Methodological Procedures to Acquire and Analyze Ultrasound Images of Swallowing: A Scoping Review.

This scoping review aimed to identify methodological procedures for acquiring and analyzing ultrasound images related to swallowing in adults and older adults. The inclusion criteria were based on the PCC strategy (participants, concept, and context), as follows: population (adults and older adults), concept (ultrasound assessment), and context (swallowing assessment). The review included observational, experimental, descriptive, and analytical studies and excluded those that were not available in full, animal studies, in vitro studies, letters to the editor, errata, study protocols, and those that used ultrasound for purposes other than swallowing. There were no language and time restrictions. Two independent blinded professionals selected 81 articles that met the inclusion criteria from different databases. The most evaluated parameters included tongue morphology and movements, hyoid bone displacement, swallowing muscle area, and pharyngeal residue detection, such as pharyngeal wall mobility. They used convex and linear transducers (3 MHz to 8 MHz) positioned in the submental, laryngeal, and lateral regions of the neck. The subjects were seated and instructed to eat different food volumes and consistencies. The literature mapping showed that ultrasound is a promising diagnostic tool, helping clinicians understand swallowing disorders, as it provides static and dynamic images in different modes and positions. Also, patients receive real-time biofeedback of changes related to dysphagia.

Hyoid Bone Movement During Swallowing in Female Thyroidectomy Patients: A Kinematic Ultrasound Study.

The aim of this study was to investigate the measures of displacement, time and velocity of hyoid bone movement in female thyroidectomy patients. Fifty-eight ultrasound videos of 29 women during swallowing were analyzed. The sample was divided into experimental group (EG), composed of 12 women following total or partial thyroidectomy; and control group (CG) of 17 healthy women. The kinematic measures of displacement, time and velocity of hyoid bone displacement were tracked during swallowing of 10 ml of liquid (water) and 10 ml of thickened liquid (honey) in both groups for comparisons. Additional analysis included bolus consistency effect and relationship with clinical characteristics. Ultrasound videos were analyzed according to a standardized protocol using ImageJ software. Displacement, time and velocity of hyoid movement during swallowing of 10 ml of liquid or thickened liquid were not statistically different between female thyroidectomy patients and healthy women. There is no bolus consistency effect on kinematic measures in both groups, but among thyroidectomy patients, velocity of hyoid bone movement is significantly faster in those with swallowing complaints.

Voice Therapy for Older Adults During the COVID-19 Pandemic in Brazil.

OBJECTIVE: To characterize the clinical practice of Brazilian speech-language-hearing therapists regarding voice therapy for older adults during the COVID-19 pandemic. METHODS: Cross-sectional survey conducted remotely. Data were collected through a form shared online with approximately 1.500 speech-language-hearing therapists. The form included voice therapy practice with older adults during the COVID-19 pandemic. It was responded by 155 voice experts. RESULTS: Most respondents were females with over 21 years' experience in vocal health care, working with both in-person therapy and teletherapy. Obtaining acoustic parameters and using therapy strategies for breathing and body training were the most reported changes in remote therapy during the pandemic. The main difficulties involved wearing masks in in-person therapy and assessing the voice in teletherapy. Patient adherence and goals reached were deemed positive by most participants. Associations were found between place and format of service; between patient adherence and goals reached; and between difficulties in teletherapy and use of complementary therapeutic resources. CONCLUSION: The COVID-19 pandemic led Brazilian speech-language-hearing therapists to change their clinical practice with older adults in both remote and in-person therapy. The main changes involved wearing masks in in-person therapy and assessing the voice in teletherapy. Remote therapy proved to be a safe and effective possibility.

Thermography in complementary assessments of head and neck muscles: A scoping review.

