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At least 1,027 records · Page 57Linked to original sources
PubMed2000

Refinement of velopharyngoplasty in patients with cleft palate by covering the pharyngeal flap with nasal mucosa from the velum.

The velopharyngoplasty performed using the popular Sanvenero-Rosselli method improves the speech quality of patients with cleft palate suffering from persistent velopharyngeal insufficiency despite successful closure of the hard and soft palates. However, often a relatively narrow pharyngeal bridge results due to healing not only by granulation and scar contraction, but also due to the insertion of the inferior tip of the flap into a narrow bed. Elevation of two velar flaps with nasal mucosa to cover the exposed muscular undersurface of the pharyngeal flap produces a broader recipient bed into which the pharyngeal flap can be spread. The speech quality of 27 patients treated with this modified method (group B) was compared with that of 27 patients without this modification (group A). Eight weeks after velopharyngoplasty (followed by uneventful wound healing) the speech quality of group B was significantly better than that of group A (p<0.03 MannWhitney U-test). This difference was even more evident when comparing the preoperative with the postoperative speech quality (p<0.005). Thus, covering the exposed muscular layer of the pharyngeal flap with nasal mucosa of the velum is an important modification of velopharyngoplasty for the improvement of speech quality.

Adolescent↗
PubMed2001

[Phoniatric aspects in microsurgical removal of benign vocal cord changes].

INTRODUCTION: Microsurgery of benign vocal cord lesions is usually done to improve, to restore or to preserve patients' voice. Solid anatomical and physiological knowledge concerning the voice are basic requirements of any surgeon operating in this field. PREOPERATIVE DIAGNOSTICS AND DOCUMENTATION: The significance of patients' history as well as phoniatric investigation, laryngoscopic and stroboscopic findings and their proper documentation are presented. INDICATIONS: The surgical procedure must be part of an extensive therapeutical concept that also takes into consideration drug therapy as well as voice therapy procedures to improve voice quality. POSTOPERATIVE REGIMEN: The care for the patient's voice usually goes beyond surgery. To gain the best possible postoperative results, several steps are necessary in addition to surgical procedures. These steps will be pointed out.

Humans↗
PubMed2006

Respiratory muscle strength training: functional outcomes versus plasticity.

Respiratory muscle strength training is a paradigm that has been used for numerous years with a variety of populations including but not limited to spinal cord injury, chronic obstructive pulmonary disease, multiple sclerosis, Parkinson's disease, voice disordered, sedentary elderly, and healthy young. The respiratory muscle strength program discussed here is an expiratory muscle strength training and uses a pressure threshold device with a regimented treatment protocol. The primary purpose of the expiratory muscle strength training program is to promote strength in the expiratory muscles. The training protocol occurs five times per day, 5 days a week, and consists of ~15-20 minutes per day of training by the user at home. The device threshold is changed weekly by a clinician to maintain a threshold load of 75% of an individual's maximum expiratory pressure. The threshold setting of the device is always based on the individual's recorded maximum expiratory pressure generated into a digital pressure gauge. Results of 4 weeks of expiratory muscle strength training protocols indicate up to a 50% improvement for healthy subjects, those with multiple sclerosis, and those with spinal cord injury. The potential transfer of expiratory muscle strength to functional outcomes is discussed, as well as how strength-training paradigms may influence cortical plasticity.

Breathing Exercises↗
PubMed1989

[Dysarthrophonia of Parkinson syndrome].

Disorders of speech are a common and sometimes even the first symptom of parkinsonism. The various features of parkinsonian speech disorder include repetitive phenomena, disturbances of respiration, dysphonia, and impairment of articulation. This review aims at summarizing the neurological, phoniatric, and phonetical data regarding symptomatology, pathophysiology, and therapy of parkinsonian dysarthrophonia.

Dysarthria↗
PubMed1998

[External vocal cord medialization: functional outcome].

