Eficácia da laringoplastia de injeção (ácido hialurônico e\ou hidroxiapatita de cálcio) no tratamento da incompetência glótica. Revisão sistemática e metanálise.
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Data
2022-12-05
Autores
Henriques, Débora Pereira
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Hidroxiapatita de cálcio (CaHA) e ácido hialurônico (AH) são usados para incompetência glótica, mas ainda falta padronizações. Objetivos: avaliar a eficácia dos tratamentos para incompetência de prega vocal com HA ou CaHA. Métodos: foram selecionados estudos que avaliaram a função das pregas vocais antes e após quatro a seis semanas e seis meses de injeção de HA ou CaHA. Participantes: adultos com atrofias, cicatrizes e paralisia unilateral com incompetência glótica. Intervenção: injeção de CaHA ou HA. Controle: mesmos participantes da intervenção antes do tratamento. Desfecho primário: tempo máximo de fonação (TMF). Desfechos secundários: pontuação no questionário de Índice de Desvantagem Vocal (IDV); parâmetros G e B da escala GRBAS – Avaliação Perceptivo-Auditiva da voz. Bases de dados: MEDLINE, PUBMED, LILACS, SCOPUS, EMBASE, Cochrane, clinicaltrials.gov, ensaios publicados e não publicados. Para a síntese dos resultados foi utilizado o programa Revman 5.4. Resultados: 708 estudos foram identificados, 12 artigos foram incluídos (seis CaHA; sete HA). A diferença média do TMF após quatro a seis semanas foi 5,48 (IC 95% 4,01 a 6,94, I2= 56%), e após seis meses foi de 5,97 (IC 95% 4,86 a 7,07, I2= 0%). Houve uma redução média do IDV em quatro a seis semanas de -39,32 (IC 95% - 48,33 a -30,30, I²= 27%), e em seis meses foi de -30,13 (IC 95% - 35,95 a -24,32, I²= 33%). Houve uma redução média no valor de G em quatro a seis semanas de -1,43 (IC 95% - 1,77 a -1,08, I²= 87%) e em seis meses de -1,33 (IC 95% - 1,60 a - 1,07, I²= 65%). O valor de B em quatro a seis semanas teve redução de -1,46 (IC 95% -1,78 a – 1,14, I²= 71%), e em seis meses foi de -1,33 (IC 95% -1,60 a – 1,07, I²= 65%). A qualidade da evidência para o TMF de quatro a seis semanas foi considerada moderada, e para seis meses foi considerada alta. Conclusões: as substâncias injetáveis, hidroxiapatita ou ácido hialurônico, mostraram-se eficazes no tratamento da incompetência a glótica.
Injectable laryngoplasty’s efficacy (hyaluronic acid and\or calcium hydroxyapatite) in the treatment of glottic incopetence. Systematic review and meta-analysis. Introduction: Calcium hydroxyapatite (CaHA) and hyaluronic acid (HA) are used for glottic insufficiency, but it lacks standardization. Objectives: to evaluate the efficacy of treatments for vocal fold insufficiency with AH or CaHA. Methods: studies evaluating vocal fold function before and after four a six weeks and six months of HA or CaHA injection were selected. Participants: adults with atrophy, scarring and unilateral paralysis with glottic insufficiency. Intervention: injection of CaHA or HA. Control: same intervention participants before treatment. Primary outcome: maximum phonation time (MPT). Secondary outcomes: score in the Vocal Handicap Index (VHI) questionnaire; Parameters G and B of the GRBAS scale - Auditory-Perceptual Evaluation of the voice. Databases: MEDLINE, PUBMED, LILACS, SCOPUS, EMBASE, Cochrane, clinicaltrials.gov, published and unpublished trials. Revman 5.4 program was used to synthesis the results. Results: 708 studies were identified, 12 articles were included (six CaHA; seven HA). The mean difference in MPT after four a six weeks was 5,48 (CI 95% 4,01 to 6,94, I2= 56%), and after six months it was 5.97 (95% CI 4.86 to 7.07, I²= 0%). There was an average reduction in the VHI in four a six weeks of -39.32 (95% CI - 48.33 to -30.30, I²= 27%), and in six months it was -30.13 (95% CI - 35.95 to -24.32, I²= 33%). There was an average 3 reduction in G value in four a six weeks of -1,43 (CI 95% - 1,77 to -1,08, I²= 87%) and in six months of -1.33 (95% CI - 1.60 to - 1.07, I²= 65%). The value of B in four a six weeks had a reduction of -1.46 (95% CI -1.78 a – 1.14, I²= 71%), and in six months it was -1.33 (95% CI -1.60 to - 1.07, I²= 65%). The quality of evidence for four a six weeks MPT was considered moderate, and for six months was considered high. Conclusions: injectable substances, hydroxyapatite or hyaluronic acid, proved to be effective in the treatment of glottic insufficiency
Injectable laryngoplasty’s efficacy (hyaluronic acid and\or calcium hydroxyapatite) in the treatment of glottic incopetence. Systematic review and meta-analysis. Introduction: Calcium hydroxyapatite (CaHA) and hyaluronic acid (HA) are used for glottic insufficiency, but it lacks standardization. Objectives: to evaluate the efficacy of treatments for vocal fold insufficiency with AH or CaHA. Methods: studies evaluating vocal fold function before and after four a six weeks and six months of HA or CaHA injection were selected. Participants: adults with atrophy, scarring and unilateral paralysis with glottic insufficiency. Intervention: injection of CaHA or HA. Control: same intervention participants before treatment. Primary outcome: maximum phonation time (MPT). Secondary outcomes: score in the Vocal Handicap Index (VHI) questionnaire; Parameters G and B of the GRBAS scale - Auditory-Perceptual Evaluation of the voice. Databases: MEDLINE, PUBMED, LILACS, SCOPUS, EMBASE, Cochrane, clinicaltrials.gov, published and unpublished trials. Revman 5.4 program was used to synthesis the results. Results: 708 studies were identified, 12 articles were included (six CaHA; seven HA). The mean difference in MPT after four a six weeks was 5,48 (CI 95% 4,01 to 6,94, I2= 56%), and after six months it was 5.97 (95% CI 4.86 to 7.07, I²= 0%). There was an average reduction in the VHI in four a six weeks of -39.32 (95% CI - 48.33 to -30.30, I²= 27%), and in six months it was -30.13 (95% CI - 35.95 to -24.32, I²= 33%). There was an average 3 reduction in G value in four a six weeks of -1,43 (CI 95% - 1,77 to -1,08, I²= 87%) and in six months of -1.33 (95% CI - 1.60 to - 1.07, I²= 65%). The value of B in four a six weeks had a reduction of -1.46 (95% CI -1.78 a – 1.14, I²= 71%), and in six months it was -1.33 (95% CI -1.60 to - 1.07, I²= 65%). The quality of evidence for four a six weeks MPT was considered moderate, and for six months was considered high. Conclusions: injectable substances, hydroxyapatite or hyaluronic acid, proved to be effective in the treatment of glottic insufficiency
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Palavras-chave
Incompetência glótica, Ácido hialurônico, Hidroxiapatita de cálcio, Revisão sistemática, Glottic incompetence, Hyaluronic acid, Calcium hydroxyapatite, Systematic review