Deglutição em pacientes com laringite / Swallowing in patients with laryngitis

ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

RESUMO CONTEXTO: Disfagia é uma queixa presente em 32% dos pacientes com laringite. OBJETIVO: O objetivo desta investigação foi avaliar o trânsito oral e faríngeo de pacientes com laringite, com a hipótese de que a alteração no trânsito do bolo pela boca e faringe pode estar envolvida com a queixa de disfagia. MÉTODOS: A avaliação videofluoroscópica da deglutição de bolos líquido, pastoso e sólido foi realizada em 21 pacientes com laringite, 10 deles com disfagia e 21 voluntários normais da mesma idade e sexo. Duas deglutições de 5 mL de bolo líquido, duas deglutições de bolo pastoso e duas deglutições de bolo sólido foram avaliadas em sequência casual definida por sorteio. Bolo líquido foi sulfato de bário 100%, e o bolo pastoso foi preparado com 50 mL de bário líquido e 4 g de espessante alimentar (amido e maltodextrina). O bolo sólido foi 2,2 g de uma bolacha macia embebida em bário líquido. A duração da preparação oral, trânsito oral, trânsito faríngeo, depuração da faringe, abertura do esfíncter superior do esôfago, movimento do hióide e do trânsito oral-faríngeo foram medidas. Precedendo a videofluoroscopia todos pacientes realizaram exame de pHmetria de 24 horas. RESULTADOS: O registro do pH intraesofágico distal revelou resultado anormal em 10 pacientes. Pacientes com laringite apresentaram maior duração da preparação oral para bolo pastoso e um tempo de trânsito oral mais rápido para bolo sólido. Os pacientes com laringite e disfagia tiveram uma preparação oral mais longa para bolo pastoso e sólido e tempo de trânsito oral menor com bolos líquido, pastoso e sólido. CONCLUSÃO: Preparação oral mais longa para bolos pastoso e sólido e trânsito mais rápido através da boca são situações associadas com a presença de disfagia em pacientes com laringite.

Comparação do corticoide inalatório e oral no tratamento da disfonia aguda / Use of inhaled versus oral steroids for acute dysphonia

A disfonia aguda é um quadro comum na prática clínica. Seu tratamento, principalmente em adultos, não é bem definido na literatura. O corticoide é o tratamento medicamentoso mais recomendado. Os estudos existentes, entretanto, não são suficientes para a determinação da superioridade entre diferentes corticoides e a melhor forma de administração. OBJETIVO: Este estudo clínico prospectivo teve como objetivo comparar o efeito do corticoide inalatório na forma de pó seco com o efeito do corticoide oral, no tratamento da disfonia aguda. MÉTODO: Foram avaliados 32 pacientes adultos, divididos em dois grupos de 16 pacientes para cada um dos tratamentos, antes e após sete dias do uso da medicação. Os pacientes foram submetidos à videolaringosocpia e avaliação perceptiva e acústica da voz. RESULTADOS: O tratamento inalatório e oral reduziram significativamente a hiperemia, o edema e melhorou o movimento muco-ondulatório; entretanto, a redução do edema foi estatisticamente mais significativa (p = 0,012) nos pacientes tratados com a forma inalatória. A comparação dos valores da análise perceptiva auditiva e das medidas acústicas após tratamento entre os grupos, entretanto, não apresentou significância estatística. CONCLUSÃO: Houve melhora significativa da laringite aguda nas avaliações realizadas, em todos os pacientes estudados, com os dois tratamentos. O tratamento com corticoide inalatório foi significativamente mais efetivo na redução do edema.

Acute dysphonia is a frequent condition in clinical practice. Its treatment, especially in adults, is not well established in the literature. Steroids are the most recommended drug treatment. However, the existing studies are not enough to establish superiority among the different steroids and the best route of administration. OBJECTIVE: This prospective clinical study aimed at comparing the effect of inhaling steroids as a dry powder with the effect of oral steroids to treat acute dysphonia. METHOD: We assessed 32 adult patients, broken down into two groups of 16 patients in each one of the treatments, before and seven days after the use of the medication. The patients were submitted to videolaryngoscopy and perceptive and acoustic voice assessment. RESULT: Oral and inhalation treatment significantly reduced hyperemia and edema, and improved the muco-ondulatory movement; nonetheless, edema reduction was statistically more significant (p = 0.012) in the patients treated with the inhalation form of the drug. However, comparing the values of the auditory perceptive analysis and the acoustic measures after treatment between the groups was not statistically significant. CONCLUSION: There was a significant improvement in the acute laryngitis concerning the assessments carried out in all the patients assessed, concerning the two treatments. The inhalation steroid treatment was significantly more effective in reducing the edema.

