RESUMO
Introducción: existen diferentes factores de riesgo que pueden llegar a generar alteraciones vocales en los profesores en el ejercicio de su labor. Esta investigación busca establecer la relación entre el conocimiento de los factores de riesgo vocal y la presencia de síntomas asociados a enfermedad vocal en profesores universitarios. Método: se llevó a cabo un estudio observacional descriptivo con un diseño trans-versal con 200 profesores seleccionados bajo criterios de exclusión y exclusión. Se aplicó una encuesta online de conocimiento de los factores de riesgo vocal y la subes-cala física del Índice de Incapacidad Vocal (VHI). Para el análisis estadístico se usó Stata 14. Resultados: se encontró que los docentes presentan conocimiento de los factores de riesgo vocal y la presencia de síntomas es leve. La relación entre estas dos variables fue negativa, es decir, a mayor conocimiento vocal menor presencia de síntomas. Conclusiones: a pesar de encontrarse relación entre las variables de estudio, el nivel de significancia es bajo. Las investigaciones que indagan el conocimiento de los factores de riesgo vocal son reducidas, por lo que se recomienda continuar investi-gando esta temática
Introduction: there are different risk factors that can generate vocal alterations in teachers in the exercise of their work. This research seeks to establish the relationship between knowledge of vocal risk factors and the presence of symptoms associated with vocal disease in college teachers. Method: a descriptive observational study was carried out with a cross-sectional design with 200 teachers selected under exclusion and exclusion criteria. An online survey of knowledge of vocal risk factors and the physical subscale of the Vocal Disa-bility Index (VHI) were applied. Stata 14 was used for statistical analysis.Results: it was found that teachers present knowledge of vocal risk factors and the presence of symptoms is mild. The relationship between these two variables was ne-gative, that is, the higher the vocal knowledge, the lower the presence of symptoms.Conclusions: despite finding a relationship between the study variables, the level of significance is low. The investigations that research the knowledge of the vocal risk factors are limited. Therefore, it is recommended to continue investigating this topic.
Assuntos
Humanos , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/prevenção & controle , Disfonia/diagnóstico , Sinais e Sintomas , Distúrbios da Voz/reabilitação , Fatores de Risco , Conhecimento , Docentes , Disfunção da Prega Vocal/diagnósticoRESUMO
Introduction: Vocal cord dysfunction is characterized by unintentional paradoxical vocal cord movement resulting in abnormal inappropriate adduction, especially during inspiration; this predominantly manifests as unresponsive asthma or unexplained stridor. It is prudent to be well informed about the condition, since the primary presentation may mask other airway disorders. Objective: This descriptive study was intended to analyze presentations of vocal cord dysfunction in a tertiary care referral hospital. The current understanding regarding the pathophysiology and management of the condition were also explored. Methods: A total of 27 patients diagnosed with vocal cord dysfunction were analyzed based on demographic characteristics, presentations, associations and examination findings. The mechanism of causation, etiological factors implicated, diagnostic considerations and treatment options were evaluated by analysis of the current literature. Results: There was a strong female predilection noted among the study population ( n = 27), which had a mean age of 31. The most common presentations were stridor (44%) and refractory asthma (41%). Laryngopharyngeal reflux disease was the most common association in the majority (66%) of the patients, with a strong overlay of anxiety, demonstrable in 48% of the patients. Conclusion: Being aware of the condition is key to avoid misdiagnosis in vocal cord dysfunction. Fiberoptic laryngoscopy is the diagnostic gold standard to demonstrate paradoxical vocal cord adduction during an attack. A multidisciplinary approach should be adapted for the management, which should be specific and tailored for individual patients (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Prega Vocal/fisiopatologia , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/fisiopatologia , Asma , Espirometria , Diagnóstico Diferencial , Refluxo Laringofaríngeo , Disfunção da Prega Vocal/terapia , LaringoscopiaRESUMO
Exercise-induced dyspnea is a common pediatric question but difficult to address since usually symptoms are described ambiguously by the child or parents. Most of times dyspnea is secondary to poor training but sometimes may be due to an underlying condition like exercise-induced bronchoconstriction or vocal cord dysfunction. To provide clinicians with a practical approach about exercise-induced dyspnea we have review pathogenesis and clinical characteristics of respiratory diseases and proposed an algorithm for study.
Frecuentemente nos vemos enfrentados a evaluar un niño con síntomas vagos asociados al ejercicio que el mismo paciente o sus padres describen como ahogo o sensación de pecho apretado. La mayoría de las veces se trata de cansancio atribuible al ejercicio normal que solo refleja pobre condicionamiento físico del individuo; sin embargo, este cansancio puede ser desproporcionado al esfuerzo, lo que obliga a considerar enfermedades comunes como asma o poco comunes como disfunción de cuerdas vocales. El objetivo de esta revisión es actualizar el conocimiento aquellas enfermedades respiratorias que forman parte del diagnóstico diferencial de la disnea asociada al ejercicio y proponer un algoritmo de estudio que permita un acercamiento práctico según causas de origen.
