Neuropatía laríngea y movimiento paradojal de cuerdas vocales en la edad pediátrica: reporte de un caso / Laryngeal neuropathy and paradoxical vocal fold motion in the pediatric age: case report

Resumen La neuropatía laríngea es una condición de hipersensibilidad, hiperreactividad e hiper-función laríngea secundaria a un desequilibrio entre las aferencias y eferencias laríngeas. La respuesta individual y exagerada frente a diversos gatillantes específicos puede generar síntomas como tos crónica, parestesia laríngea, carraspera, disfonía, estridor, sensación de globus faríngeo, movimiento paradojal de las cuerdas vocales (también conocido como disfunción cordal) y/o laringoespasmo. Existe abundante literatura sobre neuropatía laríngea en adultos, sin embargo, en niños es limitada. El objetivo de este artículo es dar a conocer un caso de neuropatía laríngea en la edad pediátrica y la importancia de su consideración en el enfrentamiento de estos pacientes. Se presenta caso clínico de un paciente de 13 años, con antecedente de cirugía cardiaca reciente, evoluciona con disfonía severa evidenciándose aparente inmovilidad cordal bilateral con resultados discordantes entre nasofibrolaringoscopía y electromiografía laríngea. Posteriormente presenta mejorías en su voz, sin embargo, se agregan otros síntomas laringológicos como carraspera, globus faríngeo y estridor no explicados por causas anatómicas. Se expone la evaluación y abordaje otorrinolaringológico-fonoaudiológico para el caso. Se concluye que el diagnóstico de neuropatía laríngea requiere un alto índice de sospecha clínica ante signos laringológicos sugerentes, debiendo descartarse causas orgánicas y estructurales. El abordaje otorrinolaringológico-fonoaudiológico constituye el pilar terapéutico asociado al uso de neuromoduladores en casos seleccionados.

Abstract Laryngeal neuropathy is a condition of hypersensitivity, hyperresponsiveness and laryngeal hyperfunction secondary to an imbalance between laryngeal afferent and efferent information. The individual and exaggerated response to diverse specific triggers can lead to symptoms such as chronic cough, laryngeal paresthesia, throat clearing, dysphonia, stridor, globus pharyngeus, vocal cord dysfunction, and/or laryngospasm. There is plentiful literature on laryngeal neuropathy in adults, however, in children, it is limited. Here, we present a case report of laryngeal neuropathy in the pediatric age and discuss the importance of its consideration in the approach of these patients. A case of a 13-year-old patient, recently intervened with cardiac surgery that evolves with severe dysphonia is presented. Nasofibrolaryngoscopy shows apparent bilateral vocal fold immobility with discordant results in laryngeal electromyography. Later, his voice improves but other laryngological symptoms appeared, such as throat clearing, globus pharyngeus and stridor, not explained by anatomical causes. The otolaryngological-speech therapy evaluation and approach for the case is exposed. We conclude that for the diagnosis of laryngeal neuropathy, a high index of clinical suspicion is required in the presence of suggestive laryngological symptoms, and organic and structural causes must be previously ruled out. The otorhinolaryngological-logopedic approach constitutes the mainstay of treatment associated with the use of neuromodulators in selected cases.

Algoritmo para el manejo de la obstrucción laríngea en pediatría / Algorithm for the management of laryngeal obstruction in pediatrics

La laringe se localiza en la encrucijada aerodigestiva; cualquier patología que la comprometa tendrá repercusión en la respiración, la deglución y/o la voz. Se divide en tres regiones: la supraglotis (comprende la epiglotis, las bandas ventriculares y los ventrículos laríngeos), la glotis (espacio limitado por las cuerdas vocales) y la subglotis (zona más estrecha de la vía aérea pediátrica y único punto rodeado en su totalidad por cartílago: el anillo cricoides). La obstrucción laríngea se puede presentar como una condición aguda potencialmente fatal o como un proceso crónico. El síntoma principal es el estridor inspiratorio o bifásico. La etiología varía mucho según la edad y puede ser de origen congénito, inflamatorio, infeccioso, traumático, neoplásico o iatrogénico. Se describen las patologías que ocasionan obstrucción laríngea con más frecuencia o que revisten importancia por su gravedad, sus síntomas orientadores para el diagnóstico presuntivo, los estudios complementarios y el tratamiento.

The larynx is at the aerodigestive crossroads; any pathology that involves it will have an impact on breathing, swallowing and/or the voice. It`s divided into three regions: supraglottis (includes epiglottis, ventricular bands and laryngeal ventricles), glottis (space limited by the vocal cords) and subglottis (narrowest area of pediatric airway and the only point of larynx completely surrounded by cartilage: the cricoid ring). Laryngeal obstruction can present as a potentially fatal acute condition or as a chronic process. The main symptom is inspiratory or biphasic stridor. The etiology varies widely according to age and it may be of congenital, inflammatory, infectious, traumatic, neoplastic or iatrogenic origin. We describe the pathologies that cause laryngeal obstruction, either those that occur very often or those which are important for their severity, their guiding symptoms to the presumptive diagnosis, additional studies and treatment.

