Efeitos de um programa de fonoterapia da voz em grupo de pacientes com disfonia: estudo piloto / Effects of a voice therapy program in a group of patients with dysphonia: a pilot study

RESUMO Objetivo Identificar os efeitos de um programa de fonoterapia da voz em grupo de pacientes com disfonia, por meio de avaliações perceptivo-auditiva e autopercepção vocal. Métodos Estudo-piloto de ensaio clínico não controlado, com amostra de conveniência. O estudo contou com 22 participantes com diagnóstico otorrinolaringológico de disfonia. Dentre eles, 15 mulheres e sete homens, com média de idade de 59,4 ± 12,53. Foram realizadas dez sessões de terapia fonoaudiológica em grupos de cinco a seis pessoas, com abordagens diretas e indiretas, baseadas no Programa Integral de Reabilitação Vocal (PIRV). Os participantes foram avaliados individualmente, antes e após a realização do programa terapêutico. A avaliação incluiu análise de autopercepção com a Escala de Sintomas Vocais (ESV) e perceptivo-auditiva da qualidade vocal com a escala Grade, Roughness, Breathness, Asteny, Strain, (GRBAS), realizadas por fonoaudiólogos especialistas em voz. Resultados Após o programa terapêutico, observou-se diferença significativa na pontuação de grau geral de alteração da ESV (p=0,002) e também nas subescalas Limitação (p=0,002) e Emocional (p=0,006), indicando autopercepção de redução dos sintomas vocais após intervenção. No entanto, destaca-se que não foram encontrados resultados significativos na comparação pré e pós-tratamento com relação à qualidade vocal. Conclusão O programa de fonoterapia da voz teve efeitos estatisticamente significativos em relação aos sintomas vocais autorrelatados, sinalizando um caminho promissor de abordagem eclética para a terapia vocal em grupo.

ABSTRACT Purpose To identify the effects of a phonotherapy program in a group of patients with dysphonia through auditory-perceptual and vocal self-perception assessments. Methods Pilot study: an uncontrolled clinical trial with a convenience sample. Twenty-two patients with an otorhinolaryngological diagnosis of dysphonia participated in the study, including 15 women and 7 men, with a mean age of 59.4 ± 12.53, who underwent 10 speech therapy sessions in groups of 5 to 6 people, with direct and indirect therapy based on the Comprehensive Vocal Rehabilitation Program (CVRP). Patients were individually assessed before and after the therapeutic program, the assessment included auditory-perceptual analysis with the Vocal Symptoms Scale (VSS) and auditory-perceptual analysis of voice quality GRBAS, performed by speech-language pathologists specializing in voice. Results After the therapeutic program, there was a significant difference in the score for the general degree of change in the VSS (p=0.002), and also in the limitation (p=0.002) and emotional (p=0.006) subscales, indicating selfperceived reduction in vocal symptoms after intervention. However, no significant results were found in the pre- and posttreatment comparison regarding vocal quality. Conclusion The study demonstrated that the voice therapy program had statistically significant effects in relation to self-reported vocal symptoms, thus signaling a promising path for an eclectic approach to group vocal therapy.

Transcutaneous Electrical Nerve Stimulation in Dysphonic Patients: A Systematic Review.

OBJECTIVE: This paper aims to systematically review the application methods and clinical outcomes of transcutaneous electrical nerve stimulation (TENS) in the rehabilitation of dysphonic patients. METHODS: The study consists of a systematic review performed in the Medline (via PubMed), Cochrane Library, Scopus and Lilacs databases, using a search strategy related to the research theme. Inclusion criteria involve experimental studies that investigated the effects of TENS on dysphonic patients, published in the last 15 years in Portuguese, English or Spanish. The Physiotherapy Evidence-Based Database was used to evaluate the methodological quality of the articles. RESULTS: In the first search, 100 publications were found, 57 of which were duplicated and 23 did not address TENS as an intervention. According to the exclusion criteria of the remaining 20 studies, eight were selected for this review. The studies showed a pattern regarding the application of TENS. Of the studies analyzed, 87.5% had effective results after the intervention. Regarding pain, studies have found a reduction of this symptom in the neck, shoulders, back, masseter, and larynx. In the perceptual analysis, an improvement was verified in the parameters of tension, breathiness, roughness, instability, and asthenia. In addition, different types of vocal symptoms such as pain, burning, lump in the throat and effort to speak were reduced after TENS. CONCLUSION: Although the studies included in this review indicate that there were changes related to the reduction of vocal symptoms, reduction of pain and improvement of vocal quality after the application of TENS in dysphonic patients, studies with a higher level of evidence and rigorous assessments of methodological quality are necessary so that findings are more robust and replicable in clinical practice.

Motivational Stage Analysis of Patients with Behavioral Dysphonia.

OBJECTIVE: To analyze the applicability of the University of Rhode Island Change Assessment (URICA)-VOICE scale before and after a therapeutic program for functional balance in voice production. PATIENTS AND METHODS: The sample comprised 26 adult participants (18 female) from the -Brazilian Public Healthcare System. The URICA-VOICE scale was applied prior to the intervention and after 10 sessions of a therapeutic program. RESULTS: The motivational stage values were significantly increased after the intervention compared with the first application of the scale. Precontemplation and action were the stages most commonly reported by the participants. Significant differences were found in 6 statements of the URICA-VOICE scale after voice therapy. CONCLUSIONS: The motivational stage of the participants improved after voice therapy. Being motivated is important for adherence to behavioral changes regarding the voice, and this study shows that using the URICA-VOICE scale in clinical practice is essential to measure patient performance in the voice therapy process, as well as to determine the ideal moment of discharge.