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：本研究旨在评估经治疗的副球孢子菌病（paracoccidioidomycosis, PCM）患者的喉后遗症对其生活质量的影响。方法：本横断面研究于巴西南马托格罗索联邦大学附属医院耳鼻咽喉科门诊开展。共纳入32例经临床及免疫学确认治愈的PCM患者，其中16例在疾病活动期存在喉部受累（喉部PCM组），剩余16例无喉部受累（对照组）。所有受试者均接受结构化访谈、耳鼻咽喉科检查、电子喉镜检查、视频内镜吞咽功能检查，并完成两份嗓音自我评估问卷——嗓音相关生活质量量表（Voice-related Quality of Life, V-RQOL）与嗓音障碍指数（Voice Handicap Index, VHI），同时要求其以0~10分的量表对自身嗓音质量进行自我评分。结果：研究显示，50%的受试者存在发声障碍。与对照组相比，喉部PCM组患者的V-RQOL评分及嗓音质量自我评估得分均更低；两组间VHI评分无显著差异。尽管视频内镜检查可见少量轻微异常，但所有受试者均未出现吞咽障碍后遗症。结论：本研究中受试者无吞咽障碍主诉，纤维内镜吞咽评估仅见少量轻微异常，提示该评估仅需在特定病例中开展。存在喉部受累的患者V-RQOL评分及嗓音质量自我评估得分均更低。本研究有助于深化当前对PCM受累喉部的功能评估以及发声障碍对生活质量影响的认知。