Quistes subglóticos adquiridos: Reporte de tres casos y revisión de la literatura / Acquired subglottic cysts: Report of three cases and review of the literature

Los quistes subglóticos adquiridos son una causa rara de estridor en la infancia, cuyo reporte ha ido en aumento en las últimas décadas. Su aparición se relaciona con la prematurez y la intubación en el periodo neonatal. Histológicamente, se observa una obstrucción de las glándulas mucosas de la subglotis debido una metaplasia escamosa del epitelio respiratorio. Esta es una condición que usualmente requiere de un alto índice de sospecha para llegar al diagnóstico, ya que pueden confundirse con otras patologías como laringitis aguda (croup), laringomalacia o asma. La nasofibroscopía permite sospechar su presencia, pero el gold standard diagnóstico lo constituye la laringo-tra-queo-broncoscopía directa en pabellón. Existen diversas técnicas para su manejo, siendo las más frecuentemente utilizadas la marsupialización con instrumental frío y láser. La recurrencia es frecuente, por lo que algunos autores han utilizado mitomicina C y la terapia antirreflujo para intentar disminuirla. Sin embargo, hasta la fecha falta evidencia de calidad que permita llegar a un consenso respecto al manejo ideal de esta patología. En este trabajo, presentamos tres casos clínico de pacientes con antecedentes de prematurez que fueron diagnosticados con quistes subglóticos adquiridos y manejados en un hospital pediátrico de alta complejidad.

Acquired subglottic cysts are an infrequent cause of stridor in infants, which has been increasingly reported in the last decades. Its appearance is related to prematurity and intubation in the neonatal period. Histologically, findings are characterized by an obstruction of the mucosal glands, due to squamous metaplasia of the respiratory epithelium. This condition usually requires a high index of suspicion to be diagnosed, as it can be misdiagnosed as croup, laryngomalacia or asthma. Flexible nasendoscopy allows an initial exploration of the larynx, but direct laryngo-tracheo-bronchoscopy in the operating room is the diagnostic gold standard. There are several techniques for its management, but the most frequently used are cold-steel marsupialization and laser. Recurrence is common, and some authors have used mitomycin C and antireflux therapy to try to decrease it. However, up to date, there is a lack of high-quality evidence, regarding the ideal management of this pathology, which prevents reaching a consensus. In this article, we present three clinical cases of premature patients who were diagnosed with subglottic cysts, treated in a tertiary pediatric hospital.

Enfermedad de Rosai-Dorfman con compromiso laríngeo: a propósito de un caso / Rosai-Dorfman disease with laryngeal involvement: about a case

RESUMEN La enfermedad de Rosai-Dorfman (ERD) o histiocitosis sinusal con linfadenopatía masiva es una enfermedad infrecuente, de etiología desconocida caracterizada por linfadenopatías cervicales masivas bilaterales. El compromiso extraganglionar puede ocurrir en diferentes sitios, incluida la vía aérea, en la cual la localización nasosinusal es la más frecuente, pero puede comprometer también otros sitios de la vía aérea superior. Dentro de éstos, el compromiso laríngeo es muy poco frecuente. Se presenta el caso de una paciente de 82 años con antecedentes de ERD localizada en los ganglios linfáticos cervicales en remisión espontánea, que desarrolló posteriormente una obstrucción subaguda de las vías respiratorias. La tomografía computarizada y la nasofaringolaringoscopía mostraron lesiones subglóticas que obstruían severamente las vías respiratorias. Se realizó una traqueostomía de emergencia y biopsia de las lesiones, confirmando el diagnóstico de ERD extranodal.

ABSTRACT Rosai-Dorfman disease or sinus histiocytosis with massive lymphadenopathy is a rare disease of unknown etiology characterized by bilateral massive cervical lymphadenopathy. Extranodal involvement can occur in different sites including airway where nasosinusal involvement is common but this disease may occur in other sites of the upper airway. Laryngeal involvement is rare. We present the case of an 82-year-old female patient with a history of Rosai-Dorfman disease located in cervical lymph nodes in spontaneous remission that subsequently develops airway obstruction. Computed tomographic scan and nasopharyngolaryngoscopy showed subglottic lessons that severely obstructed the airway. Emergency tracheotomy and biopsy were performed, confirming the diagnosis of extranodal RDD. Patient was observed and tracheostomy was maintained with good tolerance.

