Aspectos anatômicos e funcionais da língua após frenectomia em gemelares: relato de casos clínicos / Anatomic and functional aspects of the tongue after frenectomy in twin: clinical cases report

Objetivo: Relatar dois casos clínicos de alteração de frênulo lingual em gemelares, com 10 anos de idade, ambas do sexo feminino, avaliadas nos aspectos anatômicos e funcionais da língua antes e 15 dias após a frenectomia. Relato de casos: Inicialmente, o odontopediatra realizou a anamnese com a mãe. Em seguida, as participantes foram submetidas à avaliação clínica odontológica e, posteriormente, foi realizada a avaliação fonoaudiológica do frênulo lingual. A avaliação fonoaudiológica foi realizada por meio do Protocolo de Avaliação do Frênulo da Língua, que foi aplicado antes e 15 dias após a frenectomia. As duas participantes apresentaram melhor desempenho em provas anatômicas após o procedimento cirúrgico. Entretanto, algumas alterações, principalmente ao elevar a língua, continuaram sendo observadas em uma das pacientes 15 dias após a frenectomia. Ademais, as duas participantes passaram a executar a maioria dos movimentos de língua com maior precisão. No que se refere à fala, somente a participante que apresentava um maior número de alterações fonéticas anteriores, permaneceu com algumas alterações na fala decorridos 15 dias da cirurgia. Discussão: Algumas dificuldades envolvendo mobilidade da língua e alterações na fala podem persistir após a realização da cirurgia, indicando a necessidade de intervenção fonoaudiológica específica. Conclusão: Ambos os casos apresentaram melhora no desempenho tanto nas provas anatômicas quanto funcionais após a frenectomia.

Aim: to report two clinical cases of alteration of the lingual frenulum in twins, aged 10 years, both female, evaluated in the anatomical and functional aspects of the tongue before and 15 days after the frenectomy. Case reports: Initially, the paediatric dentistry performed the anamnesis with the mother. Then, the participants were submitted to a dental clinical evaluation and, sub-sequently, the speech language pathologist evaluation of the lingual frenulum was performed. The speech language pathologist assessment was performed using the Tongue Frenulum Evaluation Protocol, which was applied before and 15 days after the frenectomy. Both participants performed better in anatomical tests after the surgical procedure. However, some changes, especially when elevating the tongue, continued to be observed in one of the patients 15 days after the frenectomy. In addition, the two participants started to perform most of the tongue movements with greater precision. About speech, only the participant who had a greater number of previous phonetic changes, remained with some speech disorders after 15 days of surgery. Discussion: Some di-fficulties involving mobility of the tongue and changes in speech may persist after surgery, indicating the need for specific speech therapy intervention. Conclusion:Both cases showed improvement in performance both in anatomical and functional tests after frenectomy

Profile of users receiving Speech-Language Therapy service at a Critical Patient Unit / Perfil de usuarios que reciben atención fonoaudiológica en una unidad de paciente crítico

ABSTRACT Objective: to describe the profile of patients treated by Speech-Language therapists in a Critical Patient Unit. Methods: an ex post facto, observational and descriptive study was carried out. Monthly statistical data of patients hospitalized in the period January-December 2018 were analyzed, in the Intensive Care Unit at a public hospital. Data were described from the analysis of frequency and measures of central tendency. The distribution of the variables was determined through the skewness-kurtosis test, considering a significance level of p<0.05. Results: 217 individuals got 868 speech-language therapy services. Men (57.26%), older than 65 years old, required a more frequent intervention. The main medical diagnosis of admission to the unit corresponded to non-specific pathologies (57.14%), respiratory disease (15.21%) and cerebrovascular disease (12.79%). The speech-language therapy functions were related to the evaluation of swallowing (54.31%) and voice (32.4%). In relation to the intervention, the treatment of dysphagia (25.82%) and oral motor functions (25.04%) was predominant in the duties. Functions associated with language, speech and cognition were secondary. Conclusion: the profile of the critical patient and the speech-language therapy work in this field represent a first step to characterize the role of the speech-language therapist in Intensive Medicine teams.

