Navegando por Palavras-chave "Disfagia"

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    Análise da fase faríngea da deglutição em indivíduos submetidos à cricohioidoepiglotopexia: Aspecto em “cascata” e angulação do hióide
    (Universidade Federal de São Paulo (UNIFESP), 2006-12-31) Catelan, Silvia Rovath César [UNIFESP]; Lederman, Henrique Manoel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose:. To describe anatomically the swallowing pattern on individuals underwent supracricoid partial laryngectomy (SCPL) reconstructed by cricohyoidoepiglottopexy (CHEP) technique and analyze the angulation of the hyoid bone as a risk factor for aspiration. Methods: Thirteen individuals, 11 males and 2 females were studied, and the median age was 63,5 (48 to 79). They underwent to SCPL-CHEP between March 1997 and September 2002, and were submitted to an Imaging Dynamic Swallowing Study (IDSS) in 2002 at the Imaging Diagnostic Department of the Sâo Paulo Federal University. Softwares Shortcut Premier 6.5 and Photoshop (Adobe) were used to capture and digitalize the selected images which were analyzed through visual observation. The angulations measurements of the hyoid bone were obtained using the software Image J of the National Institute of Health (NIH), running in a HP Pavilion zf1130 computer. The images were analyzed frame by frame by a radiologist and two speech patologists. Results: The study has revealed a cascade pattern of swallowing resultant from the remanescent structures position during oral and pharyngeal swallowing phases. Five individuals presented tracheal aspiration. The lower limit for the angulation of the hyoid bone for the individuals without aspiration was 60°. Conclusion: The individuals who underwent to a SCPL-CHEP presented a cascade swallowing pattern. The occurrence of tracheal aspiration was related to the angulation of the hyoid bone post-operatory.
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    Análise Da Interface Entre A Disfagia E As Implicações Nutricionais Nos Pacientes Com Doença Do Neurônio Motor
    (Universidade Federal de São Paulo (UNIFESP), 2017-01-31) Alves, Percilia Cardoso Lopes [UNIFESP]; Oliveira, Acary Souza Bulle [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Amyotriphic Lateral Sclerosis (ALS)is a disease in which there is impairment of the lower and upper motor neurons and the Bulbar Progressive Palsy (BPP) of the lower motor neuron of the brainstem; Both are within the Motor Neuron Disease (MND) group. Muscle weakness is a common sign that can trigger dysphagia. Purpose: To analyze the interaction between dysphagia and nutritional implications in the patient with MND. Method: Through observational, transversal, analytical and prospectiveresearch, 59 patients were evaluated, being 42 (71.18%) with ALS (47.62% male and 52.38%, female) and 17 (28.82%) with BPP (7 (41.17%) male and 17 (58.83%) female. The patients underwent speech therapy and nutritional evaluation; moreover, have been applied: functional range of consistencies (FOIS), scales of functionality (ALSFRS-R and EGELA) and respiratory assessment (peak cough flow).Results: 100% of patients with BPP presented oral and pharyngeal phase changes, while patients with ALS had less changes in oral (66.67%) and pharyngeal phase (73.80%). In nutritional evaluation, malnutrition was observed in 35.71% of patients with ALS and 23.52% of the patients with BPP. 28% (ALS) and 41.17% (BPP) of the patients made use of enteral route.Conclusion: Dysphagia was present in all patients with diagnosis of BPP, relating to increased frequency of malnutrition. Body mass index and Protein Energy Malnutrition score showed correlation with ALSFRS-R functionality. There was correlation between body mass indexes, the scale of food consistency (FOIS) and the peak cough flow.
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    Aspectos temporais da festinação lingual e da fase faríngea da deglutição em pacientes com Doença de Parkinson
    (Universidade Federal de São Paulo (UNIFESP), 2021) Santana, Suelen Correia [UNIFESP]; Goncalves, Maria Ines Rebelo [UNIFESP]; Universidade Federal de São Paulo
    Aspiration pneumonia is the leading cause of death in patients with Parkinson's disease (PD). In clinical practice, the videodeglutoesophagogram (VDEG) exam is the most common method for evaluating swallowing disorders. The results of this exam influence the recommendations of the speech therapist regarding the therapy and/or intervention of swallowing. Objective: To analyze lingual festination and temporal aspects of the pharyngeal phase of swallowing in individuals with PD, using videodeglutoesophagogram exams Method: Videodeglutoesophagogram (VDEG) images of 79 individuals were selected, 39 from the control group (CG). and 40 individuals from the Parkinson group (GP). The VDEG images were analyzed using the Virtual Dub program, considering the presence of FL and the beginning of the pharyngeal phase of swallowing the instant that the bolus goes beyond the posterior nasal spine and the end was measured in two moments: total entry of food into the esophagus (1) and relaxation of pharyngeal constriction (2). Data were statistically analyzed using the following tests: Chi-square, Wilcoxon and Mann-Whitney. Results: We identified lingual festination in 17.5% of the patients in the GP, and it was predominantly present in the beaten pasty consistency, the duration of the pharyngeal phase of swallowing 2 (DFFD2) was greater than the duration of the pharyngeal phase of swallowing 1 (DFFD1) regardless of sex, age, in the PD control groups. Conclusion: CL occurred in 17.5% (n=7) of the RG sample studied; in the 5% of patients in the PG that it was possible to measure the FL, we observed longer duration of the FL in the pasty consistency; there were significant differences between DFFD2 and DFFD1 in relation to age group and food consistencies, both in the CG and in the PG; laryngotracheal aspiration was not observed in the studied sample.
