[Causes of vocal cord dyscinesia and its original factors after endotracheal intubation].

PubMed

Sun, Anke; Zhang, Tiezheng; Liu, Wenyuan; Tang, Weiwei; Guo, Xiaohong

2012-03-01

To research the causes of postintubation vocal cord dyskinesia and its contributing factors. The causes of vocal cord dyskinesia were confirmed by laryngoscope, three-dimensional spiral CT, stroboscope, and the analysis of therapy. The factors relevant to the causes of vocal cord dyskinesia were analysed based on the following elements: (1) the anatomic or pathological condition of patients or the technical skills of anesthetists. (2) emaciated or obese body and neck. (3) the age of patients. (4) the duration of endotracheal tube retention. (5) the types of operations. (6) anesthesia procedure. Among 135 patients, 128 cases (94.81%) manifested arytenoid dislocation, 7 cases (5.19%) vocal cord paralysis. The study showed that the vocal cord dyskinesia associated with anatomic or pathological condition of patients and technical skills of anesthetists (with intubation difficulty) accounted for 76.30%. The patients with relative emaciated body or neck accounted for 90.62% in cases without intubation difficulty. Age had no significant analytical relationship with vocal cord dyskinesia. Prolonged intubation (endotracheal tube retention over 12 hours) was accounted for only 17.64%. The incidence of vocal cord dyskinesia was nearly 0.5% in patients underwent cardio-thoracic surgery, accounting for 59.26% of all the patients. There are two major causes of vocal cord dyskinesia: arytenoid dislocation and vocal cord paralysis, and the rate of vocal cord dyskinesia could be reduced by the improvement of technical skill of anesthetists and/or sufficient attention to the intubation condition of patients.

Vocal cord paralysis after aortic arch surgery: predictors and clinical outcome.

PubMed

Ohta, Noriyuki; Kuratani, Toru; Hagihira, Satoshi; Kazumi, Ken-Ichiro; Kaneko, Mitsunori; Mori, Takahiko

2006-04-01

This study is retrospective cohort study of data on vocal cord paralysis after aortic arch surgery collected during 14 years at a general hospital. We investigated factors in the development of vocal cord paralysis after aortic arch surgery and the effect of vocal cord paralysis on clinical course and outcome. We reviewed data for 182 patients who underwent aortic arch surgery for aortic arch aneurysm and aortic dissection between 1989 and 2003, of whom 58 patients had proximal aortic repair, 62 had distal arch repair, and 62 had total arch repair. We assessed factors associated with the development of vocal cord paralysis and examined in detail the clinical outcome of patients with vocal cord paralysis. Postoperative vocal cord paralysis occurred in 40 patients. Multiple logistic regression analysis revealed the following risk factors with odds ratios (OR) for vocal cord paralysis: extension of procedures into distal arch (OR, 17.0), chronic dilatation of the aorta at the left subclavian artery (OR, 9.14), and total arch repair (OR, 4.24). Adoption of open-style stent-grafts reduced the incidence of vocal cord paralysis (OR, 0.031). The postoperative occurrence of vocal cord paralysis itself emerges as an independent predictor of pulmonary complications (OR, 4.12) and leads to a longer duration of hospital stay. The risk of vocal cord paralysis after aortic arch surgery depends on surgical factors, such as aneurysmal involvement of the distal arch, or the application of newer, less invasive surgical procedures. Vocal cord paralysis after aortic arch surgery itself, under aggressive postoperative respiratory management, did not increase aspiration pneumonia but was associated with postoperative complications leading to higher hospital mortality and prolonged hospitalization.

[Clinical study on vocal cords spontaneous rehabilitation after CO2 laser surgery].

PubMed

Zhang, Qingxiang; Hu, Huiying; Sun, Guoyan; Yu, Zhenkun

2014-10-01

To study the spontaneous rehabilitation and phonation quality of vocal cords after different types of CO2 laser microsurgery. Surgical procedures based on Remacle system Type I, Type II, Type III, Type IV and Type V a respectively. Three hundred and fifteen cases with hoarseness based on strobe laryngoscopy results were prospectively assigned to different group according to vocal lesions apperence,vocal vibration and imaging of larynx CT/MRI. Each group holded 63 cases. The investigation included the vocal cords morphological features,the patients' subjective feelings and objective results of vocal cords. There are no severe complications for all patients in perioperative period. Vocal scar found in Type I ,1 case; Type II, 9 cases ;Type III, 47 cases; Type IV, 61 cases and Type Va 63 cases respectively after surgery. The difference of Vocal scar formation after surgery between surgical procedures are statistical significance (χ2 = 222.24, P < 0.05). Hoarseness improved after the surgery in 59 cases of Type I , 51 cases of Type II, 43 cases of Type III, 21 cases of Type IV and 17 cases of Type Va. There are statistically significance (χ2 = 89.46, P < 0.05) between different surgical procedures. The parameters of strobe laryngoscope: there are statistical significance on jitter between procedures (F 44.51, P < 0.05), but without difference within Type I and Type II (P > 0.05). This happened in shimmer parameter and the maximum phonation time (MPT) as jitter. There are no statistical significance between Type IV and Type Va on MPT (P > 0.05). Morphological and functional rehabilitation of vocal cord will be affected obviously when the body layer is injured. The depth and range of the CO2 laser microsurgery are the key factors affecting the vocal rehabilitation.

Is there a correlation of sonographic measurements of true vocal cords with gender or body mass indices in normal healthy volunteers?

PubMed Central

Bright, Leah; Secko, Michael; Mehta, Ninfa; Paladino, Lorenzo; Sinert, Richard

2014-01-01

Background: Ultrasound is a readily available, non-invasive technique to visualize airway dimensions at the patient's bedside and possibly predict difficult airways before invasively looking; however, it has rarely been used for emergency investigation of the larynx. There is limited literature on the sonographic measurements of true vocal cords in adults and normal parameters must be established before abnormal parameters can be accurately identified. Objectives: The primary objective of the following study is to identify the normal sonographic values of human true vocal cords in an adult population. A secondary objective is to determine if there is a difference in true vocal cord measurements in people with different body mass indices (BMIs). The third objective was to determine if there was a statistical difference in the measurements for both genders. Materials and Methods: True vocal cord measurements were obtained in healthy volunteers by ultrasound fellowship trained emergency medicine physicians using a high frequency linear transducer orientated transversely across the anterior surface of the neck at the level of the thyroid cartilage. The width of the true vocal cord was measured perpendicularly to the length of the cord at its mid-portion. This method was duplicated from a previous study to create a standard of measurement acquisition. Results: A total of 38 subjects were enrolled. The study demonstrated no correlation between vocal cord measurements and patient's characteristics of height, weight, or BMI's. When accounting for vocal cord measurements by gender, males had larger BMI's and larger vocal cord measurements compared with females subjects with a statistically significant different in right vocal cord measurements for females compared with male subjects. Conclusion: No correlation was seen between vocal cord measurements and person's BMIs. In the study group of normal volunteers, there was a difference in size between the male and female vocal cord size. PMID:24812456

Is there a correlation of sonographic measurements of true vocal cords with gender or body mass indices in normal healthy volunteers?

PubMed

Bright, Leah; Secko, Michael; Mehta, Ninfa; Paladino, Lorenzo; Sinert, Richard

2014-04-01

Ultrasound is a readily available, non-invasive technique to visualize airway dimensions at the patient's bedside and possibly predict difficult airways before invasively looking; however, it has rarely been used for emergency investigation of the larynx. There is limited literature on the sonographic measurements of true vocal cords in adults and normal parameters must be established before abnormal parameters can be accurately identified. The primary objective of the following study is to identify the normal sonographic values of human true vocal cords in an adult population. A secondary objective is to determine if there is a difference in true vocal cord measurements in people with different body mass indices (BMIs). The third objective was to determine if there was a statistical difference in the measurements for both genders. True vocal cord measurements were obtained in healthy volunteers by ultrasound fellowship trained emergency medicine physicians using a high frequency linear transducer orientated transversely across the anterior surface of the neck at the level of the thyroid cartilage. The width of the true vocal cord was measured perpendicularly to the length of the cord at its mid-portion. This method was duplicated from a previous study to create a standard of measurement acquisition. A total of 38 subjects were enrolled. The study demonstrated no correlation between vocal cord measurements and patient's characteristics of height, weight, or BMI's. When accounting for vocal cord measurements by gender, males had larger BMI's and larger vocal cord measurements compared with females subjects with a statistically significant different in right vocal cord measurements for females compared with male subjects. No correlation was seen between vocal cord measurements and person's BMIs. In the study group of normal volunteers, there was a difference in size between the male and female vocal cord size.

Vocal cord paralysis after aortic surgery.

PubMed

DiLisio, Ralph P; Mazzeffi, Michael A; Bodian, Carol A; Fischer, Gregory W

2013-06-01

The purpose of this study was to investigate variables associated with vocal cord paralysis during complex aortic procedures. A retrospective review. A tertiary care center. Four hundred ninety-eight patients who underwent aortic surgery between 2002 and 2007. Two groups were studied. Group A patients had procedures only involving their aortic root and/or ascending aorta. Group B patients had procedures only involving their aortic arch and/or descending aorta. The incidence of vocal cord paralysis was higher (7.26% v 0.8%) in group B patients (p < 0.0001). Increasing the duration of cardiopulmonary bypass time was associated with an increased risk of vocal cord paralysis and death in both groups A and B (p = 0.0002 and 0.002, respectively). Additionally, within group B, descending aneurysms emerged as an independent risk factor associated with vocal cord paralysis (p = 0.03). Length of stay was statistically significantly longer among group A patients who suffered vocal cord paralysis (p = 0.017) and trended toward significance in group B patients who suffered vocal cord paralysis (p = 0.059). The association between tracheostomy and vocal cord paralysis among group A patients reached statistical significance (p = 0.007) and trended toward significance in group B patients (p = 0.057). Increasing duration of cardiopulmonary bypass time was associated with a higher risk of vocal cord paralysis in patients undergoing aortic surgery. Additionally, within group B patients, descending aortic aneurysm was an independent risk factor associated with vocal cord paralysis. Most importantly, vocal cord paralysis appeared to have an association between an increased length of stay and tracheostomy among a select group of patients undergoing aortic surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

Irritant vocal cord dysfunction at first misdiagnosed as reactive airway dysfunction syndrome.

PubMed

Galdi, Eugenia; Perfetti, Luca; Pagella, Fabio; Bertino, Giulia; Ferrari, Massimo; Moscato, Gianna

2005-06-01

This report describes a case of vocal cord dysfunction at first misdiagnosed as reactive airway dysfunction syndrome (RADS). A woman developed recurrent episodes of cough, dyspnea, and wheezing unresponsive to asthma therapy after irritant exposure to glutaraldehyde. Direct laryngoscopy was performed immediately after the induction of symptoms. Laryngoscopy showed a paradoxical adduction of the vocal cord on inspiration. Vocal cord dysfunction was diagnosed. A case of vocal cord dysfunction occurred after exposure to glutaraldhyde in a person with a history highly suggestive of RADS. Vocal cord dysfunction should always be considered in the differential diagnosis of patients with acute respiratory symptoms after exposure to irritants and with asthma-like symptoms that fail to respond to conventional asthma therapy.

Vocal cord mucosal flap for the treatment of acquired anterior laryngeal web.

PubMed

Xiao, Yang; Wang, Jun; Han, Demin; Ma, Lijing; Ye, Jingying; Xu, Wen

2014-01-01

Anterior glottic web is one type of laryngeal stenosis. Previous surgical methods had some drawbacks, such as large surgical trauma, long postoperative recovery time, and multiple-stage surgery. This study aimed to explore better treatment to repair anterior glottis web. We performed vocal cord mucosal flap procedure on 32 patients with anterior laryngeal webs. All subjects received vocal cord scar releasing and vocal cord mucosal flap repair and suture under general anesthesia with selfretaining laryngoscope. All 32 patients completed surgery in one stage, without postoperative laryngeal edema, difficulty in breathing, or other complications. After the surgery, the anterior commissure of vocal cords recovered to a decent triangle shape in 28 patients; however, in four patients there were 2 to 3 mm adhesion residuals on the anterior ends of the vocal cords, accompanied by scar appearance of bilateral vocal cords. The GRB score, voice handicap index scores, and maximum phonation time score significantly improved in all patients after the surgery. There was no evidence of recurrent laryngeal webbing in the 6-month follow-up. Vocal cords mucosal flap repair surgery has the advantages of less trauma, quick recovery, and significant improvement of the voice in the treatment of laryngeal webs.

An analysis-by-synthesis approach to the estimation of vocal cord polyp features.

PubMed

Koizumi, T; Taniguchi, S; Itakura, F

1993-09-01

This paper deals with a new noninvasive method of estimating vocal cord polyp features through hoarse-voice analysis. A noteworthy feature of this method is that it enables us not only to discriminate hoarse voices caused by pathological vocal cords with a single golf-ball-like polyp from normal voices, but also to estimate polyp features such as the mass and dimension of polyp through the use of a novel model of pathological vocal cords which has been devised to simulate the subtle movement of the vocal cords. A synthetic hoarse voice produced with a hoarse-voice synthesizer is compared with a natural hoarse voice caused by the vocal cord polyp in terms of a distance measure and the polyp features are estimated by minimizing the distance measure. Some estimates of polyp dimension that have been obtained by applying this procedure to hoarse voices are found to compare favorably with actual polyp dimensions, demonstrating that the procedure is effective for estimating the features of golf-ball-like vocal cord polyps.

Study of the thermal distribution in vocal cords irradiated by an optical source for the treatment of voice disabilities

NASA Astrophysics Data System (ADS)

Arce-Diego, José L.; Fanjul-Vélez, Félix; Borragán-Torre, Alfonso

2006-02-01

Vocal cords disorders constitute an important problem for people suffering from them. Particularly the reduction of mucosal wave movement is not appropriately treated by conventional therapies, like drugs administration or surgery. In this work, an alternative therapy, consisting in controlled temperature increases by means of optical sources is proposed. The distribution of heat inside vocal cords when an optical source illuminates them is studied. Optical and thermal properties of tissue are discussed, as a basis for the appropriate knowledge of its behaviour. Propagation of light is shown using the Radiation Transfer Theory (RTT) and a numerical Monte Carlo model. A thermal transfer model, that uses the results of the propagation of radiation, determines the distribution of temperature in the tissue. Two widely used lasers are considered, Nd:YAG (1064 nm) and KTP (532 nm). Adequate amounts of radiation, resulting in temperature rise, must be achieved in order to avoid damage in vocal cords and so to assure an improvement in the vocal functions of the patient. The limits in temperature should be considered with a combined temperature-time and Arrhenius analysis.

[Vocal cord paralysis associated with tracheal intubation: incidence, risk analysis, and classification of severity].

PubMed

Kikura, Mutsuhito; Suzuki, Yuji; Itagaki, Taiga; Sato, Tsunehisa; Nishino, Junko

2015-01-01

Vocal cord paralysis after tracheal intubation is rare. It causes severe hoarseness and aspiration, and delays recovery and discharge. Arytenoid cartilage dislocation and recurrent nerve paralysis are main causes of vocal cord paralysis. Physical stimulation of the tracheal tube as well as patient and surgical characteristics also contribute. Vocal cord paralysis occurs in 1 (0.07%) of 1,500 general surgery patients and on the left side in 70% of cases. It is associated with surgery/anesthesia time (two-fold, 3-6 hours; 15-fold, over 6 hours), age (three-fold, over 50 years), and diabetes mellitus or hypertension (two-fold). Symptoms resolve in 2-3 months. In adult cardiovascular surgery, vocal cord paralysis occurs in 1 (0.7-2%) of 50-100 cardiac surgery patients and 1 (8.6-32%) of 3-10 thoracic aortic surgery patients. In pediatric cardiac surgery, vocal cord paralysis occurs in 1 (0.1-0.5%) of 200-1,000 patients. We classified the severity of vocal cord paralysis as I, severe hoarseness; II, aspiration or dysphagia; and III, bilateral vocal cord paralysis, aspiration pneumonia, or the need for tracheal re-intubation or tracheotomy. We discuss the importance of informed consent for the patient and family.

[A case of vocal cord contact granuloma after vocal cord polyp surgery].

PubMed

Qiu, Zhili; Jiang, Xiaoping; Yuan, Xiaodong

2016-01-01

The vocal cord polyp is easy to relapse after surgery, but if the patient has recurrence in a short term, it is necessary to consider it as postoperative vocal cord contact granuloma. If the patients with contact granuloma after surgical treatment had severe impact on the pronunciation, it is necessary to be operated and confirmed by pathology and given the treatment of acid suppression, in order to avoid postoperative recurrence.

Endoscopic laser arytenoidectomy with the use of CO2 laser

NASA Astrophysics Data System (ADS)

Malandrakis, S.; Prokopakis, E. P.; Sidoris, M.; Karatzanis, A.; Velegrakis, G.; Helidonis, Emmanuel S.

2004-06-01

Upper airway obstruction due to bilateral vocal cord paralysis presents a serious challenge to the Otolaryngologist. Various surgical techniques have been advocated for the management of patients with vocal cord patients with vocal cord paralysis. Among these techniques, the individual use of laser CO2 arytenoidectomy and posterior cordotomy has gained wide acceptance. In this report, we describe our experience in the management of bilateral vocal cord paralysis by combining posterior partial cordotomy as described by Dennis and Kashima with total arytenoidectomy as described by Ossoff. We report the long term results in the management of 24 patients with bilateral vocal cord paralysis treated in our Department during the last 9 years.

Vocal cords-carina distance in anaesthetised Caucasian adults and its clinical implications for tracheal intubation.

PubMed

Pang, G; Edwards, M J; Greenland, K B

2010-11-01

Previous work has assessed vocal cords-carina distance in Chinese patients and compared it to commonly used tracheal tubes. In addition, an attempt was made to identify surface anatomy measurements with short tracheas. We have examined the length of tracheas in Caucasian patients and compared it with currently used tracheal tubes. We have investigated a wider range of surface anatomy measurements in an attempt to correlate measurements with vocal cords-carina distance and identifying patients who may be at risk of endobronchial intubation. In this study, the vocal cords-carina distance was measured in 150 anaesthetised Caucasian patients with a fibreoptic bronchoscope. We also attempted to correlate height and various surface anatomy measurements on the patients' chest, neck and limb regions to predict those patients at risk of endobronchial intubation. The mean vocal cords-carina distance was 12.7 cm (standard deviation 1.6 cm). The best predictors in our study of vocal cords-carina distance less than 11.3 cm were a height of < or = 182 cm, an ulnar length of < or = 31.2 cm or a thyroid to xiphisternum distance of < or = 31.8 cm. This correlation is poor however and prediction of vocal cords-carina distance remains difficult clinically. It was therefore concluded that surface anatomy measurements are a poor predictor of vocal cords-carina distance.

Vocal Cord Paralysis

MedlinePlus

... paralysis. Known causes may include: Injury to the vocal cord during surgery. Surgery on or near your neck or upper ... Factors that may increase your risk of developing vocal cord paralysis include: Undergoing throat or chest surgery. People who need surgery on their thyroid, throat ...

Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation

PubMed Central

Park, Hee-Sun; Kim, Ha-Jung; Ro, Young-Jin; Yang, Hong-Seuk; Koh, Won-Uk

2017-01-01

Abstract Rationale: Recurrent laryngeal nerve block is an uncommon complication that can occur after an interscalene brachial plexus block (ISB), which may lead to vocal cord palsy or paresis. However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion. To the best of our knowledge, there are no reports of bilateral vocal cord paresis, which occurred after a continuous ISB and endotracheal intubation in a patient with no history of vocal cord injury or surgery of the neck. Patient concerns: A 59 year old woman was planned for open acromioplasty and rotator cuff repair under general anesthesia. General anesthesia was induced following an ISB using 0.2% ropivacaine and catheter insertion for postoperative pain control. Diagnoses: While recovering in the postanesthesia care unit (PACU), however, the patient complained of a sore throat and hoarseness without respiratory insufficiency. On the morning of the first postoperative day, she still complained of mild dyspnea, dysphonia, and slight aspiration. She was subsequently diagnosed with bilateral vocal cord paresis following an endoscopic laryngoscopy examination. Interventions: The continuous ISB catheter was immediately removed and the dyspnea and hoarseness symptoms improved, although mild aspiration during drinking water was still present. Outcomes: On the 4th postoperative day, a laryngoscopy examination revealed that the right vocal cord movement had returned to normal but that the left vocal cord paresis still remained. Lessons: When ISB is planned, a detailed history-taking and examination of the airway are essential for patient safety and we recommend that any local anesthetics be carefully injected under ultrasound guidance. We also recommend the use of low concentration of local anesthetics to avoid possible paralysis of the vocal cord. PMID:28403100

Vocal Cord Paralysis and Laryngeal Trauma in Cardiac Surgery

PubMed Central

Chen, Yung-Yuan; Chia, Yeo-Yee; Wang, Pa-Chun; Lin, Hsiu-Yen; Tsai, Chiu-Ling; Hou, Shaw-Min

2017-01-01

Background Cardiac surgery – associated iatrogenic laryngeal trauma is often overlooked. We investigated the risk factors of vocal cord paralysis in cardiac surgery. Methods Medical records were reviewed from 169 patients who underwent elective or emergency cardiac surgeries. Patients had transesophageal echocardiography (TEE) placed either under video fiberscopic image guidance (guided group) or blind placement (blind group). Routine postoperative otolaryngologist consultation with video laryngoscopic recording were performed. Results Vocal cord paralyses were found in 18 patients (10.7%; left-13, right-4, bilateral-1). The risk of vocal cord paralysis was associated with emergency operation [odds ratio, 97.5 (95% confidence interval [CI], 2.9 to 366), p = 0.01]. Use of fiberscope-guided TEE [odds ratio, 0.04 (95% CI 0.01 to 0.87), p = 0.04] can effectively reduce vocal cord injury. Conclusions Emergency cardiac surgery increased the risk of vocal cord paralysis. Fiberscope-guided TEE placement is recommended for all patients having cardiac surgery to decrease the risk of severe peri-operative laryngeal trauma. PMID:29167615

Vocal Cord Paralysis and Laryngeal Trauma in Cardiac Surgery.

PubMed

Chen, Yung-Yuan; Chia, Yeo-Yee; Wang, Pa-Chun; Lin, Hsiu-Yen; Tsai, Chiu-Ling; Hou, Shaw-Min

2017-11-01

Cardiac surgery - associated iatrogenic laryngeal trauma is often overlooked. We investigated the risk factors of vocal cord paralysis in cardiac surgery. Medical records were reviewed from 169 patients who underwent elective or emergency cardiac surgeries. Patients had transesophageal echocardiography (TEE) placed either under video fiberscopic image guidance (guided group) or blind placement (blind group). Routine postoperative otolaryngologist consultation with video laryngoscopic recording were performed. Vocal cord paralyses were found in 18 patients (10.7%; left-13, right-4, bilateral-1). The risk of vocal cord paralysis was associated with emergency operation [odds ratio, 97.5 (95% confidence interval [CI], 2.9 to 366), p = 0.01]. Use of fiberscope-guided TEE [odds ratio, 0.04 (95% CI 0.01 to 0.87), p = 0.04] can effectively reduce vocal cord injury. Emergency cardiac surgery increased the risk of vocal cord paralysis. Fiberscope-guided TEE placement is recommended for all patients having cardiac surgery to decrease the risk of severe peri-operative laryngeal trauma.

[Persistent Bilateral Vocal Cord Paralysis after General Anesthesia in a Patient with Multiple System Atrophy: A Case Report].

PubMed

Konishi, Hanako; Mizota, Toshiyuki; Fukuda, Kazuhiko

2015-06-01

We report a case of persistent bilateral vocal cord paralysis which developed after spine surgery under general anesthesia in a patient with multiple system atrophy. A 64-year-old woman was scheduled to receive spinal fusion surgery for kyphoscoliosis. She did not have apparent symptoms of vocal cord paralysis such as hoarseness before surgery. The surgery was performed smoothly under general anesthesia with endotracheal intubation. However, immediately after extubation, the patient developed severe upper airway obstruction and was re-intubated. Fiberoptic laryngoscopy revealed bilateral vocal cord abductor paralysis. Vocal cord paralysis did not improve and she received tracheotomy on the 12th day after surgery. She also showed symptoms of autonomic nervous system dysfunction and cerebellar ataxia, and was diagnosed as multiple system atrophy on postoperative day 64. We discuss differential diagnosis of persistent vocal cord paralysis after general anesthesia, and anesthetic management of a patient with multiple system atrophy.

Mycosis fungoides of the true vocal cord: a case report and review of the literature.

PubMed

Maleki, Zahra; Azmi, Farrukh

2010-09-01

Mycosis fungoides is the most common type of cutaneous malignant T cell lymphoma which primarily affects skin. However, extracutaneous manifestation may occur in advanced stages, mostly observed in postmortem studies. We present a case of mycosis fungoides that disseminated to the true vocal cord of a 48-year-old African American man who presented with hoarseness. Only two cases that have also demonstrated a rare involvement of the true vocal cord have been reported in the English literature. In both cases, mycosis fungoides infiltration of the true vocal cord was seen postmortem, along with visceral dissemination of mycosis fungoides. We herein describe a single extracutaneous manifestation of mycosis fungoides in the true vocal cord of a living patient with a 21-year diagnosis of mycosis fungoides. Vocal cord involvement by mycosis fungoides must be considered as one of the differential diagnoses in any mycosis fungoides patients who complain of persistent hoarseness. Awareness of this entity is clinically important due to the necessity of a different management.

Efficacy and safety of acute injection laryngoplasty for vocal cord paralysis following thoracic surgery.

PubMed

Graboyes, Evan M; Bradley, Joseph P; Meyers, Bryan F; Nussenbaum, Brian

2011-11-01

The primary objective of this study was to evaluate the effectiveness and safety of injection laryngoplasty using a temporary injectable agent in the acute setting for patients with unilateral vocal cord paralysis following thoracic surgical procedures. Retrospective consecutive case series in an academic institution. Inclusion criteria included patients acutely treated with injection laryngoplasty from January 1, 2006, to March 31, 2010, for a unilateral vocal cord paralysis that occurred after a thoracic surgical procedure (N = 20). All patients were injected with Radiesse Voice Gel using microlaryngoscopy technique. The mean time to vocal cord injection from the time of thoracic surgery was 4.5 days. There was one operative-related complication of intraoperative bile reflux that caused a pneumonitis. Ninety percent of patients were recommended for strict nothing by mouth prior to injection. Of these, 94% were allowed an oral diet following injection, and 67% tolerated a regular diet. None of the patients required subsequent procedures for aspiration or dysphagia, and 25% required further intervention after discharge for persistent dysphonia. Patients with a known nerve transection had a higher rate of dysphonia requiring further surgical procedures than those who did not have a known nerve transection. Acute treatment of thoracic surgery-related unilateral vocal cord paralysis with injection laryngoplasty appears safe and effective at preventing postoperative aspiration pneumonia and improves swallowing function to allow resumption of an oral diet. A single injection is often the only required treatment. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Bilateral vocal cord paralysis in children.

PubMed

Chen, Eunice Y; Inglis, Andrew F

2008-10-01

Bilateral vocal cord paralysis in children with its many causes presents a challenging problem to the pediatric otolaryngologist. Traditionally, management of bilateral vocal cord paralysis includes securing the airway with a tracheotomy and waiting for spontaneous recovery. Surgeons have tried a variety of surgical procedures in lieu of or in addition to tracheotomy, but none are perfect solutions to the problem. This article reviews the current surgical procedures for bilateral vocal cord paralysis in the pediatric population with a particular focus on the senior author's experience with the endoscopic posterior costal cartilage grafting procedure.

A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma.

PubMed

Arıkan, Akif Enes; Teksöz, Serkan; Bilgin, İsmail Ahmet; Tarhan, Özge; Özyeğin, Ateş

2017-01-01

Although vocal cord paralysis (VCP) following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis following thyroidectomy can be caused by a vocal cord hematoma with an incidence of 1.4% due to direct injury during orotracheal intubation. In this article, we present a case of VCP caused by vocal cord hematoma. A 32-year-old male patient who has been receiving propylthiouracil treatment for toxic multinodular goiter since 10 years was admitted to our hospital to be operated because of persisting complaints. The patient was hospitalized for sutureless thyroidectomy after he became euthyroid. Preoperative fiberoptic laryngoscopy performed by the ear, nose, and throat department revealed bilaterally motile vocal folds and a completely open airway. Patient underwent sutureless total thyroidectomy with a vessel sealing device (Ligasure TM LF1212, Covidien, CO), and a minivac drainage system was placed in the thyroid lodge. On the morning of the first postoperative day, 50 mL of serosanguinous fluid was drained. The patient's voice was normal, and there was no ecchymosis. Postoperative fiberoptic laryngoscopy revealed a hematoma near the right vocal fold and paralysis of the right vocal fold; however, the airway was open. It should be kept in mind that VCP is not solely due to surgery but can also result from intubation, as observed in this case.

A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma

PubMed Central

Arıkan, Akif Enes; Teksöz, Serkan; Bilgin, İsmail Ahmet; Tarhan, Özge; Özyeğin, Ateş

2017-01-01

Although vocal cord paralysis (VCP) following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis following thyroidectomy can be caused by a vocal cord hematoma with an incidence of 1.4% due to direct injury during orotracheal intubation. In this article, we present a case of VCP caused by vocal cord hematoma. A 32-year-old male patient who has been receiving propylthiouracil treatment for toxic multinodular goiter since 10 years was admitted to our hospital to be operated because of persisting complaints. The patient was hospitalized for sutureless thyroidectomy after he became euthyroid. Preoperative fiberoptic laryngoscopy performed by the ear, nose, and throat department revealed bilaterally motile vocal folds and a completely open airway. Patient underwent sutureless total thyroidectomy with a vessel sealing device (LigasureTM LF1212, Covidien, CO), and a minivac drainage system was placed in the thyroid lodge. On the morning of the first postoperative day, 50 mL of serosanguinous fluid was drained. The patient’s voice was normal, and there was no ecchymosis. Postoperative fiberoptic laryngoscopy revealed a hematoma near the right vocal fold and paralysis of the right vocal fold; however, the airway was open. It should be kept in mind that VCP is not solely due to surgery but can also result from intubation, as observed in this case. PMID:29260141

[Vocal cord paralysis after thyroid surgery : Current medicolegal aspects of intraoperative neuromonitoring].

PubMed

Dralle, H; Schneider, R; Lorenz, K; Phuong, N Thanh; Sekulla, C; Machens, A

2015-07-01

Intraoperative neuromonitoring (IONM) has been commercially available for approximately 15 years and is highly predictive in thyroid gland surgery concerning either postoperative vocal fold mobility in the case of an intact signal for muscle action electromyogram (EMG, > 99 % right negative) or vocal fold dysfunction in the case of loss of signal (> 70 % right positive). The use of IONM improves the intraoperative identification of recurrent laryngeal nerve function and due to the high predictive value with respect to the expected vocal cord function the result of IONM has to be integrated into the surgical concept of thyroidectomy. Unilateral loss of function of the recurrent laryngeal nerve cannot be completely avoided despite correct application of IONM; however, bilateral vocal fold palsy can be safely avoided when contralateral surgery is cancelled after a loss of signal occurs during resection of the first side in planned bilateral surgery (alternative strategy). Patients have to be informed preoperatively about the limitations of IONM and potential strategy changes during planned bilateral surgery. Surgeons should apply IONM according to the published current recommendations and by selecting a risk-oriented intraoperative strategy in the case of loss of signal from the recurrent laryngeal nerve.

Endotracheal Tube Electrodes to Assess Vocal Cord Motor Function During Surgery in the Cerebellopontine Angle.

PubMed

Romagna, Alexander; Rachinger, Walter; Schwartz, Christoph; Mehrkens, Jan-Hinnerk; Betz, Christian; Briegel, Josef; Schnell, Oliver; Tonn, Jörg-Christian; Schichor, Christian; Thon, Niklas

2015-09-01

The 10th cranial nerve (CN X) is at risk during surgery in the lower cerebellopontine angle (CPA). To evaluate endotracheal surface electrodes for assessment of CN X motor function during CPA surgery. Twenty patients were enrolled. Electrophysiological recordings were analyzed and retrospectively correlated with clinical, imaging, and intraoperative data. Recordings from endotracheal surface electrodes were reliable and eligible for analyses in 17 patients; in 3 patients, no surface electrode compound motor action potentials (CMAPs) could be obtained. Those patients with sufficient recordings underwent surgery in the CPA for tumors in 14 patients and for nontumor pathologies in 3 patients. In 12 patients, bipolar stimulation of motor rootlets in the CPA resulted in simultaneous CMAPs recorded from both surface electrodes and needle electrodes placed in the soft palate. Coactivation was particularly seen in patients with an intricate relationship between lower cranial nerves and tumor formations (n = 9/10). Amplitudes and latencies of vocal cord CMAPs showed high interindividual but low intraindividual variability. Parameters were not well correlated with the type of surgery (tumor vs nontumor surgery) and lower CN anatomy (displaced vs undisplaced). In 2 patients, vocal cord CMAPs were lost during tumor surgery, which was associated with postoperative dysphagia and hoarseness in 1 patient. Endotracheal surface electrodes allow identification of vocal cord motor rootlets in the CPA. Worsening of CMAP parameters might indicate functional impairment. These aspects support the use of endotracheal surface electrodes in selected patients in whom the vagus nerve might be at risk during CPA surgery.

Vocal fold granulomas in six brachycephalic dogs: clinical, macroscopical and histological features.

PubMed

Sarran, D; Caron, A; Billet, J P

2018-06-05

Vocal cord granulomas are rarely observed in brachycephalic breeds but often reported in humans as contact granulomas. Six French bulldogs were included in this retrospective descriptive study. Endoscopic laryngeal examinations were performed on all dogs under general anaesthesia. Vocal cord lesions were exclusively unilateral, exophytic, approximately 3-mm wide ulcerated mucosal nodules, arising from the vocal cord. Histopathological examination mainly revealed chronic inflammatory changes on the laryngeal epithelium which were consistent with laryngeal granulomas described in humans, except for the location: vocal cord in dogs versus vocal process in humans. In humans, granulomas result from chronic physical or chemical insult to laryngeal mucosa (chronic cough or throat clearing, vocal abuse, gastro-esophageal reflux). In brachycephalic breeds, chronic inspiratory efforts and air turbulences and gastro-esophageal reflux are suspected to result in chronic laryngeal inflammation. © 2018 British Small Animal Veterinary Association.

[Study of the supra-glottic pressure during partial constriction of the vocal tract].

PubMed

Suares, M; Cayrayre, F; Ouaknine, M; de la Brèteque, B Amy; Giovanni, A

2004-01-01

Phonation in a small plastic tube 22 cm length and 5 mms diameter (basic exercise of the method of Dr Amy de la Brèteque), is current practice in vocal rehabilitation in France. This work aims to show the effects of this method on the glottic vibration. The hypothesis was that at the time of phonation in the tube with a strong flow as recommended in the method, the vocal cords vibrate without contact. This limits the mechanical trauma at this level. We have analyzed the sound production in a tube in 11 trained and not trained subjects. We simultaneously collected the intra-oral air pressure and the vocal signal which was subjected to a spectral analysis. Spectral analysis confirmed that the signal was produced correctly i.e. with a strong flow and without interruption of the sound less rich in harmonics. We interpreted these results in the light of our preceding works on the glottic vibration and we show that this vocal production was of the sinusoidal type; this implies the absence of physical contact between the vocal cords, which validates our hypothesis. Further works are necessary to better understand the physical relations between the supra-glottic aerodynamic phenomena and the vibratory functioning of the vocal cords and also to analyze the therapeutic potential ofthe method within speech therapy rehabilitation.

[Developing a canine vocal fold scar model by CO₂ laser and studying the LOX, HSP70 and HA expression in its extra celluar matrix].

PubMed

Liang, G T; Duan, B Y; Zhang, Y Y; Luo, S W; Lu, L; Yang, L P; Wang, B R

2017-01-20

Objective: Building a canine vocal fold scar model and analyzing the changes in morphology, histopathology and related factors of extra cellular matrix (ECM) of vocal cord healing at different time periods. Method: Five experimental dogs were randomly divided into the control group(one dog) and the experimental group (four dogs). No special treatment was done on the control group, and the experimental group was given CO₂ laser through laryngoscope with minimally invasive surgery on bilateral vocal cords. Observation of the morphological changes of injured vocal cords was made at five different time, pre-operation and 6 h, 3 w, 8 w and 12 w post-operation. HE staining, immunofluorescence, were used respectively to observe the histopathological and ultrastructural changes of each layer of vocal cord. Observation were made on the changing pattern of lysyl oxidase (LOX), heat shock proteins70 (HSP70), and the integrated optical density index (IOD) of Hyaluronic acid (HA) in vocal cord tissues. Result: ①Laryngoscope shows there were mild congestion and edema and inflammatory exudation on the wound surface of vocal cord 3w post-operation. On the wound surface of vocal cord 8 w post-operation, the congestion and edema disappear, the local contraction sink, and no adhesion and granulation form. 12 w post-operation, the surface of the vocal cord was smooth, there were local contractures, vocal fold scar form, and hoarseness in the bilateral vocal cords was obvious. ②HE staining shows 6 h post-operation there were a large number of inflammatory cell infiltration, red blood cell leakage, and cell congestion and edema on the wound surface of vocal cord. 3 w post-operation, there were fibroblast proliferation, angiogenesis, and a large number of fibrous tissues disorderly arranged on the wound surface of vocal cord. 8w post-operation, each layer of fibrous tissues were in hyperplasia and the blood vessels was thicken after on the wound surface of vocal cord, 12 w post-operation, a large number of collagens increases and were in group or fasciculation disorder. There were many irregular gaps in fibers, and blood vessels and glands become rare or disappear. ③The immunofluorescence showed LOX, HSP70 and HA were all localized in the cellular cytoplasm and nucleus. The expression levels were different at different postoperative time, and they were mainly relatively strong expressed in the inflammatory cells, vascular endothelial cells and the glands. ④The comparison of IOD values: The IOD values of LOX were different at different time periods ( P < 0.05). There were no significant differences in IOD of HSP70 between pre-operation and 12 w post-operation, but there are significant differences among other groups ( P < 0.05). There were no significant differences in IOD of HA between pre-operation and 12 w post-operation, but there were significant differences among other groups ( P < 0.01). ⑤The expression of LOX decreased 6h post-operation and increased 3-12 w post-operation. The expression of HSP70 post-operation reached the peak 6 h post-operation and decreased 3-12 w post-operation. The expression of HA decreased 6 h post-operation, increased to the peak 8 w post-operation, and decreased 8-12 w post-operation.⑥The transmission electron microscope showed 3 w to 8 w post-operation, in the intrinsic layer of the vocal cord, the fibroblasts were extremely active, the cells swelled, and the organelles were abundant.12 w post-operation, there were a small number of fibroblasts in the active state, and larger gaps between the fibers and fewer and thinner elastic fibers. Conclusion: CO₂ laser ablation of vocal cords under the Micro Post-Laryngoscope could establish reliable animal model of vocal fold scar, and 12 w reticular the vocal fold scars basically form. LOX, HSP70, HA play different roles at early, middle, and late stages in the vocal fold scar formation, and they can be used as a more sensitive index for vocal fold scar formation. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

The forgotten cause of stridor in the emergency department.

PubMed

Ng, Tian-Tee

2017-01-01

Paradoxical Vocal Fold Movement Disorder is where the larynx exhibits paradoxical vocal cords closure during respiration, creating partial airway obstruction. Causes of vocal fold movement disorder are multifactorial, and patients describe tightness of throat, difficulty getting air in, have stridor, and do not respond to inhalers. We propose using transnasal laryngoscopy examination, which will show narrowing of vocal cords on inspiration, and The Pittsburgh Vocal Cord Dysfunction Index with a cutoff score of ≥4 to distinguish vocal fold movement disorder from asthma and other causes of stridor. Management of paradoxical vocal fold movement disorder involves a combination of pharmacological, psychological, psychiatric, and speech training. Paradoxical vocal fold movement disorder is a very treatable cause of stridor, so long as it is identified and other organic causes are excluded.

Towards a computer-aided diagnosis system for vocal cord diseases.

PubMed

Verikas, A; Gelzinis, A; Bacauskiene, M; Uloza, V

2006-01-01

The objective of this work is to investigate a possibility of creating a computer-aided decision support system for an automated analysis of vocal cord images aiming to categorize diseases of vocal cords. The problem is treated as a pattern recognition task. To obtain a concise and informative representation of a vocal cord image, colour, texture, and geometrical features are used. The representation is further analyzed by a pattern classifier categorizing the image into healthy, diffuse, and nodular classes. The approach developed was tested on 785 vocal cord images collected at the Department of Otolaryngology, Kaunas University of Medicine, Lithuania. A correct classification rate of over 87% was obtained when categorizing a set of unseen images into the aforementioned three classes. Bearing in mind the high similarity of the decision classes, the results obtained are rather encouraging and the developed tools could be very helpful for assuring objective analysis of the images of laryngeal diseases.

Asthma mimic: Case report and literature review of vocal cord nodule associated with wheezing.

PubMed

Kashif, Muhammad; Singh, Tushi; Aslam, Ahsan; Khaja, Misbahuddin

2017-01-01

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Various clinical conditions can mimic asthma, such as foreign body aspiration, subglottic stenosis, congestive heart failure, diffuse panbronchiolitis, aortic arch anomalies, reactive airway dysfunction syndrome, chronic obstructive pulmonary disease, retrosternal goiter, vocal cord tumors, other airway tumors, and vocal cord dysfunction. Upper airway obstruction can be a life-threatening emergency. Here, we present the case of a 58-year-old female with recurrent hospital visits for wheezing and exacerbations of asthma, who was later found to have a vocal cord nodule confirmed to be squamous cell carcinoma, which was mimicking like asthma.

Bilateral vocal cord paralysis secondary to head and neck surgery.

PubMed

Tekin, Muhammet; Acar, Gul Ozbilen; Kaytaz, Asim; Savrun, Feray Karaali; Çelik, Melek; Cam, Osman Halit

2012-01-01

Even endotracheal intubation could be considered safe in operations under general anesthesia; rarely, it could cause recurrent laryngeal nerve paralysis as a complication. As mentioned in the literature, as a possible reason for this, anterior branches of the recurrent laryngeal nerve in the larynx could suffer from compression between the posteromedial part of the thyroid cartilage and the cuff of the tube. In the literature, unilateral vocal cord paralysis due to endotracheal intubation occurs more frequently in comparison to bilateral vocal cord paralysis. These types of palsies usually totally improve in approximately 6 months. A patient who experienced bilateral vocal cord paralysis in the early postoperative period after undergoing an endotracheal intubation process for general anesthesia and primary partial lip resection and supraomohyoid neck dissection due to lower lip carcinoma is presented in our article. Although vocal cord paralysis occurring after head and neck surgery is first thought as a complication of the surgery, endotracheal intubation should be considered as a possible cause of this paralysis. In relation with this patient, causes, clinical symptoms, and treatment procedures of vocal cord paralysis due to endotracheal intubation are discussed under guidance of the literature.

Functional outcomes of endoscopic arytenoid abduction lateropexy for unilateral vocal cord paralysis with dyspnea.

PubMed

Matievics, Vera; Bach, Adam; Sztano, Balazs; Bere, Zsofia; Tobias, Zoltan; Castellanos, Paul F; Mueller, Andreas H; Rovo, Laszló

2017-10-01

In unilateral vocal cord paralysis (UVCP), hoarseness is usually the leading symptom; however, the diminished airway might lead to breathing problems as well, especially with exertion. The application of the classic resection glottis enlarging or medialization procedures might shift the breathing and/or the voice to a worse condition. The non-destructive endoscopic arytenoid abduction lateropexy (EAAL) might be a solution for this problem. The aim of our study was to analyze the phonatory and respiratory outcomes of this treatment concept. The first year phoniatric [Jitter, Shimmer, harmonics-to-noise ratio (HNR), maximum phonation time (MPT), fundamental frequency (F 0 ), Voice Handicap Index (VHI), Dysphonia Severity Index (DSI), Global-Roughness-Breathiness scale (GRB)], peak inspiratory flow (PIF), and quality of life (QoL) were evaluated in ten UVCP patients treated by EAAL for dyspnea generally presented on exertion. PIF, Jitter, QoL, GRB, and VHI significantly improved. DSI, HNR, and MPT got non-significantly better. F 0 slightly increased in all patients, a mild deterioration of shimmer was observed. These results prove that improving respiratory function is not necessarily associated with a deterioration in voice quality. The EAAL provides a significant improvement in breathing and the vibratory parameters of the postoperative, more tensed and straightened vocal cords proved to be more advantageous than the original (para) median 'loose' position. The over-adduction of the contralateral side more or less compensates for the disadvantageous, more lateral position of the operated side. EAAL might be an alternative treatment for unilateral vocal cord paralysis associated with breathing problems.

[Vocal cord paralysis after endotracheal intubation: an uncommon complication of general anesthesia].

PubMed

Hurtado Nazal, Claudia; Araneda Vilches, Andrea; Vergara Marín, Carolina; García Contreras, Karen; Napolitano Valenzuela, Carla; Badía Ventí, Pedro

2018-04-05

General anesthesia is a safe, frequent procedure in clinical practice. Although it is very unusual in procedures not related to head and or neck surgery, vocal cord paralysis is a serious and important complication. Incidence has been associated with patient age and comorbidities, as well as the position of the endotracheal tube and cuff. It can become a dangerous scenario because it predisposes aspiration. To present a case and analyze the risk factors associated with increased risk of vocal cord paralysis described in the literature. 53 year-old diabetic man, who developed hoarseness in the postoperative period after receiving general anesthesia for an elective abdominal laparoscopic surgery. Otolaryngological evaluation showed left vocal cord paralysis. Vocal cord paralysis can be a serious complication of general anesthesia because of important voice dysfunction and risk of aspiration. The management is not yet fully established, so prevention and early diagnosis is essential. Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Influence of the vocal cord mobility in salvage surgery after radiotherapy for early-stage squamous cell carcinoma of the glottic larynx.

PubMed

Gorphe, Philippe; Blanchard, Pierre; Temam, Stephane; Janot, François

2015-10-01

Disease relapses occur in up to 40% of cases after radiotherapy (RT) for early-stage glottic laryngeal neoplasms, and the foremost remaining treatment option is salvage total laryngectomy (STL). Our objectives were to review the outcomes of patients treated with salvage surgery after RT for early-stage carcinoma of the glottic larynx and to assess prognostic factors. We retrospectively analyzed 43 patients who underwent surgery. Overall and disease-free survival rates among subgroups were calculated and compared, stratified by preoperative stage, vocal cord mobility and postoperative histopathologic data. Recurrences occurred 22.7 months after the end of RT. Surgery was STL in 33 cases (76.8%). The main prognostic factors associated with survival rates were initial vocal cord mobility, vocal cord mobility at the diagnosis of recurrence, and changes in mobility. Vocal cord mobility is an important clinical criterion in treatment decision making for early-stage glottis carcinoma and remains important during follow-up.

Relationship of vocal cord paralysis to the coil diameter of vagus nerve stimulator leads.

PubMed

Robinson, Leslie C; Winston, Ken R

2015-03-01

This investigation was done to examine, following implantation of vagus nerve stimulators, the relationship of vocal cord paralysis to the inner diameter of the coils used to attach the stimulator lead to the nerve. All data in this investigation were collected, as mandated by the FDA, by the manufacturer of vagus nerve stimulators and were made available without restrictions for analysis by the authors. The data reflect all initial device implantations in the United States for the period from 1997 through 2012. Vocal cord paralysis was reported in 193 of 51,882 implantations. In patients aged 18 years and older, the incidence of paralysis was 0.26% when the stimulator leads had coil diameters of 3 mm and 0.51% when the leads had 2-mm-diameter coils (p < 0.05). Across all age groups, the incidence of vocal cord paralysis increased with age at implantation for leads having 2-mm-diameter coils. In patients aged 18 years and older, vocal cord paralysis occurred at almost twice the rate with the implantation of vagus nerve stimulator leads having 2-mm-diameter coils than with leads having 3-mm-diameter coils. The incidence of vocal cord paralysis increases with patient age at implantation.

Ultrasonography assessment of vocal cords mobility in children after cardiac surgery.

PubMed

Shaath, Ghassan A; Jijeh, Abdulraouf; Alkurdi, Ahmad; Ismail, Sameh; Elbarbary, Mahmoud; Kabbani, Mohamed S

2012-07-01

Upper airway obstruction after pediatric cardiac surgery is not uncommon. In the cardiac surgical population, an important etiology is vocal cord paresis or paralysis following extubation. In this study, we aimed to evaluate the feasibility and accuracy of ultrasonography (US) assessment of the vocal cords mobility and compare it to fiber-optic laryngoscope (FL). A prospective pilot study has been conducted in Pediatric Cardiac ICU (PCICU) at King Abdulaziz Cardiac Center (KACC) from the 1st of June 2009 till the end of July 2010. Patients who had cardiac surgery manifested with significant signs of upper airway obstruction were included. Each procedure was performed by different operators who were blinded to each other report. Results of invasive (FL) and non-invasive ultrasonography (US) investigations were compared. Ten patients developed persistent significant upper airway obstruction after cardiac surgery were included in the study. Their mean ± SEM of weight and age were 4.6 ± 0.4 kg and 126.4 ± 51.4 days, respectively. All patients were referred to bedside US screening for vocal cord mobility. The results of US were compared subsequently with FL findings. Results were identical in nine (90%) patients and partially different in one (10%). Six patients showed abnormal glottal movement while the other four patients demonstrated normal vocal cords mobility by FL. Sensitivity of US was 100% and specificity of 80%. US assessment of vocal cord is simple, non-invasive and reliable tool to assess vocal cords mobility in the critical care settings. This screening tool requires skills that can be easily obtained.

Preoperative vocal cord paralysis and its association with malignant thyroid disease and other pathological features.

PubMed

Kay-Rivest, Emily; Mitmaker, Elliot; Payne, Richard J; Hier, Michael P; Mlynarek, Alex M; Young, Jonathan; Forest, Véronique-Isabelle

2015-09-11

Vocal cord paralysis (VCP) is found in both benign and malignant thyroid disease. This study was performed to determine if the presence of preoperative VCP predicts malignancy. A retrospective analysis was performed on a cohort of 1923 consecutive patients undergoing thyroid surgery. The incidence of preoperative VCP was recorded. Patient and nodule characteristics were correlated with final pathology. 1.3% of our cohort was found to have preoperative VCP. Malignant pathology was discovered in 76% of patients with preoperative VCP. Among these patients, 72% had a left sided paralysis. 10.5% of patients with preoperative VCP had perineural invasion (PNI) on final pathology, compared to 1.1% of patients with normal VC function. Preoperative VCP appears to be a strong, though not an absolute, indicator of malignancy. Most VCP were on the left side. Assessing for preoperative VCP is crucial in all patients who need thyroid surgery, as even benign nodules can be accompanied by preoperative vocal cord paralysis.

Optogenetic control of contractile function in skeletal muscle

PubMed Central

Bruegmann, Tobias; van Bremen, Tobias; Vogt, Christoph C.; Send, Thorsten; Fleischmann, Bernd K.; Sasse, Philipp

2015-01-01

Optogenetic stimulation allows activation of cells with high spatial and temporal precision. Here we show direct optogenetic stimulation of skeletal muscle from transgenic mice expressing the light-sensitive channel Channelrhodopsin-2 (ChR2). Largest tetanic contractions are observed with 5-ms light pulses at 30 Hz, resulting in 84% of the maximal force induced by electrical stimulation. We demonstrate the utility of this approach by selectively stimulating with a light guide individual intralaryngeal muscles in explanted larynges from ChR2-transgenic mice, which enables selective opening and closing of the vocal cords. Furthermore, systemic injection of adeno-associated virus into wild-type mice provides sufficient ChR2 expression for optogenetic opening of the vocal cords. Thus, direct optogenetic stimulation of skeletal muscle generates large force and provides the distinct advantage of localized and cell-type-specific activation. This technology could be useful for therapeutic purposes, such as restoring the mobility of the vocal cords in patients suffering from laryngeal paralysis. PMID:26035411

[Treatment of bilateral vocal cord paralysis by hemi-phrenic nerve transfer].

PubMed

Song, W; Li, M; Zheng, H L; Sun, L; Chen, S C; Chen, D H; Liu, F; Zhu, M H; Zhang, C Y; Wang, W

2017-04-07

Objective: To investigate the surgical effect of reinnervation of bilateral posterior cricoarytenoid muscles(PCA) with left hemi-phrenic nerve and endoscopic laser arytenoid resection in bilateral vocal cord fold paralysis(BVFP) and to analyze the pros and cons of the two methods. Methods: One hundred and seventeen BVFP patients who underwent reinnervation of bilateral PCA using the left hemi-phrenic nerve approach (nerve group, n =52) or laser arytenoidectomy(laser group, n =65) were enrolled in this study from Jan.2009 to Dec.2015.Vocal perception evaluation, video stroboscopy, pulmonary function test and laryngeal electromyography were preformed in all patients both preoperatively and postoperative1y.Extubution rate was calculated postoperative1y. Results: Most of the vocal function parameters in nerve group were improved postoperatively compared with preoperative parameters, albeit without a significant difference( P >0.05), while laser group showed a significant deterioration in voice quality postoperative1y( P <0.05). The two groups showed significant difference in voice quality postoperative1y( P <0.05). Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abductive movements ( P <0.05). But the amplitude in nerve group was larger than that in laser group ( P <0.05). 89% of the patients in nerve group were inhale physiological vocal cord abductions. Postoperative glottal closure showed no significant difference in nerve group ( P >0.05), while showed various increment in laser group( P <0.05). Differences between the two groups were statistically significant( P <0.05). The pulmonary function in both groups was better after operation, reaching the reference value. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. The decannulation rate were 88.5% and 81.5% in nerve group and laser group respectively. In both groups, patients presented aspiration symptoms postoperatively, and rdieved soon, except 2 patients in laser group suffered repeated aspiration. Conclusions: Reinnervation of bilateral PCA muscles using left hemi-phrenic nerve can restore inspiratory vocal fold abduction to a satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity, and do not affect swallowing function, greatly improving the quality of life of the patients.

Hypnosis for Asthma and Vocal Cord Dysfunction in a Patient With Autism.

PubMed

Kaslovsky, Robert; Gottsegen, David

2015-10-01

Wheezing in children often is the result of asthma, but vocal cord dysfunction (VCD) may cause stridor or sounds that sometimes are misattributed to the wheezing of asthma. The frequent comorbidity of asthma and VCD also adds to the difficulty in making a clear diagnosis. The challenges of evaluating and treating wheezing are complicated further in children with developmental disorders, such as autism, because of the difficulties of obtaining an adequate history and assessing the clinical response to treatment. This article presents a patient with multiple psychiatric problems, including autism, with severe recurrent wheezing as a result of vocal cord dysfunction and asthma. Hypnosis has previously proven efficacious for treating vocal cord dysfunction, and in this case, hypnotic techniques were major factors in successful symptom control.

[Surgical excision and botulinum toxin A injection for vocal process granuloma].

PubMed

Ma, Lijing; Xiao, Yang; Ye, Jingying; Yang, Qingwen; Wang, Jun

2015-01-01

To study the efficacy of treatment with microsurgery in combination with local injection of type A botulinum toxin for vocal process granuloma. 28 patients with vocal process granuloma received endotracheal intubation under general anesthesia. The lesion was removed with micro-scissor and CO2 laster under a self-retaining laryngoscope and microscope. The incision and mucous membrane surrounding the wound was closed with 8-0 absorbable suture. 4-point injection of botulinum toxin type A 8-15 u was then performed along the thyroarytenoid muscle and arytenoid muscle of the same side. Postoperative medication was administered based on disease causes. All patients experienced vocal cord dyskinesia of the injected side 2-3 days after surgery. At 1 month after the surgery, wound healing was good in all the 28 patients, and the vocal cord movement was limited at the injected side. At 3 months, movement of the bilateral vocal cords was normal, and the vocal cord process mucosa was smooth. Patients were followed up for more than a year, and only one patient had recurrence in 2 months after surgery. The cure rate was 96. 4%. Combination of laryngeal microsurgery and type A botulinum toxin local injection can shorten the treatment course of vocal process granuloma.

Laryngoscopy (For Parents)

MedlinePlus

... throat, where the voice box (larynx) containing the vocal cords is located. It helps doctors identify the ... bright light attached, to examine the larynx and vocal cords. Indirect laryngoscopy is not typically used with ...

[The three-dimensional simulation of arytenoid cartilage movement].

PubMed

Zhang, Jun; Wang, Xuefeng

2011-08-01

Exploring the characteristics of arytenoid cartilage movement. Using Pro/ENGINEER (Pro/E) software, the cricoid cartilage, arytenoid cartilage and vocal cords were simulated to the three-dimensional reconstruction, by analyzing the trajectory of arytenoid cartilage in the joint surface from the cricoid cartilage and arytenoid cartilage composition. The 3D animation simulation showed the normal movement patterns of the vocal cords and the characteristics of vocal cords movement in occasion of arytenoid cartilage dislocation vividly. The three-dimensional model has clinical significance for arytenoid cartilage movement disorders.

[Analysis of the causes of 117 infants with persistent hoarseness].

PubMed

Li, Li; Yang, Teng-fei; Xu, Zheng-min

2011-04-01

To explore the causes of persistent hoarseness in infants. One hundred and seventeen infants with persistent hoarseness treated in the department of otorhinolaryngology in Children's Hospital of Fudan University between June 2008 and July 2010 were retrospectively analyzed (all patients received antibiotic therapy for 2 weeks and the symptoms were not relieved after that). The patients were divided into three groups according to the age at first visit: 22 newborns, < 6 months old in 60 cases, < 12 months old in 35 cases. All patients had video laryngoscope examinations. Some of them received CT scan, cardiac ultrasonography and pathological examination in additional. The diagnosis was established by clinical history and imaging modalities, and the causes were analyzed subsequently. Among the 117 patients, 45 cases were vocal hypertrophy and hyperplasia (37.81%), 39 cases were vocal cord paralyses (32.78%), 7 cases were laryngeal hemangiomas (5.89%), 4 cases were laryngeal webs and cyst (3.36%), 2 cases were vocal cord polyps (1.68%), 2 cases were glottic incompetence (1.68%), 1 case was laryngeal papillomas(0.84%), 1 case was vocal code granulomas (0.84%), 1 case was glottis restricted by neck lymphangioma (0.84%); 4 cases were undetermined and 13 cases were no abnormalities. The percentage of patients with congenital heart diseases (19 cases) in vocal cord paralysis was 48.72%. The proportion of vocal cord paralysis in younger group was higher than that in elder one, their percentage were 50.00%, 36.67% and 17.14% respectively (χ(2) = 7.18, P < 0.05). A variety of causes can lead to persistent hoarseness in infants. The majority of them are vocal hypertrophy and hyperplasia, followed by vocal cord paralyze. Vocal cord paralysis is more common in younger infants than in elder ones, and the main causes are post-cardiac surgery and congenital heart disease.

Laryngopharyngeal Reflux and Children

MedlinePlus

... with the voice box (larynx) and causes the vocal cords to close to prevent aspiration of the material ... as a narrowing of the area below the vocal cords (subglottic stenosis), hoarseness, and possibly eustachian tube dysfunction ...

The 3D Printing of the Paralyzed Vocal Fold: Added Value in Injection Laryngoplasty.

PubMed

Hamdan, Abdul-Latif; Haddad, Ghassan; Haydar, Ali; Hamade, Ramsey

2017-08-18

Three-dimensional (3D) printing has had numerous applications in various disciplines, especially otolaryngology. We report the first case of a high-fidelity 3D-printed model of the vocal cords of a patient with unilateral vocal cord paralysis in need of injection laryngoplasty. A case report was carried out. A tailored 3D-printed anatomically precise models for injection laryngoplasty has the potential to enhance preoperative planning, resident teaching, and patient education. A 3D printing model of the paralyzed vocal cord has an added value in the preoperative assessment of patients undergoing injection laryngoplasty. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A rare case of a sharp foreign body on the vocal cord.

PubMed

Nor Hisyam, C I; Misron, K; Mohamad, I

2017-01-01

A foreign body (FB) in the upper aerodigestive tract is a common clinical problem that presents as as acute emergency. Sharp FB, such as fish bone or chicken bone, commonly lodges in the tonsil, base of tongue, vallecula or pyriform fossa. Dislodgement of a FB into the laryngopharynx is very rare and specifically onto the vocal cord is extremely uncommon. This case report illustrates a rare case of a sharp FB that was dislodged into the airway and stuck on to the right vocal cord, which was removed under local anaesthesia.

IMRT for Image-Guided Single Vocal Cord Irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Osman, Sarah O.S., E-mail: s.osman@erasmusmc.nl; Astreinidou, Eleftheria; Boer, Hans C.J. de

2012-02-01

Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRTmore » plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose {+-} standard deviation to the planning target volume was 67 {+-} 1 Gy. The contralateral vocal cord dose was reduced from 66 {+-} 1 Gy in the conventional plans to 39 {+-} 8 Gy and 36 {+-} 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.« less

Assessment of vocal cord nodules: a case study in speech processing by using Hilbert-Huang Transform

NASA Astrophysics Data System (ADS)

Civera, M.; Filosi, C. M.; Pugno, N. M.; Silvestrini, M.; Surace, C.; Worden, K.

2017-05-01

Vocal cord nodules represent a pathological condition for which the growth of unnatural masses on vocal folds affects the patients. Among other effects, changes in the vocal cords’ overall mass and stiffness alter their vibratory behaviour, thus changing the vocal emission generated by them. This causes dysphonia, i.e. abnormalities in the patients’ voice, which can be analysed and inspected via audio signals. However, the evaluation of voice condition through speech processing is not a trivial task, as standard methods based on the Fourier Transform, fail to fit the non-stationary nature of vocal signals. In this study, four audio tracks, provided by a volunteer patient, whose vocal fold nodules have been surgically removed, were analysed using a relatively new technique: the Hilbert-Huang Transform (HHT) via Empirical Mode Decomposition (EMD); specifically, by using the CEEMDAN (Complete Ensemble EMD with Adaptive Noise) algorithm. This method has been applied here to speech signals, which were recorded before removal surgery and during convalescence, to investigate specific trends. Possibilities offered by the HHT are exposed, but also some limitations of decomposing the signals into so-called intrinsic mode functions (IMFs) are highlighted. The results of these preliminary studies are intended to be a basis for the development of new viable alternatives to the softwares currently used for the analysis and evaluation of pathological voice.

Intraoperative nerve monitoring in laryngotracheal surgery.

PubMed

Bolufer, Sergio; Coves, María Dolores; Gálvez, Carlos; Villalona, Gustavo Adolfo

Laryngotracheal surgery has an inherent risk of injury to the recurrent laryngeal nerves (RLN). These complications go from minor dysphonia to even bilateral vocal cord paralysis. The intraoperative neuromonitoring of the RLN was developed in the field of thyroid surgery, in order to preserve nerve and vocal cord function. However, tracheal surgery requires in-field intubation of the distal trachea, which limits the use of nerve monitoring using conventional endotracheal tube with surface electrodes. Given these challenges, we present an alternative method for nerve monitoring during laryngotracheal surgery through the insertion of electrodes within the endolaryngeal musculature by bilateral puncture. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Voice analysis before and after vocal rehabilitation in patients following open surgery on vocal cords.

PubMed

Bunijevac, Mila; Petrović-Lazić, Mirjana; Jovanović-Simić, Nadica; Vuković, Mile

2016-02-01

The major role of larynx in speech, respiration and swallowing makes carcinomas of this region and their treatment very influential for patients' life quality. The aim of this study was to assess the importance of voice therapy in patients after open surgery on vocal cords. This study included 21 male patients and the control group of 19 subjects. The vowel (A) was recorded and analyzed for each examinee. All the patients were recorded twice: firstly, when they contacted the clinic and secondly, after a three-month vocal therapy, which was held twiceper week on an outpatient basis. The voice analysis was carried out in the Ear, Nose and Throat (ENT) Clinic, Clinical Hospital Center "Zvezdara" in Belgrade. The values of the acoustic parameters in the patients submitted to open surgery on the vocal cords before vocal rehabilitation and the control group subjects were significantly different in all specified parameters. These results suggest that the voice of the patients was damaged before vocal rehabilitation. The results of the acoustic parameters of the vowel (A) before and after vocal rehabilitation of the patients with open surgery on vocal cords were statistically significantly different. Among the parameters--Jitter (%), Shimmer (%)--the observed difference was highly statistically significant (p < 0.01). The voice turbulence index and the noise/harmonic ratio were also notably improved, and the observed difference was statistically significant (p < 0.05). The analysis of the tremor intensity index showed no significant improvement and the observed difference was not statistically significant (p > 0.05 ). CONCLUSION. There was a significant improvement of the acoustic parameters of the vowel (A) in the study subjects three months following vocal therapy. Only one out of five representative parameters showed no significant improvement.

Laryngeal Electromyography is Helpful for Cardiovocal Syndrome.

PubMed

Akbulut, Sevtap; Inan, Rahsan; Demir, Mehmet Gökhan; Cakan, Dogan

2016-01-01

Laryngeal electromyography is used in the evaluation of vocal cord paralysis to confirm the diagnosis, to guide the diagnostic work-up for etiology, to provide prognostic information and to help choose the correct treatment for the patient. Cardiovocal syndrome is characterised by vocal cord paralysis due to a cardiovascular disease. A wide spectrum of conditions can result in this syndrome. Here we present a case of cardiovocal syndrome in association with primary pulmonary hypertension. Laryngeal electromyography was used to guide the work-up of differential diagnosis and also for further intervention with respect to vocal cord paralysis in this patient.

Vocal cord dysfunction in a child.

PubMed

Juliá, J C; Martorell, A; Armengot, M A; Lluch, R; Boluda, C F; Cerdá, J C; Alvarez, V

1999-07-01

Vocal cord dysfunction (VCD) involves paradoxical adduction of the vocal cord during the respiratory cycle. This usually occurs during inspiration, but can also be seen in expiration. Vocal cord appositioning produces airflow obstruction sufficient to cause wheezing, shortness of breath, chest tightness, and coughing. These symptoms often imitate the respiratory alterations of asthma, thus leading to inappropriate treatment; intubation or tracheotomy may prove necessary. An 11-year-old girl was admitted with intractable dyspnea. She had been diagnosed with atopic asthma, although she failed to respond to an increase in antiasthma medication, including high-dose oral steroids. Flow-volume loops were abnormal, with evidence of variable extrathoracic airway obstruction, manifested as a flat inspiratory loop. No structural abnormalities were seen with either computed tomography (CT) or magnetic resonance imaging (MRI). Fibroscopy revealed paradoxical adduction of the vocal cords during the respiratory cycle, no obstructive disorder being observed. After the diagnosis of VCD, the clinical manifestations resolved with psychiatric treatment. Adduction was not demonstrable at repeat fibroscopy after treatment. VCD may simulate bronchial asthma; it may also be associated with that disorder, thus masking the diagnosis. It should be suspected in patients with recurrent wheezing who fail to respond to usual asthma treatment. An early diagnosis avoids unnecessary aggressive management. Treatment should consist of respiratory and phonatory exercises; psychotherapy may be useful.

[Pursed Lips Inspiration for Vocal Cord Dysfunction].

PubMed

Maruyama, Yumiko; Tsukada, Yayoi; Hirai, Nobuyuki; Nakanishi, Yosuke; Yoshizaki, Tomokazu

2015-01-01

Paradoxical vocal cord motion (PVCM) during vocal cord dysfunction (VCD) generally occurs spasmodically and transiently. After we had experienced 36 cases of VCD and successfully treated with conservative treatment including "pursed lips inspiration" method, we experienced a boy who had persistent PVCM. It was observed his PVCM vanished when he breathed in through pursed lips, while it appeared again when he stopped pursed lips inspiration. An airway reflex has been reported where the negative pressure in the subglottic space resulting from the inspiratory effort against a narrowed glottis activates the vocal cord adductor. VCD is considered to have both acceleration of laryngeal closure reflex against airway stimuli and active adductive movement of vocal cords against negative pressure in the subglottic space as underlying factors. The pursed lips inspiration method enables VCD patients not only to accomplish slow and light breathing but also to decrease the difference in the pressure between the supra--and subglottic space by occluding the nasal cavity and voluntary puckering up of the mouth which generate negative pressure in the supraglottic space. This is the first report of the pursed lips inspiration method as a treatment for VCD. Pursed lips inspiration is a simple method which is easy to perform anytime, anywhere without any special equipment, and is considered to be worth trying for VCD.

Assessment of breathing patterns and respiratory muscle recruitment during singing and speech in quadriplegia.

PubMed

Tamplin, Jeanette; Brazzale, Danny J; Pretto, Jeffrey J; Ruehland, Warren R; Buttifant, Mary; Brown, Douglas J; Berlowitz, David J

2011-02-01

To explore how respiratory impairment after cervical spinal cord injury affects vocal function, and to explore muscle recruitment strategies used during vocal tasks after quadriplegia. It was hypothesized that to achieve the increased respiratory support required for singing and loud speech, people with quadriplegia use different patterns of muscle recruitment and control strategies compared with control subjects without spinal cord injury. Matched, parallel-group design. Large university-affiliated public hospital. Consenting participants with motor-complete C5-7 quadriplegia (n=6) and able-bodied age-matched controls (n=6) were assessed on physiologic and voice measures during vocal tasks. Not applicable. Standard respiratory function testing, surface electromyographic activity from accessory respiratory muscles, sound pressure levels during vocal tasks, the Voice Handicap Index, and the Perceptual Voice Profile. The group with quadriplegia had a reduced lung capacity (vital capacity, 71% vs 102% of predicted; P=.028), more perceived voice problems (Voice Handicap Index score, 22.5 vs 6.5; P=.046), and greater recruitment of accessory respiratory muscles during both loud and soft volumes (P=.028) than the able-bodied controls. The group with quadriplegia also demonstrated higher accessory muscle activation in changing from soft to loud speech (P=.028). People with quadriplegia have impaired vocal ability and use different muscle recruitment strategies during speech than the able-bodied. These findings will enable us to target specific measurements of respiratory physiology for assessing functional improvements in response to formal therapeutic singing training. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Paradoxical Vocal Cord Motion in Pediatric Patients.

PubMed

Palla, John; Friedman, Aaron D

2016-05-01

Paradoxical vocal cord motion (PVCM), also termed vocal cord dysfunction, is a poorly understood disorder of episodic dyspnea characterized by inappropriate vocal cord adduction during inspiration and potentially during expiration. It can coexist or be confused with asthma, so appropriate diagnosis is key to optimizing treatment success. Although many patients with PVCM may have underlying psychologic issues, there is emerging evidence to suggest that this entity is not psychogenic in every patient. Both laryngeal irritants and exercise have been identified as additional contributing factors in PVCM. Diagnosis of PVCM requires awake laryngoscopic confirmation. However, many patients do not exhibit signs of PVCM during this examination, despite provocation during testing. Therefore, clinical history remains key in determining which patients should proceed with behavioral therapy under the guidance of a speech pathologist. In addition, treatment may include limiting patient exposure to potential sources of laryngeal irritation. Refractory patients may benefit from psychologic assessment and treatment. [Pediatr Ann. 2016;45(5):e184-e188.]. Copyright 2016, SLACK Incorporated.

Inducible Laryngeal Obstruction: Excessive Dynamic Airway Collapse vs. Inducible Laryngeal Obstruction

DTIC Science & Technology

2017-10-20

testing unremarkable (’lilble 1) • Repeat exerciBe laryogoacopy found laryngeal edema and no 1LO Noted to have expindory wheezing belt belrd over...DLo/VA 4.l! 187" ) Vocal cord edema or paralysis Paradoxical vocal cord motion Laryngeal stenosls Laryngocele Tonsillar hypertrophy Post nasal

Congenital H-type tracheoesophageal fistula: A multicenter review of outcomes in a rare disease.

PubMed

Fallon, Sara C; Langer, Jacob C; St Peter, Shawn D; Tsao, KuoJen; Kellagher, Caroline M; Lal, Dave R; Whitehouse, Jill S; Diesen, Diana L; Rollins, Michael D; Pontarelli, Elizabeth; Malek, Marcus M; Iqbal, Corey W; Upperman, Jeffrey S; Leys, Charles M; Wulkan, Mark L; Hill, Sarah J; Blakely, Martin L; Kane, Timothy D; Wesson, David E

2017-11-01

To perform a multicenter review of outcomes in patients with H-type tracheoesophageal fistula (TEF) in order to better understand the incidence and causes of post-operative complications. H-type TEF without esophageal atresia (EA) is a rare anomaly with a fundamentally different management algorithm than the more common types of EA/TEF. Outcomes after surgical treatment of H-type TEF are largely unknown, but many authoritative textbooks describe a high incidence of respiratory complications. A multicenter retrospective review of all H-type TEF patients treated at 14 tertiary children's hospital from 2002-2012 was performed. Data were systematically collected concerning associated anomalies, operative techniques, hospital course, and short and long-term outcomes. Descriptive analyses were performed. We identified 102 patients (median 9.5 per center, range 1-16) with H-type TEF. The overall survival was 97%. Most patients were repaired via the cervical approach (96%). The in-hospital complication rate, excluding vocal cord issues, was 16%; this included an 8% post-operative leak rate. Twenty-two percent failed initial extubation after repair. A total of 22% of the entire group had vocal cord abnormalities (paralysis or paresis) on laryngoscopy that were likely because of recurrent laryngeal nerve injury. Nine percent required a tracheostomy. Only 3% had a recurrent fistula, all of which were treated with reoperation. There is a high rate of recurrent laryngeal nerve injury after H-type TEF repair. This underscores the need for meticulous surgical technique at the initial repair and suggests that early vocal cord evaluation should be performed for any post-operative respiratory difficulty. Routine evaluation of vocal cord function after H-type TEF repair should be considered. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.

Analysis of thermal damage in vocal cords for the prevention of collateral laser treatment effects

NASA Astrophysics Data System (ADS)

Fanjul Vélez, Félix; Luis Arce-Diego, José; del Barrio Fernández, Ángela; Borragán Torre, Alfonso

2007-05-01

The importance of vocal cords for the interaction with the world around is obviously known. Vocal cords disorders can be divided mainly into three categories: difficulty of movement of one or both vocal folds, lesion formation on them, and difficulty or lack of mucosal wave movement. In this last case, a laser heating treatment can be useful in order to improve tissue vibration. However, thermal damage should be considered to adjust laser parameters and so to prevent irreversible harmful effects to the patient. in this work, an analysis of thermal damage in vocal folds is proposed. Firstly thermo-optical laser-tissue interaction is studied, by means of a RTT (Radiation Transfer Theory) model solved with a Monte Carlo approach for the optical propagation of radiation, and a bio-heat equation, with a finite difference numerical method based solution, taking into account blood perfusion and boundary effects, for the thermal distribution. The spatial-temporal temperature distributions are obtained for two widely used lasers, Nd:YAG (1064 nm) and KTP (532 nm). From these data, an Arrhenius thermal damage analysis allows a prediction of possible laser treatment harmful effects on vocal cords that could cause scar formation or tissue burn. Different source powers and exposition times are considered, in such a way that an approximation of adequate wavelength, power and duration is achieved, in order to implement an efficient and safe laser treatment.

Using Hyaluronic Acid for Improving Vocal Function in a Prepubescent Boy With an Atrophied Right Vocal Fold.

PubMed

Cohen, Wendy; Wynne, David McGregor

2015-07-01

A single case study is reported of a child who underwent several surgical procedures as result of congenital grade III subglottic stenosis. The anterior aspect of the right vocal cord was damaged and underwent atrophy during one of these procedures. Now, an active 10-year-old, the patient has become increasingly aware of his vocal limitations on functional activities. Injection of hyaluronic acid into the vocal folds has been known to provide improved voice quality in adults although there are no known cases reported of this procedure in children. This article reports voice outcomes after injection of hyaluronic acid into the Reinke's space in a single case study. Voice recordings were made before, after, and 1 month after injection. The voice recordings were subject to acoustic and perceptual analysis. Post and follow-up voice recordings demonstrate decreased jitter, shimmer, and harmonics-to-noise ratio. Perceptual evaluation indicates improved voice quality. Injection of hyaluronic acid in children who require voice augmentation is possible and may contribute to increased vocal function and improved voice outcomes. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Reconstructive procedures for impaired upper airway function: laryngeal respiration

PubMed Central

Müller, Andreas

2005-01-01

The larynx is the "bottleneck" of the human airway. For this reason, the effects of stenosing laryngeal pathologies on the vital factor respiratory gas exchange are particularly critical. Internal stabilization is a prerequisite for recovery of the laryngeal respiratory function in severe forms of inspiratory collapse (laryngomalacia). Effective laser surgery techniques have been developed to this end in recent years. Glottis-dilating surgery in cases of bilateral vocal cord motion impairment is now moving in the direction of endoscopic laser cordotomy or cordectomy, whereas arytenoidectomy and open surgical procedures are now used only rarely due to higher secondary morbidity rates. In individual cases, in particular if functional recovery is expected, temporary laterofixation of a vocal cord using an endoscopic suturing technique can be a helpful approach. Extensive laryngeal defects can be covered by means of composite grafts with mucosal lining, a supporting skeleton and their own vascularization. Autologous transplantation of the larynx, with its complex surgical and immunological problems, has become a manageable procedure. The problems of post-transplantation reinnervation and risk assessment of immunosuppression-induced recurrence of the tumor are still under consideration. Reanimation of the bilaterally paralyzed larynx by means of neurorrhaphy (neurosuture), neural grafting and, more recently, functional electrostimulation (pacemaker) represents a challenge for the coming years. In most cases of paralysis of the recurrent laryngeal nerve, a part of the muscles is maintained by synkinetic reinnervation when therapy is carried out, which however also prevents effective vocal cord movement due to simultaneous activity of agonists and antagonists. Modulation of reinnervation by means of electrostimulation and modern genetic therapy approaches justify hopes of better outcomes in the future. PMID:22073057

Hoarseness caused by arytenoid dislocation after surgery for lung cancer.

