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Voice disorders in mucosal leishmaniasis
Ana Cristina Nunes Ruas1, Márcia Mendonça Lucena2, Ananda Dutra da Costa2
1Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil; Department of Speech Pathology, Federal University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil.
Introduction:
Leishmaniasis is considered as one of the six most important infectious diseases because of its high detection coefficient and ability to produce deformities. In most cases, mucosal leishmaniasis (ML) occurs as a consequence of cutaneous leishmaniasis. If left untreated, mucosal lesions can leave sequelae, interfering in the swallowing, breathing, voice and speech processes and requiring rehabilitation.
Objective:
To describe the anatomical characteristics and voice quality of ML patients.
Materials And Methods:
A descriptive transversal study was conducted in a cohort of ML patients treated at the Laboratory for Leishmaniasis Surveillance of the Evandro Chagas National Institute of Infectious Diseases-Fiocruz, between 2010 and 2013. The patients were submitted to otorhinolaryngologic clinical examination by endoscopy of the upper airways and digestive tract and to speech-language assessment through directed anamnesis, auditory perception, phonation times and vocal acoustic analysis. The variables of interest were epidemiologic (sex and age) and clinic (lesion location, associated symptoms and voice quality.
Results:
26 patients under ML treatment and monitored by speech therapists were studied. 21 (81%) were male and five (19%) female, with ages ranging from 15 to 78 years (54.5+15.0 years). The lesions were distributed in the following structures 88.5% nasal, 38.5% oral, 34.6% pharyngeal and 19.2% laryngeal, with some patients presenting lesions in more than one anatomic site. The main complaint was nasal obstruction (73.1%), followed by dysphonia (38.5%), odynophagia (30.8%) and dysphagia (26.9%). 23 patients (84.6%) presented voice quality perturbations. Dysphonia was significantly associated to lesions in the larynx, pharynx and oral cavity.
Conclusion:
We observed that vocal quality perturbations are frequent in patients with mucosal leishmaniasis, even without laryngeal lesions; they are probably associated to disorders of some resonance structures (larynx, pharynx and nasal and oral cavities) or even to compensation mechanisms caused by the presence of lesions in the upper airways and digestive tract.
Insights
Mucosal leishmaniasis (ML) frequently causes voice problems, even without direct laryngeal lesions. These voice quality changes are likely due to affected resonance structures or compensatory mechanisms in ML patients.
Area of Science:
- Infectious Diseases
- Otolaryngology
- Speech-Language Pathology
Background:
- Leishmaniasis is a major global infectious disease causing deformities.
- Mucosal leishmaniasis (ML) often follows cutaneous leishmaniasis and can cause lasting damage.
- Untreated ML sequelae impact swallowing, breathing, voice, and speech, necessitating rehabilitation.
Purpose of the Study:
- To characterize the anatomical locations of lesions in mucosal leishmaniasis patients.
- To assess the voice quality of individuals with mucosal leishmaniasis.
Main Methods:
- A descriptive transversal study of 26 ML patients treated between 2010-2013.
- Otorhinolaryngologic examination via endoscopy of upper airways and digestive tract.
- Speech-language assessment including anamnesis, auditory perception, phonation times, and acoustic analysis.
Main Results:
- Lesions were most common in nasal (88.5%), oral (38.5%), pharyngeal (34.6%), and laryngeal (19.2%) structures.
- Nasal obstruction (73.1%) was the primary complaint, followed by dysphonia (38.5%), odynophagia (30.8%), and dysphagia (26.9%).
- Voice quality perturbations were observed in 84.6% of patients, significantly associated with laryngeal, pharyngeal, and oral lesions.
Conclusions:
- Vocal quality perturbations are common in ML patients, irrespective of laryngeal involvement.
- These voice changes may stem from resonance structure disorders (larynx, pharynx, nasal/oral cavities).
- Compensatory mechanisms due to upper airway/digestive tract lesions likely contribute to voice alterations.
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