A distonia é uma síndrome que consiste de contrações musculares involuntárias que resultam em movimentos distorcidos e repetitivos e/ou posturas anormais. O tratamento pode ser por farmacoterapia, com drogas anticolinérgicas ou com a injeção de toxina botulínica no grupo de músculos afetados. O objetivo do trabalho foi avaliar a deglutição nos pacientes com distonia laríngea, antes e após o tratamento com a toxina botulínica. Nossa hipótese foi que a toxina botulínica modificaria a deglutição dos pacientes com distonia laríngea. Foram avaliados 17 indivíduos adultos, acima de 18 anos de idade, com diagnóstico clínico de distonia laríngea antes e após o tratamento com o uso de toxina botulínica do tipo A, e 20 indivíduos adultos saudáveis como controles. Os participantes foram submetidos à anamnese fonoaudiológica e avaliação videofluoroscópica da deglutição. Os pacientes com distonia foram avaliados antes e 30 dias após a injeção de toxina botulínica, guiada por eletromiografia. Na videofluoroscopia foram avaliadas 6 deglutições de 5mL, sendo 3 na consistência líquida (sulfato de bário 100%, e 3 na consistência pastosa (3g do espessante alimentar ThickenUp Clear, em 50 mL de sulfato de bário (100%) oferecidas em uma colher. A ordem das deglutições foi aleatória. Foram estudadas as fases oral e faríngea da deglutição, com registro de 30 quadros por segundo. Os pacientes com distonia laríngea apresentaram aumento de resíduos na região oral e em valécula e maior número de deglutições. Os pacientes apresentaram tempo de trânsito faríngeo (TTF) menor do que os controles (p<0,01), para os bolos nas consistências líquida e pastosa. O TTF foi menor após aplicação do que antes da aplicação da toxina botulínica, quando da deglutição do bolo pastoso. Portanto, concluiu-se que os pacientes com distonia laríngea, comparado a controles, têm trânsito mais rápido pela faringe, aumento de resíduos na região oral e em valécula e maior número de deglutições para o mesmo volume.Trinta dias após a aplicação da toxina botulínica foi observado diminuição da duração do trânsito pela faringe, com o bolo pastoso, e resposta tardia do movimento do osso hióide em relação à chegada do bolo na faringe. / Dystonia is a syndrome consisting of involuntary muscle contractions that result in distorted and repetitive movements and/or abnormal postures. Treatment may be by pharmacotherapy with anticholinergic drugs or with the injection of botulinum toxin in the affected muscle group. The aim of this study was to evaluate swallowing in patients with dystonia before and after treatment with botulinum toxin. Our hypothesis was that botulinum toxin modify the swallowing of patients with spastic dystonia. Seventeen adult subjects over the age of 18 years with clinically diagnosed dystonia were evaluated before and after treatment with botulinum toxin type A and compared to 20 healthy adults as controls. Participants underwent phonologic anamnesis and videofluoroscopy assessment of swallowing. Patients with dystonia were assessed before and 30 days after injection of botulinum toxin, guided by electromyography. In fluoroscopy, 6 swallows were evaluated of 5ml: 3 in a liquid consistency (100% barium sulfate) and 3 in a pasty consistency (3g of food thickener, ThickenUp Clear) in 50 mL of 100% barium sulfate, offered on a spoon. The oral and pharyngeal phases of swallowing were studied from swallows of random order, with registration of 30 frames per second. Patients with dystonia showed an increase of residue in the oral region and vallecula and greater number of multiple swallows. Patients had less pharyngeal transit time (PTT) than controls (p<0.01) for boluses of liquid and pasty consistencies. PTT was lower after the application of botulinum toxin than before with the swallowing of a pasty bolus. It was concluded that patients with dystonia, compared to controls, have more rapid transit through the pharynx, increased residues in the oral region and vallecula and a greater number of swallows for the same volume. Thirty days after the botulinum toxin, it was observed a shorter pharyngeal transit time with paste bolus, and delayed hyoid movement response to bolus presence in pharynx.