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    Avaliação Da Disfagia Em Pacientes Com Apneia Obstrutiva Do Sono
    (Universidade Federal de São Paulo (UNIFESP), 2017-07-31) Campanholo, Milena De Almeida Torres [UNIFESP]; Haddad, Fernanda Louise Martinho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: There is evidence that the trauma caused by snoring in the pharynx could cause dysphagia in patients with obstructive sleep apnea (OSA), but the literature is still scarce to define the factors associated with the presence of dysphagia in these patients. Sixty-seven patients with moderate or severe apnea (apnea and hypopnea index - AHI> 15 hours) were enrolled. The patients underwent a sleep questionnaire, a quality of life in dysphagia questionnaire (SWAL-Qol), a questionnaire on symptoms of Laryngopharyngeal Reflux (LRP), a Reflux Symptom Index (RSI), a score based on endolaryngeal videolaryngoscopic findings, a Reflux Finding Score (RFS) and a fiberoptic endoscopic evaluation of swallowing (FEES). Patients with at least one sign of alteration in FEES were considered as having dysphagia and clinical and polysomnographic parameters were compared between the groups. Results: 67 patients were included in the study, 49 men and 18 women, average age 46 ± 11 years. 26.86% of the patients had altered FEES, and the most frequent alteration was the early oral leak with fluid. Comparing the groups with and without dysphagia, men gender was the only clinical parameter that predominant in the group with dysphagia (p = 0.04). This finding was confirmed in the regression analysis (p = 0.01). There was no difference at polysomnographic features, presence of RFL and in the quality of life in the comparison between the groups. Conclusions: The presence of dysphagia in patients with moderate to severe apnea is frequent and subclinical, reinforcing the need to investigate this symptom in this group of patients, and the most frequent finding was the spillage with liquid trials. However, the presence of dysphagia did not impact patients' quality of life, suggesting that, although frequent, its repercussion is mild. There was no relevance in the association of clinical, polysomnographic parameters and the presence of LRP with the presence of dysphagia.
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    Avaliação da motilidade faríngea pela manometria de alta resolução em pacientes submetidos a tireoplastia tipo I
    (Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Pinna, Bruno de Rezende [UNIFESP]; Biase, Noemi Grigoletto de [UNIFESP]; Fernandes, Fernando Augusto Mardiros Herbella [UNIFESP]; http://lattes.cnpq.br/4035568020554599; http://lattes.cnpq.br/3156326658988323; http://lattes.cnpq.br/9966897407737956; Universidade Federal de São Paulo (UNIFESP)
    Objectives: This study aims to compare the motility of the pharynx and UES in patients with UVFI before and after thyroplasty type I. Methods: We prospectively studied 15 patients with UVFI that underwent thyroplasty type I. Subjects were divided according to the topography of vagal injury and presence of dysphagia. High resolution manometry (HRM) was performed before and 30 days after surgery. Time and pressure manometric parameters at the topography of the velopharynx, epiglottis and UES were recorded. Results: Dysphagia was present in 67% of patients. 73% had lower vagal injuries. Manometric parameters did not change after thyroplasty for the whole population. The group of dysphagic patients; however, had an increase in residual pressure at the UES after thyroplasty (1.2 vs. 5.2 mmHg - p=0.05). Patients with low vagal injury developed higher peak pressure (100 vs. 108.9 mmHg - p=<0.001); lower rise time (347 vs. 330 ms - p=0.04); and higher up stroke (260 vs. 266.2 mmHg/ms p= 0.04) at the topography of the velopharynx after thyroplasty. Conclusion: Pharyngeal motility is affected by thyroplasty type I in patients with dysphagia and low vagal injury.
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    Avaliação de disfagia após aplicação de toxina botulínica em músculo tireoaritenoideo
    (Universidade Federal de São Paulo (UNIFESP), 2019-05-30) Haidar, Raissa Ferreira Goncalves [UNIFESP]; Biase, Noemi Grigoletto De [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To verify the frequency and degree of dysphagia presented by patients submitted to the application of botulinum toxin in thyroarytenoid muscle. Also to identifying the risk factors for the presentation of this swallowing disorder. Methods: 20 patients participated in the study. All participants were submitted to the application of botulinum toxin with the aid of electromyography. For evaluation of dysphagia, fiberoptic endoscopic evaluation of swallowing was used. The examination was performed twice, one before the application of botulinum toxin and other on the 7th day after application. The exam was recorded and later analyzed by 2 otorhinolaryngologists. The data were then computed and sent to the analysis. Results: 90% of the patients were female and the mean age was 62.8 years. 45% had a diagnosis of laryngeal dystonia of adduction, 40% of dystonic tremor, 10% of dysphonia due to musculoskeletal tension and 5% of essential tremor. In the fiberoptic endoscoy evaluation of swallowing before the application of botulinum toxin, 40% of the patients presented some alteration in the examination characterizing the presence of dysphagia (0% aspiration, 15% penetration and 35% presence of residues). When we repeated the test 7 days after the application of botulinum toxin, the frequency of patients with dysphagia in the sample increased to 75% (10% aspiration, 25% penetration and 65% presence of residues).Conclusion: When evaluating dysphagia with fiberoptic endoscopy evaluation of swallowing, we conclude that the application of botulinum toxin increased the frequency of dysphagia in the sample by 35 percentage points. Most of the patients presented, after the botulinum toxin, mild dysphagia, characterized only by the presence of residues. The presence of aspiration occurred only in patients who had previously dysphagic alterations.
