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PubMedDate not supplied

[Digital analysis of the acoustic signal in vocal pathology diagnosis. Sensitivity and specificity of shimmer and jitter measurements].

OBJECTIVE: The aim of this study was to calculate the sensitivity and specificity of shimmer (APQ) and jitter (RAP) in the diagnosis of vocal pathology. PATIENTS AND METHODS: Digital audio tape (DAT) recorded voices of 64 hoarse patients (20 men and 44 women) and 64 persons without hoarseness (20 men and 44 women), all professional teachers, were analyzed acoustically. The vowel /a/ was analyzed physically using Sound Scope software. Eight parameters were examined using Sound Scope 1.0: amplitude of the perturbation quotient (APQ), harmonics-to-noise ratio (HNR), breathiness (BR), relative average perturbation (RAP), fundamental frequency (F0) and the standard deviation (SD) of F0, and intensity and its SD. RESULTS: Taking 5.5% as a normal APQ value for this algorithm, the sensitivity was 0.75 and the specificity was 0.64. Seventy percent of the normal teachers had a RAP below 0.40% in women and below 0.32% in men, and 85% of hoarse teachers had higher values than those reported by us. As for BR, taking 17.5 dB as a normal reference, this algorithm had a sensitivity of 0.73 and a specificity of 0.41. CONCLUSIONS: Individual study of these tests is interesting because each one measures a different aspect of vocal function. They are most useful when studied together.

Adult↗
PubMed1980

Laryngoscopic and voice characteristics of aged persons.

Laryngoscopic and voice changes in aged persons were examined in 20 men and 20 women with a mean age of 75 years. From recordings of their voices, voice quality was assessed and the fundamental frequency and pitch perturbation were measured. The characteristic findings obtained were as follows: the aged men tended to show marked vocal fold atrophy and/or edema, with a higher fundamental frequency of voice than young men, and the aged women tended to have vocal fold edema and slight hoarseness, with a lower fundamental frequency than young women. Voice changes in senescence are characterized by slight hoarseness or a noticeable change in fundamental frequency of voice. Change in the mass of vocal folds, due, for example, to atrophy or edema, is considered to be the greatest factor in these voice changes.

Aged↗
PubMed1984

Discrete subaortic stenosis as part of a short stature syndrome.

Observations in a family point to the existence of autosomal dominant inheritance for discrete subaortic stenosis (DSS), which made up part of a multisystem disorder. Both parents, offspring of two full siblings, had short stature, obstructive lung disease (OLD), hoarseness and upturned nose. The father alone had aortic stenosis and inguinal hernia. The six offspring, aged from 13 to 28 years, were followed up for up to 8 years. While one of them was virtually normal, and one had only minor abnormalities, four siblings displayed clinical signs of progressive aortic stenosis. Of the two eldest siblings who eventually died, necropsy in one showed a discrete subaortic stenosis, which was hemodynamically proven in one and surgically corrected in another sibling. Upturned nose was present in each examined member of the family, short stature and hoarseness in five of the siblings, DSS in four, OLD, inguinal hernia and congested episcleral veins in three, kyphoscoliosis in two, while epicanthus, strabismus, microphthalmos and widely spaced teeth were noted in the deceased female. The prevalence of some of these traits in roughly three-quarters of the sibship was consistent with an underlying single gene abnormality in affected heterozygous parents. We proposed that this constitutes a new syndrome.

Adolescent↗
PubMed2004

Familial amyotrophic lateral sclerosis with bulbar onset and a novel Asp101Tyr Cu/Zn superoxide dismutase gene mutation.

We describe a patient with familial amyotrophic lateral sclerosis (FALS) in whom we identified a novel missense mutation in exon 4 (Asp101Tyr) of the Cu/Zn superoxide dismutase (SOD1) gene. The disease started with a bulbar symptom (rapidly progressive hoarseness) and at autopsy showed degenerative changes restricted to the upper and lower motor neuron systems (more strictly, with lower motor predominance, showing the most severe degeneration in the nucleus ambiguus). Occasional intracytoplasmic Lewy-body-like hyaline inclusions that were immunoreactive for ubiquitin and SOD1, but immunonegative for neurofilament protein, were found in the lower motor neurons. This is the first report of hoarseness as the initial manifestation of FALS. This SOD1 gene mutation may be associated with a particular clinicopathological phenotype.

Amyotrophic Lateral Sclerosis↗
PubMed2004

Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?

