Reinke Edema: Factors that Interfere with Vocal Recovery after Surgery

Abstract Introduction Dysphonia and lower pitch after surgery of Reinke edema are common. They are caused especially due to chronic smoking but, probably, other factors should be associated. Objectives To evaluate the results of laryngeal microsurgery in patients with Reinke edema, following a standardized postoperative guidance protocol in our service. Methods Retrospective study. Thirty patients (3 males; 27 females) were included, 70% between 41 and 60 years old. The parameters analyzed in the pre- and postoperative (between 4 and 6 months) of patients undergoing laryngeal microsurgery for Reinke edema were: smoking, vocal symptoms, videolaryngostroboscopy, voice therapy, perceptual and acoustic vocal evaluation, histopathological report. Results Smoking was reported by 100% of the patients and maintained in the postoperative period by 80%. Complete improvement of symptoms in the postoperative period was reported by 43% of them, partial improvement by 40%, and maintenance by 17%. There was low adherence to voice therapy in the pre- and postsurgery. Postoperative videolaryngoscopy indicated congestion (19), atrophy and bowed vocal fold (1), subepithelial edema (2), and normal findings (8). The histological findings were subepithelial edema, enlargement of vessels, inflammation, epithelial hyperplasia, and thickening of the basement membrane. The perceptual and acoustic vocal analyzes indicated improvement of the analyzed parameters. Conclusions The maintenance of some vocal symptoms and laryngeal alterations in videolaryngoscopy after microsurgery of Reinke edema is frequent, even in patients who follow the recommendations of vocal rest and control of gastroesophageal reflux. Vocal symptoms are attributed to changes in the laryngeal mucosa caused by chronic smoking, aggravated by the maintenance of addiction in the postoperative period.

Frailty and mortality in long-term care facilities for older people in Brazil: a survival analysis / Fragilidade e mortalidade em instituições de longa permanência para idosos no Brasil: estudo de sobrevivência

OBJECTIVES: To investigate the effect of frailty on 1-year mortality in long term-care facility (LTCF) residents. METHODS: This was a prospective cohort study with survival analysis of 209 participants living in 15 Brazilian LTCFs. Data on chronic diseases, age, sex, medication use, dependence in activities of daily living (ADLs; Katz index), and frailty (FRAIL scale) were collected at baseline, and death after 1 year was the outcome measure. Kaplan-Meier estimate and log-rank test were used to analyze the survival of residents. RESULTS: In the initial assessment, 65.07 of the residents were women, and the median age was 82 (interquartile range, 71­88) years, with 55% being over 80 years old. Overall, 88% had 2 or more diseases, 59.81% were using 5 or more medications, 42.11% were considered frail, 34.92% pre-frail, and 22.97% robust, and 69.94% were dependent in 3 or more ADLs. During the 12-month follow-up, 19.61% of the residents (n=41) died. In the survival analysis for death, there was a statistically significant association with frailty (p=0.03) and dependence in ADLs (p=0.04). CONCLUSIONS: In this population of LTCF residents, frailty and functional dependence were associated with death.

OBJETIVOS: Investigar o efeito da fragilidade na mortalidade em 1 ano em residentes de instituições de longa permanência para idosos (ILPIs). METODOLOGIA: Estudo de coorte prospectivo com análise de sobrevivência de 209 participantes residentes em 15 ILPIs brasileiras. Dados sobre doenças crônicas, idade, sexo, uso de medicamentos, dependência nas atividades da vida diária (AVDs; índice de Katz) e fragilidade (escala FRAIL) foram coletados no início do estudo, e morte após 1 ano foi a medida de desfecho. A estimativa de Kaplan-Meier e o teste de log-rank foram usados para analisar a sobrevida dos residentes.. RESULTADOS: Na avaliação inicial, 65,07% dos residentes eram mulheres e a mediana da idade era de 82 (intervalo interquartil, 71­88) anos, 55% com mais de 80 anos. Em geral, 88% tinham 2 ou mais doenças, 59,81% usavam 5 ou mais medicamentos, 42,11% foram considerados frágeis, 34,92% pré-frágeis e 22,97% robustos e 69,91% eram dependentes em 3 ou mais AVDs. No decorrer do seguimento de 12 meses, 19,61% dos residentes (n =41) evoluíram para óbito. Na análise de sobrevivência para evento morte, houve associação estatisticamente significativa com fragilidade (p=0,03) e dependência para AVDs (p=0,04). CONCLUSÕES: Nesta população de residentes de ILPIs, fragilidade e dependência funcional estiveram associadas ao óbito.