A laringectomia total que resulta em perda da fonte sonora e na reabilitação por meio da voz traqueoesofágica, com a prótese fonatória, tem sido amplamente empregada por apresentar resultados satisfatórios e pela rápida reabilitação. Para a produção sonora traqueoesofágica, participam o esôfago, a transição faringoeosofágica e a faringe. A orofaringe e a rinofaringe mantêm-se preservadas após a laringectomia total e fazem parte do mecanismo de ressonância vocal. Porém, nada se sabe a respeito da interferência da rinofaringe para a produção da voz traqueoesofágica. Por este motivo, o objetivo deste estudo foi determinar os valores da nasalância e a nasalidade da voz traqueoesofágica em laringectomizados totais, usuários de prótese (grupo estudo), falantes do português brasileiro e comparar com falantes laríngeos (grupo controle). O estudo contou com a participação de 25 laringectomizados totais, usuários de prótese traqueoesofágica, destes, 20 homens e cinco mulheres, com idade entre 45 e 82 anos e média de 61 anos e cinco meses. O grupo controle foi composto de 40 voluntários, 28 homens e 12 mulheres, com idade entre 44 e 80 anos e média de 61 anos e nove meses. Todos os participantes foram submetidos ao exame nasovideoendoscópico para avaliação anatomofuncional da rinofaringe e do mecanismo velofaríngeo, à avaliação objetiva da nasalância, realizada por meio de um nasômetro, e à avaliação perceptivo-auditiva da nasalidade. A amostra da fala foi composta por frases orais e nasais padronizadas para o português brasileiro. A avaliação perceptivo-auditiva da nasalidade foi realizada por dois juízes fonoaudiólogos, com experiência na área de voz. Os resultados revelaram que, durante a emissão de frases orais, não houve diferença (p=0,13) entre os grupos, com relação à nasalância. Porém, para as frases nasais, os laringectomizados demonstraram maior nasalância (p=0,001). A sensibilidade da nasalância em identificar o laringectomizado total, durante a emissão das frases nasais, foi de 80% e a especificidade de 72,5%, estipulando-se o valor de corte em 54,5%. Para as frases orais, para o valor de corte de 19,5%, a sensibilidade foi de 36% e a especificidade de 80%. Para a nasalidade, notou-se confiabilidade intrajuiz perfeita ou quase perfeita (Kappa=1,0), em todas as análises. A concordância interjuízes variou de substancial a perfeita ou quase perfeita (Kappa entre 0,715 e 1,0). Comparando-se os achados da avaliação perceptivo-auditiva entre os grupos, eles se mostraram iguais, tanto para as frases orais (p=0,39) quanto para as frases nasais (p=1,00). A sensibilidade da análise perceptivo-auditiva para identificar presença ou ausência da nasalidade nos laringectomizados foi de 100%, tanto para as frases nasais quanto para as orais, a especificidade foi de 0 a 11,1%, e a acurácia, de 80% a 68%, respectivamente para as frases nasais e para as frases orais. Concluiu-se que os laringectomizados totais apresentam maior nasalância nas frases nasais que falantes laríngeos, reforçando que a impedância do trato vocal remanescente, após a laringectomia, não impede a presença de energia acústica nasal para a produção dos respectivos sons percebidos na avaliação perceptivo-auditiva. / Total laryngectomy results in the loss of of the sound source, and rehabilitation with a tracheoesophageal voice prosthesis has been widely used because of its satisfactory and rapid results. The esophagus, pharyngoesophageal transition and pharynx participate in tracheoesophageal sound production. After total laryngectomy, the oropharynx and rhinopharinx continue to be preserved and are part of the mechanism of voice resonance. However, there is no information about the interference of the rhinopharynx for the production of tracheoesophageal voice. Thus, the objective of the present study was to determine