Intervenção Fonoterapêutica em Pacientes com Sequela de Leishmaniose Mucosa e Cutânea

Abstract

INTRODUCTION: Cutaneous Leishmaniasis is a stigmatizing disease, considered a serious public health problem. It has three classic clinical forms, including the cutaneous and mucosal forms. The first mainly affects the upper and lower limbs, with ulcerated lesions, which may be multiple or single. The second affects the upper respiratory tract, with destructive lesions, which may affect the voice, swallowing and breathing of patients. OBJECTIVE: To characterize the voice and verify the vocal response to speech therapy intervention in patients with sequelae of mucosal leishmaniasis and sequelae of cutaneous leishmaniasis. METHODS: The vocal emission /a:/ of 22 participants from each group (total of 44 cases) was collected for computerized voice analysis using the Kay PENTAX® Real Time Spectrogram and Multi Dimensional Voice Program Advanced programs, and for auditory-perceptual analysis using the RASATI scale. RESULTS: Before speech therapy, participants with Mucosal Leishmaniasis had a statistically significant result, where 5 (27.7%) participants presented asthenic vocal quality and alterations in the parameters of frequency measurements, frequency disturbance, noise and subharmonic measurements. Of the participants with Cutaneous Leishmaniasis, 8 (36.4%) presented grade 1 vocal instability. After speech therapy, it was observed that patients with Cutaneous Leishmaniasis presented a reduction in the degree of roughness and improvement in the acoustic parameters of frequency disturbance. The group with sequelae of Mucosal Leishmaniasis showed a reduction in the measurements of subharmonic segments. Only the group with sequelae of Cutaneous Leishmaniasis had statistically significant results regarding spectrography, with improvements in the following parameters: intensity of the color of the trace, presence of noise, replacement of harmonics by noise, definition and regularity of harmonics, regularity of low frequencies and of the entire spectrogram and for anti-resonance. There was no statistically significant difference regarding the Vocal Behavior Profile. CONCLUSION: The two groups presented vocal alterations in different degrees before vocal therapy, with patients with Mucosal Leishmaniasis presenting more severe degrees. After the speech therapy intervention, participants with sequelae of Cutaneous Leishmaniasis had more vocal benefits after the technique was performed, possibly because they did not present lesions in the vocal tract.