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Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 53-61, Jan.-Mar. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1090553


Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças da Laringe/cirurgia , Doenças da Laringe/epidemiologia , Laringe/cirurgia , Microcirurgia , Papiloma/cirurgia , Riscos Ocupacionais , Envelhecimento/fisiologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/epidemiologia , Fatores Sexuais , Edema Laríngeo/cirurgia , Edema Laríngeo/epidemiologia , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/epidemiologia , Registros Médicos , Estudos Transversais , Estudos Retrospectivos , Fatores Etários
Neumol. pediátr. (En línea) ; 14(3): 126-130, sept. 2019. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-1087566


Gastroesophageal reflux is a frequent condition in the daily life of infants and older children. When reflux causes symptoms, it is called gastroesophageal reflux disease. Different extraesophageal symptoms have been frequently attributed to gastroesophageal reflux, however, new diagnostic techniques available, such as pHmetry with impedance measurement, have allowed us to evaluate and eventually dismiss such relationships. In this article we review the relationship between gastroesophageal reflux and laryngeal pathology, chronic cough, asthma and aspiration. In general terms, the empirical treatment of a presumed reflux is not recommended in asymptomatic patients, in whom its presence is not demonstrated by techniques such as pHmetry with impedance, given that therapeutic response is low and similar to placebo, with potential adverse effects.

El reflujo gastroesofágico es una condición frecuente en la vida diaria de lactantes y niños mayores. Cuando produce síntomas, se denomina enfermedad por reflujo gastroesofágico. Se ha atribuido frecuentemente diferentes síntomas extraesofágicos al reflujo, sin embargo, nuevas técnicas diagnósticas disponibles, como la pHmetría con medición de impedanciometría, han permitido evaluar y eventualmente descartar tales asociaciones. En este artículo se revisa la relación entre el reflujo gastroesofágico y patología laríngea, tos crónica, asma y aspiración. En términos generales, no se recomienda el tratamiento empírico de un supuesto reflujo en pacientes asintomáticos, en quienes tampoco esté demostrada su presencia por técnicas como la pHmetría con impedanciometría, dado que la respuesta terapéutica es baja y similar a placebo, con potenciales efectos adversos.

Humanos , Lactente , Criança , Doenças Respiratórias/etiologia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Asma/etiologia , Refluxo Gastroesofágico/terapia , Doenças da Laringe/etiologia , Endoscopia do Sistema Digestório , Tosse/etiologia , Aspiração Respiratória/etiologia , Concentração de Íons de Hidrogênio , Manometria
Int. arch. otorhinolaryngol. (Impr.) ; 23(3): 331-337, July-Sept. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1040030


Abstract Introduction Sulcus vocalis is defined as a longitudinal depression on the vocal cord, parallel to its free border. Its most marked characteristic is breathlessness, caused by incomplete glottal closure, in addition to roughness, due to the decrease in mucosal wave amplitude of the vocal cords. Vocal acoustic aspects, such as fundamental voice frequency, jitter, and shimmer, may also be altered in individuals with this type of laryngeal disorder. To assess the voice of individuals with sulcus vocalis, studies generally include a sample of subjects with vocal symptoms, excluding asymptomatic persons. To better characterize the vocal characteristics of individuals with sulcus vocalis, their asymptomatic counterparts must also be included. Objective Characterize the larynx and voice of asymptomatic adults with sulcus vocalis. Method A total of 26 adults, 13 with sulcus vocalis (experimental group) and 13 without (control group) were assessed. All the participants were submitted to suspension microlaryngoscopy, voice self-assessment, auditory perception and acoustic evaluation of the voice. Results Among the individuals with sulcus vocalis, 78% of the sulci were type I and 22% type II. Auditory perception assessment obtained statistically significant lower scores in individuals with sulcus vocalis compared with the control group, and a slight difference in the overall degree of hoarseness and roughness. No statistically significant intergroup diferences were found in self-reported voice or acoustic assessment. Conclusion Type I was the predominant sulcus vocalis observed in individuals without voice complaints, who may also exhibit slight changes in vocal quality and roughness.

Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Prega Vocal/fisiopatologia , Doenças da Laringe/fisiopatologia , Laringe/fisiopatologia , Percepção Auditiva , Acústica da Fala , Qualidade da Voz , Estudos Transversais
Int. arch. otorhinolaryngol. (Impr.) ; 23(1): 18-24, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002171


Abstract Introduction Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical tools. Objective To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure. Methods This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015. Results The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures. Conclusion The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution. (AU)

Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Laringoscopia/métodos , Microcirurgia/métodos , Brasil , Doenças da Laringe/cirurgia , Estudos Transversais , Estudos Retrospectivos , Laringoscopia/instrumentação
Int. arch. otorhinolaryngol. (Impr.) ; 23(1): 60-64, Jan.-Mar. 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002175


