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.

Effect of Vocal Therapy Associated With TENS in Women With Behavioral Dysphonia.

PURPOSE: This study aimed to investigate the effect of transcutaneous electrical nerve stimulation (TENS) associated with vocal therapy in women with behavioral dysphonia. METHOD: Seventeen women with behavioral dysphonia were divided into an experimental group (n = 8) and a placebo group (n = 9). All were submitted to six sessions of vocal therapy, according to the Comprehensive Voice Rehabilitation Program. In the experimental group, therapy was associated with TENS (30 minutes) and in the placebo group, the electrodes were placed and the equipment remained off. The vocal handicap, the voice through the acoustic and auditory perception evaluation, the electrical activity, and the superficial temperature of the suprahyoid and infrahyoid muscles were evaluated. Pre and post data were compared by parametric and nonparametric tests. RESULTS: There was a decreased in vocal handicap of the placebo group (P = 0.002) and a decreased in the percentage of electrical activity of the right (P = 0.036) and left (P = 0.017) infrahyoid muscles of the experimental group in vowel emission and sequential speech (P = 0.036). There was an increase in temperature in the right infrahyoid region in vowel emission (P = 0.027) and the temperature difference decreased quantitatively between the supra and infrahyoid regions in the experimental group. CONCLUSION: TENS associated with vocal therapy reduced the electrical activity of the infrahyoid muscles and balance the temperature between the supra- and infrahyoid regions in women with behavioral dysphonia.

Effect of Electrical Stimulation on the Treatment of Dysphonia: A Systematic Review.

OBJECTIVES: The aim of this study was to review systematically the literature and to investigate the effects of electrical stimulation in treating dysphonia. STUDY DESIGN: This is a systematic review. METHODS: The publications indexed on the MEDLINE, LILACS, PubMed, Web of Science, and SciELO databases were searched. Original articles with experimental, clinical trial and randomized studies involving a control group and approaching dysphonia treatment with electrical stimulation in humans, regardless of age, gender, or race were included. Those excluded were theses, editorials, comments and opinions, reflexive articles, case studies, experimental studies with animals, models, projects, reports and technical reports, and review articles, as well as articles approaching other alterations, not related to dysphonia. RESULTS: Eleven articles were found and it evaluated the effects of neuromuscular electrical stimulation (NMES) and transcutaneous electrical nerve stimulation on dysphonia caused by vocal fold paralysis, spasmodic dysphonia, behavioral dysphonia, and in patients with vocal fold nodules. The methodological analysis of the articles through the PEDro scale resulted in a mean score of 5.18; the studies were classified as either high quality (N = 3) or fair quality (N = 8). The results indicated that electrical stimulation had a therapeutic effect on various aspects of dysphonia. However, due to the high risk of bias and the heterogeneity of the studies, it is not possible to state the effectiveness of electrical stimulation in treating dysphonia. CONCLUSION: Using electrical stimulation as an evidence-based conventional rehabilitation therapy in the treatment of dysphonia cannot yet be done.

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.

Biofeedback in dysphonia - progress and challenges / Biofeedback em disfonia - progresso e desafios

Abstract Introduction There is evidence that all the complex machinery involved in speech acts along with the auditory system, and their adjustments can be altered. Objective To present the evidence of biofeedback application for treatment of vocal disorders, emphasizing the muscle tension dysphonia. Methods A systematic review was conducted in Scielo, Lilacs, PubMed and Web of Sciences databases, using the combination of descriptors, and admitting as inclusion criteria: articles published in journals with editorial committee, reporting cases or experimental or quasi-experimental research on the use of biofeedback in real time as additional source of treatment monitoring of muscle tension dysphonia or for vocal training. Results Thirty-three articles were identified in databases, and seven were included in the qualitative synthesis. The beginning of electromyographic biofeedback studies applied to speech therapy were promising and pointed to a new method that enabled good results in muscle tension dysphonia. Nonetheless, the discussion of the results lacked physiological evidence that could serve as their basis. The search for such explanations has become a challenge for speech therapists, and determined two research lines: one dedicated to the improvement of the electromyographic biofeedback methodology for voice disorders, to reduce confounding variables, and the other dedicated to the research of neural processes involved in changing the muscle engram of normal and dysphonic patients. Conclusion There is evidence that the electromyographic biofeedback promotes changes in the neural networks responsible for speech, and can change behavior for vocal emissions with quality.