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    Caracterização do risco de disfagia em paciente com doença de Parkinson
    (Universidade Federal de São Paulo, 2021) Costa, Edneia Maurer [UNIFESP]; Bommarito, Silvana [UNIFESP]; http://lattes.cnpq.br/5606969949793059; http://lattes.cnpq.br/8868259447609563
    Introdução: Depois da Doença de Alzheimer (DA), a Doença de Parkinson (DP) é a doença neurodegenerativa mais comum, acometendo homens e mulheres, independentemente de suas etnias e ocupações. A disfagia costuma afetar 80% dos pacientes com DP podendo levar a óbito. Objetivo: Caracterizar o risco de disfagia do paciente com Doença de Parkinson, segundo a escala Hoehn & Yahr. Metodologia: Estudo clínico e prospectivo CEP n: 0661/2017. A amostra foi composta por 150 indivíduos divididos (grupo experimental – GE com faixa etária entre 56 e 82 anos e um grupo controle – GC com 80 indivíduos com faixa etária entre 63 e 97 anos). O GE apresentava diagnóstico de DP Idiopática com medicação estável, sem atendimento prévio no serviço de Fonoaudiologia e o GC indivíduos que não apresentavam queixas relacionadas à deglutição ou diagnóstico prévio de disfagia. Toda a amostra respondeu o protocolo Mini Exame de Estado Mental – MEEM e o EAT-10 e o GE ainda foi avaliado, por uma fisioterapeuta, segundo a Escala Modificada de incapacidade Hoehn e Yahr, Shenkman et al 2001; Horta, 1996 para indicar o grau de deficiência da incapacidade clínica. Resultados: Do total de 70 pacientes com Doença de Parkinson, 22, ou seja, 31,45% obtiveram no protocolo EAT-10, escore igual ou maior que 3. Dentre esses, os pacientes encontram-se todos os estágios da escala de, exceto o estágio 01. Houve, correlação estatisticamente significante entre o total do EAT-10 e a escolaridade em anos (rho=-0,27, p-valor=0,025) e MEEM (rho=-0,26, p-valor=0,030); a questão 10 e hipertensão arterial sistêmica (HAS) (rho=0,25, p-valor=0,043); questão 09 e escolaridade em anos (rho=-0,24, p-valor=0,045), estágio da DP (rho=0,33, p-valor=0,006) e MEEM (rho=-0,28, p-valor=0,022). Na questão 04 encontrou-se correlação estatisticamente significante entre escolaridade em anos (rho=-0,26, p-valor=0,029), diabetes mellitus (DM) (rho=0,26, p-valor=0,035) e MEEM (rho=-0,32, p-valor=0,007). Na questão 02 identificou-se correlação estatisticamente significante entre essa questão do EAT 10 e o estágio da DP (rho=0,30, p-valor=0,013). Conclusão: A disfagia se mostrou presente a partir do estágio 1,5 da Doença de Parkinson. Houve relação direta da autopercepção da disfagia com a maior pontuação na escala Hoehn & Yahr na DP, estando os maiores valores alcançados no total do EAT-10 associados a baixa escolaridade e, menores resultados do MEEM. As comorbidades hipertensão e diabetes mellitus apresentaram relação direta nas respostas a respeito "engolir me deixa estressado" e "preciso fazer força para engolir" respectivamente.
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    Correlação entre contratilidade esofágica e força muscular esquelética em indivíduos saudáveis
    (Universidade Federal de São Paulo, 2024-02-02) Andrade, Marcel Lima [UNIFESP]; Fernandes, Fernando Augusto Mardiros Herbella [UNIFESP]; Katayama, Rafael Cauê [UNIFESP]; http://lattes.cnpq.br/8333349236057831; http://lattes.cnpq.br/4035568020554599; http://lattes.cnpq.br/1435125702975315
    Objetivo: avaliar a correlação entre contratilidade esofágica e força muscular esquelética em voluntários saudáveis. Métodos: Foi realizado estudo de teste diagnóstico com 20 voluntários saudáveis do sexo masculino entre 20 e 40 anos. Foram avaliados dados demográficos e antropométricos (idade, massa, altura e calculado o índice de massa corpórea). A força muscular esquelética da mão dominante foi mensurada por meio do teste de preensão palmar com um dinamômetro digital, sendo aferida por três vezes e então utilizada a média das medidas aferida em quilogramas (kg). Os voluntários foram submetidos à manometria esofágica de alta resolução, sendo mensurado a integral de contração distal (ICD) e integral de contração proximal (ICP). Variáveis paramétricas foram expressas em média ± desvio padrão (variação) e realizada correlação entre elas foi calculada através do teste de Pearson, considerando como significante p<0,05. Resultados: A idade média dos voluntários foi de 30,85 ± 2,41 (30-36) anos, massa média de 74,90 ± 5,09 (63,52 – 87,13) kg e altura média de 1,77 ± 0,05 (1,70 – 1,87) m. A média das 3 mensurações da força de preensão foi de 39,77 ± 5,27 (28,87 – 49,33) kg. A média das 10 deglutições da DCI foi de 1394,96 ± 753,76 (302,06 – 3209,11) mmHg.s.cm, enquanto das 10 deglutições da PCI foi de 362,01 ± 354,75 (58,8 – 707,10) mmHg.s.cm. Não foi observada correlação linear entre as variáveis força de preensão palmar e DCI (R = 0,0969, p = 0,684) e entre as variáveis força de preensão palmar e PCI (R = 0,0455, p = 0,213). Conclusões: Não houve correlação entre força muscular esquelética e contratilidade esofágica em indivíduos saudáveis.
