Evolução dos nódulos vocais em criança nas diversas modalidades de tratamentos
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Data
2018-12-13
Autores
Gramuglia, Andréa Cristina Joia
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Universidade Estadual Paulista (Unesp)
Resumo
Objetivo: Estudar a evolução dos nódulos vocais em crianças nas diversas modalidades de tratamentos: fonoterapia, expectante e cirurgia. Casuística e métodos: Coorte longitudinal prospectivo. Foram incluídas 30 crianças (7a 12 anos) com nódulos vocais atendidas entre 2013 a 2018, avaliadas nos momentos: M1 (caso novo), M2 (retorno um ano), M3 (retorno dois anos). Parâmetros estudados: questionário de qualidade de vida em voz pediátrico (QVV-Pediátrico); videolaringoscopia; análise vocal perceptivo-auditiva (escala GRBASI), análise vocal acústica (software MDVP), cálculo do tempo máximo de fonação (TMF) e da relação s/z. Em M1, todas as crianças foram encaminhadas à fonoterapia após o diagnóstico; em M2, casos de insucesso após um ano de fonoterapia ou piora dos sintomas foram encaminhados à microcirurgia. Em M3 (após dois anos), todas as crianças foram convocadas para as reavaliações. Ao final da coleta, as crianças foram inseridas em três tipos de tratamentos: G1-fonoterapia (n-15); G2- expectante (n-7); G3-cirurgia (n-8). Resultados: houve predomínio dos meninos. Os escores QVVP, GRBASI e análise acústica apresentaram melhora nos momentos finais (M3), especialmente no grupo fonoterapia, seguido pelo grupo cirurgia. Videolaringoscopias: houve melhora completa e parcial das lesões, respectivamente, no grupo fonoterapia (86,6% e 13,3%), cirurgia (62,5% e 37,5%) e expectante (42,8% e 33%). Apenas uma criança do grupo expectante não apresentou melhora das lesões (14,28%). Conclusões: Os resultados deste estudo permitiram-nos concluir que houve melhora dos atributos avaliados nos momentos finais do estudo nos três grupos, sendo mais expressivos no grupo de crianças submetidas à fonoterapia. O crescimento da laringe infantil durante a adolescência foi importante fator na reabsorção das lesões nodulares, mesmo nas crianças que não realizaram nenhum tipo de tratamento, correspondendo ao grupo expectante.
Objective: To study the evolution of vocal nodules in children in the many modalities of treatment: voice therapy, expectant and surgery. Casuistry and methods: Longitudinal prospective cohort. Were included 30 children (7 to 12 years) with vocal nodules attended between 2013 to 2018, evaluated in the moments: M1 (first evaluation), M2 (follow up of one year), M3 (follow up of two years). Studied parameters: Pediatric Voice-Related Quality-of-Life (VR-QOL-P); videolaryngoscopy; perceptive-auditory vocal analysis (GRBASI scale), acoustic vocal analysis (software MDVP), maximum phonation time calculation (TMF) and of the s/z ratio. In M1, all were forwarded to voice therapy after diagnosis; in M2, unsuccessful cases after one year of voice therapy were forwarded to microsurgery. Cases of worsening of the voice or doubts in the diagnosis were forwarded to direct laryngoscopy. In M3 (after two years), all children were invited for re-evaluation and were distributed in three conduct groups: the voice therapy group (n=15); expectant group (n=7); and surgery group (n=8). Results: There has been a predominance of boys. The VR-QOL-P, GRBASI and acoustic analysis scores showed improvement in the final moments (M3), being more evident in the voice therapy group, followed by the surgery group. Videolaryngoscopy showed complete and partial improvement of the lesions, respectively, in the voice therapy group (86,6% and 13,3%), surgery (62,5% and 37,5%) and expectant (42,8% and 33%). Only two children of the expectant group did not present improvement of lesions (14%). Conclusions: There has been improvement of the evaluated attributes in the final moments of the study in the three groups, it being more expressive in the voice therapy group. The growth of the child’s larynx during adolescence was an important factor in the reabsorption of the nodules, even in children that did not undergo any type of treatment, corresponding to the expectant group.
Objective: To study the evolution of vocal nodules in children in the many modalities of treatment: voice therapy, expectant and surgery. Casuistry and methods: Longitudinal prospective cohort. Were included 30 children (7 to 12 years) with vocal nodules attended between 2013 to 2018, evaluated in the moments: M1 (first evaluation), M2 (follow up of one year), M3 (follow up of two years). Studied parameters: Pediatric Voice-Related Quality-of-Life (VR-QOL-P); videolaryngoscopy; perceptive-auditory vocal analysis (GRBASI scale), acoustic vocal analysis (software MDVP), maximum phonation time calculation (TMF) and of the s/z ratio. In M1, all were forwarded to voice therapy after diagnosis; in M2, unsuccessful cases after one year of voice therapy were forwarded to microsurgery. Cases of worsening of the voice or doubts in the diagnosis were forwarded to direct laryngoscopy. In M3 (after two years), all children were invited for re-evaluation and were distributed in three conduct groups: the voice therapy group (n=15); expectant group (n=7); and surgery group (n=8). Results: There has been a predominance of boys. The VR-QOL-P, GRBASI and acoustic analysis scores showed improvement in the final moments (M3), being more evident in the voice therapy group, followed by the surgery group. Videolaryngoscopy showed complete and partial improvement of the lesions, respectively, in the voice therapy group (86,6% and 13,3%), surgery (62,5% and 37,5%) and expectant (42,8% and 33%). Only two children of the expectant group did not present improvement of lesions (14%). Conclusions: There has been improvement of the evaluated attributes in the final moments of the study in the three groups, it being more expressive in the voice therapy group. The growth of the child’s larynx during adolescence was an important factor in the reabsorption of the nodules, even in children that did not undergo any type of treatment, corresponding to the expectant group.
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Palavras-chave
análise vocal, cirurgia, crianças, fonoterapia, nódulos vocais, tratamento, videolaringoscopia, vocal analysis, surgery, children, voice therapy, vocal nodules, videolaryngoscopy