Profile of Laryngeal Microsurgeries in Patients Over 60 Years Old

Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.

Laryngeal and vocal alterations after thyroidectomy / Alterações laríngeas e vocais após tireoidectomia

Abstract Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21). Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.

Resumo Introdução: A disfonia é um sintoma comum após a tireoidectomia. Objetivo: Analisar os sintomas vocais, auditivo-perceptivos e acústica vocal, videolaringoscopia, procedimento cirúrgico e achados histopatológicos em pacientes submetidos à tireoidectomia. Método: Estudo prospectivo. Pacientes submetidos à tireoidectomia foram avaliados da seguinte forma: anamnese, laringoscopia e avaliações vocais acústicas. Momentos: pré-operatório, 1ª avaliação pós (15 dias), 2ª avaliação pós (1 mês), 3ª avaliação pós (3 meses) e 4ª avaliação pós-operatória (6 meses). Resultados: Dos 151 pacientes, 130 eram mulheres e 21, homens. Tipos de cirurgia: lobectomia + istmectomia n = 40, tireoidectomia total n = 88, tireoidectomia + dissecção de linfonodo n = 23. Sintomas vocais foram relatados por 42 pacientes na 1ª avaliação pós-operatória (27,8%), reduzidos para 7,2% após 6 meses. Na análise acústica, f0 e APQ estavam diminuídos nas mulheres. As videolaringoscopias mostraram que 144 pacientes (95,3%) tiveram exames normais no momento pré-operatório. Paralisia das cordas vocais foi diagnosticada em 34 pacientes na 1ª avaliação pós-operatória, 32 do nervo laríngeo recorrente (lobectomia + istmectomia - n = 6; tireoidectomia total - n = 17; tireoidectomia total + dissecção de linfonodos - n = 9) e 2 do nervo laríngeo superior (lobectomia + istmectomia - n = 1; tireoidectomia total + dissecção de linfonodos - n = 1). Após 6 meses, 10 pacientes persistiram com paralisia do nervo laríngeo recorrente (6,6%). Histopatologia e correlação com paralisia das cordas vocais: bócio coloide nodular (n = 76; paralisia n = 13), tireoidite (n = 8; paralisia n = 0) e carcinoma (n = 67; paralisia n = 21). Conclusão: Os sintomas vocais, relatados por 27,8% dos pacientes na 1ª avaliação pós-operatória, diminuíram para 7% em 6 meses. Na análise acústica, f0 e APQ diminuíram. A paralisia transitória de cordas vocais secundária à lesão do nervo laríngeo recorrente e nervo laríngeo superior ocorreu, respectivamente, em 21% e 1,3% dos pacientes, reduziu-se para 6,6% e 0% após 6 meses.

Proposed computerized protocol for epidemiological study of patients undergoing microsurgery of the larynx

Introduction: The merging of medicine with information technology facilitates the retrieval of stored data, aiding the conduct of research with greater scientific rigor. Studies in the field of otorhinolaryngology, specifically in the area of laryngology and voice, are of fundamental importance, since 70% of the economically active need their voice to work. Objective: To create a computerized protocol of the diseases of the larynx, apply and validate it, and use it to evaluate patients undergoing laryngoscopic microsurgery of the larynx. Method: We created a database of ENT diseases through a literature review of textbooks and scientific articles. Next, we computerized the data and incorporated it into the SINPE©, creating a master protocol (ENT diseases) and a specific protocol (laryngeal diseases). Data were collected prospectively from patients undergoing laryngeal microsurgery in the ENT Hospital of Paraná. The collected data were analyzed with graphs through the SINPE© Analyzer module. Results: We evaluated 245 patients aged 9-79 years, and determined that 36.61% (93 patients) underwent surgery for the presence of polyps on the vocal folds, 12.6% (32) underwent surgery for papillomatosis, and 11.83% (29) underwent surgery for intracordal cysts. Conclusions: The creation of an electronic database of clinical ENT diseases was feasible. We were also able to implement and validate the protocol. The database may be released to physicians involved in clinical data collection and retrieval of information to conduct scientific research in an organized manner. The most common laryngeal disorders identified were polyps, papilloma, and intracordal cysts...

Comorbidities in severe asthma: frequency of rhinitis, nasal polyposis, gastroesophageal reflux disease, vocal cord dysfunction and bronchiectasis

OBJECTIVES: Severe asthma is found in approximately 10 percent of patients with asthma. Some factors associated with worse asthma control include rhinitis, gastroesophageal reflux disease, vocal cord dysfunction (VCD), nasal polyposis and bronchiectasis. Therefore, we evaluated the prevalence of these illnesses in patients with severe asthma. METHODS: We conducted a retrospective analysis of data obtained from electronic medical records of patients with severe asthma between January 2006 and June 2008. Symptoms of rhinitis and gastroesophageal reflux disease were evaluated as well as intolerance to nonsteroidal anti-inflammatory drugs. We evaluated the results of esophagogastroduodenoscopy, videolaryngoscopy and CT scans of the chest in order to confirm gastroesophageal reflux disease, nasal polyposis, vocal cord dysfunction and bronchiectasis. RESULTS: We evaluated 245 patients. Rhinitis symptoms were present in 224 patients (91.4 percent); 18 (7.3 percent) had intolerance to nonsteroidal anti-inflammatory drugs, and 8 (3.3 percent) had nasal polyposis. Symptoms of gastroesophageal reflux disease were reported for 173 (70.6 percent) patients, although the diagnosis of gastroesophageal reflux disease was confirmed based on esophagogastroduodenoscopy or laryngoscopy findings in just 58 (33.6 percent) patients. Vocal cord dysfunction was suspected in 16 (6.5 percent) and confirmed through laryngoscopy in 4 (1.6 percent). The patient records provided CT scans of the chest for 105 patients, and 26 (24.8 percent) showed bronchiectasis. DISCUSSION: Rhinitis and gastroesophageal reflux disease were the most common comorbidities observed, in addition to bronchiectasis. Therefore, in patients with severe asthma, associated diseases should be investigated as the cause of respiratory symptoms and uncontrolled asthma.

Reflujo faringolaríngeo: revisión bibliográfica: [revisión] / Pharyngolaryngeal reflux: a literature review: [revision]

El reflujo faringolaríngeo (RFL) es un síndrome que se asocia a una constelación de síntomas. Entre ellos los más frecuentemente descritos son la disfonía, la fatiga vocal, el globus faríngeo, la tos crónica y la carraspera. Se realizó una búsqueda exhaustiva en bases de datos internacionales y nacionales en relación a RFL. Se utilizaron palabras clave como globus, carraspera, laringitis, disfonía y reflujo gastroesofágico. Se obtuvieron alrededor de 35 referencias en relación al tema estudiado, siendo la mayoría publicadas con posterioridad al año 2000. En relación a su etiología, se cree que el flujo retrógrado de contenido gástrico hacia la faringe sería el hecho más importante para su génesis, pero recientemente se ha demostrado que si bien este hecho patológico es fundamental en la producción de los síntomas, existen factores adicionales, capaces de perpetuarlo, permitiendo considerar al RFL como una entidad diferente del reflujo gastroesofágico (RGE).

Pharyngolaryngeal reflux (RFL) is a syndrome associated to a variety of symptoms. Among them, the most frequently described are dysphonia, vocal fatigue, pharyngeal globus, chronic coughing and throat clearing. An exhaustive search of international and national databases was performed. Globus, throat clearing, laryngitis and gastroesophageal reflux were used as keywords. Some 35 search-related references were retrieved, of which most were published from 2000 to date. Respect to the etiology of pharyngolaryngeal reflux, the current view is that gastric contain reflux to the pharynx is the most important factor, but recently it has been demonstrated that, although this pathological trait is pivotal for symptoms appearance, there are additional factors that could perpetuate the symptoms in time, which contribute to consider RFL as a different entity from gastroesophageal reflux (RGE).