the nasalance and nasality values of tracheoesophageal voice in total laryngectomees speaking Brazilian Portuguese wearing a prosthesis (study groups) and to compare them to those of laryngeal speakers (control group). The study was conducted on 25 total laryngectomees wearing a tracheoesophageal prosthesis, 20 men and five women aged 45 to 82 years (mean: 61 years and five months). The control group consisted of 40 volunteers, 28 men and 12 women aged 44 to 80 years (mean: 61 years and nine months). All participants were submitted to nasovideoendoscopy for anatomofunctional evaluation of the rhinopharynx and of the velopharyngeal mechanism, to objective evaluation of nasalance by means of a nasometer, and to auditory-perceptual evaluation of nasality. The speech sample consisted of oral and nasal sentences standardized for Brazilian Portuguese. Auditory-perceptual evaluation of nasality was performed by two speech therapist raters with experience in the voice area. The results revealed no difference in nasalance between groups (p=0.13) during the emission of oral sentences. However, for the nasal sentences the laryngectomees demonstrated greater nasalance (p=0.001). The sensitivity of nasalance in identifying the total laryngectomees during the emission of nasal sentences was 80% and specificity was 72.5%, with the cut-off value being stipulated at 54.5%. For the oral sentences, for a cut-off value of 19.5%, sensitivity was 36% and specificity 80%. Inter-rater reliability was perfect or almost perfect (Kappa=1.0) for nasality in all analyses. Inter-rater concordance ranged from substantial to perfect or almost perfect (Kappa of 0.715 to 1.0). Comparrison of the findings of auditory-perceptual evaluation showed no difference between groups regarding the oral (p=0.39) and nasal (p=1.00) sentences. The sensitivity of the auditory-perceptual analysis for the identification of the presence or absence of nasality in the laryngectomees was 100% both for the nasal and the oral sentences, specificity was 0 and 11.1%, and accuracye 80% and 68%, respectively, for the nasal and oral phases. We conclude that total laryngectomees show greater nasalance in nasal sentences than laryngeal speakers, supporting the notion that the impedance of the vocal tract remaining after laryngectomy does not prevent the presence of nasal acoustic energy for the production of the respective sounds perceived in auditory-perceptual evaluation.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-03-29T11:26:06Z No. of bitstreams: 1 cristinatostesvieiramaciel.pdf: 4843448 bytes, checksum: 7a1ffce0f381832d62e4362d7b91f5cb (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-03-30T11:17:09Z (GMT) No. of bitstreams: 1 cristinatostesvieiramaciel.pdf: 4843448 bytes, checksum: 7a1ffce0f381832d62e4362d7b91f5cb (MD5) / Made available in DSpace on 2017-03-30T11:17:09Z (GMT). No. of bitstreams: 1 cristinatostesvieiramaciel.pdf: 4843448 bytes, checksum: 7a1ffce0f381832d62e4362d7b91f5cb (MD5) Previous issue date: 2009-07-27 / Os tumores de laringe representam 25% dos tumores de cabeça e pescoço e cerca de 2% de todos os cânceres no Brasil. No entanto, é pouco conhecida a evolução dos pacientes portadores deste câncer, após ser determinado o fim das possibilidades de sua cura. Os estudos sobre a qualidade de vida destes pacientes visam sugerir como desenvolver o tratamento para que haja uma menor repercussão dos sintomas do câncer e/ou tratamento no desempenho diário do paciente. Diversos instrumentos específicos foram criados com o objetivo de quantificar a qualidade de vida de pacientes portadores do câncer de cabeça e pescoço, dentre eles o Functional Assessment Cancer Therapy FACT Head and Neck (HN). Este questionário aborda a qualidade de vida durante ou após a terapêutica e reflete a perspectiva do