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RESUMO Objetivo: analisar a qualidade de vida relacionada à voz em pacientes laringectomizados totais participantes de um grupo de apoio. Métodos: a população estudada foi constituída por 11 indivíduos laringectomizados totais, de ambos os sexos com idade compreendida entre 43 e 84 anos, falantes por meio de voz traqueoesofágica ou laringe eletrônica. Foi aplicado o protocolo Qualidade de Vida em Voz (QVV) e uma escala representada por uma régua de dez centímetros para aferição da satisfação da comunicação. Resultados: os indivíduos falantes traqueoesofágicos apresentaram melhores resultados no escore global do QVV em relação aos usuários de laringe eletrônica (p=0.026). Os sujeitos que apresentaram melhores índices globais no QVV apresentaram melhores índices de satisfação com a comunicação (p=0.001). Os índices de satisfação com a comunicação apresentaram relação com o tempo de cirurgia (p=0.050). Não foram encontradas associações entre a satisfação com a comunicação e as variáveis sociodemográficas sexo (p=0.154) e idade (p=0.303). Conclusão: pode-se observar que quanto maior o tempo de cirurgia mais satisfeito o indivíduo está com a comunicação. Observou-se ainda que o QVV é uma medida fidedigna da satisfação na comunicação de laringectomizados totais.
ABSTRACT Purpose: to analyze the voice-related quality of life in totally laryngectomized patients in speech therapy for a support group. Methods: the studied population was composed of 11 totally laryngectomized subjects of both genders between 43 and 83 years of age, who speak using a trachoesophageal prosthesis or electronic larynx. The patients answered the Brazilian Portuguese version of the Voice-Related Quality of Life (VR-QOL) questionnaire and rated their satisfaction with their communication on a 10cm visual analogic scale. Results were submitted to statistical analysis with a 5% significance level. Results: tracheoesophageal prosthesis speakers had better results in the global score of the VR-QOL when compared with electronic larynx speakers (p=0.026). The subject with higher global V-RQOL scores had higher satisfaction levels regarding their communication (p=0.001). Satisfaction levels with communication were also statistically related to time of surgery (p=0.05). There were no statistically significant associations regarding satisfaction with communication and sociodemographic variables sex (p=0.154) and age (p=0.303). Conclusion: individuals with more time since surgery are better satisfied with their communication. Satisfaction levels showed that the VR-QOL is a reliable measure of communication satisfaction of totally laryngectomized patients.
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PURPOSE: To assess the effect of a program of singing training on the voice of total laryngectomees wearing tracheoesophageal voice prosthesis, considering the quality of alaryngeal phonation, vocal extension and the musical elements of tunning and legato. METHODS: Five laryngectomees wearing tracheoesophageal voice prosthesis completed the singing training program over a period of three months, with exploration of the strengthening of the respiratory muscles and vocalization and with evaluation of perceptive-auditory and singing voice being performed before and after 12 sessions of singing therapy. RESULTS: After the program of singing voice training, the quality of tracheoesophageal voice showed improvement or the persistence of the general degree of dysphonia for the emitted vowels and for the parameters of roughness and breathiness. For the vowel "a", the pitch was displaced to grave in two participants and to acute in one, and remained adequate in the others. A similar situation was observed also for the vowel "i". After the singing program, all participants presented tunning and most of them showed a greater presence of legato. The vocal extension improved in all participants. CONCLUSION: Singing training seems to have a favorable effect on the quality of tracheoesophageal phonation and on singing voice.
Subject(s)
Female , Humans , Male , Middle Aged , Larynx, Artificial , Laryngectomy/rehabilitation , Singing , Speech Therapy/methods , Voice Training , Auditory Perception , Music , Pitch Perception , Resistance Training/methods , Respiratory Muscles/physiology , Speech, Alaryngeal , Voice QualityABSTRACT
TEMA: reabilitação do laringectomizado total. OBJETIVO: correlacionar a proficiência de voz e de fala de laringectomizados totais usuários de prótese traqueoesofágica com a pressão intraluminal da transição faringoesofágica no repouso e durante a fonação. MÉTODO: foram estudados 12 laringectomizados totais com voz traqueoesofágica, usuários de prótese fonatória, submetidos à coleta e registro do material de voz e da fala, que foram avaliados por três expertos, utilizando-se um protocolo de julgamento geral da comunicação traqueoesofágica. Em seguida, os indivíduos foram encaminhados à manometria esofágica para avaliar a pressão intraluminal da transição faringoesofágica durante a fonação e no repouso. RESULTADOS: durante a fonação, os indivíduos caracterizados como bons falantes (16,7 por cento) pelos expertos apresentaram valores médios de amplitude de pressão na transição faringoesofágica de 27,48mmHg. Entre os falantes moderados (52,5 por cento), obteve-se amplitude média de 30,63mmHg e para os piores falantes (30,8 por cento), 38,72mmHg. Durante o repouso, os melhores falantes apresentaram pressão média de 14,72mmHg, os moderados, 13,04mmHg e os piores falantes, 3,54mmHg. CONCLUSÃO: os melhores falantes apresentaram os menores valores de amplitude de pressão durante a fonação. Em contrapartida, a pressão em repouso foi maior para os bons falantes e menor para os piores, sugerindo que a elevação da pressão na transição faringoesofágica durante a fonação prejudica a qualidade da comunicação traqueoesofágica com a prótese fonatória.