INTRODUCTION: Infrared thermography has the potential to help assess human head and neck muscles, as thermal variation measurements due to muscle imbalance can contribute to the evaluation and therapeutic follow-up of various clinical conditions in the field of health. OBJECTIVE: This study investigated, with a scoping review, the use of infrared thermography in complementary assessments of human head and neck muscles to determine the extent of research on the topic, what methodologies are used in thermal assessment and thermographic analysis, what regions are assessed, and what results are expected in thermography. METHODS: LILACS, MEDLINE, SciELO, and Web of Science were the databases searched to identify articles published on the topic, with no restriction of language or time of publication. Descriptive, analytical, and experimental observational studies on the assessment of the human head and neck muscle surface temperature with infrared thermography were included. Case studies, case series, methodological accuracy, literature review, animal studies, studies that assessed patients with head and neck cancer, and studies that did not assess head and neck muscle temperature with thermography were excluded. The articles were analysed with a protocol developed by the authors, with data on author, year, country, type of study, sample characterisation, muscles assessed, outcomes investigated, thermal assessment methodology, thermographic analysis methodology and thermography measurements. RESULTS: This review identified and analysed 27 articles. The studies assessed thermal distribution in normal individuals and those with pathologies related to hyper- and hypofunctional head and neck muscle conditions for diagnosis or therapeutic follow-up. The masseter, temporal, digastric, anterior cervical region, orbicularis oris, frontalis, buccinator, suprahyoid, trapezius, sternocleidomastoid and levator scapulae muscles were assessed. Quantitative analyses with area selection tool predominated, considering absolute temperatures and temperature differences. The studies investigated temperature and its relationship with myogenic pain, quantitative assessment of muscle parameters and blood flow velocity. The mean temperature ranged from 32.97°C (±2.21) to 34.90°C, and hyper-radiant and/or asymmetric regions were observed in hyperfunctional conditions and normal subjects after muscle activation. CONCLUSION: Thermography is used in complementary assessments of head and neck muscles, identifying hyper-radiant regions and thermal asymmetry related to muscle tension and activation state. Papers are limited to specific clinical conditions and few muscle groups, besides having great methodological variability.

Reliability of Ultrasound Examination of Hyoid Bone Displacement Amplitude: A Systematic Review and Meta-Analysis.

In swallowing, the hyoid bone moves up and forward in response to the activation of suprahyoid muscles, opening the upper esophageal sphincter and aiding the airway protection mechanism. This displacement measure has been analyzed with ultrasound images because this method does not expose the patient to radiation, has a good cost-benefit ratio, and is safe for the patient. However, there is no consensus on the reliability of this ultrasound measure. The objective of this study was to analyze the reliability of measuring hyoid bone displacement amplitude in swallowing with ultrasound. The systematic review encompassed five databases (MEDLINE, Scopus, EMBASE, Web of Science, Cochrane Library) and gray literature. There was no limitation of language or year of publication. The search/selection/extraction methodology was conducted by two authors blindly and independently, and differences were solved by a third rater. Three studies met the eligibility criteria: two of them analyzed the reliability in non-dysphagic populations and the other, in dysphagic patients. The transducer was positioned in the submandibular region in all studies. The authors were not clear about the training time to acquire and analyze ultrasound images. The meta-analysis had an interrater reliability of 0.858 (95% CI: 0.744-0.924) and intrarater reliability of 0.968 (95% CI: 0.903-0.990). There was, however, heterogeneity of p = 0.005 for intrarater reliability. Despite good reliability, the heterogeneity reinforces the importance of training and protocol standardization for image acquisition and analysis.

Oropharyngeal Geometry and the Singing Voice: Immediate Effect of Two Semi-Occluded Vocal Tract Exercises.

PURPOSE: The aim of this study was to verify the immediate effect of a flexible resonance tube in water and of lip trill on oropharyngeal geometry and vocal acoustic parameters of singers without vocal symptoms. METHODS: Twenty-two adult singers participated in the study. They had an average age of 27 (±4.8) years. Participants were split into two groups: a group composed of 12 singers who performed the flexible resonance tube (FRT) exercise and a group of 10 singers who performed the Lip Trill technique (LTT). Acoustic pharyngometry and acoustic analysis of the voice were used to assess oropharyngeal geometry before and after the exercises. RESULTS: After performing the techniques, the vocal tract length was longer in the group that performed the FRT, compared to the one that performed the LTT. In the acoustic evaluation, there was an improvement in the glottal to noise excitation ratio and a decrease in noise in the group of singers who performed the LTT. In the analysis by sex men had a longer oral cavity compared to women and after application of the techniques greater volume of the vocal tract. CONCLUSION: There was variation in the oropharyngeal geometry with the FRT, while the LTT had a positive effect on the vocal acoustic parameters related to glottal noise.