paciente frente ao tratamento discutindo e expondo as possíveis fragilidades do tratamento. Objetivos: Estimar a qualidade de vida de indivíduos submetidos ao tratamento de câncer de laringe no Município de Juiz de Fora, MG, identificando as variáveis que a influenciaram. Metodologia: estudo transversal envolvendo 60 pacientes com tumor primário de laringe com, no mínimo, 1 ano de sobrevida, submetido a tratamento em 02 centros de referência para a assistência oncológica de Juiz de Fora no período compreendido entre 2001 a 2007. Foram aplicados dois instrumentos: um contendo dados exploratórios e o FACT-HN, adaptado para a língua portuguesa. A análise bivariada preliminar selecionou as variáveis com valores de p≤0,20. Em seguida, foi realizada a regressão linear múltipla, utilizando-se a técnica enter. No modelo multivariado final permaneceram as variáveis cujos valores de p foram ≤0,10. Resultados: Na análise bivariada (p≤ 0,20) apresentaram maior significância as variáveis sociodemográficas “sexo”, “anos de escolaridade” e clínico-funcionais “análise do tratamento recebido”, “tratamento fonoaudiológico e nutricional”. Após a análise multivariada, ainda mostraram uma associação significativa a variável sociodemográfica “anos de escolaridade” e as variáveis clínico-funcionais “análise do tratamento recebido”, “tratamento fonoaudiológico e nutricional”. Conclusões: Tanto os fatores sociodemográficos; socioeconômicos e clínico-funcionais, ainda que de forma diferente, interferem na qualidade de vida do paciente. Nos três domínios que constituem o FACT-HN (TOI, FACTG e FACTHN), houve aparente influência de fatores sociodemográficos e clínico-funcionais na qualidade de vida dos pacientes. / Although laryngeal cancer accounts for 25% of head and neck malignancies, and 2% of all malignancies in Brazil, the outcome of patients with no possibility of cure is not well known. Studies on the quality of life of such patients focus on measures to limit the impact of clinical symptoms and treatment untoward effects on daily performance. Several specific tools were developed to quantify the quality of life of head and neck cancer patients, the Functional Assessment Cancer Therapy - Head and Neck (FACT-HN) among them. Focusing on the quality of life during or after therapy, this questionnaire reflects the patient`s perspective concerning therapy and reveals possible treatment weaknesses. Objectives: Assess the quality of life of subjects undergoing treatment for laryngeal cancer in the municipality of Juiz de Fora, MG, Brazil, and identify significant variables. Method: Cross-sectional study of 60 patients with primary laryngeal cancer, with at least 1-year-survival, and treated at 2 oncology reference centers in Juiz de Fora, in the year 2001/2007. An investigative tool consisting of exploratory data and the Portuguese-adapted FACTHN were used. Preliminary bivariate analysis selected variables with p values ≤0.20. Subsequent multiple linear regression analysis was performed with the enter technique. On the final multivariate model, variables with p values ≤0.10 remained. Results: On bivariate analysis (p≤ 0.20) greater significance was found for the sociodemographic variables (gender and years of schooling) and for the clinicalfunctional variables (treatment appraisal with hindsight and speech and nutritional therapies). Treatment appraisal with hindsight and speech and nutritional therapies still showed a significant association after multivariate analysis. Conclusions: Sociodemographic, socioeconomic and clinical-functional factors interfere with the quality of life of such patients, albeit in a different way. In the three domains that make up the FACT-HN (TOI, FACTG e FACTHN), sociodemographic and clinicalfunctional factors seemingly influenced the quality of life of these patients.

