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Navegando por Palavras-chave "larynx"

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Acesso aberto (Open Access)
Analysis of hyaluronic acid concentration in rat vocal folds during estral and gravidic puerperal cycles
(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2009-10-01) Pedroso, José Eduardo de Sá [UNIFESP]; Brasil, Osiris de Oliveira Campones do [UNIFESP]; Martins, João Roberto Maciel [UNIFESP]; Nader, Helena Bonciani [UNIFESP]; Simões, Manuel de Jesus [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Hormone plays an important role in the larynx. Among other substances, vocal folds contain hyaluronic acid, which tissue concentration may vary according to hormone action. AIM: the objective of this study is to analyze hyaluronic acid concentration in the vocal folds during estral and gravidic-puerperal cycles. MATERIALS AND METHODS: Experimental study. 40 adult rats were divided into two groups. In the first group we used 20 rats to establish the concentration of hyaluronic acid during the estral cycle and in the second group, 20 animals were submitted to the same procedure but during the gravidic-puerperal cycle. RESULTS: Variations in hyaluronic acid concentration was not observed during the estral cycle. In the gravidic puerperal cycle group, an increase in hyaluronic acid concentration was observed in the puerperal subgroup. Comparing the two groups of estral and gravidic-puerperal cycles, no difference was observed. CONCLUSIONS: In comparing all subgroups of estral and gravidic-puerperal cycles, an increase in hyaluronic acid concentration was noticed only in the puerperal phase.
Somente Metadadados
Angled endoscopic laryngeal surgery: A new technique for diagnosis, surgery, and CO2 laser application
(Lippincott Williams & Wilkins, 2002-06-01) Morgado, P. F.; Pontes, PAL; Universidade Federal de São Paulo (UNIFESP)
Objective: To present the development and application of a new technique to perform cold and laser laryngeal surgery. Study Design: A prospective study of 11 patients submitted for endoscopic laryngeal surgery. Methods: the technique used an endoscope with a 45degrees upward curve of its distal end; a set of angled instruments including an intraoral retractor, scissors, and forceps; and a surgical CO2 laser microtip. Eleven patients with laryngeal diseases and an indication for microsurgery underwent angled endoscopic laryngeal surgery successfully. Four patients underwent laser surgery. the CO2 laser was set between 0.5 and 2.0 W at normal exposure times and delivered distally through a lens composition within the angled handpiece. Results: the lesions were precisely treated with minimal bleeding. the excised areas healed promptly, and no excessive scarring from laser application has been observed in a 5-month postoperative video laryngoscopy follow-up. No major morbidity and no worsening of the voice occurred in any of the patients. A wide-angle view with a greater depth of field than the surgical microscope and a three-dimensional view were obtained as a result of the use of an endoscope in this technique; visualization of undersurfaces and an unobstructed visual field have been a result of the endoscope use as well. A beam waist ranging between 200 and 350 mum was produced. Conclusions: the approach described in the present study may help the laryngologist overcome some of the shortcomings and difficulties in laryngeal surgery, especially when dealing with patients in whom adverse anatomy and certain clinical conditions contraindicate microlaryngoscopy. Because of a delivery of laser waves at shorter distances from the lesions, a more precise tissue exeresis with minimal disturbances to the vocal folds might be accomplished as a result of the smaller beam waist produced. Distal delivery of laser waves also reduces the risks of stray laser beam striking nontargeted areas. Long-term studies with a larger number of patients are necessary.
Acesso aberto (Open Access)
Aplicações de Gelfoam® como tratamento de emergência na insuficiência glótica em cantora
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2004-06-01) Pontes, Paulo A. L. [UNIFESP]; Vieira, Vanessa P.; Universidade Federal de São Paulo (UNIFESP); Instituto da Laringe - INLAR Instituto da Laringe - INLAR
Gelfoam® , a product referred to patients presenting unilateral vocal fold paralysis, was applied to a female singer who showed glottic insufficiency by vocal fold atrophy and who needed urgently to proceed with her professional activities. The product was applied through percutaneous and translumination viae, in clinic, and followed by vocal assessments to confirm the efficacy of the treatment. There were realized two series with one year of interval, both with two applications, respectively 28 and 30 days. The result was positive allowing the patient to return to her activities and to conclude her work during the period that Gelfoam®, that was in progressive absorption, permitted a glottic coaptation compatible with the necessities of the voice use.
