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At least 127 records · Page 7Linked to original sources

Chest wall vibrations in singers.

The chest wall vibrations generated by phonation were examined with respect to origin, amplitude, and spectrum in seven singers. The vibrations were picked up in male and female singer subjects by means of small accelerometers, which were fastened to the skin on the center of the sternum, and, for the purpose of comparison, on the thyroid cartilage and on the trachea a few cm below the larynx. Among the factors which influence the chest wall vibrations, the subglottal pressure oscillations seem to represent the most important excitation, while the mechanical shocks from the vocal fold vibrations seem secondary. Supra- and subglottal resonances seem moderately influential. The results of the investigation suggest that it is the voice source, particularly the amplitude of its fundamental, which is reflected in the chest wall vibrations. The amplitude of these vibrations seem to lie above the threshold of the Pacinian receptors for vibratory sensation as long as the fundamental frequency is below approximately 300 Hz. The amplitude of the voice source fundamental and hence the sensation of chest vibrations vary considerably as phonation is changed along the phonatory dimension which ranges from "pressed/tense/strained" through "flow" to "breathy" phonation. For this reason it seems likely that the sensation of chest vibrations can serve as a useful nonauditory and hence room-independent signal for the voluntary control of phonation.

Adult↗

Evaluations of Blom-Singer tracheoesophageal puncture prostheses performance.

Empirical and theoretical approaches to the assessment of Blom-Singer tracheoesophageal puncture prosthesis performance are described in this paper. The results of empirical studies provide new insights about the behavior of Blom-Singer devices. Namely, the overall average resistance (about 126 cm H2O/LPS) of these devices stems from two major factors: air entrance and air exit effects. The magnitudes of airway resistance for each of these factors and the relative contribution each factor makes to the total airway resistance of these prostheses are delineated. The performance of these devices and modifications thereof are shown to be characterized and predicted quite well using a one-dimensional, spring-constant mathematical model.

Airway Resistance↗

Custom modification of the Blom-Singer tracheostoma valve housing.

A technique is presented for modifying the Blom-Singer tracheostoma valve housing to improve peristomal skin adherence for hands-free tracheoesophageal speech production following total laryngectomy. The finished product is thin, flexible, and maintains enhanced tear strength. The edges of a standard housing device for the Blom-Singer valve are trimmed to allow for better accommodation to the tissue surface without distortion. A punch biopsy instrument is used to cut uniform holes around the housing device to allow for permeation of the silicone mixture for better mechanical adherence of the materials.

Adhesives↗

Electrolaryngographically derived voice source changes of child and adolescent singers.

Children are the most likely demographic group to undertake regular singing or singing training, but to date there has been little quantitative research into the voice production of children. The authors used closed quotient (CQ) measurements to analyse the singing voices of over 200 male and female, trained and untrained singers aged 8-18 years for differences in voice source according to sex, vocal training and age. Results indicated that the voice source production of subjects could be clearly divided into groups according to age, sex and the level of vocal training received. It was concluded that the process of training a young voice has a quantifiable effect upon the voice source. It was also concluded that sex differences result in significant differences in the voice source of child and adolescent singers.

Adolescent↗

Peter Singer and 'lives not worth living'--comments on a flawed argument from analogy.

The Australian bioethicist Peter Singer has presented an intriguing argument for the opinion that it is quite proper (morally) to deem the lives of certain individuals not worth living and so to kill them. The argument is based on the alleged analogy between the ordinary clinical judgement that a life with a broken leg is worse than a life with an intact leg (other things being equal), and that the broken leg therefore ought to be mended, on the one hand, and the judgement that the lives of some individuals, for example, severely disabled infants, are not worth living and therefore ought to be terminated, on the other. In the present article it is argued that Singer's argument is flawed, intellectually and/or ethically.

Bioethics↗

A study of menses-related changes to the larynx in singers with voice abuse.

Fifteen vocally abusive and 15 healthy female classical singers were examined before and outside menses by means of laryngoscopy, laryngostroboscopy and electroglottography. Investigation before menses revealed more extensive alteration of the larynx in vocally abusive singers than in healthy ones. Subsequent investigation, after the inappropriate use of their voice had been eliminated, indicated decreased changes to the larynx. It was concluded that premenstrual hyperchanges were a result of combined abuse- and menses-related influence on the larynx, and that laryngeal examination before menstruation could be a useful test for the presence of physiologically correct singing.

Adolescent↗

Internal voice sensitivities in opera singers.

To control their voices, singers rely not only on auditory feedback but also on proprioceptive feedback supplied by internal voice sensitivities (IVS). IVS, which are essentially pallesthetic (vibratory) and kinesthetic (muscular), provide singers with precise landmarks for controlling their emission. This means of control is more reliable than auditory feedback in which the voice is substantially modified by the acoustics of the environment.

Auditory Perception↗

Determination of laryngeal muscle tension in professional singers.