RESUMEN Objetivo: describir el perfil de usuarios atendidos por fonoaudiólogos en una unidad de paciente crítico. Métodos: se realizó un estudio observacional descriptivo con temporalidad ex post facto. Se analizaron los resúmenes estadísticos mensuales de usuarios internados durante los meses de enero a diciembre de 2018, en la unidad de cuidados intensivos de un hospital público. Se describieron los datos a partir de análisis de frecuencia y medidas de tendencia central. La distribución de las variables se determinó mediante skewness-kurtosis test, considerando un nivel de significancia p<0,05. Resultados: 217 sujetos recibieron 868 atenciones fonoaudiológicas. Los hombres (57,26%) mayores de 65 años requirieron una intervención más frecuente. Los principales diagnósticos médicos de ingreso a la unidad correspondieron a patologías inespecíficas (57,14%), enfermedades respiratorias (15,21%) y cerebrovasculares (12,79%). Las funciones de fonoaudiología se relacionaron con la evaluación de la deglución (54,31%) y de la voz (32,4%). En cuanto a la intervención, el tratamiento de la disfagia (25,82%) y las funciones motoras orales (25,04%) dominaron la carga laboral. Las funciones asociadas con el lenguaje, el habla y la cognición fueron secundarias. Conclusión: el perfil del paciente crítico y las labores fonoaudiológicas en este ámbito representan un primer paso para caracterizar el rol profesional del fonoaudiólogo en el contexto de los equipos de medicina intensiva.

Optimizing speech outcomes for cleft palate.

PURPOSE OF REVIEW: Cleft lip with or without palate is one of the most common pediatric birth anomalies. Patients with cleft palate often have speech difficulties from underlying anatomical defects that can persist after surgery. This significantly impacts child development. There is a lack of evidence exploring, which surgical techniques optimize speech outcomes. The purpose of this update is to report on recent literature investigating how to optimize speech outcomes for cleft palate. RECENT FINDINGS: The two-flap palatoplasty with intravelar veloplasty (IVVP) and Furlow double-opposing Z-plasty has the strongest evidence for optimizing speech. One-stage palatal repair is favored at 10-14 months of age, while delays are associated with significant speech deficits. For postoperative speech deficits, there is no significant difference between the pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation. Surgical management should be guided by closure pattern and velopharyngeal gap but few studies stratify by these characteristics. SUMMARY: According to recent evidence, the two-flap palatoplasty with IVVP and Furlow palatoplasty result in the best speech. The pharyngeal flap, sphincter pharyngoplasty, and posterior pharyngeal wall augmentation are all viable techniques to correct residual velopharyngeal insufficiency. Future research should focus on incorporating standardized measures and more robust study designs.

Rehabilitation of speech disorders following glossectomy, based on ultrasound visual illustration and feedback.

Intraoral surgery for tongue cancer usually induces speech disorders that have a negative impact on communication and quality of life. Studies have documented the benefit of tongue ultrasound imaging as a visual articulatory feedback for speech rehabilitation. This study aims to assess specifically the complementary contribution of visual feedback to visual illustration (i.e. the display of ultrasound video of target language movements) for the speech rehabilitation of glossectomised patients. Two therapy conditions were used alternately for ten glossectomised French patients randomly divided into two cohorts. The IF cohort benefitted from 10 sessions using illustration alone (IL condition) followed by 10 sessions using illustration supplemented by visual feedback (IL+F condition). The FI cohort followed the opposite protocol, i.e. the first 10 sessions with the IL+F condition, followed by 10 sessions with the IL condition. Phonetic accuracy (Percent Consonants Correct) was monitored at baseline (T0, before the first series) and after each series (T1 and T2) using clinical speech-language assessments. None of the contrasts computed between the two conditions, using logistic regression with random effects models, were found to be statistically significant for the group analysis of assessment scores. Results were significant for a few individuals, with balanced advantages in both conditions. In conclusion, the use of articulatory visual feedback does not seem to bring a decisive advantage over the use of visual illustration, though speech therapists and patients reported that ultrasound feedback was useful at the beginning. This result should be confirmed by similar studies involving other types of speech disorders.