Acesso 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.
Acesso aberto (Open Access)
Avaliação laríngea em pacientes reumatológicos
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-08-01) Ramos, Hugo Valter Lisboa [UNIFESP]; Pillon, Jackeline [UNIFESP]; Kosugi, Eduardo Macoto [UNIFESP]; Fujita, Reginaldo Raimundo [UNIFESP]; Pontes, Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Rheumatic diseases usually promote several systemic disorders, which can affect blood vessels, mucosa and serosa of the aerodigestive tract. Scarce laryngeal involvement has been described in these patients and this study aims at investigating laryngeal alterations found in patients with rheumatic diseases. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD: A transversal study was developed with systemic lupus erythematous, systemic sclerosis and mixed connective tissue disease's patients. They were evaluated by means of clinical examinations and videolaryngoestroboscopy. RESULTS: Twenty-seven patients were included in the study, 26 succeeded in completing the videolaryngoestroboscopy. Laryngeal abnormalities were seen in 11 of 12 patients with lupus, in all 11 patients with sclerodermia and in 3 patients with mixed connective tissue disease. Vocal fold bamboo node was observed in 5 patients and 92.3% of all patients presented laryngeal signs of gastroesophageal reflux disease. CONCLUSION: We noticed 5 vocal fold bamboo nodes and gastroesophageal reflux disease in almost all patients.
Acesso aberto (Open Access)
Avaliação videoquimográfica da vibração de pregas vocais no pré e pós hidratação
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2004-12-01) Fujita, Reginaldo Raimundo [UNIFESP]; Ferreira, Ana Elisa; Sarkovas, Caroline; Universidade Federal de São Paulo (UNIFESP)
Keeping the body hydrated is one of the factors that contribute to organic and functional laryngeal health, especially for professional voice users. Hydration is considered an important factor for the prevention and treatment of dysphonias. There is no objective evaluation that quantifies water present in the vocal fold tissue. AIM: To evaluate changes in vocal folds investigated through videokymography after internal and external hydration of voice professionals. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: We assessed six male professional voice users after leaving the workplace (six hours) and without having drunk water for the past four hours. We conducted ENT evaluation, comprising the first laryngeal assessment with laryngoscopy with and without stroboscopic and videokymography. These people were submitted to external and internal laryngeal hydration. They drank two glasses of hydrating solution with electrolytes, Passion Fruit Flavor (total of 300 ml), at room temperature, and external hydration with inhalation of saline solution at 0.9% during 10 minutes. Using videokymography we evaluated the time of open and closed phases during phonation, defining a quotient between these two parameters. RESULTS: We found five subjects with reduced or increased quotient. CONCLUSION: Videokymography was able to detect differences at the vibrating characteristics of vocal folds before and after hydration.
Acesso aberto (Open Access)
Configuração das pregas vestibulares à fonação em adultos com e sem disfonia
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-02-01) Nemetz, Marcos Antônio [UNIFESP]; Pontes, Paulo Augusto de Lima [UNIFESP]; Vieira, Vanessa Pedrosa [UNIFESP]; Yazaki, Reinaldo Kazuo [UNIFESP]; Universidade Regional de Blumenau; Universidade Federal de São Paulo (UNIFESP)
The real participation of the vestibular folds during phonation mechanism is unknown. How vestibular folds change their configuration during phonation is still unclear. Learning about these changes in the functional mechanism of vestibular fold would be helpful for the evaluation of pathological conditions. AIM: The objective of the present study was to analyze the configuration of laryngeal vestibular folds during phonation (sustained emission of vowel /µ/) by comparing exams of individuals without vocal complaints (the normal voice group) with those with vocal complaints. STUDY DESIGN: Transversal simple study. MATERIAL AND METHOD: 120 images of larynges were analyzed, 60 of normal voice individuals and 60 of dysphonic subjects, with equal gender distribution. The position of the free margin of the vestibular fold was identified in relation to a straight line that brought together the anterior and posterior insertions. Regarding this position, three types of configurations were described: concave, when it was in a lateral position, convex when it was in a medial position, and linear when it overlapped. RESULTS: Out of the 240 vestibular folds, 158 were concave, 41 convex and 31 linear. The concave form was predominant in both groups in relation to the other two forms, although the number of convex and linear forms increased in the dysphonic group. Analyzing the behavior of these forms in each gender we noticed that among women, the linear form was significantly increased in the dysphonic group, whereas among men there was significant increase in convex form. CONCLUSION: We concluded that there were differences in behavior of vestibular folds in the dysphonic group in relation to the normal voice group, and that the differences occurred differently in both gender groups.