Abstract Introduction The human larynx is a very important organ for communication. Many conditions lead to scarring of the vocal folds, decreasing voice quality. Objective We aimed to determine whether fibroblast growth factors (FGFs) may influence tissue integration of grafted fascia into the vocal folds of an animal model. Methods This is an experimental animal study with 12 adult rabbits that were submitted to a grafting fragment obtained from superficial cervical fascia into the vocal fold lamina propria, bilaterally. The right vocal fold was injected with FGFs. The animals were sacrificed after 1 month or 12 months, depending on the group they were assigned to, and a histological analysis of their vocal folds was performed.We analyzed the histological changes (such as the presence of fibrosis and neovascularization) induced by the acute or chronic inflammatory reactions. Results The FGFs induced acute inflammatory changes in all animals after 1 month of the initial experiment. The presence of FGFs triggered more fibrosis than the expected due to the surgical procedure itself when compared with the control side of all animals after 12 months of the initial experiment. Conclusions Fibroblast growth factors alone do not represent a good therapeutic option in phonosurgery, since we observed higher levels of fibrosis in the vocal fold lamina propria. Further studies combining more substances may be necessary to elucidate the best option to be used in this kind of surgery. (AU)

Animais , Prega Vocal/patologia , Fascia Lata/transplante , Fatores de Crescimento de Fibroblastos/farmacologia , Coelhos , Fibrose/etiologia , Doenças da Laringe/congênito , Inflamação/induzido quimicamente , Neovascularização Patológica/etiologia
Int. arch. otorhinolaryngol. (Impr.) ; 23(1): 116-124, Jan.-Mar. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1002187


Abstract Introduction Vocal fold polyps are one of themost frequent benign laryngeal lesions, impacting the quality of life of those affected by them, primarily the vocal production. Despite being a well-established therapy in conjunction with surgery, speech therapy alone may also be effective in treating these lesions. As such, otolaryngologists and speech therapists need updated bibliographic knowledge on the issue. Objective To describe the literature findings on vocal fold polyps that discuss prevalence, etiology, histology, physiopathology, vocal characteristics or treatment. Data Synthesis The present study is a review article based on a bibliographic search using platforms, databases and search engines, with no restrictions on means of publication, methodological quality or language. All the articles on vocal fold polyps pertaining to the object of study published in the past 15 years were included. Among the characteristics investigated, the most discussed were prevalence of men, smoking as an etiological cofactor, the possibility of histological differentiation from vocal nodules, the relationship with cover minor structural alterations, and the indication and effectiveness of different treatment options. Conclusion Despite the discrepancies found in the present literature review on vocal fold polyps, there has been a notable scientific progress in the otolaryngologic techniques and in the effectiveness of speech therapy as initial treatment, with direct and indirect techniques, corroborating the need for scientific investigation of the issue.

Humanos , Masculino , Feminino , Pólipos , Prega Vocal , Doenças da Laringe , Pólipos/diagnóstico , Pólipos/etiologia , Pólipos/fisiopatologia , Pólipos/patologia , Pólipos/terapia , Pólipos/epidemiologia , Tabagismo/complicações , Prega Vocal/patologia , Diagnóstico Diferencial
Acta otorrinolaringol. cir. cabeza cuello ; 47(3): 165-171, 2019. ilus
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1095190


Introducción: el diagnóstico y tratamiento prenatal de múltiples enfermedades son posibles en la actualidad dado el conocimiento anatómico, el desarrollo tecnológico y la integración de varias áreas de la medicina. Objetivo: realizar la identificación ecográfica de la anatomía de la laringe fetal. Diseño: observacional descriptivo. Metodología: se realizó un estudio descriptivo en ultrasonografías de laringes fetales de 10 gestantes en la segunda mitad del embarazo, durante la ecografía morfológica; se determinó la identificación de las estructuras, tales como epiglotis, aritenoides, pliegues vocales y su movilidad, subglotis, tráquea, división traqueoesofágica, diámetro de la subglotis y de la tráquea proximal. Resultados: lamedia de la edad gestacional de los fetos evaluados fue de 26 semanas (20-34+5) 50 % de sexo femenino y 50 % masculino; se logró la visualización de todas las estructuras laríngeas en 2D en el 100% de los casos, en ningún caso de la división traqueoesofágica. El movimiento de los pliegues vocales fue fácilmente reconocible en todos los casos. Conclusiones: aunque las alteraciones congénitas laríngeas representan una baja incidencia, es fundamental el desarrollo en el conocimiento de la anatomía laríngea desde el punto de vista fetal para su diagnóstico ecográfico y posible tratamiento temprano.

Objective: Prenatal diagnosis and treatment for multiple diseases are now possible thanks to the anatomic knowledge available, the technological development and the integration of different areas of medicine; the aim of this study was to identify through ultrasound the anatomy of the fetal larynx. Design: Descriptive study. Methods: a descriptive study with ultrasounds of 10 pregnant women's fetuses' larynges during the second half of their gestation was carried out, during the morphological ultrasound structures such as the epiglottis, arytenoids, vocal folds and their movement, subglottis, trachea, tracheoesophageal division, subglottis diameter and proximal trachea were identified. Results: The fetuses' gestational age median was 26 weeks (20-34+5), 50 % females, 50 % males. The visualization of all laryngeal structures in 2D was possible in 100 % of the cases; the tracheoesophageal division was not seen in any case. The movement of the vocal folds was easily identified in all cases. Conclusions: Even though laryngeal congenital anomalies show low incidence, the development of the larynx anatomic knowledge at the fetal stage is fundamental to early diagnose diseases, anomalies and disorders through ultrasound and have the possibility of recommending early treatments.

