Características laríngeas e de deglutição em idosos pós-acidente vascular encefálico: um estudo preliminar
Laryngeal and swallowing characteristics in elderly after stroke: a preliminary study
Jonan Emi Valencia Cardenas; Cris Magna dos Santos Oliveira; Raquel Rodrigues Rosa; Gabriele Ramos de Luccas; Claudia Tiemi Mituuti; Kelly Cristina Alves Silverio; Alcione Ghedini Brasolotto; Giédre Berretin-Felix
Resumo
Palavras-chave
Abstract
Purpose: To carry out a comparative analysis between the aspects of safety (penetration/aspiration) and efficiency (residues) of swallowing with the morphological characteristics and phonatory functional behavior of the larynx, in elderly after stroke, in the late phase.
Methods: Observational and retrospective study carried out based on the analysis of recordings of Fiberoptic Endoscopic Evaluation of Swallowing and Laryngoscopy examinations of speech and swallowing in 24 patients. The following were considered: laryngeal asymmetry, arching of the membranous portion, increased volume of the vestibular folds, classification of glottic closure, presence of median and anteroposterior constriction during phonation. For swallowing, the Penetration and Aspiration scales, the Yale Pharyngeal Residue Severity Rating Scale to classify residues in valleculae and pyriform sinuses, and the pharyngeal residue scale proposed by Kelly et al. (2006) were used. The Mann-Whitney and Kruskal-Wallis tests were applied, considering a significance level of 5%.
Results: Most patients presented arching of the membranous portion of the vocal folds and increased volume of the vestibular folds, as well as anteroposterior constriction of the arytenoids. Laryngeal penetration, presence of residues in valleculae, pyriform sinuses and pharynx were identified for IDDSI 0 and 4 consistencies, and aspiration with IDDSI 0. At IDDSI level 0, the presence of anteroposterior constriction of the arytenoids during phonation was associated with lower scores on the Penetration-Aspiration Scale (p=0.016) and the Pharyngeal Residue Scale (p=0.013). Lower scores on the residual scale in valleculas were observed according to the amount of epiglottis coverage (p=0.017) for IDDSI 4. Furthermore, the absence of vocal fold asymmetry was associated with lower pharyngeal residue scores (p=0.025) and vallecular residue scores (p=0.008) for IDDSI level 7.
Conclusion: Swallowing safety and efficiency differ in individuals with late post-stroke presenting anteroposterior constriction, and swallowing efficiency also varies according to the degree of epiglottic coverage and vocal fold symmetry in these individuals.
Keywords
References
1 Garcia de Oliveira GG, Waters C. Perfil epidemiológico dos pacientes com acidente vascular cerebral isquêmico. Rev Neurocienc. 2021;66:e019.
2 Rajati F, Rajati M, Rasulehvandi R, Kazeminia M. Prevalence of stroke in the elderly: a systematic review and meta-analysis. Interdiscip Neurosurg. 2023;32:101746.
3 Fraga B, Almeida S, Santana M, Cassol M. Efficacy of myofunctional therapy associated with voice therapy in the rehabilitation of neurogenic oropharyngeal dysphagia: a pilot study. Int Arch Otorhinolaryngol. 2018;22(3):225-30.
4 Santos KW, Scheeren B, Maciel AC, Cassol M. Vocal variability post swallowing in individuals with and without oropharyngeal dysphagia. Int Arch Otorhinolaryngol. 2015;19(1):61-6.
5 Andrade LGC. Estudo da correlação entre qualidade vocal e disfagia pós-Acidente Vascular Cerebral: aspectos acústicos, fisiológicos e perceptivos [dissertação]. São Paulo: Pontifícia Universidade Católica de São Paulo; 2004. 193 p.
6 Linden P, Siebens AA. Dysphagia: predicting laryngeal penetration. Arch Phys Med Rehabil. 1983;64(6):281-4. PMid:6860100.
7 Godoy JF, Brasolotto AG, Berretin-Félix G, Fernandes AY. Neuroradiology and voice findings in stroke. CoDAS. 2015;27(3):229-36.
8 Oh BM, Seok H, Kim SH, Lee SY, Park SJ, Kim BJ, et al. Correlation between articulatory diadochokinetic parameters and dysphagia parameters in subacute stroke patients. Ann Rehabil Med. 2023;47(3):192-204.
9 Santos KW, Scheeren B, Maciel AC, Cassol M. Modificação da voz após deglutição: compatibilidade com achados da videofluoroscopia. CoDAS. 2017;29(6):e20170004.
