Correction to: Cervicofacial and Pharyngolaryngeal Lymphedema and Deglutition After Head and Neck Cancer Treatment.

The original version of this article unfortunately contained a mistake. Figure 2 was repeated in Figure 3.

Cervicofacial and Pharyngolaryngeal Lymphedema and Deglutition After Head and Neck Cancer Treatment.

One of the sequelae of head and neck cancer treatment is secondary lymphedema, with important impact on breathing, swallowing and vocal functions. The aim of the study was to assess the presence, staging characteristics and relationship of external and internal lymphedema and dysphagia after head and neck cancer treatment. The MDACC Lymphedema Rating Scale in Head and Neck Cancer was employed for the assessment and staging of face and neck lymphedema; the Radiotherapy Edema Scale for internal lymphedema; and a fiberoptic endoscopic evaluation of swallowing (FEES) for swallowing. The sample consisted of 46 patients with a diagnosis of head and neck cancer. Lymphedema was detected in 97.8% (45) of the evaluations with predominance of the composite type (73.9%-34). A high percentage of external lymphedema of the neck (71.7%-33) and submandibular (63%-29) were detected, with predominance of the more advanced levels. Internal edema was found in almost all structures and spaces at moderate/severe level. At FEES, residue (higher percentage in valleculae and pyriform sinus), penetration and aspirations were observed. The residue was detected in higher occurrence in patients with composite lymphedema (p = 0.012). The combined treatment with radiotherapy was related to submandibular external lymphedema (p = 0.009), altered pharyngolaryngeal sensitivity (0.040), presence of residue (p = 0.001) and penetration to pasty (p = 0.007) and internal edema in almost all structures. There was also a higher percentage of residue in cases with internal altered pharyngolaryngeal sensitivity, residue, penetration and aspiration. Combined treatment with radiotherapy is an associated factor of edema. Cervicofacial and pharyngolaryngeal lymphedema is a frequent event after treatment for HNC, with important impact on swallowing performance characterised by altered pharyngolaryngeal sensitivity, residue, penetration and aspiration. Combined treatment with radiotherapy is an associated factor.

Translation and adaptation of the Radiotherapy Edema Rating Scale to Brazilian Portuguese / Tradução e adaptação para o português brasileiro da Escala de Classificação do Edema da Radioterapia

Abstract Introduction: Internal lymphedema is one of the sequelae of head and neck cancer treatment that can lead to varying degrees of swallowing, speech, and respiration alterations. The Radiotherapy Edema Rating Scale, developed by Patterson et al., is a tool used to evaluate pharyngeal and laryngeal edema. Objective: To translate into Brazilian Portuguese, to culturally adapt and test this scale in patients undergoing treatment for head and neck cancer. Methods: The process followed the international guidelines and translation steps by two head and neck surgeons and back-translation performed independently by two North-American natives. The final version of the test was evaluated based on the assessment of 18 patients by two head and neck surgeons and two speech therapists using the scales in Brazilian Portuguese. Results: The translation and cultural adaptation were satisfactorily performed by the members of the committee in charge. Conclusion: The translation and adaptation into Brazilian Portuguese of the Radiotherapy Edema Rating Scale was successfully performed and showed to be easy to apply.

Resumo Introdução: O linfedema interno é uma das sequelas do tratamento para o câncer de cabeça e pescoço, pode levar a alterações de grau variado na deglutição, voz e respiração. A Escala do Edema da Radioterapia (Radiotherapy Edema Rating Scale), elaborada por Patterson et al., é uma ferramenta de avaliação do edema de faringe e laringe. Objetivo: Traduzir, para o português brasileiro, adaptar culturalmente e testar essa escala em pacientes submetidos ao tratamento para o câncer de cabeça e pescoço. Método: O processo seguiu as diretrizes internacionais e as etapas de tradução por dois cirurgiões de cabeça e pescoço e a retrotradução de forma independente por dois nativos norte-americanos. O teste da versão final para avaliação foi realizado a partir da avaliação de 18 pacientes por dois médicos cirurgiões de cabeça e pescoço e duas fonoaudiólogas por meio da aplicação das escalas em português. Resultados: A tradução e a adaptação cultural foram executadas satisfatoriamente pelos membros do comitê responsável. Conclusão: A tradução e adaptação da Escala do Edema da Radioterapia para o português foi bem-sucedida e de fácil aplicação.

