Effect of Wendler glottoplasty on voice and quality of life of transgender women

Abstract Objective: To investigate the effect of Wendler glottoplasty on voice feminization, voice quality and voice-related quality of life. Methods: Prospective interventional cohort of transgender women submitted to Wendler glottoplasty. Acoustic analysis of the voice included assessment of fundamental frequency, maximum phonation time formant frequencies (F1 and F2), frequency range, jitter and shimmer. Voice quality was blindly assessed through GRBAS scale. Voice-related quality of life was measured using the Trans Woman Voice Questionnaire and the self-perceived femininity of the voice. Results: A total of 7 patients were included. The mean age was 35.4 years, and the mean postoperative follow-up time was 13.7 months. There was a mean increase of 47.9 ± 46.6 Hz (p = 0.023) in sustained/e/F0 and a mean increase of 24.6 ± 27.5 Hz (p = 0.029) in speaking F0 after glottoplasty. There was no statistical significance in the pre- and postoperative comparison of maximum phonation time, formant frequencies, frequency range, jitter, shimmer, and grade, roughness, breathiness, asthenia, and strain scale. Trans Woman Voice Questionnaire decreased following surgery from 98.3 ± 9.2 to 54.1 ± 25.0 (p = 0.007) and mean self-perceived femininity of the voice increased from 2.8 ± 1.8 to 7.7 ± 2.4 (p = 0.008). One patient (14%) presented a postoperative granuloma and there was 1 (14%) premature suture dehiscence. Conclusion: Glottoplasty is safe and effective for feminizing the voice of transgender women. There was an increase in fundamental frequency, without aggravating other acoustic parameters or voice quality. Voice-related quality of life improved after surgery.

Ophthalmological findings in patients suspected with COVID-19 at a tertiary hospital in Pernambuco, Brazil / Achados oftalmológicos em pacientes com suspeita de COVID-19 atendidos na triagem do HC-UFPE

ABSTRACT Purpose: This study evaluated the frequency of the most common ophthalmological, neurological, and systemic findings in symptomatic patients seen at a COVID-19 screening service at Hospital das Clínicas - Universidade Federal de Pernambuco. Methods: A total of 104 patients under clinical suspicion of SARS-CoV-2 infection underwent medical evaluation through an ophthalmological and systemic symptoms survey. All participants selected for the study underwent COVID-19 RT-PCR testing. Results: The mean age was 38.8 years, with 44.23% between 31 and 40 years old, 68.27% female, and 31.73% male. The most common symptoms in patients with a positive RT-PCR test were cough (69.23%), fever (42.3%), hyposmia (38.46%), myalgia (38.46%), and ageusia (30.77%). In the positive group, 34.61% presented with ophthalmological symptoms: burning (19.23%), eye pain (11.54%), foreign body sensation (7.7%), hyperemia (7.7%), and tearing (3.84%). Conclusions: Systemic clinical features were characteristic of upper respiratory infection, but neurological findings of hyposmia and anosmia proved to be important markers for suspicion of SARS-CoV-2 infection. Ophthalmic symptoms in patients with COVID-19 were similar to those observed in other viral conditions and may precede systemic conditions. A high rate of self-medication was observed for general symptoms compared with ophthalmological conditions.

RESUMO Objetivo: Avaliar a frequência dos sintomas oftalmológicos, neurológicos e sistêmicos mais comuns em pacientes sintomáticos atendidos no serviço de triagem de COVID-19 do Hospital das Clínicas da UFPE. Métodos: Cento e quatro pacientes com suspeita clínica de infecção por Sars-Cov-2 foram submetidos a avaliação médica e aplicação de questionário sobre a sintomatologia oftalmológica, neurológica e sistêmica. Todos os participantes do estudo tiveram exame de RT-PCR para COVID-19 solicitado. Resultados: A média de idade foi de 38,8 anos, com 44,23% entre 31 e 40 anos. Mulheres corresponderam a 68,27% dos atendimentos e homens a 31,73%. Os sintomas mais frequentes nos pacientes com RT-PCR positivo foram: tosse (69,23%), febre (42,3%), mialgia (38,46%), hiposmia (38,46%), e ageusia (30,77%). Neste grupo, os sintomas oftalmológicos estiveram presentes em 34,61%, sendo: ardor (19,23%), dor ocular (11,54%), sensação de corpo estranho (7,7%), hiperemia (7,7%) e lacrimejamento (3,84%) os mais encontrados. Conclusões: O quadro clínico sistêmico foi característico de infecção respiratória alta, porém os achados neurológicos de hiposmia e anosmia mostraram-se importantes marcadores para a suspeição dos casos de infecção por COVID-19. Os sintomas oftalmológicos dos pacientes com COVID-19 foram semelhantes aos presentes em outros quadros virais, podendo preceder o quadro sistêmico. Houve uma alta taxa de automedicação para os sintomas gerais quando comparado ao quadro oftalmológico.