Acesso aberto (Open Access)
Desenvolvimento de protótipo para aplicação do laser de CO2 na laringe humana a curtas distâncias
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2002-03-01) Morgado, Plínio F. [UNIFESP]; Wagner, Paulo [UNIFESP]; Neves, Luciano R. [UNIFESP]; Pontes, Paulo A. De L. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Introduction: Laser endolaryngeal surgery has been performed with 350 and 400mm focal length (f ) lenses which converge the laser beam to a minimum spot size, called beam waist. The beam waist size can be described as: 2omega0 =lambdaf /pw², where lambda is the CO2 wavelength and 2omega is the beam diameter. We developed an optical system which produces a very small beam waist. This small shaft of laser is delivered precisely on the target resulting in a reduced impact spot size enhancing precision and lessening surrounding tissue trauma on laryngeal surgery. Aim: To present an optical system which delivers the laser beam at a small distance from the human glottis. Study design: Clinical trial. Material and Methods: The manufactured prototype has two metallic cylindrical shafts joined in a 135º angle from the horizontal. A coated mirror positioned in its joint change the ray path in the same angle. Two coated lenses converge the laser to a calculated beam waist. The hand piece was coupled to the laser articulated arm and the system was set to 0.5 - 2.0 W at 0.05 sec. exposure time. Laryngeal exposure was achieved with the angled videolaryngoscopy. Three patients with vocal fold polyp underwent laser surgery with the technique above described. Results: A beam waist ranging from 200 to 250 mum was obtained (lambdaCO2 = 10,6 mum). The technique offered adequate laryngeal exposure and satisfactory image quality for a proper laser application. No technical difficulties nor major bleeding or mucosal charring was observed during the treatment. No excessive scarring was observed in a two-month follow-up laryngoscopy. Conclusion: The developed prototype produced very small laser shafts which are useful in the treatment of vocal fold polyps.
Acesso aberto (Open Access)
Difícil manejo do paciente com distonia segmentar respiratória
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-04-01) De Biase, Noemi Grigoletto [UNIFESP]; Pontes, Paulo Augusto de Lima [UNIFESP]; Santos Junior, Vanier; Vieira, Vanessa Pedrosa [UNIFESP]; Zambonato, Priscila [UNIFESP]; Yazaki, Reinaldo Kazuo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Fundação para o Estudo e Tratamento das Deformidades Crânio-Faciais
Respiratory dystonia is a rare and difficult to diagnose disorder, that causes breathing restriction of various degrees. The objective of the study is to report the case of a patient with respiratory dystonia involving the larynx and the pharynx and its evolution concerning spasms intensity and control. CASE REPORT: A 24 year-old-man has been followed for 5 years. The diagnosis was made by means of nasofibroscopy and electromyography. Treatment was carried out with laryngeal and pharyngeal Botulin toxin injections, as it became necessary for symptoms control. CONCLUSION: The difficult management can be secondary to the lack of knowledge on the etiology and physiopathology of the impairment, and because of the limitations in the treatment of associated respiratory symptoms.
