Vocal deviation in individuals with suggestive signs and symptoms of laryngopharyngeal reflux
Desvio vocal em indivíduos com sinais e sintomas sugestivos de refluxo laringofaríngeo
Ana Julia Sartori; Régis Dewes; Glaucya Madazio; Felipe Moreti; Mara Behlau
Abstract
Purpose: Verify and compare vocal deviation in quality, vocal symptoms and reflux symptom index in patients with clinical diagnosis of laryngopharyngeal reflux (LPR). Methods: 100 individuals of both genders participated in this prospective study, aged between 18 and 60 years old, who presented signs of LPR in the nasofibrolaryngological exam. Participants answered the Reflux Symptom Index (RSI) questionnaire to determine the reflux index and the Voice Symptom Scale (VoiSS). Their voices were recorded for the auditory-perceptual assessment. Three speech therapists with voice experience were contacted and the most reliable one was maintained. Results: 100 examined voices, 34 were classified as adapted and 66 as deviated. The predominant vocal quality type was rough and a slight degree of deviation. The average score on VoiSS and RSI of individuals with deviated voice is significantly higher than the adapted voice group on both protocols (p<0.01). The symptom reported with most frequency and intensity, in both analyses, was throat clearing. There were statistically significant differences once analyzed the vocal quality types by pairs: rough-adapted (p=0.0021) and tense-adapted (p=0.0075) on VoiSS, and rough-adapted (p=0.001) on RSI. Conclusion: Individuals with deviated voice reported higher occurrence of LPR related vocal signals and symptoms measured by VoiSS and RSI. The numerous theories about the disease do not make possible a single conclusion on the subject. Further studies are needed in the area to assist the professional in the diagnosis and treatment of the RLF patient.
Keywords
Resumo
Objetivo: verificar e comparar o desvio da qualidade vocal, sintomas vocais e índice de sintomas de refluxo em pacientes com diagnóstico clínico sugestivo de refluxo laringofaríngeo (RLF). Método: participaram deste estudo prospectivo 100 indivíduos de ambos os sexos, com faixa etária entre 18 e 60 anos que apresentaram sinais de RLF no exame nasofibrolaringológico. Os participantes responderam ao questionário Índice de Sintomas do Refluxo Faringo-Laríngeo (ISRFL) para determinar presença de sintomas de refluxo e a Escala de Sintomas Vocais (ESV). Tiveram suas vozes gravadas para a avaliação perceptivoauditiva. Foram contatadas três fonoaudiólogas com experiência em voz e manteve-se a de maior confiabilidade. Resultados: 100 vozes avaliadas, 34 eram adaptadas e 66 desviadas. O tipo de qualidade vocal predominante foi rugoso e o grau de desvio leve. A média dos escores no ESV e ISRFL dos indivíduos com vozes desviadas foi significativamente maior que no grupo de vozes adaptadas em ambos os protocolos (p<0,01). O sintoma relatado com maior frequência e intensidade, em ambas as avaliações, foi pigarro. Houve diferenças estatisticamente significativas quando analisados os pares dos tipos de qualidade vocal: rugosa-adaptada (p=0,0021) e tensa-adaptada (p=0,0075) no ESV, e rugosa-adaptada (p=0,001) no ISRFL. Conclusão: indivíduos com vozes desviadas referiram maior ocorrência de sinais e sintomas vocais relacionadas ao RLF mensurados pela ESV e ISRFL. As inúmeras teorias a respeito da doença não tornam possível uma única conclusão sobre o assunto. São necessários novos estudos na área a fim de auxiliar o profissional no diagnóstico e tratamento do paciente com RLF.
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Referências
1. Behlau M, Azevedo R, Pontes P. Conceito de voz normal e classificação das disfonias. In: Behlau M, editor. Voz - O livro do especialista. Rio de Janeiro: Revinter; 2001.
2. Vaezi MF, Hicks DM, Abelson TI, Richter JE. Laryngealsigns and symptoms and gastroesophageal reflux disease (GERD). A critical assessment of cause and effect association. Clin Gastroenterol Hepatol. 2003;1(5):333-44. http:// dx.doi.org/10.1053/S1542-3565(03)00177-0. PMid:15017651.