BACKGROUND: Comprehensive evaluation of voice function is the precondition for indication and quality control of every phonosurgical procedure. In 53 patients presenting with glottic insufficiencies of different etiologies an external vocal fold medialisation was performed. Functional voice results obtained with this operation are presented and discussed. METHODS: The following voice parameters were measured preoperatively and postoperatively, and statistical comparison was performed: mean fundamental frequency and sound pressure level, frequency and intensity range (voice range profile), perceptual evaluation of hoarseness, and maximum phonation time. The impairment of vocal communication skills was rated on a newly developed 7-point scale. A combined parameter called "Voice Dysfunction Index" was introduced for global assessment of vocal abilities in particular for long term observations. RESULTS: Statistically significant improvement of all voice parameters was demonstrated. Interestingly, in nearly all measurements male patients yielded significantly better results than females. Glottic insufficiencies due to scarring produced poorer functional results but without statistical significance. A statistically significant correlation between the preoperative and postoperative Voice Dysfunction Index could be observed. This score was also significantly correlated with the degree of glottal gap. No significant correlation between voice results and preoperative delay or follow-up period were observed. Voice therapy was performed in 81% of the patients. Correlation of duration of voice therapy and voice results was statistically significant and negative. Analysis of this surprising result showed that it was caused by some patients with vocal fold scarring in whom outcome was poor despite a long period of voice therapy. CONCLUSIONS: Significant improvement of vocal function can be obtained by external vocal fold medialization in patients with glottic insufficiencies. Glottal gaps caused by vocal fold scarring and/or atrophy can be treated with this method, too. However, results are not as good as in paralysis and require additional long term voice therapy. Satisfying results can be expected in patients with a long history of disturbances, and in older patients. Due to the reversibility of the operation, external vocal fold medialization can be performed even in cases of palsy prior to the spontaneous recovery period. The degree of glottic gap determines the functional disturbance. The degree of the preoperative impairment correlates with the outcome. Results are stable with respect to the follow-up period (mean 66 weeks).

Adult↗
PubMed1998

[Voice quality after partial laser laryngectomy].

BACKGROUND: We conducted a prospective study to investigate voice quality after transoral endolaryngeal laser surgery in terms of ability to communicate effectively. Eighty patients with T1 or T2 glottic carcinoma were enrolled in the study. The main objective was to identify the influence of type and extent of surgery on postoperative voice parameters after endoscopic laser surgery. MATERIAL AND METHODS: The postoperative mechanism of phonation was assessed by videostroboscopy six months after surgery at the earliest. A phonetogram was produced and its area calculated (relative phonetogram, RP) in relation to a gender-specific normal phonetogram. A speech therapist (ST) and a trained otolaryngologist (TO) rated each voice independently for communication ability in a grade from 1 (poor) to 6 (near normal). RESULTS: After simple cordectomy the mean values were as follows: RP = 24.8%, TO = 3.26, ST = 3.33. When the anterior commissure was completely preserved mean results were better (RP = 34%, TO = 3.92, ST = 3.83). Results were worse following extended cordectomy (RP = 14.7%, TO = 2.82, ST = 3.00) and transglottic resection (RP = 13.7%, TO = 2.30, ST = 2.86), but similar within these two groups. The parameters RP, TO, and ST do not differ significantly between the group who had speech therapy after surgery (N = 33) and the group who did not (N = 47). Voice production at glottic level yields better results for every parameter than supraglottic substitute phonation. The amount of tissue removed was less significant. CONCLUSION: We conclude that postoperative phonatory results correlate with the postoperative mechanism of phonation. There is no linear correlation with the amount of tissue removed. Comparing similar types of resection preservation of the anterior commissure plays a key role. From the data in this study there is no evidence of a significant benefit from speech therapy. The parameter RP is an effective and relatively simple parameter to complete auditive voice assessment.

Endoscopy↗
PubMed1992

[Assessing the quality of the speaking voice after therapy of T1 and T2 vocal cord cancers].

All studies which analysed voice quality after T1 and T2 glottic cancer employed sustained vowels for evaluation. Sustained vowels can often be produced more clearly than expected in a severe degree of hoarseness in running speech. In this investigation voice quality was analysed by measuring the signal-to-noise-ratio (SNRc) in running speech. For evaluation these data were correlated to the scores from an auditive evaluation and from a clinical examination of the larynx considering functional parameters. 39 patients were examined after different therapies (primary radiation, chordectomy, frontolateral partial resection). The grading of the three different methods for characterisation of the voice quality correlated well. Therefore the SNRc is presumed to be a valuable additional method to the psychoacoustic voice evaluation. Comparison of voice quality after different therapies provided no significant difference between radiotherapy and chordectomy. The functional results after frontolateral partial resection were significantly less satisfying as expected.

Aged↗
PubMed1992

[What is the value of measuring "singer's formant" in phoniatry?].