Translation and adaptation of the Radiotherapy Edema Rating Scale to Brazilian Portuguese.

INTRODUCTION: Internal lymphedema is one of the sequelae of head and neck cancer treatment that can lead to varying degrees of swallowing, speech, and respiration alterations. The Radiotherapy Edema Rating Scale, developed by Patterson et al., is a tool used to evaluate pharyngeal and laryngeal edema. OBJECTIVE: To translate into Brazilian Portuguese, to culturally adapt and test this scale in patients undergoing treatment for head and neck cancer. METHODS: The process followed the international guidelines and translation steps by two head and neck surgeons and back-translation performed independently by two North-American natives. The final version of the test was evaluated based on the assessment of 18 patients by two head and neck surgeons and two speech therapists using the scales in Brazilian Portuguese. RESULTS: The translation and cultural adaptation were satisfactorily performed by the members of the committee in charge. CONCLUSION: The translation and adaptation into Brazilian Portuguese of the Radiotherapy Edema Rating Scale was successfully performed and showed to be easy to apply.

Translation and adaptation to Brazilian Portuguese of the Lymphedema Rating Scale in Head and Neck Cancer.

OBJECTIVE: Translate to brazilian portuguese, culturally adapt and test the rating and classification scales of cervicofacial lymphedema of the MD Anderson Cancer Center Head and Neck Lymphedema Protocol (MDACC HNL) in patients undergoing treatment for head and neck cancer. METHODS: The process followed international guidelines and translation stages by two head and neck surgeons, and back translation independently by two native Americans. The test of final version was based on the evaluation of 18 patients by one speech pathologist and one physical therapist who applied the scales in Portuguese. RESULTS: The translation of the three scales was carried out independently and the translators reached a consensus for the final version. Minor modifications were made by translating two terms into the Assessment of the Face. Versions of back-translation were similar to each other. The instrument was successfully applied to patients independently. CONCLUSION: The translation and cultural adaptation of the assessment and rating scale of the cervicofacial lymphedema of the MD Anderson Cancer Center Head and Neck Lymphedema Protocol to the Brazilian Portuguese were successful.

Translation and adaptation to Brazilian Portuguese of the Lymphedema Rating Scale in Head and Neck Cancer / Tradução e adaptação para o português brasileiro da Lymphedema Rating Scale in Head and Neck Cancer

ABSTRACT Objective: Translate to brazilian portuguese, culturally adapt and test the rating and classification scales of cervicofacial lymphedema of the MD Anderson Cancer Center Head and Neck Lymphedema Protocol (MDACC HNL) in patients undergoing treatment for head and neck cancer. Methods: The process followed international guidelines and translation stages by two head and neck surgeons, and back translation independently by two native Americans. The test of final version was based on the evaluation of 18 patients by one speech pathologist and one physical therapist who applied the scales in Portuguese. Results: The translation of the three scales was carried out independently and the translators reached a consensus for the final version. Minor modifications were made by translating two terms into the Assessment of the Face. Versions of back-translation were similar to each other. The instrument was successfully applied to patients independently. Conclusion: The translation and cultural adaptation of the assessment and rating scale of the cervicofacial lymphedema of the MD Anderson Cancer Center Head and Neck Lymphedema Protocol to the Brazilian Portuguese were successful.

RESUMO Objetivo: Traduzir, para o português brasileiro, adaptar culturalmente e testar as escalas de avaliação e classificação do linfedema cérvico-facial do MD Anderson Cancer Center Head and Neck Lymphedema Protocol (MDACC HNL) em pacientes submetidos ao tratamento para o câncer de cabeça e pescoço. Métodos: O processo seguiu as diretrizes internacionais e as etapas de tradução por dois cirurgiões de cabeça e pescoço, além de retrotradução de forma independente por dois nativos norte-americanos. O teste da versão final foi realizado a partir da avaliação de 18 pacientes por um fonoaudiólogo e um fisioterapeuta, por meio da aplicação das escalas em português. Resultados: A tradução das três escalas foi realizada de forma independente, e os tradutores chegaram a um consenso para a versão final. Foram feitas pequenas modificações, ao serem traduzidos dois termos em Assessment of the Face . As versões da retrotradução foram semelhantes entre si. O instrumento foi aplicado com sucesso nos pacientes de forma independente. Conclusão: A tradução e a adaptação das escalas de avaliação e classificação do linfedema cérvico-facial do MD Anderson Cancer Center Head and Neck Lymphedema protocol para o português foram bem sucedidas.

Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis.

UNLABELLED: Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. OBJECTIVE: This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. METHODS: This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. RESULTS: Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). CONCLUSION: Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

Videolaringoestroboscopia e avaliação vocal em pacientes portadores de artrite reumatoide / Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

A artrite pode afetar a laringe com rouquidão e fadiga vocal. OBJETIVO: Avaliar as manifestações laríngeas da artrite reumatoide. MÉTODOS: Estudo prospectivo de 27 pacientes com artrite reumatoide por meio de videolaringoestroboscopia, avaliação perceptivo-auditiva da voz por meio da escala GIRBAS, análise acústica e questionário do Índice de desvantagem vocal. RESULTADOS: Queixas laríngeas foram descritas por 19 pacientes, principalmente disfonia intermitente e sensação de corpo estranho na garganta. O achado laringoscópico mais frequente foi o cavalgamento das aritenoides. Três pacientes apresentaram pitch considerada grave. Nove tiveram o grau de disfonia e rugosidade discretos. As medianas das medidas acústicas foram: F0, 198,39 Hz; Jitter, 0,815; Shimmer, 4,915; e NHR, 0,144. Em relação ao índice de desvantagem vocal, a mediana foi zero para todos os domínios. Existiu significância estatística relacionando a queixa vocal com todos os domínios desse índice. A classe funcional teve relação estatisticamente significante com: cavalgamento de aritenoides (p = 0,001), PPQ (p = 0,0257), Shimmer (p = 0,0295), APQ (p = 0,0195) e com o domínio físico e total do IDV (p = 0,0227 e p = 0,0425). CONCLUSÃO: Queixa laríngea foi referida por 70,4% dos pacientes e alterações laringoscópicas foram verificadas em 48%. A avaliação acústica da voz e a autopercepção mostraram-se alterados.

Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. OBJECTIVE: This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. METHODS: This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. RESULTS: Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). CONCLUSION: Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.

[Swallowing after non-surgical treatment (radiation therapy / radiochemotherapy protocol) of laryngeal cancer]. / Deglutição após tratamento não cirúrgico (radioterápico/ radioquimioterápico) do câncer de laringe.

UNLABELLED: Radiation therapy and radiochemotherapy protocols can cause swallowing difficulties. AIM: To evaluate swallowing in patients undergoing radiation therapy and radiochemotherapy protocol only for the treatment of laryngeal tumors. METHODS: A prospective study of 20 patients, with a mean age of 62 years, at the end of oncological therapy. Six patients (30%) underwent radiation therapy, and 14 patients (70%) underwent combined therapy. The mean time between treatment and an evaluation of swallowing was 8.5 months. Videofluoroscopy was done to assess the preparatory, oral and pharyngeal phases of swallowing. RESULTS: All patients had only an oral diet. Normal swallowing was present in only 25% of patients. The swallowing videofluoroscopic examination identified the following changes: bolus formation (85%), bolus ejection (60%), oral cavity stasis (55%), changes in the onset of the pharyngeal phase (100%), decreased laryngeal elevation (65%), and hypopharyngeal stasis (80%). Laryngeal penetration was observed in 25% of the cases; 40% presented tracheal aspiration. The grade of penetration/aspiration was mild in 60% of cases. Aspiration was silent in 35% of patients. Although 75% of patients had dysphagia, only 25% complained of swallowing difficulties. CONCLUSION: Patients with laryngeal cancer that underwent radiation therapy/combined treatment can present changes in all swallowing phases, or may be asymptomatic.