Humanos , Ultrassonografia Pré-Natal , Prega Vocal , Doenças da Laringe
Acta otorrinolaringol. cir. cabeza cuello ; 47(2): 101-107, 2019. ilus, tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1094891


Introducción: las lesiones vasculares (LV) de los pliegues vocales hacen parte del grupo de alteraciones estructurales mínimas de la laringe. Se caracterizan por la presencia de disfonía refractaria, usualmente de difícil diagnóstico y manejo. Objetivos: describir las características clínico-demográficas y realizar una caracterización de los hallazgos quirúrgicos de los pliegues vocales en pacientes con LV atendidos en un centro de atención de IV nivel en Bogotá. Diseño: estudio observacional de corte transversal. Métodos: se revisaron los registros clínicos de pacientes con disfonía diagnosticados con lesiones vasculares por microlaringoscopia. Se observó la frecuencia y distribución de las lesiones vasculares según cada tipo de lesión y se describió la relación entre lesiones vasculares y otras patologías laríngeas. Resultados: se incluyeron 43 pacientes entre los 15 y 80 años. La distribución por género fue de 48,8 % hombres y 51,2 % mujeres. El 69,8 % de los pacientes eran profesionales de la voz. Los síntomas más prevalentes fueron disfonía (65,2 %) y fonastenia (27,9 %). La presentación de las LV en orden de frecuencia fue: disposición anómala de los vasos sanguíneos (42,9 %), várices (26,5 %), ectasia papilar (22,4 %) y hemorragia (8,2 %). Conclusión: los hallazgos sociodemográficos y la presentación clínica fueron similares a los reportados en otros estudios. La presentación con mayor frecuencia fue en profesionales de la voz, la cual estaba asociada con el abuso vocal; por lo tanto, es un posible factor causal de la aparición de LV de los pliegues vocales.

Introduction: the vascular lesions (VL) of the vocal folds form part of the group of minor structural alterations of the vocal fold, they are characterized by the presence of a refractory dysphonia that usually is of difficult diagnosis and treatment. Aim: describe demographic and clinical characteristics of this lesions and categorize the surgical finding in patients with VL of vocal folds diagnosed in an IVth level complexity hospital in Bogota. Methods: we reviewed the clinical records of patients with vascular lesions diagnosed by microlaryngoscopy. We observed the frequency and distribution of vascular lesions according to each type of injury and described the relationship between vascular lesions and other laryngeal lesions. Results: 43 patients were included, between 15 and 80 years old. Gender distribution was 48,8 % men and 51,2 % women. 69,8 % of patients were professional vocalist. The most prevalent symptoms were dysphonia (65,2 %) and vocal fatigue (27,9 %). The presentation of VL in order of frequency were: abnormal disposition of blood vessels (42,9 %) varices (26,5 %), papilar ectasia (22,4 %) and hemorraghe (8,2 %). Conclusions: the sociodemographic findings and clinical presentation of this disease were similar to the reported by other studies. The highest presentation was seen in professional vocalist associated with vocal abuse, this being a possible causal factor of the appearance of LV of the vocal folds.

Humanos , Doenças da Laringe , Prega Vocal , Malformações Vasculares
Rev. patol. trop ; 47(4): 255-260, dez. 2018. ilus
Artigo em Inglês | LILACS | ID: biblio-996647


Mammomonogamus laryngeus (sin.: Syngamus laryngeus) is a nematode which parasites the respiratory tract of some animals. It is occasionally seen in humans, who present symptoms similar to other diseases with respiratory manifestations, such as a chronic dry cough and chest pain, in addition to a "foreign body" sensation in the throat. It can be diagnosed through rhinolaryngoscopy or bronchoscopy examinations, but this often occurs only after spontaneous expectoration of the worms, a long period of symptomatology and the use of several types of medication. In this report, we describe a case of syngamosis in Florianópolis (Santa Catarina, Brazil). The patient consulted several health professionals during the course of the disease and was prescribed numerous drugs. Diagnosis was eventually reached after the spontaneous expectoration of a nematode couple

Humanos , Doenças Respiratórias , Doenças da Laringe , Técnicas de Diagnóstico do Sistema Respiratório , Nematoides
Distúrb. comun ; 30(4): 767-775, dez. 2018. ilus
Artigo em Português | LILACS | ID: biblio-995914


Introdução: Os docentes estão expostos a diversos fatores de riscos ocupacionais, e acredita-se que qualidade vocal não está relacionada apenas com ausência de alteração, mas sim com bem-estar geral do indivíduo. Existem vários fatores que contribuem para o aparecimento de problemas vocais nos professores como: o uso inadequado da voz, competição vocal, sobrecarga vocal, hábitos inadequados como exemplo (cigarro e álcool). Objetivo: O presente estudo teve como objetivo analisar as principais alterações vocais em professores e consistiu em uma pesquisa bibliográfica, descritiva de caráter qualitativo. Método: Realizou-se um levantamento da literatura nacional e internacional, publicada nos idiomas Inglês, Espanhol, Português entre 2007 e 2017. Foram selecionados por meio das bases de dados "Biblioteca Virtual em Saúde" (BVS) e "Scientific Electronic Library" (SciELO), utilizando-se os descritores, professores, patologias da voz, saúde vocal e prevenção. Resultados: Observou-se que as principais patologias encontradas foram os nódulos, pólipos, edema de Reinke, cisto e sulco vocal. A rouquidão é o principal sintoma descrito pelos docentes, mas é preciso se preocupar com os demais sintomas sendo eles: fadiga vocal, falhas na voz, falta de ar, ardência na garganta, esforço para falar. Conclusão: Verificou-se na literatura estudada a sugestão de adotar uma política pública de saúde com o objetivo de educar e conscientizar os docentes quanto a noções de higiene vocal, estratégias de comunicação, economia vocal e valorização da profissão, que são ferramentas necessárias para diminuir os índices elevados de docentes com algum tipo de alteração vocal.

