[Effects of Speech Therapy in Hospitalized Patients with Post-Stroke Dysphagia: A Systematic Review of Observational Studies]. / Efeitos da Terapia da Fala em Pacientes Internados com Disfagia Pós-Acidente Cerebrovascular: Revisão Sistemática de Estudos Observacionais.

INTRODUCTION: Since dysphagia may be one of the brain post-stroke consequences, the objective of this study was to analyze the average recovery time of patients with cerebrovascular accident and dysphagia subjected to speech therapy in a hospital bed. MATERIAL AND METHODS: Systematic review performed following the 'Preferred Reporting Items is Systematic Reviews and MetaAnalyses' instructions. The search was performed in different electronic databases, without restriction of time and language. The studies were evaluated regarding their methodological quality. RESULTS: Of 5671 titles, five studies were included. 176 patients with stroke and dysphagia were obtained (aged between 22 and 91 years old - average: 68.95), with no preference regarding gender. Improvement occurred in 84.26% of the subjects and the recovery time was between one and ninety days (average: 22 days). Randomization, blinding, loss to follow-up and withdrawal were not performed with control group in any study. DISCUSSION: The success of rehabilitation of oropharyngeal dysphagia as a post-stroke sequela will depend on the extent, location of the neurological lesion and early intervention in the hospital bed. Despite the recognition of health professionals about the importance of swallowing rehabilitation for these patients, there is a lack of studies that support an evidence-based practice, although the results point to improvements in this regard. CONCLUSION: Speech therapy in hospital bed in post-stroke hospitalized patients with dysphagia seems to bring satisfactory results in the short-term, revealing the importance of diagnosis and early intervention in these cases.

Introdução: Como a disfagia pode ser uma das sequelas pós-acidente cerebrovascular encefálico, o objetivo deste estudo foi analisar o tempo médio de recuperação de doentes com acidente cerebrovascular encefálico e disfagia submetidos à terapia da fala na beira do leito hospitalar. Material e Métodos: Revisão sistemática realizada a partir do Preferred Reporting Items is Systematic Reviews and Meta-Analyses. A busca foi realizada em diferentes bancos de dados, sem restrição de tempo e idioma. Os estudos foram avaliados quanto à sua qualidade metodológica.Resultados: De 5671 registos rastreados, cinco estudos foram elegíveis. Obtiveram-se 176 doentes com acidente cerebrovascular encefálico e disfagia (idades entre 22 e 91 anos - média: 68,95), sem prevalência quanto ao género. A melhora no quadro da disfagia ocorreu em 84,26% dos sujeitos e o tempo de recuperação entre um e noventa dias (média: 22). Em nenhum estudo foi realizada a randomização, o cegamento, o manejo de perdas, desistências e realizado com grupo controlo. Discussão: O sucesso da reabilitação da disfagia orofaríngea como sequela pós-acidente vascular encefálico dependerá da extensão, da localização da lesão neurológica e da intervenção precoce no leito hospitalar. Apesar do reconhecimento dos profissionais da saúde sobre a importância da reabilitação da deglutição para esses doentes, há carência de estudos que suportem uma prática baseada em evidências, embora os resultados apontem melhoras neste sentido. Conclusão: A terapia da fala na beira do leito em doentes disfágicos pós- acidente cerebrovascular encefálico parece trazer resultados satisfatórios em curto período de tempo, revelando a importância do diagnóstico e da intervenção da terapia da fala precoces.

Cancer treatment in determination of hearing loss / Tratamento oncológico na determinação das alterações auditivas

ABSTRACT INTRODUCTION: Chemotherapy and radiotherapy in oncology have repercussions in hearing health, and can damage structures of the inner ear. These repercussions usually, result in a bilateral and irreversible hearing loss. OBJECTIVE: To identify sensorineural hearing loss cases with complaints of tinnitus and difficulty in speech understanding and investigate their relationship with the types of chemotherapy and radiotherapy the patients received. METHODS: Cross-sectional, clinical, observational, analytical, historical cohort study of 58 subjects treated in a public hospital in the state of Sergipe, diagnosed with neoplasia. The subjects were submitted to anamnesis, conventional pure tone audiometry, and speech recognition threshold. RESULTS: Of the 116 ears, 25.9% presented sensorioneural hearing loss characterized by changes in high frequencies. There was a positive correlation between hearing loss and the association of chemotherapy and radiotherapy ( p = 0.035; R = 0.196). The auditory complaint analysis shows that most of the subjects had tinnitus and speech understanding difficulty, even with a normal auditory threshold. CONCLUSIONS: Cancer treatment causes hearing loss, associated with the administration of chemotherapy and radiotherapy. Cyclophosphamide increased the risk of causing hearing loss. Complaints of tinnitus and speech understanding difficulty were observed.

RESUMO INTRODUÇÃO: O tratamento quimioterápico e radioterápico na oncologia tem repercussão na saúde auditiva e pode lesar estruturas da orelha interna. Ocasiona perda auditiva, geralmente bilateral e irreversível. OBJETIVO: Identificar casos de perda auditiva sensorioneural e sua relação com a média de sessões de quimioterapia e radioterapia, com queixas de zumbido e dificuldade de entendimento da fala, bem como sua relação com medicamentos quimioterápicos. MÉTODO: Estudo de coorte histórica com corte transversal, clínico, observacional, analítico e retrospectivo em 58 sujeitos de um hospital público de Sergipe diagnosticados com neoplasia. Realizou-se anamnese, avaliação audiológica tonal convencional e pesquisa do limiar de reconhecimento de fala. RESULTADOS: Das 116 orelhas; 25,9% apresentaram perda auditiva sensorioneural caracterizada por alterações nas frequências agudas. Observou-se correlação significativa entre perda auditiva e associação da quimioterapia e radioterapia (p = 0,035; R = 0,196). Na análise das queixas auditivas, verificou-se que a maioria apresentou zumbido e dificuldade de entendimento de fala, mesmo com limiares auditivos normais. CONCLUSÕES: O tratamento oncológico gera perda auditiva, que foi determinada pela associação da quimioterapia e radioterapia. Ciclofosfamida aumentou as chances de gerar perda auditiva. Verificou-se presença de queixas de zumbido e dificuldade de entendimento da fala.

Cancer treatment in determination of hearing loss.

INTRODUCTION: Chemotherapy and radiotherapy in oncology have repercussions in hearing health, and can damage structures of the inner ear. These repercussions usually, result in a bilateral and irreversible hearing loss. OBJECTIVE: To identify sensorineural hearing loss cases with complaints of tinnitus and difficulty in speech understanding and investigate their relationship with the types of chemotherapy and radiotherapy the patients received. METHODS: Cross-sectional, clinical, observational, analytical, historical cohort study of 58 subjects treated in a public hospital in the state of Sergipe, diagnosed with neoplasia. The subjects were submitted to anamnesis, conventional pure tone audiometry, and speech recognition threshold. RESULTS: Of the 116 ears, 25.9% presented sensorioneural hearing loss characterized by changes in high frequencies. There was a positive correlation between hearing loss and the association of chemotherapy and radiotherapy (p=0.035; R=0.196). The auditory complaint analysis shows that most of the subjects had tinnitus and speech understanding difficulty, even with a normal auditory threshold. CONCLUSIONS: Cancer treatment causes hearing loss, associated with the administration of chemotherapy and radiotherapy. Cyclophosphamide increased the risk of causing hearing loss. Complaints of tinnitus and speech understanding difficulty were observed.