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- ItemAcesso aberto (Open Access)Achados fonoaudiológicos em pacientes submetidos a anastomose hipoglosso facial(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2003-06-01) Silva, Elisabete C. C. F. [UNIFESP]; Testa, Jose Ricardo Gurgel [UNIFESP]; Fukuda, Yotaka [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Bandeirantes de São Paulo Ciências da Reabilitação Neuro-MotoraThe hypoglossal-facial anastomosis (HFA) have been related in patients with facial nerve lesion where proximal segment more other surgical produceres had been faited or had not been possible success. AIM: The objective of the present research is to verify the evidence of mobility in the phonoarticulate organs, speech function, chew and swallowing in patients sujected to HFA. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Eight patients with peripheral facial paralysis (PFP) were evaluated and subjected to HFA at UNIFESP/EPM in the period from 1989 to 2000, with 6 females and 2 males, aged between 21 and 71 years with an average of 50 years. Of these, 5 after exeresis of Acoustic Neurinoma, 1 after exeresis of Fibrosarcoma, 1 after a gunshot wound and 1 after idiopathic peripheral facial paralysis of poor evolution. In the phonoaudiological evaluation, the protocol used involved identification data; classification of the facial nerve; treatments carried out; facial symmetry in repose and on voluntary movement; synhinesis of the eyes, mouth, nose and cheeks; phonoarticulate and tongue disorders; changes in chew and of the palate and a questionary concerning the appearence of the respective disturbances. RESULTS: The degree of pos anastomosis and reabilitation ranged to the eyes between II and V and to the mouth between III and V (House & Brakemann, 1985). We came to the conclusion that the recover was satisfactory and important but patients'recover expectation were inferior. There have been noted: articulatory imprecision chewing disfunction, deficit sphincteral function of oral muscles and disphage.
- ItemAcesso aberto (Open Access)Análise quantitativa das fibras mielínicas dos nervos laríngeos em humanos de acordo com a idade(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2008-02-01) Tiago, Romualdo Suzano Louzeiro [UNIFESP]; Pontes, Paulo Augusto de Lima [UNIFESP]; Brasil, Osiris de Oliveira Campones do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION AND AIM: To carry out a morphometric analysis of myelinic fibers in laryngeal nerves aiming to identify quantitative changes as a result of aging. Study design: Clinical and experimental. MATERIAL AND METHOD: A 1cm fragment was collected from the superior laryngeal nerves and recurrent laryngeal nerves taken from twelve male cadavers. The sample was divided into two groups: those aged below 60 years (Adult) and those aged 60 years or more (Elderly). The material was evaluated under light microscopy coupled with an image analysis system. RESULTS: The total number of myelinic fibers from the superior laryngeal nerve was similar in both age groups; there was, however, a trend for a higher number of 1μm fibers in the adult group (p=0.0744). The adult group had a higher total number of myelinic fibers in the recurrent laryngeal nerve (p=0.0006), and this difference was seen in fibers with diameters betwee 1-3μm (p<0.007). The adult group had a higher total number of myelinic fibers in the laryngeal nerves (sum of superior laryngeal nerves and recurrent laryngeal nerves fibers) compared to the elderly group (p<0.0091). CONCLUSION:The total number of myelinic fibers in laryngeal nerves is higher for the group aged below 60 years.
- ItemAcesso aberto (Open Access)Aplicação de toxina botulínica tipo A para reduzir a saliva em pacientes com esclerose lateral amiotrófica(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-10-01) Manrique, Dayse [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)AIM: To demonstrate the effect of local application of Botox® in patients with amyotrophic lateral sclerosis (ALS), following our 2002 institutional protocol of sialorrhea treatment. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Five patients with ALS assisted at Clinic of Otolaryngology of AACD (Associação de Assistência à Criança Deficiente). They were all submitted to local application of Botox® in salivary glands and followed up for a year. The protocol consisted of clinical questionnaire about the inability of swallowing saliva and its repercussions in quality of life. Patients were submitted to previous odontological treatment, had intolerance to the adverse effects of anti-cholinergic agents and had not used Botox® for at least six months. The application was guided by ultrasound and the doses were 30U in one point for submandibular gland, and 20U in two points for each parotid gland, after topic anesthetic with prilocaine. RESULTS: Five patients with ALS with sialorrhea, aged 45 to 59 years, were submitted to Botox® salivary glands application. We observed that the symptoms of sialorrhea changed dramatically in four patients. Three patients stayed almost four months without complaints with repercussion in quality of life. No patient presented local or systemic effects with local injection of Botox®.