Introduction: Teachers are exposed to several occupational risk factors, and it is believed that vocal quality is related not only to absence of change, but to general well-being of the individual. There are several factors that contribute to the development of vocal problems in teachers such as: inadequate use of voice, vocal competition, vocal overload, inappropriate habits as an example (cigarette and alcohol). Objective: This study aimed to analyze the main vocal changes in teachers and consisted of a descriptive bibliographical research of a qualitative nature. Method: A survey of the national and international literature was published in English, Spanish and Portuguese between 2007 and 2017. The descriptors, teachers, voice pathologies, and vocal health were selected using the "Biblioteca Virtual em Saúde" (BVS) and "Scientific Electronic Library" (SciELO) databases. Results: It was observed that the main pathologies found were nodules, polyps, Reinke's edema, cyst and vocal groove. Hoarseness is the main symptom described by the teachers, but it is necessary to worry about the other symptoms being: vocal fatigue, voice failures, shortness of breath, burning throat, effort to speak. Conclusion: It was verified in the studied literature the suggestion of adopting a public health policy with the objective of educating and making teachers aware of notions of vocal hygiene, communication strategies, vocal economy and valorization of the profession are necessary tools to reduce the indices of teachers with some type of vocal alteration.

Introducción: Los docentes están expuestos a diversos factores de riesgo ocupacional, y se cree que calidad vocal no está relacionada sólo con ausencia de alteración, sino con el bienestar general del individuo. Hay varios factores que contribuyen a la aparición de problemas vocales en los profesores como: el uso inadecuado de la voz, competencia vocal, sobrecarga vocal, hábitos inadecuados como ejemplo (cigarrillo y alcohol). Objetivo: El presente estudio tuvo como objetivo analizar las principales alteraciones vocales en profesores y consistió en una investigación bibliográfica, descriptiva de carácter cualitativo. Métodos: Se realizó un estudio de la literatura nacional e internacional, publicado en los idiomas Inglés, español, portugués entre 2007 y 2017 fueron seleccionados a través de bases de datos "Biblioteca Virtual em Saúde" (BVS) y "Scientific Electronic Library" (SciELO), utilizando los descriptores, los maestros, las enfermedades de la voz, salud vocal y prevención. Resultados: Se observó que las principales patologías encontradas fueron los nódulos, pólipos, edema de Reinke, quiste y surco vocal. La ronquera es el principal síntoma descrito por los docentes, pero hay que preocuparse por los demás síntomas que son: fatiga vocal, fallas en la voz, falta de aire, ardor en la garganta, esfuerzo para hablar. Conclusión: Se verificó en la literatura estudiada la sugerencia de adoptar una política pública de salud con el objetivo de educar y concientizar a los docentes en cuanto a nociones de higiene vocal, estrategias de comunicación, economía vocal y valorización de la profesión son herramientas necesarias para disminuir los índices altos de docentes con algún tipo de alteración vocal.

Humanos , Adulto , Voz , Qualidade da Voz , Doenças da Laringe , Saúde do Trabalhador , Prevenção de Doenças , Docentes
Rev. otorrinolaringol. cir. cabeza cuello ; 78(1): 78-83, mar. 2018. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-902818


RESUMEN La amiloidosis es una enfermedad poco frecuente, de etiología desconocida, caracterizada por la presencia de depósitos extracelulares de proteínas fibrilares en diversos órganos y tejidos, teniendo una amplia gama de manifestaciones clínicas según localización y tamaño de los depósitos. En cabeza y cuello, el sitio de presentación más frecuente es la laringe. Suele presentarse con disfonía y/o disnea progresiva, cuyo tratamiento definitivo, sin estar estandarizado, suele ser la resección quirúrgica. Se presenta a continuación el caso de un paciente de 78 años, con historia de disnea en reposo y estridor laríngeo leve de 6 meses de evolución, cuya nasofibroscopía evidenció una masa subglótica, determinando lumen crítico de vía aérea superior. Biopsia reveló amiloidosis, siendo tratado de manera exitosa con exéresis tumoral vía laringoscopía directa.

ABSTRACT Amyloidosis is a rare disease of unknown etiology, characterized by the presence of extracellular acumulations of fibrillar proteins in a variety of organs and tissues, with a wide range of clinical manifestations depending on the location and size of the deposits. In head and neck, the most common site of presentation is the larynx. It usually presents with dysphonia and / or progressive dyspnea, whose definitive treatment, without being standardized, is usually surgical resection. A case of a 78-year-old patient with a history of dyspnea at rest and mild laryngeal stridor of 6 months of evolution is presented, whose nasofibroscopy showed a subglottic mass at the cricoid level, determining a critical upper airway lumen. Biopsy revealed extensive amyloidosis of the upper respiratory tract mucosa, being successfully treated with tumoral excision under direct laryngoscopy.

