Hoarseness seems to be the primary type of voice disorder occurring in school-aged children. Voice experts have suggested measurement of maximum phonation times as a clinical tool for assessing vocal function (Fairbanks, 1940; Westlake and Rutherford, 1961; Irwin, 1965; Boone, 1971). Most of the studies on duration of phonation have used adults as subjects; few investigations have involved children. An apparent need, therefore, existed to investigate duration of phonation in young children.

A common problem following general anesthesia is postoperative sore throat (POST) and postoperative hoarseness (PH). Symptoms directly correlated with less satisfaction according to the patients. The overall aim of this thesis was to describe patients' postoperative sore throat and hoarseness after general anesthesia with endotracheal intubation or laryngeal mask airway. As well as to investigate the risk factors that are associated with the symptoms, and to test methods that may prevent sore throat and hoarseness after a general anaesthetics. A total of 889 patients are included in the four studies. Incidence of POST varied from 21% up to 52 % depending on endotracheal tube (ETT) size in women (I-IV) and in men was the incidence 32-38% (III-IV). There were no gender difference in POST in study III and IV. The overall incidence of PH varied from 42- 59% (I-IV) in all patients, with no gender differences (III-IV). Following a laryngeal mask airway (LMA) 19% of the patients had POST and 33% of the patients reported PH. Patients with POST do seem to be able to localize their pain in the throat (IV). Different risk factors are shown to contribute to both POST and PH in men and women (II-III). To intubate with a smaller ETT size, 6.0 vs. 7.0 decreased POST in women in the early postoperative period as well as their discomfort from their POST (I). Only 6% of men who needed a laryngeal mask airway had POST compared to 26% of women. The symptoms are more discomforting after an ETT vs. an LMA up to 24 hours (IV). More patients have sore throat and hoarseness in the early postoperative period, but the symptoms can remain up to almost 5 days postoperatively (I, IV). In summary, sore throat and hoarseness following general anesthesia, affects many patients postoperatively. To intubate women with endotracheal size 6.0 decreases both sore throat and hoarseness postoperatively. Women are more likely than men to have a sore throat when a laryngeal mask airway is used.

Orientador: Regina Helena Garcia Martins / Banca: Emanuel Celice Castilho / Banca: Glaucia Maria Ferreira da Silva Mazeto / Banca: Christiano de Giacomo Carneiro / Banca: Marcio Abrahão / Resumo: Introdução: Disfonia no pós-operatório de tireoidectomia é frequente, principalmente nos primeiros dias, devido à proximidade da glândula com as estruturas da laringe. Dentre as causas destacam-se a paralisia de pregas vocais por lesões dos nervos laríngeos. Objetivo: analisar, em pacientes submetidos à tireoidectomia, a presença de sintomas vocais, as características vocais perceptivo-auditivas e acústicas e os achados videolaringoscópicos, correlacionando-os ao tipo de procedimento cirúrgico e ao laudo histopatológico. Casuística e Métodos: 151 pacientes submetidos à tireoidectomia em nosso serviço entre 2012 e 2015 e que aceitaram participar do estudo foram submetidos às avaliações: anamnese, videolaringoscopia, e avaliações vocais perceptivo-auditivas e acústicas. Momentos estudados: pré-operatório, 1º pós (até 15 dias), 2º Pós (1mês), 3º Pós (3 meses) e 4º pós (6 meses), este último foi reservado aos pacientes que mantinham alterações videolaringoscópicas até o 3º Pós. Resultados: Dentre os 151 pacientes (130 mulheres; 21 homens), os sintomas vocais tiveram o seguinte curso: Pré (n-4; 2.6%), 1º Pós (42; 27.8%), 2º Pós (23; 15.2%); 3º Pós (15; 10%), 4º pós (11; 7.2%). Na escala GRBASI os parâmetros comprometidos foram G, R e I. O Tempo Máximo de Fonação não se alterou entre os momentos, apenas entre os gêneros. Houve diminuição de f0 e APQ no pós-operatório nas análises acústicas. As videolaringoscopias registraram 34 paralisias (32 do nervo laríngeo recorrente e dois do ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