The singing formant is the product of an articulatory gesture. Devices for phonetogram measurement often claim the ability to determine it. However, they measure rather the overtone content or the noise of the voice than the formant. Moreover, the voice efficiency (ratio of the sound pressure in the frequency band 2-5 kHz to the total sound pressure), also measured by these devices, is not defined in a physical or physiological sense. Such measurement does not evaluate the efficiency of the vocal apparatus.

Humans↗
PubMed1997

[Speech disorders in ENT practice].

The most frequent speech and language disorders which ENT doctors are confronted with are generally known to be and presented as: delayed speech and language development, dystalia, dysglossia, rhinolalia, dysarthria, and verbal fluency disorders (stuttering, cluttering). The diagnostic portion in comparison to the therapeutic part is always greater and quite different. The close cooperation with representatives of phoniatrics and pedaudiology, as well as logopedics and other specialities such as neurology, and internal medicine is highly necessary.

Adult↗
PubMed1997

[CO2 laser versus conventional microlaryngoscopy in benign changes of the vocal cords].

BACKGROUND: Microsurgical treatment of benign vocal fold lesions as nodules, polyps, and Reinke's edema is a routine intervention in phonosurgery. After laser treatment of malignant neoplasms of the larynx has been accepted as a technical advance by most laryngologists, use of the laser has been also proposed for benign lesions. PATIENTS: Forty-four patients with a benign lesion of the vocal fold were randomized and operated conventionally or with the CO2-laser. Preoperatively, two days, one month, and four months postoperatively, the patients were queried about vocal problems and their subjective rating of their voice quality. Videolaryngostroboscopy was performed, the maximal phonation time was determined, and a phonetogram of the speaking and of the singing voice was registered. A phonetically balanced text and sustained vowels were registered on a DAT recorder and used for subjective rating by experienced listeners and electroacoustic analysis. RESULTS: All parameters showed worsening immediately postoperatively and an improvement later compared to the preoperative value. There was no statistical difference between conventional treatment and CO2 laser treatment. CONCLUSIONS: Microsurgical treatment of benign lesions of the glottis either by CO2 laser or by conventional surgery leeds to comparable results as seen in the final result.

Adult↗
PubMed1995

[Practical significance of measuring high formant spectra in phoniatric voice assessment].

The measurement of sound energy in the spectral region between 2 and 5 kHz provides additional information to the auditive assessment of voice quality. It can be applied to healthy an sick voices, e. g. in tracing the therapeutic course. Devices for measuring voice range profiles with the possibility of evaluating the high formant region are especially useful and valuable. But, nonetheless, simultaneous auditive assessment is crucial to avoid misinterpretation. Calculation of the quotient of the sound pressure level in the region between 2 and 5 kHz by the total sound pressure level allows to determine vocal sound characteristics and changes of the sound. Pre- and postoperative sound spectra obtained from the voices of patients with diseases of the vocal folds illustrate the improvement of the harmonic structure and the decrease of noise components. The measurement of the high formant intensity has proven to be appropriate for the registration of the voice quality before and after therapy in 130 cases. Although the value of these measurements is highly validated in the phoniatric practice, extensive studies and, especially, expert discussions are still needed. The authors come to terms with opinions that question the validity of the described methods.

Follow-Up Studies↗
PubMed1998

Chronic cough: in search of the etiology.

Successful treatment of a voice problem requires an accurate diagnosis. The clinician often needs to piece the diagnosis together from previous treatments that failed, from an accurate and involved case history, and from examination of the larynx during speech and vegetative tasks. This case challenges the clinician's ability to question appropriately, to listen intently, and to observe critically before making the diagnosis. With the correct diagnosis, the patient found relief from her chronic cough.

Chronic Disease↗
PubMed2000

Student Research Award 1999: comparative contrast of voice measurements.

Currently, a variety of objective and subjective measures are available to describe voice and voice function. Despite these various tools, there is no standard measure of voice function that incorporates both objective and subjective measures. The goal of this research was to study the relationship between objective, subjective, and patient-based measures of voice function. Objective voice function was measured with 4 laboratory-based parameters (subglottic pressure, airflow at the lips, maximum phonation time, and vocal efficiency), subjective function with the GRBAS (grade, rough, breathy, asthenic, strained) scale, and patient-based function according to an overall global rating of quality. The objective and subjective measures were significantly related to each other (P < 0.05); the objective and patient-based measures were also related (P = 0.019), but the subjective and patient-based measures were not related. We demonstrate a significant relationship between some but not all measures of voice function. We believe that subjective measures provide additional valuable information not obtained from objective measures alone.