Effects of Voiced Gargling on the Electrical Activity of Extrinsic Laryngeal Muscles and Vocal Self-assessment.

OBJECTIVE: To verify the immediate effects of voiced gargling on the electrical activity of extrinsic laryngeal muscles and vocal self-assessment. METHODS: A sample of 20 individuals of both sexes, mean age of 31.95 (±11.57) years, were equally divided in two groups according to the presence or absence of vocal complaint. Both groups were evaluated by surface electromyography of the suprahyoid (SH) and infrahyoid (IH) muscle areas during rest, phonation of the sustained vowel [Ɛ] in habitual and strong intensities; phonation of rising and falling glissando; and counting from 1 to 10. Surface electromyography was assessed before and after the voiced gargling exercise, which lasted 1 minute. All participants self-rated their voice and phonatory comfort after the exercise. Wilcoxon and Mann-Whitney tests were applied, as well as Fisher's exact test and linear-to-linear test. The level of significance was 5%. RESULTS: The percentage of electrical activity of the SH muscle area decreased in the glissando and counting tasks in the group with vocal complaint, as well as in phonation of sustained vowel in strong intensity in the group without complaint. Decrease was also observed in the right IH muscle area at rest and during sustained vowel phonation at habitual and strong intensities. Percentage of muscular electrical activity was lower in the group with complaint in the following situations: IH muscle area on both sides, at rest and during habitual phonation of sustained vowel and glissando before and after the exercise; right IH muscle area, during counting and strong phonation of sustained vowel before and after exercise; left IH muscle area, in the counting task, just after intervention. Most participants noticed improvement in voice (70%) and phonatory comfort (65%). CONCLUSIONS: Voiced gargling during 1 minute promotes immediate effects on the electrical activity of the extrinsic laryngeal muscles in individuals with or without vocal complaint. Most individuals reported improved voice and phonatory comfort after exercise.

Effect of Resonance Tube Technique on Oropharyngeal Geometry and Voice in Individuals with Parkinson's Disease.

OBJECTIVE: To verify the immediate effect of the flexible resonance tube vocal technique on the oropharyngeal geometry and vocal acoustic parameters of individuals with Parkinson's disease (PD) and to study the correlation between oropharyngeal geometry and the intensity and fundamental frequency (f0) parameters of the voice. METHODS: Forty individuals participated-20 with PD and 20 healthy individuals, with a mean age of 60.95 (± 5.69) years. There were 10 men and 10 women in each group. All underwent pharyngometric analysis of the vocal tract and voice acoustics parameters before and after use of the vocal technique with a flexible resonance tube. RESULTS: After the technique, there was a reduction in pharyngeal cavity volume only in females in the healthy group, a reduction in shimmer values in females in both groups and males in PD group and an improvement in noise parameters in females in the PD group. There was a negative correlation between vocal tract volume and intensity, between f0 and vocal tract volume, between f0 and oropharyngeal junction area, between f0 and oral cavity volume as well as a positive correlation between oral cavity length and f0. CONCLUSION: The vocal technique with the flexible resonance tube applied to individuals with PD improved the subjects' voice quality in the perceptual and acoustic voice parameters. Regarding the oropharyngeal geometry, it was possible to observe its correlation with the parameters of vocal intensity and frequency in the studied population.

Effects of electromyographic biofeedback as an adjunctive therapy in the treatment of swallowing disorders: a systematic review of the literature.