PubMed

Kurihara, Nobuyasu; Imai, Kazuhiro; Minamiya, Yoshihiro; Saito, Hajime; Takashima, Shinogu; Kudo, Satoshi; Kawaharada, Yasushi; Ogawa, Jun-Ichi

2014-12-01

The patient was a 64-year-old woman with no history of laryngeal disorders. She underwent video-assisted right lower lobectomy and node dissection for lung cancer. Using a stylet while the patient was under general anesthesia, tracheal intubation with a 35-French gauge left-sided double-lumen endobronchial tube was successfully performed on the first attempt. The patient developed slight hoarseness on postoperative day 1, and we initially suspected recurrent laryngeal nerve paralysis caused by the surgery, which we elected to treat conservatively. However, because her hoarseness had not improved 4 months after surgery, we evaluated her vocal cords using laryngoscopy. This revealed severe dysfunction of the right vocal cord and arytenoid dislocation, which we treated through reduction using a balloon catheter. By 6 months, the patient's vocal cord mobility had improved. Arytenoid dislocation is a rare complication, but should be suspected when patients have right vocal fold paralysis after lung cancer surgery.

Surgical Interventions for Pediatric Unilateral Vocal Cord Paralysis: A Systematic Review.

PubMed

Butskiy, Oleksandr; Mistry, Bhavik; Chadha, Neil K

2015-07-01

The most widely used surgical interventions for pediatric unilateral vocal cord paralysis include injection laryngoplasty, thyroplasty, and laryngeal reinnervation. Despite increasing interest in surgical interventions for unilateral vocal cord paralysis in children, the surgical outcomes data in children are scarce. To appraise and summarize the available evidence for pediatric unilateral vocal cord paralysis surgical strategies. MEDLINE (1946-2014) and EMBASE (1980-2014) were searched for publications that described the results of laryngoplasty, thyroplasty, or laryngeal reinnervation for pediatric unilateral vocal cord paralysis. Further studies were identified from bibliographies of relevant studies, gray literature, and annual scientific assemblies. Two reviewers independently appraised the selected studies for quality, level of evidence, and risk of bias as well as extracted data, including unilateral vocal cord paralysis origin, voice outcomes, swallowing outcomes, and adverse events. Of 366 identified studies, the inclusion criteria were met by 15 studies: 6 observational studies, 6 case series, and 3 case reports. All 36 children undergoing laryngeal reinnervation (8 studies) had improvement or resolution of dysphonia. Of 31 children receiving injection laryngoplasty (6 studies), most experienced improvement in voice quality, speech, swallowing, aspiration, and glottic closure. Of 12 children treated by thyroplasty (5 studies), 2 experienced resolution of dysphonia, 4 had some improvement, and 4 had no improvement (2 patients had undocumented outcomes). Thyroplasty resolved or improved aspiration in 7 of 8 patients. Published studies suggest that reinnervation may be the most effective surgical intervention for children with dysphonia; however, long-term follow-up data are lacking. With the exception of polytetrafluoroethylene injections, injection laryngoplasty was reported to be a relatively safe, nonpermanent, and effective option for most children with dysphonia. Thyroplasty appears to have fallen out favor in recent years because of difficulty in performing this procedure in children under local anesthesia, but it continues to be a viable option for children with aspiration.

Carotid-Sparing Intensity-Modulated Radiotherapy for Early-Stage Squamous Cell Carcinoma of the True Vocal Cord

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chera, Bhishamjit S.; Amdur, Robert J., E-mail: amdurr@shands.ufl.ed; Morris, Christopher G.

2010-08-01

Purpose: To compare radiation doses to carotid arteries among various radiotherapy techniques for treatment of early-stage squamous cell carcinoma (SCC) of the true vocal cords. Methods and Materials: Five patients were simulated using computed tomography (CT). Clinical and planning target volumes (PTV) were created for bilateral and unilateral stage T1 vocal cord cancers. Planning risk volumes for the carotid arteries and spinal cord were delineated. For each patient, three treatment plans were designed for bilateral and unilateral target volumes: opposed laterals (LATS), three-dimensional conformal radiotherapy (3DCRT), and intensity-modulated radiotherapy (IMRT), for a total of 30 plans. More than 95% ofmore » the PTV received the prescription dose (63Gy at 2.25 Gy per treatment). Results: Carotid dose was lowest with IMRT. With a bilateral vocal cord target, the median carotid dose was 10Gy with IMRT vs. 25 Gy with 3DCRT and 38 Gy with LATS (p < 0.05); with a unilateral target, the median carotid dose was 4 Gy with IMRT vs. 19 Gy with 3DCRT and 39 Gy with LATS (p < 0.05). The dosimetric tradeoff with IMRT is a small area of high dose in the PTV. The worst heterogeneity results were at a maximum point dose of 80 Gy (127%) in a unilateral target that was close to the carotid. Conclusions: There is no question that IMRT can reduce the dose to the carotid arteries in patients with early-stage vocal cord cancer. The question is whether the potential advantage of reducing the carotid dose outweighs the risk of tumor recurrence due to contouring errors and organ motion and the risk of complications from dose heterogeneity.« less

Transgender Phonosurgery: A Systematic Review and Meta-analysis.

PubMed

Song, Tara Elena; Jiang, Nancy

2017-05-01

Objectives Different surgical techniques have been described in the literature to increase vocal pitch. The purpose of this study is to systematically review these surgeries and perform a meta-analysis to determine which technique increases pitch the most. Data Sources CINAHL, Cochrane, Embase, Medline, PubMed, and Science Direct. Review Methods A systematic review and meta-analysis of the literature was performed using the CINAHL, Cochrane, Embase, Medline, PubMed, and Science Direct databases. Studies were eligible for inclusion if they evaluated pitch-elevating phonosurgical techniques in live humans and performed pre- and postoperative acoustic analysis. Data were gathered regarding surgical technique, pre- and postoperative fundamental frequencies, perioperative care measures, and complications. Results Twenty-nine studies were identified. After applying inclusion and exclusion criteria, a total of 13 studies were included in the meta-analysis. Mechanisms of pitch elevation included increasing vocal cord tension (cricothyroid approximation), shortening the vocal cord length (cold knife glottoplasty, laser-shortening glottoplasty), and decreasing mass (laser reduction glottoplasty). The most common interventions were shortening techniques and cricothyroid approximation (6 studies each). The largest increase in fundamental frequency was seen with techniques that shortened the vocal cords. Preoperative speech therapy, postoperative voice rest, and reporting of patient satisfaction were inconsistent. Many of the studies were limited by low power and short length of follow-up. Conclusions Multiple techniques for elevation of vocal pitch exist, but vocal cord shortening procedures appear to result in the largest increase in fundamental frequency.

A systematic review of psychological interventions for adult and pediatric patients with vocal cord dysfunction.

PubMed

Guglani, Loveleen; Atkinson, Sarah; Hosanagar, Avinash; Guglani, Lokesh

2014-01-01

Vocal cord dysfunction (VCD) or paradoxical vocal-fold motion (PVFM) is a functional disorder of the vocal cords that requires multidisciplinary treatment. Besides relaxation techniques, the use of psychological interventions can help treat the underlying psychological co-morbidities. There is currently no literature that examines the effectiveness of psychological interventions for VCD/PVFM. To review the evidence for psychological interventions used for the treatment of patients with VCD/PVFM. We searched electronic databases for English medical literature using Pubmed (Medline), PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Registry of Controlled Trials, and Clinicaltrials.gov. The date range for our search is from June 1964 to June 2014. We included studies that reported the use of psychological interventions in both adults and children diagnosed with VCD/PVFM. We included randomized controlled trials, case-control studies, retrospective chart reviews, prospective case series, and individual case reports. Most reported studies are small case series or individual case reports that have described the use of interventions such as psychotherapy, behavioral therapy, use of anti-anxiety and anti-depressant medications, and hypnotherapy in conjunction with breathing exercises taught by speech therapists for symptomatic relief. Among the various psychological interventions that have been reported, there is no data regarding effectiveness and/or superiority of one approach over another in either adult or pediatric patients. Psychological interventions have a role to play in the management of adult and pediatric patients with VCD/PVFM. Future prospective studies using uniform approaches for treatment of associated psychopathology may help address this question.

PVCM, PVCD, EPL, and irritable larynx syndrome: what are we talking about and how do we treat it?

PubMed

Andrianopoulos, M V; Gallivan, G J; Gallivan, K H

2000-12-01

Paroxysmal vocal cord movement/motion (PVCM), paroxysmal vocal cord dysfunction (PVCD), episodic paroxysmal laryngospasm (EPL), and irritable larynx syndrome (ILS) are terms used to describe laryngeal dysfunction masquerading as asthma, upper airway obstruction, or functional and organic voice disorders. The differential diagnosis of PVCM, PVCD, EPL, and ILS is critical to successful medical and behavioral management of the patient. During the past 10 years, 27 subjects, ages 15-79 years, were identified to have paroxysms of inspiratory stridor, acute respiratory distress, associated aphonia and dysphonia, resulting in misdiagnosis and unnecessary emergency treatments, including endotracheal intubation, cardiopulmonary resuscitation, massive pharmacotherapy, or tracheostomy. A multifactorial management program is proposed utilizing principles of motor learning, neurolinguistic programming model, respiratory and phonatory synchronization, relaxation techniques, concurrent monitoring of behavioral adjustments, and formal psychological counseling.

Vocal Cord Paralysis After Thoracic Aortic Surgery: Incidence and Impact on Clinical Outcomes.

PubMed

Lodewyks, Carly L; White, Christopher W; Bay, Graham; Hiebert, Brett; Wu, Bella; Barker, Mark; Kirkpatrick, Iain; Arora, Rakesh C; Moon, Michael; Pascoe, Edward

2015-07-01

Vocal cord paralysis (VCP) is a serious complication associated with thoracic aortic surgery; however, there is a paucity of literature regarding the incidence and impact of VCP on postoperative outcomes. We sought to determine the incidence of VCP and its impact on clinical outcomes in patients who underwent thoracic aortic repair at our center. A retrospective chart review was conducted on all patients who underwent thoracic aortic surgery between January 2009 and September 2012. A total of 259 patients underwent a thoracic aortic procedure during the study period. Vocal cord paralysis was diagnosed in 12 (5%) patients, a median of 6 [3 to 21] days after extubation. The incidence was 1%, 0%, 20%, and 25% in those undergoing an open ascending, hemiarch, total arch, or descending aortic procedure, respectively. Patients with VCP had an increased incidence of pneumonia (58% vs 17%, p = 0.003), readmission to the intensive care unit for respiratory failure (17% vs 2%, p = 0.047), and longer hospital length of stay (18 [11 to 43] days versus 9 [6 to 15] days, p = 0.002). A propensity-matched analysis confirmed a higher incidence of pneumonia (58% vs 17%, p = 0.020) and longer hospital length of stay (18 [11 to 43] vs 10 [7 to 14] days, p = 0.015) in patients suffering VCP. Vocal cord paralysis is a common complication in patients undergoing open surgery of the aortic arch and descending aorta, and is associated with significant morbidity. Further research may be warranted to determine if early fiberoptic examination and consideration of a vocal cord medialization procedure may mitigate the morbidity associated with VCP. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Bilateral Vocal Cord Palsy with Arnold Chiari Malformation: A Rare Case Series

PubMed Central

Arora, Nikhil; Meher, Ravi; Bhargava, Eishaan K.

2016-01-01

Stridor in paediatric age group is not an uncommon presentation to the ENT emergency. The range of differential diagnosis is vast. The presentation may vary from noisy breathing to severe respiratory distress and apnea. Early and meticulous diagnosis is crucial for the management as the condition may be life threatening. We report a rare case series of 3 infants with Arnold Chiari Malformation who presented to the hospital with stridor and were diagnosed with bilateral vocal cord palsy. These 3 infants had similar underlying neurological condition with hydrocephalus and raised intracranial pressure. Chiari malformation is the one of the most common congenital central nervous system anomaly associated with bilateral vocal cord paralysis. However, the presentation is rare. This article, thus, emphasizes the significance of early diagnosis and immediate management of this condition. PMID:27790480

Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery.

PubMed

Haerle, Stephan; Sidler, D; Linder, Th; Mueller, W

2008-12-01

The aims were to assess the technical feasibility of using a single electrode in the posterior arytenoid muscles (PAM) for intraoperative monitoring of the recurrent laryngeal nerve (RLN) in thyroid surgery, to validate the new method against the insertion of electrodes placed in the vocal cord muscle, and to report the results of the clinical application of the new concept. A total of 52 patients were enrolled. The handling and safety of RLN monitoring was tested by simultaneous registration of the EMG response from vocal fold electrodes and PAM electrodes. Acoustically and electromyographically we found nearly the same values for the arytenoid muscles as for the vocal folds, although the signals taken from the vocal folds were slightly stronger. PAM recording using a single bipolar electrode is technically feasible and as reliable compared to the standard vocal cord monitoring.

Glottic airway gain after 'suture arytenoid laterofixation' in bilateral vocal cord paralysis.

PubMed

Korkmaz, Mehmet Hakan; Bayır, Ömer; Tatar, Emel Çadallı; Saylam, Güleser; Öcal, Bülent; Keseroğlu, Kemal; Özdek, Ali

2015-09-01

This method is an easy, non-expensive, and effective technique in bilateral vocal cord paralysis to improve glottic airway and clinical performance. To evaluate the effectiveness of 'suture arytenoid laterofixation' surgery in bilateral vocal cord paralysis. A retrospective analysis of patients' medical history undergoing 'suture arytenoid laterofixation' surgery for bilateral vocal cord paralysis. This technique was applied under general anesthesia with both microlaryngoscopy and video-monitoring. Two 16 g needles and one 1/0 nylon thread were used for the procedure with 1 cm skin incision; no tracheotomy or tissue excision was required. Pre-post-operative photographs of the glottic region were taken from the endoscopic records, and the areas of rima glottis openings were calculated with the Image-J programme. Forty-seven patients were analyzed. The mean pre-post-operative rima glottis areas were 1.11 ± 0.56 and 2.24 ± 0.93 mm(2), respectively (p < 0.001). Five patients with previous tracheotomy were decannulated within a few days after the operation. In three patients, mild complications developed in the early post-operative period (two laryngeal edemas, one submucosal hematoma). Tracheotomy was performed to only one pregnant patient in the post-operative first day. None of the patients had granulation formation or synechia.

[Etiology and diagnostic methods in vocal cord paralysis].

PubMed

Jørgensen, Gita; Clausen, Eva Wiinstedt; Mantoni, Margit Y; Misciattelli, Lorenzo; Balle, Viggo

2003-02-10

The etiology of vocal cord paralysis (VCP) is varied. There is lack of consensus regarding the choice of investigations to be used in the evaluation of VCP. The aim of this study was to establish the etiology, assess the diagnostic methods used in the evaluation, and outline an algorithm for future evaluation of unilateral vocal cord paralysis (UVCP). Charts of all patients (n = 94) with the diagnostic code of VCP were reviewed, and reexaminations were performed of patients in whom no etiology was found after the initial symptoms. The etiology of UVCP was neoplasm in 34%, surgical trauma in 12%, and miscellaneous causes in 54%. The etiology of bilateral vocal cord paralysis (BVCP) was neoplasm in 24%, surgical trauma in 24%, and miscellaneous causes in 52%. The reexaminations did not reveal any cancer diseases in the patients concerned. The most effective diagnostic method was CT-scanning while the least effective was thyroid scanning. Because cancer is a common cause of VCP a thorough evaluation is necessary. For UVCP we recommend history and physical examination, X-ray of the chest, ultrasonography of the neck, and CT-scanning of the superior mediastinum. If these prove negative, panendoscopy should be performed. Workup of patients with idiopathic VCP should include examination, X-ray of the chest at 6-month intervals, and annual CT-scanning for two years.

Vocal function after transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancer.

PubMed

Tanaka, Shingo; Tomifuji, Masayuki; Araki, Koji; Uno, Kosuke; Tanaka, Yuya; Mizokami, Daisuke; Suzuki, Hiroshi; Miyagawa, Yoshihiro; Taniai, Shinichi; Shiotani, Akihiro

2017-04-01

The resection of the medial and lateral pyriform sinus was associated with post-operative voice impairment after TOVS. Scar contracture around the cricoarytenoid joint lead to arytenoid fixation toward lateral position, and this wound healing process caused insufficient glottis closure. Although oncological and functional outcomes of TOVS was satisfactory, surgeons should mention the risk of post-operative voice impairment in pre-operative counseling. Transoral surgery is a minimally invasive treatment option for hypopharyngeal and supraglottic cancer. Post-operative vocal function was satisfactory in most cases, but in some cases vocal cord was fixed and occasionally voice impairment persists. Vocal function of 55 patients who underwent transoral videolaryngoscopic surgery (TOVS) for hypopharyngeal and supraglottic cancers was evaluated by the GRBAS perceptive scale, aerodynamic tests and acoustic analyses, and the Voice Handicap Index questionnaire. The risk factors for voice impairment were identified. Voice impairment (G score ≧2) was found in 16 cases (29.1%). Univariate analysis revealed that the resection of medial and lateral pyriform sinus (p = .0018) and neck dissection (p = .0421) were associated with post-operative voice impairment. Multivariate analysis revealed that the resection of medial and lateral pyriform sinus (p = .0021) was associated with post-operative voice impairment.

Superiority of resection over enucleation for schwannomas of the cervical vagus nerve: A retrospective cohort study of 22 consecutive patients.

PubMed

Illuminati, Giulio; Pizzardi, Giulia; Minni, Antonio; Masci, Federica; Ciamberlano, Bernardo; Pasqua, Rocco; Calio, Francesco G; Vietri, Francesco

2016-05-01

Schwannoma of the cervical vagus nerve is rare. Treatment options include intracapsular enucleation and en bloc resection. The purpose of this study was to compare the outcomes of enucleation and resection in terms of postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence, quality-adjusted life-year (QALY) and vocal handicap index (VHI). Twentytwo consecutive patients were divided into two groups. Patients in group A (n = 9) underwent intracapsular enucleation, whereas patients in Group B (n = 13) underwent en bloc resection. Main endpoints of the study were postoperative mortality and morbidity, freedom from vocal cord palsy, freedom from local recurrence and quality of life. The quality of life after surgery was assessed according to the quality-adjusted life-year (QALY) EQ-5D-5L methodology, and calculation of the voice handicap index (VHI). Postoperative mortality was nil. Morbidity included 1 wound dehiscence in group A and 2 transitory dysphagias in group B. Freedom from vocal cord palsy was 22% in group A and zero in group B (p = 0.15). Operation-specific local recurrence rate was 33% (3/9 patients) in group A and nil in group B (0/23 patients) (p = 0.05). QALYs was 0.55 in group A and 0.54 in group B (p = 1.0). VHI was 23.77 in group A and 26.15 in group B (p = 1.00). Resection is superior to enucleation in terms of freedom from local recurrence. Functional results are comparable for both techniques. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Chronic vocal cord palsy in Thuringia, Germany: a population-based study on epidemiology and outcome.

PubMed

Djugai, S; Boeger, D; Buentzel, J; Esser, D; Hoffmann, K; Jecker, P; Mueller, A; Radtke, G; Bohne, S; Finkensieper, M; Volk, G F; Guntinas-Lichius, O

2014-02-01

Although surgical treatment of patients with chronic vocal cord palsy (VCP) is an integral part of clinical routine of otorhinolaryngologists, there is nearly no population-based data published on incidence and efficiency of this surgery country-wide or nation-wide. 1430 patients with chronic VCP were treated in a department of otorhinolaryngology between 2005 and 2010 in Thuringia, Germany. VCP was unilateral and bilateral in 63 and 18%, respectively. The affected side was not documented in 20%. Iatrogenic lesions of the recurrent nerve (42%) and neoplastic infiltration (27%) were the leading etiologies. 192 patients (13%) received surgical treatment. 31% of patient needed more than one surgery. The rate of surgeries was higher for bilateral VCP (p < 0.0001). Vocal cord augmentation was the most frequent surgery for unilateral VCP and posterior cordectomy for bilateral VCP. The complication rate was high (16%), but not different between unilateral and bilateral VCP (p = 0.108). The risk for tracheostomy was higher in the bilateral VCP group (p < 0.0001). Voice improvement was better after treatment of unilateral VCP (p < 0.0001). Breathing improvement was more frequent after bilateral VCP (p = 0.028). Dysphagia did not improve significantly. The rate of better voice, breathing, and swallowing function was higher in patients treated surgically than without surgery (all p < 0.0001). The rate of patients admitted for treatment of vocal fold palsy was 9.9/100,000 habitants. The surgical rate of VCP was 1.38/100,000 habitants. This population-based analysis shows that surgery for VCP is performed with higher incidence than expected effectively, but with relevant risks in daily routine of otorhinolaryngologists.

The role of adjustment of expiratory effort in the control of vocal intensity: clinical assessment of phonatory function.

PubMed

Makiyama, Kiyoshi; Yoshihashi, Hidetaka; Mogitate, Manabu; Kida, Akinori

2005-04-01

To determine the role of the adjustment of expiratory effort in the control of vocal intensity. An intensity-loading test was performed by using the airway interruption method. Three groups of subjects were used: a control group thought to resemble normal vocal fold closure, a group of patients with Reinke's edema thought to represent increased mass at the level of the vocal folds, and a group with vocal fold paralysis that was thought to represent a group with lack of adequate vocal fold closure. In the control group, expiratory lung pressure and airway resistance slightly increased. In the patients with Reinke's edema, expiratory lung pressure, and airway resistance significantly increased. In this group, the voice intensity was controlled by laryngeal adjustment, but a greater expiratory effort was needed because of a greater increase in glottal resistance. In the patients with vocal cord paralysis, airway resistance did not increase even with a high-intensity voice. Vocal intensity was controlled by expiratory effort. If there is sufficient ability for laryngeal adjustment, vocal intensity is controlled primarily by laryngeal adjustment and by expiratory adjustment in response to increased glottal resistance. However, vocal intensity is controlled by expiratory effort when laryngeal adjustment ability is poor.

[Experimental study on the impact of photodynamic therapy on the normal vocal cord injury].

PubMed

Liu, Haiyan; Huang, Yongwang; Wang, Shanshan; Li, Yingxin; Yin, Huijuan; Gao, Xiaowei

2015-12-01

To investigate the reactive characteristics of normal vocal cord tissues to photodynamic therapy (PDT) and the damage effects of different concentration of photosensitizer and different light on normal rabbit vocal cord. Making the preliminary research of PDT in clinical treatment of chronic inflammation of the vocal cords and precancerous lesions. Twenty-five healthy Japanese big ear experimental rabbits were randomly divided into 5 groups: low work rate low dose group A (100 mW, 10%5-ALA), high work rate low dose group B (200 mW, 10%5-ALA), high work rate high dose group C (200 mW, 20%5-ALA), low work rate high dose group D (100 mW, 20%5-ALA) and normal control group E. The issue damage and wound recovery were observed in 1 d, 3 d, 7 d, 14 d, 28 d after intervention. A severe inflammation reaction was observed in group A, B, C, D after intervened with PDT compared to normal group. The reaction of group A was lighter, and the reaction of group C was the most serious. The content of collagenous fiber, hyaluronic acid and fibronectin in vocal fold lamina layer was significantly higher than that in normal group (P<0.05). Different degrees of fiber proliferation were observed in all groups. The content of each component of vocal fold lamina layer tended to be normal slightly higher level in 28 d. Observation by electron microscope showed that there were no significant differences in A, B, C, D, E in 28 d after intervention. Recoverable damage repair process can be detected in rabbit vocal after intervened with PDT, which began in 7 d and basically completed in 28 d. In a certain concentration (10%-20%) and dose range (100-200 mW). The higher of photodynamic dose, the more serious of the damage. And the damage was basically reversible.

Perceptual Detection of Subtle Dysphonic Traits in Individuals with Cervical Spinal Cord Injury Using an Audience Response Systems Approach.

PubMed

Johansson, Kerstin; Strömbergsson, Sofia; Robieux, Camille; McAllister, Anita

2017-01-01

Reduced respiratory function following lower cervical spinal cord injuries (CSCIs) may indirectly result in vocal dysfunction. Although self-reports indicate voice change and limitations following CSCI, earlier efforts using global perceptual ratings to distinguish speakers with CSCI from noninjured speakers have not been very successful. We investigate the use of an audience response system-based approach to distinguish speakers with CSCI from noninjured speakers, and explore whether specific vocal traits can be identified as characteristic for speakers with CSCI. Fourteen speech-language pathologists participated in a web-based perceptual task, where their overt reactions to vocal dysfunction were registered during the continuous playback of recordings of 36 speakers (18 with CSCI, and 18 matched controls). Dysphonic events were identified through manual perceptual analysis, to allow the exploration of connections between dysphonic events and listener reactions. More dysphonic events, and more listener reactions, were registered for speakers with CSCI than for noninjured speakers. Strain (particularly in phrase-final position) and creak (particularly in nonphrase-final position) distinguish speakers with CSCI from noninjured speakers. For the identification of intermittent and subtle signs of vocal dysfunction, an approach where the temporal distribution of symptoms is registered offers a viable means to distinguish speakers affected by voice dysfunction from non-affected speakers. In speakers with CSCI, clinicians should listen for presence of final strain and nonfinal creak, and pay attention to self-reported voice function and voice problems, to identify individuals in need for clinical assessment and intervention. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

[Is subtotal bilateral thyroidectomy still indicated in patients with Grave's disease?].

PubMed

Bilosi, M; Binquet, C; Goudet, P; Lalanne-Mistrih, M L; Brun, J M; Cougard, P

2002-02-01

To evaluate the morbidity and the functional results of subtotal bilateral thyroidectomy in patients (TST) with Graves' disease. A retrospective study was performed in 128 patients. They were 23 males and 105 females with a median age of 34 years (range: 14-68). Weight of remnant tissue was between 4 and 5 g. Thyroid functional status was evaluated, at 3 months and after a follow-up period ranged from 1 to 5 years, by measurement of serum concentration of free T4 and/or free T3 and TSH. They were no post-operative death. Surgical complications were 2 vocal cord palsies and 17 hypocalcemia (inf. to 2 mmol/L). After a median follow-up of 2 years, they were no longer any cases of vocal cord dysfunction and no case of permanent hypoparathyroidism. Functional results were established in 118 patients: 46 patients had clinical hypothyroidism (39%), 64 patients had latent hypothyroidism or euthyroidism (54.2%), and 8 had recurrent hyperthyroidism (6.8%). These results suggest that TST with a remnant mass inferior to 5 g provides a low level of recurrent hyperthyroidism and allows to give no drug therapy to half patients. In our opinion, TST is still indicated in Graves' disease.

Vocal cord dysfunction related to water-damaged buildings.

PubMed

Cummings, Kristin J; Fink, Jordan N; Vasudev, Monica; Piacitelli, Chris; Kreiss, Kathleen

2013-01-01

Vocal cord dysfunction (VCD) is the intermittent paradoxical adduction of the vocal cords during respiration, resulting in variable upper airway obstruction. Exposure to damp indoor environments is associated with adverse respiratory health outcomes, including asthma, but its role in the development of VCD is not well described. We describe the spectrum of respiratory illness in occupants of 2 water-damaged office buildings. The National Institute for Occupational Safety and Health conducted a health hazard evaluation that included interviews with managers, a maintenance officer, a remediation specialist who had evaluated the 2 buildings, employees, and consulting physicians. In addition, medical records and reports of building evaluations were reviewed. Diagnostic evaluations for VCD had been conducted at the Asthma and Allergy Center of the Medical College of Wisconsin. Two cases of VCD were temporally related to occupancy of water-damaged buildings. The patients experienced cough, chest tightness, dyspnea, wheezing, and hoarseness when in the buildings. Spirometry was normal. Methacholine challenge did not show bronchial hyperreactivity but did elicit symptoms of VCD and inspiratory flow-volume loop truncation. Direct laryngoscopy revealed vocal cord adduction during inspiration. Coworkers developed upper and lower respiratory symptoms; their diagnoses included sinusitis and asthma, consistent with recognized effects of exposure to indoor dampness. Building evaluations provided evidence of water damage and mold growth. VCD can occur with exposure to water-damaged buildings and should be considered in exposed patients with asthma-like symptoms. Published by Elsevier Inc.

[Mediafixation of the vocal cord through the external approach in the patients presenting with unilateral laryngeal paralysis].

PubMed

Starostina, S V; Mareev, O V; Nikolenko, V N

2013-01-01

The objective of the present work was to develop a method for the modification of the vocal cord during the treatment of the patients presenting with unilateral laryngeal paralysis taking into consideration individual peculiarities of stereotopometric characteristics of the larynx in the subjects of different gender, neck structure, and body constitution. The earlier proposed method of laryngostereotopometry was employed in this study. The following body features were measured prior to surgery: the total length, acromial diameter, chest circumference, neck length and circumference; the degree of the fissure of glottis closure was measured by transnasal fibrolaryngoscopy. The transplant was cut out of the quadrangular cartilage of the nasal septum in the form of a prism having the base shaped as an isosceles triangle with the base equal to the width of the fissure of glottis; the vertical and horizontal sizes of the transplant were calculated from the formulas of multiple linear regression analysis. The autotransplant was introduced through the "window" in the plate of the shield-like cartilage between its internal perichondrium and the thyroarytenoid muscle of the arytenoid cartilage of the paralysed vocal cord in the horizontal direction in front of the site of attachment of the vocal cord of arytenoids cartilage up to the projection of the anterior commissure with fixation to the shield-like cartilage by a ligature.

Vocal cord paralysis: What matters between idiopathic and non-idiopathic cases?

PubMed

Özbal Koç, Ayça Eltaf; Türkoğlu, Seda Babakurban; Erol, Ozan; Erbek, Selim

2016-01-01

This study aims to evaluate the demographic and clinical characteristics of patients with idiopathic and non-idiopathic vocal cord paralysis (VCP). This retrospective cohort was performed on data extracted from medical files of 92 consecutive patients (43 males, 49 females; median age 52.1±23.1 years; min. 1 - max. 87) with VCP diagnosed in the otorhinolaryngology department between April 2012 and December 2015. Diagnoses associated with VCP, side of involvement (right, left or bilateral) and previous medical histories were noted and compared between patients with idiopathic and non-idiopathic VCP. Vocal cord paralysis occurred on the left side (n=56, 60.9%), right side (n=28, 30.4%) or bilaterally (n=8, 8.7%). A clinical entity related with VCP was identified in 63 patients (68.5%), while 29 (31.5%) patients had idiopathic VCP. Most common etiologies for VCP were thyroid surgery (n=32, 34.8%), cardiovascular surgery (n=9, 9.8%), lung cancer (n=6, 6.5%) and cardiac anomalies (n=4, 4.3%), respectively. Patients with idiopathic VCP were significantly older (p<0.001), while gender distribution (p=0.121) and side of involvement (p=0.340) did not differ between two groups. Vocal cord paralysis is a relatively common clinical entity with substantial rate of morbidity. Identification of the underlying etiology and awareness on the clinical characteristics are keystones for foreseeing complications and determining the appropriate therapeutic modality.

CMT2C with vocal cord paresis associated with short stature and mutations in the TRPV4 gene

PubMed Central

Chen, D.-H.; Sul, Y.; Weiss, M.; Hillel, A.; Lipe, H.; Wolff, J.; Matsushita, M.; Raskind, W.; Bird, T.

2010-01-01

Background: Recently, mutations in the transient receptor potential cation channel, subfamily V, member 4 gene (TRPV4) have been reported in Charcot-Marie-Tooth Type 2C (CMT2C) with vocal cord paresis. Other mutations in this same gene have been described in separate families with various skeletal dysplasias. Further clarification is needed of the different phenotypes associated with this gene. Methods: We performed clinical evaluation, electrophysiology, and genetic analysis of the TRPV4 gene in 2 families with CMT2C. Results: Two multigenerational families had a motor greater than sensory axonal neuropathy associated with variable vocal cord paresis. The vocal cord paresis varied from absent to severe, requiring permanent tracheotomy in 2 subjects. One family with mild neuropathy also manifested pronounced short stature, more than 2 SD below the average height for white Americans. There was one instance of dolichocephaly. A novel S542Y mutation in the TRPV4 gene was identified in this family. The other family had a more severe, progressive, motor neuropathy with sensory loss, but less remarkable short stature and an R315W mutation in TRPV4. Third cranial nerve involvement and sleep apnea occurred in one subject in each family. Conclusion: CMT2C with axonal neuropathy, vocal cord paresis, and short stature is a unique syndrome associated with mutations in the TRPV4 gene. Mutations in TRPV4 can cause abnormalities in bone, peripheral nerve, or both and may result in highly variable orthopedic and neurologic phenotypes. GLOSSARY CMAP = compound muscle action potential; CMT = Charcot-Marie-Tooth; CMT2C = Charcot-Marie-Tooth Type 2C; HMSN = hereditary motor and sensory neuropathy; NCV = nerve conduction velocity; RFLP = restriction fragment length polymorphism; SMA = spinal muscular atrophy; SNAP = sensory nerve action potential; SPSMA = scapuloperoneal spinal muscular atrophy. PMID:21115951

Clinicopathological parameters associated with histological background and recurrence after surgical intervention of vocal cord leukoplakia.

PubMed

Cui, Weixin; Xu, Wen; Yang, Qingwen; Hu, Rong

2017-06-01

Histological examination of biopsy shows usefulness in the diagnosis of vocal cord leukoplakia; however, in considerable amount of cases, the examination cannot provide definitive diagnosis of malignancy from benign conditions such as hyperplasia and dysplasia. The present work therefore was aimed to identify clinicopathological factors and molecular markers predictive of recurrence and malignant transformation of vocal cord leukoplakia.Clinical data of 555 cases of vocal cord leukoplakia enrolled from July 1999 to June 2014 were analyzed. The cohort consisted of keratosis (n = 137), hyperplasia (n = 139), dysplasia (n = 177), and primary (n = 10) and invasive (n = 46) carcinoma. Correlations between patients' backgrounds, clinicopathological factors, molecular markers (p53, p16, Ki67, cytokeratin, and proliferating cell nuclear antigen), and histology backgrounds were examined using by Pearson Chi-squared or Fisher exact test. Reflux symptom index (RSI) and reflux finding score (RFS) before and after treatment were compared using Wilcoxon signed-rank test. Risk factors for disease recurrence were identified using Cox proportional hazards models of multivariate analysis. Time to recurrence was analyzed using log-rank test of Kaplan-Meier method.In the present cohort, alcohol drinking was found associated with GRBAS grade (P = .0258) and the site (P = .0298) of leukoplakia. For the different disease types, chief complaint (P = .0179), GRBAS grade (P = .0101), mucosal wave (P < .0001), and molecular markers p53 (P < .0001) and Ki67 (P < .0001) were identified as correlates. RSI and RFS were significantly lowered by surgical intervention. A single side of leukoplakia was predictive of a lower risk of recurrence (odds ratio, 0.378; 95% confidence interval, 0.197-0.723; P = .0033). Absence of mucosal wave was associated with a shorter time-to-recurrence (P = .0357).The present work identified clinicopathological factors and molecular markers associated with the different histology of vocal cord leukoplakia, and also the prognostic factor for the low risk of recurrence after surgery.

Simultaneous determination of neuromuscular blockade at the adducting and abducting laryngeal muscles using phonomyography.

PubMed

Hemmerling, Thomas M; Michaud, Guillaume; Trager, Guillaume; Donati, François

2004-06-01

Phonomyography (PMG) is a new method for measuring neuromuscular blockade (NMB) at the larynx. In this study, we used PMG to compare NMB at the posterior cricoarytenoid (PCA) and the lateral cricoarytenoid muscle (LCA) in humans. Twelve patients were included in this study. Endotracheal intubation was performed without aid of neuromuscular blocking drugs. One small condenser microphone was inserted beside the vocal cords into the muscular process at the base of the arytenoid cartilage to record acoustic responses of the LCA (vocal cord adduction), and a second microphone was placed behind the larynx to measure NMB of the PCA (vocal cord abduction). Stimulation of the recurrent laryngeal nerve was performed using superficial electrodes placed at the neck (midline between jugular notch and cricoid cartilage) using train-of-four (TOF) stimulation every 12 s. After supramaximal stimulation, mivacurium 0.1 mg/kg was injected and onset, peak effect, and offset of NMB measured and compared using t-test (P < 0.05). The data are presented as mean (SD). Peak effect, onset time, and early recovery to 25% of control twitch height were not significantly different between PCA and LCA at 86% (13) versus 78% (16), 2.3 min (0.45) versus 2.3 min (1.0), and 9.55 min (3.05) versus 8.5 min (4.7), respectively. However, recovery to 75%, 90% of control twitch height, and recovery to a TOF ratio of 0.8 were significantly longer at the PCA than at the LCA at 14 min (4) versus 11 min (5), 17 min (5) versus 11.8 min (5.6), and 17.5 min (5.6) versus 12.3 min (5.5), respectively. The authors conclude that recovery of NMB at the PCA takes longer than at the LCA in humans after mivacurium. After neuromuscular blockade in humans, the recovery of the ability to open the vocal cords takes longer than the ability to close the vocal cords.

Asthma and Vocal Cord Dysfunction: Can You Tell the Difference?

PubMed

Corjulo, Michael; Schoessler, Sally

2016-11-01

School nurses care for students with asthma on a daily basis, but what happens when the asthma medication is administered and symptoms persist? As a part of care coordination, the school nurse provides ongoing assessment and care for students with asthma. When symptoms persist despite treatment, school nurses need to consider other issues such as Vocal Cord Dysfunction (VCD). The purpose of this article is to highlight the similarities and differences in the pathophysiology and treatment of both asthma and VCD.

Evolutionary Origins for Social Vocalization in a Vertebrate Hindbrain–Spinal Compartment

PubMed Central

Bass, Andrew H.; Gilland, Edwin H.; Baker, Robert

2008-01-01

The macroevolutionary events leading to neural innovations for social communication, such as vocalization, are essentially unexplored. Many fish vocalize during female courtship and territorial defense, as do amphibians, birds, and mammals. Here, we map the neural circuitry for vocalization in larval fish and show that the vocal network develops in a segment-like region across the most caudal hindbrain and rostral spinal cord. Taxonomic analysis demonstrates a highly conserved pattern between fish and all major lineages of vocal tetrapods. We propose that the vocal basis for acoustic communication among vertebrates evolved from an ancestrally shared developmental compartment already present in the early fishes. PMID:18635807

The voiced pronunciation of initial phonemes predicts the gender of names.

PubMed

Slepian, Michael L; Galinsky, Adam D

2016-04-01

Although it is known that certain names gain popularity within a culture because of historical events, it is unknown how names become associated with different social categories in the first place. We propose that vocal cord vibration during the pronunciation of an initial phoneme plays a critical role in explaining which names are assigned to males versus females. This produces a voiced gendered name effect, whereby voiced phonemes (vibration of the vocal cords) are more associated with male names, and unvoiced phonemes (no vibration of the vocal cords) are more associated with female names. Eleven studies test this association between voiced names and gender (a) using 270 million names (more than 80,000 unique names) given to children over 75 years, (b) names across 2 cultures (the U.S. and India), and (c) hundreds of novel names. The voiced gendered name effect was mediated through how hard or soft names sounded, and moderated by gender stereotype endorsement. Although extensive work has demonstrated morphological and physical cues to gender (e.g., facial, bodily, vocal), this work provides a systematic account of name-based cues to gender. Overall, the current research extends work on sound symbolism to names; the way in which a name sounds can be symbolically related to stereotypes associated with its social category. (c) 2016 APA, all rights reserved).

Low dose Photofrin PDT for recurrent in-situ squamous cell tumors of the head and neck

NASA Astrophysics Data System (ADS)

Allison, R. R.; Austerlitz, C.; Sheng, C.; Mota, H.; Brodish, B.; Camnitz, P.; Sibata, C. H.

2009-06-01

Multifocal recurrence of in-situ squamous cell cancer of the oral cavity, pharynx and vocal cord following surgical failure can be a therapeutic dilemma. Salvage surgery or radiation may be an option but morbidity can be significant. We evaluated the potential role of low dose Photofrin (1.2mg/Kg) Photodynamic Therapy for this cohort of patients. A total of 25 patients with multifocal recurrent in-situ squamous cell cancer of the oral cavity, pharynx and vocal cord who had failed local resection, and where additional surgery or radiation therapy would likely result in permanent morbidity, were offered Photodynamic Therapy. PDT consisted of off label infusion of Photofrin (1.2mg/kg) followed 48 hours later by illumination at 630nm employing a light diffuser (300J) and/or microlens (150Jcm2). All patients completed their prescribed PDT and no patient has been lost to follow up (minimum 1 year). No photosensitivity reactions were noted. No significant morbidity was seen. All patients were able to maintain oral nutrition. Procedure related pain was well controlled by one week of oral narcotics. At one month post PDT all patients were biopsy negative in the treatment region and no failures within the treatment region have been noted. No fibrosis or permanent PDT morbidity has been seen with follow up to three years. Vocal cord and voice function were excellent. Three patients developed new regions of in-situ disease outside the PDT fields, two underwent additional PDT and one had laser resection. Low dose Photofrin PDT offers excellent palliation and durable local control of recurrent in-situ squamous cell cancers of the oral cavity, pharynx and true cords. This is a well tolerated therapy. Low dose Photofrin appears to improve selectivity and minimize normal tissue injury. It should be tested in a larger patient population.

Bronchoscopy findings in children with recurrent and chronic stridor.

PubMed

Najada, Abdelhamid S; Dahabreh, Muna M

2011-01-01

To describe the bronchoscopic findings and treatment decision of children with chronic or recurrent stridor referred to the pediatric respiratory clinic at Queen Rania Hospital for Children. All children who underwent flexible bronchoscopy at the pediatric bronchoscopy unit for chronic stridor from January 2009 to January 2010 were included. Stridor was divided into 3 groups: inspiratory, expiratory, or biphasic. All patients from 2 weeks of age till 14 years were included. Files of these patients were retrospectively reviewed. A specially formulated data sheet including clinical history and physical findings, type of stridor, bronchoscopic findings, and management decision was used. Radiologic investigation results were included when relevant. Flexible bronchoscopy was performed under sedation and topical anesthesia. A total of 64 children [35 (54.7%) male and 29 (45.3%) female] were included. Twenty-four patients had inspiratory stridor. There were 33 patients with biphasic stridor (subglottic stenosis in 9, paradoxical vocal cord movement in 6, vascular ring in 5, subglottic hemangioma in 3, vocal cord paralyses in 4, foreign body in 2, laryngeal web in 2, and absent vocal cord and tracheal bronchus in 1 each). Seven children had expiratory stridor. Of patients with laryngomalacia, 50% had associated tracheomalacia and 70% of those with laryngomalacia and all patients with tracheomalacia had associated gastroesophageal reflux. Two patients with paradoxical vocal cord movement were found to have Arnold-Chiari malformation. All patients with vascular rings underwent surgery. Flexible bronchoscopy should be performed in all patients with chronic or recurrent stridor to assess the airway and guide further investigations and management.

Treatment outcome of vocal cord leukoplakia by transoral laser microsurgery.

PubMed

Yang, Shih-Wei; Chao, Wei-Chieh; Lee, Yun-Shien; Chang, Liang-Che; Hsieh, Tsan-Yu; Chen, Tai-An; Luo, Cheng-Ming

2017-01-01

The aim of this study is to evaluate the treatment outcome and analyze the associated factors of postoperative recurrence in patients who received transoral laser microsurgery for vocal cord leukoplakia. The demographic, histopathological data were retrospectively reviewed and the factors associated with recurrence of vocal leukoplakia after surgery were analyzed statistically. A total of 44 patients, including 36 males and 8 females, with a mean age of 50.4 ± 13.4 years, were enrolled. All the patients received excision of the vocal leukoplakia by carbon dioxide laser (2-4 Watt, ultrapulse mode) under general anesthesia. No patients had malignant transformation after surgery. Postoperative recurrence occurred in 10 patients (22.7 %). Univariate analysis showed that patients who had the habit of cigarette smoking, alcohol drinking, and presence of gastroesophageal reflux disease tended to recur. Among these risk factors, presence of gastroesophageal reflux disease (odds ratio 8.43) was the independent prognostic factor for recurrence using multivariate logistic regression analysis. Carbon dioxide laser excision is effective for treating vocal leukoplakia that is still confined to dysplasia of any degree, with acceptable morbidity. This study suggests that the presence of gastroesophageal reflux disease is the prognostic indicator for postoperative recurrence of vocal leukoplakia. Aggressive treatment of reflux disease for those who have received surgical excision for vocal leukoplakia is indicated.

Day surgery for vocal fold lesions using a double-bent 60-mm Cathelin needle.

PubMed

Toyomura, Fumimasa; Tokashiki, Ryoji; Hiramatsu, Hiroyuki; Tsukahara, Kiyoaki; Motohashi, Ray; Sakurai, Eriko; Nomoto, Masaki; Suzuki, Mamoru

2014-11-01

Day surgery for vocal cord lesions overcomes the disadvantages of laryngomicrosurgery under general anesthesia. We present our experience with treatment of vocal fold lesions using a long double-bend Cathelin needle that can access all parts of the vocal cords. A 23G, 60-mm-long Cathelin needle was bent twice by 45(o) at a distance of 1 and 2 cm from the tip, and was attached to a syringe. Under topical anesthesia and nasal endoscopy of the laryngopharynx, the needle was inserted percutaneously perpendicular to the skin, the direction of insertion being altered when the bends in the needle reached the skin surface. This allows the tip of the needle to access all parts of the glottis, allowing the performance of procedures such as biopsies, excision of lesions, and injection into the vocal folds. Between January 2011 and December 2013, we used this technique to perform vocal fold procedures in 566 patients presenting for treatment of spasmodic dysphonia (412 cases, 73 %) and other vocal fold lesions. Only minor complications, such as hematoma (3 patients, 0.5 %) and slight bleeding from the puncture site in the epiglottic vallecula (all patients, 100 %), which ceased spontaneously within 10 min, were seen. Erroneous puncture occurred in three patients (0.5 %) and the puncture had to be repeated in 38 patients (6.7 %). The procedure was completed successfully in all cases (100 %). Surgery for vocal fold lesions under topical anesthesia using our double-bend Cathelin needle technique is simple, safe, and useful.

In vivo office-based dynamic imaging of vocal cords in awake patients with swept-source optical coherence tomography

NASA Astrophysics Data System (ADS)

Yu, Lingfeng; Liu, Gangjun; Rubinstein, Marc; Saidi, Arya; Guo, Shuguang; Wong, Brian J. F.; Chen, Zhongping

2009-02-01

Optical coherence tomography (OCT) is an evolving noninvasive imaging modality and has been used to image the human larynx during surgical endoscopy. The design of a long GRIN lens based probe capable of capturing images of the human larynx by use of swept-source OCT during a typical office-based laryngoscopy examination is presented. In vivo OCT imaging of the human larynx is demonstrated with 40 fame/second. Dynamic vibration of the vocal folds is recorded to provide not only high-resolution cross-sectional tissue structures but also vibration parameters, such as the vibration frequency and magnitude of the vocal cord, which provide important information for clinical diagnosis and treatment, as well as in fundamental research of the voice. Office-based OCT is a promising imaging modality to study the larynx.

Study of the Histopathologic Characteristics and Surface Morphologies of Glottic Carcinomas With Anterior Vocal Commissure Involvement.

PubMed

Wu, Jianhui; Zhao, Jing; Wang, Zhangfeng; Li, Zenghong; Luo, Jie; Liao, Bing; Yang, Zhiyun; Liu, Qihong; Wang, Bin; Wen, Weiping; Lei, Wenbin

2015-07-01

This article explores the features and the role of the anterior vocal commissure (AVC) structure and the surface morphologies of glottic carcinomas with AVC involvement to provide a reference for the selection of transoral carbon dioxide (CO2) laser surgery. A total of 31 cases of glottic carcinomas with AVC involvement from May 2012 to January 2014 were included. All patients underwent electronic laryngoscopic examinations and computed tomography scans to determine the surface morphology. After surgery, the tumor specimens were resected integrally, and axial serial sections parallel to the plane of vocal cords were taken to explore the features and possible invasion paths of the glottic carcinomas with AVC involvement. The rates of involvement of the supraglottis and subglottis were 71.4% and 14.8%, respectively, via the AVC. The involvement of the superficial layer of the unilateral or bilateral vocal cords without involvement of the vocal muscle in the AVC region (IVM) or the cartilage was present in 15 cases (48.4%). The involvement of the superficial layer of the unilateral and bilateral vocal cords occurred in 16 cases (51.6%) with the IVM in 13 cases and the involvement of the intermediate lamina of the thyroid cartilage (ITC) in 8 cases. The involvement of the ITC was associated with the involvement of the vocal muscle of the AVC region (P < 0.05). Among the pushing carcinomas, 15 of 21 (71.4%) presented with well-defined tumor mass, and 8 of 10 (80.0%) infiltrating carcinomas presented with multiple tumor nests that were often surrounded by fibrosis (P < 0.05). The AVC is an important path of invasion of subglottic in glottic carcinomas but less so for suparglottic. The Broyles' ligaments acted as a barrier against the spread of the tumors to the thyroid cartilage, but this role was obviously weaken by the involvement of the vocal muscle of the AVC region. The infiltrating carcinomas presented with multiple tumor nests in fibrous tissue. When CO2 laser microsurgery is considered as a treatment option, these facts should be kept in mind.

Study of the Histopathologic Characteristics and Surface Morphologies of Glottic Carcinomas With Anterior Vocal Commissure Involvement

PubMed Central

Wu, Jianhui; Zhao, Jing; Wang, Zhangfeng; Li, Zenghong; Luo, Jie; Liao, Bing; Yang, Zhiyun; Liu, Qihong; Wang, Bin; Wen, Weiping; Lei, Wenbin

2015-01-01

Abstract This article explores the features and the role of the anterior vocal commissure (AVC) structure and the surface morphologies of glottic carcinomas with AVC involvement to provide a reference for the selection of transoral carbon dioxide (CO2) laser surgery. A total of 31 cases of glottic carcinomas with AVC involvement from May 2012 to January 2014 were included. All patients underwent electronic laryngoscopic examinations and computed tomography scans to determine the surface morphology. After surgery, the tumor specimens were resected integrally, and axial serial sections parallel to the plane of vocal cords were taken to explore the features and possible invasion paths of the glottic carcinomas with AVC involvement. The rates of involvement of the supraglottis and subglottis were 71.4% and 14.8%, respectively, via the AVC. The involvement of the superficial layer of the unilateral or bilateral vocal cords without involvement of the vocal muscle in the AVC region (IVM) or the cartilage was present in 15 cases (48.4%). The involvement of the superficial layer of the unilateral and bilateral vocal cords occurred in 16 cases (51.6%) with the IVM in 13 cases and the involvement of the intermediate lamina of the thyroid cartilage (ITC) in 8 cases. The involvement of the ITC was associated with the involvement of the vocal muscle of the AVC region (P < 0.05). Among the pushing carcinomas, 15 of 21 (71.4%) presented with well-defined tumor mass, and 8 of 10 (80.0%) infiltrating carcinomas presented with multiple tumor nests that were often surrounded by fibrosis (P < 0.05). The AVC is an important path of invasion of subglottic in glottic carcinomas but less so for suparglottic. The Broyles’ ligaments acted as a barrier against the spread of the tumors to the thyroid cartilage, but this role was obviously weaken by the involvement of the vocal muscle of the AVC region. The infiltrating carcinomas presented with multiple tumor nests in fibrous tissue. When CO2 laser microsurgery is considered as a treatment option, these facts should be kept in mind. PMID:26200618

[The ultra-rapid cinematography of the larynx, its contributions in speech pathology].

PubMed

Chevaillier, G; Sauvaget, E; Herman, P; Tran Ba Huy, P

2010-01-01

The development in the medical field of high speed cinematography and its dissemination in the field of speech pathology will probably change the way we view the larynx and diagnose its disorders. So far only the stroboscope could inform us about the appearance of vocal cord vibration but with certain limitations. Indeed the wave motion of the vocal cords is really only apparent motion. It is made possible through the phenomenon of retinal persistence of images and light intermittent vocal folds set to the frequency of the voice and out of phase by a few Hertz. This technique has several disadvantages: The need for the voice to trigger the strobe light; a low number of frames per second (25 fps) recorded; frame loss for the period between unlit two flashes; limitation in the study of the upper voice spectrum (gearing). The ultra-rapid cinematography brings a big difference in design since the digital recording can shoot up to 4000 frames per second with permanent lighting of the larynx. The slow reading of short sequences permits us to view the actual movement of vibrating structures, and to analyze the behavior of the vibrator during the transitional phases of the attack, depreciation and termination of sound. The footage in high resolution permits a detailed analysis of the movements of opening and closing of the vocal cords in phonation and respiration, and the diagnosis of lesions.

Electrophysiological neural monitoring of the laryngeal nerves in thyroid surgery: review of the current literature

PubMed Central

Deniwar, Ahmed; Randolph, Gregory

2015-01-01

Recurrent laryngeal nerve (RLN) injury is one of the most common complications of thyroid surgery. RLN injury can cause vocal cord paralysis, affecting the patient’s voice and the quality of life. Injury of the external branch of the superior laryngeal nerve (EBSLN) can cause cricothyroid muscle denervation affecting high vocal tones. Thus, securing the laryngeal nerves in these surgeries is of utmost importance. Visual identification of the nerves has long been the standard method for this precaution. Intraoperative neuromonitoring (IONM) has been introduced as a novel technology to improve the protection of the laryngeal nerves and reduce the rate of RLN injury. The aim of this article is to provide a brief description of the technique and review the literature to illustrate the value of IONM. IONM can provide early identification of anatomical variations and unusual nerve routes, which carry a higher risk of injury if not detected. IONM helps in prognosticating postoperative nerve function. Moreover, by detecting nerve injury intraoperatively, it aids in staging bilateral surgeries to avoid bilateral vocal cord paralysis and tracheostomy. The article will discuss the value of continuous IONM (C-IOMN) that may prevent nerve injury by detecting EMG waveform changes indicating impending nerve injury. Herein, we are also discussing anatomy of laryngeal nerves and aspects of its injury. PMID:26425449

Management of unilateral true vocal cord paralysis in children.

PubMed

Setlur, Jennifer; Hartnick, Christopher J

2012-12-01

Historically, information gained from the treatment of unilateral true vocal cord paralysis (UVCP) in adults was the same used to treat children. Today, there is a growing body of literature aimed specifically at the treatment of this condition in children. It is an area of growing interest as UVCP can significantly impact a child's quality of life. Children with UVCP may present with stridor, dysphonia, aspiration, feeding difficulties, or a combination of these symptoms. Diagnosis relies on laryngoscopy, but other adjuncts such as ultrasound and laryngeal electromyography may also be helpful in making the diagnosis and forming a treatment plan. In many instances, there is effective compensation by the contralateral vocal fold, making surgical intervention unnecessary. Children who cannot compensate for a unilateral defect may suffer from significant dysphonia that can affect their quality of life because their ability to be understood may be diminished. In these patients, treatment in the form of medialization or reinnervation of the affected recurrent laryngeal nerve may be warranted. UVCP is a well recognized problem in pediatric patients with disordered voice and feeding problems. Some patients will spontaneously recover their laryngeal function. For those who do not, a variety of reliable techniques are available for rehabilitative treatment. Improved diagnostics and a growing understanding of prognosis can help guide therapy decisions along with the goals and desires of the patient and his or her family.

A simple method for accurate endotracheal placement of an intubation tube in Guinea pigs to assess lung injury following chemical exposure.

PubMed

Nambiar, M P; Gordon, R K; Moran, T S; Richards, S M; Sciuto, A M

2007-01-01

ABSTRACT Guinea pigs are considered as the animal model of choice for toxicology and medical countermeasure studies against chemical warfare agents (CWAs) and toxic organophosphate pesticides because of the low levels of carboxylesterase compared to rats and mice. However, it is difficult to intubate guinea pigs without damaging the larynx to perform CWA inhalation experiments. We describe an easy technique of intubation of guinea pigs for accurate endotracheal placement of the intubation tube. The technique involves a speculum made by cutting the medium-size ear speculum in the midline leaving behind the intact circular connector to the otoscope. Guinea pigs were anesthetized with Telazol/meditomidine, the tongue was pulled using blunt forceps, and an otoscope attached with the specially prepared speculum was inserted gently. Insertion of the speculum raises the epiglottis and restrains the movements of vocal cord, which allows smooth insertion of the metal stylet-reinforced intubation tube. Accurate endotracheal placement of the intubation tube was achieved by measuring the length from the tracheal bifurcation to vocal cord and vocal cord to the upper front teeth. The average length of the trachea in guinea pigs (275 +/- 25 g) was 5.5 +/- 0.2 cm and the distance from the vocal cord to the front teeth was typically 3 cm. Coinciding an intubation tube marked at 6 cm with the upper front teeth accurately places the intubation tube 2.5 cm above the tracheal bifurcation. This simple method of intubation does not disturb the natural flora of the mouth and causes minimum laryngeal damage. It is rapid and reliable, and will be very valuable in inhalation exposure to chemical/biological warfare agents or toxic chemicals to assess respiratory toxicity and develop medical countermeasures.

Changes in aerodynamics during vocal cord dysfunction.

PubMed

Frank-Ito, Dennis O; Schulz, Kristine; Vess, Gina; Witsell, David L

2015-02-01

Changes in laryngeal airflow dynamics during episodes of vocal cord dysfunction (VCD) have not been well described. Very little is known about how inspiratory airflow is impacted when the vocal cords transition from normal inhalation state to a paradoxical adducted state; and how much change in laryngeal airflow and resistance occur before symptoms of stridor and air hunger emerge. This study provides new insight on the effects of VCD on respiratory airflow using computational fluid dynamics (CFD) techniques. Computed tomography images of a subject with normal vocal cords opening at the time of scanning were digitally modified to mimic an episode of VCD. To quantify and compare changes in inspiratory flow during VCD attack and normal inhalation, steady-state, laminar simulations were performed for three different breathing rates. Pressure-flow analysis during VCD revealed that increasing inspiratory effort is not as efficient as in normal inhalation. Airflow resistance at the epiglottis was higher in the normal state (0.04Pa.s/mL versus 0.02Pa.s/mL) than in VCD; while resistance at the glottis and trachea remained roughly the same (0.04Pa.s/mL) during normal inhalation, it escalated during VCD (0.11Pa.s/mL and 0.13Pa.s/mL at the glottis and trachea, respectively). Peak airflow velocity and vorticity occurred around the glottis during VCD, and at the epiglottis during normal inhalation. This pilot study demonstrates that attempting to force more inspired air will yield greater glottal resistance during VCD. Furthermore, there were evidence of abrupt laryngeal pressure gradient, chaotic airflow and high concentration of shear stresses in the glottal region. Copyright © 2014 Elsevier Ltd. All rights reserved.

Recurrent largngeal nerve paralysis: a laryngographic and computed tomographic study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Agha, F.P.

Vocal cord paralysis is a relatively common entity, usually resulting from a pathologic process of the vagus nerve or its recurrent larynegeal branch. It is rarely caused by intralargngeal lesions. Four teen patients with recurrent laryngeal nerve paralysis (RLNP) were evaluated by laryngography, computed tomography (CT), or both. In the evaluation of the paramedian cord, CT was limited in its ability to differentiate between tumor or RLNP as the cause of the fixed cord, but it yielded more information than laryngography on the structural abnormalities of the larynx and pre-epiglottic and paralaryngeal spaces. Laryngography revealed distinct features of RLNP andmore » is the procedure of choice for evaluation of functional abnormalities of the larynx until further experience with faster CT scanners and dynamic scanning of the larynx is gained.« less

Effect of high-dose vocal fold injection of cidofovir and bevacizumab in a porcine model.

PubMed

Ahmed, Mostafa M; Connor, Matthew P; Palazzolo, Mitzi; Thompson, Michelle E; Lospinoso, Josh; O'Connor, Peter; Howard, N Scott; Maturo, Stephen C

2017-03-01

Perform a follow-up study to investigate the histologic impact of high-dose intralaryngeal cidofovir injections in porcine vocal cords, either alone or in combination with bevacizumab, and compared to saline controls. This was an in vivo study involving 24 pigs with blinded pathologist review of specimens. Six groups were created, with four subjects in each group. Each subject received 10 or 20 mg of either cidofovir or bevacizumab alone, or in combination, injected into the right vocal cord. The left vocal fold was used as a saline control. Three separate injections were made at 2-week intervals. Larynges were harvested at 8 and 12 weeks, stained with hematoxylin and eosin and trichrome stain, and reviewed for histologic changes by two blinded pathologists. Minimal inflammation, edema, and atypia were noted with all treatments. Increased glandular inflammation was noted with 10 mg bevacizumab (P < 0.05), which decreased when combined with 10 mg cidofovir (P < 0.05). No lamina propria or muscle fibrosis was observed. Drug duration had no statistically significant histologic impact. High-dose cidofovir and bevacizumab do not induce detrimental vocal fold changes. Combination cidofovir and bevacizumab do not cause vocal fold scarring. Further work is needed to assess systemic concentration with this high-dose combination in humans. N/A. Laryngoscope, 127:671-675, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Office-based dynamic imaging of vocal cords in awake patients with swept-source optical coherence tomography

NASA Astrophysics Data System (ADS)

Yu, Lingfeng; Liu, Gangjun; Rubinstein, Marc; Saidi, Arya; Wong, Brian J. F.; Chen, Zhongping

2009-11-01

Optical coherence tomography (OCT) is an evolving noninvasive imaging modality that has been used to image the human larynx during surgical endoscopy. The design of a long gradient index (GRIN) lens-based probe capable of capturing images of the human larynx by use of swept-source OCT during a typical office-based laryngoscopy examination is presented. In vivo OCT imaging of the human larynx is demonstrated with a rate of 40 frames per second. Dynamic vibration of the vocal folds is recorded to provide not only high-resolution cross-sectional tissue structures but also vibration parameters, such as the vibration frequency and magnitude of the vocal cords, which provides important information for clinical diagnosis and treatment, as well as fundamental research of the voice itself. Office-based OCT is a promising imaging modality to study the larynx for physicians in otolaryngology.

[The role of laryngeal electromyography in the diagnosis of vocal cord movement disorders].

PubMed

Bach, Ádám; Sztanó, Balázs; Kiss, József Géza; Volk, Gerd Fabian; Müller, Andreas; Pototschnig, Claus; Rovó, László

2018-02-01

The development of the therapeutic possibilities of vocal cord immobility necessitated the parallel renewal of diagnostic methods. In the last years, laryngeal electromyography, which was first introduced more than 70 years ago, has been re-discovered. After reviewing the international literature and their own experience, the authors present the indications, technical requirements, method and, particularly, the evaluation of the results of this procedure. Laryngeal electromyography makes the differentiation between mechanical fixation and immobility with neurological origin of the vocal folds possible. In case of laryngeal paralysis/paresis it also evaluates objectively the severity of neural injury, the prognosis of the disease and the necessity of any glottis-widening procedure. The widespread application of dynamic rehabilitation interventions is not conceivable without the routine application of laryngeal electromyography, so this sensitive diagnostic tool has to be introduced in all laryngological centers. Orv Hetil. 2018; 159(8): 303-311.

Office-based dynamic imaging of vocal cords in awake patients with swept-source optical coherence tomography.

PubMed

Yu, Lingfeng; Liu, Gangjun; Rubinstein, Marc; Saidi, Arya; Wong, Brian J F; Chen, Zhongping

2009-01-01

Optical coherence tomography (OCT) is an evolving noninvasive imaging modality that has been used to image the human larynx during surgical endoscopy. The design of a long gradient index (GRIN) lens-based probe capable of capturing images of the human larynx by use of swept-source OCT during a typical office-based laryngoscopy examination is presented. In vivo OCT imaging of the human larynx is demonstrated with a rate of 40 frames per second. Dynamic vibration of the vocal folds is recorded to provide not only high-resolution cross-sectional tissue structures but also vibration parameters, such as the vibration frequency and magnitude of the vocal cords, which provides important information for clinical diagnosis and treatment, as well as fundamental research of the voice itself. Office-based OCT is a promising imaging modality to study the larynx for physicians in otolaryngology.

Office-based dynamic imaging of vocal cords in awake patients with swept-source optical coherence tomography

PubMed Central

Yu, Lingfeng; Liu, Gangjun; Rubinstein, Marc; Saidi, Arya; Wong, Brian J.F.; Chen, Zhongping

2009-01-01

Optical coherence tomography (OCT) is an evolving noninvasive imaging modality that has been used to image the human larynx during surgical endoscopy. The design of a long gradient index (GRIN) lens–based probe capable of capturing images of the human larynx by use of swept-source OCT during a typical office-based laryngoscopy examination is presented. In vivo OCT imaging of the human larynx is demonstrated with a rate of 40 frames per second. Dynamic vibration of the vocal folds is recorded to provide not only high-resolution cross-sectional tissue structures but also vibration parameters, such as the vibration frequency and magnitude of the vocal cords, which provides important information for clinical diagnosis and treatment, as well as fundamental research of the voice itself. Office-based OCT is a promising imaging modality to study the larynx for physicians in otolaryngology. PMID:20059258

Computerized Analysis of Acoustic Characteristics of Patients with Internal Nasal Valve Collapse Before and After Functional Rhinoplasty

PubMed Central

Rezaei, Fariba; Omrani, Mohammad Reza; Abnavi, Fateme; Mojiri, Fariba; Golabbakhsh, Marzieh; Barati, Sohrab; Mahaki, Behzad

2015-01-01

Acoustic analysis of sounds produced during speech provides significant information about the physiology of larynx and vocal tract. The analysis of voice power spectrum is a fundamental sensitive method of acoustic assessment that provides valuable information about the voice source and characteristics of vocal tract resonance cavities. The changes in long-term average spectrum (LTAS) spectral tilt and harmony to noise ratio (HNR) were analyzed to assess the voice quality before and after functional rhinoplasty in patients with internal nasal valve collapse. Before and 3 months after functional rhinoplasty, 12 participants were evaluated and HNR and LTAS spectral tilt in /a/ and /i/ vowels were estimated. It was seen that an increase in HNR and a decrease in LTAS spectral tilt existed after surgery. Mean LTAS spectral tilt in vowel /a/ decreased from 2.37 ± 1.04 to 2.28 ± 1.17 (P = 0.388), and it was decreased from 4.16 ± 1.65 to 2.73 ± 0.69 in vowel /i/ (P = 0.008). Mean HNR in the vowel /a/ increased from 20.71 ± 3.93 to 25.06 ± 2.67 (P = 0.002), and it was increased from 21.28 ± 4.11 to 25.26 ± 3.94 in vowel /i/ (P = 0.002). Modification of the vocal tract caused the vocal cords to close sufficiently, and this showed that although rhinoplasty did not affect the larynx directly, it changes the structure of the vocal tract and consequently the resonance of voice production. The aim of this study was to investigate the changes in voice parameters after functional rhinoplasty in patients with internal nasal valve collapse by computerized analysis of acoustic characteristics. PMID:26955564

Diagnosing vocal cord dysfunction in young athletes.

PubMed

Rhodes, Rea Kae

2008-12-01

To provide an overview of the pathophysiology, steps in making a diagnosis, differential diagnosis, and treatment methods for vocal cord dysfunction (VCD) in young athletes. Review of published literature about VCD and exercise-induced asthma (EIA) and a case study. The clinical presentation of VCD is often confusing. A young athlete who is having difficulty "catching his breath" may have more than EIA. Young athletes who have been previously diagnosed with EIA may actually have VCD. The ability to correctly differentiate VCD from other causes of respiratory distress can lead to accurate interventions, save precious time in an acute situation, and promote long-term control of this condition.

Single Vocal Cord Irradiation: Image Guided Intensity Modulated Hypofractionated Radiation Therapy for T1a Glottic Cancer: Early Clinical Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Al-Mamgani, Abrahim, E-mail: a.almamgani@nki.nl; Kwa, Stefan L.S.; Tans, Lisa

2015-10-01

Purpose: To report, from a retrospective analysis of prospectively collected data, on the feasibility, outcome, toxicity, and voice-handicap index (VHI) of patients with T1a glottic cancer treated by a novel intensity modulated radiation therapy technique developed at our institution to treat only the involved vocal cord: single vocal cord irradiation (SVCI). Methods and Materials: Thirty patients with T1a glottic cancer were treated by means of SVCI. Dose prescription was set to 16 × 3.63 Gy (total dose 58.08 Gy). The clinical target volume was the entire vocal cord. Setup verification was done by means of an online correction protocol using cone beam computed tomography. Datamore » for voice quality assessment were collected prospectively at baseline, end of treatment, and 4, 6, and 12 weeks and 6, 12, and 18 months after treatment using VHI questionnaires. Results: After a median follow-up of 30 months (range, 7-50 months), the 2-year local control and overall survival rates were 100% and 90% because no single local recurrence was reported and 3 patients died because of comorbidity. All patients have completed the intended treatment schedule; no treatment interruptions and no grade 3 acute toxicity were reported. Grade 2 acute dermatitis or dysphagia was reported in only 5 patients (17%). No serious late toxicity was reported; only 1 patient developed temporary grade 2 laryngeal edema, and responded to a short-course of corticosteroid. The VHI improved significantly, from 33.5 at baseline to 9.5 and 10 at 6 weeks and 18 months, respectively (P<.001). The control group, treated to the whole larynx, had comparable local control rates (92.2% vs 100%, P=.24) but more acute toxicity (66% vs 17%, P<.0001) and higher VHI scores (23.8 and 16.7 at 6 weeks and 18 months, respectively, P<.0001). Conclusion: Single vocal cord irradiation is feasible and resulted in maximal local control rate at 2 years. The deterioration in VHI scores was slight and temporary and subsequently improved to normal levels. Long-term follow-up is needed to consolidate these promising results.« less

Functional organ preservation in laryngeal and hypopharyngeal cancer

PubMed Central

Ambrosch, Petra; Fazel, Asita

2012-01-01

The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications. PMID:22558052

Improvement of a Vocal Fold Imaging System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krauter, K. G.

Medical professionals can better serve their patients through continual update of their imaging tools. A wide range of pathologies and disease may afflict human vocal cords or, as they’re also known, vocal folds. These diseases can affect human speech hampering the ability of the patient to communicate. Vocal folds must be opened for breathing and the closed to produce speech. Currently methodologies to image markers of potential pathologies are difficult to use and often fail to detect early signs of disease. These current methodologies rely on a strobe light and slower frame rate camera in an attempt to obtain imagesmore » as the vocal folds travel over the full extent of their motion.« less

A robotic voice simulator and the interactive training for hearing-impaired people.

PubMed

Sawada, Hideyuki; Kitani, Mitsuki; Hayashi, Yasumori

2008-01-01

A talking and singing robot which adaptively learns the vocalization skill by means of an auditory feedback learning algorithm is being developed. The robot consists of motor-controlled vocal organs such as vocal cords, a vocal tract and a nasal cavity to generate a natural voice imitating a human vocalization. In this study, the robot is applied to the training system of speech articulation for the hearing-impaired, because the robot is able to reproduce their vocalization and to teach them how it is to be improved to generate clear speech. The paper briefly introduces the mechanical construction of the robot and how it autonomously acquires the vocalization skill in the auditory feedback learning by listening to human speech. Then the training system is described, together with the evaluation of the speech training by auditory impaired people.

Long-term functional outcome after unilateral cordectomy.

PubMed

Keilmann, Annerose; Napiontek, Ulrike; Engel, Christiane; Nakarat, Todsaporn; Schneider, Astrid; Mann, Wolf

2011-01-01

Our aim was to longitudinally analyze the vocal outcome after endoscopic CO(2) laser resection of early glottic carcinoma. Sixteen patients treated with laser surgery for T1 or T2 tumors of the vocal cords received voice therapy and were examined 1, 2, 3, 4.5, 6 and 12 months postoperatively. Besides videolaryngostroboscopy, each examination included history, phonetogram of the speaking and the singing voice, language-specific hoarseness diagram and a questionnaire (Voice Handicap Index 12 in German). Objective parameters demonstrated a broad variability with a slight tendency of improvement over time. For the maximal phonation time a nearly constant improvement was seen. After an initial improvement deterioration for subjective assessment in the Voice Handicap Index was noted in most patients 3-6 months postoperatively. The functional outcome after cordectomy is variable. MESSAGE OF THE PAPER: Discrepancies between objective findings and patient satisfaction over time have to be considered after cordectomy. Copyright © 2010 S. Karger AG, Basel.

[Observation of the dysphonia severity index in evaluating curative effect of vocal cord polyp surgery].

PubMed

Zhou, Zhou; Ge, Pingjiang; Liu, Qian; Liu, Ming; Zhang, Wei

2015-08-01

To investigate the applicability of the eysphonia severity index (DSI) in evaluating effects of surgery between before and after groups of vocal polyp patients. Analyses of measurement data pre and pro-surgery of 70 vocal polyp patients and 35 no voice disorders volunteers (control group). The voice quality was measured subjectively with the voice handicap index (VHI), the GRBAS and fiber electronic laryngoscopy. Measures of maximum phonation time (MPT), shimmer and jitter were obtained for each subject by using DiVAS 2.30 (XION, Germany). The DiVAS 2.30 had spotanenously calculate the scores of DSI. Using SPSS 17.0 to find the differences of DSI scores among the three groups by one-way ANOVA variance analysis. And finding out of the correlation with DSI scores and VHI scores, GRBAS, MPT, jitter and shimmer. DSI improved significantly after surgery in the vocal polyps group (mean difference DSI -2.92 and 1.87, respectively) and also in the control group (mean difference DSI -2.92 and 2.30, respectively). However, no significant difference between the control group and the after surgery group. By using Pearson correlation analysis, this study observed a strong correlation between the DSI scores and the VHI scores, the values of GRBAS, shimmer (P < 0.01). DSI is an effective and high accuracy multi-parameter system for evaluation of vocal cord polyp patients as an independent assessment of dysphonia. DSI also can be used in evaluation of the effects of the vocal polyps surgery.

Coblator Arytenoidectomy in the Treatment of Bilateral Vocal Cord Paralysis

PubMed Central

Googe, Benjamin; Nida, Andrew; Schweinfurth, John

2015-01-01

A 77-year-old female with bilateral vocal cord paralysis and dependent tracheostomy status after total thyroidectomy presented to clinic for evaluation of decannulation via arytenoidectomy. Preliminary data suggests coblation versus standard CO2 laser ablation in arytenoidectomy may provide benefits in terms of decreased tissue necrosis and patient outcome. The patient elected to proceed with arytenoidectomy by coblation. The initial procedure went well but postoperative bleeding required a return trip to the operating room for hemostasis. In the coming months the patient's tracheostomy tube was gradually downsized and eventually capped. She was decannulated eight months after surgery, speaking well and without complaints. Details of the surgical procedure and outcome will be discussed. PMID:26457217

Vocal Cord Palsy in Children With Cancer: A 10-Year Analysis of UK Pediatric Intensive Care Admissions.

PubMed

Capsomidis, Anna; Hall, Andrew; Daya, Hamid; Round, Jonathan; Lancaster, Donna; Bate, Jessica

2017-05-01

Vocal cord palsy (VCP) is a rare but potentially life-threatening complication in children with cancer. This study reviews UK Intensive Care admissions for children with cancer and VCP using data obtained from the Pediatric Intensive Care Audit Network (PICANet) database. 26 children with cancer and VCP were admitted to intensive care from 2002 to 2012. The majority of admissions (23/26) required respiratory intervention (17 invasive ventilation, 8 noninvasive ventilation, and 5 tracheostomy). VCP should be considered early in children with cancer who present with signs of upper airway obstruction, especially in those receiving vinca-alkaloids as VCP is likely to be reversible.