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Efeito da vacina contra papilomavírus humano (tipos 6, 11, 16 e 18) no tratamento de crianças com papilomatose respiratória recorrente
(Universidade Federal de São Paulo (UNIFESP), 2015-12-16) Hermann, Juliana Sato [UNIFESP]; Pignatari, Shirley Shizue Nagata Pignatari [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
Purpose: To evaluate whether the tetravalent vaccine against human papilomavírus (HPV) (types 6, 11, 16 and 18), when administered in a group of patients with juvenile-onset recurrent respiratory papillomatosis (RRP), influences the clinical course of the disease. Method: Uncontrolled intervention study of patients with juvenile-onset RRP of the Clinic of Pediatric Otorhinolaryngology, Federal University of São Paulo, where nine patients aged between 9-17 years received three doses of prophylactic quadrivalent vaccine against HVP (Gardasil®) and were followed for one year. The staging of disease, the intervals between relapses, the intervals between surgeries and their number during the year prior to vaccination and the first year of follow-up after vaccination were compared. Results: Eight patients had disease due to HPV-6 and one per HPV-11. There was no statistically significant change between the previous and subsequent years of vaccination in relation to clinical score (p = 0,083), anatomical score (p = 0,257), interval between relapses (p = 0,062), interval between surgery (p = 0,357) and the number of surgeries (p = 0,180). All patients had relapsed following vaccination. Conclusion: Vaccination with Gardasil® did not affect the clinical course of patients with juvenile-onset RRP during the study period.
Acesso aberto (Open Access)
Eletromiografia laríngea em pacientes com disfonia e fechamento glótico incompleto
(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2012-12-01) De Biase, Noemi Grigoletto [UNIFESP]; Korn, Gustavo Polacow [UNIFESP]; Gugliemino, Grazzia; Pontes, Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); International Federation of ORL Societies
The lack of specificity in laryngoscopical examination requires that the diagnosis of superior laryngeal and recurrent laryngeal nerve involvement be carried out with the aid of electromyography. OBJECTIVE: This study aims to assess the electrophysiological function of the superior and inferior laryngeal nerves by measuring the electrical activity of the muscles they innervate in dysphonic patients with incomplete closure of the vocal folds during phonation. METHOD: Thirty-nine patients with incomplete glottic closure were enrolled in a prospective study and had their cricothyroid, thyroarytenoid, and lateral cricoarytenoid muscles examined bilaterally through electromyography. Insertion activity, electrical activity at rest (fibrillation, positive wave and fasciculation) and during muscle voluntary contraction (recruitment, amplitude, potential length and latency between electrical activity and phonation) were measured. RESULTS: No altered test results were observed for parameters insertion activity and electrical activity at rest. None of the patients had recruitment dysfunction. The mean electrical potential amplitude values were within normal range for the tested muscles, as were potential durations and latency times between the onset of electrical activity and phonation. CONCLUSION: No signs of denervation were seen in the thyroarytenoid, cricothyroid, and lateral cricoarytenoid muscles of the studied patients.
Acesso aberto (Open Access)
Estenose subglótica como manifestação clínica da granulomatose de Wegener em adolescentes: relato de caso e revisão de literatura
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2003-10-01) Machado, Márcia C.; Melo, Erich Christiano Madruga de; Sá, Paula M. de; Silva, Danielle A. da; G. Junior., Antônio Rafael; Brasil, Osíris de Oliveira Camponês do [UNIFESP]; Hospital do Servidor Público do Estado de São Paulo Serviço de Otorrinolaringologia/Cabeça e Pescoço; Faculdade de Medicina de São Paulo Divisão de Clínica Otorrinolaringológica; Universidade Federal de São Paulo (UNIFESP)
Wegener's Granulomatosis is a well-characterized systemic vasculitis and necrotising granulomatous inflammation of the upper, lower respiratory tracts and the kidneys. The initial manifestations of the disease usually occur in patients over than twenty years old. The otolaryngologic symptoms like rhinorrhea, recurrent sinusitis and epistaxis are commonly present in early course of the disease. It seems that subglottic stenosis is correlated to Wegener's granumatosis in adolescents. We describe a case of a patient that developed subglottic stenosis associated with Wegener's granulomatosis in childhood during the course of the disease.
