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Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue.ObjectiveThis paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis.MethodsThis 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.ResultsNineteen 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).ConclusionLaryngeal 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.

Os grandes avanços na compreensão da fisiologia vocal e o desenvolvimento científico e tecnológico na área de voz permitiram transpor o limite terapêutico através dos meios para a detecção precoce de alterações vocais. OBJETIVO: Avaliar indivíduos sem queixa vocal e correlacionar possíveis achados telelaringo-estroboscópicos, perceptivo-auditivos e acústicos. FORMA DE ESTUDO: Observacional coorte com corte transversal. CASUÍSTICA E MÉTODO: Foram avaliados 21 indivíduos do sexo masculino, com idade variando de 20 a 50 e mediana de 33 anos, sem queixas vocais, que não faziam uso de tabaco nem de destilados. Os sujeitos foram submetidos às avaliações telelaringo-estroboscópica, perceptivo-auditiva e acústica da voz. RESULTADOS: Do total de sujeitos avaliados, 57,15% apresentaram alteração em uma ou mais das avaliações realizadas. À telelaringo-estroboscopia, observou-se fenda vocal triangular posterior em 4 sujeitos. Dez apresentaram alteração na análise perceptivo-auditiva, observando-se os seguintes parâmetros: instabilidade, rouquidão e soprosidade, todos em grau discreto. Na avaliação da ressonância, três apresentaram cada foco hipernasal, cul de sac e laringo-faríngea. A avaliação acústica apresentou as seguintes médias: f0 - 125,69 Hz; jitter - 0,22%; shimmer - 3,06%; NNE -12,29 dB; HNR - 20,75 dB; freqüência do tremor - 2,09 Hz; amplitude do tremor - 1,16 Hz. Alguns sujeitos apresentaram valores de shimmer% e freqüência do tremor maiores do que a média. CONCLUSÃO: Foram detectadas alterações em 57,15% das avaliações realizadas em indivíduos sem queixas vocais. Esses achados podem ser indicativos de uma variação da normalidade ou representar uma predisposição a alterações glóticas e vocais que, com o passar do tempo, podem desenvolver-se. Em todas as avaliações alteradas houve alteração de parâmetro acústico. The great progress in understanding the vocal physiology and the scientific and technological development in the voice area allow transposing the therapeutic limit through the means for the precocious detection of vocal changes. OBJECTIVE: to evaluate subjects without vocal complaint, and to correlate possible videostroboscopic, perceptual and acoustic analysis finding. STUDY DESIGN: Observacional cohort with transversal cut. PATIENTS AND METHODS: 21 men without vocal complaints were studied. Their ages ranged from 20 to 50 with median of 33. They were neither alcohol nor smoke users. The subjects underwent the videostroboscopic, perceptual and acoustic evaluations. RESULTS: 57.15% of the subjects presented any alteration in one or more of the evaluated aspects. In the videostroboscopy it was observed posterior triangular gap in 4 subjects. Ten subjects presented a mild grade alteration in the perceptual analysis, in instability, hoarseness and breathiness parameters. Three subjects presented respectively hipernasal, cul de sac and pharyngolaryngeal resonance focus. The acoustic evaluation presented the following averages: f0 125.69 Hz; jitter 0.22%; shimmer 3.06%; NNE -12.29 dB; HNR 20.75 dB; tremor frequency 2.09 Hz; tremor amplitude 1.16 Hz. Some subjects presented shimmer% values and tremor frequency largest than the average. CONCLUSION: Alterations were detected in 57.15% of the evaluations of subjects without vocal complaints. Those changes could be variations of the normality, or they could indicate a predisposition to future glottic and vocal alterations in the course of the time. There was any acoustic aspect change in all the evaluations, which presented alteration.

