Dysphagia progression and swallowing management in Parkinson's disease: an observational study

IntroductionDysphagia is relatively common in individuals with neurological disorders.ObjectiveTo describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease.MethodsIt is a long-term study with 24 patients. The patients were observed in a five-year period (2006–2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal–Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan–Meier analysis.ResultsDuring the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises.ConclusionThe swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series.     

Acoustic rhinometry in mouth breathing patients: a systematic review

IntroductionWhen there is a change in the physiological pattern of nasal breathing, mouth breathing may already be present. The diagnosis of mouth breathing is related to nasal patency. One way to access nasal patency is by acoustic rhinometry.ObjectiveTo systematically review the effectiveness of acoustic rhinometry for the diagnosis of patients with mouth breathing.MethodsElectronic databases LILACS, MEDLINE via PubMed and Bireme, SciELO, Web of Science, Scopus, PsycInfo, CINAHL, and Science Direct, from August to December 2013, were consulted. 11,439 articles were found: 30 from LILACS, 54 from MEDLINE via Bireme, 5558 from MEDLINE via PubMed, 11 from SciELO, 2056 from Web of Science, 1734 from Scopus, 13 from PsycInfo, 1108 from CINAHL, and 875 from Science Direct. Of these, two articles were selected.ResultsThe heterogeneity in the use of equipment and materials for the assessment of respiratory mode in these studies reveals that there is not yet consensus in the assessment and diagnosis of patients with mouth breathing.ConclusionAccording to the articles, acoustic rhinometry has been used for almost twenty years, but controlled studies attesting to the efficacy of measuring the geometry of nasal cavities for complementary diagnosis of respiratory mode are warranted.     

Olfactory and taste disorders in COVID-19: a systematic review

IntroductionThe SARS-CoV-2 virus causes COVID-19, and it is responsible for the largest pandemic since the 1918 H1N1 influenza outbreak. The classic symptoms of the disease have been well defined by the World Health Organization; however, olfactory/gustatory disorders have been reported in some studies, but there are still several missing points in the understanding and in the consensus about the clinical management of these cases.ObjectiveTo identify evidence in the scientific literature about olfactory/gustatory disorders, their clinical presentation, prevalence and possible specific treatments associated with COVID-19.MethodsA systematic review of articles published up to April 25, 2020 was performed in Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus and Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine and Reasearch Gate. Inclusion criteria: (1) Studies on patients with COVID-19; (2) Records of COVID-19 signs/symptoms, and olfactory/gustatory functions. Exclusion criteria: (1) Studies on non-human coronavirus; (2) Review articles; (3) Experimental studies (in animals or in vitro); (4) Olfactory/gustatory disorders initiated prior to SARS-CoV-2 infection. The risk assessment of bias of the selected studies was performed using the Newcastle-Ottawa scale.ResultsSix articles from the 1788 records met the inclusion criteria and were analyzed. A total of 1457 patients of different ethnicities were assessed; of them, 885 (60.7%) and 822 (56.4%) had smell and taste disorders, respectively, with women being most often affected. There were olfactory/gustatory disorders even without nasal obstruction/rhinorrhea and beginning even before the signs/symptoms of COVID-19; the recovery of smell/taste, when it occurs, usually happened in the first two weeks after COVID-19 resolution. There is evidence that olfactory/gustatory disorders are strong predictors of infection by SARS-CoV-2, and it is possible to recommend patient isolation, as early as of the medical consultation, preventing the spread of the virus. No scientific evidence has been identified for effective treatments for any of the disorders.ConclusionOlfactory/gustatory disorders may occur at varying intensities and prior to the general symptoms of COVID-19 and should be considered as part of the clinical features of COVID-19, even in mild cases. There is still no scientific evidence of specific treatments for such disorders in COVID-19 disease.     

Auditory findings associated with Zika virus infection: an integrative review

IntroductionPossible associations between Zika virus infection and hearing loss were observed during the epidemic in the Americas.ObjectiveTo describe the auditory alterations, pathogenesis and recommendations for follow-up in individuals with prenatal or acquired Zika virus infection.MethodsBibliographic research conducted in March/2018–April/2019 at the main available databases. Article selection, data extraction and quality evaluation were carried out by two independent reviewers. Studies containing auditory evaluation of patients with congenital or acquired Zika virus infection; and/or hypotheses or evidences on the pathophysiology of auditory impairment associated with Zika virus; and/or recommendations on screening and follow-up of patients with auditory impairment by Zika virus were included.ResultsA total of 27 articles were selected. Sensorineural and transient hearing loss were reported in six adults with acquired Zika virus infection. Of the 962 studied children, 482 had microcephaly and 145 had diagnostic confirmation of Zika virus; 515 of the 624 children with auditory evaluation performed only screening tests with otoacoustic emissions testing and/or automated click-stimuli auditory brainstem response testing. Studies in prenatally exposed children were very heterogeneous and great variations in the frequency of altered otoacoustic emissions and automated click-stimuli auditory brainstem response occurred across the studies. Altered otoacoustic emissions varied from 0% to 75%, while altered automated click-stimuli auditory brainstem response varied from 0% to 29.2%. Sensorineural, retrocochlear or central origin impairment could not be ruled out. One study with infected mice found no microscopic damage to cochlear hair cells. Studies on the pathogenesis of auditory changes in humans are limited to hypotheses and recommendations still include points of controversy.ConclusionThe available data are still insufficient to understand the full spectrum of the involvement of the auditory organs by Zika virus, the pathogenesis of this involvement or even to confirm the causal association between auditory involvement and virus infection. The screening and follow-up recommendations still present points of controversy.     

