Comparative analysis of masseter muscle electrical activity by nasal patency in children with rhinitis and asthma: a pilot observational study.

PURPOSE: This pilot cross-sectional study aimed to evaluate differences in electromyographic activity patterns of the masseter muscle according to the nasal patency in children with rhinitis and asthma. METHODS: The study included 43 children aged 5-14 years with rhinitis and/or asthma. Patients underwent peak nasal inspiratory flow (PNIF) measurement to assess nasal patency, and electromyographic evaluation of the right and left masseter muscles during chewing and at rest. Electromyographic activity patterns according to nasal patency were compared using the Mann-Whitney test, and effect sizes were measured using the Glass rank biserial (rb) correlation. A p-value of < 0.05 was considered statistically significant. RESULTS: No significant differences in electromyographic activity of the masseter muscle at rest, during unilateral chewing, or during habitual chewing were found between the groups. However, we found that patients with low nasal patency had a median electric activity of the right masseter muscle during maximum contraction of 60.53 (51.74-72.43), while those with adequate nasal patency had a median of 77.40 (56.71-88.45). Although the difference in myoelectric activity between the groups did not reach statistical significance (p = 0.061) at the adopted significance level of 5%, the size of the difference between groups were considered moderate (rb = 0.338) and a potential association between nasal patency and the muscular function of the masseter muscle could be suggested. CONCLUSION: The study found no differences in the electromyographic activity of the masseter muscle at rest, during unilateral chewing, or during habitual chewing among children with rhinitis and asthma based on nasal patency. Further research with larger sample sizes is needed to validate these findings and gain a better understanding of the impact of nasal patency on the muscular function of the masseter muscle.

Swallowing capacity and gravity of the laryngotracheal aspiration risk in atypical cerebellar stroke: case report. / Capacidade de deglutição e gravidade do risco de aspiração laringotraqueal no Acidente Vascular Encefálico atípico em via cerebelar: relato de caso.

This case report aimed to evaluate the swallowing capacity and the severity of the risk of laryngotracheal aspiration of a 52-year-old female patient with atypical and rare stroke, with major injury in the cerebellar pathway. In order to measure swallowing capacity and risk of aspiration a routine clinical assessment used in the speech therapy clinic was performed and two valid clinical tests were used: Massey Bedside Swallowing Screen (MBSS) and Gugging Swallowing Screen (GUSS). After evaluation with the clinical tests, it was observed that the patient had reduced swallowing capacity, performance characterized as pathological, 100% dysfunction in the water swallowing test (MBSS), presence of choking, coughing, change in vocal quality and anterior escape. In the assessment of risk of aspiration with the GUSS, the patient presented moderate dysphagia and risk of laryngotracheal aspiration.This case report demonstrated that moderate dysphagia is found in a stroke patient with lesions that affect the cerebellum. Standardized and validated clinical tests such as GUSS and MBSS should also be used to assess the risk of dysphagia after stroke at ambulatory care.

Esse relato de caso teve o objetivo de avaliar a capacidade de deglutição e a gravidade do risco de aspiração laringotraqueal de uma paciente, 52 anos, com Acidente Vascular Encefálico (AVE) atípico, com comprometimento na via cerebelar. Para mensurar a capacidade de deglutição e do risco de aspiração foram utilizados a avaliação de rotina na clínica de fonoaudiologia e dois testes clínicos validados: o Massey Bedside Swallowing Screen (MBSS) e o Gugging Swallowing Screen (GUSS). Após a avaliação com os testes clínicos, foi observado que a paciente apresentou capacidade de deglutição diminuída, desempenho caracterizado como patológico e de risco, com 100% de alteração no teste de deglutição de água pelo MBSS, presença de engasgo, tosse, alteração na qualidade vocal e escape anterior de alimento. Já na avaliação do risco de aspiração com o GUSS, a paciente apresentou disfagia moderada e com risco de aspiração laringotraqueal. A disfagia pode estar presente em casos de AVE com lesão anatômica comprometendo o cerebelo e suas vias, o que sugere a importância de avaliação específica da deglutição nesses casos. Os testes GUSS e o MBSS podem ser utilizados para avaliação de casos atípicos de AVE em fase ambulatorial, com objetivos de avaliar o risco de aspiração e a capacidade de deglutição.