Humanos , Masculino , Idoso , Doenças da Laringe/cirurgia , Doenças da Laringe/diagnóstico , Amiloidose/cirurgia , Amiloidose/diagnóstico , Laringoscopia/métodos , Dispneia , Disfonia
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-999318


Introducción: El síndrome de apnea obstructiva del sueño, es una patología frecuente en nuestro medio y ha cobrado gran interés por su asociación a otras enfermedades. El colapso laríngeo es causa frecuente de no mejoría (persistencia de índice de apnea-hipopnea residual elevado) tras el manejo de otros niveles de la vía aérea. Objetivo: Realizar una descripción sociodemográfica y clínica de una serie de pacientes con laringomalacia y síndrome de apnea obstructiva del sueño. Diseño: Estudio de serie de casos. Métodos: Se realiza un reporte de casos de una serie de pacientes manejados en el Hospital Militar Central y Clínica Universitaria Hospital San Rafael de Bogotá, con síndrome de apnea obstructiva del sueño y laringomalacia a quienes se les realizó supraglotoplastia, entre los años 2015 - 2017. Resultados: Se incluyeron 11 pacientes con edad promedio de 6.8 años. El diagnóstico se realizó mediante somnoendoscopia. El tipo más frecuente de laringomalacia fue tipo III en 7 pacientes (63.6%), seguido de laringomalacia tipo II en 4 casos (36.3%). 6 de los pacientes (54.5%) presentaban un trastorno genético y/o neurológico asociado. La mayoría de los pacientes mejoraron su sintomatología durante el sueño, aunque 2 no presentaron un resultado favorable tras el procedimiento quirúrgico. Conclusiones: Los resultados de este estudio sugieren una relación entre laringomalacia y SAHOS en la edad pediátrica.

Introduction: Obstructive sleep apnea syndrome is a frequent disease in our region and due to its association with other diseases its importance is high. Larynx´s collapse is a frequent cause of non-improvement (persistence of residual apnea-hypopnea index) after treatment of other obstructive areas inside the airway. Objective: To perform a sociodemographic and clinical description of a series of patients with laryngomalacia and obstructive sleep apnea syndrome. Design: Case series. Materials and methods: We present a report of patients managed at the Hospital Militar Central and University Hospital "Clínica San Rafael" of Bogotá, with obstructive sleep apnea and laryngomalacia syndrome who underwent supraglotoplasty between the years 2015 - 2017. Results: Eleven patients with an average age of 6.8 years were included. The diagnosis was made by somnoendoscopy. The most frequent type of laryngomalacia was type III in 7 patients (63.6%), followed by type II in 4 cases (36.3%). 6 of the patients (54.5%) presented an associated genetic and/or neurological disorder. Most of the patients improved their symptoms during sleep, although some did not show a favorable result after the surgical procedure. Conclusions: The study results suggest a relationship between laryngomalacia and OSAS in children.

Humanos , Síndromes da Apneia do Sono , Doenças da Laringe , Laringomalácia
Rev. otorrinolaringol. cir. cabeza cuello ; 77(3): 239-245, set. 2017. tab, ilus
Artigo em Espanhol | LILACS | ID: biblio-902771


Introducción: Los quistes de cuerda vocal son una causa relativamente frecuente de disfonía. Su origen es aún controversial, y su diagnóstico y manejo continúan siendo un desafío clínico. Objetivo: Exponer y analizar las características clínicas de los quistes de cuerda vocal en nuestra serie de pacientes. Material y método: Estudio retrospectivo descriptivo de los pacientes con diagnóstico de quiste de cuerda vocal atendidos en nuestro centro entre junio de 2012 y diciembre de 2015. Resultados: Se atendieron 44 pacientes con diagnóstico de quiste de cuerda vocal, lo que representa el 4,32% de las consultas en nuestro Centro de Voz. La mayoría de los pacientes fueron adultos, y de ellos el 68,29% correspondió a mujeres. El 34,1% de los pacientes fueron sometidos a tratamíento quirúrgico con técnica de microfonocirugía. El 75% de los pacientes operados presentó mejoría en patrón de onda mucosa videolaringoestroboscópica. Todos los pacientes en los que se disponía de encuestas de valoración subjetiva de la voz pre y posoperatorias demostraron mejoría vocal significativa. Conclusión: Los quistes de cuerda vocal son lesiones que afectan a niños y adultos. La videolaringoestroboscopía es clave en el diagnóstico de estas lesiones, y el tratamiento quirúrgico con microfonocirugía es efectiva en cuanto a resultados vocales desde el punto de vista anatómico y funcional.

Introduction: Vocal cord cysts are a relatively frequent cause of dysphonia. Their origin is still controversial, and their diagnosis and management continue to be a clinical challenge. Aim: To describe and analyze the clinical characteristics of vocal cord cysts in our series of patients. Material and method: Descriptive retrospective study of patients with diagnosis of vocal cord cyst attended in our center between June 2012 and December 2015. Results: 44 patients had the diagnosis of vocal cord cyst, which represents 4.32% of the patients that attended our Voice Center during that period. Most of the patients were adults, and among them 68.29% corresponded to women. 34.1% of the patients were submitted to surgical treatment with microphonosurgery technique. 75% of the surgical patients presented an improvement in the pattern of the videolaryngostroboscopic mucosal wave. All the patients in which pre and postsurgical subjective voice assessment polls were available, showed a significant voice improvement. Conclusion: Vocal cord cysts are lesions that affect both children and adults. The videolaryngostroboscopy evaluation is key in the diagnosis of these lesions, and the surgical treatment with microphonosurgery is effective in terms of anatomical and functional vocal results.

