Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. Objective: This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. Methods: This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. Results: Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). Conclusion: Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered

Comparative study between total laryngectomy and organ preservation protocols in advanced laryngeal carcinoma

Introdução: Não há um consenso com relação às diferentes modalidades utilizadas para o tratamento do carcinoma avançado de laringe e seu efeito no prognóstico e função. Objetivo: Comparar os resultados de sobrevivência e funcionais de pacientes com câncer de laringe avançado submetidos a laringectomia total (LT) ou tratamento não-cirúrgico para preservação de órgão através de uma revisão sistemática e metanálise. Métodos: Realizada uma revisão da literatura nas bases MedLine, Scielo, Lilacs, Cochrane e EMBASE até setembro de 2019. A revisão sistemática e metanálise foram realizadas comparando a preservação de órgão e LT em pacientes com carcinoma de laringe avançado. Resultados: Quando analisados como um todo, o tratamento cirúrgico foi associado a melhores resultados de sobrevivência. Quando estratificados por estadiamento, enquanto paciente com estádio T4 tiveram menor risco de morte com a LT, não houve diferença significativa entre os tratamentos em paciente com tumores T3. Apesar de não haver relação com a ocorrência de complicações, a cirurgia esteve relacionada a menor chance de disfagia tardia e dependência de tubo para alimentação. Conclusão: Pacientes com tumores T4 deveriam ter a LT como tratamento de escolha. Para pacientes com estadiamento T3, não há diferença quanto ao risco de mortalidade em relação à opção terapêutica, entretanto, há um maior risco de disfagia quando não realizada a cirurgiaIntroduction: There is no consensus on how the treatment used for advanced laryngeal carcinoma cases can affect prognosis and functional results. Aim: To compare survival and functional outcomes of patients with advanced laryngeal carcinomas undergoing total laryngectomy (TL) or non-surgical organ preservation treatment through a systematic review and meta-analysis. Methods: The literature survey included research in MedLine, Scielo, Lilacs, Cochrane and EMBASE until September, 2019. A systematic review and metanalysis was made comparing organ preservation treatment and TL in patients with advanced laryngeal squamous cell carcinoma. Results: When analyzed as a whole, the surgical treatment was associated with better survival outcomes. When stratifying by T stage, while patients with T4 staging have less risk of mortality with TL, there is no difference between the different treatments for patients with T3 tumors. Although there is no relationship with the occurrence of complications, surgery is related to a lower chance of late dysphagia and dependence on feeding tube. Conclusion: Patients with T4 tumors should undergo TL as their treatment of choice. For patients with T3 tumors, there is no differences on the risk of mortality according to the therapeutic option, however, there is a greater chance of dysphagia when surgery is not performe

Aspiration Biopsy by Fine Needle of Cervical Adenopathy Guided by Ultrasonography

Introduction: The fine needle aspiration biopsy (FNAB) is deemed to be a diagnostic option replacing the lymph nodes open dissection. Nevertheless, the diagnosis obtained is frequently insufficient clinically. Objective: To evaluate the accuracy of FNAB diagnostic guided by ultrasonography (USG) in the cervical adenopathy approach. Methods: Consecutive series study of 186 patients who were submitted to retrospective USG-guided FNAB of cervical adenopathy. The final diagnosis was determined by the biopsy histopathological exam by excision of the lymph node when applied or clinical follow-up for more than one year. Sensitivity, specialty, predictive values and accuracy were evaluated. Results: There was a total of 54 malignancy diagnosis, five of tuberculosis and 127 of nonspecific chronic lymphadenitis. The sensitivity, specificity, predictive values of the negative and positive tests and FNAB accuracy were respectively of 79.5%, 99.1%, 88.2%, 98.3% and 91.4%. Conclusion: As the positive FNAB is highly predictive of the final histological diagnosis, the negative result must be carefully interpreted