Development and validation of the protocol for the evaluation of voice in patients with hearing impairment (PEV-SHI)

IntroductionThe voice of individuals with hearing impairment has been widely described, and can be compromised in all levels of the phonatory system.ObjectiveTo develop and validate an instrument for evaluating the voice of this population.MethodsThe instrument underwent the validation steps suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. The study sample consisted of seventy-eight Brazilian people with cochlear implants (experimental group) and 78 individuals with normal hearing (control group), divided in groups by age range — children from 3 to 5 years; children from 6 to 10 years and adults from 18 to 46 years. The study sample participated in a voice recording of the sustained vowel /a/, connected speech and spontaneous conversation, in which three voice specialists rated using the proposed instrument. It consists of visual-analog scales of suprasegmental aspects, respiratory-phonatory coordination, resonance, phonation, additional parameters and general vocal perception.ResultsEvaluation by an expert committee and a pilot test established content validity. Reliability measures showed excellent test-retest reproducibility for the majority of the parameters. Analysis with the ROC curve showed that perceptual evaluation with the sustained vowel did not strongly differentiate individuals with cochlear implants from those with normal hearing, and the parameter “speech rate” did not differentiate the groups at all. For the connected speech and spontaneous conversation, the majority of the parameters differentiated the experimental group from the control group with an area under the curve ≥0.7. The cutoff values with maximum specificity and sensitivity were 30.5 for mild, 49.0 for moderate and 69.5 for intense deviation.ConclusionsThe protocol for the evaluation of voice in subjects with hearing impairment, PEV-SHI, is a reliable and useful tool for assessing the particularities of the voice of individuals with hearing impairment treated with cochlear implants and can be used in research and clinical settings to standardize evaluation and facilitate information exchange among services.     

Factors associated with voice disorders among the elderly: a systematic review

Introduction

During the aging process, natural modifications occur in the larynx and the structures involved in phonation which explain the specific characteristics found in the voices of elderly persons. When, at any moment, a voice fails and there is interference with communication, a voice disorder has occurred. This can generate disadvantages in communicative efficiency and have a negative impact on quality of life, compromising mechanisms of socialization, the maintenance of autonomy, and the sense of well-being. Nevertheless, there appears to be little clarity about which factors are associated with voice disorders in this population, especially from an epidemiological perspective.

Predictive factors for oropharyngeal dysphagia after prolonged orotracheal intubation

Introduction

Lesions in the oral cavity, pharynx and larynx due to endotracheal intubation can cause reduction in the local motility and sensitivity, impairing the swallowing process, resulting in oropharyngeal dysphagia.

Hearing health network: a spatial analysis

IntroductionIn order to meet the demands of the patient population with hearing impairment, the Hearing Health Care Network was created, consisting of primary care actions of medium and high complexity. Spatial analysis through geoprocessing is a way to understand the organization of such services.ObjectiveTo analyze the organization of the Hearing Health Care Network of the State of Minas Gerais.MethodsCross-sectional analytical study using geoprocessing techniques. The absolute frequency and the frequency per 1000 inhabitants of the following variables were analyzed: assessment and diagnosis, selection and adaptation of hearing aids, follow-up, and speech therapy. The spatial analysis unit was the health micro-region.ResultsThe assessment and diagnosis, selection, and adaptation of hearing aids and follow-up had a higher absolute number in the micro-regions with hearing health services. The follow-up procedure showed the lowest occurrence. Speech therapy showed higher occurrence in the state, both in absolute numbers, as well as per population.ConclusionThe use of geoprocessing techniques allowed the identification of the care flow as a function of the procedure performance frequency, population concentration, and territory distribution. All procedures offered by the Hearing Health Care Network are performed for users of all micro-regions of the state.     

Performance of the phonatory deviation diagram in the evaluation of rough and breathy synthesized voices

Introduction

Voice disorders alter the sound signal in several ways, combining several types of vocal emission disturbances and noise. The phonatory deviation diagram is a two-dimensional chart that allows the evaluation of the vocal signal based on the combination of periodicity (jitter, shimmer, and correlation coefficient) and noise (Glottal to Noise Excitation) measurements. The use of synthesized signals, where one has a greater control and knowledge of the production conditions, may allow a better understanding of the physiological and acoustic mechanisms underlying the vocal emission and its main perceptual-auditory correlates regarding the intensity of the deviation and types of vocal quality.

