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

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.

摘要
背景：本研究旨在评估喉部后遗症对经治疗肺球孢子菌病（PCM）患者生活质量的影响。
方法：本研究为横断面研究，在巴西马托格罗索州联邦大学附属医院的耳鼻喉科门诊进行。纳入了32名在临床和免疫学上被认为已治愈的PCM患者：其中16名患者在疾病活跃期出现喉部受累（喉部PCM组）和16名未出现喉部受累（对照组）。他们接受了结构化访谈、耳鼻喉科检查、喉镜检查、视频内窥镜吞咽研究，并完成了两项语音自我评估问卷——语音相关生活质量（V-RQOL）和语音障碍指数（VHI），同时被要求对他们的声音进行从零到十的评分（声音质量自我评估）。
结果：50%的患者存在声嘶。喉部PCM患者在与对照组相比，V-RQOL和声音质量自我评估的得分较差。两组之间在VHI上没有发现显著差异。没有参与者出现吞咽困难后遗症，尽管在视频内窥镜检查中观察到一些轻微的变化。
结论：没有出现吞咽困难的主诉，且在纤维内窥镜评估吞咽过程中仅发现少数轻微变化，这表明此类评估应仅针对特定病例进行。喉部受累的患者表现出更差的V-RQOL和声音质量自我评估。本研究有助于增进对PCM影响的喉部功能评估及声嘶对生活质量影响的认识。