PURPOSE: To describe the primary effects of electromyographic biofeedback therapy on swallowing via a systematic review. METHODS: A blind search was carried out by two researchers in the PubMed and Bireme platforms and in the Medline, Lilacs, SciELO, PsycINFO, CINAHL, and Web of Science databases, and the journal articles identified therein were evaluated for inclusion in the study. Original articles associated with the theme were selected with no population-, region-, or language-associated limits. A protocol was created for this study with the following points: author, year, place, number and characteristics of participants, activities evaluated, instruments used, and main results. The PEDro scale was used to analyze the quality of the studies. RESULTS: Among the 686 articles identified in the combined searches, 566 were duplicates. A total of 65 articles were discarded after the title and abstract were read, and a further 29 articles were discarded after the full text was read, yielding a total of six articles for inclusion. In summary, the results lead us to believe that positive effects on the laryngeal lifting capacity, improved swallowing functions, and increased excursion and maximal elevation of the hyoid bone, may be directly related to this method of therapy. CONCLUSIONS: Adjunctive therapeutic protocols with biofeedback electromyography exert positive effects on swallowing function.

Neoplasm seeding in biopsy tract of the musculoskeletal system. A systematic review.

To identify, through a systematic literature review, the characteristics of neoplasm seeding in biopsy performed on the musculoskeletal system. We performed a search on PubMed, MEDLINE, LILACS and SciELO from August to October 2010. We included articles that addressed the neoplasm seeding in biopsy performed on the musculoskeletal system. The search was limited to English, Spanish and Portuguese as publication languages, but it was not limited by year of publication. We retrieved 2858 articles, but only seven were selected based on inclusion and exclusion criteria. Other four papers were found in the references of selected articles, totalizing 11 articles that were used to perform this systematic review. Issues may be raised in the literature: age and gender don't seem to influence the occurrence of neoplasm seeding; without resection of the biopsy tract, the possibility of local recurrence is very real; the influence of the type of tumor in the occurrence of neoplasm seeding is uncertain; it is impossible to conclude whether the closed biopsy technique has a lower chance of neoplasm seeding; it is likely that adjuvant chemotherapy has a protective effect against neoplasm seeding; an unfavorable prognosis is expected according to neoplasm seeding results.

Gustatory and olfactory dysfunction in laryngectomized patients.

UNLABELLED: After total laryngectomy surgery, nasal airflow is moved permanently to the tracheostomy opening, compromising the contact of odorant molecules with the nasal cavity, which may reflect changes in the olfactory and gustatory perception in these individuals. OBJECTIVE: To evaluate the functions of smell and taste in total laryngectomized patients. STUDY DESIGN: a study of series. METHOD: The sample included a group of 25 patients submitted to total laryngectomy and another group of 25 patients who did not underwent the procedure. The taste function was evaluated by gustatory strips of filter paper. To assess the olfactory function we employed the Brief Smell Identification Test. RESULTS: Among the laryngectomized patients there was more hypogeusia (80%, p < 0.05), as well as hyposmia (88%, p < 0.001), alone and concomitant (72%, p < 0.001). Concerning flavor discrimination, the bitter taste did not differ between the groups - which was different from the other flavors. In the olfactory aspect, laryngectomized patients performed worse in detecting warning and food-related odors. We found that a history of smoking and alcohol consumption were significantly more frequent among laryngectomized patients. CONCLUSION: We found a decrease of gustatory and olfactory functions in total laryngectomized patients in this study.

The use of electrognathography in jaw movement research: a literature review.

The measurement of mandibular movements is a complex task that can be simplified through the use of electrognathography (EGN), an examination that can be applied as an auxiliary method for the diagnosis or follow-up of the evolution of specific therapeutics applied to the stomatognathic system. The aim of the present study was to review the literature pertaining to the use of EGN as a method for monitoring jaw movements in the research and treatments related to the stomathognathic system. A literature review was made by searching for articles in PubMED, MEDLINE (1997-2010), MEDLINE (1966-1996), LILACS, Ovid, BBO and SciELO databases. In this systematic review, 373 articles were found, of these, 23 articles were selected. The study concluded that EGN can be used with advantages in varied clinical situations, although it is a technique still not widely applied.