Amiloidosis laríngea: a propósito de un caso / Laryngeal amyloidosis: a case report

RESUMEN La amiloidosis es una enfermedad poco frecuente, de etiología desconocida, caracterizada por la presencia de depósitos extracelulares de proteínas fibrilares en diversos órganos y tejidos, teniendo una amplia gama de manifestaciones clínicas según localización y tamaño de los depósitos. En cabeza y cuello, el sitio de presentación más frecuente es la laringe. Suele presentarse con disfonía y/o disnea progresiva, cuyo tratamiento definitivo, sin estar estandarizado, suele ser la resección quirúrgica. Se presenta a continuación el caso de un paciente de 78 años, con historia de disnea en reposo y estridor laríngeo leve de 6 meses de evolución, cuya nasofibroscopía evidenció una masa subglótica, determinando lumen crítico de vía aérea superior. Biopsia reveló amiloidosis, siendo tratado de manera exitosa con exéresis tumoral vía laringoscopía directa.

ABSTRACT Amyloidosis is a rare disease of unknown etiology, characterized by the presence of extracellular acumulations of fibrillar proteins in a variety of organs and tissues, with a wide range of clinical manifestations depending on the location and size of the deposits. In head and neck, the most common site of presentation is the larynx. It usually presents with dysphonia and / or progressive dyspnea, whose definitive treatment, without being standardized, is usually surgical resection. A case of a 78-year-old patient with a history of dyspnea at rest and mild laryngeal stridor of 6 months of evolution is presented, whose nasofibroscopy showed a subglottic mass at the cricoid level, determining a critical upper airway lumen. Biopsy revealed extensive amyloidosis of the upper respiratory tract mucosa, being successfully treated with tumoral excision under direct laryngoscopy.

Voice deviation, dysphonia risk screening and quality of life in individuals with various laryngeal diagnoses

OBJECTIVES: To characterize the voice quality of individuals with dysphonia and to investigate possible correlations between the degree of voice deviation (D) and scores on the Dysphonia Risk Screening Protocol-General (DRSP), the Voice-Related Quality of Life (V-RQOL) measure and the Voice Handicap Index, short version (VHI-10). METHODS: The sample included 200 individuals with dysphonia. Following laryngoscopy, the participants completed the DRSP, the V-RQOL measure, and the VHI-10; subsequently, voice samples were recorded for auditory-perceptual and acoustic analyses. The correlation between the score for each questionnaire and the overall degree of vocal deviation was analyzed, as was the correlation among the scores for the three questionnaires. RESULTS: Most of the participants (62%) were female, and the mean age of the sample was 49 years. The most common laryngeal diagnosis was organic dysphonia (79.5%). The mean D was 59.54, and the predominance of roughness had a mean of 54.74. All the participants exhibited at least one abnormal acoustic aspect. The mean questionnaire scores were DRSP, 44.7; V-RQOL, 57.1; and VHI-10, 16. An inverse correlation was found between the V-RQOL score and D; however, a positive correlation was found between both the VHI-10 and DRSP scores and D. CONCLUSION: A predominance of adult women, organic dysphonia, moderate voice deviation, high dysphonia risk, and low to moderate quality of life impact characterized our sample. There were correlations between the scores of each of the three questionnaires and the degree of voice deviation. It should be noted that the DRSP monitored the degree of dysphonia severity, which reinforces its applicability for patients with different laryngeal diagnoses.

Quistes de cuerda vocal: experiencia en 44 pacientes del Centro de Voz del Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile / Vocal Cord Cysts: experience in 44 patients from the Voice Center of the Department of Otorhinolaryngology Pontificia Universidad Católica de Chile

Introducción: Los quistes de cuerda vocal son una causa relativamente frecuente de disfonía. Su origen es aún controversial, y su diagnóstico y manejo continúan siendo un desafío clínico. Objetivo: Exponer y analizar las características clínicas de los quistes de cuerda vocal en nuestra serie de pacientes. Material y método: Estudio retrospectivo descriptivo de los pacientes con diagnóstico de quiste de cuerda vocal atendidos en nuestro centro entre junio de 2012 y diciembre de 2015. Resultados: Se atendieron 44 pacientes con diagnóstico de quiste de cuerda vocal, lo que representa el 4,32% de las consultas en nuestro Centro de Voz. La mayoría de los pacientes fueron adultos, y de ellos el 68,29% correspondió a mujeres. El 34,1% de los pacientes fueron sometidos a tratamíento quirúrgico con técnica de microfonocirugía. El 75% de los pacientes operados presentó mejoría en patrón de onda mucosa videolaringoestroboscópica. Todos los pacientes en los que se disponía de encuestas de valoración subjetiva de la voz pre y posoperatorias demostraron mejoría vocal significativa. Conclusión: Los quistes de cuerda vocal son lesiones que afectan a niños y adultos. La videolaringoestroboscopía es clave en el diagnóstico de estas lesiones, y el tratamiento quirúrgico con microfonocirugía es efectiva en cuanto a resultados vocales desde el punto de vista anatómico y funcional.