Central auditory processing in teenagers with non-cholesteatomatous chronic otitis media

IntroductionEvidences of possible effects of early age otitis media with effusion in the central auditory processing, emphasize the need to consider such effects also in subjects with chronic otitis media.AimTo investigate and analyze the impact of non-cholesteatomatous chronic otitis media on central auditory processing in teenagers.MethodsThis is a study in which 68 teenagers were recruited, 34 with a diagnosis of non-cholesteatomatous chronic otitis media (study group) and 34 without otological disease history (control group). The evaluation of the subjects consisted of: anamnesis, pure-tone threshold audiometry, speech audiometry and a behavioral test battery for assessment of central auditory processing.ResultsA statistically significant difference was found between the means observed in the study and control groups in all tests performed. An association was found between the control group and subgroups of the study group with unilateral alterations in all tests. An association was shown between the results for the control group and study group for family income, with a greater impact on subjects with a lower income.ConclusionsNon-cholesteatomatous chronic otitis media affects the central auditory processing in teenagers suffering from the disorder, and monaural low-redundancy hearing is the most affected auditory mechanism. Unilateral conductive changes cause more damage than bilateral ones, and lower family income seems to lead to more changes to the central auditory processing of subjects with non-cholesteatomatous chronic otitis media.     

Multidimensional effects of voice therapy in patients affected by unilateral vocal fold paralysis due to cancer

Introduction

Patients with unilateral vocal fold paralysis may demonstrate different degrees of voice perturbation depending on the position of the paralyzed vocal fold. Understanding the effectiveness of voice therapy in this population may be an important coefficient to define the therapeutic approach.

Performance of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implant: a systematic review

IntroductionCurrently, there are no doubts about the benefits of cochlear implants for the development of children with severe or profound hearing loss. However, there is still no consensus among researchers and professionals regarding the benefits for the improvement of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implants.ObjectiveReview the available evidence in the literature to answer the following: “What is the performance of hearing skills in children with auditory neuropathy spectrum disorder using cochlear implants?”MethodsSystematic review of the literature through electronic database consultation, considering publications in the period 2002–2013.ResultsTwenty-two studies met the criteria and were included in the systematic review.ConclusionThe analyzed studies demonstrated that after cochlear implant surgery, individuals with auditory neuropathy spectrum disorder improved their performance of hearing skills and had similar performance to that of children with sensorineural hearing loss using cochlear implant.     

Questionnaires and checklists for central auditory processing screening used in Brazil: a systematic review

Introduction

The action of listening involves a complex interaction between the peripheral and central auditory systems. Central auditory processing disorder can be described as any problem in one or more auditory abilities. Literature reports that behavioral questionnaires and checklists can be applied to screen individuals at risk for central auditory processing disorder.

Osteonecrosis of the jaws: a review and update in etiology and treatment

Introduction

Osteonecrosis of the jaws can result either from radiation, used in radiotherapy for treatment of malignant tumors, or medications used for bone remodeling and anti-angiogenesis such as bisphosphonates. These conditions can be associated with triggering factors such as infection, trauma and decreased vascularity. The management of patients with osteonecrosis of the jaws requires caution since there is no specific treatment that acts isolated and decidedly. However, different treatment modalities can be employed in an associated manner to control and stabilize lesions.

Diagnosing acquired syphilis through oral lesions: the 12 year experience of an Oral Medicine Center

IntroductionA resurgence of syphilis in Brazil has been reported in recent years.ObjectiveWith this in mind, the present study sought to investigate the frequency, demographics, and clinical characteristics of patients with acquired syphilis with oral involvement who received medical care at an Oral Medicine Reference Center in a Brazilian Public Hospital.MethodsA retrospective study, spanning a period of 12 years, was performed to identify changing trends in syphilis over time. Medical records from all patients diagnosed with acquired syphilis who received medical care at the Hospital's Oral Medicine Clinic from 2005 to 2016 were reviewed, and the demographic and clinical data were collected.ResultsA total of 85 patients had been diagnosed with acquired syphilis, with a significant increase in the number of cases over the past 5 years. Patients ranged from 16 to 76 years of age, with a peak in the third and fourth decades. Forty-eight cases affected males (56.5%), while 37 cases affected females (43.5%). Most of the oral lesions appeared as unique ulcers or plaques, with the lips and tongue representing the most affected sites. All cases were positive for Venereal Disease Research Laboratory or Fluorescent Treponemal Antibody Absorption, and treatment was performed with Penicillin G benzathine in most cases (84.7%).ConclusionThe frequency of oral syphilis has been rising over time and oral lesions may well represent a diagnostic clue; therefore, oral health professionals must be made aware and properly trained in an attempt to develop a high degree of clinical suspicion in the diagnosis of syphilis.