- ItemAcesso aberto (Open Access)Aspectos histomorfométricos do nervo laríngeo superior(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2002-03-01) Tiago, Romualdo Suzano Louzeiro [UNIFESP]; Munhoz, Mário Sérgio Lei [UNIFESP]; Faria, Flavio Paulo de [UNIFESP]; Guilherme, Arnaldo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: The larynx plays a primal role in the maintenance of life. The perfect integration between its afferent and efferent pathways, provided by the superior laryngeal nerve (SLN) and by recurrent laryngeal nerve, avoids foreign body aspiration and maintains the intrinsic laryngeal muscle tone by means of the reflexes elicited by the mucus wave movements. Aspirations and pneumonias as well as dysphonias, more frequently found among the elderly, might be triggered by disorders affecting these same neural pathways. Aim: The aim of this study was to assess the histomorphometryc characteristics of the SLN in elderly subjects in comparison to adults. Materials and method: A fragment of each side of the superior laryngeal nerve was obtained during necropsy examination and two different age groups were gathered. One group was made up of 5 adult subjects averaging 39,6 years of age and one was constituted of 6 elderly subjects averaging 71,7 years of age. The material was examined in a 40x objective lens microscope, connected to a computerized image analyzing system and the nerve s main parameters as the myelinated fibers frequency, fiber density per mm2, and intraperineural area were found. Results: A statistically significant reduction of the smaller myelinated fibers (1 and 2 mm) was observed in the Elderly group. No difference was noted in the myelinated fiber frequency of the left/right sides. Conclusion: Being the low diameter superior laryngeal nerve myelinated fibers functionally responsible for the reflex of glotic closure, their reduction in the elderly subjects may be related, alongside with other factors, to a greater predisposition to aspiration and voice disorders.
- ItemAcesso aberto (Open Access)Aspectos morfométricos do nervo hipoglosso humano em adultos e idosos(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-10-01) Tiago, Romualdo Suzano Louzeiro [UNIFESP]; Faria, Flavio Paulo de [UNIFESP]; Pontes, Paulo Augusto de Lima [UNIFESP]; Brasil, Osíris de Oliveira Camponês do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)AIM: Perform a morphometric analysis of the myelinic fibers of the right hypoglossal nerve, in two age groups; to verify quantitative changes as a result of the aging process. STUDY DESIGN: anatomic. MATERIAL AND METHOD: A 1cm fragment of the right hypoglossal nerve was collected from 12 male corpses without any medical history of diseases such as: diabetes, alcoholism, and malignant neoplasia. The sample was divided in two groups: group with six corpses under sixty years old (adult), and another group with six corpses sixty years old or above (elderly). The material was fixed at 2.5% glutaldehyde and 2% paraformaldehyde solution; post-fixed at 2% osmium tetroxide; dehydrated with increasing ethanol concentrations, and included in epoxy resin. Semi-thin sections of 0.3µm were obtaining, colored in 1% toluidine blue, and evaluated with light microscope combined with image analyzing system. The following morphometric data were quantified: intraperineural transversal section area, number, and diameter of the myelinic fibers. RESULTS: The intraperineural area of the hypoglossal nerve was similar in both age groups (p=0.8691). The average area in the adult group was 1.697mm² and in the elderly group it was 1.649mm². The total number of myelinic fibers of the hypoglossal nerve was similar in both age groups (p=0.9018). The adult group presented an average of 10,286 ± 2,308 myelinic fibers, and the elderly group presented an average of 10,141 ± 1,590 myelinic fibers. A bimodal distribution of the myelinic fibers was observed, with a significant peak on the 9µm fibers, and another smaller peak on the 2µm fibers. CONCLUSION: The intraperineural area and the total number of myelinic fibers of the right hypoglossal nerve are similar in both age groups.
- ItemAcesso aberto (Open Access)Avaliação clínica e videofluoroscópica da deglutição em crianças com paralisia cerebral tetraparética espástica(Academia Brasileira de Neurologia - ABNEURO, 2003-09-01) Furkim, Ana Maria [UNIFESP]; Behlau, Mara [UNIFESP]; Weckx, Luc Louis Maurice [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); CEFAC; HCORCerebral palsy is a condition that may be associated with swallowing disorders, that is, oropharingeal dysphagia. The aim of this study was to characterize and compare the swallowing processes of 32 children with this condition, by clinical and videofluoroscopic evaluation, with special focus on tracheal aspiration detectability. Results show an important compromise of oral phase. The most important findings during the pharyngeal phase were velopharingeal incompetence and residuals on the pharyngeal recesses. Aspiration was more common with liquids, before and after deglutition. On clinical and videofluoroscopic evaluation, cervical hyperextension was the commonest postural abnormality. Videofluoroscopy confirmed the occurrence of aspiration on most of the cases that presented suggestive signs of aspiration during clinical evaluation. We conclude that clinical and videofluoroscopic evaluations are complementary on deglutition evaluation and together may point to the most specific rehabilitation procedure.
