Vocal Impact in Patients With Unilateral Diaphragmatic Paralysis

Flávia Badaró; Mayra Caleffi-Pereira; João Paulo Macedo; Mara Behlau; André Luís Pereira de Albuquerque

doi:10.1016/j.jvoice.2022.11.031

Vocal Impact in Patients With Unilateral Diaphragmatic Paralysis

J Voice. 2023 Jan 9:S0892-1997(22)00382-4. doi: 10.1016/j.jvoice.2022.11.031. Online ahead of print.

Authors

Flávia Badaró¹, Mayra Caleffi-Pereira², João Paulo Macedo³, Mara Behlau⁴, André Luís Pereira de Albuquerque⁵

Affiliations

¹ Health Sciences Area, Sírio-Libanês Teaching and Research Institute, Sao Paulo São Paulo, Brazil; Health Sciences Area, Centro de Estudos da Voz - CEV, São Paulo, São Paulo, Brazil. Electronic address: flabadaro@gmail.com.
² Health Sciences Area, Sírio-Libanês Teaching and Research Institute, Sao Paulo São Paulo, Brazil.
³ Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo São Paulo, Brazil.
⁴ Health Sciences Area, Centro de Estudos da Voz - CEV, São Paulo, São Paulo, Brazil.
⁵ Health Sciences Area, Sírio-Libanês Teaching and Research Institute, Sao Paulo São Paulo, Brazil; Pulmonary Division, Heart Institute (Incor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo São Paulo, Brazil.

PMID: 36631345
DOI: 10.1016/j.jvoice.2022.11.031

Abstract

Objectives: This study aimed to investigate the possible vocal impact confirmed by diagnostic tests, the degree of perception of possible vocal impairment by patients with Unilateral Diaphragmatic paralysis (UDP) and its correlation with ventilatory weakness.

Methods: The researchers conducted an analytical, observational and case-control study with 70 individuals, including 35 UDP patients and 35 healthy patients in a control group, who underwent the following assessments: 1) Self-assessment of voice handicap (VHI-10); 2) Self-Assessment of Quality of Life (SF-36); 3) Self-Assessment of Dyspnea (MRC); 4) Objective vocal measures (Maximum Phonation Time (MPT) in /a/, /s/, /z/ and glottal-to-noise excitation ratio); 5) Functional respiratory pressures (Spirometry and maximum ventilatory pressures); 6) General degree of dysphonia - G on the GRBAS Scale. The sex, age and body mass index (BMI) of the individuals were the variables used to match the sample of this study.

Results: When compared with controls, patients with UDP had a restrictive functional pattern and inspiratory weakness, with symptoms of dyspnea and worsening quality of life. When associated with a possible vocal impact, these patients had voice handicap and decreased MPT values for all phonemes, especially /a/. There was also a correlation between vocal performance and inspiratory weakness. However, it should be noted that, despite having vocal impairment, many patients did not report the perception of this fact, somehow neglecting such impairment.

Conclusions: In addition to the expected weakness of the ventilatory muscles, patients with UDP had clinically verified vocal impact, and those who had greater inspiratory weakness also had greater voice impairment. Finally, it is relevant that not all patients perceived such vocal impact, which showed a very reduced perception of this impairment in patients with UDP.

Keywords: Diaphragmatic dysfunction; Dyspnea; Respiratory paralysis; Voice; Voice quality.