A obesidade é uma endemia, com prevalência estimada, entre os anos de 1989 e 1994, de quase 40% na população norte-americana e 20% na população brasileira, que traz diversos problemas de saúde no seu contexto biopsicossocial. Dentre essas comorbidades discute-se a característica da voz destes indivíduos. O objetivo deste estudo foi caracterizar os parâmetros vocais dos indivíduos portadores de obesidade mórbida, comparado-os aos de indivíduos não obesos, através da análise acústica e perceptivo-auditiva no sentido de caracterizar seu padrão vocal. Método: Foram selecionados 45 indivíduos adultos voluntários do Ambulatório de Obesidade da Disciplina de Cirurgia do Aparelho Digestivo, de ambos os sexos com IMC acima de 35 Kg/m2. Para cada indivíduo do grupo em estudo, foi selecionado também um individuo adulto voluntário, pareado por sexo, idade e tabagismo, porém com IMC abaixo de 30 Kg/m2. Todos os indivíduos foram submetidos a exame laringológico e à gravação da voz no Setor de Fonoaudiologia do Ambulatório de Otorrinolaringologia. Foi realizada análise estatística onde os valores de p menores que 0,05 foram considerados estatisticamente significantes. Os resultados mostraram que os indivíduos portadores de obesidade mórbida apresentaram mais frequentemente: sinais laríngeos sugestivos de lesão por RGE; 4 vezes mais rouquidão, 3 vezes mais instabilidade, 5 vezes mais soprosidade; 5 vezes mais estrangulamento aos finais das emissões; Jitter, Shimmer e Ruído alterados e Tempos Máximos Fonatórios inferiores em relação aos indivíduos do grupo controle. Concluiu-se que o indivíduo portador de obesidade mórbida tem sua voz caracterizada como: rouca, soprosa e com instabilidade fonatória, com Jitter e Shimmer alterados, TMF diminuídos e com presença de estrangulamento da voz ao final das emissões. / Obesity is an endemic illness whose estimated prevalence, from 1989 to 1994, was 40% amongst North American people and 20% amongst Brazilian people. It is a disease that causes several health problems on a biopsychosocial basis. Amongst these consequences of obesity, the voice characteristics of affected people is a target of discussion and analysis. The purpose of this study was to set the voice patterns of people affected by morbid obesity, by making a comparison to the voice patterns of people who are not fat. The comparison was made through the acoustic and auditory-perceptive analysis in order to establish the voice patterns. Method: We have selected 45 adults who are volunteers coming from the Center for Obesity Specialized in the Digestive System Surgery. The selected people were men and women whose Body Mass Index (BMI) is higher than 35 kg/ m2. For each person selected, there is another one, also adult, same sex, age and smoking habit, but with a BMI under than 30 kg/ m2. All the volunteers made laryngology test and their voice was recorded in the Phonoaudiology Department, from the Center of Otorhinolaryngology. We prepared the statistics, disregarding the values under 0.05, considered statistically insignificant. The results showed that the patients affected by morbid obesity presented more frequently: signs on their larynx that indicate gastroesophageal reflux (GER); 4 (four) times more hoarseness, 3 (three) times more instability, 5 (five) times more vocal fatigue and breathing; 5 (five) times more voice cracking. Besides these disabilities, people affected by morbid obesity presented changes in Jitter, Shimmer and Noise, as well as low Maximum Phonation Time (MPT). We conclude that people affected by morbid obesity present roughness, breathness with phonatory instability, changes in Jitter and Shimmer, low MPT and cracking voice

Submitted by Renata Mizusaki Iyomasa null (remizusaki@yahoo.com.br) on 2016-10-26T23:46:40Z No. of bitstreams: 1 Tese Renata Corrigida com Ficha Catalográfica 2016-10-26.pdf: 1915036 bytes, checksum: 7accff32e9ecea70b6c8941ebfba6eb8 (MD5) / Approved for entry into archive by Juliano Benedito Ferreira (julianoferreira@reitoria.unesp.br) on 2016-11-01T15:39:57Z (GMT) No. of bitstreams: 1 iyomasa_rm_me_bot.pdf: 1915036 bytes, checksum: 7accff32e9ecea70b6c8941ebfba6eb8 (MD5) / Made available in DSpace on 2016-11-01T15:39:57Z (GMT). No. of bitstreams: 1 iyomasa_rm_me_bot.pdf: 1915036 bytes, checksum: 7accff32e9ecea70b6c8941ebfba6eb8 (MD5) Previous issue date: 2016-09-30 / Introdução: Disfonia no pós-operatório de tireoidectomia é frequente, principalmente nos primeiros dias, devido à proximidade da glândula com as estruturas da laringe. Dentre as causas destacam-se a paralisia de pregas vocais por lesões dos nervos laríngeos. Objetivo: analisar, em pacientes submetidos à tireoidectomia, a presença de sintomas vocais, as características vocais perceptivo-auditivas e acústicas e os achados videolaringoscópicos, correlacionando-os ao tipo de procedimento cirúrgico e ao laudo histopatológico. Casuística e Métodos: 151 pacientes submetidos à tireoidectomia em nosso serviço entre 2012 e 2015 e que aceitaram participar do estudo foram submetidos às avaliações: anamnese, videolaringoscopia, e avaliações vocais perceptivo-auditivas e acústicas. Momentos estudados: pré-operatório, 1º pós (até 15 dias), 2º Pós (1mês), 3º Pós (3 meses) e 4º pós (6 meses), este último foi reservado aos pacientes que mantinham alterações videolaringoscópicas até o 3º Pós. Resultados: Dentre os 151 pacientes (130 mulheres; 21 homens), os sintomas vocais tiveram o seguinte curso: Pré (n-4; 2.6%), 1º Pós (42; 27.8%), 2º Pós (23; 15.2%); 3º Pós (15; 10%), 4º pós (11; 7.2%). Na escala GRBASI os parâmetros comprometidos foram G, R e I. O Tempo Máximo de Fonação não se alterou entre os momentos, apenas entre os gêneros. Houve diminuição de f0 e APQ no pós-operatório nas análises acústicas. As videolaringoscopias registraram 34 paralisias (32 do nervo laríngeo recorrente e dois do nervo laríngeo superior). Após seis meses, apenas 10 pacientes mantinham a paralisia do nervo laríngeo recorrente (6.6%). Laudos histopatológicos: bócio coloide (76), tireoidite (8) e carcinoma (67). Cirurgias: loboistmectomia (40), tireoidectomia total (88), tireoidectomia total + esvaziamento cervical (23). Conclusão: Sintomas vocais foram reportados por 27.8% dos pacientes no 1º pós-operatório de tireoidectomia, reduzindo para 7% em seis meses. Na escala GRBASI, os parâmetros G, R e I estavam alterados bem como f0 e APQ nas análises acústicas. Paralisia temporária de pregas vocais por comprometimento do nervo laríngeo recorrente ocorreu em 21% dos pacientes, mantendo-se após seis meses em apenas 6.6% dos casos. Paralisia temporária por comprometimento do nervo laríngeo superior ocorreu em 1.3%, havendo recuperação completa de todos os casos em seis meses. / Introduction: Post thyroidectomy dysphonia is frequent, especially in the early postoperative days, due to the proximity of the gland with the laryngeal structures. Vocal cord paralysis consequent to injuries to the laryngeal nerves is among the most important causes. Objectives: To analyze, in patients who undergo thyroidectomy, the presence of vocal symptoms, auditory-perceptual, and acoustic vocal characteristics, as well as videolaryngoscopy findings, relating them to the type of surgical procedure and histopathological findings. Patients and Methods: 151 patients submitted to thyroidectomy in our university hospital between 2012 and 2015 and who agreed to participate in the study were evaluated as follows: anamnesis, laryngoscopy, auditory-perceptual and acoustic vocal assessments. Moments studied: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months), the latter reserved for patients who remained with videolaryngoscopy alterations at the 3rd postoperative evaluation. Results: Among the 151 patients (130 women; 21 men), vocal symptoms presented as follows: Pre (n-4; 2.6%), 1st post (42; 27.8%), 2nd post (23; 15.2%); 3rd post (15; 10%) 4th post (11; 7.2%). On the GRBASI scale the abnormal parameters were G, R and I. Maximum Phonation Time did not change between times, only between genders. In the acoustic analysis, f0 and APQ decrease in women. Videolaryngoscopies showed 34 paralyses (32 of the recurrent laryngeal nerve and 2 of the superior laryngeal). After six months, only 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology reports: colloid nodular goiter (76), thyroiditis (8), and carcinoma (67). Surgeries: lobectomy with isthmusectomy (40), total thyroidectomy (88), total thyroidectomy + neck dissection (23). Conclusion: Vocal symptoms were reported by 27.8% of our patients in the 1st postoperative evaluation after thyroidectomy, reducing to 7% in six months.In the GRBSI scale, the parameters G, R, I as well as f0 and APQ in the acoustic analysis were abnormal.Temporary paralysis of the vocal folds secondary to recurrent laryngeal nerve injury occurred in 21% of the patients, persisting after six months in only 6.6% of cases. Temporary paralysis consequent to superior laryngeal nerve injury occurred in 1.3%, with complete recovery in all cases within six months.