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    Distância base de língua - parede posterior da faringe, aspiração laringotraqueal e resíduos faríngeos pós acidente vascular cerebral
    (Universidade Federal de São Paulo (UNIFESP), 2021) Zica, Guilherme Maia [UNIFESP]; Goncalves, Maria Ines Rebelo [UNIFESP]; Universidade Federal de São Paulo
    Objective: To investigate the association between base tongue-posterior pharyngeal wall distance (BT-PPW) at rest with supraglottic penetration, laryngotracheal aspiration and pharyngeal residues in individuals after stroke. Method: Descriptive, cross-sectional and retrospective study of swallowing videofluoroscopy exams in 56 patients with medical diagnosis of stroke and a control group with 84 individuals. The distance between the base of the tongue and the posterior wall of the pharynx at rest was measured using the Image J program. The measure found was correlated with the sociodemographic characteristics and the clinical findings of swallowing. Results: Regarding the BT-PPW measures, statistical significance was observed in relation to gender; male patients had greater distance means than female patients (M>F). Regarding the BT-PPW measures, statistical significance was observed in relation to age; being that elderly patients had greater distance means than adult patients (elderly>adults). Conclusions: Male patients had significantly greater distance means than female patients (M>F). Elderly patients had significantly higher mean distances than adult patients (elderly>adults). There were no statistically significant correlations in relation to the BT-PPW distance with the swallowing findings (penetration, aspiration and residues).
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    Fluxo salivar e sua relação entre percepção de xerostomia e sintomas de disfagia na Doença de Parkinson
    (Universidade Federal de São Paulo, 2024-10-02) Brito, Cássia Lumenna Silva [UNIFESP]; Bommarito, Silvana [UNIFESP]; Said, Angelica da Veiga [UNIFESP]; Castelo, Paula Midori [UNIFESP]; http://lattes.cnpq.br/4999433899060641; http://lattes.cnpq.br/4525318283387445; http://lattes.cnpq.br/5606969949793059; https://lattes.cnpq.br/4238331977509845
    Introdução: A Doença de Parkinson (DP) é uma doença crônica e progressiva do sistema nervoso central, e as disfunções gastrointestinais, incluindo hipersialorréia, disfagia e constipação, foram inicialmente descritas no relatório original de James Parkinson. A saliva é um componente importante para a formação do bolo alimentar e deglutição,desse modo, é importante analisar possíveis alterações no mecanismo salivar do indivíduo com DP, como a hipersialorreia, e a percepção de xerostomia, e como elas podem impactar a capacidade deglutitória de um indivíduo.Objetivo: Avaliar o fluxo salivar, estimulado e não estimulado, de indivíduos com Doença de Parkinson e relacionar os achados com a percepção de xerostomia e sintomas de disfagia. Metodologia: Foi selecionada uma base de dados secundários coletada de um estudo clínico e prospectivo aprovado pelo Comitê de Ética da Universidade Federal de São Paulo– UNIFESP/EPM sob o parecer nº 4.957.768. Uma amostra de conveniência foi selecionada e formada por 66 adultos com idades entre 40 e 85 anos, 36 homens e 30 mulheres, com diagnóstico de DP em acompanhamento na Associação Brasil Parkinson, em São Paulo, Brasil. E foi formado um grupo controle pareado, com a participação de 30 adultos não portadores da DP. A amostra passou por uma anamnese, avaliação cognitiva, avaliação dos sintomas de disfagia, avaliação da percepção da xerostomia e avaliação do fluxo salivar. Foram coletadas amostras de saliva estimulada e não estimulada e em seguida, pesadas em gramas para posterior conversão em mL. A análise estatística foi realizada através dos testes Qui-Quadrado, t-Student e Wilcoxon, também calculou-se a correlação de Spearman utilizando-se o software STATA/MP 18.0 for Windows (StataCorp, 2023. College Station, TX, USA: StataCorp LLC). Resultados: Os indivíduos com DP apresentaram uma maior média de saliva não estimulada comparada ao gupo controle. Houve risco para disfagia na DP, sem relação com o aumento médio de saliva. A percepção de xerostomia foi maior na DP; Houve aumento da percepção à medida que o fluxo não estimulado diminui no controle, e correlação entre o fluxo estimulado e a xerostomia no grupo DP, à medida que a xerostomia aumenta o fluxo estimulado diminui no grupo DP, sem correlação no controle. Conclusões: Fica evidente a importância da manutenção deste fluido e do cuidado multiprofissional para com os indivíduos portadores da DP.