Compreensão de leitura em disléxicos após programa de intervenção / Reading comprehension in dyslexic schoolchildren after an intervention program

RESUMO Objetivo Elaborar um programa terapêutico fonoaudiológico e verificar seus efeitos na compreensão de leitura de escolares disléxicos. Método Participaram do estudo onze escolares de 4º e 5° anos do ensino fundamental, diagnosticados com Dislexia do Desenvolvimento, com idades entre nove e onze anos, sendo oito meninos. Todos foram submetidos ao programa terapêutico fonoaudiológico com 16 sessões, divididas em quatro níveis de complexidade. Em cada sessão, foram utilizados um texto adaptado com a Técnica de Cloze e tarefas de Compreensão Textual e Ortografia. Os sujeitos realizaram avaliação da compreensão leitora no pré e no pós-teste com um texto do Teste de Compreensão Leitora de Textos Expositivos, adaptado com a Técnica de Cloze estrutural sem apoio, seguido da Avaliação dos Níveis de Compreensão de Leitura. Resultados Os sujeitos apresentaram melhor desempenho na compreensão leitora no pós-teste, tanto no preenchimento do texto adaptado com a Técnica de Cloze e nas respostas às Perguntas de Compreensão Textual quanto no nível de compreensão de leitura atingido. Conclusão O programa elaborado gerou melhor desempenho na compreensão leitora dos escolares disléxicos e na motivação para a leitura. A Técnica de Cloze e as Perguntas de Compreensão Textual foram instrumentos úteis para desenvolver e apontar mudanças na compreensão de leitura dos sujeitos desta pesquisa. Trata-se de estudo relevante, por elaborar e verificar os efeitos de um programa específico de remediação para disléxicos, com uma proposta de aplicação de textos usando a Técnica de Cloze e aliando-a a outras tarefas diversificadas de compreensão de leitura textual e ortografia.

ABSTRACT Purpose To develop a Speech-language Pathology (SLP) program and verify its effects on the reading comprehension of dyslexic students. Methods Participants were eleven 4th and 5th-grade Elementary School students, eight boys and three girls, aged 9-11 years, diagnosed with developmental dyslexia. All individuals underwent the therapeutic program, which was composed of 16 sessions divided into four levels of complexity. A text adapted according to the Cloze technique and reading comprehension and orthography tasks were used in each session. The schoolchildren had their reading comprehension assessed pre- and post-program using a text available at the Test of Reading Comprehension of Expository Texts, adapted for application of the structural Cloze technique without support, according to the Evaluation of Reading Comprehension Levels. Results The participants showed better performance in reading comprehension at the post-program assessment not only in the filling of blanks in the text adapted according to the Cloze technique and in the Responses to Reading Comprehension Questions, but also in the level of reading comprehension achieved. Conclusion The SLP program improved the reading comprehension performance and increased motivation to reading of dyslexic schoolchildren. Both the Cloze technique and the Reading Comprehension Questions were useful tools to develop and identify changes in the reading comprehension of the students assessed. This study is relevant because it prepared and verified the effects of a specific remediation program for schoolchildren with dyslexia by proposing the use of texts adapted according to the Cloze technique combined with other various tasks of reading comprehension and orthography.

Contribuições da CIF para uma abordagem integral na atenção à Saúde de Crianças e Adolescentes / Contributions of ICF to an integral approach in the Health Care for Children and Adolescents

RESUMO Objetivo: Investigar a participação e funcionalidade de crianças e adolescentes com alterações de fala utilizando a Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Método: Pesquisa descritiva-analítica de abordagem qualitativa-quantitativa com 30 participantes com alteração de fala (CAF) e 30 com desenvolvimento típico de fala (DTF). Para a coleta de dados, realizaram-se entrevistas semiestruturadas com os participantes, estudo de prontuário, observação dos participantes quanto aos aspectos de fala e aplicação de questionário estruturado com os responsáveis. Os dados coletados foram utilizados para seleção de qualificadores das categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde. Para comparação dos qualificadores entre grupos, utilizou-se o Teste Mann-Whitney, e a análise de conteúdo temática, para as entrevistas. Resultados: Os participantes do grupo CAF relataram maior grau de dificuldade do que o grupo DTF. As alterações de fala repercutiram significativamente em Funções do Corpo (articulação e fluência), Atividades e Participação (conversa, relacionamentos, realização de rotinas e lidar com estresse) e Fatores Ambientais (atitudes de familiares, amigos e conhecidos). Conclusão: Os resultados evidenciam o impacto das alterações de fala e suas implicações sociais para estas crianças e adolescentes. A CIF permitiu compreender a saúde em complexidade e integralidade, possibilitando assim o planejamento de estratégias para amenizar o impacto dessas alterações individual e coletivamente. Podendo ser base, futuramente, para a criação de políticas públicas e ações que poderão melhorar a qualidade de vida e promover a saúde dessa população.

