Os papéis ocupacionais de pessoas com câncer de cabeça e pescoço

The head and neck cancer has a high incidence and high mortality and its diagnosis and treatment infl uence the occupational life of the diseased person and their family. OBJECTIVE: To know the configuration of the occupational roles of people with this type of cancer, undergoing total or partial laryngectomy. METHODS: A quantitative, exploratory cross-sectional study approved by the Ethics Committee (Proc. No. 1102/2010). We used the protocol “List of Identifi cation of Occupational Roles”, validated in Brazil; quantitative data were analyzed by chi-square test. Additional qualitative data were collected through open interviews and analyzed by the method of content analysis. PATIENTS: Study group with 30 persons served by Head and Neck Surgery (CCP), with 15 ward in the immediate post-surgical, outpatient and 15, (at least one year after surgery). Control group consisting of 30 people without cancer. Were selected from the outpatient clinic 3 (20% of the study group) for interviews. RESULTS: It was demonstrated that there were changes or loss of occupational roles, especially the role of worker. CONCLUSION: The psychosocial and occupational consequences of head and neck cancer should be considered and cared for better and more effective treatment provided to this population.O câncer de cabeça e pescoço tem elevada incidência e alta mortalidade e seu diagnóstico e tratamento influenciam a vida ocupacional da pessoa adoecida e de seus familiares. OBJETIVO: conhecer a configuração dos papéis ocupacionais de pessoas com este tipo de câncer, submetidas a laringectomia total ou parcial. MÉTODO: Estudo quantitativo, exploratório e transversal, aprovado pelo Comitê de Ética (Proc. nº 1102/2010). Foi utilizado o protocolo “Lista de Identificação dos Papéis Ocupacionais”, validada no Brasil; os dados quantitativos foram analisados pelo teste do Qui quadrado. Dados qualitativos complementares foram coletados por entrevista aberta e analisados pelo método de análise de conteúdo temático. CASUÍSTICA: Grupo de estudo com 30 pessoas atendidas pela Cirurgia de Cabeça e Pescoço (CCP), sendo 15 da enfermaria, no pós-cirúrgico imediato, e 15 do Ambulatório, (no mínimo um ano após a cirurgia). Grupo-controle composto por 30 pessoas sem diagnóstico de câncer. Foram selecionadas 3 do ambulatório (20% do grupo de estudo) para as entrevistas. RESULTADOS: Demonstrou-se que ocorreram mudanças ou perdas de papéis ocupacionais, principalmente do papel de trabalhador. CONCLUSÃO: As consequências psicossociais e ocupacionais do câncer de cabeça e pescoço devem ser consideradas e cuidadas para um melhor e mais efi caz tratamento prestado a essa população

Traqueostomia

Tracheostomy consists in creating an opening in the anterior aspect of the cervical trachea, communicating the tracheal lumen with external environment. It is recommended in cases of upper airway obstruction, prolonged orotracheal intubation, respiratory muscles weakness and mandatory secretion removal.In general, tracheostomy is performed in situations of respiratory distress that cannot be resolved in ashort time.Traqueostomia consiste na abertura da parede anterior da traqueia comunicando-a com o meio externo. Está indicada em situações onde existe obstrução da via aérea alta, acúmulo de secreção traqueal,debilidade da musculatura respiratória e intubação traqueal prolongada. Ou seja, a indicação ocorreem situações em que a dificuldade respiratória não possa ser revertida em curto espaço de tempo

Phonatory function after prolonged voice use in brazilian woman

OBJECTIVES: To evaluate the behavior of the phonatory function and the perceived strain in Brazilian young women, before and after a test of prolonged voice use test, for a period of one continuous hour.METHODS: Twenty young women without laryngeal disorders participated in the study and were submitted to vocal acoustic analysis (MDVP-Advanced, CSL-Kay Pentax(r)), perceptual voice assessment, carried out by five judges, and the measurement of speech-strain level using a visual analog scale before and after a prolonged use of the voice, from the reading of a standardized text for one hour in usual vocal intensity and frequency, without breaks for hydration or vocal rest. The description and comparison between the variables and the appropriate statistical analysis were carried out.RESULTS: The acoustic parameters of fundamental (f0) and low frequency (Flo) of the emission increased after 1 hour of voice use, while the values for the amplitude tremor intensity index (Atri), amplitude variation (vAm), noise-to-harmonic ratio (NHR), and soft phonation index (SPI) were reduced after the prolonged voice use test. The judges agreed with the decrease in the overall level of dysphonia (kappa=0.66), roughness (kappa=0.59), and vocal breathiness (kappa=0.73); increased phonatory stability (kappa=0.64); vocal projection (kappa=0.48); pitch (kappa=0.74); and loudness (kappa=0.65). The phonatory strain increased significantly after the test (p=0.003).CONCLUSION: One hour of prolonged voice use seems to favor laryngeal adaptation and increased adductor muscle activity to maintain vocal efficiency. However, the self-perception of vocal strain is evident and can be understood as a sign of muscle fatigue caused by continuous use

Correlation of intraluminal esophageal pressure with the dynamic extension of tracheoesophageal voice in total laryngectomees