Submitted by CAROLINE FERNANDES RIMOLI null (carol@rimoli.med.br) on 2017-01-11T20:16:02Z No. of bitstreams: 1 Caroline Fernandes Rimoli_Dissertacao_Mestrado_FMB_UNESP_versao final após defesa frente e verso.pdf: 1745845 bytes, checksum: d465e22347663cedd8ff9ad19e5b940b (MD5) / Approved for entry into archive by LUIZA DE MENEZES ROMANETTO (luizamenezes@reitoria.unesp.br) on 2017-01-12T18:06:07Z (GMT) No. of bitstreams: 1 rimoli_cf_me_bot.pdf: 1745845 bytes, checksum: d465e22347663cedd8ff9ad19e5b940b (MD5) / Made available in DSpace on 2017-01-12T18:06:07Z (GMT). No. of bitstreams: 1 rimoli_cf_me_bot.pdf: 1745845 bytes, checksum: d465e22347663cedd8ff9ad19e5b940b (MD5) Previous issue date: 2016-11-17 / Introdução: os granulomas laríngeos são lesões benignas, não neoplásicas, uni ou bilaterais, de etiologia variável, que ocorrem no terço posterior das pregas vocais ou na região aritenoídea. Os sintomas são diversos, sendo o mais comum a rouquidão. Os granulomas decorrentes de intubação são altamente recidivantes e não existe consenso quanto ao melhor tratamento. Objetivo: comparar a efetividade dos tratamentos dos granulomas laríngeos decorrentes de intubação endotraqueal. Métodos: foram realizadas revisão sistemática e metanálise proporcional de estudos sobre o tratamento de granulomas laríngeos decorrentes de intubação endotraqueal, seja ele primário ou recidivante. Os critérios de elegibilidade foram: ensaios clínicos randomizados e estudos prospectivos controlados, e na ausência destes, aceitos também estudos retrospectivos e prospectivos não controlados com no mínimo cinco participantes. Os desfechos estudados foram resolução, recidiva e tempo para resolução do granuloma. Os estudos foram identificados na base de dados Pubmed, Embase, Lilacs e Cochrane. Para a análise dos dados e metanálise, utilizou-se o programa StatsDirect 3.0.121. Resultados: dentre os 578 artigos encontrados, 61 foram lidos na íntegra e seis selecionados para a revisão, totalizando 85 pacientes, com idade variando de 21 a 86 anos. Os tratamentos encontrados foram: antirrefluxo, fonoterapia, anti-inflamatórios, corticoterapia, antibioticoterapia, sulfato de zinco e cirurgia. Para o tratamento primário, foram estudados 85 pacientes, de seis estudos, divididos em dois grupos: cirúrgico ± associações (41 pacientes), com chance de resolução de 75% (IC 95%: 0,3% a 100%, I2= 90%), e risco absoluto de recidiva de 25% (IC 95%: 0,2% a 71%), e clínico (44 pacientes), com chance de resolução de 86% (IC 95%: 67% a 97%), e risco absoluto de recidiva de 14% (IC 95%: 3% a 33%). Na interpretação da metanálise, não houve diferença estatisticamente significativa entre os grupos, já que houve sobreposição dos intervalos de confiança. Três estudos, englobando 19 pacientes, estudaram o tratamento secundário (quando houve insucesso ou recidiva após o tratamento primário), sendo que três indivíduos apresentaram nova recidiva. O tempo de tratamento necessário para a resolução das lesões variou muito, desde imediato, como após as cirurgias, como até 23 meses, no caso do corticosteroide inalatório (budesonida). O sulfato de zinco levou um tempo de quatro a 12 semanas. O tratamento antirrefluxo não teve um tempo bem especificado em todos os estudos. Conclusão: não identificamos diferença estatisticamente significativa entre as modalidades de tratamento para os granulomas de intubação. Certamente, esse resultado foi influenciado pela falta de estudos mais abrangentes e criteriosos, principalmente ensaios clínicos, e também pelo número reduzido de pacientes em cada estudo. O tratamento que apresentou menor tempo médio para resolução do granuloma foi o cirúrgico, e o maior, corticosteroide (budesonida) inalatório. / Introduction: laryngeal granulomas are benign, non-neoplastic lesions that can occur unilaterally or bilaterally for various causes. They are usually located in the posterior third of the vocal folds or in the arytenoid region. Patients may present a number of symptoms, the main one being hoarseness. Post-intubation granulomas are highly recurrent and there is no consensus on the best treatment. Objective: to compare the effectiveness of treatments of laryngeal granulomas secondary to endotracheal intubation. Methods: systematic review and proportion meta-analysis of studies that address the treatment of laryngeal granulomas caused by endotracheal intubation. The eligibility criteria were: randomized controlled trials and controlled prospective studies, and in the absence of these, retrospective and prospective uncontrolled studies were also accepted, with at least five participants. The outcomes that were measured were resolution, recurrence and time to resolve the granuloma. Databases searched were Pubmed, Embase, Lilacs and Cochrane. Statistical analysis was performed with the StatsDirect version 3.0.121 software. Results: among the 578 articles found, 61 were eligible for full reading and 11 articles were included, involving 85 patients, with ages varying from 21 to 86 years). The treatments were: anti-reflux, speech therapy, anti-inflammatory drugs, corticosteroids, antibiotics, zinc sulfate and surgery. For the primary treatment, 85 patients were investigated in six studies, divided into two groups: surgical ± associations (41 patients), with chance of resolution of 75% (95% CI: 0,3% to 100%, I2= 90%), and absolute risk of recurrence of 25% (95% CI: 0,2% to 71%) and clinical (44 patients), with chance of resolution of 86% (95% CI: 67% to 97%), and absolute risk of recurrence of 14% (95% CI: 3 to 33%). In the interpretation of the meta-analysis, there was no statistical significance between the groups, since there was an overlap of confidence intervals. Three studies involving 19 patients analyzed secondary treatment (when there was failure or recidive after primary treatment). Three patients had a new recurrence. The treatment time required for the resolution of the lesions varied greatly, from immediate, as after surgery, as up to 23 months, in the case of inhaled corticosteroid (budesonide). The zinc sulfate took a time of four to 12 weeks. The antireflux treatment did not have a well-specified time in all studies. Conclusion: we have not identified a statistical significance between the treatment modalities for intubation granulomas. Certainly, this result was influenced by the lack of more comprehensive and solid studies, particularly clinical trials, and also by the small number of patients in each study. The treatment that had the lowest mean time to resolve the granuloma was surgery, and the highest was inhaled corticosteroid (budesonide).

A obesidade é uma endemia, com prevalência estimada, entre os anos de 1989 e 1994, de quase 40% na população norte-americana e 20% na população brasileira, que traz diversos problemas de saúde no seu contexto biopsicossocial. Dentre essas comorbidades discute-se a característica da voz destes indivíduos. O objetivo deste estudo foi caracterizar os parâmetros vocais dos indivíduos portadores de obesidade mórbida, comparado-os aos de indivíduos não obesos, através da análise acústica e perceptivo-auditiva no sentido de caracterizar seu padrão vocal. Método: Foram selecionados 45 indivíduos adultos voluntários do Ambulatório de Obesidade da Disciplina de Cirurgia do Aparelho Digestivo, de ambos os sexos com IMC acima de 35 Kg/m2. Para cada indivíduo do grupo em estudo, foi selecionado também um individuo adulto voluntário, pareado por sexo, idade e tabagismo, porém com IMC abaixo de 30 Kg/m2. Todos os indivíduos foram submetidos a exame laringológico e à gravação da voz no Setor de Fonoaudiologia do Ambulatório de Otorrinolaringologia. Foi realizada análise estatística onde os valores de p menores que 0,05 foram considerados estatisticamente significantes. Os resultados mostraram que os indivíduos portadores de obesidade mórbida apresentaram mais frequentemente: sinais laríngeos sugestivos de lesão por RGE; 4 vezes mais rouquidão, 3 vezes mais instabilidade, 5 vezes mais soprosidade; 5 vezes mais estrangulamento aos finais das emissões; Jitter, Shimmer e Ruído alterados e Tempos Máximos Fonatórios inferiores em relação aos indivíduos do grupo controle. Concluiu-se que o indivíduo portador de obesidade mórbida tem sua voz caracterizada como: rouca, soprosa e com instabilidade fonatória, com Jitter e Shimmer alterados, TMF diminuídos e com presença de estrangulamento da voz ao final das emissões. / Obesity is an endemic illness