- ItemAcesso aberto (Open Access)Avaliação clínica, endoscópica e manométrica da deglutição em pacientes com miastenia grave autoimune adquirida(Academia Brasileira de Neurologia - ABNEURO, 2002-12-01) Oda, Adriana Leico [UNIFESP]; Chiappetta, Ana Lúcia de Magalhães Leal [UNIFESP]; Annes, Marcelo [UNIFESP]; Marchesan, Irene Queiroz; Oliveira, Acary Souza Bulle [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Campinas (UNICAMP)Dysphagia, or difficulty swallowing, is a common problem following myasthenia gravis (MG) and may lead to aspiration of saliva, food or liquids. We herein present 22 MG patients, with complaint of dysphagia, evaluated by phonoaudiological evaluation, nasofibrolaryngoscopical analysis and manometry of upper esophageal sphincter. The main objective was to evaluate the phases of the swallowing process and anatomical and functional aspects of oropharyngeal musculature. The age of patients varied from 19 to 74 years; being 19 female and 3 male. The main data were: (1) statistically significant relation between the phonoaudiological clinical evaluation and nasofibrolaryngoscopical one; (2) stomatognatical system disorders present in 100%; (3) swallowing and chewing disorders present in 100%, when clinically evaluated, and in 81,8% when evaluated by the nasofibrolaryngoscopy; (4) statistically significant relation between penetration/aspiration and antecedents of pneumonia; (5) stomatognatical muscles very altered, difficulty controlling the bolus, collection of food in the pharynx or larynx and presence of penetration and/or aspiration showed significant correlation with weakness of a pharyngeal muscles. These findings justify the necessity to evaluate clinically the swallowing phases in MG patients, with the main purpose to prevent both aspiration and dehidration from inadequate oral intake.
- ItemAcesso aberto (Open Access)Correlação entre os achados clínicos da deglutição e os achados da tomografia computadorizada de crânio em pacientes com acidente vascular cerebral isquêmico na fase aguda da doença(Academia Brasileira de Neurologia - ABNEURO, 2006-12-01) Barros, Anna Flávia Ferraz; Fábio, Soraia Ramos Cabette; Furkim, Ana Maria [UNIFESP]; CEFAC; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Stroke is one of the main causes of permanent lesions in adults and can provoke global motor sequels, speech and language alterations, and swallowing. During the acute phase, the detection of aspiration risks is essential to prevent lung complications and to allow appropriate therapeutic interventions, making possible precocious oral feeding. In the literature, the correlations between the disturbance of the deglutition and the location of the lesion in patients with stroke are not specific. This way, the objective of the present study was to determine if correlation exists between the location of the vascular lesion and dysphagia in acute ischemic stroke patients. Bedside clinical evaluation of deglutition was made in 27 patients with acute ischemic stroke and the results were compared with the computed tomography findings. In the clinical evaluation, 48% patients were dysphagic and 52% had functional deglutition. In dysphagic patients, 84% had lesion in carotid territory, with 76% in the middle cerebral artery. In patients with functional deglutition, 57% had lesion in the middle cerebral artery and 22% in the posterior cerebral artery. In 50% of the patients with functional deglutition and in 46% of the dysphagics the lesion was in the left hemisphere. In conclusion, the hemispherical location is not associated with the presence or not of dysphagia, however most of the dysphagic patients presented alterations in the carotid territory, especially in the middle cerebral artery.
- ItemAcesso aberto (Open Access)Disfagia como complicação da cirurgia da coluna cervical via anterior(Academia Brasileira de Neurologia - ABNEURO, 2004-06-01) Falavigna, Asdrubal [UNIFESP]; Righesso Neto, Orlando; Ferraz, Fernando Antonio Patriani [UNIFESP]; Martinato, Geraldo [UNIFESP]; Riegel, Rafael Ernesto [UNIFESP]; Universidade de Caxias do Sul; Universidade Federal de São Paulo (UNIFESP)Dysphagia is one of the complications of anterior cervical surgery. Although common, few articles were published on this subject. Its incidence and duration varie depending on the author. We show a prospective study, analyzing the incidence, duration and quality of the dysphagia after anterior cervical surgery.