Comparison of botulinum toxin and propranolol for essential and dystonic vocal tremors

OBJECTIVES: Vocal tremors, which cause social difficulties for patients, may be classified as resting or action tremors. Of the vocal action tremors, essential and dystonic tremors are the most common. Botulinum toxin and oral medications have been used to treat vocal tremors, but no comparative clinical trials have been performed. The aim of this study was to compare the effects of botulinum toxin injection and the oral administration of propranolol in the treatment of essential and dystonic vocal tremors. METHODS: This clinical trial recruited 15 patients, divided into essential and dystonic vocal tremor groups. Patients in both groups received successive treatment with botulinum toxin and propranolol. The treatments were administered at different times; the order of treatment was randomly selected. Patients were assessed with flexible nasofibrolaryngoscopy and with perceptual and acoustic voice evaluations. A statistical significance level of 0.05 (5%) was used. RESULTS: Botulinum toxin produced statistically significant improvements in perceptual measures of vocal instability in patients with dystonic vocal tremors compared with baseline values and treatment with propranolol. The acoustic measure of variability in the fundamental frequency was significantly lower in patients with dystonic vocal tremors after treatment with botulinum toxin. CONCLUSION: Essential and dystonic vocal tremors responded differently to treatment. Dystonic vocal tremors responded significantly to treatment with botulinum toxin but not oral propranolol. Essential vocal tremors did not respond significantly to either treatment, perhaps due to the small number of patients, which is a limitation of this research.

Laryngoscopy evaluation protocol for the differentiation of essential and dystonic voice tremor / Protocolo de avaliação por laringoscopia para diferenciar tremor vocal essencial e distônico

ABSTRACT INTRODUCTION: Although syndromes that cause voice tremor have singular characteristics, the differential diagnosis of these diseases is a challenge because of the overlap of the existing signs and symptoms. OBJECTIVE: To develop a task-specific protocol to assess voice tremor by means of nasofibrolaryngoscopy and to identify those tasks that can distinguish between essential and dystonic tremor syndromes. METHODS: Cross-sectional study. The transnasal fiberoptic laryngoscopy protocol, which consisted of the assessment of palate, pharynx and larynx tremor during the performance of several vocal and non-vocal tasks with distinct phenomenological characteristics, was applied to 19 patients with voice tremor. Patients were diagnosed with essential or dystonic tremor according to the phenomenological characterization of each group. Once they were classified, the tasks associated with the presence of tremor in each syndrome were identified. RESULTS: The tasks that significantly contributed to the differential diagnosis between essential and dystonic tremor were /s/ production, continuous whistling and reduction of tremor in falsetto. These tasks were phenomenologically different with respect to the presence of tremor in the two syndromes. CONCLUSION: The protocol of specific tasks by means of transnasal fiberoptic laryngoscopy is a viable method to differentiate between essential and dystonic voice tremor syndromes through the following tasks: /s/ production, continuous whistling and reduction of tremor in falsetto.