Os grandes avanços na compreensão da fisiologia vocal e o desenvolvimento científico e tecnológico na área de voz permitiram transpor o limite terapêutico através dos meios para a detecção precoce de alterações vocais. OBJETIVO: Avaliar indivíduos sem queixa vocal e correlacionar possíveis achados telelaringo-estroboscópicos, perceptivo-auditivos e acústicos. FORMA DE ESTUDO: Observacional coorte com corte transversal. CASUÍSTICA E MÉTODO: Foram avaliados 21 indivíduos do sexo masculino, com idade variando de 20 a 50 e mediana de 33 anos, sem queixas vocais, que não faziam uso de tabaco nem de destilados. Os sujeitos foram submetidos às avaliações telelaringo-estroboscópica, perceptivo-auditiva e acústica da voz. RESULTADOS: Do total de sujeitos avaliados, 57,15% apresentaram alteração em uma ou mais das avaliações realizadas. À telelaringo-estroboscopia, observou-se fenda vocal triangular posterior em 4 sujeitos. Dez apresentaram alteração na análise perceptivo-auditiva, observando-se os seguintes parâmetros: instabilidade, rouquidão e soprosidade, todos em grau discreto. Na avaliação da ressonância, três apresentaram cada foco hipernasal, cul de sac e laringo-faríngea. A avaliação acústica apresentou as seguintes médias: f0 - 125,69 Hz; jitter - 0,22%; shimmer - 3,06%; NNE -12,29 dB; HNR - 20,75 dB; freqüência do tremor - 2,09 Hz; amplitude do tremor - 1,16 Hz. Alguns sujeitos apresentaram valores de shimmer% e freqüência do tremor maiores do que a média. CONCLUSÃO: Foram detectadas alterações em 57,15% das avaliações realizadas em indivíduos sem queixas vocais. Esses achados podem ser indicativos de uma variação da normalidade ou representar uma predisposição a alterações glóticas e vocais que, com o passar do tempo, podem desenvolver-se. Em todas as avaliações alteradas houve alteração de parâmetro acústico.The great progress in understanding the vocal physiology and the scientific and technological development in the voice area allow transposing the therapeutic limit through the means for the precocious detection of vocal changes. OBJECTIVE: to evaluate subjects without vocal complaint, and to correlate possible videostroboscopic, perceptual and acoustic analysis finding. STUDY DESIGN: Observacional cohort with transversal cut. PATIENTS AND METHODS: 21 men without vocal complaints were studied. Their ages ranged from 20 to 50 with median of 33. They were neither alcohol nor smoke users. The subjects underwent the videostroboscopic, perceptual and acoustic evaluations. RESULTS: 57.15% of the subjects presented any alteration in one or more of the evaluated aspects. In the videostroboscopy it was observed posterior triangular gap in 4 subjects. Ten subjects presented a mild grade alteration in the perceptual analysis, in instability, hoarseness and breathiness parameters. Three subjects presented respectively hipernasal, cul de sac and pharyngolaryngeal resonance focus. The acoustic evaluation presented the following averages: f0 125.69 Hz; jitter 0.22%; shimmer 3.06%; NNE -12.29 dB; HNR 20.75 dB; tremor frequency 2.09 Hz; tremor amplitude 1.16 Hz. Some subjects presented shimmer% values and tremor frequency largest than the average. CONCLUSION: Alterations were detected in 57.15% of the evaluations of subjects without vocal complaints. Those changes could be variations of the normality, or they could indicate a predisposition to future glottic and vocal alterations in the course of the time. There was any acoustic aspect change in all the evaluations, which presented alteration.

O tratamento radioterapico/ radioquimioterapico para tumores de laringe pode ocasionar sequelas na degluticao. OBJETIVO: Avaliar caracteristicas da degluticao de pacientes tratados por radioterapia/ radioquimioterapia para tumores de laringe. MATERIAL E METODO: Estudo prospectivo com 20 individuos, idade media de 62 anos, apos termino do tratamento oncologico. Destes, 6 (30%) foram tratados por radioterapia exclusiva e 14 (70%) por radioquimioterapia. O tempo medio decorrido do tratamento medico ao momento da avaliacao fonoaudiologica foi de 8,5 meses. Foi realizada avaliacao videofluoroscopica da degluticao orofaringea e analisados eventos das fases preparatoria, oral e faringea da degluticao. RESULTADOS: Todos os pacientes se alimentavam com via oral exclusiva. Apenas 25% da amostra apresentavam degluticao dentro dos limites da normalidade. A videofluoroscopia da degluticao identificou os seguintes eventos alterados: formacao do bolo (85%), ejecao do bolo (60%), estases na cavidade oral (55%), alteracao no inicio da fase faringea (100%), reducao da elevacao da laringe (65%) e estase em hipofaringe (80%). A penetracao laringea foi diagnosticada em 25% dos casos e 40% penetracoes seguidas de aspiracoes traqueais. O grau de penetracao/ aspiracao foi considerado discreto em 60%, porem em 35% da amostra a aspiracao foi silenciosa. Embora 75% da amostra apresentassem algum grau de disfagia, apenas 25% dos pacientes referiam queixa de degluticao. CONCLUSAO: Pacientes com câncer de laringe tratados com radioterapia/ radioquimioterapia podem apresentar alteracoes em todas as fases da degluticao, mesmo na ausencia de sintomas.