Orientador: Carlos Takahiro Chone / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T13:57:24Z (GMT). No. of bitstreams: 1 Moraes_JulianaLopesde_M.pdf: 943040 bytes, checksum: 4d94adb829d86ae614ad5e737c31b7af (MD5) Previous issue date: 2014 / Resumo: Objetivo: Comparar a qualidade de vida do paciente tratado cirurgicamente por câncer avançado de laringe com aquele que foi submetido a quimioradioterapia exclusivos. Método: Revisão sistemática que utilizou, para a seleção dos artigos, 06 bases de dados (PubMed, MedLine, Embase, Web of Science, Cochrane Library e Lilacs) e as palavras-chave "head and neck cancer"; "advanced laryngeal cancer"; "laryngeal neoplasm"; larynx cancer"; "quality of life"; "outcomes/functional results";"total laringectomy"; "chemoradiotherapy". Os critérios de inclusão foram estudos específicos de câncer avançado de laringe, com comparação de modalidades de tratamento e avaliação da qualidade de vida. Resultados: Foram encontrados 321 artigos. Nove artigos preencheram todos os critérios de inclusão e desses, apenas três possuíam desenho metodológico e instrumento de mensuração de qualidade de vida comparáveis entre si e foram submetidos à metanálise . Os resultados evidenciaram que 90% dos estudos são retrospectivos e não randomizados. O tempo pós-tratamento em que os questionários de qualidade de vida foram aplicados mostrou grande variabilidade (3 meses a 11 anos). Conclusão: A meta-análise dos três estudos comparativos mostraram uma melhor qualidade de vida após o tratamento para indivíduos tratados com quimioradioterapia exlcusiva. No entanto, devido a existência de poucos estudos com dados relevantes na literatura, é necessário realizar pesquisas futuras com as seguintes características: (a) estudos prospectivos e randomizados, (b) multicêntrico, com maior número de indivíduos, e (c) enfatizando o funcional sequelas que ambos os tratamentos acarretam / Abstract: Objective: To compare studies of quality of life in patients undergoing chemoradiotherapy or surgery for advanced laryngeal cancer. Method: Articles were selected for a systematic review by searching six databases (PubMed, Medline, Embase, Web of Science, Cochrane Library and Lilacs) for keywords "head and neck cancer," "advanced laryngeal cancer," "laryngeal neoplasm," "larynx cancer," "quality of life," "outcomes and functional results," "total laryngectomy" and "chemoradiotherapy." The included studies must related to advanced larynx cancer, comparisons of treatment modalities and assessment of patient quality of life in validated scales, well defined inclusion and exclusion criteria. Articles with poor methodological evaluation and duplicated results were excluded. Results: It was found 321 articles. Nine articles fitted to all inclusion criteria and of these, only three observed comparable methodological designs and standardized instruments for measuring quality of life and therefore subjected to meta-analysis. Our analysis observed that 90% of the studies were retrospective and nonrandomized. The time point post-treatment at which the quality of life questionnaires were assessed varied widely (3 months to 11 years). Conclusion: The meta-analysis of three comparable studies showed improved quality of life after treatment for subjects treated with chemoradiation alone. However, because of few studies with relevant data in literature, it is necessary to conduct future research with the following study characteristics: (a) prospective and randomized; (b) multicentric, with larger numbers of subjects; and (c) emphasizing the functional sequelae that both treatments entail / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

Abstract Automated quantitative computer-assisted morphometric analysis of immunohistochemical expression of markers of neoplastic development and progression in experimentally induced and in human neoplasms showed very high sensitivity and reproducibility, allowing analysis of large numbers of cell and tissue components. Totals of 26 million pixels, 25,000 cells and 1500 vessels were examined, with a sensitivity exceeding 99% and reproducibility exceeding 99%. The total expression of proliferating cell nuclear antigen (PCNA) and p53 increased consistently during 7H-dibenz[c, g] carbazole (DBC)-induced formation of dysplasias and squamous cell carcinomas (SCC:s) in hamster lung. In dysplasia, nuclear size and PCNA staining intensity increased; in SCC:s nuclear size decreased. In a retrospective study on archival material of human laryngeal squamous cell carcinomas, the occurrence and location of PCNA-positive cells were specifically related to the degree of differentiation. In SCC:s nuclear size decreased, while shape alterations and PCNA staining intensity increased in relation to degree of malignancy. In DBC-induced respiratory carcinogenesis increased collagen matrix synthesis occurred prior to neoplasm development. Among squamous cell carcinomas, in well-differentiated tumors, collagen deposition increased, as did fiber size, in moderately differentiated tumors collagen synthesis and the deposition of new collagen decreased. The increase in transforming growth factor beta expression in differentiated cells and in the matrix was isoform-specific. Increased angiogenesis in laryngeal tumor development occurred in preneoplastic states and in SCC: s, inversely related to the degree of differentiation. In well-differentiated neoplasms the vessels were lying in the direction of the BM, in moderately differentiated neoplasms vessels were lying in the direction of tumor invasion and in poorly differentiated neoplasms irregular, partly abnormal vessels intermixed with tumor cells. Small regular vessels predominated in benign conditions and large, irregular vessels in malignant conditions. Experimental models provided the advantage of examining homogenous, well-characterized neoplasm progression without interfering with the process. Morphometric methods provided detailed information on large numbers of cells, useful for studies of tumor behavior and with potential clinical applications.