Deglutição após tratamento não cirúrgico (radioterápico/ radioquimioterápico) do câncer de laringe / Swallowing after non-surgical treatment (radiation therapy / radiochemotherapy protocol) of laryngeal cancer

O tratamento radioterápico/ radioquimioterápico para tumores de laringe pode ocasionar sequelas na deglutição. OBJETIVO: Avaliar características da deglutição de pacientes tratados por radioterapia/ radioquimioterapia para tumores de laringe. MATERIAL E MÉTODO: Estudo prospectivo com 20 indivíduos, idade média de 62 anos, após término do tratamento oncológico. Destes, 6 (30 por cento) foram tratados por radioterapia exclusiva e 14 (70 por cento) por radioquimioterapia. O tempo médio decorrido do tratamento médico ao momento da avaliação fonoaudiológica foi de 8,5 meses. Foi realizada avaliação videofluoroscópica da deglutição orofaríngea e analisados eventos das fases preparatória, oral e faríngea da deglutição. RESULTADOS: Todos os pacientes se alimentavam com via oral exclusiva. Apenas 25 por cento da amostra apresentavam deglutição dentro dos limites da normalidade. A videofluoroscopia da deglutição identificou os seguintes eventos alterados: formação do bolo (85 por cento), ejeção do bolo (60 por cento), estases na cavidade oral (55 por cento), alteração no início da fase faríngea (100 por cento), redução da elevação da laringe (65 por cento) e estase em hipofaringe (80 por cento). A penetração laríngea foi diagnosticada em 25 por cento dos casos e 40 por cento penetrações seguidas de aspirações traqueais. O grau de penetração/ aspiração foi considerado discreto em 60 por cento, porém em 35 por cento da amostra a aspiração foi silenciosa. Embora 75 por cento da amostra apresentassem algum grau de disfagia, apenas 25 por cento dos pacientes referiam queixa de deglutição. CONCLUSÃO: Pacientes com câncer de laringe tratados com radioterapia/ radioquimioterapia podem apresentar alterações em todas as fases da deglutição, mesmo na ausência de sintomas.

Radiation therapy and radiochemotherapy protocols can cause swallowing difficulties. AIM: To evaluate swallowing in patients undergoing radiation therapy and radiochemotherapy protocol only for the treatment of laryngeal tumors. METHODS: A prospective study of 20 patients, with a mean age of 62 years, at the end of oncological therapy. Six patients (30 percent) underwent radiation therapy, and 14 patients (70 percent) underwent combined therapy. The mean time between treatment and an evaluation of swallowing was 8.5 months. Videofluoroscopy was done to assess the preparatory, oral and pharyngeal phases of swallowing. RESULTS: All patients had only an oral diet. Normal swallowing was present in only 25 percent of patients. The swallowing videofluoroscopic examination identified the following changes: bolus formation (85 percent), bolus ejection (60 percent), oral cavity stasis (55 percent), changes in the onset of the pharyngeal phase (100 percent), decreased laryngeal elevation (65 percent), and hypopharyngeal stasis (80 percent). Laryngeal penetration was observed in 25 percent of the cases; 40 percent presented tracheal aspiration. The grade of penetration/aspiration was mild in 60 percent of cases. Aspiration was silent in 35 percent of patients. Although 75 percent of patients had dysphagia, only 25 percent complained of swallowing difficulties. CONCLUSION: Patients with laryngeal cancer that underwent radiation therapy/combined treatment can present changes in all swallowing phases, or may be asymptomatic.

Voice and swallowing disorders: functional results and quality of life following supracricoid laryngectomy with cricohyoidoepiglottopexy.

We conducted a prospective study of 11 patients with laryngeal cancer who underwent supracricoid laryngectomy with cricohyoidoepiglottopexy. Our goal was to evaluate their postoperative voice and swallowing function and to ascertain the impact that surgery had on patient-perceived quality of life. Postoperative assessments were made by auditory perception analyses, objective voice analyses, the Voice Handicap Index questionnaire, the Quality of Life in Swallowing Disorders questionnaire, and videofluoroscopy. Following surgery, 8 patients experienced severe dysphonia and 3 experienced moderate dysphonia. Also, 5 patients experienced mild to severe dysphagia whereas 6 patients experienced normal or near-normal swallowing function. Postoperative acoustic measurements were higher than expected, and spectrographic evaluation revealed the presence of high-grade noise without predominant concentration over the spectrum. Some association with the grade of dysphonia and self-perception of voice handicap was observed. With regard to swallowing, 5 patients (45.5%) showed a decrease in laryngeal remnant elevation and a slight or moderate degree of stasis in the oropharynx. Overall, patients reported good quality of life regarding both voice and swallowing. No relationship between the functional swallowing and the number of preserved arytenoid cartilages was observed.