Radiation therapy and radiochemotherapy protocols can cause swallowing difficulties.To evaluate swallowing in patients undergoing radiation therapy and radiochemotherapy protocol only for the treatment of laryngeal tumors.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.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.Patients with laryngeal cancer that underwent radiation therapy/combined treatment can present changes in all swallowing phases, or may be asymptomatic.

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.

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. 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%) dos pacientes, sendo 66,6% de grau discreto e 33,3% 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.

OBJETIVO: Investigar as contribuições da fonoterapia na voz, na deglutição e na qualidade de vida de pacientes com alteração unilateral de mobilidade de prega vocal. MÉTODOS: Os sujeitos foram 13 pacientes, de ambos os sexos, com alteração unilateral de mobilidade de prega vocal. Foi realizado um levantamento da história clínica, dos dados de avaliação pré e pós-fonoterapia e da qualidade de vida dos mesmos a partir dos prontuários, das fitas de exame e das gravações de exames. RESULTADOS: Após a intervenção fonoaudiológica foi possível observar: nove pacientes apresentaram melhora da qualidade vocal após fonoterapia; todos os pacientes apresentaram melhora em pelo menos um parâmetro da avaliação acústica; dez pacientes apresentaram classificação dentro dos limites de normalidade em relação à escala de severidade da disfagia e nove em relação à escala de penetração/aspiração; seis pacientes referiram menor desvantagem vocal; nove pacientes referiram menor impacto da disfagia na qualidade de vida. CONCLUSÃO: Os resultados apontam melhoras na voz, na deglutição, na limitação vocal e na qualidade de vida relacionada à deglutição após fonoterapia. Pode-se dizer que a fonoterapia parece ser efetiva na melhora da voz, da deglutição, do nível de desvantagem vocal e da qualidade de vida em deglutição de pacientes com alterações na mobilidade das pregas vocais. PURPOSE: To investigate the contributions of speech therapy in voice, deglutition and quality of life of participants with unilateral vocal cords mobility alteration. METHODS: The subjects were 13 patients, both genders, with unilateral vocal cords mobility alteration. A research of clinical history, evaluation prior and post speech therapy and quality of life was carried out based on protocols, exam tapes and recordings from the participants' files. RESULTS: After speech therapy, it was possible to observe that: nine participants had better vocal quality at the end of the intervention process; all participants showed improvement of at least one parameter of the acoustic evaluation; ten participants were classified as within normality regarding the dysphagia severity scale and nine regarding the penetration/aspiration scale; six patients referred less vocal disadvantage; nine subjects referred less impact of dysphagia in quality of life. CONCLUSION: Results showed improvements in voice, deglutition, vocal handicap and quality of life related to the deglutition after speech therapy. It can be concluded that speech therapy seems to be effective for voice, deglutition, vocal handicap and quality of life improvement of patients with vocal cords mobility alteration.

