Biomedical subjects

P D Blalock

Publications and source records attributed to P D Blalock.

8 recordsLinked to original sources

PubMed2001

Occult laryngeal pathology in a community-based cohort.

BACKGROUND: Little information is available regarding the prevalence of laryngeal pathology in adults. PURPOSE: To estimate the prevalence of occult laryngeal pathology in a community-based cohort of adults over 40 years of age. METHODS: One hundred consecutive volunteers over age 40 with no history of voice disorders were enrolled. All completed a self-administered laryngeal symptom questionnaire and underwent a comprehensive head and neck examination including transnasal fiberoptic laryngoscopy. RESULTS: The mean age of the cohort was 61 years. Vocal fold bowing (presbylaryngis) was present in 72% of the patients, and findings of laryngopharyngeal reflux were present in 64% of the cohort. In addition, other laryngeal pathology were identified in 21%. Only 12% had a completely normal laryngeal examination. CONCLUSIONS: Occult laryngeal pathology is very common in persons over 40. Findings suggestive of laryngopharyngeal reflux are present in 64%, and vocal fold bowing is present in 72% of persons over 40.

Adult↗

PubMed2001

Fascia augmentation of the vocal fold: graft yield in the canine and preliminary clinical experience.

INTRODUCTION: Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance. STUDY DESIGN: A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model. METHODS: Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow-up was 9 months. RESULTS: In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%-84%) compared with autologous lipoinjection (47%; range, 7%-96%; P =.57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P <.0001). Acoustical parameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly (P <.05) in all patients after fascia augmentation. CONCLUSIONS: Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency.

Adipose Tissue↗

PubMed2000

Vocal fold paresis.

Vocal fold paresis (VFP) is a relatively common and often overlooked condition that can be difficult to diagnose based on the laryngeal examination alone. A retrospective review of the records of 50 consecutive adult patients with VFP was performed. In each case, the diagnosis of VFP was confirmed by laryngeal electromyography. The presenting symptoms were dysphonia (100%), vocal fatigue (76%), diplophonia (40%), and odynophonia (12%), and the findings were unilateral vocal fold hypomobility (50%), unilateral bowing (36%), and bilateral bowing (22%). Laryngoplasty and/or lipoinjection was performed in 54% of the subjects, and significant vocal improvement was achieved in 85%. VFP appears to be underdiagnosed because many VFP patients have compensatory hyperkinetic disorders at presentation. Although the diagnosis of VFP may be suspected based on the patient's symptoms and findings, the diagnostic sine qua non is laryngeal electromyography. In addition, surgical treatment for VFP appears to be safe and effective.

Adult↗

PubMed1998

Bilateral medialization laryngoplasty.

OBJECTIVES: To present indications, techniques, and results of bilateral medialization laryngoplasty (BML). STUDY DESIGN: Retrospective review of 39 consecutive patients who had BML for correction of glottal insufficiency attributable to presbylaryngis (n = 16), bilateral vocal fold paresis (n = 13), unilateral paralysis with contralateral bowing (n = 4), and other miscellaneous neurologic diseases (n = 6). METHODS: Complete preoperative and postoperative clinical and acoustical data were analyzed for 74% (29/39) of the subjects. All 39 subjects completed a patient survey to assess their long-term outcomes. RESULTS: Overall, 90% (35/39) of the patients who had BML experienced significant improvement in voice and swallowing function. Subsequently, 36% (14/39) of the patients underwent adjunctive lipoinjection for closure of small residual glottal gaps (vocal "fine-tuning"). Of the BML patients (with or without lipoinjection) who had complete preoperative and postoperative voice data, 83% (24/29) had complete glottal closure after surgery, resulting in normal or near-normal voices. Eighty-five percent (33/39) of the patients responded that they "would have surgery again." Of the six patients who said that they would not have surgery again, three had good results and one had progressive neurologic disease. The mean duration of follow-up was 17 months. CONCLUSIONS: BML is an effective rehabilitative surgical treatment for symptomatic vocal fold bowing. In addition, lipoinjection is useful as an adjunct to BML to enhance the voice outcome in selected cases.

Female↗

PubMed1991

Functional voice disorders.

Functional voice disorders (FVDs) are common. The diagnostic criteria for six types of FVD and the results of treatment in a large series of patients are reported. Voice therapy was effective in 69% of the patients. Failure of voice therapy usually correlated with continued tobacco use, noncompliance with therapy, or premature termination of therapy.

Adult↗

PubMed1988

Vocal fatigue and dysphonia in the professional voice user: Bogart-Bacall syndrome.

Over the past 5 years, the authors have treated 67 adult professional voice users with a musculoskeletal tension disorder involving the larynx and supporting structures and leading to vocal dysfunction. Common clinical features in both sexes were muscle tension in the neck, poor control of the breath stream, and an abnormally low-pitched speaking voice. Most of the men sounded like Humphrey Bogart and the women like Lauren Bacall. These cases represent a discrete clinical vocal fatigue syndrome, the treatment of which is patient education and voice therapy.

Adult↗

PubMed1986

Ratings of intelligibility of esophageal and tracheoesophageal speech.

Audio-recorded oral reading and continuous discourse speech samples were obtained from esophageal and tracheoesophageal speakers. The samples were rated twice by each of two groups of listeners, one experienced and the other inexperienced with alaryngeal speech. The main finding was that reliable mean ratings of intelligibility of both types of speech can be obtained from experienced and from inexperienced judges. The experienced and inexperienced listeners tended to rank the speakers similarly with regard to the intelligibility of their speech samples. The reading and discourse samples also tended to be ranked similarly with regard to intelligibility. The tracheoesophageal speakers' samples as a group were rated as more intelligible than were those of the esophageal speakers.

Humans↗

PubMedDate not supplied

Classification and approach to patients with functional voice disorders.

Functional voice disorders result from vocal misuse or abuse; they are more easily recognized than other psychosomatic disorders because the clinician is able to visualize the laryngeal structure and function. If those structures appear normal, then an aberration of voice quality can be assumed to be functional. Functional dysphonia with prolonged aberrant vocal usage may lead to development of secondary pathological lesions of the larynx, which, although true pathological entities, must be recognized as resulting from the underlying and preceding functional disorder. In this report, we present a classification of and an approach to the diagnosis and treatment of functional voice disorders. On the basis of our clinical experience with 52 patients, we distinguished five types of functional voice disorders: type 1, hysterical aphonia/dysphonia; type 2, habituated hoarseness; type 3, falsetto voice, type 4, vocal abuse; and type 5, postoperative dysphonia. Forty-eight of the 52 patients (92%) were followed for a median period of 16 months (range 2-51 months). Therapy yielded excellent results in patients with types 1, 2 and 3; good results with types 4 and 5.

Adolescent↗