RESUMO INTRODUÇÃO: Apesar de haver características próprias entre as síndromes causadoras do tremor vocal, o diagnóstico diferencial destas doenças é um desafio pela sobreposição de sinais e sintomas presentes. OBJETIVO: Desenvolver protocolo de tarefas específicas na avaliação do tremor vocal por nasofibrolaringoscopia e identificar aquelas que diferenciem as síndromes de tremor essencial e distônico. MÉTODO: Estudo transversal. O protocolo de nasofibrolaringoscopia, que consistiu na avaliação do tremor em palato, faringe e laringe durante execução de diversas tarefas fonatórias e não-fonatórias com características fenomenológicas distintas, foi aplicado em 19 pacientes com tremor vocal. Os pacientes foram diagnosticados como tremor essencial ou distônico a partir da caracterização fenomenológica de cada grupo. Uma vez classificados, determinou-se quais tarefas estavam associadas à presença de tremor nas diferentes síndromes. RESULTADOS: As tarefas que contribuíram significativamente na distinção do tremor essencial e distônico foram a emissão /s/, assobio contínuo e redução do tremor no agudo, pois apresentaram-se fenomenologicamente diferentes quanto à presença do tremor entre as duas síndromes. CONCLUSÃO: O protocolo de tarefas específicas por nasofibrolaringoscopia é um método viável para diferenciar as síndromes de tremor vocal essencial e distônico por meio das tarefas: emissão /s/, assobio contínuo e redução do tremor no agudo.

Laryngeal Leishmaniasis

Introduction: Leishmaniasis is classified into three clinical presentations: visceral, coetaneous and mucocutaneous. The latter is usually secondary to hematogenous spread after months or years of skin infection and can manifest as infiltrative lesions, ulcerated or vegetating in nose, pharynx, larynx and mouth, associated or not with ganglionics infarction. Laryngeal involvement is part of the differential diagnosis of lesions in this topography as nonspecific chronic laryngitis, granulomatosis and even tumors of the upper aerodigestive tract presenting atypical evolution. Sometimes it is difficult for the correct diagnosis of Leishmaniasis, with description of cases in the literature were conducted improperly. Objective: The objective of this study is to report a case of laryngeal Leishmaniasis addressing the difficulty of diagnosis, complications and treatment applied. Case Report: A patient with pain throat, dysphagia, odynophagia, dysphonia and weight loss, with no improvement with symptomatic medication. At telelaringoscopy, infiltrative lesion showed nodular supraglottis. He underwent a tracheotomy for airway obstruction and biopsy with immunohistochemical study for a definitive diagnosis of laryngeal Leishmaniasis. The patient was referred to the infectious diseases that initiated treatment with N-methylglucamine antimoniate with satisfactory response to therapy. Final Comments: Faced with a clinical suspicion of granulomatous diseases, it is essential to follow protocol laboratory evaluation associated with histological injury, to get a precise definition etiological without prolonging the time of diagnosis. Medical treatment for mucosal Leishmaniasis, recommended by the World Health Organization, was adequate in the case of laryngeal disorders, with complete resolution of symptoms...

Manifestações faringo-laríngeas da síndrome pós-poliomielite / Pharyngolaryngeal manifestations of post-polio syndrome

INTRODUÇÃO: A Síndrome pós-poliomielite (SPP) caracteriza-se por um novo episódio de atrofia ou fraqueza muscular em indivíduos acometidos por poliomielite prévia. Os sintomas iniciam-se após um período prolongado de estabilidade clínica que varia de 20 a 40 anos depois do quadro inicial da poliomielite. Dentre os mecanismos fisiopatológicos, o mais provável é que a síndrome represente um processo de desgaste e exaustão metabólica neuronal devido a um processo contínuo de desnervação-reinervação que se inicia após o quadro agudo inicial. OBJETIVO: Revisar as características clínicas e fisiopatológicas da SPP, assim como apresentar a abordagem em casos com manifestações faringo-laríngeas. RELATO DO CASO: Apresentamos o caso clínico de um paciente masculino com 48 anos de idade, com queixas principais disfonia e disfagia e história prévia de poliomielite. O paciente foi submetido à investigação diagnóstica, na qual encontram-se descritos os achados psicoacústicos da voz, laringoscópicos, eletromiográficos e da videoendoscopia da deglutição compatíveis com SPP. O tratamento consistiu em fonoterapia num total de 11 sessões semanais e orientações gerais para deglutição com melhora satisfatória dos sintomas. COMENTÁRIOS FINAIS: As manifestações faringo-laríngeas da SPP são passíveis de tratamento, obtendo-se resultados satisfatórios com melhora na qualidade de vida dos pacientes.