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    Impacto Da Tireoplastia Tipo I Na Qualidade De Vida Relacionada A Disfagia De Pacientes Com Imobilidade De Prega Vocal Unilateral
    (Universidade Federal de São Paulo (UNIFESP), 2018-03-29) Castro, Thaiana Carneiro De [UNIFESP]; Haddad, Fernanda Louise Martinho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction Dysphagia Can Lead To Functional Limitations And Complications That Compromise An Individual's Quality Of Life. Patients With Laryngeal Immobility May Have Dysphonia And Dysphagia, But Studies Evaluating The Impact Of Surgical Treatment By Thyroplasty On The Improvement Of Dysphagia Are Scarce In The Literature. Objective To Evaluate The Impact Of Type I Thyroplasty On The Improvement Of Dysphagia-Related Quality Of Life In Patients With Unilateral Vocal Fold Immobility. Method This Is An Observational, Prospective And Longitudinal Study. Eleven Patients With Dysphagia, Who Had Type I Thyroplasty Due To Vocal Fold Immobility, Were Evaluated Through The Questionnaire "Quality Of Life In Swallowing Disorders" (Swal Qol). The Findings Were Compared Without Pre And Postoperative. Results The Mean Age Was 46.6 ± 17.1 Years, With Female Predominance (72.7%) And Left Side Immobility 5 (54.5%). An Average Score In All Domains Of Swal Qol Showed Improvement After Surgical Intervention. The Domain With The
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    A influência da idade na deglutição orofaríngea de adultos e idosos saudáveis
    (Universidade Federal de São Paulo, 2024-06-11) Dall’Oglio, Giovana Piovesan [UNIFESP]; Abrahão, Márcio [UNIFESP]; http://lattes.cnpq.br/4440305851848835; http://lattes.cnpq.br/3483387711312494
    Objetivos: Caracterizar o perfil da deglutição da população adulta e idosa saudável, avaliar a autopercepção da deglutição através do questionário EAT-10, avaliar a concordância entre os examinadores quanto aos parâmetros da VED, identificar sinais (parâmetros qualitativos) sugestivos do desenvolvimento da disfagia e a influência da idade na deglutição. Métodos: Foram recrutados 184 voluntários adultos a partir dos 20 anos de idade. Os voluntários responderam ao questionário EAT-10 e foram submetidos à videoendoscopia da deglutição (VED). Os achados da avaliação instrumental foram descritos conforme faixa etária e relacionados às questões do EAT-10. Resultados: A idade variou de 20 a 97 anos, sendo 86 homens (46,7%). Não houve correlação do questionário EAT-10 com a idade ou com os achados da VED. O perfil da deglutição do adulto saudável se caracterizou por ausência de escape posterior, disparo do reflexo da deglutição até a valécula, clareamento total do alimento em 2 deglutições para todas as consistências ofertadas em mais de 90% dos casos. Não sequenciamento da deglutição, estase salivar, resíduo, penetração e aspiração (variáveis de interesse) de uma ou mais consistências foram encontrados respectivamente em 3,8%, 3,26%, 13,6%, 4,89% e 0,5% da amostra. Houve associação estatisticamente significativa entre a presença de estase salivar e idade, assim como do resíduo total (R-total: todas as consistências) e idade. A maior proporção de presença de estase salivar e R-total ocorreu na faixa etária ≥80 anos (p=0,039). Nossos resultados não mostraram associação estatisticamente significativa entre penetração e idade. Não houve significância estatística na associação entre as variáveis de interesse na VED (p≤0,05), exceto para a associação penetração e resíduo (p=0,003). Conclusões: O perfil da deglutição da população adulta e idosa saudável foi determinado. O questionário EAT-10 não se mostrou útil na autopercepção de disfagia. Houve alto valor de concordância entre os examinadores para todos os parâmetros. A presença de resíduo infere alteração da eficiência da deglutição, portanto disfagia, e quando associado à penetração reforça o diagnóstico de disfagia e infere alteração da segurança da deglutição. A idade não influencia a deglutição de adultos e idosos saudáveis de forma linear, porém, a população com idade superior a 80 anos mostrou predomínio dos achados sugestivos de disfagia. Estes dados representam novos valores de referência, que poderão ser utilizados como comparativos em trabalhos futuros.
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    Prevalência de alterações de deglutição em idosos sem sequelas neurológicas: perfil da deglutição do idoso do município de Santos/SP
    (Universidade Federal de São Paulo (UNIFESP), 2020-08-13) Diaz, Juliana Gonzalez [UNIFESP]; Lombardi Júnior, Imperio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Several studies report that 40 to 60% of older people have some difficulty chewing and/or swallowing, which can lead to malnutrition, dehydration, weight loss, a lack of eating desire, etc. ​Objective: ​Identify older adults with swallowing difficulties in the city of Santos, Brazil, among users of the public healthcare system. ​Methods: A cross-sectional study was conducted with 100 individuals aged 60 to 90 years with no neurological disorders. Patient histories were taken and a stomatognathic evaluations were performed. The Mini Mental Health Examination and swallowing-related quality of life questionnaire (SWAL-QOL) were administered. The clinical swallowing assessment was performed with liquid, pasty, and solid foods using two assessment protocols. ​Results: ​We found complaints of poorly adapted dentures among 49.3% of denture wearers and a high incidence of hypofunction of orofacial muscles. Sixty-five percent of the respondents had facial muscle hypofunction, 51% exhibited lip hypofunction, and 49% exhibited tongue hypofunction. Moreover, 54% reported difficulty swallowing. On the SWAL-QOL questionnaire, 37% reported choking when eating food, 44% reported choking when drinking liquids, 29% reported coughing during meals, and 77% reported difficulty chewing. Conclusions: ​The present study revealed an important incidence of complaints related to swallowing difficulties among older people in the city of Santos characteristic of presbyphagia, with structural and physiological changes. The most prevalent conditions were poorly adapted dentures and hypofunction of orofacial muscles, underscoring the importance of stomatognathic interventions in primary care.
