Uso de manometria computadorizada para estudo do espasmo do segmento faringoesofágico em pacientes com voz traqueoesofágica inadequada antes e após aplicação de toxina botulínica

Abstract

Tracheoesophageal voice (TEV) with voice prosthesis (VP) is an efficient and reproducible method used in vocal rehabilitation after total laryngectomy (TL), prevented by spasms in the pharyngoesophageal segment (PES). Computerized Manometry (CM) is a new, direct and objective method used to assess the PES. Aim: to carry out an objective analysis of the PES, with CM, before and after the injection of botulinum toxin (BT). Study design: clinical-prospective. Materials and Methods: analysis of eight patients consecutively submitted to TL with TEV and VP, without vocal emission, with PES spasms seen through videofluoroscopy, considered the gold standard for spasm detection. All had their spasms treated with the injection of 100 units of BT in the PES. The assessment was based on PES videofluoroscopy and CM, before and after BT injection. Results: There was a PES pressure reduction according to the CM after BT injection in all patients. The average pressure in the PES seen through the CM in eight patients before BT injection was 25.36 mmHg, and afterwards it dropped to 14.31 mmHg (p=0.004). There was vocal emission without stress and PES spasm improvement seen through the videolaryngoscopy after BT injection. Conclusion: We observed a reduction in PES pressure after BT injection, seen through CM in all the patients, with spasms improvement seen through videofluoroscopy.

The applicability of high resolution manometry in total laryngectomy

“…Regarding myotomy, some authors have observed that there is a decrease in the peak of pharyngeal pressure and a decrease in spasms and hypertonicity in total laryngectomy patients (16,17,18,19) . In our study, none of the patients underwent these procedures.…”

Tratamento do câncer de laringe: revisão da literatura publicada nos últimos dez anos

“…Speech therapy is included in publications on the treatment of laryngeal cancer, in studies dealing with rehabilitation of functions related to communications (in this case, especially oral communication) [22][23][24][25][26][27] , evaluation of quality of life 9,12,25,[28][29][30] , swallowing rehabilitation 9,28,30 and alterations of smell and taste 31 . During the research it was also verified a considerable percentage of publications from the nursing sector related with the bio-psycho-social aspects directly linked to the rehabilitation and/or postoperative handling/care which the patients must be submitted to [32][33][34][35][36][37][38][39] .…”