Composition and abundance of microbiota in the pharynx in patients with laryngeal carcinoma and vocal cord polyps.

PubMed

Gong, Hongli; Wang, Boyan; Shi, Yi; Shi, Yong; Xiao, Xiyan; Cao, Pengyu; Tao, Lei; Wang, Yuezhu; Zhou, Liang

2017-08-01

The pharynx is an important site of microbiota colonization, but the bacterial populations at this site have been relatively unexplored by culture-independent approaches. The aim of this study was to characterize the microbiota structure of the pharynx. Pyrosequencing of 16S rRNA gene libraries was used to characterize the pharyngeal microbiota using swab samples from 68 subjects with laryngeal cancer and 28 subjects with vocal cord polyps. Overall, the major phylum was Firmicutes, with Streptococcus as the predominant genus in the pharyngeal communities. Nine core operational taxonomic units detected from Streptococcus, Fusobacterium, Prevotella, Granulicatella, and Veillonella accounted for 21.3% of the total sequences detected. However, there was no difference in bacterial communities in the pharynx from patients with laryngeal cancer and vocal cord polyps. The relative abundance of Firmicutes was inversely correlated with Fusobacteria, Proteobacteria, Actinobacteria, and Bacteroidetes. The correlation was evident at the genus level, and the relative abundance of Streptococcus was inversely associated with Fusobacterium, Leptotrichia, Neisseria, Actinomyces, and Prevotella. This study presented a profile for the overall structure of the microbiota in pharyngeal swab samples. Inverse correlations were found between Streptococcus and other bacterial communities, suggesting that potential antagonism may exist among pharyngeal microbiota.

Endotracheal intubation

MedlinePlus

... bleeding from the esophagus or stomach. Risks include: Bleeding Infection Trauma to the voice box (larynx), thyroid gland, vocal cords and windpipe (trachea), or esophagus Puncture or tearing ( ...

Vocal Cord Nodules, Polyps, and Cysts

MedlinePlus

... Programs Professional Development Home AcademyU Home Study Course Maintenance of Certification Conferences & Events Practice Management Home Resources Quality Clinical Data Registry Research Reimbursement ...

Intubating conditions and side effects of propofol, remifentanil and sevoflurane compared with propofol, remifentanil and rocuronium: a randomised, prospective, clinical trial

PubMed Central

2014-01-01

Background Tracheal intubation without muscle relaxants is usually performed with remifentanil and propofol or sevoflurane. Remifentanil 1.0 to 4.0 μg·kg-1 and propofol 2.0-3.0 mg·kg-1 or sevoflurane up to 8.0 Vol% provide acceptable, i.e. excellent or good intubating conditions. We hypothesized that sevoflurane 1.0 MAC would provide acceptable intubating conditions when combined with propofol and remifentanil. Methods Eighty-three patients to be intubated were randomised to two groups. The SEVO group received propofol 1.5 mg kg-1, remifentanil 0.30 μg kg min-1 and sevoflurane 1.0 MAC; the MR group received the same doses of propofol and remifentanil plus rocuronium 0.45 mg kg-1. We evaluated intubation and extubation conditions, mean arterial pressure (MAP), heart rate (HR) and bispectral index (BIS). The vocal cords were examined for injury by videolaryngoscopy before and 24 hours after surgery. Results Acceptable intubating conditions were seen more frequently with rocuronium than with sevoflurane: 97% versus 82%; p = 0.03; the subscore for vocal cords was comparable: 100% versus 98%. MAP before intubation decreased significantly compared with the MAP at baseline to the same extent in both groups; ephedrine IV was given in 15 (SEVO) versus 16 (MR) patients; p = 0.93. BIS at tracheal intubation was 27 (13-65) in the SEVO group, 29 (14-62) in the MR group; p = 0.07. Vocal cord injuries (oedema, haematoma) were similar: 4 patients in each group. Conclusions Overall intubating conditions were better when rocuronium was used; the subscore for vocal cords was comparable. The incidence of side effects was the same in the two groups. Trial registration ClinicalTrials.Gov: NCT 01591031. PMID:24860256

[Perioperative Management of a Child with Vocal Adhesion Leading to Unexpected Difficult Airway].

PubMed

Hitosugi, Takashi; Tsukamoto, Masanori; Fujiwara, Shigeki; Yokoyama, Takeshi

2016-06-01

We report a child with vocal cord adhesion encountered during induction of anesthesia. A 4-month-old girl was scheduled for bilateral lip plasty. She was intubated for one week due to pneumonia at the age of 3 days. Hoarseness and stridor appeared just after extubation. Although laryngo-fiberoptic examination had been tried several times, otorhinologists could not find any abnormality. We once decided to postpone the operation because of severe stridor. However, laryngofiberoptic examination could not reveal any abnormality, and we rescheduled the operation. Tracheal intubation using laryngoscope was not possible due to vocal cord adhesion. Finally, 2.5 mm ID tracheal tube was intubated by using a fiberscope, and lip plasty was performed. The patient stayed in the ICU for 7 days after surgery. Tracheotomy was performed 3 weeks after the operation. We should pay attention to stridor in an infant before general anesthesia, since it suggests severe airway narrowing although laryngo-fiberoptic examination could not find any abnormalities.

Laser arytenoidectomy in the management of bilateral vocal cord paralysis in children.

PubMed

Aubry, Karine; Leboulanger, Nicolas; Harris, Robert; Genty, Erwan; Denoyelle, Françoise; Garabedian, Erea-Noël

2010-05-01

To analyse the efficacy of CO(2) laser arytenoidectomy in the management of bilateral vocal cord paralysis in children. Retrospective series of 17 patients who underwent laser arytenoidectomy for bilateral vocal cord between 1995 and 2008 in a tertiary care institution. All patients had bilateral laryngeal paralysis, in isolation (n=5) or associated with concomitant airway conditions (n=12). All cases had anterior prolapse of the arytenoids with partial obstruction of the airway on inspiration. 12/17 patients (70.5%) were tracheotomy-dependant, 2/17 were in-extubatable, and 3/17 had severe airway limitation, effort dyspnea and poor sleep pattern. Main outcome measures were decannulation rate for patients with tracheotomy, occurrence of aspiration and quality of voice. The mean age was 2.8 years old. 9/12 patients with tracheotomy (75%) were decannulated with a median delay of 2 months (2 days to 18 months). Both of the intubated patients were extubated with a median delay of 36h. One of the decannulated patients who re-presented with a residual dyspnea after the arytenoidectomy was improved by a further laser cordotomy. 2/17 patients (11.7%) had post-operative persistent aspirations (with pneumopathies in one case), 5/17 patients were dysphonic, 3 improved with speech therapy and 2 with intracordal lipoinjection. Laser arytenoidectomy is effective for improving the breathing in children presenting with a bilateral vocal fold paralysis associated with obstructive arytenoid prolapse. Results are good as a first-line surgery or following laryngo-tracheal surgery. Voice outcomes are satisfactory. However, aspiration is a rare complication. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial.

PubMed

Fujimaki, Yoko; Tsunoda, Koichi; Kobayashi, Rika; Tonghyo, Chong; Tanaka, Fujinobu; Kuroda, Hiroyuki; Numata, Tsutomu; Ishii, Toyota; Kuroda, Reiko; Masuda, Sawako; Hashimoto, Sho; Misawa, Hayato; Shindo, Naoko; Mori, Takahiro; Mori, Hiroko; Uchiyama, Naoki; Kamei, Yuichirou; Tanaka, Masashi; Hamaya, Hironobu; Funatsuki, Shingo; Usui, Satoko; Ito, Ikuno; Hamada, Kohei; Shindo, Akihito; Tokumaru, Yutaka; Morita, Yoko; Ueha, Rumi; Nito, Takaharu; Kikuta, Shu; Sekimoto, Sotaro; Kondo, Kenji; Sakamoto, Takashi; Itoh, Kenji; Yamasoba, Tatsuya; Matsumoto, Sumio

2017-08-01

To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency. Parallel-arm, individual randomized controlled trial. Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups. Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly ( p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference ( p < 0.001). The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly. gov Identifier-UMIN000015567.

Results of intraoperative neuromonitoring in thyroid surgery and preoperative vocal cord paralysis.

PubMed

Lorenz, Kerstin; Abuazab, Mohammed; Sekulla, Carsten; Schneider, Rick; Nguyen Thanh, Phuong; Dralle, Henning

2014-03-01

Systematic studies of intermittent intraoperative neuromonitoring (IONM) have shown that IONM enhances recurrent laryngeal nerve (RLN) identification via functional assessment, but does not significantly reduce rates of vocal cord (VC) paralysis (VCP). The reliability of functional nerve assessment depends on the preoperative integrity of VC mobility. The present study was therefore performed to analyze the validity of IONM in patients with pre-existing VC paralysis. Of 8,128 patients, 285 (3.5 %) with preoperative VCP underwent thyroid surgery using standardized IONM of the RLN and vagus nerves (VNs). VC function was assessed by pre- and postoperative direct videolaryngoscopy. Quantitative parameters of IONM in patients with VCP were compared with IONM in patients with intact VC function. Clinical symptoms and surgical outcomes of patients with pre-existing VCP were analyzed. A total of 244 patients revealed negative, and 41 revealed positive IONM on the side of the VCP. VCP with positive IONM revealed significantly lower amplitudes of VN and RLN than intact VN (p = 0.010) and RLN (p = 0.011). Symptoms of patients with VCP included hoarseness (25 %), dyspnea (29 %), stridor (13 %), and dysphagia (13 %); 13 % were asymptomatic. New VCP occurred in five patients, ten needed tracheostomy for various reasons, and one patient died. Patients with pre-existing VCP revealed significantly reduced amplitude of ipsilateral VN and RLN, indicating retained nerve conductivity despite VC immobility. Preoperative laryngoscopy is therefore indispensable for reliable IONM and risk assessment, even in patients without voice abnormalities.

Multidimensional vocal assessment after laser treatment for recurrent respiratory papillomatosis.

PubMed

Kono, Takeyuki; Yabe, Haruna; Uno, Kosuke; Saito, Koichiro; Ogawa, Kaoru

2017-03-01

Recurrent respiratory papillomatosis (RRP) is a benign epithelial tumor that exhibits a high frequency of recurrence. This study assesses the vocal function after laser treatment for RRP, particularly in relation to the frequency of surgery. Retrospective study. Thirty RRP patients who underwent laser surgery that controlled the tumor were included. Preoperative and postoperative Grade, Roughness, Breathiness, Asthenia, and Strain Scale, videostroboscopic findings, aerodynamic and acoustic parameters, and self-assessment questionnaires were measured and compared with an age- and sex-matched control group. Subsequently, to evaluate the association between postoperative voice quality and the number of surgeries, the patients were divided into three groups (group 1: single surgery, group 2: 2-5 surgeries, group3: >6 surgeries), and comparative multidimensional vocal assessments were performed. The mean number of surgeries was 3.4 (range, 1-8). Although all patients exhibited poorer vocal function than the control group preoperatively, they showed improvement in postoperative subjective and objective parameters. However, four patients who underwent one surgery with relatively aggressive ablation exhibited vocal cord scarring and deteriorated objective parameters. All remaining patients showed voice quality that was on par with the control group. Subgroup analysis proved no association between post-therapeutic voice quality and the patient characteristics, including preoperative staging and the number of surgical treatments performed. RRP patients can achieve a close to normal voice with high satisfaction even after recurrent surgical treatment when ablation of a subepithelial lesion using sufficient laser energy is adequate. 3b Laryngoscope, 127:679-684, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Experimental Assessment of the Laryngeal Jet Effect on the Fluid Flow Pattern within the Trachea

NASA Astrophysics Data System (ADS)

Salehi, Mehran

Drug aerosol inhalation is a modern way to combat lung diseases. It is also becoming the preferred route for insulin delivery, pain management, cancer therapy and nanotherapetutics. The specific airflow characteristics within the central human airways, however, have a major influence on aerosol delivery and particle deposition. In this study the association of human inspiratory laryngeal function on the unique transitional turbulence this creates in the central airways and its association to particle deposition were investigated. The true vocal cords expand with increasing inspiratory flow rates and independently, with enlarging lung volumes. This creates a specific constriction to the inspiratory airstream and subsequent vortex formation below each vocal cord. The study compares triangular vocal cord shapes (physiologic) to rectangular (symmetric) shapes over a range of inspiratory directed flows. Disturbances below the laryngeal obstruction were visualized and the turbulence intensities as a function of distance below the vocal cord constriction in scale models under similitude flow conditions for a human trachea was also measured using laser Doppler anemometry in both primary (axial) and secondary (tangential) directions in a simplified larynx-trachea model. The turbulence length scale and energy spectrum were also calculated using hot-wire anemometer data to determine the size distribution of eddies and the rate of energy decay along the trachea for different larynx geometries and Reynolds numbers. Both visualizations and measurements were made at Reynolds numbers between 1000 and 4000 which represent mild to severe breathing conditions. The larynx geometry is modeled by a constriction inside a straight tube. The group of constrictions consists of 2 rectangular and triangular shapes at apex angles of 45°, 60° and 75° degrees. The base circular tube was 5 cm in diameter (D) and 30 cm in length (L) (to keep the relative ratio of L/D=6). The inlet area created by the larynx constriction is approximately 10% and 50% of the tube area. Forty eight different combinations of aperture, area ratio, angle of the glottis and flow rates were visualized. Arrays of 72 measurements were made respectively at downstream planes of 1D and 3D from the larynx within the trachea. Results show that both the average and rms velocities change rapidly with respect to distance down the trachea. High levels of turbulence intensity at the anterior part indicate the potential region for particle deposition. The two vortices below the laryngeal constriction appear to interact, creating a transitional turbulence which propagates down the trachea, developing a structure to the turbulence which enhances the lateral flow energies and in turn enhances particle movements toward the tracheal walls (especially the posterior membranous tracheal wall) and subsequent particle capture. It appears that the locations of particle capture on the tracheal walls are at sites optimal for subsequent expectoration with cough.

[Phoniatric surgery and conservative treatment of vocal cord hematoma].

PubMed

Milutinović, Z

1997-01-01

Functional-traumatic lesions of the vocal fold include mucous stranding, "nodular" lesions, polyps, cysts, contact hyperplasia and haematoma of the vocal fold. An acute voice overuse may result in bleeding (haematoma) within the vocal fold. This may be in the form of petechial bleeding, or a genuine haematoma develops within the tissues of the vocal fold. Haematoma may also arise as a consequence of prolonged cough, forceful vomiting, lifting of a heavy weight, various effortful activities, etc. Haematoma is usually located close to the vocal fold free edge and therefore disturbs the glottic closure during phonation. The treatment is adapted to the size and localization of haematoma, as well as to the time elapsed from onset of the lesion. Phonosurgery can be used in therapy, as well as corticosteroid treatment. A series of 102 vocal fold haematomas has been treated by phonosurgery (39) and conservative therapy (63). Phonosurgical interventions were performed by an indirect approach, by use of microstroboscopy (28 patients) and videostroboscopy (11 causes). Conservative treatment consisted of corticosteroid therapy. During a 10-year period 1550 phonosurgical operations were performed for benign lesions of the vocal fold, including 39 haematomas (2.5%). It was established that recovery of vibration pattern was significantly faster in the surgery group in comparison to the group of patients treated conservatively. All surgical patients were operated within the first several days after the onset of symptoms. In case of a vocal fold haematoma, it is very important to establish the diagnosis as soon as possible in order to start with the therapy early enough. Within the first several days after the onset (the best within 24-48 hours) a phonosurgical treatment is indicated, preferably by the use of indirect videostroboscopy. If the treatment is started later we use corticoids. However, the results are inferior as compared to surgery. We did not perform direct microlaryngoscopy in these cases, for a lack of function monitoring and possible local trauma to the tissues. In the majority of cases the voice therapy is required as well.

Laser vocal cordectomy fails to effectively reduce respiratory noise in horses with laryngeal hemiplegia.

PubMed

Brown, Jennifer A; Derksen, Frederik J; Stick, John A; Hartmann, William M; Robinson, N Edward

2005-01-01

To report the effect of unilateral laser vocal cordectomy on respiratory noise and airway function in horses with experimentally induced laryngeal hemiplegia (LH). Experimental study. Six Standardbred horses without upper airway abnormalities at rest or during high-speed treadmill exercise. Respiratory sounds and inspiratory trans-upper airway pressure (P(Ui)) were measured before (baseline) and 14 days after induction of LH by left recurrent laryngeal neurectomy, and again 30, 60, 90, and 120 days after endoscopically assisted laser cordectomy of the left vocal cord. Data were collected with the horses exercising on a treadmill at a speed producing maximum heart rate (HR(max)). In horses exercising at HR(max), induction of LH caused a significant increase in P(Ui), sound level (SL), and the sound intensity of formant 2 (F(2)) and 3 (F(3)). The sound intensity of formant 1 (F(1)) was unaffected by induction of LH. Laser vocal cordectomy had no effect on SL, or on the sound intensity of F(1) and F(3). At 30, 60, 90, and 120 days after surgery, P(Ui) and the sound intensity of F(2) were significantly reduced, but these variables remained significantly different from baseline values. Unilateral laser vocal cordectomy did not effectively improve upper airway noise in horses with LH. The procedure decreased upper airway obstruction to the same degree as bilateral ventriculocordectomy. Currently, laser vocal cordectomy cannot be recommended for the treatment of upper airway noise in horses with LH.

Bilateral vocal cord paralysis and hypothyroidism as presenting symptoms of Williams-Beuren syndrome: a case report.

PubMed

Koren, Ilana; Kessel, Ira; Rotschild, Avi; Cohen-Kerem, Raanan

2015-09-01

Williams-Beuren syndrome is a rare neurodevelopmental disorder caused by deletion of 1.5-1.8Mb genes on chromosome 7q11.23. The syndrome was first described as a triad of supra-valvular aortic stenosis, mental retardation, and distinctive facial features. Our patient was referred due to audible inspiratory stridor when he was seven days old. Following endoscopy he was diagnosed with bilateral vocal cord paralysis and was eventually intubated due to respiratory de-compensation followed by tracheotomy. On further workup he was diagnosed with hypothyroidism. Genetic workup supported the diagnosis of Williams-Beuren syndrome. We report here a case with an unusual clinical presentation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

JS-X syndrome: A multiple congenital malformation with vocal cord paralysis, ear deformity, hearing loss, shoulder musculature underdevelopment, and X-linked recessive inheritance.

PubMed

Hoeve, Hans L J; Brooks, Alice S; Smit, Liesbeth S

2015-07-01

We report on a family with a not earlier described multiple congenital malformation. Several male family members suffer from laryngeal obstruction caused by bilateral vocal cord paralysis, outer and middle ear deformity with conductive and sensorineural hearing loss, facial dysmorphisms, and underdeveloped shoulder musculature. The affected female members only have middle ear deformity and hearing loss. The pedigree is suggestive of an X-linked recessive inheritance pattern. SNP-array revealed a deletion and duplication on Xq28 in the affected family members. A possible aetiology is a neurocristopathy with most symptoms expressed in structures derived from branchial arches. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Laryngeal Manifestations of Neurofibromatosis.

PubMed

Naunheim, Matthew R; Plotkin, Scott R; Franco, Ramon A; Song, Phillip C

2016-03-01

To describe the range of findings in patients with neurofibromatosis (NF) presenting to a laryngology clinic and to analyze the etiologic factors of vocal fold dysfunction in this cohort. Case series with chart review. Tertiary laryngology practice. All cases of NF presenting to an academic laryngology practice were retrospectively reviewed (August 2005 to May 2014), with a total of 34 cases. Demographic data, symptoms, and endoscopic examination findings were reviewed. Etiologic factors of laryngeal complaints were analyzed with reference to NF-associated pathologies and surgical history. Thirty-four patients with NF-1 or NF-2 were evaluated, and 28 of these patients (6 NF-1 and 22 NF-2) had laryngeal pathology. The most common presenting symptoms were vocal weakness (n = 21), dysphagia (n = 5), and globus (n = 4). Three patients had NF-related vocal fold masses on examination, including 2 neurofibromas and 1 schwannoma. Unilateral vocal cord paralysis was seen in 17 patients; bilateral paralysis was observed in 5 patients. Of patients with unilateral or bilateral paralysis, 20 had intracranial masses (vestibular schwannoma, meningioma, or skull base tumors), and 16 had previously undergone surgery for these lesions. Of the patients with NF-associated intracranial tumors, 87.0% presented with vocal cord paralysis, whereas only 40.0% of those without intracranial masses had paralysis (P = .0560). Seven patients underwent medialization procedures. Neurofibromatosis patients may present to laryngology clinic with primary laryngeal tumors or, more commonly, unilateral or bilateral paralysis. Otolaryngologists should be keenly aware of vocal fold paralysis caused by the NF-associated tumors, with particular attention to bilateral paralysis in NF-2. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Vocal Cord Nodules, Polyps, and Cysts

MedlinePlus

... Humanitarian Efforts International Outreach Advocacy Board of Governors Industry Programs Professional Development Home AcademyU Home Study Course Maintenance of Certification Conferences & Events Practice Management Home Resources ...

Impact of vocal cord ultrasonography on endocrine surgery practices.

PubMed

Carneiro-Pla, Denise; Solorzano, Carmen C; Wilhelm, Scott M

2016-01-01

It is common practice to perform flexible laryngoscopy (FL) to ensure true vocal cord (TVC) mobility in patients with previous neck operations or patients with suspected VC dysfunction. Vocal cord ultrasonography (VCUS) is accurate in identifying TVC paralysis. The goal of this study is to evaluate the impact of VCUS as the initial study to confirm TVC mobility in patients requiring preoperative FL. A total of 194 consecutive patients with indications for preoperative FL underwent VCUS. In group 1, 52 patients had FL regardless of the results of VCUS, whereas in group 2, 142 patients had VCUS followed by FL only when VCUS was unsatisfactory. VCUS visualized TVC/arytenoids in 164 of 194 (85%) patients. TVC visualization was more common in women (95%) and in patients without thyroid cartilage calcification (92%) (P < .0005). VCUS predicted all paralyzed TVC. In group 2, 76% of patients had adequate VCUS and avoided preoperative FL. Among 24% of patients in whom VCUS was inadequate, 16 had preoperative FL attributable to a lack of TVC visualization, 6 had abnormal TVC mobility, 11 needed additional confirmations, and 2 had previous FL for another reason. VCUS changed surgeon practices by avoiding the need for preoperative FL in the majority of patients. This noninvasive and sensitive method demonstrates TVC mobility and safely precludes preoperative FL in most patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Involuntary expiratory phonation as a dose-related consequence of L-dopa therapy in a patient with Parkinson's disease.

PubMed

Ishii, Kosuke; Kumada, Masanobu; Ueki, Akira; Yamamoto, Masanori; Hirose, Hajime

2003-12-01

We report a case of involuntary phonation caused by abnormal vocal cord movements during expiration in a patient with Parkinson's disease. A 60-year-old woman had been treated for parkinsonism at the outpatient clinic of the Department of Neurology since August 1999. She began to groan involuntarily in the daytime in September 2001. She could not eat well while groaning. Stridor was not noted during sleep at night. Endoscopic examination of the larynx revealed insufficient abduction of the bilateral vocal cords, although the glottis was not so small as to cause stridor during inspiration. During expiration, however, the vocal cords adducted, resulting in the involuntary production of voice. Electromyography showed an increase in the activity of the thyroarytenoid and lateral cricoarytenoid muscles. This muscle activity was further enhanced during inspiration. The involuntary phonation disappeared when the patient's dose of L-dopa was decreased, although she had a decrease in her systemic mobility as well. When the dose of L-dopa was increased to the therapeutic level, involuntary phonation recurred, and her voluntary systemic activity improved. In the present case, it was considered that excessive dopaminergic denervation occurred in the nerve innervating the laryngeal adductors. Involuntary voice appeared to be produced by hypertonus of the laryngeal adductors because of a lowering in the threshold level for L-dopa, even though the drug was administered at the usual dose.

Hiccups

MedlinePlus

... a hiccup is a quick closing of your vocal cords. This is what causes the "hic" sound ... or excited A bloated stomach Certain medicines Abdominal surgery Metabolic disorders Central nervous system disorders Hiccups usually ...

Speech Therapy Telepractice for Vocal Cord Dysfunction (VCD): MaineCare (Medicaid) Cost Savings

PubMed Central

Towey, Michael P.

2012-01-01

This Brief Communication represents an analysis of the cost savings to MaineCare (also referred to as Medicaid) directly attributable to service provided via speech therapy telepractice. Seven female (primarily adolescent) MaineCare patients consecutively referred to Waldo County General Hospital (WCGH) with suspected diagnosis of Vocal Cord Dysfunction (VCD) were treated by speech therapy telepractice. Outcome data demonstrated a first month cost savings of $2376.72. The analysis additionally projected thousands of dollars of potential savings each month in reduced medical costs for this patient group as a result of successful treatment via speech therapy telepractice. The study suggests that without access to speech therapy telepractice for patients with VCD, the medical costs to MaineCare will be ongoing and significant. PMID:25945195

Speech recovery device

DOE Office of Scientific and Technical Information (OSTI.GOV)

Frankle, Christen M.

2000-10-19

There is provided an apparatus and method for assisting speech recovery in people with inability to speak due to aphasia, apraxia or another condition with similar effect. A hollow, rigid, thin-walled tube with semi-circular or semi-elliptical cut out shapes at each open end is positioned such that one end mates with the throat/voice box area of the neck of the assistor and the other end mates with the throat/voice box area of the assisted. The speaking person (assistor) makes sounds that produce standing wave vibrations at the same frequency in the vocal cords of the assisted person. Driving the assistedmore » person's vocal cords with the assisted person being able to hear the correct tone enables the assisted person to speak by simply amplifying the vibration of membranes in their throat.« less

Speech recovery device

DOEpatents

Frankle, Christen M.

2004-04-20

There is provided an apparatus and method for assisting speech recovery in people with inability to speak due to aphasia, apraxia or another condition with similar effect. A hollow, rigid, thin-walled tube with semi-circular or semi-elliptical cut out shapes at each open end is positioned such that one end mates with the throat/voice box area of the neck of the assistor and the other end mates with the throat/voice box area of the assisted. The speaking person (assistor) makes sounds that produce standing wave vibrations at the same frequency in the vocal cords of the assisted person. Driving the assisted person's vocal cords with the assisted person being able to hear the correct tone enables the assisted person to speak by simply amplifying the vibration of membranes in their throat.

Study of endolaryngeal structures by videolaryngoscopy after hanging: a new approach to understanding the physiopathogenesis.

PubMed

Duband, S; Timoshenko, A P; Mohammedi, R; Prades, J-M; Barral, F-G; Debout, M; Péoc'h, M

2009-11-20

To evaluate laryngoscopic findings in hanging cases and to compare them with magnetic resonance imaging (MRI) and forensic autopsy results. Postmortem nasolaryngofibroscopy and MRI of five people who died from hanging were performed. Three people who died from other causes than hanging were also examined with a flexible laryngofibroscope. The results were compared with injuries discovered during forensic autopsy. In all five hanging cases, laryngofibroscopic investigation showed a vocal fold position in complete adduction confirmed by MRI. This position did not seem to be influenced by the intensity of the forces applied to neck or postmortem delay and cadaveric phenomena. The vocal cords of the three non-hanging deceased were found in the intermediate position. These findings could suggest that pressure applied to the cervical nervous and cartilaginous structures or their elongation during hanging could lead to closure of the glottis with vocal cord adduction maintained after death. Laryngofibroscopic examination in hanging cases could be very useful in confirming the vital character of the hanging and understanding asphyxial phenomena in incomplete suspension without laryngeal crush.

A novel variation of the recurrent laryngeal nerve.

PubMed

Wu, Gaosong; Wang, Kun

2017-06-02

Injury to the recurrent laryngeal nerve is one of the most severe complications of thyroid surgery. Several anatomic variations of the nerve increase the likelihood of iatrogenic damage. A 50-year-old woman was presented to our department with a nodule in the right thyroid lobe, and she reported no voice changes. She had no history of surgery or radiation to the head or neck. Fine-needle aspiration was recorded as papillary thyroid carcinoma. The preoperative laryngoscopy revealed left vocal cord paralysis. Right thyroid lobectomy was performed. A scarce course of the left recurrent laryngeal nerve was found during the operation that ascended along the medial edge of the superior thyroid pole and finally disappeared beneath the superior cornu of the thyroid cartilage without any tracheal, esophageal, or laryngeal branches. The patient was discharged on the third postoperative day with the diagnoses of papillary thyroid carcinoma and congenital left vocal cord paralysis. The novel variation of the recurrent laryngeal nerve may challenge the current concept of the anatomy of the nerve. The vocal folds mobility should be examined routinely before surgery in patients undergoing thyroid operation.

Inducible laryngeal obstruction during exercise: moving beyond vocal cords with new insights.

PubMed

Olin, James Tod; Clary, Matthew S; Deardorff, Emily H; Johnston, Kristina; Morris, Michael J; Sokoya, Mofiyinfolu; Staudenmayer, Herman; Christopher, Kent L

2015-02-01

Exercise as an important part of life for the health and wellness of children and adults. Inducible laryngeal obstruction (ILO) is a consensus term used to describe a group of disorders previously called vocal cord dysfunction, paradoxical vocal fold motion, and numerous other terms. Exercise-ILO can impair one's ability to exercise, can be confused with asthma, leading to unnecessary prescription of asthma controller and rescue medication, and results in increased healthcare resource utilization including (rarely) emergency care. It is characterized by episodic shortness of breath and noisy breathing that generally occurs at high work rates. The present diagnostic gold standard for all types of ILO is laryngoscopic visualization of inappropriate glottic or supraglottic movement resulting in airway narrowing during a spontaneous event or provocation challenge. A number of different behavioral techniques, including speech therapy, biofeedback, and cognitive-behavioral psychotherapy, may be appropriate to treat individual patients. A consensus nomenclature, which will allow for better characterization of patients, coupled with new diagnostic techniques, may further define the epidemiology and etiology of ILO as well as enable objective evaluation of therapeutic modalities.

21 CFR 874.1325 - Electroglottograph.

Code of Federal Regulations, 2014 CFR

2014-04-01

... the electrical impedance of the larynx to aid in assessing the degree of closure of the vocal cords, confirm larygeal diagnosis, aid behavioral treatment of voice disorders, and aid research concerning the...

21 CFR 874.1325 - Electroglottograph.

Code of Federal Regulations, 2012 CFR

2012-04-01

... the electrical impedance of the larynx to aid in assessing the degree of closure of the vocal cords, confirm larygeal diagnosis, aid behavioral treatment of voice disorders, and aid research concerning the...

21 CFR 874.1325 - Electroglottograph.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the electrical impedance of the larynx to aid in assessing the degree of closure of the vocal cords, confirm larygeal diagnosis, aid behavioral treatment of voice disorders, and aid research concerning the...

21 CFR 874.1325 - Electroglottograph.

Code of Federal Regulations, 2013 CFR

2013-04-01

... the electrical impedance of the larynx to aid in assessing the degree of closure of the vocal cords, confirm larygeal diagnosis, aid behavioral treatment of voice disorders, and aid research concerning the...

21 CFR 874.1325 - Electroglottograph.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the electrical impedance of the larynx to aid in assessing the degree of closure of the vocal cords, confirm larygeal diagnosis, aid behavioral treatment of voice disorders, and aid research concerning the...

Throat or larynx cancer

MedlinePlus

Vocal cord cancer; Throat cancer; Laryngeal cancer; Cancer of the glottis; Cancer of oropharynx or hypopharynx ... use tobacco are at risk of developing throat cancer. Drinking too much alcohol over a long time ...

Tracheostomy tube - speaking

MedlinePlus

... most of the air from passing through your vocal cords. Instead, your breath (air) goes out through your tracheostomy tube (trach). At the time of your surgery, the first trach tube will have a balloon ( ...

What's the Difference Between Vocal Cord Dysfunction and Asthma?

MedlinePlus

... of Privacy Practices Notice of Nondiscrimination Manage Cookies Advertising Mayo Clinic is a not-for-profit organization and proceeds from Web advertising help support our mission. Mayo Clinic does not ...

Hypnosis as a diagnostic modality for vocal cord dysfunction.

PubMed

Anbar, R D; Hehir, D A

2000-12-01

Vocal cord dysfunction (VCD) is a condition of paradoxical adduction of the vocal cords during the inspiratory phase of the respiratory cycle. VCD often presents as stridorous breathing, which may be misdiagnosed as asthma. The mismanagement of this disorder may result in unnecessary treatment and iatrogenic morbidity. An association with psychogenic factors has been reported, and a higher incidence of anxiety-related illness has been demonstrated in patients with VCD. Definitive diagnosis of VCD is made by visualization of adducted cords during an acute episode using nasopharyngeal fiber-optic laryngoscopy. Diagnosis can be problematic, because it may be difficult to reproduce an attack in a controlled setting. To maximize diagnostic yield during laryngoscopy, provocation of symptoms using methacholine, histamine, or exercise challenges have been used. We report a case of an 11-year-old boy, wherein hypnotic suggestion was used as an alternative method to achieve a diagnosis of VCD. The patient was admitted to the pediatric intensive care unit for elective fiber-optic laryngoscopy to confirm a diagnosis of VCD. The patient had a 4-year history of refractory asthma, severe gastroesophageal reflux disease (GERD) for which he had undergone a Nissen fundoplication, and suspected VCD. At 9 years of age the patient began manifesting monthly respiratory distress episodes of a severe character different from those that had been attributed to his asthma. Typically, he awoke from sleep with shortness of breath and difficulty with inhalation. He described a "neck attack" during which he felt as if the walls of his throat were "beating together." The patient was at times noted by his mother to exhibit a "suckling" behavior before onset of his respiratory distress episodes. On 4 occasions the patient became unconscious during an attack and then spontaneously regained consciousness after a few minutes. On these occasions, he was transported by ambulance to the hospital and the severe difficulty with inhalation resolved within a few minutes on treatment with oxygen and bronchodilators. Sometimes he was noted to manifest wheezing for several hours, which was responsive to bronchodilator therapy. Given the severity of the patient's disease, it was imperative to determine whether VCD was a complicating factor. It was proposed that an attempt be made to induce VCD by hypnotic suggestion while the patient underwent a fiberscopic laryngoscopy to establish a definitive diagnosis. The patient and his mother gave written consent for this procedure. He was admitted for observation to the pediatric intensive care unit for the induction attempt. The patient requested that no local anesthesia be applied in his nose before passage of the laryngoscope because he wanted to eat right after the procedure. Therefore, the nasopharyngeal laryngoscope was inserted while he used self-hypnosis as the sole form of anesthesia. He demonstrated no discomfort during its passing. Once the vocal cords were visualized, the patient was instructed to develop an episode of respiratory distress while in a state of hypnosis by recalling a recent "neck attack." His vocal cords then were observed to adduct anteriorly with each inspiration. The patient then was asked to relax his neck. When he did, the vocal cords immediately abducted with inspiration, and he breathed easily. After removal of the laryngoscope, the patient alerted from hypnosis and said he felt well. He reported no recollection of the procedure, thus demonstrating spontaneous amnesia that sometimes is associated with hypnosis. Because the diagnosis of VCD was confirmed, the patient was encouraged to use self-hypnosis and speech therapy techniques to control his symptoms. He also was referred for counseling. To our knowledge this is the first description in the medical literature of the use of hypnotic suggestion for making a diagnosis of VCD. (ABSTRACT TRUNCATED)

Spasmodic dysphonia

MedlinePlus

Medicine that treats spasm of the vocal cord muscles may be tried. They appear to work in up to one half of people, at best. Some of these medicines have bothersome side effects. Botulinum toxin (Botox) treatments may ...

Primary candidiasis and squamous cell carcinoma of the larynx: report of a case.

PubMed

Lee, Dong Hoon; Cho, Hyong Ho

2013-02-01

Primary candidiasis is rare and often confused with a pre-cancerous lesion, squamous cell carcinoma, or verrucous carcinoma. We report an extremely rare case of squamous cell carcinoma of the vocal cord following primary candidiasis. A 62-year-old man presented to our department reporting a 1-month history of hoarseness. He underwent laryngeal microscopic surgery for a presumptive diagnosis of glottic carcinoma. Histopathologic examination revealed candidiasis and scattered moderate dysplasia. He was treated with itraconazole for 4 weeks, and followed up without any recurrence of candidiasis. However, the 42-month follow-up examination revealed a focal whitish lesion on the right true vocal cord, and a repeat biopsy of this area revealed squamous cell carcinoma without evidence of candidiasis. The patient was treated with radiotherapy and remains well with no signs of tumor recurrence or candidiasis.

Efficacy of a Single Dose of Basic Fibroblast Growth Factor: Clinical Observation for 1 Year.

PubMed

Suzuki, Hirotaka; Makiyama, Kiyoshi; Hirai, Ryoji; Matsuzaki, Hiroumi; Furusaka, Toru; Oshima, Takeshi

2016-11-01

Basic fibroblast growth factor promotes wound healing by accelerating healthy granulation and epithelialization. However, the duration of the effects of a single intracordal injection of basic fibroblast growth factor has not been established, and administration intervals and timing have yet to be standardized. Here, we administered a single injection to patients with insufficient glottic closure and conducted follow-up examinations with high-speed digital imaging to determine the duration of the treatment response. Case series. For treatment, 20 µg/mL recombinant human basic fibroblast growth factor was injected into two vocal cords. The following examinations were performed before the procedure and at 3-month intervals for 12 months starting at 1 month postinjection: Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale assessment, maximum phonation time, acoustic analysis, high-speed digital imaging, glottal wave analysis, and kymographic analysis. Postinjection, the GRBAS scale score decreased, and the maximum phonation time was prolonged. In addition, the mean minimum glottal area and mean minimum glottal distance decreased. These changes were significant at 12 months postinjection compared with preinjection. However, there were no significant changes in the vibrations of the vocal cord margins. The intracordal injection of basic fibroblast growth factor improved insufficient glottic closure without reducing the vibrations of the vocal cord margins. This effect remained evident at 12 months postinjection. A single injection can be expected to yield a sufficient and persistent long-term effect. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test.

PubMed

Tay, Tunn Ren; Hoy, Ryan; Richards, Amanda L; Paddle, Paul; Hew, Mark

2017-03-01

Timely diagnosis of vocal cord dysfunction (VCD), more recently termed "inducible laryngeal obstruction," is important because VCD is often misdiagnosed as asthma, resulting in delayed diagnosis and inappropriate treatment. Visualization of paradoxical vocal cord movement on laryngoscopy is the gold standard for diagnosis, but is limited by poor test sensitivity. Provocation tests may improve the diagnosis of VCD, but the diagnostic performance of current tests is less than ideal. Alternative provocation tests are required. This pilot study demonstrates the feasibility of using inhaled mannitol for concurrent investigation of laryngeal and bronchial hyperresponsiveness. Consecutive patients with suspected VCD seen at our institution's asthma clinic underwent flexible laryngoscopy at baseline and following mannitol challenge. VCD was diagnosed on laryngoscopy based on inspiratory adduction, or >50% expiratory adduction of the vocal cords. Bronchial hyperresponsiveness after mannitol challenge was also assessed. We evaluated the interrater agreement of postmannitol laryngoscopy between respiratory specialists and laryngologists. Fourteen patients with suspected VCD in the context of asthma evaluation were included in the study. Mannitol provocation demonstrated VCD in three of the seven patients with normal baseline laryngoscopy (42.9%). Only two patients had bronchial hyperresponsiveness. There was substantial interrater agreement between respiratory specialists and laryngologists, kappa = 0.696 (95% confidence interval: 0.324-1) (P = 0.006). Inhaled mannitol can be used to induce VCD. It is well tolerated and can evaluate laryngeal and bronchial hyperresponsiveness at the same setting. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Readability and Understandability of Online Vocal Cord Paralysis Materials.

PubMed

Balakrishnan, Vini; Chandy, Zachariah; Hseih, Amy; Bui, Thanh-Lan; Verma, Sunil P

2016-03-01

Patients use several online resources to learn about vocal cord paralysis (VCP). The objective of this study was to assess the readability and understandability of online VCP patient education materials (PEMs), with readability assessments and the Patient Education Materials Evaluation Tool (PEMAT), respectively. The relationship between readability and understandability was then analyzed. Descriptive and correlational design. Online PEMs were identified by performing a Google search with the term "vocal cord paralysis." After scientific webpages, news articles, and information for medical professionals were excluded, 29 articles from the first 50 search results were considered. Readability analysis was performed with 6 formulas. Four individuals with different educational backgrounds conducted understandability analysis with the PEMAT. Fleiss's Kappa interrater reliability analysis determined consistency among raters. Correlation between readability and understandability was determined with Pearson's correlation test. The reading level of the reviewed articles ranged from grades 9 to 17. Understandability ranged from 29% to 82%. Correlation analysis demonstrated a strong negative correlation between materials' readability and understandability (r = -0.462, P < .05). Online PEMs pertaining to VCP are written above the recommended reading levels. Overall, materials written at lower grade levels are more understandable. However, articles of identical grade levels had varying levels of understandability. The PEMAT may provide a more critical evaluation of the quality of a PEM when compared with readability formulas. Both readability and understandability should be used to evaluate PEMs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Vocal cord paralysis post patent ductus arteriosus ligation surgery: risks and co-morbidities.

PubMed

Rukholm, Gavin; Farrokhyar, Forough; Reid, Diane

2012-11-01

1. To determine the prevalence of left vocal cord paralysis (LVCP) post patent ductus arteriosus (PDA) ligation at a Tertiary Care Centre. 2. To identify risk factors associated with LVCP. 3. To identify co-morbidities associated with LVCP. 4. To determine the frequency of pre- and post-operative nasopharyngolaryngoscopic (NPL) examination in this patient population. Retrospective chart review of all infants who underwent PDA ligation surgery at a tertiary care academic hospital between July 2003 and July 2010. Data on patient age, gender, weight, method of PDA ligation, and results of NPL scoping were collected, as well as patient co-morbidities post PDA ligation. One hundred and fifteen patients underwent PDA ligation surgery. Four patients were excluded due to bilateral vocal cord paralysis. Of the remaining 111 patients, nineteen patients (17.1%) were found to have LVCP. Low birth weight was identified as a significant risk factor for LVCP (p=0.002). Gastroesophageal reflux was identified as a significant co-morbidity associated with LVCP post PDA ligation (p=0.002). Only 0.9% of patients were scoped pre-operatively, and 27.9% were scoped postoperatively. LVCP is associated with multiple morbidities. The authors strongly recommend routine post-operative scoping of all patients post PDA ligation surgery, and preoperative scoping when possible. A prospective study is warranted, in order to confirm the prevalence of LVCP as well as risk factors and associated co-morbidities. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

Recurrent Laryngeal Nerve Injury and Swallowing Dysfunction in Neonatal Aortic Arch Repair.

PubMed

Pourmoghadam, Kamal K; DeCampli, William M; Ruzmetov, Mark; Kosko, James; Kishawi, Sami; O'Brien, Michael; Cowden, Amanda; Piggott, Kurt; Fakioglu, Harun

2017-11-01

We evaluated the incidence, clinical effect, and recovery rate of vocal cord dysfunction (VCD) and swallowing dysfunction in neonates undergoing aortic arch repair. We retrospectively evaluated 101 neonates who underwent aortic arch reconstruction from 2008 to 2015. Direct flexible laryngoscopy was performed in 89 patients before initiation of postoperative oral feeding after Norwood (n = 63) and non-Norwood (n = 26) arch reconstruction. We defined VCD as immobility of vocal cords or their lack of coaptation and poor mobility. The incidence of VCD after aortic arch repair was 48% (n = 43). There was no significant difference between the VCD and non-VCD groups in postoperative length of stay, extubation failure, cardiopulmonary bypass, cross-clamp, selective cerebral perfusion time, operative death, and The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) Congenital Heart Surgery Mortality Categories. Placement of gastrostomy (p = 0.03) and documented aspiration (p = 0.01) were significantly more common in VCD patients. The incidence of VCD was 41% (n = 26) after Norwood and 65% (n = 17) after non-Norwood repairs (p = 0.06). Gastrostomy was required in 44 Norwood patients vs 9 non-Norwood patients (p = 0.004). Median length of stay was similar in Norwood patients with or without VCD (p = .28) but was significantly longer in non-Norwood patients with VCD vs those without (p = 0.002). At follow-up direct flexible laryngoscopy, VCD recovery was 74% (14 of 19) in the Norwood group and 86% (12 of 14) in the non-Norwood group. The incidence of VCD and swallowing dysfunction in neonates undergoing aortic arch reconstruction is high. Patients with VCD have a significantly higher incidence of gastrostomy placement and aspiration. In the Norwood population, length of stay is not associated with presence or absence of VCD. More than 70% of patients in each group who had direct flexible laryngoscopy follow-up recovered vocal cord function. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Tremor

MedlinePlus

Tremors are unintentional trembling or shaking movements in one or more parts of your body. Most tremors occur in the hands. You can also have arm, head, face, vocal cord, trunk, and leg tremors. Tremors are most common in middle-aged and ...

[Does intraoperative nerve monitoring reduce the rate of recurrent nerve palsies during thyroid surgery?].

PubMed

Timmermann, W; Dralle, H; Hamelmann, W; Thomusch, O; Sekulla, C; Meyer, Th; Timm, S; Thiede, A

2002-05-01

Two different aspects of the influence of neuromonitoring on the possible reduction of post-operative recurrent laryngeal nerve palsies require critical examination: the nerve identification and the monitoring of it's functions. Due to the additional information from the EMG signals, neuromonitoring is the best method for identifying the nerves as compared to visual identification alone. There are still no randomized studies available that compare the visual and electrophysiological recurrent laryngeal nerve detection in thyroid operations with respect to the postoperative nerve palsies. Nevertheless, comparisons with historical collectives show that a constant low nerve-palsy-rate was achieved with electrophysiological detection in comparison to visual detection. The rate of nerve identification is normally very high and amounts to 99 % in our own patients. The data obtained during the "Quality assurance of benign and malignant Goiter" study show that in hemithyreoidectomy and subtotal resection, lower nerve-palsy-rates are achieved with neuromonitoring as compared to solely visual detection. Following subtotal resection, this discrepancy becomes even statistically significant. While monitoring the nerve functions with the presently used neuromonitoring technique, it is possible to observe the EMG-signal remaining constant or decreasing in volume. Assuming that a constant neuromonitoring signal represents a normal vocal cord, our evaluation shows that there is a small percentage of false negative and positive results. Looking at the permanent recurrent nerve palsy rates, this method has a specificity of 98 %, a sensitivity of 100 %, a positive prognostic value of 10 %, and a negative prognostic value of 100 %. Although an altered neuromonitoring signal can be taken as a clear indication of eventual nerve damage, an absolutely reliable statement about the postoperative vocal cord function is presently not possible with intraoperative neuromonitoring.

Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options.

PubMed

Zur, Karen B; Carroll, Linda M

2015-12-01

To establish the benefit of ansa cervicalis-recurrent laryngeal nerve reinnervation (ANSA-RLN) for the management of dysphonia secondary to unilateral vocal cord paralysis (UVCP) in children. Children treated with ANSA-RLN for the management of dysphonia secondary to unilateral vocal fold immobility will have superior acoustic, perceptual, and stroboscopic outcomes compared to injection laryngoplasty and observation. Retrospective case-series chart review. Laryngeal, perceptual, and acoustic analysis of dysphonia was performed in 33 children (age 2-16 years) diagnosed with UVCP. Comparison of pre-post function for treatment groups (no treatment, injection laryngoplasty, ANSA-RLN) with additional comparison between gestational ages, age at initial evaluation, and gender were examined. Perceptual measures included Pediatric Voice Handicap Index (pVHI) and Grade, Roughness, Breathiness, Asthenia, Strain (GBRAS) perceptual rating. Objective measures included semitone (ST) range, jitter%, shimmer%, noise-to-harmonic ratio, voicing, and maximum phonation time. Post-treatment, pVHI, jitter%, and ST were significantly improved for ANSA-RLN subjects compared to injection subjects. Improved function (laryngeal diadochokinesis, pVHI, GRBAS, and/or acoustic) was observed in all ANSA-RLN subjects who had vocal fold paralysis as the only laryngeal diagnosis. This study presents one of the largest studies of pediatric vocal fold paralysis diagnosis and treatment. The study looks at the spectrum of function in patients with UVCP and looks at the outcomes of options: no treatment, injection laryngoplasty, and ANSA-RLN. Although surgical outcomes vary, both injection laryngoplasty and ANSA-RLN show benefit in laryngeal function, voice stability, voice capacity, perceptual rating, and pVHI scores. Both injection laryngoplasty and ANSA-RLN showed improvements post-treatment, and should be considered for management of pediatric UVCP. However, the ANSA-RLN group showed better and longer-lasting perceptual and acoustic parameters in comparison with the injection and control groups. Reinnervation, even long term after the onset of vocal fold paralysis, should be considered a viable permanent treatment for pediatric UVCP. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Intraoperative Recurrent Laryngeal Nerve Monitoring in a Patient with Contralateral Vocal Fold Palsy.

PubMed

Na, Bub-Se; Choi, Jin-Ho; Park, In Kyu; Kim, Young Tae; Kang, Chang Hyun

2017-10-01

Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.

Phonological outcome of laryngeal framework surgery by different anesthesia protocols: a single-surgeon experience.

PubMed

Kanazawa, Takeharu; Watanabe, Yusuke; Komazawa, Daigo; Indo, Kanako; Misawa, Kiyoshi; Nagatomo, Takafumi; Shimada, Mari; Iino, Yukiko; Ichimura, Keiichi

2014-02-01

Similar to combined arytenoid adduction and medialization laryngoplasty (i.e. combined surgery) under local anesthesia, general anesthesia by intubation or by the laryngeal mask airway (LMA) method significantly improves phonological outcome. Thus, laryngeal framework surgery under general anesthesia is a promising surgical approach for selected patients with unilateral vocal cord paralysis (UVCP). The advantages of laryngeal framework surgery under local anesthesia have been described, but no studies exist concerning the difference in phonological outcome of laryngeal framework surgery performed under general anesthesia. To add new information, we retrospectively investigated the phonological outcome of the combined surgery performed under three different anesthesia protocols. Thirty-nine consecutive patients with severe UVCP underwent the combined surgery under three anesthesia protocols performed by a single surgeon: (1) under general anesthesia by intubation, (2) under general anesthesia using LMA, and (3) under local anesthesia. Under all anesthesia protocols, the vocal cords of most patients could be positioned such that the best vocal outcome could be expected. Statistical analyses demonstrated improved maximum phonation time and mean airflow rate, and grade, roughness, breathiness, asthenia, and strain (GRBAS) scale in all patients, regardless of their anesthesia protocol. Furthermore, of the three protocols, local anesthesia had the shortest operation time.

Meconium concentration and amniotic fluid index influence the outcome of amnioinfusion.

PubMed

Puertas, A; Carrillo, M P; çlvarez, M; Cañizares, J M; Miño, M; Malde, J

2001-10-01

To determine the usefulness of amnioinfusion as a function of meconium concentration and amniotic fluid index. This was a prospective study of 206 pregnant women in whom amniotic fluid was moderately or heavily stained with meconium, according to subjective evaluation. The women were assigned randomly to receive amnioinfusion (n=103) or no amnioinfusion (control group, n=103). The results were compared in women with =/<15 % or >15 % meconium in the amniotic fluid (measured by centrifugation), and in women in whom the amniotic fluid index calculated 60 min after insertion of the amnioinfusion catheter was <10 or =/>10. In women with >15% meconium, amnioinfusion decreased the rate of cesarian sections motivated by fetal distress (2.5% vs 22.2%), and in women with =/<15% meconium, amnioinfusion decreased the presence of meconium below the vocal cords (6.4% vs 25.9%). Greater benefits after amnioinfusion were seen in women with an amniotic fluid index =/>10: the rate of cesarian sections was lower (1.3% vs 13.3%), as was the frequency of meconium below the vocal cords (10.1% vs 33.3%). Beneficial effects of amnioinfusion were seen in women with high and low concentrations of meconium, and with high and low amniotic fluid indexes. These criteria should therefore not be used to decide whether amnioinfusion is indicated when the amniotic fluid is moderately or heavily stained with meconium.

Parathyroid gland removal

MedlinePlus

... nerves going to the muscles that move your vocal cords. You may have a hoarse or weaker voice which could be temporary or permanent. Difficulty breathing. This is very rare and almost always goes away several weeks or months after surgery.

Delayed Unilateral Soft Palate Palsy without Vocal Cord Involvement after Microvascular Decompression for Hemifacial Spasm

PubMed Central

Park, Jae Han; Jo, Kyung Il

2013-01-01

Microvascular decompression is a very effective and relatively safe surgical modality in the treatment of hemifacial spasm. But rare debilitating complications have been reported such as cranial nerve dysfunctions. We have experienced a very rare case of unilateral soft palate palsy without the involvement of vocal cord following microvascular decompression. A 33-year-old female presented to our out-patient clinic with a history of left hemifacial spasm for 5 years. On postoperative 5th day, patient started to exhibit hoarsness with swallowing difficulty. Symptoms persisted despite rehabilitation. Various laboratory work up with magnetic resonance image showed no abnormal lesions. Two years after surgery patient showed complete recovery of unitaleral soft palate palsy. Various etiologies of unilateral soft palate palsy are reviewed as the treatment and prognosis differs greatly on the cause. Although rare, it is important to keep in mind that such complication could occur after microvascular decompression. PMID:24003372

Simultaneous use of intrapartum fetal pulse oximetry and amnioinfusion in meconium stained amniotic fluid.

PubMed

Halvax, László; Szabó, István; Vizer, Miklós; Csermely, Tamás; Ertl, Tibor

2002-09-10

Fetal pulse oximetry is a minimally invasive, simple technique which continuously helps to reflect in utero well-being. The presence of meconium in the amniotic fluid may be a clinical sign of fetal hypoxaemia. Amnioinfusion has a beneficial effect on the incidence of meconium aspiration syndrome (MAS), and the presence of meconium below the level of the vocal cords. We studied the impact of amnioinfusion combined with fetal pulse oximetry on the incidence of meconium aspiration syndrome and operative delivery. The retrospective analysis revealed that the presence of meconium below the level of vocal cords was significantly reduced. The frequency of cesarean section is decreased, however, it did not reach statistical significance. Fetal pulse oximetry may be used in combination with amnioinfusion and cardiotocography (CTG) to reduce the risk of meconium aspiration syndrome and the number of instrumental deliveries and improve perinatal outcome. Copyright 2002 Elsevier Science Ireland Ltd.

An Overview of Laryngeal Muscle Single Fiber Electromyography.

PubMed

Bertorini, Tulio E; Sharaf, Aboubakar G

2015-08-01

Needle electromyography is an important tool in the diagnosis of neuromuscular diseases and has also been applied successfully in the evaluation of the vocal cord paralysis. Laryngeal electromyography, initially described by Weddell, is used to determine the cause of vocal cord paralysis and to differentiate organic from nonorganic causes of speech disorders. This test allows the diagnosis of lower motor neuron and nerve paralysis as well as myopathies. Laryngeal electromyography also helps to determine the prognosis of paralysis caused by traumatic injury of the laryngeal nerves and is used for guidance during botulinum toxin injection in spasmodic dysphonias. Single fiber electromyography is used to diagnose abnormalities of neuromuscular transmission and is applied in the study the architecture of the motor unit in muscles. This article reviews the techniques of laryngeal muscles single fiber electromyography, provides limited informative data, and discusses its potential value in the evaluation of patients with dysphonia.

Sports Ultrasound: Applications Beyond the Musculoskeletal System.

PubMed

Finnoff, Jonathan T; Ray, Jeremiah; Corrado, Gianmichael; Kerkhof, Deanna; Hill, John

2016-09-01

Traditionally, ultrasound has been used to evaluate musculoskeletal injuries in athletes; however, ultrasound applications extend well beyond musculoskeletal conditions, many of which are pertinent to athletes. Articles were identified in PubMed using the search terms ultrasound, echocardiogram, preparticipation physical examination, glycogen, focused assessment with sonography of trauma, optic nerve, and vocal cord dysfunction. No date restrictions were placed on the literature search. Clinical review. Level 4. Several potential applications of nonmusculoskeletal ultrasound in sports medicine are presented, including extended Focused Assessment with Sonography for Trauma (eFAST), limited echocardiographic screening during preparticipation physical examinations, assessment of muscle glycogen stores, optic nerve sheath diameter measurements in athletes with increased intracranial pressure, and assessment of vocal cord dysfunction in athletes. Ultrasound can potentially be used to assist athletes with monitoring their muscle glycogen stores and the diagnosis of multiple nonmusculoskeletal conditions within sports medicine. © 2016 The Author(s).

Autonomic neuropathy resulting in recurrent laryngeal nerve palsy in an HIV patient with Hodgkin lymphoma receiving vinblastine and antiretroviral therapy.

PubMed

Cherif, S; Danino, S; Yoganathan, K

2015-03-01

Hoarseness of voice due to vocal cord paresis as a result of recurrent laryngeal nerve palsy has been well recognised. Recurrent laryngeal nerve palsy is commonly caused by compression due to tumour or lymph nodes or by surgical damage. Vinca alkaloids are well known to cause peripheral neuropathy. However, vinca alkaloids causing recurrent laryngeal nerve palsy has been reported rarely in children. We report a case of an adult patient with HIV who developed hoarseness of voice due to vocal cord paralysis during vinblastine treatment for Hodgkin lymphoma. Mediastinal and hilar lymph node enlargement in such patients may distract clinicians from considering alternative causes of recurrent laryngeal nerve palsy, with potential ensuing severe or even life-threatening stridor. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Transoral robotic surgery of the vocal cord.

PubMed

Blanco, Ray Gervacio F; Ha, Patrick K; Califano, Joseph A; Saunders, John M

2011-03-01

The standard endoscopic surgical approach in the management of laryngeal lesions is by the use of a laryngoscope, microscope, and laser. This requires the surgeon to work within the confines of the laryngoscope. At times, it requires repositioning of the laryngoscope and microscope to gain access to a specific area. The surgery also requires line-of-sight observation to complete the operation. The introduction of transoral robotic surgery in head and neck surgery brings the advantages of three-dimensional magnification, increased degrees of freedom with the effector arms, and an articulating distal end that mimics hand movements. To date, transoral robotic surgery of vocal cord surgery requires the use of a tracheostomy in patients. Here we report the use of a CO(2) laser fiber and the Da Vinci robotic platform (Intuitive Surgical) for the surgical management of a T1 glottic squamous cell carcinoma.

Learning to detect vocal hyperfunction from ambulatory neck-surface acceleration features: initial results for vocal fold nodules.

PubMed

Ghassemi, Marzyeh; Van Stan, Jarrad H; Mehta, Daryush D; Zañartu, Matías; Cheyne, Harold A; Hillman, Robert E; Guttag, John V

2014-06-01

Voice disorders are medical conditions that often result from vocal abuse/misuse which is referred to generically as vocal hyperfunction. Standard voice assessment approaches cannot accurately determine the actual nature, prevalence, and pathological impact of hyperfunctional vocal behaviors because such behaviors can vary greatly across the course of an individual's typical day and may not be clearly demonstrated during a brief clinical encounter. Thus, it would be clinically valuable to develop noninvasive ambulatory measures that can reliably differentiate vocal hyperfunction from normal patterns of vocal behavior. As an initial step toward this goal we used an accelerometer taped to the neck surface to provide a continuous, noninvasive acceleration signal designed to capture some aspects of vocal behavior related to vocal cord nodules, a common manifestation of vocal hyperfunction. We gathered data from 12 female adult patients diagnosed with vocal fold nodules and 12 control speakers matched for age and occupation. We derived features from weeklong neck-surface acceleration recordings by using distributions of sound pressure level and fundamental frequency over 5-min windows of the acceleration signal and normalized these features so that intersubject comparisons were meaningful. We then used supervised machine learning to show that the two groups exhibit distinct vocal behaviors that can be detected using the acceleration signal. We were able to correctly classify 22 of the 24 subjects, suggesting that in the future measures of the acceleration signal could be used to detect patients with the types of aberrant vocal behaviors that are associated with hyperfunctional voice disorders.

Vocal cord dysfunction in former World Trade Center (WTC) rescue and recovery workers and volunteers.

PubMed

de la Hoz, Rafael E; Shohet, Michael R; Bienenfeld, Laura A; Afilaka, Aboaba A; Levin, Stephen M; Herbert, Robin

2008-03-01

Vocal cord dysfunction (VCD) is a condition characterized by paradoxical partial adduction of the vocal cords on inspiration. It has been associated with exposures to irritants, as well as with psychological illnesses and conditions. Workers who participated in the recovery of the WTC disaster site were exposed to a large amount of irritants as well as considerable psychological stressors. We describe the clinical characteristics of 10 symptomatic former WTC workers diagnosed with this condition, as well as the frequency of spirometric findings suggestive of variable extrathoracic obstruction. Workers who became symptomatic after their WTC work experience have been evaluated clinically by a multidisciplinary team at an academic medical center. The evaluation included history, physical examination, chest radiograph, blood tests, and pre- and post-bronchodilator spirometry in all patients. Additional evaluations and diagnostic tests included otolaryngological evaluation with flexible rhinolaryngoscopy and stroboscopy, gastroenterological and psychiatric evaluations. A randomly selected sample of 172 spirometry results were reviewed for evidence of inspiratory flow limitation. Variable extrathoracic obstruction was found in 18.6% of the spirometries. Ten patients were diagnosed with VCD. In addition to symptoms suggestive of co-morbid conditions (particularly rhinitis and acid reflux disease), most of the 10 patients had (1) hoarseness, (2) dyspnea that was not associated with bronchial hyperreactivity, or (3) dyspnea associated with asthma, with either mild bronchial hyperreactivity and/or poor response to asthma treatment. VCD appears to be part of the spectrum of airway disorders caused by occupational exposures at the WTC disaster site. Further study of this association is warranted.

What Is Vocal Cord Dysfunction (VCD)?

MedlinePlus

... from asthma, VCD, or both at the same time. Am J Respir Crit Care Med Vol. 180, P5-P6, 2009. Online Version Updated September 2013 ATS Patient Education Series © 2009 American Thoracic Society www.thoracic.org ATS ...

Anatomical study of the final common pathway for vocalization in the cat

NASA Technical Reports Server (NTRS)

Holstege, Gert

1989-01-01

Results are presented of an anatomical study of the neuronal pathways in the cat, via which the periaqueductal gray (PAG) produces excitation of motoneurons involved in vocalization. It is shown that a specific cell group in the lateral part of the caudal PAG and in the tegmentum just lateral to it projects bilaterally to the nucleus retroambiguus (NRA) in the caudal medulla oblongata. Neurons in the NRA in turn project, via a contralateral pathway through the ventral funiculus of the spinal cord, to the motoneuronal cell groups innervating intercostal and abdominal muscles. In the brainstem, the NRA neurons project to the motoneuronal cell groups innervating mouth-opening and perioral muscles as well as to motoneurons innervating the pharynx, soft palate, and tongue. These results indicate that the projections from PAG via NRA to vocalization motoneurons form the final common pathway in vocalization.

Voice and endocrinology

PubMed Central

Hari Kumar, K. V. S.; Garg, Anurag; Ajai Chandra, N. S.; Singh, S. P.; Datta, Rakesh

2016-01-01

Voice is one of the advanced features of natural evolution that differentiates human beings from other primates. The human voice is capable of conveying the thoughts into spoken words along with a subtle emotion to the tone. This extraordinary character of the voice in expressing multiple emotions is the gift of God to the human beings and helps in effective interpersonal communication. Voice generation involves close interaction between cerebral signals and the peripheral apparatus consisting of the larynx, vocal cords, and trachea. The human voice is susceptible to the hormonal changes throughout life right from the puberty until senescence. Thyroid, gonadal and growth hormones have tremendous impact on the structure and function of the vocal apparatus. The alteration of voice is observed even in physiological states such as puberty and menstruation. Astute clinical observers make out the changes in the voice and refer the patients for endocrine evaluation. In this review, we shall discuss the hormonal influence on the voice apparatus in normal and endocrine disorders. PMID:27730065

Vocal cord paralysis in children.

PubMed

King, Ericka F; Blumin, Joel H

2009-12-01

Vocal fold paralysis (VFP) is an increasingly commonly identified problem in the pediatric patient. Diagnostic and management techniques honed in adult laryngologic practice have been successfully applied to children. Iatrogenic causes, including cardiothoracic procedures, remain a common cause of unilateral VFP. Neurologic disorders predominate in the cause of bilateral VFP. Diagnosis with electromyography is currently being evaluated in children. Treatment of VFP is centered around symptomology, which is commonly divided between voice and airway concerns. Speech therapy shows promise in older children. Surgical management for unilateral VFP with injection laryngoplasty is commonly performed and well tolerated. Laryngeal reinnervation is currently being applied to the pediatric population as a permanent treatment and offers several advantages over laryngeal framework procedures. For bilateral VFP, tracheotomy is still commonly performed. Glottic dilation procedures are performed both openly and endoscopically with a high degree of success. VFP is a well recognized problem in pediatric patients with disordered voice and breathing. Some patients will spontaneously recover their laryngeal function. For those who do not, a variety of reliable techniques are available for rehabilitative treatment.

FDG-PET/CT can rule out malignancy in patients with vocal cord palsy.

PubMed

Thomassen, Anders; Nielsen, Anne Lerberg; Lauridsen, Jeppe Kiilerich; Blomberg, Björn Alexander; Hess, Søren; Petersen, Henrik; Johansen, Allan; Asmussen, Jon Thor; Sørensen, Jesper Roed; Johansen, Jørgen; Godballe, Christian; Høilund-Carlsen, Poul Flemming

2014-01-01

The aim was to investigate the performance of (18)F-fluorodeoxyglucose PET/CT to rule out malignancy in patients with confirmed vocal cord palsy (VCP). Between January 2011 and June 2013, we retrospectively included consecutive patients referred to PET/CT with paresis or paralysis of one or both vocal cords. PET/CT results were compared to clinical workup and histopathology. The study comprised 65 patients (32 females) with a mean age of 66±12 years (range 37-89). Eleven patients (17%) had antecedent cancer. Twenty-seven (42%) were diagnosed with cancer during follow-up. The palsy was right-sided in 24 patients, left-sided in 37, and bilateral in 4. Median follow-up was 7 months (interquartile range 4-11 months). Patients without cancer were followed for at least three months. PET/CT suggested a malignancy in 35 patients (27 true positives, 8 false positives) and showed none in 30 (30 true negatives, 0 false negatives). Thus, the sensitivity, specificity, positive and negative predictive values, and accuracy were (95% confidence intervals in parenthesis): 100% (88%-100%), 79% (64%-89%), 77% (61%-88%), 100% (89%-100%), and 88% (78%-94%), respectively. Sixteen patients had palliative treatment, while 11 were treated with curative intent, emphasising the severity of VCP and the need for a rapid and accurate diagnostic work-up. In this retrospective survey, biopsy proven malignancy (whether newly diagnosed or relapsed) was the cause of VCP in almost half of patients (42%). PET/CT had a high sensitivity (100%) with a relatively high false positive rate, but was excellent in ruling out malignancy (negative predictive value 100%).

Robot-assisted transnasal laryngoplasty in cadaveric models: Quantifying forces and identifying challenges.

PubMed

Groom, Kelly; Wang, Long; Simaan, Nabil; Netterville, James

2015-05-01

We expanded our prior work with transnasal robotic surgery (TNRS) in this study with the following aims: 1) use a cadaveric model to evaluate the feasibility of laryngoplasty with TNRS, 2) measure robot insertion times and forces, and 3) identify operational challenges to further guide the development of a flexible robotic system. Cadaveric study. A 5-mm robot was guided to the larynx via a transnasal approach. Insertion times and forces using TNRS and a 4-mm flexible fiberoptic laryngoscope (FFL) were measured. Target sites on the true vocal cords were marked, and the TNRS was telemanipulated to perform injection laryngoplasty. Insertion times averaged 5.05 seconds (range, 3.8-10.4 seconds) for the TNRS and 7.97 seconds (range, 6.2-11.6 seconds) for the FFL. Insertion forces averaged 2.06 newtons (range, 1.56-5.55 newtons) for the TNRS and 0.43 newtons (range, 0.157-1.138 newtons) for the FFL. The unpaired t test between times and forces revealed P values of .0024 and .0000658, respectively. Seven target injection sites on three vocal cords in two cadaveric larynxes were successfully injected. In two out of nine sites marked, we were unable to access the vocal cord due tongue base collapse that obscured the posterior airway. TNRS is able to effectively access the larynx, although in a supine model may be limited by tongue base collapse. Forces with TNRS were significantly higher than with the FFL, albeit within the same scale. Despite increased forces, there was no evidence of tissue trauma using TNRS. NA Laryngoscope, 125:1166-1168, 2015. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Intraoperative Mapping and Monitoring for Rootlets of the Lower Cranial Nerves Related to Vocal Cord Movement.

PubMed

Wanibuchi, Masahiko; Akiyama, Yukinori; Mikami, Takeshi; Komatsu, Katsuya; Sugino, Toshiya; Suzuki, Kengo; Kanno, Aya; Ohtaki, Shunya; Noshiro, Shouhei; Mikuni, Nobuhiro

2016-06-01

Damage to the motor division of the lower cranial nerves that run into the jugular foramen leads to hoarseness, dysphagia, and the risk of aspiration pneumonia; therefore, its functional preservation during surgical procedures is important. Intraoperative mapping and monitoring of the motor rootlets at the cerebellomedullary cistern using endotracheal tube electrodes is a safe and effective procedure to prevent its injury. To study the location of the somatic and autonomic motor fibers of the lower cranial nerves related to vocal cord movement. Twenty-four patients with pathologies at the cerebellopontine lesion were studied. General anesthesia was maintained with fentanyl and propofol. A monopolar stimulator was used at amplitudes of 0.05 to 0.1 mA. Both acoustic and visual signals were displayed as vocalis muscle electromyographic activity using endotracheal tube surface electrodes. The average number of rootlets was 7.4 (range, 5-10); 75% of patients had 7 or 8 rootlets. As many as 6 rootlets (2-4 in most cases) were responsive in each patient. In 23 of the 24 patients, the responding rootlets congregated on the caudal side. The maximum electromyographic response was predominantly in the most caudal or second most caudal rootlet in 79%. The majority of motor fibers of the lower cranial nerves run through the caudal part of the rootlets at the cerebellomedullary cistern, and the maximal electromyographic response was elicited at the most caudal or second most caudal rootlet. EMG, electromyographic.

Inhaled particle deposition in unsteady-state respiratory flow at a numerically constructed model of the human larynx.

PubMed

Takano, Hiroshi; Nishida, Naohiro; Itoh, Masayuki; Hyo, Noboru; Majima, Yuichi

2006-01-01

To evaluate the clinical effectiveness of aerosol therapy for the lower and upper respiratory airways, particle deposition at the human laryngeal region has been analyzed with various unsteady-state respiratory flow-patterns. The flow profiles and trajectory of aerosol particles were calculated by 3-D thermo-fluid analysis of a finite volume method (FVM) with 8-CPUs parallel computational system. A reconstructed physical model of the real laryngeal airways was modified from 3-D CAM modeling function of Rhinoceros based on the images of Magnetic Resonance Imaging (MRI). By using 104 MRI images taken vertically and horizontally at intervals of 2 mm on the oral cavity and the pharynx-larynx respectively, 3-D physical model of the laryngeal airways was obtained. The numerical results of flow profile analyzed by the unsteady-state respiration model showed that vortex flow was occurred with time at near larynx, showing uniform flow profile in both the oral cavity and upper side of pharynx. The vortex was appeared at the anterior part of the epiglottis and downward of the vocal cord. However, it was confirmed that few particles deposit in the vocal cord. In these cases, the particle deposition was taken place mostly at the oral cavity and the oropharynx. On the other hand, the relationship between the particle deposition efficiency and the impaction in the laryngeal region was well agreement with the data sets of ICRP task group (1993) for the larynx deposition.

Mass psychogenic illness: psychological predisposition and iatrogenic pseudo-vocal cord dysfunction and pseudo-reactive airways disease syndrome.

PubMed

Staudenmayer, Herman; Christopher, Kent L; Repsher, Lawrence; Hill, Ronald H

2011-06-01

A multidisciplinary team assessed five patients who alleged chronic medically unexplained multiorgan system symptoms described by idiopathic environmental intolerance allegedly triggered by exposure to solvents used in membrane roofing repair work on an office building. The event precipitated an incident of mass psychogenic illness (MPI). Treating physicians diagnosed irritant-associated vocal cord dysfunction (IVCD) and reactive airways disease syndrome (RADS) resulting from exposure. The authors conducted medical, psychological, and industrial hygiene evaluations. Air monitoring data for total volatile organic compounds obtained during the 2-day exposure period, measurements of emissions during membrane roofing repair at a similar site, mathematical modeling of air contaminant concentrations, and injection of tracer gas into the incident building revealed exposure levels well below those doses anticipated to cause clinical symptoms. There was no objective medical evidence validating symptoms. Review of the medical records indicated that the video laryngoscopy data, pulmonary function tests, and medical examinations relied upon by the treating physicians were inconsistent with published criteria for IVCD and RADS. Psychological evaluation identified defensiveness and self-serving misrepresentations of exaggerated health concerns associated with somatization and malingering. Each case had personality traits associated with at least one personality disorder. Social histories identified premorbid life events and stressors associated with distress. This is the first study to assess psychological predisposition, social interaction among the plaintiffs, and iatrogenic reinforcement of beliefs by diagnoses of pseudo-disorders associated with patient misrepresentation of exaggerated health concerns in an incident of MPI.

Perioperative practices in thyroid surgery: An international survey.

PubMed

Maniakas, Anastasios; Christopoulos, Apostolos; Bissada, Eric; Guertin, Louis; Olivier, Marie-Jo; Malaise, Jacques; Ayad, Tareck

2017-07-01

Perioperative practices in thyroid surgery vary from one specialty, institution, or country to the next. We evaluated the preoperative, intraoperative, and postoperative practices of thyroid surgeons focusing on preoperative ultrasound, vocal cord evaluation, wound drains, and hospitalization duration, among others. A survey was sent to 7 different otolaryngology and endocrine/general surgery associations. There were 965 respondents from 52 countries. Surgeon-performed ultrasound is practiced by more than one third of respondents. Otolaryngologists perform preoperative and postoperative vocal cord evaluation more often than endocrine/general surgeons (p < .001). Sixty percent of respondents either never place drains or place drains <50% of the time in thyroid lobectomies (43% for total thyroidectomies). Outpatient thyroid surgery is most frequently performed by surgeons in the United States (63%). This epidemiologic study is the first global thyroid survey of its kind and clearly demonstrates the variability and evolving trends in thyroid surgery. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1296-1305, 2017. © 2017 Wiley Periodicals, Inc.

Soft tissue effects of the THC:YAG laser on canine vocal cords.

PubMed

Kay, S L; Oz, M C; Haber, M; Blitzer, A; Treat, M R; Trokel, S L

1992-09-01

Recently, a laser based on a thulium-holmium-chromium (THC) doped Yttrium-aluminum-garnet (YAG) rod has been developed that produces light of 2.15 microns wavelength and can be transmitted through a low OH- silica fiberoptic cable. This wavelength falls on one of the peaks of the energy absorption spectrum of water. Thus, the THC:YAG laser eliminates the disadvantage of a cumbersome delivery system found in the CO2 laser while still providing precise cutting and minimal tissue injury inherent in lasers emitting light absorbed by water. We evaluated the soft tissue effects of this laser on canine vocal cords. Ablative lesions were produced by the THC:YAG laser and histologically examined on postoperative days 1, 7, and 28. Results indicate that the depth of tissue penetration is easily controlled and the healing response to tissue injury is comparable to that of the CO2 laser. The THC:YAG laser should prove to be a superior laser for use in otorhinolaryngology, especially when adapted to a flexible endoscope.

Brainstem origins for cortical 'what' and 'where' pathways in the auditory system.

PubMed

Kraus, Nina; Nicol, Trent

2005-04-01

We have developed a data-driven conceptual framework that links two areas of science: the source-filter model of acoustics and cortical sensory processing streams. The source-filter model describes the mechanics behind speech production: the identity of the speaker is carried largely in the vocal cord source and the message is shaped by the ever-changing filters of the vocal tract. Sensory processing streams, popularly called 'what' and 'where' pathways, are well established in the visual system as a neural scheme for separately carrying different facets of visual objects, namely their identity and their position/motion, to the cortex. A similar functional organization has been postulated in the auditory system. Both speaker identity and the spoken message, which are simultaneously conveyed in the acoustic structure of speech, can be disentangled into discrete brainstem response components. We argue that these two response classes are early manifestations of auditory 'what' and 'where' streams in the cortex. This brainstem link forges a new understanding of the relationship between the acoustics of speech and cortical processing streams, unites two hitherto separate areas in science, and provides a model for future investigations of auditory function.