Resumo Introdução Há evidências de que o complexo aparato envolvido no ato da fala, juntamente com o sistema auditivo, e seus ajustes podem ser alterados. Objetivo Apresentar evidências da aplicação de biofeedback (biorretroalimentação) para tratamento de distúrbios vocais, enfatizar a disfonia de tensão muscular. Método Realizou-se uma revisão sistemática nas bases de dados de Scielo, Lilacs, PubMed e Web of Sciences, utilizando a combinação de descritores e admitindo como critérios de inclusão: artigos publicados em revistas com comitê editorial, relatos de casos ou pesquisas experimentais ou quase experimentais sobre o uso debiofeedbackem tempo real como fonte adicional de monitoração de tratamento de disfonia de tensão muscular ou para treinamento vocal. Resultados Trinta e três artigos foram identificados em bases de dados, e sete foram incluídos na síntese qualitativa. O início dos estudos de biofeedbackeletromiográficos aplicados à terapia fonoaudiológica foram promissores e indicaram um novo método que permitiu bons resultados na disfonia de tensão muscular. No entanto, a discussão dos resultados carecia de evidências fisiológicas que pudessem servir de base. A busca por tais explicações tornou-se um desafio para os fonoaudiólogos e determinou duas linhas de pesquisa: uma dedicada à melhoria da metodologia de biofeedbackeletromiográfico para distúrbios da voz, para reduzir as variáveis de confusão e outra dedicada à pesquisa de processos neurais envolvidos na alteração do engrama muscular de pacientes normais e disfônicos. Conclusão Há evidências de que o biofeedback eletromiográfico promove mudanças nas redes neurais responsáveis pela fala e pode mudar o comportamento para emissões vocais com qualidade.

Biofeedback in dysphonia - progress and challenges.

INTRODUCTION: There is evidence that all the complex machinery involved in speech acts along with the auditory system, and their adjustments can be altered. OBJECTIVE: To present the evidence of biofeedback application for treatment of vocal disorders, emphasizing the muscle tension dysphonia. METHODS: A systematic review was conducted in Scielo, Lilacs, PubMed and Web of Sciences databases, using the combination of descriptors, and admitting as inclusion criteria: articles published in journals with editorial committee, reporting cases or experimental or quasi-experimental research on the use of biofeedback in real time as additional source of treatment monitoring of muscle tension dysphonia or for vocal training. RESULTS: Thirty-three articles were identified in databases, and seven were included in the qualitative synthesis. The beginning of electromyographic biofeedback studies applied to speech therapy were promising and pointed to a new method that enabled good results in muscle tension dysphonia. Nonetheless, the discussion of the results lacked physiological evidence that could serve as their basis. The search for such explanations has become a challenge for speech therapists, and determined two research lines: one dedicated to the improvement of the electromyographic biofeedback methodology for voice disorders, to reduce confounding variables, and the other dedicated to the research of neural processes involved in changing the muscle engram of normal and dysphonic patients. CONCLUSION: There is evidence that the electromyographic biofeedback promotes changes in the neural networks responsible for speech, and can change behavior for vocal emissions with quality.

Contributions of neuroimaging in singing voice studies: a systematic review / Contribuições da neuroimagem no estudo da voz cantada: revisão sistemática

ABSTRACT It is assumed that singing is a highly complex activity, which requires the activation and interconnection of sensorimotor areas. The aim of the current research was to present the evidence from neuroimaging studies in the performance of the motor and sensory system in the process of singing. Research articles on the characteristics of human singing analyzed by neuroimaging, which were published between 1990 and 2016, and indexed and listed in databases such as PubMed, BIREME, Lilacs, Web of Science, Scopus, and EBSCO were chosen for this systematic review. A total of 9 articles, employing magnetoencephalography, functional magnetic resonance imaging, positron emission tomography, and electrocorticography were chosen. These neuroimaging approaches enabled the identification of a neural network interconnecting the spoken and singing voice, to identify, modulate, and correct pitch. This network changed with the singer's training, variations in melodic structure and harmonized singing, amusia, and the relationship among the brain areas that are responsible for speech, singing, and the persistence of musicality. Since knowledge of the neural networks that control singing is still scarce, the use of neuroimaging methods to elucidate these pathways should be a focus of future research.

