Competência glótica na doença pulmonar obstrutiva crônica

Cassiani, Rachel de Aguiar; Aguiar-Ricz, Lílian; Santos, Carla Manfredi dos; Martinez, José Antonio Baddini; Dantas, Roberto Oliveira

Resumos

OBJETIVO: Correlacionar a medida do tempo máximo de fonação (TMF) com o volume de ar pulmonar expirado no primeiro segundo do sopro (VEF1) e comparar o TMF, emissão do "s", "z" e relação s/z em indivíduos saudáveis e indivíduos com doença pulmonar obstrutiva crônica (DPOC). MÉTODOS: Foram avaliados 14 voluntários saudáveis, com média de idade de 65 anos, e 16 indivíduos com DPOC, com média de idade de 68 anos. O diagnóstico da doença foi clínico e também obtido por exames da função pulmonar. Os participantes foram submetidos à espirometria para apreciação dos parâmetros VEF1, capacidade vital forçada (CVF) e o índice de Tiffeneau (VEF1/CVF). Registrou-se a emissão prolongada das vogais "a", "i", "u" para análise do tempo máximo de fonação na condição normal e forçada e aferiu-se a relação s/z após a sustentação dos fonemas /s/ e /z/. RESULTADOS: Nos dois grupos, o TMF com a fonação normal foi menor do que o tempo máximo de fonação, com a fonação forçada. A mediana do TMF do grupo controle foi maior do que a do grupo com DPOC, com a fonação normal e a fonação forçada. Não houve correlação entre o tempo máximo de fonação e os valores de VEF1 nos grupos. CONCLUSÃO: Pacientes com DPOC tem diminuição do tempo máximo de fonação e a relação s/z sugere falta de coaptação glótica. Não houve correlação do TMF e a medida do VEF1.

Laringe; Doença Pulmonar Obstrutiva Crônica; Fonação; Voz; Disfonia

PURPOSE: This study correlates the extent of maximum phonation time (MPT) with the volume of air exhaled in the first second pulmonary (FEV1) and compares the MPT emission of /s/, /z/ and s/z ratio in healthy subjects and those with chronic obstructive pulmonary disease (COPD). METHODS: We studied 14 normal volunteers (control group), mean age 65 years, and 16 patients with COPD, mean age 68 years. The diagnosis of COPD was done by clinical and pulmonary function evaluation. Participants underwent spirometry for analysis of the parameters FEV1, forced vital capacity (FVC) and Tiffeneau index (FEV1/FVC). The maximum phonation time, along with phonemes /s/ and /z/, s/z ratio correlation, and maximum phonation time in both normal and forced phonation were collected and recorded. RESULTS: In both groups, the maximum phonation time with normal phonation was lower than the maximum phonation time with forced phonation. The median of the maximum phonation time in the control group was higher than in the COPD group. There was no correlation between the maximum phonation time and FEV1, in normal volunteers and patients with COPD. CONCLUSION: Patients with COPD have decreased maximum phonation time, while the s/z ratio does not suggest changes in the level of the vocal folds, since the values found were within the normal range. There was no correlation of the TMF and the measure of FEV1.

Larynx; Pulmonary Disease, Chronic Obstructive; Phonation; Voice; Dysphonia

¹
Ministério da Saúde. Departamento de Gestão e Incorporação de Tecnologias em Saúde da Secretaria de Ciência, Tecnologia e Insumos Estratégicos – DGITS/SCTIE. Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC) - Relatório n° 30.
²
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist AS, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: gold executive summary. Am J Respir Crit Care Med. 2007;176(6):532-55.
³
Iwarson J, Sundberg J. Effects of lung volume on vertical larynx position during phonation. J Voice. 1998;12(2):159-65.
⁴
Jardim JR, Oliveira J, Nascimento O. II Consenso Brasileiro de Doença Pulmonar Obstrutiva Crônica (DPOC). J Bras Pneumol. 2004;30:1-42.
⁵
Killian KJ, Leblanc P, Martin DH, Summers E, Jones NL, Campbell EJ. Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation. Am Rev Respir Dis. 1992;146(4):935-40.
⁶
Donahoe M, Rogers RM, Wilson DO, Pennock BE. Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary. Am Rev Respir Dis. 1989;140(2):385-91.
⁷
Binazzi B, Lanini B, Bianchi R, Romagnoli I, Nerini M, Gigliotti F, et al. Breathing pattern and kinematics in normal subjects during speech, singing and loud whispering. Acta Physiol (Oxf). 2006;186:233-46.
⁸
Binazzi B, Lanini B, Romagnoli I, Garuglieri S, Stendardi L, Bianchi R, et al. Dyspnea during speech in chronic obstructive pulmonary disease patients: effects of pulmonary rehabilitation. Respiration. 2011;81(5): 379-85.
⁹
Solomon NP, Garlitz SJ, Milbrath RL. Respiratory and laryngeal contribuitions to maximum phonation duration. J Voice. 2000;14(3):331-40.
¹⁰
Cielo CA, Conterno G, Carvalho CDM, Finger LS. Disfonias: relação s/z e tipos de voz. Rev CEFAC. 2008;10(4):536-47.
¹¹
Eckel FC, Boone DR. The S/Z ratio as an indicator of laryngeal pathology. J Speech Hear Disord. 1981;46(2):147-9.
¹²
Pereira CAC, Barreto SP, Simões JG, Pereira FWL, Gerstler JG, Nakatani J. Valores de referência para espirometria em uma amostra da população brasileira adulta. J Pneumol. 1982;18(1):10-22.
¹³
Behlau M, Madázio G, Feijó D, Pontes P. Avaliação de voz. In: Behlau M (org). Voz: o livro do especialista. Vol 1. Rio de Janeiro: Revinter; 2005. p.85-120.
¹⁴
OâDonnell DE, Revill SM, Webb KA. Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(5):770-7.
¹⁵
Lee L, Friesen M, Lambert IR, Loudon RG. Evaluation of dyspnea during physical and speech activities in patients with pulmonary diseases. Chest. 1998;113:625-32.
¹⁶
Milstein CF, Watson PJ. The effects of lung volume initiation on speech: a perceptual study. J Voice. 2004;18(1):38-45.
¹⁷
Van Der Berg J. Myoelastic-aerodinamic theory of voice production. J Speech Hear Res. 1958;1(3):227-44.
¹⁸
Iwarsson J, Thomasson M, Sundberg J. Effects of lung volume on the glottal voice source. J Voice. 1998;12(4):424-33.
¹⁹
Hoit J, Solomon NP, Hixon T. Effect of lung volume on voice onset time (VOT). J Speech Hear Res. 1993;36(3):516-21.