In order to study internal laryngeal muscular tension, 60 opera singers were examined. We determined the EGG quasi-open quotient (QOQ) by means of a crescendo singing task. The region between low (QOQ in 'piano') and high vocal intensity (QOQ in 'forte') is called volume of the QOQ. It was revealed that the volume of the QOQ is a reliable indication of the laryngeal muscular tension of the singers. This method reveals the early stages of muscular tension disturbances before objective changes in the larynx are present.

Adult↗

Singer's dystonia: first report of a variant of spasmodic dysphonia.

OBJECTIVES: We discuss the phonatory characteristics of a previously undescribed focal laryngeal dystonia present in the singing voice. METHODS: We performed a retrospective chart review of 5 patients with singer's dystonia at a neurolaryngology referral center. RESULTS: Four patients reviewed demonstrated phonatory characteristics consistent with adductor spasmodic dysphonia present in their singing voice. One patient demonstrated abductor spasmodic dysphonia in the singing voice. Each patient initially exhibited normal connected speech in conversational voicing. The treatment protocol and outcome are discussed, including the use of botulinum toxin. CONCLUSIONS: Singer's dystonia is a previously undescribed neurologic disorder that should be understood by those who treat voice performers and voice disorders.

Adult↗

Pulsed angiolytic laser treatment of ectasias and varices in singers.

OBJECTIVES: Varices and ectasias in singers are typically the result of phonotraumatic shearing stresses and/or collision forces on the microcirculation within the superficial lamina propria. These lesions can be debilitating in performing vocalists because of the effect of recurrent hemorrhage and/or as a contributing factor to the morbidity of other mass lesions such as polyps, nodules, and cysts. Phonomicrosurgical treatment of performers is understandably approached with great trepidation, as the vocal liability of surgically disturbing the superficial lamina propria and epithelium must be balanced with the inherent detrimental vocal effect(s) of the lesion(s). Pulsed angiolytic lasers that emit radiation at high absorbance peaks of oxyhemoglobin were examined to determine whether they were an efficacious treatment approach for ectasias and varices based on these lasers' mechanisms of action and prior experience in phonomicrosurgery. METHODS: A prospective trial was done in 39 patients (40 procedures in 54 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 25 cases) and a 532-nm pulsed KTP laser (15 cases) in a noncontact mode to treat 65 varices and 43 ectasias. Twenty-nine of 39 patients had varices and ectasias associated with other phonotraumatic mass lesions that required resection. RESULTS: All patients have resumed full vocal activities, and no patient has had a subsequent hemorrhage or vocal deterioration. CONCLUSIONS: Both the 585-nm PDL and the 532-nm pulsed KTP laser were found to be efficacious and relatively safe treatment modalities for vascular abnormalities of the vocal folds in singers. Noncontact selective photoangiolysis of the aberrant vessels prevented future bleeding without substantial photothermal trauma to the overlying epithelium and surrounding delicate superficial lamina propria, thereby allowing for optimal postoperative mucosal pliability and glottal sound production. However, the pulsed KTP laser was substantially easier to use because of its enhanced hemostasis due to its longer pulse width. Vessel wall rupture was commonplace during use of the 585-nm PDL, but rarely occurred during photoangiolysis with the 532-nm pulsed KTP laser.

Dilatation, Pathologic↗

Surgical voice restoration with the Blom-Singer prosthesis following laryngopharyngoesophagectomy and pharyngogastric anastomosis.

Surgical voice restoration using the Blom-Singer technique is a well-established procedure in patients who have undergone simple laryngectomy. Operations for hypopharyngeal carcinoma are more extensive and require reconstruction using regional skin or myocutaneous flaps, or reanastomosis with colon, jejunum, or stomach. We report the use of the Blom-Singer prosthesis in four patients who had undergone pharyngogastric repair following laryngopharyngoesophagectomy and who had failed to achieve a satisfactory voice. All patients initially developed good speech using the prosthesis. Two patients subsequently had their prostheses removed: one because of recurrent malignant disease and one because the procedure had not significantly altered the quality of the voice. The remaining two patients have continued to use the device at 2 and 5 years after insertion with good voice production.

Anastomosis, Surgical↗

Tracheoesophageal puncture for voice restoration: modification of the Blom-Singer technique.

We have used a modification of the Blom-Singer technique in our last 24 tracheoesophageal punctures, performed on 20 patients. At the time of puncture a surgical stent with an indwelling Dacron polyester suture is placed to form the fistula. Forty-eight to 72 hours later the stent is backed out of the puncture site but the suture is allowed to remain. The Blom-Singer duckbill prosthesis is fitted and taped in the routine fashion. The suture is left to traverse the tracheoesophageal tract until the time of discharge, when it is removed. At discharge the patient is given a Silastic dilator, to be used if the puncture site becomes too small to allow for insertion of the duckbill prosthesis. Seventeen of the 20 patients in this group obtained good voice. Six operations would have been failures because of the loss of the patient's prosthesis in the immediate postoperative period if the modified technique had not been used.

