Coaptação glótica, proporção glótica e angulo de abertura das pregas vocais em crianças

BV UNIFESP: Teses e dissertaçõe

Da importância da biópsia de aspiração com agulha fina nos tumores cervicais

BV UNIFESP: Teses e dissertaçõe

Otorhinolaryngology without borders

65165

Influence of smoking isolated and associated to multifactorial aspects in vocal acoustic parameters

Introduction:Smoking affect voice quality in a long period of time, but other factors may compromise it, such as professional using of voice, habits, alcohol dependence and GERD. The aim was associate the influence of these factors on vocal parameters.Study design:Contemporary cohort study with cross-sectional.Materials and methods:Eighty adults of 35 to 60 years old had participated in this study, they had been divided into two groups, smokers (GF) and control (GC). There was application of questionnaire and voices were recorded. Praat software has been used for voice assessment and Man-Whitney, chi-square and logistic regression has been used for statistical analysis.Results:The GF had a higher incidence of alcohol dependence, coughing, throat clearing and professional voice using. Respecting to the acoustic parameters: noise-to-harmonic ratio (NHR), jitter and shimmer, the GF presented higher values. Relating these data to the questionnaire, it's noticed that female gender have influence over all acoustic parameters, GERD have influence over jitter and smoking can affect fundamental frequency, jitter, shimmer and NHR.Conclusion:Smoking interferes in acoustics parameters isolated and associated with alcohol dependence, GERD, cough, throat clearing, gender and professional using of voice.Introdução:O fumo pode interferir negativamente na qualidade vocal e outros fatores associados, como o uso profissional da voz, hábitos, etilismo e refluxo gástrico-esofágico, podem potencializar essa interferência. O objetivo do estudo foi analisar a associação do tabagismo e dos demais fatores aos parâmetros acústicos vocais.Forma de estudo:Estudo de coorte contemporâneo com corte transversal.Materiais e métodos:Participaram do estudo 80 adultos, entre 35 e 60 anos, classificados nos grupos fumante (GF) e controle (GC). Foi realizada aplicação de questionário e gravação das vozes. A avaliação acústica foi realizada com o software Praat. Foram utilizados os testes Mann-Whitney, qui-quadrado e regressão linear simples.Resultados:O GF apresentou maior prevalência de etilismo, tosse, hábito de pigarrear e uso profissional da voz, assim como apresentou valores aumentados para relação ruído-harmônico (NHR), jitter e shimmer. Foi estabelecida correlação entre o gênero feminino e todos os parâmetros acústicos, assim como entre o RGE, o aumento do jitter e o hábito de fumar, o agravamento da frequência fundamental, o aumento do jitter, o shimmer e a NHR.Conclusão:O fumo interfere nos parâmetros acústicos de modo isolado e/ou associado ao etilismo, tosse, hábito de pigarrear, RGE e uso profissional da voz

Levels II and III neck dissection for larynx cancer with N0 neck

AbstractThe removal of level II, III, and IV metastases has gained importance in the treatment of squamous cell carcinomas (SCC) of the neck and larynx. This study assessed the possibility of removing level II and level III metastases only, given the low likelihood of occurrence of metastatic lymph nodes on level IV in SCCs of the larynx.ObjectiveThis study aimed to analyze the prevalence rates of metastatic lymph nodes on level IV in laryngeal SCC patients.MethodsThis prospective study enrolled consecutive patients with laryngeal SCC submitted to neck lymph node dissection. Neck levels were identified and marked for future histopathology testing.ResultsSix percent (3/54) of the necks had level IV metastatic lymph nodes. All cN0 necks (42) were free from level IV metastasis. Histopathology testing done in the cN (+) necks (12) revealed that 25% of the level IV specimens were positive for SCC. The difference between cN0 and cN (+) necks was statistically significant (p = 0.009). Level IV metastases never occurred in isolation, and were always associated with level II or level III involvement (p = 0.002).ConclusionThe prevalence rate for lymph node metastasis in cN0 necks was 0%. Level IV metastatic lymph nodes were correlated to cN (+) necks. Level IV metastasis was associated with the presence of metastatic lymph nodes in levels II or III

Laryngeal electromyography techniques and clinical use

Laryngeal electromyography is considered a valuable diagnostic tool for voice disorders. The technique, described almost 70 years ago, evolved 3 decades later, mainly because of the growing interest of laryngologists and speech pathologists. In the authors' opinion, the reduced number of neurophysiologists involved in laryngeal electromyography groups is, at some instance, related to the difficulty to start the learning process and the multidisciplinary approach the field requires. This review highlights the anatomy and physiology needed to perform laryngeal electromyography and its clinical usefulness in the new field known as neurolaryngology32427428

Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection

CONTEXT: Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. OBJECTIVE: To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. TYPE OF STUDY: Non-randomized retrospective study. SETTING: Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. METHODS: Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. RESULTS: The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the submandibular triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. DISCUSSION: The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. CONCLUSIONS: The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients

Clinical Versus Computed Tomography Evaluation In The Diagnosis And Management Of Deep Neck Infection.

Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. Non-randomized retrospective study. Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the submandibular triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.122259-6

Tomografia computadorizada versus avaliação clínica no diagnóstico e tratamento das infecções cervicais profundas

CONTEXT: Deep neck infections have high potential for severe complications and even death, if not properly managed. The difference between clinical and computed tomography findings may demonstrate that clinical evaluation alone underestimates disease extent, which may lead to conservative treatment with worse prognosis. OBJECTIVE: To compare clinical and computed tomography findings from neck spaces affected by deep neck infections and to determine the main clinical and radiological features associated with these. TYPE OF STUDY: Non-randomized retrospective study. SETTING: Department of Otolaryngology and Head and Neck, Universidade Estadual de Campinas. METHODS: Medical charts of 65 patients with deep neck infections were evaluated. Age, gender, clinical complaints, physical findings, computed tomography scan and x-ray imaging, microbiology, treatment and outcome were analyzed. All clinical signs and symptoms were evaluated and stratified in order of frequency. The frequency of neck space involvement in such infections was also assessed from the clinical and tomographic evaluation. All clinical and computed tomography findings were compared with surgical observation. RESULTS: The most frequent clinical findings were neck swelling, local pain, erythema and locally increased temperature. Physical evaluation showed that the most affected site was the submandibular triangle (49.2% of cases). However, computed tomography showed this to be the lateropharyngeal space (65% of cases) and that more than one deep cervical space was compromised in 90% of cases, as demonstrated by the extent of swelling and increased contrast signs in soft tissue. DISCUSSION: The most frequent clinical symptoms of deep cervical infections were cervical pain, increased cervical volume and fever. The important signs seen via computed tomography were increased contrast in soft neck tissues and swelling. Such examination is the most important method for correct evaluation of cervical spaces involved in infection, and thus for correct surgical drainage. CONCLUSIONS: The most frequent clinical findings were cervical mass, neck pain, local erythema and locally increased temperature. Computed tomography demonstrated that the lateropharyngeal space was the most affected neck space. More than one deep neck space was compromised in 90% of cases. Clinical evaluation underestimated the extent of deep neck infection in 70% of patients.CONTEXTO: Infecções profundas do pescoço têm um potencial alto para complicações graves e morte, se não corretamente diagnosticadas e tratadas. A diferença entre resultados de avaliação clínica e tomográfica pode demonstrar que a avaliação clínica isolada subestima a extensão de doença, o que pode conduzir a tratamento conservador e a pior prognóstico. OBJETIVO: Comparar achados clínicos à tomografia computadorizada de pescoço em relação aos espaços cervicais envolvidos e determinar as características clínicas e radiológicas principais associadas com infecção de espaço profundo de pescoço. TIPO DE ESTUDO: Estudo retrospectivo não randomizado. LOCAL: Departamento de Otorrinolaringologia - Cabeça e Pescoço, Universidade Estatal de Campinas, Brasil, um centro universitário, terciário. MÉTODOS: Foi avaliado prontuário médico de 65 pacientes com infecções profundas de pescoço. Foram analisados idade, gênero, queixas clínicas, exames físicos, resultados de raios-x e tomografia computadorizada, microbiologia, tratamento e resultados. Foram avaliados os sinais clínicos e sintomas, estratificados em ordem de freqüência. A freqüência de espaços cervicais profundos envolvidos nesta infecção também foram avaliados clínico e tomograficamente. Todos resultados clínicos e tomográficos foram comparados com a observação cirúrgica em relação aos espaços cervicais afetados por infecção. RESULTADOS: Os resultados clínicos mais freqüentes foram inchaço cervical, dor local, eritema cutâneo local e aumento localizado de temperatura. O local mais afetado de acordo com a avaliação física foi o triângulo de submandibular (49,2%), mas, à tomografia computadorizada cervical, foi o espaço látero-faríngeo (65%). Mais de um espaço cervical profundo foi acometido, de acordo com a tomografia computadorizada cervical, em 90% dos pacientes, como demonstrado pela extensão do edema e aumento de captação de tecidos moles, e em geral apenas um espaço à avaliação clínica isolada. DISCUSSÃO: Os sintomas clínicos mais freqüentes das infecções cervicais profundas foram dor cervical, aumento de volume cervical e febre. Sinais importantes da tomografia computadorizada, para avaliação desta infecção, foram aumento de captação de contraste em tecidos moles do pescoço e edema. O espaço profundo do pescoço mais afetado pela infecção foi o laterofaríngeo, pela tomografia computadorizada do pescoço. O espaço submandibular foi o mais freqüente, ao exame físico, mas foi o segundo mais freqüente, de acordo com a tomografia computadorizada do pescoço, uma vez que o láterofaríngeo é um espaço difícil de ser examinado. Este exame é o mais importante para avaliação correta dos espaços cervicais envolvidos para a sua correta drenagem cirúrgica. CONCLUSÕES: Os achados clínicos mais freqüentes foram massa cervical, dor de pescoço, eritema de pele local e aumento de temperatura local. Avaliação com tomografia computadorizada cervical, demonstrou o espaço láterofaríngeo como o espaço cervical mais afetado. Mais de um espaço profundo de pescoço esteve acometido em 90% dos pacientes à tomografia computadorizada cervical. Avaliação clínica subestima a extensão de infecção profunda do pescoço em 70% de pacientes.25926