Capacidade de deglutição e gravidade do risco de aspiração laringotraqueal no Acidente Vascular Encefálico atípico em via cerebelar: relato de caso / Swallowing capacity and gravity of the laryngotracheal aspiration risk in atypical cerebellar stroke: case report

RESUMO Esse relato de caso teve o objetivo de avaliar a capacidade de deglutição e a gravidade do risco de aspiração laringotraqueal de uma paciente, 52 anos, com Acidente Vascular Encefálico (AVE) atípico, com comprometimento na via cerebelar. Para mensurar a capacidade de deglutição e do risco de aspiração foram utilizados a avaliação de rotina na clínica de fonoaudiologia e dois testes clínicos validados: o Massey Bedside Swallowing Screen (MBSS) e o Gugging Swallowing Screen (GUSS). Após a avaliação com os testes clínicos, foi observado que a paciente apresentou capacidade de deglutição diminuída, desempenho caracterizado como patológico e de risco, com 100% de alteração no teste de deglutição de água pelo MBSS, presença de engasgo, tosse, alteração na qualidade vocal e escape anterior de alimento. Já na avaliação do risco de aspiração com o GUSS, a paciente apresentou disfagia moderada e com risco de aspiração laringotraqueal. A disfagia pode estar presente em casos de AVE com lesão anatômica comprometendo o cerebelo e suas vias, o que sugere a importância de avaliação específica da deglutição nesses casos. Os testes GUSS e o MBSS podem ser utilizados para avaliação de casos atípicos de AVE em fase ambulatorial, com objetivos de avaliar o risco de aspiração e a capacidade de deglutição.

ABSTRACT This case report aimed to evaluate the swallowing capacity and the severity of the risk of laryngotracheal aspiration of a 52-year-old female patient with atypical and rare stroke, with major injury in the cerebellar pathway. In order to measure swallowing capacity and risk of aspiration a routine clinical assessment used in the speech therapy clinic was performed and two valid clinical tests were used: Massey Bedside Swallowing Screen (MBSS) and Gugging Swallowing Screen (GUSS). After evaluation with the clinical tests, it was observed that the patient had reduced swallowing capacity, performance characterized as pathological, 100% dysfunction in the water swallowing test (MBSS), presence of choking, coughing, change in vocal quality and anterior escape. In the assessment of risk of aspiration with the GUSS, the patient presented moderate dysphagia and risk of laryngotracheal aspiration.This case report demonstrated that moderate dysphagia is found in a stroke patient with lesions that affect the cerebellum. Standardized and validated clinical tests such as GUSS and MBSS should also be used to assess the risk of dysphagia after stroke at ambulatory care.

Frailty syndrome and risks for falling in the elderly community. / Síndrome da fragilidade e riscos para quedas em idosos da comunidade.

PURPOSE: To identify the prevalence of Frailty Syndrome in the elderly and the relationship with risk of falling. METHODS: Descriptive, cross-sectional, and analytical clinical study. One hundred and one volunteers over 60 years old were submitted to audiological evaluation, Dynamic Gait Index - Brazilian brief (DGI), Timed Up and Go (TUG) and Edmonton Fragility Scale (EFE) that verified, respectively, hearing thresholds, frailty syndrome, functional and dynamic balance, and risk of falling. The simple percentual distribution, the Wilcoxon´s test and the Bivariate Correlation with Pearson's coefficient were used for statistical analysis. Limits equal to or less than 1.0 and 5.0% were adopted. RESULTS: EFE identified 22.8% of volunteers as fragile and 22.8% as vulnerable. DGI and TUG found 34.6% and 84.1% of at risk for falls, respectively. Significant correlations between EFE and DGI (p <0.01), EFE and TUG (p <0.01), and DGI and TUG (p <0.01) were observed. Pearson's coefficient between EFE and DGI, EFE and TUG, and DGI and TUG were -0.26, -0.41, and 0.46, respectively. An association between DGI and TUG and age (p <0.01) was identified. No correlation between EFE and sex or age was found. CONCLUSION: Frailty and pre-frailty were identified in a significant segment of the volunteers, especially in the oldest subjects. Functional and dynamic balance were moderately correlated with frailty, which demonstrated that frailty syndrome increases the risk of falls.