Introduction: Vocal cord cysts are a relatively frequent cause of dysphonia. Their origin is still controversial, and their diagnosis and management continue to be a clinical challenge. Aim: To describe and analyze the clinical characteristics of vocal cord cysts in our series of patients. Material and method: Descriptive retrospective study of patients with diagnosis of vocal cord cyst attended in our center between June 2012 and December 2015. Results: 44 patients had the diagnosis of vocal cord cyst, which represents 4.32% of the patients that attended our Voice Center during that period. Most of the patients were adults, and among them 68.29% corresponded to women. 34.1% of the patients were submitted to surgical treatment with microphonosurgery technique. 75% of the surgical patients presented an improvement in the pattern of the videolaryngostroboscopic mucosal wave. All the patients in which pre and postsurgical subjective voice assessment polls were available, showed a significant voice improvement. Conclusion: Vocal cord cysts are lesions that affect both children and adults. The videolaryngostroboscopy evaluation is key in the diagnosis of these lesions, and the surgical treatment with microphonosurgery is effective in terms of anatomical and functional vocal results.

Pólipo bilateral de cuerda vocal: presentación de un caso clínico / Bilateral vocal cord polyp: case report

Los pólipos de cuerda vocal son lesiones laríngeas benignas. Se asocian a micro-traumatismos por mal uso vocal que generan remodelación de la lámina propia y el epitelio. Es más frecuente en hombres entre los veinte y cuarenta años. En la gran mayoría de los casos se presenta de manera unilateral. Si bien estas lesiones están bien documentadas en la literatura, es raro encontrar presentaciones bilaterales, por lo que su enfrentamiento y manejo puede ser discutible. Se presenta el caso de una paciente de sexo femenino de 41 años, fumadora, que consulta por disfonía de larga data. Se diagnostican pólipos bilaterales de cuerda vocal, realizando una intervención quirúrgica en un tiempo, con un resultado favorable.

Vocal cord polyps are benign Iaryngeal lesions. They are associated to micro traumatisms because ofvocal misuse, generating a remodelation of the lamina propria and the epithelium. It is more common in men between twenty and forty years of age. In the vast majority of cases it unilaterally occurs. While these are well documented injuries in the literature, it is rare to find bilateral presentations, so their confrontation and management may be debatable. We present the case of a female patient, smoker, who consulted for chronic dysphonia. Bilateral vocal cord polyps were diagnosed, performing a bilateral resection with a positive outcome.

Presentación inusual de fracturas laríngeas: reporte de dos casos de fracturas laríngeas no traumáticas / Unusual presentation of laryngeal fractures: report of two cases of non-traumatic laryngeal fractures

Las fracturas laríngeas se producen principalmente en el contexto de traumas cervicales, ahorcamiento o estrangulamiento. Las fracturas laríngeas no traumáticas son excepcionales, existiendo escasos reportes en la literatura. A continuación, presentamos dos casos de fracturas laríngeas no traumáticas evaluadas en nuestro servicio.

Laryngeal fractures occur mainly in the context of cervical trauma, hanging or strangulation. Nontraumatic laryngeal fractures are rare and there are fewreports in the literature. We present two cases of nontraumatic laryngeal fractures evaluated in our service.

Incidence and endoscopic characteristics of acute laryngeal lesions in children undergoing endotracheal intubation / Incidência e características endoscópicas de lesões agudas laríngeas em crianças submetidas à intubação endotraqueal

ABSTRACT INTRODUCTION: Acute laryngeal lesions after intubation appear to be precursors of chronic lesions. OBJECTIVE: To describe the incidence and type of acute laryngeal lesions after extubation in a pediatric intensive care unit (PICU). METHODS: A cohort study involving children from birth to <5 years, submitted to intubation for more than 24 h in the PICU of an university hospital. In the first eight hours after extubation, a flexible fiberoptic laryngoscopy (FFL) was performed at the bedside. Those with moderate to severe abnormalities underwent a second examination seven to ten days later. RESULTS: 177 patients were included, with a median age of 2.46 months. The mean intubation time was 8.19 days. Seventy-three (41.2%) patients had moderate or severe alterations at the FFL, with the remaining showing only minor alterations or normal results. During follow-up, 16 children from the group with moderate to severe lesions developed subglottic stenosis. One patient from the normal FFL group had subglottic stenosis, resulting in an incidence of 9.6% of chronic lesions. CONCLUSION: Most children in the study developed mild acute laryngeal lesions caused by endotracheal intubation, which improved in a few days after extubation.

