Sulco vocal: revisão de literatura e apresentação de série de casos
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2023-10-16
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Universidade Estadual Paulista (Unesp)
Resumo
Sulco vocal constitui uma imperfeição do epitélio de cobertura das pregas vocais, formando uma depressão longitudinal que corre paralela à borda livre, podendo comprometer drasticamente a lâmina própria no local. Os sintomas vocais mais comuns são rouquidão, fadiga e esforço vocal. Há lacunas na literatura quanto aos dados epidemiológicos, clínicos e de etiologia, bem como quanto ao tratamento mais eficaz.
Objetivos: 1) Realizar revisão descritiva extensa da literatura sobre sulco vocal; 2) Realizar um estudo clínico retrospectivo analisando dados demográficos, sintomas vocais, achados endoscópicos e de análises vocais perceptivas e acústicas dos pacientes com diagnóstico de sulco vocal; 3) Analisar os resultados dos tratamentos cirúrgicos desses pacientes por meio dos parâmetros vocais (perceptivos e acústicos) pré e pós-operatórios, bem como a técnica cirúrgica utilizada.
Métodos: para o trabalho de revisão foi realizada uma revisão da literatura nas principais bases de dados (Pubmed, COCHRANE, Embase, LILACS, SciELO e Web of Science, Scopus) utilizando as palavras “sulcus vocalis; laryngeal sulcus”. Foram abordados conceitos sobre etiologia, classificação, aspectos epidemiológicos, sintomas vocais, métodos de diagnósticos e tratamentos. Para o estudo clínico retrospectivo, foi realizada análise de dados demográficos, sintomas vocais, achados videolaringoestroboscópicos, análises vocais (perceptivo-auditivas e acústicas) e tempo máximo de fonação, dos pacientes com sulco vocal atendidos nos ambulatórios de distúrbios da voz do Hospital das Clínicas da Faculdade de Medicina de Botucatu. Em um segundo momento, foram identificados os pacientes que haviam sido submetidos à microcirurgia de laringe e analisados os registros pré e pós-operatórios das análises vocais perceptivo-auditivas (escala GRBAS) e acústica computadorizada, bem como cálculo do tempo máximo de fonação (TMF) e técnica cirúrgica utilizada em cada caso.
Resultados: Foram incluídos 60 pacientes com diagnóstico confirmado de sulco vocal (39 mulheres e 21 homens), idade média 45 anos, sintomas crônicos de rouquidão, fadiga vocal e cansaço ao falar. Sulco tipo II (90%), tipo III (10%), em 23% dos casos houve associação do sulco com outras lesões benignas, especialmente pólipos vocais. As avaliações vocais mostraram disfonia de grau leve a moderado, rugosidade e soprosidade da voz, tempo máximo de fonação em torno de 10 segundos, valores elevados de jitter, PPQ e SPI. Foram submetidos à microcirurgia de sulco vocal 22 pacientes (14 mulheres e 8 homens) por diferentes técnicas e as avaliações vocais pós-operatórias mostram diminuição nos escores do GRBAS, aumento dos valores do TMF e diminuição dos valores do SPI. Os demais parâmetros acústicos mantiveram-se inalterados.
Conclusões: As vozes dos pacientes com sulco vocal caracterizam-se por disfonia de grau leve a moderado, rugosidade e soprosidade, frequência fundamental elevada (especialmente em homens). O tratamento cirúrgico promove melhora das qualidades vocais, aumento do tempo de fonação, diminui a soprosidade porém mantém algum grau de disfonia, indicando reparação incompleta da mucosa de cobertura das pregas vocais.