Rehabilitation approaches to dysphagia that was developed for a patient who attempted to commit suicide by hanging: a case report.

PubMed

Kii, Y; Mizuma, M

2014-04-01

We report our experience with a case of attempted suicidal hanging presenting with dysphagia, in which rehabilitation approaches resulted in improvement. A 36-year-old man was discovered collapsed at home. From the finding of a broken cord nearby, attempted suicide by hanging was suspected. He was transported to hospital after 40 minutes, and regained consciousness after emergency treatment. There were no noteworthy findings on brain magnetic resonance imaging, cervical spine computed tomography, or vocal cord examination. There were no noteworthy psychiatric disorders or cognitive abnormalities. On hospital day 10, he showed signs of dysphagia. Videofluoroscopic examination of swallowing revealed piriform sinuses residue and aspiration after ingestion of jelly in any posture. Rehabilitation approaches were started based on the diagnosis of dysphagia due to impaired transit through the piriform sinuses. The patient achieved independent oral intake by 40 days after the injury. In this case, dysphagia was considered attributable to compression of the vagus nerves running along the lateral aspects of the neck by the cord used in the hanging. If compression is brief, full functional recovery can be expected. Implementation of rehabilitation approaches is also important in this situation.

Preliminary clinical results of pulsed-dye laser therapy for recurrent respiratory papillomatosis

NASA Astrophysics Data System (ADS)

McMillan, Kathleen; Shapshay, Stanley M.; McGilligan, J. A.; Wang, Zhi; Rebeiz, Elie E.

1998-07-01

Recurrent respiratory papillomatosis (RRP) is a viral disease characterized by the growth of benign tumors on the vocal cords. Standard management of RRP currently consists of CO2 laser microsurgical ablation of the papillomas. Because of the recurrent nature of this disease, patients are often faced with significant cumulative risk of soft tissue complications such as vocal cord scarring. As a minimally traumatic alternative to management of RRP, we have investigated the use of the 585 nm pulsed dye laser (PDL) to cause regression of the papillomas by selective eradication of the tumor microvasculature. Three patients have been treated with the PDL at fluences of 6 J/cm2 (double pulses per irradiated site), 8 J/cm2 (single pulses), and 10 J/cm2 (single pulses), at noncritical areas within the larynx, using a specially designed micromanipulator. Lesions on the true cords were treated with the CO2 laser. Clinical examination showed that PDL treatment appeared to produce complete regression of papillomas. Unlike the sites of lesions treated by the CO2 laser, the epithelial surface at the PDL treatment sites was preserved intact. The presumed mechanism for papilloma regression following PDL treatment involves acute or chronic localized hypoxia caused by loss of tumor microvasculature.

Microscopie non-lineaire pour l'imagerie des cordes vocales

NASA Astrophysics Data System (ADS)

Deterre, Romain

The vocal cords are two folds of epithelial tissues located in the larynx and are involved in production of the human voice. Despite their apparent simplicity, their internal structure is complex. Each fold can be divided into several layers with different mechanical properties. The gold standard for studying their structure - histology - has the inconvenience of being very invasive. Non-linear microscopy is an optical imaging technique which allows images to be taken in depth within samples in a non invasive manner. It also offers intrinsic contrasts, allowing the identification of certain fibrous proteins - elastin and collagen - which are responsible for the mechanical properties of epithelious tissues. The main goal of this research project was to assess nonlinear microscopy's performances for vocal fold imaging. The study has been broken down in two separate tasks. The first one was to evaluate the nonlinear modalities contrast against histology. For that purpose, we chose to first take images of thin samples and compare them to the corresponding histological slides. The second task was to make tests to transcribe the results obtained to in vivo imaging. A custom-built nonlinear imaging system was used for these experiments. It was developed to allow acquisition of wide-field images. A C++ based software was developped to control the microscope and allow treatment and visualization of the images. After being built, the system was further tested to check its performances in comparison with the theoretical limit as described in the literature. Thin slices of vocal folds were obtained from the team of Pr Christopher J. Hartnick from Massachusetts Eye and Ear Infirmary, Harvard Medical School. Specialists from his team analysed the histological samples to extract structural data from the vocal folds. A good correlation was measured between histological and nonlinear data. A first step in evaluating the possibility for translating these results towards in vivo imaging was performed during this project. A swine's larynx was obtained, and vocal folds were extracted for imaging purposes. This experiment showed that it is indeed possible to localize various macrostructures of the tissues with nonlinear microscopy.

Vocal fold immobility: a longitudinal analysis of etiology over 20 years.

PubMed

Rosenthal, Laura H Swibel; Benninger, Michael S; Deeb, Robert H

2007-10-01

To determine the current etiology of vocal fold immobility, identify changing trends over the last 20 years, and compare results to historical reports. The present study is a retrospective analysis of all patients seen within a tertiary care institution between 1996 and 2005 with vocal fold immobility. The results were combined with a previous study of patients within the same institution from 1985 through 1995. Results were compared to the literature. The medical records of all patients assigned a primary or additional diagnostic code for vocal cord paralysis were obtained from the electronic database. Eight hundred twenty-seven patients were available for analysis (435 from the most recent cohort), which is substantially larger than any reported series to date. Vocal fold immobility was most commonly associated with a surgical procedure (37%). Nonthyroid surgeries (66%), such as anterior cervical approaches to the spine and carotid endarterectomies, have surpassed thyroid surgery (33%) as the most common iatrogenic causes. These data represent a change from historical figures in which extralaryngeal malignancies were considered the major cause of unilateral immobility. Thyroidectomy continues to cause the majority (80%) of iatrogenic bilateral vocal fold immobility and 30% of all bilateral immobility. This 20-year longitudinal assessment revealed that the etiology of unilateral vocal fold immobility has changed such that there has been a shift from extralaryngeal malignancies to nonthyroid surgical procedures as the major cause. Thyroid surgery remains the most common cause of bilateral vocal fold immobility.

Bedside screen for oral cavity structure, salivary flow, and vocal production over the 14days following endotracheal extubation.

PubMed

Chen, Cheryl Chia-Hui; Wu, Kuo-Hsiang; Ku, Shih-Chi; Chan, Ding-Cheng; Lee, Jang-Jaer; Wang, Tyng-Guey; Hsiao, Tzu-Yu

2018-06-01

To describe the sequelae of oral endotracheal intubation by evaluating prevalence rates of structural injury, hyposalivation, and impaired vocal production over 14days following extubation. Consecutive adults (≥20years, N=114) with prolonged (≥48h) endotracheal intubation were enrolled from medical intensive care units at a university hospital. Participants were assessed by trained nurses at 2, 7, and 14days after extubation, using a standardized bedside screening protocol. Within 48-hour postextubation, structural injuries were common, with 51% having restricted mouth opening. Unstimulated salivary flow was reduced in 43%. For vocal production, 51% had inadequate breathing support for phonation, dysphonia was common (94% had hoarseness and 36% showed reduced efficiency of vocal fold closure), and >40% had impaired articulatory precision. By 14days postextubation, recovery was noted in most conditions, but reduced efficiency of vocal fold closure persisted. Restricted mouth opening (39%) and reduced salivary flow (34%) remained highly prevalent. After extubation, restricted mouth opening, reduced salivary flow, and dysphonia were common and prolonged in recovery. Reduced efficiency of vocal cord closure persisted at 14days postextubation. The extent and duration of these sequelae remind clinicians to screen for them up to 2weeks after extubation. Copyright © 2017 Elsevier Inc. All rights reserved.

Time to competency, reliability of flexible transnasal laryngoscopy by training level: a pilot study.

PubMed

Brook, Christopher D; Platt, Michael P; Russell, Kimberly; Grillone, Gregory A; Aliphas, Avner; Noordzij, J Pieter

2015-05-01

To determine the progression of flexible transnasal laryngoscopy reliability and competency in otolaryngology residency training. Prospective case control study. Academic otolaryngology department. Medical students, otolaryngology residents, and otolaryngology attending physicians. Fourteen otolaryngology residents from PGY-1 to PGY-5 and 3 attending otolaryngologists viewed 25 selected and digitally recorded flexible transnasal laryngoscopies. The evaluators were asked to rate 13 items relating to abnormalities in the oropharynx, hypopharynx, larynx, and subglottis. The level of concern and level of comfort with the diagnosis were assessed. Intraclass correlations were calculated for each topic and by level of training to determine reliability within each class and compare competency versus attending interpretations. Intraclass correlation of residents compared to attending physicians demonstrated significant improvements by year for left and right vocal fold immobility, subglottic stenosis, laryngeal mass, left and right vocal cord abnormalities, and level of concern. Additionally, pooled vocal cord mobility and pooled results in categories with good attending reliability demonstrated stepwise improvement as well. For these categories, resident reliability was found to be statistically similar to attending physicians in all categories by PGY-3. There were no trends for base of tongue abnormalities, pharyngeal abnormalities, and pharyngeal and hypopharyngeal masses. Resident competency for flexible transnasal laryngoscopy progresses during residency to reliability with attending otolaryngologists by the PGY-3 year over key facets of the examination. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2015.

Singers' Vocal Function Knowledge Levels, Sensorimotor Self-awareness of Vocal Tract, and Impact of Functional Voice Rehabilitation on the Vocal Function Knowledge and Self-awareness of Vocal Tract.

PubMed

Sielska-Badurek, Ewelina; Osuch-Wójcikiewicz, Ewa; Sobol, Maria; Kazanecka, Ewa; Niemczyk, Kazimierz

2017-01-01

This study investigated vocal function knowledge and vocal tract sensorimotor self-awareness and the impact of functional voice rehabilitation on vocal function knowledge and self-awareness. This is a prospective, randomized study. Twenty singers (study group [SG]) completed a questionnaire before and after functional voice rehabilitation. Twenty additional singers, representing the control group, also completed the questionnaire without functional voice rehabilitation at a 3-month interval. The questionnaire consisted of three parts. The first part evaluated the singers' attitude to the anatomical and physiological knowledge of the vocal tract and their self-esteem of the knowledge level. The second part assessed the theoretical knowledge of the singers' vocal tract physiology. The third part of the questionnaire assessed singers' sensorimotor self-awareness of the vocal tract. The results showed that most singers indicated that knowledge of the vocal tract's anatomy and physiology is useful (59% SG, 67% control group). However, 75% of all participants defined their knowledge of the vocal tract's anatomy and physiology as weak or inadequate. In the SG, vocal function knowledge at the first assessment was 45%. After rehabilitation, the level increased to 67.7%. Vocal tract sensorimotor self-awareness initially was 38.9% in SG but rose to 66.7%. Findings of the study suggest that classical singers lack knowledge about the physiology of the vocal mechanism, especially the breathing patterns. In addition, they have low sensorimotor self-awareness of their vocal tract. The results suggest that singers would benefit from receiving services from phoniatrists and speech-language pathologists during their voice training. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A Case of Brown-Vialetto-Van Laere Syndrome Due To a Novel Mutation in SLC52A3 Gene

PubMed Central

Thulasi, Venkatraman; Veerapandiyan, Aravindhan; Pletcher, Beth A.; Tong, Chun M.

2017-01-01

Brown-Vialetto-Van Laere syndrome is a rare disorder characterized by motor, sensory, and cranial neuronopathies, associated with mutations in SLC52A2 and SLC52A3 genes that code for human riboflavin transporters RFVT2 and RFVT3, respectively. The authors describe the clinical course of a 6-year-old girl with Brown-Vialetto-Van Laere syndrome and a novel homozygous mutation c.1156T>C in the SLC52A3 gene, who presented at the age of 2.5 years with progressive brain stem dysfunction including ptosis, facial weakness, hearing loss, dysphagia, anarthria with bilateral vocal cord paralysis, and ataxic gait. She subsequently developed respiratory failure requiring tracheostomy and worsening dysphagia necessitating a gastrostomy. Following riboflavin supplementation, resolution of facial diplegia and ataxia, improvements in ptosis, and bulbar function including vocalization and respiration were noted. However, her sensorineural hearing loss remained unchanged. Similar to other cases of Brown-Vialetto-Van Laere syndrome, our patient responded favorably to early riboflavin supplementation with significant but not complete neurologic recovery. PMID:28856173

A Case of Brown-Vialetto-Van Laere Syndrome Due To a Novel Mutation in SLC52A3 Gene: Clinical Course and Response to Riboflavin.

PubMed

Thulasi, Venkatraman; Veerapandiyan, Aravindhan; Pletcher, Beth A; Tong, Chun M; Ming, Xue

2017-01-01

Brown-Vialetto-Van Laere syndrome is a rare disorder characterized by motor, sensory, and cranial neuronopathies, associated with mutations in SLC52A2 and SLC52A3 genes that code for human riboflavin transporters RFVT2 and RFVT3, respectively. The authors describe the clinical course of a 6-year-old girl with Brown-Vialetto-Van Laere syndrome and a novel homozygous mutation c.1156T>C in the SLC52A3 gene, who presented at the age of 2.5 years with progressive brain stem dysfunction including ptosis, facial weakness, hearing loss, dysphagia, anarthria with bilateral vocal cord paralysis, and ataxic gait. She subsequently developed respiratory failure requiring tracheostomy and worsening dysphagia necessitating a gastrostomy. Following riboflavin supplementation, resolution of facial diplegia and ataxia, improvements in ptosis, and bulbar function including vocalization and respiration were noted. However, her sensorineural hearing loss remained unchanged. Similar to other cases of Brown-Vialetto-Van Laere syndrome, our patient responded favorably to early riboflavin supplementation with significant but not complete neurologic recovery.

The power of your vocal image.

PubMed

McCoy, L A

1996-03-01

Your vocal image is the impression that listeners form of you based on the sound of your voice. In a dental office, where the initial patient contact usually occurs over the phone, your vocal image is vitally important. According to social psychologists, people begin to make relatively durable first impressions within six to 12 seconds of perceiving a sensory cue. This means that patients begin to form their impressions of a telephone speaker almost immediately. Based on the qualities of the speaker's voice and how it is used, they'll form impressions related to everything from the speaker's physical and personality characteristics to his or her intellectual ability, and eventually even generalize their impressions to include the office that the speaker represents. If you want to improve your vocal image, you must first be aware of exactly what that image is. There are two factors that combine to create a vocal impression--the speaker's physical vocal tools and the sound that is created by them. The five physical tools involved are the lungs, vocal cords, throat, mouth and ears. At each stage in the sound production process, we can easily fall into negative habits and lazy patterns if we're not careful. Although we can't do much about our physical voice mechanism, we can certainly exercise a great deal of control over how our voice is used. A strong, confident voice is an essential part of effective interpersonal communication. If you want to project an image of confidence and professionalism, don't overlook the subtle benefits of effective vocal power.

Assessment of Infant Cry: Acoustic Cry Analysis and Parental Perception

ERIC Educational Resources Information Center

LaGasse, Linda L.; Neal, A. Rebecca; Lester, Barry M.

2005-01-01

Infant crying signals distress to potential caretakers who can alleviate the aversive conditions that gave rise to the cry. The cry signal results from coordination among several brain regions that control respiration and vocal cord vibration from which the cry sounds are produced. Previous work has shown a relationship between acoustic…

Prediction of Difficult Laryngoscopy in Obese Patients by Ultrasound Quantification of Anterior Neck Soft Tissue1

PubMed Central

Ezri, T.; Gewürtz, G.; Sessler, D.I.; Medalion, B.; Szmuk, P.; Hagberg, C.; Susmallian, S.

2005-01-01

Prediction of difficult laryngoscopy in obese patients is challenging. In 50 morbidly obese patients, we quantified the neck soft tissue from skin to anterior aspect of trachea at the vocal cords using ultrasound. Thyromental distance <6 cm, mouth opening <4 cm, limited neck mobility, Mallampati score >2, abnormal upper teeth, neck circumference >45 cm, and sleep apnoea were considered predictors of difficult laryngoscopy. Of the nine (18%) difficult laryngoscopy cases, seven had obstructive sleep apnoea history; whereas, only 2 of the 41 easy laryngoscopy patients did (P<0.001). Difficult laryngoscopy patients had larger neck circumference [50 (3.8) vs. 43.5 (2.2) cm; P<0.001] and more pre-tracheal soft tissue [28 (2.7) mm vs. 17.5 (1.8) mm; P<0.001] [mean (SD)]. Soft tissue values completely separated difficult and easy laryngoscopies. None of the other predictors correlated with difficult laryngoscopy. Thus, an abundance of pretracheal soft tissue at the level of vocal cords is a good predictor of difficult laryngoscopy in obese patients. PMID:14616599

[The effect of smoking and forced use of the voice to development of the vocal polyps].

PubMed

Gnjatic, M; Stankovic, P; Djukić, V

2009-01-01

Dysphonia is often caused by polyps which are benign changes of pseudotumors. With their presence they are hampering with glotis oclusion. Laryngomicroscopy of general and endotracheal anaesthesia has been preformed on all of the patients. Microsurgical technique has been used to remove the polyps. Bioptic material was analyzed in pathophysiological laboratory of clinic of pathology in Banjaluka. All of the results were presented through tables and graphic representations. Frequency of polyps through age and sex groups, along with the examination of ethyological factors in emergence of polyps of vocal cords. Results are in accordance with the results of other authors who were involved in similar problematics. Through analysis of our data we percieve that the abuse of voice is part of ethiological factors that lead not only to emergence of vocal fold lesions but aswell as other benign changes.

Videolaryngostroboscopic observation of mucus layer during vocal cord vibration in patients with vocal nodules before and after surgery.

PubMed

Hsiung, Ming-Wang

2004-03-01

Under normal conditions, the vocal fold mucus layer is too thin to permit observation using videolaryngostroboscopy (VLS) during phonation. However, vocal nodules (VNs) typically cause congealed and sticky mucus to appear on the vocal fold. Reports in the literature regarding this phenomenon are limited. The aim of this study was to review VLS recordings of VN patients, analyzing changes that occurred in the mucus layer that covers the vocal fold during vibration following VN surgery. Using VLS, we studied the occurrence of, and changes in, vocal fold mucus layers in 160 VN patients before and after surgery. Eighty-eight patients (55%) were found to have a mucus layer during preoperative examinations. Of these mucus layers, 21 (13%) were located on the anterior commissure or anterior third of the vocal fold (A), 58 (36.3%) on the junction of the anterior and middle thirds (M), 1 (0.6%) on the posterior third (P), 5 (3.1%) on both A and M and 3 (1.9%) on both M and P. Fifty-six (35%) cases were found to have a mucus layer during postoperative examinations. Of these, 44 (27.5%) were located on A, 8 (5%) on M, 1 (0.6%) on P and 3 (1.9%) on both A and M. These results indicate that changes in the mechanical force on the vocal fold, alteration of the laryngeal secretory gland and improper aerodynamic airflow result in increased mucus viscosity and aggregation in VN patients and that the combination of these factors further increases the severity of dysphonia. Surgery to remove vocal nodes may be an effective method to eliminate both vocal bumps and aggregated mucus. Based on the present results, it is recommended that future research should compare surgery to remove VN against other mucus layer reduction methods in order to determine which is the most effective.

In-Office Excision En Masse of a Vocal Process Granuloma Using the Potassium-Titanyl-Phosphate Laser.

PubMed

Mascarella, Marco A; Young, Jonathan

2016-01-01

In-office laryngeal surgery is taking on a more commonplace role in the treatment of laryngeal disorders. The potassium-titanyl-phosphate (KTP) laser has been a resourceful adjunct to the management of patients with mucosal lesions of the vocal cords. However, a paucity of data exists for its use in postintubation granulomas treated in-office. A 43-year-old female presented with voice hoarseness and found to have a large obstructing postintubation granuloma which was treated by in-office KTP laser and en masse excision. We report the successful case of a patient receiving in-office treatment for a large vocal process granuloma using the KTP laser with en masse excision. The combined use of the KTP laser and forceps in-office can be valuable to the surgical management of vocal process granulomas, given their numerous recurrences. New avenues in office-based surgical management of laryngeal disorders can offer accessibility and decreased morbidity to patients. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer

PubMed Central

Gupta, Babita; Kohli, Santvana; Farooque, Kamran; Jalwal, Gopal; Gupta, Deepak; Sinha, Sumit; Chandralekha

2014-01-01

Overview: Awake fiberoptic bronchoscope (FOB) guided intubation is the gold standard of airway management in patients with cervical spine injury. It is essential to sufficiently anesthetize the upper airway before the performance of awake FOB guided intubation in order to ensure patient comfort and cooperation. This randomized controlled study was performed to compare two methods of airway anesthesia, namely ultrasonic nebulization of local anesthetic and performance of airway blocks. Materials and Methods: A total of 50 adult patients with cervical spine injury were randomly allocated into two groups. Group L received airway anesthesia through ultrasonic nebulization of 10 ml of 4% lignocaine and Group NB received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) each with 2 ml of 2% lignocaine and viscous lignocaine gargles. FOB guided orotracheal intubation was then performed. Hemodynamic variables at baseline and during the procedure, patient recall, vocal cord visibility, ease of intubation, coughing/gagging episodes, and signs of lignocaine toxicity were noted. Results: The observations did not reveal any significant differences in demographics or hemodynamic parameters at any time during the study. However, the time taken for intubation was significantly lower in Group NB as compared with the Group L. Group L had an increased number of coughing/gagging episodes as compared with Group NB. Vocal cord visibility and ease of intubation were better in patients who received airway blocks and hence the amount of supplemental lignocaine used was less in this group. Overall patient comfort was better in Group NB with fewer incidences of unpleasant recalls as compared with Group L. Conclusion: Upper airway blocks provide better quality of anesthesia than lignocaine nebulization as assessed by patient recall of procedure, coughing/gagging episodes, ease of intubation, vocal cord visibility, and time taken to intubate. PMID:25538514

Does topical lidocaine before tracheal intubation attenuate airway responses in children? An observational audit.

PubMed

Hamilton, Nigel D; Hegarty, Mary; Calder, Alyson; Erb, Thomas O; von Ungern-Sternberg, Britta S

2012-04-01

The use of topical lidocaine, applied to the airways with various administration techniques, is common practice in pediatric anesthesia in many institutions. However, it remains unclear whether these practices achieve their intended goal of reducing the risk of perioperative respiratory adverse events (PRAE) in children undergoing elective endotracheal intubation without neuromuscular blockade (NMB). The relative frequency of PRAE (laryngospasm, coughing, desaturation <95%) associated with no use of topical airway lidocaine (TAL), with TAL sprayed directly onto the vocal cords, and TAL administered blindly into the pharynx was assessed. This prospective audit involved 1000 patients undergoing general anesthesia with elective endotracheal intubation without NMB. Patients with suspected difficult airways or undergoing airway surgery were excluded. The use of TAL and the mode of administration were recorded. Respiratory adverse events were recorded in the perioperative period. Two hundred and fifty-four patients had the vocal cords sprayed under direct vision, 236 had lidocaine blindly dripped into the pharynx, and 510 received no TAL. The mean age and known risk factors for PRAE (asthma, recent upper respiratory tract infection (≤2 weeks), passive smoking, hayfever, past or present eczema, nocturnal dry cough) were similar among the groups. The proportion of patients with desaturation (<95%) between induction of anesthesia and discharge from the recovery room was higher in the two groups who received TAL (data combined for all patients receiving lidocaine regardless of administration method, P = 0.01) compared to those who received no TAL. No difference in the rates of laryngospasm (P = 0.13) or cough (P = 0.07) was observed among the groups. There was no difference in the rates of PRAE between the groups given TAL directly onto the vocal cords and in those whom received TAL blindly. The incidence of desaturation was higher in patients receiving TAL compared with children who did not. This association should perhaps be considered when contemplating the use of this technique. © 2011 Blackwell Publishing Ltd.

[Correlation of Rab coupling protein expression with clinicopathological characteristics and prognosis in laryngeal squamous cell carcinoma].

PubMed

Dai, Yaozhang; Liu, Yong; Tian, Xiufen; Zhang, Xin

2015-02-01

To explore the RCP protein expression and its clinicopathological significance in laryngeal squamous cell carcinoma (LSCC). RCP protein expression in human head and neck squamous cell carcinoma cell lines (NP-69, Tu686, Tu212, M2 and M4) was analyzed by Western blotting. Besides, its expression in 87 cases of LSCC, 18 cases of adjacent epithelial mucosa and 16 cases of vocal cord leukoplakia was detected by immunohistochemistry, and their correlation with clinicopathological parameters and patients' outcome was analyzed. The NP-69, Tu212 Tu686, M2 and M4 cells showed a gradual increase in the expression of RCP protein. The average relative expression levels of RCP protein in the NP-69, Tu212, Tu686, M2 and M4 cells were 0.05±0.01, 0.38±0.05, 0.63±0.02, 0.84±0.06 and 0.96±0.04, respectively. The same situation occurred in the adjacent mucosa, vocal cord leukoplakia and LSCC. Specifically, only 3 of 18 adjacent mucosa showed a low RCP expression (scored 0-2). Although the 16 cases of vocal cord leukoplakia had a low RCP expression, all their scores ranged from 0 to 3. While in the LSCC specimens, 59 (67.8%) cases demonstrated a high RCP expression (scored 8-15), 18 cases showed a lower RCP expression (scored 4-7), and only 10 cases were scored 2-3. Among the 87 LSCC cases, there were 28 cases (32.2%) of low RCP expression and 59 cases of high RCP expression. All the 18 cases of cancer-adjacent tissues and 16 cases of vocal cord leukoplakia were of low RCP expression. RCP overexpression was significantly associated with T classification, clinical staging, lymph node metastasis and recurrence (P<0.05 for all). Survival analysis revealed that the 5-year survival rate was 40.0% in the patients with high RCP expression and 75.0% in the patients with low RCP expression, the tumor-free 5-year survival rate was 30.7% and 64.0%, respectively, both showing a significant difference between the two subgroups (P<0.05). Univariate analysis revealed that alcohol history; smoking, T classification, clinical staging, lymph node metastasis and RCP expression were significantly associated with a poor prognosis (P<0.05 for all). The multivariate analysis showed that only recurrence and RCP expression were independent prognostic factors affecting the prognosis for patients with LSCC (P<0.05 for both). Expression of RCP protein may contribute to the malignant progression of LSCC, and may become a novel marker predicting tumor recurrence, cervical lymph node metastasis and prognosis for patients with laryngeal squamous cell carcinoma.

Use of loupes magnification and microsurgical technique in thyroid surgery: ten years experience in a single center

PubMed Central

D’ORAZI, V.; PANUNZI, A.; DI LORENZO, E.; ORTENSI, AL.; CIALINI, M.; ANICHINI, S.; ORTENSI, A.

2016-01-01

Aim The use of microsurgical technique and loupes magnification as a support to traditional surgery can help surgical performance and prevent complications in thyroid surgery. Patients and methods Between January 2004 and December 2014, 782 patients with thyroid diseases were operated by our team with microsurgical technique and loupes magnification 4.5x. All patients had pre and postoperative vocal cords assessment and calcemia and the collected data were analysed. Results Among the 782 patients, only six patients (0.77%) had unilateral vocal fold immobility treated with medical therapy, phoniatric and neck physiotherapy. All six patients showed complete laryngeal recovery of motility 6/8 weeks after treatment. There were not cases of permanent monolateral or bilateral vocal cord palsy. In 84 patients there were signs and symptoms of hypocalcemia. In 81 patients (10.36%) the restoring of biochemical parameters and the resolution of symptoms occurred between 2 and 6 weeks and in 3 cases (0.38%) there was permanent hypocalcemia more than six months. Conclusion The use of microsurgical technique and loupes magnification in thyroid surgery are safety and effective procedures, that require an appropriate training in reconstructive microsurgery, but may significantly reduce post-operative complications. Here, we report for the first time the largest series of thyroid surgery performed with the use of microsurgical technique and loupes magnification, analysing the postoperative morbidity. In view of our results, we suggest the routine use of 4.5X loupes and microsurgical technique in thyroid surgery. PMID:27734792

The respiratory-vocal system of songbirds: anatomy, physiology, and neural control.

PubMed

Schmidt, Marc F; Martin Wild, J

2014-01-01

This wide-ranging review presents an overview of the respiratory-vocal system in songbirds, which are the only other vertebrate group known to display a degree of respiratory control during song rivalling that of humans during speech; this despite the fact that the peripheral components of both the respiratory and vocal systems differ substantially in the two groups. We first provide a brief description of these peripheral components in songbirds (lungs, air sacs and respiratory muscles, vocal organ (syrinx), upper vocal tract) and then proceed to a review of the organization of central respiratory-related neurons in the spinal cord and brainstem, the latter having an organization fundamentally similar to that of the ventral respiratory group of mammals. The second half of the review describes the nature of the motor commands generated in a specialized "cortical" song control circuit and how these might engage brainstem respiratory networks to shape the temporal structure of song. We also discuss a bilaterally projecting "respiratory-thalamic" pathway that links the respiratory system to "cortical" song control nuclei. This necessary pathway for song originates in the brainstem's primary inspiratory center and is hypothesized to play a vital role in synchronizing song motor commands both within and across hemispheres. © 2014 Elsevier B.V. All rights reserved.

The respiratory-vocal system of songbirds: Anatomy, physiology, and neural control

PubMed Central

Schmidt, Marc F.; Wild, J. Martin

2015-01-01

This wide-ranging review presents an overview of the respiratory-vocal system in songbirds, which are the only other vertebrate group known to display a degree of respiratory control during song rivalling that of humans during speech; this despite the fact that the peripheral components of both the respiratory and vocal systems differ substantially in the two groups. We first provide a brief description of these peripheral components in songbirds (lungs, air sacs and respiratory muscles, vocal organ (syrinx), upper vocal tract) and then proceed to a review of the organization of central respiratory-related neurons in the spinal cord and brainstem, the latter having an organization fundamentally similar to that of the ventral respiratory group of mammals. The second half of the review describes the nature of the motor commands generated in a specialized “cortical” song control circuit and how these might engage brainstem respiratory networks to shape the temporal structure of song. We also discuss a bilaterally projecting “respiratory-thalamic” pathway that links the respiratory system to “cortical” song control nuclei. This necessary pathway for song originates in the brainstem’s primary inspiratory center and is hypothesized to play a vital role in synchronizing song motor commands both within and across hemispheres. PMID:25194204

Singers' interest and knowledge levels of vocal function and dysfunction: survey findings.

PubMed

Braun-Janzen, Colleen; Zeine, Lina

2009-07-01

A questionnaire investigating the levels of interest in and knowledge of vocal function and dysfunction was completed by 129 singers. Those with professional singing experience indicated significantly greater interest and higher perceived knowledge levels than amateurs in areas of vocal anatomy and physiology, vocal hygiene, and functional vocal pathologies. Greater interest levels, but not higher perceived knowledge levels were reported by professional singers (PSs) in the area of the role of the speech-language pathologist (SLP) and the voice. Professionals answered significantly more knowledge-based questions correctly than amateurs in all areas except the role of the SLP and the voice. However, findings indicated wide variability in knowledge levels of both groups. Singing teachers (STs) within the group significantly outperformed the remainder of the group in areas of vocal anatomy and physiology, vocal hygiene, and functional vocal pathologies. Scores of the choir directors (CDs) within the group were not significantly superior to the remainder of the group except in the area of functional vocal pathologies. Implications for a preventative approach to vocal health are discussed.

Intraoperative handheld probe for 3D imaging of pediatric benign vocal fold lesions using optical coherence tomography (Conference Presentation)

NASA Astrophysics Data System (ADS)

Benboujja, Fouzi; Garcia, Jordan; Beaudette, Kathy; Strupler, Mathias; Hartnick, Christopher J.; Boudoux, Caroline

2016-02-01

Excessive and repetitive force applied on vocal fold tissue can induce benign vocal fold lesions. Children affected suffer from chronic hoarseness. In this instance, the vibratory ability of the folds, a complex layered microanatomy, becomes impaired. Histological findings have shown that lesions produce a remodeling of sup-epithelial vocal fold layers. However, our understanding of lesion features and development is still limited. Indeed, conventional imaging techniques do not allow a non-invasive assessment of sub-epithelial integrity of the vocal fold. Furthermore, it remains challenging to differentiate these sub-epithelial lesions (such as bilateral nodules, polyps and cysts) from a clinical perspective, as their outer surfaces are relatively similar. As treatment strategy differs for each lesion type, it is critical to efficiently differentiate sub-epithelial alterations involved in benign lesions. In this study, we developed an optical coherence tomography (OCT) based handheld probe suitable for pediatric laryngological imaging. The probe allows for rapid three-dimensional imaging of vocal fold lesions. The system is adapted to allow for high-resolution intra-operative imaging. We imaged 20 patients undergoing direct laryngoscopy during which we looked at different benign pediatric pathologies such as bilateral nodules, cysts and laryngeal papillomatosis and compared them to healthy tissue. We qualitatively and quantitatively characterized laryngeal pathologies and demonstrated the added advantage of using 3D OCT imaging for lesion discrimination and margin assessment. OCT evaluation of the integrity of the vocal cord could yield to a better pediatric management of laryngeal diseases.

Posterior cricoarytenoid muscle electrophysiologic changes are predictive of vocal cord paralysis with recurrent laryngeal nerve compressive injury in a canine model.

PubMed

Puram, Sidharth V; Chow, Harold; Wu, Che-Wei; Heaton, James T; Kamani, Dipti; Gorti, Gautham; Chiang, Feng Yu; Dionigi, Gianlorenzo; Barczynski, Marcin; Schneider, Rick; Dralle, Henning; Lorenz, Kerstin; Randolph, Gregory W

2016-12-01

Injury to the recurrent laryngeal nerve (RLN) is a dreaded complication of endocrine surgery. Intraoperative neural monitoring (IONM) has been increasingly utilized to assess the functional status of the RLN. Although the posterior cricoarytenoid muscle (PCA) is innervated by the RLN as the abductor of the larynx, PCA electromyography (EMG) is infrequently recorded during IONM and PCA activity after RLN compressive injury remains poorly characterized. Single-subject prospective animal study. We employed a canine model to identify postcricoid EMG correlates of postoperative vocal cord paralysis (VCP). Postcricoid electrode recordings were obtained before and after compressive RLN injury associated with VCP. Normative postcricoid recordings revealed mean amplitude of 1288 microvolt (μV) and latency of 8.2 millisecond (ms) with maximum (1 milliamp [mA]) vagal stimulation, and mean amplitude of 1807 μV and latency of 3.5 ms with maximum (1 mA) RLN stimulation. Following injury that was associated with VCP, there was 62.1% decrement in postcricoid EMG amplitude with maximum vagal stimulation and 80% decrement with maximum RLN stimulation. Threshold stimulation of the vagus increased by 23%, and there was a corresponding 42% decrease in amplitude. For RLN stimulation, latency increased by 17.3% following injury, whereas threshold stimulation increased by 61% with 35.5% decrement in EMG amplitude. Thus, if RLN amplitude decreases by ≥ 80%, with absolute amplitude of ≤ 300 μV or less and latency increase of ≥ 10%, RLN injury is likely associated with VCP. Our results predict postoperative VCP based on postcricoid electromyographic IONM and may guide surgical decision making. NA Laryngoscope, 126:2744-2751, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

The Effects of Hormonal Contraception on the Voice: History of Its Evolution in the Literature.

PubMed

Rodney, Jennifer P; Sataloff, Robert Thayer

2016-11-01

Women of reproductive age commonly use hormonal contraceptives, the vocal effects of which have been studied. Otolaryngologists should be aware of this relationship to make recommendations on hormonal contraception as it relates to each patient's voice requirements. A comprehensive literature review of PubMed was completed. The terms "contraception," "vocal folds," "vocal cords," and "voice" were searched in various combinations. Articles from 1971 to 2015 that addressed the effects of contraception on the vocal folds were included. In total, 24 articles were available for review. Historically, contraception was believed to affect the voice negatively. However, more recent studies using low-dose oral contraceptive pills (OCPs) show that they stabilize the voice. However, stabilization generally occurs only during sustained vowel production; connected speech appears unaffected. Therefore, singers may be the only population that experiences clinically increased vocal stability as a result of taking hormonal contraceptives. Only combined OCPs have been studied; other forms of hormonal contraception have not been evaluated for effects on the voice. Significant variability exists between studies in the physical attributes of patients and parameters tested. Hormonal contraception likely has no clinically perceptible effects on the speaking voice. Singers may experience increased vocal stability with low-dose, combined OCP use. Other available forms of contraception have not been studied. Greater consistency in methodology is needed in future research, and other forms of hormonal contraception require study. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Major depressive disorder discrimination using vocal acoustic features.

PubMed

Taguchi, Takaya; Tachikawa, Hirokazu; Nemoto, Kiyotaka; Suzuki, Masayuki; Nagano, Toru; Tachibana, Ryuki; Nishimura, Masafumi; Arai, Tetsuaki

2018-01-01

The voice carries various information produced by vibrations of the vocal cords and the vocal tract. Though many studies have reported a relationship between vocal acoustic features and depression, including mel-frequency cepstrum coefficients (MFCCs) which applied to speech recognition, there have been few studies in which acoustic features allowed discrimination of patients with depressive disorder. Vocal acoustic features as biomarker of depression could make differential diagnosis of patients with depressive state. In order to achieve differential diagnosis of depression, in this preliminary study, we examined whether vocal acoustic features could allow discrimination between depressive patients and healthy controls. Subjects were 36 patients who met the criteria for major depressive disorder and 36 healthy controls with no current or past psychiatric disorders. Voices of reading out digits before and after verbal fluency task were recorded. Voices were analyzed using OpenSMILE. The extracted acoustic features, including MFCCs, were used for group comparison and discriminant analysis between patients and controls. The second dimension of MFCC (MFCC 2) was significantly different between groups and allowed the discrimination between patients and controls with a sensitivity of 77.8% and a specificity of 86.1%. The difference in MFCC 2 between the two groups reflected an energy difference of frequency around 2000-3000Hz. The MFCC 2 was significantly different between depressive patients and controls. This feature could be a useful biomarker to detect major depressive disorder. Sample size was relatively small. Psychotropics could have a confounding effect on voice. Copyright © 2017 Elsevier B.V. All rights reserved.

Functional regeneration of recurrent laryngeal nerve injury during thyroid surgery using an asymmetrically porous nerve guide conduit in an animal model.

PubMed

Choi, Jeong-Seok; Oh, Se Heang; An, Hye-Young; Kim, Young-Mo; Lee, Jin Ho; Lim, Jae-Yol

2014-01-01

Vocal cord paralysis (VCP) caused by recurrent laryngeal nerve (RLN) damage during thyroidectomy commonly results in serious medico-legal problems. The purpose of this study was to evaluate the usefulness of an asymmetrically porous polycaprolactone (PCL)/Pluronic F127 nerve guide conduit (NGC) for functional regeneration in a RLN injury animal model. A biodegradable, asymmetrically porous PCL/F127 NGC with selective permeability was fabricated for use in this study. A 10-mm segment of left RLN was resected in 28 New Zealand white rabbits, and then an asymmetrically porous NGC or a nonporous silicone tube was interposed between both stumps and securely fixed. Vocal cord mobility was endoscopically evaluated at one, four, and eight weeks postoperatively. Nerve growth through NGCs was assessed by toluidine blue staining, and thyroarytenoid (TA) muscle atrophy was evaluated by hematoxylin and eosin staining. Immunohistochemical stainings for acetylcholinesterase (AchE), anti-neurofilament (NF), and anti-S100 protein were also conducted, and transmission electron microscopy (TEM) was used to evaluate functional nerve regeneration. At eight weeks postoperatively, endoscopic evaluations showed significantly better recovery from VCP in the asymmetrically porous PCL/F127 NGC group (6 of 10 rabbits) than in the silicone tube group (1 of 10 rabbits). Continued nerve growth on the damaged nerve endings was observed with time in the asymmetrically porous PCL/F127 NGC-interposed RLNs. TA muscle dimensions and AchE expressions in TA muscle were significantly greater in the asymmetrically porous PCL/F127 NGC group than in the silicone tube group. Furthermore, immunohistochemical staining revealed the expression of NF and S100 protein in the regenerated nerves in the asymmetrically porous PCL/F127 NGC group at eight weeks postoperatively, and at this time, TEM imaging showed myelinated axons in the regenerated RLNs. The study shows that asymmetrically porous PCL/F127 NGC provides a favorable environment for RLN regeneration and that it has therapeutic potential for the regeneration of RLN damage.

Functional Regeneration of Recurrent Laryngeal Nerve Injury During Thyroid Surgery Using an Asymmetrically Porous Nerve Guide Conduit in an Animal Model

PubMed Central

Choi, Jeong-Seok; Oh, Se Heang; An, Hye-Young; Kim, Young-Mo; Lee, Jin Ho

2014-01-01

Background: Vocal cord paralysis (VCP) caused by recurrent laryngeal nerve (RLN) damage during thyroidectomy commonly results in serious medico-legal problems. The purpose of this study was to evaluate the usefulness of an asymmetrically porous polycaprolactone (PCL)/Pluronic F127 nerve guide conduit (NGC) for functional regeneration in a RLN injury animal model. Methods: A biodegradable, asymmetrically porous PCL/F127 NGC with selective permeability was fabricated for use in this study. A 10-mm segment of left RLN was resected in 28 New Zealand white rabbits, and then an asymmetrically porous NGC or a nonporous silicone tube was interposed between both stumps and securely fixed. Vocal cord mobility was endoscopically evaluated at one, four, and eight weeks postoperatively. Nerve growth through NGCs was assessed by toluidine blue staining, and thyroarytenoid (TA) muscle atrophy was evaluated by hematoxylin and eosin staining. Immunohistochemical stainings for acetylcholinesterase (AchE), anti-neurofilament (NF), and anti-S100 protein were also conducted, and transmission electron microscopy (TEM) was used to evaluate functional nerve regeneration. Results: At eight weeks postoperatively, endoscopic evaluations showed significantly better recovery from VCP in the asymmetrically porous PCL/F127 NGC group (6 of 10 rabbits) than in the silicone tube group (1 of 10 rabbits). Continued nerve growth on the damaged nerve endings was observed with time in the asymmetrically porous PCL/F127 NGC-interposed RLNs. TA muscle dimensions and AchE expressions in TA muscle were significantly greater in the asymmetrically porous PCL/F127 NGC group than in the silicone tube group. Furthermore, immunohistochemical staining revealed the expression of NF and S100 protein in the regenerated nerves in the asymmetrically porous PCL/F127 NGC group at eight weeks postoperatively, and at this time, TEM imaging showed myelinated axons in the regenerated RLNs. Conclusion: The study shows that asymmetrically porous PCL/F127 NGC provides a favorable environment for RLN regeneration and that it has therapeutic potential for the regeneration of RLN damage. PMID:24015805

Photodynamic therapy and the treatment of neoplastic diseases of the larynx

NASA Astrophysics Data System (ADS)

Biel, Merrill A.

1995-05-01

Photodynamic therapy (PDT) is an innovative treatment involving the use of light-sensitive drugs to selectively identify and destroy diseased cells. Therefore, photodynamic therapy has the potential to treat and cure precancerous and early cancerous lesions (carcinoma in situ (CIS), T1 and T2) of the larynx while preserving normal tissue. Twenty-four patients with recurrent leukoplakia and carcinomas of the larynx were treated with PDT with follow-up to 60 months. Fourteen patients with T1 squamous cell carcinomas of the vocal cord, 2 patients with a T2 squamous cell carcinoma of the vocal cord failing radiotherapy, and 6 patients with CIS and sever atypia were treated with PDT and obtained a complete response and are disease free. One patient with a T3 carcinoma of the larynx was treated with PDT but died 5 weeks post-treatment of unrelated causes and could not be assessed. Photodynamic therapy is a promising therapy for treatment of precancerous and cancerous lesions of the larynx. This therapy may be particularly beneficial for the treatment of recurrent carcinomas of the larynx that have failed conventional radiotherapy, thereby preserving voice and eliminating the need for destructive laryngeal surgery.

Simple and fast orotracheal intubation procedure in rats.

PubMed

Tomasello, Giovanni; Damiani, Francesco; Cassata, Giovanni; Palumbo, Vincenzo Davide; Sinagra, Emanuele; Damiani, Provvidenza; Bruno, Antonino; Cicero, Luca; Cupido, Francesco; Carini, Francesco; Lo Monte, Attilio Ignazio

2016-05-06

Endotracheal intubation in the rat is difficult because of the extremely small size of anatomical structures (oral cavity, epiglottis and vocal cords), small inlet for an endotracheal tube and the lack of proper technical instruments. In this study we used seventy rats weighting 400-500 g. The equipment needed for the intubation was an operating table, a longish of cotton, a cotton tip, orotracheal tube, neonatal laryngoscope blades, KTR4 small animal ventilator and isoflurane for inhalation anaesthesia. Premedication was carried out by medetomidine hydrochloride 1 mg/mL; then, thanks to a closed glass chamber, a mixture of oxygen and isoflurane was administered. By means of a neonatal laryngoscope the orotracheal tube was advanced into the oral cavity until the wire guide was visualized trough the vocal cords; then it was passed through them. The tube was introduced directly into the larynx over the wire guide; successively, the guide was removed and the tube placed into the trachea. Breathing was confirmed using a glove, cut at the end of a finger, simulating a small balloon. We achieved a fast and simple orotracheal intubation in all animals employed. We believe that our procedure is easier and faster than those previously reported in scientific literature.

The Informational Patterns of Laughter

NASA Astrophysics Data System (ADS)

Bea, José A.; Marijuán, Pedro C.

2003-06-01

Laughter is one of the most characteristic -and enigmatic- communicational traits of human individuals. Its analysis has to take into account a variety of emotional, social, cognitive, and communicational factors densely interconnected. In this article we study laughter just as an auditive signal (as a 'neutral' information carrier), and we compare its structure with the regular traits of linguistic signals. In the experimental records of human laughter that we have performed, the most noticeable trait is the disorder content of frequencies. In comparison with the sonograms of vowels, the information content of which appears as a characteristic, regular function of the first vibration modes of the dynamic system formed, for each vowel, by the vocal cords and the accompanying resonance of the vocalization apparatus, the sonograms of laughter are highly irregular. In the episodes of laughter, a highly random content in frequencies appears, reason why it cannot be considered as a genuine codification of patterned information like in linguistic signals. In order to numerically gauge the disorder content of laughter frequencies, we have performed several "entropy" measures of the spectra -trying to unambiguously identify spontaneous laughter from "faked", articulated laughter. Interestingly, Shannon's entropy (the most natural candidate) performs rather poorly.

Assessment of voice, speech and communication changes associated with cervical spinal cord injury.

PubMed

Johansson, Kerstin; Seiger, Åke; Forsén, Malin; Holmgren Nilsson, Jeanette; Hartelius, Lena; Schalling, Ellika

2018-02-24

Respiratory muscle impairment following cervical spinal cord injury (CSCI) may lead to reduced voice function, although the individual variation is large. Voice problems in this population may not always receive attention since individuals with CSCI face other, more acute and life-threatening issues that need/receive attention. Currently there is no consensus on the tasks suitable to identify the specific voice impairments and functional voice changes experienced by individuals with CSCI. To examine which voice/speech tasks identify the specific voice and communication changes associated with CSCI, habitual and maximum speech performance of a group with CSCI was compared with that of a healthy control group (CG), and the findings were related to respiratory function and to self-reported voice problems. Respiratory, aerodynamic, acoustic and self-reported voice data from 19 individuals (nine women and 10 men, aged 23-59 years, heights = 153-192 cm) with CSCI (levels C3-C7) were compared with data from a CG consisting of 19 carefully matched non-injured people (nine women and 10 men, aged 19-59 years, heights = 152-187 cm). Despite considerable variability of performance, highly significant differences between the group with CSCI and the CG were found in maximum phonation time, maximum duration of breath phrases, maximum sound pressure level and maximum voice area in voice-range profiles (all p = .000). Subglottal pressure was lower and phonatory stability was reduced in some of the individuals with CSCI, but differences between the groups were not statistically significant. Six of 19 had voice handicap index (VHI) scores above 20 (the cut-off for voice disorder). Individuals with a vital capacity below 50% of the expected for an equivalent reference individual performed significantly worse than participants with more normal vital capacity. Completeness and level of injury seemed to impact vocal function in some individuals. A combination of maximum performance speech tasks, respiratory tasks and self-reported information on voice problems help to identify individuals with reduced voice function following CSCI. Early identification of individuals with voice changes post-CSCI, and introducing appropriate rehabilitation strategies, may help to minimize development of maladaptive voice behaviours such as vocal strain, which can lead to further impairments and limitations to communication participation. © 2018 Royal College of Speech and Language Therapists.

Consensus statement: Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis.

PubMed

Munin, Michael C; Heman-Ackah, Yolanda D; Rosen, Clark A; Sulica, Lucian; Maronian, Nicole; Mandel, Steven; Carey, Bridget T; Craig, Earl; Gronseth, Gary

2016-06-01

The purpose of this study was to develop an evidence-based consensus statement regarding use of laryngeal electromyography (LEMG) for diagnosis and treatment of vocal fold paralysis after recurrent laryngeal neuropathy (RLN). Two questions regarding LEMG were analyzed: (1) Does LEMG predict recovery in patients with acute unilateral or bilateral vocal fold paralysis? (2) Do LEMG findings change clinical management in these individuals? A systematic review was performed using American Academy of Neurology criteria for rating of diagnostic accuracy. Active voluntary motor unit potential recruitment and presence of polyphasic motor unit potentials within the first 6 months after lesion onset predicted recovery. Positive sharp waves and/or fibrillation potentials did not predict outcome. The presence of electrical synkinesis may decrease the likelihood of recovery, based on 1 published study. LEMG altered clinical management by changing the initial diagnosis from RLN in 48% of cases. Cricoarytenoid fixation and superior laryngeal neuropathy were the most common other diagnoses observed. If prognostic information is required in a patient with vocal fold paralysis that is more than 4 weeks and less than 6 months in duration, then LEMG should be performed. LEMG may be performed to clarify treatment decisions for vocal fold immobility that is presumed to be caused by RLN. Muscle Nerve 53: 850-855, 2016. © 2016 Wiley Periodicals, Inc.

Bilateral Cricoarytenoid Arthritis: A Cause of Recurrent Upper Airway Obstruction in Rheumatoid Arthritis

PubMed Central

Pradhan, Pradeep; Bhardwaj, Abhishek; Venkatachalam, VP

2016-01-01

We report a case of bilateral cricoarytenoid joint arthritis with history of rheumatoid arthritis, presented with stridor to the outpatient department. Endolaryngoscopy revealed adducted vocal cords and a nodule over left arytenoid which later confirmed to be rheumatoid nodule on histopathologic examination. Initially, although patient responded well to medical treatment, recurrence was noticed after 6 months follow-up. PMID:27418875

Carotid space infection: A case report.

PubMed

Anithakumari, A M; Girish, Rai B

2006-01-01

A case of isolated carotid space abscess is reported here for its rarity. No identifiable cause was detected in this case. Management involved incision and drainage of the abscess, close monitoring for the signs of complications and 8 weeks long antibiotic coverage. The only stigma of the abscess six months after presentation is a unilateral vocal cord palsy. A brief review of relate literature is also included.

Vocal cord palsy after anterior cervical spine surgery: a qualitative systematic review.

PubMed

Tan, Tze P; Govindarajulu, Arun P; Massicotte, Eric M; Venkatraghavan, Lashmi

2014-07-01

Vocal cord palsy (VCP) is a known complication of anterior cervical spine surgery. However, the true incidence and interventions to minimize this complication are not well studied. To conduct a systematic review to identify the incidence, risk, and interventions for VCP after anterior cervical spine surgery. This is a qualitative systematic literature review. Prospective and retrospective trials of patients undergoing anterior cervical spine surgery that reported on postoperative VCP or recurrent laryngeal nerve palsy. Primary: incidence of VCP after anterior cervical spine surgery; secondary: risk factors and interventions for prevention of VCP after anterior cervical spine surgery. Electronic searches were conducted on Ovid Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systemic Reviews for clinical studies reporting VCP in anterior cervical spine surgery, limited to studies published between 1995 and June 2013 in English and French languages. After selection of studies independently by two review authors, data on incidence, risk, and interventions were extracted. Qualitative analysis was performed on three domains: quality of studies, strength of evidence, and impact of interventions. Our search has identified 187 abstracts, and 34 studies met our inclusion criteria. The incidence of VCP ranges from 2.3% to 24.2%. Significant heterogeneity in study design and definition of VCP were used in the published studies. There is good evidence that reoperation increases the risk of VCP. One study of moderate strength suggests that operating from the right side may increase the risk of VCP. Among the interventions studied, endotracheal tube (ETT) cuff pressure monitoring with deflation during retraction has shown to reduce the incidence from 6% to 2%, but this result was not confirmed by randomized control trials. Limited evidence exists for other interventions of intraoperative electromyographic monitoring and methylprednisolone. Vocal cord palsy is a significant morbidity after anterior cervical surgery with incidence up to 24.2% in the immediate postoperative period, with a higher risk in reoperation of the anterior cervical spine. Moderate evidence exists for ETT cuff pressure adjustment in preventing this complication. Copyright © 2014 Elsevier Inc. All rights reserved.

[Surgery for benign goiter in Germany: fewer operations, changed resectional strategy, fewer complications].

PubMed

Dralle, H; Stang, A; Sekulla, C; Rusner, C; Lorenz, K; Machens, A

2014-03-01

The increase of certain operations in the wake of the introduction of the German Diagnosis-Related Groups (G-DRG) system rekindled debate on the risk-benefit profile of what is widely being perceived as a too high number of thyroidectomies for benign goiter in Germany. The numbers of thyroidectomy for benign goiter from 2005-2011 were obtained from the Federal Bureau of Statistics ("Statistisches Bundesamt"). For the purpose of the study, the following operation and procedure key (OPS) codes were selected: hemithyroidectomy (OPS code 5-061); partial thyroid resection (OPS code 5-062); total thyroidectomy (OPS code 5-063); and thyroid surgeries via sternotomy (OPS code 5-064). The rates of permanent hypoparathyroidism and vocal cord palsy were calculated based on two prospective multicenter evaluation studies conducted in 1998-2001 (PETS 1) and 2010-2013 (PETS 2) in Germany. Between 2005 and 2011, the number of thyroidectomies for benign thyroid goiter decreased by 8 %, and the age-standardized surgery rate decreased by 6 % in men (2005: 599 per 1 million; 2011: 565 per 1 million) and 11 % in women (2005: 1641 per 1 million; 2011: 1463 per 1 million). At the same time, the rates of partial and subtotal thyroidectomy decreased by 59 % in men and 64 % in women, whereas the rates of hemithyroidectomy and total thyroidectomy increased by 65 % (113 %) in men and 42 % (97 %) in women. Despite a greater proportion of thyroidectomies over time, the approximated rates for postoperative hypoparathyroidism were reduced from 2.98 to 0.83 % and for postoperative vocal cord palsy from 1.06 to 0.86 %. Irrespective of that decline, either complication was more frequent after total than after subtotal thyroidectomy. The total number of thyroid surgeries due to benign goiter has decreased substantially in Germany from 2005 through 2011. Despite changes in the resectional strategy with an increase in the total number thyroidectomies and a decrease of subtotal resections, the rates for postoperative hypoparathyroidism and vocal cord palsy have decreased. The complication rates for total thyroidectomy, however, are still higher compared to subtotal resection. An individualized risk-oriented surgical approach is warranted.

Randomized Trial of Hyperfractionation Versus Conventional Fractionation in T2 Squamous Cell Carcinoma of the Vocal Cord (RTOG 9512)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Trotti, Andy, E-mail: andy.trotti@moffitt.org; Zhang, Qiang; Bentzen, Søren M.

2014-08-01

Purpose: To compare hyperfractionation versus standard fractionation for T2N0 vocal cord carcinoma in a randomized controlled trial. Methods and Materials: Patients with T2 vocal cord cancer were stratified by substage (T2a vs T2b) and randomly assigned to receive either hyperfractionation (HFX) to 79.2 Gy in 66 fractions of 1.2 Gy given twice a day, or standard fractionation (SFX) to 70 Gy in 35 fractions given once a day. The trial was designed to detect a 55% reduction in the local failure hazard rate with 80% statistical power. Results: Between April 1996 and July 2003, a total of 250 patients were enrolled. Of 239more » patients analyzable for outcomes, 94% were male, 83% had a Karnofsky performance status of 90-100, and 62% had T2a tumor. Median follow-up for all surviving patients was 7.9 years (range, 0.6-13.1 years). The 5-year local control (LC) rate was 8 points higher but not statistically significant (P=.14 for HFX [78%] vs SFX [70%]), corresponding to a 30% hazard rate reduction. The 5-year disease-free survival (DFS) was 49% versus 40% (P=.13) and overall survival (OS) was 72% versus 63% (P=.29). HFX was associated with higher rates of acute skin, mucosal, and laryngeal toxicity. Grade 3-4 late effects were similar with a 5-year cumulative incidence of 8.5% (3.4%-13.6%) after SFX and 8.5% (3.4%-13.5%) after HFX. Conclusions: The 5-year local control was modestly higher with HFX compared to SFX for T2 glottic carcinoma, but the difference was not statistically significant. These results are consistent with prior studies of hyperfractionation showing a benefit in local control. Substaging by T2a versus T2b carries prognostic value for DFS and OS. For cost and convenience reasons other altered fractionation schedules have been adopted in routine practice.« less

Experimental study of the effects of surface mucus viscosity on the glottic cycle.

PubMed

Ayache, Stéphane; Ouaknine, Maurice; Dejonkere, Philippe; Prindere, Pierre; Giovanni, Antoine

2004-03-01

Numerous clinical findings indicate that viscosity of laryngeal mucosa is a crucial factor in glottal perfomance. Experience using experimental test benches has shown the importance of humidifying air stream used to induce vibration in excised larynges. Nevertheless, there is a lack of knowledge particularly regarding the physicochemical properties of laryngeal mucus. The purpose of this study was to research vocal fold vibration in excised larynges using artificial mucus of precisely known viscosity. Eight freshly harvested porcine larynges were examined. Parameters measured were Fo and vocal fold contact time. Measurements were performed under three conditions: basal (no fluid application on vocal cord surface), after application of a fluid of 60cP viscosity (Visc60), and after application of a fluid of 100cP viscosity (Visc100). Electroglottographic measurements were performed at two different times for each condition: 1 s after airflow onset (T1) and 6 seconds after airflow onset (T2). Statistical analysis consisted of comparing data obtained under each condition at T1 and T2. The results showed a significant decrease in Fo after application of Visc60 and Visc100 fluids and a decrease in Fo at T2. Closure time was significantly higher under Visc60 conditions and under Visc100 conditions than under basal conditions. Application of artificial mucus to the mucosa of the vocal folds lowered vibratory frequency and prolonged the contact phase. Our interpretation of this data is that the presence of mucus on the surface of the vocal folds generated superficial tension and caused adhesion, which is a source of nonlinearity in vocal vibration.

Intravenous mesenchymal stem cell therapy after recurrent laryngeal nerve injury: a preliminary study.

PubMed

Lerner, Michael Z; Matsushita, Takashi; Lankford, Karen L; Radtke, Christine; Kocsis, Jeffery D; Young, Nwanmegha O

2014-11-01

Intravenous administration of mesenchymal stem cells (MSCs) has been recently shown to enhance functional recovery after stroke and spinal cord injury. The therapeutic properties of MSCs are attributed to their secretion of a variety of potent antiinflammatory and neurotrophic factors. We hypothesize that intravenous administration of MSCs after recurrent laryngeal nerve (RLN) injury in the rat may enhance functional recovery. Animal Research. Twelve 250-gram Sprague-Dawley rats underwent a controlled crush injury to the left RLN. After confirming postoperative vocal fold immobility, each rat was intravenously infused with either green fluorescent protein-expressing MSCs or control media in a randomized and blinded fashion. Videolaryngoscopy was performed weekly. The laryngoscopy video recordings were reviewed and rated by a fellowship-trained laryngologist who remained blinded to the intervention using a 0 to 3 scale. At 1 week postinjury, the MSC-infused group showed a trend for higher average functional recovery scores compared to the control group (2.2 vs 1.3), but it did not reach statistical significance (P value of 0.06). By 2 weeks, however, both groups exhibited complete return of function. These pilot data indicate that with complete nerve transection by crush injury of the RLN in rat, there is complete recovery of vocal fold mobility at 2 weeks. At 1 week postinjury, animals receiving intravenous infusion of MSCs showed a trend for greater functional recovery, suggesting a potential beneficial effect of MSCs; however, this did not reach statistical significance. Therefore, no definite conclusions can be drawn from these data and further study is required. N/A. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

[Comparative study of respiratory mechanisms between professional lyrical singers and beginners].

PubMed

Lassalle, A; Grini, M N; Amy de la Bretèque, B; Ouaknine, M; Giovanni, A

2002-01-01

The apprenticeship for classical singing requires years of training due to its complexity. This training is directed at the different levels of the vocal apparatus: the source of energy or air flow (lungs), the vibrator (vocal cords) and the resonators (bucco-pharyngeal cavity). For this study we have concentrated on the first level, that is, respiration. When a greater demand of vocal activity is required respiration becomes more sustained and more complex; this is when difficulties may be observed. Singers overcome these difficulties through different strategies according to their level of vocal training. Our study compared respiratory strategies used by professional singers and singing students (first year conservatoire students) during singing tasks; none of the subjects had any history of vocal pathology. Electromyographic analysis of muscle activity was registered for the rectus abdominals muscle, external oblique muscle and transverse muscle with surface electrodes. Kinetic analysis was used to measure thoracic cage displacement: pressure sensitive belts were placed around the pubis, the epigastric region and thorax. The subjects were asked to perform two vocal tasks: vocalization of a sustained "i" and singing of an extract of a vaccaï. Results were compared between the 7 professional singers and the 6 singing students. They allowed us to confirm the existence of distinct respiratory strategies according to the level of vocal training, as described in literature. Professional singers inhibited the activity of their rectus abdominals muscles during singing and used mostly their external oblique and transverse muscles, thus, sustaining an expanded ribcage and a longer expiratory breath. Singing students, on the other hand, worked intensively all the abdominal muscles leading to a collapse of the ribcage. Management of air was more difficult and breath was shorter. Future studies will consider a larger population sample in order to define quantitative parameters that might allow a significant differentiation of respiratory strategies between professional singers and singing students.

Intraoperative neural monitoring in thyroid surgery: lessons learned from animal studies

PubMed Central

Randolph, Gregory W.; Lu, I-Cheng; Chang, Pi-Ying; Chen, Yi-Ting; Hun, Pao-Chu; Lin, Yi-Chu; Dionigi, Gianlorenzo; Chiang, Feng-Yu

2016-01-01

Recurrent laryngeal nerve (RLN) injury remains a significant morbidity associated with thyroid and parathyroid surgery. In the past decade, surgeons have increasingly used intraoperative neural monitoring (IONM) as an adjunct technique for localizing and identifying the RLN, detecting RLN injury, and predicting the outcome of vocal cord function. In recent years, many animal studies have investigated common pitfalls and new applications of IONM. For example, the use of IONM technology in animal models has proven valuable in studies of the electrophysiology of RLN injury. The advent of animal studies has substantially improved understanding of IONM technology. Lessons learned from animal studies have immediate clinical applications in establishing reliable strategies for preventing intraoperative RLN injury. This article gives an overview of the research progress on IONM-relevant animal models. PMID:27867861

Outcomes of Thoracic Endovascular Aortic Repair and Subclavian Revascularization Techniques

PubMed Central

Zamor, Kimberly C; Eskandari, Mark K; Rodriguez, Heron E; Ho, Karen J; Morasch, Mark D; Hoel, Andrew W

2015-01-01

Background Practice guidelines regarding management of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) are based on low quality evidence and there is limited literature that addresses optimal revascularization techniques. The purpose of this study is to compare outcomes of LSA coverage during TEVAR and revascularization techniques. Study Design We performed a single-center retrospective cohort study from 2001–2013. Patients were categorized by LSA revascularization and by revascularization technique, carotid-subclavian bypass (CSB) or subclavian-carotid transposition (SCT). Thirty-day and mid-term stroke, spinal cord ischemia, vocal cord paralysis, upper extremity ischemia, primary patency of revascularization, and mortality were compared. Results Eighty patients underwent TEVAR with LSA coverage, 25% (n=20) were unrevascularized and the remaining patients underwent CSB (n=22, 27.5%) or SCT (n=38, 47.5%). Mean follow-up time was 24.9 months. Comparisons between unrevascularized and revascularized patients were significant for a higher rate of 30-day stroke (25% vs. 2%, p=0.003) and upper extremity ischemia (15% vs. 0%, p=0.014). However, there was no difference in 30-day or mid-term rates of spinal cord ischemia, vocal cord paralysis, or mortality. There were no statistically significant differences in 30-day or midterm outcomes for CSB vs. SCT. Primary patency of revascularizations was 100%. Survival analysis comparing unrevascularized vs. revascularized LSA, was statistically significant for freedom from stroke and upper extremity ischemia, p=0.02 and p=0.003, respectively. After adjustment for advanced age, urgency and coronary artery disease, LSA revascularization was associated with lower rates of peri-operative adverse events (OR 0.23, p=0.034). Conclusions During TEVAR, LSA coverage without revascularization is associated with an increased risk of stroke and upper extremity ischemia. When LSA coverage is required during TEVAR, CSB and SCT are equally acceptable options. PMID:25872688

Autologous Platelet-Poor Plasma Gel for Injection Laryngoplasty

PubMed Central

Woo, Seung Hoon; Kim, Jin Pyeong; Park, Jung Je; Chung, Phil-Sang

2013-01-01

Purpose To overcome the potential disadvantages of the use of foreign materials and autologous fat or collagen, we introduce here an autologous plasma gel for injection laryngoplasty. The purpose of this study was to present a new injection material, a plasma gel, and to discuss its clinical effectiveness. Materials and Methods From 2 mL of blood, the platelet poor serum layer was collected and heated at 100℃ for 12 min to form a plasma gel. The plasma gel was then injected into a targeted site; the safety and efficacy thereof were evaluated in 30 rats. We also conducted a phase I/II clinical study of plasma gel injection laryngoplasty in 11 unilateral vocal fold paralysis patients. Results The plasma gel was semi-solid and an easily injectable material. Of note, plasma gel maintains the same consistency for up to 1 year in a sealed bottle. However, exposure to room air causes the plasma gel to disappear within 1 month. In our animal study, the autologous plasma gel remained in situ for 6 months in animals with minimal inflammation. Clinical study showed that vocal cord palsy was well compensated for with the plasma gel in all patients at two months after injection with no significant complications. Jitter, shimmer, maximum, maximum phonation time (MPT) and mean voice handicap index (VHI) also improved significantly after plasma gel injection. However, because the injected plasma gel was gradually absorbed, 6 patients needed another injection, while the gel remained in place in 2 patients. Conclusion Injection laryngoplasty with autologous plasma gel may be a useful and safe treatment option for temporary vocal cord palsy. PMID:24142660

The Vocal Cord Dysfunction Questionnaire: Validity and Reliability of the Persian Version.

PubMed

Ghaemi, Hamide; Khoddami, Seyyedeh Maryam; Soleymani, Zahra; Zandieh, Fariborz; Jalaie, Shohreh; Ahanchian, Hamid; Khadivi, Ehsan

2017-12-25

The aim of this study was to develop, validate, and assess the reliability of the Persian version of Vocal Cord Dysfunction Questionnaire (VCDQ P ). The study design was cross-sectional or cultural survey. Forty-four patients with vocal fold dysfunction (VFD) and 40 healthy volunteers were recruited for the study. To assess the content validity, the prefinal questions were given to 15 experts to comment on its essential. Ten patients with VFD rated the importance of VCDQ P in detecting face validity. Eighteen of the patients with VFD completed the VCDQ 1 week later for test-retest reliability. To detect absolute reliability, standard error of measurement and smallest detected change were calculated. Concurrent validity was assessed by completing the Persian Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) by 34 patients with VFD. Discriminant validity was measured from 34 participants. The VCDQ was further validated by administering the questionnaire to 40 healthy volunteers. Validation of the VCDQ as a treatment outcome tool was conducted in 18 patients with VFD using pre- and posttreatment scores. The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.97). The standard error of measurement and smallest detected change values were acceptable (0.39 and 1.08, respectively). There was a significant correlation between the VCDQ P and the CAT total scores (P < 0.05). Discriminative validity was significantly different. The VCDQ scores in patients with VFD before and after treatment was significantly different (P < 0.001). The VCDQ was cross-culturally adapted to Persian and demonstrated to be a valid and reliable self-administered questionnaire in Persian-speaking population. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Effects of Social Games on Infant Vocalizations

ERIC Educational Resources Information Center

Hsu, Hui-Chin; Iyer, Suneeti Nathani; Fogel, Alan

2014-01-01

The aim of the present study was to examine the contextual effects of social games on prelinguistic vocalizations. The two main goals were to (1) investigate the functions of vocalizations as symptoms of affective arousal and symbols of social understanding, and (2) explore form-function (de)coupling relations between vocalization types and game…

Effects of social games on infant vocalizations*.

PubMed

Hsu, Hui-Chin; Iyer, Suneeti Nathani; Fogel, Alan

2014-01-01

The aim of the present study was to examine the contextual effects of social games on prelinguistic vocalizations. The two main goals were to (1) investigate the functions of vocalizations as symptoms of affective arousal and symbols of social understanding, and (2) explore form-function (de)coupling relations between vocalization types and game contexts. Seventy-one six-month-olds and sixty-four twelve-month-olds played with their mothers in normal and perturbed tickle and peek-a-boo games. The effects of infant age, game, game climax, and game perturbation on the frequency and types of infant vocalizations were examined. Results showed twelve-month-olds vocalized more mature canonical syllables during peek-a-boo and more primitive quasi-resonant nuclei during tickle than six-month-olds. Six- and twelve-month-olds increased their vocalizations from the set-up to climax during peek-a-boo, but they did not show such an increase during tickle. Findings support the symptom function of prelinguistic vocalizations reflecting affective arousal and the prevalence of form-function decoupling during the first year of life.

Diagnosis of Spasmodic Dysphonia Manifested by Swallowing Difficulty in Videofluoroscopic Swallowing Study

PubMed Central

Yeo, Han Gyeol; Lee, Seong Jae; Hyun, Jung Keun

2015-01-01

Spasmodic dysphonia is defined as a focal laryngeal disorder characterized by dystonic spasms of the vocal cord during speech. We described a case of a 22-year-old male patient who presented complaining of idiopathic difficulty swallowing that suddenly developed 6 months ago. The patient also reported pharyngolaryngeal pain, throat discomfort, dyspnea, and voice change. Because laryngoscopy found no specific problems, an electrodiagnostic study and videofluoroscopic swallowing study (VFSS) were performed to find the cause of dysphagia. The VFSS revealed continuous twitch-like involuntary movement of the laryngeal muscle around the vocal folds. Then, he was diagnosed with spasmodic dysphonia by VFSS, auditory-perceptual voice analysis, and physical examination. So, we report the first case of spasmodic dysphonia accompanied with difficulty swallowing that was confirmed by VFSS. PMID:25932430

New CO2 laser waveguide systems: advances in surgery of tracheal stenosis

NASA Astrophysics Data System (ADS)

Stasche, Norbert; Bernecker, Frank; Hoermann, Karl

1996-01-01

The carbon dioxide laser is a well established tool in the surgical treatment of laryngeal and tracheal stenosis. Usually the laser beam is applied by a microscope/micromanipulator device. Different types of rigid laryngoscopes and bronchoscopes provide access to nearly every area of larynx, trachea and main bronchi. In order to be treated with this equipment the target tissue has to be in a straight optical axis with the laser beam output at the micromanipulator. We report about one patient who presented with severe dyspnea due to granulation tissue directly below his left vocal cord. He was suffering from tracheomalacia for several years and was successfully treated by tracheostomy and a Montgomery's silicone T-tube as a stent. Then granulation tissue blocked the upper orifice of the Montgomery's T-tube. First removal by a carbon dioxide laser beam through the laryngoscope would have required sacrificing his intact left vocal cord. We removed the obstructing tissue by using the ArthroLaseTM System: the carbon dioxide laser beam was conducted through a 90 degree bent rigid probe, using the tracheostomy as an access. This ArthroLaseTM System was originally designed for arthroscopic surgery. In this special case however it successfully extends the use of the carbon dioxide laser in otolaryngology.

[A Case of Left Vertebral Artery Aneurysm Showing Evoked Potentials on Bilateral Electrode by the Left Vagus Nerve Stimulation to Electromyographic Tracheal Tube].

PubMed

Kadoya, Tatsuo; Uehara, Hirofumi; Yamamoto, Toshinori; Shiraishi, Munehiro; Kinoshita, Yuki; Joyashiki, Takeshi; Enokida, Kengo

2016-02-01

Previously, we reported a case of brainstem cavernous hemangioma showing false positive responses to electromyographic tracheal tube (EMG tube). We concluded that the cause was spontaneous respiration accompanied by vocal cord movement. We report a case of left vertebral artery aneurysm showing evoked potentials on bilateral electrodes by the left vagus nerve stimulation to EMG tube. An 82-year-old woman underwent clipping of a left unruptured vertebral artery-posterior inferior cerebellar artery aneurysm. General anesthesia was induced with remifentanil, propofol and suxamethonium, and was maintained with oxygen, air, remifentanil and propofol. We monitored somatosensory evoked potentials, motor evoked potentials, and electromyogram of the vocal cord. When the manipulation reached brainstem and the instrument touched the left vagus nerve, evoked potentials appeared on bilateral electrodes. EMG tube is equipped with two electrodes on both sides. We concluded that the left vagus nerve stimulation generated evoked potentials of the left laryngeal muscles, and they were simultaneously detected as potential difference between two electrodes on both sides. EMG tube is used to identify the vagus nerve. However, it is necessary to bear in mind that each vagus nerve stimulation inevitably generates evoked potentials on bilateral electrodes.

Comparison of Lyophilized Glutaraldehyde-Preserved Bovine Pericardium with Different Vascular Prostheses for Use as Vocal Cords Implants: Experimental Study

PubMed Central

Olmos-Zuñiga, J. Raúl; Jasso-Victoria, Rogelio; Gaxiola-Gaxiola, Miguel; Sotres-Vega, Avelina; Hernández-Jiménez, Claudia; Baltazares-Lipp, Matilde; Arredondo del Bosque, Fernando; Santillan-Doherty, Patricio

2015-01-01

This study compared the use of lyophilized glutaraldehyde-preserved bovine pericardium (LGPBP), polytetrafluoroethylene (PTFE), polyethylene terephthalate (PET), and Teflon felt (TF) as implants for vocal cords (VC) medialization and aimed to assess the endoscopic, macroscopic, and microscopic VC changes after medialization in a canine model. In 18 mongrel dogs, the right VC were medialized with LGPBP and the left were implanted as follows: Group I (n = 6): LGPBP and PTFE; Group II (n = 6): LGPBP and PET; Group III (n = 6): LGPBP and TF. Surgical handling of the implants was compared. Three months after surgery, macroscopic and microscopic changes of VC and implants were evaluated. LGPBP offered the best surgical handling (p = 0.005, Kruskal-Wallis). TF implants showed extrusion (p = 0.005, Kruskal-Wallis) and severe inflammation. All VC formed fibrous capsules around the implants; the ones developed by LGPBP implants were thinner (p = 0.001, ANOVA, Tukey). VC implanted with synthetic materials showed eosinophilic infiltration (p = 0.01, Kruskal-Wallis). We concluded that the LGPBP could be used as an implant for VC medialization because it is biocompatible, easy to handle and remove during surgical procedures, and nonabsorbable or extrudable and produces an inflammatory reaction similar to PTFE and PET. PMID:26075232

Adenoid cystic carcinoma of the larynx presenting with unusual subglottic mass: Case report.

PubMed

Kashiwagi, Takashi; Kanaya, Hiroaki; Konno, Wataru; Goto, Kazutaka; Hirabayashi, Hideki; Haruna, Shin-Ichi

2016-10-01

A 33-year-old woman presented with an unusual subglottic bulging mass accompanied by prolonged cough and wheeze. Laryngeal endoscopy revealed a bilateral, symmetrical mass immediately below the vocal cords with marked airway obstruction. Chronic subglottic laryngitis with inflammation or another condition such as amyloidosis was initially suspected. Cervicothoracic computed tomography revealed an obvious reduction of laryngeal caliber caused by an engulfing mass extending from just under the vocal cords to the cricoid ring, which was associated with thyroid, arytenoid, and cricoid cartilage destruction. Histopathological diagnosis of a biopsy specimen collected via a tracheotomy revealed that the lesion was a cT4aN0M0 adenoid cystic carcinoma (ACC) originating from the laryngeal minor salivary glands. The patient was treated by total laryngectomy with elective bilateral neck dissection under general anesthesia. Gross inspection of resected tissue confirmed yellowish-white, solid tumor mainly circumferentially encompassing the lumina of the cricoid ring. The histopathological findings confirmed typical ACC accompanied by a predominant cribriform appearance with no evidence of lymph node metastasis. The patient remains well and free of recurrence or metastasis. We herein describe laryngeal ACC and discuss radiological images and the surgical pathology. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparison of lyophilized glutaraldehyde-preserved bovine pericardium with different vascular prostheses for use as vocal cords implants: experimental study.

