quality-of-life related to swallowing. CONCLUSION: The results obtained in this study indicate that voice therapy proposal in the present study, before, during and immediately after radiation therapy, did not contribute to improve voice results. In relation to swallowing, the swallowing therapy intervention can be useful to reduce the incidence of the changes throughout the radiation therapy treatment (AU)