HPV and precancerous lesions of anal canal in women: systematic review.

OBJECTIVE: The infection caused by human papillomavirus (HPV) in the anogenital area is considered the most common sexually transmitted infection in the world. Although anal cancer is relatively uncommon in the general population, there has been a significant increase in incidence in recent years. In this review, we focused on research on anal lesions in women. METHOD: Research on HPV and precancerous lesions of the anal canal was examined by a systematic literature review in the Cochrane Centre of Brazil, where 1,734 publications were identified in the databases Scielo Brazil, Pubmed, Lilac, Medline, and Old Medline, for the period 1966 to 2010. We selected two papers, published in 1994 and 2009, based on the inclusion-exclusion criteria. RESULTS: The first paper refers to the study of the anal canal in HIV-negative women with previous genital pathology and its relationship to the presence of HPV, and the other compares two groups of women who are HIV+ and HIV- and its relationship with anal disease and HPV. CONCLUSION: The existence of previous genital neoplasia associated with HPV promotes the development of anal lesions, especially in younger patients, and a poor immune status contributes to the appearance of this pathologic finding.

Analysis of the masticatory process of asthmatic children: Clinical and electromyographic research.

INTRODUCTION: The prevalence of asthma has grown considerably in recent decades, but some studies have shown stabilization of this trend. The masticatory process of asthmatic children may be altered due to asthma-related anatomo-functional changes. OBJECTIVE: The study objective was to determine the clinical and electromyographic characteristics of the masticatory process in asthmatic children and compare the electrical activities of their masseter and anterior temporal muscles (at rest and during maximal voluntary contraction and mastication) with those of non-asthmatic children. METHOD: Case study. Asthmatic and non-asthmatic groups, each consisting of 30 children of both sexes between 6 and 10 years of age, were evaluated. Mastication was evaluated clinically and electromyographically in all subjects. RESULTS: The masticatory process did not differ significantly between asthmatic and non-asthmatic children. CONCLUSION: Although the masticatory process did not differ significantly between asthmatic and non-asthmatic children, the masticatory process of asthmatic children may be altered because of anatomical changes of Asthma.

Limits on quality of life in communication after total laryngectomy.

INTRODUCTION: Among people affected by cancer, the impairment of quality of life of people affected by cancer can cause have devastating effects. The self-image of patients after post-laryngectomyzed patients may be find themselves compromised, affecting the quality of life in this population. OBJECTIVE: To characterize quality of life in related to communication in people who have undergone went total laryngectomy surgery. METHODS: This is an observational study, with a cross-sectional and descriptive series. Design of series study. The sample were comprised 15 patients interviewed the period from January to February of 2011. We used the Quality Protocol for Life Communication in Post-laryngectomy adapted from Bertocello (2004); which this questionnaire contains 55 questions. The protocol was organized from the nature of using responses classified as positive and negative aspects, proposals in with respect to five 5 communication domains: family relationships, social relationships, personal analysis; morphofunctional aspect, and use of writing. To promote and guarantee the autonomy of the respondents, was examiners made use of used assistive technology with the Visual Response Scale. RESULTS: The responses that total laryngectomy compromises the quality of life in communication amounted to 463 occurrences (65.7%), and that who responses suggesting good quality of life were represented with amounted to 242 occurrences (34.3%), from a total of 705 occurrencesresponses. From Among the five 5 Communication domains, four 4 had percentages of above 63% for occurrences of negative content for impact on communication. Appearance Morphofunctional appearance gave the had the highest percentage of negative content, amounting to 77.3% of cases. CONCLUSIONS: The results showed important limitations of a personal and social nature due to poor communication with their peers. Thus, there is a need for multidisciplinary interventions that aim to minimize the entrapment of negative impact on these people communication among these patients.

Respiratory muscle strength in asthmatic children.