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    Proposta de um programa de terapia fonoaudiológica em pacientes com ataxia espinocerebelar tipo 3
    (Universidade Federal de São Paulo (UNIFESP), 2020-09-22) Diaferia, Giovana Lucia Azevedo [UNIFESP]; Barsottini, Orlando Graziani Povoas [UNIFESP]; Universidade Federal de São Paulo
    Spinocerebellar ataxia type 3 (SCA3) is a degenerative disease that is inherited in an autosomal dominant pattern. It is caused by a mutation located on the chromosome 14q resulting in abnormal CAG triplet repeats. It affects different population groups with an estimated prevalence of 1:100,000 in Brazil. This disease usually manifests between 30 and 50 years of age and first symptoms include ataxia, gait disturbance and abnormal ocular motricity. The degenerative process underlying SCA3 affects many different regions and/or functions of the central nervous system (CNS) and the peripheral nervous system (PNS) including areas and pathways that are involved in motor speech and swallowing. With progression of the disease, individuals with SCA3 exhibit communication and swallowing deterioration. Speech-language interventions for speech, voice and swallowing problems are important because patients with difficulty swallowing are at risk of repeated aspiration and dysarthria affects normal socialization. Objectives: To evaluate the impact of a speech therapy rehabilitation program on phonoarticulation, voice, swallowing and quality of life (QoL) of patients with SCA3. Methods: All participants were randomly assigned to two groups, an intervention group receiving speech therapy (STG) and a control group (CG). The intervention comprised a 12-session speech therapy rehabilitation program consisting of oral, pharyngeal and laryngeal strengthening exercises—so-called ATAXIA – Myofunctional Orofacial and Vocal Therapy (A-MOVT). All participants underwent pre- and post-intervention clinical evaluations using a phonoarticulation assessment tool developed by the Mayo Clinic; nasofibrolaryngoscopy; videoendoscopic swallowing study; and orofacial motricity assessment based on Expanded Protocol of Orofacial Myofunctional Evaluation with Scores (OMES). They were also assessed by four different QoL instruments: The World Health Organization's Quality of Life (WHOQoL-Bref); Living with Dysarthria, (LwD); Quality of Life in Swallowing Disorders (SWAL-QoL); and EAT-10 Food Assessment Tool. Results: The study sample included 48 patients with SCA3 (STG = 25; CG = 23), 33 (69%) females and 15 (31%) males; mean age 47.1±11.4 years; mean age at symptom onset 36.9±11.3 years; and disease duration 11.9±13.3 years. The International Cooperative Ataxia Rating Scale (ICARS) scores were 32.4±20.2 and the Scale for the Assessment and Rating of Ataxia (SARA) scores were 11.8±8.0. At the end of the three-month intervention, the STG showed significant improvements in dysphagia (0.56±0.87 [pre-] vs. 0.00±0.00 [post-]; p<0.001); dysarthria (1.92±0.27 [pre-] vs. 0.84±0.62 [post-], p<0.001); and orofacial motricity (153.00±16.12 [pre-] vs. 205.44±27.55 [post-], p<0.001). There were significant changes in the QoL in the STG compared to the CG when assessed by the LwD (179.12±62.55 vs. 129.88±51.42, p<0.001), SWAL-QoL (79.04±13.97 vs. 82.87±11.91, p=0.010) and EAT-10 (5.16±7.55 vs. 2.08±3.85, p=0.018). Conclusions: Patients with SCA3 should receive continuous speech therapy as part of the A-MOVT program since rehabilitation therapy improves difficulty swallowing and dysarthria.
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    Reabilitação fonoaudiológica da disfagia em pacientes pediátricos com tumor encefálico
    (Universidade Federal de São Paulo (UNIFESP), 2010-02-24) Radzinsky, Tatiana Couto [UNIFESP]; Gonçalves, Maria Inês Rebelo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To verify the efficacy of the dysphagia therapy performed by speech pathologists in pediatric patients with brain tumors using the Functional Oral Intake Scale (FOIS; Crary et al, 2005). Materials and Methods: The sample consisted children and adolescents with central nervous system tumors (23 male and 8 female), ages ranging from 11 months to 22 years old. Was performed a retrospective charts review of patients with central nervous system tumors and diagnosed oropharyngeal dysphagia, that were submitted to swallowing rehabilitation during internment period at the Pediatric Oncology Institute (IOP/GRAACC/UNIFESP) in the period from September 2003 to July 2009. To obtain the data, an evolution chart protocol was created, comprising patient’s identification, gender, initial diagnosis, underlying disease, injury site, speech-language diagnosis, specific tumor treatment, speech-language evaluation date, speech-language discharge date, number of speech-language therapy sessions, complications during the therapy period, respiratory conditions, and intubation period. Was used the Functional Oral Intake Scale (FOIS), a functional feeding evaluation scale, enabling to classify the patient according to the feeding intake (Crary, 2005). In addition, for speech-language diagnosis definition, and modified version of the Dysphagia Outcome and Severity Scale (O’Neil, 1999) was utilized. The scores were registered during the pre therapy period (speech-language functional evaluation) and post therapy. Improvement was considered when there was a change in the score to level 5 or higher, and decline when the score changed level 5 or lower. Results: All 31 patients showed improvement in the FOIS scale level after speech-language therapy. Level 5 or higher was achieved by 17 (54.8%) and was observed that 14 patients (45.2%) maintained the same FOIS level, not evolving as adequately. Results show that 19 patients (61.7%) presented severe dysphagia during the pre therapy period, out of those 11 (57.9%) managed to evolve to mild dysphagia, functional deglutition or normal deglutition. The dysphagia severity degree lowered in the post therapy on 21 patients (67.7%) while 10 (32.3%) maintained the same score. Conclusion: The patients that showed major improvement on the FOIS level had few clinical complications, tumors with better prognosis, and mean age of 12 years, whereas the patients that evolved in a less significant manner all presented clinical complications (decreased level of alertness and/or worsening of the clinical picture), tumors with bad prognosis (glioblastoma multiform stage IV, anaplasic ependymoma stage II, high-grade meduloblastoma, and brainstem glioma), in addition to mean age of 7.8 years.