- ItemSomente MetadadadosEfeitos da estimulação do fluxo aéreo nasal na deglutição em pacientes com ataxia-telangiectasia(Universidade Federal de São Paulo (UNIFESP), 2014-08-19) Nishinaka, Maria Lucia Tomoko [UNIFESP]; Carvalho, Beatriz Tavares Costa Carvalho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Ataxia-Telangiectasia - AT is a rare neuromuscular disease caused by a mutation in the chromosome-encoded 11q22-23 ATM genes. Clinical manifestations included: progressive ataxia, oculocutaneous telangiectasia, ocular apraxia, immunodeficiency, recurrent sinopulmonary infections, increased risk for development of malignancy, hypersensitivity to radiation, dysarthria and dysphagia. Despiste the complexity of clinical manifestations, the patients present a progressive muscle impairment, involving the orofacial and respiratory muscles resulting in significant decline in lung function and worsening of dysphagia in these patients. Speech therapy may help to improve the orofacial functions with improved dysphagia (swallowing disorders) in various degenerative diseases such as Parkinson's, Amyotrophic Lateral Sclerosis, Machado-Joseph disease, Friedreich's ataxia and olivopontocerebellar atrophy. To date there aren?t any speech-language studies that show its effects in patients with AT. Furthermore, our professional experience suggests that speech therapy can help in improving the quality of life of individuals, leading us to the challenge of promoting this scientific study. Objective: This study aims to evaluate the effectiveness of speech therapy adapted for patients with AT, with purpose to improve their respiratory function, and its effects on swallowing-related quality of life after 18 months of treatment. Method: The study was conducted on ten patients: five who had been treated weekly (Group S) and five, monthly (Group M). All underwent speech evaluation and the parent or guardian responded jointly with their children to a quality of life questionnaire for dysphagia SWAL-QOL at baseline and after 18 months of speech therapy adapted for these patients. A NFIP (Peak Nasal Inspiratory Flow), and MIP (maximum inspiratory pressure) were performed at the beginning 0, 6, 12 and 18 months. Results: During treatment the improvement of nasal patency and inspiratory muscle strength was observed over time in both groups, but higher in Group S. After treatment the Group S showed a significant improvement in areas such as swallowing burden, symptoms and mental health, compared to the initial results, resulting in improving the quality of life of these patients. The Group M showed improvement but not significant in any of the areas, however, initially have had a better swallowing-related quality of life compared with Group S. All reported improvement in breathing, swallowing and ease of chewing. Conclusion: We conclude that the speech therapy adapted for patients with Ataxia Telangiectasia was effective in the improvement of oral functions, especially respiration and swallowing, assisting in improving the quality of life.
- ItemAcesso aberto (Open Access)Schwanoma de laringe: relato de caso(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2004-04-01) Melo, Erich Christiano M.; Tiago, Romualdo Suzano L. [UNIFESP]; Brasil, Osíris de Oliveira Camponês do [UNIFESP]; El Hassan, Soraia [UNIFESP]; Brito, Lupércio Luz; Sá, Paula Magalhães De; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Hospital do Servidor Público Estadual de São Paulo Serviço de OtorrinolaringologiaSchwannomas are benign, slow-growing, encapsulated tumors, which appear on the sheath of sensitive or cranial motor nerves Schwann cells, and having no nervous elements. They rarely appear on the larynx, and there are sporadic reports in the literature. This work has as purpose to report a case of laryngeal schwannoma. A 82 years-old woman, born and residing in the city of São Paulo, SP, went to the Hospital, suffering from slowly progressive, long-term dysphagia for solids and globus sensation. The indirect laryngoscopy with a 70º rigid telescope revealed a submucous tumor, rounded, at the interarytenoid region. A neck computed tomography was made, revealing an apparently solid lesion, with no central necrosis and no extension to deeper levels, the greatest diameter of which was of 2.5 cm. The patient underwent a larynx microsurgery with tumor full removal. The histological analysis revealed a laryngeal schwannoma. The patient recovered well with no no signs of recurrence or residual tumor until now.
- ItemAcesso aberto (Open Access)Swallowing disorders after ischemic stroke(Academia Brasileira de Neurologia - ABNEURO, 2011-10-01) Remesso, Gabriela Camargo [UNIFESP]; Fukujima, Marcia Maiumi [UNIFESP]; Chiappetta, Ana Lúcia de Magalhães Leal [UNIFESP]; Oda, Adriana Leico [UNIFESP]; Aguiar, Alexandre Santos; Oliveira, Acary Souza Bulle [UNIFESP]; Prado, Gilmar Fernandes do [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To investigate occurrences of swallowing disorders after ischemic stroke. METHOD: This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. RESULTS: 50.5% were men and 49.5% women; mean age 65.3 years (SD=±11.7) (p<0.001). Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p<0.001) and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p<0.001). CONCLUSION: Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.