OBJETIVO: Identificar a prevalência da Síndrome da Fragilidade em idosos e suas relações com o risco para quedas. MÉTODO: Estudo clínico descritivo, transversal e analítico. Cento e um voluntários com mais de 60 anos, foram submetidos à avaliação audiológica, Dynamic Gait Index ­ Brazilian brief (DGI), Timed Up and Go(TUG) e Escala de Fragilidade de Edmonton (EFE) que determinaram, respectivamente, os limiares auditivos, síndrome da fragilidade, equilíbrio funcional e dinâmico e risco para quedas. Utilizou-se a distribuição percentual simples, o teste de Wilcoxon e de Correlação Bivariada com coeficiente de Pearson para a análise estatística. Foram adotados limites iguais inferiores a 1,0 e 5,0%. RESULTADOS: A EFE identificou 22,8% dos voluntários como frágeis e 22,8% como vulneráveis. O DGI e o TUG classificaram 34,6 e 84,1% de riscos para quedas. Ocorreu correlação significativa entre a EFE e o DGI (p<0,01), a EFE e o TUG (p<0,01) e o DGI e TUG (p<0,01). O coeficiente de Pearson entre EFE e o DGI, entre o EFE e o TUG e DGI e TUG foram -0,26, -0,41 e 0,46 respectivamente. Ocorreu associação entre DGI e TUG e idade (p<0,01). Não houve correlação entre a EFE com sexo e idade. CONCLUSÃO: A fragilidade e pré-fragilidade foi identificada em uma parcela expressiva dos voluntários, sobretudo nos mais longevos. O equilíbrio funcional e o dinâmico se correlacionaram moderamente com fragilidade, o que demonstrou que a Síndrome da fragilidade aumenta o risco para quedas.

Telefonoaudiologia: uma revisão integrativa / Telephonoaudiology: an integrative review / Telefonoaudiologia: una revisión integradora

Introdução: A pandemia do Coronavírus trouxe a necessidade do distanciamento social. A partir dessa nova realidade, o Conselho Federal de Fonoaudiologia (CFFa) recomendou o uso da telefonoaudiologia para permitir a continuidade do atendimento fonoaudiológico. Embora a telefonoaudiologia não seja uma prática inédita, dúvidas quanto à sua utilização e eficácia, quando comparada ao atendimento presencial, ainda permeia a prática clínica. Objetivo: realizar uma revisão integrativa da literatura sobre a eficácia da telefonoaudiologia comparada ao atendimento presencial. Métodos: foi realizada uma revisão integrativa da literatura cientifica, sem restrição de idioma e tempo, nas bases de dados: Pubmed, Web of Science, Science Direct, Cochrane e Google Scholar. Resultados: vinte e um artigos foram selecionados. A unanimidade dos artigos demostrou que não houve diferença estatística significante entre as configurações. Nos estudos com foco na avaliação, os métodos de teste (presencial X teleavaliação) foram altamente correlacionados e com alta confiabilidade inter examinador. Nos artigos com foco na terapia, em ambas as configurações de tratamento, houve melhora significativa dos parâmetros avaliados. Os artigos que realizaram pesquisa de satisfação na modalidade de telefonoaudiologia, em quase a totalidade dos estudos, os pacientes e/ou responsáveis relataram moderada a alta satisfação e indicaram disposição de participar novamente de avaliação e/ou terapia na configuração de atendimento remoto. Conclusão: a literatura atual em telefonoaudiologia sugere o uso do atendimento remoto e demonstra a não inferioridade deste quando comparado ao atendimento presencial. Porém, a maioria desses estudos apresenta baixa evidência cientifica.

Introduction: The Coronavirus pandemic brought about the need for social distancing. Based on this new reality, the Brazilian Federal Council of Speech, Language and Hearing Sciences (CFFa) recommended the use of telephonoaudiology to enable the continuity of speech therapy assistance. Although this is not an unprecedented practice, doubts about telephonoaudiology use and its effectiveness, when compared to face-to-face care, still permeate the clinical practice. Objective: to perform an integrative review of the literature on the effectiveness of telephonoaudiology technologies when compared to face to face care. Methods: an integrative review of the scientific literature was carried out, without the restriction of language and time, in the databases: Pubmed, Web of Science, Science Direct, Cochrane, and Google Scholar. Results: twenty-one articles were selected. The unanimity of the papers demonstrated that there was no statistically significant difference between the configurations. In studies focused on evaluation, the test methods (face to face vs. telephonoaudiology) were highly correlated and presented high inter-examiner reliability. In papers focusing on therapy, in both treatment configurations, there was a significant improvement in the parameters evaluated. In almost all the papers that conducted telephonoaudiology satisfaction surveys, patients and/or guardians reported moderate to high satisfaction andindicated a willingness to participate again in assessmentand/ortherapy in the configuration of remote care. Conclusion: the current literature on telephonoaudiology suggests the use of remote care and demonstrates its non-inferiority when compared to face to face care. However, most of these studies have low scientific evidence.