Resumo Introdução: As lesões laríngeas agudas após a intubação parecem ser precursoras das lesões crônicas. Objetivo: Descrever a incidência e o tipo de lesões laríngeas agudas após extubação em Unidade de Terapia Intensiva Pediátrica (UTIP). Método: Estudo de coorte envolvendo crianças de 0 a 5 anos incompletos, com intubação por mais de 24 horas na UTIP de um hospital universitário. Nas primeiras 8 horas após extubação, uma nasofibrolaringoscopia à beira do leito foi realizada. Aqueles com anormalidades moderadas a graves foram submetidos a novo exame entre 7-10 dias após. Resultados: 177 pacientes foram incluídos, com idade mediana de 2,46 meses. O tempo médio de intubação foi de 8,19 dias. Setenta e três (41,2%) pacientes apresentaram alterações moderadas ou graves à laringoscopia, o restante mostrando apenas alterações leves ou exame normal. Durante o acompanhamento, 16 crianças do grupo lesões moderada a grave desenvolveram estenose subglótica. Um paciente do grupo laringoscopia normal teve estenose subglótica, somando-se uma incidência de 9,6% de lesões crônicas. Conclusão: A maioria das crianças do estudo desenvolveu lesões laríngeas agudas leves decorrentes da intubação endotraqueal, com melhora em alguns dias após a extubação.

Estridores laríngeos supraglóticos / Supraglottic laryngeal stridors / Estridores laríngeos supraglóticos

Toda obstrucción de la vía aérea se expresa por un estridor que será diferente según la localización de la obstrucción. El estridor es un ruido ocasionado por el pasaje de aire en forma turbulenta a través de una vía aérea con calibre disminuido. Cuando la obstrucción se ubica por encima de las cuerdas vocales el estridor será inspiratorio. Describimos diferentes patologías de la laringe supraglótica, congénitas y adquiridas, que presentan estridor en algún momento de su evolución.

An obstructed airway causes stridor. Stridor willbe different depending on the location of the obstruction. Stridor is a noise caused by the passage ofturbulent air through a diminished airway caliber. If the obstruction occurs above the vocal cords, itwill be inspiratory. We describe different pathologies of the supraglotticlarynx, both congenital and acquired, producingstridor at some moment of their evolution.

Uma via aérea obstruída provoca estridor. Estridor será diferente dependendo da localização da obstrução. Estridor é um ruído causado pela passagemdo ar turbulento através de uma diminuição do calibre das vias aéreas. Nós descrevemos diferentes patologias da laringe supraglótica, tanto congênitas e adquiridas, que apresentam stridor em algum momento de sua evolução.

Reconhecimento automático de Distonia Laríngea com base na sustentação do Pitch / Automatic Laryngeal Dystonia recognition based on Pitch sustainment / Reconocimiento automático de distonía laríngea basado en el apoyo de la Pitch

Objetivos: Desenvolver uma ferramenta automatizada para reconhecimento dos segmentos sem presença de voz durante a fonação do paciente com base na sustentação do Pitch. Método: Os procedimentos para construção e verificação da técnica são a aquisição da voz, janelamento, aplicação da Transformada Discreta de Fourier, detecção do Pitch e a verificação do Pitch. Resultados: Com a análise das 101 vozes, a ferramenta diagnosticou 56 vozes com Distonia Laríngea e 45 como saudáveis. Já o especialista diagnosticou 53 vozes com Distonia Laríngea e 48 como vozes saudáveis. Conclusão: Os resultados demonstraram que o diagnóstico realizado pela ferramenta e pelo especialista são equivalentes e, portanto, a proposta de utilizar a sustentação do Pitch como métrica para reconhecimento da patologia mostrou-se eficiente...

Objectives: Develop an automated tool for recognition of segments without the presence of voice during phonation of the patient based on Pitch sustainment. Method: The procedures for construction and verification of the technique are the acquisition of voice, windowing, application of Discrete Fourier Transform, the Pitch detection and verification of Pitch. Results: With the analysis of 101 voices, the tool diagnosed 56 voices with laryngeal dystonia and 45 as healthy. Already the specialist diagnosed 53 voices with laryngeal dystonia and 48 voices as healthy. Conclusion: The results showed that the diagnosis made by the tool and specialist is equivalent and therefore the proposed use of the Pitch sustainment as a measure for the recognition of the pathology was effective...

Objetivos: Desarrollar una herramienta automatizada para el reconocimiento de segmentos sin la presencia de la voz durante la fonación basado en el apoyo de la Pitch. Método: Los procedimientos para la construcción y la verificación de la técnica son la adquisición de la voz, de ventanas, la aplicación de la Transformada Discreta de Fourier, la detección de tono y la verificación de Pitch. Resultados: Con el análisis de 101 voces, la herramienta ha diagnosticado 56 voces con distonía laríngea y 45 lo más saludable. Ya el especialista diagnostica 53 voces con distonía laríngea y 48 voces tan saludables. Conclusión: Los resultados mostraron que el diagnóstico realizado por la herramienta y por el especialista son equivalentes y por lo tanto el uso propuesto de la Pitch apoyo como una métrica para el reconocimiento de la patología fue eficiente...