3. Koufman J, Sataloff RT, Toohill R. Laryngopharyngeal reflux: consensus conference report. J Voice. 1996;10(3):215-6. http://dx.doi.org/10.1016/ S0892-1997(96)80001-4. PMid:8865091.
4. Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the Committee on Speech, Voice, and Swallowing Disorders of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2002;127(1):32-5. http://dx.doi. org/10.1067/mhn.2002.125760. PMid:12161727.
5. Koufman JA, Amin MR, Panetti M. Prevalence of reflux in 113 consecutive patients with laryngeal and voice disorders. Otolaryngol Head Neck Surg. 2000;123(4):385-8. http://dx.doi.org/10.1067/mhn.2000.109935. PMid:11020172.
6. Axford SE, Sharp N, Dettmar PW, Ross PE, Panetti M, Pearson JP, et al. Cell biology of laryngeal epithelial defences in health and disease: preliminary studies. Ann Otol Rhinol Laryngol. 2001;110(12):1099-108. http://dx.doi. org/10.1177/000348940111001203. PMid:11768697.
7. Johnston N, Bulmer D, Gill GA, Panetti M, Ross PE, Pearson JP, et al. Cell biology of laryngeal epithelial defences in health and disease: further studies. Ann Otol Rhinol Laryngol. 2003;112(6):481-91. http://dx.doi. org/10.1177/000348940311200601. PMid:12834114.
8. Johnston N, Knight J, Dettmar PW, Lively MO, Koufman J. Pepsin and carbonic anhydrase isoenzyme III as diagnostic markers for laryngopharyngeal reflux disease. Laryngoscope. 2004;114(12):2129-34. http://dx.doi. org/10.1097/01.mlg.0000149445.07146.03. PMid:15564833.
9. Koufman JA. The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991;101(4 Pt 2, suppl. 53):1-78. http://dx.doi.org/10.1002/lary.1991.101. s53.1. PMid:1895864.
10. Lechien JR, Saussez S, Harmegnies B, Finck C, Burns JA. Laryngopharyngeal reflux and voice disorders: a multifactorial model of etiology and pathophysiology. J Voice. 2017;31(6):733-52. http://dx.doi.org/10.1016/j. jvoice.2017.03.015. PMid:28438489.
11. Ramírez DAM, Jiménez VMV, López XH, Ysunza PA. Acoustic analysis of voice and electroglottography in patients with laryngopharyngeal reflux. J Voice. 2018;32(3):281-4. http://dx.doi.org/10.1016/j.jvoice.2017.05.009. PMid:28596098.
12. Koufman JA, Belafsky BC, Bach KK, Daniel E, Postma GN. Prevalence of esophagitis in patients with pH-documented laryngopharyngeal reflux. Laryngoscope. 2002;112(9):1606-9. http://dx.doi.org/10.1097/00005537- 200209000-00014. PMid:12352672.
13. Mesallam TA, Malki KH, Farahat M, Bukhari M, Alharethy S. Voice problems among laryngopharyngeal reflux patients diagnosed with oropharyngeal pH monitoring. Folia Phoniatr Logop. 2013;65(6):280-7. http://dx.doi.org/10.1159/000362835. PMid:24861352.
14. Pribuisiene R, Uloza V, Kupcinskas L, Jonaitis L. Perceptual and acoustic characteristics of voice changes in reflux laryngitis patients. J Voice. 2006;20(1):128-36. http://dx.doi.org/10.1016/j.jvoice.2004.12.001. PMid:15925484.
15. Ross JA, Noordzji JP, Woo P. Voice disorders in patients with suspected laryngo-pharyngeal reflux disease. J Voice. 1998;12(1):84-8. http://dx.doi. org/10.1016/S0892-1997(98)80078-7. PMid:9619982.
16. Belafsky PC, Postma GN, Koufman JA. Validity and reliability of the Reflux Symptom Index (RSI). J Voice. 2002;16(2):274-7. http://dx.doi. org/10.1016/S0892-1997(02)00097-8. PMid:12150380
17. Moreti F, Zambon F, Oliveira G, Behlau M. Equivalência cultural da versão brasileira da Voice Symptom Scale – VoiSS. J Soc Bras Fonoaudiol. 2011;23(4):398-400. http://dx.doi.org/10.1590/S2179-64912011000400018. PMid:22231064.