PubMed

Olmos-Zuñiga, J Raúl; Jasso-Victoria, Rogelio; Gaxiola-Gaxiola, Miguel; Sotres-Vega, Avelina; Hernández-Jiménez, Claudia; Baltazares-Lipp, Matilde; Arredondo del Bosque, Fernando; Santillan-Doherty, Patricio

2015-01-01

This study compared the use of lyophilized glutaraldehyde-preserved bovine pericardium (LGPBP), polytetrafluoroethylene (PTFE), polyethylene terephthalate (PET), and Teflon felt (TF) as implants for vocal cords (VC) medialization and aimed to assess the endoscopic, macroscopic, and microscopic VC changes after medialization in a canine model. In 18 mongrel dogs, the right VC were medialized with LGPBP and the left were implanted as follows: Group I (n = 6): LGPBP and PTFE; Group II (n = 6): LGPBP and PET; Group III (n = 6): LGPBP and TF. Surgical handling of the implants was compared. Three months after surgery, macroscopic and microscopic changes of VC and implants were evaluated. LGPBP offered the best surgical handling (p = 0.005, Kruskal-Wallis). TF implants showed extrusion (p = 0.005, Kruskal-Wallis) and severe inflammation. All VC formed fibrous capsules around the implants; the ones developed by LGPBP implants were thinner (p = 0.001, ANOVA, Tukey). VC implanted with synthetic materials showed eosinophilic infiltration (p = 0.01, Kruskal-Wallis). We concluded that the LGPBP could be used as an implant for VC medialization because it is biocompatible, easy to handle and remove during surgical procedures, and nonabsorbable or extrudable and produces an inflammatory reaction similar to PTFE and PET.

Functional flexibility of infant vocalization and the emergence of language

PubMed Central

Oller, D. Kimbrough; Buder, Eugene H.; Ramsdell, Heather L.; Warlaumont, Anne S.; Chorna, Lesya; Bakeman, Roger

2013-01-01

We report on the emergence of functional flexibility in vocalizations of human infants. This vastly underappreciated capability becomes apparent when prelinguistic vocalizations express a full range of emotional content—positive, neutral, and negative. The data show that at least three types of infant vocalizations (squeals, vowel-like sounds, and growls) occur with this full range of expression by 3–4 mo of age. In contrast, infant cry and laughter, which are species-specific signals apparently homologous to vocal calls in other primates, show functional stability, with cry overwhelmingly expressing negative and laughter positive emotional states. Functional flexibility is a sine qua non in spoken language, because all words or sentences can be produced as expressions of varying emotional states and because learning conventional “meanings” requires the ability to produce sounds that are free of any predetermined function. Functional flexibility is a defining characteristic of language, and empirically it appears before syntax, word learning, and even earlier-developing features presumed to be critical to language (e.g., joint attention, syllable imitation, and canonical babbling). The appearance of functional flexibility early in the first year of human life is a critical step in the development of vocal language and may have been a critical step in the evolution of human language, preceding protosyntax and even primitive single words. Such flexible affect expression of vocalizations has not yet been reported for any nonhuman primate but if found to occur would suggest deep roots for functional flexibility of vocalization in our primate heritage. PMID:23550164

Assessment of the functions of vocal behavior in children with developmental disabilities: a replication.

PubMed

Kelley, Michael E; Shillingsburg, M Alice; Castro, M Jicel; Addison, Laura R; LaRue, Robert H; Martins, Megan P

2007-01-01

Although experimental analysis methodologies have been useful for identifying the function of a wide variety of target behaviors (e.g., Iwata, Dorsey, Slifer, Bauman, & Richman, 1982/1994), only recently have such procedures been applied to verbal operants (Lerman et al., 2005). In the current study, we conducted a systematic replication of the methodology developed by Lerman et al. Participants were 4 children who had been diagnosed with developmental disabilities and who engaged in limited vocal behavior. The function of vocal behavior was assessed by exposing target vocal responses to experimental analyses. Results showed that experimental analyses were generally useful for identifying the functions of vocal behavior across all participants.

Impacts and limitations of medialization thyroplasty on swallowing function of patients with unilateral vocal fold paralysis.

PubMed

Tateya, Ichiro; Hirano, Shigeru; Kishimoto, Yo; Suehiro, Atsushi; Kojima, Tsuyohi; Ohno, Satoshi; Ito, Juichi

2010-11-01

Medialization thyroplasty was effective in improving swallowing function as well as vocal function in most cases with unilateral vocal fold paralysis. The impact of medialization thryoplasty was insufficient for the case with severe atrophy and that in which the vocal fold was fixed in the lateral position. To evaluate the impacts and limitations of medialization thyroplasty on swallowing function of the patients with unilateral vocal fold paralysis. Eight cases (mean age 68.5 years) with unilateral vocal fold paralysis chiefly complaining of swallowing disturbance were studied. All patients underwent thyroplasty type I. The causes of the paralysis were lung cancer in four cases, esophageal cancer in one case, aortic aneurysm in one case, subarachnoid hemorrhage in one case, and unknown in one case. Subjective swallowing function score, maximum phonation time (MPT), mean flow rate (MFR), amplitude perturbation quotient (APQ), and pitch perturbation quotient (PPQ) were examined pre- and postoperatively. The swallowing score improved in all except two cases. However, bilateral thryoplasty was necessary for the case with severe vocal fold atrophy and arytenoid adduction was needed for the case in which the vocal fold was fixed in the lateral position. The swallowing score, MPT, and MFR showed significant improvement after surgery.

Adapted to Roar: Functional Morphology of Tiger and Lion Vocal Folds

PubMed Central

Klemuk, Sarah A.; Riede, Tobias; Walsh, Edward J.; Titze, Ingo R.

2011-01-01

Vocal production requires active control of the respiratory system, larynx and vocal tract. Vocal sounds in mammals are produced by flow-induced vocal fold oscillation, which requires vocal fold tissue that can sustain the mechanical stress during phonation. Our understanding of the relationship between morphology and vocal function of vocal folds is very limited. Here we tested the hypothesis that vocal fold morphology and viscoelastic properties allow a prediction of fundamental frequency range of sounds that can be produced, and minimal lung pressure necessary to initiate phonation. We tested the hypothesis in lions and tigers who are well-known for producing low frequency and very loud roaring sounds that expose vocal folds to large stresses. In histological sections, we found that the Panthera vocal fold lamina propria consists of a lateral region with adipocytes embedded in a network of collagen and elastin fibers and hyaluronan. There is also a medial region that contains only fibrous proteins and hyaluronan but no fat cells. Young's moduli range between 10 and 2000 kPa for strains up to 60%. Shear moduli ranged between 0.1 and 2 kPa and differed between layers. Biomechanical and morphological data were used to make predictions of fundamental frequency and subglottal pressure ranges. Such predictions agreed well with measurements from natural phonation and phonation of excised larynges, respectively. We assume that fat shapes Panthera vocal folds into an advantageous geometry for phonation and it protects vocal folds. Its primary function is probably not to increase vocal fold mass as suggested previously. The large square-shaped Panthera vocal fold eases phonation onset and thereby extends the dynamic range of the voice. PMID:22073246

A Multidimensional Study of Vocal Function Following Radiation Therapy for Laryngeal Cancers.

PubMed

Angadi, Vrushali; Dressler, Emily; Stemple, Joseph

2017-06-01

Radiation therapy (XRT) has proven to be an effective curative modality in the treatment of laryngeal cancers. However, XRT also has deleterious effects on vocal function. To demonstrate the multidimensional nature of deficits in vocal function as a result of radiation therapy for laryngeal cancer. Cohort study. Vocal function parameters were chosen from the 5 domains of voice assessment to complete a multidimensional assessment battery. Adults irradiated (XRT group) for laryngeal cancers were compared to a control group of individuals with no history of head and neck cancers or radiation therapy. The control group was matched in age, sex, and pack years of smoking. Eighteen participants were recruited for the study. The XRT group demonstrated significantly worse clinical values as compared to the control group across select parameters in the each of the 5 domains of voice assessment. Radiation therapy for laryngeal cancers results in multidimensional deficits in vocal function. Notably, these deficits persist long term. In the present study sample, multidimensional deficits were persistent 2 to 7 years following completion of XRT. The observed multidimensional persistent vocal difficulties highlight the importance of vocal rehabilitation in the irradiated larynx cancer population.

Viscoelastic properties of rabbit vocal folds after augmentation.

PubMed

Hertegård, Stellan; Dahlqvist, Ake; Laurent, Claude; Borzacchiello, Assunta; Ambrosio, Luigi

2003-03-01

Vocal fold function is closely related to tissue viscoelasticity. Augmentation substances may alter the viscoelastic properties of vocal fold tissues and hence their vibratory capacity. We sought to investigate the viscoelastic properties of rabbit vocal folds in vitro after injections of various augmentation substances. Polytetrafluoroethylene (Teflon), cross-linked collagen (Zyplast), and cross-linked hyaluronan, hylan b gel (Hylaform) were injected into the lamina propria and the thyroarytenoid muscle of rabbit vocal folds. Dynamic viscosity of the injected vocal fold as a function of frequency was measured with a Bohlin parallel-plate rheometer during small-amplitude oscillation. All injected vocal folds showed a decreasing dynamic viscosity with increasing frequency. Vocal fold samples injected with hylan b gel showed the lowest dynamic viscosity, quite close to noninjected control samples. Vocal folds injected with polytetrafluoroethylene showed the highest dynamic viscosity followed by the collagen samples. The data indicated that hylan b gel in short-term renders the most natural viscoelastic properties to the vocal fold among the substances tested. This is of importance to restore/preserve the vibratory capacity of the vocal folds when glottal insufficiency is treated with injections.

Characterizing the graded structure of false killer whale (Pseudorca crassidens) vocalizations.

PubMed

Murray, S O; Mercado, E; Roitblat, H L

1998-09-01

The vocalizations from two, captive false killer whales (Pseudorca crassidens) were analyzed. The structure of the vocalizations was best modeled as lying along a continuum with trains of discrete, exponentially damped sinusoidal pulses at one end and continuous sinusoidal signals at the other end. Pulse trains were graded as a function of the interval between pulses where the minimum interval between pulses could be zero milliseconds. The transition from a pulse train with no inter-pulse interval to a whistle could be modeled by gradations in the degree of damping. There were many examples of vocalizations that were gradually modulated from pulse trains to whistles. There were also vocalizations that showed rapid shifts in signal type--for example, switching immediately from a whistle to a pulse train. These data have implications when considering both the possible function(s) of the vocalizations and the potential sound production mechanism(s). A short-time duty cycle measure was developed to characterize the graded structure of the vocalizations. A random sample of 500 vocalizations was characterized by combining the duty cycle measure with peak frequency measurements. The analysis method proved to be an effective metric for describing the graded structure of false killer whale vocalizations.

[Immediate recurrent laryngeal nerve reconstruction in the treatment of thyroid cancer invading the recurrent laryngeal nerve].

PubMed

Feng, Yun; Yang, Dazhang; Liu, Dandan; Chen, Jian; Bi, Qingling; Luo, Keqiang

2014-08-01

To explore the application of immediate recurrent laryngeal nerve reconstruction in the treatment of thyroid cancer invading the recurrent laryngeal nerve. Ten patients with thyroid cancer invading unilateral recurrent laryngeal nerve underwent radical surgery and immediate recurrent laryngeal nerve reconstruction. The reconstructive surgical approach included recurrent laryngeal nerve decompression surgery, end-to-end anastomosis of the recurrent laryngeal nerve, anastomosis of ansa cervicalis nerve to the recurrent laryngeal nerve, and nerve-muscle pedicle (NMP) technique. Among the ten patients, one underwent nerve decompression, one underwent end-to-end anastomosis of the recurrent laryngeal nerve, seven had anastomosis of ansa cervicalis to recurrent laryngeal nerve, and one case had anastomosis of ansa cervicalis to recurrent laryngeal nerve combined with nerve-muscle pedicle (NMP) technique. The effect of surgery was evaluated by videolaryngoscopy, maximum phonation time (MPT), phonation efficiency index (PEI) and voice assessment. T-test was used in the statistical analysis. All of the 10 patients had no complications including tumor recurrence and hypoparathyroidism after the surgery. Their hoarseness symptoms were improved, and the patients returned to normal or near-normal voice. Postoperative videolaryngoscopy showed that paralyzed vocal cord returned to normal muscle tone and volume, and the vocal cord vibration and mucosal wave were symmetric and the patients got good glottal closure. The pre- and post-operative maximum phone times of the patients were (4.52 ± 0.89) s and (11.91 ± 1.87) s, respectively (P < 0.01). The pre- and post-operative phonation efficiency indices were (1.37 ± 0.43) s/L and (4.02 ± 1.33) s/L, respectively (P < 0.05). In patients with thyroid cancer invading unilateral recurrent laryngeal nerve, immediate recurrent laryngeal nerve reconstruction following radical surgery of thyroid cancer can effectively achieve recovery in phonation function and improve the quality of life of the patients.

Contribution to the understanding of the etiology of vocal fold cysts: a functional and histologic study.

PubMed

Milutinović, Z; Vasiljević, J

1992-05-01

The etiological theories of vocal fold cysts can be divided into two basic groups: those of congenital and acquired cysts. In ongoing practice, the authors had noted that the greater number of cysts appeared at the functionally most active segment of the vocal folds which, on the other hand, has the least number of glands. Also, it had been noted that patients with vocal fold cysts tended to have hyperkinetic patterns of voice production. These observations indicated the possibility of a functional aspect in the etiology of vocal fold cysts, and consideration of such a possibility was the aim of this work. In 37 cases, the exact location of the cyst was established. In addition, the muscular activity of the phonatory apparatus was estimated, patient self-descriptions with respect to talkativeness were taken into account, and histological evaluations were made. The cysts were most frequently found in the area of the junction of the anterior and middle thirds of the free edge of the vocal fold. Muscular activity during speech and phonation was increased in study patients. Sixty-five percent of patients had epidermoid cysts and 35% had retention cysts of the vocal fold. According to study results, the functional aspect of cyst genesis has a marked role in the etiology of vocal fold cysts, which points to the great importance of functional care for cyst patients.

Risk Factors of Voice Disorders and Impact of Vocal Hygiene Awareness Program Among Teachers in Public Schools in Egypt.

PubMed

Bolbol, Sarah A; Zalat, Marwa M; Hammam, Rehab A M; Elnakeb, Nasser L

2017-03-01

Even though many studies have explored the problem of voice disorders among teachers worldwide, this problem is still not adequately studied in Egypt. The following study was conducted to investigate the risk factors of voice disorders among an Egyptian sample of school teachers, to measure the effect of a vocal hygiene awareness program on them, and to investigate their vocal cord lesions. One hundred fifty-six teachers working in public schools and 180 administrative workers in the Faculty of Medicine in the same city participated in this study. They completed a self-administered questionnaire investigating voice disorders, and were subjected to a voice awareness program and a clinical examination. Voice-related symptoms and Voice Handicap Index were statistically significantly higher among teachers compared with the control subjects. Work duration and high frequency of classes per week of ≥15 were the most statistically significant indicators influencing a teacher's voice. Three months after application of vocal hygiene awareness program, the teachers who were studied showed a statistically significant increase in their awareness about vocal hygiene tips. Egyptian teachers working in public schools are dealing with classes that include a great number of students per class. They also have to deal with unprofessional facilities and limited assisting resources. Therefore, they are highly exposed to the risk of voice-related disorders. Increasing awareness about healthy behavior with the voice in their occupations will help in improving their quality of work and in minimizing any permanent impairments and/or disability. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Inter- and Intrafraction Target Motion in Highly Focused Single Vocal Cord Irradiation of T1a Larynx Cancer Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kwa, Stefan L.S., E-mail: s.kwa@erasmusmc.nl; Al-Mamgani, Abrahim; Osman, Sarah O.S.

2015-09-01

Purpose: The purpose of this study was to verify clinical target volume–planning target volume (CTV-PTV) margins in single vocal cord irradiation (SVCI) of T1a larynx tumors and characterize inter- and intrafraction target motion. Methods and Materials: For 42 patients, a single vocal cord was irradiated using intensity modulated radiation therapy at a total dose of 58.1 Gy (16 fractions × 3.63 Gy). A daily cone beam computed tomography (CBCT) scan was performed to online correct the setup of the thyroid cartilage after patient positioning with in-room lasers (interfraction motion correction). To monitor intrafraction motion, CBCT scans were also acquired just after patient repositioning and aftermore » dose delivery. A mixed online-offline setup correction protocol (“O2 protocol”) was designed to compensate for both inter- and intrafraction motion. Results: Observed interfraction, systematic (Σ), and random (σ) setup errors in left-right (LR), craniocaudal (CC), and anteroposterior (AP) directions were 0.9, 2.0, and 1.1 mm and 1.0, 1.6, and 1.0 mm, respectively. After correction of these errors, the following intrafraction movements derived from the CBCT acquired after dose delivery were: Σ = 0.4, 1.3, and 0.7 mm, and σ = 0.8, 1.4, and 0.8 mm. More than half of the patients showed a systematic non-zero intrafraction shift in target position, (ie, the mean intrafraction displacement over the treatment fractions was statistically significantly different from zero; P<.05). With the applied CTV-PTV margins (for most patients 3, 5, and 3 mm in LR, CC, and AP directions, respectively), the minimum CTV dose, estimated from the target displacements observed in the last CBCT, was at least 94% of the prescribed dose for all patients and more than 98% for most patients (37 of 42). The proposed O2 protocol could effectively reduce the systematic intrafraction errors observed after dose delivery to almost zero (Σ = 0.1, 0.2, 0.2 mm). Conclusions: With adequate image guidance and CTV-PTV margins in LR, CC, and AP directions of 3, 5, and 3 mm, respectively, excellent target coverage in SVCI could be ensured.« less

Phonomicrosurgery in singers and performing artists: treatment outcomes, management theories, and future directions.

PubMed

Zeitels, Steven M; Hillman, Robert E; Desloge, Rosemary; Mauri, Marcello; Doyle, Patricia B

2002-12-01

Phonomicrosurgery in performing artists has historically been approached with great trepidation, and vocal outcome data are sparse. The vocal liability of surgically disturbing the superficial lamina propria (SLP) and epithelium must be balanced with the inherent detrimental vocal effect of the lesion(s). A prospective investigation was performed on 185 performing artists who underwent phonomicrosurgical resection of 365 lesions: 201 nodules, 71 polyps, 66 varices and ectasias, 13 cysts, 8 keratotic lesions, 2 granulomas, 2 Reinke's edema, and 2 papillomas. Nearly all patients with SLP lesions reported improvement in their postsurgical vocal function. This subjective result was supported by objective acoustic and aerodynamic measures. All postsurgical objective vocal function measures fell within normal limits, including a few that displayed presurgical abnormalities. However, given the relative insensitivity of standard objective measures to assess higher-level vocal performance-related factors, it is even more noteworthy that 8 of 24 objective measures displayed statistically significant postsurgical improvements in vocal function. Such changes in objective measures mostly reflect overall enhancement in the efficiency of voice production. Phonomicrosurgical resection of vocal fold lesions in performing artists is enjoying an expanding role because of a variety of improvements in diagnostic assessment, surgical instrumentation and techniques, and specialized rehabilitation. Most of these lesions are the result of phonotrauma and arise within the SLP. Successful management depends on prudent patient selection and counseling, ultraprecise technique, and vigorqus vocal rehabilitation. Furthermore, an understanding of the vocal function and dysfunction of this high-performance population provides all otolaryngologists who manage laryngeal problems with valuable information that they can extrapolate for use in their practices.

Relation of structural and vibratory kinematics of the vocal folds to two acoustic measures of breathy voice based on computational modeling

PubMed Central

Samlan, Robin A.; Story, Brad H.

2011-01-01

Purpose To relate vocal fold structure and kinematics to two acoustic measures: cepstral peak prominence (CPP) and the amplitude of the first harmonic relative to the second (H1-H2). Method A computational, kinematic model of the medial surfaces of the vocal folds was used to specify features of vocal fold structure and vibration in a manner consistent with breathy voice. Four model parameters were altered: degree of vocal fold adduction, surface bulging, vibratory nodal point, and supraglottal constriction. CPP and H1-H2 were measured from simulated glottal area, glottal flow and acoustic waveforms and related to the underlying vocal fold kinematics. Results CPP decreased with increased separation of the vocal processes, whereas the nodal point location had little effect. H1-H2 increased as a function of separation of the vocal processes in the range of 1–1.5 mm and decreased with separation > 1.5 mm. Conclusions CPP is generally a function of vocal process separation. H1*-H2* will increase or decrease with vocal process separation based on vocal fold shape, pivot point for the rotational mode, and supraglottal vocal tract shape, limiting its utility as an indicator of breathy voice. Future work will relate the perception of breathiness to vocal fold kinematics and acoustic measures. PMID:21498582

Trial-Based Functional Analysis Informs Treatment for Vocal Scripting.

PubMed

Rispoli, Mandy; Brodhead, Matthew; Wolfe, Katie; Gregori, Emily

2018-05-01

Research on trial-based functional analysis has primarily focused on socially maintained challenging behaviors. However, procedural modifications may be necessary to clarify ambiguous assessment results. The purposes of this study were to evaluate the utility of iterative modifications to trial-based functional analysis on the identification of putative reinforcement and subsequent treatment for vocal scripting. For all participants, modifications to the trial-based functional analysis identified a primary function of automatic reinforcement. The structure of the trial-based format led to identification of social attention as an abolishing operation for vocal scripting. A noncontingent attention treatment was evaluated using withdrawal designs for each participant. This noncontingent attention treatment resulted in near zero levels of vocal scripting for all participants. Implications for research and practice are presented.

Further evaluation of methods to identify matched stimulation.

PubMed

Rapp, John T

2007-01-01

The effects of preferred stimulation on the vocal stereotypy of 2 individuals were evaluated in two experiments. The results of Experiment 1 showed that (a) the vocal stereotypy of both participants persisted in the absence of social consequences, (b) 1 participant manipulated toys that did and did not produce auditory stimulation, but only sound-producing toys decreased his vocal stereotypy, and (c) only noncontingent music decreased vocal stereotypy for the other participant, but sterotypy paradoxically increased when toys were presented with music. Using a three-component multiple schedule, the results of Experiment 2 showed that the vocal stereotypy of both participants remained below preintervention levels following the removal of auditory stimulation and that 1 participant's vocal stereotypy increased following the removal of contingent reprimands. These patterns suggest that auditory stimulation functioned as an abolishing operation for vocal stereotypy and reprimands functioned as an establishing operation for vocal stereotypy. Together, the two experiments provide a method for identifying alternative stimulation that may substitute for automatically reinforced behavior.

Combining Multiobjective Optimization and Cluster Analysis to Study Vocal Fold Functional Morphology

PubMed Central

Palaparthi, Anil; Riede, Tobias

2017-01-01

Morphological design and the relationship between form and function have great influence on the functionality of a biological organ. However, the simultaneous investigation of morphological diversity and function is difficult in complex natural systems. We have developed a multiobjective optimization (MOO) approach in association with cluster analysis to study the form-function relation in vocal folds. An evolutionary algorithm (NSGA-II) was used to integrate MOO with an existing finite element model of the laryngeal sound source. Vocal fold morphology parameters served as decision variables and acoustic requirements (fundamental frequency, sound pressure level) as objective functions. A two-layer and a three-layer vocal fold configuration were explored to produce the targeted acoustic requirements. The mutation and crossover parameters of the NSGA-II algorithm were chosen to maximize a hypervolume indicator. The results were expressed using cluster analysis and were validated against a brute force method. Results from the MOO and the brute force approaches were comparable. The MOO approach demonstrated greater resolution in the exploration of the morphological space. In association with cluster analysis, MOO can efficiently explore vocal fold functional morphology. PMID:24771563

Vocal coordination and vocal imitation: a role for mirror neurons?

PubMed

Newman, John D

2014-04-01

Some birds and mammals have vocal communication systems in which coordination between individuals is important. Examples would include duetting or antiphonal calling in some birds and mammals, rapid exchanges of the same vocalization, and vocal exchanges between paired individuals and other nearby pairs. Mirror neurons may play a role in such systems but become functional only after experience.

Assessing and treating vocal stereotypy in children with autism.

PubMed

Ahearn, William H; Clark, Kathy M; MacDonald, Rebecca P F; Chung, Bo In

2007-01-01

Previous research implies that stereotypic behavior tends to be maintained by the sensory consequences produced by engaging in the response. Few investigations, however, have focused on vocal stereotypy. The current study examined the noncommunicative vocalizations of 4 children with an autism spectrum disorder. First, functional analyses were conducted in an attempt to identify the function of each child's behavior. For each of the participants, it was found that vocal stereotypy was likely not maintained by the social consequences. Following assessment, response interruption and redirection (RIRD) was implemented in an ABAB design to determine whether vocal stereotypy could be successfully redirected. RIRD involved a teacher issuing a series of vocal demands the child readily complied with during regular academic programming. Vocal demands were presented contingent on the occurrence of vocal stereotypy and were continuously presented until the child complied with three consecutively issued demands without emitting vocal stereotypy. For each child, RIRD produced levels of vocal stereotypy substantially lower than those observed in baseline. For 3 of the children, an increase in appropriate communication was also observed. The children's teachers were trained to implement RIRD. Brief follow-up probes and anecdotal information implied that the treatment had a positive impact in the natural environment.

Assessing and Treating Vocal Stereotypy in children with Autism

PubMed Central

Ahearn, William H; Clark, Kathy M; MacDonald, Rebecca P.F; In Chung, Bo

2007-01-01

Previous research implies that stereotypic behavior tends to be maintained by the sensory consequences produced by engaging in the response. Few investigations, however, have focused on vocal stereotypy. The current study examined the noncommunicative vocalizations of 4 children with an autism spectrum disorder. First, functional analyses were conducted in an attempt to identify the function of each child's behavior. For each of the participants, it was found that vocal stereotypy was likely not maintained by the social consequences. Following assessment, response interruption and redirection (RIRD) was implemented in an ABAB design to determine whether vocal stereotypy could be successfully redirected. RIRD involved a teacher issuing a series of vocal demands the child readily complied with during regular academic programming. Vocal demands were presented contingent on the occurrence of vocal stereotypy and were continuously presented until the child complied with three consecutively issued demands without emitting vocal stereotypy. For each child, RIRD produced levels of vocal stereotypy substantially lower than those observed in baseline. For 3 of the children, an increase in appropriate communication was also observed. The children's teachers were trained to implement RIRD. Brief follow-up probes and anecdotal information implied that the treatment had a positive impact in the natural environment. PMID:17624067

Human mutant huntingtin disrupts vocal learning in transgenic songbirds.

PubMed

Liu, Wan-Chun; Kohn, Jessica; Szwed, Sarah K; Pariser, Eben; Sepe, Sharon; Haripal, Bhagwattie; Oshimori, Naoki; Marsala, Martin; Miyanohara, Atsushi; Lee, Ramee

2015-11-01

Speech and vocal impairments characterize many neurological disorders. However, the neurogenetic mechanisms of these disorders are not well understood, and current animal models do not have the necessary circuitry to recapitulate vocal learning deficits. We developed germline transgenic songbirds, zebra finches (Taneiopygia guttata) expressing human mutant huntingtin (mHTT), a protein responsible for the progressive deterioration of motor and cognitive function in Huntington's disease (HD). Although generally healthy, the mutant songbirds had severe vocal disorders, including poor vocal imitation, stuttering, and progressive syntax and syllable degradation. Their song abnormalities were associated with HD-related neuropathology and dysfunction of the cortical-basal ganglia (CBG) song circuit. These transgenics are, to the best of our knowledge, the first experimentally created, functional mutant songbirds. Their progressive and quantifiable vocal disorder, combined with circuit dysfunction in the CBG song system, offers a model for genetic manipulation and the development of therapeutic strategies for CBG-related vocal and motor disorders.

Surgical margins in head and neck squamous cell carcinoma: what is 'close'?

PubMed

Alicandri-Ciufelli, Matteo; Bonali, Marco; Piccinini, Alessia; Marra, Laura; Ghidini, Angelo; Cunsolo, Elio Maria; Maiorana, Antonino; Presutti, Livio; Conte, Pier Franco

2013-09-01

The aim of this systematic review is to evaluate the definition of close margin in head and neck squamous cell carcinoma (HNSCC), and its possible prognostic significance. An appropriate string was run on PubMed to retrieve articles discussing the 'close' surgical margin issue in HNSCC. A double cross-check was performed on citations and full-text articles retrieved. In total, 348 articles were identified. Further references were included by using the option "Titles in your search terms" option in PubMed. 15 papers were finally included for qualitative synthesis. In vocal cord surgery of HNSCC, a close margin could be considered to be ≤1 mm, in the larynx ≤5 mm, in the oral cavity ≤4 mm, and in the oropharynx ≤5 mm. In each patient, the choice of extent of close margin should be balanced against general condition, tumor stage, and functional issues to indicate appropriate adjuvant therapy.

Phonatory threshold pressure in a healthy population before and after aerosol treatment, a preliminary study.

PubMed

Grini-Grandval, M N; Bingenheimer, S; Maunsell, R; Ouaknine, M; Giovanni, A

2002-01-01

The viscosity of the surface mucus of the vocal cords is one of the important elements for good laryngeal functioning. It has been demonstrated that inhalation of hydrated air increases the phonatory threshold pressure by decreasing viscosity of the mucus (1) leading to a more regular vibration that can be appreciated by jitter (2). In an attempt to correlate the concepts of tissue viscosity and surface mucus considering the theoretical model of vibration we measured the phonatory threshold pressure in 6 healthy female subjects before and after aerosol treatment. We were able to demonstrate that the pressure threshold is lower (3.15 hPa) after aerosol treatment than before (3.79 hPa) and this was statistically significant (p: 0.041). The discussion is based on this decrease of mucus viscosity applied to the physiological concepts necessary to understand glottic vibration.

How to precisely measure the volume velocity transfer function of physical vocal tract models by external excitation

PubMed Central

Mainka, Alexander; Kürbis, Steffen; Birkholz, Peter

2018-01-01

Recently, 3D printing has been increasingly used to create physical models of the vocal tract with geometries obtained from magnetic resonance imaging. These printed models allow measuring the vocal tract transfer function, which is not reliably possible in vivo for the vocal tract of living humans. The transfer functions enable the detailed examination of the acoustic effects of specific articulatory strategies in speaking and singing, and the validation of acoustic plane-wave models for realistic vocal tract geometries in articulatory speech synthesis. To measure the acoustic transfer function of 3D-printed models, two techniques have been described: (1) excitation of the models with a broadband sound source at the glottis and measurement of the sound pressure radiated from the lips, and (2) excitation of the models with an external source in front of the lips and measurement of the sound pressure inside the models at the glottal end. The former method is more frequently used and more intuitive due to its similarity to speech production. However, the latter method avoids the intricate problem of constructing a suitable broadband glottal source and is therefore more effective. It has been shown to yield a transfer function similar, but not exactly equal to the volume velocity transfer function between the glottis and the lips, which is usually used to characterize vocal tract acoustics. Here, we revisit this method and show both, theoretically and experimentally, how it can be extended to yield the precise volume velocity transfer function of the vocal tract. PMID:29543829

Resting-Associated Vocalization Emitted by Captive Asian House Shrews (Suncus murinus): Acoustic Structure and Variability in an Unusual Mammalian Vocalization

PubMed Central

Schneiderová, Irena; Zouhar, Jan

2014-01-01

Shrews have rich vocal repertoires that include vocalizations within the human audible frequency range and ultrasonic vocalizations. Here, we recorded and analyzed in detail the acoustic structure of a vocalization with unclear functional significance that was spontaneously produced by 15 adult, captive Asian house shrews (Suncus murinus) while they were lying motionless and resting in their nests. This vocalization was usually emitted repeatedly in a long series with regular intervals. It showed some structural variability; however, the shrews most frequently emitted a tonal, low-frequency vocalization with minimal frequency modulation and a low, non-vocal click that was clearly noticeable at its beginning. There was no effect of sex, but the acoustic structure of the analyzed vocalizations differed significantly between individual shrews. The encoded individuality was low, but it cannot be excluded that this individuality would allow discrimination of family members, i.e., a male and female with their young, collectively resting in a common nest. The question remains whether the Asian house shrews indeed perceive the presence of their mates, parents or young resting in a common nest via the resting-associated vocalization and whether they use it to discriminate among their family members. Additional studies are needed to explain the possible functional significance of resting-associated vocalizations emitted by captive Asian house shrews. Our study highlights that the acoustic communication of shrews is a relatively understudied topic, particularly considering that they are highly vocal mammals. PMID:25390304

Relation of structural and vibratory kinematics of the vocal folds to two acoustic measures of breathy voice based on computational modeling.

PubMed

Samlan, Robin A; Story, Brad H

2011-10-01

To relate vocal fold structure and kinematics to 2 acoustic measures: cepstral peak prominence (CPP) and the amplitude of the first harmonic relative to the second (H1-H2). The authors used a computational, kinematic model of the medial surfaces of the vocal folds to specify features of vocal fold structure and vibration in a manner consistent with breathy voice. Four model parameters were altered: degree of vocal fold adduction, surface bulging, vibratory nodal point, and supraglottal constriction. CPP and H1-H2 were measured from simulated glottal area, glottal flow, and acoustic waveforms and were related to the underlying vocal fold kinematics. CPP decreased with increased separation of the vocal processes, whereas the nodal point location had little effect. H1-H2 increased as a function of separation of the vocal processes in the range of 1.0 mm to 1.5 mm and decreased with separation > 1.5 mm. CPP is generally a function of vocal process separation. H1*-H2* (see paragraph 6 of article text for an explanation of the asterisks) will increase or decrease with vocal process separation on the basis of vocal fold shape, pivot point for the rotational mode, and supraglottal vocal tract shape, limiting its utility as an indicator of breathy voice. Future work will relate the perception of breathiness to vocal fold kinematics and acoustic measures.

Vocal Function in Introverts and Extraverts during a Psychological Stress Reactivity Protocol

ERIC Educational Resources Information Center

Dietrich, Maria; Verdolini Abbott, Katherine

2012-01-01

Purpose: To examine the proposal that introversion predictably influences extralaryngeal and vocal behavior in vocally healthy individuals compared with individuals with extraversion and whether differences are of a nature that may support a risk hypothesis for primary muscle tension dysphonia. Method: Fifty-four vocally healthy female adults…

Assessment and Treatment of Stereotypic Vocalizations in a Taiwanese Adolescent with Autism: A Case Study

ERIC Educational Resources Information Center

Wu, Ya-Ping; Mirenda, Pat; Wang, Hwa-Pey; Chen, Ming-Chung

2010-01-01

This case study describes the processes of functional analysis and modality assessment that were utilized to design a communication intervention for an adolescent with autism who engaged in loud and disruptive vocalizations for most of the school day. The functional analysis suggested that the vocalizations served both tangible and escape…

Life Experience of Patients With Unilateral Vocal Fold Paralysis.

PubMed

Francis, David O; Sherman, Ariel E; Hovis, Kristen L; Bonnet, Kemberlee; Schlundt, David; Garrett, C Gaelyn; Davies, Louise

2018-05-01

Clinicians and patients benefit when they have a clear understanding of how medical conditions influence patients' life experiences. Patients' perspectives on life with unilateral vocal fold paralysis have not been well described. To promote patient-centered care by characterizing the patient experiences of living with unilateral vocal fold paralysis. This study used mixed methods: surveys using the voice and dysphagia handicap indexes (VHI and DHI) and semistructured interviews with adults with unilateral vocal cord paralysis recruited from a tertiary voice center. Recorded interviews were transcribed, coded using a hierarchical coding system, and analyzed using an iterative inductive-deductive approach. Symptom domains of the patient experience. In 36 patients (26 [72%] were female, and the median age and interquartile range [IQR] were 63 years [48-68 years]; median interview duration, 42 minutes), median VHI and DHI scores were 96 (IQR, 77-108) and 55.5 (IQR, 35-89) at the time of interviews, respectively. Frustration, isolation, fear, and altered self-identity were primary themes permeating patients' experiences. Frustrations related to limitations in communication, employment, and the medical system. Sources of fear included a loss of control, fear of further dysfunction or permanent disability, concern for health consequences (eg, aspiration pneumonia), and/or an inability to call for help in emergency situations. These experiences were modified by the following factors: resilience, self-efficacy, perceived sense of control, and social support systems. Effects of unilateral vocal fold paralysis extend beyond impaired voice and other somatic symptoms. Awareness of the extent to which these patients experience frustration, isolation, fear, and altered self-identity is important. A patient-centered approach to optimizing unilateral vocal fold paralysis treatment is enhanced by an understanding of both the physical dimension of this condition and how patients cope with the considerable emotional and social consequences. Recognizing the psychosocial dimensions of disease allows clinicians to communicate more effectively, be more empathetic, and to better personalize treatment plans, which may lead to improved patient care and patient satisfaction.

Vocalizations of adult male Asian koels (Eudynamys scolopacea) in the breeding season.

PubMed

Khan, Abdul Aziz; Qureshi, Irfan Zia

2017-01-01

Defining the vocal repertoire provides a basis for understanding the role of acoustic signals in sexual and social interactions of an animal. The Asian koel (Eudynamys scolopacea) is a migratory bird which spends its summer breeding season in the plains of Pakistan. The bird is typically wary and secretive but produces loud and distinct calls, making it easily detected when unseen. Like the other birds in the wild, presumably Asian koels use their calls for social cohesion and coordination of different behaviors. To date, the description of vocal repertoire of the male Asian koel has been lacking. Presently we analyzed and described for the first time the vocalizations of the adult male Asian koel, recorded in two consecutive breeding seasons. Using 10 call parameters, we categorized the vocalization type into six different categories on the basis of spectrogram and statistical analyses, namely the; "type 1 cooee call", "type 2 cooee call", "type 1 coegh call", "type 2 coegh call", "wurroo call" and "coe call". These names were assigned not on the basis of functional analysis and were therefore onomatopoeic. Stepwise cross validated discriminant function analysis classified the vocalization correctly (100%) into the predicted vocal categories that we initially classified on the basis of spectrographic examination. Our findings enrich the biological knowledge about vocalizations of the adult male Asian koel and provide a foundation for future acoustic monitoring of the species, as well as for comparative studies with vocalizations of other bird species of the cuckoo family. Further studies on the vocalizations of the Asian koel are required to unravel their functions in sexual selection and individual recognition.

Vocal fold paralysis secondary to phonotrauma.

PubMed

Klein, Travis A L; Gaziano, Joy E; Ridley, Marion B

2014-01-01

A unique case of acute onset vocal fold paralysis secondary to phonotrauma is presented. The cause was forceful vocalization by a drill instructor on a firearm range. Imaging studies revealed extensive intralaryngeal and retropharyngeal hemorrhage. Laryngoscopy showed a complete left vocal fold paralysis. Relative voice rest was recommended, and the patient regained normal vocal fold mobility and function after approximately 12 weeks. Copyright © 2014 The Voice Foundation. All rights reserved.

Integrating perspectives on vocal performance and consistency

PubMed Central

Sakata, Jon T.; Vehrencamp, Sandra L.

2012-01-01

SUMMARY Recent experiments in divergent fields of birdsong have revealed that vocal performance is important for reproductive success and under active control by distinct neural circuits. Vocal consistency, the degree to which the spectral properties (e.g. dominant or fundamental frequency) of song elements are produced consistently from rendition to rendition, has been highlighted as a biologically important aspect of vocal performance. Here, we synthesize functional, developmental and mechanistic (neurophysiological) perspectives to generate an integrated understanding of this facet of vocal performance. Behavioral studies in the field and laboratory have found that vocal consistency is affected by social context, season and development, and, moreover, positively correlated with reproductive success. Mechanistic investigations have revealed a contribution of forebrain and basal ganglia circuits and sex steroid hormones to the control of vocal consistency. Across behavioral, developmental and mechanistic studies, a convergent theme regarding the importance of vocal practice in juvenile and adult songbirds emerges, providing a basis for linking these levels of analysis. By understanding vocal consistency at these levels, we gain an appreciation for the various dimensions of song control and plasticity and argue that genes regulating the function of basal ganglia circuits and sex steroid hormones could be sculpted by sexual selection. PMID:22189763

Bipedicled strap muscle transposition for vocal fold deficit after laser cordectomy in early glottic cancer patients.

PubMed

Su, Chih-Ying; Chuang, Hui-Ching; Tsai, Shang-Shyue; Chiu, Jeng-Fen

2005-03-01

In treating early glottic carcinomas, the outcomes of endoscopic laser cordectomy have been proven to be valuable in local control, survival, and vocal function preservation. In some extended cases, however, laser cordectomy may leave patients with poor vocal function because of vocal fold deficit. This work assesses the vocal outcome of medialization laryngoplasty with bipedicled strap muscle transposition for vocal fold deficit resulting from laser cordectomy in early glottic cancer patients. A prospective clinical series. Thirteen early glottic cancer patients who had vocal fold deficit caused by previous laser cordectomy underwent medialization laryngoplasty with bipedicled strap muscle transposition. The thyroid lamina on the cordectomy side was paramedially separated. The inner perichondrium was circumspectly raised from the overlying thyroid cartilage. After separating the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally. A bipedicled strap muscle flap was then transposed into the area between the lamina and the paraglottic soft tissue. The thyroid cartilages were carefully sutured back in position. All patients received pre- and postoperative voice assessments comprising laryngostroboscopy and vocal function studies. Vocal enhancement was present in 92% (12/13) of patients after medialization laryngoplasty with strap muscle transposition. The glottal closure and maximal phonation time were noticeably improved by surgery. No dyspnea or other significant complications were observed in any patients. The outcomes show that bipedicled strap muscle transposition is a prosthesis-free, safe, and valuable laryngoplastic technique for correcting glottal incompetence caused by endoscopic laser cordectomy in early glottic cancer patients.

Apoptosis and Vocal Fold Disease: Clinically Relevant Implications of Epithelial Cell Death

ERIC Educational Resources Information Center

Novaleski, Carolyn K.; Carter, Bruce D.; Sivasankar, M. Preeti; Ridner, Sheila H.; Dietrich, Mary S.; Rousseau, Bernard

2017-01-01

Purpose: Vocal fold diseases affecting the epithelium have a detrimental impact on vocal function. This review article provides an overview of apoptosis, the most commonly studied type of programmed cell death. Because apoptosis can damage epithelial cells, this article examines the implications of apoptosis on diseases affecting the vocal fold…

Learning while Babbling: Prelinguistic Object-Directed Vocalizations Indicate a Readiness to Learn

ERIC Educational Resources Information Center

Goldstein, Michael H.; Schwade, Jennifer; Briesch, Jacquelyn; Syal, Supriya

2010-01-01

Two studies illustrate the functional significance of a new category of prelinguistic vocalizing--object-directed vocalizations (ODVs)--and show that these sounds are connected to learning about words and objects. Experiment 1 tested 12-month-old infants' perceptual learning of objects that elicited ODVs. Fourteen infants' vocalizations were…

Functional assessment of the ex vivo vocal folds through biomechanical testing: A review

PubMed Central

Dion, Gregory R.; Jeswani, Seema; Roof, Scott; Fritz, Mark; Coelho, Paulo; Sobieraj, Michael; Amin, Milan R.; Branski, Ryan C.

2016-01-01

The human vocal folds are complex structures made up of distinct layers that vary in cellular and extracellular composition. The mechanical properties of vocal fold tissue are fundamental to the study of both the acoustics and biomechanics of voice production. To date, quantitative methods have been applied to characterize the vocal fold tissue in both normal and pathologic conditions. This review describes, summarizes, and discusses the most commonly employed methods for vocal fold biomechanical testing. Force-elongation, torsional parallel plate rheometry, simple-shear parallel plate rheometry, linear skin rheometry, and indentation are the most frequently employed biomechanical tests for vocal fold tissues and each provide material properties data that can be used to compare native tissue verses diseased for treated tissue. Force-elongation testing is clinically useful, as it allows for functional unit testing, while rheometry provides physiologically relevant shear data, and nanoindentation permits micrometer scale testing across different areas of the vocal fold as well as whole organ testing. Thoughtful selection of the testing technique during experimental design to evaluate a hypothesis is important to optimizing biomechanical testing of vocal fold tissues. PMID:27127075

[Surgery of benign vocal fold lesions].

PubMed

Olthoff, A

2016-09-01

Surgical treatment of benign vocal fold lesions can be indicated for clinical or functional reasons. The principles of phonosurgery have to be maintained in either case. The appropriate phonosurgical technique depends on the type of vocal fold lesion. Depending on the findings, phonosurgery aims to maintain or improve voice quality. The evaluation of clinical and functional results includes indirect laryngoscopy, videostroboscopy, and voice analysis.

Analysis of the Istanbul Forensic Medicine Institute expert decisions on recurrent laryngeal nerve injuries due to thyroidectomy between 2008-2012.

PubMed

Karakaya, M Arif; Koç, Okay; Ekiz, Feza; Ağaçhan, A Feran; Göret, Nuri Emrah

2016-01-01

The aim of this study was to evaluate the approach of Forensic Medicine Institution for recurrent laryngeal nerve injuries. In addition, parameters that were taken into consideration by Forensic Medicine Institution in the differentiation of complication and malpractice were evaluated. The files of 38 patients, with recurrent laryngeal nerve injury following thyroidectomy, that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012 were retrospectively investigated. Data regarding expert decisions, age, gender, diagnosis, hospital type, preoperative vocal cord examination, intraoperative nerve monitoring (IONM), identification of nerve injury during operation, repair of nerve during operation, and type of injury were assessed. Surgeons were found to be faulty in all files with bilateral nerve injury, however, one-sided injury files were considered as a medical complication. Twenty-one (55.2%) patients were female, and 17 (44.8%) were male, with a mean age of 35,8 in women, and 34,1 in men. None of these patients had undergone preoperative vocal cord assessment. The recurrent laryngeal nerve was intraoperatively identified in 21 (55.2%) patients, while it was not seen in 17 (44.8%) patients. IONM was not applied in any patients. There was no attempt for nerve repair during any operation. Nineteen patients had unilateral, and 19 patients had bilateral nerve damage. Bilateral recurrent laryngeal nerve injuries are considered as malpractice, when imaging or pathology reports fail to state a cause for difficulty in nerve identification.

Effects of topical benzocaine and lignocaine on upper airway reflex sensitivity.

PubMed

Raphael, J H; Stanley, G D; Langton, J A

1996-02-01

We studied the degree and duration of effect on upper airway reflex sensitivity of oral benzocaine lozenges, nebulised lignocaine and lignocaine sprayed onto the vocal cords under direct vision, using low concentrations of ammonia as a stimulus to upper airway receptors. Ten minutes after the administration of oral benzocaine 20 mg the threshold response of the upper airway to ammonia (NH3TR) had risen significantly from baseline mean (SEM) of 680 (95) to 975 (109) ppm of ammonia with a return to baseline values after 25 min (n = 8, p < 0.05, repeated measures of ANOVA; p < 0.001, t-test). A direct spray of lignocaine 100 mg onto the vocal cords resulted in a significant elevation in NH3TR from a baseline mean (SEM) of 665 (81) to a maximum of 1600 (88) ppm of ammonia with a significant elevation in the threshold persisting for 100 min (n = 7, p < 0.001, repeated measures of ANOVA; p < 0.05, t-test). The application of 4% nebulised lignocaine 4 ml significantly increased NH3TR from a baseline mean (SEM) of 770 (56) to a maximum of 1190 (63) ppm of ammonia with a significant elevation in the threshold persisting for 30 min (n = 8, p < 0.001, repeated measures of ANOVA; p < 0.05, t-test). The maximum elevations in NH3TR with the two methods of lignocaine delivery were significantly different (p < 0.01, 2-way ANOVA).

Randomised trial of amnioinfusion during labour with meconium stained amniotic fluid.

PubMed

Rathor, Asmita Muthal; Singh, Ruchira; Ramji, S; Tripathi, Reva

2002-01-01

To assess the effect of amnioinfusion during labour with meconium stained amniotic fluid on caesarean section rate and perinatal outcome. Prospective randomised controlled study. A tertiary care teaching hospital in India. Women in labour at term with meconium stained amniotic fluid. Two hundred women in labour with > or = 37 weeks gestation, single cephalic presentation with moderate or thick meconium were randomised to control and amnioinfusion groups at a 1:1 ratio. Amnioinfusion was performed using 500 mL of normal saline over a period of 30 minutes in a study group. The control group received routine care. Both groups had intermittent auscultation of fetal heart rate during labour. The primary outcome measure was caesarean section rate. Secondary outcome measures were meconium aspiration syndrome, 1 minute and 5 minute apgar < 7, hypoxic ischaemic encephalopathy, neonatal intensive care unit admission, meconium at the level of vocal cords. The caesarean section rate in the amnioinfusion group was less than the control group (RR 0.47; 95% CI 0.24-0.93). Amnioinfusion was associated with a significant decrease in the incidence of meconium at the vocal cords (P = 0.001); improvement in 1 minute apgar scores (P < 0.05), respiratory distress (P = 0.002) and fewer admissions to nursery compared with the controls. This sample size was inadequate to study the impact on meconium aspiration syndrome. Amnioinfusion in an under resourced labour ward decreases caesarean section rates and fetal morbidity.

Total fixation of cricoarytenoid joint of a patient with rheumatoid arthritis and Hashimoto thyroiditis.

PubMed

Stojanović, Stevan P; Zivić, Ljubica; Stojanović, Jasmina; Belić, Branislav

2010-01-01

The incidence of cricoarytenoid joint fixation in case of rheumatoid arthritis is 17 to 33%. In later stages of rheumatoid arthritis, a gradual fixation of cricoarytenoid joint develops and both halves of the larynx become less movable which calls for endotracheal intubation; while total fixation of this joint demands surgical tracheotomy. Hashimoto thyroiditis can display symptoms which are difficult to distinguish from the ones present in total fixation of cricoarytenoid joint caused by rheumatoid arthritis. A 60-year-old woman in terminal stage of rheumatoid arthritis and Hashimoto thyroiditis, diagnosed after clinical and other examinations. She was treated for strident breathing with surgical tracheotomy. The microscopic examination of the larynx with the use of laryngoscopic pincers suggested the immovability of the right and very limited movability of the left arytenoid cartilage. A computerized endovideostroboscopy showed only passive vertical vibrating movements of the right vocal cord and irregular vibrations of the left vocal cord. Total fixation of the cricoarytenoid joint can be caused by many pathological processes, but so far references have shown no case of rheumatoid arthritis and Hashimoto thyroiditis. In differential diagnostics, one of many examinations is the microscopic examination of the larynx, but it is very important to determine the movability of the arytenoid cartilage with the use of appropriate instruments in total endotracheal anaesthesia while the patient is fully relaxed. Movements in cricoarytenoid joints in patients with Hashimoto thyroiditis and the same conditions are preserved.

The nasogastric tube syndrome: two case reports and review of the literature.

PubMed

Apostolakis, L W; Funk, G F; Urdaneta, L F; McCulloch, T M; Jeyapalan, M M

2001-01-01

The nasogastric tube syndrome is a potentially life-threatening complication of an indwelling nasogastric (NG) tube. The syndrome is thought to result from ulceration and infection of the posterior cricoid region with subsequent dysfunction of vocal cord abduction. This dysfunction may present as complete loss of vocal cord abduction manifested as serious airway compromise. Reports of this syndrome are infrequent, with only 29 cases published to date. Two additional cases of nasogastric tube syndrome diagnosed at the University of Iowa Hospitals and Clinics over a 2-year period are presented. A search of MEDLINE (1966 through February 1999), including review of those articles' references identified seven previous publications, including 29 case reports. These 29 cases are reviewed and the findings summarized. Twenty-nine cases of NG tube syndrome are identified, with 16 of these occurring in the preantibiotic period. Including the two cases presented here, 15 contemporary patients are examined. Among these 15 cases, 10 required tracheostomy, on average 8.5 days after NG tube placement. Although the fully manifested syndrome presents quite dramatically, we suspect that a clinical spectrum of severity exists with less severe cases going unrecognized. Consistent with previous reports, we found that direct visualization of the postcricoid region is required to rule out the diagnosis and recommend such action be taken whenever the diagnosis is suspected. Treatment should include establishment of a safe airway, removal of the tube whenever possible, antibiotic therapy, and antireflux therapy.

Influence of Left-Right Asymmetries on Voice Quality in Simulated Paramedian Vocal Fold Paralysis

ERIC Educational Resources Information Center

Samlan, Robin A.; Story, Brad H.

2017-01-01

Purpose: The purpose of this study was to determine the vocal fold structural and vibratory symmetries that are important to vocal function and voice quality in a simulated paramedian vocal fold paralysis. Method: A computational kinematic speech production model was used to simulate an exemplar "voice" on the basis of asymmetric…

Effect of pneumotach on measurement of vocal function

NASA Astrophysics Data System (ADS)

Walters, Gage; McPhail, Michael; Krane, Michael

2017-11-01

Aerodynamic and acoustic measurements of vocal function were performed in a physical model of the human airway with and without a pneumotach (Rothenberg mask), used by clinicians to measure vocal volume flow. The purpose of these experiments was to assess whether the device alters acoustic and aerodynamic conditions sufficiently to change phonation behavior. The airway model, which mimics acoustic behavior of an adult human airway from trachea to mouth, consists of a 31.5cm long straight duct with a 2.54cm square cross section. Model vocal folds comprised of molded silicone rubber were set into vibration by introducing airflow from a compressed air source. Measurements included transglottal pressure difference, mean volume flow, vocal fold vibratory motion, and sound pressure measured at the mouth. The experiments show that while the pneumotach imparted measurable aerodynamic and acoustic loads on the system, measurement of mean glottal resistance was not affected. Acoustic pressure levels were attenuated, however, suggesting clinical acoustic measurements of vocal function need correction when performed in conjunction with a pneumotach Acknowledge support from NIH DC R01005642-11.

Microvascular lesions of the true vocal fold.

PubMed

Postma, G N; Courey, M S; Ossoff, R H

1998-06-01

Microvascular lesions, also called varices or capillary ectasias, in contrast to vocal fold polyps with telangiectatic vessels, are relatively small lesions arising from the microcirculation of the vocal fold. Varices are most commonly seen in female professional vocalists and may be secondary to repetitive trauma, hormonal variations, or repeated inflammation. Microvascular lesions may either be asymptomatic or cause frank dysphonia by interrupting the normal vibratory pattern, mass, or closure of the vocal folds. They may also lead to vocal fold hemorrhage, scarring, or polyp formation. Laryngovideostroboscopy is the key in determining the functional significance of vocal fold varices. Management of patients with a varix includes medical therapy, speech therapy, and occasionally surgical vaporization. Indications for surgery are recurrent hemorrhage, enlargement of the varix, development of a mass in conjunction with the varix or hemorrhage, and unacceptable dysphonia after maximal medical and speech therapy due to a functionally significant varix.

A voice region in the monkey brain.

PubMed

Petkov, Christopher I; Kayser, Christoph; Steudel, Thomas; Whittingstall, Kevin; Augath, Mark; Logothetis, Nikos K

2008-03-01

For vocal animals, recognizing species-specific vocalizations is important for survival and social interactions. In humans, a voice region has been identified that is sensitive to human voices and vocalizations. As this region also strongly responds to speech, it is unclear whether it is tightly associated with linguistic processing and is thus unique to humans. Using functional magnetic resonance imaging of macaque monkeys (Old World primates, Macaca mulatta) we discovered a high-level auditory region that prefers species-specific vocalizations over other vocalizations and sounds. This region not only showed sensitivity to the 'voice' of the species, but also to the vocal identify of conspecific individuals. The monkey voice region is located on the superior-temporal plane and belongs to an anterior auditory 'what' pathway. These results establish functional relationships with the human voice region and support the notion that, for different primate species, the anterior temporal regions of the brain are adapted for recognizing communication signals from conspecifics.

[The recovery study of excising the different range of dog's anterior commissure by semiconductor laser].

PubMed

Sun, Guangbin; Tang, Haihong; Fang, Qin; Liang, Gengtian; Xu, Limin; Huang, Yideng

2008-05-01

To explore the effective method to treat the glottic carcinoma invading the anterior commissure, we observed the difference of three kinds of operation to the anterior commissure of dogs by semiconductor laser. Twelve dogs were divided into 3 groups at random, A: to cauterize to the thyroid cartilage's inner membrane of the anterior commissure, the right ventricular bands and vocal cord, the anterior and 1/3 of the left vocal cord; B: to cauterize part of the thyroid cartilage of the anterior commissure besides A; C: to open a window about 5 mm x 5 mm on the thyroid cartilage of the anterior commissure besides B. To take photos to observe the dogs' laryngeal wound with digital camera or electrolaryngoscope immediately, 1 week and 4 weeks, then to record the hoarseness, body weight and complications etc. All the dogs' laser surgery were completed successfully. To observe the gross specimen, it was identical between the extent of excising and the design preoperation. One week later, the neonatal membrane covered the wound incomplete. Edematization, inflammatory reaction, pseudomembrane and the hoarseness were not heavy too. No obvious complication in group A. The neonatal membrane covered the wound incomplete. Edema, inflammatory reaction, pseudomembrane and granulation can be seen in group B. Exudation was heavy in local, erosion and infected, the hoarseness was severe. No other obvious complications in C. Different extent of adhesion could be seen at the anterior commissure in group A, B and C after 4 weeks, the laryngeal web formed, and the length of vocal cord was shorter than before. The color and luster of anterior commissure membrane was normal basically, the inflammatory reaction was not heavy in A and B groups. The anterior commissural membrane appeared the dark red chronic inflammatory reaction; the window was closed by neonatal membrane completely and had no infection in group C. To observe the gross specimen: the wound of anterior commissure was covered by prosthetic epithelia completely in three groups. The window was closed by complete membrane at the anterior commissure. The No. 1- 3 dog's conditions of hoarseness in three groups after 4 weeks: slight in A group, little severe in B and C group. The change of weight was not obvious at the pre or postoperative in group A and B. No obvious complication happened in each group postoperation. The three operative methods have satisfied effects,the recovery of wound can cure well finally and no severe complications happened. It is valuable in clinic.

Experimental analysis of the characteristics of artificial vocal folds.

PubMed

Misun, Vojtech; Svancara, Pavel; Vasek, Martin

2011-05-01

Specialized literature presents a number of models describing the function of the vocal folds. In most of those models, an emphasis is placed on the air flowing through the glottis and, further, on the effect of the parameters of the air alone (its mass, speed, and so forth). The article focuses on the constructional definition of artificial vocal folds and their experimental analysis. The analysis is conducted for voiced source voice phonation and for the changing mean value of the subglottal pressure. The article further deals with the analysis of the pressure of the airflow through the vocal folds, which is cut (separated) into individual pulses by the vibrating vocal folds. The analysis results show that air pulse characteristics are relevant to voice generation, as they are produced by the flowing air and vibrating vocal folds. A number of artificial vocal folds have been constructed to date, and the aforementioned view of their phonation is confirmed by their analysis. The experiments have confirmed that man is able to consciously affect only two parameters of the source voice, that is, its fundamental frequency and voice intensity. The main forces acting on the vocal folds during phonation are as follows: subglottal air pressure and elastic and inertia forces of the vocal folds' structure. The correctness of the function of the artificial vocal folds is documented by the experimental verification of the spectra of several types of artificial vocal folds. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Vocal learning in elephants: neural bases and adaptive context

PubMed Central

Stoeger, Angela S; Manger, Paul

2014-01-01

In the last decade clear evidence has accumulated that elephants are capable of vocal production learning. Examples of vocal imitation are documented in African (Loxodonta africana) and Asian (Elephas maximus) elephants, but little is known about the function of vocal learning within the natural communication systems of either species. We are also just starting to identify the neural basis of elephant vocalizations. The African elephant diencephalon and brainstem possess specializations related to aspects of neural information processing in the motor system (affecting the timing and learning of trunk movements) and the auditory and vocalization system. Comparative interdisciplinary (from behavioral to neuroanatomical) studies are strongly warranted to increase our understanding of both vocal learning and vocal behavior in elephants. PMID:25062469

Female mice ultrasonically interact with males during courtship displays

PubMed Central

Neunuebel, Joshua P; Taylor, Adam L; Arthur, Ben J; Egnor, SE Roian

2015-01-01

During courtship males attract females with elaborate behaviors. In mice, these displays include ultrasonic vocalizations. Ultrasonic courtship vocalizations were previously attributed to the courting male, despite evidence that both sexes produce virtually indistinguishable vocalizations. Because of this similarity, and the difficulty of assigning vocalizations to individuals, the vocal contribution of each individual during courtship is unknown. To address this question, we developed a microphone array system to localize vocalizations from socially interacting, individual adult mice. With this system, we show that female mice vocally interact with males during courtship. Males and females jointly increased their vocalization rates during chases. Furthermore, a female's participation in these vocal interactions may function as a signal that indicates a state of increased receptivity. Our results reveal a novel form of vocal communication during mouse courtship, and lay the groundwork for a mechanistic dissection of communication during social behavior. DOI: http://dx.doi.org/10.7554/eLife.06203.001 PMID:26020291

A meta-analysis of outcomes of hydration intervention on phonation threshold pressure.

PubMed

Leydon, Ciara; Wroblewski, Marcin; Eichorn, Naomi; Sivasankar, Mahalakshmi

2010-11-01

Vocal fold hydration is purported to promote optimal biomechanical characteristics of vocal fold mucosa, increase efficiency of vocal fold oscillation, and enhance voice quality. The purpose of this work was to determine the magnitude and consistency of the effect of vocal fold hydration on vocal fold function across published clinical studies. We completed a comprehensive meta-analysis of the effects of superficial and systemic vocal fold hydration on phonation threshold pressure (PTP), a measure of efficiency of voice production. We identified 34 studies that examined the effects of hydration on vocal function. Of these studies, 14 examined the effects of hydration on PTP. Nine of these articles met the criteria for inclusion in this analysis. We observed an average effect size of 0.33, indicating that, overall, hydration treatment demonstrated a tendency to reduce PTP. However, this decrease in phonatory effort did not reach significance at the 95% confidence level. The effects of hydration intervention varied considerably across studies (-0.19 to 3.96). We considered that two factors, pitch level of the task and vocal health of participants, may have contributed to this variability in findings. However, our analysis found that these factors could not account for differences in effect size. To understand the variability in outcomes across studies, the role of factors that may impact the effects of hydration, such as the amount, type, and duration of intervention, must be determined. Only then can we obtain data to guide best clinical practice for protecting and rehabilitating vocal function. Copyright © 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Tissue Engineering-based Therapeutic Strategies for Vocal Fold Repair and Regeneration

PubMed Central

Li, Linqing; Stiadle, Jeanna M.; Lau, Hang K.; Zerdoum, Aidan B.; Jia, Xinqiao; L.Thibeault, Susan; Kiick, Kristi L.

2016-01-01

Vocal folds are soft laryngeal connective tissues with distinct layered structures and complex multicomponent matrix compositions that endow phonatory and respiratory functions. This delicate tissue is easily damaged by various environmental factors and pathological conditions, altering vocal biomechanics and causing debilitating vocal disorders that detrimentally affect the daily lives of suffering individuals. Modern techniques and advanced knowledge of regenerative medicine have led to a deeper understanding of the microstructure, microphysiology, and micropathophysiology of vocal fold tissues. State-of-the-art materials ranging from extracecullar-matrix (ECM)-derived biomaterials to synthetic polymer scaffolds have been proposed for the prevention and treatment of voice disorders including vocal fold scarring and fibrosis. This review intends to provide a thorough overview of current achievements in the field of vocal fold tissue engineering, including the fabrication of injectable biomaterials to mimic in vitro cell microenvironments, novel designs of bioreactors that capture in vivo tissue biomechanics, and establishment of various animal models to characterize the in vivo biocompatibility of these materials. The combination of polymeric scaffolds, cell transplantation, biomechanical stimulation, and delivery of antifibrotic growth factors will lead to successful restoration of functional vocal folds and improved vocal recovery in animal models, facilitating the application of these materials and related methodologies in clinical practice. PMID:27619243

Vocal fold ion transport and mucin expression following acrolein exposure

PubMed Central

Levendoski, Elizabeth Erickson; Sivasankar, M. Preeti

2014-01-01

The vocal fold epithelium is exposed to inhaled particulates including pollutants during breathing in everyday environments. Yet, our understanding of the effects of pollutants on vocal fold epithelial function is extremely limited. The objective of this study was to investigate the effect of the pollutant acrolein on two vocal fold epithelial mechanisms: ion transport and mucin synthesis. These mechanisms were chosen as each plays a critical role in vocal defense and in maintaining surface hydration which is necessary for optimal voice production. Healthy, native porcine vocal folds (N=85) were excised and exposed to an acrolein or sham challenge. A 60 minute acrolein, but not sham challenge significantly reduced ion transport and inhibited cyclic adenosine monophosphate-dependent increases in ion transport. Decreases in ion transport were associated with reduced sodium absorption. Within the same timeline, no significant acrolein-induced changes in mucin gene or protein expression were observed. These results improve our understanding of the effects of acrolein on key vocal fold epithelial functions and inform the development of future investigations that seek to elucidate the impact of a wide range of pollutant exposures on vocal fold health. PMID:24648011

Functional flexibility in wild bonobo vocal behaviour

PubMed Central

Archbold, Jahmaira; Zuberbühler, Klaus

2015-01-01

A shared principle in the evolution of language and the development of speech is the emergence of functional flexibility, the capacity of vocal signals to express a range of emotional states independently of context and biological function. Functional flexibility has recently been demonstrated in the vocalisations of pre-linguistic human infants, which has been contrasted to the functionally fixed vocal behaviour of non-human primates. Here, we revisited the presumed chasm in functional flexibility between human and non-human primate vocal behaviour, with a study on our closest living primate relatives, the bonobo (Pan paniscus). We found that wild bonobos use a specific call type (the “peep”) across a range of contexts that cover the full valence range (positive-neutral-negative) in much of their daily activities, including feeding, travel, rest, aggression, alarm, nesting and grooming. Peeps were produced in functionally flexible ways in some contexts, but not others. Crucially, calls did not vary acoustically between neutral and positive contexts, suggesting that recipients take pragmatic information into account to make inferences about call meaning. In comparison, peeps during negative contexts were acoustically distinct. Our data suggest that the capacity for functional flexibility has evolutionary roots that predate the evolution of human speech. We interpret this evidence as an example of an evolutionary early transition away from fixed vocal signalling towards functional flexibility. PMID:26290789

Diagnostic and therapeutic pitfalls in benign vocal fold diseases

PubMed Central

Bohlender, Jörg

2013-01-01

More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis. PMID:24403969

Multifunctional and Context-Dependent Control of Vocal Acoustics by Individual Muscles

PubMed Central

Srivastava, Kyle H.; Elemans, Coen P.H.

2015-01-01

The relationship between muscle activity and behavioral output determines how the brain controls and modifies complex skills. In vocal control, ensembles of muscles are used to precisely tune single acoustic parameters such as fundamental frequency and sound amplitude. If individual vocal muscles were dedicated to the control of single parameters, then the brain could control each parameter independently by modulating the appropriate muscle or muscles. Alternatively, if each muscle influenced multiple parameters, a more complex control strategy would be required to selectively modulate a single parameter. Additionally, it is unknown whether the function of single muscles is fixed or varies across different vocal gestures. A fixed relationship would allow the brain to use the same changes in muscle activation to, for example, increase the fundamental frequency of different vocal gestures, whereas a context-dependent scheme would require the brain to calculate different motor modifications in each case. We tested the hypothesis that single muscles control multiple acoustic parameters and that the function of single muscles varies across gestures using three complementary approaches. First, we recorded electromyographic data from vocal muscles in singing Bengalese finches. Second, we electrically perturbed the activity of single muscles during song. Third, we developed an ex vivo technique to analyze the biomechanical and acoustic consequences of single-muscle perturbations. We found that single muscles drive changes in multiple parameters and that the function of single muscles differs across vocal gestures, suggesting that the brain uses a complex, gesture-dependent control scheme to regulate vocal output. PMID:26490859

Vocal tract shapes in different singing functions used in musical theater singing-a pilot study.

PubMed

Echternach, Matthias; Popeil, Lisa; Traser, Louisa; Wienhausen, Sascha; Richter, Bernhard

2014-09-01

Singing styles in Musical Theater singing might differ in many ways from Western Classical singing. However, vocal tract adjustments are not understood in detail. Vocal tract shapes of a single professional Music Theater female subject were analyzed concerning different aspects of singing styles using dynamic real-time magnetic resonance imaging technology with a frame rate of 8 fps. The different tasks include register differences, belting, and vibrato strategies. Articulatory differences were found between head register, modal register, and belting. Also, some vibrato strategies ("jazzy" vibrato) do involve vocal tract adjustments, whereas others (classical vibrato) do not. Vocal tract shaping might contribute to the establishment of different singing functions in Musical Theater singing. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Ascending aortic aneurysm causing hoarse voice: a variant of Ortner's syndrome

PubMed Central

Eccles, Sinan Robert; Banks, John; Kumar, Pankaj

2012-01-01

A 68-year-old man with a persistent hoarse voice was found to have a left vocal cord paralysis. Clinical examination revealed signs consistent with aortic regurgitation. Subsequent investigation revealed an ascending aortic aneurysm. He underwent aortic root and ascending aorta replacement and his hoarseness improved. Ortner's syndrome refers to hoarseness due to recurrent laryngeal nerve palsy secondary to a cardiovascular abnormality. Recurrent laryngeal nerve palsy due to aneurysmal dilation of the ascending aorta is extremely rare, with aneurysms of the aortic arch being a more common cause. PMID:23060380

Hypertensive crisis in a patient with thyroid cancer.

PubMed

Asha, H S; Seshadri, M S; Rajaratnam, Simon

2012-01-01

Phaeochromocytomas may be discovered incidentally when patients present with hypertensive crisis during general anaesthesia. A 49-year-old man underwent thyroidectomy 25 years ago and was diagnosed to have spindle cell carcinoma of the thyroid. He presented with recent onset of hoarseness of voice and was found to have a vocal cord nodule. He developed a hypertensive crisis during surgery. He was subsequently evaluated and found to have bilateral phaeochromocytoma. Further evaluation revealed a RET proto-oncogene mutation at codon 634 consistent with multiple endocrine neoplasia (MEN)-2A. Copyright 2012, NMJI.

Early experience shapes vocal neural coding and perception in songbirds

PubMed Central

Woolley, Sarah M. N.

2012-01-01

Songbirds, like humans, are highly accomplished vocal learners. The many parallels between speech and birdsong and conserved features of mammalian and avian auditory systems have led to the emergence of the songbird as a model system for studying the perceptual mechanisms of vocal communication. Laboratory research on songbirds allows the careful control of early life experience and high-resolution analysis of brain function during vocal learning, production and perception. Here, I review what songbird studies have revealed about the role of early experience in the development of vocal behavior, auditory perception and the processing of learned vocalizations by auditory neurons. The findings of these studies suggest general principles for how exposure to vocalizations during development and into adulthood influences the perception of learned vocal signals. PMID:22711657

Iconicity can ground the creation of vocal symbols.

PubMed

Perlman, Marcus; Dale, Rick; Lupyan, Gary

2015-08-01

Studies of gestural communication systems find that they originate from spontaneously created iconic gestures. Yet, we know little about how people create vocal communication systems, and many have suggested that vocalizations do not afford iconicity beyond trivial instances of onomatopoeia. It is unknown whether people can generate vocal communication systems through a process of iconic creation similar to gestural systems. Here, we examine the creation and development of a rudimentary vocal symbol system in a laboratory setting. Pairs of participants generated novel vocalizations for 18 different meanings in an iterative 'vocal' charades communication game. The communicators quickly converged on stable vocalizations, and naive listeners could correctly infer their meanings in subsequent playback experiments. People's ability to guess the meanings of these novel vocalizations was predicted by how close the vocalization was to an iconic 'meaning template' we derived from the production data. These results strongly suggest that the meaningfulness of these vocalizations derived from iconicity. Our findings illuminate a mechanism by which iconicity can ground the creation of vocal symbols, analogous to the function of iconicity in gestural communication systems.

Effects of human fatigue on speech signals

NASA Astrophysics Data System (ADS)

Stamoulis, Catherine

2004-05-01

Cognitive performance may be significantly affected by fatigue. In the case of critical personnel, such as pilots, monitoring human fatigue is essential to ensure safety and success of a given operation. One of the modalities that may be used for this purpose is speech, which is sensitive to respiratory changes and increased muscle tension of vocal cords, induced by fatigue. Age, gender, vocal tract length, physical and emotional state may significantly alter speech intensity, duration, rhythm, and spectral characteristics. In addition to changes in speech rhythm, fatigue may also affect the quality of speech, such as articulation. In a noisy environment, detecting fatigue-related changes in speech signals, particularly subtle changes at the onset of fatigue, may be difficult. Therefore, in a performance-monitoring system, speech parameters which are significantly affected by fatigue need to be identified and extracted from input signals. For this purpose, a series of experiments was performed under slowly varying cognitive load conditions and at different times of the day. The results of the data analysis are presented here.

The excitatory amino acid receptor antagonist MK-801 prevents the hypersensitivity induced by spinal cord ischemia in the rat

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hao, J.X.; Xu, X.J.; Aldskogius, H.

1991-08-01

Protection by the NMDA receptor antagonist MK-801 against transient spinal cord ischemia-induced hypersensitivity was studied in rats. The spinal ischemia was initiated by vascular occlusion resulting from the interaction between the photosensitizing dye Erythrosin B and an argon laser beam. The hypersensitivity, termed allodynia, where the animals reacted by vocalization to nonnoxious mechanical stimuli in the flank area, was consistently observed during several days after induction of the ischemia. Pretreatment with MK-801 (0.1-0.5 mg/kg, iv) 10 min before laser irradiation dose dependently prevented the occurrence of allodynia. The neuroprotective effect of MK-801 was not reduced by maintaining normal body temperaturemore » during and after irradiation. There was a significant negative correlation between the delay in the administration of MK-801 after irradiation and the protective effect of the drug. Histological examination revealed slight morphological damage in the spinal cord in 38% of control rats after 1 min of laser irradiation without pretreatment with MK-801. No morphological abnormalities were observed in rats after pretreatment with MK-801 (0.5 mg/kg). The present results provide further evidence for the involvement of excitatory amino acids, through activation of the NMDA receptor, in the development of dysfunction following ischemic trauma to the spinal cord.« less

Three-dimensional biomechanical properties of human vocal folds: parameter optimization of a numerical model to match in vitro dynamics.

PubMed

Yang, Anxiong; Berry, David A; Kaltenbacher, Manfred; Döllinger, Michael

2012-02-01

The human voice signal originates from the vibrations of the two vocal folds within the larynx. The interactions of several intrinsic laryngeal muscles adduct and shape the vocal folds to facilitate vibration in response to airflow. Three-dimensional vocal fold dynamics are extracted from in vitro hemilarynx experiments and fitted by a numerical three-dimensional-multi-mass-model (3DM) using an optimization procedure. In this work, the 3DM dynamics are optimized over 24 experimental data sets to estimate biomechanical vocal fold properties during phonation. Accuracy of the optimization is verified by low normalized error (0.13 ± 0.02), high correlation (83% ± 2%), and reproducible subglottal pressure values. The optimized, 3DM parameters yielded biomechanical variations in tissue properties along the vocal fold surface, including variations in both the local mass and stiffness of vocal folds. That is, both mass and stiffness increased along the superior-to-inferior direction. These variations were statistically analyzed under different experimental conditions (e.g., an increase in tension as a function of vocal fold elongation and an increase in stiffness and a decrease in mass as a function of glottal airflow). The study showed that physiologically relevant vocal fold tissue properties, which cannot be directly measured during in vivo human phonation, can be captured using this 3D-modeling technique. © 2012 Acoustical Society of America

Three-dimensional biomechanical properties of human vocal folds: Parameter optimization of a numerical model to match in vitro dynamics

PubMed Central

Yang, Anxiong; Berry, David A.; Kaltenbacher, Manfred; Döllinger, Michael

2012-01-01

The human voice signal originates from the vibrations of the two vocal folds within the larynx. The interactions of several intrinsic laryngeal muscles adduct and shape the vocal folds to facilitate vibration in response to airflow. Three-dimensional vocal fold dynamics are extracted from in vitro hemilarynx experiments and fitted by a numerical three-dimensional-multi-mass-model (3DM) using an optimization procedure. In this work, the 3DM dynamics are optimized over 24 experimental data sets to estimate biomechanical vocal fold properties during phonation. Accuracy of the optimization is verified by low normalized error (0.13 ± 0.02), high correlation (83% ± 2%), and reproducible subglottal pressure values. The optimized, 3DM parameters yielded biomechanical variations in tissue properties along the vocal fold surface, including variations in both the local mass and stiffness of vocal folds. That is, both mass and stiffness increased along the superior-to-inferior direction. These variations were statistically analyzed under different experimental conditions (e.g., an increase in tension as a function of vocal fold elongation and an increase in stiffness and a decrease in mass as a function of glottal airflow). The study showed that physiologically relevant vocal fold tissue properties, which cannot be directly measured during in vivo human phonation, can be captured using this 3D-modeling technique. PMID:22352511

Coos, booms, and hoots: The evolution of closed-mouth vocal behavior in birds.

