Biomedical subjects

O Schindler

Publications and source records attributed to O Schindler.

At least 19 recordsLinked to original sources

PubMed2005

Voice after supracricoid laryngectomy: subjective, objective and self-assessment data.

Supracricoid laryngectomy (SCL) is an efficient surgical procedure for the treatment of selected laryngeal carcinoma, presently being performed not only in Europe but also in North America. The functional goals of the technique are voice and swallowing without a permanent tracheostoma. Perceptual and acoustic voice characteristics after SCL have been reported by different authors, but self-assessment data together with subjective and objective data have only been reported for a small number of subjects. Twenty male subjects, with a mean age of 71 years (range: 51-82 years) who underwent a SCL at least one year before our observation, were included in the study. Each subject underwent a flexible laryngoscopy and his voice was perceptually rated using the GRBAS scale. Objective examination included: maximum phonation time (MPT), voice spectrograms and syllable diadochokinesis on a single breath. Finally, each subject assessed his own voice using the Voice Handicap Index (VHI). The mean values of the GRBAS scale were respectively 2.4, 2.6, 2.4, 0.8, 0.5, 0.8. Mean MPT was 7.5 s, while for voice spectrograms the mean value of the Yanagihara scale was 3.7. Mean syllable diadochokinesis appeared as 3.3 syllables/s. Mean value of the VHI was 29.9. Subjective and objective data show a severely dysphonic voice after SCL; self-assessment data, on the contrary, reveal only moderate functional and emotional consequences. While perceptual, aerodynamic and acoustic data are in line with previous reports, self-assessment data were less severe in our subjects compared to what appears in the literature. It is concluded that self-assessment explores a different dimension of the patient's voice and that even if a severe dysphonia is present the consequences on everyday oral communication are only moderate.

Aged↗

PubMed2005

Role of videoendoscopy in phoniatrics: data from three years of daily practice.

Phoniatrics is the medical specialty involved in the management of communication and swallowing disorders. Videoendoscopy plays an important role in the assessment of various disorders in the clinical practice of phoniatrics: the voice as well as the speech and swallowing mechanisms can be analysed through this procedure. Aim of the study is to describe videoendoscopic application in daily phoniatric practice: data on 1627 participants, consecutively examined, are reported. A total of 2004 videoendoscopy examinations were performed between March 1999 and December 2002. Study population comprising 1627 patients (716 male, 911 female); age ranged from 0.6 to 97 years. The following parameters were considered: a) function to be assessed through videoendoscopy (voice, speech, swallowing, other); b) phoniatric nosological chapter in participants with a recognized disease; c) age of participant; d) occupation of participant; d) medical discipline related to disease identified. Three populations were analysed: study population (1627 subjects), subjects requiring phoniatric consultation for voice and swallowing assessment. The participants examined endoscopically required a phoniatric consultation in order to have a voice or a swallowing assessment, respectively, in 67% and 20% of the cases. In 411 out of 1095 (37.5%) voice evaluations, no disorder was identified, while in most of the swallowing assessments (93.1%), a clear dysphagic disorder was detected. A bimodal distribution appeared in the 1627 participants and in the voice population with a first peak at age 20-40 years and a second peak at age 50-70. In the swallowing population, the number of participants examined appeared to increase with age. In the swallowing population, pensioners and clerks represent almost 80% of the population; in the total population, as well as in the voice populations, pensioners as well as teachers, singers and students are well represented. In most cases (52.5%), no clear disease was present. The two areas of disease most represented were otorhinolaryngology and neurology.

Adolescent↗

PubMed2005

Intensity and fundamental frequency control in tracheoesophageal voice.