RESUMO Admite-se que o canto seja uma atividade de alta complexidade pois requer ativação e interconexão de áreas sensório-motoras. Esta pesquisa teve como objetivo apresentar as evidências originadas por estudos de neuroimagem sobre a atuação do sistema motor e sensitivo na produção do canto. Na construção da revisão sistemática, foram premissas o período de publicação entre 1990 e 2016, artigos publicados em periódicos indexados e constantes nas bases de dados PubMed, BIREME, Lilacs, Web of Science, Scopus ou EBSCO, referentes a estudos sobre características do canto humano analisadas por neuroimagem. Os nove artigos analisados, com emprego de magnetoencefalografia, imagem por ressonância magnética funcional, tomografia por emissão de pósitrons ou eletrocorticografia, possibilitaram comprovar existência de uma rede neuronal interligada entre a modalidade falada e cantada para identificação, modulação e correção de violações de pitch, que podem ser alteradas com o treinamento do cantor, bem como alteração da estrutura melódica e harmonização do canto, amusia, relação entre áreas cerebrais responsáveis pela fala, canto e persistência da musicalidade. Assim, o conhecimento das áreas cerebrais e das interconexões necessárias ao canto ainda é escasso e deve ser um tema de pesquisas no futuro, empregando métodos de neuroimagem.

Prevalence of voice disorders in the elderly: a systematic review of population-based studies.

Voice disorders can occur in the elderly as a result of natural anatomical and physiological changes or greater exposure to pathological conditions in the aging, affecting communication and quality of life. Nevertheless, data about the prevalence of voice disorders in this phase of life are not well known in a population-based perspective. The aim of the present systematic review was to identify the prevalence of vocal disorders in persons aged 60 years or more in population-based studies. A systematic review was undertaken in eleven electronic databases based on preferred reporting items for systematic reviews and meta-analysis statement (PRISMA) criteria. The methodological quality of the studies was analyzed with strengthening the reporting of observational studies in epidemiology (STROBE) directives. The search was conducted independently by two researchers. Four articles satisfied the criteria of eligibility. The prevalence of vocal disorders in the general population aged 60 years or more ranged from 4.8 to 29.1%. The studies were different in terms of the methodological procedures and the STROBE directives were not completely satisfied by any of the articles selected. The prevalence of vocal disorders in the general elderly population ranged from low to moderate in population-based studies. The methodological discrepancies of the studies compromised the reliability of the estimated data. Upgrading the methodological quality of studies and designing a short, valid and easy-to-use functional voice-related instrument are urgently required in health surveys to determine the prevalence of vocal disorders among elderly individuals.

Normalization patterns of the surface electromyographic signal in the phonation evaluation.

PURPOSE: The aim of the study was to compare the different parameters, regarding the peak and mean, at different phonatory tasks for standardization of electromyography signal of electrical activity (EA) of the laryngeal extrinsic muscles on voice evaluation. METHODS: The electrical potentials of the suprahyoid (SH) and infrahyoid (IH) muscles of 35 voluntary nondysphonic subjects were evaluated using three evaluations of rest, two maneuvers to determine maximum voluntary sustained activity (MVSA), and usual and strong intensity of vowel /ɛ/ and 20-30 count emissions. The EA signal was converted using root mean square in microvolts and normalized by mean and peak of each task. The selected normalization task was that with minor coefficient of variation for all muscles. RESULTS: The tasks that provided minor coefficient of variation of EA in both muscle groups were the peak of vowel /ɛ/ (mean potentials equal to 43.31 ± 2.97 for right IH, 36.27 ± 2.76 for left IH, and 42.11 ± 2.57 for SH) and the 20-30 count emissions (mean potentials equal to 31.30 ± 308 for right IH, 30.56 ± 2.76 for left IH, and 30.43 ± 4.22 for SH), both in usual intensity and MVSA, as second option. CONCLUSIONS: The peak of vowel /ɛ/ and 20-30 count emissions is usual intensity, and the MVSA as second option should be considered for signal normalization in SH and IH muscles, and may provide conditions for using the surface electromyography in voice clinic.