STUDY OBJECTIVES: To study endotracheal tube (ETT) cuff pressures during nitrous oxide (N2O) anesthesia when the cuffs are inflated with air to achieve sealing pressure, and to evaluate the frequency of postoperative laryngotracheal complaints. DESIGN: Prospective, randomized, blind study. SETTING: Metropolitan teaching hospital. PATIENTS: 50 ASA physical status I and II patients scheduled for elective abdominal surgery. INTERVENTIONS: Patients received standard general anesthesia with 66% N2O in oxygen. In 25 patients, the ETT cuff was inflated with air to achieve a sealing pressure (Pseal group). In 25 patients, the ETT cuff was inflated with air to achieve a pressure of 25 cm H2O (P25 group). MEASUREMENTS AND MAIN RESULTS: ETT intracuff pressures were recorded before (control) and at 30, 60, 90, 120, and 150 minutes during N2O administration. We investigated the frequency and intensity of sore throat, hoarseness, and dysphagia in patients in the Post-Anesthesia Care Unit (PACU) and 24 hours following tracheal extubation. The cuff pressures in the Pseal group were significantly lower than in the P25 group at all time points studied (p < 0.001), with a significant increase with time in both groups (p < 0.001). The cuff pressures exceeded the critical pressure of 30 cm H2O only after 90 minutes in the Pseal group and already by 30 minutes in the P25 group. The frequency and intensity of sore throat, hoarseness, and dysphagia were similar in both groups in the PACU and 24 hours after tracheal extubation (p > 0.05). CONCLUSIONS: Minimum ETT sealing cuff pressure during N2O anesthesia did not prevent, but instead attenuated, the increase in cuff pressure and did not decrease postoperative laryngotracheal complaints.

Adult↗
PubMed2005

Laryngotracheoplastic resection for primary tumors of the proximal airway.

BACKGROUND: Primary tumors of the airway with proximity to vocal cords and recurrent laryngeal nerves can be resected with sparing of the larynx. Long-term data on survival and local recurrence after laryngotracheal resection are scarce. METHODS: We conducted a retrospective study of laryngotracheal resection and reconstruction for primary tumors of the airway since 1972. RESULTS: Twenty-five patients aged 15 to 77 years presented with adenoid cystic carcinomas (n = 9), squamous cell carcinomas (n = 6), and other airway tumors (n = 10). Subglottic resection consisted of anterior cricoid in 5 patients; posterior cricoid mucosa in 9 patients, with resection of the posterior cricoid plate in 3 patients; lateral resection in 7 patients; and combined anterior and posterior elements in 4 patients. Vascularized trachea was tailored to reconstruct the defect. Seven patients without hoarseness required resection of the recurrent laryngeal nerve, and 4 other patients with hoarseness did not. There were no operative deaths. Two (8.0%) patients who had received prior high-dose cervical radiation had anastomotic separation, one requiring laryngectomy. One patient needed permanent tracheostomy, and temporary (<2 months) airway tubes were used in 5 patients. Sixteen patients received postoperative radiation. Median follow-up was 101 months. Four (16%) patients died of disease. Overall survival at 5 and 10 years was 79% and 64%, respectively. No patient underwent laryngectomy for recurrence. CONCLUSION: Laryngotracheal resection and immediate reconstruction for subglottic tumors is achieved with good preservation of voice, low morbidity, and no compromise of long-term survival.

Adolescent↗
PubMed2006

[Ortner's syndrome and giant-cell vasculitis].

INTRODUCTION: Ortner's syndrome was first described as a left laryngeal nerve palsy caused by a dilated left atrium in mitral stenosis. Aortic aneurysm is another well-documented etiology. CASE RECORD: We report the case of a 90 year-old woman with temporal arteritis with recent onset hoarseness, and simultaneous discovery of aortic arch aneurysm and left vocal cord palsy. DISCUSSION: The occurrence of hoarseness and aortic aneurysm in Giant-cell vasculitis is discussed. We suggest to consider Horton's disease (GCA) as a possible etiology of Ortner's cardio-vocal syndrome.

Adrenal Cortex Hormones↗
PubMed1994

Use of standardized patients to identify deficits in student performance and curriculum effectiveness.