10 Moreti F, Morasco-Geraldini B, Claudino-Lopes SA, Carrara-de Angelis E. Sinais, sintomas e função vocal em indivíduos com disfagia tratados de câncer de cabeça e pescoço. Audiol Commun Res. 2018;23(0):e1873.
11 Clavé P, Terré R, de Kraa M, Serra M. Approaching oropharyngeal dysphagia. Rev Esp Enferm Dig. 2004;96(2):119-31.
12 Pontes P, Yamasaki R, Behlau M. Morphology and functional aspects of the senile larynx. Folia Phoniatr Logop. 2006;58(3):151-8.
13 Cichero JAY, Lam P, Steele CM, Hanson B, Chen J, Dantas RO, et al. Development of international terminology and definitions for texture-modified foods and thickened fluids used in dysphagia management: the IDDSI framework. Dysphagia. 2017;32(2):293-314.
14 Rosenbek J, Robbins J, Roecker E, Coyle J, Wood J. A penetration-aspiration scale. Dysphagia. 1996;11(2):93-8.
15 Neubauer P, Rademaker A, Leder S. The Yale pharyngeal residue severety rating scale: an anatomically defined anda image-based tool. Dysphagia. 2015;30(5):521-8.
16 Kelly A, Leslie P, Beale T, Payten C, Drinnan M. Fibreoptic endoscopic evaluation of swalliwing and videofluoroscopy: does examination type influence perception of pharyngeal residue severity. Clin Otolaryngol. 2006;31(5):425-32.
17 Fleiss JL. Statistical methods for rates and proportions. New York: John Wiley & Sons; 1981. p. 212-36.
18 Bovolin PC. Deglutição e voz em idosos com sequelas de acidente vascular encefálico [dissertação]. Bauru: Faculdade de Odontologia de Bauru, Universidade de São Paulo; 2013.
19 Pontes P, Brasolotto A, Behlau M. Glottic characteristics and voice com complaint in the elderly. J Voice. 2005;19(1):84-94.
20 Martins R, Pessin A, Nassib D. Aging voice and the laryngeal muscle atrophy. Laryngoscope. 2015;125(11):2518-21.
21 Altman W, Schaefer D, Yu G, Hertegard S, Lundy S, Blumin H, et al. the voice and laryngeal dysfunction in stroke: a report from the Neurolaryngology Subcommittee of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg. 2007;136(6):873-81.
22 Santos KW, Rodrigues EC, Rech RS, Ros Wendland EM, Neves M, Hugo FN, et al. Using voice change as an indicator of dysphagia: a systematic review. Dysphagia. 2022;37(4):736-48.
23 Leopold N, Daniels S. Supranuclear control of swallowing. Dysphagia. 2010;25(3):250-7.
24 Mihai PG, Otto M, Domin M, Platz T, Hamdy S, Lotze M. Brain imaging correlates of recovered swallowing after dysphagic stroke: a fMRI and DWI study. Neuroimage Clin. 2016;12:1013-21.
25 Cabib C, Ortega O, Vilardell N, Mundet L, Clavé P, Rofes L. Chronic post-stroke oropharyngeal dysphagia is associated with impaired cortical activation to pharyngeal sensory inputs. Eur J Neurol. 2017;24(11):1355-62.
26 Martin RE. Neuroplasticity and swallowing. Dysphagia. 2009;24(2):218-29.
27 Rofes L, Muriana D, Palomeras E, Vilardell N, Palomera E, Alvarez-Berdugo D, et al. Prevalence, risk factors and complications of oropharyngeal dysphagia in stroke patients: a cohort study. Neurogastroenterol Motil. 2018;30(8):e13338.
28 Andrade M, Cavalcante R, Haguette E. Achados da videoendoscopia da deglutição em adultos com disfagia orofaríngea neurogênica. Rev Soc Bras Fonoaudiol. 2009;14(3):454-62.
29 Kamarunas E, McCullough G, Guidry T, Mennemeier M, Schluterman K. Effects of topical nasal anesthetic on fiberoptic endoscopic examination of swallowing with sensory testing (FEESST). Dysphagia. 2014;29(1):33-43.
30 Khedr EM, Abbass MA, Soliman RK, Zaki AF, Gamea A. Post-stroke dysphagia: frequency, risk factors, and topographic representation: hospital-based study. Egypt J Neurol Psychiat Neurosurg. 2021;57(1):23.
Submitted date:
05/24/2024
Accepted date:
11/26/2024
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