Full text
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| Author(s): |
Telma Kioko Takeshita Monaretti
Total Authors: 1
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| Document type: | Master's Dissertation |
| Press: | Ribeirão Preto. |
| Institution: | Universidade de São Paulo (USP). Faculdade de Medicina de Ribeirão Preto (PCARP/BC) |
| Defense date: | 2010-04-12 |
| Examining board members: |
Lilian Neto Aguiar Ricz;
Elisabete Carrara Angelis;
Roberto Oliveira Dantas
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| Advisor: | Lilian Neto Aguiar Ricz |
| Abstract | |
The objective of this study was to relate the dimensions and the intraluminal pressure of the pharyngoesophageal transition and the voice and speech proficiency characterization of individuals with tracheoesophageal prosthesis. The participants of the study were 20 total laryngectomized people with secondary insertion of tracheoesophageal prosthesis (Provox®, Atos Medical AB), characterized by 17 men and three women, with average age of 61 years and seven months, submitted to classic total laryngectomy, with closing of layers mucous, submucous and muscular for reconstruction of pharynx. All the patients had been submitted to collection and register of the voice and speech material with the use of video camera in a silent room. The evaluation of the voice and speech proficiency was performed by four experts, by means of an evaluation protocol of the tracheoesophageal communication. After that, esophageal manometry was carried out to evaluate the intraluminal pressure of the pharyngoesophageal transition during the drawn out emission of the vowel \"a\" and during rest. Finally, the videofluoroscopy was performed. At first the patient was oriented to swallow 20ml of barium sulphate aiming the identification of the anatomical structures; afterwards the patient was oriented to emit three times the drawn out vowel \"a\". Two pictures of the videofluoroscopy examination during phonation and rest were selected, and their dimensions were evaluated by three experts by means of computer software. Such results, 65% of the total laryngectomized with tracheoesophageal prosthesis were characterized as moderate speakers. The intraluminal pressure obtained during the phonation was 38,1mmHg, and 13,83mmHg during rest. PTFE-PAF and PTFE-PPF dimensions were respectively 4,73mm and 14,31mm (rest); and 5,22mm and 18,56mm (phonation). CLTFE was 12,55mm during rest and 10,55mm during phonation. During phonation, there was positive correlation between PTFE-PAF and the TFE intraluminal pressure amplitude (0,41). Inverse correlations were evidenced between CLTFE and the pressure amplitude (-0,27) during rest, and between PTFE-PPF and pressure amplitude during phonation (-0,24). The good speakers presented pressure values of 13,1mmHg during rest and 25,5mmHg during phonation. Considering the pharyngoesophageal transition, good speakers presented a bigger PTFE-PAF (5,39mm) and a smaller PTFE-PPF (13,07mm) during rest, when compared to moderate and bad ones. However an opposite situation occurred during phonation, and PTFE-PAF was about 3,86mm and PTFE-PPF about 24,3mm. CLTFE had an intermediate value during rest (16,31mm) and during phonation (12,36mm) among the moderate and bad speakers with tracheoesophageal prosthesis. A conclusion was that the voice and speech proficiency of majority of the tracheoesophageal speakers was characterized as moderate. The pressure amplitudes and the PTFE-PPF and CLTFE dimensions of pharyngoesophageal transition presented significant differences, when considering rest and phonation conditions. When compared to moderate and bad speakers with tracheoesophageal prosthesis, the good ones presented intermediate value of intraluminal pressure during rest and a smaller value during phonation. The good speakers presented a bigger PTFE-PAF and a smaller PTFE-PPF during rest, and a bigger PTFE-PPF and a smaller PTFE-PPF during phonation, when compared to moderate and bad speakers. Only CLTFE had intermediate values during the two evaluated conditions for the good tracheoesophageal speakers. (AU) | |
| FAPESP's process: | 08/07793-8 - Correlation between intraluminal pressure and quantitative measures of the pharyngoesophageal transition functional behavior at rest and during phonation |
| Grantee: | Telma Kioko Takeshita Monaretti |
| Support Opportunities: | Scholarships in Brazil - Master |