Laringitis por reflujo: mito o realidad? / Reflux laryngitis: mith or reality?

La enfermedad por reflujo gastroesofágico (ERGE) es un trastorno gastrointestinal frecuente que representa una de las causas de consulta más común en medicina general y gastroenterología. Recientemente, se ha descrito que la ERGE puede asociarse a manifestaciones otorrinolaringológicas como laringitis, tos crónica, odinofagia, escurrimiento nasal posterior y asma. En su fisiopatología se involucran mecanismos directos e indirectos, considerándose al ácido como el agente más nocivo, aunque otras sustancias pueden lesionar las estructuras laríngeas como pepsina, moco y contenidos duodenales. El diagnóstico de ERGE laríngeo se basa en la realización cuestionarios específicos, laringoscopia y la pHmetría ambulatoria de 2 canales. Independientemente del método diagnóstico empleado, cuando se asume que la ERGE es causa de síntomas laríngeos, en la actualidad el uso de medicamentos que suprimen el acido (especialmente IBPs) constituye la piedra angular del tratamiento, aunque los resultados clínicos sobre su efectividad son muy controversiales. En la presente revisión se analizan los aspectos más controversiales respecto a la fisiopatología, diagnóstico y tratamiento de las manifestaciones laríngeas de la ERGE...

Gastro-esophageal reflux disease (GERD) is a frequent gastrointestinal disorder that has became one of the most common conditions presenting in general and gastroenterology practice. Recently, it has been described that GERD may have otolaryngological manifestations such as laryngitis, chronic cough, odynophagia, posterior nasal drip and asthma. Several patophysiological mechanisms have been described, but abnormal acid exposure is the most important. However, there is evidence that other substances can damage laryngeal structures, such as pepsin, mucus and duodenal content). Laryngeal GERD is diagnosed by using specific questionnaires, or by the presence of laryngeal signs in the laryngoscopy or by the detection of abnormal acid exposure using a dual ambulatory pH monitoring. Suppressive acid secretion drugs (specifi cally PPI´s) represent the gold standard therapy when laryngeal symptoms are related to GERD. However, the evidence regarding the effectiveness of PPI´s in laryngeal GERD are controversial. In this review, we analyze the most relevant issues regarding the pathophysiology, diagnosis and treatment of laryngeal GERD...

Non malignant hoarsness of voice in old age patients

Geriatric Voice and Laryngeal Dysfunctions many as ten to fifteen percent of elderly individuals have vocal dysfunction. Voice weakness and articulator imprecision are particularly difficult when an individual's peer group is also likely to have significant hearing losses. This impact on day to day existence can be devastating. Dysfunctions may be classified into those that are part of the aging process and those associated with other pathologies. Some characteristics of the aging voice include altered pitch, roughness, percent of elderly individuals have vocal dysfunction. Voice weakness and articulator imprecision are particularly difficult when an individuals peer group is also likbreathiness. Routine laryngoscope often reveals dark the vocal ligaments commonly seen in aged men may result in thinner vocal cords that vibrate more rapidly. These changes of Routine laryngoscope often reveal a yellowish grayish discoloration of the vocal folds with bowing may contribute to the vocal fold Francis B etal [1999], Bailey, B [1998]. The aim of our work is giving spotlight of that hoarseness of vice in old age not only aging phenomena but also we must but others common causes of voice disorder in our differential diagnosis as in these study We founded that there are many pathological changes as Nodules [8.5%]; polyps [20%]; Reinke's edema [22.8%]; Vocal fold hemorrhage [8.5%]; Vocal fold paralysis or paresis [17,1%], Acid reflux larengitis [11.4%], Presbylaryngis [14,3%].The procedures of treatment depended on the characteristics of patients; microlaryngosurgery for 15% of nodules patients and 20% to the polyps patients. fat injection for 40% Presbylaryngis patients; six weeks of medical treatment in form of antacid is the ideal treatment in aside reflux laryngitis, conservative treatment in form of anticoagulant and abolish any predisposing trauma are excellent management in case of vocal fold hemorrhage. surgical removal for all cases of Reinke's edema. Injection of fat in 35% patients accepted surgical procedures in vocal cord paralysis and speech therapy for patients refused surgery. Intensive speech therapy is very effective for all patients with or without surgical interference and that very helpful treatment in old age group. There are many diseases may be its course may leaden to vice disorder as its complication in old age like Cerebrovascular diseases; cardiac patients with history of I. C. U admission and others diseases association with hoarseness of voice but may be without rule as diabetes mellitus and hypertension patients