RESUMO
RESUMO Objetivo Analisar, por meio da comparação entre a abertura máxima mandibular, a efetividade de programa terapêutico miofuncional oral em pacientes com câncer de boca ou orofaringe submetidos à radioterapia adjuvante. Método Estudo prospectivo envolvendo cinco pacientes adultos e cinco idosos em pós-operatório de cirurgia de boca/orofaringe que aguardavam início da radioterapia ou até a quinta sessão. No início e no final do programa, os participantes tiveram suas medidas de abertura máxima mandibular mensuradas por meio de paquímetro e foram selecionados cinco exercícios - dois de mobilidade e três de tração mandibular - com controle presencial durante oito semanas, perfazendo um total de dez semanas. Dados descritivos e a comparação das medidas pré e pós-fonoterapia por meio do teste de Wilcoxon foram considerados na análise dos dados. Resultados Dez pacientes finalizaram o programa terapêutico (duas mulheres e oito homens), com média de idade de 58,4 anos, mediana de 57,0 anos. Apresentaram média de abertura máxima mandibular de 31,6 ± 11,7 mm antes do tratamento e 36,4 ± 8,0 mm no pós-terapia (p=0,021). Conclusão O programa terapêutico miofuncional oral proposto promoveu aumento da abertura máxima vertical da mandíbula de pacientes submetidos à radioterapia e/ou quimioterapia adjuvante para tratamento de câncer de boca e orofaringe.
ABSTRACT Purpose Assess the effectiveness of an orofacial myofunctional therapeutic program in patients with oral or oropharyngeal cancer submitted to adjuvant radiotherapy through pre- and post-program comparison of maximum mandibular opening. Methods Prospective study involving five adult patients and five elderly patients postoperatively to oral cavity/oropharynx surgery who were awaiting the beginning of radiotherapy or had undergone fewer than five treatment sessions. The study participants had their maximum jaw opening measured using a sliding caliper at the beginning and end of the program. Two mobility exercises and three mandibular traction exercises were selected and weekly monitored presentially for 10 weeks. Descriptive data and pre- and post-therapy comparative measures were statistically analyzed using the Wilcoxon test. Results Ten patients (two women and eight men) with mean age of 58.4 years, median of 57.0 years, completed the therapeutic program. They presented mean maximum mandibular opening of 31.6 ± 11.7 and 36.4 ± 8.0 mm pre- and post-therapy, respectively (p =0.021). Conclusion The proposed orofacial myofunctional therapeutic program increased the maximum jaw opening of patients referred to adjuvant radiotherapy for oral cavity or oropharynx cancer treatment.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Lesões por Radiação/reabilitação , Trismo/reabilitação , Neoplasias Orofaríngeas/radioterapia , Estatísticas não Paramétricas , Terapia Miofuncional/métodos , Lesões por Radiação/fisiopatologia , Fonoterapia/métodos , Trismo/etiologia , Trismo/fisiopatologia , Neoplasias Orofaríngeas/fisiopatologia , Projetos Piloto , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento , Terapia por Exercício/métodos , Pessoa de Meia-Idade , Boca/efeitos da radiação , Boca/fisiopatologiaRESUMO
OBJECTIVE: To compare the efficacy and feasibility of teleaudiometry with that of sweep audiometry in elementary school children, using pure-tone audiometry as the gold standard. METHODS: A total of 243 students with a mean age of 8.3 years participated in the study. Of these, 118 were boys, and 125 were girls. The following procedures were performed: teleaudiometry screening with software that evaluates hearing at frequencies of 1,000, 2000 and 4000 Hz at 25 dBHL; sweep audiometry screening in an acoustic booth (20 dBHL at the same frequencies); pure-tone audiometry thresholds in an acoustic booth (frequencies of 500, 1000, 2000 and 4000 Hz); and acoustic immittance measurements. RESULTS: The diagnostic capacities of the teleaudiometry/sweep audiometry screening methods were as follows: sensitivity ϝ 58%/65%; specificity ϝ 86%/99%; positive predictive value ϝ 51%/91%; negative predictive value ϝ 89%/92%; and accuracy ϝ 81%/92%. Teleaudiometry and sweep audiometry showed moderate agreement. Furthermore, the use of these methods in series with immittance testing improved the specificity, whereas parallel testing improved the sensitivity. CONCLUSION: Teleaudiometry was found to be reliable and feasible for screening hearing in school children. Moreover, teleaudiometry is the preferred method for remote areas where specialized personnel and specific equipment are not available, and its use may reduce the costs of hearing screening programs. .