Swallowing and quality of life after total laryngectomy and pharyngolaryngectomy.

UNLABELLED: Dysphagia can be a consequence of total laryngectomy even in the absence of symptoms and it could indeed directly or indirectly compromise quality of life. AIM: To evaluate the characteristics of swallowing after total laryngectomy and pharyngolaryngectomy with pharyngeal T closure, correlating them with the Quality of Life in Swallowing Disorders questionnaire. METHODS: A prospective evaluation was performed in 28 patients; fifteen undergoing total laryngectomy and thirteen undergoing total pharyngolaryngectomy. Swallowing was evaluated through videofluoroscopy regarding the preparatory, oral and pharyngeal phases of swallowing, and the quality of life related to swallowing questionnaire was employed to measure quality of life. RESULTS: Anatomical and functional changes were observed under videofluoroscopic evaluation. Dysphagia was diagnosed in 18 patients (64.3%), being mild in 66.6% and moderate/severe in 33.3%. The questionnaire indicated good quality of life in almost all scales. Complaints of dysphagia were associated to the burden (p=0.036) and mental health scale (p=0.031). The questionnaire indicated impact on the mental health scale for patients with severe dysphagia (p=0.012). CONCLUSIONS: High incidence of dysphagia was observed in some quality of life assessments, especially of mild degree.

Swallowing and quality of life after total laryngectomy and pharyngolaryngectomy / Deglutição e qualidade de vida após laringectomia e faringolaringectomia total

Dysphagia can be a consequence of total laryngectomy even in the absence of symptoms and it could indeed directly or indirectly compromise quality of life. AIM: To evaluate the characteristics of swallowing after total laryngectomy and pharyngolaryngectomy with pharyngeal T closure, correlating them with the Quality of Life in Swallowing Disorders questionnaire. METHODS: A prospective evaluation was performed in 28 patients; fifteen undergoing total laryngectomy and thirteen undergoing total pharyngolaryngectomy. Swallowing was evaluated through videofluoroscopy regarding the preparatory, oral and pharyngeal phases of swallowing, and the quality of life related to swallowing questionnaire was employed to measure quality of life. RESULTS: Anatomical and functional changes were observed under videofluoroscopic evaluation. Dysphagia was diagnosed in 18 patients (64.3 percent), being mild in 66.6 percent and moderate/severe in 33.3 percent. The questionnaire indicated good quality of life in almost all scales. Complaints of dysphagia were associated to the burden (p=0.036) and mental health scale (p=0.031). The questionnaire indicated impact on the mental health scale for patients with severe dysphagia (p=0.012). CONCLUSIONS: High incidence of dysphagia was observed in some quality of life assessments, especially of mild degree.

A disfagia pode ser uma das consequências após a laringectomia total mesmo na ausência de sintomas e comprometer direta ou indiretamente a qualidade vida. OBJETIVO: Avaliar as características da deglutição após a laringectomia total e faringolaringectomia com fechamento em T e correlacionar com o questionário Quality of Life in Swallowing Disorders. MATERIAL E MÉTODO: Estudo prospectivo através da avaliação de 28 pacientes, quinze submetidos à laringectomia total e treze à faringolaringectomia. A deglutição foi avaliada através da videofluoroscopia em relação às fases preparatória, oral e faríngea e o questionário de qualidade de vida relacionada à deglutição foi aplicado para mensurar a qualidade de vida. RESULTADOS: Na avaliação videofluoroscópica foram observadas alterações anatômicas e funcionais. A disfagia foi diagnosticada em 18 (64,3 por cento) dos pacientes, sendo 66,6 por cento de grau discreto e 33,3 por cento de grau moderado/severo. O questionário indicou boa qualidade de vida em quase todas as escalas. As queixas de deglutição apresentaram associação com o questionário nas escalas fardo (p=0,036) e saúde mental (p=0,031). O questionário indicou impacto na escala saúde mental para os pacientes com disfagia de grau severo (p=0,012). CONCLUSÃO: Observamos grande incidência de disfagia de grau predominantemente discreto com repercussão em algumas escalas da qualidade de vida.