Acesso aberto (Open Access)
Estudo histológico da ossificação da cartilagem tireóidea
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2003-12-01) Cruz, Walter P.; Dedivitis, Rogério Aparecido [UNIFESP]; Sementilli, Ângelo [UNIFESP]; Rapoport, Abrão [UNIFESP]; Hospital Heliópolis; Universidade Federal de São Paulo (UNIFESP); Hospital Ana Costa Serviço de Anatomia Patológica; Universidade de São Paulo (USP)
The process of ossification and formation of bone marrow occurs in the larynx cartilages with age. The knowledge of this change is important for differentiation with cartilage invasion by cancer. AIM: Cranial and caudal segments of the thyroid cartilage were obtained from adult male larynges in order to evaluate comparatively the histological changes regarding to the ossification and the bone marrow formation. STUDY DESIGN: Experimental. MATERIAL AND METHOD: Seven male adult larynges were obtained from cadavers underwent necrological examination in Posto Médico-Legal de Santos, da Polícia Civil do Estado de São Paulo. The ages ranged from 39 to 60, with median of 53. There were no available data about tobacco and alcohol consumption. The specimens underwent decalcification and stained with H-E. Histometry was performed for quantitative analysis of the ossification while the bone marrow was analyzed according to qualitative criteria (presence or absence). RESULTS: The average ossification was 42.8% and the bone marrow presence was observed in 57.1% in the cranial segments. In the caudal segments, the average ossification was 72.8%, and the bone marrow was detected in 87.5% of the specimens. CONCLUSION: The ossification in the thyroid cartilage and the bone marrow formation increase and occur earlier moving downward from the cranial to the caudal aspects.
Acesso aberto (Open Access)
Esvaziamento cervical no carcinoma epidermoide de laringe: indicação de esvaziamento eletivo contralateral
(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2012-04-01) Amar, Ali [UNIFESP]; Chedid, Helma Maria; Franzi, Sergio Altino; Rapoport, Abrão [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Heliópolis; Universidade de São Paulo (USP)
Unilateral or bilateral neck dissection must be considered in the treatment of laryngeal cancer AIM: To evaluate the prevalence of contralateral metastases in larynx cancer and distribution of these metastases according to lymph node levels in the neck. METHOD: Retrospective longitudinal study of 272 charts from patients with squamous cell cancer of the larynx treated between 1996 and 2004; and we selected 104 surgical cases submitted to neck dissection. We evaluated the incidence of bilateral or contralateral metastases, according to the location and extension of the primary tumor, considering the anatomical sub-sites and the midline. RESULTS: Contralateral metastases in lateral tumors were observed in 3.5% of glottic lesions and in 26% of supraglottic lesions. Contralateral metastases were uncommon in N0 patients. Lymph nodes levels IIa and III were the most commonly involved in the neck. CONCLUSION: In lateral glottic tumors there is no need for elective contralateral neck dissection. In supraglottic lesions without ipsilateral metastases, the incidence of hidden metastasis does not justify elective contralateral dissection. The midline is not a reliable indicator of the risk of contralateral laryngeal tumors.
Acesso aberto (Open Access)
Fatores prognósticos no tratamento do carcinoma epidermóide da laringe: cirurgia conservadora x radical
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2007-12-01) Vidal, Maria Da Graça Caminha [UNIFESP]; Cervantes, Onivaldo [UNIFESP]; Abrahão, Márcio [UNIFESP]; Hojaij, Flávio Carneiro [UNIFESP]; Amar, Ali [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Santa Maria Hospital SCCP; Universidade de São Paulo (USP); Hospital Heliópolis
The present study aimed at assessing the other sites as the carcinoma spreads, as well as therapeutic results, in larynx preservation and patient survival. STUDY TYPE: It is a Longitudinal Historical Cohort Study, a retrospective clinical study. MATERIALS AND METHODS: A hundred and sixty (160) patients treated at Escola Paulista de Medicina ( Paulista Medical School) - São Paulo Hospital, from January 1988 to December 2004 were examined as for the spreading of their larynx carcinoma. Those patients whose evaluations were at least two years old after treatment were the only ones accepted. The parametric tests used were: Test X2, Fisher s test, and Kaplan-Meier s curve. RESULTS: The posterior commissure and the infraglottis were significant in terms of the laryngectomy: glottal tumors AC: (p=0.03) AP: (p=0.0001); AC: (p=0.0007) AP: (p<0.0001), respectively. The infraglottis was significant in G+SG tumors in AP: (p=0.04) and in death rate AP: (p=0.03). CONCLUSION: total laryngectomy is the treatment of choice in the presence of total involvement of the posterior commissure and the infraglottis. The latter may compromise survival, according to local invasion, even in the presence of free surgical margins.
