Resumo: Introdução: Estamos diante de uma pandemia de grande impacto mundial como resultado da rápida propagação do novo coronavírus, COVID-19. A comunidade médica está ainda conhecendo o comportamento desse vírus e as repercussões do ponto de vista populacional. Todo esse conhecimento é extremamente dinâmico, por isso algumas condutas ainda não estão bem estabelecidas. O otorrinolaringologista tem um papel central no manejo dessa situação em que deve avaliar o paciente e evitar a contaminação dos profissionais da saúde e dos demais pacientes. Dessa forma, as recomendações da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial (ABORL-CCF) têm por objetivo principal reduzir a propagação do novo coronavírus durante o atendimento otorrinolaringológico e auxiliar no manejo desses pacientes. Método: Revisão das principais recomendações das sociedades científicas nacionais, internacionais, decisões de órgãos governamentais e de conselhos de classe. Os tópicos serão relativos aos aspectos gerais do COVID-19, equipamentos de proteção individual, cuidados no atendimento ao paciente, as rotinas dos exames endoscópicos e o manejo de aspectos nasossinusais, otológicos e pediátricos relacionados ao COVID-19. Resultados: É considerado crucial o uso de equipamento de proteção individual no atendimento otorrinolaringológico de rotina. Recomendamos postergar atendimentos, exames e cirurgias eletivas para diminuir a propagação do COVID-19. Da mesma forma, recomendamos mudança de rotinas em diversas áreas da otorrinolaringologia. Além disso, orientações sobre o uso do recurso da telemedicina durante o período de vigência da pandemia. Conclusões: Estamos ainda no início da pandemia do COVID-19 e as evidências científicas são ainda escassas, por isso essas recomendações da ABORL-CCF para os otorrinolaringologistas podem sofrer atualizações baseadas nos novos conhecimentos e no padrão de disseminação do novo coronavírus.

Abstract Introduction: We are facing a pandemic with a great impact worldwide, as a result of the rapid spread of the novel coronavirus (COVID-19). The medical community is still getting to know behavior of this virus and the consequences from a population point of view. All this knowledge is extremely dynamic, so some behaviors are still not well established. Otorhinolaryngologists have a central role in the management of this situation, in which they must assess the patient, avoid contamination to and by health professionals and other patients. Thus, the recommendations of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery (ABORL-CCF) have the main objective of reducing the spread of the new coronavirus during otorhinolaryngological care and assisting in the management of these patients. Methods: Review of the main recommendations of national and international scientific societies, decisions by government agencies and class councils. The topics will be related to the general aspects of COVID-19, personal protective equipment, care in patient assistance, endoscopic exam routines and the management of sinonasal, otological and pediatric evaluations related to COVID-19. Results: The use of personal protective equipment is considered crucial in routine ENT care. We recommend postponing appointments, exams and elective surgeries to reduce the spread of COVID-19. Similarly, we recommend changing routines in several areas of otolaryngology. Additionally, guidance is provided on the use of telemedicine resources during the pandemic period. Conclusions: We are still at the beginning of the COVID-19 pandemic and scientific evidence is still scarce and incomplete, so these ABORL-CCF recommendations for otorhinolaryngologists may be updated based on new knowledge and the pattern of the new coronavirus spread.

OBJETIVO: Propor e verificar a exequibilidade de programa de intervenção fonoaudiológica para indivíduos com sinais de presbilaringe com ou sem queixa vocal. MÉTODO: Dentre 20 idosos integrantes da pesquisa, participaram deste piloto três idosas com média de 67 anos. Antes e após o programa, realizaram exame laringológico, gravação da voz com protocolo CAPE-V, responderam ao Protocolo de Rastreio de Risco de Disfonia (PRRD) e participaram do Programa Vocal Cognitivo para presbifonia elaborado com fundamentação teórica na epistemologia genética de Jean Piaget associado a técnicas vocais baseadas na literatura. É composto por seis sessões, cada uma com ênfase em diferentes aspectos da produção vocal. RESULTADOS: Após o programa, loudness, coordenação pneumofonoarticulatória, clareza articulatória, jitter e proporção harmônico-ruído melhoraram, ficando dentro do esperado para a faixa etária. Nas três participantes observou-se melhora da qualidade vocal, aumento da frequência fundamental e melhora dos tempos máximos de fonação. Em duas observou-se tensão associada à elevação da loudness e melhora no escore PRRD. Observou-se nas participantes redução dos sinais de presbilaringe observados ao exame de laringoscopia, com melhora da coaptação glótica e movimentação da onda mucosa. CONCLUSÃO: Os resultados preliminares apontam perspectivas animadoras em relação à proposta com melhora dos aspectos analisados. O programa proposto mostrou-se exequível e bem delineado, não sendo necessários ajustes para continuidade do projeto.