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    Refluxo esôfago-esofágico em adultos: queixas e classificação da disfagia
    (Universidade Federal de São Paulo, 2021-12-03) Silva, Gizella Malvina da [UNIFESP]; Gonçalves, Maria Inês Rebelo [UNIFESP]; Oliveira Neto, Isabella Christina; http://lattes.cnpq.br/3179651142271447; http://lattes.cnpq.br/9327083927146744
    Introdução: As fases da deglutição são: oral, faríngea e esofágica. Um distúrbio no processo da deglutição é chamado de disfagia, podendo acarretar uma vulnerabilidade do indivíduo, como comprometimento pulmonar e hidronutritivo. O videodeglutoesofagograma permite visualizar e avaliar a segurança da alimentação por via oral. Objetivo: Verificar se pacientes adultos com refluxo esofago-esofágico analisados por videodeglutoesofagograma da deglutição apresentam queixas de disfagia, e classificar a disfagia quando presente. Método: O estudo analisou por meio de laudos de videodeglutoesofagograma pacientes com refluxo esôfago-esofágico com e sem disfagia. Resultados: As queixas mais apresentadas, em indivíduos disfágicos e não disfágicos foram, respectivamente: pigarro (17% e 54,7%), dificuldade de engolir (17% e 13,2%), azia (17% e 52,8%), engasgos (12,8% e 18,9%) e sensação de alimento parado/incômodo (6,4% e 9,4%. Os pacientes apresentaram disfagias orofaríngeas (95%) e faringoesofágica (4,2%), sendo que o grau da disfagia foi 37% leve, 20,8% leve para moderada, 33,3% moderado e 8,9% grave. Conclusões: As queixas mais apresentadas em indivíduos disfágicos foram, em ordem decrescente: pigarro, dificuldade de engolir, azia/queimação, engasgo e sensação de alimento parado/incômodo. Nos pacientes não disfágicos a ordem decrescente de queixas foi, respectivamente: pigarro, azia, engasgo, dificuldade de engolir e sensação de alimento parado/incômodo. Quanto ao local da disfagia 95% dos pacientes disfágicos apresentou disfagia orofaríngea e 4,2% disfagia faringoesofágica. Os graus de disfagia foram: leve com 37.5%, leve para moderado 20,8%, moderado 33,3% e grave 8,9%.
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    Tempo de intubação orotraqueal e disfagia: incidência, intervenção fonoaudiológica e indicadores de prognóstico na reabilitação
    (Universidade Federal de São Paulo (UNIFESP), 2018-02-22) Lobrigate, Nadia Lais [UNIFESP]; Goncalves, Maria Ines Rebelo [UNIFESP]; http://lattes.cnpq.br/9327083927146744; http://lattes.cnpq.br/7781220439331958; Universidade Federal de São Paulo (UNIFESP)
    OBJETIVOS: Avaliar a incidência da disfagia segundo tempo de intubação orotraqueal; verificar a eficiência da reabilitação fonoaudiológica segundo o tempo de intubação orotraqueal, além de verificar os indicadores de prognóstico dos pacientes disfágicos que atingiram níveis funcional ou normal nas escalas durante a reabilitação. MÉTODO: Estudo observacional, analítico e retrospectivo, realizado no Serviço Integrado de Fonoaudiologia (SIF) do Hospital São Paulo, por meio da análise dos prontuários de 91 pacientes que estiveram internados na UTI geral entre os anos de 2014 e 2016, submetidos à intubação orotraqueal por período superior a 24 horas e sem alterações neurológicas. Os pacientes foram divididos em GI, GII e GIII, de acordo com o tempo de intubação orotraqueal e foram submetidos à avaliação inicial e final visando a classificação da funcionalidade da alimentação e gravidade da disfagia, de acordo com as Escalas FOIS e DOSS. O banco de dados coletado foi registrado no programa EXCEL e os dados foram analisados estatisticamente por meio dos testes tindependente e os testes de ANOVA, conforme conveniência. RESULTADOS: 48,35% da amostra total apresentaram disfagia após a extubação. A reabilitação fonoaudiológica foi benéfica para a maioria dos pacientes (n=36; 81,81%), uma vez que conseguiram evoluir o nível de ingestão de alimento por via oral e reduzir a gravidade da disfagia. O número de terapias e a ausência de intercorrências durante o tratamento foi significante para a melhora dos pacientes nas escalas, sendo que os pacientes que melhoraram receberam, significantemente, maior número de terapias e apresentaram menos presença de intercorrências, comparandoos às pessoas que não melhoraram. O indicador significante de prognóstico de bons resultados de tratamento foi a ausência de intercorrências durante a reabilitação. CONCLUSÕES: Pacientes submetidos à intubação orotraqueal, independente de sua duração. A reabilitação fonoaudiológica foi eficiente em todos os grupos. Os indicadores de prognóstico que influenciaram na melhora da deglutição foram: maior número de sessões de fonoterapia e ausência de intercorrências durante o período da reabilitação. O tempo de IOT foi diretamente proporcional ao tempo de uso de VAA e ao tempo de internação hospitalar. O reestabelecimento da deglutição até os níveis funcional e normal foi possível nos pacientes que apresentaram menor número de intercorrências. As escalas FOIS e DOSS apresentaram nível de associação significante.
