Estado de los profesionales de la voz en Colombia / State of the professional voice in Colombia

Objetivos: Evaluar las características patológicas más frecuentes en los profesionales de la voz colombianos. Mostrar los factores de riesgo en esta población, individualizándolos según cada profesión. Diseño: Estudio observacional descriptivo, de corte transversal. Métodos: Revisión de historias clínicas y estroboscopias realizadas entre los años 2006 y 2010. Encuestas personales, para preguntar sobre las características de la población evaluada. Se hallaron medidas de tendencia central para las variables cuantitativas y porcentajes para las cualitativas. Resultados: 825 pacientes, 39% hombres y 60,1% mujeres, dentro de los cuales el 22,4% eran profesores; 9% tuvieron entrenamiento vocal; 80,4% presentaron disfonía como síntoma principal. El hallazgo estroboscópico más frecuente fue tensión muscular supraglótica. El 72% no conocen el término “profesional de la voz”, el 78% trabajan con su voz entre un 70-100%, y los pacientes esperan alrededor de seis meses para ser valorados por laringología. Conclusión: Los profesionales de la voz en Colombia tienen una alta prevalencia de trastornos de la voz, similares a los reportados en la literatura mundial, que se correlacionan con la ausencia de entrenamiento vocal y atención tardía...

Objectives: Evaluation of a specific professional voice user’s population in Colombia. Determine the professions more often related to voice issues, their most frequent clinical and stroboscopic findings, preference in gender, lack of voice training, knowledge on voice care and the proficiency in medical attention in the context of a 3rd world country. We propose the potentially related risk factors in each job. Design: Descriptive observational study. Cross sectional. Methods: Data was extracted from the principal author’s patient database. Interviews and stroboscopies made between January 2006 and December 2010. Medical attention perspectives and knowledge on voice care was obtained form a survey conducted in 100 professional voice users included in the study. Results: 1334 patients were included. 825 of them were professional voice users, 39% males and 60.1% females. Teachers represented 22.4% of the population. 9% of the patients had professional voice training. 80.4 % presented with dysphonia as their principal symptom. The most frequent stroboscopic finding was augmented suppraglotic activity. Surveys shows 72% of the patients were not familiarized with the term “professional voice user”. 78% of the patients use their voice 70-100% of their work time. Most patients waited over 6 months to have consultation with a laryngologist. Conclusions: There is a higher prevalence of voice disorders among voice professional users in Colombia with numbers similar to those reported worldwide. There is a correlation with the lack of voice training, delayed health care, lack of knowledge on voice training and voice hygiene and voice disorders...

Patología benigna de laringe en docentes y cantantes / Benign diseases of larynx in teachers and singers

La disfonía es uno de los motivos de consulta más frecuente en docentes y cantantes, quienes presentan un índice alto de patología de voz. Son muy pocos los estudios en nuestro medio acercade la patología laríngea en la población descrita a pesar de conocerse su alta probabilidad de lesiones laríngeas. Objetivo: Describir las características estroboscópicas y factores de riesgoasociados en pacientes con abuso de voz (cantantes y docentes) que consultaron entre agosto de 2006 y noviembre de 2009 por disfonía crónica y se encontraron con lesiones benignas de laringe. Materiales y métodos: Se realizó un estudio de corte transversal, de tipo retrospectivo. Resultados:365 pacientes fueron incluidos en el estudio, 302 docentes y 63 cantantes. Se describen la distribución de género, la frecuencia fundamental, los hallazgos glóticos la periodicidad, la simetría, ondamucosa y factores de riesgo asociados. Conclusión: La frecuencia de presentación de patología laríngea en pacientes con abuso vocal, en nuestro medio es muy alta. Encontramos cambios asociados a RGE y los nódulos vocales como principales diagnósticos en este grupo de pacientes. De igualmanera es mayor la presencia de patología laríngea en personas con varios años de desarrollo de laprofesión. Factores como exposición a polvo de tiza, cigarrillo, estrés, falta de educación vocal, periodos prolongados de sobreesfuerzo vocal, llevan a un aumento en la presentación de este tipo de patología.