Datas de Publicação

Publicação nesta coleção
14 Out 2013
Data do Fascículo
2013

Histórico

Recebido
05 Out 2012
Aceito
12 Ago 2013

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] ¹
Ministério da Saúde. Departamento de Gestão e Incorporação de Tecnologias em Saúde da Secretaria de Ciência, Tecnologia e Insumos Estratégicos – DGITS/SCTIE. Comissão Nacional de Incorporação de Tecnologias no SUS (CONITEC) - Relatório n° 30.

[2] ²
Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist AS, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: gold executive summary. Am J Respir Crit Care Med. 2007;176(6):532-55.

[3] ³
Iwarson J, Sundberg J. Effects of lung volume on vertical larynx position during phonation. J Voice. 1998;12(2):159-65.

[4] ⁴
Jardim JR, Oliveira J, Nascimento O. II Consenso Brasileiro de Doença Pulmonar Obstrutiva Crônica (DPOC). J Bras Pneumol. 2004;30:1-42.

[5] ⁵
Killian KJ, Leblanc P, Martin DH, Summers E, Jones NL, Campbell EJ. Exercise capacity and ventilatory, circulatory, and symptom limitation in patients with chronic airflow limitation. Am Rev Respir Dis. 1992;146(4):935-40.

[6] ⁶
Donahoe M, Rogers RM, Wilson DO, Pennock BE. Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary. Am Rev Respir Dis. 1989;140(2):385-91.

[7] ⁷
Binazzi B, Lanini B, Bianchi R, Romagnoli I, Nerini M, Gigliotti F, et al. Breathing pattern and kinematics in normal subjects during speech, singing and loud whispering. Acta Physiol (Oxf). 2006;186:233-46.

[8] ⁸
Binazzi B, Lanini B, Romagnoli I, Garuglieri S, Stendardi L, Bianchi R, et al. Dyspnea during speech in chronic obstructive pulmonary disease patients: effects of pulmonary rehabilitation. Respiration. 2011;81(5): 379-85.

[9] ⁹
Solomon NP, Garlitz SJ, Milbrath RL. Respiratory and laryngeal contribuitions to maximum phonation duration. J Voice. 2000;14(3):331-40.

[10] ¹⁰
Cielo CA, Conterno G, Carvalho CDM, Finger LS. Disfonias: relação s/z e tipos de voz. Rev CEFAC. 2008;10(4):536-47.

[11] ¹¹
Eckel FC, Boone DR. The S/Z ratio as an indicator of laryngeal pathology. J Speech Hear Disord. 1981;46(2):147-9.

[12] ¹²
Pereira CAC, Barreto SP, Simões JG, Pereira FWL, Gerstler JG, Nakatani J. Valores de referência para espirometria em uma amostra da população brasileira adulta. J Pneumol. 1982;18(1):10-22.

[13] ¹³
Behlau M, Madázio G, Feijó D, Pontes P. Avaliação de voz. In: Behlau M (org). Voz: o livro do especialista. Vol 1. Rio de Janeiro: Revinter; 2005. p.85-120.

[14] ¹⁴
OâDonnell DE, Revill SM, Webb KA. Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;164(5):770-7.

[15] ¹⁵
Lee L, Friesen M, Lambert IR, Loudon RG. Evaluation of dyspnea during physical and speech activities in patients with pulmonary diseases. Chest. 1998;113:625-32.

[16] ¹⁶
Milstein CF, Watson PJ. The effects of lung volume initiation on speech: a perceptual study. J Voice. 2004;18(1):38-45.

[17] ¹⁷
Van Der Berg J. Myoelastic-aerodinamic theory of voice production. J Speech Hear Res. 1958;1(3):227-44.

[18] ¹⁸
Iwarsson J, Thomasson M, Sundberg J. Effects of lung volume on the glottal voice source. J Voice. 1998;12(4):424-33.

[19] ¹⁹
Hoit J, Solomon NP, Hixon T. Effect of lung volume on voice onset time (VOT). J Speech Hear Res. 1993;36(3):516-21.

Brasil

Brasil

Competência glótica na doença pulmonar obstrutiva crônica

Glottal competence in chronic obstructive pulmonary disease

Resumos

Datas de Publicação

Histórico