Implicações da traqueostomia na comunicação e na deglutição: [revisão] / Trcheotomy implication upon communication and swallowing: [review]

Nas últimas duas décadas, pesquisadores e clínicos têm-se preocupado com o impacto da traqueostomia na respiração, comunicação e deglutição. A traqueostomia está associada ao aumento do risco da aspiração e a decanulação irá melhorar a qualidade das funções. Nos casos de fácil oclusão da traqueostomia, é necessário gradativamente aumentar o tempo de oclusão e observar o quadro clínico respiratório. A sequência irá variar de acordo com a doença de base e as condições respiratórias. O impacto da traqueostomia na fisiologia da deglutição pode ser mecânico e/ou funcional.

In the last two decades, researchers and clinicians have been concerned to the impact of tracheotomy upon the respiration, communication and swallowing. The tracheotomy is associated to the increased risk of aspiration, and the decanulization can improve the functions quality. In those cases with easy occlusion of the tracheotomy, it is necessary gradually increasing the occlusion time and to observe the respiratory clinical condition. The sequence will vary according to the basic disease and the respiratory situation. The impact of the tracheotomy on the swallowing physiology can be both mechanical and/or functional.

Sintomas e sinais de alterações da deglutição após a tireoidectomia / Symptoms and signs of swallowing changes after thyroidectomy

Introdução: Sintomas e sinais clínicos de alteração de deglutição podem manifestar-se em pacientes com doença da tireóide. Objetivo: Caracterizar os sintomas e sinais de deglutição pré e pós-tireoidectomias. Métodos: Estudo prospectivo com 40 pacientes agendados para cirurgia de tireóide, submetidos à avaliação clínica da deglutição em três momentos: pré-operatório, pós-operatório imediato e pós-operatório tardio. Foi realizada anamnese para estudo dos sintomas e aplicada avaliação clínica da deglutição com 200mL de líquido contínuo e sólido. Resultados: Participaram 40 pacientes submetidos à tireoidectomia, sendo que 35 (87,5%) foram submetidos à tireoidectomia total e cinco à tireoidectomia parcial (12,5%). Na anamnese, os sintomas foram referidos nos três momentos do estudo, sendo 19 (47,5%) no pré-operatório, 26 (65%) no pós-imediato e 17 (48,5%) no pós-operatório tardio. A avaliação clínica da deglutição detectou a presença de alterações em dez (25%) no período pré-operatório, oito (20%) no pós-operatório imediato e cinco (14%) no pós-operatório tardio. Pacientes com nódulo de tamanho ? 3cm apresentaram maior ocorrência de sintomas e sinais clínicos de alteração de deglutição em todos os momentos do estudo. Conclusões: Pacientes com doença da tireóide podem apresentar sintomas e sinais clínicos desde o pré-operatório, com uma tendência a reduzir até o pós-operatório tardio.

Introduction: Clinical symptoms and signals of deglutition changes can be referred to by patients with thyroid diseases. Objectives: To characterize the swallowing symptoms and signals before and after the thyroidectomy. Methods: Prospective study with 40 patients undergoing thyroid surgery, submitted to the clinical evaluation of the deglutition in 3 moments: preoperative, early and late postoperative periods. The anamnesis and the clinical evaluation of the continuous swallowing of 200mL of liquid and solid consistence were applied. Results: Among the 40 patients, 35 patients (87.5%) underwent total thyroidectomy and 5 underwent partial thyroidectomy (12.5%). The symptoms were referred to in the 3 periods of the study, being 19 (47.5%) in the preoperative, 26 (65%) in the early postoperative and 17 (48.5%) in the late postoperative. The clinical evaluation of the deglutition detected the presence oh changes in 10 (25%) in the preoperative, 8 (20%) in the early postoperative and 5 (14%) the late postoperative periods. Patients with nodule larger than 3cm presented higher occurrence of clinical symptoms and signals of deglutition changes in all moments. Conclusion: Patients with thyroid diseases can present clinical symptoms and signals since the preoperative period, with some trend of decreasing till the late postoperative period.

