We found more male vocal process granuloma, except when associated with laryngeal intubation. The most frequent related etiopathogenic factor was laryngeal-pharynx reflux, followed by laryngeal intubation and vocal abuse. Clinical management with proton-pump inhibitor (PPI), topical inhalant steroid and phonotherapy was enough for remission on 48.6% of the patients. Surgery for removal of the granuloma associated with clinical management was effective in 90% of the events. Later recurrences (more than one year) were noticed in five patients, suggesting that associated etiopathogenic factors should be held for a long time.

dysphagi a is a symptom associated with an array of anatomical and functional changes which must be assessed by a multidisciplinary team to guarantee optimal evaluation and treatment, preventing potential complications. Aim:The aim of the present study is to present the combined protocol of clinical and swallowing videoendoscopy carried by enT doctors and speech therapists in the dysphagia Group of the enT department -university Hospital.Materials and Methods: retrospective study concerning the use of a protocol made up of patient interview and clinical examination, followed by an objective evaluation with swallowing videoendoscopy. The exam was performed in 1,332 patients from May 2001 to december 2008. There were 726 (54.50%) males and 606 (45.50%) females, between 22 days and 99 years old. Results:We found: 427 (32.08%) cases of normal swallowing, 273 (20.48%) mild dysphagia, 224 (16.81%) moderate dysphagia, 373 (27.99%) severe dysphagia and 35 (2.64%) inconclusive exams. Conclusion:The combined protocol (Otolaryngology and Speech Therapy), is a good way to approach the dysphagic patient, helping to achieve early and safe deglutition diagnosis as far as disorder severity and treatment are concerned. Braz J Otorhinolaryngol. 2011;77(2):201-13. ORIgInAL ARTIcLE BJORL

Vocal process granuloma is a disease whose etiopathogenesis is not well defined. Therefore, its clinical and surgical treatment is not standardized and its therapeutic results depend on the hospital where it is seen. Aim: Aiming to characterize patients with vocal process granuloma treated in our hospital, the therapeutic approach used and clinical evolution. Material and method: We performed a retrospective review of records. Results: We found more male vocal process granuloma, except when associated with laryngeal intubation. The most frequent related etiopathogenic factor was laryngeal-pharynx reflux, followed by laryngeal intubation and vocal abuse. Clinical management with proton-pump inhibitor (PPI), topical inhalant steroid and phonotherapy was enough for remission on 48.6% of the patients. Surgery for removal of the granuloma associated with clinical management was effective in 90% of the events. Later recurrences (more than one year) were noticed in five patients, suggesting that associated etiopathogenic factors should be held for a long time.

We present a rare case of dermatomyosites associated with severe oropharyngeal dysphagia. A 13 year old female patient, being followed at the Rheumatologic Department, was referred to the Otolaryngology Department of the University of São Paulo School of Medicine Hospital. She complained of swallowing problems, especially with solids. Following our dysphagia study protocol, we employed a speech pathologist and otolaryngology evaluation, mainly for clinical history, examination of anatomical structures involved with swallowing events, cranium nerves integrity and videoendoscopic swallowing study. We diagnosed severe oropharyngeal dysphagia, with aspiration of saliva and food of all consistencies. We advised against oral feeding and recommended a diet through a gastric tube. She started with therapy and xerostomia medication, together with the treatment of the base disease. The patient showed a significant improvement, noticed by the clinical evaluation and the control videoendoscopic swallowing study, with the possibility of returning to oral feeding. The authors stress the incidence of oropharyngeal dysphagia in dermatomyosites and suggest the videoendoscopic swallowing study as a good exam for diagnosis and follow-up of these patients.

We present a rare case of dermatomyosites associated with severe oropharyngeal dysphagia. A 13 year old female patient, being followed at the Rheumatologic Department, was referred to the Otolaryngology Department of the University of São Paulo School of Medicine Hospital. She complained of swallowing problems, especially with solids. Following our dysphagia study protocol, we employed a speech pathologist and otolaryngology evaluation, mainly for clinical history, examination of anatomical structures involved with swallowing events, cranium nerves integrity and videoendoscopic swallowing study. We diagnosed severe oropharyngeal dysphagia, with aspiration of saliva and food of all consistencies. We advised against oral feeding and recommended a diet through a gastric tube. She started with therapy and xerostomia medication, together with the treatment of the base disease. The patient showed a significant improvement, noticed by the clinical evaluation and the control videoendoscopic swallowing study, with the possibility of returning to oral feeding. The authors stress the incidence of oropharyngeal dysphagia in dermatomyosites and suggest the videoendoscopic swallowing study as a good exam for diagnosis and follow-up of these patients.

Otorrinolaringologia da FMUSP, pelo exemplo de integridade e serenidade. Ao Prof. Dr. Luiz Ubirajara Sennes, Prof. Livre-Docente e Associado da Disciplina de Otorrinolaringologia da FMUSP. Coordenador do Programa de Pós-Graduação em Otorrinolaringologia da FMUSP, meu orientador, pela confiança, amizade e ensinamentos. Ao Prof. Dr. Domingos Hiroshi Tsuji, Prof. Livre-Docente e Associado da Disciplina de Otorrinolaringologia da FMUSP. Chefe do Grupo de Voz da Divisão de Clínica da FMUSP (HCFMUSP), por me receber com tanto carinho nesta instituição. Ao Prof. Dr. Wilson Jacob Filho, Prof. Titular da Disciplina de Geriatria da FMUSP, pelo exemplo de dedicação, de competência e amor ao trabalho.

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