Publications by authors named "Adriana Bueno Benito Pessin"

11 Publications

  • Page 1 of 1

Sectorial Analysis of the Fibrous Matrix of Vocal Folds in the Elderly.

J Voice 2022 May 4;36(3):309-315. Epub 2020 Aug 4.

Institute of Bioscience. Department of Morphology, Univ. Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil.

Objective: to determine the sectorial concentration of fibrous matrix along the vocal folds of the elderly.

Methods: Thirteen fresh vocal folds were removed from 13 cadavers. The subjects were divided into two groups: control group (CG) - age range 25-40 years (n = 5), and elderly group (EG), aged ≥70 years (n-8). The vocal folds were separated according to regions in: anterior macula flava (AMF), posterior macula flava (PMF), medial region (M) and lateral region of the membranous vocal fold (L). The material was examined using a scanning electron microscope and 10 pictures per region were obtained at 1200x magnification. The area of fibrous matrix was quantified in both groups using the AVSOFT Biovew Program.

Results: Percentage (%) of fibrous matrix per region (%): AMF (EG = 86.78%; CG = 81.63%); PMF (EG = 88.19%; CG = 81.52%); M (EG = 84.92%; CG = 77.96%); L (EG = 83.93%; CG = 78.91%). Irregular distribution of a dense fibrous matrix was also more evident in the elderly's larynges in a qualitative assessments.

Conclusion: A higher concentration of fibrous matrix was observed in the vocal folds of the elderly when compared to the control at all the studied regions. The greatest increase in the concentration of fibers in the medial portion of the body of the vocal folds is probably due to the phonatory stimulation. The macula flava remains functional even in the senile larynx.
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May 2022

Vocal Characteristics of Patients With Morbid Obesity.

J Voice 2021 Mar 21;35(2):329.e7-329.e11. Epub 2019 Oct 21.

Department of Surgery, São Paulo State University (Unesp), Botucatu, Sao Paulo, Brazil.

Introduction: Obesity modifies vocal characteristics, causing abnormal fat deposition in the abdominal region and upper airways. For some authors the voice of the obese is not different from nonobese and the vocal symptoms are scarce; for others dysphonia in obese is reported by 70% of them and the voice becomes hoarse, breathy, and unstable.

Objective: To characterize the voice of patients with morbid obesity.

Methods: Two groups were included: Obese (n-27), aged between 26 and 59 years, selected for bariatric surgery; Control (n-27), matched in age, with ideal weight for height.

Parameters: Vocal self-assessment (Vocal Disadvantage Index-IDV and Quality of Life and Voice-QVV); Perceptual-auditory vocal evaluation (GRBASI scale), maximum phonation time; Acoustic vocal analysis and Videolaryngoscopic exams.

Results: In obese, the most frequent symptoms were gastroesophageal and hoarseness. The vocal self-evaluation did not record any relevant complaints in both groups. In obese, the perceptual-auditory voice evaluations indicated significant changes in R (roughness), B (breathiness), I (instability), and S (tension) parameters. Acoustic vocal analysis recorded changes in the noise-harmonic ratio (NHR) and soft phonation index (SPI) parameters. The videolaryngoscopy examinations showed, in control and obese groups, respectively: normal: 92.5% and 55.5%; posterior pachydermia: 11.1% and 33.3%; mid-posterior bowing: 0% and 7.4%; edema/congestion: 0% and 7.40%.

Conclusion: The voice of the obese becomes discreetly hoarse, breathless, and unstable. The most frequent videolaryngoscopic findings in obese patients are hyperemia and edema of vocal folds and posterior pachydermia, related to acid laryngitis, secondary to gastroesophageal reflux.
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March 2021

Transmission Electron Microscopy of the Presbylarynx in the Process of Voice Aging.

J Voice 2018 Jan 10;32(1):3-7. Epub 2017 Oct 10.

Department of Ophthalmology, Otorhinolaryngology and Head Neck Surgery, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil.