Background The main goals of larynx preservation protocols are preservation of a functional larynx with intact voice and maintenance of normal deglutition. However, few studies have addressed functional outcomes. Objectives To evaluate voice and swallowing in patients enrolled in a larynx preservation protocol. Design and Setting Acoustic analysis of 15 patients and videofluoroscopic evaluation of 14 patients who underwent chemoradiotherapy in an attempt to preserve the larynx. Patients Forty-three patients with larynx or hypopharynx squamous cell carcinomas were treated with weekly paclitaxel (30 mg/m 2 ) and cisplatin (20 mg/m 2 ) concurrent to radiotherapy (180-rad/d fraction [1.8 Gy] to 7040 rad [70.4 Gy]). Voice was analyzed perceptually and acoustically in 15 patients. Videofluoroscopic evaluation of swallowing was performed in 14 patients, focusing on oropharyngeal motility disorders, stasis, laryngeal penetration, aspiration, and dysphagia severity. Results Vocal analysis produced normal results in 1 patient, mild dysphonia in 4, moderate dysphonia in 6, and severe dysphonia in 4. The mean fundamental frequency for acoustic analysis was 131.4 Hz for men and 109.8 Hz for women. Acoustic measures of perturbation and noise were above the reference limits, indicating changes in the voice signal. Swallowing analysis showed inefficient bolus preparation in 13 patients and changes in the bolus propulsion in 12. Stasis was observed in all areas of the oropharynx. Five patients had reduction in laryngeal elevation, and 12 had stasis in the hypopharynx. Five patients presented with silent aspiration. We detected functional swallowing in 3 patients, mild dysphagia in 7, mild or moderate dysphagia in 2, and severe dysphagia in 2. Conclusions Laryngeal preservation resulted in voice and swallowing abnormalities, but they tend to be mild to moderate, allowing intelligible communication and efficient swallowing in most patients.

Background The swallowing deficits that result from oral or oropharyngeal resections vary considerably depending on the site, extension of the resection, and type of reconstruction. Most patients will experience some degree of dysphagia despite the reconstructive effort. Furthermore, a glossectomy is frequently associated with voice and speech difficulties. Objectives To characterize swallowing in patients who underwent a glossectomy and to define the limits and the compensatory movements using video fluoroscopic analysis. Design and Setting Video fluoroscopic evaluation of 15 patients who underwent glossectomies at the Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo, Sao Paulo, Brazil. Patients We examined 15 patients: 5 who underwent a partial glossectomy, 2 who underwent a subtotal glossectomy, and 8 who underwent a total glossectomy with laryngeal preservation and reconstruction with myocutaneous flaps (9 pectoralis major flaps and 1 latissimus dorsi flap). The 15 patients were enrolled in a program that included voice, speech, and swallowing rehabilitation. Results All patients who underwent a partial glossectomy had difficulties with formation and anteroposterior propulsion of the bolus in the oral cavity and an increase in oral transit time, which was more evident with materials of thicker consistencies. All patients who underwent a total or subtotal glossectomy with laryngeal preservation had an increase in oral transit time and stasis of food in the oral cavity, the pharynx, and the superior esophageal sphincter. Of the 15 patients, 2 had moderate and asymptomatic aspiration. These 2 patients had swallowing compensations, such as increased buccal, mandibular, pharyngeal, and laryngeal activity and voluntary protection of the larynx during swallowing. Conclusions This study demonstrates the effectiveness of swallowing in patients who were enrolled in voice, speech, and swallowing rehabilitation after undergoing a partial or total glossectomy. An increase in oral transit time was detected in all patients. Only 2 of the 10 patients who underwent a total glossectomy had persistent asymptomatic aspiration.

The aim of this study was to integrative review of publications concerning the role of speech and language therapists in regards to communication strategies in palliative care, as well as the characterization of the types of communication used in these cases. The search was conducted in the databases SciELO, LILACS and PubMed from 2001 to 2016. The studies selected included abstracts or full articles addressing aspects of communication in palliative care, especially those related to speech and language therapy, with an emphasis on communication. Ten articles focused on communication, and published after 2004, were selected, half being literature reviews, two, case reports, two others, quantitative exploratory studies, and one, a qualitative exploratory study, with only 3 specifically describing the communication strategies used by speech and language therapists in patients in palliative care. The descriptors found were: palliative care, communication, speech and language therapy, quality of life, dysphagia, swallowing and elderly. Four of the ten articles showed the importance of patients communication in palliative care. When described, it is up to the speech and language therapist to provide family support, evaluate the patient, favore patient-family and patient-team intervention, manage and intervene in communication and swallowing. Finally, the most used communication strategies were non-verbal communication, communication board, electronic equipment, verbal communication and speech valve. The analysis of the characterization of the communication in palliative care over the past 15 years allowed concluding that the attention to communication is recent and is only described in a few reports, includes non-verbal communication in different ways as the most frequent resource, but provides oral communication as an important factor for maintaining dignity and comfort in this scenario. Speech and language therapist are the main interlocutors for the maintenance, mediation and adaptation of communication, within the multidisciplinary team as well as among patients, their family and the care team.