ABSTRACT Purpose: To investigate participation, and functionality of children and adolescents with speech disorders using the International Classification of Functioning, Disability and Health (ICF). Method: Descriptive and analytical research of qualitative and quantitative approach. The sample was composed of 30 participants with speech disorders and 30 with typical speech development. For data collection, it was conducted semi-structured interviews with the participants, medical record review, observation of speech aspects' participants, and analyzed study of medical records. The collected data were used to qualify the framework codes. The Mann-Whitney Test was used for comparison between groups, and thematic content analysis for the interviews. Results: Participants with speech disorders reported more difficulties than the participants with typical speech development. Speech disorders significantly impacted on the Body Functions (articulation and fluency), Activities and Participation (conversation, relationships, carrying out the routine and handling of stress) and Environmental Factors (attitudes of family, friends and acquaintances). Conclusion: The results show the impact of speech disorders and their social consequences for these children and adolescents. The ICF allowed us to comprehend health in all its complexity and integrality, making possible to plan strategies to soften the disorders impact in an individual and collective perspective. Then, ICF can be used, in the future, for elaboration of public policies and actions that will improve the quality of life and promote the health of this population.

Tyrosine Kinase Inhibitor Use and Wound Healing in Tracheoesophageal Punctures.

Tyrosine kinase inhibitors (TKIs) aid in prolonging life in patients with advanced locoregional thyroid malignancy. Such patients may undergo total laryngectomy for local disease control and tracheoesophageal puncture (TEP) for speech rehabilitation. Enlargement of TEP fistulas is usually attributed to wound healing issues and leads to major complications. Four laryngectomies with TEP were performed between 2015 and 2016 and subsequently placed on a TKI. Three patients developed a complication after TKI treatment, and 2 patients had a tracheoesophageal fistula. Patients should be counseled about possible wound healing risks associated with TKIs.

Normal Speech Should be the Expected Outcome in the Adopted Cleft Child.

Significantly worse speech outcomes and higher complication rates are reported among internationally adopted cleft patients. We evaluated our cohort to provide more accurate counseling to adoptive parents. METHODS: We reviewed internationally adopted children with unrepaired cleft palate who had 2-flap palatoplasty with radical intravelarveloplasty from 2003 to 2015 in a single-surgeon, consecutive series. RESULTS: Seventy-two children adopted with unrepaired cleft palate were identified, 2 with syndromic association. The average age at palatoplasty was 28.1 months. Meaningful speech assessment was available in 58 patients. Successful speech was defined by a competent or borderline-competent velopharyngeal mechanism (Pittsburgh Weighted Speech Score <2). Twenty-five patients (43%) had successful speech outcomes. Twenty-nine patients (50%) were recommended secondary operation for nasality. Nonfistula repair secondary operation was performed using the following: fat grafting (9 patients, 43%), intravelarveloplasty (8 patients, 38%), and sphincter pharyngoplasty (4 patients, 19%). The average Pittsburgh Weighted Speech Score improved 5.8 to 1.3 (P = 1.3E-6); 4.8 to 1.0 (P = 0.0009) with fat grafting alone. After all interventions, normal speech was achieved in 43 (74%) of 58 patients. Palatal fistula (9.2% vs 0.9%, P = 0.001) and velopharyngeal insufficiency (50% vs 6.7%, P = 0.0004) rates were both significantly higher in the internationally adopted cohort than our nonadopted population data. The need for secondary surgery was independent of cleft type (P = 0.89), age (P = 0.78), or presence of a "wide" cleft (P = 1). CONCLUSIONS: Our results demonstrate higher fistula and secondary surgery rates. Successful speech outcomes were achieved in most patients with minimally invasive secondary procedures.

A scoping review of rehabilitation interventions for survivors of head and neck cancer.

Purpose: The objectives of this scoping review were to summarize, understand, and disseminate findings from a broad body of literature on rehabilitation interventions used with survivors of head and neck cancer. Method: Searches were conducted in six databases. Inclusion criteria were studies of adult head and neck cancer survivors with a predefined primary rehabilitation outcome as a result of an intervention. Excluded were studies not written in English, opinion papers, or studies where the intervention was not carried out by a rehabilitation healthcare service. A second level, full-text review of the studies was conducted. A thematic analysis was used to examine and combine study findings. Results: A total of 3804 results were retrieved from all sources resulting in 39 papers that were analyzed. The thematic analysis of the included papers represented interventions focusing on swallowing and nutrition, speech, physical therapy, assistive devices, complementary and alternative modalities, comprehensive interdisciplinary programs, and preventive rehabilitation programs. Conclusion: This review has provided an overview of the scope of rehabilitation interventions available for survivors of head and neck cancer and preliminary information about their efficacy. This is foundational information for the development and refinement of rehabilitation interventions and programs for head and neck cancer survivors. Implications for Rehabilitation The existing evidence suggests that survivors of head and neck cancer can benefit from early screening of potential rehabilitation needs and being involved in preventive rehabilitation programs pre-surgery when possible. Rehabilitation programs should consider swallowing interventions for patients as evidence reports improved swallowing function, decreased pain and discomfort, and reduced duration of feeding tube use. Rehabilitation programs should consider nutritional interventions after radiotherapy: Patients benefited from stabilized weights, improved nutritional status, and an improved quality of life. Physical exercise interventions demonstrated improvements in physical function, muscular endurance, range of motion, overall quality of life, and showed reductions in pain, and fatigue.

Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip / Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip

Abstract Introduction: The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up. Objective: To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency. Methods: Patients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p < 0.05). Results: Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5 ± 0.7) was significantly (p < 0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8 ± 0.4 and 1.7 ± 0.9, respectively). Conclusion: The buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.

Resumo: Introdução: A interpretação dos resultados de fala obtidos com o retalho miomucoso do músculo bucinador no tratamento da insuficiência velofaríngea em pacientes fissurados tem sido limitada pela restrição do número de pacientes e do tempo de seguimento pós-operatório. Objetivo: Avaliar o efeito do retalho miomucoso do músculo bucinador sobre a hipernasalidade da fala no tratamento de pacientes fissurados com insuficiência velofaríngea. Método: Foram avaliados pacientes com fissura palatina (± lábio) reparada, com retalho miomucoso do músculo bucinador bilateral para a correção cirúrgica da insuficiência velofaríngea. A hipernasalidade (escores 0 [ausente], 1 [leve], 2 [moderada] ou 3 [severa]) foi analisada por três avaliadores por meio da mensuração dos registros audiovisuais coletados nos períodos pré-operatório e pós-operatórios recente e tardio (3 e 12 meses, respectivamente). Os valores foram considerados significativos para um intervalo de confiança de 95% (p < 0,05). Resultado: Foram incluídos 37 pacientes fissurados com hipernasalidade moderada (16,2%) ou severa (83,8%) no período pré-operatório. As análises do período pós-operatório tardio revelaram que a hipernasalidade (0,5 ± 0,7) foi significativamente (p < 0,05) menor do que a hipernasalidade dos períodos pré-operatório e pós-operatório recente (2,8 ± 0,4 e 1,7 ± 0,9; respectivamente). Conclusão: O retalho miomucoso do músculo bucinador é eficaz na redução/eliminação da hipernasalidade nos pacientes fissurados com insuficiência velofaríngea.

Safety and Efficacy Concerns of Autologous Fat Grafting for Velopharyngeal Insufficiency.

OBJECTIVE: Autologous fat grafting of the velopharynx has been well described for the treatment of velopharyngeal insufficiency (VPI), with most studies purporting it as a technique with low morbidity useful in the treatment of mild VPI. Prompted by 3 cases of obstructive sleep apnea (OSA) following fat grafting of the velopharynx, we undertook a review of the outcomes of this procedure at our unit. DESIGN: Retrospective case series. PARTICIPANTS: All patients who underwent autologous fat grafting for VPI at the Royal Children's Hospital Melbourne. MAIN OUTCOME MEASURES: Preoperative nasendoscopy findings, perceptual speech assessment results, and rates of revisional surgery and complications. RESULTS: Twenty-eight patients were included in the study. Three patients (11%) developed severe OSA requiring removal of the grafted fat. In a subanalysis of cleft patients, there was a reported improvement in hypernasality in 63% though only 25% had complete resolution of their hypernasality. Patients who had an improvement in speech were more likely to have a velopharyngeal gap of less than 0.5 cm2 on preoperative nasendoscopy. All 3 patients who developed OSA had syndromes associated with hypotonia. CONCLUSIONS: This study raises serious concerns over the safety and efficacy of fat grafting for VPI. Overall, there was a relatively high complication rate with generally poor speech results in our series of patients. Stringent criteria should be used to select candidates for fat grafting, namely, a velopharyngeal gap less than 0.5 cm2 and the absence of a syndrome associated with hypotonia.

Digitised evaluation of speech intelligibility using vowels in maxillectomy patients.