Introducción: La pandemia del coronavirus provocó la necesidad de desapego social. Con base en esta nueva realidad, el Consejo Federal de Terapia del Habla (CFFa) recomendó el uso de telefonoaudiologia para permitir la continuidad de la asistencia de la terapia del habla. Si bien el telefonoaudiologia una práctica inédita, las dudas sobre su uso y efectividad, en comparación con la atención presencial, aún impregna la práctica clínica. Objetivo: realizar una revisión integradora de la literatura sobre la efectividad de telefonoaudiologia frente a la atención asistente personal. Métodos: se realizó una revisión integradora de la literatura científica, sin restricciones de idioma y tiempo, en las bases de datos: Pubmed, Web os Science, Science Direct, Cochrane y Google Scholar. Resultados: se seleccionaron veintiún artículos. La unanimidad de los artículos demostró que no hubo diferencia estadísticamente significativa entre las configuraciones. En los estudios centrados en la evaluación, los métodos de prueba (asistente personal versus telefonoaudiologia) estaban altamente correlacionados y tenían una alta confiabilidad entre examinadores. En los artículos centrados en la terapia, en ambas configuraciones de tratamiento, hubo una mejora significativa en los parámetros evaluados. Los artículos que realizaron encuesta de satisfacción en forma de telefonoaudiologia, en casi todos los estudios, los pacientes y / o tutores reportaron satisfacción moderada a alta e indicaron disposición a participar nuevamente en la evaluación y / o terapia en la configuración de la atención remota. Conclusión: la literatura actual sobre s telefonoaudiologia ugiere el uso de la atención remota y demuestra su no inferioridad en comparación con la atención personal. Sin embargo, la mayoría de estos estudios tienen poca evidencia científica.

Association between deleterious oral habits and asthma in children: a systematic review and meta-analysis.

Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2-17 years. Information on DOH was obtained from the verbal report of the children's parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13-1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00-1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.

Association between deleterious oral habits and asthma in children: a systematic review and meta-analysis

Abstract: Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2-17 years. Information on DOH was obtained from the verbal report of the children's parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13-1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00-1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.

Síndrome da fragilidade e riscos para quedas em idosos da comunidade / Frailty syndrome and risks for falling in the elderly community

RESUMO Objetivo Identificar a prevalência da Síndrome da Fragilidade em idosos e suas relações com o risco para quedas. Método Estudo clínico descritivo, transversal e analítico. Cento e um voluntários com mais de 60 anos, foram submetidos à avaliação audiológica, Dynamic Gait Index - Brazilian brief (DGI), Timed Up and Go(TUG) e Escala de Fragilidade de Edmonton (EFE) que determinaram, respectivamente, os limiares auditivos, síndrome da fragilidade, equilíbrio funcional e dinâmico e risco para quedas. Utilizou-se a distribuição percentual simples, o teste de Wilcoxon e de Correlação Bivariada com coeficiente de Pearson para a análise estatística. Foram adotados limites iguais inferiores a 1,0 e 5,0%. Resultados A EFE identificou 22,8% dos voluntários como frágeis e 22,8% como vulneráveis. O DGI e o TUG classificaram 34,6 e 84,1% de riscos para quedas. Ocorreu correlação significativa entre a EFE e o DGI (p<0,01), a EFE e o TUG (p<0,01) e o DGI e TUG (p<0,01). O coeficiente de Pearson entre EFE e o DGI, entre o EFE e o TUG e DGI e TUG foram -0,26, -0,41 e 0,46 respectivamente. Ocorreu associação entre DGI e TUG e idade (p<0,01). Não houve correlação entre a EFE com sexo e idade. Conclusão A fragilidade e pré-fragilidade foi identificada em uma parcela expressiva dos voluntários, sobretudo nos mais longevos. O equilíbrio funcional e o dinâmico se correlacionaram moderamente com fragilidade, o que demonstrou que a Síndrome da fragilidade aumenta o risco para quedas.