PURPOSE: To propose and verify the feasibility of a vocal program intervention in patients with presbylarynx signs with or without vocal complaints. METHOD: Among 20 elder participants of the current research, 3 female patients with median age of 67 years were chosen for the pilot study. Laryngological examination, vocal recording with CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) protocol, and Screening Protocol of Risk of Dysphonia (SPRD) were conducted before and after the program intervention. They joined the Cognitive Vocal Program for presbyphonia based on the genetic epistemology by Jean Piaget associated with vocal techniques based on scientific literature. This program is structured with six sessions and each one of them is focused in different aspects of vocal production. RESULTS: After the program intervention, some aspects such as loudness, coordination between breathing and speaking, accuracy in articulatory movements, jitter, and harmonics-to-noise ratio improved with parameters within the expected range for the age group. Three female participants were observed for better vocal quality, higher fundamental frequency, and better maximum phonation time. In two cases, tension related to loudness elevation and better scores on SPRD was observed. Using by high-speed laryngeal image, we also observed reduction of presbylarynx signs, and remarkable improvement in glottis closure competence and mucosal wave movement of the patients with and without vocal complaints. CONCLUSION: The preliminary results suggest encouraging prospects for the proposal with improvement in the aspects analyzed. This program was well designed and did not require any further adjustments.

Introduction  The study of the dynamic properties of vocal fold vibration is important for understanding the vocal production mechanism and the impact of organic and functional changes. The advent of high-speed videolaryngoscopy (HSV) has provided the possibility of seeing the real cycle of vocal fold vibration in detail through high sampling rate of successive frames and adequate spatial resolution. Objective  To describe the technique, advantages, and limitations of using HSV and digital videokymography in the diagnosis of vocal pathologies. Methods  We used HSV and digital videokymography to evaluate one normophonic individual and four patients with vocal fold pathologies (nodules, unilateral paralysis of the left vocal fold, intracordal cyst, and adductor spasmodic dysphonia). The vocal fold vibration parameters (glottic closure, vibrational symmetry, periodicity, mucosal wave, amplitude, and glottal cycle phases) were assessed. Results  Differences in the vocal vibration parameters were observed and correlated with the pathophysiology. Conclusion  HSV is the latest diagnostic tool in visual examination of vocal behavior and has considerable potential to refine our knowledge regarding the vocal fold vibration and voice production, as well as regarding the impact of pathologic conditions have on the mechanism of phonation.

OBJETIVO: Identificar efeitos imediatos das vibrações sonorizadas e do som basal em indivíduos saudáveis por meio de parâmetros acústicos e quimografia de alta velocidade. MÉTODOS: Participaram 30 sujeitos, 12 homens e 18 mulheres (19 a 45 anos) sem alterações laríngeas. As vozes foram gravadas à taxa de 44.100 amostras/segundo e as videolaringoscopias de 4.000 quadros/segundo, antes e depois dos exercícios vocais. Foi desenvolvida uma rotina computacional para extrair Jitter e Shimmer. Foram geradas quimografias de alta velocidade a partir das imagens laríngeas para a análise dos tempos de fase: fechada (FF); aberta (FA); de fechamento (Ff) e de abertura (Fa), e usados o Teste t de Student pareado e o teste Mann-Whitney, com nível de significância de 0,05. RESULTADOS: Após as vibrações sonorizadas, houve diminuição de Jitter (0,018 para homens e p<0,01para mulheres) para ambos os gêneros e diminuição de Shimmer (p<0,01) ao gênero feminino. Houve diminuição de FF (p=0,046) e de Ff (p=0,026) e aumento de FA (p=0,05) em pregas vocais femininas. Após o som basal, foram identificados diminuição de Jitter (p<0,01) em vozes femininas e da Ff (p=0,026) em pregas vocais masculinas. CONCLUSÃO: Foi possível verificar mais efeitos imediatos positivos após as vibrações sonorizadas principalmente em qualidade vocal e pregas vocais de mulheres. No entanto, são necessárias pesquisas com maior número de amostras masculinas e investigação sobre o tempo adequado do som basal para corroboração dos resultados desta pesquisa.

Purpose: To identify the immediate effects of voiced vibration and vocal fry exercises on healthy subjects by means of acoustic parameters and high-speed kymography. Methods: Thirty healthy subjects (18 women and 12 men, aged from 19 to 45 years old) participated in this study. The voices were recorded at the range of 44.100 samples/second, before and after of the vocal exercises. We developed a computational routine to extract jitter and shimmer. High-speed kymography was generated from laryngeal images for the analysis of the phase times: closed (CPh), open (OPh), of closing (cPh) and of opening (oPh) and used the paired t-Student test and the Mann-Whitney test, with a significance level of 0.05. Results: After voiced vibrations, acoustic parameters showed reduced jitter for both genders (p=0.018 for men and p<0.01 for women) and reduced shimmer for female voices (p<0.01). There was a decrease in CPh (p=0.046) and cPh (p=0.026) and an increase in OPh (p=0.05) in female vocal folds. After vocal fry, we identified decreased jitter (p<0.01) in female voices and cPh (p=0.026) in male vocal folds. Conclusion: We observed more positive immediate effects of the voiced vibrations, mainly in voice quality and vocal folds among females. Nevertheless, studies with larger male sample and investigation of the appropriate time of vocal fry are necessary to confirm the results of this search.