PubMed

Riede, Tobias; Eliason, Chad M; Miller, Edward H; Goller, Franz; Clarke, Julia A

2016-08-01

Most birds vocalize with an open beak, but vocalization with a closed beak into an inflating cavity occurs in territorial or courtship displays in disparate species throughout birds. Closed-mouth vocalizations generate resonance conditions that favor low-frequency sounds. By contrast, open-mouth vocalizations cover a wider frequency range. Here we describe closed-mouth vocalizations of birds from functional and morphological perspectives and assess the distribution of closed-mouth vocalizations in birds and related outgroups. Ancestral-state optimizations of body size and vocal behavior indicate that closed-mouth vocalizations are unlikely to be ancestral in birds and have evolved independently at least 16 times within Aves, predominantly in large-bodied lineages. Closed-mouth vocalizations are rare in the small-bodied passerines. In light of these results and body size trends in nonavian dinosaurs, we suggest that the capacity for closed-mouth vocalization was present in at least some extinct nonavian dinosaurs. As in birds, this behavior may have been limited to sexually selected vocal displays, and hence would have co-occurred with open-mouthed vocalizations. © 2016 The Author(s). Evolution © 2016 The Society for the Study of Evolution.

An Analysis of Vocal Stereotypy and Therapist Fading

ERIC Educational Resources Information Center

Athens, Elizabeth S.; Vollmer, Timothy R.; Sloman, Kimberly N.; Pipkin, Claire St. Peter

2008-01-01

A functional analysis for a boy with Down syndrome and autism suggested that vocal stereotypy was maintained by automatic reinforcement. The analysis also showed that instructions and noncontingent attention suppressed vocal stereotypy. A treatment package consisting of noncontingent attention, contingent demands, and response cost effectively…

Avian vocal mimicry: a unified conceptual framework.

PubMed

Dalziell, Anastasia H; Welbergen, Justin A; Igic, Branislav; Magrath, Robert D

2015-05-01

Mimicry is a classical example of adaptive signal design. Here, we review the current state of research into vocal mimicry in birds. Avian vocal mimicry is a conspicuous and often spectacular form of animal communication, occurring in many distantly related species. However, the proximate and ultimate causes of vocal mimicry are poorly understood. In the first part of this review, we argue that progress has been impeded by conceptual confusion over what constitutes vocal mimicry. We propose a modified version of Vane-Wright's (1980) widely used definition of mimicry. According to our definition, a vocalisation is mimetic if the behaviour of the receiver changes after perceiving the acoustic resemblance between the mimic and the model, and the behavioural change confers a selective advantage on the mimic. Mimicry is therefore specifically a functional concept where the resemblance between heterospecific sounds is a target of selection. It is distinct from other forms of vocal resemblance including those that are the result of chance or common ancestry, and those that have emerged as a by-product of other processes such as ecological convergence and selection for large song-type repertoires. Thus, our definition provides a general and functionally coherent framework for determining what constitutes vocal mimicry, and takes account of the diversity of vocalisations that incorporate heterospecific sounds. In the second part we assess and revise hypotheses for the evolution of avian vocal mimicry in the light of our new definition. Most of the current evidence is anecdotal, but the diverse contexts and acoustic structures of putative vocal mimicry suggest that mimicry has multiple functions across and within species. There is strong experimental evidence that vocal mimicry can be deceptive, and can facilitate parasitic interactions. There is also increasing support for the use of vocal mimicry in predator defence, although the mechanisms are unclear. Less progress has been made in explaining why many birds incorporate heterospecific sounds into their sexual displays, and in determining whether these vocalisations are functionally mimetic or by-products of sexual selection for other traits such as repertoire size. Overall, this discussion reveals a more central role for vocal mimicry in the behavioural ecology of birds than has previously been appreciated. The final part of this review identifies important areas for future research. Detailed empirical data are needed on individual species, including on the structure of mimetic signals, the contexts in which mimicry is produced, how mimicry is acquired, and the ecological relationships between mimic, model and receiver. At present, there is little information and no consensus about the various costs of vocal mimicry for the protagonists in the mimicry complex. The diversity and complexity of vocal mimicry in birds raises important questions for the study of animal communication and challenges our view of the nature of mimicry itself. Therefore, a better understanding of avian vocal mimicry is essential if we are to account fully for the diversity of animal signals. © 2014 The Authors. Biological Reviews © 2014 Cambridge Philosophical Society.

Vocal learning beyond imitation: mechanisms of adaptive vocal development in songbirds and human infants

PubMed Central

Tchernichovski, Ofer; Marcus, Gary

2014-01-01

Studies of vocal learning in songbirds typically focus on the acquisition of sensory templates for song imitation and on the consequent process of matching song production to templates. However, functional vocal development also requires the capacity to adaptively diverge from sensory templates, and to flexibly assemble vocal units. Examples of adaptive divergence include the corrective imitation of abnormal songs, and the decreased tendency to copy overabundant syllables. Such frequency-dependent effects might mirror tradeoffs between the assimilation of group identity (culture) while establishing individual and flexibly expressive songs. Intriguingly, although the requirements for vocal plasticity vary across songbirds, and more so between birdsong and language, the capacity to flexibly assemble vocal sounds develops in a similar, stepwise manner across species. Therefore, universal features of vocal learning go well beyond the capacity to imitate. PMID:25005823

Vocal Fry Use in Adult Female Speakers Exposed to Two Languages.

PubMed

Gibson, Todd A; Summers, Connie; Walls, Sydney

2017-07-01

Several studies have identified the widespread use of vocal fry among American women. Popular explanations for this phenomenon appeal to sociolinguistic purposes that likely take significant time for second language users to learn. The objective of this study was to determine if mere exposure to this vocal register, as opposed to nuanced sociolinguistic motivations, might explain its widespread use. This study used multigroup within- and between-subjects design. Fifty-eight women from one of three language background groups (functionally monolingual in English, functionally monolingual in Spanish, and Spanish-English bilinguals) living in El Paso, Texas, repeated a list of nonwords conforming to the sound rules of English and another list of nonwords conforming to the sound rules of Spanish. Perceptual analysis identified each episode of vocal fry. There were no statistically significant differences between groups in their frequency of vocal fry use despite large differences in their amount of English-language exposure. All groups produced more vocal fry when repeating English than when repeating Spanish nonwords. Because the human perceptual system encodes for vocal qualities even after minimal language experience, the widespread use of vocal fry among female residents in the United States likely is owing to mere exposure to English rather than nuanced sociolinguistic motivations. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Assessment of canine vocal fold function after injection of a new biomaterial designed to treat phonatory mucosal scarring.

PubMed

Karajanagi, Sandeep S; Lopez-Guerra, Gerardo; Park, Hyoungshin; Kobler, James B; Galindo, Marilyn; Aanestad, Jon; Mehta, Daryush D; Kumai, Yoshihiko; Giordano, Nicholas; d'Almeida, Anthony; Heaton, James T; Langer, Robert; Herrera, Victoria L M; Faquin, William; Hillman, Robert E; Zeitels, Steven M

2011-03-01

Most cases of irresolvable hoarseness are due to deficiencies in the pliability and volume of the superficial lamina propria of the phonatory mucosa. By using a US Food and Drug Administration-approved polymer, polyethylene glycol (PEG), we created a novel hydrogel (PEG30) and investigated its effects on multiple vocal fold structural and functional parameters. We injected PEG30 unilaterally into 16 normal canine vocal folds with survival times of 1 to 4 months. High-speed videos of vocal fold vibration, induced by intratracheal airflow, and phonation threshold pressures were recorded at 4 time points per subject. Three-dimensional reconstruction analysis of 11.7 T magnetic resonance images and histologic analysis identified 3 cases wherein PEG30 injections were the most superficial, so as to maximally impact vibratory function. These cases were subjected to in-depth analyses. High-speed video analysis of the 3 selected cases showed minimal to no reduction in the maximum vibratory amplitudes of vocal folds injected with PEG30 compared to the non-injected, contralateral vocal fold. All PEG30-injected vocal folds displayed mucosal wave activity with low average phonation threshold pressures. No significant inflammation was observed on microlaryngoscopic examination. Magnetic resonance imaging and histologic analyses revealed time-dependent resorption of the PEG30 hydrogel by phagocytosis with minimal tissue reaction or fibrosis. The PEG30 hydrogel is a promising biocompatible candidate biomaterial to restore form and function to deficient phonatory mucosa, while not mechanically impeding residual endogenous superficial lamina propria.

Iconicity can ground the creation of vocal symbols

PubMed Central

Perlman, Marcus; Dale, Rick; Lupyan, Gary

2015-01-01

Studies of gestural communication systems find that they originate from spontaneously created iconic gestures. Yet, we know little about how people create vocal communication systems, and many have suggested that vocalizations do not afford iconicity beyond trivial instances of onomatopoeia. It is unknown whether people can generate vocal communication systems through a process of iconic creation similar to gestural systems. Here, we examine the creation and development of a rudimentary vocal symbol system in a laboratory setting. Pairs of participants generated novel vocalizations for 18 different meanings in an iterative ‘vocal’ charades communication game. The communicators quickly converged on stable vocalizations, and naive listeners could correctly infer their meanings in subsequent playback experiments. People's ability to guess the meanings of these novel vocalizations was predicted by how close the vocalization was to an iconic ‘meaning template’ we derived from the production data. These results strongly suggest that the meaningfulness of these vocalizations derived from iconicity. Our findings illuminate a mechanism by which iconicity can ground the creation of vocal symbols, analogous to the function of iconicity in gestural communication systems. PMID:26361547

Glottal Aerodynamic Measures in Women with Phonotraumatic and Nonphonotraumatic Vocal Hyperfunction

ERIC Educational Resources Information Center

Espinoza, Victor M.; Zañartu, Matías; Van Stan, Jarrad H.; Mehta, Daryush D.; Hillman, Robert E.

2017-01-01

Purpose: The purpose of this study was to determine the validity of preliminary reports showing that glottal aerodynamic measures can identify pathophysiological phonatory mechanisms for phonotraumatic and nonphonotraumatic vocal hyperfunction, which are each distinctly different from normal vocal function. Method: Glottal aerodynamic measures…

Analysis of the Istanbul Forensic Medicine Institute expert decisions on recurrent laryngeal nerve injuries due to thyroidectomy between 2008–2012

PubMed Central

Karakaya, M. Arif; Koç, Okay; Ekiz, Feza; Ağaçhan, A. Feran; Göret, Nuri Emrah

2016-01-01

Objective: The aim of this study was to evaluate the approach of Forensic Medicine Institution for recurrent laryngeal nerve injuries. In addition, parameters that were taken into consideration by Forensic Medicine Institution in the differentiation of complication and malpractice were evaluated. Material and Methods: The files of 38 patients, with recurrent laryngeal nerve injury following thyroidectomy, that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008–2012 were retrospectively investigated. Data regarding expert decisions, age, gender, diagnosis, hospital type, preoperative vocal cord examination, intraoperative nerve monitoring (IONM), identification of nerve injury during operation, repair of nerve during operation, and type of injury were assessed. Results: Surgeons were found to be faulty in all files with bilateral nerve injury, however, one-sided injury files were considered as a medical complication. Twenty-one (55.2%) patients were female, and 17 (44.8%) were male, with a mean age of 35,8 in women, and 34,1 in men. None of these patients had undergone preoperative vocal cord assessment. The recurrent laryngeal nerve was intraoperatively identified in 21 (55.2%) patients, while it was not seen in 17 (44.8%) patients. IONM was not applied in any patients. There was no attempt for nerve repair during any operation. Nineteen patients had unilateral, and 19 patients had bilateral nerve damage. Conclusion: Bilateral recurrent laryngeal nerve injuries are considered as malpractice, when imaging or pathology reports fail to state a cause for difficulty in nerve identification. PMID:26985157

Intrapartum amnioinfusion for meconium-stained fluid: meta-analysis of prospective clinical trials.

PubMed

Pierce, J; Gaudier, F L; Sanchez-Ramos, L

2000-06-01

To evaluate the effectiveness of intrapartum prophylactic amnioinfusion in pregnancies complicated by meconium-stained amniotic fluid. We identified prospective clinical trials of amnioinfusion in pregnancies complicated by meconium-stained amniotic fluid (AF) published in English by using computerized databases, references in published studies, and index reviews. We analyzed prospective studies of intrapartum amnioinfusion for meconium-stained AF. In every case, group allocation was based exclusively on meconium in AF. Only published studies with clearly documented outcome data were included. The trials were evaluated for meconium below the vocal cords, meconium aspiration syndrome, fetal acidemia, cesarean delivery, and postpartum endometritis. Each trial was evaluated for the quality of its methodology, inclusion and exclusion criteria, adequacy of randomization, amnioinfusion protocols, definition of outcomes, and statistical analyses. Thirteen studies met inclusion criteria for our systematic review. Odds ratios (ORs) with their 95% confidence intervals (CIs) were calculated for each outcome. Estimates of ORs and risk differences for dichotomous outcomes were calculated using random and fixed-effects models. We tested for homogeneity across the studies. We found that intrapartum amnioinfusion significantly reduced the frequency of meconium aspiration syndrome (OR 0.30; 95% CI 0.19, 0. 46), of meconium below the vocal cords, and neonatal acidemia. Subjects allocated to receive amnioinfusion also had a significantly lower overall cesarean rate (OR 0.74, 95% CI 0.59, 0.93) without increased postpartum endometritis. Amnioinfusion in cases of meconium-stained fluid significantly improves neonatal outcome, lowers the cesarean delivery rate, and does not increase the postpartum endometritis rate.

Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant

PubMed Central

Uludağ, Mehmet; Yetkin, Gürkan; Oran, Ebru Şen; Aygün, Nurcihan; Celayir, Fevzi; İşgör, Adnan

2017-01-01

Objective Recognition of extralaryngeal branching of the recurrent laryngeal nerve is crucial because prevention of vocal cord paralysis requires preservation of all branches of the recurrent laryngeal nerve. We assessed the prevalence of extralaryngeal branching of the recurrent laryngeal nerve and the median branching distance from the point of bifurcation to the entry point of the nerve into the larynx. Material and Methods Prospective operative data on recurrent laryngeal nerve branching were collected from 94 patients who underwent thyroid or parathyroid surgery between September 2011 and May 2012. Results A total of 161 recurrent laryngeal nerves were examined (82 right, 79 left). Overall, 77 (47.8%) of 161 recurrent laryngeal nerves were bifurcated before entering the larynx. There were 36 (43.9%) branching nerves on the right and 41 (51.9%) branching nerves on the left, and there was no significant difference between the sides in terms of branching (p=0.471). Among 67 patients who underwent bilateral exploration, 28.4% were found to have bilateral branching, 40.3% had unilateral branching, and the remaining 31.3% had no branching. The median branching distance was 15 mm (5–60mm). Conclusion Extralaryngeal division of recurrent laryngeal nerve is a common and asymmetric anatomical variant. These variations can be easily recognized if the recurrent laryngeal nerve is identified at the level of the inferior thyroid artery and then dissected totally to the entry point of the larynx. Inadvertent division of a branch may lead to vocal cord palsy postoperatively, even when the surgeon believes the integrity of the nerve has been preserved. PMID:28944327

Extralaryngeal division of the recurrent laryngeal nerve: A common and asymmetric anatomical variant.

PubMed

Uludağ, Mehmet; Yetkin, Gürkan; Oran, Ebru Şen; Aygün, Nurcihan; Celayir, Fevzi; İşgör, Adnan

2017-01-01

Recognition of extralaryngeal branching of the recurrent laryngeal nerve is crucial because prevention of vocal cord paralysis requires preservation of all branches of the recurrent laryngeal nerve. We assessed the prevalence of extralaryngeal branching of the recurrent laryngeal nerve and the median branching distance from the point of bifurcation to the entry point of the nerve into the larynx. Prospective operative data on recurrent laryngeal nerve branching were collected from 94 patients who underwent thyroid or parathyroid surgery between September 2011 and May 2012. A total of 161 recurrent laryngeal nerves were examined (82 right, 79 left). Overall, 77 (47.8%) of 161 recurrent laryngeal nerves were bifurcated before entering the larynx. There were 36 (43.9%) branching nerves on the right and 41 (51.9%) branching nerves on the left, and there was no significant difference between the sides in terms of branching (p=0.471). Among 67 patients who underwent bilateral exploration, 28.4% were found to have bilateral branching, 40.3% had unilateral branching, and the remaining 31.3% had no branching. The median branching distance was 15 mm (5-60mm). Extralaryngeal division of recurrent laryngeal nerve is a common and asymmetric anatomical variant. These variations can be easily recognized if the recurrent laryngeal nerve is identified at the level of the inferior thyroid artery and then dissected totally to the entry point of the larynx. Inadvertent division of a branch may lead to vocal cord palsy postoperatively, even when the surgeon believes the integrity of the nerve has been preserved.

The use of ultrasound for communication by the big brown bat (Eptesicus fuscus)

NASA Astrophysics Data System (ADS)

Grilliot, Matthew E.

2007-12-01

Communication signals are important regulators of mating behavior in many animals. Various pre- and post-copulatory mechanisms have been suggested to play a role in the reproductive success and mating strategies of many mammals. Recent studies have cited sperm competition as a possible post-copulatory mechanism of selection in bats, but few studies have examined which pre-copulatory mechanisms influence mate selection. Although it is generally accepted that bats emit vocalizations that function for communication purposes as well as the more universally recognized echolocation function, there is lack of actual empirical support for this idea. In this dissertation, I test the hypothesis that ultrasonic vocalizations of big brown bats are sexually dimorphic and differ contextually in the mating season. I used playback experiments to test the response of male and female big brown bats to variations in ultrasonic vocalizations of the opposite sex and to determine if ultrasonic vocalizations are used for mate selection. My data suggest that males were likely to select ultrasonic vocalization of frequently copulating females, but females did not select ultrasonic vocalizations of frequently copulating males over infrequently copulating males. These results suggest that mate selection of male big brown bats is influenced by ultrasonic vocalizations of females.

Vocal copying of individually distinctive signature whistles in bottlenose dolphins

PubMed Central

King, Stephanie L.; Sayigh, Laela S.; Wells, Randall S.; Fellner, Wendi; Janik, Vincent M.

2013-01-01

Vocal learning is relatively common in birds but less so in mammals. Sexual selection and individual or group recognition have been identified as major forces in its evolution. While important in the development of vocal displays, vocal learning also allows signal copying in social interactions. Such copying can function in addressing or labelling selected conspecifics. Most examples of addressing in non-humans come from bird song, where matching occurs in an aggressive context. However, in other animals, addressing with learned signals is very much an affiliative signal. We studied the function of vocal copying in a mammal that shows vocal learning as well as complex cognitive and social behaviour, the bottlenose dolphin (Tursiops truncatus). Copying occurred almost exclusively between close associates such as mother–calf pairs and male alliances during separation and was not followed by aggression. All copies were clearly recognizable as such because copiers consistently modified some acoustic parameters of a signal when copying it. We found no evidence for the use of copying in aggression or deception. This use of vocal copying is similar to its use in human language, where the maintenance of social bonds appears to be more important than the immediate defence of resources. PMID:23427174

Further evaluation of response interruption and redirection as treatment for stereotypy.

PubMed

Ahrens, Erin N; Lerman, Dorothea C; Kodak, Tiffany; Worsdell, April S; Keegan, Courtney

2011-01-01

The effects of 2 forms of response interruption and redirection (RIRD)-motor RIRD and vocal RIRD-were examined with 4 boys with autism to evaluate further the effects of this intervention and its potential underlying mechanisms. In Experiment 1, the effects of motor RIRD and vocal RIRD on vocal stereotypy and appropriate vocalizations were compared for 2 participants. In Experiment 2, the effects of both RIRD procedures on both vocal and motor stereotypy and appropriate vocalizations were compared with 2 additional participants. Results suggested that RIRD was effective regardless of the procedural variation or topography of stereotypy and that vocal RIRD functioned as a punisher. This mechanism was further explored with 1 participant by manipulating the schedule of RIRD in Experiment 3. Results were consistent with the punishment interpretation.

FURTHER EVALUATION OF RESPONSE INTERRUPTION AND REDIRECTION AS TREATMENT FOR STEREOTYPY

PubMed Central

Ahrens, Erin N; Lerman, Dorothea C; Kodak, Tiffany; Worsdell, April S; Keegan, Courtney

2011-01-01

The effects of 2 forms of response interruption and redirection (RIRD)—motor RIRD and vocal RIRD—were examined with 4 boys with autism to evaluate further the effects of this intervention and its potential underlying mechanisms. In Experiment 1, the effects of motor RIRD and vocal RIRD on vocal stereotypy and appropriate vocalizations were compared for 2 participants. In Experiment 2, the effects of both RIRD procedures on both vocal and motor stereotypy and appropriate vocalizations were compared with 2 additional participants. Results suggested that RIRD was effective regardless of the procedural variation or topography of stereotypy and that vocal RIRD functioned as a punisher. This mechanism was further explored with 1 participant by manipulating the schedule of RIRD in Experiment 3. Results were consistent with the punishment interpretation. PMID:21541130

Repertoire and classification of non-song calls in Southeast Alaskan humpback whales (Megaptera novaeangliae).

PubMed

Fournet, Michelle E; Szabo, Andy; Mellinger, David K

2015-01-01

On low-latitude breeding grounds, humpback whales produce complex and highly stereotyped songs as well as a range of non-song sounds associated with breeding behaviors. While on their Southeast Alaskan foraging grounds, humpback whales produce a range of previously unclassified non-song vocalizations. This study investigates the vocal repertoire of Southeast Alaskan humpback whales from a sample of 299 non-song vocalizations collected over a 3-month period on foraging grounds in Frederick Sound, Southeast Alaska. Three classification systems were used, including aural spectrogram analysis, statistical cluster analysis, and discriminant function analysis, to describe and classify vocalizations. A hierarchical acoustic structure was identified; vocalizations were classified into 16 individual call types nested within four vocal classes. The combined classification method shows promise for identifying variability in call stereotypy between vocal groupings and is recommended for future classification of broad vocal repertoires.

Identification of a motor to auditory pathway important for vocal learning

PubMed Central

Roberts, Todd F.; Hisey, Erin; Tanaka, Masashi; Kearney, Matthew; Chattree, Gaurav; Yang, Cindy F.; Shah, Nirao M.; Mooney, Richard

2017-01-01

Summary Learning to vocalize depends on the ability to adaptively modify the temporal and spectral features of vocal elements. Neurons that convey motor-related signals to the auditory system are theorized to facilitate vocal learning, but the identity and function of such neurons remain unknown. Here we identify a previously unknown neuron type in the songbird brain that transmits vocal motor signals to the auditory cortex. Genetically ablating these neurons in juveniles disrupted their ability to imitate features of an adult tutor’s song. Ablating these neurons in adults had little effect on previously learned songs, but interfered with their ability to adaptively modify the duration of vocal elements and largely prevented the degradation of song’s temporal features normally caused by deafening. These findings identify a motor to auditory circuit essential to vocal imitation and to the adaptive modification of vocal timing. PMID:28504672

Acoustic Analysis and Electroglottography in Elite Vocal Performers.

PubMed

Villafuerte-Gonzalez, Rocio; Valadez-Jimenez, Victor M; Sierra-Ramirez, Jose A; Ysunza, Pablo Antonio; Chavarria-Villafuerte, Karen; Hernandez-Lopez, Xochiquetzal

2017-05-01

Acoustic analysis of voice (AAV) and electroglottography (EGG) have been used for assessing vocal quality in patients with voice disorders. The effectiveness of these procedures for detecting mild disturbances in vocal quality in elite vocal performers has been controversial. To compare acoustic parameters obtained by AAV and EGG before and after vocal training to determine the effectiveness of these procedures for detecting vocal improvements in elite vocal performers. Thirty-three elite vocal performers were studied. The study group included 14 males and 19 females, ages 18-40 years, without a history of voice disorders. Acoustic parameters were obtained through AAV and EGG before and after vocal training using the Linklater method. Nonsignificant differences (P > 0.05) were found between values of fundamental frequency (F 0 ), shimmer, and jitter obtained by both procedures before vocal training. Mean F 0 was similar after vocal training. Jitter percentage as measured by AAV showed nonsignificant differences (P > 0.05) before and after vocal training. Shimmer percentage as measured by AAV demonstrated a significant reduction (P < 0.05) after vocal training. As measured by EGG after vocal training, shimmer and jitter were significantly reduced (P < 0.05); open quotient was significantly increased (P < 0.05); and irregularity was significantly reduced (P < 0.05). AAV and EGG were effective for detecting improvements in vocal function after vocal training in male and female elite vocal performers undergoing vocal training. EGG demonstrated better efficacy for detecting improvements and provided additional parameters as compared to AAV. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Multiple Coordination Patterns in Infant and Adult Vocalizations

PubMed Central

Abney, Drew H.; Warlaumont, Anne S.; Oller, D. Kimbrough; Wallot, Sebastian; Kello, Christopher T.

2017-01-01

The study of vocal coordination between infants and adults has led to important insights into the development of social, cognitive, emotional and linguistic abilities. We used an automatic system to identify vocalizations produced by infants and adults over the course of the day for fifteen infants studied longitudinally during the first two years of life. We measured three different types of vocal coordination: coincidence-based, rate-based, and cluster-based. Coincidence-based and rate-based coordination are established measures in the developmental literature. Cluster-based coordination is new and measures the strength of matching in the degree to which vocalization events occur in hierarchically nested clusters. We investigated whether various coordination patterns differ as a function of vocalization type, whether different coordination patterns provide unique information about the dynamics of vocal interaction, and how the various coordination patterns each relate to infant age. All vocal coordination patterns displayed greater coordination for infant speech-related vocalizations, adults adapted the hierarchical clustering of their vocalizations to match that of infants, and each of the three coordination patterns had unique associations with infant age. Altogether, our results indicate that vocal coordination between infants and adults is multifaceted, suggesting a complex relationship between vocal coordination and the development of vocal communication. PMID:29375276

Flexible piezoelectric nanogenerator in wearable self-powered active sensor for respiration and healthcare monitoring

NASA Astrophysics Data System (ADS)

Liu, Z.; Zhang, S.; Jin, Y. M.; Ouyang, H.; Zou, Y.; Wang, X. X.; Xie, L. X.; Li, Z.

2017-06-01

A wearable self-powered active sensor for respiration and healthcare monitoring was fabricated based on a flexible piezoelectric nanogenerator. An electrospinning poly(vinylidene fluoride) thin film on silicone substrate was polarized to fabricate the flexible nanogenerator and its electrical property was measured. When periodically stretched by a linear motor, the flexible piezoelectric nanogenerator generated an output open-circuit voltage and short-circuit current of up to 1.5 V and 400 nA, respectively. Through integration with an elastic bandage, a wearable self-powered sensor was fabricated and used to monitor human respiration, subtle muscle movement, and voice recognition. As respiration proceeded, the electrical output signals of the sensor corresponded to the signals measured by a physiological signal recording system with good reliability and feasibility. This self-powered, wearable active sensor has significant potential for applications in pulmonary function evaluation, respiratory monitoring, and detection of gesture and vocal cord vibration for the personal healthcare monitoring of disabled or paralyzed patients.

Vocalization frequency and duration are coded in separate hindbrain nuclei.

PubMed

Chagnaud, Boris P; Baker, Robert; Bass, Andrew H

2011-06-14

Temporal patterning is an essential feature of neural networks producing precisely timed behaviours such as vocalizations that are widely used in vertebrate social communication. Here we show that intrinsic and network properties of separate hindbrain neuronal populations encode the natural call attributes of frequency and duration in vocal fish. Intracellular structure/function analyses indicate that call duration is encoded by a sustained membrane depolarization in vocal prepacemaker neurons that innervate downstream pacemaker neurons. Pacemaker neurons, in turn, encode call frequency by rhythmic, ultrafast oscillations in their membrane potential. Pharmacological manipulations show prepacemaker activity to be independent of pacemaker function, thus accounting for natural variation in duration which is the predominant feature distinguishing call types. Prepacemaker neurons also innervate key hindbrain auditory nuclei thereby effectively serving as a call-duration corollary discharge. We propose that premotor compartmentalization of neurons coding distinct acoustic attributes is a fundamental trait of hindbrain vocal pattern generators among vertebrates.

Vocalization frequency and duration are coded in separate hindbrain nuclei

PubMed Central

Chagnaud, Boris P.; Baker, Robert; Bass, Andrew H.

2011-01-01

Temporal patterning is an essential feature of neural networks producing precisely timed behaviours such as vocalizations that are widely used in vertebrate social communication. Here we show that intrinsic and network properties of separate hindbrain neuronal populations encode the natural call attributes of frequency and duration in vocal fish. Intracellular structure/function analyses indicate that call duration is encoded by a sustained membrane depolarization in vocal prepacemaker neurons that innervate downstream pacemaker neurons. Pacemaker neurons, in turn, encode call frequency by rhythmic, ultrafast oscillations in their membrane potential. Pharmacological manipulations show prepacemaker activity to be independent of pacemaker function, thus accounting for natural variation in duration which is the predominant feature distinguishing call types. Prepacemaker neurons also innervate key hindbrain auditory nuclei thereby effectively serving as a call-duration corollary discharge. We propose that premotor compartmentalization of neurons coding distinct acoustic attributes is a fundamental trait of hindbrain vocal pattern generators among vertebrates. PMID:21673667

Acoustic characterization of ultrasonic vocalizations by a nocturnal primate Tarsius syrichta.

PubMed

Gursky-Doyen, Sharon

2013-07-01

This preliminary study characterizes the ultrasonic vocalizations produced by Philippine tarsiers, Tarsius syrichta. Data were collected at the Philippine Tarsier Foundation Sanctuary in Corella, Bohol, Philippines, from July through October 2010. Recordings were made on a Wildlife Acoustics Ultrasonic Song Meter 2 BAT from 29 wild, free-living adult resident T. syrichta (23 females and six males). A total of 10,309 USVs were recorded. These vocalizations fell into three main categories: chirps, twitters, and whistles. Chirps were the most frequent, followed by twitters and whistles. Whereas chirps and twitters were emitted by both male and female Philippine tarsiers, whistles were only emitted by adult males. Given that vocalizations reported in this study were exclusively recorded during capture and handling, it is very likely that these vocalizations function as distress calls. However, as the long whistle was only given by adult males who were captured at the same time as the female or the group's infant, the function of the long whistle might be slightly different than the function of the other relatively lower-frequency USVs.

Shear properties of vocal fold mucosal tissues and their effect on vocal fold oscillation

NASA Astrophysics Data System (ADS)

Chan, Roger Wai Kai

Viscoelastic shear properties of vocal fold mucosal tissues and phonosurgical biomaterials were measured with a parallel-plate rotational rheometer. Elastic, viscous and damping properties were quantified as a function of frequency (0.01 Hz to 15 Hz) for human vocal fold mucosal tissues (N = 15), implantable biomaterials commonly used in the treatment of vocal fold paralysis (Teflon, gelatin, and collagen) (the non-mucosal group), and biomaterials currently or potentially useful in the treatment of vocal fold mucosal defects (adipose tissue or fat, hyaluronic acid, and fibronectin) (the mucosal group). It was found that intersubject differences as large as an order of magnitude were often observed for the shear properties of vocal fold mucosal tissues, part of which may be age- and gender-related. Shear properties of the non-mucosal group biomaterials were often much higher than those of the mucosal group biomaterials, which were relatively close to the shear properties of mucosal tissues. Viscoelastic and rheological modeling showed that shear properties of human vocal fold mucosa may be described by a quasi-linear viscoelastic theory and a statistical network theory, based upon which extrapolations to audio frequencies were possible. A theory of small-amplitude vocal fold oscillation was revisited to describe the effects of tissue shear properties on vocal fold oscillation and phonation threshold pressure, a measure of the 'ease' of phonation and an objective indication of vocal function. It was found that phonation threshold pressure is directly related to the viscous shear modulus or the 'effective damping modulus', a concept proposed to quantify the effective amount of damping in vocal fold oscillation. The mucosal group biomaterials were incorporated into the artificial vocal fold mucosa of a physical model in order to empirically assess their effects on phonation threshold pressure. Results showed that higher threshold pressures were consistently observed for higher concentrations of hyaluronic acid and for hyaluronic acid mixed with fibronectin, in correlation with their differences in viscous shear modulus and effective damping modulus. Implications for phonosurgery were discussed in terms of the choice of optimal biomaterials for the surgical management of vocal fold mucosal defects and lamina propria deficiencies.

Neural Correlates of Vocal Production and Motor Control in Human Heschl's Gyrus

PubMed Central

Oya, Hiroyuki; Nourski, Kirill V.; Kawasaki, Hiroto; Larson, Charles R.; Brugge, John F.; Howard, Matthew A.; Greenlee, Jeremy D.W.

2016-01-01

The present study investigated how pitch frequency, a perceptually relevant aspect of periodicity in natural human vocalizations, is encoded in Heschl's gyrus (HG), and how this information may be used to influence vocal pitch motor control. We recorded local field potentials from multicontact depth electrodes implanted in HG of 14 neurosurgical epilepsy patients as they vocalized vowel sounds and received brief (200 ms) pitch perturbations at 100 Cents in their auditory feedback. Event-related band power responses to vocalizations showed sustained frequency following responses that tracked voice fundamental frequency (F0) and were significantly enhanced in posteromedial HG during speaking compared with when subjects listened to the playback of their own voice. In addition to frequency following responses, a transient response component within the high gamma frequency band (75–150 Hz) was identified. When this response followed the onset of vocalization, the magnitude of the response was the same for the speaking and playback conditions. In contrast, when this response followed a pitch shift, its magnitude was significantly enhanced during speaking compared with playback. We also observed that, in anterolateral HG, the power of high gamma responses to pitch shifts correlated with the magnitude of compensatory vocal responses. These findings demonstrate a functional parcellation of HG with neural activity that encodes pitch in natural human voice, distinguishes between self-generated and passively heard vocalizations, detects discrepancies between the intended and heard vocalization, and contains information about the resulting behavioral vocal compensations in response to auditory feedback pitch perturbations. SIGNIFICANCE STATEMENT The present study is a significant contribution to our understanding of sensor-motor mechanisms of vocal production and motor control. The findings demonstrate distinct functional parcellation of core and noncore areas within human auditory cortex on Heschl's gyrus that process natural human vocalizations and pitch perturbations in the auditory feedback. In addition, our data provide evidence for distinct roles of high gamma neural oscillations and frequency following responses for processing periodicity in human vocalizations during vocal production and motor control. PMID:26888939

The objective vocal quality, vocal risk factors, vocal complaints, and corporal pain in Dutch female students training to be speech-language pathologists during the 4 years of study.

PubMed

Van Lierde, Kristiane M; D'haeseleer, Evelien; Wuyts, Floris L; De Ley, Sophia; Geldof, Ruben; De Vuyst, Julie; Sofie, Claeys

2010-09-01

The purpose of the present cross-sectional study was to determine the objective vocal quality and the vocal characteristics (vocal risk factors, vocal and corporal complaints) in 197 female students in speech-language pathology during the 4 years of study. The objective vocal quality was measured by means of the Dysphonia Severity Index (DSI). Perceptual voice assessment, the Voice Handicap Index (VHI), questionnaires addressing vocal risks, and vocal and corporal complaints during and/or after voice usage were performed. Speech-language pathology (SLP) students have a borderline vocal quality corresponding to a DSI% of 68. The analysis of variance revealed no significant change of the objective vocal quality between the first bachelor year and the master year. No psychosocial handicapping effect of the voice was observed by means of the VHI total, though there was an effect at the functional VHI level in addition to some vocal complaints. Ninety-three percent of the student SLPs reported the presence of corporal pain during and/or after speaking. In particular, sore throat and headache were mentioned as the prevalent corporal pain symptoms. A longitudinal study of the objective vocal quality of the same subjects during their career as an SLP might provide new insights. 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis

PubMed Central

Zheng, Hongliang; Chen, Donghui; Zhu, Minhui; Wang, Wei; Liu, Fei; Zhang, Caiyun

2013-01-01

Objective To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. Methods Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. Results Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P < 0.05); most of the vocal function parameters were improved postoperatively compared with the preoperative parameters, albeit without a significant difference (P > 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. Conclusions Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity. PMID:24098581

Identifying Knowledge Gaps in Clinicians Who Evaluate and Treat Vocal Performing Artists in College Health Settings.

PubMed

McKinnon-Howe, Leah; Dowdall, Jayme

2018-05-01

The goal of this study was to identify knowledge gaps in clinicians who evaluate and treat performing artists for illnesses and injuries that affect vocal function in college health settings. This pilot study utilized a web-based cross-sectional survey design incorporating common clinical scenarios to test knowledge of evaluation and management strategies in the vocal performing artist. A web-based survey was administered to a purposive sample of 28 clinicians to identify the approach utilized to evaluate and treat vocal performing artists in college health settings, and factors that might affect knowledge gaps and influence referral patterns to voice specialists. Twenty-eight clinicians were surveyed, with 36% of respondents incorrectly identifying appropriate vocal hygiene measures, 56% of respondents failing to identify symptoms of vocal fold hemorrhage, 84% failing to identify other indications for referral to a voice specialist, 96% of respondents acknowledging unfamiliarity with the Voice Handicap Index and the Singers Voice Handicap Index, and 68% acknowledging unfamiliarity with the Reflux Symptom Index. The data elucidated specific knowledge gaps in college health providers who are responsible for evaluating and treating common illnesses that affect vocal function, and triaging and referring students experiencing symptoms of potential vocal emergencies. Future work is needed to improve the standard of care for this population. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Standardized laryngeal videostroboscopic rating: differences between untrained and trained male and female subjects, and effects of varying sound intensity, fundamental frequency, and age.

PubMed

Sulter, A M; Schutte, H K; Miller, D G

1996-06-01

To determine the influence of the factors gender, vocal training, sound intensity, pitch, and aging on vocal function, videolaryngostroboscopic images of 214 subjects, subdivided according to gender and status of vocal training, were evaluated by three judges with standardized rating scales, comprising aspects of laryngeal appearance (larynx/pharynx ratio; epiglottal shape; asymmetry arytenoid region; compensatory adjustments; thickness, width, length, and elasticity of vocal folds) and glottal functioning (amplitudes of excursion; duration, percentage, and type of vocal fold closure; phase differences; location of glottal chink). The video registrations were made while the subjects performed a set of phonatory tasks, comprising the utterance of the vowel /i/ at three levels of both fundamental frequency and sound intensity. Analysis of the rating scales showed generally sufficient agreement among judges. With the exception of more frequently observed complete closure and lateral phase differences of vocal fold excursions in trained subjects, no further differences were established between untrained and trained subjects. With an alpha level of p = 0.005, men differed from women with respect to laryngeal appearance (larynx/pharynx ratio, compensatory adjustments, and the presence of omega and deviant-shaped epiglottises), and their vocal folds were rated thicker in the vertical dimension, smaller in the lateral dimension, longer, and more tense, with smaller amplitudes of excursion during vibration. Glottal closure in male subjects was rated more complete, but briefer in duration. Significant effects of the factors pitch, sound intensity, and age on vocal fold appearance and glottal functioning were ascertained. Awareness of the influence of these factors, as well as the factor gender, on the rated scales is essential for an adequate evaluation of laryngostroboscopic images.

Contemporary Commercial Music Singing Students-Voice Quality and Vocal Function at the Beginning of Singing Training.

PubMed

Sielska-Badurek, Ewelina M; Sobol, Maria; Olszowska, Katarzyna; Niemczyk, Kazimierz

2017-10-03

The purpose of this study was to assess the voice quality and the vocal tract function in popular singing students at the beginning of their singing training at the High School of Music. This is a retrospective cross-sectional study. The study consisted of 45 popular singing students (35 females and 10 males, mean age: 19.9 ± 2.8 years). They were assessed in the first 2 months of their 4-year singing training at the High School of Music, between 2013 and 2016. Voice quality and vocal tract function were evaluated using videolaryngostroboscopy, palpation of the vocal tract structures, the perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, the Voice Handicap Index, and the Singing Voice Handicap Index (SVHI). Twenty-two percent of Contemporary Commercial Music singing students began their education in the High School, with vocal nodules. Palpation of the vocal tract structure showed in 50% correct motions and tension in speaking and in 39.3% in singing. Perceptual voice assessment showed in 80% proper speaking voice quality and in 82.4% proper singing voice quality. The mean vocal fundamental frequency while speaking in females was 214 Hz and in males was 116 Hz. Dysphonia Severity Index was at the level of 2, and maximum phonation time was 17.7 seconds. The Voice Handicap Index and the SVHI remained within the normal range: 7.5 and 19, respectively. Perceptual singing voice assessment correlated with the SVHI (P = 0.006). Twenty-two percent of the Contemporary Commercial Music singing students began their education in the High School, with organic vocal fold lesions. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A study of vocal nonlinearities in humpback whale songs: from production mechanisms to acoustic analysis.

PubMed

Cazau, Dorian; Adam, Olivier; Aubin, Thierry; Laitman, Jeffrey T; Reidenberg, Joy S

2016-10-10

Although mammalian vocalizations are predominantly harmonically structured, they can exhibit an acoustic complexity with nonlinear vocal sounds, including deterministic chaos and frequency jumps. Such sounds are normative events in mammalian vocalizations, and can be directly traceable to the nonlinear nature of vocal-fold dynamics underlying typical mammalian sound production. In this study, we give qualitative descriptions and quantitative analyses of nonlinearities in the song repertoire of humpback whales from the Ste Marie channel (Madagascar) to provide more insight into the potential communication functions and underlying production mechanisms of these features. A low-dimensional biomechanical modeling of the whale's U-fold (vocal folds homolog) is used to relate specific vocal mechanisms to nonlinear vocal features. Recordings of living humpback whales were searched for occurrences of vocal nonlinearities (instabilities). Temporal distributions of nonlinearities were assessed within sound units, and between different songs. The anatomical production sources of vocal nonlinearities and the communication context of their occurrences in recordings are discussed. Our results show that vocal nonlinearities may be a communication strategy that conveys information about the whale's body size and physical fitness, and thus may be an important component of humpback whale songs.

A study of vocal nonlinearities in humpback whale songs: from production mechanisms to acoustic analysis

NASA Astrophysics Data System (ADS)

Cazau, Dorian; Adam, Olivier; Aubin, Thierry; Laitman, Jeffrey T.; Reidenberg, Joy S.

2016-10-01

Although mammalian vocalizations are predominantly harmonically structured, they can exhibit an acoustic complexity with nonlinear vocal sounds, including deterministic chaos and frequency jumps. Such sounds are normative events in mammalian vocalizations, and can be directly traceable to the nonlinear nature of vocal-fold dynamics underlying typical mammalian sound production. In this study, we give qualitative descriptions and quantitative analyses of nonlinearities in the song repertoire of humpback whales from the Ste Marie channel (Madagascar) to provide more insight into the potential communication functions and underlying production mechanisms of these features. A low-dimensional biomechanical modeling of the whale’s U-fold (vocal folds homolog) is used to relate specific vocal mechanisms to nonlinear vocal features. Recordings of living humpback whales were searched for occurrences of vocal nonlinearities (instabilities). Temporal distributions of nonlinearities were assessed within sound units, and between different songs. The anatomical production sources of vocal nonlinearities and the communication context of their occurrences in recordings are discussed. Our results show that vocal nonlinearities may be a communication strategy that conveys information about the whale’s body size and physical fitness, and thus may be an important component of humpback whale songs.

Improvement of Vocal Pathologies Diagnosis Using High-Speed Videolaryngoscopy

PubMed Central

Tsuji, Domingos Hiroshi; Hachiya, Adriana; Dajer, Maria Eugenia; Ishikawa, Camila Cristina; Takahashi, Marystella Tomoe; Montagnoli, Arlindo Neto

2014-01-01

Introduction The study of the dynamic properties of vocal fold vibration is important for understanding the vocal production mechanism and the impact of organic and functional changes. The advent of high-speed videolaryngoscopy (HSV) has provided the possibility of seeing the real cycle of vocal fold vibration in detail through high sampling rate of successive frames and adequate spatial resolution. Objective To describe the technique, advantages, and limitations of using HSV and digital videokymography in the diagnosis of vocal pathologies. Methods We used HSV and digital videokymography to evaluate one normophonic individual and four patients with vocal fold pathologies (nodules, unilateral paralysis of the left vocal fold, intracordal cyst, and adductor spasmodic dysphonia). The vocal fold vibration parameters (glottic closure, vibrational symmetry, periodicity, mucosal wave, amplitude, and glottal cycle phases) were assessed. Results Differences in the vocal vibration parameters were observed and correlated with the pathophysiology. Conclusion HSV is the latest diagnostic tool in visual examination of vocal behavior and has considerable potential to refine our knowledge regarding the vocal fold vibration and voice production, as well as regarding the impact of pathologic conditions have on the mechanism of phonation. PMID:25992109

Effect of Performance Time of the Semi-Occluded Vocal Tract Exercises in Dysphonic Children.

PubMed

Ramos, Lorena de Almeida; Gama, Ana Cristina Côrtes

2017-05-01

This study aimed to verify the effects of execution time on auditory-perceptual and acoustic responses in children with dysphonia completing straw phonation exercises. A randomized, prospective, comparative intra-subject study design was used. Twenty-seven children, ranging from 5 to 10 years of age, diagnosed with vocal cord nodules or cysts, were enrolled in the study. All subjects included in the Experimental Group were also included in the Control Group which involved complete voice rest. Sustained vowels (/a/e/ε/e/) counting from 1 to 10 were recorded before the exercises (m0) and then again after the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of straw phonation exercises. The recordings were randomized and presented to five speech therapists, who evaluated vocal quality based on the Grade Roughness Breathiness Asthenia/Strain Instability scale. For acoustic analysis, fundamental frequency, jitter, shimmer, glottal to noise excitation ratio, and noise parameters were analyzed. Reduced roughness, breathiness, and noise measurements as well as increased glottal to noise excitation ratio were observed in the Experimental Group after 3 minutes of exercise. Reduced grade of dysphonia and breathiness were noted after 5 minutes. The ideal duration of straw phonation in children with dysphonia is from 3 to 5 minutes. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Transmasculine People's Voice Function: A Review of the Currently Available Evidence.

PubMed

Azul, David; Nygren, Ulrika; Södersten, Maria; Neuschaefer-Rube, Christiane

2017-03-01

This study aims to evaluate the currently available discursive and empirical data relating to those aspects of transmasculine people's vocal situations that are not primarily gender-related, to identify restrictions to voice function that have been observed in this population, and to make suggestions for future voice research and clinical practice. We conducted a comprehensive review of the voice literature. Publications were identified by searching six electronic databases and bibliographies of relevant articles. Twenty-two publications met inclusion criteria. Discourses and empirical data were analyzed for factors and practices that impact on voice function and for indications of voice function-related problems in transmasculine people. The quality of the evidence was appraised. The extent and quality of studies investigating transmasculine people's voice function was found to be limited. There was mixed evidence to suggest that transmasculine people might experience restrictions to a range of domains of voice function, including vocal power, vocal control/stability, glottal function, pitch range/variability, vocal endurance, and voice quality. More research into the different factors and practices affecting transmasculine people's voice function that takes account of a range of parameters of voice function and considers participants' self-evaluations is needed to establish how functional voice production can be best supported in this population. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Unusual case of choking due to assassin bug ( Cydnocoris gilvus).

PubMed

Sonar, Vaibhav; Patil, Sachin

2018-01-01

Choking is a form of asphyxia which is caused by an obstruction within the air passages. Here, we report a case of obstruction of the upper respiratory tract due to assassin bug ( Cydnocoris gilvus) where allegations of medical negligence were made by relatives of the deceased. Autopsy findings demonstrated that an insect was present inside the larynx, lodged at the epiglottis. Multiple haemorrhagic patches were present at the base of the tongue, larynx, epiglottis, vocal cords and tracheal bifurcation. As Reduviidae can be successfully used as a biological pest-control agents, they should be used with due precaution.

Ground zero: not asthma at all.

PubMed

de Benedictis, Fernando Maria; de Benedictis, Diletta; Mirabile, Lorenzo; Pozzi, Marco; Guerrieri, Arcangela; Di Pillo, Sabrina

2015-09-01

Upper airway obstruction is commonly misdiagnosed as asthma. We report on four children with recurrent respiratory symptoms who had been erroneously diagnosed as having asthma and who received anti-asthma medication for several years. The evaluation of spirometry tracing was neglected in all cases. Subglottic stenosis, tracheomalacia secondary to tracheo-esophageal fistula, double aortic arch, and vocal cord dysfunction were suspected by direct inspection of the flow-volume curves and eventually diagnosed. The value of clinical history and careful evaluation of spirometry tracing in children with persistent respiratory symptoms is critically discussed. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Pleomorphic rhabdomyosarcoma of the larynx--a case report and literature review].

PubMed

Prgomet, Drago; Males, Josip; Manojlović, Spomenka; Bumber, Zeljko

2006-06-01

Rhabdomyosarcoma is a very rare malignant tumor of the larynx which can present in a number of histologic variants. The pleomorphic variant of the tumor has been described in 16 patients to date. Being a rarity, rhabdomyosarcoma is as a rule managed according to the principle of treatment for malignant mesenchymal tumors of the head and neck, and includes radical surgery with postoperative radiotherapy and/or chemotherapy. A case is presented of a pleomorphic rhabdomyosarcoma of the vocal cord. Successfully treated by endoscopic CO2 laser cordectomy with adjuvant chemotherapy and 6-year uneventful follow up.

The Vocal Repertoire of Adult and Neonate Giant Otters (Pteronura brasiliensis)

PubMed Central

Mumm, Christina A. S.; Knörnschild, Mirjam

2014-01-01

Animals use vocalizations to exchange information about external events, their own physical or motivational state, or about individuality and social affiliation. Infant babbling can enhance the development of the full adult vocal repertoire by providing ample opportunity for practice. Giant otters are very social and frequently vocalizing animals. They live in highly cohesive groups, generally including a reproductive pair and their offspring born in different years. This basic social structure may vary in the degree of relatedness of the group members. Individuals engage in shared group activities and different social roles and thus, the social organization of giant otters provides a basis for complex and long-term individual relationships. We recorded and analysed the vocalizations of adult and neonate giant otters from wild and captive groups. We classified the adult vocalizations according to their acoustic structure, and described their main behavioural context. Additionally, we present the first description of vocalizations uttered in babbling bouts of new born giant otters. We expected to find 1) a sophisticated vocal repertoire that would reflect the species’ complex social organisation, 2) that giant otter vocalizations have a clear relationship between signal structure and function, and 3) that the vocal repertoire of new born giant otters would comprise age-specific vocalizations as well as precursors of the adult repertoire. We found a vocal repertoire with 22 distinct vocalization types produced by adults and 11 vocalization types within the babbling bouts of the neonates. A comparison within the otter subfamily suggests a relation between vocal and social complexity, with the giant otters being the socially and vocally most complex species. PMID:25391142

The vocal repertoire of the African Penguin (Spheniscus demersus): structure and function of calls.

PubMed

Favaro, Livio; Ozella, Laura; Pessani, Daniela

2014-01-01

The African Penguin (Spheniscus demersus) is a highly social and vocal seabird. However, currently available descriptions of the vocal repertoire of African Penguin are mostly limited to basic descriptions of calls. Here we provide, for the first time, a detailed description of the vocal behaviour of this species by collecting audio and video recordings from a large captive colony. We combine visual examinations of spectrograms with spectral and temporal acoustic analyses to determine vocal categories. Moreover, we used a principal component analysis, followed by signal classification with a discriminant function analysis, for statistical validation of the vocalisation types. In addition, we identified the behavioural contexts in which calls were uttered. The results show that four basic vocalisations can be found in the vocal repertoire of adult African Penguin, namely a contact call emitted by isolated birds, an agonistic call used in aggressive interactions, an ecstatic display song uttered by single birds, and a mutual display song vocalised by pairs, at their nests. Moreover, we identified two distinct vocalisations interpreted as begging calls by nesting chicks (begging peep) and unweaned juveniles (begging moan). Finally, we discussed the importance of specific acoustic parameters in classifying calls and the possible use of the source-filter theory of vocal production to study penguin vocalisations.

Manatee (Trichechus manatus) vocalization usage in relation to environmental noise levels.

PubMed

Miksis-Olds, Jennifer L; Tyack, Peter L

2009-03-01

Noise can interfere with acoustic communication by masking signals that contain biologically important information. Communication theory recognizes several ways a sender can modify its acoustic signal to compensate for noise, including increasing the source level of a signal, its repetition, its duration, shifting frequency outside that of the noise band, or shifting the timing of signal emission outside of noise periods. The extent to which animals would be expected to use these compensation mechanisms depends on the benefit of successful communication, risk of failure, and the cost of compensation. Here we study whether a coastal marine mammal, the manatee, can modify vocalizations as a function of behavioral context and ambient noise level. To investigate whether and how manatees modify their vocalizations, natural vocalization usage and structure were examined in terms of vocalization rate, duration, frequency, and source level. Vocalizations were classified into two call types, chirps and squeaks, which were analyzed independently. In conditions of elevated noise levels, call rates decreased during feeding and social behaviors, and the duration of each call type was differently influenced by the presence of calves. These results suggest that ambient noise levels do have a detectable effect on manatee communication and that manatees modify their vocalizations as a function of noise in specific behavioral contexts.

Responses of primate frontal cortex neurons during natural vocal communication.

PubMed

Miller, Cory T; Thomas, A Wren; Nummela, Samuel U; de la Mothe, Lisa A

2015-08-01

The role of primate frontal cortex in vocal communication and its significance in language evolution have a controversial history. While evidence indicates that vocalization processing occurs in ventrolateral prefrontal cortex neurons, vocal-motor activity has been conjectured to be primarily subcortical and suggestive of a distinctly different neural architecture from humans. Direct evidence of neural activity during natural vocal communication is limited, as previous studies were performed in chair-restrained animals. Here we recorded the activity of single neurons across multiple regions of prefrontal and premotor cortex while freely moving marmosets engaged in a natural vocal behavior known as antiphonal calling. Our aim was to test whether neurons in marmoset frontal cortex exhibited responses during vocal-signal processing and/or vocal-motor production in the context of active, natural communication. We observed motor-related changes in single neuron activity during vocal production, but relatively weak sensory responses for vocalization processing during this natural behavior. Vocal-motor responses occurred both prior to and during call production and were typically coupled to the timing of each vocalization pulse. Despite the relatively weak sensory responses a population classifier was able to distinguish between neural activity that occurred during presentations of vocalization stimuli that elicited an antiphonal response and those that did not. These findings are suggestive of the role that nonhuman primate frontal cortex neurons play in natural communication and provide an important foundation for more explicit tests of the functional contributions of these neocortical areas during vocal behaviors. Copyright © 2015 the American Physiological Society.

Responses of primate frontal cortex neurons during natural vocal communication

PubMed Central

Thomas, A. Wren; Nummela, Samuel U.; de la Mothe, Lisa A.

2015-01-01

The role of primate frontal cortex in vocal communication and its significance in language evolution have a controversial history. While evidence indicates that vocalization processing occurs in ventrolateral prefrontal cortex neurons, vocal-motor activity has been conjectured to be primarily subcortical and suggestive of a distinctly different neural architecture from humans. Direct evidence of neural activity during natural vocal communication is limited, as previous studies were performed in chair-restrained animals. Here we recorded the activity of single neurons across multiple regions of prefrontal and premotor cortex while freely moving marmosets engaged in a natural vocal behavior known as antiphonal calling. Our aim was to test whether neurons in marmoset frontal cortex exhibited responses during vocal-signal processing and/or vocal-motor production in the context of active, natural communication. We observed motor-related changes in single neuron activity during vocal production, but relatively weak sensory responses for vocalization processing during this natural behavior. Vocal-motor responses occurred both prior to and during call production and were typically coupled to the timing of each vocalization pulse. Despite the relatively weak sensory responses a population classifier was able to distinguish between neural activity that occurred during presentations of vocalization stimuli that elicited an antiphonal response and those that did not. These findings are suggestive of the role that nonhuman primate frontal cortex neurons play in natural communication and provide an important foundation for more explicit tests of the functional contributions of these neocortical areas during vocal behaviors. PMID:26084912

Preservice Music Teacher Voice Use, Vocal Health, and Voice Function before and during Student Teaching

ERIC Educational Resources Information Center

Brunkan, Melissa C.

2018-01-01

Preservice music teachers often use their voices differently during the semesters leading up to student teaching as compared to during the semester itself. Vocal demands often increase and change as students move from a student role to full-time teacher role. Consequently, music student teachers frequently experience vocal distress symptoms that…

[The comparative assessment of the vocal function in the professional voice users and non-occupational voice users in the late adulthood].

PubMed

Pavlikhin, O G; Romanenko, S G; Krasnikova, D I; Lesogorova, E V; Yakovlev, V S

The objective of the present study was to evaluate the clinical and functional condition of the voice apparatus in the elderly patients and to elaborate recommendations for the prevention of disturbances of the vocal function in the professional voice users. This comprehensive study involved 95 patients including the active professional voice users (n=48) and 45 non-occupational voice users at the age from 61 to 82 years with the employment history varying from 32 to 51 years. The study was designed to obtain the voice characteristics by means of the subjective auditory assessment, microlaryngoscopy, video laryngostroboscopy, determination of maximum phonation time (MPT), and computer-assisted acoustic analysis of the voice with the use of the MDVP Kay Pentaxy system. The level of anxiety of the patients was estimated based on the results of the HADS questionnaire study. It is concluded that the majority of the disturbances of the vocal function in the professional voice users have the functional nature. It is concluded that the method of neuro-muscular electrophonopedic stimulation (NMEPS) of laryngeal muscles is the method of choice for the diagnostics of the vocal function of the voice users in the late adulthood. It is recommended that the professional vocal load for such subjects should not exceed 12-14 hours per week. Rational psychotherapy must constitute an important component of the system of measures intended to support the working capacity of the voice users belonging to this age group.

Videostrobolaryngoscopy of mucus layer during vocal fold vibration in patients with laryngeal tension-fatigue syndrome.

PubMed

Hsiao, Tzu-Yu; Liu, Chia-Ming; Lin, Kai-Nan

2002-06-01

The mucus layer on the vocal folds was examined by videostrobolaryngoscopy in patients with laryngeal tension-fatigue syndrome, a chronic functional dysphonia due to vocal abuse and misuse. Besides the findings in previous reports (such as abnormal glottal closure, phase or amplitude asymmetry, and the irregular mucosal wave), the vocal folds during vibration had an uneven mucus surface. The occurrence of an uneven mucus layer on vocal folds was significantly greater in subjects with this voice disorder (83% or 250 of 301 patients in this series) than in those without voice disorders (18.5% or 5 of 27). The increase of mucus viscosity, mucus aggregation, and the formation of rough surfaces on the vocal folds alter the mechanical properties that contribute to vibration of the cover of the vocal folds, and thereby worsen the symptoms of dysphonia in patients with laryngeal tension-fatigue syndrome.

Convergence of calls as animals form social bonds, active compensation for noisy communication channels, and the evolution of vocal learning in mammals.

PubMed

Tyack, Peter L

2008-08-01

The classic evidence for vocal production learning involves imitation of novel, often anthropogenic sounds. Among mammals, this has been reported for dolphins, elephants, harbor seals, and humans. A broader taxonomic distribution has been reported for vocal convergence, where the acoustic properties of calls from different individuals converge when they are housed together in captivity or form social bonds in the wild. Vocal convergence has been demonstrated for animals as diverse as songbirds, parakeets, hummingbirds, bats, elephants, cetaceans, and primates. For most species, call convergence is thought to reflect a group-distinctive identifier, with shared calls reflecting and strengthening social bonds. A ubiquitous function for vocal production learning that is starting to receive attention involves modifying signals to improve communication in a noisy channel. Pooling data on vocal imitation, vocal convergence, and compensation for noise suggests a wider taxonomic distribution of vocal production learning among mammals than has been generally appreciated. The wide taxonomic distribution of this evidence for vocal production learning suggests that perhaps more of the neural underpinnings for vocal production learning are in place in mammals than is usually recognized. (c) 2008 APA, all rights reserved

Visualizing sound emission of elephant vocalizations: evidence for two rumble production types.

PubMed

Stoeger, Angela S; Heilmann, Gunnar; Zeppelzauer, Matthias; Ganswindt, André; Hensman, Sean; Charlton, Benjamin D

2012-01-01

Recent comparative data reveal that formant frequencies are cues to body size in animals, due to a close relationship between formant frequency spacing, vocal tract length and overall body size. Accordingly, intriguing morphological adaptations to elongate the vocal tract in order to lower formants occur in several species, with the size exaggeration hypothesis being proposed to justify most of these observations. While the elephant trunk is strongly implicated to account for the low formants of elephant rumbles, it is unknown whether elephants emit these vocalizations exclusively through the trunk, or whether the mouth is also involved in rumble production. In this study we used a sound visualization method (an acoustic camera) to record rumbles of five captive African elephants during spatial separation and subsequent bonding situations. Our results showed that the female elephants in our analysis produced two distinct types of rumble vocalizations based on vocal path differences: a nasally- and an orally-emitted rumble. Interestingly, nasal rumbles predominated during contact calling, whereas oral rumbles were mainly produced in bonding situations. In addition, nasal and oral rumbles varied considerably in their acoustic structure. In particular, the values of the first two formants reflected the estimated lengths of the vocal paths, corresponding to a vocal tract length of around 2 meters for nasal, and around 0.7 meters for oral rumbles. These results suggest that African elephants may be switching vocal paths to actively vary vocal tract length (with considerable variation in formants) according to context, and call for further research investigating the function of formant modulation in elephant vocalizations. Furthermore, by confirming the use of the elephant trunk in long distance rumble production, our findings provide an explanation for the extremely low formants in these calls, and may also indicate that formant lowering functions to increase call propagation distances in this species'.

Visualizing Sound Emission of Elephant Vocalizations: Evidence for Two Rumble Production Types

PubMed Central

Stoeger, Angela S.; Heilmann, Gunnar; Zeppelzauer, Matthias; Ganswindt, André; Hensman, Sean; Charlton, Benjamin D.

2012-01-01

Recent comparative data reveal that formant frequencies are cues to body size in animals, due to a close relationship between formant frequency spacing, vocal tract length and overall body size. Accordingly, intriguing morphological adaptations to elongate the vocal tract in order to lower formants occur in several species, with the size exaggeration hypothesis being proposed to justify most of these observations. While the elephant trunk is strongly implicated to account for the low formants of elephant rumbles, it is unknown whether elephants emit these vocalizations exclusively through the trunk, or whether the mouth is also involved in rumble production. In this study we used a sound visualization method (an acoustic camera) to record rumbles of five captive African elephants during spatial separation and subsequent bonding situations. Our results showed that the female elephants in our analysis produced two distinct types of rumble vocalizations based on vocal path differences: a nasally- and an orally-emitted rumble. Interestingly, nasal rumbles predominated during contact calling, whereas oral rumbles were mainly produced in bonding situations. In addition, nasal and oral rumbles varied considerably in their acoustic structure. In particular, the values of the first two formants reflected the estimated lengths of the vocal paths, corresponding to a vocal tract length of around 2 meters for nasal, and around 0.7 meters for oral rumbles. These results suggest that African elephants may be switching vocal paths to actively vary vocal tract length (with considerable variation in formants) according to context, and call for further research investigating the function of formant modulation in elephant vocalizations. Furthermore, by confirming the use of the elephant trunk in long distance rumble production, our findings provide an explanation for the extremely low formants in these calls, and may also indicate that formant lowering functions to increase call propagation distances in this species'. PMID:23155427

Recovery of laryngeal nerve function with sugammadex after rocuronium-induced profound neuromuscular block.

PubMed

Pavoni, Vittorio; Gianesello, Lara; Martinelli, Cristiana; Horton, Andrew; Nella, Alessandra; Gori, Gabriele; Simonelli, Martina; De Scisciolo, Giuseppe

2016-09-01

The aim of this study was to evaluate the efficacy of sugammadex in reversing profound rocuronium-induced neuromuscular block at the laryngeal adductor muscles using motor-evoked potentials (mMEPs). A prospective observational study. University surgical center. Twenty patients with American Society of Anesthesiologists physical class I-II status who underwent propofol-remifentanil anesthesia for the surgery of the thyroid gland. Patients were enrolled for reversal of profound neuromuscular block (sugammadex 16 mg/kg, 3 minutes after rocuronium 1.2 mg/kg). To prevent laryngeal nerve injury during the surgical procedures, all patients underwent neurophysiologic monitoring using mMEPs from vocal muscles. At the same time, the registration of TOF-Watch acceleromyograph at the adductor pollicis muscle response to ulnar nerve stimulation was performed; recovery was defined as a train-of-four (TOF) ratio ≥0.9. After injection of 16 mg/kg of sugammadex, the mean time to recovery of the basal mMEPs response at the laryngeal adductor muscles was 70 ± 18.2 seconds. The mean time to recovery of the TOF ratio to 0.9 was 118 ± 80 seconds. In the postoperative period, 12 patients received follow-up evaluation of the vocal cords and no lesions caused by the surface laryngeal electrode during electrophysiological monitoring were noted. Recovery from profound rocuronium-induced block on the larynx is fast and complete with sugammadex. In urgent scenarios, "early" extubation can be performed, even with a TOF ratio ≤0.9. However, all procedures to prevent postoperative residual curarization should still be immediately undertaken. Copyright © 2016 Elsevier Inc. All rights reserved.

Auditory–vocal mirroring in songbirds

PubMed Central

Mooney, Richard

2014-01-01

Mirror neurons are theorized to serve as a neural substrate for spoken language in humans, but the existence and functions of auditory–vocal mirror neurons in the human brain remain largely matters of speculation. Songbirds resemble humans in their capacity for vocal learning and depend on their learned songs to facilitate courtship and individual recognition. Recent neurophysiological studies have detected putative auditory–vocal mirror neurons in a sensorimotor region of the songbird's brain that plays an important role in expressive and receptive aspects of vocal communication. This review discusses the auditory and motor-related properties of these cells, considers their potential role on song learning and communication in relation to classical studies of birdsong, and points to the circuit and developmental mechanisms that may give rise to auditory–vocal mirroring in the songbird's brain. PMID:24778375

Auditory-vocal mirroring in songbirds.

PubMed

Mooney, Richard

2014-01-01

Mirror neurons are theorized to serve as a neural substrate for spoken language in humans, but the existence and functions of auditory-vocal mirror neurons in the human brain remain largely matters of speculation. Songbirds resemble humans in their capacity for vocal learning and depend on their learned songs to facilitate courtship and individual recognition. Recent neurophysiological studies have detected putative auditory-vocal mirror neurons in a sensorimotor region of the songbird's brain that plays an important role in expressive and receptive aspects of vocal communication. This review discusses the auditory and motor-related properties of these cells, considers their potential role on song learning and communication in relation to classical studies of birdsong, and points to the circuit and developmental mechanisms that may give rise to auditory-vocal mirroring in the songbird's brain.

Intraoperative laryngeal electromyography in children with vocal fold immobility: results of a multicenter longitudinal study.

PubMed

Maturo, Stephen C; Braun, Nicole; Brown, David J; Chong, Peter Siao Tick; Kerschner, Joseph E; Hartnick, Christopher J

2011-12-01

To determine whether laryngeal electromyography (LEMG) can predict recurrent laryngeal nerve function return in children and whether LEMG can aid in the management of vocal fold immobility (VFI). Prospective case series. Tertiary pediatric aerodigestive centers. Twenty-five children aged 14 days to 7 years at the time of first LEMG (mean age, 21.4 months) with VFI who underwent flexible fiberoptic laryngeal examination, intraoperative LEMG of the thyroarytenoid muscles, and 12-month follow-up. To compare results of LEMG with flexible fiberoptic laryngeal examination in children with vocal fold paresis and to determine if LEMG can predict vocal fold return. In children who had a patent ductus arteriosus ligation, the LEMG data suggest that if there is no activity 6 months after injury, then the nerve is unlikely to regain function. In 3 of 3 children with central causes of VFI, normal LEMG findings predicted return of nerve function 2 to 7 months before vocal fold movement on fiberoptic examination. Finally, in 3 of 3 children with idiopathic VFI, LEMG predicted return within 2 to 14 months of vocal folds with normal findings. Intraoperative LEMG is a safe, easy-to-use method for determining the likelihood of recurrent laryngeal nerve function return in children who have undergone patent ductus arteriosus ligation, in children with centrally correctable lesions, and in children with idiopathic VFI. More work is needed in the area of pediatric LEMG, but it is possible that LEMG data can be used to aid in management strategies and provide families with more information to make better informed decisions regarding their child's care.

Computation of physiological human vocal fold parameters by mathematical optimization of a biomechanical model

PubMed Central

Yang, Anxiong; Stingl, Michael; Berry, David A.; Lohscheller, Jörg; Voigt, Daniel; Eysholdt, Ulrich; Döllinger, Michael

2011-01-01

With the use of an endoscopic, high-speed camera, vocal fold dynamics may be observed clinically during phonation. However, observation and subjective judgment alone may be insufficient for clinical diagnosis and documentation of improved vocal function, especially when the laryngeal disease lacks any clear morphological presentation. In this study, biomechanical parameters of the vocal folds are computed by adjusting the corresponding parameters of a three-dimensional model until the dynamics of both systems are similar. First, a mathematical optimization method is presented. Next, model parameters (such as pressure, tension and masses) are adjusted to reproduce vocal fold dynamics, and the deduced parameters are physiologically interpreted. Various combinations of global and local optimization techniques are attempted. Evaluation of the optimization procedure is performed using 50 synthetically generated data sets. The results show sufficient reliability, including 0.07 normalized error, 96% correlation, and 91% accuracy. The technique is also demonstrated on data from human hemilarynx experiments, in which a low normalized error (0.16) and high correlation (84%) values were achieved. In the future, this technique may be applied to clinical high-speed images, yielding objective measures with which to document improved vocal function of patients with voice disorders. PMID:21877808

FoxP2 Expression in a Highly Vocal Teleost Fish with Comparisons to Tetrapods.

PubMed

Pengra, Ian G G; Marchaterre, Margaret A; Bass, Andrew H

2018-04-19

Motivated by studies of speech deficits in humans, several studies over the past two decades have investigated the potential role of a forkhead domain transcription factor, FoxP2, in the central control of acoustic signaling/vocalization among vertebrates. Comparative neuroanatomical studies that mainly include mammalian and avian species have mapped the distribution of FoxP2 expression in multiple brain regions that imply a greater functional significance beyond vocalization that might be shared broadly across vertebrate lineages. To date, reports for teleost fish have been limited in number and scope to nonvocal species. Here, we map the neuroanatomical distribution of FoxP2 mRNA expression in a highly vocal teleost, the plainfin midshipman (Porichthys notatus). We report an extensive overlap between FoxP2 expression and vocal, auditory, and steroid-signaling systems with robust expression at multiple sites in the telencephalon, the preoptic area, the diencephalon, and the midbrain. Label was far more restricted in the hindbrain though robust in one region of the reticular formation. A comparison with other teleosts and tetrapods suggests an evolutionarily conserved FoxP2 phenotype important to vocal-acoustic and, more broadly, sensorimotor function among vertebrates. © 2018 S. Karger AG, Basel.

Production of ultrasonic vocalizations by Peromyscus mice in the wild

PubMed Central

Kalcounis-Rueppell, Matina C; Metheny, Jackie D; Vonhof, Maarten J

2006-01-01

Background There has been considerable research on rodent ultrasound in the laboratory and these sounds have been well quantified and characterized. Despite the value of research on ultrasound produced by mice in the lab, it is unclear if, and when, these sounds are produced in the wild, and how they function in natural habitats. Results We have made the first recordings of ultrasonic vocalizations produced by two free-living species of mice in the genus Peromyscus (P. californicus and P. boylii) on long term study grids in California. Over 6 nights, we recorded 65 unique ultrasonic vocalization phrases from Peromyscus. The ultrasonic vocalizations we recorded represent 7 different motifs. Within each motif, there was considerable variation in the acoustic characteristics suggesting individual and contextual variation in the production of ultrasound by these species. Conclusion The discovery of the production of ultrasonic vocalizations by Peromyscus in the wild highlights an underappreciated component in the behavior of these model organisms. The ability to examine the production of ultrasonic vocalizations in the wild offers excellent opportunities to test hypotheses regarding the function of ultrasound produced by rodents in a natural context. PMID:16507093

Voice quality after treatment of early vocal cord cancer: a randomized trial comparing laser surgery with radiation therapy.

PubMed

Aaltonen, Leena-Maija; Rautiainen, Noora; Sellman, Jaana; Saarilahti, Kauko; Mäkitie, Antti; Rihkanen, Heikki; Laranne, Jussi; Kleemola, Leenamaija; Wigren, Tuija; Sala, Eeva; Lindholm, Paula; Grenman, Reidar; Joensuu, Heikki

2014-10-01

Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial. Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO2 laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality was assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living. Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization. Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option. Copyright © 2014 Elsevier Inc. All rights reserved.

[Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery].

PubMed

Karakus, Osman; Kaya, Cengiz; Ustun, Faik Emre; Koksal, Ersin; Ustun, Yasemin Burcu

2015-01-01

Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack-Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p<0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Laryngopharyngeal reflux and herpes simplex virus type 2 are possible risk factors for adult-onset recurrent respiratory papillomatosis (prospective case-control study).

PubMed

Formánek, M; Jančatová, D; Komínek, P; Matoušek, P; Zeleník, K

2017-06-01

The human papillomavirus (HPV) causes recurrent respiratory papillomatosis (RRP). Although HPV prevalence is high, the incidence of papillomatosis is low. Thus, factors other than HPV infection probably contribute to RRP. This study investigated whether patients with papillomatosis are more often infected with herpes simplex virus type 2 and chlamydia trachomatis (ChT) and whether laryngopharyngeal reflux (LPR) occurs in this group of patients more often. Prospective case-control study. Department of Otorhinolaryngology of University Hospital. The study included 20 patients with adult-onset RRP and 20 adult patients with vocal cord cyst and no pathology of laryngeal mucosa (control group). Immunohistochemical analysis of pepsin, HPV, herpes simplex virus type 2 and ChT was performed in biopsy specimens of laryngeal papillomas and of healthy laryngeal mucosa (control group) obtained from medial part of removed vocal cord cyst during microlaryngoscopy procedures. Pathologic LPR (pepsin in tissue) was diagnosed in 8/20 (40.0%) patients with papillomatosis and in 0/20 control patients (P = .003). Herpes simplex virus type 2 was present in 9/20 (45.0%) patients with papillomatosis and in 0/20 control patients (P = .001). Five specimens were positive for both pepsin and herpes simplex virus type 2. No samples were positive for ChT. There were no significant differences between groups for age, body mass index, diabetes mellitus and gastrooesophageal reflux disease. Tobacco exposure was not more frequent in RRP group either (P = .01). Results show that LPR and herpes simplex virus type 2 are significantly more often present in patients with RRP. LPR and herpes simplex virus type 2 might activate latent HPV infection and thereby be possible risk factors for RRP. © 2016 John Wiley & Sons Ltd.

Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes.

PubMed

Suda, Koichi; Ishida, Yoshinori; Kawamura, Yuichiro; Inaba, Kazuki; Kanaya, Seiichiro; Teramukai, Satoshi; Satoh, Seiji; Uyama, Ichiro

2012-07-01

Meticulous mediastinal lymphadenectomy frequently induces recurrent laryngeal nerve palsy (RLNP). Surgical robots with impressive dexterity and precise dissection skills have been developed to help surgeons perform operations. The objective of this study was to determine the impact on short-term outcomes of robot-assisted thoracoscopic radical esophagectomy performed on patients in the prone position for the treatment of esophageal squamous cell carcinoma, including its impact on RLNP. A single-institution nonrandomized prospective study was performed. The patients (n = 36) with resectable esophageal squamous cell carcinoma were divided into two groups: patients who agreed to robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy performed in the prone position (n = 16, robot-assisted group) without insurance reimbursement, and those who agreed to undergo the same operation without robot assistance but with health insurance coverage (n = 20, control group). These patients were observed for 30 days following surgery to assess short-term surgical outcomes, including the incidence of vocal cord palsy, hoarseness, and aspiration. Robot assistance significantly reduced the incidence of vocal cord palsy (p = 0.018) and hoarseness (p = 0.015) and the time on the ventilator (p = 0.025). There was no in-hospital mortality in either group. There were no significant differences between the two groups with respect to patient background, except for the use of preoperative therapy (robot-assisted group

Voice Quality After Treatment of Early Vocal Cord Cancer: A Randomized Trial Comparing Laser Surgery With Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aaltonen, Leena-Maija, E-mail: leena-maija.aaltonen@hus.fi; Rautiainen, Noora; Sellman, Jaana

Objective: Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial. Methods and Materials: Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO{sub 2} laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality wasmore » assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living. Results: Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization. Conclusions: Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.« less

Viscoelasticity of rabbit vocal folds after injection augmentation.