Tracheo-oesophageal voice prostheses are currently widely used following total laryngectomy. Data on maximum phonation time and spectrum have been studied by various Authors and are well known. On the contrary, intensity and fundamental frequency control have received little attention. Intensity and fundamental frequency play an important role in the prosodic aspects of speech. Fundamental frequency variations have been studied in tone language speakers, but the ability to voluntarily change intensity and fundamental frequency remain to be fully investigated. Aim of the present study was to analyse the ability of tracheo-oesophageal voice users to change intensity and fundamental frequency. A total of 12 male subjects who underwent total laryngectomy, in whom a tracheo-oesophageal prosthesis had been inserted, were considered. Maximum phonation time was calculated. Each subject was asked to utter an /a/ as loud as possible and an /a/ as soft as possible. Each subject was then asked to utter an /a/ at comfortable pitch and then at an interval of a fifth. Intensity as well as fundamental frequency variations were compared using Wilcoxon signed rank test. Correlation between maximum phonation time and variation in intensity and in fundamental frequency as well as between the two latter variables was calculated using Spearman's rank correlation coefficient. Mean maximum phonation time was 8 (+/- 3.8) sec. Mean energy was 50 (+/- 4.8) dB SPL for soft phonation and 68 (+/- 4.7) dB SPL for loud phonation. The difference observed was statistically significant (p < 0.02). Mean fundamental frequency values were 106 (+/- 14) Hz and 135 (+/- 34) Hz at the interval of a fifth. The difference observed was statistically significant (p < 0.02). Tracheo-oesophageal voice users were able to change intensity and fundamental frequency, but their control was rather poor. Variations in intensity, as well as fundamental frequency, did not show any correlation with maximum phonation time, and were not correlated with each other. In conclusion, the tracheo-oesophageal voice allows small fundamental frequency variations, but their control appears difficult. On the contrary, intensity variations appear larger and control somewhat easier.

Aged↗

PubMed2003

Comparison between two perception tests in patients with severe and profoundly severe prelingual sensori-neural deafness.

Patients with severe and profoundly severe bilateral sensorineural prelingual deafness constitute a group of particular interest in the organization of the National Health Service; every patient must, in fact, follow a prosthetic-rehabilitative-educational programme lasting many years and organized under different areas to compensate for his/her communicative difficulties, especially with regard to the speech canal. No reliable data providing details of the efficacy and efficiency of any of these points is available. A critical point in the rehabilitation process is that of auditory perception training. Of the few auditory perception tests presently available in Italian, the following were examined: namely, EARS (Evaluation of Auditory Responses to Speech) battery, on the one hand, and the Italian version of the ESP (Early Speech Perception), GASP (Glendonald Auditory Screening Procedure). NU-CHIPS (Northwestern University Children's Perception of Speech) and WIPI (Word Intelligibility by Picture Identification) tests on the other. A group of 10 patients presenting severe and profoundly severe bilateral sensori-neural prelingual deafness received the two tests at the beginning and after six months of auditory perception rehabilitation. The findings emerging from the two different test sessions were analysed and compared. The EARS battery was seen to have enabled even very early and highly developed stages of auditory perception to be detected in comparison with the other battery, which, however, was more accurate in evaluating the ability to discriminate and identify words on the basis of their spectral characteristics. The Authors propose the combined use of the two test batteries to evaluate the efficacy and efficiency of auditory perception training in patients with severe and profoundly severe bilateral sensori-neural prelingual deafness.

Auditory Threshold↗

PubMed2003

Swallowing disorders: management data.

Aim of the investigation was to assess the workload and verify the results of oropharyngeal dysphagia management in a large state hospital by means of a descriptive, observational prospective study and descriptive statistical analysis. 81 patients [37 females, 44 males, mean age 61.3 (+/- 13) years] suffering from oropharyngeal dysphagia were evaluated and treated in the in- and outpatient Divisions of the "Azienda Ospedaliera S. Giovanni Battista" in Turin. Treatment of oropharyngeal dysphagia included changes in consistency and texture of food, compensatory postures of head, strengthening exercises for oropharyngeal muscles, and stimulation of pharyngeal sensitivity. In data collection and analysis, the following were used as outcome measures: mode of nutrition delivery (oral, enteral, parenteral), dietary adjustments, presence of aspiration or penetration, and use of compensatory head positioning. Results showed that the number of patients fed by parenteral or enteral tube (50/81 prior to treatment) dropped to 36/81 upon discharge from hospital. Those unable to take anything by mouth, from 55 dropped to 9. The number of patients with aspiration or penetration dropped, respectively, from 47 and 8 to 20 and 4. Postural changes were used in 15 cases. Data obtained indicate that oropharyngeal dysphagia rehabilitation outcomes are promising. Better understanding of the rheological characteristics of food and a stricter, more rigorous evaluation of the outcomes on activities and social participation are warranted.

