Estimulação elétrica nervosa transcutânea em mulheres disfônicas

Abstract

TEMA: estudos mostram correlação entre disfonia e tensão muscular. OBJETIVO: avaliar a atividade elétrica dos músculos supra-hióideos (SH), esternocleidomastóideo (ECM) e trapézio (T) bilateralmente, a dor e a voz, após aplicação da estimulação elétrica nervosa transcutânea (TENS). MÉTODO: participaram dez mulheres com nódulos ou espessamento mucoso bilateral e fenda à fonação. As voluntárias receberam dez sessões de TENS (200µs e 10Hz) por 30 minutos. A dor foi avaliada pela escala visual analógica, a voz por meio de laringoscopia, análise perceptivo-auditiva e acústica e o sinal mioelétrico pela raiz quadrada da média (RMS). A coleta dos dados de voz e EMG deu-se por emissão da vogal /E/ e fala espontânea. A análise estatística constou do teste de Shapiro-Wilk, seguido do teste de Wilcoxon ou t Student ou de Friedman (p < 0,05). RESULTADOS: observou-se que a TENS diminuiu o RMS, pré e pós-tratamento, para TD (2,80 ± 1,36 para 1,77 ± 0,93), TE (3,62 ± 2,10 para 2,10 ± 1,06), ECME (2,64 ± 0,69 para 1,94 ± 0,95) e SH (11,59 ± 7,72 para 7,82 ± 5,95) durante a emissão da vogal /E/, e TD (3,56 ± 2,77 para 1,93 ± 1,13), TE (4,68 ± 2,56 para 3,09 ± 2,31), ECMD (3,94 ± 2,04 para 2,51 ± 1,87) e ECME (3,54 ± 1,04 para 3,12 ± 3,00) durante a fala espontânea (FE), além da diminuição da dor. Quanto à voz, ocorreu diminuição do grau das lesões laríngeas e, na análise perceptivo-auditiva, não houve diferença durante a emissão da vogal /E/, porém durante a FE ocorreu diminuição do grau de disfonia e rouquidão. CONCLUSÃO: a TENS é eficaz na melhora do quadro clínico e funcional de mulheres disfônicas.

The Effectiveness of Physiotherapy and Complementary Therapies on Voice Disorders: A Systematic Review of Randomized Controlled Trials

“…An investigation with similar results was conducted by Guirro et al (12), where 10 participants with dysphonia performed 10 TENS sessions (200 µs and 10 Hz; 4 electrodes applied in the trapezius and sternocleidomastoid muscles bilaterally), with pain relief through VAS. The TENS decreased the Root Media readings of right and left trapezius, left sternocleidomastoid, and suprahyoid muscles during the production of the/e/vowel and for right and left trapezius as well as right and left sternocleidomastoid during spontaneous speech.…”

“…Physiotherapy, which consisted of a systematic approach of manual therapy, education, and therapeutic exercises, had similar results to voice therapy, improving voice handicap index scores (11). Transcutaneous electrical nerve stimulation (TENS) has been shown to promote pain relief in trapezius and sternocleidomastoid muscles, decreased the root media readings in trapezius, sternocleidomastoid, and suprahyoid muscles during the production of the/e/vowel and reduce the level of dysphonia and hoarseness during spontaneous speech in dysphonic participants (12). A manual therapy, usually associated with complementary therapies like osteopathy and chiropractic but also used by physiotherapists, which that has been shown to increase range of motion, reduce muscle tension and pain which suggest that may improve voice quality (13, 14) was spinal manipulation.…”

Uso da eletroestimulação na clínica fonoaudiológica: uma revisão integrativa da literatura

“…According to the literature, there are few publications on the applicability of electrical stimulation in the treatment of dysphonia [14][15][16][17][18][19][20] and studies that were part of this review show applicability in different vocal and with different approaches and that there is little proven scientific evidence on their behalf. However, research on the application of this new feature in the speech therapy clinical practice is recent and some questions deserve to be answered because there is controversy in the literature that may be related to the heterogeneity of the samples studied, since the surveys were conducted with different etiological frames of dysphonia, and various ages, as well as the lack of standardization method, and does not define the follow-up of patients during and after treatment.…”

“…A survey 17 evaluated the effect of TENS on the pattern of activation of masticatory muscles in 10 dysphonic women with nodules or bilateral mucus thickening, and phonation fissure, justified by the fact that women dysphonic present increased muscle tension in the neck and shoulder girdle. TENS was applied on the upper fibers of the trapezius and sternocleidomastoid bilaterally, seeking muscular balance and relaxation of these muscles.…”

Electrical Stimulation in Treatment of Pharyngolaryngeal Dysfunctions

“…Therapeutic procedures usually involve voice therapy; however, surgical procedures might be necessary in certain cases. Guirro et al [21] found that transcutaneous electrical nerve stimulation (a subtype of NMES) resulted in a decrease in hoarseness, the level of dysphonia and laryngeal injuries as well as relief of pain in women with nodules or bilateral mucus thickening and phonation fissure.…”