PubMed

Dahlqvist, Ake; Gärskog, Ola; Laurent, Claude; Hertegård, Stellan; Ambrosio, Luigi; Borzacchiello, Assunta

2004-01-01

Vocal fold function is related to the viscoelasticity of the vocal fold tissue. Augmentation substances used for injection treatment of voice insufficiency may alter the viscoelastic properties of vocal folds and their vibratory capacity. The objective was to compare the mechanical properties (viscoelasticity) of various injectable substances and the viscoelasticity of rabbit vocal folds, 6 months after injection with one of these substances. Animal model. Cross-linked collagen (Zyplast), double cross-linked hyaluronan (hylan B gel), dextranomers in hyaluronan (DHIA), and polytetrafluoroethylene (Teflon) were injected into rabbit vocal folds. Six months after the injection, the animals were killed and the right- and left-side vocal folds were removed. Dynamic viscosity of the injected substances and the vocal folds was measured with a Bohlin parallel-plate rheometer during small-amplitude oscillation. All injected vocal folds showed a decreasing dynamic viscosity with increasing frequency. Hylan B gel and DiHA showed the lowest dynamic viscosity values, and vocal folds injected with these substances also showed the lowest dynamic viscosity (similar to noninjected control samples). Teflon (and vocal folds injected with Teflon) showed the highest dynamic viscosity values, followed by the collagen samples. Substances with low viscoelasticity alter the mechanical properties of the vocal fold to a lesser degree than substances with a high viscoelasticity. The data indicated that hylan B gel and DiHA render the most natural viscoelastic properties to the vocal folds. These substances seem to be appropriate for preserving or restoring the vibratory capacity of the vocal folds when glottal insufficiency is treated with augmentative injections.

Neural Representation of a Target Auditory Memory in a Cortico-Basal Ganglia Pathway

PubMed Central

Bottjer, Sarah W.

2013-01-01

Vocal learning in songbirds, like speech acquisition in humans, entails a period of sensorimotor integration during which vocalizations are evaluated via auditory feedback and progressively refined to achieve an imitation of memorized vocal sounds. This process requires the brain to compare feedback of current vocal behavior to a memory of target vocal sounds. We report the discovery of two distinct populations of neurons in a cortico-basal ganglia circuit of juvenile songbirds (zebra finches, Taeniopygia guttata) during vocal learning: (1) one in which neurons are selectively tuned to memorized sounds and (2) another in which neurons are selectively tuned to self-produced vocalizations. These results suggest that neurons tuned to learned vocal sounds encode a memory of those target sounds, whereas neurons tuned to self-produced vocalizations encode a representation of current vocal sounds. The presence of neurons tuned to memorized sounds is limited to early stages of sensorimotor integration: after learning, the incidence of neurons encoding memorized vocal sounds was greatly diminished. In contrast to this circuit, neurons known to drive vocal behavior through a parallel cortico-basal ganglia pathway show little selective tuning until late in learning. One interpretation of these data is that representations of current and target vocal sounds in the shell circuit are used to compare ongoing patterns of vocal feedback to memorized sounds, whereas the parallel core circuit has a motor-related role in learning. Such a functional subdivision is similar to mammalian cortico-basal ganglia pathways in which associative-limbic circuits mediate goal-directed responses, whereas sensorimotor circuits support motor aspects of learning. PMID:24005299

Comparison of three and four-field radiotherapy technique and the effect of laryngeal shield on vocal and spinal cord radiation dose in radiotherapy of non-laryngeal head and neck tumors

NASA Astrophysics Data System (ADS)

Pour, Noushin Hassan; Farajollahi, Alireza; Jamali, Masoud; Zeinali, Ahad; Jangjou, Amir Ghasemi

2018-03-01

Introduction: Due to the effect of radiation on both the tumor and the surrounding normal tissues, the side effects of radiation in normal tissues are expected. One of the important complications in the head and neck radiotherapy is the doses reached to the larynx and spinal cord of patients with non-laryngeal head and neck tumors. Materials and Methods: In this study, CT scan images of 25 patients with non-laryngeal tumors including; lymph nodes, tongue, oropharynx and nasopharynx were used. A three-field and a four-field treatment planning with and without laryngeal shield in 3D CRT technique were planned for each patient. Subsequently, the values of Dmin, Dmean, Dmax and Dose Volume Histogram from the treatment planning system and NTCP values of spinal cord and larynx were calculated with BIOPLAN and MATLAB software for all patients. Results: Statistical results showed that mean values of doses of larynx in both three and four-field methods were significantly different between with and without shield groups. Comparison of absorbed dose didn't show any difference between the three and four field methods (P>0.05). Using Shield, just the mean and minimum doses of spinal cord decreased in both three and four fields. The NTCP of the spinal cord and larynx by three and four-field methods with shield in the LKB and EUD models significantly are less than that of the three and four fields without shields, and in the four-field method NTCP of larynx is less than three radiation field. Conclusion: The results of this study indicate that there is no significant difference in doses reached to larynx and spinal cord between the treatments techniques, but laryngeal shield reduce dose and NTCP values in larynx considerably.

Do obesity and weight loss affect vocal function?

PubMed

Solomon, Nancy Pearl; Helou, Leah B; Dietrich-Burns, Katie; Stojadinovic, Alexander

2011-02-01

Obesity may be associated with increased tissue bulk in the laryngeal airway, neck, and chest wall, and as such may affect vocal function. Eight obese and eight nonobese adults participated in this study; the obese participants underwent bariatric surgical procedures. This mixed-design study included cross-sectional analysis for group differences and longitudinal analysis for multidimensional changes in vocal function from four assessments collected over 6 months. No significant differences were detected between groups from the preoperative assessment. Further, no changes were detected over time for acoustic parameters, maximum phonation time, laryngeal airway resistance, and airflow during a sustained vowel for either group. Only minor differences were detected for strain, pitch, and loudness perceptions of voice over time, but not between groups. Phonation threshold pressure (PTP), at comfortable and high pitches (30% and 80% of the F0 range) changed significantly over time, but not between groups. Examination of individual data revealed a trend for PTP at 30% F0 to decrease as body mass index decreased. PTP may be informative for assessing vocal function in clients who present with obesity and voice symptoms. © Thieme Medical Publishers.

Harbor Seal (Phoca vitulina) Reproductive Advertisement Behavior and the Effects of Vessel Noise

NASA Astrophysics Data System (ADS)

Matthews, Leanna P.

Harbor seals (Phoca vitulina) are a widely distributed pinniped species that mate underwater. Similar to other aquatically mating pinnipeds, male harbor seals produce vocalizations during the breeding season that function in male-male interactions and possibly as an attractant for females. I investigated multiple aspects of these reproductive advertisement displays in a population of harbor seals in Glacier Bay National Park and Preserve, Alaska. First, I looked at vocal production as a function of environmental variables, including season, daylight, and tidal state. Vocalizations were highly seasonal and detection of these vocalizations peaked in June and July, which correspond with the estimated time of breeding. Vocalizations also varied with light, with the lowest probability of detection during the day and the highest probability of detection at night. The high probability of detection corresponded to when females are known to forage. These results are similar to the vocal behavior of previously studied populations. However, unlike previously studied populations, the detection of harbor seal breeding vocalizations did not vary with tidal state. This is likely due to the location of the hydrophone, as it was not near the haul out and depth was therefore not significantly influenced by changes in tidal height. I also investigated the source levels and call parameters of vocalizations, as well as call rate and territoriality. The average source level of harbor seal breeding vocalizations was 144 dB re 1 ?Pa at 1 m and measurements ranged from 129 to 149 dB re 1 ?Pa. Analysis of call parameters indicated that vocalizations of harbor seals in Glacier Bay were similar in duration to other populations, but were much lower in frequency. During the breeding season, there were two discrete calling areas that likely represent two individual males; the average call rate in these display areas was approximately 1 call per minute. The harbor seal breeding season also overlaps with peak tourism in Glacier Bay, and the majority of tourists visit the park on a motorized vessel. Because of this overlap, I investigated the impacts of vessel noise on the vocal behavior of individual males. In the presence of vessel noise, male harbor seals increase the amplitude of their vocalizations, decrease the duration, and increase the minimum frequency. These vocal shifts are similar to studies of noise impacts on other species across taxa, but it is unknown how this could impact the reproductive success of male harbor seals. Finally, I looked at the role of female preference for male vocalizations. Using playbacks of male vocalizations to captive female harbor seals, I found that females have a higher response to vocalizations that correspond to dominant males. Females were less responsive to subordinate male vocalizations, which had a shorter duration and a higher frequency. Given that male harbor seals decrease the duration and increase the frequency of vocalizations in the presence of noise, it is possible that these vocalizations become less attractive in noise.

Psychogenic dysphonia: diversity of clinical and vocal manifestations in a case series.

PubMed

Martins, Regina Helena Garcia; Tavares, Elaine Lara Mendes; Ranalli, Paula Ferreira; Branco, Anete; Pessin, Adriana Bueno Benito

2014-01-01

Psychogenic dysphonia is a functional disorder with variable clinical manifestations. To assess the clinical and vocal characteristics of patients with psychogenic dysphonia in a case series. The study included 28 adult patients with psychogenic dysphonia, evaluated at a University hospital in the last ten years. Assessed variables included gender, age, occupation, vocal symptoms, vocal characteristics, and videolaryngostroboscopic findings. 28 patients (26 women and 2 men) were assessed. Their occupations included: housekeeper (n=17), teacher (n=4), salesclerk (n=4), nurse (n=1), retired (n=1), and psychologist (n=1). Sudden symptom onset was reported by 16 patients and progressive symptom onset was reported by 12; intermittent evolution was reported by 15; symptom duration longer than three months was reported by 21 patients. Videolaryngostroboscopy showed only functional disorders; no patient had structural lesions or changes in vocal fold mobility. Conversion aphonia, skeletal muscle tension, and intermittent voicing were the most frequent vocal emission manifestation forms. In this case series of patients with psychogenic dysphonia, the most frequent form of clinical presentation was conversion aphonia, followed by musculoskeletal tension and intermittent voicing. The clinical and vocal aspects of 28 patients with psychogenic dysphonia, as well as the particularities of each case, are discussed. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Chronic naltrindole administration does not modify the inhibitory effect of morphine on vocalization responses in the tail electric stimulation test in rats.

PubMed

Fernández, B; Alberti, I; Kitchen, I; Paz Viveros, M

1999-01-29

To address the existence of possible functional interactions between delta- and mu- receptors in relation to the affective component of pain, we have studied the effects of functional blockade of delta-receptors by a chronic treatment with naltrindole (1 mg/kg, 8 consecutive days) on antinociceptive responses to morphine (2 and 5 mg/kg) in the tail electric stimulation test, in adult male rats. The thresholds for the motor response (tail withdrawal), vocalization during stimulus and vocalization afterdischarge were assessed. These responses are considered to be integrated at spinal, medulla oblongata and diencephalon-rhinencephalon levels, respectively. The results show that the vocalization during stimulus and the vocalization afterdischarge were significantly affected by morphine in a dose dependent manner, the latter response being the most sensitive to the effects of the mu-opioid agonist. However, no significant effect was observed on motor responses at the doses used in this study. Chronic naltrindole treatment did not modify the inhibitory effect of morphine on the vocalization responses. Since the vocalization afterdischarge is related to the affective component of pain, the data suggest that the delta-opioid receptor is not involved in the supraspinal mechanisms at which these responses are organized and that there is not a mu-delta interaction in the modulation of the affective responses to noxious electrical stimulation.

Vocal Tract Morphology in Inhaling Singing: An MRI-Based Study.

PubMed

Moerman, Mieke; Vanhecke, Françoise; Van Assche, Lieven; Vercruysse, Johan; Daemers, Kristin; Leman, Marc

2016-07-01

Inhaling singing is a recently developed singing technique explored by the soprano singer Françoise Vanhecke. It is based on an inspiratory airflow instead of an expiratory airflow. This article describes the anatomical structural differences of the vocal tract between inhaling and exhaling singing. We hypothesize that the vocal tract alters significantly in inhaling singing, especially concerning the configuration of the anatomical structures in the oral cavity and the subglottal region. This is a prospective study. A professional singer (F.V.) performed sustained tones from F5 chromatically rising up to Bb5 on the vowel /a/. Vocal tract anatomy is assessed by magnetic resonance imaging. Wilcoxon directional testing demonstrates (1) that the vocal tract volume above the glottal region does not differ statistically in contrast to the subglottal region and (2) significant changes in the configuration of the tongue, the upright position of the epiglottis, the length of the floor of mouth, and the distance between the teeth. The narrowing of the subglottis is considered to be secondary to suction forces used in the inhaling singing technique. The changes in the anatomical structures above the vocal folds possibly suggest a valve-like function controlling the air inlet together with the regulator function of the resonator capacities of the vocal tract. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Perceptual connections between prepubertal children's voices in their speaking behavior and their singing behavior.

PubMed

Rinta, Tiija Elisabet; Welch, Graham F

2009-11-01

Traditionally, children's speaking and singing behaviors have been regarded as two separate sets of behaviors. Nevertheless, according to the voice-scientific view, all vocal functioning is interconnected due to the fact that we exploit the same voice and the same physiological mechanisms in generating all vocalization. The intention of the study was to investigate whether prepubertal children's speaking and singing behaviors are connected perceptually. Voice recordings were conducted with 60 10-year-old children. Each child performed a set of speaking and singing tasks in the voice experiments. Each voice sample was analyzed perceptually with a specially designed perceptual voice assessment protocol. The main finding was that the children's vocal functioning and voice quality in their speaking behavior correlated statistically significantly with those in their singing behavior. The findings imply that children's speaking and singing behaviors are perceptually connected through their vocal functioning and voice quality. Thus, it can be argued that children possess one voice that is used for generating their speaking and singing behaviors.

Intrinsic Resting-State Functional Connectivity in the Human Spinal Cord at 3.0 T.

PubMed

San Emeterio Nateras, Oscar; Yu, Fang; Muir, Eric R; Bazan, Carlos; Franklin, Crystal G; Li, Wei; Li, Jinqi; Lancaster, Jack L; Duong, Timothy Q

2016-04-01

To apply resting-state functional magnetic resonance (MR) imaging to map functional connectivity of the human spinal cord. Studies were performed in nine self-declared healthy volunteers with informed consent and institutional review board approval. Resting-state functional MR imaging was performed to map functional connectivity of the human cervical spinal cord from C1 to C4 at 1 × 1 × 3-mm resolution with a 3.0-T clinical MR imaging unit. Independent component analysis (ICA) was performed to derive resting-state functional MR imaging z-score maps rendered on two-dimensional and three-dimensional images. Seed-based analysis was performed for cross validation with ICA networks by using Pearson correlation. Reproducibility analysis of resting-state functional MR imaging maps from four repeated trials in a single participant yielded a mean z score of 6 ± 1 (P < .0001). The centroid coordinates across the four trials deviated by 2 in-plane voxels ± 2 mm (standard deviation) and up to one adjacent image section ± 3 mm. ICA of group resting-state functional MR imaging data revealed prominent functional connectivity patterns within the spinal cord gray matter. There were statistically significant (z score > 3, P < .001) bilateral, unilateral, and intersegmental correlations in the ventral horns, dorsal horns, and central spinal cord gray matter. Three-dimensional surface rendering provided visualization of these components along the length of the spinal cord. Seed-based analysis showed that many ICA components exhibited strong and significant (P < .05) correlations, corroborating the ICA results. Resting-state functional MR imaging connectivity networks are qualitatively consistent with known neuroanatomic and functional structures in the spinal cord. Resting-state functional MR imaging of the human cervical spinal cord with a 3.0-T clinical MR imaging unit and standard MR imaging protocols and hardware reveals prominent functional connectivity patterns within the spinal cord gray matter, consistent with known functional and anatomic layouts of the spinal cord.

Identifying stimuli that alter immediate and subsequent levels of vocal stereotypy: a further analysis of functionally matched stimulation.

PubMed

Lanovaz, Marc J; Fletcher, Sarah E; Rapp, John T

2009-09-01

We used a three-component multiple-schedule with a brief reversal design to evaluate the effects of structurally unmatched and matched stimuli on immediate and subsequent vocal stereotypy that was displayed by three children with autism spectrum disorders. For 2 of the 3 participants, access to matched stimuli, unmatched stimuli, and music decreased immediate levels of vocal stereotypy; however, with the exception of matched stimuli for one participant, none of the stimuli produced a clear abolishing operation for subsequent vocal stereotypy. That is, vocal stereotypy typically increased to baseline levels shortly after alternative stimulation was removed. Detection of motivating operations for each participant's vocal stereotypy was aided by the analysis of component distributions. The results are discussed in terms of immediate and subsequent effects of preferred stimuli on automatically reinforced problem behavior.

[Long term result of arytenoidectomy with CO₂ laser for dyspnoea in iatrogenic bilateral vocal fold paralysis patients].

PubMed

Cheng, Q H; Ge, P J; Sheng, X L; Jiang, J; Zhang, S Y; Chen, S H

2016-03-20

Objective: To investigate the optimal time of tracheotomy/arytenoidectomy and the improvement of dyspnoea, dysphonia and dysphagia after arytenoidectomy with CO₂ laser in iatrogenic bilateral vocal folds paralysis patients. Method: Thirty patients [29 females, 56 (49-60) years, one male, 49 years] with bilateral vocal cords paralysis resulted from neck surgery were retrospectively analyzed by case archived information and following-up questionnaire. The data included patients' dysponea time, degree and duration from tracheotomy/arytenoidectomy to neck surgery. Twenty sixty patients required unilateral partial/total arytenoidectomy. The results of treatment were evaluated by questionnaire including dyspnoea, dysphonia and dysphagia. Result: All patients whose bilateral vocal paralysis were resulted from thyroid gland surgery. Dysponea occurred immediately after thyroidectomy surgery in 14 cases (46.7%), and 2 years later after thyroidectomy in 13 cases (43.3%), 8 years later in 3 cases (10.0%). There was one (3.3%) patient without tracheotomy. The duration of tracheotomy/arytenoidectomy to neck surgery was significantly correlated with duration of tracheotomy/arytenoidectomy to dyspnoea appearance ( r =0.879, P <0.05), not correlated with duration of thyroid surgery to dyspnoea appearance. There is significantly negative correlation between degree of dyspnoea and duration of tracheotomy/arytenoidectomy to neck surgery ( r =0.452, P <0.05). Twenty six patients appeared dyspnoea and underwent CO₂ laser arytenoidectomy after thyoidectomy 0.5-23 years. Five patients did unilateral total arytenoidectomy and 21 patients did unilateral partial arytenoidectomy. After 12-96 months following up, dyspnoea improved in 24 patients, no improved in 2 patients. Dysphonia improved and remained in 17 patients, being worse mildly in 8 patients and obviously in one patient. Dysphagia improved and remained in 24 patients, being worse in 2 patients. There was no difference between total and partial arytenoidectomy in dyspnoea, dysphonia and dysphagia. Conclusion: The morbidity of dyspnoea was correlated with time after neck surgery. It was rarely necessary to take tracheotomy immediately in bilateral vocal fords paralysis patients after neck surgery. The severer degree of dyspnoea led to shorter duration between neck surgery and tracheotomy/arytenoidectomy. There was obvious improvement after arytenoidectomy in dyspnoea, no significant change in dysphonia and dysphagia. The effect of total arytenoidectomy on bilateral vocal paralysis was similar to partial arytenoidectomy. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

Discriminating Simulated Vocal Tremor Source Using Amplitude Modulation Spectra

PubMed Central

Carbonell, Kathy M.; Lester, Rosemary A.; Story, Brad H.; Lotto, Andrew J.

2014-01-01

Objectives/Hypothesis Sources of vocal tremor are difficult to categorize perceptually and acoustically. This paper describes a preliminary attempt to discriminate vocal tremor sources through the use of spectral measures of the amplitude envelope. The hypothesis is that different vocal tremor sources are associated with distinct patterns of acoustic amplitude modulations. Study Design Statistical categorization methods (discriminant function analysis) were used to discriminate signals from simulated vocal tremor with different sources using only acoustic measures derived from the amplitude envelopes. Methods Simulations of vocal tremor were created by modulating parameters of a vocal fold model corresponding to oscillations of respiratory driving pressure (respiratory tremor), degree of vocal fold adduction (adductory tremor) and fundamental frequency of vocal fold vibration (F0 tremor). The acoustic measures were based on spectral analyses of the amplitude envelope computed across the entire signal and within select frequency bands. Results The signals could be categorized (with accuracy well above chance) in terms of the simulated tremor source using only measures of the amplitude envelope spectrum even when multiple sources of tremor were included. Conclusions These results supply initial support for an amplitude-envelope based approach to identify the source of vocal tremor and provide further evidence for the rich information about talker characteristics present in the temporal structure of the amplitude envelope. PMID:25532813

Vocal Fold Epithelial Barrier in Health and Injury A Research Review

PubMed Central

Levendoski, Elizabeth Erickson; Leydon, Ciara; Thibeault, Susan L.

2015-01-01

Purpose Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment. This barrier provides structural stability to the vocal folds and protects underlying connective tissue from injury while being nearly continuously exposed to potentially hazardous insults including environmental or systemic-based irritants such as pollutants and reflux, surgical procedures, and vibratory trauma. Small disruptions in the epithelial barrier may have a large impact on susceptibility to injury and overall vocal health. The purpose of this article is to provide a broad-based review of our current knowledge of the vocal fold epithelial barrier. Methods A comprehensive review of the literature was conducted. Details of the structure of the vocal fold epithelial barrier are presented and evaluated in the context of function in injury and pathology. The importance of the epithelial-associated vocal fold mucus barrier is also introduced. Results/Conclusions Information presented in this review is valuable for clinicians and researchers as it highlights the importance of this understudied portion of the vocal folds to overall vocal health and disease. Prevention and treatment of injury to the epithelial barrier is a significant area awaiting further investigation. PMID:24686981

Mechanomimetic hydrogels for vocal fold lamina propria regeneration.

PubMed

Kutty, Jaishankar K; Webb, Ken

2009-01-01

Vocal fold injury commonly leads to reduced vocal quality due to scarring-induced alterations in matrix composition and tissue biomechanics. The long-term hypothesis motivating our work is that rapid restoration of phonation and the associated dynamic mechanical environment will reduce scarring and promote regenerative healing. Toward this end, the objective of this study was to develop mechanomimetic, degradable hydrogels approximating the viscoelastic properties of the vocal ligament and mucosa that may be photopolymerized in situ to restore structural integrity to vocal fold tissues. The tensile and rheological properties of hydrogels (targeting the vocal ligament and mucosa, respectively) were varied as a function of macromer concentration. PEG diacrylate-based hydrogels exhibited linear stress-strain response and elastic modulus consistent with the properties of the vocal ligament at low strains (0-15%), but did not replicate the non-linear behavior observed in native tissue at higher strains. Methacrylated hyaluronic acid hydrogels displayed dynamic viscosity consistent with native vocal mucosa, while elastic shear moduli values were several-fold higher. Cell culture studies indicated that both hydrogels supported spreading, proliferation and collagen/proteoglycan matrix deposition by encapsulated fibroblasts throughout the 3D network.

The vocal sac of Hylodidae (Amphibia, Anura): Phylogenetic and functional implications of a unique morphology.

PubMed

Elias-Costa, Agustin J; Montesinos, Rachel; Grant, Taran; Faivovich, Julián

2017-11-01

Anuran vocal sacs are elastic chambers that recycle exhaled air during vocalizations and are present in males of most species of frogs. Most knowledge of the diversity of vocal sacs relates to external morphology; detailed information on internal anatomy is available for few groups of frogs. Frogs of the family Hylodidae, which is endemic to the Atlantic Forest of Brazil and adjacent Argentina and Paraguay, have three patterns of vocal sac morphology-that is, single, subgular; paired, lateral; and absent. The submandibular musculature and structure of the vocal sac mucosa (the internal wall of the vocal sac) of exemplar species of this family and relatives were studied. In contrast to previous accounts, we found that all species of Crossodactylus and Hylodes possess paired, lateral vocal sacs, with the internal mucosa of each sac being separate from the contralateral one. Unlike all other frogs for which data are available, the mucosa of the vocal sacs in these genera is not supported externally by the mm. intermandibularis and interhyoideus. Rather, the vocal sac mucosa projects through the musculature and is free in the submandibular lymphatic sac. The presence of paired, lateral vocal sacs, the internal separation of the sac mucosae, and their projection through the m. interhyoideus are synapomorphies of the family. Furthermore, the specific configuration of the m. interhyoideus allows asymmetric inflation of paired vocal sacs, a feature only reported in species of these diurnal, stream-dwelling frogs. © 2017 Wiley Periodicals, Inc.

Common Vocal Effects and Partial Glottal Vibration in Professional Nonclassical Singers.

PubMed

Caffier, Philipp P; Ibrahim Nasr, Ahmed; Ropero Rendon, Maria Del Mar; Wienhausen, Sascha; Forbes, Eleanor; Seidner, Wolfram; Nawka, Tadeus

2018-05-01

To multidimensionally investigate common vocal effects in experienced professional nonclassical singers, to examine their mechanism of production and reproducibility, to demonstrate the existence of partial glottal vibration, and to assess the potential of damage to the voice from nonclassical singing. Individual cohort study. Ten male singers aged between 25 and 46 years (34 ± 7 years [mean ± SD]) with different stylistic backgrounds were recruited (five pop/rock/metal, five musical theater). Participants repeatedly presented the usual nonclassical vocal effects and techniques in their repertoire. All performances were documented and analyzed using established instruments (eg, auditory-perceptual assessment, videolaryngostroboscopy, electroglottography, voice function diagnostics). The vocal apparatus of all singers was healthy and capable of high performance. Typical nonclassical vocal effects were breathy voice, creaky voice, vocal fry, grunting, distortion, rattle, belt, and twang. All effects could be easily differentiated from each other. They were intraindividually consistently repeatable and also interindividually produced in a similar manner. A special feature in one singer was the first evidence of partial glottal vibration when belting in the high register. The unintended transition to this reduced voice quality was accompanied by physical fatigue and inflexible respiratory support. The long-lasting use of the investigated nonclassical vocal effects had no negative impact on trained singers. The possibility of long-term damage depends on the individual constitution, specific use, duration, and extent of the hyperfunction. The incidence of partial glottal vibration and its consequences require continuing research to learn more about efficient and healthy vocal function in nonclassical singing. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Sexual selection on male vocal fundamental frequency in humans and other anthropoids.

PubMed

Puts, David A; Hill, Alexander K; Bailey, Drew H; Walker, Robert S; Rendall, Drew; Wheatley, John R; Welling, Lisa L M; Dawood, Khytam; Cárdenas, Rodrigo; Burriss, Robert P; Jablonski, Nina G; Shriver, Mark D; Weiss, Daniel; Lameira, Adriano R; Apicella, Coren L; Owren, Michael J; Barelli, Claudia; Glenn, Mary E; Ramos-Fernandez, Gabriel

2016-04-27

In many primates, including humans, the vocalizations of males and females differ dramatically, with male vocalizations and vocal anatomy often seeming to exaggerate apparent body size. These traits may be favoured by sexual selection because low-frequency male vocalizations intimidate rivals and/or attract females, but this hypothesis has not been systematically tested across primates, nor is it clear why competitors and potential mates should attend to vocalization frequencies. Here we show across anthropoids that sexual dimorphism in fundamental frequency (F0) increased during evolutionary transitions towards polygyny, and decreased during transitions towards monogamy. Surprisingly, humans exhibit greater F0 sexual dimorphism than any other ape. We also show that low-F0 vocalizations predict perceptions of men's dominance and attractiveness, and predict hormone profiles (low cortisol and high testosterone) related to immune function. These results suggest that low male F0 signals condition to competitors and mates, and evolved in male anthropoids in response to the intensity of mating competition. © 2016 The Author(s).

Tissue engineering therapies for the vocal fold lamina propria.

PubMed

Kutty, Jaishankar K; Webb, Ken

2009-09-01

The vocal folds are laryngeal connective tissues with complex matrix composition/organization that provide the viscoelastic mechanical properties required for voice production. Vocal fold injury results in alterations in tissue structure and corresponding changes in tissue biomechanics that reduce vocal quality. Recent work has begun to elucidate the biochemical changes underlying injury-induced pathology and to apply tissue engineering principles to the prevention and reversal of vocal fold scarring. Based on the extensive history of injectable biomaterials in laryngeal surgery, a major focus of regenerative therapies has been the development of novel scaffolds with controlled in vivo residence time and viscoelastic properties approximating the native tissue. Additional strategies have included cell transplantation and delivery of the antifibrotic cytokine hepatocyte growth factor, as well as investigation of the effects of the unique vocal fold vibratory microenvironment using in vitro dynamic culture systems. Recent achievements of significant reductions in fibrosis and improved recovery of native tissue viscoelasticity and vibratory/functional performance in animal models are rapidly moving vocal fold tissue engineering toward clinical application.

Vocal performance affects metabolic rate in dolphins: implications for animals communicating in noisy environments.

PubMed

Holt, Marla M; Noren, Dawn P; Dunkin, Robin C; Williams, Terrie M

2015-06-01

Many animals produce louder, longer or more repetitious vocalizations to compensate for increases in environmental noise. Biological costs of increased vocal effort in response to noise, including energetic costs, remain empirically undefined in many taxa, particularly in marine mammals that rely on sound for fundamental biological functions in increasingly noisy habitats. For this investigation, we tested the hypothesis that an increase in vocal effort would result in an energetic cost to the signaler by experimentally measuring oxygen consumption during rest and a 2 min vocal period in dolphins that were trained to vary vocal loudness across trials. Vocal effort was quantified as the total acoustic energy of sounds produced. Metabolic rates during the vocal period were, on average, 1.2 and 1.5 times resting metabolic rate (RMR) in dolphin A and B, respectively. As vocal effort increased, we found that there was a significant increase in metabolic rate over RMR during the 2 min following sound production in both dolphins, and in total oxygen consumption (metabolic cost of sound production plus recovery costs) in the dolphin that showed a wider range of vocal effort across trials. Increases in vocal effort, as a consequence of increases in vocal amplitude, repetition rate and/or duration, are consistent with behavioral responses to noise in free-ranging animals. Here, we empirically demonstrate for the first time in a marine mammal, that these vocal modifications can have an energetic impact at the individual level and, importantly, these data provide a mechanistic foundation for evaluating biological consequences of vocal modification in noise-polluted habitats. © 2015. Published by The Company of Biologists Ltd.

Long-term consequences of vocal fold hemorrhage.

PubMed

Kerwin, Lewis J; Estes, Christine; Oromendia, Clara; Christos, Paul; Sulica, Lucian

2017-04-01

To assess the long-term impact of vocal fold hemorrhage (VFH) on vocal function and health, and compare these parameters to those in similar patients who have not had VFH. Retrospective cohort study. Patients with a history of VFH (N = 41) were characterized through a review of records and assessed by means of a survey for vocal health and professional functioning as well as the Voice Handicap Index-10 (VHI-10) and, if appropriate (n = 30, 73.2%), the Singing Voice Handicap Index (SVHI-10). They were compared to a group of demographically and occupationally similar patients without VFH (N = 25, 60.9%). Patients with multiple episodes of VFH (n = 9, 22.0%) were compared to patients with a single event. After a median of 41 months follow-up, patients with VFH had favorable vocal function assessment and low median VHI-10 and SVHI-10 scores (4 and 6, respectively), substantially similar to patients without VFH (VHI-10, P = .905 and SVHI 10, P =.991). The two groups showed similarly low rates of change in occupation (7.3%vs. 8.0%, P =.999). Patients with VFH were more likely to have missed days of work due to a voice problem. Analysis of patients with one versus multiple VFH episodes showed no differences, except patients with multiple episodes had significantly greater confidence in their ability to address future VFH. Contrary to commonly held belief, VFH appears to have no significant long-term impact on vocational stability, subjective voice quality, or perceptions of vocal function. Moreover, among those with VFH, recurrence seems only to diminish anxiety over this transient injury. 4 Laryngoscope, 127:900-906, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Using active shape modeling based on MRI to study morphologic and pitch-related functional changes affecting vocal structures and the airway.

PubMed

Miller, Nicola A; Gregory, Jennifer S; Aspden, Richard M; Stollery, Peter J; Gilbert, Fiona J

2014-09-01

The shape of the vocal tract and associated structures (eg, tongue and velum) is complicated and varies according to development and function. This variability challenges interpretation of voice experiments. Quantifying differences between shapes and understanding how vocal structures move in relation to each other is difficult using traditional linear and angle measurements. With statistical shape models, shape can be characterized in terms of independent modes of variation. Here, we build an active shape model (ASM) to assess morphologic and pitch-related functional changes affecting vocal structures and the airway. Using a cross-sectional study design, we obtained six midsagittal magnetic resonance images from 10 healthy adults (five men and five women) at rest, while breathing out, and while listening to, and humming low and high notes. Eighty landmark points were chosen to define the shape of interest and an ASM was built using these (60) images. Principal component analysis was used to identify independent modes of variation, and statistical analysis was performed using one-way repeated-measures analysis of variance. Twenty modes of variation were identified with modes 1 and 2 accounting for half the total variance. Modes 1 and 9 were significantly associated with humming low and high notes (P < 0.001) and showed coordinated changes affecting the cervical spine, vocal structures, and airway. Mode 2 highlighted wide structural variations between subjects. This study highlights the potential of active shape modeling to advance understanding of factors underlying morphologic and pitch-related functional variations affecting vocal structures and the airway in health and disease. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Anaphylaxis to drugs.

PubMed

Kuruvilla, Merin; Khan, David A

2015-05-01

Drug-induced anaphylaxis is a common cause of anaphylaxis and a leading cause of fatal anaphylaxis. Antibiotics, radiocontrast, and nonsteroidal anti-inflammatory drugs are commonly implicated drugs. Vocal cord dysfunction can mimic anaphylaxis and is often overlooked. β-Lactams are a common cause of anaphylaxis; however, skin testing and drug challenge can usually determine tolerability of other classes of β-lactams. Nonionic contrast agents cause anaphylaxis less frequently than ionic contrast, and immunoglobulin E-mediated mechanisms may have a role in some of these reactions. Skin testing with radiocontrast may have a role in evaluating patients with anaphylaxis to nonionic contrast. Copyright © 2015 Elsevier Inc. All rights reserved.

Oral frostbite injury from intentional abuse of a fluorinated hydrocarbon.

PubMed

Kuspis, D A; Krenzelok, E P

1999-01-01

A serious but rarely reported complication of halogenated hydrocarbon inhalation abuse is severe mucosal frostbite. A 16-year-old male attempted to "get high" by inhaling airbrush propellant which contained 1,1-difluoroethane (CAS #75-376). The patient lost consciousness and upon awakening his lips and tongue were frozen. He suffered first- and second-degree burns of the larynx with vocal cord involvement and first-degree burns of the trachea, main stem bronchi, and esophagus. The oral cavity had second- and third-degree burns which required debridement. This case demonstrates the unusual but severe damage that can occur with the abuse of fluorinated hydrocarbons.

Changes in Infants' Vocalizations as a Function of Differential Acoustic Stimulation

ERIC Educational Resources Information Center

Webster, R. L.; And Others

1972-01-01

Results of this study indicated that the frequency of an auditory stimulus is a dimension to which infants differentially respond in terms of response rate and acoustic characteristics of their vocalizations. (Authors)

Vocal Ergonomics in the Workplace: Heating, Ventilation, and Air-Conditioning Method Influences on Vocal Comfort and Function.

PubMed

Sandage, Mary J; Rahn, Keith A; Smith, Audrey G

2017-02-01

The purpose of this study was to examine the influence of the heating, ventilation, and air-conditioning method on voice function following a voicing task using ecologically valid offices, one with radiant HVAC and one with forced air. A total of 12 consented participants (6 women, 6 men) narrated a video in each of 4 environmental conditions in a within-between repeated-measures design. Acoustic data were collected with an ambulatory phonation monitor and perceived phonatory effort was determined following the voicing task. Data were analyzed using a within-between repeated-measures analysis of variance with significance set at α < .05. Perceived phonatory effort did not differ between environments; however, a significant difference in vocal amplitude between 2 trials was identified for the male participants and physiologically significant differences in vocal amplitude were identified for male and female participants. The findings suggest that perceived phonatory effort may not be a sensitive measure of vocal function differences following a voicing task in ecologically valid office spaces despite significant acoustic findings. Future research should address longer exposure to environmental differences combined with a longer voicing task within ecologically valid work spaces as well as the recruitment of participants who have particular vulnerability to environmental perturbations.

Comparison of Motor-Evoked Potentials Versus Somatosensory-Evoked Potentials as Early Indicators of Neural Compromise in Rat Model of Spinal Cord Compression.

PubMed

Morris, Susan H; Howard, Jason J; El-Hawary, Ron

2017-03-15

Randomized controlled study comparing the efficacy of intraoperative somatosensory-evoked potentials (SSEPs) versus transcranial motor-evoked potentials (TcMEPs) as early indicators of neural compromise and predictors of postoperative function in a rat model of spinal cord compression. To compare the relative efficacy of SSEPs and TcMEPs to detect spinal cord compromise and predict postoperative functional deficit after spinal cord compression. There is controversy regarding the efficacy of SSEPs versus TcMEPs to detect intraoperative spinal cord compromise and predict functional outcomes. Previous trials provide some guidance as to the role of each modality in spinal cord monitoring but randomized controlled trials, which are not feasible in humans, are lacking. Twenty-four adult male Wistar rats were evenly divided into three experimental groups and one control group. The experimental groups were determined according to the length of time that 100% TcMEP signal loss was maintained: 0, 5, or 15 minutes. All animals had standardized preoperative functional testing. Spinal cord compromise was initiated utilizing a validated protocol, which involved compression via a balloon catheter introduced into the thoracic sublaminar space. Both SSEPs and TcMEPs were recorded during cord compression for each experimental group. Functional behavioral testing using two validated methods (tilt and modified Tarlov) was repeated 24 hours after termination of spinal cord compression. Post hoc, animals were redistributed into two functional subgroups, noncompromised and compromised, for statistical analysis. TcMEPs consistently detected spinal cord compromise either in advance of or at the same time as SSEPs; however, the delay in SSEP response was not significant for cases when compromised postoperative function resulted. Both SSEP and TcMEP amplitude recovery correlated well with postoperative functional scores. TcMEPs are more sensitive to spinal cord compromise than SSEPs, but the recovery profiles of both SSEP and TcMEP amplitudes are good predictors of postoperative function. 2.

The Human Voice in Speech and Singing

NASA Astrophysics Data System (ADS)

Lindblom, Björn; Sundberg, Johan

This chapter speech describes various aspects of the human voice as a means of communication in speech and singing. From the point of view of function, vocal sounds can be regarded as the end result of a three stage process: (1) the compression of air in the respiratory system, which produces an exhalatory airstream, (2) the vibrating vocal folds' transformation of this air stream to an intermittent or pulsating air stream, which is a complex tone, referred to as the voice source, and (3) the filtering of this complex tone in the vocal tract resonator. The main function of the respiratory system is to generate an overpressure of air under the glottis, or a subglottal pressure. Section 16.1 describes different aspects of the respiratory system of significance to speech and singing, including lung volume ranges, subglottal pressures, and how this pressure is affected by the ever-varying recoil forces. The complex tone generated when the air stream from the lungs passes the vibrating vocal folds can be varied in at least three dimensions: fundamental frequency, amplitude and spectrum. Section 16.2 describes how these properties of the voice source are affected by the subglottal pressure, the length and stiffness of the vocal folds and how firmly the vocal folds are adducted. Section 16.3 gives an account of the vocal tract filter, how its form determines the frequencies of its resonances, and Sect. 16.4 gives an account for how these resonance frequencies or formants shape the vocal sounds by imposing spectrum peaks separated by spectrum valleys, and how the frequencies of these peaks determine vowel and voice qualities. The remaining sections of the chapter describe various aspects of the acoustic signals used for vocal communication in speech and singing. The syllable structure is discussed in Sect. 16.5, the closely related aspects of rhythmicity and timing in speech and singing is described in Sect. 16.6, and pitch and rhythm aspects in Sect. 16.7. The impressive control of all these acoustic characteristics of vocal signals is discussed in Sect. 16.8, while Sect. 16.9 considers expressive aspects of vocal communication.

The Human Voice in Speech and Singing

NASA Astrophysics Data System (ADS)

Lindblom, Björn; Sundberg, Johan

This chapter describes various aspects of the human voice as a means of communication in speech and singing. From the point of view of function, vocal sounds can be regarded as the end result of a three stage process: (1) the compression of air in the respiratory system, which produces an exhalatory airstream, (2) the vibrating vocal folds' transformation of this air stream to an intermittent or pulsating air stream, which is a complex tone, referred to as the voice source, and (3) the filtering of this complex tone in the vocal tract resonator. The main function of the respiratory system is to generate an overpressure of air under the glottis, or a subglottal pressure. Section 16.1 describes different aspects of the respiratory system of significance to speech and singing, including lung volume ranges, subglottal pressures, and how this pressure is affected by the ever-varying recoil forces. The complex tone generated when the air stream from the lungs passes the vibrating vocal folds can be varied in at least three dimensions: fundamental frequency, amplitude and spectrum. Section 16.2 describes how these properties of the voice source are affected by the subglottal pressure, the length and stiffness of the vocal folds and how firmly the vocal folds are adducted. Section 16.3 gives an account of the vocal tract filter, how its form determines the frequencies of its resonances, and Sect. 16.4 gives an account for how these resonance frequencies or formants shape the vocal sounds by imposing spectrum peaks separated by spectrum valleys, and how the frequencies of these peaks determine vowel and voice qualities. The remaining sections of the chapter describe various aspects of the acoustic signals used for vocal communication in speech and singing. The syllable structure is discussed in Sect. 16.5, the closely related aspects of rhythmicity and timing in speech and singing is described in Sect. 16.6, and pitch and rhythm aspects in Sect. 16.7. The impressive control of all these acoustic characteristics of vocal signals is discussed in Sect. 16.8, while Sect. 16.9 considers expressive aspects of vocal communication.

Directing Spinal Cord Plasticity: The Impact of Stretch Therapy on Functional Recovery after Spinal Cord Injury

DTIC Science & Technology

2015-10-01

AWARD NUMBER: W81XWH-12-1-0587 TITLE: Directing Spinal Cord Plasticity: The Impact of Stretch Therapy on Functional Recovery after Spinal Cord...3. DATES COVERED (From - To) 30Sep2014 - 29Sep2015 4. TITLE AND SUBTITLE Directing Spinal Cord Plasticity: The Impact of Stretch Therapy on...ABSTRACT Essentially all spinal cord injured patients receive stretching therapies beginning within the first few weeks post-injury. Despite this fact

Two-dimensional vocal tracts with three-dimensional behavior in the numerical generation of vowels.

PubMed

Arnela, Marc; Guasch, Oriol

2014-01-01

Two-dimensional (2D) numerical simulations of vocal tract acoustics may provide a good balance between the high quality of three-dimensional (3D) finite element approaches and the low computational cost of one-dimensional (1D) techniques. However, 2D models are usually generated by considering the 2D vocal tract as a midsagittal cut of a 3D version, i.e., using the same radius function, wall impedance, glottal flow, and radiation losses as in 3D, which leads to strong discrepancies in the resulting vocal tract transfer functions. In this work, a four step methodology is proposed to match the behavior of 2D simulations with that of 3D vocal tracts with circular cross-sections. First, the 2D vocal tract profile becomes modified to tune the formant locations. Second, the 2D wall impedance is adjusted to fit the formant bandwidths. Third, the 2D glottal flow gets scaled to recover 3D pressure levels. Fourth and last, the 2D radiation model is tuned to match the 3D model following an optimization process. The procedure is tested for vowels /a/, /i/, and /u/ and the obtained results are compared with those of a full 3D simulation, a conventional 2D approach, and a 1D chain matrix model.

Numb rats walk - a behavioural and fMRI comparison of mild and moderate spinal cord injury.

PubMed

Hofstetter, Christoph P; Schweinhardt, Petra; Klason, Tomas; Olson, Lars; Spenger, Christian

2003-12-01

Assessment of sensory function serves as a sensitive measure for predicting the functional outcome following spinal cord injury in patients. However, little is known about loss and recovery of sensory function in rodent spinal cord injury models as most tests of sensory functions rely on behaviour and thus motor function. We used functional magnetic resonance imaging (fMRI) to investigate cortical and thalamic BOLD-signal changes in response to limb stimulation following mild or moderate thoracic spinal cord weight drop injury in Sprague-Dawley rats. While there was recovery of close to normal hindlimb motor function as determined by open field locomotor testing following both degrees of injury, recovery of hindlimb sensory function as determined by fMRI and hot plate testing was only seen following mild injury and not following moderate injury. Thus, moderate injury can lead to near normal hindlimb motor function in animals with major sensory deficits. Recovered fMRI signals following mild injury had a partly altered cortical distribution engaging also ipsilateral somatosensory cortex and the cingulate gyrus. Importantly, thoracic spinal cord injury also affected sensory representation of the upper nonaffected limbs. Thus, cortical and thalamic activation in response to forelimb stimulation was significantly increased 16 weeks after spinal cord injury compared to control animals. We conclude that both forelimb and hindlimb cortical sensory representation is altered following thoracic spinal cord injury. Furthermore tests of sensory function that are independent of motor behaviour are needed in rodent spinal cord injury research.

Clinical interpretation of the Spinal Cord Injury Functional Index (SCI-FI).

PubMed

Fyffe, Denise; Kalpakjian, Claire Z; Slavin, Mary; Kisala, Pamela; Ni, Pengsheng; Kirshblum, Steven C; Tulsky, David S; Jette, Alan M

2016-09-01

To provide validation of functional ability levels for the Spinal Cord Injury - Functional Index (SCI-FI). Cross-sectional. Inpatient rehabilitation hospital and community settings. A sample of 855 individuals with traumatic spinal cord injury enrolled in 6 rehabilitation centers participating in the National Spinal Cord Injury Model Systems Network. Not Applicable. Spinal Cord Injury-Functional Index (SCI-FI). Cluster analyses identified three distinct groups that represent low, mid-range and high SCI-FI functional ability levels. Comparison of clusters on personal and other injury characteristics suggested some significant differences between groups. These results strongly support the use of SCI-FI functional ability levels to document the perceived functional abilities of persons with SCI. Results of the cluster analysis suggest that the SCI-FI functional ability levels capture function by injury characteristics. Clinical implications regarding tracking functional activity trajectories during follow-up visits are discussed.

Restoration of Bladder and Bowel Function Using Electrical Stimulation and Block after Spinal Cord Injury

DTIC Science & Technology

2015-10-01

AWARD NUMBER: W81XWH-14-2-0132 TITLE: Restoration of Bladder and Bowel Function Using Electrical Stimulation and Block after Spinal Cord Injury...Sept 2015 4. TITLE AND SUBTITLE Restoration of Bladder and Bowel Function Using Electrical Stimulation and Block after Spinal Cord Injury 5a...evaluate the restoration of bladder and bowel function using electrical stimulation and block after spinal cord injury in human subjects. All staff

Functional reinnervation of vocal folds after selective laryngeal adductor denervation-reinnervation surgery for spasmodic dysphonia.

PubMed

DeConde, Adam S; Long, Jennifer L; Armin, Bob B; Berke, Gerald S

2012-09-01

Selective laryngeal adductor denervation-reinnervation surgery (SLAD-R) offers a viable surgical alternative for patients with adductor spasmodic dysphonia refractory to botulinum toxin injections. SLAD-R selectively denervates the symptomatic thyroarytenoid muscle by dividing the distal adductor branch of the recurrent laryngeal nerve (RLN), and preventing reinnervation, by the proximal RLN and maintaining vocal fold bulk and tone by reinnervating the distal RLN with the ansa cervicalis. We present a patient who had previously undergone successful SLAD-R but presented 10 years postoperatively with a new regional dystonia involving his strap muscles translocated to his reinnervated larynx by his previous ansa-RLN neurorraphy. The patient's symptomatic vocal fold adduction resolved completely on division of the ansa-RLN neurorraphy confirming successful selective functional reinnervation of vocal fold adductors by the ansa cervicalis. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Nocturnal "humming" vocalizations: adding a piece to the puzzle of giraffe vocal communication.

PubMed

Baotic, Anton; Sicks, Florian; Stoeger, Angela S

2015-09-09

Recent research reveals that giraffes (Giraffa camelopardalis sp.) exhibit a socially structured, fission-fusion system. In other species possessing this kind of society, information exchange is important and vocal communication is usually well developed. But is this true for giraffes? Giraffes are known to produce sounds, but there is no evidence that they use vocalizations for communication. Reports on giraffe vocalizations are mainly anecdotal and the missing acoustic descriptions make it difficult to establish a call nomenclature. Despite inconclusive evidence to date, it is widely assumed that giraffes produce infrasonic vocalizations similar to elephants. In order to initiate a more detailed investigation of the vocal communication in giraffes, we collected data of captive individuals during day and night. We particularly focussed on detecting tonal, infrasonic or sustained vocalizations. We collected over 947 h of audio material in three European zoos and quantified the spectral and temporal components of acoustic signals to obtain an accurate set of acoustic parameters. Besides the known burst, snorts and grunts, we detected harmonic, sustained and frequency-modulated "humming" vocalizations during night recordings. None of the recorded vocalizations were within the infrasonic range. These results show that giraffes do produce vocalizations, which, based on their acoustic structure, might have the potential to function as communicative signals to convey information about the physical and motivational attributes of the caller. The data further reveal that the assumption of infrasonic communication in giraffes needs to be considered with caution and requires further investigations in future studies.

The Interaction of Surface Hydration and Vocal Loading on Voice Measures.

PubMed

Fujiki, Robert Brinton; Chapleau, Abigail; Sundarrajan, Anusha; McKenna, Victoria; Sivasankar, M Preeti

2017-03-01

Vocal loading tasks provide insight regarding the mechanisms underlying healthy laryngeal function. Determining the manner in which the larynx can most efficiently be loaded is a complex task. The goal of this study was to determine if vocal loading could be achieved in 30 minutes by altering phonatory mode. Owing to the fact that surface hydration facilitates efficient vocal fold oscillation, the effects of environmental humidity on vocal loading were also examined. This study also investigated whether the detrimental effects of vocal loading could be attenuated by increasing environmental humidity. Sixteen vocally healthy adults (8 men, 8 women) completed a 30-minute vocal loading task in low and moderate humidity. The order of humidities was counterbalanced across subjects. The vocal loading task consisted of reading with elevated pitch and pressed vocal quality and low pitch and pressed and/or raspy vocal quality in the presence of 65 dB ambient, multi-talker babble noise. Significant effects were observed for (1) cepstral peak prominence on soft sustained phonation at 10th and 80th pitches, (2) perceived phonatory effort, and (3) perceived tiredness ratings. No loading effects were observed for cepstral peak prominence on the rainbow passage, although fundamental frequency on the rainbow passage increased post loading. No main effect was observed for humidity. Following a 30-minute vocal loading task involving altering laryngeal vibratory mode in combination with increased volume. Also, moderate environmental humidity did not significantly attenuate the negative effects of loading. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

The importance of hyaluronic acid in vocal fold biomechanics.

PubMed

Chan, R W; Gray, S D; Titze, I R

2001-06-01

This study examined the influence of hyaluronic acid (HA) on the biomechanical properties of the human vocal fold cover (the superficial layer of the lamina propria). Vocal fold tissues were freshly excised from 5 adult male cadavers and were treated with bovine testicular hyaluronidase to selectively remove HA from the lamina propria extracellular matrix (ECM). Linear viscoelastic shear properties (elastic shear modulus and dynamic viscosity) of the tissue samples before and after enzymatic treatment were quantified as a function of frequency (0.01 to 15 Hz) by a parallel-plate rotational rheometer at 37 degrees C. On removing HA from the vocal fold ECM, the elastic shear modulus (G' ) or stiffness of the vocal fold cover decreased by an average of around 35%, while the dynamic viscosity (eta') increased by 70% at higher frequencies (>1 Hz). The results suggested that HA plays an important role in determining the biomechanical properties of the vocal fold cover. As a highly hydrated glycosaminoglycan in the vocal fold ECM, it likely contributes to the maintenance of an optimal tissue viscosity that may facilitate phonation, and an optimal tissue stiffness that may be important for vocal fundamental frequency control. HA has been proposed as a potential bioimplant for the surgical repair of vocal fold ECM defects (eg, vocal fold scarring and sulcus vocalis). Our results suggested that such clinical use may be potentially optimal for voice production from a biomechanical perspective.

Primate vocal communication: a useful tool for understanding human speech and language evolution?

PubMed

Fedurek, Pawel; Slocombe, Katie E

2011-04-01

Language is a uniquely human trait, and questions of how and why it evolved have been intriguing scientists for years. Nonhuman primates (primates) are our closest living relatives, and their behavior can be used to estimate the capacities of our extinct ancestors. As humans and many primate species rely on vocalizations as their primary mode of communication, the vocal behavior of primates has been an obvious target for studies investigating the evolutionary roots of human speech and language. By studying the similarities and differences between human and primate vocalizations, comparative research has the potential to clarify the evolutionary processes that shaped human speech and language. This review examines some of the seminal and recent studies that contribute to our knowledge regarding the link between primate calls and human language and speech. We focus on three main aspects of primate vocal behavior: functional reference, call combinations, and vocal learning. Studies in these areas indicate that despite important differences, primate vocal communication exhibits some key features characterizing human language. They also indicate, however, that some critical aspects of speech, such as vocal plasticity, are not shared with our primate cousins. We conclude that comparative research on primate vocal behavior is a very promising tool for deepening our understanding of the evolution of human speech and language, but much is still to be done as many aspects of monkey and ape vocalizations remain largely unexplored.

Functional morphology of the Alligator mississippiensis larynx with implications for vocal production.

PubMed

Riede, Tobias; Li, Zhiheng; Tokuda, Isao T; Farmer, Colleen G

2015-04-01

Sauropsid vocalization is mediated by the syrinx in birds and the larynx in extant reptiles; but whereas avian vocal production has received much attention, the vocal mechanism of basal reptilians is poorly understood. The American alligator (Alligator mississippiensis) displays a large vocal repertoire during mating and in parent-offspring interactions. Although vocal outputs of these behaviors have received some attention, the underlying mechanism of sound production remains speculative. Here, we investigate the laryngeal anatomy of juvenile and adult animals by macroscopic and histological methods. Observations of the cartilaginous framework and associated muscles largely corroborate earlier findings, but one muscle, the cricoarytenoideus, exhibits a heretofore unknown extrinsic insertion that has important implications for effective regulation of vocal fold length and tension. Histological investigation of the larynx revealed a layered vocal fold morphology. The thick lamina propria consists of non-homogenous extracellular matrix containing collagen fibers that are tightly packed below the epithelium but loosely organized deep inside the vocal fold. We found few elastic fibers but comparatively high proportions of hyaluronan. Similar organizational complexity is also seen in mammalian vocal folds and the labia of the avian syrinx: convergent morphologies that suggest analogous mechanisms for sound production. In tensile tests, alligator vocal folds demonstrated a linear stress-strain behavior in the low strain region and nonlinear stress responses at strains larger than 15%, which is similar to mammalian vocal fold tissue. We have integrated morphological and physiological data in a two-mass vocal fold model, providing a systematic description of the possible acoustic space that could be available to an alligator larynx. Mapping actual call production onto possible acoustic space validates the model's predictions. © 2015. Published by The Company of Biologists Ltd.

Current Understanding and Future Directions for Vocal Fold Mechanobiology

PubMed Central

Li, Nicole Y.K.; Heris, Hossein K.; Mongeau, Luc

2013-01-01

The vocal folds, which are located in the larynx, are the main organ of voice production for human communication. The vocal folds are under continuous biomechanical stress similar to other mechanically active organs, such as the heart, lungs, tendons and muscles. During speech and singing, the vocal folds oscillate at frequencies ranging from 20 Hz to 3 kHz with amplitudes of a few millimeters. The biomechanical stress associated with accumulated phonation is believed to alter vocal fold cell activity and tissue structure in many ways. Excessive phonatory stress can damage tissue structure and induce a cell-mediated inflammatory response, resulting in a pathological vocal fold lesion. On the other hand, phonatory stress is one major factor in the maturation of the vocal folds into a specialized tri-layer structure. One specific form of vocal fold oscillation, which involves low impact and large amplitude excursion, is prescribed therapeutically for patients with mild vocal fold injuries. Although biomechanical forces affect vocal fold physiology and pathology, there is little understanding of how mechanical forces regulate these processes at the cellular and molecular level. Research into vocal fold mechanobiology has burgeoned over the past several years. Vocal fold bioreactors are being developed in several laboratories to provide a biomimic environment that allows the systematic manipulation of physical and biological factors on the cells of interest in vitro. Computer models have been used to simulate the integrated response of cells and proteins as a function of phonation stress. The purpose of this paper is to review current research on the mechanobiology of the vocal folds as it relates to growth, pathogenesis and treatment as well as to propose specific research directions that will advance our understanding of this subject. PMID:24812638

Augmentation surgery on the cartilaginous portion of the vocal fold in a patient with cricoarytenoid joint ankylosis.

PubMed

Fukahori, Mioko; Chitose, Shun-Ichi; Sato, Kiminori; Kamimura, Hiroyuki; Sato, Kiminobu; On, Ririko; Umeno, Hirohito

2018-08-01

Surgical management of cricoarytenoid joint (CAJ) ankylosis is challenging and has the risk of worsening voice quality. In the present case, augmentation surgery was performed on the cartilaginous portion of the vocal fold in a patient with CAJ ankylosis. A 24-year-old man sustained blunt trauma to the anterior neck three years prior to developing severe breathiness. Posterior glottal insufficiency resulting from lateral fixation of the right vocal fold was observed during phonation under laryngoscopy. In addition, electromyography and CT scan revealed severe ankylosis of the right CAJ. Type I thyroplasty performed on the right vocal fold did not improve postoperative vocal function. Therefore, augmentation surgery on the cartilaginous portion of the right vocal fold was performed via endolaryngeal microsurgery under general anesthesia with jet ventilation. A piece of temporalis fascia was autotransplanted into the submucosal space created at the posterior cartilaginous portion of the right vocal fold. This resulted in the narrowing of the posterior glottal gap during phonation, leading to improvement in hoarseness. Microsurgical management with autologous fascia augmentation of the cartilaginous portion of the vocal fold can be effective in patients with lateral vocal fold fixation due to CAJ ankylosis. Copyright © 2017 Elsevier B.V. All rights reserved.

Multi-parameter analysis of titanium vocal fold medializing implant in an excised larynx model

PubMed Central

Witt, Rachel E.; Hoffman, Matthew R.; Friedrich, Gerhard; Rieves, Adam L.; Schoepke, Benjamin J.; Jiang, Jack J.

2010-01-01

Objective Evaluate the efficacy of the titanium vocal fold medializing implant (TVFMI) for the treatment of unilateral vocal fold paralysis (UVFP) based on acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup. Methods Measurements were recorded on eight excised canine larynges with simulated UVFP before and after medialization with the TVFMI. Results Phonation threshold flow (PTF) and phonation threshold power (PTW) decreased significantly after medialization (p<0.001; p=0.008). Phonation threshold pressure (PTP) also decreased, but this difference was not significant (p=0.081). Percent jitter and percent shimmer decreased significantly after medialization (p=0.005; p=0.034). Signal to noise ratio (SNR) increased significantly (p=0.05). Differences in mucosal wave characteristics were discernable, but not significant. Phase difference between the normal and paralyzed vocal fold and amplitude of the paralyzed vocal fold decreased (p=0.15; p=0.78). Glottal gap decreased significantly (p=0.004). Conclusions The TVFMI was effective in achieving vocal fold medialization, improving vocal aerodynamic and acoustic characteristics of phonation significantly and mucosal wave characteristics discernibly. This study provides objective, quantitative support for the use of the TVFMI in improving vocal function in patients with unilateral vocal fold paralysis. PMID:20336924

Biomechanical effects of hydration in vocal fold tissues.

PubMed

Chan, Roger W; Tayama, Niro

2002-05-01

It has often been hypothesized, with little empirical support, that vocal fold hydration affects voice production by mediating changes in vocal fold tissue rheology. To test this hypothesis, we attempted in this study to quantify the effects of hydration on the viscoelastic shear properties of vocal fold tissues in vitro. Osmotic changes in hydration (dehydration and rehydration) of 5 excised canine larynges were induced by sequential incubation of the tissues in isotonic, hypertonic, and hypotonic solutions. Elastic shear modulus (G'), dynamic viscosity eta' and the damping ratio zeta of the vocal fold mucosa (lamina propria) were measured as a function of frequency (0.01 to 15 Hz) with a torsional rheometer. Vocal fold tissue stiffness (G') and viscosity (eta) increased significantly (by 4 to 7 times) with the osmotically induced dehydration, whereas they decreased by 22% to 38% on the induced rehydration. Damping ratio (zeta) also increased with dehydration and decreased with rehydration, but the detected differences were not statistically significant at all frequencies. These findings support the long-standing hypothesis that hydration affects vocal fold vibration by altering tissue rheologic (or viscoelastic) properties. Our results demonstrated the biomechanical importance of hydration in vocal fold tissues and suggested that hydration approaches may potentially improve the biomechanics of phonation in vocal fold lesions involving disordered fluid balance.

Facial Expression Enhances Emotion Perception Compared to Vocal Prosody: Behavioral and fMRI Studies.

PubMed

Zhang, Heming; Chen, Xuhai; Chen, Shengdong; Li, Yansong; Chen, Changming; Long, Quanshan; Yuan, Jiajin

2018-05-09

Facial and vocal expressions are essential modalities mediating the perception of emotion and social communication. Nonetheless, currently little is known about how emotion perception and its neural substrates differ across facial expression and vocal prosody. To clarify this issue, functional MRI scans were acquired in Study 1, in which participants were asked to discriminate the valence of emotional expression (angry, happy or neutral) from facial, vocal, or bimodal stimuli. In Study 2, we used an affective priming task (unimodal materials as primers and bimodal materials as target) and participants were asked to rate the intensity, valence, and arousal of the targets. Study 1 showed higher accuracy and shorter response latencies in the facial than in the vocal modality for a happy expression. Whole-brain analysis showed enhanced activation during facial compared to vocal emotions in the inferior temporal-occipital regions. Region of interest analysis showed a higher percentage signal change for facial than for vocal anger in the superior temporal sulcus. Study 2 showed that facial relative to vocal priming of anger had a greater influence on perceived emotion for bimodal targets, irrespective of the target valence. These findings suggest that facial expression is associated with enhanced emotion perception compared to equivalent vocal prosodies.

Vocalization of Emotional and Social Expressions in Korean-Speaking Toddlers with Autism Spectrum Disorder and Those with Developmental Delay.

PubMed

Lee, Kyung Sook; Shin, Yee Jin; Yoo, Hee Jeong; Lee, Gui Jong; Ryu, Jeong; Son, Oweol; Cho, Sook Whan

2018-05-01

This study aimed to examine the development of socializing and emotional expressions through vocalizations and joint attention (JA) behaviors in Korean-speaking children with autism spectrum disorder (ASD), compared to those with developmental delay (DD). Video samples were collected from 28 toddlers with ASD and 18 age-matched toddlers with DD, and vocalizations were each coded in detail for the purpose of this retrospective research. In addition to some statistical analysis, Computerized Language Analysis was conducted to obtain the final results. Although they produced a higher number of vocalizations than the DD group, the ASD group did not engage in emotional or social interactions with their caretakers, whereas the DD group did. The children with ASD used more atypical vocalizations and socially unengaged vocalizations than the children with DD did. JA using vocalizations in the ASD group, in particular, was largely dyadic, with triadic types occurring at a significantly lower frequency than those in the DD group. Results from this study indicate the importance of assessing early vocalizations in toddlers with ASD, suggesting that some common symptoms of ASD, such as lack of typical, emotional, and social functions in early vocalizations, could be used to develop screening and intervention programs related to ASD. © Copyright: Yonsei University College of Medicine 2018.

The vagal nerve stimulation outcome, and laryngeal effect: Otolaryngologists roles and perspective.

PubMed

Al Omari, Ahmad I; Alzoubi, Firas Q; Alsalem, Mohammad M; Aburahma, Samah K; Mardini, Diala T; Castellanos, Paul F

Epilepsy is one of the most common neurologic disorders. Vagus nerve stimulation (VNS), first investigated in 1938 and subsequently studied as a potential therapy for epilepsy. The FDA approved the use of VNS in 1997 as an adjunctive non-pharmacologic symptomatic treatment option for refractory epilepsy for adults and adolescents over 12years. VNS can cause laryngeal and voice side effects that can be managed by otolaryngologists safely and effectively. This study is to review the outcomes of vagal nerve stimulator (VNS) implantation in terms of the surgical procedures, complications, seizure frequency, and the clinical effect on larynx and vocal folds motion. Series of thirty consecutive patients who had VNS implantation between 2007 and 2014 were recruited. Seizure-frequency outcome, surgical complications and device adverse effects of VNS were retrospectively reviewed. Additional evaluation included use of the Voice Handicap Index and Maximum Phonation Time (MPT) were conducted before and after the implantation. Videolaryngoscopy was used to evaluate the vocal fold mobility before and after the VNS implantation. Seizure frequency reduction over a minimum of 2years of follow up demonstrated: 100% in seizure frequency reduction in 1 patient, drastic reduction in seizure frequency (70-90%) in 9 patients, a good reduction in terms of seizure frequency (50%) in 8 patients, a 30% reduction in 5 patients, no response in 6 patients, and 1 patient had increased frequency. The most commonly reported adverse effects after VNS activation were coughing and voice changes with pitch breaks, as well as mild intermittent shortness of breath in 33% of patients. For those patients secondary supraglottic muscle tension and hyper function with reduced left vocal fold mobility were noticed on videolaryngoscopy, though none had aspiration problems. Surgical complications included a wound dehiscence in one patient (3%) which was surgically managed, minor intra-operative bleeding 3%; a superficial wound infection in one patient (3%) which was treated conservatively, none of the complications necessitated VNS removal. VNS appears to be an effective non-pharmacologic adjuvant therapy in patients with medically refractory seizures. With the favorable adverse-effect profile previously described, VNS is generally well tolerated and of a great benefit to such patients. Laryngeal side effects, of which hoarseness being of the greatest repetition, are the most common after the VNS implantation. VNS can affect the voice and reduced vocal cord motion on the implantation side with secondary supraglottic muscle tension. Otolaryngologists are not only capable of performing VNS implantation, but can also manage surgical complications, assess laryngeal side effects and treat them as needed. Copyright © 2017 Elsevier Inc. All rights reserved.

Multiple sclerosis lesions affect intrinsic functional connectivity of the spinal cord.

PubMed

Conrad, Benjamin N; Barry, Robert L; Rogers, Baxter P; Maki, Satoshi; Mishra, Arabinda; Thukral, Saakshi; Sriram, Subramaniam; Bhatia, Aashim; Pawate, Siddharama; Gore, John C; Smith, Seth A

2018-06-01

Patients with multiple sclerosis present with focal lesions throughout the spinal cord. There is a clinical need for non-invasive measurements of spinal cord activity and functional organization in multiple sclerosis, given the cord's critical role in the disease. Recent reports of spontaneous blood oxygenation level-dependent fluctuations in the spinal cord using functional MRI suggest that, like the brain, cord activity at rest is organized into distinct, synchronized functional networks among grey matter regions, likely related to motor and sensory systems. Previous studies looking at stimulus-evoked activity in the spinal cord of patients with multiple sclerosis have demonstrated increased levels of activation as well as a more bilateral distribution of activity compared to controls. Functional connectivity studies of brain networks in multiple sclerosis have revealed widespread alterations, which may take on a dynamic trajectory over the course of the disease, with compensatory increases in connectivity followed by decreases associated with structural damage. We build upon this literature by examining functional connectivity in the spinal cord of patients with multiple sclerosis. Using ultra-high field 7 T imaging along with processing strategies for robust spinal cord functional MRI and lesion identification, the present study assessed functional connectivity within cervical cord grey matter of patients with relapsing-remitting multiple sclerosis (n = 22) compared to a large sample of healthy controls (n = 56). Patient anatomical images were rated for lesions by three independent raters, with consensus ratings revealing 19 of 22 patients presented with lesions somewhere in the imaged volume. Linear mixed models were used to assess effects of lesion location on functional connectivity. Analysis in control subjects demonstrated a robust pattern of connectivity among ventral grey matter regions as well as a distinct network among dorsal regions. A gender effect was also observed in controls whereby females demonstrated higher ventral network connectivity. Wilcoxon rank-sum tests detected no differences in average connectivity or power of low frequency fluctuations in patients compared to controls. The presence of lesions was, however, associated with local alterations in connectivity with differential effects depending on columnar location. The patient results suggest that spinal cord functional networks are generally intact in relapsing-remitting multiple sclerosis but that lesions are associated with focal abnormalities in intrinsic connectivity. These findings are discussed in light of the current literature on spinal cord functional MRI and the potential neurological underpinnings.

Laryngeal Reinnervation Using Ansa Cervicalis for Thyroid Surgery-Related Unilateral Vocal Fold Paralysis: A Long-Term Outcome Analysis of 237 Cases

PubMed Central

Li, Ding; Li, Meng; Xia, Siwen; Zheng, Hongliang

2011-01-01

Objective To evaluate the long-term efficacy of delayed laryngeal reinnervation using the main branch of the ansa cervicalis in treatment of unilateral vocal fold paralysis (UVFP) caused by thyroid surgery. Summary of Background Data UVFP remains a serious complication of thyroid surgery. Up to now, a completely satisfactory surgical treatment of UVFP has been elusive. Methods From Jan. 1996 to Jan. 2008, a total of 237 UVFP patients who underwent ansa cervicalis main branch-to-recurrent laryngeal nerve (RLN) anastomosis were enrolled as UVFP group; another 237 age- and gender-matched normal subjects served as control group. Videostroboscopy, vocal function assessment (acoustic analysis, perceptual evaluation and maximum phonation time), and electromyography were performed preoperatively and postoperatively. The mean follow-up period was 5.2±2.7 years, ranging from 2 to 12 years. Results Analysis of videostroboscopic findings indicated that the glottic closure, vocal fold edge, vocal fold position, phase symmetry and regularity were significantly improved in the UVFP group (P<0.001, postoperative vs. preoperative). The postoperative parameters of vocal function were also significantly improved in the UVFP group (P<0.001) and showed no statistical differences compared to the control group (P>0.05, respectively). Postoperative laryngeal electromyography confirmed successful reinnervation of laryngeal muscle. Conclusions Delayed laryngeal reinnervation with the main branch of ansa cervicalis is a feasible and effective approach for treatment of thyroid surgery-related UVFP; it can restore the physiological laryngeal phonatory function to the normal or a nearly normal voice quality. PMID:21559458

Cochlear Implants Special Issue Article: Vocal Emotion Recognition by Normal-Hearing Listeners and Cochlear Implant Users

PubMed Central

Luo, Xin; Fu, Qian-Jie; Galvin, John J.

2007-01-01

The present study investigated the ability of normal-hearing listeners and cochlear implant users to recognize vocal emotions. Sentences were produced by 1 male and 1 female talker according to 5 target emotions: angry, anxious, happy, sad, and neutral. Overall amplitude differences between the stimuli were either preserved or normalized. In experiment 1, vocal emotion recognition was measured in normal-hearing and cochlear implant listeners; cochlear implant subjects were tested using their clinically assigned processors. When overall amplitude cues were preserved, normal-hearing listeners achieved near-perfect performance, whereas listeners with cochlear implant recognized less than half of the target emotions. Removing the overall amplitude cues significantly worsened mean normal-hearing and cochlear implant performance. In experiment 2, vocal emotion recognition was measured in listeners with cochlear implant as a function of the number of channels (from 1 to 8) and envelope filter cutoff frequency (50 vs 400 Hz) in experimental speech processors. In experiment 3, vocal emotion recognition was measured in normal-hearing listeners as a function of the number of channels (from 1 to 16) and envelope filter cutoff frequency (50 vs 500 Hz) in acoustic cochlear implant simulations. Results from experiments 2 and 3 showed that both cochlear implant and normal-hearing performance significantly improved as the number of channels or the envelope filter cutoff frequency was increased. The results suggest that spectral, temporal, and overall amplitude cues each contribute to vocal emotion recognition. The poorer cochlear implant performance is most likely attributable to the lack of salient pitch cues and the limited functional spectral resolution. PMID:18003871

Material parameter computation for multi-layered vocal fold models.

PubMed

Schmidt, Bastian; Stingl, Michael; Leugering, Günter; Berry, David A; Döllinger, Michael

2011-04-01

Today, the prevention and treatment of voice disorders is an ever-increasing health concern. Since many occupations rely on verbal communication, vocal health is necessary just to maintain one's livelihood. Commonly applied models to study vocal fold vibrations and air flow distributions are self sustained physical models of the larynx composed of artificial silicone vocal folds. Choosing appropriate mechanical parameters for these vocal fold models while considering simplifications due to manufacturing restrictions is difficult but crucial for achieving realistic behavior. In the present work, a combination of experimental and numerical approaches to compute material parameters for synthetic vocal fold models is presented. The material parameters are derived from deformation behaviors of excised human larynges. The resulting deformations are used as reference displacements for a tracking functional to be optimized. Material optimization was applied to three-dimensional vocal fold models based on isotropic and transverse-isotropic material laws, considering both a layered model with homogeneous material properties on each layer and an inhomogeneous model. The best results exhibited a transversal-isotropic inhomogeneous (i.e., not producible) model. For the homogeneous model (three layers), the transversal-isotropic material parameters were also computed for each layer yielding deformations similar to the measured human vocal fold deformations.

Vocal function in introverts and extraverts during a psychological stress reactivity protocol.

PubMed

Dietrich, Maria; Verdolini Abbott, Katherine

2012-06-01

To examine the proposal that introversion predictably influences extralaryngeal and vocal behavior in vocally healthy individuals compared with individuals with extraversion and whether differences are of a nature that may support a risk hypothesis for primary muscle tension dysphonia. Fifty-four vocally healthy female adults between the ages of 18 and 35 years were divided into 2 groups: introversion (n = 27) and extraversion (n = 27). All participants completed a psychological stress reactivity experiment. Before, during, and after the stressor (public speaking), participants were assessed on extralaryngeal muscle activity (surface electromyography: submental, infrahyoid; control site: tibialis anterior), perceived vocal effort, and vocal acoustics (fundamental frequency and intensity). Participants in the introversion group exhibited significantly greater infrahyoid muscle activity throughout the protocol and during perceived stress than participants in the extraversion group. For both groups, perceived vocal effort significantly increased during stress, and acoustic measures significantly decreased. Infrahyoid muscle activity during the stress phase was significantly correlated with introversion and Voice Handicap Index scores but not with vocal effort scores. The data provided evidence of distinct differences in extralaryngeal behavior between introverts and extraverts. The findings are consistent with the trait theory of voice disorders (Roy & Bless, 2000).

Adipose stromal cells improve healing of vocal fold scar: Morphological and functional evidences.

PubMed

de Bonnecaze, Guillaume; Chaput, Benoit; Woisard, Virginie; Uro-Coste, Emmanuelle; Swider, Pascal; Vergez, Sebastien; Serrano, Elie; Casteilla, Louis; Planat-Benard, Valerie

2016-08-01

Adipose derived stromal cells (ASCs) are abundant and easy to prepare. Such cells may be useful for treating severe vocal disturbance caused by acute vocal fold scars. Prospective animal experiments with controls. Twenty New-Zealand white rabbits were used in the present study. We evaluated vocal fold healing, with or without injection of autologous ASCs, after acute scarring. A defined lesion was created and the ASCs were immediately injected. Vocal fold regeneration was evaluated histomorphometrically and via viscoelastic analysis using an electrodynamic shaker. Six weeks after ASC injection, vocal folds exhibited significantly less inflammation than control folds (P < 0.005). In addition, hypertrophy of the lamina propria and fibrosis were significantly reduced upon ASC injection (P < 0.02). The decrease in viscoelastic parameters was less important in the ASC injected group compared to the noninjected group (P = 0.08). Injection of autologous ASCs improved vocal fold healing in our preclinical model. Further studies are needed, but this method may be useful in humans. NA. Laryngoscope, 126:E278-E285, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Vocalization of echolocation-like pulses for interindividual interaction in horseshoe bats (Rhinolophus ferrumequinum).