INTRODUCTION: The post-polio syndrome (PPS) is characterized by a new episod of atrophy or muscle weakness in individuals previously affected by poliomyelitis. The symptoms start from an extended period of clinical stability ranging from 20 to 40 years, after the initial chart of polio. Among the pathophysiological mechanisms, the most likely is that the syndrome represents a process of attrition and neuronal metabolic exhaustion due to a continuous process of denervation reinnervation which begins after the initial acute. OBJECTIVE: Review the clinical characteristics and pathophysiological of PPS,as well as present the approach in cases with pharyngolaryngeal manifestations. CASE REPORT: We present the clinical case of a male patient with 48 years old, with main complaints of dysphonia, dysphagia and previous history of polio. The patient underwent a diagnostic investigation, in which the voice psychoacoustic findings are described. Laringoscopic, electromyographic and the videoendoscopy of swallowing compatible with PPS. The treatment consisted in phonotherapy in a total of 11 weekly sessions and guidelines for swallowing, with satisfactory improvement of the symptoms. FINAL COMMENTS: The pharyngolaryngeal manifestations of PPS are susceptible to treatment, obtaining satisfactory results, with improvement of life quality of the patients.

Sarcoidose laríngea: revisão de literatura / Laryngeal sarcoidosis: literature review

INTRODUÇÃO: A sarcoidose laríngea é uma doença granulomatosa que representa um desafio em relação ao diagnóstico e o tratamento. MÉTODO: Nesta revisão são abordados todos os aspectos da doença, incluindo etiologia, manifestações clínicas em adultos e crianças, diagnóstico e tratamento, a partir da base de dados Medline, Lilacs e Scielo, incluindo-se artigos de língua inglesa e portuguesa publicados no período de 1973 a 2008. COMENTÁRIOS FINAIS: Apesar dos avanços ocorridos na investigação e tratamento da sarcoidose, é uma doença que ainda se mantém sem etiologia e fisiopatologia definidas, constituindo um diagnóstico de exclusão pela ausência de exames específicos e por sua provável origem multifatorial. O acometimento laríngeo, apesar de raro, é suspeitado principalmente diante de história prévia de sarcoidose sistêmica, e a pesquisa dos diagnósticos diferenciais deve ser extensa para não passarem desapercebidas doenças graves como neoplasias malignas.

INTRODUCTION: Laryngeal sarcoidosis is a granulomatous disease representing a challenge as regards diagnosis and treatment. METHOD: In this review, all aspects of the disease are involved, including etiology, clinical manifestations in adults and children, diagnosis, and treatment, by searching through Medline, Lilacs and Scielo databases, as well as English and Portuguese articles published from 1973 to 2008. FINAL COMMENTS: Despite the breakthroughs in its diagnosis and treatment, sarcoidosis is a disease that remains without a clear etiology and physiopathology, becoming an exclusion diagnosis due to both the lack of precise exams and its likely multifactor background. Laryngeal impairment, however infrequent, is a suspicion mainly when there is a precedent history of systemic sarcoidosis, and the research for differentiated diagnosis must be wide-ranging so as to prevent severe diseases like malign neoplasia from being unnoticed.

Comparison of clinical characteristics of patients with adductor laryngeal dystonia in the focal and segmental types / Comparação entre características clínicas de pacientes com distonia laríngea de adução nas formas focal e segmentar

Dystonia is a central motor processing neurological disorder characterized by abnormal, often action-induced, involuntary movements or uncontrolled spasms. AIM: To compare patients with the diagnoses of focal and segmental adductor laryngeal dystonia at the Neurolarynx Outpatient Clinic of the Federal University of São Paulo. MATERIALS AND METHODS: A clinical retrospective study of data collected from patient registries from 2003 to 2009. RESULTS: Of 34 patients, 25 presented focal dystonia and 9 presented segmental dystonia. There were 30 females (88. 2 percent) and 4 males (11. 8 percent). A relation with a traumatic event was reported in 11 cases (32. 4 percent). Vocal tremor was observed in 21 patients (61. 8 percent). The mean age at onset, the age at diagnosis, and time between the onset and the diagnosis were respectively 55, 61. 3 and 6. 3 years. There was no statistical difference between patients with focal laryngeal adductor dystonia and segmental dystonia in the study data. CONCLUSIONS: There were no statistical differences among patients with focal adductor laryngeal dystonia and segmental dystonia relating to age of onset, age of diagnosis, gender, time between onset and diagnosis, presence of associated tremor, and relation to trauma.