ABSTRACT Purpose To identify the prevalence of Frailty Syndrome in the elderly and the relationship with risk of falling. Methods Descriptive, cross-sectional, and analytical clinical study. One hundred and one volunteers over 60 years old were submitted to audiological evaluation, Dynamic Gait Index - Brazilian brief (DGI), Timed Up and Go (TUG) and Edmonton Fragility Scale (EFE) that verified, respectively, hearing thresholds, frailty syndrome, functional and dynamic balance, and risk of falling. The simple percentual distribution, the Wilcoxon´s test and the Bivariate Correlation with Pearson's coefficient were used for statistical analysis. Limits equal to or less than 1.0 and 5.0% were adopted. Results EFE identified 22.8% of volunteers as fragile and 22.8% as vulnerable. DGI and TUG found 34.6% and 84.1% of at risk for falls, respectively. Significant correlations between EFE and DGI (p <0.01), EFE and TUG (p <0.01), and DGI and TUG (p <0.01) were observed. Pearson's coefficient between EFE and DGI, EFE and TUG, and DGI and TUG were -0.26, -0.41, and 0.46, respectively. An association between DGI and TUG and age (p <0.01) was identified. No correlation between EFE and sex or age was found. Conclusion Frailty and pre-frailty were identified in a significant segment of the volunteers, especially in the oldest subjects. Functional and dynamic balance were moderately correlated with frailty, which demonstrated that frailty syndrome increases the risk of falls.

Speech therapy´s intervention for falling prevention in aging. / Intervenção fonoaudiológica na prevenção de quedas no envelhecimento.

PURPOSE: to verify the effectiveness of a Speech Therapy intervention program to decrease the risk of falls in elderly people. METHODS: Exploratory and intervention study where upon 148 volunteers from community, both genders, with an average of 68.6(± 6.5) years were submitted to the Dynamic Gait Index (DGI)- Brazilian brief and the Timed Up and Go (TUG). Volunteers with or without potential risk for falling were invited to participate in a 50-minutes long intervention program carried out for five consecutive weeks, based on Cawthorne and Cooksey exercises. Seventy-two volunteers 68.1(±6.5) years presented in at least three meeting, were reassessed. The results were analyzed by Wilcoxon, Chi-square, Spearman and Correlation Matrix tests, with p≤5.0%. RESULTS: Thirty-seven (25.0%) and 106 (71.6%) participants presented, respectively, risks for falls in the DGI-Brazilian brief and TUG. There was negative correlation between the DGI-Brazilian brief (p=0.034) and positive with the TUG (p=0.0071) with age and both instruments (p=0.00000016). Through the comparison the initial and final data a positive correlation was found for the DGI-Brazilian brief and for TUG in the Chi-square test and by Wilcoxon's. Better performance was observed in both tests after the intervention. CONCLUSION: The intervention was effective in decreasing the risk for falls and improving gait performance, and functional and dynamic balance.

OBJETIVO: Verificar a eficácia de uma intervenção fonoaudiológica para diminuição do risco de quedas. MÉTODO: Estudo exploratório e de intervenção em que 148 voluntários socialmente ativos, de ambos os sexos, com média de 68,6(±6,5) anos foram avaliados pelo Dynamic Gait Index (DGI)­Brazilian brief e o Timed Up and Go (TUG). Todos os voluntários, com e sem risco para quedas, foram convidados para o programa de intervenção realizado em cinco semanas consecutivas, com duração de 50 minutos baseados nos exercícios de Cawthorne e Cooksey. Destes, 72 com 68,1(±6,5) anos, com e sem riscos para quedas, que participaram de, pelos menos, três encontros foram reavaliados. Foram utilizados o teste de Wilcoxon, Qui-quadrado, Spearman e Matriz de Correlação, com p≤5,0%. RESULTADOS: Inicialmente, 37(25,0%) e 106(71,6%) dos voluntários apresentaram, respectivamente, riscos para quedas no DGI­Brazilian brief e no TUG. Verificou-se correlação negativa do DGI-Brazilian brief (p=0,034) e positiva com o TUG (p=0,0071) com a idade e entre os dois instrumentos (p=0,00000016). Na comparação dos dados iniciais e finais de 72 voluntários averiguou-se correlação positiva no DGI-Brazilian brief e TUG no teste do Qui-quadrado e de Wilkoxon. Foi observado melhor desempenho nestes testes após a intervenção. CONCLUSÃO: A intervenção foi eficaz, uma vez que diminuiu o risco para quedas e melhorou o desempenho da marcha e equilíbrio funcional e dinâmico.