Diagnóstico clínico e análise histológica de nódulos e pólipos vocais / Clinical diagnosis and histological analysis of vocal nodules and polyps

Estudos atuais enfatizam a importância da correlação clínico-histológica nas afecções laríngeas. OBJETIVO: Comparar o diagnóstico otorrinolaringológico com anatomopatológico de 132 espécimes cirúrgicos, provenientes de 119 pacientes operados de nódulos e pólipos vocais. MÉTODO: Estudo retrospectivo. Foram levantados os blocos de parafina correspondentes às lesões dos pacientes operados. Realizaram-se novos cortes histológicos, totalizando 396 novas lâminas, divididas em três grupos: hematoxilina e eosina, tricômico de Gomori e PAS. Foram analisados os parâmetros histológicos: epitélio, lâmina própria, membrana basal, alterações vasculares. Foram comparados os diagnósticos anatomopatológico e laringológico. Realizou-se análise estatística verificando os aspectos histológicos predominantes em cada lesão. RESULTADOS: Houve concordância entre o diagnóstico clínico e anatomopatológico em 123 (93,18%) lesões das 132 analisadas (42,42% nódulos e 50,76% pólipos). Nos parâmetros histológicos, verificou-se: alterações epiteliais como hiperplasia nos nódulos (82,14%) e atrofia nos pólipos (31,34%). Lâmina própria: edema nos pólipos (71,43%), fibrose nos nódulos (57,14%). Membrana basal: espessada nos nódulos (100%), fina/sem alteração nos pólipos (100%). Houve predomínio das alterações vasculares nos pólipos. CONCLUSÃO: Notou-se elevada correlação entre o diagnóstico otorrinolaringológico e o anatomopatológico. Histopatologicamente, nódulos apresentaram-se com alterações predominantemente epiteliais, fibrose na lâmina própria e espessamento da membrana basal, enquanto os pólipos por alterações estritamente de lâmina própria e aspectos vasculares.

Recent studies emphasize the importance of the clinical-histology correlation in laryngeal pathologies. OBJECTIVE: To compare the ENT diagnosis with the pathology diagnosis one of 132 surgical specimens, from 119 patients with vocal nodules and polyps. METHOD: Retrospective study. We investigated the paraffin blocks corresponding to the lesions of the operated patients. We made new histology cross-sections, totaling 396 new slides, divided into three groups: hematoxylin and eosin, Gomori trichrome and PAS. We analyzed the following histological parameters: epithelium, lamina propria, basement membrane, vascular changes. We compared the laryngological and pathological diagnoses, and we did the statistical analysis, checking the predominant histological aspects in each lesion. RESULTS: There was an agreement between the clinical and pathological diagnoses in 123 (93.18%) of 132 lesions analyzed (42.42% nodules and 50.76% polyps). In the histological parameters we found: epithelial changes such as nodules hyperplasia (82.14%) and polyp atrophy (31.34%). Lamina propria: edema in polyps (71.43%), fibrosis in the nodules (57.14%). Basement membrane: thickened nodules (100%), thin/no change in polyps (100%). There was a predominance of vascular changes in the polyps. CONCLUSION: We found a high correlation between the ENT diagnosis and the pathology report. Histopathologically, the nodules presented with predominantly epithelial changes, lamina propria and basement membrane fibrosis, while the polyps by changes strictly on the lamina propria and vascular aspects.

Alterações laríngeas em pacientes com artrite reumatoide / Laryngeal involvement in rheumatoid arthritis

Aprevalência do envolvimento laríngeo em pacientes com artrite reumatoide (AR) varia de 13% a 75%. As manifestações específicas compreendem a artrite cricoaritenóidea e os nódulos reumatoides em pregas vocais. OBJETIVO: O objetivo da pesquisa é avaliar a prevalência da disfonia e das alterações laríngeas à videolaringoscopia em pacientes com AR e a associação com o grau de atividade da doença. MÉTODO: Trata-se de estudo clínico transversal que avaliou pacientes com AR quanto ao escore de atividade de doença em 28 articulações (DAS-28), sintomas laríngeos, incluindo a aplicação da versão traduzida do Voice Handicap Index, e realizou videolaringoscopia, comparando com um grupo controle. RESULTADOS: Foram avaliados 47 pacientes com artrite reumatoide e 40 controles. As prevalências de disfonia e de alterações videolaringoscópicas foram, respectivamente, de 12,8% e 72,3% em pacientes com AR. A média do DAS-28 foi de 3,3 ± 1,2; 26 (74,3%) dos 35 pacientes com doença ativa apresentaram alterações laríngeas (p = 0,713). A laringite posterior (44,7%) foi o diagnóstico mais comum em pacientes com AR. CONCLUSÃO: A prevalência de alterações laríngeas em pacientes com AR foi 72,4% e a prevalência de disfonia foi 12,8%. Não houve relação significativa entre alterações laríngeas e grau de atividade da doença.