Humanos , Masculino , Feminino , Criança , Adulto , Prega Vocal/cirurgia , Prega Vocal/patologia , Doenças da Laringe/cirurgia , Doenças da Laringe/patologia , Cistos/cirurgia , Cistos/patologia , Doenças da Laringe/diagnóstico , Estudos Retrospectivos , Cistos/diagnóstico , Estroboscopia , Disfonia/etiologia , Laringoscopia , Microcirurgia/métodos
Rev. otorrinolaringol. cir. cabeza cuello ; 77(2): 164-168, jun. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-902757


Los pólipos de cuerda vocal son lesiones laríngeas benignas. Se asocian a micro-traumatismos por mal uso vocal que generan remodelación de la lámina propia y el epitelio. Es más frecuente en hombres entre los veinte y cuarenta años. En la gran mayoría de los casos se presenta de manera unilateral. Si bien estas lesiones están bien documentadas en la literatura, es raro encontrar presentaciones bilaterales, por lo que su enfrentamiento y manejo puede ser discutible. Se presenta el caso de una paciente de sexo femenino de 41 años, fumadora, que consulta por disfonía de larga data. Se diagnostican pólipos bilaterales de cuerda vocal, realizando una intervención quirúrgica en un tiempo, con un resultado favorable.

Vocal cord polyps are benign Iaryngeal lesions. They are associated to micro traumatisms because ofvocal misuse, generating a remodelation of the lamina propria and the epithelium. It is more common in men between twenty and forty years of age. In the vast majority of cases it unilaterally occurs. While these are well documented injuries in the literature, it is rare to find bilateral presentations, so their confrontation and management may be debatable. We present the case of a female patient, smoker, who consulted for chronic dysphonia. Bilateral vocal cord polyps were diagnosed, performing a bilateral resection with a positive outcome.

Humanos , Feminino , Adulto , Pólipos/cirurgia , Prega Vocal/cirurgia , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Microcirurgia/métodos , Pólipos/diagnóstico , Prega Vocal/patologia , Doenças da Laringe/diagnóstico
Rev. otorrinolaringol. cir. cabeza cuello ; 77(2): 188-192, jun. 2017. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: biblio-902761


El láser como alternativa a la cirugía abierta de la vía aérea superior ha venido a modificar la forma de abordaje de las patologías en esta área, pero no deja de ser un procedimiento costoso que no está al alcance de todos los servicios. Por este motivo se han reinventado nuevas formas de abordaje que cumplan los mismos requisitos tanto de la cirugía abierta como con láser pero con un menor coste. Presentamos una serie de 30 casos realizados en un período de 6 años por motivos tanto tumorales como no, en los que se realizaron abordajes cerrados a través de microcirugía con disección mediante microelectrodos. Obteniendo pocas complicaciones y una disminución de la estancia hospitalaria significativa. Con lo cual nos parece una técnica eficiente para abordajes de este tipo.

The laser as an alternative to open surgery of the upper airway has come to change the form of approaching the disease in this area, but it is still an expensive procedure that is not available to all services. For this reason a new ways of approach to meet the same requirements both open as laser but at a lower cost surgery. We present a series of 30 cases performed over a period of 6 years for reasons as much tumor, which closed approaches through microsurgical dissection were performed using microelectrodes. Obtaining few complications and significant decreased hospital stay. Our considerations is it seems an efficient technique for such approaches.

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Doenças da Laringe/cirurgia , Eletrocirurgia/métodos , Laringectomia/métodos , Microcirurgia/métodos , Neoplasias Laríngeas/cirurgia , Microdissecção , Eletrodos
Rev. otorrinolaringol. cir. cabeza cuello ; 77(2): 193-196, jun. 2017. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-902762


Las fracturas laríngeas se producen principalmente en el contexto de traumas cervicales, ahorcamiento o estrangulamiento. Las fracturas laríngeas no traumáticas son excepcionales, existiendo escasos reportes en la literatura. A continuación, presentamos dos casos de fracturas laríngeas no traumáticas evaluadas en nuestro servicio.

Laryngeal fractures occur mainly in the context of cervical trauma, hanging or strangulation. Nontraumatic laryngeal fractures are rare and there are fewreports in the literature. We present two cases of nontraumatic laryngeal fractures evaluated in our service.

Humanos , Masculino , Adulto , Doenças da Laringe/diagnóstico , Laringe/lesões , Espirro , Tomografia Computadorizada por Raios X , Doenças da Laringe/etiologia , Doenças da Laringe/tratamento farmacológico , Corticosteroides/uso terapêutico , Deglutição , Laringoscopia , Anti-Inflamatórios/uso terapêutico
Arch. argent. pediatr ; 115(1): e31-e33, feb. 2017.
Artigo em Inglês, Espanhol | LILACS | ID: biblio-838327


La insuficiencia respiratoria posoperatoria es una complicación grave de la tiroidectomia, y su origen puede ser multifactorial, especialmente en los niños. Presentamos el caso de dos hermanos sometidos a una tiroidectomia que luego tuvieron dificultad respiratoria. Para la disección de la tiroides se emplearon un bisturí armónico y el sistema de sellado vascular bipolar electrotérmico. Ambos pacientes presentaron problemas para respirar tempranamente en el posoperatorio. El hermano mayor tuvo dificultad respiratoria leve durante 24 horas, que se resolvió espontáneamente. Se extubó a la hermana menor, pero tuvo estridor grave acompañado de tiraje intercostal y retracción abdominal. Se la volvió a intubar y se la trasladó a la UCI, donde se la conectó a un respirador. Permaneció en la UCI durante 14 días debido a múltiples intentos fallidos de extubación. Es probable que los síntomas fueran más graves en la niña pequeña debido a que la pared de la tráquea era más blanda y los cartílagos, más débiles. Es necesario considerar las posibles complicaciones respiratorias posoperatorias a causa de una lesión térmica o una técnica quirúrgica inadecuada tras una tiroidectomía.