INTRODUCTION: Endolaryngeal injection of botulinum toxin into the thyroarytenoid (TA) muscle is one of the methods for treatment of focal laryngeal dystonia. However, after treatment, there is variation in laryngeal configuration as well as the side effects reported by patients. As a consequence of the functional variability of results, it was hypothesized that botulinum toxin diffuses beyond the limits of the muscle into which it is injected. OBJECTIVES: After injection of botulinum toxin into the TA muscle for the treatment of focal laryngeal dystonia, patients differ in terms of laryngeal configuration and side effects. We hypothesized that this toxin diffuses from the target muscle to adjacent muscles. METHOD: The TA muscles of 18 cadaver larynges were injected with aniline blue (0.2 mL). After fixation in formaldehyde and nitric acid decalcification, the larynges were sectioned in the coronal plane and the intrinsic muscles were analyzed. RESULTS: We found diffusion of aniline blue to the lateral cricoarytenoid muscle, cricothyroid muscle, and posterior cricoarytenoid muscle in 94.3%, 42.9%, and 8.6% of the cases, respectively. In terms of the degree of diffusion to adjacent muscles, we found no differences related to the size (height and width) of the TA muscle or to gender. CONCLUSIONS: Our findings suggest that diffusion of botulinum toxin from its injection site in the TA muscle to the lateral cricoarytenoid muscle is likely in most cases. On the other hand, diffusion to the cricothyroid muscle occurs in approximately half of cases and diffusion to the posterior cricoarytenoid muscle occurs in very few cases.

INTRODUCTION: The effects of voiced vibration technique can be assessed by laryngeal imaging. Kymographic images derived from high-speed videoendoscopy allow actual visualization of vocal folds vibration. PURPOSE: The aim of this study is to identify the immediate effects of the voiced vibration technique in healthy vocal folds using high-speed digital laryngeal imaging. METHODS: Samples were obtained from 15 healthy subjects with no history of voice disorders (6 men and 9 women aged 21 to 43 years). High-speed videoendoscopy recordings were performed before and after the voiced vibration technique. Kymographic images were obtained using high-speed videoendoscopy. The vocal folds were examined in their open and closed positions and the characteristics of the opening and closing phases were determined. A customize computational routine was used quantify these parameters. The closing, opening, and speed quotients were also calculated. RESULTS: In this study, women displayed statistically significant differences in opened phase (P= 0.05*), closed phase (P= 0.046*), and closing phase (P= 0.026*) phase characteristics. Men displayed the highest difference rate in opening time characteristics (P= 0.06). The closing and opening quotients for the female group showed significant differences (P= 0.029* and P= 0.049*, respectively). The speed quotient exhibited statistically significant differences in the male group (P= 0.048*). CONCLUSION: The kymographic images indicated that the immediate effect of the voiced vibration technique was smooth contact in healthy vocal fold vibration.

Há na literatura inúmeras descrições de amiloidose limitada à laringe, sendo que esta afecção corresponde a cerca de 1% dos tumores benignos da laringe. Entretanto, há somente três relatos de amiloidose acometendo a região do anel de Waldeyer. Descreveremos um raro caso de amiloidose em que há acometimento de sítios distintos do trato aéreo-digestivo superior: pilar amigdaliano, rinofaringe, supraglote e glote, sem continuidade aparente do tecido amilóide. Abordaremos, também, o seguimento pós-operatório com uma disfagia grave.

There are some reports of localized amyloidosis in the larynx, an entity that corresponds to one percent of all benign tumors of this region. However, there are only two cases of amyloidosis in the Waldeyer's ring 6, 13, 14. We hereby describe a rare case of amyloidosis in areas not associated with the upper aero-digestive tract: tonsil pillar, rhinopharynx, supraglottis and glottis, without visible continuity of amyloid tissue. We will also discuss post-operative follow up with severe dysphagia.

