Transcutaneous Laryngeal Ultrasonography for the Assessment of Laryngeal Function After Thyroidectomy: A Review.

OBJECTIVE: This review set out to examine the applicability of transcutaneous laryngeal ultrasonography (TLUSG) for the assessment of laryngeal function after thyroidectomy. METHODS: An integrative review of the literature was performed using Medline/PubMed, LILACS, and SciELO databases. The methodological quality of the studies was analyzed using the appraisal tool for cross-sectional studies. RESULTS: All 8 included articles investigated laryngeal function with regard to the risk of vocal fold immobility after thyroidectomy. The results regarding the diagnostic power of TLUSG for this assessment are controversial, and there is a tendency to use this examination as a screening procedure for subsequent confirmation by flexible laryngoscopy. CONCLUSIONS: Transcutaneous laryngeal ultrasonography is a viable, noninvasive, and useful tool to assess laryngeal function after thyroidectomy, but current available evidence suggests that it does not replace flexible laryngoscopy for the diagnosis of vocal fold immobility.

Quantitative Ultrasound Assessment of Hyoid Bone Displacement During Swallowing Following Thyroidectomy.

The aim of this study was to investigate temporal ultrasound measurements of the hyoid bone displacement during swallowing following thyroidectomy in women and to relate these measures to age, clinical outcomes, and upper digestive airway symptoms. The sample was divided into an experimental group (EG) of 20 women who underwent thyroidectomy (mean age = 49.55 years ± 15.14) and a control group (CG) of 20 healthy women volunteers (mean age = 40.75 years ± 15.92). Both groups were submitted to ultrasound assessment to obtain four temporal measurements of hyoid bone displacement during swallowing: elevation, anteriorization, maximum displacement, and maintenance of maximum displacement. In both groups, swallowing of ten milliliters of liquid and the same volume of thickened liquid (honey) were analyzed. The images were recorded on video (30 frames/second) and analyzed according to a standardized protocol. Temporal measurements of hyoid bone elevation and maximum displacement during swallowing of thickened liquid were significantly shorter in EG (p = 0.034 and p = 0.020, respectively). There were no differences in the swallowing of liquid, and no other variable was related to the ultrasound temporal measurements investigated. This study concludes that women who undergo thyroidectomy have a shorter time of hyoid bone elevation and maximum displacement during swallowing of 10 mL of thickened liquid.

Nutritional risk and signs and symptoms of swallowing disorders in hospitalized elderly / Risco nutricional e sinais e sintomas de alterações da deglutição em idosos hospitalizados

ABSTRACT Purpose: to relate nutritional risk and signs and symptoms of swallowing disorders as reported by hospitalized elderly, as well as to correlate the Mini-Nutritional Assessment (MNA) total score with the total number of signs and symptoms. Methods: a cross-sectional study with a convenience sample of 28 hospitalized patients, mean age of 72.18 ± 5.92 years, 15 (53.6%) males. The nutritional risk was evaluated by the MNA total score. Signs and symptoms of alterations in swallowing were investigated by means of an interview with 11 items. The Spearman's correlation coefficient and the Mann-Whitney test were applied. The confidence interval was of 95%. Results: half the sample reported at least one sign or symptom of alteration in swallowing, with choking being the most frequent (32.1%). The MNA total score median (19.75) indicated nutritional risk. Elderly who reported choking presented worse performance in the MNA (p = 0.05). There was no correlation between the MNA total score and the total number of signs and symptoms of alterations in swallowing. Conclusion: nutritional risk was higher in hospitalized elderly with complaint of choking, but no correlation was found between the total number of signs and symptoms of alterations in swallowing and the MNA total score in this population.