Palavras-chave: Distúrbios da voz, Disfonia, Rouquidão, Sulco vocal, Sulco laríngeo, Videolaringoscopia
Sulcus vocalis consists of an imperfection of the covering epithelium of the vocal folds, forming a longitudinal depression that runs parallel to its free edge, which can significantly compromise the lamina propria in that area. The most common vocal symptoms are hoarseness, fatigue and vocal effort. There are gaps in the literature regarding epidemiological, clinical and etiological data, as well as regarding the most effective treatment. Objectives: 1) Carry out an extensive descriptive review of the literature on sulcus vocalis; 2) Conduct a retrospective clinical study analyzing demographic data, vocal symptoms, endoscopic findings and perceptual and acoustic vocal analysis of patients diagnosed with sulcus vocalis; 3) To analyze the results of these patients' surgical treatments through vocal parameters (perceptual and acoustic) pre and postoperatively, as well as the surgical technique used. Methods: A literature review was carried out in the main databases (Pubmed, COCHRANE, Embase, LILACS, SciELO and Web of science, Scopus) using the words “sulcus vocalis; laryngeal sulcus”. Concepts about etiology, classification, epidemiological aspects, vocal symptoms, diagnostic methods and treatments were discussed. Regarding the retrospective clinical study, analysis of demographic data, vocal symptoms, videolaryngostroboscopic findings, vocal analysis (auditory-perceptual and acoustic) and maximum phonation time (MPT) of patients with sulcus vocalis attended at the Voice Disorders outpatient clinics of the Hospital das Clínicas of Botucatu Faculty of Medicine. In a second moment, the patients who had undergone laryngeal microsurgery were identified and the pre and postoperative records of the vocal auditory-perceptual analysis (GRBAS scale) and computerized acoustic analysis were analyzed, as well as the calculation of the maximum phonation time and the surgical technique used in each case. Results: We included 60 patients with a confirmed diagnosis of sulcus vocalis (39 women and 21 men), mean age 45 years, simultaneous symptoms of hoarseness, vocal fatigue and tiredness when speaking. Type II sulcus (90%), type III (10%), in 23% of the cases there was an association of the sulcus with other benign lesions, especially vocal polyps. Vocal statements showed mild to moderate dysphonia, voice roughness and breathiness, maximum phonation time around 10 seconds, high jitter, PPQ and SPI values. Twenty-two patients (14 women and 8 men) underwent sulcus vocalis microsurgery using different techniques, and postoperative vocal assessments show an increase in GRBAS scores, an increase in MPT values, and a decrease in SPI values. The other acoustic parameters remained unchanged. Conclusions: The voices of patients with sulcus vocalis are characterized by mild to moderate dysphonia, roughness and breathiness, high fundamental frequency (especially in men). Surgical treatment promotes improvements in vocal qualities, increased phonation time, decreased breathiness, but maintains some degree of dysphonia, providing incomplete replacement of the mucosa covering the vocal folds. Keywords: Vocal cord dysfunction, Voice disorders, Dysphonia, Hoarseness, Vocal sulcus, Vocal fold sulcus, Laryngeal sulcus, Videolaryngoscopy
Sulcus vocalis consists of an imperfection of the covering epithelium of the vocal folds, forming a longitudinal depression that runs parallel to its free edge, which can significantly compromise the lamina propria in that area. The most common vocal symptoms are hoarseness, fatigue and vocal effort. There are gaps in the literature regarding epidemiological, clinical and etiological data, as well as regarding the most effective treatment. Objectives: 1) Carry out an extensive descriptive review of the literature on sulcus vocalis; 2) Conduct a retrospective clinical study analyzing demographic data, vocal symptoms, endoscopic findings and perceptual and acoustic vocal analysis of patients diagnosed with sulcus vocalis; 3) To analyze the results of these patients' surgical treatments through vocal parameters (perceptual and acoustic) pre and postoperatively, as well as the surgical technique used. Methods: A literature review was carried out in the main databases (Pubmed, COCHRANE, Embase, LILACS, SciELO and Web of science, Scopus) using the words “sulcus vocalis; laryngeal sulcus”. Concepts about etiology, classification, epidemiological aspects, vocal symptoms, diagnostic methods and treatments were discussed. Regarding the retrospective clinical study, analysis of demographic data, vocal symptoms, videolaryngostroboscopic findings, vocal analysis (auditory-perceptual and acoustic) and maximum phonation time (MPT) of patients with sulcus vocalis attended at the Voice Disorders outpatient clinics of the Hospital das Clínicas of Botucatu Faculty of Medicine. In a second moment, the patients who had undergone laryngeal microsurgery were identified and the pre and postoperative records of the vocal auditory-perceptual analysis (GRBAS scale) and computerized acoustic analysis were analyzed, as well as the calculation of the maximum phonation time and the surgical technique used in each case. Results: We included 60 patients with a confirmed diagnosis of sulcus vocalis (39 women and 21 men), mean age 45 years, simultaneous symptoms of hoarseness, vocal fatigue and tiredness when speaking. Type II sulcus (90%), type III (10%), in 23% of the cases there was an association of the sulcus with other benign lesions, especially vocal polyps. Vocal statements showed mild to moderate dysphonia, voice roughness and breathiness, maximum phonation time around 10 seconds, high jitter, PPQ and SPI values. Twenty-two patients (14 women and 8 men) underwent sulcus vocalis microsurgery using different techniques, and postoperative vocal assessments show an increase in GRBAS scores, an increase in MPT values, and a decrease in SPI values. The other acoustic parameters remained unchanged. Conclusions: The voices of patients with sulcus vocalis are characterized by mild to moderate dysphonia, roughness and breathiness, high fundamental frequency (especially in men). Surgical treatment promotes improvements in vocal qualities, increased phonation time, decreased breathiness, but maintains some degree of dysphonia, providing incomplete replacement of the mucosa covering the vocal folds. Keywords: Vocal cord dysfunction, Voice disorders, Dysphonia, Hoarseness, Vocal sulcus, Vocal fold sulcus, Laryngeal sulcus, Videolaryngoscopy
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Palavras-chave
Sulco vocal, Sulco laríngeo, Distúrbios da voz, Disfonia, Rouquidão, Sulcus vocalis, Laryngeal sulcus, Vocal fold sulcus, Voice disorders, Dysphonia, Hoarseness