Telehealth in audiology: an integrative review.

We performed an integrative review on the scientific literature about the use of telehealth in audiology care. Through high criteria search of published studies on the "Biblioteca Virtual em Saúde" - Virtual Health Library, PubMed, and Scientific Electronic Library Online databases, nine articles were selected. It was possible to verify that the use of telehealth in audiology is feasible and efficient, because it could promote audiological care for patients from away places. This process reaches more patients and communities by breaking down geographic barriers, and it offers a specific service not available with less cost and more quickly when compared with traditional speech therapy care.

Manejo fonoaudiológico do paciente traqueostomizado no contexto da Covid-19: uma revisão do conhecimento atual / Speech therapy management of the tracheostomized patient in the context of Covid-19: a review of current knowledge / Manejo fonoaudiológico del paciente traqueostomizado en el contexto del Covid-19: una revisión de los conocimientos actuales

Introdução: O SARS-CoV-2 se estabeleceu como um dos principais agentes etiológicos de instabilidade da função pulmonar e repercussões no trato respiratório. Devido à necessidade de suporte ventilatório prolongado, pode ser observado aumento na demanda da indicação da traqueostomia. Objetivo: verificar as evidências disponíveis sobre o manejo fonoaudiológico da traqueostomia em pacientes com COVID-19, através de uma revisão breve do conhecimento atual. Método: As buscas foram realizadas nas bases de dados do Pubmed, Lilacs, Scielo, Web of Science, Scopus e Google Scholar, no período de agosto de 2020, através dos descritores "tracheostomy and COVID-19", extraídos do Medical Subject Headings (MeSH) e dos Descritores em Ciências da Saúde (DeCS). Resultados: seis estudos foram selecionados, de acordo com os critérios de elegibilidade. O processo de desmame do cuff ou troca da cânula da traqueostomia foi sugerido após resultado negativo para COVID-19. Os estudos sugerem avaliação clínica da deglutição, o uso de cânulas sem fenestra, com cuff insuflado. O uso de equipamentos de proteção individual foi fortemente indicado durante os procedimentos. Não há consenso quanto à intervenção fonoaudiológica para pacientes traqueostomizados com COVID-19. Conclusão: Esta revisão não mostrou evidências científicas sobre o manejo fonoaudiológico da traqueostomia em pacientes com COVID-19.

Introduction: SARS-CoV-2 has established itself as one of the main etiological agents of instability of pulmonary function and repercussions in the respiratory tract. Due to the need for prolonged ventilatory support, an increased demand for tracheostomy indication. Objective: to verify the available evidence on the speech therapy management of tracheostomy in patients with COVID-19, through a brief review of current knowledge. Method: Searches were carried out in the databases of Pubmed, Lilacs, Scielo, Web of Science, Scopus and Google Scholar, in the period of August 2020, using the descriptors "tracheostomy and COVID-19", extracted from the Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS). Results: six studies were selected, according to the eligibility criteria. The process of weaning the cuff or changing the tracheostomy cannula was suggested after a negative result for COVID-19. Studies suggest clinical evaluation of swallowing, the use of cannulas without fenestra, with inflated cuff. The use of personal protective equipment was strongly recommended during the procedures. There is no consensus regarding speech therapy for patients with tracheostomy with COVID-19. Conclusion:This review did not show any scientific evidence on the speech therapy management of tracheostomy in patients with COVID-19.