INTRODUCTION: Changes in the respiratory system of asthmatics are also due to the mechanical disadvantage caused by the increased airway resistance. OBJECTIVE: The study aims to evaluate the respiratory muscle strength and nutritional status of asthmatic children. METHOD: This is a prospective descriptive and transversal study with 50 children aged 7 to 12 years, who were placed into 2 groups, asthmatic and non-asthmatic. Respiratory muscle strength was evaluated on the basis of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). The nutritional status was evaluated by measuring the anthropometric data, including height, weight, and body mass index (BMI). The findings were subjected to analysis of variance, chi-square, and Student's t test, and p-values < 0.05 was considered statistically significant. RESULTS: In our comparisons, we observed statistically significantly lower values for age, weight, and height in asthmatic patients: 8.52 ± 1.49 years, 30.62 ± 7.66 kg, and 129.85 ± 10.24 cm, respectively, vs. non-asthmatic children(9.79 ± 1.51 years, 39.92 ± 16.57 kg, and 139.04 ± 11.62 cm, respectively). There was no significant increase in MIP and MEP between the groups: MIP was -84.96 ± 27.52 cmH2O for the asthmatic group and -88.56 ± 26.50 cmH2O for the non-asthmatic group, and MEP was 64.48 ± 19.23 cmH2O for asthmatic children and +66.72 ± 16.56 cmH2O for non-asthmatics. CONCLUSION: There was no statistically significant difference between groups, but we observed that MIP and MEP were slightly higher in the non-asthmatic group than in the asthmatic group.

The role of cytology in the diagnosis of musculoskeletal neoplasms: systematic review.

The authors systematically reviewed the literature of the last decade on the role of cytology in the evaluation of musculoskeletal neoplasms, and its diagnostic accuracy. A search was carried out on the databases PubMed, MEDLINE, LILACS and SciELO, selecting articles in which cytology was used in the diagnosis of musculoskeletal neoplasms. Limits were used for English, Spanish and Portuguese, and only articles published since 2000 were selected. 757 articles were retrieved, 24 of which were selected based on criteria of inclusion and exclusion. It was concluded that although promising in the assessment of musculoskeletal neoplasms, cytology obtained by fine needle aspiration is less accurate and reliable than histological evaluation of such lesions.

Role of maximal inspiratory presure in the evaluetion of respiratory muscle strength in asthmatics - Systematic review. / Papel da pressão inspiratória máxima na avaliação da força muscular respiratória em asmáticos - Revisão sistemática.

UNLABELLED: Asthma is a chronic illness of the airways that can reduce respiratory muscle strength due to the resulting hyperinflation or treatment with corticosteroids. One of the ways to evaluate this respiratory muscular weakness is the Maximal Inspiratory Pressure (PImax). METHODS: A systematic review of the databases PUBMED/MEDLINE, LILACS and SCIELO was carried through, using the key words: Asthma, respiratory muscle and muscle strength. RESULTS: Fifty were found and six articles that evaluated the PImax in asthmatics, from these, thirty were excluded, making a total of twenty six articles. FINAL CONSIDERATIONS: Through the present revision we show the effectiveness of PImax in evaluating respiratory muscle strength in asthmatics. More studies are needed, however, fot better understanding of the asthmatic individual. Rev Port Pneumol 2010; XVI (3): 463-470.

Effects of asthma in nutritional status in children: A systematic review. / Efeitos da asma no estado nutricional em crianças: Revisão sistemática.

INTRODUCTION: Asthma is a chronic inflammatory disease of high prevalence, considered a public health problem and is thought to be one cause of low birth weight and growth retardation. PURPOSE: The purpose of this article was to review in literature the effects of asthma on the nutritional status in children. MATERIAL AND METHODS: A systematic review was made by searching for articles in PubMed, SciELO and LILACS databases. Review articles, studies with adults or research that did not evaluate the effects of asthma in children were excluded. Hence original articles in humans were included. RESULTS: In the systematic review we found 901 articles in MEDLINE (1966-1996), 47 in LILACS and SciELO in the 16 Brazil, totaling 964 articles. Of these, 17 articles were selected. CONCLUSION: Evidence that asthma interferes in nutritional status can not be proven in this study. Rev Port Pneumol 2010; XVI (4): 617-626.