Electrical activity of extrinsic laryngeal muscles in subjects with and without dysphonia.

OBJECTIVE: To compare dysphonic individuals to nondysphonic with regards to electrical activity of extrinsic laryngeal muscles related to perceptual and acoustic vocal parameters. HYPOTHESIS: Dysphonic individuals have higher electrical activity in the supra and infrahyoid muscles than those nondysphonic. STUDY DESIGN: Prospective, cross-sectional, case series study. METHODS: Forty-one subjects, divided into two groups according to the presence of dysphonia, underwent evaluation of surface electromyography, auditory-perceptual, and acoustic evaluations of voice during the vocal rest and sustained emissions of the vowel /ε/ and count of 20 to 30 at usual and strong intensities. RESULTS: The dysphonic group differed significantly from the nondysphonic by (1) lower electrical activity normalized by the maximum sustained voluntary activity evaluated in all tasks of phonation in the suprahyoid group; (2) lower recruitment of electrical activity in emissions of strong intensity compared with those of usual intensity in the suprahyoid muscles to emit the vowel /ε/ (13.66 ± 5.17 in dysphonic group and 35.20 ± 7.60 in the nondysphonic group, P = 0.029) and in the infrahyoid muscles in the count of 20 to 30 (14.90 ± 4.69 vs. 42.01 ± 6.15; P < 0.001) and to emit the vowel /ε/ (11.47 ± 6.52 vs. 22.66 ± 9.05, P < 0.001); (3) lower vocal intensity to produce the vowel /ε/ in usual and strong intensities and count in strong intensity. The electrical activities of the maximum sustained voluntary activity were reduced with increasing degree of dysphonia. CONCLUSIONS: There was lower electrical activity of the extrinsic laryngeal muscles in dysphonic individuals compared with nondysphonic, and related to the degree of dysphonia.

Preferência de lado mastigatório e simetria facial em laringectomizados totais: estudo clínico e eletromiográfico / Preference side masticatory and facial symmetry in total laryngectomy: clinical and electromyographic study

OBJETIVO: observar se existe relação entre a preferência do lado mastigatório, antropometria facial e atividade elétrica do músculo masseter em laringectomizados totais. MÉTODOS: a coleta de dados, realizada no setor de Fonoaudiologia do Hospital de Câncer de Pernambuco (HCP), contou com a participação de quinze voluntários laringectomizados totais do gênero masculino e idade média de 64 anos. Foi realizada aferição das distâncias entre os pontos antropométricos faciais ex e ch nas hemifaces dos voluntários e posteriormente executado exame eletromiográfico dos músculos masseteres, bilateralmente, nos momentos de máxima intercuspidação habitual (MIH), mastigações unilaterais direita e esquerda e durante mastigação habitual. Realizou-se filmagem durante a mastigação habitual para identificação do lado de preferência mastigatória. RESULTADOS: os indivíduos cuja preferência mastigatória foi do lado direito, apresentaram o lado esquerdo da face com maior medida (72,37mm); já os indivíduos cuja preferência mastigatória foi do lado esquerdo, apresentaram maior medida da face do lado direito (68,85mm). Quando a mastigação apresentou-se unilateral direita a atividade elétrica do masseter direito atingiu média de 123,57% enquanto o masseter esquerdo alcançou média igual a 84,85% de atividade em relação à MIH (p = 0,016). CONCLUSÃO: em laringectomizados as medidas antropométricas faciais correlacionam-se com o lado de preferência de mastigação e os valores eletromiográficos dos masseteres durante a mastigação.

PURPOSE: to observe whether a relationship exists between the preference of chewing side, facial anthropometry and electrical activity of masseter muscle in total laryngectomy. METHODS: data collection, performed in the Speech Therapy Cancer Hospital of Pernambuco (HCP), with the participation of fifteen volunteers laryngectomized males and mean age of 64 years. We performed measurement of distances between points and anthropometric facial ex ch in hemifaces of volunteers and later executed EMG of the masseter muscles, bilaterally, in his habitual intercuspal (MHI), unilateral right and left chewing and during mastication. Filming took place during mastication to identify the side of the preference side. RESULTS: individuals whose right side is the masticatory predominance showed of the left side of the face to a greater extent (72.37 mm), while those whose prevalence of side left masticatory had higher estensão the side right (68.85 mm). In unilateral chewing right the electrical activity of the right masseter had an average 123.57% , while the left masseter showed an average 84.85% of the activity in relation to MHI (p = 0.016). CONCLUSION: in laryngectomized anthropometric facial measurements correlate with the preference side chewing and the values of the masseter EMG during mastication.