The prevalence of laryngeal involvement in Rheumatoid Arthritis (RA) ranges from 13 to 75%. The specific RA manifestations include the cricoarytenoid arthritis and the presence of rheumatoid nodules in the vocal folds. OBJECTIVE: The objective of this study is to evaluate the prevalence of dysphonia and laryngeal alterations on videolaryngoscopy in RA patients and their association with disease activity. METHOD: This is a clinical cross-sectional study that evaluated patients with rheumatoid arthritis as to their disease activity score in 28 joints (DAS-28), laryngeal symptoms, application of a Portuguese version of the Voice Handicap Index and videolaryngoscopy findings, comparing them with a control group. RESULTS: We evaluated 47 (54%) patients with rheumatoid arthritis and 40 (46%) controls. The prevalence of dysphonia and videolaryngoscopy changes was respectively 12.8% and 72.4% in patients with RA. The mean of DAS-28 was 3.3 ± 1.2; 26 (74.3%) of 35 patients presenting active disease had laryngeal changes (p = 0.713). Posterior laryngitis was the most common diagnosis (44.7%). CONCLUSION: The prevalence of laryngeal disorders in RA patients was 72.4% and the prevalence of dysphonia was 12.8%. There was no significant relationship between laryngeal disorders and disease activity.

Parâmetros vocais perceptivo-auditivos e acústicos em crianças com nódulos vocais / Parameters vocal perceptual and acoustic in the children with vocal nodules

Nódulos vocais são as principais causas de disfonias infantis. As análises vocais perceptivo-auditivas e acústicas têm sido utilizadas para diferenciar as vozes de crianças com nódulos, de vozes normais. Determinar os parâmetros vocais perceptivo-auditivos e acústicos em crianças de quatro a 11 anos com diagnóstico de nódulos vocais. Realizado estudo comparativo que incluiu 100 crianças de quatro a 11 anos, com diagnóstico videolaringoscópico de nódulos vocais (grupo nódulos-GN) e 100 crianças da mesma faixa etária, sem sintomas vocais e com exames de videolaringoscopia normais (grupo controle-GC). Todas foram submetidas às análises vocais perceptivo-auditivas (escala GRBASI), ao cálculo do Tempo Máximo de Fonação e da relação s/z e à análise vocal acústica (programa MDVP). Crianças com nódulos vocais (GN) apresentaram valores menores do TMF, especialmente para os fonemas /z/ e /a/ (p<0,05). O TMF aumentou com a idade em ambos os grupos e a relação /s/z não se deferiu. As avaliações perceptivo auditivas indicaram maior comprometimento nas crianças do grupo nódulos do que do controle, nos parâmetros: G (79 versus 24), R (53 versus 3), B (67 versus 23) e Strain (35 versus 1). As medidas acústicas Jitter, Pich Perturbation Quotient (PPQ), Shimmer, Amplitude Perturbation Quotient (APQ), Noise Harmonic Ratio (NHR) e Soft Phonation Index (SPI) mostraram-se mais elevados no grupo nódulos. O parâmetro f0 não diferiu entre os grupos. Os parâmetros vocais Tempo Máximo de Fonação (TMF), perceptivo-auditivos (GRBS) e acústicos (Jitter, PPQ, Shimmer, APQ, NHR e SPI) mostraram-se mais comprometidos nas crianças com nódulos, sendo importantes métodos de avaliação nas disfonias infantis...

Vocal nodules constitute the major causes of dysphonia during childhood. Auditoryperceptual and acoustic vocal analyses have been used to differentiate voice with nodules from normal voice in children. To study the value of auditory-perceptual and acoustic vocal analyses in assessments of children with nodules. A comparative study was carried out including 100 children aged between 4 and 11 years, with videolaryngoscopic diagnosis of vocal nodules (nodule group), and 100 children within the same age range, without vocal symptoms and with normal videolaryngoscopic exams (control group). All children were subjected to auditory-perceptual vocal analyses (GRBASI scale), calculation of Maximum Phonation Time and s/z ratio, and acoustic vocal analysis (MDVP software). There was no difference in the values of maximum phonation time and s/z ratio between groups. Auditory-perceptual analysis indicated greater compromising of voice parameters for the nodule than for the control group: G (79 versus 24), R (53 versus 3), B (67 versus 23) and S (35 versus 1). The acoustic parameters jitter, PPQ, shimmer, APQ, NHR and SPI showed higher values in the nodule than in the control group. The parameter f0 did not differ between groups...