Postoperative respiratory insufficiency is a serious complication of total thyroidectomies which can be multifactorial, especially in children. We report two siblings who had undergone thyroidectomy with subsequent respiratory distress. Electrothermal bipolar and harmonic scalpel were used during thyroid dissections. Both patients had early postoperative respiratory problems. The older one suffered from mild respiratory distress for 24 hours and then he spontaneously recovered. The younger one was extubated but then she had serious stridor accompanied with abdominal and intercostal retractions. She was re-intubated and admitted to ICU for mechanical ventilatory support, where she stayed for 14 days due to multiple failed extubation attempts. The symptoms were more severe in the younger child probably due to softer tracheal wall and weaker tracheal cartilages. We should keep in mind the probable postoperative respiratory complications due to thermal injury or inappropriate surgical technique after thyroid surgeries.

Humanos , Masculino , Feminino , Pré-Escolar , Criança , Complicações Pós-Operatórias/etiologia , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Doenças da Traqueia/etiologia , Queimaduras/complicações , Doenças da Laringe/etiologia , Edema/etiologia , Eletrocirurgia/efeitos adversos , Queimaduras/etiologia , Complicações Intraoperatórias/etiologia
Rev. otorrinolaringol. cir. cabeza cuello ; 76(3): 280-285, dic. 2016. ilus, graf, tab
Artigo em Espanhol | LILACS | ID: biblio-845627


Introducción: La tiroidectomía es una de las cirugías más frecuentes realizadas en cabeza y cuello. Existen escasos reportes de experiencia en tiroidectomías en servicios de otorrinolaringología en Chile. Objetivo: Analizar la experiencia clínica con las tiroidectomías totales realizadas en el Servicio de ORL y Cirugía de Cabeza y Cuello de nuestro hospital. Material y método: Estudio descriptivo retrospectivo. Revisión de fichas clínicas de pacientes sometidos a tiroidectomías totales (TT) entre los años 2010 y 2014 en nuestro servicio. Resultados: Se realizaron 271 tiroidectomías totales. La indicación más frecuente fue por tamaño (51%). Los diagnósticos más frecuentes fueron carcinomas papilares (46%) e hiperplasia folicularcoloidea (37%). Se presentaron lesiones transitorias del nervio laríngeo recurrente en 2,9%, y lesiones persistentes en 2,5%. Hipocalcemia transitoria se presentó en el 25% de los pacientes. Discusión: Nuestra serie presenta resultados concordantes con la literatura, presenta una baja tasa de complicaciones, las cuales se observan principalmente en pacientes con vaciamiento cervical y/o en que se observaron 2 o menos paratiroides. Conclusiones: La tiroidectomía total es una técnica quirúrgica segura y nuestra experiencia presenta resultados concordantes a los publicados en la literatura internacional.

Introduction: Thyroidectomy is one of the most common surgeries performed in head and neck. There are few reports of experience in thyroidectomy in otolaryngology services in Chile. Aim: To analyze the clinical experience with total thyroidectomy performed in the service of ENT and Head and Neck Surgery of our hospital. Material and method: Retrospective descriptive study. Review of medical records of patients undergoing total thyroidectomy (TT) between 2010 and 2014 in our service records. Results: A total of 271 thyroidectomy were performed. The most frequent indication was size (51%). The most frequent diagnoses were papillary carcinomas (46%) and follicular colloid hyperplasia (37%). We found 2.5% of transient recurrent laryngeal nerve injury and 2.9% had persistent lesions. Transient hypocalcemia occurred in 25% of patients. Discussion: Our series shows good agreement with literature, it has a low rate of complications, which are mainly seen in patients with neck dissection and/or observed 2 or less parathyroid during surgery. Conclusions: Total thyroidectomy is a safe surgical technique, and our experience shows consistent results to those reported in international literature.

Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Doenças da Laringe/cirurgia , Doenças da Glândula Tireoide/cirurgia , Tireoidectomia/estatística & dados numéricos , Hipocalcemia/cirurgia , Complicações Pós-Operatórias , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Estudos Retrospectivos , Tireoidectomia/métodos
Rev. otorrinolaringol. cir. cabeza cuello ; 76(2): 236-241, ago. 2016. ilus
Artigo em Espanhol | LILACS | ID: lil-793974


El quiste de vallécula congénito es una malformación de vía aérea poco frecuente que se manifiesta principalmente con estridor laríngeo y que puede plantear problemas diagnósticos y terapéuticos complejos, a menudo en situaciones de riesgo vital. Se presenta el caso de un recién nacido de pretérmino (RNPT) de 36 semanas pequeño edad gesta-cional (PEG), portador de un estridor laríngeo congénito y mal incremento pondoestatural que en relación a una infección respiratoria baja, presentó empeoramiento del estridor laríngeo a los 48 días de edad cronológica. Por insuficiencia respiratoria aguda requirió de intubación orotraqueal que no resultó dificultosa. La extubación fue fallida por presentar estridor inspiratorio franco. La nasofibroscopía demostró una lesión de aspecto quístico en base de lengua que desplazaba la epiglotis hacia posterior obstruyendo parcialmente el lumen de la vía aérea. Por laringoscopía directa se realizó marsupialización. Se realiza la revisión bibliográfica y se analiza el caso y su tratamiento.