Introduction: Microscopy studies of presbylarynx have identified epithelial atrophy, as well as vocal muscle atrophy, increased collagen, and decreased nonfibrous proteins of the extracellular matrix. Studies on the ultrastructure of presbylarynx are rare and can help us understand the pathophysiology of presbyphonia.

Objective: To describe details on the ultrastructure of presbylarynx by transmission electron microscopy (TEM).

Subjects And Methods: Sixteen human larynges were removed and distributed in two groups: control (n = 8; 30-50 years; six females, two males) and seniors (n = 8; 75-92 years; six females, two males). After preparation for TEM, the specimens, including epithelium and lamina propria, were examined and photographed at increasing magnification.

Results: Control: the epithelium was intact, with overlapped cells, and with desmosomes between the intercellular junctions. The basement membrane was continuous and uniform, and the lamina propria contained collagen and elastic fibers in a regularly distributed loose arrangement, as well as some fibroblasts of different shapes. Senior: the epithelial cells were separated by enlarged intercellular junctions. The basement membrane was delicate and continuous. In the lamina propria there was predominance of elongated fibroblasts. Under the basement membrane a dense network of collagen fibers could be identified.

Conclusions: In this study with TEM some structural changes were identified, particularly in the larynx of the elderly, both in the epithelium and lamina propria, some of them with likely participation of fibroblasts, which reinforces the importance of additional ultrastructure as well as molecular studies targeting those cells, as they are the main precursors of the components of the extracellular matrix.
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January 2018

Are Vocal Alterations Caused by Smoking in Reinke's Edema in Women Entirely Reversible After Microsurgery and Smoking Cessation?

J Voice 2017 May 21;31(3):380.e11-380.e14. Epub 2016 Jul 21.

Speech Therapy, Discipline of Otolaryngology, UNESP Universidade Estadual Paulista, Botucatu, São Paulo, Brazil.

Background: Reinke's edema is a benign lesion of the vocal folds that affects chronic smokers, especially women. The voice becomes hoarse and virilized, and the treatment is microsurgery. However, even after surgery and smoking cessation, many patients remain with a deep and hoarse voice.

Objectives: The aim of the present study was to compare pre- and postoperative acoustic and perceptual-auditory vocal analyses of women with Reinke's edema and of women in the control group, who were non-smokers.

Methods: A total of 20 women with videolaryngoscopy diagnosis of Reinke's edema who underwent laryngeal microsurgery were evaluated pre- and postoperatively (6 months) by videolaryngoscopy, acoustic voice, and perceptual-auditory analyses (General degree of dysphonia, Roughness, Breathiness, Asthenia, Strain, and Instability [GRBASI] scale), and the maximum phonation times were calculated. The pre- and postoperative parameters of the women with Reinke's edema were compared with those of the control group of women with no laryngeal lesions, smoking habit, or vocal symptoms.

Results: Acoustic vocal perceptual-auditory analyses and the maximum phonation time of women with Reinke's edema improved significantly in the postoperative evaluations; nevertheless, 6 months after surgery, their voices became worse than the voices of the women from the control group.

Conclusions: Abnormalities caused by smoking in Reinke's edema in women are not fully reversible with surgery and smoking cessation. One explanation would be the presence of possible structural alterations in fibroblasts caused by the toxicity of cigarette components, resulting in the uncontrolled production of fibrous matrix in the lamina propria, and preventing complete vocal recovery.
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May 2017

Scanning Electron Microscopy of the Presbylarynx.

Otolaryngol Head Neck Surg 2016 06 22;154(6):1073-8. Epub 2016 Mar 22.

Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Univ Estadual Paulista, Botucatu Medical School (Unesp), Botucatu (SP), Brazil

Objective: To describe the findings on the presbylarynx under scanning electron microscopy.

Study Design: Cadaver study.

Setting: Universidade Estadual Paulista (Botucatu, São Paulo, Brazil).

Subjects And Methods: Sixteen vocal folds were removed during necropsies and distributed into 2 age groups: control (n = 8; aged 30-50 years) and elderly (n = 8; aged 75-92 years). The right vocal fold was dissected, fixed in glutaraldehyde 2.5%, and prepared for scanning electron microscopy. The thickness of the epithelium was measured using a scandium morphometric digital program.