18. Moreti F, Zambon F, Oliveira G, Behlau M. Cross-cultural adaptation, validation, and cut off values of the brazilian version of the Voice Symptom Scale-VoiSS. J Voice. 2014;28(4):458-68. http://dx.doi.org/10.1016/j. jvoice.2013.11.009. PMid:24560004.
19. Behlau M, Madazio G, Moreti F, Oliveira G, Santos LM, Paulinelli BR, et al Efficiency and cutoff values of self-assessment instruments on the impact of a voice problem. J Voice. 2016;30(4):506.e9-18. http://dx.doi. org/10.1016/j.jvoice.2015.05.022. PMid:26168902.
20. Yamasaki R, Madazio G, Leão SH, Padovani M, Azevedo R, Behlau M. Auditory-perceptual Evaluation of Normal and Dysphonic Voices Using the Voice Deviation Scale. J Voice. 2017;31(1):67-71. http://dx.doi. org/10.1016/j.jvoice.2016.01.004. PMid:26873420.
21. Amarasiri DL, Pathmeswaran A, Silva HJ, Ranasinha CD. Response of the airways and automatic nervous system to acid perfusion of the esophagus in patients with asthma: a laboratory study. BMC Pulm Med. 2013;13(1):33. http://dx.doi.org/10.1186/1471-2466-13-33. PMid:23724936.
22. Schneider GT, Vaezi MF, Francis DO. Reflux and voice disorders: have we established causality? Curr Otorhinolaryngol Rep. 2016;4(3):157-67. http://dx.doi.org/10.1007/s40136-016-0121-5. PMid:28163985.
23. Andrade BMR, Giannini SPP, Duprat AM, Ferreira LP. Relação entre a presença de sinais videolaringoscópicos sugestivos de refluxo laringofaríngeo e distúrbio de voz em professoras. CoDAS. 2016;28(3):302-10. http:// dx.doi.org/10.1590/2317-1782/20162015122. PMid:27409417.
24. Ricci G, Wolf AE, Barbosa AP, Moreti F, Gielow I, Behlau M. Sinais e sintomas de refluxo laringofaríngeo e sua relação com queixas e qualidade vocal. CoDAS. 2020;32(5):e20180052. http://dx.doi.org/10.1590/2317- 1782/20202018052. PMid:33174981.
25. Ferriolli E, Oliveira RB, Matsuda MN, Braga FJ, Dantas RO. Aging, esophageal motility, and gastroesophageal reflux. J Am Geriatr Soc. 1998;46(12):1534-7. http://dx.doi.org/10.1111/j.1532-5415.1998.tb01538.x. PMid:9848814.
26. Sirin S, Öz F. Laryngopharyngeal reflux concept: what is known and what should we focus on? Braz J Otorhinolaryngol. 2019;85(2):133-5. http:// dx.doi.org/10.1016/j.bjorl.2019.01.001. PMid:30709645.
27. Eckley CA, Costa HO. Estudo da concentração salivar do fator de crescimento dérmico em indivíduos com laringite crônica por refluxo laringofaríngeo. Rev Bras Otorrinolaringol. 2003;69(5):590-7. http://dx.doi.org/10.1590/ S0034-72992003000500002.
28. Zucato B, Behlau M. Índice de Sintomas do Refluxo Faringo-Laríngeo: relação com os principais sintomas de refluxo gastroesofágico, nível de uso de voz e triagem vocal. Rev CEFAC. 2012;14(6):1197-203. http:// dx.doi.org/10.1590/S1516-18462012005000078.
29. Fernandez CAP, Lopez JP. Vocal fold nodules. Risk factors in teachers. A case control study design. Acta Otorrinolaringol Esp. 2003;54(4):253-60. http://dx.doi.org/10.1016/S0001-6519(03)78412-X. PMid:12825241.
30. Preciado J, Pérez C, Calzada M, Preciado P. Incidencia y prevalencia de los trastornos de la voz en el personal docente de La Rioja Estudio clínico: cuestionario, examen de la función vocal, análisis acústico y vídeolaringoestroboscopia. Acta Otorrinolaringol Esp. 2005;56(5):202-10. http://dx.doi.org/10.1016/S0001-6519(05)78601-5. PMid:15960123.
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