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.

This dissertation investigates the role of grammatical versus methodological influences in the production and perception of final devoicing in experimentally-elicited speech from Russian. It addresses the question of how the partial preservation of the phonological voicing contrast in word-final obstruents is affected by (i) task-independent factors that reflect phonological and lexical properties of stimuli words (underlying voicing, word length, lexical competition) and (ii) task-dependent biases that arise due to the nature of the experimental task performed by the speaker (availability of orthographic inputs, presence of minimal pairs among the stimuli). Results of a series of acoustic production and perceptual identification tasks reveal that task-dependent factors account for the presence of robust and perceptually salient differences in the parameter of phonetic voicing. Several types of stimuli items also show limited but statistically significant differences in closure/frication duration and release duration that are independent of the presence of orthography or inclusion of full minimal pairs among test items. Taken together, these findings indicate that non-grammatical factors can play a prominent biasing role in both production and perception of the voicing contrast in experimentally-elicited speech, such that certain voicing-dependent cues are maintained only in the presence of task-dependent pressures. However, not all incompletely neutralized differences between phonologically voiced versus voiceless final obstruents can be attributed to the effects of orthography or inclusion of minimal pairs among the stimuli. In the theoretical domain, these results are argued to favour a less restrictive definition of neutralization and a model of phonology that views devoicing as a loss of the primary acoustic cue to the underlying voicing contrast rather than complete identity of the [voiced] feature.

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

No description available.

Several studies involving excised animal larynges have been performed to simulate the structural and physiological properties of the human larynx. The most common way to preserve the laryngeal tissue being studied is by immersing it in a 0.9% isotonic saline solution and then flash freezing it. Isotonic saline is used empirically to replenish the potential ion loss that occurs postmortem. Each larynx is flash frozen so it can be used at a more convenient time while still maintaining the integrity of the tissue. However, the preservation methods found in previous studies tend to vary and no consensus had been reached about which method of preservation is ideal. This study sought to investigate the effects of solution and storage on phonation threshold pressure (PTP). Phonation threshold pressure is commonly used to investigate mucosal wave of the vocal folds, prephonatory glottal width, and vocal fold cover. This study involved a prospective, mixed experimental design with three groups, including a control group and two experimental groups. Each group consisted of 10 bench-mounted porcine larynges. The control group was immersed in 0.9% isotonic saline, flash frozen with liquid nitrogen within 24 hours postmortem, and thawed overnight before the experiment. The second group was immersed in 0.9% isotonic saline and the third group was submersed in Ringer's solution. Each of these groups was kept in their solution in a refrigerator for approximately 15 hours and was used for the experiment within 24 hours postmortem. Each larynx was mounted on a bench on a tabletop with three micropositioners to adduct and elongate the vocal folds. A pseudolung connected to the trachea directed humidified air to the vocal folds subglottally until phonation was achieved. The larynges in all three groups underwent these phonatory trials with 5-minute desiccation trials between each until phonation could no longer be achieved. Phonation threshold pressure was then observed and compared within groups and between groups. The signals were obtained using MATLAB. The results indicated that PTP was lowest for the frozen versus fresh groups. PTP values increased slightly for the frozen group, but the frozen group demonstrated less variability across specimens as compared to the fresh groups. Collectively, these results indicate that there are substantial differences between fresh and frozen specimens. These differences should be considered when designing tissue studies for purposes of generalization to human phonation.