Sistematización en el proceso de evaluación y terapia del pólipo de cuerda vocal: encuesta a médicos otorrinolaringólogos chilenos / Assessment and therapy process systematization of vocal fold polyps: a survey to Chilean otorhynolaryngologists

Esta investigación tiene por propósito describir las indicaciones terapéuticas, prescritas por médicos otorrinolaringólogos a pacientes diagnosticados con pólipo cordal. Se describen las etapas de evaluación, reposo vocal e indicaciones terapéuticas. El estudio intenta develar la presencia de una sistematización en el proceso anterior. Dicha información es recabada a partir de una encuesta vía mail aplicada a 29 médicos pertenecientes a la Sociedad Chilena de Otorrinolaringología (N=205). Los datos obtenidos permiten concluir que no existe un estándar en las indicaciones que se preguntan en la encuesta. Sin embargo, el total de médicos consultados manifiesta que sería útil la elaboración de protocolos para la evaluación y tratamiento de los pacientes con alteración vocal.

This research is aimed at describing the therapeutic indications, prescribed by otorhynolaryngologists polyp patients diagnosed with tailpiece, including assessment, voice rest and therapeutic indications. The study attempts to reveal the presence of systematization in the previous process. This information is collected from a survey via e-mail applied to 29 physicians belonging to the Chilean Society of Otolaryngology (n =205). The data obtained indicate that there is no standard in the information asked for in the survey. However, the total number of doctors surveyed stated that the development of protocols for assessment and treatment of patients with vocal alteration would be useful.

Comprometimento da árvore respiratória na granulomatose de Wegener / Laryngeal and tracheobronchial involvement in Wegener's granulomatosis

INTRODUÇÃO: A granulomatose de Wegener (GW) é uma forma de vasculite sistêmica que envolve primariamente as vias aéreas superiores e inferiores e os rins. As manifestações mais frequentes nas vias aéreas são estenose subglótica e inflamações, estenoses da traqueia e dos brônquios. A visualização endoscópica das vias aéreas é a melhor ferramenta para avaliação, diagnóstico e manejo dessas alterações. OBJETIVOS: Descrever as alterações endoscópicas encontradas na mucosa das vias aéreas de um grupo de pacientes com GW submetido à broncoscopia no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP) e relatar as intervenções terapêuticas broncoscópicas utilizadas em alguns casos. MÉTODOS: Foram estudados 15 pacientes com diagnóstico de GW provenientes do Ambulatório de Vasculites da Disciplina de Pneumologia do HC-FMUSP, encaminhados para a realização de broncoscopia no serviço de Endoscopia Respiratória do HC-FMUSP no período de 2003 a 2007. RESULTADOS: Dos 15 pacientes avaliados, 11 eram mulheres (73,33 por cento) com idade média de 34 ± 11,5 anos. Foram encontradas alterações das vias aéreas em 80 por cento dos pacientes, e o achado endoscópico mais frequente foi estenose subglótica (n = 6). Realizou-se broncoscopia terapêutica em três pacientes com estenose subglótica e em outros três com estenose brônquica, todos apresentando bons resultados. CONCLUSÃO: A broncoscopia permite diagnóstico, acompanhamento e tratamento das lesões de vias aéreas na GW, constituindo-se um recurso terapêutico pouco invasivo em casos selecionados.

INTRODUCTION: Wegener's granulomatosis (WG) is a form of systemic vasculitis that involves primarily the upper and lower airways and the kidneys. The most frequent airway manifestations include subglottic stenosis and inflammation, and tracheal and bronchial stenoses. The endoscopic visualization of the airways is the best tool for assessing, diagnosing and managing those changes. OBJECTIVES: To describe the endoscopic abnormalities found in the airway mucosa of a group of patients with WG undergoing bronchoscopy at Hospital das Clínicas of the Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), and to report the therapeutic bronchoscopic interventions used in some cases. METHODS: The study assessed 15 patients diagnosed with GW from the Vasculitis Outpatient Clinic of the Department of Pulmonology, HC-FMUSP, referred for bronchoscopy at the Service of Respiratory Endoscopy, HC-FMUSP, from 2003 to 2007. RESULTS: Fifteen patients were studied [11 females (73.33 percent)]; mean age, 34 ± 11.5 years. Airway changes were found in 80 percent of the patients, and the most frequent endoscopic finding was subglottic stenosis (n = 6). Therapeutic bronchoscopy was performed in three patients with subglottic stenosis and in other three patients with bronchial stenosis, all showing good results. CONCLUSION: Bronchoscopy allows for diagnosing, monitoring, and treating the airway lesions in WG, being a minimally invasive therapeutic option in selected cases.