whose estimated prevalence, from 1989 to 1994, was 40% amongst North American people and 20% amongst Brazilian people. It is a disease that causes several health problems on a biopsychosocial basis. Amongst these consequences of obesity, the voice characteristics of affected people is a target of discussion and analysis. The purpose of this study was to set the voice patterns of people affected by morbid obesity, by making a comparison to the voice patterns of people who are not fat. The comparison was made through the acoustic and auditory-perceptive analysis in order to establish the voice patterns. Method: We have selected 45 adults who are volunteers coming from the Center for Obesity Specialized in the Digestive System Surgery. The selected people were men and women whose Body Mass Index (BMI) is higher than 35 kg/ m2. For each person selected, there is another one, also adult, same sex, age and smoking habit, but with a BMI under than 30 kg/ m2. All the volunteers made laryngology test and their voice was recorded in the Phonoaudiology Department, from the Center of Otorhinolaryngology. We prepared the statistics, disregarding the values under 0.05, considered statistically insignificant. The results showed that the patients affected by morbid obesity presented more frequently: signs on their larynx that indicate gastroesophageal reflux (GER); 4 (four) times more hoarseness, 3 (three) times more instability, 5 (five) times more vocal fatigue and breathing; 5 (five) times more voice cracking. Besides these disabilities, people affected by morbid obesity presented changes in Jitter, Shimmer and Noise, as well as low Maximum Phonation Time (MPT). We conclude that people affected by morbid obesity present roughness, breathness with phonatory instability, changes in Jitter and Shimmer, low MPT and cracking voice

Litteraturen beskriver larynxmask som ett skonsamt alternativ till intubation med endotrakealtub. Tidigare studier visar dock att det inte är ovanligt med halsbesvär postoperativt, i form av halsont och/eller heshet. Syftet med studien var att undersöka förekomst och karaktär av halsbesvär postoperativt efter användning av två olika larynxmasker. Författarna genomförde en pilotstudie där nitton vuxna patienter, både män och kvinnor, som erhållit Pro-Breathe® eller I-gel® larynxmask under anestesin ingick. Patienterna intervjuades 60 minuter respektive 24 timmar efter uttagandet av larynxmasken. Intervjun bestod av två slutna frågor om halsont och heshet samt en öppen fråga om hur det kändes i halsen. Den öppna frågan visade att andra typer av halsbesvär förekommer, bland annat irritabilitet, svårigheter att svälja, torrhet och svullnadskänsla. Pilotstudiens metod lämpade sig att använda och svarade mot studiens syfte. Resultatet visade att olika typer av halsbesvär var vanligt postoperativt. Åtta av tio patienter som haft Pro-Breathe® samt sju av nio patienter som haft I-gel® hade någon typ av halsbesvär. / The literature describes the laryngeal mask as a gentle alternative to intubation with endotracheal tube. Previous studies show that it is not unusual with throat discomfort postoperatively, in terms of sore throat and/or hoarseness/dysphonia. The aim of this study was to investigate the presence and nature of throat discomfort postoperatively after the use of two different laryngeal masks. The authors conducted a pilot study in which nineteen adult patients, both men and women, who received Pro-Breathe® or I-gel® laryngeal mask during anesthesia was included. The patients were interviewed 60 minutes and 24 hours after the laryngeal mask were removed. The interview consisted of two sealed questions about sore throat and hoarseness/dysphonia and one open question about how it felt in the throat. The open question showed that other types of throat discomforts occurred, including irritability, difficulty swallowing, dryness and swelling sensation. The method of the pilot-study was suitable to use and responded to the study's purpose. The results showed that different types of throat discomfort were common postoperatively. Eight out of ten patients who received Pro-Breathe® and seven out of nine patients who received I-gel® had some type of throat discomfort.

