Distonia laríngea de adução: proposta e avaliação de protocolo de nasofibrolaringoscopia

Abstract

Dyst onias are organic central motor processing disorders characterized by involuntary muscular contractions or incontrollable spasms induced by task-specific movements. Adduction laryngeal dystonias present with important speech impairments, with inappropriate spasms and abrupt voice breaks. The diagnosis is based on clinical features, evaluation by a speech therapist and transnasal fiber optic laryngoscopy. Aim: Our objective is to propose and evaluate a task-oriented transnasal fiber optic laryngoscopy protocol, which shows the spasms, and propose maneuvers that reduce or make them disappear, in order to facilitate the diagnosis. Methods: transversal study. Analysis of the transnasal fiber optic laryngoscopy records of 15 patients with adductor laryngeal dystonia using the proposed protocol. Results: most of the speech and non-vocal tasks allowed us to identify the spasms and reduce or make them disappear. We propose the exclusion of two of the maneuvers that don't bring new data to the evaluation. Conclusion: the protocol was useful for the evaluation of the patients, showing changes in muscle behavior in the structure under investigation.

Dysphonia Severity Degree and Phonation Onset Latency in Laryngeal Adductor Dystonia

“…18 A 4-point ordinal scale was used. They classified the degree of dysphonia severity in the following scale: 0-no alteration perceived; 1-mild degree of dysphonia; 2-moderate degree of dysphonia; and 3-severe degree of dysphonia.…”

Comparison of clinical characteristics of patients with adductor laryngeal dystonia in the focal and segmental types

“…The voice takes on a characteristic strain-strangled quality, with frequent breaks in sonority and evident effort 3,10 . Tremor may accompany all forms 9,11 .…”

“…Adduction laryngeal dystonia is the most frequent form; the adductor muscles contract significantly during phonation, resulting in inappropriate hyperadcuction 8 . The voice takes on a characteristic strain-strangled quality, with frequent breaks in sonority and evident effort 3, 10 . Tremor may accompany all forms 9, 11 .…”

“…The diagnosis of laryngeal dystonia is made clinically: a perceptive-auditory voice assessment and nasofibrolaryngoscopy 8, 10 . Diagnostic tests, such as weak and strong utterance of high and low pitch sounds, and phrases where muted or sonorous phonemes predominate, help in the differential diagnosis of laryngeal dystonia 10 . Electromyography may help confirm the diagnosis, especially the respiratory forms 8, 9, 12 .…”

Anatomia Da Face

“…Distonias são desordens orgânicas do processamento motor central, caracterizadas por contrações musculares involuntárias ou espasmos incontroláveis induzidos durante uma atividade. Como não existe exame específico, o diagnóstico é baseado em sinais clínicos: avaliação perceptivo-auditiva da voz e laringoscopia, em especial por meio do nasofibroscópio com fibra óptica flexível (DE BIASE et al, 2006).…”