Much literature supports the value of performance-based tests for obtaining an overall assessment of clinical skills; however, these tests can also identify specific deficits in medical curriculum and student learning. This study, conducted over a period of 2.5 years, used standardized patients to identify deficiencies in medical students' evaluation of a patient with "hoarseness and cough." Each of 230 students performed a physical examination and took a medical history, and each was evaluated on 29 items according to predetermined criteria. We conclude the following: (1) When examining a patient complaining of hoarseness and cough, students frequently did not screen for hemoptysis, thyroid problems, and otalgia; (2) Overall test performance correlated positively with the time of year of the rotation, but screening for certain items (including hemoptysis, thyroid problems, and otalgia) appeared not to depend on rotation; (3) Several important items significantly differentiated the more knowledgeable student from the less knowledgeable student.

Clinical Clerkship↗
PubMed1996

Vocal cord medialization for unilateral paralysis associated with intrathoracic malignancies.

Patients with unilateral vocal cord paralysis from intrathoracic malignancies may have significant dysfunctions of speech, swallowing, ventilation, and effective coughing as a result of inadequate compensation of the nonparalyzed cord. In patients with already compromised pulmonary function, aspiration can be a life-threatening event. Sixty-three patients with intrathoracic malignancies required surgical correction of vocal cord paralysis. Primary pathology included lung cancer (49), esophageal cancer (nine), and miscellaneous tumors (five). Symptoms included hoarseness (62), dyspnea (21), aspiration (26), weight loss (19), dysphagia (14), and pneumonia (14). The surgical procedures included medial displacement of the vocal cord with silicone elastomer (48), temporary Gelfoam injection (seven), and Teflon (polytetrafluoroethylene) injection (eight) to move the affected cord to a medial position. In 11 patients, the operation was performed in the acute postoperative setting to improve pulmonary toilet. Symptomatic improvement was noted in the following proportions of affected patients: hoarseness, 92%; dyspnea, 90%; dysphagia, 93%; aspiration, 92%; pneumonia, 93%; and weight loss, 47%. Overall success rate of the intervention was 57 of 63 patients (90%). All 11 patients treated in the acute setting had immediate improvement. A variety of complications occurred in 17% of patients. Surgical management of vocal cord paralysis in patients with intrathoracic malignancies prevents life-threatening pulmonary complications in the acute postoperative setting. In chronic situations, it provides patients with improved speech, swallowing, and pulmonary function, resulting in improved quality of life, even for patients not cured of their disease.

Adult↗
PubMed2003

A case report of difficult diagnosis in the patient with advanced laryngeal tuberculosis.

We report a patient with severe laryngeal tuberculosis (LTB) involving thyroid cartilage and combined with whole-bone metastasis. A 57-year-old male had presented only with hoarseness. Radiological findings were indicative of suspected metastasis from a malignant tumor. However, tuberculosis was considered by histopathological findings, and so sputum samples were tested for acid-fast bacilli and purified protein derivatives of tuberculin in order to detect the presence of LTB. A polymerase chain reaction confirmed the diagnosis. Anti-tuberculous medications were effective in resolving the hoarseness, and the removal of the mass in the right wing of thyroid cartilage was confirmed by computed tomography (CT).

Antitubercular Agents↗
PubMed1987

Laryngeal trauma vs length of intubation.

The frequency histograms of six patients' laryngographs were studied pre- and post-endotracheal intubation. The changes were correlated with the length of intubation. The post-operative hoarse voice was seen as an increase in the spread of the lower frequencies, and an increase in the fundamental frequency. The latter change was thought to be a subconscious compensation for the hoarseness. The increased lower frequency spread as measured by standard deviation was directly proportional to the length of intubation.

Adolescent↗
PubMed1984

Laryngeal edema as the only symptom of hypersensitivity to salicylic acid and other substances.

Idiosyncrasy to salicylic acid and related substances is well known, the most common symptoms being asthma, rhinorrhea and urticaria. We here describe two cases whose only symptoms were hoarseness and in which inspection revealed laryngeal edema when the patients ingested any of these substances. In cases of chronic recurring hoarseness, a history should be taken with respect to such hypersensitivity and suspect cases should be challenged, since a strict diet may improve the symptoms.

Adult↗
PubMed2005

A comparison of the proseal laryngeal mask airway, the laryngeal tube S and the oesophageal-tracheal combitube during routine surgical procedures.