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.

Use of surface electromyography in phonation studies: an integrative review

Surface electromyography has been used to assess the extrinsic laryngeal muscles during chewing and swallowing, but there have been few studies assessing these muscles during phonation. OBJECTIVE: To investigate the current state of knowledge regarding the use of surface electromyography for evaluation of the electrical activity of the extrinsic muscles of the larynx during phonation by means of an integrative review. METHOD: We searched for articles and other papers in the PubMed, Medline/Bireme, and Scielo databases that were published between 1980 and 2012, by using the following descriptors: surface electromyography and voice, surface electromyography and phonation, and surface electromyography and dysphonia. The articles were selectedon the basis ofinclusion and exclusion criteria. DATA SYNTHESIS: This was carried out with a cross critical matrix. We selected 27 papers,i.e., 24 articles and 3 theses. The studies differed methodologically with regards to sample size and investigation techniques, making it difficult to compare them, but showed differences in electrical activity between the studied groups (dysphonicsubjects, non-dysphonicsubjects, singers, and others). CONCLUSION: Electromyography has clinical applicability when technical precautions with respect to application and analysis are obeyed. However, it is necessary to adopt a universal system of assessment tasks and related measurement techniques to allow comparisons between studies...

Disfuncao gustatoria e olfatoria em laringectomizados / Gustatory and olfactory dysfunction in laryngectomized patients

Após a cirurgia de laringectomia total, o fluxo aéreo nasal é transferido definitivamente para o traqueostoma, comprometendo a chegada de moléculas odoríferas até a cavidade nasal, podendo repercutir em alterações na percepção olfatória e gustatória nesses indivíduos. OBJETIVO: Avaliar as funções do olfato e do paladar em laringectomizados totais. Desenho do estudo: Estudo de série. MÉTODO: A amostra envolveu um grupo com 25 pacientes submetidos à laringectomia total e outro grupo de comparação com 25 pacientes não laringectomizados. A função gustatória foi avaliada por tiras gustativas de papel de filtro. Para avaliação da função olfatória, foi aplicado o teste Brief Smell Identification Test. RESULTADOS: No grupo de laringectomizados, houve maior frequência de hipogeusia (80%; p < 0,05), assim como de hiposmia (88%; p < 0,001), isoladas e concomitantes (72%; p < 0,001). Na discriminação dos sabores, o sabor amargo não diferiu entre os grupos, diferentemente dos demais sabores. No aspecto olfatório, os laringectomizados tiveram pior desempenho na detecção de odores de alerta e os relacionados à alimentação. Identificou-se que história de tabagismo e de alcoolismo foi significantemente mais frequente dentre laringectomizados. CONCLUSÃO: A diminuição das funções olfatória e gustatória em laringectomizados totais foi evidenciada nesse estudo. .

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. .

Use of surface electromyography in phonation studies: an integrative review.

INTRODUCTION: Surface electromyography has been used to assess the extrinsic laryngeal muscles during chewing and swallowing, but there have been few studies assessing these muscles during phonation. OBJECTIVE: To investigate the current state of knowledge regarding the use of surface electromyography for evaluation of the electrical activity of the extrinsic muscles of the larynx during phonation by means of an integrative review. METHOD: We searched for articles and other papers in the PubMed, Medline/Bireme, and Scielo databases that were published between 1980 and 2012, by using the following descriptors: surface electromyography and voice, surface electromyography and phonation, and surface electromyography and dysphonia. The articles were selectedon the basis ofinclusion and exclusion criteria. DATA SYNTHESIS: This was carried out with a cross critical matrix. We selected 27 papers,i.e., 24 articles and 3 theses. The studies differed methodologically with regards to sample size and investigation techniques, making it difficult to compare them, but showed differences in electrical activity between the studied groups (dysphonicsubjects, non-dysphonicsubjects, singers, and others). CONCLUSION: Electromyography has clinical applicability when technical precautions with respect to application and analysis are obeyed. However, it is necessary to adopt a universal system of assessment tasks and related measurement techniques to allow comparisons between studies.