Adult↗
PubMed2002

Office-based treatment of laryngeal papillomatosis with percutaneous injection of cidofovir.

OBJECTIVE: Our aim was to report our experience with office-based treatment of severe laryngeal papillomatosis with percutaneous injection of cidofovir in a case series of 5 patients. STUDY DESIGN AND SETTING: We conducted a retrospective review of a case series in a tertiary academic care voice disorders clinic. Adult patients with papillomas of the vocal cords and anterior commissure received percutaneous injection using a point-touch technique. Clinical improvement or remission of the papillomatosis was noted. RESULTS: Before initiation of office treatments, patients required direct laryngoscopy and CO(2) laser ablation of papillomas on average every 2.8 months. There were no complications related to the injection technique. During a treatment period of 7 to 16 months (mean 12 months), a significant reduction in the volume of papillomatosis was achieved in all patients. One patient received 2 treatments and another received 1 treatment in the operating room for final clearance of papillomas. CONCLUSION: Office-based treatment of adult patients with anterior laryngeal papillomatosis using percutaneous injection of cidofovir reduces the need for repeated direct laryngoscopy and laser ablation under general anesthesia. SIGNIFICANCE: Percutaneous injection treatment with cidofovir is a useful adjunct to direct laryngoscopy and laser ablation in the treatment of laryngeal papillomatosis.

Adult↗
PubMed2003

Perceptual and acoustic evaluation of individuals with laryngopharyngeal reflux pre- and post-treatment.

Thirteen individuals with laryngopharyngeal reflux (LPR) were studied pre- and post-treatment. The effect of treatment on perceptual ratings of voice quality and frequency and intensity measures was examined. Relationships between perceptual and acoustic parameters were assessed descriptively. Results showed a small, but significant improvement in the perception of voice quality post-treatment. No significant differences were found between pre- and post-treatment means for any of the acoustic measures except harmonics-to-noise ratio (HNR). Descriptive analyses showed some association between perceptual ratings and acoustic measures. Discussion of results focuses on severity of LPR.

Adult↗
PubMed2001

Effect of aggressive therapy on laryngeal symptoms and voice characteristics in patients with gastroesophageal reflux.

Gastroesophageal reflux (GER) is associated with a variety of laryngopharyngeal signs and symptoms. Injury of the laryngopharynx as a result of GER can be refractory to conventional antireflux therapy. This prospective study was undertaken to evaluate the prevalence of laryngopharyngeal signs and symptoms in patients with documented GER and to assess the response to a high-dose combination antireflux therapy consisting of cisapride and pantoprazole. Twenty-two patients with symptoms of GER were enrolled. After baseline evaluation using a history questionnaire for symptoms, laryngeal endoscopy and vocal acoustic analysis, patients were started on treatment consisting of pantoprazole 40 mg b.d. and cisapride 20 mg twice daily. Repeat history and otolaryngologic evaluation was performed at 4 weeks. Laryngopharyngeal symptoms were frequent in most patients, with throat clearing and globus being the most prevalent symptoms followed by vocal fatigue and excess mucus production. Almost 90% of the patients had abnormal endoscopic laryngeal findings but the acoustic parameters did not show any abnormal results except for mild elevation in the shimmer. After treatment, all symptoms and endoscopic abnormalities improved significantly except for intermittent dysphonia and laryngeal mucosal redness. Acoustic abnormalities did not change significantly following therapy. Laryngeal symptoms and voice abnormalities are highly prevalent in patients with GER. Combination antireflux therapy with a proton pump inhibitor and a prokinetic agent results in rapid symptomatic and endoscopic response in the majority of patients.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2004

Type 2 thyroplasty for spasmodic dysphonia: fixation using a titanium bridge.

OBJECTIVE: In order to facilitate surgery for spasmodic dysphonia, i.e. type 2 thyroplasty, a device was designed to fix the incised edges of the thyroid cartilage firmly. MATERIAL AND METHODS: Various types and sizes of titanium bridge were developed for clinical use. RESULTS: The results of surgery for spasmodic dysphonia were satisfactory in all 10 cases in which the new titanium bridge was used. No complications have been encountered to date. CONCLUSION: Type 2 thyroplasty for spasmodic dysphonia was made easier to perform using the new titanium bridge, and more stable fixation of the reconstructed thyroid cartilage was achieved.

Humans↗