Voice disorders in residual paracoccidioidomycosis in upper airways and digestive tract.

BACKGROUND: Paracoccidioidomycosis (PCM) is a systemic mycosis of acute and chronic evolution, caused by species belonging to the genus Paracoccidioides. It is considered the most prevalent systemic endemic mycosis in Latin America, with cases in the tropical and subtropical regions. Residual PCM refers to the fibrotic scar sequelae resulting from the disease treatment which, when associated with collagen accumulation, leads to functional and anatomic alterations in the organs. AIMS: The aim of this study was to evaluate the vocal function of patients with residual PCM in upper airways and digestive tract. METHODS: We performed a cross-sectional study in 2010 in a cohort of 21 patients with residual PCM in upper airways and digestive tract. RESULTS: The average age was 49.48±9.1 years, and only two (9.5%) patients were female. The study was performed in the 1-113 month-period (median 27) after the end of drug treatment. Five (23.8%) patients had alterations in the larynx as a sequela of the disease. However, all patients had vocal changes in vocal auditory perceptual analysis by GRBASI scale. The computerized acoustic analysis using the software Vox Metria, showed that 11 patients (52.4%) presented alterations in jitter, 15 (71.4%) in shimmer, 8 (38.1%) in F0, 4 (19%) in glottal to noise excitation (GNE), 7 (33.3%) in the presence of noise and 12 (57.1%) in the presence of vibratory irregularity. CONCLUSIONS: The great frequency of alterations in residual PCM suggests that the patients in such phase could benefit from a multidisciplinary treatment, offering them integral monitoring of the disease, including speech rehabilitation after the PCM is healed.

Factors Associated with Clinical and Topographical Features of Laryngeal Tuberculosis.

INTRODUCTION: Laryngeal tuberculosis (LTB) is the most frequent granulomatous disease of the larynx and represents less than 2% of extrapulmonary TB cases. There are no pathognomonic clinical and endoscopic features of this disease and studies on LTB that can assist in its diagnostic characterization are lacking. OBJECTIVE: To identify factors associated with clinical and topographical features of LTB. METHOD: a retrospective cross-sectional study was conducted from the medical records of 36 patients with confirmed LTB diagnosis. RESULTS: Dysphonia and cough were the main symptoms presented by patients and the true vocal folds the most frequently affected site. The average of the duration of the disease evolution was significantly higher in patients with dysphonia than in patients without this symptom. We observed association between dysphonia and true vocal fold lesions and between odynophagia and lesions in the epiglottis, arytenoids and aryepiglottic folds. Odynophagia was more frequent in individuals with lesions in four or more laryngeal sites. Weight loss equal or above 10% of the body weight was more frequent in patients with odynophagia as first symptom and in patients with ulcerated lesion. Dyspnea on exertion was more frequent in individuals with more extensive laryngeal lesions. The percentage of smokers with lesions in four or more laryngeal sites was greater than that found in non-smokers. Laryngeal tissue fragment bacilloscopy and culture examinations were less positive than sputum ones. CONCLUSIONS: Smoking appears to be associated with the development of more extensive LTB lesions, and LTB with dyspnea on exertion and odynophagia with consequent impairment of nutritional status. We emphasize the need for histopathologic confirmation, once positive sputum bacteriological examinations seem not to necessarily reflect laryngeal involvement.

Evaluation of voice disorders in patients with active laryngeal tuberculosis.

INTRODUCTION: Laryngeal tuberculosis (LTB) is the most frequent larynx granulomatous disease. In general there is lung involvement, but in an important proportion of cases you can find LTB without pulmonary disease. The lesions observed in LTB, such as ulceration and fibrosis, can interfere in the process of voice production. The involvement of the mucous lining of the vocal folds can change their flexibility and, consequently, change voice quality, and the main symptom is dysphonia present in almost 90% of cases. OBJECTIVE: To describe the anatomical characteristics and voice quality in LTB patients. MATERIAL AND METHOD: A descriptive cross-sectional study was conducted with 24 patients. RESULT: The most frequently affected sites were vocal folds in 87.5% patients, vestibular folds in 66.7%, epiglottis in 41.7%, arytenoid in 50%, aryepiglottic folds in 33.3%, and interarytenoid region in 33.3% patients. We found 95.8% cases of dysphonia. The voice acoustic analysis showed 58.3% cases of Jitter alterations, 83.3% of Shimmer and 70.8% of GNE. CONCLUSION: Voice disorders found in active laryngeal tuberculosis are similar to those reported after clinical healing of the disease, suggesting that sequelae and vocal adjustments may install during the active phase of the disease, negatively impacting the process of vocal quality reestablishment.

Voice disorders in mucosal leishmaniasis.

