Análise funcional e qualidade de vida relacionada à voz e à deglutição de pacientes tratados por câncer de orofaringe / Functional analysis and quality of life related to voice and swallowing in patients treated for oropharyngeal cancer

RESUMO

Objetivo: Caracterizar a presença e o grau de distúrbios fonoarticulatórios e de deglutição e correlacioná-los com a avaliação da qualidade de vida relacionada à voz e deglutição de pacientes tratados por tumor de orofaringe. Casuística e Metodologia: Foram identificados 200 pacientes tratados por câncer de palato mole e loja amigdaliana no período de janeiro de 1990 a dezembro de 2005. ... Para a coleta de dados foram realizadas as seguintes avaliações 1) avaliação clínica do sistema estomatognático 2) avaliação perceptiva-auditiva das emissões das vogais /a/, /i/ e da fala espontânea e avaliação acústica da voz através da vogal /a/ /e/, 3) avaliação da deglutição através da videofluoroscopia, 4) Avaliação da qualidade de vida relacionada à voz e à deglutição através dos questionários específicos VHI (Voice Handicap Index- Índice de Desvantagem Vocal – JACOBSON at al. 1997), ... Resultados: As principais alterações observadas na avaliação do sistema estomatognático foram de sensibilidade e mobilidade de língua, palato mole, regiões julgais e simetria de face e de língua. ... A avaliação de fala demonstrou presença de ressonância hipernasal, e alteração da articulação, modulação e inteligibilidade de fala, assim como presença de erros articulatórios como golpe de glote no lugar de consoantes orais, fricativa faríngea, redução da pressão oral, distorção de fricativos e escape de ar nasal. ... Conclusão: As alterações de sensibilidade, mobilidade e simetria dos órgãos fonoarticulatórios e as alterações de fala estão relacionadas com as alterações sobre as funções de voz, fala e deglutição e apresenta impacto negativo na qualidade de vida relacionada à voz e à deglutição...

ABSTRACT

Objective: To characterize the presence and degree of phonoarticulatory and swallowing disturbances, and correlate these findings with an assessment of quality of life related to voice and swallowing in patients treated for tumor of the oropharyngeal. Casuistic and Methods: A total of 200 patients treated for cancer of the soft palate and tonsil between January 1990 and December 2005 were identified. Following exclusion for a several of causes, the study was based on analysis of a sample of 20 patients. Clinical, therapeutic and rehabilitation data were obtained from the medical records of the patients at the Medical Archivies Service of Hospital A.C. Camargo. All cases were restaged by a specialist physician in head and neck surgery, according to the Classification of Malignant Tumors ­TNM (UICC 2002). Data collection encompassed the following assessments 1) clinical assessment of the stomatognathic system, 2) perceptive-auditory assessment of the vowels /a/, /i/ and spontaneous speech, as well as voice assessment using the /a/ vowel, 3) assessment of swallowing by videofluoroscopy, 4) assessment of quality of life related to voice and swallowing using specific VHI (Voice Handicap Index ­ Jacobson at al. 1997), QVV (Portuguese version of the V-RQOL, VoiceRelated Quality of Life - Hogikyan and Sethuraman 1999) and SWAL-QOL (Quality of Life in Swallowing Disorders ­ MCHORNEY et al. 2002, Portuguese version Brazil) questionnaires. Perceptive-auditory analysis of the voice was performed by 5 speech therapists, and measures of speech and swallowing parameters by 3 speech therapists. Results: The main changes observed in the assessment of the stomatognathic system were sensitivity and mobility of the tongue, soft palate, cheeks and face and tongue symmetry. Rough, unstable and nasal voice qualities were prevalent in the studied patient population. Alterations in naturalness, acceptability, pleasantness in voice were observed as well as changes in overall evaluation of speech intelligibility and final assessment of communication. With the exception of fundamental frequency, all acoustic parameters were altered. The speech assessment demonstrated the presence of hypernasal resonance, and changes in speech articulation, modulation and intelligibility, along with articulatory errors such as glottal stops instead of oral consonants, pharyngeal fricative, reduction in oral pressure, distortion in fricatives and nasal air escape. The swallowing assessment revealed alterations in oral ejection and stasis, nasal penetration of food, stasis in oropharynx and hypopharynx, with the presence of laryngeal penetration with dysphagia classified at discrete levels. Quality of life in relation to voice presented good scores (VHI and QVV), although for quality of life related to swallowing there was a negative impact for the domains duration of feeding, desire to feed oneself, and food selection. Statistically significant correlations were observed for alterations seen in assessment of the stomatognathic system and alterations in speech with different domains on quality of life related to voice (VHI and QVV) and swallowing (SWAL-QOL) questionnaires. Voice alterations observed in the auditory-perceptive and acoustic analysis, as well as the swallowing alterations, presented no correlation with quality of life questionnaires. Conclusion: Alterations in sensitivity, mobility and symmetry of phonoarticulatory organs are linked to alterations in voice, speech and swallowing functions and present a negative impact on quality of life related to voice and swallowing of oropharyngeal cancer patients.