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Journal of Venomous Animals and Toxins including Tropical Diseases

On-line version ISSN 1678-9199

J. Venom. Anim. Toxins incl. Trop. Dis vol.9 no.1 Botucatu  2003 

Laryngeal lesions and resulting dysphonia in patients with paracoccidioidomycosis.



THESIS: S. A. T. Weber submitted this dissertation for her Masters in Tropical Diseases at Botucatu School of Medicine, São Paulo State University, UNESP, Botucatu, São Paulo, Brazil, 2002.

Advisor: Professor Rinaldo Poncio Mendes

Address to correspondence



ABSTRACT: Paracoccidioidomycosis (PBM) is a systemic disease, endemic in Latin America, caused by the thermally dimorphic fungus Paracoccidioides brasiliensis. The third most frequent involved organ is the larynx. We studied 15 normal male subjects and 35 male PBM patients to describe laryngeal lesions and the resulting dysphonia. Thirty post-treatment patients were submitted to follow-up, 15 with pulmonary disease and 15 with larynx involvement. Five PBM patients with laryngeal lesions were evaluated at the beginning and after four months of anti-fungal treatment. All patients were submitted to perceptual and acoustic voice analysis; those with laryngeal lesions were submitted to endoscopic examination. Voice analysis showed more severe dysphonia in the laryngeal lesion group (P<0.01), characterized by hoarseness and breathiness. Voices of all groups of patients showed instability at perceptual analysis (P<0.01). Fifty percent of PBM patients with laryngeal lesions had severe dysphonia; dysphonia index (ID) > 7. The Dr. Speech program, Tiger Electronics, did not accept the voices of seven patients with laryngeal lesions for acoustic analysis due to severe dysphonia. Jitter was elevated in six PBM patients with laryngeal lesions. Eighty percent of PBM patients with laryngeal lesions showed two or more compromised laryngeal structures at endoscopic examination. The vocal cords showed changes in all PBM patients with laryngeal lesions already treated, and in four of five patients with active laryngeal disease. The most frequent lesion was a fibrous thickening of the vocal cords. The other affected structures were arytenoids, epiglottis, and vestibular folds. Moriform lesion, highly suggestive of PBM, was found in three of five PBM patients before the beginning of treatment. We concluded that laryngeal involvement in PBM frequently causes severe dysphonia; an otorhinolaryngologic examination is of major importance for all PBM patients.

Key words: Paracoccidioides brasiliensis, laryngeal lesions, dysphonia, voice analysis, Dr. Speech, moriform lesion, endoscopy



Address to correspondence
S. A. T. Weber
Departamento de Doenças Tropicais e Diagnóstico por Imagem, Faculdade de Medicina de Botucatu, UNESP
Distrito Rubião Junior, s/n
18618-000, Botucatu, SP, Brasil

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