Factors Associated With Attrition in Randomized Controlled Trials of Vocal Rehabilitation: Systematic Review and Meta-Analysis.

OBJECTIVES/HYPOTHESIS: This study aimed to determine the dropout rates and the reasons for dropout in randomized clinical trials of vocal rehabilitation. STUDY DESIGN: This study used systematic review and meta-analysis (CRD42013003807). METHODS: We included randomized controlled trials for voice disorders. In June 2015, we searched the following databases: MEDLINE, EMBASE, Cochrane, Clinical Trials, and AJSLP. The titles and abstracts or full texts of articles were independently analyzed by two reviewers. Study quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) scale. Our initial research base included more than 8491 articles. RESULTS: A total of 51 articles were obtained using our eligibility criteria. The low-quality studies evaluated had higher dropout rates (odds ratio: 3.3, 95% confidence interval: 1.04-12.9). Studies with healthy patients (45%) or vocal training versus no training (25%) also had higher dropout rates. Methodological issues seemed to have a greater influence on the dropout rates of the studies included in the co-occurrence matrix. CONCLUSIONS: Dropout rates of approximately 15% occur in randomized clinical trials of speech therapy when assessed by the Grading of Recommendations Assessment, Development and Evaluation. Studies with lower methodological quality had higher patient loss rates. Methodological and clinical reasons accounted for the highest dropout rates in the studies included in this meta-analysis.

Effects of Repetitive Transcranial Magnetic Stimulation in the Rehabilitation of Communication and Deglutition Disorders: Systematic Review of Randomized Controlled Trials.

OBJECTIVE: To systematically review randomized controlled trials that evaluate the effects of repetitive transcranial magnetic stimulation (rTMS) on rehabilitation aspects related to communication and swallowing functions. METHODS: A search was conducted on PubMed, Clinical Trials, Cochrane Library, and ASHA electronic databases. Studies were judged according to the eligibility criteria and analyzed by 2 independent and blinded researchers. RESULTS: We analyzed 9 studies: 4 about aphasia, 3 about dysphagia, 1 about dysarthria in Parkinson's disease and 1 about linguistic deficits in Alzheimer's disease. All aphasia studies used low-frequency rTMS to stimulate Broca's homologous area. High-frequency rTMS was applied over the pharyngoesophageal cortex from the left and/or right hemisphere in the dysphagia studies and over the left dorsolateral prefrontal cortex in the Parkinson's and Alzheimer's studies. Two aphasia and all dysphagia studies showed a significant improvement of the disorder, compared to the sham group. The other 2 studies related to aphasia found a benefit restricted to subgroups with a severe case or injury on the anterior portion of the language cortical area, respectively, whereas the Alzheimer's study demonstrated positive effects specific to auditory comprehension. There were no changes for vocal function in the Parkinson's study. CONCLUSION: The benefits of the technique and its applicability in neurogenic disorders related to communication and deglutition are still uncertain. Therefore, other randomized controlled trials are needed to clarify the optimal stimulation protocol for each disorder studied and its real effects.

Videoendoscopic Evaluation of Swallowing After Thyroidectomy: 7 and 60 Days.

Deglutition complaints are frequent after thyroidectomy. The purpose of this study was to follow-up on patients with thyroidectomy indication to compare the videoendoscopic evaluation of swallowing on the seventh day (early postoperative, EPO) and on the 60th day after thyroidectomy, (late postoperative, LPO) and to compare patients that evolved with normal laryngeal mobility (NLM) and abnormal laryngeal mobility (ALM). Nasofibroscopic evaluation was performed preoperatively (PRE), on the EPO and LPO. Two groups were compared: ALM and NLM. The majority of people were women, age bracket 46-65, who underwent total thyroidectomy and with high frequency of carcinoma. 30 out of the 54 patients in the study had change in swallowing (55 %). Dysphagia occurred in 87 % (13/15) of patients with ALM in the EPO and remained in 67 % of them in the LPO. In the NLM group, dysphagia occurred in 44 % (17/39) in EPO and 25 % in LPO. There was a statistical difference between PRE and EPO, and PRE and LPO (P < 0,001). In the ALM group, liquid penetration and aspiration were identified in 33 % of the cases during EPO (P = 0,014); retention of food occurred in 87 % in EPO and in 60 % in LPO (P < 0,001). Dysphagia occurs in patients after thyroid surgery (regardless of larynx mobility alteration) and characterized by stasis of food in the oro and hypopharynx, which is also noticed in LPO, though more frequently in EPO.

Uso de substâncias psicoativas, alterações vocais e qualidade de vida em usuários de drogas lícitas e ilícitas / Substance use, voice changes and quality of life in licit and illicit drug users