PURPOSE: To evaluate and correlate the amplitude of esophageal contractions triggered by swallowing water with dynamic extension and habitual, strong and weak sound intensity in total laryngectomees wearing a tracheoesophageal prosthesis. METHODS: Thirty total laryngectomees using tracheoesophageal voice with a phonatory prosthesis were evaluated by measuring the amplitude of contractions in the proximal, middle and distal esophagus and the pressure of the pharyngoesophageal transition by manometry. In order to measure vocal intensity the subject was asked to emit phonation of the vowel /a/ at habitual, strong and weak intensity which was captured with a sound pressure meter. Dynamic extension was calculated by subtracting strong intensity from weak intensity. RESULTS: A positive correlation was observed between contraction amplitude and dynamic extension in the proximal (rho: 0.45; p=0.01) and distal (rho: 0.41; p=0.02) esophagus There was no correlation with other parameters.. Total laryngectomees wearing a phonatory prosthesis with a dynamic extension above 21 dBNPS had greater contraction amplitude than laryngectomees with a dynamic extension below this value. CONCLUSIONS: There was a positive correlation between pressure amplitude in the proximal and distal esophagus and increased dynamic extension. The individuals with normal dynamic extension had greater contraction amplitude in the proximal esophagus than individuals with dynamic extension lower than the expected values for age

SWALLOWING IN PATIENTS WITH LARYNGITIS

ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis

Occupational roles of people with head and neck cancer

O câncer de cabeça e pescoço tem elevada incidência e alta mortalidade e seu diagnóstico e tratamento influenciam a vida ocupacional da pessoa adoecida e de seus familiares. OBJETIVO: conhecer a configuração dos papéis ocupacionais de pessoas com este tipo de câncer, submetidas a laringectomia total ou parcial. MÉTODO: Estudo quantitativo, exploratório e transversal, aprovado pelo Comitê de Ética (Proc. nº 1102/2010). Foi utilizado o protocolo “Lista de Identificação dos Papéis Ocupacionais”, validada no Brasil; os dados quantitativos foram analisados pelo teste do Qui quadrado. Dados qualitativos complementares foram coletados por entrevista aberta e analisados pelo método de análise de conteúdo temático. CASUÍSTICA: Grupo de estudo com 30 pessoas atendidas pela Cirurgia de Cabeça e Pescoço (CCP), sendo 15 da enfermaria, no pós-cirúrgico imediato, e 15 do Ambulatório, (no mínimo um ano após a cirurgia). Grupo-controle composto por 30 pessoas sem diagnóstico de câncer. Foram selecionadas 3 do ambulatório (20% do grupo de estudo) para as entrevistas. RESULTADOS: Demonstrou-se que ocorreram mudanças ou perdas de papéis ocupacionais, principalmente do papel de trabalhador. CONCLUSÃO: As consequências psicossociais e ocupacionais do câncer de cabeça e pescoço devem ser consideradas e cuidadas para um melhor e mais efi caz tratamento prestado a essa população.The head and neck cancer has a high incidence and high mortality and its diagnosis and treatment infl uence the occupational life of the diseased person and their family. OBJECTIVE: To know the configuration of the occupational roles of people with this type of cancer, undergoing total or partial laryngectomy. METHODS: A quantitative, exploratory cross-sectional study approved by the Ethics Committee (Proc. No. 1102/2010). We used the protocol “List of Identifi cation of Occupational Roles”, validated in Brazil; quantitative data were analyzed by chi-square test. Additional qualitative data were collected through open interviews and analyzed by the method of content analysis. PATIENTS: Study group with 30 persons served by Head and Neck Surgery (CCP), with 15 ward in the immediate post-surgical, outpatient and 15, (at least one year after surgery). Control group consisting of 30 people without cancer. Were selected from the outpatient clinic 3 (20% of the study group) for interviews. RESULTS: It was demonstrated that there were changes or loss of occupational roles, especially the role of worker. CONCLUSION: The psychosocial and occupational consequences of head and neck cancer should be considered and cared for better and more effective treatment provided to this population

Effect of singing training on total laryngectomees wearing a tracheoesophageal voice prosthesis

PURPOSE: To assess the effect of a program of singing training on the voice of total laryngectomees wearing tracheoesophageal voice prosthesis, considering the quality of alaryngeal phonation, vocal extension and the musical elements of tunning and legato. METHODS: Five laryngectomees wearing tracheoesophageal voice prosthesis completed the singing training program over a period of three months, with exploration of the strengthening of the respiratory muscles and vocalization and with evaluation of perceptive-auditory and singing voice being performed before and after 12 sessions of singing therapy. RESULTS: After the program of singing voice training, the quality of tracheoesophageal voice showed improvement or the persistence of the general degree of dysphonia for the emitted vowels and for the parameters of roughness and breathiness. For the vowel "a", the pitch was displaced to grave in two participants and to acute in one, and remained adequate in the others. A similar situation was observed also for the vowel "i". After the singing program, all participants presented tunning and most of them showed a greater presence of legato. The vocal extension improved in all participants. CONCLUSION: Singing training seems to have a favorable effect on the quality of tracheoesophageal phonation and on singing voice

Central mucoepidermoid carcinoma: Report of 2 cases

Central mucoepidermoid carcinoma is a rare mandibular neoplasm. The objective of this paper was to report two cases. (C) 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved