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PubMed2005

[Voice disorders in rheumatoid arthritis].

UNLABELLED: The report presents three patients with coincidence of voice disorders and rheumatoid arthritis. Material consisted of 3 females aged 39, 48 and 74 years. Methods included phoniatric examination, videolaryngoscopy, stroboscopy and acoustic voice analysis MDVP). RESULTS: In the two youngest patients the laryngoscopic changes were located on vocal folds, mostly as yellow nodules. The appropriate mobility of both vocal folds was found. The MDVP analysis particularly revealed changes in parameters describing perturbation of amplitude in both cases. In the third case oedema in the region of the crico-arytenoid joints and vestibular folds were observed. MDVP analysis showed slight disturbances in the parameters describing frequency perturbation.

Adult↗
PubMed1999

High-speed digital imaging of neoglottic vibration after total laryngectomy.

OBJECTIVES: To establish the applicability of digital high-speed imaging in studying neoglottic mucosal vibration after total laryngectomy and to perform a structured evaluation of the recordings using a standardized assessment form to gain insight about the anatomical and morphologic characteristics of the neoglottis. DESIGN: Evaluation of a new clinical tool and description of clinical disorders in a patient survey. SETTING: The Netherlands Cancer Institute, Amsterdam. PATIENTS: Forty-six patients who underwent laryngectomy, 36 who underwent standard total laryngectomy and 10 who underwent a partial or total pharynx reconstruction (ie, myocutaneous pectoralis major flap [n = 4], free radial forearm flap [n = 2], tubed gastric pull-up [n = 3], and full gastric pull-up [n = 1]). INTERVENTION: Digital high-speed imaging, using a 90 degrees rigid laryngoscope, of the neoglottic vibration in prosthetic tracheoesophageal speakers after total laryngectomy. MAIN OUTCOME MEASURES: Digital high-speed imaging might overcome some of the problems of stroboscopy in studying irregular voices and could, therefore, be expected to give more insight into the anatomical and morphologic characteristics of the neoglottis. RESULTS: Digital high-speed recordings could be obtained in 44 of 46 patients. Using a structured evaluation form, a wide variability in anatomical and morphologic features could be established. CONCLUSIONS: Digital high-speed imaging appeared to be a useful tool in studying the irregular vibrations of the neoglottis. Evaluation by the structured evaluation form gives a good idea about the wide variability in anatomical and morphologic features of the neoglottis.

Aged↗
PubMed1979

Influence of thyroid surgery on voice function and laryngeal symptoms.

A comprehensive examination of voice function and laryngeal symptoms was applied systematically to 20 patients undergoing thyroid surgery. Patients were excluded from the series if there had been previous neck surgery or if postoperative indirect laryngoscopy showed abnormal cord mobility. Examination before operation showed that patients with sporadic non-toxic goitre or medically pre-treated toxic goitre had impaired voice function based on stroboscopy, electro-glottography, phono-oscillometry and determination of voice range, phonation time, pitch, and peak flow. Three months after thyroid surgery the voice function was significantly improved although not normal in non-toxic goitre patients, whereas the voice function in patients with thyrotoxicosis was unchanged. The number of laryngeal symptoms was significantly reduced in non-toxic goitres following surgery and unaltered in the group with thyrotoxicosis.

Adolescent↗
PubMed1996

Vocal fold vibration in simulated head voice phonation in excised canine larynges.

In order to establish precise vibratory patterns and their clinical implication for phonation, the mode of vibration of the vocal folds around the time of register transition in excised canine larynges was analyzed multi-directionally according to various acoustic parameters. Phonation was simulated by artificially tensing the cricothyroid muscles. Vibration of the vocal folds around the time of register transition was filmed from above using ultra-high-speed cinematography and in a frontal plane using X-ray stroboscopy. Acoustic parameters included subglottic pressure, pitch, intensity and tension and were recorded simultaneously during register transition. The fundamental vibration patterns observed during vocal phonation were the same as that involved in chest voice phonation in excised canine larynges, with respect to the traveling wave of the vocal fold vibration. Changes in the physical properties of the vocal folds were considered to occur at register transition. These changes were probably strongly dependent upon changes in the structure of the lamina propria. Head voice phonation requires adaptability of the lamina propria and is less efficient than chest voice phonation. Hence, head voice phonation would be one method for assessing the condition of the vocal folds.

Animals↗
PubMed2004

[Not all vocal cord failure following thyroid surgery is recurrent paresis due to damage during operation. Statement of the German Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery concerning recurring paresis due to intubation].

Since the phoniatrician H. Bauer described the first case of recurrent laryngeal nerve palsy most likely caused by intubation some 45 years ago, several case reports have been published. However, systematic analyses regarding the frequency of recurrent laryngeal nerve palsies due to intubation are scarce, and none of them has used the proper methods to demonstrate clearly that such a mechanism exists. Currently available data justify the assumption that not every recurrent laryngeal nerve palsy following thyroid surgery is due to the operation itself and that the damage caused by intubation, however, may only account for a minority of these cases. The differential diagnosis of postoperative recurrent laryngeal nerve palsy requires the use of specific tools which go beyond simple laryngoscopy and include stroboscopy as well as intra- and extralaryngeal electromyography. A partial palsy of recurrent laryngeal nerve due to intubation would be associated with severe dysphonia or aphonia, not with dyspnea because of the typical intermediate position of the paralyzed vocal folds with a normal electromyographic function of the cricothyroid muscle. The use of these methods to identify the nature of postoperative recurrent laryngeal nerve palsy is recommended in cases of regular intraoperative neuromonitoring but postoperatively impaired function of the vocal cords.

Diagnosis, Differential↗
PubMed2003

[Operative voice pitch raising in male-to-female transsexuals. A survey of our technique and results].

BACKGROUND: Transsexuality constitutes a complex,permanent transposition due to a paradoxical sense of belonging to the opposite sex. The persons concerned experience such a high degree of suffering that they strive to undergo operative sex reversal. Mainly in the case of male-to-female transsexuals this may often lead to a subsequent discrepancy between the external appearance and the character of the voice,since only a deepening of the voice can be achieved by hormonal treatment and not a raising of its pitch.Also,logopedic treatment on its own cannot,as a rule, guarantee a lasting success. In order to adapt the voice as an essential aspect of human identity to the external female appearance,a variety of phonosurgical operation techniques have been developed since the seventies. PATIENTS AND METHODS: In 1993 a modified cricothyroidal approximation via miniplates, following ISSHIKI's technique, has been performed at the ENT Department of the Martin-Luther-University of Halle-Wittenberg. This procedure is based upon an approximation of the cricoid and thyroid cartilages resulting in an increase in the vocal cord tension. This intervention does not affect the inner structures of the larynx and is on principle reversible. Combined with a chondrolaryngoplasty it allows for a reduction of the Adam's apple. So far 57 patients have undergone this surgical intervention. Laryngoscopy, stroboscopy and a detailed voice diagnostic, as well as ultrasound and computertomographic examinations of the larynx are performed pre and postoperatively in order to record the anatomical-physiological and functional data. RESULTS AND CONCLUSIONS: So far good functional results could be achieved showing an average rise of the medium voice range by approximately one fourth. As a long-term result a permanent raising of the basic voice pitch has been reported. The majority of the patients are satisfied with the functional and cosmetic effect reporting an enhanced self-esteem.

Adult↗
PubMed2006

[Bright white vocal folds and capillary ectasias. Late sequelae after radiotherapy].

We report on visible laryngeal changes after radiotherapy. In this study, three women and two men aged 50-64 years were involved. In three cases, the primary tumor was a carcinoma of the thyroid gland and in one case a carcinoma of the esophagus. Due to dysplasia of the vocal folds, one patient underwent primary radiotherapy. Endoscopy was performed 4 to 22 years after radiotherapy. The larynx was examined by video-laryngoscopy and stroboscopy. We found a characteristic pattern of the vocal folds in all patients: bright white vocal fold surface, ectasia of capillaries and increased angiogenesis. We only found this pattern in patients after radiotherapy. In our opinion, these findings are late sequelae of radiotherapy. The picture of laryngitis due to radiotherapy can be distinguished from chronic laryngitis of other etiology using these criteria.

Adenocarcinoma, Follicular↗
PubMed1997

[Follow-up of patients with laryngeal contact granuloma].

A conservative approach (vocal rest, voice therapy, antibiotic treatment of infections and/or management of esophageal reflux) and microsurgery have been used to heal laryngeal contact granulomas. Unfortunately, recurrences have been found in most cases. In the present study we followed 45 patients after an initial diagnosis of a contact granuloma was made based on laryngoscopy and stroboscopy with video-documentation. All studies were conducted in the Department of Phoniatrics (University of Göttingen) during the past four years, with follow-ups made at 3 month-intervals up to 12 months after diagnosis. All patients were counselled using a focal psychosomatic approach. Follow-up was possible for 41 patients. Findings showed that 19 patients lost their contact granulomas completely without therapy, 12 of which occurred over a period to 13 months after diagnosis. Seven patients underwent microsurgery at their own requests, with 5 developing recurrences when compared with the first diagnosis, 15 patients still had a contact granuloma. Emotional strain in connection with specific personality traits seemed to operate as a significant variable in the remission of contact granulomas.

Adult↗
PubMed1999

[Measuring therapy success in laryngeal paralysis based on voice parameters].

The clinical courses of vocal rehabilitation of patients with different degrees of laryngeal paralysis can proceed very differently, but usually do not correspond with the physical changes of glottic function seen on laryngoscopy and stroboscopy. In this study 43 patients with laryngeal paralyses were examined, of whom 28 had regeneration of nerve function. Fifteen did not show any improvement in glottal function. All patients were asked to describe their voices, after which subjective data were compared to objective findings concerning vocal penetrating capacity, voice attack, volume, and capacity. In particular, voice capacity, attack, and vocal penetrating capacity were found to be valid in reflecting therapeutic effects and for estimating voice capability.

Adult↗
PubMed1999

[Medication-induced vocal cord paralysis as an uncommon cause of cord paralysis].

A case is reported of a 57-year-old man who was found to have a right vocal cord paralysis that most likely followed prolonged treatment with the anti-arrythmic medication Amiodaron-HCl (Cordarex). Phoniatric treatment was given for 5 1/2 months, during which time microlaryngoscopy and stroboscopy were performed. With the help of speech therapy, mobility of the paralyzed cord was seen to begin to return 3 1/2 months after discontinuing the Amiodaron-HCl. Full cord mobility has not returned to date.

Amiodarone↗
PubMed2003

Hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review.

Arytenoid subluxation is a well-known cause of hoarseness due to incomplete glottic closure with intact inferior laryngeal nerves after severe laryngeal trauma. We report the case of a young man presenting after laryngeal blunt trauma with hoarseness, easy fatigue during phonation, marked difficulty with his high-pitch and singing voice and decreased phonation time, but intact function of both inferior laryngeal nerves, intact endolaryngeal mucosa sensibility and normal CT scans of the larynx and the neck. Due to the asymmetric anteromedial position of the right arytenoid with incomplete glottic closure, the primary diagnosis was arytenoid subluxation, and the patient was referred for instantaneous relocation therapy. The stroboscopic and electromyographic diagnosis of a unilateral paresis of the external branch of the right superior laryngeal nerve caused the therapy to be changed. Without repositioning, the patient had a total recovery of voice quality when the paresis receded 2 months later. In conclusion, the unilateral paresis of the external branch of the superior laryngeal nerve after laryngeal blunt trauma is reported here for the first time. Although the clinical findings are familiar sequelae of thyroid surgery, they may be misdiagnosed as arytenoid subluxation after laryngeal blunt trauma. Stroboscopy and electromyography permitted the correct diagnosis.

Adult↗
PubMed1996

Use of the recursion formula of the Gompertz survival function to evaluate life-table data.

The recursion formula of the Gompertz function is an established method for the analysis of growth processes. In the present study the recursion formula of the Gompertz survival function 1n S(t + s) = a + b x ln S(t) is introduced for the analysis of survival data, where S(t) is the survival fraction at age 1, s is the constant age increment between two consecutive measurements of the survival fraction and a and b are parameters. With the help of this method--and provided stroboscopial measurements of rates of survival are available--the Gompertz survival function, instead of the corresponding mortality function, can be determined directly using linear regression analysis. The application of the present algorithm is demonstrated by analysing two sets of data taken from the literature (survival of Drosophila imagoes and of female centenarians) using linear regression analysis to fit survival or mortality rates to the corresponding models. In both cases the quality of fit was superior by using the algorithm presently introduced. Moreover, survival functions calculated from the fits to the mortality law only poorly predict the survival data. On the contrary, the results of the present method not only fit to the measurements, but, for both sets of data the mortality parameters calculated by the present method are essentially identical to those obtained by a corresponding application of a non-linear Marquardt-Levenberg algorithm to fit the same sets of data to the explicit form of the Gompertz survival function. Taking into consideration the advantages of using a linear fit (goodness-of-fit test and efficient statistical comparison of survival patterns) the method of the recursion formula of the Gompertz survival function is the most preferable method to fit survival data to the Gompertz function.

Aged↗
PubMed1995

Voice disorders in children.

The pediatric otolaryngologist has an especially important role in the differential diagnosis and treatment of two voice disorders; these are the voice quality problems (dysphony) and the resonance problems (rhinophony). The first step in the examination is to preclude the organic causes. The functional dysphonia is mostly related to voice abuse/misuse, but may be present on a psychosomatic basis; environmental factors can also play a role in the etiology and the personality structure has been found to be very relevant. The perceptual evaluation of voice is of obvious importance. Endoscopy with a transnasal flexible scope makes it possible, in practically all cases, to identify the morphodynamic changes. Stroboscopy and phonetography can be carried out only in older children, sometimes a 'trial treatment' is of valuable help. The therapy can be divided into five groups (counselling, voice re-education, drug treatment, psychotherapy, surgery), but should be always individual. An open question: how to choose the preferable treatment of vocal nodules: surgery, conservative or wait-and-see? According to a detailed survey in Kurume University Hospital the following can be stated: if the patient is in trouble due to hoarseness, and immediate improvement of his voice is necessary, surgery should be indicated; if they need the improvement but do not need it urgently, voice therapy is recommended; without motivation vocal hygiene is proposed. No matter what treatment patients receive, their voices improve in the majority after puberty, but 15% of the patients do not show any improvement. In cases of hoarseness due to long-term postintubational glottic lesions logopedic treatment is the only therapeutic possibility. The delay of speech development of tracheotomized children can and should be avoided by applying proper cannula technique and by logopedic training. The physiological nasality which depends upon the undisturbed activity of the velopharyngeal closure, can become pathologic in four forms: closed, open, mixed and alternating nasality (rhinophonolalia). In the diagnosis of hyperrhinophony due to VPI X-ray procedures, supplemented with nasendoscopy, proved to be the most informative methods, the etiology (neuromyogen processes) may be revealed by electrophysiological methods; the voice and speech can be assessed and visualized by nasometry, but the detailed speech evaluation is indispensable. The basic possibilities of treatment are as follows: speech therapy, surgery, speech bulb, electrotherapy and medicines. The basis of operative treatment is flap surgery. The anatomical result of 1000 (velo) pharyngoplasties carried out in Madarász and Heim Pál Children's Hospital (Budapest) is good in 98%, the hyperrhinophony ceased or became minimal in 90% after surgery. The ideal age for operation is 4.5 years.

Adolescent↗
PubMedDate not supplied

Synchronizing videostroboscopic images of human laryngeal vibration with physiological signals.

PURPOSE: This report describes a new system that permits the precise correlation of videostroboscopic images with corresponding physiological measures, such as glottography and subglottic pressure. METHOD: A healthy volunteer had unilateral vocal cord paralysis induced by infiltrating local anesthesia into the recurrent and superior laryngeal nerve. Vocal-fold vibrations were monitored by photoglottography (PGG) and electroglottography (EGG). Analog signals from the EGG and PGG were synchronized with the video and correlated. RESULTS: The method described permits images to be sampled throughout sustained phonation. This technique allows study of events during glottic vibration. Results obtained have been in close agreement with previous studies that correlate the vocal-fold morphology to glottographic signal using other methods. This technique is inexpensive in comparison with high-speed filming. The main disadvantage of this method is related to the limitations of stroboscopy.

Adult↗
PubMed1990

Active radial and transverse motile responses of outer hair cells in the organ of Corti.

In isolated outer hair cells (OHCs) electrically induced movements of high frequencies have been described. The experiments, however, gave no information whether fast OHC motility exists in situ. In the present report, we developed a technique to prepare viable half turn explants from the guinea-pig cochlea which could be kept as organ culture. Several video imaging methods and pixel-by-pixel, digital-image subtractions allowed simultaneous observations and quantitative measurements at video rates of 688 x 512 localizations of investigated segments of the organ of Corti (OC). When living cochlea explants were exposed to an electrical a.c. field, the OHCs in the OC followed this field by shortenings and elongations of their cell bodies and by radial movements of their cuticular plates (CP). This was accompanied by radial displacements of the hair bundles. In the apical turns video stroboscopy allowed recording of in situ movements of OHCs up to auditory frequencies. In all experiments motile responses were most prominent in the three rows of the OHCs. No or less pronounced passive motile responses could be observed at the tunnel of Corti (TC) and in the inner hair cells (IHCs). Mechanical decoupling of OHCs and IHCs at the TC resulted in a loss of IHC movements, whereas OHCs were uneffected. Motility was detectable in the presence of physiological salt solutions (300 mOsm/l) and in iso-osmolar mannitol or sorbitol solutions. The electrically induced motile responses were not suppressed in the presence of dinitrophenol or cytochalasin B. Thus, the present report shows active transverse and radial motile responses of OHCs in the OC, which are electro-mechanical in situ processes. The results indicate how outer hair cell electromotility may influence hearing when it occurs within the mechanical framework of the OC.

Animals↗
PubMed2006

Evaluation of voice pathology based on the estimation of vocal fold biomechanical parameters.

Voice disorders are a source of increasing concern as normal voice quality is a social demand for at least one third of the population in developed countries in cases where voice is an essential resource in professional exercise. In addition, the growing exposure to certain pathogenic factors such as smoking, alcohol abuse, air pollution, and acoustic contamination, and other problems such as gastro-esopharyngeal reflux or allergy as well as aging, aggravate voice disorders. Voice pathologies justify the assignment of larger resources to prevention policies, early detection, and less aggressive treatments. Traditional pathology detection relies on perceptive evaluation methods (GRABS), acoustic analysis, and visual inspection (indirect laryngoscopy, and modern fibro-endo-stroboscopy). This article describes a method for voice pathology detection based on the noninvasive estimation of vocal cord biomechanical parameters derived from voice using specific signal processing methods. Preliminary results using records from patients showing four frequent causes of voice pathology (nodules, polyps, chronic laryngitis, and Reinke's edema) are given. The results show that the alteration (distortion, unbalance, or deviation) of cord biomechanical parameters may serve as an indicator of pathology. Statistical methods based on hierarchical clustering and principal component analysis reveal that combining biomechanical estimates with classic perturbation parameters increases the accuracy of acoustic analysis, improving the detection of voice pathology. This research could open new possibilities for noninvasive screening of vocal fold pathologies and could be used in the implantation of e-health voice care services.

Biomechanical Phenomena↗
PubMed2006

Vocal problems among teachers: evaluation of a preventive voice program.

Vocal education programs for teachers may prevent the emergence of vocal disorders; however, only a few studies have tried to evaluate the effectiveness of these preventive programs, particularly in the long term. Two hundred and sixty-four subjects, mostly kindergarten and primary school female teachers, participated in a course on voice care, including a theoretical seminar (120 minutes) and a short voice group therapy (180 minutes, small groups of 20 subjects). For 3 months, they had to either attend the vocal ergonomics norms and, as psychological reinforcement, they had to make out a daily report of vocal abuse, or to follow the given exercises for a more efficient vocal technique, reporting on whether the time scheduled was respected or not. The effectiveness of the course was assessed in a group of 21 female teachers through a randomized controlled study. Evaluation comprehended stroboscopy, perceptual and electro-acoustical voice analysis, Voice Handicap Index, and a course benefit questionnaire. A group of 20 teachers matched for age, working years, hoarseness grade, and vocal demand served as a control group. At 3 months evaluation, participants demonstrated amelioration in the global dysphonia rates (P=0.0003), jitter (P=0.0001), shimmer (P=0.0001), MPT (P=0.0001), and VHI (P=0.0001). Twelve months after the course, the positive effects remained, although they were slightly reduced. In conclusion, a course inclusive of two lectures, a short group voice therapy, home-controlled voice exercises, and hygiene, represents a feasible and cost-effective primary prevention of voice disorders in a homogeneous and well-motivated population of teachers.

Adult↗
PubMed2006

Mucosal wave: a normophonic study across visualization techniques.

Visualization of vocal fold vibration is essential for accurate diagnoses and optimal treatment of persons with voice disorders. Recently, scientific and anecdotal reports have evidenced an increased amount of variation in the diagnostically relevant features of extent and symmetry of mucosal wave magnitude in normophonic speakers. The objectives of this study were to preliminarily ascertain the variation in mucosal wave magnitude and symmetry for normophonic speakers as assessed via standard and novel techniques, and compare findings across modal and pressed phonations. A correlational design with a multiple baseline across visualization methods approach was used. Mucosal wave presence, magnitude, and symmetry from 52 normophonic speakers were judged via stroboscopy, high-speed videoendoscopy (HSV) playback, mucosal wave playback, and mucosal wave kymography playback. Results demonstrate a prevalence of atypical magnitude and symmetry of mucosal wave during modal and pressed phonations by normophonic persons, differences across techniques, and a relationship between judgments and habitual fundamental frequency. Given the prevalence of mucosal wave magnitude and symmetry variations in the normophonic population, overdiagnosis may be possible without caution. The various visualization techniques provided unique information suggesting that it may be beneficial to use both full view and kymographic visualization techniques in combination. A major restriction of the current commercial HSV systems is the frame rate, typically limited to 2000 frames per second, which appears insufficient for most female habitual phonations.

Adolescent↗