OBJETIVOS: investigar a qualidade de vida e voz, além das principais alterações perceptivo-auditivas e as medidas acústicas jitter, shimmer e Glottal Noise Excitation em usuários de substâncias psicoativas lícitas e/ou ilícitas que buscaram um centro de tratamento para dependência química. MÉTODOS: estudo transversal. Os participantes responderam aos questionários de Mensuração de Qualidade de Vida em Voz e World Health Organization Quality of Life Instrument-Bref. Além disso foi realizado, um registro vocal da vogal /a/ e de uma contagem de números de 1 a 20. Os registros vocais foram avaliados por meio da escala GRBAS-I (G - grau global da disfonia, R - rugosidade, B - soprosidade, A - astenia, S - tensão) e a análise acústica (jitter, shimmer, Glottal noise excitation) pelo software VoxMetria. RESULTADOS: avaliaram-se 29 protocolos e registros de voz; na amostra, 19 (65,5%) eram homens; a idade média da amostra foi de 37,8 anos. Os escores de ambos os questionários não apresentaram diferenças entre os usuários de drogas lícitas e os de drogas ilícitas. Na análise perceptiva por meio da GRBAS-I, eles mostraram predominância de alterações discretas e moderadas nos itens grau geral da disfonia, rugosidade e instabilidade para usuárias de drogas ilícitas. A medida acústica jitter e o shimmer estavam alterados para homens e mulheres, e o desvio padrão da frequência fundamental também estava alterado. CONCLUSÃO: alterações de qualidade de vida e voz foram identificadas em ambos os usuários. A maioria dos usuários apresentou alterações nas medidas de jitter e shimmer. Usuários de drogas ilícitas apresentaram mais alterações de Glottal Noise Excitation e desvio padrão da frequência fundamental. .

PURPOSES: to investigate the Quality of Life and Voice in addition to the main perceptual-auditory changes and the acoustic measures jitter, shimmer and Glottal Noise Excitation in users of licit and/or illicit psychoactive substances who sought a treatment center for chemical dependency. METHODS: cross-sectional study in which participants responded the questionnaires Voice-Related Quality of Life survey and World Health Organization Quality of Life Instrument-Bref. Voice recordings of the vowel /a/ and a count from 1 to 20 were performed. The voice recordings were evaluated by GRBAS-I (G - overall degree of dysphonia, R - roughness, B - breathiness, A - asthenia, S - strain) scale and acoustic analysis by the software VoXmetria. RESULTS: 29 protocols and voice recordings were assessed, 19 (65.5%) subjects of the sample were male, and the mean age of the sample evaluated was 37.8 years. The scores of both questionnaires indicate no differences between users of licit or illicit drugs. The perceptual analysis through GRBAS-I revealed the prevalence of mild and moderate changes in the items overal degree of dysphonia, roughness, and instability for licit and illicit drug users. Jitter and shimmer were altered for men and women, as was the standard deviation of the fundamental frequency. CONCLUSION: changes in quality of life and voice were identified in users of both licit and illicit drugs. Most users showed changes in jitter and shimmer. Illicit drug users had more changes in Glottal Noise Excitation and standard deviation of the fundamental frequency. .

Análise videofluoroscópica da deglutição após laringectomia total / Videofluoroscopic evaluation of swallowing after total laryngectomy

Introdução: As queixas de deglutição dos pacientes submetidos à laringectomia total são pouco valorizadas, devido ao impacto da perda da voz laríngea. Além disso, quando se refere à disfagia, a relevância é dada à fase esofágica. Objetivo: Descrever os resultados da análise videofluoroscópica da deglutição de pacientes laringectomizados totais. Método: estudo descritivo/retrospectivo da análise dos exames de 22 laringectomizados totais e dos prontuários com informações de deglutição. O protocolo de análise da imagem videofluoroscópica envolveu dados de mobilidade da base de língua, mobilidade do véu palatino, trânsito esofágico e estases nas consistências líquida, pastosa e, quando possível, na sólida. Resultados: Dentre os disfágicos (95%), 48% apresentou movimento de posteriorização da base de língua reduzido (PBL); 24%, redução no fechamento de véu palatino (VP); 76%, estase em base de língua (BL); 71%, em topografia de valécula (TV); 81%, em transição faringo-esofágica (TFE); 71%, em segmento faringoesofágico (SFE); 52%, em área de armazenamento de ar (AA); 86%, trânsito esofágico lento (TEL); 9%, estenose esofágica (EE). Quanto às informações de deglutição, 73% apresentou queixa para sólidos. Conclusão: a ausência de queixa na deglutição não significa normalidade do exame. A disfagia não ocorre somente na fase esofágica e sim também nas fases oral e faríngea, caracterizada por trânsito lento e estase.

Introduction: The self-reported dysphagia following total laryngectomy is underestimated and the deglutition disorders have been associated with esophageal phase. Objective: To describe features of deglutition in a population of patients submitted to total laryngectomy. Methods: Retrospective study of videofluoroscopic examination with 22 patients and analysis of swallowing’s information. The protocol of videofluoroscopic examination involved: mobility of base-of-tongue; mobility of soft palate; esophageal transit and residue with liquid; pureed and, when possible, solid food. Results: 96% had dysphagia. Of these patients, 48% had reduction in base-of-tongue movement posteriorization (BTM); 24% showed reduction in soft palate movement (SPM); 76% had residue in base-of-tongue (RBT); 71% had residue in pseudovallecula (PV); 81% had residue in pharyngoesophageal transition (PT); 71% had residue in pharyngoesophageal segment (PS); 52% showed an area of air reservation (AAR); 86% had prolonged esophageal transit times (ETTP); 9% suffered esophageal stenosis (ES). Regarding selfreported deglutition, 73% had some difficulty to swallow solid food. Conclusion: The absence of self-report dysphagia following total laryngectomy was not always associated with normal findings at videofluoroscopic examination. Swallowing disorders were detected in all phases of deglutition, not only in esophageal phase.