Results: In the control group, the epithelium had 5 to 7 overlapped cell layers, rare desquamation cells, and little undulation with protruding intercellular junctions. The lamina propria showed a uniform network of collagen and elastic fibers in the superficial layer. A dense network of collagen was identified in the deeper layer. In the elderly group, the epithelium was atrophic (2-3 cells), with more desquamation cells and intercellular junctions delimited by deep sulci. The epithelial thickness was lower in elderly than in controls (mean [SD], 221.64 [145.90] µm vs 41.79 [21.40] µm, respectively). The lamina propria had a dense and irregular distribution of collagen and elastic fibers in the superficial layer. In the deep layers, the collagen fibers formed a true fibrotic and rigid skeleton.

Conclusion: Scanning electron microscopy identified several changes in the elderly larynx, differentiating it from the controls. These alterations are probably related to the aging process of the vocal folds. However, the exact interpretation of these findings requires additional studies, even to the molecular level, having the fibroblasts as targets.
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June 2016

Ortner's syndrome: a rare cause of sudden hoarseness in the older person.

Age Ageing 2016 Jan 11;45(1):177. Epub 2015 Nov 11.

Ophtalmology, Otorhinolaryngology and Head and Neck Surgery, Univ. Estadual Paulista, Botucatu, São Paulo, Brazil.

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January 2016

Aging voice and the laryngeal muscle atrophy.

Laryngoscope 2015 Nov 7;125(11):2518-21. Epub 2015 Jul 7.

Department of Anatomy, Institute of Bioscience-UNESP, Univ Estadual Paulista, Botucatu, SP, Brazil.

Objectives/hypothesis: To study by means of morphometric measurements the severity of vocal muscle atrophy in the elderly.

Study Design: Cadaver study.

Setting: Universidade Estadual Paulista (UNESP), Botucatu Medical School, Brazil.

Subjects And Methods: Thirty vocal folds were collected from necropsies distributed into three groups: aged 60 to 75 years (n=10); aged 76 to 90 years (n=10); and a control group aged 30 to 50 years (n=10). Specimens for histology were obtained from the middle portion of the vocal folds. The stained specimens were analyzed using Axion Vision software (coupled to a Zeiss [Oberkochen, Germany] microscope) and used in the morphometric analyses conducted with the ImageJ software. The diameters of 200 muscle fibers from each slide were measured, and the mean values were statistically analyzed.

Results: The mean values of the diameters of the vocal muscle fibers of the elderly age groups were smaller than in the control: control (30-50 years: 16.389 μm); elderly (60-75 years: 14.412 μm; 76-90 years: 14.162 μm) (P<0.01). No statistical differences were observed between genders.

Conclusion: The morphometric analysis showed smaller diameters of vocal muscle fibers in the elderly when compared to controls, demonstrating the atrophy of the muscle. No statistical differences were observed between genders.

Level Of Evidence: N/A.
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November 2015

Psychogenic dysphonia: diversity of clinical and vocal manifestations in a case series.

Braz J Otorhinolaryngol 2014 Nov-Dec;80(6):497-502. Epub 2014 Sep 16.

Faculdade de Medicina de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP, Brazil.

Introduction: Psychogenic dysphonia is a functional disorder with variable clinical manifestations.

Objective: To assess the clinical and vocal characteristics of patients with psychogenic dysphonia in a case series.

Methods: The study included 28 adult patients with psychogenic dysphonia, evaluated at a University hospital in the last ten years. Assessed variables included gender, age, occupation, vocal symptoms, vocal characteristics, and videolaryngostroboscopic findings.