Orientador: Regina Helena Garcia Martins / Coorientador: Daniele Cristina Cataneo / Resumo: Introdução: os granulomas laríngeos são lesões benignas, não neoplásicas, uni ou bilaterais, de etiologia variável, que ocorrem no terço posterior das pregas vocais ou na região aritenoídea. Os sintomas são diversos, sendo o mais comum a rouquidão. Os granulomas decorrentes de intubação são altamente recidivantes e não existe consenso quanto ao melhor tratamento. Objetivo: comparar a efetividade dos tratamentos dos granulomas laríngeos decorrentes de intubação endotraqueal. Métodos: foram realizadas revisão sistemática e metanálise proporcional de estudos sobre o tratamento de granulomas laríngeos decorrentes de intubação endotraqueal, seja ele primário ou recidivante. Os critérios de elegibilidade foram: ensaios clínicos randomizados e estudos prospectivos controlados, e na ausência destes, aceitos também estudos retrospectivos e prospectivos não controlados com no mínimo cinco participantes. Os desfechos estudados foram resolução, recidiva e tempo para resolução do granuloma. Os estudos foram identificados na base de dados Pubmed, Embase, Lilacs e Cochrane. Para a análise dos dados e metanálise, utilizou-se o programa StatsDirect 3.0.121. Resultados: dentre os 578 artigos encontrados, 61 foram lidos na íntegra e seis selecionados para a revisão, totalizando 85 pacientes, com idade variando de 21 a 86 anos. Os tratamentos encontrados foram: antirrefluxo, fonoterapia, anti-inflamatórios, corticoterapia, antibioticoterapia, sulfato de zinco e cirurgia. Para o tratamento primár... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Laryngeal granulomas are benign, non-neoplastic lesions that can occur unilaterally or bilaterally for various causes. They are usually located in the posterior third of the vocal folds or in the arytenoid region. Patients may present a number of symptoms, the main one being hoarseness. Post-intubation granulomas are highly recurrent and there is no consensus on the best treatment. Objective: to compare the effectiveness of treatments of laryngeal granulomas secondary to endotracheal intubation. Methods: systematic review and proportion meta-analysis of studies that address the treatment of laryngeal granulomas caused by endotracheal intubation. The eligibility criteria were: randomized controlled trials and controlled prospective studies, and in the absence of these, retrospective and prospective uncontrolled studies were also accepted, with at least five participants. The outcomes that were measured were resolution, recurrence and time to resolve the granuloma. Databases searched were Pubmed, Embase, Lilacs and Cochrane. Statistical analysis was performed with the StatsDirect version 3.0.121 software. Results: among the 578 articles found, 61 were eligible for full reading and 11 articles were included, involving 85 patients, with ages varying from 21 to 86 years). The treatments were: anti-reflux, speech therapy, anti-inflammatory drugs, corticosteroids, antibiotics, zinc sulfate and surgery. For the primary treatment, 85 patients were investigated in six studies, divided into two groups: surgical ± associations (41 patients), with chance of resolution of 75% (95% CI: 0,3% to 100%, I2= 90%), and absolute risk of recurrence of 25% (95% CI: 0,2% to 71%) and clinical (44 patients), with chance of resolution of 86% (95% CI: 67% to 97%), and absolute risk of recurrence of 14% (95% CI: 3 to 33%). In the interpretation of the meta-analysis, there was no statistical significance... (Complete abstract click electronic access below) / Mestre

Introduction: Juvenile onset recurrent respiratory papillomatosis (JoRRP) is the commonest benign paediatric neoplasm. There is no curative treatment, but the condition is self-limiting. Current primary treatment is aimed at symptomatic relief, comprising of serial surgical debulking of obstructive papillomas along the respiratory tract, with voice preservation. Adjuvant therapy is indicated in severe cases. Objective: A review of children with JoRRP presenting to the ENT Department at Red Cross War Memorial Children’s Hospital (RCWMCH) over 2 years. Evaluation of the pattern of disease and factors that may contribute to disease severity were reviewed. Method: Retrospective folder review of children with histologically confirmed laryngeal papillomatosis over above the time period. Results: Twenty children were included. Nine were male, 11 were female. The median age at diagnosis was 2.4 years (11 - 109 months). Presentation at < 3 years was noted in 5/7 of the most severe cases. Nine of 20 were HPV serotyped; 5 were type 11, and 4 were type 6. Eighty percent (16/20) were HIV negative; 10% (2/20) HIV positive; and 10% (2/20) were unknown. A total of 90 surgical procedures were performed; the highest number of surgeries per child was 13. Inter-surgical time was 1 to 164 weeks (median 9 weeks). Four received Gardasil vaccination as adjuvant therapy, 3 of who showed a reduction in disease severity. Conclusion: JoRRP commonly presents around the first 3 years of life. Severe cases can be life-threatening, often with multiple hospital admissions for clearance of surgical papillomata. Severe cases presented before 3 years. Gardasil vaccination as adjuvant therapy has promise. No identifiable risk factors in our review were noted. HIV co-infection and HPV type were not risk factors for severity.