Quality of life and deglutition after total laryngectomy

Introduction: Total laryngectomy creates deglutition disorders and causes a decrease in quality of life Aim: To describe the impact of swallowing and quality of life of patients after total laryngectomy. Method: A case series study. Patients completed a Swallowing and Quality of Life questionnaire composed of 44 questions assessing 11 domains related to quality of life (burden, eating duration, eating desire, frequency of symptoms, food selection, communication, fear, mental health, social functioning, sleep, and fatigue). The analysis was performed using descriptive statistics, including measures of central tendency and variability. Results: The sample comprised 15 patients who underwent total laryngectomy and adjuvant radiotherapy. Of these, 66.7% classified their health as good and 73% reported no restrictions on food consistency. The domains "communication" and "fear" represented severe impact and "eating duration" represented moderate impact on quality of life. The items with lower scores were: longer time to eat than others (domain "eating duration"), cough and cough to remove the liquid or food of the mouth when they are stopped (domain "symptom frequency"), difficulties in understanding (domain "communication") and fear of choking and having pneumonia (domain "fear"). Conclusion: After total laryngectomy, patients report that swallowing issues have moderate to severe impact in "communication," "fear," and "eating duration" domains...

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...

Incomplete swallowing and retracted tongue maneuvers for electromyographic signal normalization of the extrinsic muscles of the larynx.

PURPOSE: To investigate which muscular maneuvers provide larger electric activity (EA) of the suprahyoid (SH) and infrahyoid (IH) muscles to be used as surface electromyography (SEMG) signal normalization reference. METHODS: The electrical potentials of the SH and IH muscles of 12 subjects were evaluated using six muscular maneuvers, involving the position of the tongue and effort. It was selected as maximum voluntary sustained activity maneuver, the one having the minor coefficient of variation and the smallest value for each muscle group. The EA signal was converted using the root mean square in microvolts. It was considered then the maximum signal of each maneuver as the difference between the mean of three measures and the resting potential. RESULTS: The maneuvers that provided higher mean potentials with minor coefficient of variation and smallest P value were incomplete swallowing (IS) with effort (mean potential equal to 56.73±8.68 with coefficient of variation of 15.30%) in SH group, and tongue retracted with mouth open (TROM, mean potential equal to 46.57±7.83 with coefficient of variation of 16.81%) in IH group. CONCLUSION: The IS with effort and TROM maneuvers should be considered for signal normalization in these muscles, respectively, and may provide conditions for using the SEMG in voice clinic. SIGNIFICANCE: The use of normalization standards in researches of SH and IH muscles in the voice area will allow comparisons among future works.

Quality of life and deglutition after total laryngectomy.

INTRODUCTION: Total laryngectomy creates deglutition disorders and causes a decrease in quality of life Aim: To describe the impact of swallowing and quality of life of patients after total laryngectomy. METHOD: A case series study. Patients completed a Swallowing and Quality of Life questionnaire composed of 44 questions assessing 11 domains related to quality of life (burden, eating duration, eating desire, frequency of symptoms, food selection, communication, fear, mental health, social functioning, sleep, and fatigue). The analysis was performed using descriptive statistics, including measures of central tendency and variability. RESULTS: The sample comprised 15 patients who underwent total laryngectomy and adjuvant radiotherapy. Of these, 66.7% classified their health as good and 73% reported no restrictions on food consistency. The domains "communication" and "fear" represented severe impact and "eating duration" represented moderate impact on quality of life. The items with lower scores were: longer time to eat than others (domain "eating duration"), cough and cough to remove the liquid or food of the mouth when they are stopped (domain "symptom frequency"), difficulties in understanding (domain "communication") and fear of choking and having pneumonia (domain "fear"). CONCLUSION: After total laryngectomy, patients report that swallowing issues have moderate to severe impact in "communication," "fear," and "eating duration" domains.

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.