Results: 28 patients (26 women and 2 men) were assessed. Their occupations included: housekeeper (n=17), teacher (n=4), salesclerk (n=4), nurse (n=1), retired (n=1), and psychologist (n=1). Sudden symptom onset was reported by 16 patients and progressive symptom onset was reported by 12; intermittent evolution was reported by 15; symptom duration longer than three months was reported by 21 patients. Videolaryngostroboscopy showed only functional disorders; no patient had structural lesions or changes in vocal fold mobility. Conversion aphonia, skeletal muscle tension, and intermittent voicing were the most frequent vocal emission manifestation forms.

Conclusions: In this case series of patients with psychogenic dysphonia, the most frequent form of clinical presentation was conversion aphonia, followed by musculoskeletal tension and intermittent voicing. The clinical and vocal aspects of 28 patients with psychogenic dysphonia, as well as the particularities of each case, are discussed.
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March 2015

Aging voice: presbyphonia.

Aging Clin Exp Res 2014 Feb 26;26(1):1-5. Epub 2013 Sep 26.

Department of Otorhinolaryngology, Botucatu Medical School, São Paulo State University, Botucatu, São Paulo, Brazil,

Presbyphonia is a physiological process of aging voice that includes morphological changes in the coverage mucosa, muscle, and cartilage. We revised the morphological, endoscopic, and vocal acoustic changes that occur in presbyphonia and discussed some treatments proposed to minimize glottal incompetence and improve vocal performance of the elderly.
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February 2014

Maximum phonation time and s/z ratio in a large child cohort.

J Voice 2012 Sep 20;26(5):675.e1-4. Epub 2012 Jun 20.

Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Botucatu Medical School, São Paulo State University, São Paulo, Brazil.

Aim: The purpose of this study was to provide normal values for maximum phonation time (MPT) and the s/z ratio by examining 1660 children aged 4-12 years and without vocal signs or symptoms.

Methods: The technique was based on the sustained emission of the /a/ vowel and fricatives /s/ and /z/.

Results: The average of the MPT in children of the different age groups was as follows: 6.09 seconds for the age group 4-6 years (males, 5.97; female, 6.21 seconds), 7.94 seconds for the age group 7-9 years (males, 8.07; females, 7.79 seconds), and 8.98 for the age group 10-12 years (males, 9.05; females, 8.92 seconds). The overall average for males was 7.78 and females 7.64 seconds. The s/z ratio was near 1.0 in most children but above 1.2 in 133 children and below 0.8 in 133 children.

Conclusion: These values of MPT and s/z ratio can be used as normative in further pediatric studies.
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September 2012

Auditory evaluation in patients with type 1 diabetes.

Ann Otol Rhinol Laryngol 2008 May;117(5):366-70

Departments of Otorhinolaryngology, Ophthalmology and Head and Neck Surgery, School of Medicine, São Paulo State University, Botucatu, Brazil.

Objectives: We performed a prospective clinical study of the cochleovestibular symptoms and the risk cofactors and characteristics of hearing loss in patients with type 1 diabetes.

Methods: Group 1 consisted of 40 patients with type 1 diabetes, and group 2 consisted of 20 control subjects without diabetes. All participants answered a questionnaire, and their medical records were reviewed. They also were submitted to otorhinolaryngological examinations and to auditory tests (pure tone audiometry and acoustic immitance and auditory brain stem response [ABR] tests).

Results: Dyslipidemia, hypertension, retinopathy, and diabetic neuropathy were not frequent in the patients of group 1, but incipient nephropathy was present in 47.5% of them. The most frequent cochleovestibular symptoms were tinnitus and hearing loss. Sensorineural hearing loss was found in 4 patients of group 1 and was predominantly bilateral, symmetric, and affecting the high frequencies, coexisting with normal vocal discrimination. These patients had a longer time from diabetes diagnosis and had poor glycemia control. A delay of ABR interpeak latency I-III was observed in 11.25% of the group 1 ears. All patients of group 2 presented normal audiograms and ABR tests.

Conclusions: In group 1, the most frequent cochleovestibular symptoms were tinnitus and hearing loss. The sensorineural hearing loss was mild, symmetric, and predominantly high-frequency. A delay of ABR interpeak latencies was detected in the patients of group 1 who had normal audiometric thresholds.
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May 2008