PubMed

Kobayasi, Kohta I; Hiryu, Shizuko; Shimozawa, Ryota; Riquimaroux, Hiroshi

2012-11-01

Although much is known about the echolocation of horseshoe bats (Rhinolophus spp.), little is known about the characteristics and function of their communication calls. This study focused on a stereotyped behavior of a bat approaching a companion animal in the colony, and examined their interaction and vocalization during this behavior. The bats emit echolocation-like vocalizations when approaching each other and these vocalizations contain a "buildup" pulse sequence, in which the frequency of the pulse increases gradually to normal echolocation pulse frequencies. The results suggest that the echolocation-like pulses serve an important role in communication within the colony.

[Spanish validation of the International Spinal Cord Injury Pulmonary Function Basic Data Set questionnaire for the study of the repercussion of spinal cord injury in the respiratory system].

PubMed

Gómez Garrido, Alba; León Espitia, Ana María; Montesinos Magraner, Lluïsa; Ramirez Galceran, Lucrecia; Soler Canudes, Emilia; González Viejo, Miguel Angel

2015-12-07

The dysfunction of the respiratory system and the breathing complications in persons with injured spinal cord has an effect on the morbidity and the mortality of the disease. The objectives were: 1) to translate to Spanish and validate the questionnaire of international consensus: International Spinal Cord Injury Pulmonary Function Basic Data Set, and 2) to determine the influence of chronic spinal cord injury in the respiratory system in terms of respiratory functionalism. Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. We tested the reliability of that questionnaire. We conducted a descriptive transversal study to determine the degree of involvement of the respiratory system in spinal cord injury. A percentage of 91.9 did not have any respiratory pathology before spinal cord injury and 54.8% of patients smoked. A percentage of 27.4 of patients presented breathing complications one year after the injury. Results of the respiratory function tests were: FVC 67%, FEV1 72% and PEF 70%. Concordance and reliability were 98%. The Spanish version of the questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory involvement in spinal cord injury. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

Does the intrathecal propofol have a neuroprotective effect on spinal cord ischemia?

PubMed Central

Sahin, Murat; Gullu, Huriye; Peker, Kemal; Sayar, Ilyas; Binici, Orhan; Yildiz, Huseyin

2015-01-01

The neuroprotective effects of propofol have been confirmed. However, it remains unclear whether intrathecal administration of propofol exhibits neuroprotective effects on spinal cord ischemia. At 1 hour prior to spinal cord ischemia, propofol (100 and 300 µg) was intrathecally administered in rats with spinal cord ischemia. Propofol pre-treatment greatly improved rat pathological changes and neurological function deficits at 24 hours after spinal cord ischemia. These results suggest that intrathecal administration of propofol exhibits neuroprotective effects on spinal cord structural and functional damage caused by ischemia. PMID:26807119

Does the intrathecal propofol have a neuroprotective effect on spinal cord ischemia?

PubMed

Sahin, Murat; Gullu, Huriye; Peker, Kemal; Sayar, Ilyas; Binici, Orhan; Yildiz, Huseyin

2015-11-01

The neuroprotective effects of propofol have been confirmed. However, it remains unclear whether intrathecal administration of propofol exhibits neuroprotective effects on spinal cord ischemia. At 1 hour prior to spinal cord ischemia, propofol (100 and 300 µg) was intrathecally administered in rats with spinal cord ischemia. Propofol pre-treatment greatly improved rat pathological changes and neurological function deficits at 24 hours after spinal cord ischemia. These results suggest that intrathecal administration of propofol exhibits neuroprotective effects on spinal cord structural and functional damage caused by ischemia.

Vocal Ergonomics in the Workplace: Heating, Ventilation, and Air-Conditioning Method Influences on Vocal Comfort and Function

ERIC Educational Resources Information Center

Sandage, Mary J.; Rahn, Keith A.; Smith, Audrey G.

2017-01-01

Purpose: The purpose of this study was to examine the influence of the heating, ventilation, and air-conditioning method on voice function following a voicing task using ecologically valid offices, one with radiant HVAC and one with forced air. Method: A total of 12 consented participants (6 women, 6 men) narrated a video in each of 4…

A Computational Study of Vocal Fold Dehydration During Phonation.

PubMed

Wu, Liang; Zhang, Zhaoyan

2017-12-01

While vocal fold dehydration is often considered an important factor contributing to vocal fatigue, it still remains unclear whether vocal fold vibration alone is able to induce severe dehydration that has a noticeable effect on phonation and perceived vocal effort. A three-dimensional model was developed to investigate vocal fold systemic dehydration and surface dehydration during phonation. Based on the linear poroelastic theory, the model considered water resupply from blood vessels through the lateral boundary, water movement within the vocal folds, water exchange between the vocal folds and the surface liquid layer through the epithelium, and surface fluid accumulation and discharge to the glottal airway. Parametric studies were conducted to investigate water loss within the vocal folds and from the surface after a 5-min sustained phonation under different permeability and vibration conditions. The results showed that the dehydration generally increased with increasing vibration amplitude, increasing epithelial permeability, and reduced water resupply. With adequate water resupply, a large-amplitude vibration can induce an overall systemic dehydration as high as 3%. The distribution of water loss within the vocal folds was non-uniform, and a local dehydration higher than 5% was observed even under conditions of a low overall systemic dehydration (<1%). Such high level of water loss may severely affect tissue properties, muscular functions, and phonations characteristics. In contrast, water loss of the surface liquid layer was generally an order of magnitude higher than water loss inside the vocal folds, indicating that the surface dehydration level is likely not a good indicator of the systemic dehydration.

Cooperative vocal control in marmoset monkeys via vocal feedback

PubMed Central

Choi, Jung Yoon; Takahashi, Daniel Y.

2015-01-01

Humans adjust speech amplitude as a function of distance from a listener; we do so in a manner that would compensate for such distance. This ability is presumed to be the product of high-level sociocognitive skills. Nonhuman primates are thought to lack such socially related flexibility in vocal production. Using predictions from a simple arousal-based model whereby vocal feedback from a conspecific modulates the drive to produce a vocalization, we tested whether another primate exhibits this type of cooperative vocal control. We conducted a playback experiment with marmoset monkeys and simulated “far-away” and “nearby” conspecifics using contact calls that differed in sound intensity. We found that marmoset monkeys increased the amplitude of their contact calls and produced such calls with shorter response latencies toward more distant conspecifics. The same was not true in response to changing levels of background noise. To account for how simulated conspecific distance can change both the amplitude and timing of vocal responses, we developed a model that incorporates dynamic interactions between the auditory system and limbic “drive” systems. Overall, our data show that, like humans, marmoset monkeys cooperatively control the acoustics of their vocalizations according to changes in listener distance, increasing the likelihood that a conspecific will hear their call. However, we propose that such cooperative vocal control is a system property that does not necessitate any particularly advanced sociocognitive skill. At least in marmosets, this vocal control can be parsimoniously explained by the regulation of arousal states across two interacting individuals via vocal feedback. PMID:25925323

Clinical interpretation of the Spinal Cord Injury Functional Index (SCI-FI)

PubMed Central

Fyffe, Denise; Kalpakjian, Claire Z.; Slavin, Mary; Kisala, Pamela; Ni, Pengsheng; Kirshblum, Steven C.; Tulsky, David S.; Jette, Alan M.

2016-01-01

Objective: To provide validation of functional ability levels for the Spinal Cord Injury – Functional Index (SCI-FI). Design: Cross-sectional. Setting: Inpatient rehabilitation hospital and community settings. Participants: A sample of 855 individuals with traumatic spinal cord injury enrolled in 6 rehabilitation centers participating in the National Spinal Cord Injury Model Systems Network. Interventions: Not Applicable. Main Outcome Measures: Spinal Cord Injury-Functional Index (SCI-FI). Results: Cluster analyses identified three distinct groups that represent low, mid-range and high SCI-FI functional ability levels. Comparison of clusters on personal and other injury characteristics suggested some significant differences between groups. Conclusions: These results strongly support the use of SCI-FI functional ability levels to document the perceived functional abilities of persons with SCI. Results of the cluster analysis suggest that the SCI-FI functional ability levels capture function by injury characteristics. Clinical implications regarding tracking functional activity trajectories during follow-up visits are discussed. PMID:26781769

Comparison of vocal outcomes after angiolytic laser surgery and microflap surgery for vocal polyps.

PubMed

Mizuta, Masanobu; Hiwatashi, Nao; Kobayashi, Toshiki; Kaneko, Mami; Tateya, Ichiro; Hirano, Shigeru

2015-12-01

The microflap technique is a standard procedure for the treatment of vocal fold polyps. Angiolytic laser surgery carried out under topical anesthesia is an alternative method for vocal polyp removal. However, it is not clear whether angiolytic laser surgery has the same effects on vocal outcomes as the microflap technique because of a lack of studies comparing both procedures. In the current study, vocal outcomes after both procedures were compared to clarify the effects of angiolytic laser surgery for vocal polyp removal. Vocal outcomes were reviewed for patients who underwent angiolytic laser surgery (n=20, laser group) or microflap surgery (n=34, microflap group) for vocal polyp removal. The data analyzed included patient and lesion characteristics, number of surgeries required for complete resolution, and aerodynamic and acoustic examinations before and after surgery. In the laser surgery group, complete resolution of the lesion was achieved with a single procedure in 17 cases (85%) and with two procedures in 3 cases (15%). Postoperative aerodynamic and acoustic parameters demonstrated significant improvement compared to preoperative parameters in both the laser surgery group and the microflap surgery group. There were no significant differences in any postoperative aerodynamic and acoustic parameters between the two groups. The current retrospective study demonstrated that angiolytic laser surgery achieved complete resolution of vocal polyps within two procedures. Postoperative effects on aerodynamic and acoustic functions were similar to those after microflap surgery. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Vocal tract and glottal function during and after vocal exercising with resonance tube and straw.

PubMed

Guzman, Marco; Laukkanen, Anne-Maria; Krupa, Petr; Horáček, Jaromir; Švec, Jan G; Geneid, Ahmed

2013-07-01

The present study aimed to investigate the vocal tract and glottal function during and after phonation into a tube and a stirring straw. A male classically trained singer was assessed. Computerized tomography (CT) was performed when the subject produced [a:] at comfortable speaking pitch, phonated into the resonance tube and when repeating [a:] after the exercise. Similar procedure was performed with a narrow straw after 15 minutes silence. Anatomic distances and area measures were obtained from CT midsagittal and transversal images. Acoustic, perceptual, electroglottographic (EGG), and subglottic pressure measures were also obtained. During and after phonation into the tube or straw, the velum closed the nasal passage better, the larynx position lowered, and hypopharynx area widened. Moreover, the ratio between the inlet of the lower pharynx and the outlet of the epilaryngeal tube became larger during and after tube/straw phonation. Acoustic results revealed a stronger spectral prominence in the singer/speaker's formant cluster region after exercising. Listening test demonstrated better voice quality after straw/tube than before. Contact quotient derived from EGG decreased during both tube and straw and remained lower after exercising. Subglottic pressure increased during straw and remained somewhat higher after it. CT and acoustic results indicated that vocal exercises with increased vocal tract impedance lead to increased vocal efficiency and economy. One of the major changes was the more prominent singer's/speaker's formant cluster. Vocal tract and glottal modifications were more prominent during and after straw exercising compared with tube phonation. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Cortical inter-hemispheric circuits for multimodal vocal learning in songbirds.

PubMed

Paterson, Amy K; Bottjer, Sarah W

2017-10-15

Vocal learning in songbirds and humans is strongly influenced by social interactions based on sensory inputs from several modalities. Songbird vocal learning is mediated by cortico-basal ganglia circuits that include the SHELL region of lateral magnocellular nucleus of the anterior nidopallium (LMAN), but little is known concerning neural pathways that could integrate multimodal sensory information with SHELL circuitry. In addition, cortical pathways that mediate the precise coordination between hemispheres required for song production have been little studied. In order to identify candidate mechanisms for multimodal sensory integration and bilateral coordination for vocal learning in zebra finches, we investigated the anatomical organization of two regions that receive input from SHELL: the dorsal caudolateral nidopallium (dNCL SHELL ) and a region within the ventral arcopallium (Av). Anterograde and retrograde tracing experiments revealed a topographically organized inter-hemispheric circuit: SHELL and dNCL SHELL , as well as adjacent nidopallial areas, send axonal projections to ipsilateral Av; Av in turn projects to contralateral SHELL, dNCL SHELL , and regions of nidopallium adjacent to each. Av on each side also projects directly to contralateral Av. dNCL SHELL and Av each integrate inputs from ipsilateral SHELL with inputs from sensory regions in surrounding nidopallium, suggesting that they function to integrate multimodal sensory information with song-related responses within LMAN-SHELL during vocal learning. Av projections share this integrated information from the ipsilateral hemisphere with contralateral sensory and song-learning regions. Our results suggest that the inter-hemispheric pathway through Av may function to integrate multimodal sensory feedback with vocal-learning circuitry and coordinate bilateral vocal behavior. © 2017 Wiley Periodicals, Inc.

Insights into the role of elastin in vocal fold health and disease

PubMed Central

Moore, Jaime

2011-01-01

Elastic fibers are large, complex and surprisingly poorly understood extracellular matrix (ECM) macromolecules. The elastin fiber, generated from a single human gene - elastin (ELN), is a self assembling integral protein that endows critical mechanic proprieties to elastic tissues and organs such as the skin, lungs, and arteries. The biology of elastic fibers is complex because they have multiple components, a tightly regulated developmental deposition, a multi-step hierarchical assembly and unique biomechanical functions. Elastin is present in vocal folds, where it plays a pivotal role in the quality of phonation. This review article provides an overview of the genesis of elastin and its wide- ranging structure and function. Specific distribution within the vocal fold lamina propria across the lifespan in normal and pathological states and its contribution to vocal fold biomechanics will be examined. Elastin and elastin-derived molecules are increasingly investigated for their application in tissue engineering. The properties of various elastin– based materials will be discussed and their current and future applications evaluated. A new level of understanding of the biomechanical properties of vocal fold elastin composites and their molecular basis should lead to new strategies for elastic fiber repair and regeneration in aging and disease. PMID:21708449

Ansa-RLN reinnervation for unilateral vocal fold paralysis in adolescents and young adults.

PubMed

Smith, Marshall E; Roy, Nelson; Stoddard, Kelly

2008-09-01

To assess the outcomes of management of unilateral vocal fold paralysis by ansa-RLN reinnervation in a series of patients ages 12-21. Clinical outcomes study. Six consecutive adolescents and young adults (ages 12-21 years) seeking treatment for unilateral vocal fold paralysis and glottal incompetence underwent ansa-RLN neurorraphy. Pre- and post-operative voice recordings acquired at least 1 year following surgery were submitted to acoustic and perceptual analysis. Patient-based measures were also taken. Mean perceptual visual analogue scale rating of dysphonia severity (0mm=profoundly abnormal voice, 100mm=completely normal voice) improved from 50mm pre-operatively to 82mm post-operatively. Mean maximum phonation time improved from 6.5s to 13.2s. Pitch and dynamic range were also observed to improve. Global self-ratings of voice function (0-100%) increased from 31.2% to 81.6% of normal. Ansa-RLN reinnervation is an effective treatment option for adolescents and young adults with unilateral vocal fold paralysis. The procedure has the potential to improve vocal function substantially, especially in those with isolated paralysis of the recurrent laryngeal nerve. The procedure alleviates the disadvantages associated with other surgical options for this age group.

Photobiomodulation in laser surgery

NASA Astrophysics Data System (ADS)

Liu, Timon Cheng-Yi; Rong, Dong-Liang; Huang, Jin; Deng, Xiao-Yuan; Liu, Song-Hao

2006-01-01

Laser surgery provides good exposure with clear operating fields and satisfactory preliminary functional results. In contrast to conventional excision, it was found that matrix metalloproteinases and the tissue inhibitors of metalloproteinases -1 mRNA expression is higher, myofibroblasts appeared and disappeared slower in laser excision wounds. It has been suggested that the better anatomical and functional results achieved following laser cordectomy may be explained by the fact that such procedures result in better, more rapid healing processes to recover vocal cord for early glottic tumors and better. In this paper, the role of photobiomodulation in laser surgery will be discussed by the cultured monolayer normal human skin fibroblast model of the photobiomodulation of marginal irradiation of high intensity laser beam, the photobiomodulation related to the irradiated tissue, the biological information model of photobiomodulation and the animal models of laser surgery. Although high intensity laser beam is so intense that it destroys the irradiated cells or tissue, its marginal irradiation intensity is so low that there is photobiomodulation on non-damage cells to modulate the regeneration of partly damaged tissue so that the surgery of laser of different parameters results in different post-surgical recovery. It was concluded that photobiomodulation might play an important role in the long-term effects of laser surgery, which might be used to design laser surgery.

Simultaneous Brain–Cervical Cord fMRI Reveals Intrinsic Spinal Cord Plasticity during Motor Sequence Learning

PubMed Central

Cohen-Adad, Julien; Marchand-Pauvert, Veronique; Benali, Habib; Doyon, Julien

2015-01-01

The spinal cord participates in the execution of skilled movements by translating high-level cerebral motor representations into musculotopic commands. Yet, the extent to which motor skill acquisition relies on intrinsic spinal cord processes remains unknown. To date, attempts to address this question were limited by difficulties in separating spinal local effects from supraspinal influences through traditional electrophysiological and neuroimaging methods. Here, for the first time, we provide evidence for local learning-induced plasticity in intact human spinal cord through simultaneous functional magnetic resonance imaging of the brain and spinal cord during motor sequence learning. Specifically, we show learning-related modulation of activity in the C6–C8 spinal region, which is independent from that of related supraspinal sensorimotor structures. Moreover, a brain–spinal cord functional connectivity analysis demonstrates that the initial linear relationship between the spinal cord and sensorimotor cortex gradually fades away over the course of motor sequence learning, while the connectivity between spinal activity and cerebellum gains strength. These data suggest that the spinal cord not only constitutes an active functional component of the human motor learning network but also contributes distinctively from the brain to the learning process. The present findings open new avenues for rehabilitation of patients with spinal cord injuries, as they demonstrate that this part of the central nervous system is much more plastic than assumed before. Yet, the neurophysiological mechanisms underlying this intrinsic functional plasticity in the spinal cord warrant further investigations. PMID:26125597

Simultaneous Brain-Cervical Cord fMRI Reveals Intrinsic Spinal Cord Plasticity during Motor Sequence Learning.

PubMed

Vahdat, Shahabeddin; Lungu, Ovidiu; Cohen-Adad, Julien; Marchand-Pauvert, Veronique; Benali, Habib; Doyon, Julien

2015-06-01

The spinal cord participates in the execution of skilled movements by translating high-level cerebral motor representations into musculotopic commands. Yet, the extent to which motor skill acquisition relies on intrinsic spinal cord processes remains unknown. To date, attempts to address this question were limited by difficulties in separating spinal local effects from supraspinal influences through traditional electrophysiological and neuroimaging methods. Here, for the first time, we provide evidence for local learning-induced plasticity in intact human spinal cord through simultaneous functional magnetic resonance imaging of the brain and spinal cord during motor sequence learning. Specifically, we show learning-related modulation of activity in the C6-C8 spinal region, which is independent from that of related supraspinal sensorimotor structures. Moreover, a brain-spinal cord functional connectivity analysis demonstrates that the initial linear relationship between the spinal cord and sensorimotor cortex gradually fades away over the course of motor sequence learning, while the connectivity between spinal activity and cerebellum gains strength. These data suggest that the spinal cord not only constitutes an active functional component of the human motor learning network but also contributes distinctively from the brain to the learning process. The present findings open new avenues for rehabilitation of patients with spinal cord injuries, as they demonstrate that this part of the central nervous system is much more plastic than assumed before. Yet, the neurophysiological mechanisms underlying this intrinsic functional plasticity in the spinal cord warrant further investigations.

A biorobotic model of the human larynx.

PubMed

Manti, M; Cianchetti, M; Nacci, A; Ursino, F; Laschi, C

2015-08-01

This work focuses on a physical model of the human larynx that replicates its main components and functions. The prototype reproduces the multilayer vocal folds and the ab/adduction movements. In particular, the vocal folds prototype is made with soft materials whose mechanical properties have been obtained to be similar to the natural tissue in terms of viscoelasticity. A computational model was used to study fluid-structure interaction between vocal folds and the airflow. This tool allowed us to make a comparison between theoretical and experimental results. Measurements were performed with this prototype in an experimental platform comprising a controlled air flow, pressure sensors and a high-speed camera for measuring vocal fold vibrations. Data included oscillation frequency at the onset pressure and glottal width. Results show that the combination between vocal fold geometry, mechanical properties and dimensions exhibits an oscillation frequency close to that of the human vocal fold. Moreover, computational results show a high correlation with the experimental one.

Vocal Development as a Guide to Modeling the Evolution of Language.

PubMed

Oller, D Kimbrough; Griebel, Ulrike; Warlaumont, Anne S

2016-04-01

Modeling of evolution and development of language has principally utilized mature units of spoken language, phonemes and words, as both targets and inputs. This approach cannot address the earliest phases of development because young infants are unable to produce such language features. We argue that units of early vocal development-protophones and their primitive illocutionary/perlocutionary forces-should be targeted in evolutionary modeling because they suggest likely units of hominin vocalization/communication shortly after the split from the chimpanzee/bonobo lineage, and because early development of spontaneous vocal capability is a logically necessary step toward vocal language, a root capability without which other crucial steps toward vocal language capability are impossible. Modeling of language evolution/development must account for dynamic change in early communicative units of form/function across time. We argue for interactive contributions of sender/infants and receiver/caregivers in a feedback loop involving both development and evolution and propose to begin computational modeling at the hominin break from the primate communicative background. Copyright © 2016 Cognitive Science Society, Inc.

Exploring the zebra finch Taeniopygia guttata as a novel animal model for the speech-language deficit of fragile X syndrome.

PubMed

Winograd, Claudia; Ceman, Stephanie

2012-01-01

Fragile X syndrome (FXS) is the most common cause of inherited intellectual disability and presents with markedly atypical speech-language, likely due to impaired vocal learning. Although current models have been useful for studies of some aspects of FXS, zebra finch is the only tractable lab model for vocal learning. The neural circuits for vocal learning in the zebra finch have clear relationships to the pathways in the human brain that may be affected in FXS. Further, finch vocal learning may be quantified using software designed specifically for this purpose. Knockdown of the zebra finch FMR1 gene may ultimately enable novel tests of therapies that are modality-specific, using drugs or even social strategies, to ameliorate deficits in vocal development and function. In this chapter, we describe the utility of the zebra finch model and present a hypothesis for the role of FMRP in the developing neural circuitry for vocalization.

Spasmodic dysphonia follow-up with videolaryngoscopy and voice spectrography during treatment with botulinum toxin.

PubMed

Esposito, Marcello; Dubbioso, R; Apisa, P; Allocca, R; Santoro, L; Cesari, U

2015-09-01

Spasmodic dysphonia (SD) is a focal dystonia of laryngeal muscles seriously impairing quality of voice. Adductor SD (ADSD) is the most common presentation of this disorder that can be identified by specialized phoniatricians and neurologists firstly on a clinical evaluation and then confirmed by videolaryngoscopy (VL). Botulinum toxin (BTX) injection with electromyographic guidance in muscles around vocal cords is the most effective treatment. Voice Handicap Index (VHI) questionnaire is the main tool to assess dysphonia and response to treatment. Objective of this study is to perform VL and voice spectrography (VS) to confirm the efficacy of BTX injections over time. 13 patients with ADSD were studied with VHI, VL and VS before and after 4 consecutive treatment with onobotulinumtoxin-A. For each treatment vocal improvement was proved by a significant reduction of VHI score and increase of maximum time phonation and harmonic-to-noise ratio while VL showed the absence of spasm in most of patients. No change of the response to BTX was found between injections. This study supports the efficacy of the treatment of SD with BTX with objective measurements and suggests that the efficacy of recurring treatments is stable over time.

Endoscopic management of bilateral vocal fold paralysis in newborns and infants.

PubMed

Sedaghat, Sahba; Tapia, Mario; Fredes, Felipe; Rojas, Pablo

2017-06-01

Bilateral vocal cord paralysis in adducted position (BVCPAd) is a severe cause of airway obstruction and usually debuts with stridor and airway distress necessitating immediate intervention. Tracheostomy has long been the gold standard for treating this condition, but has significant associated morbidity and mortality in pediatric patients. New conservative procedures have emerged to treat this condition thus avoiding tracheostomy, like endoscopic anterior and posterior cricoid split (EAPCS). The objective of this paper was to review our experience with EAPCS in newborns and infants. Prospective study involving patients undergoing endoscopic EAPCS for symptomatic BVCPAd. The primary outcomes were tracheostomy avoidance and resolution of airway symptoms. Three patients underwent EAPCS between January 2016 and December 2016. All patients stayed at least 7 days in the Intensive Care Unit (ICU) intubated. All patients presented complete resolution of their symptoms due to airway obstruction, without the need for tracheostomy. EAPCS is a novel and effective alternative to treat BVCPAd in patients under 1 year old. Our study is an initial experience; more cases are required to identify the real impact and benefits of this technique and to determine the proper selection of patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Exercise Preconditioning Protects against Spinal Cord Injury in Rats by Upregulating Neuronal and Astroglial Heat Shock Protein 72

PubMed Central

Chang, Cheng-Kuei; Chou, Willy; Lin, Hung-Jung; Huang, Yi-Ching; Tang, Ling-Yu; Lin, Mao-Tsun; Chang, Ching-Ping

2014-01-01

The heat shock protein 72 (HSP 72) is a universal marker of stress protein whose expression can be induced by physical exercise. Here we report that, in a localized model of spinal cord injury (SCI), exercised rats (given pre-SCI exercise) had significantly higher levels of neuronal and astroglial HSP 72, a lower functional deficit, fewer spinal cord contusions, and fewer apoptotic cells than did non-exercised rats. pSUPER plasmid expressing HSP 72 small interfering RNA (SiRNA-HSP 72) was injected into the injured spinal cords. In addition to reducing neuronal and astroglial HSP 72, the (SiRNA-HSP 72) significantly attenuated the beneficial effects of exercise preconditioning in reducing functional deficits as well as spinal cord contusion and apoptosis. Because exercise preconditioning induces increased neuronal and astroglial levels of HSP 72 in the gray matter of normal spinal cord tissue, exercise preconditioning promoted functional recovery in rats after SCI by upregulating neuronal and astroglial HSP 72 in the gray matter of the injured spinal cord. We reveal an important function of neuronal and astroglial HSP 72 in protecting neuronal and astroglial apoptosis in the injured spinal cord. We conclude that HSP 72-mediated exercise preconditioning is a promising strategy for facilitating functional recovery from SCI. PMID:25334068

Differential Use of Vocal and Gestural Communication by Chimpanzees (Pan troglodytes) in Response to the Attentional Status of a Human (Homo sapiens)

PubMed Central

Hostetter, Autumn B.; Cantero, Monica; Hopkins, William D.

2007-01-01

This study examined the communicative behavior of 49 captive chimpanzees (Pan troglodytes), particularly their use of vocalizations, manual gestures, and other auditory- or tactile-based behaviors as a means of gaining an inattentive audience’s attention. A human (Homo sapiens) experimenter held a banana while oriented either toward or away from the chimpanzee. The chimpanzees’ behavior was recorded for 60 s. Chimpanzees emitted vocalizations faster and were more likely to produce vocalizations as their 1st communicative behavior when a human was oriented away from them. Chimpanzees used manual gestures more frequently and faster when the human was oriented toward them. These results replicate the findings of earlier studies on chimpanzee gestural communication and provide new information about the intentional and functional use of their vocalizations. PMID:11824896

Experience-dependent modulation of feedback integration during singing: role of the right anterior insula.

PubMed

Kleber, Boris; Zeitouni, Anthony G; Friberg, Anders; Zatorre, Robert J

2013-04-03

Somatosensation plays an important role in the motor control of vocal functions, yet its neural correlate and relation to vocal learning is not well understood. We used fMRI in 17 trained singers and 12 nonsingers to study the effects of vocal-fold anesthesia on the vocal-motor singing network as a function of singing expertise. Tasks required participants to sing musical target intervals under normal conditions and after anesthesia. At the behavioral level, anesthesia altered pitch accuracy in both groups, but singers were less affected than nonsingers, indicating an experience-dependent effect of the intervention. At the neural level, this difference was accompanied by distinct patterns of decreased activation in singers (cortical and subcortical sensory and motor areas) and nonsingers (subcortical motor areas only) respectively, suggesting that anesthesia affected the higher-level voluntary (explicit) motor and sensorimotor integration network more in experienced singers, and the lower-level (implicit) subcortical motor loops in nonsingers. The right anterior insular cortex (AIC) was identified as the principal area dissociating the effect of expertise as a function of anesthesia by three separate sources of evidence. First, it responded differently to anesthesia in singers (decreased activation) and nonsingers (increased activation). Second, functional connectivity between AIC and bilateral A1, M1, and S1 was reduced in singers but augmented in nonsingers. Third, increased BOLD activity in right AIC in singers was correlated with larger pitch deviation under anesthesia. We conclude that the right AIC and sensory-motor areas play a role in experience-dependent modulation of feedback integration for vocal motor control during singing.

Relationship between patient-perceived vocal handicap and clinician-rated level of vocal dysfunction.

PubMed

Childs, Lesley F; Bielinski, Clifford; Toles, Laura; Hamilton, Amy; Deane, Janis; Mau, Ted

2015-01-01

The relationship between patient-reported vocal handicap and clinician-rated measures of vocal dysfunction is not understood. This study aimed to determine if a correlation exists between the Voice Handicap Index-10 (VHI-10) and the Voice Functional Communication Measure rating in the National Outcomes Measurement System (NOMS). Retrospective case series. Four hundred and nine voice evaluations over 12 months at a tertiary voice center were reviewed. The VHI-10 and NOMS scores, diagnoses, and potential comorbid factors were collected and analyzed. For the study population as a whole, there was a moderate negative correlation between the NOMS rating and the VHI-10 (Pearson r = -0.57). However, for a given NOMS level, there could be considerable spread in the VHI-10. In addition, as the NOMS decreased stepwise below level 4, there was a corresponding increase in the VHI-10. However, a similar trend in VHI-10 was not observed for NOMS above level 4, indicating the NOMS versus VHI-10 correlation was not linear. Among diagnostic groups, the strongest correlation was found for subjects with functional dysphonia. The NOMS versus VHI-10 correlation was not affected by gender or the coexistence of a psychiatric diagnosis. A simple relationship between VHI-10 and NOMS rating does not exist. Patients with mild vocal dysfunction have a less direct relationship between their NOMS ratings and the VHI-10. These findings provide insight into the interpretation of patient-perceived and clinician-rated measures of vocal function and may allow for better management of expectations and patient counseling in the treatment of voice disorders. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Effect of hydration and vocal rest on the vocal fatigue in amateur karaoke singers.

PubMed

Yiu, Edwin M L; Chan, Rainy M M

2003-06-01

Karaoke singing is a very popular entertainment among young people in Asia. It is a leisure singing activity with the singer's voice amplified with special acoustic effects in the backdrop of music. Music video and song captions are shown on television screen to remind the singers during singing. It is not uncommon to find participants singing continuously for four to five hours each time. As most of the karaoke singers have no formal training in singing, these amateur singers are more vulnerable to developing voice problems under these intensive singing activities. This study reports the performance of 20 young amateur singers (10 males and 10 females, aged between 20-25 years) on a series of phonatory function tasks carried out during continuous karaoke singing. Half of the singers were given water to drink and short duration of vocal rests at regular intervals during singing and the other half sang continuously without taking any water or rest. The subjects who were given hydration and vocal rests sang significantly longer than those who did not take any water or rest. The voice quality, as measured by perceptual and acoustic measures, and vocal function, as measured by phonetogram, did not show any significant changes during singing in the subjects who were given water and rest during the singing. However, subjects who sang continuously without drinking water and taking rests showed significant changes in the jitter measure and the highest pitch they could produce during singing. These results suggest that hydration and vocal rests are useful strategies to preserve voice function and quality during karaoke singing. This information is useful educational information for karaoke singers.

Experimental and Theoretical Investigations of Phonation Threshold Pressure as a Function of Vocal Fold Elongation

PubMed Central

Tao, Chao; Regner, Michael F.; Zhang, Yu; Jiang, Jack J.

2014-01-01

Summary The relationship between the vocal fold elongation and the phonation threshold pressure (PTP) was experimentally and theoretically investigated. The PTP values of seventeen excised canine larynges with 0% to 15% bilateral vocal fold elongations in 5% elongation steps were measured using an excised larynx phonation system. It was found that twelve larynges exhibited a monotonic relationship between PTP and elongation; in these larynges, the 0% elongation condition had the lowest PTP. Five larynges exhibited a PTP minimum at 5% elongation. To provide a theoretical explanation of these phenomena, a two-mass model was modified to simulate vibration of the elongated vocal folds. Two pairs of longitudinal springs were used to represent the longitudinal elastin in the vocal folds. This model showed that when the vocal folds were elongated, the increased longitudinal tension would increase the PTP value and the increased vocal fold length would decrease the PTP value. The antagonistic effects contributed by these two factors were found to be able to cause either a monotonic or a non-monotonic relationship between PTP and elongation, which were consistent with experimental observations. Because PTP describes the ease of phonation, this study suggests that there may exist a nonzero optimal vocal fold elongation for the greatest ease for phonation in some larynges. PMID:25530744

Airway Management in a Patient With Tracheal Disruption due to Penetrating Neck Trauma With Hollow Point Ammunition: A Case Report.

PubMed

Johnson, Angela M; Hill, James L; Zagorski, Dave J; McClain, Joseph M; Maronian, Nicole C

2017-11-27

Rapid sequence induction and intubation was performed for a patient in respiratory distress after a gunshot wound to the neck. Resistance was noted distal to vocal cords. With a bronchoscope unavailable, the endotracheal tube was advanced with a corkscrew maneuver. Subcutaneous emphysema had developed. The endotracheal tube was advanced into the right mainstem with adequate ventilation. Imaging illustrated tracheoesophageal injury. The patient was emergently explored. An intraluminal bullet was removed, lateral wall tracheal defect was repaired, and a tracheostomy was placed. The intubating provider should secure the airway by the method they are most comfortable, have high suspicion of airway injury, and prepare to manage airway disruption.

Airway Management in a Patient With Tracheal Disruption due to Penetrating Neck Trauma With Hollow Point Ammunition: A Case Report.

PubMed

Johnson, Angela M; Hill, James L; Zagorski, Dave J; McClain, Joseph M; Maronian, Nicole C

2018-05-01

Rapid sequence induction and intubation was performed for a patient in respiratory distress after a gunshot wound to the neck. Resistance was noted distal to vocal cords. With a bronchoscope unavailable, the endotracheal tube was advanced with a corkscrew maneuver. Subcutaneous emphysema had developed. The endotracheal tube was advanced into the right mainstem with adequate ventilation. Imaging illustrated tracheoesophageal injury. The patient was emergently explored. An intraluminal bullet was removed, lateral wall tracheal defect was repaired, and a tracheostomy was placed. The intubating provider should secure the airway by the method they are most comfortable, have high suspicion of airway injury, and prepare to manage airway disruption.

Case study involving suctioning of an electromyographic endotracheal tube.

PubMed

Evanina, Eileen Youshock; Hanisak, Jill L

2005-04-01

The electromyographic endotracheal tube (EMG-ETT) is a relatively new tool used to measure integrity of the vocal cord structures during surgery. We describe a case in which an EMG-ETT was inserted for the operative period but not replaced with an ETT during the immediate postoperative period. Intensive care unit nurses had difficulty suctioning the EMG-ETT. The patient was not provided the pulmonary toilet necessary until the EMG-ETT was removed and replaced with a regular ETT. The purpose of this article is to make anesthesia providers aware that when mechanical ventilation is required during the postoperative period, the EMG-ETT should be removed and replaced with a regular ETT to facilitate pulmonary toilet.

Quadruple cancer including Bowen's disease after arsenic injections 40 years earlier: report of a case.

PubMed

Murata, K; Iwazawa, T; Takayama, T; Yamashita, K; Okagawa, K

1994-01-01

This report describes the successful treatment of quadruple cancer including Bowen's disease in a 71-year-old man who had been given injections of salvarsan, an arsenic compound, for syphilis more than 40 years earlier. Resection of a skin lesion on his chest subsequently confirmed a diagnosis of Bowen's disease, 3 years after which he was operated on for concurrent gastric cancer and sigmoid colon cancer. A fourth cancer was discovered on his left vocal cord 2 weeks after this operation; it was resected 2 years later. A discussion of multiple malignant neoplasms and the possible relationship between arsenic and cancer is presented following this case report.

Functional outcome of vocal fold medialization thyroplasty with a hydroxyapatite implant.

PubMed

Storck, Claudio; Brockmann, Meike; Schnellmann, Elvira; Stoeckli, Sandro J; Schmid, Stephan

2007-06-01

Unilateral vocal fold paralysis can cause a persistent incomplete glottal closure during phonation, resulting in impaired voice function. The aim of this study was to evaluate functional results of medialization thyroplasty using a hydroxyapatite implant (VoCoM). Prospective observational cohort study. Between 1999 and 2003, a total of 26 patients (19 men, 7 women) undergoing medialization thyroplasty using a hydroxyapatite implant because of unilateral vocal fold paralysis were enrolled in the study. To evaluate voice function, the following parameters were measured preoperatively and postoperatively: mean fundamental frequency, mean sound pressure level, frequency and amplitude range (voice range profile), and maximum phonation time. A perceptual assessment of hoarseness was conducted using the Roughness, Breathiness, Hoarseness scale. Furthermore, the magnitude of voice related impairment of the patient's communication skills was rated on a 7-point scale. A combined parameter called the Voice Dysfunction Index (VDI) was used to rate vocal performance. All patients showed a statistically significant improvement in the VDI, in perceptual voice analysis, in maximum phonation time, and in the dynamic range of voice. One patient experienced a postoperative wound hemorrhage as a minor complication. No further complications or implant extrusions were observed. Medialization thyroplasty using a hydroxyapatite implant is a secure and efficient phonosurgical procedure. Voice quality and patient satisfaction improve significantly after treatment.

Complete segmental resection of the spine, including the spinal cord, for telangiectatic osteosarcoma: a report of 2 cases.

PubMed

Murakami, Hideki; Tomita, Katsuro; Kawahara, Norio; Oda, Makoto; Yahata, Tetsutaro; Yamaguchi, Takehiko

2006-02-15

Two case reports of telangiectatic osteosarcoma treated with complete segmental resection of the spine, including the spinal cord. To report the en bloc tumor excision, including the spinal cord, for telangiectatic osteosarcoma, and discuss the indication of cord transection and influence after cutting the spinal cord. To our knowledge, there are no previous reports describing telangiectatic osteosarcoma of the spine and the subsequent en bloc excision of the spine, including the spinal cord. The clinical and radiographic presentations of 2 cases with telangiectatic osteosarcoma are presented. Because these 2 cases already had complete paralysis for at least 1 month, it was suspected that there was no possibility of recovering spinal cord function. Complete segmental spinal resection (total en bloc spondylectomy) was performed. At that level, the spinal cord was also cut and resected. En bloc excision of the tumor with a wide margin was achieved in both cases. In the resected specimen, the nerve cells in the spinal cord had lapsed into degenerative necrosis. The pathologic findings showed that there was no hope for recovery of spinal cord function. En bloc spinal resection, including the spinal cord, is an operation allowed when there is no hope for recovery of spinal cord function. This surgery should be accepted as an option in spine tumor surgeries.

Accelerated recovery of sensorimotor function in a dog submitted to quasi-total transection of the cervical spinal cord and treated with PEG.

PubMed

Kim, C-Yoon; Hwang, In-Kyu; Kim, Hana; Jang, Se-Woong; Kim, Hong Seog; Lee, Won-Young

2016-01-01

A case report on observing the recovery of sensory-motor function after cervical spinal cord transection. Laminectomy and transection of cervical spinal cord (C5) was performed on a male beagle weighing 3.5 kg. After applying polyethylene glycol (PEG) on the severed part, reconstruction of cervical spinal cord was confirmed by the restoration of sensorimotor function. Tetraplegia was observed immediately after operation, however, the dog showed stable respiration and survival without any complication. The dog showed fast recovery after 1 week, and recovered approximately 90% of normal sensorimotor function 3 weeks after the operation, although urinary disorder was still present. All recovery stages were recorded by video camera twice a week for behavioral analysis. While current belief holds that functional recovery is impossible after a section greater than 50% at C5-6 in the canine model, this case study shows the possibility of cervical spinal cord reconstruction after near-total transection. Furthermore, this case study also confirms that PEG can truly expedite the recovery of sensorimotor function after cervical spinal cord sections in dogs.

Intra- and intergroup vocal behavior in resident killer whales, Orcinus orca.

PubMed

Weiss, Brigitte M; Symonds, Helena; Spong, Paul; Ladich, Friedrich

2007-12-01

Vocal communication within and between groups of individuals has been described extensively in birds and terrestrial mammals, however, little is known about how cetaceans utilize their sounds in their natural environment. Resident killer whales, Orcinus orca, live in highly stable matrilines and exhibit group-specific vocal dialects. Single call types cannot exclusively be associated with particular behaviors and calls are thought to function in group identification and intragroup communication. In the present study call usage of three closely related matrilines of the Northern resident community was compared in various intra- and intergroup contexts. In two out of the three matrilines significant changes in vocal behavior depending both on the presence and identity of accompanying whales were found. Most evidently, family-specific call subtypes, as well as aberrant and variable calls, were emitted at higher rates, whereas "low arousal" call types were used less in the presence of matrilines from different pods, subclans, or clans. Ways in which the observed changes may function both in intra- and intergroup communication.

Evidence-based practice: evaluation and management of unilateral vocal fold paralysis.

PubMed

Misono, Stephanie; Merati, Albert L

2012-10-01

This article discusses the causes and symptoms, evaluation, and management of unilateral vocal fold paralysis (UVFP). Cross-sectional imaging is appropriate in the work-up of idiopathic UVFP, but the routine use of serology is not well supported. The usefulness of laryngeal electromyography has remained controversial. Predictors of poor prognosis for functionally meaningful recovery include fibrillation potentials, positive sharp waves, and absent/reduced voluntary motor unit potentials. Voice therapy may be helpful. Injection and laryngeal framework surgery (medialization thyroplasty) improve vocal quality. The vocal impact of laryngeal reinnervation is comparable with that of medialization. Some patients may benefit from multiple procedures. Copyright © 2012 Elsevier Inc. All rights reserved.

Using the Natural Language Paradigm (NLP) to increase vocalizations of older adults with cognitive impairments.

PubMed

Leblanc, Linda A; Geiger, Kaneen B; Sautter, Rachael A; Sidener, Tina M

2007-01-01

The Natural Language Paradigm (NLP) has proven effective in increasing spontaneous verbalizations for children with autism. This study investigated the use of NLP with older adults with cognitive impairments served at a leisure-based adult day program for seniors. Three individuals with limited spontaneous use of functional language participated in a multiple baseline design across participants. Data were collected on appropriate and inappropriate vocalizations with appropriate vocalizations coded as prompted or unprompted during baseline and treatment sessions. All participants experienced increases in appropriate speech during NLP with variable response patterns. Additionally, the two participants with substantial inappropriate vocalizations showed decreases in inappropriate speech. Implications for intervention in day programs are discussed.

Exploring vocal recovery after cranial nerve injury in Bengalese finches.

PubMed

Urbano, Catherine M; Peterson, Jennifer R; Cooper, Brenton G

2013-02-08

Songbirds and humans use auditory feedback to acquire and maintain their vocalizations. The Bengalese finch (Lonchura striata domestica) is a songbird species that rapidly modifies its vocal output to adhere to an internal song memory. In this species, the left side of the bipartite vocal organ is specialized for producing louder, higher frequencies (≥2.2kHz) and denervation of the left vocal muscles eliminates these notes. Thus, the return of higher frequency notes after cranial nerve injury can be used as a measure of vocal recovery. Either the left or right side of the syrinx was denervated by resection of the tracheosyringeal portion of the hypoglossal nerve. Histologic analyses of syringeal muscle tissue showed significant muscle atrophy in the denervated side. After left nerve resection, songs were mainly composed of lower frequency syllables, but three out of five birds recovered higher frequency syllables. Right nerve resection minimally affected phonology, but it did change song syntax; syllable sequence became abnormally stereotyped after right nerve resection. Therefore, damage to the neuromuscular control of sound production resulted in reduced motor variability, and Bengalese finches are a potential model for functional vocal recovery following cranial nerve injury. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Management of vocal fold scar with autologous fat implantation: perceptual results.

PubMed

Neuenschwander, M C; Sataloff, R T; Abaza, M M; Hawkshaw, M J; Reiter, D; Spiegel, J R

2001-06-01

Vocal fold scar disrupts the mucosal wave and interferes with glottic closure. Treatment involves a multidisciplinary approach that includes voice therapy, medical management, and sometimes surgery. We reviewed the records of the first eight patients who underwent autologous fat implantation for vocal fold scar. Information on the etiology of scar, physical findings, and prior interventions were collected. Videotapes of videostroboscopic findings and perceptual voice ratings [Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS)] were randomized and analyzed independently by four blinded observers. Etiology of scar included mass excision (7), vocal fold stripping (3), congenital sulcus (2), and hemorrhage (1). Prior surgical procedures performed included thyroplasty (1), autologous fat injection (9), excision of scar (2), and lysis of adhesions (2). Strobovideolaryngoscopy: Statistically significant improvement was found in glottic closure, mucosal wave, and stiffness (P = 0.05). Perceptual ratings (GRBAS): Statistically significant improvement was found in all five parameters, including overall Grade, Roughness, Breathiness, Asthenia, and Strain (P = 0.05). Patients appear to have improved vocal fold function and quality of voice after autologous fat implantation in the vocal fold. Autologous fat implantation is an important adjunctive procedure in the management of vocal fold scar, and a useful addition to the armamentarium of the experienced phonomicrosurgeon.

Vocal tract characteristics in Parkinson's disease.

PubMed

Gillivan-Murphy, Patricia; Carding, Paul; Miller, Nick

2016-06-01

Voice tremor is strongly linked to the Parkinson's disease speech-voice symptom complex. Little is known about the underlying anatomic source(s) of voice tremor when it occurs. We review recent literature addressing this issue. Additionally we report findings from a study we conducted employing rating of vocal tract structures viewed using nasolaryngoscopy during vocal and nonspeech tasks. In Parkinson's disease, using laryngeal electromyography, tremor has not been identified in muscles in the vocal folds even when perceived auditorily. Preliminary findings using nasolaryngoscopy suggest that Parkinson's disease voice tremor is not associated with the vocal folds and may involve the palate, the global larynx, and the arytenoids. Tremor in the vertical larynx on /a/, and tremor in the arytenoid cartilages on /s/ differentiated patients with Parkinson's disease from neurologically healthy controls. Visual reliable detection of tremor when it is absent or borderline present, is challenging. Parkinson's disease voice tremor is likely to be related to oscillatory movement in structures across the vocal tract rather than just the vocal folds. To progress clinical practice, more refined tools for the visual rating of tremor would be beneficial. How far voice tremor represents a functionally significant factor for speakers would also add to the literature.

Vocal tract resonances in speech, singing, and playing musical instruments

PubMed Central

Wolfe, Joe; Garnier, Maëva; Smith, John

2009-01-01

In both the voice and musical wind instruments, a valve (vocal folds, lips, or reed) lies between an upstream and downstream duct: trachea and vocal tract for the voice; vocal tract and bore for the instrument. Examining the structural similarities and functional differences gives insight into their operation and the duct-valve interactions. In speech and singing, vocal tract resonances usually determine the spectral envelope and usually have a smaller influence on the operating frequency. The resonances are important not only for the phonemic information they produce, but also because of their contribution to voice timbre, loudness, and efficiency. The role of the tract resonances is usually different in brass and some woodwind instruments, where they modify and to some extent compete or collaborate with resonances of the instrument to control the vibration of a reed or the player’s lips, and∕or the spectrum of air flow into the instrument. We give a brief overview of oscillator mechanisms and vocal tract acoustics. We discuss recent and current research on how the acoustical resonances of the vocal tract are involved in singing and the playing of musical wind instruments. Finally, we compare techniques used in determining tract resonances and suggest some future developments. PMID:19649157

Laryngeal Aerodynamics in Healthy Older Adults and Adults With Parkinson's Disease.

PubMed

Matheron, Deborah; Stathopoulos, Elaine T; Huber, Jessica E; Sussman, Joan E

2017-03-01

The present study compared laryngeal aerodynamic function of healthy older adults (HOA) to adults with Parkinson's disease (PD) while speaking at a comfortable and increased vocal intensity. Laryngeal aerodynamic measures (subglottal pressure, peak-to-peak flow, minimum flow, and open quotient [OQ]) were compared between HOAs and individuals with PD who had a diagnosis of hypophonia. Increased vocal intensity was elicited via monaurally presented multitalker background noise. At a comfortable speaking intensity, HOAs and individuals with PD produced comparable vocal intensity, rates of vocal fold closure, and minimum flow. HOAs used smaller OQs, higher subglottal pressure, and lower peak-to-peak flow than individuals with PD. Both groups increased speaking intensity when speaking in noise to the same degree. However, HOAs produced increased intensity with greater driving pressure, faster vocal fold closure rates, and smaller OQs than individuals with PD. Monaural background noise elicited equivalent vocal intensity increases in HOAs and individuals with PD. Although both groups used laryngeal mechanisms as expected to increase sound pressure level, they used these mechanisms to different degrees. The HOAs appeared to have better control of the laryngeal mechanism to make changes to their vocal intensity.

Vocal tract resonances in speech, singing, and playing musical instruments.

PubMed

Wolfe, Joe; Garnier, Maëva; Smith, John

2009-01-01

IN BOTH THE VOICE AND MUSICAL WIND INSTRUMENTS, A VALVE (VOCAL FOLDS, LIPS, OR REED) LIES BETWEEN AN UPSTREAM AND DOWNSTREAM DUCT: trachea and vocal tract for the voice; vocal tract and bore for the instrument. Examining the structural similarities and functional differences gives insight into their operation and the duct-valve interactions. In speech and singing, vocal tract resonances usually determine the spectral envelope and usually have a smaller influence on the operating frequency. The resonances are important not only for the phonemic information they produce, but also because of their contribution to voice timbre, loudness, and efficiency. The role of the tract resonances is usually different in brass and some woodwind instruments, where they modify and to some extent compete or collaborate with resonances of the instrument to control the vibration of a reed or the player's lips, andor the spectrum of air flow into the instrument. We give a brief overview of oscillator mechanisms and vocal tract acoustics. We discuss recent and current research on how the acoustical resonances of the vocal tract are involved in singing and the playing of musical wind instruments. Finally, we compare techniques used in determining tract resonances and suggest some future developments.

Measurement of Lombard-like response in the beluga whale

NASA Astrophysics Data System (ADS)

Scheifele, Peter M.

2004-05-01

Noise pollution has become recognized as a potential danger to marine mammals in general, and to the St. Lawrence beluga (Delphinapterus leucas) in particular. One method to determine whether noise is having an effect on an animals auditory ability is to observe a natural and repeatable response of the auditory and vocal systems to varying noise levels. This can be accomplished by observing changes in animal vocalizations in response to auditory feedback. A response such as this observed in humans and some animals is known as the Lombard vocal response, which represents a reaction of the auditory system directly manifested by changes in vocalization level. This response is known in humans, songbirds, and some primates. In this research a population of belugas in the St. Lawrence River Estuary was tested to determine whether a vocalization-as-a-function-of-noise phenomenon existed by using hidden Markhov classified vocalizations as targets for acoustical analyses. Correlation and regression analyses of signals and noise indicated that the phenomenon does exist and results of a human subjects experiment along with results from other animal species known to exhibit the response strongly implicate the Lombard vocal response in the St. Lawrence population of beluga.

Combined Functional Voice Therapy in Singers With Muscle Tension Dysphonia in Singing.

PubMed

Sielska-Badurek, Ewelina; Osuch-Wójcikiewicz, Ewa; Sobol, Maria; Kazanecka, Ewa; Rzepakowska, Anna; Niemczyk, Kazimierz

2017-07-01

The purpose of this study was to evaluate vocal tract function and the voice quality in singers with muscle tension dysphonia (MTD) after undergoing combined functional voice therapy of the singing voice. This is a prospective, randomized study. Forty singers (29 females and 11 males, mean age: 24.6 ± 8.8 years) with MTD were enrolled in the study. The study group consisted of 20 singers who underwent combined functional voice therapy (10-15 individual sessions, 30-40 minutes each). Singers who did not opt for vocal rehabilitation consisted of the control group. Effects of rehabilitation were assessed with videolaryngostroboscopy, palpation of the vocal tract structures, flexible fiberoptic evaluation of the pharynx and the larynx, perceptual speaking and singing voice assessment, acoustic analysis, maximal phonation time, and the Voice Handicap Index. After combined functional voice therapy in the study group, great improvement was noticed in palpation of the vocal tract structures (P < 0.001), perceptual voice assessment (P < 0.001), phonetograms (P = 0.002), and singing range obtained from acoustic analysis of glissando (P < 0.001). In the control group, no statistically significant differences were found between the first and the second assessments. Combined functional voice therapy proved to be an efficacious treatment method in singers with MTD in singing. Development of palpation and perceptual singing voice examination protocols enables one to compare results before and after rehabilitation in clinics. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Hyaluronic acid hydrogels for vocal fold wound healing

PubMed Central

Gaston, Joel; Thibeault, Susan L.

2013-01-01

The unique vibrational properties inherent to the human vocal fold have a significant detrimental impact on wound healing and scar formation. Hydrogels have taken prominence as a tissue engineered strategy to restore normal vocal structure and function as cellularity is low. The frequent vibrational and shear forces applied to, and present in this connective tissue make mechanical properties of such hydrogels a priority in this active area of research. Hyaluronic acid has been chemically modified in a variety of ways to address cell function while maintaining desirable tissue mechanical properties. These various modifications have had mixed results when injected in vivo typically resulting in better biomechanical function but not necessarily with a concomitant decrease in tissue fibrosis. Recent work has focused on seeding mesenchymal progenitor cells within 3D architecture of crosslinked hydrogels. The data from these studies demonstrate that this approach has a positive effect on cells in both early and late wound healing, but little work has been done regarding the biomechanical effects of these treatments. This paper provides an overview of the various hyaluronic acid derivatives, their crosslinking agents, and their effect when implanted into the vocal folds of various animal models. PMID:23507923

Systemic Hydration: Relating Science to Clinical Practice in Vocal Health

PubMed Central

Hartley, Naomi A.; Thibeault, Susan L.

2014-01-01

Objectives To examine the current state of the science regarding the role of systemic hydration in vocal function and health. Study Design Literature Review Methods Literature search spanning multiple disciplines, including speech-language pathology, nutrition and dietetics, medicine, sports and exercise science, physiology and biomechanics. Results The relationship between hydration and physical function is an area of common interest amongst multiple professions. Each discipline provides valuable insight into the connection between performance and water balance, as well as complimentary methods of investigation. Existing voice literature suggests a relationship between hydration and voice production, however the underlying mechanisms are not yet defined and a treatment effect for systemic hydration remains to be demonstrated. Literature from other disciplines sheds light on methodological shortcomings and in some cases offers an alternative explanation for observed phenomena. Conclusions A growing body of literature in the field of voice science is documenting a relationship between hydration and vocal function, however greater understanding is required to guide best practice in the maintenance of vocal health and management of voice disorders. Integration of knowledge and technical expertise from multiple disciplines facilitates analysis of existing literature and provides guidance as to future research. PMID:24880674

Hyaluronic acid hydrogels for vocal fold wound healing.

PubMed

Gaston, Joel; Thibeault, Susan L

2013-01-01

The unique vibrational properties inherent to the human vocal fold have a significant detrimental impact on wound healing and scar formation. Hydrogels have taken prominence as a tissue engineered strategy to restore normal vocal structure and function as cellularity is low. The frequent vibrational and shear forces applied to, and present in this connective tissue make mechanical properties of such hydrogels a priority in this active area of research. Hyaluronic acid has been chemically modified in a variety of ways to address cell function while maintaining desirable tissue mechanical properties. These various modifications have had mixed results when injected in vivo typically resulting in better biomechanical function but not necessarily with a concomitant decrease in tissue fibrosis. Recent work has focused on seeding mesenchymal progenitor cells within 3D architecture of crosslinked hydrogels. The data from these studies demonstrate that this approach has a positive effect on cells in both early and late wound healing, but little work has been done regarding the biomechanical effects of these treatments. This paper provides an overview of the various hyaluronic acid derivatives, their crosslinking agents, and their effect when implanted into the vocal folds of various animal models.

The brain of opera singers: experience-dependent changes in functional activation.

PubMed

Kleber, B; Veit, R; Birbaumer, N; Gruzelier, J; Lotze, M

2010-05-01

Several studies have shown that motor-skill training over extended time periods results in reorganization of neural networks and changes in brain morphology. Yet, little is known about training-induced adaptive changes in the vocal system, which is largely subserved by intrinsic reflex mechanisms. We investigated highly accomplished opera singers, conservatory level vocal students, and laymen during overt singing of an Italian aria in a neuroimaging experiment. We provide the first evidence that the training of vocal skills is accompanied by increased functional activation of bilateral primary somatosensory cortex representing articulators and larynx. Opera singers showed additional activation in right primary sensorimotor cortex. Further training-related activation comprised the inferior parietal lobe and bilateral dorsolateral prefrontal cortex. At the subcortical level, expert singers showed increased activation in the basal ganglia, the thalamus, and the cerebellum. A regression analysis of functional activation with accumulated singing practice confirmed that vocal skills training correlates with increased activity of a cortical network for enhanced kinesthetic motor control and sensorimotor guidance together with increased involvement of implicit motor memory areas at the subcortical and cerebellar level. Our findings may have ramifications for both voice rehabilitation and deliberate practice of other implicit motor skills that require interoception.

Social functioning and autonomic nervous system sensitivity across vocal and musical emotion in Williams syndrome and autism spectrum disorder.

PubMed

Järvinen, Anna; Ng, Rowena; Crivelli, Davide; Neumann, Dirk; Arnold, Andrew J; Woo-VonHoogenstyn, Nicholas; Lai, Philip; Trauner, Doris; Bellugi, Ursula

2016-01-01

Both Williams syndrome (WS) and autism spectrum disorders (ASD) are associated with unusual auditory phenotypes with respect to processing vocal and musical stimuli, which may be shaped by the atypical social profiles that characterize the syndromes. Autonomic nervous system (ANS) reactivity to vocal and musical emotional stimuli was examined in 12 children with WS, 17 children with ASD, and 20 typically developing (TD) children, and related to their level of social functioning. The results of this small-scale study showed that after controlling for between-group differences in cognitive ability, all groups showed similar emotion identification performance across conditions. Additionally, in ASD, lower autonomic reactivity to human voice, and in TD, to musical emotion, was related to more normal social functioning. Compared to TD, both clinical groups showed increased arousal to vocalizations. A further result highlighted uniquely increased arousal to music in WS, contrasted with a decrease in arousal in ASD and TD. The ASD and WS groups exhibited arousal patterns suggestive of diminished habituation to the auditory stimuli. The results are discussed in the context of the clinical presentation of WS and ASD. © 2015 Wiley Periodicals, Inc.

Radiation Fibrosis of the Vocal Fold: From Man to Mouse

PubMed Central

Johns, Michael M.; Kolachala, Vasantha; Berg, Eric; Muller, Susan; Creighton, Frances X.; Branski, Ryan C.

2013-01-01

Objectives To characterize fundamental late tissue effects in the human vocal fold following radiation therapy. To develop a murine model of radiation fibrosis to ultimately develop both treatment and prevention paradigms. Design Translational study using archived human and fresh murine irradiated vocal fold tissue. Methods 1) Irradiated vocal fold tissue from patients undergoing laryngectomy for loss of function from radiation fibrosis were identified from pathology archives. Histomorphometry, immunohistochemistry, and whole-genome microarray as well as real-time transcriptional analyses was performed. 2) Focused radiation to the head and neck was delivered to mice in a survival fashion. One month following radiation, vocal fold tissue was analyzed with histomorphometry, immunohistochemistry, and real-time PCR transcriptional analysis for selected markers of fibrosis. Results Human irradiated vocal folds demonstrated increased collagen transcription with increased deposition and disorganization of collagen in both the thyroarytenoid muscle and the superficial lamina propria. Fibronectin were increased in the superficial lamina propria. Laminin decreased in the thyroarytenoid muscle. Whole genome microarray analysis demonstrated increased transcription of markers for fibrosis, oxidative stress, inflammation, glycosaminoglycan production and apoptosis. Irradiated murine vocal folds demonstrated increases in collagen and fibronectin transcription and deposition in the lamina propria. Transforming growth factor (TGF)-β increased in the lamina propria. Conclusion Human irradiated vocal folds demonstrate molecular changes leading to fibrosis that underlie loss of vocal fold pliability that occurs in patients following laryngeal irradiation. Irradiated murine tissue demonstrates similar findings, and this mouse model may have utility in creating prevention and treatment strategies for vocal fold radiation fibrosis. PMID:23242839

Rheometric properties of canine vocal fold tissues: Variation with anatomic location

PubMed Central

Kimura, Miwako; Mau, Ted; Chan, Roger W.

2010-01-01

Objective To evaluate the in vitro rheometric properties of the canine vocal fold lamina propria and muscle at phonatory frequencies, and their changes with anatomic location. Methods Six canine larynges were harvested immediately postmortem. Viscoelastic shear properties of anterior, middle, and posterior portions of the vocal fold cover (lamina propria) as well as those of the medial thyroarytenoid (TA) muscle (vocalis muscle) were quantified by a linear, controlled-strain simple-shear rheometer. Measurements of elastic shear modulus (G’) and dynamic viscosity (η’) of the specimens were conducted with small-amplitude sinusoidal shear deformation over a frequency range of 1 Hz to 250 Hz. Results All specimens showed similar frequency dependence of the viscoelastic functions, with G’ gradually increasing with frequency and η’ decreasing with frequency monotonically. G’ and η’ of the canine vocalis muscle were significantly higher than those of the canine vocal fold cover, and η’ of the canine vocal fold cover was significantly higher than that of the human vocal fold cover. There were no significant differences in G’ and in η’ between different portions of the canine vocal fold cover. Conclusion These preliminary data based on the canine model suggested that the vocalis muscle, while in a relaxed state in vitro, is significantly stiffer and more viscous than the vocal fold cover during vibration at phonatory frequencies. For large-amplitude vocal fold vibration involving the medial portion of the TA muscle, such distinct differences in viscoelastic properties of different layers of the vocal fold should be taken into account in multi-layered biomechanical models of phonation. PMID:21035291

Human Adipose Tissue Derived Extracellular Matrix and Methylcellulose Hydrogels Augments and Regenerates the Paralyzed Vocal Fold

PubMed Central

Kim, Eun Na; Sung, Myung Whun; Kwon, Tack-Kyun; Cho, Yong Woo; Kwon, Seong Keun

2016-01-01

Vocal fold paralysis results from various etiologies and can induce voice changes, swallowing complications, and issues with aspiration. Vocal fold paralysis is typically managed using injection laryngoplasty with fat or synthetic polymers. Injection with autologous fat has shown excellent biocompatibility. However, it has several disadvantages such as unpredictable resorption rate, morbidities associated with liposuction procedure which has to be done in operating room under general anesthesia. Human adipose-derived extracellular matrix (ECM) grafts have been reported to form new adipose tissue and have greater biostability than autologous fat graft. Here, we present an injectable hydrogel that is constructed from adipose tissue derived soluble extracellular matrix (sECM) and methylcellulose (MC) for use in vocal fold augmentation. Human sECM derived from adipose tissue was extracted using two major steps—ECM was isolated from human adipose tissue and was subsequently solubilized. Injectable sECM/MC hydrogels were prepared by blending of sECM and MC. Sustained vocal fold augmentation and symmetric vocal fold vibration were accomplished by the sECM/MC hydrogel in paralyzed vocal fold which were confirmed by laryngoscope, histology and a high-speed imaging system. There were increased number of collagen fibers and fatty granules at the injection site without significant inflammation or fibrosis. Overall, these results indicate that the sECM/MC hydrogel can enhance vocal function in paralyzed vocal folds without early resorption and has potential as a promising material for injection laryngoplasty for stable vocal fold augmentation which can overcome the shortcomings of autologous fat such as unpredictable duration and morbidity associated with the fat harvest. PMID:27768757

Bat echolocation calls facilitate social communication

PubMed Central

Knörnschild, Mirjam; Jung, Kirsten; Nagy, Martina; Metz, Markus; Kalko, Elisabeth

2012-01-01

Bat echolocation is primarily used for orientation and foraging but also holds great potential for social communication. The communicative function of echolocation calls is still largely unstudied, especially in the wild. Eavesdropping on vocal signatures encoding social information in echolocation calls has not, to our knowledge, been studied in free-living bats so far. We analysed echolocation calls of the polygynous bat Saccopteryx bilineata and found pronounced vocal signatures encoding sex and individual identity. We showed experimentally that free-living males discriminate approaching male and female conspecifics solely based on their echolocation calls. Males always produced aggressive vocalizations when hearing male echolocation calls and courtship vocalizations when hearing female echolocation calls; hence, they responded with complex social vocalizations in the appropriate social context. Our study demonstrates that social information encoded in bat echolocation calls plays a crucial and hitherto underestimated role for eavesdropping conspecifics and thus facilitates social communication in a highly mobile nocturnal mammal. PMID:23034703

Bat echolocation calls facilitate social communication.

PubMed

Knörnschild, Mirjam; Jung, Kirsten; Nagy, Martina; Metz, Markus; Kalko, Elisabeth

2012-12-07

Bat echolocation is primarily used for orientation and foraging but also holds great potential for social communication. The communicative function of echolocation calls is still largely unstudied, especially in the wild. Eavesdropping on vocal signatures encoding social information in echolocation calls has not, to our knowledge, been studied in free-living bats so far. We analysed echolocation calls of the polygynous bat Saccopteryx bilineata and found pronounced vocal signatures encoding sex and individual identity. We showed experimentally that free-living males discriminate approaching male and female conspecifics solely based on their echolocation calls. Males always produced aggressive vocalizations when hearing male echolocation calls and courtship vocalizations when hearing female echolocation calls; hence, they responded with complex social vocalizations in the appropriate social context. Our study demonstrates that social information encoded in bat echolocation calls plays a crucial and hitherto underestimated role for eavesdropping conspecifics and thus facilitates social communication in a highly mobile nocturnal mammal.

Evaluation of interventions to reduce multiply controlled vocal stereotypy.

PubMed

Scalzo, Rachel; Henry, Kelsey; Davis, Tonya N; Amos, Kally; Zoch, Tamara; Turchan, Sarah; Wagner, Tara

2015-07-01

This study examined four interventions targeted at decreasing multiply controlled vocal stereotypy for a 12-year-old boy diagnosed with autism spectrum disorder and a severe intellectual disability. These interventions included Noncontingent Music, Differential Reinforcement of Other Behaviors, Self-Recording, and Functional Communication Training (FCT). In addition to measuring vocal stereotypy during each condition, task engagement and challenging behavior were also monitored. Across conditions, vocal stereotypy did not vary significantly from baseline except in FCT, when it decreased significantly. Task engagement was higher in this condition as well. It is hypothesized that FCT provided an enriched environment by increasing social interaction and access to desired items as well as removal of less preferred activities. For these reasons, there was a decrease in the need for the participant to engage in vocal stereotypy and challenging behavior and increase in his ability to engage in a task. © The Author(s) 2015.

Properties of vocalization- and gesture-combinations in the transition to first words.

PubMed

Murillo, Eva; Capilla, Almudena

2016-07-01

Gestures and vocal elements interact from the early stages of language development, but the role of this interaction in the language learning process is not yet completely understood. The aim of this study is to explore gestural accompaniment's influence on the acoustic properties of vocalizations in the transition to first words. Eleven Spanish children aged 0;9 to 1;3 were observed longitudinally in a semi-structured play situation with an adult. Vocalizations were analyzed using several acoustic parameters based on those described by Oller et al. (2010). Results indicate that declarative vocalizations have fewer protosyllables than imperative ones, but only when they are produced with a gesture. Protosyllables duration and f(0) are more similar to those of mature speech when produced with pointing and declarative function than when produced with reaching gestures and imperative purposes. The proportion of canonical syllables produced increases with age, but only when combined with a gesture.

Evaluation of the poly(lactic-co-glycolic acid)/pluronic F127 for injection laryngoplasty in rabbits.

PubMed

Lee, Jin Ho; Kim, Dong Wook; Kim, Eun Na; Park, Seok-Won; Kim, Hee-Bok; Oh, Se Heang; Kwon, Seong Keun

2014-11-01

Poly(lactic-co-glycolic acid) (PLGA) is an aliphatic polyester and one of the most commonly used synthetic biodegradable polymers for tissue engineering. The objectives of this study were to evaluate the biocompatibility of PLGA/Pluronic F127 in the vocal fold. A randomized, prospective, controlled animal study. University laboratory. We used 18 New Zealand white rabbits, which were divided into 5% PLGA solution (n = 9) and 10% PLGA solution (n = 9) groups. The PLGA/Pluronic F127 solutions were injected into the rabbit vocal fold. Laryngoscopic exams were performed at 1, 4, and 8 weeks after implantation; then larynx specimens were sampled. High-speed video camera examination was performed for functional analysis of vocal mucosa vibration at 8 weeks after implantation. Also, we evaluated the amplitude of the mucosal wave from the laryngeal midline on high-speed recording. Histologic study of larynx specimen was performed at 4 and 8 weeks. All animals survived until the scheduled period. Laryngoscopic analysis showed that both 5% and 10% PLGA/Pluronic F127 maintained after 8 weeks after injection without significant inflammatory response. On functional analysis, high-speed camera examination revealed regular and symmetric contact of vocal fold mucosa without a distorted movement by injected PLGA/Pluronic F127. Histologically, no significant inflammation was observed in the injected vocal fold. As a vocal fold injection material, PLGA/Pluronic F127 showed a good bio-compatibility without significant inflammatory response. Further experiment will follow to elucidate its role for drug or gene delivery into the vocal fold. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.

Female harbor seal (Phoca vitulina) behavioral response to playbacks of underwater male acoustic advertisement displays

PubMed Central

Blades, Brittany; Parks, Susan E.

2018-01-01

During the breeding season, male harbor seals (Phoca vitulina) make underwater acoustic displays using vocalizations known as roars. These roars have been shown to function in territory establishment in some breeding areas and have been hypothesized to be important for female choice, but the function of these sounds remains unresolved. This study consisted of a series of playback experiments in which captive female harbor seals were exposed to recordings of male roars to determine if females respond to recordings of male vocalizations and whether or not they respond differently to roars from categories with different acoustic characteristics. The categories included roars with characteristics of dominant males (longest duration, lowest frequency), subordinate males (shortest duration, highest frequency), combinations of call parameters from dominant and subordinate males (long duration, high frequency and short duration, low frequency), and control playbacks of water noise and water noise with tonal signals in the same frequency range as male signals. Results indicate that overall females have a significantly higher level of response to playbacks that imitate male vocalizations when compared to control playbacks of water noise. Specifically, there was a higher level of response to playbacks representing dominant male vocalization when compared to the control playbacks. For most individuals, there was a greater response to playbacks representing dominant male vocalizations compared to playbacks representing subordinate male vocalizations; however, there was no statistical difference between those two playback types. Additionally, there was no difference between the playbacks of call parameter combinations and the controls. Investigating female preference for male harbor seal vocalizations is a critical step in understanding the harbor seal mating system and further studies expanding on this captive study will help shed light on this important issue. PMID:29607261

Female harbor seal (Phoca vitulina) behavioral response to playbacks of underwater male acoustic advertisement displays.

PubMed

Matthews, Leanna P; Blades, Brittany; Parks, Susan E

2018-01-01

During the breeding season, male harbor seals ( Phoca vitulina ) make underwater acoustic displays using vocalizations known as roars. These roars have been shown to function in territory establishment in some breeding areas and have been hypothesized to be important for female choice, but the function of these sounds remains unresolved. This study consisted of a series of playback experiments in which captive female harbor seals were exposed to recordings of male roars to determine if females respond to recordings of male vocalizations and whether or not they respond differently to roars from categories with different acoustic characteristics. The categories included roars with characteristics of dominant males (longest duration, lowest frequency), subordinate males (shortest duration, highest frequency), combinations of call parameters from dominant and subordinate males (long duration, high frequency and short duration, low frequency), and control playbacks of water noise and water noise with tonal signals in the same frequency range as male signals. Results indicate that overall females have a significantly higher level of response to playbacks that imitate male vocalizations when compared to control playbacks of water noise. Specifically, there was a higher level of response to playbacks representing dominant male vocalization when compared to the control playbacks. For most individuals, there was a greater response to playbacks representing dominant male vocalizations compared to playbacks representing subordinate male vocalizations; however, there was no statistical difference between those two playback types. Additionally, there was no difference between the playbacks of call parameter combinations and the controls. Investigating female preference for male harbor seal vocalizations is a critical step in understanding the harbor seal mating system and further studies expanding on this captive study will help shed light on this important issue.

Contextual effects of noise on vocalization encoding in primary auditory cortex

PubMed Central

Ni, Ruiye; Bender, David A.; Shanechi, Amirali M.; Gamble, Jeffrey R.

2016-01-01

Robust auditory perception plays a pivotal function for processing behaviorally relevant sounds, particularly with distractions from the environment. The neuronal coding enabling this ability, however, is still not well understood. In this study, we recorded single-unit activity from the primary auditory cortex (A1) of awake marmoset monkeys (Callithrix jacchus) while delivering conspecific vocalizations degraded by two different background noises: broadband white noise and vocalization babble. Noise effects on neural representation of target vocalizations were quantified by measuring the responses' similarity to those elicited by natural vocalizations as a function of signal-to-noise ratio. A clustering approach was used to describe the range of response profiles by reducing the population responses to a summary of four response classes (robust, balanced, insensitive, and brittle) under both noise conditions. This clustering approach revealed that, on average, approximately two-thirds of the neurons change their response class when encountering different noises. Therefore, the distortion induced by one particular masking background in single-unit responses is not necessarily predictable from that induced by another, suggesting the low likelihood of a unique group of noise-invariant neurons across different background conditions in A1. Regarding noise influence on neural activities, the brittle response group showed addition of spiking activity both within and between phrases of vocalizations relative to clean vocalizations, whereas the other groups generally showed spiking activity suppression within phrases, and the alteration between phrases was noise dependent. Overall, the variable single-unit responses, yet consistent response types, imply that primate A1 performs scene analysis through the collective activity of multiple neurons. NEW & NOTEWORTHY The understanding of where and how auditory scene analysis is accomplished is of broad interest to neuroscientists. In this paper, we systematically investigated neuronal coding of multiple vocalizations degraded by two distinct noises at various signal-to-noise ratios in nonhuman primates. In the process, we uncovered heterogeneity of single-unit representations for different auditory scenes yet homogeneity of responses across the population. PMID:27881720

Contextual effects of noise on vocalization encoding in primary auditory cortex.

PubMed

Ni, Ruiye; Bender, David A; Shanechi, Amirali M; Gamble, Jeffrey R; Barbour, Dennis L

2017-02-01

Robust auditory perception plays a pivotal function for processing behaviorally relevant sounds, particularly with distractions from the environment. The neuronal coding enabling this ability, however, is still not well understood. In this study, we recorded single-unit activity from the primary auditory cortex (A1) of awake marmoset monkeys (Callithrix jacchus) while delivering conspecific vocalizations degraded by two different background noises: broadband white noise and vocalization babble. Noise effects on neural representation of target vocalizations were quantified by measuring the responses' similarity to those elicited by natural vocalizations as a function of signal-to-noise ratio. A clustering approach was used to describe the range of response profiles by reducing the population responses to a summary of four response classes (robust, balanced, insensitive, and brittle) under both noise conditions. This clustering approach revealed that, on average, approximately two-thirds of the neurons change their response class when encountering different noises. Therefore, the distortion induced by one particular masking background in single-unit responses is not necessarily predictable from that induced by another, suggesting the low likelihood of a unique group of noise-invariant neurons across different background conditions in A1. Regarding noise influence on neural activities, the brittle response group showed addition of spiking activity both within and between phrases of vocalizations relative to clean vocalizations, whereas the other groups generally showed spiking activity suppression within phrases, and the alteration between phrases was noise dependent. Overall, the variable single-unit responses, yet consistent response types, imply that primate A1 performs scene analysis through the collective activity of multiple neurons. The understanding of where and how auditory scene analysis is accomplished is of broad interest to neuroscientists. In this paper, we systematically investigated neuronal coding of multiple vocalizations degraded by two distinct noises at various signal-to-noise ratios in nonhuman primates. In the process, we uncovered heterogeneity of single-unit representations for different auditory scenes yet homogeneity of responses across the population. Copyright © 2017 the American Physiological Society.