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      Impact of laryngeal sequelae on voice- and swallowing-related outcomes in paracoccidioidomycosis

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          Abstract

          Background:

          The present study was carried out aiming to evaluate the impact of laryngeal sequelae on the quality of life of treated paracoccidioidomycosis (PCM) patients.

          Methods:

          This cross-sectional study was conducted at the Otorhinolaryngology Outpatient Clinic of the University Hospital, Federal University of Mato Grosso do Sul, Brazil. Thirty-two PCM patients considered clinically and immunologically cured were included: 16 with laryngeal involvement during the active phase of the disease (laryngeal PCM group) and 16 without laryngeal involvement (control group). They were submitted to structured interview, otorhinolaryngology examination, videolaryngoscopy, videoendoscopic swallowing study, completed two questionnaires for voice self-assessment - Voice-related Quality of Life (V-RQOL) and Voice Handicap Index (VHI) - and were asked to score their voices on a scale from zero to 10 (self-assessment of vocal quality).

          Results:

          Dysphonia was present in 50% of the cases. Patients with laryngeal PCM presented worse voice-related quality of life scores on the V-RQOL and poorer vocal quality self-assessment than the control group. No significant differences in the VHI were found between the groups. None of the participants developed dysphagic sequelae, although some minor changes were observed on videoendoscopic examination.

          Conclusion:

          There were no dysphagia complaints and only a few mild changes were found on the fiberoptic endoscopic evaluation of swallowing, suggesting that this evaluation should be performed only in specific cases. Patients with laryngeal involvement presented worse V-RQOL and self-assessment voice quality. This study contributes to the current knowledge of the functional assessment of the larynx affected by PCM and the impact of dysphonia on quality of life.

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          Most cited references32

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          Brazilian guidelines for the clinical management of paracoccidioidomycosis

          Abstract Paracoccidioidomycosis is a systemic fungal disease occurring in Latin America that is associated with rural environments and agricultural activities. However, the incidence and prevalence of paracoccidiodomycosis is underestimated because of the lack of compulsory notification. If paracoccidiodomycosis is not diagnosed and treated early and adequately, the endemic fungal infection could result in serious sequelae. While the Paracoccidioides brasiliensis ( P. brasiliensis ) complex has been known to be the causal agent of paracoccidiodomycosis, a new species, Paracoccidioides lutzii ( P. lutzii ), has been reported in Rondônia, where the disease has reached epidemic levels, and in the Central West and Pará. Accurate diagnoses and availability of antigens that are reactive with the patients’ sera remain significant challenges. Therefore, the present guidelines aims to update the first Brazilian consensus on paracoccidioidomycosis by providing evidence-based recommendations for bedside patient management. This consensus summarizes etiological, ecoepidemiological, molecular epidemiological, and immunopathological data, with emphasis on clinical, microbiological, and serological diagnosis and management of clinical forms and sequelae, as well as in patients with comorbidities and immunosuppression. The consensus also includes discussion of outpatient treatments, severe disease forms, disease prevalence among special populations and resource-poor settings, a brief review of prevention and control measures, current challenges and recommendations.
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            Paracoccidioidomycosis: Current Perspectives from Brazil

            Background: This review article summarizes and updates the knowledge on paracoccidioidomycosis. P lutzii and the cryptic species of P. brasiliensis and their geographical distribution in Latin America, explaining the difficulties observed in the serological diagnosis. Objectives: Emphasis has been placed on some genetic factors as predisposing condition for paracoccidioidomycosis. Veterinary aspects were focused, showing the wide distribution of infection among animals. The cell-mediated immunity was better characterized, incorporating the recent findings. Methods: Serological methods for diagnosis were also compared for their parameters of accuracy, including the analysis of relapse. Results: Clinical forms have been better classified in order to include the pictures less frequently observesiod. Conclusion: Itraconazole and the trimethoprim-sulfamethoxazole combination was compared regarding efficacy, effectiveness and safety, demonstrating that azole should be the first choice in the treatment of paracoccidioidomycosis.
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              Evaluation of oropharyngeal dysphagia: which diagnostic tool is superior?

              S Langmore (2003)
              As flexible endoscopic examinations of swallowing become more widely used to evaluate patients with oropharyngeal dysphagia, it is important to be aware of research regarding the efficacy of this procedure as compared with the videofluoroscopy procedure. A recent evidence-based review of the field threw some long-held findings into question and has stimulated a surge of new research studying the sensitivity of the two instrumental examinations, health outcomes of patients who receive each procedure, and a look at different patient outcomes. Since 1999, one quasi-randomized clinical trial has directly compared outcomes of patients given a fluoroscopy versus a fiberoptic endoscopic evaluation of swallowing (FEES) examination. This study showed no significant difference in pneumonia rates between the two groups of patients. A multitude of studies have shown a high level of agreement between the two instrumental examinations, and the use of the term gold standard as applied to fluoroscopy is no longer appropriate. The attempt to standardize each examination has been slow, and inter-judge reliability of results has come under fire. Several new scales for quality of life and functional status are now ready to be applied to research that can measure outcomes other than pneumonia. Research to date has suggested that both instrumental examinations are valuable. It is likely that both will continue to be used and will be seen as complementary rather than competitors.
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                Author and article information

                Journal
                J Venom Anim Toxins Incl Trop Dis
                J Venom Anim Toxins Incl Trop Dis
                jvatitd
                The Journal of Venomous Animals and Toxins Including Tropical Diseases
                Centro de Estudos de Venenos e Animais Peçonhentos
                1678-9199
                17 August 2020
                2020
                : 26
                : e20200008
                Affiliations
                [1 ]Medical School, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.
                [2 ]Maria Aparecida Pedrossian University Hospital, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.
                [3 ]Botucatu Biosciences Institute (IBB), São Paulo State University (UNESP), Botucatu, SP, Brazil.
                [4 ]Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil.
                Author notes
                [* ] Correspondence: anapaniago@ 123456yahoo.com.br

                Competing interests: The authors declare that they have no competing interests.

                Authors’ contributions: NSCAP, RPM and AMMP conceived this research and designed experiments, participated in the design and interpretation of the data and wrote the paper and participated in the revisions of it. NSCAP, LME, JMB, VPG and LRC performed experiments and analysis. All authors read and approved the final manuscript.

                Author information
                http://orcid.org/0000-0003-0575-2263
                http://orcid.org/0000-0002-0661-5917
                http://orcid.org/0000-0002-8925-7712
                Article
                00324
                10.1590/1678-9199-JVATITD-2020-0008
                7433646
                87265ddd-d4ce-4366-bb9b-b77ac3dedb53

                © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 January 2020
                : 27 July 2020
                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 32
                Categories
                Research

                paracoccidioidomycosis,voice,larynx,quality of life,deglutition

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