Among the functional disabilities that patients face following maxillectomy, speech impairment is a major factor influencing quality of life. Proper rehabilitation of speech, which may include prosthodontic and surgical treatments and speech therapy, requires accurate evaluation of speech intelligibility (SI). A simple, less time-consuming yet accurate evaluation is desirable both for maxillectomy patients and the various clinicians providing maxillofacial treatment. This study sought to determine the utility of digital acoustic analysis of vowels for the prediction of SI in maxillectomy patients, based on a comprehensive understanding of speech production in the vocal tract of maxillectomy patients and its perception. Speech samples were collected from 33 male maxillectomy patients (mean age 57.4 years) in two conditions, without and with a maxillofacial prosthesis, and formant data for the vowels /a/,/e/,/i/,/o/, and /u/ were calculated based on linear predictive coding. The frequency range of formant 2 (F2) was determined by differences between the minimum and maximum frequency. An SI test was also conducted to reveal the relationship between SI score and F2 range. Statistical analyses were applied. F2 range and SI score were significantly different between the two conditions without and with a prosthesis (both P < .0001). F2 range was significantly correlated with SI score in both the conditions (Spearman's r = .843, P < .0001; r = .832, P < .0001, respectively). These findings indicate that calculating the F2 range from 5 vowels has clinical utility for the prediction of SI after maxillectomy.

Appraisal of Function After Rehabilitation With Tongue Prosthesis.

STATEMENT OF THE PROBLEM: Prosthetic rehabilitation following total glossectomy is very complex procedure from clinical as well as laboratory point of view. The basic objective of prosthodontic rehabilitation is to deliver a comfortable as well as esthetically suitable prosthesis, which restores the impaired speech and deglutition function. PURPOSE: Prosthetic rehabilitation of patients after total glossectomy with tongue prosthesis to evaluate improvement in speech as well as swallowing function. MATERIALS AND METHODS: Tongue prostheses were fabricated with high-temperature vulcanizing silicone and heat-polymerizing acrylic to restore the functions affected after surgical resection of tongue. Patient's speech was evaluated with Dr Speech software version 4. The speech software was used to assess different speech parameters such as maximum phonation time, fundamental frequency, intensity, jitter, and shimmer. Deglutition assessment was done subjectively by using a standardized questionnaire designed by the speech pathologist. Speech was recorded for assessment before prosthetic rehabilitation and 2 weeks after delivery of the tongue prosthesis. RESULTS: After analysis of various speech parameters frequency range was improved with prosthesis (ie, 172.19 Hz) as compared to without prosthesis (ie, 111.47 Hz). Speech intelligibility was improved with tongue prosthesis. Deglutition assessment revealed that patient's deglutition abilities were improved. CONCLUSION: Tongue prosthesis helps to improve speech and articulation in patients with total glossectomy. Apart from that deglutition capability is also significantly improved. CLINICAL IMPLICATIONS: Total glossectomy affects speech, mastication, and swallowing to a greater proportion. It may also lead to psychological impairment of the patient. Tongue prosthesis efficiently improves speech and deglutition abilities of the patient leading to a better quality of life.

Buccinator myomucosal flap for the treatment of velopharyngeal insufficiency in patients with cleft palate and/or lip.

INTRODUCTION: The interpretation of the speech results obtained with the buccinator myomucosal flap in the treatment of velopharyngeal insufficiency in patients with cleft palate has been limited by the restriction in the number of patients and the time of postoperative follow-up. OBJECTIVE: To evaluate the effect of the buccinator myomucosal flap on speech hypernasality in the treatment of patients with cleft palate and velopharyngeal insufficiency. METHODS: Patients with repaired cleft palate (± lip) who were submitted to surgical correction of velopharyngeal insufficiency using the bilateral buccinator myomucosal flap were assessed. Hypernasality (scores 0 [absent], 1 [mild], 2 [moderate], or 3 [severe]) was analyzed by three evaluators by measuring the audiovisual records collected in early and late preoperative and postoperative periods (3 and 12 months, respectively). The values were considered significant for a 95% Confidence Interval (p<0.05). RESULTS: Thirty-seven patients with cleft palate (± lip) showing moderate (16.2%) or severe (83.8%) hypernasality in the preoperative period were included. Analyses of the late postoperative period showed that hypernasality (0.5±0.7) was significantly (p<0.05) lower than the hypernasality of the preoperative and recent postoperative periods (2.8±0.4 and 1.7±0.9, respectively). CONCLUSION: The buccinator myomucosal flap is effective in reducing/eliminating hypernasality in patients with cleft palate (± lip) and velopharyngeal insufficiency.