The dysphonia is one of the most common reasons for consultation on teachers and singers, who have a high index of voice pathology. There are very few studies in our country about laryngeal pathology in this population in spite of knowing their high probability of laryngeal lesions. Objective: Todescribe the stroboscopic features and associated risk factors in patients with voice abuse (singers and teachers) who consulted between August 2006 and November 2009 for chronic dysphonia and being found with benign lesions of the larynx. Materials and methods: We conducted a cross-sectional,retrospective study. Results: 365 patients were included in the study, 302 teachers and 63 singers. We describe the gender distribution, the fundamental frequency, the glottis findings, periodicity, symmetry, mucosal wave and associated risk factors. Conclusion: The frequency of laryngeal pathology insingers and teachers in our area is very high. We found changes associated with GERD and vocal nodules as primary diagnosis in this patient group. Similarly, we found that there is a greater presence of laryngeal pathology in people with several years of development of the profession. Factors such as chalk dust exposure, smoking, stress, lack of vocal education, prolonged periods of vocal overuse, leadto an increase in the presence of this type of pathology.

Cuidados vocais: questão de prevenção e saúde / Vocal care: question of prevention and health

Idealizada por médicos brasileiros, a Semana Nacional da Voz conquistou o mundo devido ao enorme sucesso alcançado. Este estudo tem por objetivo demonstrar resultados obtidos durante a 9ª Semana Nacional da Voz, realizada no Hospital das Clínicas da Universidade Federal de Goiás (UFG). Durante o evento, 125 pacientes foram triados pela equipe de fonoaudiologia, preencheram manualmente um questionário elaborado para a campanha, na vigência de possíveis alterações laringofaríngeas. Os pacientes foram examinados pelo otorrinolaringologista por meio da laringoscopia indireta e, quando necessário, submetidos à videolaringoscopia. Após avaliação médica, observou-se que 52 pessoas (41,6 por cento) apresentaram alterações no aparelho fonador ou em regiões proximais, em um paciente foi detectada paralisia de prega vocal esquerda e em outra lesão tumoral. Do total de pacientes atendidos, apenas um apresentou neoplasia maligna (carcinoma escamoso), confirmada posteriormente por meio de biopsia.

Planned by Brazilian doctors, the National Week of the Voice (Semana Nacional da Voz) conquered the world due to the huge reached success. This study has the objective to demonstrate the results reached during the 9th National Week of the Voice (9ª Semana Nacional da Voz) that took place in the Hospital das Clínicas of the Federal University of Goiás. During the event, 125 patients had been selected by the phonoaudiology team and manually filled a questionnaire elaborated for the campaign in the validity of possible pharyngolaryngeal alterations. The patients had been examined by the otorhinolaryngologist using indirect laryngoscopy and, when necessary, submitted to videolaryngoscopy. After medical evaluation, it was observed that 52 people (41,6 percent) had presented alterations in the speech organs or in proximal regions, in one patient paralysis of left vocal fold was detected and one patient presented tumoral injury. Considering all the patients attended, only one presented malignant neoplasm (squamous cell carcinoma), confirmed later by biopsy.

Ações em saúde vocal: proposta de melhoria do perfil vocal de professores / Actions in vocal health: a proposal for improving the vocal profile of teachers

TEMA: vários autores têm apontado a urgência de se intensificar pesquisas e ações voltadas ao professor, na escola, de caráter preventivo e de promoção de saúde vocal, que se volta para a melhoria das condições de trabalho e do ambiente no qual ocorre a docência. Assim sendo, o objetivo deste estudo foi: analisar as queixas, os sintomas laríngeos, hábitos relacionados ao desempenho vocal e o tipo de voz de professores de uma escola da rede pública de ensino antes e após a participação em grupos de vivência de voz. MÉTODO: o estudo foi dividido em etapas com professores de uma escola pública: 1ª Etapa: entrevista, avaliação laringológica e perceptivo-auditiva da qual participaram 42 professores; 2ª Etapa: grupos de vivência de voz e 3ª Etapa: reavaliação perceptivo-auditiva - das quais participaram 13 professores. RESULTADOS: 73 por cento dos sujeitos apresentaram queixas vocais; 57,14 por cento apresentaram rouquidão de grau leve e moderado, 78,57 por cento apresentaram soprosidade e 52,38 por cento apresentaram tensão na voz. Ao exame laringológico, 75,86 por cento apresentaram fendas glóticas e 34,48 por cento espessamento mucoso. Após a vivência de voz houve diferença significativa no grau de tensão, tanto na análise da vogal /e/ como na análise da fala espontânea (p = 0,0277 para p > 0,05 para ambas). Houve melhora dos cuidados com a voz e a compreensão dos fatores intervenientes e determinantes das alterações vocais, presentes nas condições e organização do trabalho docente. CONCLUSÃO: ações educativas processuais, como os grupos de vivência de voz, se caracterizam como importantes espaços de reflexão e de mudança das relações entre trabalho e saúde do professor.

