Biomedical subjects
D E Hartman
Publications and source records attributed to D E Hartman.
Psychogenic aphonia masking mutational falsetto.
Aphonia, originally due to laryngeal inflammation, became psychogenic and superimposed on the unstable pitch of adolescent voice change. We presumed that the aphonia was adopted as a means of dealing with peer pressure to maintain a high preadolescent pitch as well. Voice therapy was effective in alleviating both the aphonia and mutational falsetto. Clinicians should be alert to underlying mutational falsetto when confronted with an aphonic or dysphonic adolescent patient with no organic laryngeal pathologic condition.
A case of vocal cord nodules masking essential (voice) tremor.
Essential tremor is a progressive, potentially debilitating disorder that may be manifested in the voice only. In the case we report, the signs occurred concurrently with the voice characteristics of vocal cord nodules but were subtle. The mildness of the voice tremor precluded treatment at this time, although the results of medical management for the disorder have not been impressive. It is probable that some patients with severe essential (voice) tremor have undergone recurrent laryngeal nerve resection for the disorder.
Vocal cord lesions and hoarseness.
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Adductor spastic dysphonia as a sign of essential (voice) tremor.
Adductor spastic dysphonia may not be one disorder but a voice sign of several different neurologic and psychiatric syndromes. This study evaluates whether rhythmic voice arrests, often components of "spastic dysphonia," are signs of essential tremor, a neurologic disorder. Data on 22 patients originally diagnosed as having spastic dysphonia, who had tremor-like or rhythmic voice arrests, were compared with data on two groups of patients who had essential (voice) tremor. The frequency of voice arrest on vowel prolongation in the group labeled spastic dysphonia was compared with the frequency of voice tremor in the groups with essential tremor. The median frequencies of 5.7, 5.0, and 5.5 Hz were not significantly different among the three groups. Patients in all three groups had tremor in other parts of the body, other scattered neurologic signs, and histories of life stress associated with the onset of their voice disorders. Although the results do not prove conclusively that the patients diagnosed as having spastic dysphonia in this study actually had essential tremor, the similarities to that disorder strongly suggest a linkage.
Clinical investigations of intermittent breathy dysphonia.
Case history and voice data for 17 patients who presented with intermittent moments of breathy dysphonia (IBD) in contextual speech were analyzed. From recorded samples of vowel prolongation four variants of phonation were identified. Of 13 patients examined neurologically, 10 (77%) had positive neurologic signs. Psychiatric and physical illnesses were often associated with onset of the voice disorder. Sex ratio of the patients in this study was nearly the same as that for adductor spastic dysphonia. Age at onset was similar to that which has been described for "functional" voice disorders. Different therapies were generally ineffective in alleviating the disorder. Although not conclusive, patients presenting with IBD in connected speech may have an underlying neurologic or psychologic disorders.
Tongue strength Part I: Following total laryngectomy.
Surgical repositioning of the genioglossus muscle, as in total laryngectomy, may have an adverse effect on the protrusive strength of the tongue. To test this premise, anterior and lateral tongue strength measures were obtained from 10 laryngectomized and 15 normal subjects by means of a pressure transducer and recording device. The results indicated no significant difference between laryngectomized and normal subjects on tongue strength measures. Further, all laryngectomized subjects were judged to have good to excellent esophageal speech. It was concluded that laryngectomy does not adversely affect the major musculature concerned with protrusive tongue strength for proficient esophageal speakers.
Extended hemilaryngectomy for T3 glottic carcinoma with preservation of speech and swallowing.
Total laryngectomy is often applied in the treatment of invasive squamous cell carcinomas that fix one side of the larynx. The major drawback, of course, is loss of the voice. In many instances, however, preservation of the uninvolved portion of the larynx is compatible with adequate tumor margins, and the preserved laryngeal remnant, although it cannot be reconstituted to allow breathing, can readily be used for voice. The principle involved is the creation of a valved tracheopharyngeal shunt, which functions as a neoglottis during expiration but constricts to close during swallowing. To accomplish this the recurrent laryngeal nerve and the myomucosal segment of intrinsic glottic musculature to which it is attached is preserved on the uninvolved side. The myomucosal segment is formed into a mucosal lined tube by releasing the soft tissues from the cartilage. The diameter and flaccidity of the tube is augmented by incorporating a flap of hypopharyngeal mucosa. Safe performance of this operation depends on careful preoperative evaluation and laryngoscopic verification and a close-working relationship with an interested surgical pathologist. The first 7 consecutive cases in which this management program has been applied are presented in review. The patients, ranging in age from 58 to 69 years old, had T3 grade 2 or 3 invasive squamous cell carcinoma. The average hospitalization was 13 days. The longest follow-up is 5 years. Clear surgical margins, local control of the disease, and satisfactory voice without significant aspiration have been achieved thus far in each case. The average subglottic pressures measured at the tracheotomy were 25 +/- 6 cm. of water (threshold opening) and 43 +/- 20 cm. of water (for phonation). Whether these encouraging initial results can be widely duplicated will probably depend on the care with which cases are selected. The dangers of applying this surgery to patients with extensive submucosal spread will be obvious to experienced laryngologists.
Tongue strength. Part II: in artificial alaryngeal speech.
Tongue strength does not appear to be reduced in proficient esophageal speakers. However, no data exist on tongue strength for laryngectomized subjects who have not developed esophageal speech. Anterior and lateral tongue strength measures were obtained from 13 laryngectomized subjects who used an artificial larynx and 15 normal subjects by means of a pressure transducer and recording device. The results indicated that laryngectomized subjects had significantly weaker tongues in two of three directions measured. It was concluded that laryngectomy may affect tongue strength, but that the method of alaryngeal speech utilized postoperatively influences the return to normal.
The perceptual identity and characteristics of aging in normal male adult speakers.
Twenty untrained male and 20 untrained female listeners were requested to judge the age of 46 male speakers from samples of conversational speech. Thirty-seven samples were judged similarly by the two groups and were therefore provided as listening stimuli for ten male and ten female speech pathologists. Through an a posteriori schema, speech pathologists were required to specify the salient features of speech judged as being characteristic of each speaker's perceived age. The results of the study indicated that untrained listeners used similar perceptual sets to judge age until after the fiftieh year of life. Regardless of sex, listeners tended to underestimate the age of the speakers. Male and female speech pathologists viewed low pitch and hoarseness as being the most salient features of speech for the speakers. Qualitative analysis revealed that the most prominent features indicated by speech pathologists could be classified according to pitch, quality, articulation, and rate of speech.
Treatment of dysarthria: a case report.
There is little information available to the speech clinician on management of dysarthria. This article presents the rationale, procedural outline, and results of an approach to communication training for one dysarthic subject in view of suggestions made by Darley et al. (1975).
Progressive speech deterioration and dysphagia in amyotrophic lateral sclerosis: case report.
Amyotrophic lateral sclerosis (ALS) is a degenerative neurologic disease having both upper and lower motor neuron signs and symptoms. When the speech musculature is involved, a mixed dysarthria and dysphagia usually result. In a 49-year-old man with ALS, dysarthria and dysphagia progressed from mild to severe forms over 17 months. Eleven months after the patient first experienced symptoms, neurologic examination showed fasciculations of the extremities and tongue, limb weakness, and hyperreflexia of the limbs and velopharyngeal mechanism. Tongue strength was one-fourth that of normal. Lingual alternate motions rates for consonant-vowel syllables were also reduced. To enhance lingual strength and swallowing, a tongue-strengthening program was developed for use with articulation training; to augment velopharyngeal function, a palatal lift was fitted; and to increase extremity strength, physical therapy was initiated. Six months after the initial neurologic examination, medical and speech reevaluation showed progressive weakness of the body parts affected initially; continued decline in tongue strength and lingual alternate motion rate; hypoactive reflex activity, indicative of progressive involvement of the lower motor neuron system; and continued deterioration of articulation and phonation owing to the progressive nature of the disease.
Perceptual features of speech for males in four perceived age decades.
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Overt responses of listeners to alaryngeal speech.
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Neurogenic dysphonia.
Disorders of phonation and resonation subsequent to damage to the central or peripheral nervous system (neurogenic dysphonia) typically occur with alterations in other aspects of motor speech: articulation, prosody, and respiration. Deficits in voice initiation or coordination of resonation with speech that occur without significant neuromuscular impairment following a lesion to Broca's area are compatible with a motor speech programming disorder, or apraxia of speech. Conversely, damage to upper or lower motor neurons subserving motor speech results in a group of neuromuscular speech disorders, the dysarthrias, which have signs including aberrations of phonation and resonation which can be differentiated. The neuropathologic and perceptual characteristics of neurogenic dysphonia are elucidated, and suggestions are provided for their identification and differentiation.
Clinical investigations of adductor spastic dysphonia.
Spastic (spasmodic) dysphonia (SD) may coexist with or reflect certain neurologic or psychogenic illnesses. The present study of four patients with adductor SD (ASD) revealed several consistent clinical findings and characteristics that could be differentiated, while other findings were not distinguishable. Oscillographic and spectral analyses suggested voice tremor as a component of the dysphonia in all ASD patients studied. Clinical neurologic and otolaryngologic findings were nonconfirmatory regarding a disease process or state.