Congenital vallecular cyst is a rare airway malformation mainly manifested by laryngeal stridor and could generate complex diagnostic and therapeutic problems, often in life-threatening situations. We present the case of a pre-term newborn of 36 weeks small for gestational age, who at 48 days of chronological age showed worsening of a congenital laryngeal stridor in the context of a lower respiratory tract infection associated to low weight gain from birth. For reasons of acute respiratory failure, orotracheal intubation was executed which was not difficult. Extubation was failed because the child presents significant inspiratory stridor. Nasofibroscopy showed a cystic lesion of the tongue base that pushed backward the epiglottis obstructing partially the airway lumen. Marsupialization was performed by direct laryngoscopy. A Bibliographic review was done and the case and its treatment are discuss.

Humanos , Masculino , Lactente , Cistos/complicações , Doenças da Laringe/etiologia , Doenças da Laringe/cirurgia , Sons Respiratórios/etiologia , Obstrução das Vias Respiratórias/etiologia , Epiglote
Bauru; s.n; 2016. 225 p. ilus, graf, tab.
Tese em Português | LILACS, BBO - Odontologia | ID: biblio-867950


Introdução: Para o tratamento das disfonias comportamentais associadas à tensão muscular são recomendadas técnicas de relaxamento cervical e laríngeo, concomitantemente à estimulação da onda de mucosa das pregas vocais, bem como adequação do fechamento glótico e suavização da emissão. Nesse sentido, o recurso da Estimulação Elétrica Nervosa Transcutânea (TENS), corrente elétrica aplicada por meio de eletrodos de superfície, tem sido utilizada no tratamento vocal de mulheres com nódulos vocais. Esta prática tem demonstrado bons resultados na qualidade vocal e na redução da dor muscular, porém, verifica-se escassez de comprovação científica dos seus efeitos somados à terapia vocal. Objetivo: verificar a efetividade da TENS de baixa frequência associada à terapia vocal no tratamento de voz em mulheres disfônicas. Método: Este estudo foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos, número 556.273. Participaram 27 mulheres com nódulos vocais, de 18 a 45 anos de idade (média de 33 anos de idade), divididas, de forma randomizada, em: Grupo Experimental (GE) – 13 mulheres que receberam 12 sessões de aplicação de TENS (pulso: 200 μs, frequência: 10 Hz, no limiar motor), com eletrodos posicionados no músculo trapézio - fibras descendentes e na região submandibular, bilateralmente, por 20 minutos, associada a 30 minutos de terapia vocal; e Grupo Controle (GC) – 14 mulheres que receberam 12 sessões de aplicação de TENS placebo (mesmas condições do GE, incluindo posicionamento dos eletrodos, porém sem receber o estímulo em forma de corrente elétrica) por 20 minutos, associada a 30 minutos de terapia vocal. Todas foram submetidas à avaliação da qualidade vocal por meio das análises perceptivo-auditiva e acústica da voz; da laringe por meio de análise perceptivo-visual; autopercepção sobre a voz, qualidade de vida por meio do protocolo de Qualidade de Vida em Voz...

Introduction: For the treatment of the behavior dysphonia associated muscle tension are recommended techniques of cervical and laryngeal relaxation, concurrently with stimulation of the mucosa wave of the vocal folds, such as adequacy of glottal closure and smoothing the emission. Thereby, the use of Transcutaneous Electrical Nerve Stimulation (TENS), electrical current applied through surface electrodes, have been used in the vocal treatment of women with vocal nodules. This practice has shown good results in vocal quality and in reducing muscle pain, however, there are few scientific evidence about their effects added to voice therapy. Proposal: to verify the effectiveness of low frequency TENS associated with voice therapy on vocal quality and laryngeal dysphonic women. Methods: This study was approved by the Research Ethics Committee, number 556.273. Twenty seven women with vocal nodules participated, 18-45 years of age (mean 33 years), divided, randomly into: experimental group (EG) - 13 women who received 12 sessions of application TENS (pulse: 200 μs, frequency 10 Hz, motor threshold), with electrodes placed on the trapezius muscle – descending fibers and submandibular area, bilaterally, for 20 minutes, associated with 30 minutes of vocal therapy; and Control Group (CG) - 14 women who received 12 sessions of application TENS placebo (same conditions as EG, including the placed of the electrodes, but without receiving the stimulus in the form of electrical current) for 20 minutes, associated with 30 minutes of vocal therapy. All were submitted to vocal quality through auditory perceptual and acoustic voice analyzes; ENT evaluation through visual perceptual analysis; vocal self-perception; voice-related quality of life through the Voice-Related Quality of Life Protocol (V-RQOL); complaints and vocal/laryngeal and musculoskeletal pain symptoms, before, immediately after treatment and one month after. Results...

Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Disfonia/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Análise de Variância , Método Duplo-Cego , Doenças da Laringe/terapia , Dor Musculoesquelética/terapia , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Prega Vocal , Qualidade da Voz