Achados perceptivo-auditivos e acústicos em pacientes submetidos à laringectomia fronto-lateral / Perceptual and acoustic analysis findings in patients undergone frontolateral laryngectomy

Introdução: a análise dos parâmetros vocais é importante na caracterização funcional após realização da laringectomia fronto-lateral. Objetivo: realizar a avaliação perceptivo-auditiva e acústica da voz nesse grupo de pacientes. Métodos: Foram avaliados 20 pacientes, sendo 18 do gênero masculino, com idade média de 61 anos. A avaliação perceptivo-auditiva foi realizada através da escala GIRBAS, enquanto a análise acústica foi feita pelo CSL modelo 4300B e pelo programa de análise vocal MDVP, Kay Elemetrics Corp. Resultados: A análise perceptivo-auditiva da voz revelou que todos os pacientes apresentaram algum grau de disfonia, caracterizado principalmente por rugosidade. Considerando os parâmetros acústicos, observou-se um importante incremento da freqüência fundamental e os valores de todos os parâmetros apresentaram-se alterados. Conclusão: A análise perceptivo-auditiva da voz indicou que todos os pacientes submetidos à laringectomia fronto-lateral apresentaram algum grau de disfonia, caracterizada principalmente pela presença de rugosidade e tensão. Na análise acústica da voz, observou-se incremento da freqüência fundamental e medidas acústicas alteradas.

Introduction: the vocal parameters analysis is important for the functional characterization after the frontolateral laryngectomy. Objective: to evaluate the perceptual and acoustic analysis finding in such patients. Methods: 20 patients were evaluated, being 18 men, and with age average of 61. The voice perceptual evaluation was performed through the GIRBAS scale, whereas the voice acoustic analysis was done through CSL-4300B and the voice analysis through the software MDVP, Kay Elemetrics Corp. Results: Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough voices. The acoustic evaluation showed an important increase in the fundamental frequency, and the values of all parameters were changed. Conclusion: In the voice perceptual evaluation, all patients presented some grade of dysphonia, mainly characterized for the presence of roughness and tension. The voice acoustic analysis showed increased fundamental frequency and altered acoustic measures.

Avaliação vocal e auto-percepção da desvantagem vocal (VHI) após laringectomia fronto-lateral / Vocal evaluation and voice handicap (VHI) self-perception after frontolateral laryngectomy

Introdução: as alterações vocais decorrentes da laringectomia fronto-lateral (LFL) podem causar impacto na qualidade de vida. Objetivo: avaliar as características vocais e a auto-percepção da desvantagem vocal de pacientes submetidos à LFL com reconstrução pelo retalho do esterno-hióideo. Pacientes e método: Foi realizada a avaliação prospectiva de 12 pacientes, com idade média de 66,5 anos, submetidos à LFL com reconstrução pelo retalho do esterno-hióideo. Seis pacientes (50%) foram submetidos à radioterapia pós-operatória, com dose média de 6006cGy. A avaliação da voz dos pacientes foi realizada através da avaliação perceptivo-auditiva da voz, com a escala GIRBAS. A desvantagem vocal foi mensurada através da aplicação do questionário VHI, sendo que quanto maior for a pontuação, pior a desvantagem vocal. As amostras foram apresentadas de forma cego-aleatória para três fonoaudiólogos com experiência superior a três anos com disfonias decorrentes do tratamento oncológico. Resultados: Um total de 83% dos pacientes apresentou disfonia, sendo 42% de grau severo. A rugosidade estava presente em 100% dos casos. O pitch foi considerado adequado em 58% da amostra e a ressonância foi julgada como laringofaríngea em 67% dos pacientes. A auto-percepção de desvantagem vocal foi referida de impacto discreto nos três domínios e, em relação à pontuação global, foi observado pior impacto no grupo de pacientes com disfonia de grau grave e moderado. Conclusão: Constatamos disfonia de grau severo, porém, com impacto discreto nos domínios avaliados pelo VHI. Esses resultados reforçam a indicação de avaliações com múltiplos enfoques, onde o diagnóstico não seja apenas do clínico especialista, mas, também, do paciente. O VHI é uma ferramenta utilizada internacionalmente que viabiliza a avaliação do ponto de vista do paciente.