RESUMO Objetivos: relacionar risco nutricional e sinais e sintomas de alterações da deglutição referidas por idosos hospitalizados, assim como correlacionar o escore total da Mini avaliação Nutricional (MAN) e o total de sinais e sintomas. Métodos: estudo transversal com amostra de 28 indivíduos hospitalizados, selecionados por conveniência, média de 72,18 ± 5,92 anos de idade, sendo 15 (53,6%) do sexo masculino. O risco nutricional foi avaliado pelo escore total da MAN. Sinais e sintomas de alterações da deglutição foram investigados por meio de entrevista com 11 itens. Foram aplicados o teste de correlação de Spearman e o teste de Mann-Whitney. O intervalo de confiança foi de 95%. Resultados: metade da amostra referiu pelo menos um sinal ou sintoma de alteração da deglutição, sendo engasgo o mais frequente (32,1%). A mediana do escore total da MAN(19,75) indicou risco nutricional. Idosos que referiram engasgo apresentaram pior desempenho na MAN (p = 0,05). Não houve correlação entre escore total da MAN e o total de sinais e sintomas de alterações da deglutição. Conclusão: o risco nutricional foi maior em idosos hospitalizados com queixa de engasgo, mas não foi encontrada correlação entre o total de sinais e sintomas de alterações da deglutição e o escore total da MAN nessa população.

Frequência combinada de queixas relacionadas à deglutição e voz antes da tireoidectomia / Combined frequency of patient-reported swallowing and voice complaints before thyroidectomy

RESUMO Objetivo Analisar a frequência combinada de queixas relacionadas à deglutição e voz, antes da tireoidectomia. Métodos Foi realizada uma análise retrospectiva de 51 entrevistas de pacientes encaminhados para tireoidectomia parcial ou total. A partir da mediana da quantidade total de cada grupo de sintomas de deglutição e voz, determinou-se a frequência combinada de queixas relacionadas à deglutição e voz. Investigou-se, ainda, como os pacientes classificaram cada uma das duas funções (excelente, muito boa, boa, razoável ou ruim) e se esta classificação se relacionava com a quantidade de sintomas e com a frequência combinada. Para a análise bivariada, foram utilizados os testes Qui-quadrado de Pearson ou exato de Fisher e o teste não paramétrico de Mann-Whitney. O nível de significância foi de 5%. Resultados A frequência combinada de queixas relacionadas à deglutição e voz antes da tireoidectomia foi de 31,4%. Os sintomas mais citados, relacionados à deglutição, foram pigarro após deglutir (39,3%), esforço para deglutir (37,2%) e engasgo (35,3%) e os relacionados à voz foram garganta seca (72,6%), pigarro na garganta (72,5%) e coceira na garganta (47%). A quantidade de sintomas foi significativamente maior entre os que classificaram a deglutição (3,13 ± 2,21) e a voz (5,91 ± 2,81) de forma negativa. Houve associação entre autoavaliação negativa da voz e a frequência combinada de queixas relacionadas à deglutição e voz (p=0,003). Conclusão A combinação de queixas relacionadas à deglutição e voz antes da tireoidectomia ocorre em um terço dos pacientes e está associada à autoavaliação negativa da voz.

ABSTRACT Purpose To analyze the combined frequency of patient-reported swallowing and voice complaints before thyroidectomy. Methods This is a retrospective analysis of 51 interviews of patients referred for partial or total thyroidectomy. The combined frequency of patient-reported swallowing and voice complaints was determined from the median of the total number of related symptoms in each group. We also investigated how patients rated each function (excellent, very good, good, fair, poor) and whether this rating was related to the number of symptoms and the combined frequency. For bivariate analysis, Pearson's chi-square test or Fisher's exact test and the nonparametric Mann-Whitney test were used. The level of significance was 5%. Results The combined frequency of patient-reported swallowing and voice complaints before thyroidectomy was 31.4%. The most commonly swallowing-related symptoms were throat clearing after swallowing (39.3%), swallowing effort (37.2%), and choking (35.3%). The most commonly voice-related symptoms were dry throat (72.6%), throat clearing (72.5%), and itchy throat (47%). The total number of symptoms was significantly higher among those who rated swallowing (3.13 ± 2.21) and voice (5.91 ± 2.81) negatively. Negative self-assessment of the voice was associated with the combined frequency of patient-reported swallowing and voice complaints (p=0.003). Conclusion The combined frequency of patient-reported swallowing and voice complaints before thyroidectomy occurs in one third of the patients and is associated with negative self-assessment of the voice.