BACKGROUND AND OBJECTIVE: This study was performed to compare three supraglottic airway devices: the ProSeal laryngeal mask airway (PLMA), the laryngeal tube S (LTS) and the oesophageal-tracheal combitube (OTC) during routine surgical procedures. METHODS: Ninety American Society of Anesthesiologists (ASA) I-III patients scheduled for routine minor obstetric surgery were randomly allocated to the PLMA (n = 30), the LTS (n = 30) or the OTC (n = 30) group, respectively. The overall success rate, insertion time, cuff pressures and resulting airway leak pressures were determined as well as a subjective assessment of handling and the incidence of sore throat, dysphagia and hoarseness were performed. RESULTS: Insertion time until the first adequate ventilation was significantly (P < 0.0001) shorter in the PLMA (median 29 s; 25-75th percentile 25-48 s; range 10-161 s; success rate 100%) and in the LTS group (38 s; 30-44 s; 13-180 s; 100%) compared to the OTC group (75 s; 48-98 s; 35-180 s; 90%). In vivo cuff pressures and airway leak pressures increased with the inflating cuff volume in all devices and were highest in the OTC group. Postoperatively, patients in the PLMA and the LTS group complained significantly less about sore throat (P < 0.001 and 0.05) and dysphagia (P < 0.001 and 0.02) compared to the OTC group, while there was no difference regarding the incidence of hoarseness. Subjective assessment of handling was comparable with the PLMA and the LTS, but inferior with the OTC. CONCLUSIONS: In conclusion, both PLMA and LTS proved to be suitable for routine surgical procedures and proved to be superior to the OTC which cannot be recommended for routine use.

Blood Pressure↗
PubMed1975

A case against teflon injection to lower vocal pitch.

A patient with severe hoarseness was seen three months after Teflon injection of both vocal folds had been performed elsewhere to lower an abnormally high pitch. Pitch analysis utilizing voice spectrography revealed no significant drop in fundamental frequency. The hoarseness is presumed to have resulted from disparate glycerin absorption, inflammatory changes of the folds, and asynchronous vibration of the folds. Vocal fold injection to increase fold thickness and lower pitch is not a simple technique and is not advised until all parameters have been thoroughly studied.

Adult↗
PubMed1978

Teflon laryngoplasty: an acoustical and perceptual study.

A 61-year-old male with a 24-year history of unilateral vocal fold paralysis was evaluated by a speech-language pathologist and an otolaryngologist for 52 weeks following Teflon injection. Tape recordings of the patient's voice were obtained one week prior to and one, eight, 20, and 52 weeks subsequent to Teflon injection. The recorded samples were presented in the backward-play mode to a panel of speech-language pathology graduate students to obtain ratings of the degree of hoarseness, roughness, and pleasantness. Results of the perceptual aspect of this study revealed a general reduction in perceived hoarseness and an enhancement of perceived pleasantness following Teflon injection. Measurement of selected acoustic properties revealed a lowering of median fundamental frequency, a reduction of fundamental aperiodicity for isolated but not excerpted vowels, an elimination of certain frictional noise components, and an increase of certain harmonic components following Teflon injection.

Hoarseness↗
PubMed2001

Response of atypical symptoms of gastro-oesophageal reflux to antireflux surgery.

BACKGROUND: Atypical manifestations of gastro-oesophageal reflux (GOR) include asthma, chest pain, cough and hoarseness. The effectiveness of antireflux surgery for these symptoms is uncertain. The present study compared symptomatic response rates for typical and atypical GOR symptoms after fundoplication. METHODS: Between October 1991 and January 1998, 324 patients underwent laparoscopic fundoplication at Emory University Hospital and returned postoperative questionnaires. Severity of typical (heartburn) and atypical (asthma, chest pain, cough and hoarseness) GOR symptoms was reported by patients on a 0-4 scale before surgery, and at 6 and 52 weeks after operation. Patients were stratified based on preoperative symptoms into three groups: group 1 (severe heartburn/minimal atypical symptoms), group 2 (severe heartburn/severe atypical symptoms) and group 3 (minimal heartburn/severe atypical symptoms). RESULTS: In group 1 (n = 173) heartburn improved in 99 per cent and resolved in 87 per cent. In group 2 (n = 95) heartburn improved in 95 per cent and resolved in 76 per cent, and atypical symptoms improved in 94 per cent and resolved in 42 per cent. In group 3 (n = 56) atypical symptoms improved in 93 per cent and resolved in 48 per cent. Although all symptoms were improved by fundoplication, resolution was more likely for heartburn than for atypical symptoms. CONCLUSION: Atypical symptoms of GOR are improved by fundoplication, but symptom resolution occurs in fewer than 50 per cent of patients.