Assuntos
Humanos , Criança , Asma Induzida por Exercício/fisiopatologia , Obstrução das Vias Respiratórias/fisiopatologia , Dispneia/fisiopatologia , Disfunção da Prega Vocal/fisiopatologia , Asma Induzida por Exercício/diagnóstico , Asma Induzida por Exercício/terapia , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/terapia , Dispneia/diagnóstico , Dispneia/terapia , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/terapiaRESUMO
INTRODUCCIÓN: La terapia vocal con tubos de resonancia, pertenece al grupo de ejercicios de tracto vocal semiocluido. Este método busca generar cambios de impedancia y de patrones vibratorios de los pliegues vocales a través de la modificación de la longitud, del diámetro y la profundidad de los tubos utilizados. El objetivo del trabajo es presentar los resultados obtenidos luego de diez sesiones de terapia vocal, utilizando tubos de resonancia en dos pacientes con diagnóstico de sulcus vocalis bilateral...
INTRODUCTION: Vocal therapy with resonance tubes, belongs to the Semi-Occluded Vocal Tract (SOVT) exercises. This method, seeks to generate changes in impedance and the vibratory pattern of vocal folds through the modification of the long, diameter and depth of the tube . The objective of the article is to present the results obtained after 10 sessions of vocal therapy, using resonance tubes as a therapeutic resource, in 2 patients diagnosed with bilateral sulcus vocalis...
INTRODUÇÃO: A terapia vocal com tubos de ressonância, pertence aos exercícios do Trato Vocal Semi-Ocluído (SOVT). Este método, busca gerar mudanças na impedância e no padrão vibratório das pregas vocais através da modificação do comprimento, diâmetro e profundidade do tubo. O objetivo do artigo é apresentar os resultados obtidos após 10 sessões de terapia vocal, utilizando tubos de ressonância como recurso terapêutico, em 2 pacientes diagnosticados com sulco vocal bilateral...
Assuntos
Humanos , Masculino , Adulto , Disfonia/reabilitação , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/reabilitação , Terapia por Exercício/métodos , Fonoaudiologia/métodosAssuntos
Transtorno Conversivo/complicações , Dispneia/etiologia , Sons Respiratórios/etiologia , Adulto , Transtorno Conversivo/diagnóstico , Transtorno Conversivo/psicologia , Diagnóstico Tardio , Dispneia/diagnóstico , Feminino , Humanos , Sons Respiratórios/diagnóstico , Procedimentos Desnecessários , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologia , Adulto JovemRESUMO
Paradoxical vocal cord motion or vocal cord dysfunction is a descriptive term for an inappropriate adduction of the vocal cords during respiration, which can cause respiratory obstruction and stridor. It is associated with psychiatric conditions in the great majority of cases. We report a 23 year-old high performance female athlete, referred for a recurrent bilateral paralysis of the vocal cords, with a history of four intensive care unit admissions for severe dyspnea and stridor, which were treated several times with intubation and with tracheostomy on two occasions. Myasthenia gravis was suspected and she was treated with pyridostigmine and prednisone. She was discharged but despite the treatment, she presented new episodes of stridor and was readmitted six months later. This time the pharmacological treatment was suspended. The neurological study disclosed a normal brain magnetic resonance, normal cerebrospinal fluid analysis and a normal electromyography. A conversion disorder was suspected and the patient was successfully treated with psychotherapy.
Assuntos
Humanos , Feminino , Adulto , Adulto Jovem , Sons Respiratórios/etiologia , Transtorno Conversivo/complicações , Dispneia/etiologia , Sons Respiratórios/diagnóstico , Procedimentos Desnecessários , Transtorno Conversivo/diagnóstico , Transtorno Conversivo/psicologia , Dispneia/diagnóstico , Diagnóstico Tardio , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/etiologiaRESUMO
BACKGROUND: Many patients with vocal cord dysfunction (VCD), with or without asthma, receive inappropriate treatment because they are misdiagnosed as having difficult-to-control asthma alone. We developed a clinical screening check list designed to aid the diagnosis of VCD. METHODS: A prospective observational study involving 80 patients aged ≥18 years, diagnosed with severe asthma. After anamnesis and physical examination, physicians completed a check list with 6 questions to identify VCD, for which the answer "yes" counted one point. Then patients underwent spirometry and laryngoscopy. On the basis of the laryngoscopic findings, we created three patient groups: VCD (vocal cord adduction during inspiration, n = 14); unconfirmed VCD (inconclusive findings, n = 29); and control (normal findings, n = 37). We attempted to determine whether any of those groups were associated with the responses to individual questions or sets of questions on the check list. RESULTS: The proportion of affirmative answers to the question "Does pulmonary auscultation reveal wheezing, predominantly in the cervical region, and/or stridor?" was significantly higher for the VCD group than for the other two groups (P = 0.006), notably in elderly patients. The variable "4 or more affirmative answers" was more common in VCD and unconfirmed VCD groups in comparison to controls (P = 0.022). CONCLUSIONS: A finding of wheezing or stridor on auscultation of the cervical region is suggestive of vocal cord dysfunction, especially in elderly patients, and such dysfunction can be confirmed through laryngoscopy. Our VCD screening check list proved to be useful in the screening of VCD among patients with severe asthma.