BACKGROUND: several authors have pointed to the urgent need of researches and actions involving teachers, in the school environment, that have a preventive and vocal health promotion character with the purpose of improving work conditions. AIM: to analyze the vocal complaints, laryngeal symptoms, vocal habits and vocal profile of teachers of a public school before and after their participation in voice workshops. METHOD: the study was divided in different steps: 1st step - closed interview, larynx and perceptive-auditory assessment in which 42 teachers were evaluated; 2nd step - voice workshops; 3rd step - perceptive-auditory reassessment in which 13 teachers were evaluated. RESULTS: 73 percent of the subjects presented vocal complaints; 57.14 percent presented mild to moderate hoarseness, 78.57 percent presented breathiness and 52.38 percent vocal tension. Evaluation of the larynx indicated that 75.86 percent of the subjects presented glottal gaps and 34.48 percent mucous thickening. After the voice workshops a significant difference was observed in the level of vocal tension, both in the analysis of the /e/ vowel and in the analysis of Spontaneous Speech (p = 0.0277 for p > 0.05 for both). Improvement was observed in vocal care and in the understanding of intervening and determinant factors for vocal alterations, which are present in the teaching environment. CONCLUSION: health actions, such as voice workshops, are important to trigger changes in the work environment as well as in the health of teachers.

Traqueostomía abierta vs traqueostomía percutánea / Open vs percutaneous tracheostomy

Introducción: La traqueostomía está indicada para prevenir el daño laríngeo producido por intubaciones prolongadas, mejorar la higiene traqueal, disminuir el espacio muerto y minimizar la estadía en Unidades de Pacientes Críticos (UPC). La técnica más utilizada es la abierta, que permite un adecuado control de la anatomía y de la hemostasia. Actualmente, en las UPC es cada vez más habitual, la realización de la técnica percutánea. Varios trabajos indican que es una técnica rápida y con menos complicaciones, pero aún existe controversia. Objetivo: Comparar a través de un estudio prospectivo, ambas técnicas en cuanto a duración del procedimiento y complicaciones peri y postoperatorias. Material y método: De un total de 91 pacientes, se seleccionaron 50 que no tenían contraindicación para realizar técnica percutánea. En esos 50 pacientes se realizó en forma aleatoria, técnica abierta y técnica percutánea obteniendo 2 grupos de 25 pacientes (Grupos AyP). Todos los pacientes fueron intervenidos en pabellón y bajo anestesia general. Resultados: La duración total del procedimiento incluida la anestesia fue de 65,8 min y de 59,2 min y la duración de la cirugía fue de 40,4 min y 32,2 min, respectivamente. Las complicaciones perioperatorias fueron: grupo A 16 por ciento (desaturación y sangrado lo más frecuente) y Grupo P: 40 por ciento (desaturación y pérdida de vía aérea lo más frecuente) y las posoperatorias de 8 por ciento y 12 por ciento (sangrado e infección lo más frecuente en ambos grupos) en los grupos AyP, respectivamente. Conclusión: Al comparar ambas técnicas, no hubo en nuestras manos diferencias estadísticamente significativas en cuanto al número de complicaciones ni en cuanto a la duración del procedimiento.

Introduction: Tracheostomy is indicated to prevent laryngeal injury in cases of long-term translaryngeal intubation, to improve tracheal hygiene, decrease the dead space and reduce the time spent in intensive care units (ICU). The open technique is the most commonly used technique, which allows for an adequate control of anatomy and haemostasis. Currently, the percutaneous technique is increasingly used in CPUs, since it is a fast technique, with less perioperative complications. However, there is still controversy on this issue. Aim: This paper is a prospective study, designed to compare both techniques in terms of procedure duration and peri- and postoperative complications. Material and method: Out of a total of 91 patients, 50 were selected that did not have any counterindications for the percutaneous technique. These 50 patients were randomly assigned to either the open or the percutanous technique groups, obtaining 2 groups of 25 patients (Groups A andP). All patients had the surgery performed in the operating room, undergeneral anesthesia. Results: Total duration of the procedure (including anesthesia) was 65.8 and 59.2 min, and surgery duration was 40.4 and 32.2 min, respectively. Perioperative complications were: Group A, 16 percent (oxygen desaturation and bleeding were the more frequent problems), and Group P, 40 percent (oxygen desaturation and airway loss were the more frequent problems). Postoperative complications In Groups A and P were 8 and 12 percent (bleeding and infection being the more frequent problems in both groups), respectively. Conclusion: In our study, a comparison of both techniques did not show significant differences regarding either number of complications or duration of the procedure.