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Importance of glottic configuration in the development of posterior laryngeal granuloma
(Annals Publ Co, 2001-08-01) Pontes, Paulo [UNIFESP]; De Biase, Noemi Grigoletto [UNIFESP]; Kyrillos, Leny Cristina Rodrigues [UNIFESP]; Pontes, Antonio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Pontificia Univ Catolica
Posterior laryngeal granuloma is frequently related to 3 predisposing factors: vocal abuse, gastroesophageal reflux disease, and orotracheal intubation. It is strongly predominant in men and rare in women, except under postintubation circumstances, in which the incidence is higher in women. The aim of this study was to characterize laryngeal conformations for each sex that, whenever associated with different causes, may lead to the onset and particular location of granulomas, according to a main predisposing factor. Sixty-six subjects whose ages ranged from 18 to 73 years were studied. They were distributed into 4 groups according to the predominant cause of granuloma: intubation, vocal abuse, gastroesophageal reflux, and idiopathic causes. The larynx was evaluated during breathing, and the glottic proportion (GP) was measured. Glottic proportion is the mathematical ratio between the midsagittal dimension of the intermembranous region and that of the intercartilaginous region of the larynx during inhalation. Its measurement was feasible in 57 patients. The groups that had a causative factor other than laryngeal orotracheal intubation had GP values statistically similar to those of each other and to the control group of men, ie, close to 1.2. The postintubation group had GP values similar to the control group of women, ie, close to 1.0; this proportion protects the arytenoid region in women's larynges when there is effort during vocal production, but makes women susceptible to orotracheal postintubation granuloma.
Acesso aberto (Open Access)
A influência da angulação na posição do telescópio na videoquimografia laríngea
(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-12-01) Pontes, Paulo Augusto de Lima [UNIFESP]; Madazio, Glaucya [UNIFESP]; Behlau, Mara [UNIFESP]; Cantoni, Luiz Alian [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Centro de Estudos da Voz de São Paulo Curso de Especialização do CEV
Videokymography is a new high-speed imaging technique to investigate vocal fold vibration. The system has been considered useful in the analysis of irregular signals, making it possible to observe left-right asymmetries, open quotient, propagation of mucosal waves, and movement of the upper and lower margins. The aim of the present study was to verify the correspondence of the videokymographic images with larynx exposition angle variation. Three Brazilian adult female subjects, with no vocal complains, were evaluated. Videokymographic images were obtained with the laryngeal endoscope 90o positioned on the measuring line, perpendicular to the glottal axis - zero degree, during a sustained ae vowel, using habitual frequency and intensity. The procedure was repeated twice and adjusted by rotating the camera in fifteen degrees from the perpendicular line to the right and to the left. The results showed clear differences depending on the position of the endoscope, suggesting the standardization of laryngeal exposition to interpretate videokymographic images correctly.
Acesso aberto (Open Access)
Influência do envelhecimento na concentração de ácido hialurônico nas pregas vocais de ratas fêmeas
(Associação Brasileira de Otorrinolaringologia e Cirurgia Cervicofacial, 2012-06-01) Ramos, Hugo Valter Lisboa [UNIFESP]; Neves, Luciano Rodrigues [UNIFESP]; Martins, João Roberto M. [UNIFESP]; Nader, Helena Bonciani [UNIFESP]; Pontes, Paulo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
The vibration of the vocal fold lamina propria is an important factor involved in vocal production and aging may change the amount of hyaluronic acid in the vocal fold leading to dysphonia. AIMS: This study compares the concentration of hyaluronic acid in vocal folds of aged and young female rats. Study design: experimental. MATERIALS AND METHODS: We used the vocal cords of 13 female rats divided into two groups: five aged rats and eight young ones. The tissue concentration of hyaluronic acid was determined using the fluorimetric method with the hyaluronic acid binding-protein coated on plates of enzyme-linked immunosorbent assay (ELISA), conjugated with biotin. Europium-labeled streptavidin was added and, after europium release with the use of enhancement solution, the final fluorescence was measured in a fluorometer. RESULTS: We found the following concentrations of hyaluronic acid in vocal fold according to the group: 581.7 ng/mg in old female rats and 1275.6 ng/mg in young female rats. Statistical analysis showed differences between groups. CONCLUSIONS: The vocal folds of old female rats have a lower concentration of hyaluronic acid when compared to such concentration on the vocal folds of young female rats.