INTRODUCTION: Leishmaniasis is considered as one of the six most important infectious diseases because of its high detection coefficient and ability to produce deformities. In most cases, mucosal leishmaniasis (ML) occurs as a consequence of cutaneous leishmaniasis. If left untreated, mucosal lesions can leave sequelae, interfering in the swallowing, breathing, voice and speech processes and requiring rehabilitation. OBJECTIVE: To describe the anatomical characteristics and voice quality of ML patients. MATERIALS AND METHODS: A descriptive transversal study was conducted in a cohort of ML patients treated at the Laboratory for Leishmaniasis Surveillance of the Evandro Chagas National Institute of Infectious Diseases-Fiocruz, between 2010 and 2013. The patients were submitted to otorhinolaryngologic clinical examination by endoscopy of the upper airways and digestive tract and to speech-language assessment through directed anamnesis, auditory perception, phonation times and vocal acoustic analysis. The variables of interest were epidemiologic (sex and age) and clinic (lesion location, associated symptoms and voice quality. RESULTS: 26 patients under ML treatment and monitored by speech therapists were studied. 21 (81%) were male and five (19%) female, with ages ranging from 15 to 78 years (54.5+15.0 years). The lesions were distributed in the following structures 88.5% nasal, 38.5% oral, 34.6% pharyngeal and 19.2% laryngeal, with some patients presenting lesions in more than one anatomic site. The main complaint was nasal obstruction (73.1%), followed by dysphonia (38.5%), odynophagia (30.8%) and dysphagia (26.9%). 23 patients (84.6%) presented voice quality perturbations. Dysphonia was significantly associated to lesions in the larynx, pharynx and oral cavity. CONCLUSION: We observed that vocal quality perturbations are frequent in patients with mucosal leishmaniasis, even without laryngeal lesions; they are probably associated to disorders of some resonance structures (larynx, pharynx and nasal and oral cavities) or even to compensation mechanisms caused by the presence of lesions in the upper airways and digestive tract.

Intervenção fonoaudiológica precoce nos distúrbios vocais em pacientes com tuberculose laríngea / Early intervention speech therapy in in voice disorders in patients with laryngeal tuberculosis

INTRODUÇÃO: Embora possa ser tratada clinicamente com sucesso, a tuberculose laríngea (TBL) pode causar mudanças irreversíveis na qualidade da voz. Raros estudos relatam intervenções fonoaudiológicas para tratar a disfonia na TBL. OBJETIVO: Avaliar a qualidade vocal dos pacientes com TBL em atividade e os efeitos da intervenção fonoaudiológica precoce na reabilitação das funções vocais alteradas nesses indivíduos. MÉTODO: Esta dissertação é composta por dois artigos desenvolvidos com dados de pacientes com TBL atendidos no Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, no período de 2010 a 2013. No primeiro foram relatadas as alterações anatômicas e vocais de três pacientes com TBL ativa antes de iniciar o tratamento. No segundo artigo foi realizado um estudo longitudinal para avaliar o impacto da terapia fonoaudiológica na recuperação das alterações vocais diagnosticadas ao início do tratamento da TBL em 11 pacientes. As avaliações fonoaudiológicas iniciais e finais foram comparadas através dos testes de McNemar, T de Student, sinal de Wilcoxon, Friedman e do Chi quadrado, considerando-se significativos os valores de p<0,05. RESULTADOS: No primeiro artigo, entre os indivíduos avaliados, observou-se que os principais sítios afetados foram as pregas vocais, pregas ariepiglóticas, aritenóides e epiglote e os principais sintomas foram disfonia, disfagia e odinofagia. No segundo artigo, foram avaliados 11 pacientes com uma média de idade 56,55 anos (±18,31), 2 eram do sexo feminino e 9 do sexo masculino, 4 pacientes eram tabagistas e 7 etilistas. A TBL e tuberculose pulmonar estavam associadas em 9 indivíduos. Nestes, encontrou-se inicialmente 100 por cento de disfonia, 54,5 por cento de disfagia e 45,5 por cento de odinofagia...

INTRODUCTION: Although it can be treated medically with success, laryngeal tuberculosis (LT) can cause irreversible changes in voice quality. Few studies report speech therapy interventions to treat dysphonia in LT. OBJECTIVE: To evaluate the vocal quality of patients with LT in activity and the effects of early languageintervention in the rehabilitation of vocal functions altered in these individuals. METHOD: This dissertation consists of two papers developed with data from patients with TBL that were treated at Clinical Research Institute Evandro Chagas, Oswaldo Cruz Foundation, in the period 2010-2013. In the first anatomical changes andvocals from three patients with active LT were reported before starting treatment. In the second article, a longitudinal study was conducted to evaluate the impact of speech therapy in the recovery of vocal disorders diagnosed at initiation of treatmentof LT in 11 patients. The initial and final speech evaluations were compared using the McNemar test , Student t, Wilcoxon sign , Friedman and Chi square and p values < 5 percent were considered significant. RESULTS: In the first article the main sites affected were the vocal folds, aryepiglottic folds, arytenoids and epiglottis and the main symptoms were dysphonia, dysphagia and odynophagia. In the second article we evaluated 11 patients with a mean age of 56.55 years (± 18.31), 2 females and 9 males, 4 patients were smokers and drinkers 7. The LT were associated with pulmonary tuberculosis and 9. These patients initially find 100 percent of dysphonia, dysphagia 54.5 percent and 45.5 percent of odynophagia. The most affected sites were the larynx: vocal folds in 81.8 percent, 63.6 percent in vestibular folds, epiglottis in 36.4 percent, 27.3 percent arytenoids, aryepiglottic folds in 36.4 percent, and interarytenoid space 9.1 percent...