Aged↗

PubMed2001

[Management of oropharyngeal dysphagia: outcomes in a group of 81 adult patients].

BACKGROUND: Aim of the study is to assess outcomes in the management of 81 patients with diagnosis of oropharyngeal dysphagia. METHODS DESIGN: retrospective study on the outcome of logopedic treatment. SETTING: patients have been assessed and treated as in- and out-patients of the Azienda Ospedaliera "S. Giovanni Battista" of Turin. PATIENTS: 81 patients, 37 female and 44 male, mean age of 61,3 years, with diagnosis of oropharyngeal dysphagia. INTERVENTION: phoniatric and logopedic assessment and management including: food consistency change, compensatory head posture, oropharyngeal muscle strengthen and pharyngeal sensibility stimulation. SURVEY: tube feeding, dietary adjustments, presence of aspiration or penetration and postural techniques utilization were used as outcome measures. RESULTS: The number of patients on tube feeding changed from 50 out of 81 before treatment to 36 out of 81 at discharge time. Subjects who couldn't take anything by mouth decreased from 55 to 9. The number of patients with aspiration or penetration changed respectively from 47 and 8 to 20 and 4. Postural techniques were used in 15 cases. CONCLUSIONS: The data suggest that outcomes of oropharyngeal dysphagia rehabilitation are promising. The role of tube feeding and of food consistencies is of key importance in the management of deglutition disorders. All clinicians dealing with dysphagic patients should know the importance of food rheologic characteristics, the consequences of alimentation by nasogastric tube and percutaneous endoscopic gastrostomy.

English Abstract↗

PubMed1995

[Microinvasive, CT-controlled periradicular therapy in treatment of chronic intervertebral disk-induced functional disorders].

The disease of the spinal column is number 2 of common diseases world-wide and leads to high business- and commerce-related losses as well as to high expenses for the health care systems. An effective treatment of this disease is given by the microinvasive. CT controlled periradicular therapy (micro PRT). Under visibility, the tip of a canula is led directly and high precisely in close neighbourhood to the prolaps, then locally NaCl and cristaline cortisone (40 mg Volon A) is instillated. The periradicular distribution and the distribution into the epidural space is documented via contrast medium. A retrospective study with 220 patients and a prospective randomized double blind study with 40 patients (10 mg vs. 40 mg Volon A) were carried out. The average age of the retrospective collective was 53.1 +/- 12.4 years, average treatment period 18.4 weeks, and the mean follow-up 17 months. The mean value of successful treatment of lumbal spine was at 60% (spine 88.5%) with protrusion, with prolaps at 75% (spine 94%), with sequester at 94%, and with stenoses at 69% (spine 60%). With 78.8% of the patients, the percentual result was constantly good at the time of questionnaire as to the end of the treatment. 7.7% still took analgesics, 5.9% were post-operated. 1.8% of the patients made a pension application. The average age of patients within the prospective randomized double-blind-study was 47.2 +/- 11.9 years. At 27.5% of the patients, the start of pain was about more than 5 years ago and goes back to about 23 years (72.5% had pain more than 1 year). The mean value of visits was 4 physicians per patient, and 5 months of follow-up. There is a high significant improvement in results within the group with 40 mg Volon A (p = 0.0351479). The entire improvement, subjectively estimated (visual analogical scale) within this group was at 90%. After end of therapy, 83.3% (n = 30) had stopped the taking of analgesics and the neurologic deficit decreased significantly. Furthermore, significant reduction of prolapses could be observed at 60% of the patients in both study groups (n = 156). The CT scopic micro PRT with 40 mg Volon A leads to a significant improvement of pain and neurologic symptoms caused by chronical disk herniation.

Adult↗

PubMed1990