Acesso aberto (Open Access)
Laryngeal and vocal analysis in bulimic patients
(Assoc Brasileira Otorrinolaringologia & Cirurgia Cervicofacial, 2010-07-01) Ferreira, Cynthia P.; Gama, Ana Cristina Cortes [UNIFESP]; Santos, Marco Aurélio Rocha [UNIFESP]; Maia, Mariana Oliveira; Hosp Santa Casa Misericordia Belo Horizonte; Universidade Federal de São Paulo (UNIFESP); Universidade Federal de Minas Gerais (UFMG)
Bulimia is an eating disorder classified as a mental disorder according to DSM-IV.Aims: The aim of the study was to evaluate vocal and laryngeal abnormalities in patients with bulimia compared to a control group.Materials & methods: Study control group. Twenty-two women were evaluated, with an age range of 18 to 34 years old. Eleven diagnosed with purging bulimia and 11 in the control group. Both groups underwent an otolaryngological, perception and acoustic evaluation. The statistic analysis was clone through a chi-square test and a Kruskall-Wallis non-parametric test, considering 5% as significance level.Results: The bulimic group presented a higher prevalence of laryngeal abnormalities compared to the control group (p=0.000). The group with bulimia had higher GRBSI values (p=0.000) and A (p=0.022) of the GRBASI scale. The results of vocal acoustics analysis of the jitter, shimmer, PPQ and APQ were higher in the bulimic group (p=0.033). No statistical significance difference in the fundamental frequency and NHR were found between both groups.Conclusion: the bulimic patients in this study presented more laryngeal, acoustics and perception evaluation disorders when compared to a control group.
Acesso aberto (Open Access)
Leishmaniose Laríngea
(Fundação Otorrinolaringologia, 2012-12-01) Moraes, Bruno Teixeira de [UNIFESP]; Amorim Filho, Francisco de Souza [UNIFESP]; Caporrino Neto, José [UNIFESP]; Saraceni Neto, Paulo [UNIFESP]; Melo Júnior, José Elson Santiago de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
INTRODUCTION: Leishmaniasis is classified into three clinical presentations: visceral, coetaneous and mucocutaneous. The latter is usually secondary to hematogenous spread after months or years of skin infection and can manifest as infiltrative lesions, ulcerated or vegetating in nose, pharynx, larynx and mouth, associated or not with ganglionics infarction. Laryngeal involvement is part of the differential diagnosis of lesions in this topography as nonspecific chronic laryngitis, granulomatosis and even tumors of the upper aerodigestive tract presenting atypical evolution. Sometimes it is difficult for the correct diagnosis of Leishmaniasis, with description of cases in the literature were conducted improperly. OBJECTIVE: The objective of this study is to report a case of laryngeal Leishmaniasis addressing the difficulty of diagnosis, complications and treatment applied. CASE REPORT: A patient with pain throat, dysphagia, odynophagia, dysphonia and weight loss, with no improvement with symptomatic medication. At telelaringoscopy, infiltrative lesion showed nodular supraglottis. He underwent a tracheotomy for airway obstruction and biopsy with immunohistochemical study for a definitive diagnosis of laryngeal Leishmaniasis. The patient was referred to the infectious diseases that initiated treatment with N-methylglucamine antimoniate with satisfactory response to therapy. FINAL COMMENTS: Faced with a clinical suspicion of granulomatous diseases, it is essential to follow protocol laboratory evaluation associated with histological injury, to get a precise definition etiological without prolonging the time of diagnosis. Medical treatment for mucosal Leishmaniasis, recommended by the World Health Organization, was adequate in the case of laryngeal disorders, with complete resolution of symptoms.

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