Programa fonoaudiológico em compreensão leitora e ortografia: efeitos na ortografia em disléxicos / Speech-language pathology program for reading comprehension and orthography: effects on the spelling of dyslexic individuals

RESUMO Objetivo Elaborar um Programa Fonoaudiológico em Compreensão Leitora e Ortografia e verificar seus efeitos na compreensão leitora e ortografia de escolares com Dislexia do Desenvolvimento. Método Participaram desta pesquisa onze indivíduos com diagnóstico de Dislexia do Desenvolvimento, com idades entre 9 e 11 anos, sendo oito meninos. Todos foram submetidos ao Programa Fonoaudiológico em Compreensão Leitora e Ortografia, composto por 16 sessões semanais individuais. Em cada sessão, foram desenvolvidas tarefas de compreensão leitora de textos e de ortografia. Antes do início e ao término do Programa, os participantes realizaram uma avaliação específica (pré e pós-teste). Resultados Os indivíduos apresentaram dificuldade na compreensão de textos, porém a técnica de Cloze foi um instrumento útil para a remediação da compreensão leitora, havendo melhora significativa no desempenho destes no pós-teste. Os disléxicos demonstraram um desempenho inferior à escolaridade em ortografia. Após o Programa, o desempenho deles evoluiu, porém permaneceu abaixo do esperado, ocorrendo o mesmo perfil de erros no pré e no pós-teste, com erros de ortografia natural e ortografia arbitrária. Conclusão O Programa Fonoaudiológico em Compreensão Leitora e Ortografia produz efeitos positivos na compreensão leitora, na ortografia e na motivação para a leitura e escrita dos participantes. Este estudo apresenta uma contribuição inédita, ao propor a estimulação conjunta da leitura e da escrita, por meio de um programa de fácil aplicabilidade e análise, em indivíduos com Dislexia do Desenvolvimento.

ABSTRACT Purpose Prepare a Speech-language Pathology Program for Reading Comprehension and Orthography and verify its effects on the reading comprehension and spelling of students with Developmental Dyslexia. Methods The study sample was composed of eleven individuals (eight males), diagnosed with Developmental Dyslexia, aged 09-11 years. All participants underwent a Speech-language Pathology Program in Reading Comprehension and Orthography comprising 16 individual weekly sessions. In each session, tasks of reading comprehension of texts and orthography were developed. At the beginning and end of the Program, the participants were submitted to a specific assessment (pre- and post-test). Results The individuals presented difficulty in reading comprehension, but the Cloze technique proved to be a useful remediation tool, and significant improvement in their performance was observed in the post-test evaluation. The dyslexic individuals showed poor performance for their educational level in the spelling assessment. At the end of the program, their performance evolved, but it remained below the expected, showing the same error pattern at the pre- and post-tests, with errors in both natural and arbitrary spelling. Conclusion The proposed Speech-language Pathology Program for Reading Comprehension and Orthography produced positive effects on the reading comprehension, spelling, and motivation to reading and writing of the participants. This study presents an unprecedented contribution by proposing joint stimulation of reading and writing by means of a program easy to apply and analyze in individuals with Developmental Dyslexia.

Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings / Tratamento de fístula periestomal traqueoesofágica grande e persistente com anéis de silicone

Abstract Introduction: Tracheoesophageal peristomal fistulae can often be solved by reducing the size of the fistula or replacing the prosthesis; however, even with conservative techniques, leakage around the fistula may continue in total laryngectomy patients. Also, several techniques have been developed to overcome this problem, including injections around the fistula, fistula closure with local flaps, myofascial flaps, or free flaps and fistula closure using a septal perforation silicon button. Objective: To present the results of the application of silicon ring expanding the voice prosthesis in patients with large and persistent peri-prosthetic fistula. Methods: A voice prosthesis was fitted to 42 patients after total laryngectomy. Leakage was detected around the prosthesis in 18 of these 42 patients. Four patients demonstrated improvement with conservative methods. Eight of 18 patients who couldn't be cured with conservative methods were treated by using primary suture closure and 4 patients were treated with local flaps. As silicon ring was applied as a primary treatment in the 2 remaining patients and also, applied to 2 patients who had recurrence after suture repair and to 2 patients who had recurrence after local flap implementation. Silicon rings were used in a total of 6 patients due to the secondary trachea-esophageal fistula. Patients were treated with provox-1 initially and later with provox-2. At the time of leakage around the fistula, 6 patients had provox-2. Results: Fistulae were treated successfully in 6 patients, and effective speech of patients was preserved. Patients experienced no adaptation problem. Prosthesis changing time was not different between silicon rings expanded and normal prosthesis applied patients. Silicon ring combined voice prosthesis was used 26 times; there was no recurrence in fistula complication during 29 ± 6 months follow up. Conclusion: Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula closure and preserving the patients speech.