Introducción: El SARS-CoV-2 se ha consolidado como uno de los principales agentes etiológicos de inestabilidad de la función pulmonar y repercusiones en el tracto respiratorio. Debido a la necesidad de soporte ventilatorio prolongado, una mayor demanda de indicación de traqueotomia. Objetivo: verificar la evidencia disponible sobre el manejo logopédico de la traqueotomía en pacientes con COVID-19, a través de una breve revisión de los conocimientos actuales. Método: Se realizaron búsquedas en las bases de datos de Pubmed, Lilacs, Scielo, Web of Science, Scopus y Google Scholar, en el período de agosto de 2020, utilizando los descriptores "traqueotomía y COVID-19", extraídos de Medical Subject Headings ( MeSH) y Descriptores de Ciencias de la Salud (DeCS). Resultados: se seleccionaron seis estudios, según los criterios de elegibilidad. El proceso de destete del manguito o cambio de cánula de traqueotomía se sugirió después de un resultado negativo para COVID-19. Los estudios sugieren una evaluación clínica de la deglución, el uso de cánulas sin fenestra, con manguito inflado. Se recomienda encarecidamente el uso de equipo de protección personal durante los procedimientos. No existe consenso con respecto a la terapia del habla para pacientes con traqueotomía con COVID-19. Conclusión: Esta revisión no mostró evidencia científica sobre el manejo logopédico de la traqueotomía en pacientes con COVID-19.

Association between nasal patency and orofacial myofunctional changes in patients with asthma and rhinitis.

PURPOSE: To verify the association between orofacial myofunctional changes and nasal patency. METHOD: Observational study of 43 children and adolescents with asthma and/or rhinitis, aged between 5 and 14 years, from May 2017 to September 2019. Patients underwent peak nasal inspiratory flow (PNIF) for nasal patency assessment and orofacial myofunctional assessment. Clinical data were obtained from an interview on the day of the patients' medical evaluation. The relationship between orofacial myofunctional changes and PNIF was analyzed using a logistic regression model. Estimates were reported as odds ratio (OR) and 95% confidence interval (95%CI). We evaluated multicollinearity using the variance inflation factor and analyzed the adjusted fit with the Akaike information criterion and McFadden's R2 metric; p value < 0.05 was considered statistically significant. RESULTS: Inadequate positioning of the mandible (OR = 11.22; 95%CI 1.83-69; p = 0.009) and the presence of tension in the facial muscles during the swallowing of liquid (OR = 4.61; 95%CI 1.31-16.20; p = 0.017) were associated with altered PNIF in children and adolescents with asthma and rhinitis. CONCLUSION: Children and adolescents with asthma and rhinitis along with reduced nasal patency presented orofacial myofunctional changes, such as inadequate positioning of the jaw and the presence of tension in the facial muscles during swallowing of liquid.

Intervenção fonoaudiológica na prevenção de quedas no envelhecimento / Speech therapy´s intervention for falling prevention in aging

RESUMO Objetivo Verificar a eficácia de uma intervenção fonoaudiológica para diminuição do risco de quedas. Método Estudo exploratório e de intervenção em que 148 voluntários socialmente ativos, de ambos os sexos, com média de 68,6(±6,5) anos foram avaliados pelo Dynamic Gait Index (DGI)-Brazilian brief e o Timed Up and Go (TUG). Todos os voluntários, com e sem risco para quedas, foram convidados para o programa de intervenção realizado em cinco semanas consecutivas, com duração de 50 minutos baseados nos exercícios de Cawthorne e Cooksey. Destes, 72 com 68,1(±6,5) anos, com e sem riscos para quedas, que participaram de, pelos menos, três encontros foram reavaliados. Foram utilizados o teste de Wilcoxon, Qui-quadrado, Spearman e Matriz de Correlação, com p≤5,0%. Resultados Inicialmente, 37(25,0%) e 106(71,6%) dos voluntários apresentaram, respectivamente, riscos para quedas no DGI-Brazilian brief e no TUG. Verificou-se correlação negativa do DGI-Brazilian brief (p=0,034) e positiva com o TUG (p=0,0071) com a idade e entre os dois instrumentos (p=0,00000016). Na comparação dos dados iniciais e finais de 72 voluntários averiguou-se correlação positiva no DGI-Brazilian brief e TUG no teste do Qui-quadrado e de Wilkoxon. Foi observado melhor desempenho nestes testes após a intervenção. Conclusão A intervenção foi eficaz, uma vez que diminuiu o risco para quedas e melhorou o desempenho da marcha e equilíbrio funcional e dinâmico.