Introduction: the vocal changes resulting from the frontolateral laryngectomy (FLL) can cause impact on the quality of life. Objective: to evaluate the vocal characteristics and the voice handicap (VHI) self-perception after FLL with reconstruction with sternumhyoid muscle flap. Patients and methods: we performed the prospective analysis of 12 patients, whose average age was 66.5 years-old, undergoing FLL with reconstruction with sternumhyoid muscle flap. Six patients (50%) were submitted to adjuvant radiation therapy whose average dose was 6006cGy. The vocal evaluation of the patients was done through the perceptual analysis with the GIRBAS scale, whereas the voice handicap was measured through the VHI questionnaire. The higher the score, the worse the voice handicap. The vocal samples were presented in a blind way to 3 Speech-Language Pathologists with experience longer than 3 years in dysphonia due to the oncological treatment. Results: a rate of 83% of the patients presented dysphonia, being 42% in severe grade. The roughness was observed in 100% of the cases. The pitch was considered adequate in 58% and the resonance was laryngopharyngeal in 67% of the patients. The impact of the voice handicap self-perception was considered mild in the three domains. Regarding the global score, the worst impact was observed in the group of patients with moderate to severe dysphonia. Conclusion: The dysphonia grade was severe. However, its impact on the domains evaluated by the VHI was mild. Those results indicate the evaluation under multiple enfoques. Thus, the diagnosis should not be performed exclusively by the specialist clinician, but by the patient himself, as well. The VHI is a toll internationally employed that allows performing the evaluation under the patient point of view.

Autopercepção da desvantagem vocal (VHI) e qualidade de vida relacionada à deglutição (SWAL-QDL) de pacientes laringectomizados totais / Voice handicap (VHI) self perception and quality-of-life related to swallowing (SWAL-QOL) of total laryngectomees

Objetivo: avaliar o índice de desvantagem vocal e a qualidade de vida (QV) relacionada à deglutição de pacientes laringectomizados totais. Método: estudo prospectivo que utilizou o questionário VHI (Voice Handicap Index), composto por 3 domínios: funcional, físico e emocional. Para avaliar a QV relacionada à deglutição foi utilizado o questionário SWAL-QOL (Quality of Life in Swallowing Disorders), composto por 10 domínios, como: fardo, desejo, freqüência de sintomas, seleção de alimentos, comunicação, medo, saúde mental, função social, sono e fadiga. A análise estatística consistiu de distribuição de freqüência e as medidas de tendência central e da variabilidade para as variáveis numéricas. Resultados: 12 pacientes com idade média de 59,6 anos, 58,3% foram submetidos à cirurgia e radioterapia pós-operatória, com dosagem média de 6634cGy. O tempo decorrido do término do tratamento oncológico ao momento da investigação variou de 3 a 41 meses, no momento do estudo todos os pacientes se alimentavam por via oral exclusiva e se comunicavam pela associação da fala articulada, de gestos e da escrita. Em relação à desvantagem vocal a média das pontuações foram 22 para o domínio funcional, 17 para o físico, 14,3 para o emocional e 53,5 para o global. O SWAL-QOL teve médias que variaram entre 53 a 85,4. Conclusão: os resultados demonstraram alterações de grau moderado em relação à auto-percepção da desvantagem vocal e a QV relacionada à deglutição.

Objective: the aim of this study was to evaluate the voice handicap index and the quality of life in swallowing disorders among patinets who underwent total laryngectomy. Methods: prospective study using VHI (Voice Handicap Index) questionnaire with three domains: functional, physic and emotional. The higher the score, the worse is the voice handicap. To evaluate the quality of life in swallowing disorders the SWAL-QOL questionnaire was used (with 44 questions that considers 10 domins: burden, eating desire, symptom frequency, food selection, communication, fear, mental health, social functioning, sleep, fatigue). The answers were converted into a score ranging from 0 to 100, being 0 the worst score and 100 the best one. Statistical analysis conssted of a descriptive analysis of the frequencies for hte categorical variables as well as the variability and the centrla tendency measures for the numerical variables. Results: 12 patients (mean age 59.6 years old) were evaluated. At the moment of the application of the questionnaires all the patients had exclusive oral intake and communication by associated articulated speech, gesticulation and writing. In relation to voice handicap the mean score were 22 to functional domain, 17 to physic, 14.3 to the emotional and 53.5 to global. The SWAL-QOL ranged from 53 to 85.4. Conclusion: the results showed moderate alterations concerning to self perception of the voice handicap and the quality of life related to swallowing.