Esophagus↗

Allergic rhinitis jeopardizing the careers of professional singers, justifies intense therapy.

A series of three patients were evaluated and treated by the Northwestern University Section of Allergy. These patients had allergic disease that threatened their professional careers as performing artists. Although the clinical manifestations of allergic rhinitis were not unusually severe, these were sufficient to interfere with the performance of these professional singers. Because previous allergic diagnostic and therapeutic regimens had not controlled the voice related symptoms, career changes were reluctantly being considered. Unusually aggressive therapy including systemic corticosteroids was initiated as a diagnostic and therapeutic trial. The resultant improvement was then maintained with more standard allergic management and the three singers were able to perform satisfactorily. This report demonstrates how allergic disease affecting three performing artists justified intense therapy to prevent job loss and the potential financial, emotional and social consequences.

Administration, Inhalation↗

Specially programmed respiratory muscle training for singers by using respiratory muscle training device (Ultrabreathe).

Respiratory muscle training is one of the major methods for enhancing the vocal function. Singers who must use their voice most frequently are well aware of the importance of respiration. However, most of them do not know precisely how to exercise their abdominal respiration. Using a respiratory training device, singers are expected to gain more efficiency in their vocal enhancement. The aim of the study was to examine the pulmonary function, the maximum inspiratory pressure (MIP) and the maximum expiratory pressure (MEP), and the maximum phonation time (MPT) in five female voice-majors students after undergoing specially programmed respiratory muscle training for 2 months. All the voice-majors had an average of 4.8 years of formal classical voice training. A respiratory muscle training device (Ultrabreathe), Tangent health Care Inc., England) was used to train the respiratory muscle. None of the pulmonary function test variables had changed after respiratory muscle training. However, the MIP, MEP, and MPT were significantly increased higher after the respiratory muscle training. This suggests that the specially programmed respiratory muscle training can improve the respiratory muscle strength and vocal function without increasing the pulmonary function.

Adult↗

[The relationship between the presence of Candida colonization in the oropharynx and on the Blom-Singer voice prosthesis and its effect on the length of prosthesis use].

OBJECTIVES: We investigated the effect of oropharyngeal Candida colonization on the contamination of the Blom-Singer voice prosthesis and its lifetime. PATIENTS AND METHODS: The study included 26 male laryngectomized patients (age range 45 to 76 years) in whom the Blom-Singer low-pressure prosthetic valve inserted required removal due to improper functioning. All patients had postoperative radiotherapy. Patients who had nystatin therapy were excluded. At the time of removal, cultures were obtained from the esophageal end of the prosthesis and from the oropharynx to be examined with regard to Candida growth. RESULTS: Candida colonization was recovered from the cultures obtained on 20 prostheses (77%) and from 14 oropharyngeal specimens (54%). The presence of oropharyngeal colonization was always associated with that on prostheses. The average lengths of prosthesis use were 5.7 months (range 4 to 9 months) and 6.2 months (range 3 to 10 months) in patients with and without positive oropharyngeal Candida colonization, respectively (p>0.05). CONCLUSION: The results suggest that the presence of oropharyngeal Candida colonization has no effect on the prosthesis lifetime.

Aged↗

[Observation on stimulation of yintang (EX-HN 3) promoting the action of expanding and unifying the vocal range of the singer].

OBJECTIVE: To observe promoting action of Yintang (EX-HN 3) on expanding and unifying the vocal range of the singer. METHODS: Yintang (EX-HN 3) was stimulated at the same time of singing, and changes of expanding and unifying of the vocal range of the subject were investigated. RESULTS: Stimulation of the acupoint could promote expanding and unifying of the vocal range of the singer, and strength coordination and completeness of expanding of the vocal range and unifying of sound area for singing. CONCLUSION: Stimulation of Yintang (EX-HN 3) is beneficial to expanding and unifying of the vocal range in singing, and to increasing vocal function.

Acupuncture Points↗

[Complications of tracheoesophageal puncture for Blom-Singer voice restoration after total laryngectomy].

OBJECTIVE: To investigate causes and treatment of complications of tracheoesophageal puncture for Blom-Singer voice restoration after total laryngectomy. METHODS: From 1986 to 2004, one hundred and fifty one cases with Blom-Singer technique after total laryngectomy for voice restoration were retrospectively analyzed. RESULTS: All cases were followed up from 6 months to 15 years. Among 151 cases, 138 cases got successful phonation and the total success rate of voice restoration was 91.4%. Of the 151 cases, 15 cases occurred complications. The rate of complications was 9.9%. The common complications included fistula granulations, infection, and leakage. Twelve cases got successful treatment accordingly, and the other 3 cases failed in phonation. CONCLUSIONS: The procedure of tracheoesophageal puncture for voice restoration is relatively simple and has low complications. this method had high phonation success and good phonation quality, which is one of the best way to make laryngectomee to speak.

Adult↗