BACKGROUND: rehabilitation of individuals with total laryngectomy. AIM: to correlate the voice and speech proficiency of individuals with total laryngectomy, users of tracheoesophageal, prosthesis with the intraluminal pharyngoesophageal transition pressure at rest and during phonation. METHOD: twelve individuals with total laryngectomy and with tracheoesophageal voice, users of speech prosthesis, were submitted to a voice and speech sample gathering and registration. These individuals were assessed by three experts using a specific protocol for the evaluation of tracheoesophageal communication. Individuals also underwent esophageal manometry in order to evaluate the intraluminal pharyngoesophageal transition pressure during rest and phonation. RESULTS: during phonation, individuals who had been characterized by the experts as good speakers (16.7 percent) presented average values of pressure amplitude during pharyngoesophageal transition of 27.48mmHg. Average amplitude of 30.63mmHg was observed for individuals classified as moderate speakers (52.5 percent), and of 38.72mmHg for individuals classified as poor speakers (30.8 percent). During rest, the good speakers presented an average pressure of 14.72mmHg, the moderate speakers of 13.04mmHg and the poor speakers of 3.54mmHg. CONCLUSION: the good speakers presented the lowest amplitude values of pharyngoesophageal transition pressure during phonation. However, the pressure observed in the rest condition was higher for the good speakers and lower for the poor speakers, suggesting that the raise in the pharyngoesophageal transition pressure during phonation damages the quality of tracheoesophageal communication when using speech prosthesis.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Larynx, Artificial , Laryngectomy/rehabilitation , Phonation/physiology , Speech, Esophageal , Speech/physiology , Communication , Esophagus/surgery , Manometry/methods , Treatment Outcome , Trachea/surgery , Voice Quality/physiologyABSTRACT
Introdução: A primeira laringectomia total data de 1873 descrita por Billroth, e foi acompanhada pela tentativa de reabilitação vocal com a prótese externa de Gussenbauer. Nos últimos anos as formas de reabilitação vocal evoluíram e a utilização da fístula traqueoesofágica com uma prótese valvulada foi proposta por Blom e Singer, em 1980. A colocação da prótese após a laringectomia é denominada de secundária e, apesar das evoluções referente à prótese vocal, a colocação secundária utilizando anestesia geral e esofagoscópio rígido pode levar a complicações como mediastinite, celulite cervical, fratura de vértebra cervical e perfuração esofágica. Objetivo: Apresentar técnica endoscópica de passagem secundária dessa prótese. Métodos: Esse trabalho foi realizado em 72 pacientes laringectomizados reabilitados com prótese vocal do tipo Blom-Singer Indwelling low pressure com colocação secundária através de técnica cirúrgica por endoscopia digestiva alta e sedação com midazolan, no período de junho de 1999 a julho de 2006, dispensando o uso de anestesia geral e internação. Resultados: Todos os pacientes foram reabilitados com a prótese tráqueo-esofágica, sem complicações relacionadas com a técnica cirúrgica. As vantagens dessa nova técnica em relação à convencional são: 1) dispensa a anestesia geral; 2) não é necessário internação do paciente; 3) menor riscos de complicações, como: hemorragia digestiva alta; mediastinite; fratura de vértebras cervicais; perfuração esofágica; 4) visibilização direta do posicionamento da prótese no esôfago.
Introduction: The first total laryngectomy was performed in 1873 by Billroth, and it was accompanied by the attempt of vocal rehabilitation with the Gussenbauer's external prosthesis. In the last years the techniques of vocal rehabilitation developed and the use of the tracheoesophageal fistula with a valvuled prosthesis was proposed by Blom and Singer in 1980. The placement of the prosthesis after laryngectomy is called secondary, and in spite of the evolutions regarding the vocal prosthesis, the secondary placement using general anesthesia and rigid esophagoscopy can take complications as mediastinitis, cervical cellulitis, fracture of cervical vertebra, and esophageal perforation. Objective: To present an endoscopic technique for the secondary placement of such prosthesis. Methods: This work was accomplished in 72 patients undergone total laryngectomy and rehabilitated with Blom-Singer Indwelling low pressure vocal prosthesis with secondary placement through new surgical technique by digestive endoscopy and mitigation with midazolan, in the period from June, 1999 to July, 2006, releasing this way the use of general anesthesia and hospitalization. Results: All patients were rehabilitated with tracheoesophageal prosthesis, without complications related with the surgical technique. The advantages of this new technique in relation to the conventional are: 1) releases the general anesthesia; 2) it is not necessary patient hospitalization; 3) smaller risks of complications as high digestive hemorrhage; mediastinitis; fracture of cervical vertebras; esophageal perforation; 4) direct visualization of the positioning of the prosthesis in the esophagus.
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0.05). There were no significant differences in sound, maximum sound intensity, breath sessions, base frequency and amplitude between the patients using artificial larynx and control group, but there were significant difference in fundamental frequency perturbation, amplitude perturbation, standardized noise energy and harmonious noise ratio(P
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Objective To evaluate the results of the Groningen valve voice prosthesis in China.Methods The Groningen valve was used to date in 10 patients with a mean age at insertion of 60.2 years from January 2003 to January 2004. Seven patients underwent primary valve insertion at the time of surgery and in three patients the prosthesis was inserted at a later date. The speech quality of this group was assessed.Results The median score was 4.6(range 3.3～6.9)which compared favourably with a similar analysis of other valve.Conclusion The Groningen valve provides a highly acceptable means of obtaining vocalization after total laryngectomy in patients.