Assuntos
Lista de Checagem/métodos , Disfunção da Prega Vocal/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários , Disfunção da Prega Vocal/etiologia , Adulto JovemRESUMO
BACKGROUND: Vocal cord dysfunction is often misdiagnosed and mistreated as asthma, which can lead to increased and unnecessary medication use and increased health care utilization. OBJECTIVE: To develop a valid scoring index that could help distinguish vocal cord dysfunction from asthma. METHODS: We compared the demographics, comorbidities, clinical symptoms, and symptom triggers of subjects with vocal cord dysfunction (n = 89) and those with asthma (n = 59). By using multivariable logistic regression, we identified distinguishing features associated with vocal cord dysfunction, which were weighted and used to generate a novel score. The scoring index also was tested in an independent sample with documented vocal cord dysfunction (n = 72). RESULTS: We identified symptoms of throat tightness and dysphonia, the absence of wheezing, and the presence of odors as a symptom trigger as key features of vocal cord dysfunction that distinguish it from asthma. We developed a weighted index based on these characteristics, the Pittsburgh Vocal Cord Dysfunction Index. By using a cutoff of ≥4, this index had good sensitivity (0.83) and specificity (0.95) for the diagnosis of vocal cord dysfunction. The scoring index also performed reasonably well in the independent convenience sample with laryngoscopy-proven vocal cord dysfunction and accurately made the diagnosis in 77.8% of subjects. CONCLUSION: The Pittsburgh Vocal Cord Dysfunction Index is proposed as a simple, valid, and easy-to-use tool for diagnosing vocal cord dysfunction. If confirmed by a prospective evaluation in broader use, it may have significant clinical utility by facilitating a timely and accurate diagnosis of vocal cord dysfunction, thereby preventing misdiagnosis and mistreatment as asthma. Future prospective validation studies will need to be performed.
Assuntos
Asma/diagnóstico , Indicadores Básicos de Saúde , Pulmão/fisiopatologia , Disfunção da Prega Vocal/diagnóstico , Prega Vocal/fisiopatologia , Adulto , Asma/epidemiologia , Asma/fisiopatologia , Distribuição de Qui-Quadrado , Comorbidade , Diagnóstico Diferencial , Disfonia/epidemiologia , Disfonia/fisiopatologia , Feminino , Humanos , Laringoscopia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Odorantes , Pennsylvania , Faringe/fisiopatologia , Fonação , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sons Respiratórios/fisiopatologia , Fatores de Risco , Disfunção da Prega Vocal/epidemiologia , Disfunção da Prega Vocal/fisiopatologiaRESUMO
Vocal cord dysfunction (also called paradoxical vocal cord motion) or paradoxical vocal fold motion (PVFM) is an event elicited by specific and nonspecific triggers in which its diagnosis is limited by the restricted number of available functional tests. This study was designed to appreciate the contribution of the spirometric changes elicited by the allergen-specific nasal provocation test (NPT) performed with Dermatophagoides pteronyssinus for the diagnosis of PVFM in subjects with known sensitization to this allergen. In total, 63 subjects with allergic rhinitis who had previously been shown to be sensitized to D. pteronyssinus and who had experienced one or more episodes of inspiratory shortness of breath underwent two spirometric tests, one before (pre-NPT) and another 15 minutes after the allergen-specific NPT (post-NPT). The forced inspiratory vital capacity (FIVC), forced inspiratory volume in 2 seconds (FIV2), and the ratio between the FIV in 1 second and FIVC (FIV1/FIVC) were measured by spirometry. The morphology of the post-NPT inspiratory loop was compared with the pre-NPT inspiratory loop. We found that 18 subjects (28.5%) showed alterations suggestive of PVFM on post-NPT spirometry (e.g., truncation and/or flattening of the inspiratory loop). The mean differences between the pre-NPT and post-NPT values for the whole group were significant using a two-tailed paired t-test for the FIVC (4.1; 95% confidence interval [CI95%], 1.4-6.8), FIV1/FIVC ratio (2.7; CI95%, 0.05-5.3), and FIV2 (7.2; CI95%, 3.4-11). Allergen-specific NPT combined with spirometry is useful to show allergen-specific laryngeal hyperresponsiveness in allergic subjects with PVFM. Brazilian clinical trial registry platform (Plataforma Brasil, CAAE 07971212.0.0000.5480).