Sensibilidade e especificidade da análise perceptivo-auditiva da voz na triagem de distúrbios laríngeos / Auditory voice-perception analysis sensitivity and specificity in the screening of laryngeal disorders

Apesar da crescente experiência adquirida com as campanhas nacionais da voz na triagem de indivíduos com alterações laríngeas, ainda não estabelecemos qual o melhor método de avaliação: triagem fonoaudiológica exclusiva, exame laringoscópico exclusivo ou trabalho conjunto médico/fonoaudiólogo para triagem. OBJETIVO: O objetivo do atual estudo foi avaliar a sensibilidade, especificidade, valor preditivo positivo e negativo da análise perceptivo auditiva da voz em comparação com videolaringoscopia como método de triagem de indivíduos com alterações laringofaríngeas. MATERIAL E MÉTODO: Foram comparados os aspectos vocais (escala GRBASI, pitch, loudness, CPF e ressonância) e videolaringoscópicos de 567 indivíduos que participaram da Campanha da Voz 2005 em um hospital universitário terciário. RESULTADOS: A alteração laríngea mais freqüente foi o refluxo laringofaríngeo (RLF) (43,5 por cento), seguida de lesões benignas (17 por cento) e suspeitas de malignas (1 por cento). A sensibilidade da avaliação perceptivo-auditiva da voz foi 91 por cento para os pacientes com lesões benignas e 100 por cento nas suspeitas de maligna, porém apenas 76 por cento no RLF. Dos exames considerados normais 52 por cento foram flagrados como tendo alterações vocais. O valor preditivo positivo foi de 71 por cento e o negativo foi de 61 por cento. CONCLUSÕES: Apesar de importante, a análise perceptivo-auditiva não deve ser usada como único instrumento de triagem em campanhas de saúde vocal.

Despite the growing experience obtained from the National Pro-Voice Campaigns in screening individuals with laryngeal alterations, we still have not established which would be the best assessment method: speech and hearing screening alone, laryngoscopy alone, or a joint work with physicians and speech therapists doing the screening together. AIM: the goal of the present study was to assess the sensitivity, specificity, positive and negative predictive values of the auditory voice-perception analysis compared to videolaryngoscopy as a screening method for individuals with laryngo-pharyngeal disorders. MATERIALS AND METHODS: We compared the vocal aspects (GRBASI scale, pitch, loudness, CPF and resonance) and videolaryngoscopic from 567 individuals who participated in the National Pro-Voice Campaign 2005 in a tertiary university hospital. RESULTS: the most frequent laryngeal alteration was laryngo-pharyngeal reflux (LFR) (43.5 percent), followed by benign lesions (17 percent) and suspected malignant lesions (1 percent). The sensitivity of the auditory voice-perception assessment was of 91 percent for patients with benign lesions and 100 percent in those with suspected malignant lesions; however, it was only 76 percent in LFR. Of those tests considered normal, there were vocal alterations in 52 percent. The positive predictive value was of 71 percent and the negative was 61 percent. CONCLUSIONS: Despite its importance, the auditory voice-perception assessment should not be used as a single screening instrument in voice health campaigns.

Prevalencia de enfermedades del oído, nariz y garganta en Chile: defunciones y egresos en 1985 / Prevalence in otorhinolaryngologic diseases in Chile: dealth and exit in 1985

Se trata de un estudio de prevalencia de las enfermedades del oído, nariz y garganta en el universo de las defunciones y egresos hospitalarios ocurridos en Chile durante 1985. Las defunciones por estas causas alcanzaron a 464, siendo la primera causa los cuerpos extraños faríngeo y laríngeo quienes presentaron 203 muertos con una tasa de 1.7 por 100.000 y 44%del total de defunciones por el grupo de causas en estudio. El 59%de ellas ocurrieron en menores de 15 años. La segunda causa de muerte es el tumor maligno de la laringe con 121 defunciones y una tasa de 1.0 por 100.000 y 26%del total. La tercera causa es la otitis media supurativa y no especificada con 23 defunciones, una tasa de 0,2 por 100.000 y 5%del total. Las causas que ocupan los cinco lugares siguientes son los tumores malignos, todos de predominio masculino. Con respecto a los egresos hospitalarios corresponden a 34.492, 65%de los cuales ocurren en menores de 15 años. La primera causa de egreso es la enfermedad crónica de las amigdalas con 13.030 hospitalizaciones, 85%de las cuales son en menores de 15 años. La segunda causa es la otitis media supurativa y no especificada con 3.571 egresos, 40%en menores de 15 años. Es interesante conocer los escenarios determinados por las defunciones y los egresos ya que es posible prevenir un número importante de ellos mediante programas educativos aplicados a nivel de la atención primaria, mejorando los hábitos de la población