Resumo Introdução: Fístulas traqueoesofágicas persistentes podem ser resolvidas através da redução do tamanho da fístula ou substituição da prótese; no entanto, mesmo com técnicas conservadoras, o pertuito em torno da fístula pode continuar em pacientes com laringectomia total. Além disso, várias técnicas têm sido desenvolvidas para superar esse problema, inclusive injeções ao redor da fístula, fechamento da fístula com retalhos locais, retalhos miofasciais ou retalhos livres e fechamento da fístula com um botão septal de silicone. Objetivo: Apresentar os resultados da aplicação de anel de silicone para expansão da prótese vocal em pacientes com grandes fístulas periprotéticas persistentes. Método: Prótese vocal foi colocada em 42 pacientes após laringectomia total, e fístula foi detectada ao redor da prótese em 18 desses 42 pacientes. Quatro pacientes obtiveram melhora com métodos conservadores. Oito dos 18 pacientes que não obtiveram sucesso com métodos conservadores foram tratados usando sutura primária e quatro pacientes foram tratados com retalhos locais. Um anel de silicone foi aplicado inicialmente nos dois pacientes restantes e, também, aplicado a dois pacientes que tiveram recorrência após a técnica de sutura e a dois pacientes que tiveram recorrência após a utilização de retalho local. No total, seis pacientes receberam anéis de silicone em decorrência da fístula traqueoesofágica secundária. Os pacientes haviam sido tratados com provox-1 inicialmente e posteriormente com provox-2. No momento da detecção da fístula em torno do estoma, seis pacientes haviam recebido provox-2. Resultados: A fístula foi tratada com sucesso em seis pacientes. Além disso, após o tratamento a fala foi mantida de forma eficaz. Não houve problema de adaptação. O tempo de troca da prótese expandida com os anéis de silicone não foi diferente do tempo que se leva para a colocação da prótese normal. O anel de silicone combinado com a prótese vocal foi usado 26 vezes em pacientes na época da troca de prótese e não houve recorrência da fístula durante os 29 ± 6 meses de acompanhamento. Conclusão: Os resultados sugerem que em casos de grandes fístulas peri-prostéticas persistentes, anéis expandidos de silicone e prótese vocal modificada são eficazes tanto para o fechamento da fístula como para a manutenção da fala do paciente.

The impact of developing a speech and swallow rehab program: Improving patient satisfaction and multidisciplinary care.

OBJECTIVES/HYPOTHESIS: The objective of this study was to evaluate the impact of developing an integrated head and neck cancer speech and swallowing rehabilitation program on physician/team focus on functional outcomes. STUDY DESIGN: Prospective cross-sectional design. METHODS: Surveys regarding physician behavior and patient satisfaction with speech and swallowing were administered in an academic oncology practice prior to and 1 year following establishment of a dedicated head and neck speech and swallowing rehabilitation program. Participants included new and established head and neck cancer patients recruited consecutively. The primary outcome was physician behavior regarding speech and swallowing outcomes (as measured by discussion of function, providing suggestions regarding function, and referral to speech-language pathology services). RESULTS: A total of 199 surveys were returned at the first time point and 271 at the second. Demographic variables were comparable between the two groups. The later cohort was more likely to report team discussion and suggestions regarding speech and swallowing function than the former (P < .001, 95% confidence interval [CI]: -0.775 to -0.265; P < .001, 95% CI: -0.928 to -0.035, respectively). Although there was no significant difference between the groups in regard to satisfaction with speech (P = .07), more favorable satisfaction with swallowing was reported by the later cohort (P = .028, 95% CI: -0.531 to -0.029). CONCLUSIONS: Integration of speech and swallowing rehabilitation into head and neck cancer programs is associated with increased physician focus on functional outcomes and greater patient satisfaction in regard to swallowing function. We advocate for standard integration of such services into the multidisciplinary head and neck cancer care team. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2578-2581, 2017.