Vocal rehabilitation in post-total pharyngolaryngoesophagectomy patient: case report

INTRODUCTION: Advanced esophageal tumors may extend to adjacent structures, and as a consequence, need more aggressive treatments as the total removal of the pharynx, larynx and esophagus. Traditionally, after a classic total laryngectomy, the possible forms of vocal rehabilitation are esophageal voice, tracheoesophageal prosthesis and electronic laryngeal prosthesis, the latter being the most indicated type of rehabilitation after the removal of the esophagus. Nonetheless, with neuronal plasticity and the adaptability of human functions, other structures can be used for vocal production. CASE REPORT: Participating in this study is a 61-year-old black male patient with a history of smoking and alcohol use since the age of 15 and visually impaired due to glaucoma 23 years earlier. The patient sought the Head and Neck Service due to a complaint of salivary incontinence and hiccup for eight years. The patient was diagnosed with spinocellular carcinoma of the esophagus (T4 N2 M0), undergoing a pharyngolaryngoesophagectomy with pharyngogastric anastomosis with bilateral modified radical neck dissection. The patient was referred to the Speech-Language Pathology Service presenting jejunostomy as an alternative feeding pathway and the presence of "voice" from the vibration of reconstructed tissue with the passage of air to the stomach. SLP therapy: There was resumed oral intake and the development of gastric voice through speech articulation training exercises similar to those used for the production of esophageal voice. The patient is currently producing simple sentences with plosive sounds and functional phrases. CONCLUSION: It was possible to observe from this clinical case that "gastric" voice can be developed as an alternative form of oral communication in patients with laryngeal and esophageal resections

Análise acústica dos formantes e das medidas de perturbação do sinal sonoro em mulheres sem queixas vocais, não fumantes e não etilista / Acoustic analysis of formants and measures of the sonorous signal disturbance in non-smoker and non-alcoholic women without vocal complaints

Introdução: A análise acústica tem como objetivo quantificar e caracterizar o sinal sonoro. Por meio dessa avaliação também é possível criar um banco de dados normativos das populações. Objetivo: Esta pesquisa teve como objetivo extrair e analisar as medidas do sinal sonoro: Freqüência Fundamental, Jitter, Shimmer, APQ (Amplitude Perturbation Quotient), PPQ (Period Perturbation Quotient), NHR (Noise Harmonic Ratio) e os valores das freqüências dos primeiros três formantes das sete vogais orais do português brasileiro falado em São Paulo. Também foi realizada a avaliação perceptivo-auditiva da voz por meio da escala GIRBAS. Método: Participaram 107 mulheres, não fumantes, não etilistas, sem queixas vocais e sem alterações laringológicas. O programa utilizado para o registro e análise da voz foi o CSL 4300B e Multi-Dimensional Voice Program (MDVP). Essas mulheres foram divididas de acordo com a idade em 3 grupos: 1 (18-39), 2 (40-60) e 3 (60-86). Resultados: Não houve diferença estatisticamente significante entre os grupos nas medidas avaliadas. Porém os valores de quase todas as medidas de perturbação do sinal sonoro (Jitter, APQ, PPQ, NHR) foram maiores no Grupo 3. Os valores de Freqüência Fundamental foram semelhantes entre os grupos estudados e o Shimmer foi maior no grupo 2. Para F1 o Grupo 3 apresentou seus valores mais elevados, F2 não houve prevalência entre os grupos e para F3 os valores foram aumentados para o Grupo 3 nas vogais /a/,/e/,/o/. Conclusão: A criação de banco de dados normativos pode favorecer as pesquisas com vozes disfônicas e normais.

Introduction: The acoustic analysis aims at quantifying and characterizing the sonorous signal. Through this assessment it is also possible to create a normative database of populations. Objective: This study aims at extracting and analyzing the measures of sonorous signal: Fundamental Frequency, Jitter, Shimmer, APQ (Amplitude Perturbation Quotient), PPQ (Period Perturbation Quotient), NHR (Noise Harmonic Ratio) and the values of the frequencies of the first three formants of the seven oral vowels of the Brazilian Portuguese spoken in São Paulo. We also carried out the voice perceptive-auditory assessment through GIRBAS scale. Method: 107 non-smoker, non-alcoholic women, without vocal complaints and laryngological alterations. The program used for the recording and analysis of voice was the CSL 4300B and Multi-Dimensional Voice Program (MDVP). These women were divided according to age into 3 groups: 1 (18-39), 2 (40-60) and 3 (60-86) Results: There was no statistically significant difference between groups in the measures evaluated. But the values of almost all measures for disturbance of the sonorous signal (Jitter, APQ, PPQ, and NHR) were higher in Group 3. The values of Fundamental Frequency were similar in the groups studied and Shimmer was higher in group 2. For F1 Group 3 showed their highest values, in F2 there was no prevalence among groups and for F3 the values were increased for Group 3 in vowels /a/, /e/, /o/. Conclusion: The creation of normative databanks could help the researches with dysphonic and normal voices.