Eletroneuromiografia da laringe : aspectos tecnicos, estudo normativo e contribuição ao diagnostico e tratamento das alterações da mobilidade das pregas vocais

AUTOR(ES)
DATA DE PUBLICAÇÃO

2004

RESUMO

Laryngeal Electromyography (LEMG) is an auxiliary method used for the comprehension and diagnosis of different neurological diseases that compromise laryngeal function. This thesis was wrote in 4 chapters: 1) Laryngeal electromyography: technical features; 2) Laryngeal electromyography in normal brazilian population; 3) Laryngeal eletromyography contribution to vocal fold immobility diagnosis; 4) Laryngeal electromyography in movement disorders: preliminary data. 1) There were described techniques for inserting needle electrodes percutaneously into the tireoaritenoideus (TA), cricotireoideus (CT), cricoaritenoideus lateralis (CAL) and cricoaritenoideus posterioris (CAP) muscles in 80 patients, 47 female and 33 male, aged between 18 to 86 years (mean 52,7y). The TA technique achieved correct location in ali patients, via cricothyroid membrane technique in 68 cases, and via thyroid cartilage technique in 12 cases. CT direct approach was performed in 58, CAP approach in 56, with digital rotation technique in 32, and through laryngeallumen in 24 cases. In 80 patients, 55 presents with vocal fold immobility and 25 with movement disorders. 2) There were described normal values of motor unit action potentials duration and amplitude of these muscles in 14 adult volunteers with no vocal disturbs, 9 female and 5 male, aged between 18 to 55 years (mean 35,6y). 3) There were described the LEMG contribution to diagnosis in 55 patients, 27 female and 28 male, aged between 18 to 86 years (mean 53,4), with vocal fold immobility, 32 left-hand side, 14 right-hand side and 9 bilateral. Patients were grouped accord to prior clinical diagnosis: 1) unknown (30 patients) ; 2) traumatic (14 patients); or 3) tumoral (11 patients). 4) There were described preliminary LEMG data in 25 patients, 18 female and 7 male, aged between 21 to 86 years (mean 51,4), with dysphonia due to movement disorders. Laryngoscopy and clinical evaluation suggests sapasmodic dysphonia (SD) in 19 patients, vocal tremor (VT) in 5 and Gilles de Ia Tourette syndrome in 1. There were described also the response to botulinum toxin A treatment in 18 patients selected to tms treatment, 14 with SD, 3 with essential VT and 1 GTS patient. There was used unilateral 2,5 U of botulinum toxin A (BOTOXR) diluted in 0,9% saline solution. In 12 aduction SD, 3 essential VT and 1 GTS patients, TA was the target muscle. In 2 patients with abduction SD, CAP was the target muscle. The improvement was significant in 11, mild in 4 and poor in 3 patients. The response to botulinum toxin A treatment was poor in both patients with abduction SD. All of 80 dysphonic patients were submitted to otorhino1aryngological, phonoaudiological and laryngeal endoscopy before LEMG. The recordings were obtained by the four channel Nihon Kohden m using percutaneously inserted concentric needle electrode in volunteers and in patients with vocal fold immobility; and monopolar needle electrode in patients with movement disorders. There were concluded: 1) The percutaneous techniques allow the correct location of the laryngea1 in patients who require this examination. The CAP approach, by digital rotation of the thyroid cartilage was found to be the most diflicult, followed by the CAL approach. TA and CT approaches gave no major problems, except with some older and obese patients. A significant complication of the TA approach via thyroid cartilage was a hematoma in one patient which partially obstructed the laryngeallumen. 2) There were descn"bed at first time in our mean the normal values for duration and amplitude of PAUM, respectively 3.8ms and 413_V for TA, 4.9ms and 585_V for CT, 4.Ims and 388_V for CAL and 4.5ms and 475_V in CAP. 3) LEMG contributed to diagnosis in ali 55 patients with vocal fold immobility. LEMG showed peripheral nerve injury in 25 patients in group 1, 12 in group 2 and 11 in group 3. LEMG was normal in 4 patients, suggesting crico-arythenoid joint fixation. In 2 patients LEMG suggests central nervous system injury and myopathy in one. 4) In the 25 patients with movement disorders LEMG was consistent with SD in 14 (normal in 5), essential VT in 3, Parkinson VT in 2 and GTS in one. Botulinum toxin treatment guided by LEMG showed good response in 15 patients. In general, the risk-benefit relation justities 1aryngeal electromyography for clinical diagnosis and treatment

ASSUNTO(S)

cordas vocais toxina botulinica pesquisa metodologia musculos

ACESSO AO ARTIGO

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