ABSTRACT Purpose to verify the effectiveness of a Speech Therapy intervention program to decrease the risk of falls in elderly people. Methods Exploratory and intervention study where upon 148 volunteers from community, both genders, with an average of 68.6(± 6.5) years were submitted to the Dynamic Gait Index (DGI)- Brazilian brief and the Timed Up and Go (TUG). Volunteers with or without potential risk for falling were invited to participate in a 50-minutes long intervention program carried out for five consecutive weeks, based on Cawthorne and Cooksey exercises. Seventy-two volunteers 68.1(±6.5) years presented in at least three meeting, were reassessed. The results were analyzed by Wilcoxon, Chi-square, Spearman and Correlation Matrix tests, with p≤5.0%. Results Thirty-seven (25.0%) and 106 (71.6%) participants presented, respectively, risks for falls in the DGI-Brazilian brief and TUG. There was negative correlation between the DGI-Brazilian brief (p=0.034) and positive with the TUG (p=0.0071) with age and both instruments (p=0.00000016). Through the comparison the initial and final data a positive correlation was found for the DGI-Brazilian brief and for TUG in the Chi-square test and by Wilcoxon's. Better performance was observed in both tests after the intervention. Conclusion The intervention was effective in decreasing the risk for falls and improving gait performance, and functional and dynamic balance.

Association Between Mouth Breathing and Asthma: a Systematic Review and Meta-analysis.

PURPOSE OF REVIEW: This systematic review and meta-analysis evaluated the association between asthma and mouth breathing. We performed a systematic search in the PubMed, SCOPUS, Lilacs, Web of Science, Google Scholar and OpenThesis databases. RECENT FINDINGS: Asthma is defined as a heterogeneous disease characterized by variable symptoms of wheezing, shortness of breath, chest oppression and/or cough, and limitation of expiratory airflow. Although several studies have examined the association between asthma and mouth breathing, there are no systematic reviews or meta-analyses that synthesize the available bodies of evidence. We used the odds ratio as a measure of the association between asthma and mouth breathing. Summary estimates were calculated using random-effects models, and the risk of bias was estimated using the Newcastle-Ottawa Scale for case-control studies and the National Institutes of Health tool for cross-sectional studies. Nine studies were included in the present systematic review. Data from 12,147 subjects were analyzed, of which 2083 were children and adolescents and 10,064 were adults. We found an association between mouth breathing and asthma in children and adolescents (OR 2.46, 95% CI 1.78-3.39) and in adults (OR 4.60, 95% CI 1.49-14.20). However, limitations were found in the methodological description of the included studies, as well as high heterogeneity among studies evaluating adult populations. This meta-analysis showed an association between mouth breathing and asthma in children, adolescents and adults, but the results should be interpreted with caution. Further studies with standardized criteria for the investigation of mouth breathing are needed.

Prática segura de audiologistas durante a pandemia de SARS-CoV-2 no Brasil / Safe practice of audiologists during the SARS-CoV-2 pandemic in Brazil

RESUMO A doença de coronavírus (COVID-19) é causada pela síndrome respiratória aguda grave coronavírus 2 (SARS-CoV-2). O vírus é transmitido, principalmente, por gotículas, espirros e aerossóis e pode ser transmitido mesmo entre pacientes assintomáticos, havendo risco de contágio durante os procedimentos do audiologista, que utiliza e reutiliza equipamentos clínicos em uma ampla variedade de pacientes. Este artigo teve como objetivo descrever as etapas que podem ser adotadas pelos audiologistas para diminuir o risco de contaminação cruzada na prática clínica, durante a pandemia de SARS-CoV-2. Recomenda-se, portanto, a esses profissionais, o uso de equipamentos de proteção individual, incluindo respiradores N95, luvas de procedimento, protetores para calçados descartáveis, protetores faciais ou óculos de segurança, gorros e aventais descartáveis, além de seguir, rigorosamente, os protocolos de biossegurança durante os cuidados audiológicos.

ABSTRACT Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV2). This virus is transmitted mainly by droplets, sneezes and aerosols and can be transmitted even among asymptomatic patients, so there is a risk of transmission during the audiologist's procedures which, in addition, use and reuse clinical equipment in a wide variety of patients. This article aims to describe the steps that can be taken by the audiologist in order to decrease the risk of cross-contamination in clinical practice during the SARS-CoV-2 pandemic in Brazil. During the COVID-19 pandemic, audiologists are recommended to use personal protective equipment including N95 respirators, clinical gloves, disposable shoe covers, face shields or safety glasses, hair covers and disposable aprons, in addition to strictly following biosafety protocols during audiological care.