A disfonia espasmódica de adução é um distúrbio vocal grave, caracterizado por espasmos dos músculos laríngeos durante a fonação, produzindo voz quebrada, tensa, forçada e estrangulada. Seus sintomas decorrem da contração intermitente e involuntária dos músculos tireoaritenóideos durante a fonação, o que resulta em pregas vocais tensas, pressionadas uma contra a outra, e no aumento da resistência glótica. OBJETIVO: Apresentar os resultados preliminares do impacto na qualidade vocal da cirurgia de Neurectomia do ramo tireoaritenóideo do laríngeo inferior, via endoscópica, associada à miectomia parcial do músculo tireoaritenóideo com laser de CO2. MATERIAL E MÉTODO: A cirurgia foi realizada em 7 pacientes (6 mulheres e 1 homem), com idades variando entre 22 e 75 anos, com diagnóstico de disfonia espasmódica de adução. Os pacientes foram submetidos ao VHI (Voice Handicap Index) no pré e pós-operatório. RESULTEDOS E CONCLUSÃO: A melhora vocal foi conseguida em todos os pacientes estudados não ocorrendo deterioração da qualidade vocal ao longo do período pós-operatório. Houve uma diferença evidente no VHI antes e após a cirurgia. Essa técnica cirúrgica mostrou-se eficaz e inovadora no tratamento da disfonia espasmódica de adução.

Impact in vocal quality in partial myectomy and neurectomy endoscopic of thyroarytenoid muscle in patients with adductor spasmodic dysphonia the adductor spasmodic dysphonia is a severe vocal disorder characterized by muscle laryngeal spasms during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms come from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold strain, pressed one against another and increased glottic resistance. AIM: report the results in the impact in vocal quality in neurectomy of the thyroarytenoid branch of the inferior laryngeal nerve by endoscopic route associated with partial myectomy of the thyroarytenoid muscle with co2 laser. MATERIAL E METHODS: the surgery was done in 07 patients ( 06 females and 01 male), aged 22 to 75, with adductor spasmodic dysphonia. They were submitted to vhi (voice handicap index) before and after surgery. RESULTS AND CONCLUSIONS: the vocal improvement was obtained in all studied patients, deterioration in vocal quality after surgery was not noticed. There was evident difference in the vhi before and after surgery. This surgical thecnique proved to be efficient and innovative in the treatment of adductor spasmodic dysphonia.

CONTEXTO E OBJETIVO: Embora seja consenso que uma anamnese e um exame clínico devam ser realizados como parte da avaliação pré-operatória, ainda há grande controvérsia a respeito dos benefícios adicionais de exames subsidiários de rastreamento na avaliação pré-operatória. Neste estudo objetivamos determinar a porcentagem de exames subsidiários alterados em uma população que foi submetida a cirurgia não-cardíaca e correlacionamos as anormalidades observadas nestes exames com mudanças realizadas nas condutas pré-operatórias. TIPO DE ESTUDO E LOCAL: Estudo transversal desenvolvido em Hospital Universitário. MÉTODOS: 991 pacientes com mais de 40 anos, que foram submetidos a operações não-cardíacas eletivas de julho de 1997 a janeiro de 2000 foram estudados. Foram avaliados o hemograma, as dosagens séricas de sódio, potássio, uréia e creatinina, os tempos de protrombina, trombina e tromboplastina parcial ativada, o eletrocardiograma e a radiografia de tórax. RESULTADOS: Dentre os 957 eletrocardiogramas realizados, alguma alteração foi observada em 504 (50,9%) casos e, dentre as 646 radiografias de tórax feitas, 271 (42,0%) apresentaram alterações. As porcentagens de exames de laboratório alterados variaram de 5,1% (tempo de protrombina) a 41,0% (hematócrito). Observamos, também, um aumento na porcentagem de exames alterados em pacientes mais idosos. CONCLUSÕES: Embora um grande número de exames subsidiários alterados seja observado na avaliação pré-operatória, estes resultados raramente interferem na conduta dos pacientes.

CONTEXT AND OBJECTIVE: Although it is generally agreed that a medical history and physical examination should be obtained as part of preoperative evaluation, there is still substantial controversy about the additional benefits of preoperative screening tests. The objective of the present study was to determine the percentage of abnormalities on laboratory tests among a population that underwent non-cardiac surgery and to correlate these tests with changes in preoperative evaluation management. DESIGN AND SETTING: Cross-sectional study, carried out in a University Hospital. METHODS: 991 patients aged over 40 years undergoing elective non-cardiac surgery from July 1997 to January 2000 were studied. Blood cell count, serum sodium, potassium, urea and creatinine, prothrombin, thrombin and partial thromboplastin time, electrocardiogram and chest X-ray were evaluated. RESULTS: Out of the 957 electrocardiograms performed, some type of abnormality was found in 504 cases (50.9%) and, among the 646 chest X-rays requested, 271 (42.0%) displayed alterations. Laboratory tests showed abnormal values ranging from 5.1% (prothrombin time) to 41.0% (hematocrit). Increased percentages of abnormal tests with increasing patient age were also observed. CONCLUSIONS: Although there were substantial numbers of screening test abnormalities in preoperative evaluations, these results seldom interfered in patient management.