A distonia é um transtorno neurológico do processamento motor central caracterizado por movimentos involuntários ou espasmos incontroláveis, induzidos por atividade. OBJETIVO: Comparar pacientes com o diagnóstico de distonia laríngea nas formas focal e distonia segmentar do Ambulatório de Neurolaringe. MATERIAL E MÉTODO: Estudo clínico retrospectivo a partir de levantamento dos prontuários entre 2003 e 2009. RESULTADOS: Dos 34 pacientes, 25 apresentaram distonia focal e 9 apresentaram distonia segmentar. Do total da amostra, 30 (88,2 por cento) eram do sexo feminino e 4 (11,8 por cento) do sexo masculino. A relação com situação traumática estava presente em 11 (32,4 por cento). O tremor associado esteve presente em 21 pacientes (61,8 por cento). A média da idade do início das queixas, idade do diagnóstico e do tempo de queixa até o diagnóstico da amostra foi respectivamente de 55 anos, 61,3 anos e 6,3 anos. Não houve diferença estatisticamente significativa entre pacientes com distonia laríngea focal e distonia laríngea nos dados pesquisados. CONCLUSÃO: Não houve diferenças entre pacientes com distonia laríngea focal e distonia laríngea segmentar quanto à idade de início, idade do diagnóstico, gênero, tempo de duração dos sintomas até o diagnóstico, presença de tremor associado e relação com situação traumática.

Radiotherapy for early glottic cancer and salvage surgery after recurrence / Radioterapia para câncer glótico inicial e resgate cirúrgico após recorrência

Early glottic cancer can be effectively treated with radiation or surgery, but recurrence is a possibility when using any of the treatment modalities. AIM: To assess the outcome of radiotherapy as initial treatment in the control of squamous cell carcinoma of vocal cord (T1) and the effectiveness of salvage surgery (endoscopic or open) after treatment failure. MATERIALS AND METHODS: A retrospective study was based on the analysis of medical records from 43 patients with T1 squamous cell carcinoma of the glottis, radiotherapy as initial treatment and follow-up period of five years. RESULTS: The rate of recurrence after radiotherapy was 30.2 percent of the cases, mean diagnosis interval was 29.5 months. As an option for salvage treatment, patients underwent open partial laryngectomy or endoscopic surgery with control rates of 77.7 percent and 25 percent respectively. CONCLUSION: Our cases showed high rates of recurrence after radiotherapy and open partial laryngectomy was more effective for the salvage surgery.

O câncer glótico inicial pode ser efetivamente tratado com radioterapia ou com cirurgia, contudo a recidiva é uma possibilidade quando utilizada qualquer uma das formas terapêuticas. OBJETIVO: Avaliar o resultado da radioterapia como tratamento inicial no controle do carcinoma epidermoide de prega vocal (T1) e a eficácia do resgate cirúrgico (endoscópico ou externo) após a falha deste tratamento. MATERIAL E MÉTODO: Foi realizado estudo retrospectivo a partir da análise de prontuários de 43 pacientes portadores de carcinoma epidermoide da glote com estadiamento T1, submetidos à radioterapia como tratamento inicial e com seguimento mínimo de cinco anos. RESULTADOS: A taxa de recidiva após radioterapia foi de 30,2 por cento dos casos, com intervalo médio de diagnóstico de 29,5 meses. Como opção para tratamento de resgate, os pacientes foram submetidos à laringectomia parcial externa ou endoscópica com taxa de controle de 77,7 por cento e 25 por cento, respectivamente. CONCLUSÃO: Nossos casos apresentaram altas taxas de recidiva após radioterapia e a laringectomia parcial externa mostrou-se mais eficaz para o resgate cirúrgico.