Características vocais perceptivo-auditivas e acústicas e achados videolaringoscópicos em pacientes submetidos à tireoidectomia
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Data
2016-09-30
Autores
Iyomasa, Renata Mizusaki [UNESP]
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Universidade Estadual Paulista (Unesp)
Resumo
Introdução: Disfonia no pós-operatório de tireoidectomia é frequente, principalmente nos primeiros dias, devido à proximidade da glândula com as estruturas da laringe. Dentre as causas destacam-se a paralisia de pregas vocais por lesões dos nervos laríngeos. Objetivo: analisar, em pacientes submetidos à tireoidectomia, a presença de sintomas vocais, as características vocais perceptivo-auditivas e acústicas e os achados videolaringoscópicos, correlacionando-os ao tipo de procedimento cirúrgico e ao laudo histopatológico. Casuística e Métodos: 151 pacientes submetidos à tireoidectomia em nosso serviço entre 2012 e 2015 e que aceitaram participar do estudo foram submetidos às avaliações: anamnese, videolaringoscopia, e avaliações vocais perceptivo-auditivas e acústicas. Momentos estudados: pré-operatório, 1º pós (até 15 dias), 2º Pós (1mês), 3º Pós (3 meses) e 4º pós (6 meses), este último foi reservado aos pacientes que mantinham alterações videolaringoscópicas até o 3º Pós. Resultados: Dentre os 151 pacientes (130 mulheres; 21 homens), os sintomas vocais tiveram o seguinte curso: Pré (n-4; 2.6%), 1º Pós (42; 27.8%), 2º Pós (23; 15.2%); 3º Pós (15; 10%), 4º pós (11; 7.2%). Na escala GRBASI os parâmetros comprometidos foram G, R e I. O Tempo Máximo de Fonação não se alterou entre os momentos, apenas entre os gêneros. Houve diminuição de f0 e APQ no pós-operatório nas análises acústicas. As videolaringoscopias registraram 34 paralisias (32 do nervo laríngeo recorrente e dois do nervo laríngeo superior). Após seis meses, apenas 10 pacientes mantinham a paralisia do nervo laríngeo recorrente (6.6%). Laudos histopatológicos: bócio coloide (76), tireoidite (8) e carcinoma (67). Cirurgias: loboistmectomia (40), tireoidectomia total (88), tireoidectomia total + esvaziamento cervical (23). Conclusão: Sintomas vocais foram reportados por 27.8% dos pacientes no 1º pós-operatório de tireoidectomia, reduzindo para 7% em seis meses. Na escala GRBASI, os parâmetros G, R e I estavam alterados bem como f0 e APQ nas análises acústicas. Paralisia temporária de pregas vocais por comprometimento do nervo laríngeo recorrente ocorreu em 21% dos pacientes, mantendo-se após seis meses em apenas 6.6% dos casos. Paralisia temporária por comprometimento do nervo laríngeo superior ocorreu em 1.3%, havendo recuperação completa de todos os casos em seis meses.
Introduction: Post thyroidectomy dysphonia is frequent, especially in the early postoperative days, due to the proximity of the gland with the laryngeal structures. Vocal cord paralysis consequent to injuries to the laryngeal nerves is among the most important causes. Objectives: To analyze, in patients who undergo thyroidectomy, the presence of vocal symptoms, auditory-perceptual, and acoustic vocal characteristics, as well as videolaryngoscopy findings, relating them to the type of surgical procedure and histopathological findings. Patients and Methods: 151 patients submitted to thyroidectomy in our university hospital between 2012 and 2015 and who agreed to participate in the study were evaluated as follows: anamnesis, laryngoscopy, auditory-perceptual and acoustic vocal assessments. Moments studied: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months), the latter reserved for patients who remained with videolaryngoscopy alterations at the 3rd postoperative evaluation. Results: Among the 151 patients (130 women; 21 men), vocal symptoms presented as follows: Pre (n-4; 2.6%), 1st post (42; 27.8%), 2nd post (23; 15.2%); 3rd post (15; 10%) 4th post (11; 7.2%). On the GRBASI scale the abnormal parameters were G, R and I. Maximum Phonation Time did not change between times, only between genders. In the acoustic analysis, f0 and APQ decrease in women. Videolaryngoscopies showed 34 paralyses (32 of the recurrent laryngeal nerve and 2 of the superior laryngeal). After six months, only 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology reports: colloid nodular goiter (76), thyroiditis (8), and carcinoma (67). Surgeries: lobectomy with isthmusectomy (40), total thyroidectomy (88), total thyroidectomy + neck dissection (23). Conclusion: Vocal symptoms were reported by 27.8% of our patients in the 1st postoperative evaluation after thyroidectomy, reducing to 7% in six months.In the GRBSI scale, the parameters G, R, I as well as f0 and APQ in the acoustic analysis were abnormal.Temporary paralysis of the vocal folds secondary to recurrent laryngeal nerve injury occurred in 21% of the patients, persisting after six months in only 6.6% of cases. Temporary paralysis consequent to superior laryngeal nerve injury occurred in 1.3%, with complete recovery in all cases within six months.
Introduction: Post thyroidectomy dysphonia is frequent, especially in the early postoperative days, due to the proximity of the gland with the laryngeal structures. Vocal cord paralysis consequent to injuries to the laryngeal nerves is among the most important causes. Objectives: To analyze, in patients who undergo thyroidectomy, the presence of vocal symptoms, auditory-perceptual, and acoustic vocal characteristics, as well as videolaryngoscopy findings, relating them to the type of surgical procedure and histopathological findings. Patients and Methods: 151 patients submitted to thyroidectomy in our university hospital between 2012 and 2015 and who agreed to participate in the study were evaluated as follows: anamnesis, laryngoscopy, auditory-perceptual and acoustic vocal assessments. Moments studied: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months), the latter reserved for patients who remained with videolaryngoscopy alterations at the 3rd postoperative evaluation. Results: Among the 151 patients (130 women; 21 men), vocal symptoms presented as follows: Pre (n-4; 2.6%), 1st post (42; 27.8%), 2nd post (23; 15.2%); 3rd post (15; 10%) 4th post (11; 7.2%). On the GRBASI scale the abnormal parameters were G, R and I. Maximum Phonation Time did not change between times, only between genders. In the acoustic analysis, f0 and APQ decrease in women. Videolaryngoscopies showed 34 paralyses (32 of the recurrent laryngeal nerve and 2 of the superior laryngeal). After six months, only 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology reports: colloid nodular goiter (76), thyroiditis (8), and carcinoma (67). Surgeries: lobectomy with isthmusectomy (40), total thyroidectomy (88), total thyroidectomy + neck dissection (23). Conclusion: Vocal symptoms were reported by 27.8% of our patients in the 1st postoperative evaluation after thyroidectomy, reducing to 7% in six months.In the GRBSI scale, the parameters G, R, I as well as f0 and APQ in the acoustic analysis were abnormal.Temporary paralysis of the vocal folds secondary to recurrent laryngeal nerve injury occurred in 21% of the patients, persisting after six months in only 6.6% of cases. Temporary paralysis consequent to superior laryngeal nerve injury occurred in 1.3%, with complete recovery in all cases within six months.
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Palavras-chave
GRBASI, Análise acústica, Disfonia, Tireoidectomia, Paralisia laríngea, Rouquidão, Thyroidectomy, Dysphonia, Hoarseness, Acoustic analysis