Asthma↗
PubMed2000

Lipoid proteinosis.

A 21-year-old man presented with a complaint of hoarseness as well as lesions along the eyelids and on his knees, elbows, and fingers. Hoarseness had developed in childhood, followed by lesions along the eyelids and on the elbows and fingers. He had developed lesions on the knees, feet, scrotum, penis, and axilla over the last 2 years. His parents were relatives, but nobody in the family showed similar features. His physical examination was normal. On dermatologic examination, there were beaded papules along the eyelids and small, yellow-white infiltrations on the tongue, buccal mucosa, palate, scrotum, and penis (Fig. 1). His tongue was firm and its mobility was limited. He also had infiltration of the frenulum (Fig. 2) and warty and hyperkeratotic papular and nodular lesions on the hands, knees, elbows (Fig. 3), and axilla. The laboratory findings and laryngoscopic examination were normal. Ophthalmologic, neurologic, and psychiatric examinations were also normal. Electroencephalogram (EEG), electromyogram (EMG), craniography, and cranial computed tomography (CT) scanning revealed no abnormality. The histopathologic examination of the skin biopsy specimens obtained from the axilla, elbow, and dorsum of the hand showed hyperkeratosis and periodic acid-Schiff-positive (PAS(+)) staining hyaline material around the dermal capillaries and sweat glands, and confirmed the diagnosis of lipoid proteinosis.

Adult↗
PubMed2001

[Manifestations of gastroesophageal reflux in the otorhinolaryngology tract].

BACKGROUND: Gastroesophageal reflux disease (GERD) is associated with a wide spectrum of otolaryngologic disorders and extraesophageal complications of the upper aerodigestive tract. Previous studies of patients diagnosed with GERD have reported symptoms such as asthma, chronic cough, pneumonia, laryngitis, but also other oral, rhinopharyngeal and laryngeal disorders, e.g. sore throat, globus sensation, and hoarseness. The objective of this study was to determine the incidence of gastroenterologic diseases in patients complaining of upper aerodigestive, pulmonary, laryngeal, pharyngeal, oral, and cervical disorders that are possibly attributable to GERD. PATIENTS: This study included 40 patients, who presented to the department of Otolaryngology with chronic complaints of at least one of the following symptoms or disorders during a minimum period of 3 months: dysphagia (n = 28), sensation of globus pharyngeus (n = 28), hoarseness (n = 20), odynophagia (n = 22), heartburn (n = 16), postnasal drip (n = 15), sore throat (n = 22), cough (n = 14), throat clearing (n = 11), laryngospasm (n = 6), and voice fatigue (n = 6). A complete examination of the head and neck was performed. Inflammatory disorders of the nose and the paranasal sinuses could not be confirmed by history, nasal endoscopy and Water's view x-ray or CT-scan of the paranasal sinuses in all patients. RESULTS: The main otorhinolaryngologic findings were laryngeal lesions (n = 38), including posterior laryngitis, erythema and edema of the interarytenoideal region, and chronic hyperplastic laryngitis. All patients were referred for gastroenterologic evaluation, where esophagogastroduodenoscopy was performed with histological examination of biopsy specimens. Different gastroenterologic diseases such as GERD, gastritis and hiatal hernia were confirmed in 30 of 40 cases, and appeared solely or in combination with each other. GERD was the most frequent gastroenterologic disease (48%), followed by hiatal hernia (45%) and Helicobacter pylori positive antrum gastritis (23%). Patients with GERD were treated with medical antireflux therapy, e.g. 20 mg to 40 mg of the proton pump inhibitor omeprazole daily. There was a remarkably good therapeutic outcome, since laryngeal disorders and findings as the result of gastroenterologic diseases resolved in 29 out of 30 patients. To date, these therapeutic results were maintained for the mean follow-up period of 8 months. CONCLUSIONS: It is concluded that in many patients, suffering from the above-mentioned otolaryngologic symptoms, occult gastroesophageal diseases are present. However, laryngoscopic findings are subtle and meticulous examination is mandatory. Medical antireflux treatment is effective for relief of symptoms and mucosal healing. Thus, extraesophageal otolaryngologic symptoms and laryngeal manifestations are to be considered as extragastrointestinal manifestations mainly of reflux disease.

Adult↗