Voz e posição de prega vocal em homens com paralisia unilateral de prega vocal

Abstract

The paralyzed vocal fold positioning and the degree of dysphonia are important inputs when one is deciding upon treatment options for unilateral vocal fold paralysis (UVFP).Objective: To check voice characteristics and paralyzed vocal fold position in men with UVFP. Materials and Methods:This is a retrospective historical cross-sectional cohort study, with data from 24 men with UVFP with mean age of 60.7 years, submitted to voice assessment by three speech therapists and three ENT physicians used laryngeal images to classify the position of the paralyzed vocal fold. Results:The paralyzed vocal fold was found in the paramedian position in 45.83% of the cases; in the intermediary position in 25%; lateral in 20.83%, and it was in the median position in 4.16%; the dysphonia resulting from the UVFP was characterized by moderate hoarseness, roughness and stress in the voice; breathiness (most had severe breathiness); weakness and instability(mostly mild); the position of the paralyzed vocal fold had a significant influence on the general degree of vocal deviation. Conclusion:The general degree of dysphonia is associated with the paralyzed vocal fold position; dysphonia is characterized by hoarseness, breathiness, roughness and stress of moderate to severe levels. Braz J Otorhinolaryngol. 2011;77(6):761-7. ORIGINAL ARTICLE

Fonoterapia com fonação em tubos em paciente com paralisia de prega vocal medializada cirurgicamente: estudo de caso

“…It can be caused by head, neck and thorax mechanic traumas, neoplasias, viral inflammatory processes or it metabolic, toxic or idiopathic origins [1][2][3] . In unilateral vocal fold paralysis, there might be: dysphagia, reduced pneumophonoarticulatory coordination, vocal fatigue, decrease of loudness and of vocal projection, reduction of vocal range, resonant unbalance, and alteration of vocal quality (hoarseness, breathiness, roughness and asthenia).…”

Characteristics of voice and personality of patients with vocal fold immobility

“…Therefore, the vagus nerve and its ramifications may undergo some injuries at any part of its pathway, resulting in the vocal fold immobility; however, the left recurrent laryngeal nerve has higher chance of being injured, due to its longer pathway (18) . This way, the vocal fold immobility may present very distinct symptoms depending on the location of the lesion in the vagus nerve.…”

“…The vocal deviation degree of patients with vocal fold immobility depends on the position of the paralyzed vocal fold, on the atrophy and laxity of the vocal fold, as well as on the surpassing of the healthy vocal fold and the constriction of the larynx (18) . In bilateral vocal fold immobility, the voice is characterized as high pitched, because of the paramedian position of both vocal folds, and the individual may have respiratory problems due to pneumonia and frequent aspirations (4,15) .…”

“…In the unilateral immobility of the vocal fold, the patient may evolve with pneumophonoarticulatory incoordination, weak voice, increase of effort to speak, vocal fatigue, roughness, reduction of intensity and vocal extension, increase of fundamental frequency, little projection, tension, maximum time of reduced phonation, breathiness, and dysphagia (4) . Breathiness and the inability of communication are referred to as one of the main losses reported by the patients with unilateral immobility of the vocal fold (18) . The breathy voice is a result from the inefficient closure of the vocal folds, causing escape of the air that modifies the vocal quality (21) , resulting in a negative impact on communication for requiring higher vocal effort during speech.…”

“…However, the roughness is mentioned as one of the most common symptoms between patients with vocal fold immobility; however, 35% of these patients may have no symptoms (15,18) , an so it may be considered as just a symptom of a greater involvement.…”