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    Tradução, equivalência cultural e validacão do questionário Munich Dysphagia test - Parkinson Disease (MDT-PD) para o português brasileiro
    (Universidade Federal de São Paulo (UNIFESP), 2019-02-22) Almeida, Luciana Escanoela Zanato [UNIFESP]; Monteiro, Silvana Bommarito [UNIFESP]; http://lattes.cnpq.br/5606969949793059; http://lattes.cnpq.br/1061663287250889; Universidade Federal de São Paulo (UNIFESP)
    Objective: to translate and validate the Brazilian version of the protocol The MunichDysphagiatest and Parkinson'sDisease (MDT-PD) Methods: A total of 102 individuals with Parkinson's disease and 95 elderly individuals who were the control group were evaluated. The objective of this study was to evaluate the Brazilian version of the Munich Dysphagia test and Parkinson's disease (MDT-PD) protocol. The translation and adaptation were performed according to the criteria of the Scientific Advisory Committee of the Medical Outcomes Trust following the steps: 1- Language and cultural translation and adaptation; 2-Validity of construct and criterion; 3-Reliability; 4- Sensitivity. Results: At the stage of translation and cultural equivalence, there were no intercurrences in the translation process, nor the need to withdraw any question, arriving at the Brazilian Portuguese version titled Dysphagia Test of Munich (TDM-DP), which presents 26 questions, in the same way as the original instrument. Regarding the validation steps, of the psychometric measures, it was possible to validate the construct, since the instrument was able to detect statistically significant differences in the self-assessment. In addition, it was possible to verify by means of regression models that there was a significant positive relation of the TDM-DP test with other instruments already validated for Brazilian Portuguese, confirming the validation of criterion. Regarding the reliability, it was possible to verify that all the questions were positively correlated. The Cronbach's alpha of 0.91 indicated that the assumption of internal consistency of the questionnaire was adequate. It was observed that the value of the intraclass correlation coefficient between the test and retest moments showed a satisfactory agreement for the complete group (r = 0.680), with respect to the sensitivity there was a difference between the pre- and post-intervention moments, with a significant reduction of the score of TDM after the intervention (p = 0.008). Conclusion: The instrument showed to have the psychometric properties necessary for the screening of the risk of dysphagia for patients with Parkinson's disease, being validated for Brazilian Portuguese with the name "Munich Dysphagia Test - Parkinson's Disease (TDM-DP)".
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    Ultrassonografia endoscópico como auxiliar no diagnóstico de esofagite eosinofílica
    (Universidade Federal de São Paulo (UNIFESP), 2021) Ferrelli, Regis Schander [UNIFESP]; Machado, Rodrigo Strehl [UNIFESP]; Universidade Federal de São Paulo
    Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by symptoms of esophageal dysfunction and histologically by inflammation with a predominance of eosinophilic infiltrate, which can lead to fibrosis and consequent increase in the esophageal wall thickness. Therefore, an endosonographic evaluation may help the diagnosis. General Objective: To measure the thickness of the esophageal wall in children and adolescents submitted to upper digestive endoscopy (UDE) using a radial endosonographic device. Specific Objectives: To measure mucosal / submucosal (MSM) thickness, muscularis propria layer (MP) and mucosa to muscularis propria layer (MMP) in children and adolescents submitted to UDE; to compare these measurements between patients with and without EoE; to correlate them with the endoscopic severity measured by the EREFS (Endoscopic Reference Score); and to evaluate the diagnostic accuracy of the esophageal thickness measurements. Methods: Prospective cross-sectional study. Twenty-six patients undergoing UDE in a Tertiary Hospital due to dyspeptic symptoms were included. Exclusion criteria: refusal to participate, eosinophilic gastroenteritis, inflammatory bowel disease, blood dyscrasia, achalasia, eosinophilic syndrome, vasculitis, dermatological conditions with esophageal involvement, graft-versus-host disease, genetic disorders, and intermediate eosinophil counts in the esophageal mucosa (5 -15 / high-power field). UDE was performed with a radial ultrasound endoscope at 12 Hz frequency. Macroscopic changes were graded according to the EREFS score, esophageal layer thickness was measured in the distal and middle thirds (thickness of MSM, MP, MMP). Finally, esophageal biopsies were collected. EoE was defined, histologically, by the presence of 15 or more eosinophils/high-power field in the esophageal epithelium. Esophageal wall thicknesses in general were compared in groups according to the occurrence or not of EoE, endoscopic and histological changes. Accuracy of the measurements for the diagnosis of EoE was assessed by ROC (receiver operating characteristics) curve analysis. Results: 26 (M19 / F7) patients (median age 10.83 years, range 5.65 - 17.46) were evaluated. Most prevalent symptoms: abdominal pain (57.7%) dysphagia (34.6%), malabsorption syndrome (34.6%), vomiting (26.9%), miscellaneous (19.2%), reflux (15.4%) and food impaction (15.4%). EoE was diagnosed in 6 patients, who presented more frequently endoscopic abnormalities (5/6 vs 5/20, P = 0.018). The mean (standard deviation) esophageal wall thickness in the distal third of the EoE and non-EoE group, in millimeters, were respectively: MSM 1.07 (0.44) and 1.11 (0.33); MP 0.67 (0.25) and 0.60 (0.19); and MMP 1.73 (0.46) and 1.72 (0.32). Mid esophagus measurements were, respectively: MSM 1.16 (0.34) and 1.15 (0.34); MP 0.63 (0.16) and 0.60 (0.2); and MMP 1.79 (0.41) and 1.74 (0.34). In ROC curve analysis, the distal MP layer thickness presented better discriminative performance, with an area under the curve of 0.61 (95% CI 0.28 to 0.93) at 0.73mm cutoff (sensitivity 66.67 %, 80% specificity, likelihood ratio of 3.33 for positive and 0.42 for negative test). Conclusion: The evaluation of esophageal thickness measurements by endosonography was feasible in children aging over 4 years of age, but there was no difference between patients with and without EoE. Thus, endosonography with a radial ultrasound endoscope did not add relevant information to the endoscopic exam for the diagnosis of EoE.