1/10. Inspiratory pressure threshold training for glottal airway limitation in laryngeal papilloma.A single-subject design was used to determine if inspiratory pressure threshold training increases inspiratory muscle strength and reduces the sensation of dyspnea during exercise and speech. The subject was a 23-year-old female with congenital juvenile papilloma which has been in remission for 10 years. A 4-week inspiratory muscle training program was implemented using an inspiratory pressure threshold trainer. The pressure threshold of the trainer was set by the experimenter. The pressure threshold setting of the trainer was based on a percentage of the subject's maximum inspiratory pressure measured prior to training. The average range of the pressure threshold was 40 to 70 cmH2O. In order for inspiratory air to flow, the subject generated inspiratory pressure, independent of airflow rate. Maximum inspiratory pressure (MIP) was the dependent variable used as the index of inspiratory muscle strength. exercise dyspnea was a dependent variable rated by the subject during a progressive treadmill test. dyspnea associated with speech was rated following production of a comfortable and loud speech task. MIP increased by 57% following the training program with a 2-scale point reduction in the perception of dyspnea during exercise. dyspnea during loud speech decreased from moderate to mild. The changes in dyspnea, both during exercise and speech, are directly related to inspiratory muscle strengthening. The results suggest that inspiratory muscle training may improve respiratory related function in patients with restrictive upper airway disorders.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/10. The association of laryngoceles with ventricular phonation.Laryngoceles represent dilatations of the laryngeal saccule that may extend internally into the airway, or externally through the thyrohyoid membrane. Unilateral laryngoceles are uncommon clinical entities and bilateral laryngoceles are rare. Certain activities like glass blowing and playing a wind instrument are associated with laryngocele development, as is laryngeal carcinoma in the ventricular area. This case describes development of bilateral laryngoceles in a patient who chronically uses ventricular phonation during speech. The pathogenesis involves repetitive elevation of intralaryngeal pressure during false vocal cord approximation, exposing the ventricles to abnormally high air pressures. The pathogenesis in this case, as well as in laryngoceles associated with occupational or anatomic risk factors, is discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = pressure (Clic here for more details about this article) |
3/10. Inspiratory pressure threshold training in a case of congenital bilateral abductor vocal fold paralysis.We present a non-surgical treatment option to decrease symptoms of dyspnea in a 6 year-old child with congenital bilateral abductor vocal fold paralysis. A respiratory muscle strength-training program was used to strengthen her inspiratory muscles for 8 months, 3 to 5 days per week. Inspiratory muscle strength increased over the course of training, resulting in reported decreases in dyspnea by both the child and parents during speech and exercise.- - - - - - - - - - ranking = 0.33333333333333keywords = pressure (Clic here for more details about this article) |
4/10. dysphonia and cervical hyperostosis: a case report.We report a case of a 77-year-old man with a 3-year-history of progressive dysphonia, without dysphagia. His voice sounded breathy; the pitch and the loudness were low. He complained of a few episodes of voice breaking. At laryngostroboscopy the adduction motion of the left true vocal cord was slower than the contralateral one. A cervical spine X-ray demonstrated a generalized vertebral osteophytosis and a 3-centimeter-long anterior osteophytic spur, originating from C6. Evaluation with barium swallow showed a dislocation of the inferior cervico-oesophagus to the right, with a preservation of its lumen. Cervical-thoracic computed tomography showed a mild pressure produced by the osteophyte on the thyroid cartilage and the presence of the radiological criteria for Forestier's disease. Therefore, the presence of dysphonia in older adults without any primary laryngeal cause, indicates a radiological study of the cervical-thoracic region, in order to discover cervical osteophytosis.- - - - - - - - - - ranking = 0.083333333333333keywords = pressure (Clic here for more details about this article) |
5/10. Inspiratory speech as a management option for spastic dysphonia. Case study.A case study is reported of a subject who has used inspiratory speech (IS) for 6 years as a means of overcoming the communication problems of long-standing adductor spastic dysphonia (ASD). The subject was studied to confirm his use of IS, determine the mechanisms of its production, investigate its effects on ventilatory gas exchange, and confirm that it was perceptually preferable to ASD expiratory speech (ES). Results showed that the production and control of a high laryngeal resistance to airflow were necessary for usable IS. voice quality was quantitatively and perceptually poor; however, the improved fluency and absence of phonatory spasm made IS the preferred speaking mode for both the listener and the speaker. Transcutaneous measurements of the partial pressures of oxygen and carbon dioxide in the subject's blood were made during extended speaking periods. These measurements indicated that ventilation was unchanged during IS, and that ventilation during ES was similar to the "hyperventilation" state of normal speakers. The reasons for the absence of phonatory spasm during IS are discussed, and the possibility of its use as a noninvasive management option for other ASD sufferers is addressed.- - - - - - - - - - ranking = 0.083333333333333keywords = pressure (Clic here for more details about this article) |
6/10. Vocal fold polyp in a professional brass/wind instrumentalist and singer.wind instrumentalists, especially brass players, and singers share common factors, including vocal tract shape, function and pressure, vocal fold opening and closure, breath vector of force and air flow rates. To understand the mechanism and function of the vocal folds with a pathological lesion, it is necessary to visualize the differing interactions of the vocal tract during wind and brass instrument playing and in singing. A school band director, singer, wind and brass instrumentalist, was referred by musician colleagues with intermittent dysphonia, aphonia, and inability to sing high notes. Simultaneous videolaryngoscopy, with and without stroboscopy, and external video examination were documented. An hourglass glottis with a sessile, cystic polyp of the left vocal fold were recorded and studied during phonation and the playing of 3 instruments. The techniques of glottic opening, closure, configuration and function varied with the type of instrument and phonatory function. singing was adversely affected by the vocal fold polyp but no harmful interaction occurred during wind/brass instrument playing. Down-stream loading in singers is at the laryngeal level and in wind/brass instrumentalists is at the embouchure. Preoperative voice therapy, phonomicrosurgery, and postoperative voice rest followed by voice therapy, succeeded in restoring her combined wind/brass instrumental and singing career.- - - - - - - - - - ranking = 0.083333333333333keywords = pressure (Clic here for more details about this article) |
7/10. dysphonia caused by Forestier's disease.A case of diffuse idiopathic skeletal hyperostosis (Forestier's disease) causing dysphonia as the presenting and only symptom is reported. The dysphonia is attributed to the mass effect in the hypopharynx and the mild pressure on the larynx. The bony mass anterior to the vertebral body is demonstrated by CT scan for the first time in the literature on Forestier's disease.- - - - - - - - - - ranking = 0.083333333333333keywords = pressure (Clic here for more details about this article) |
8/10. Stiffness of the vocal cord in dysphonia-its assessment and treatment.Due attention does not seem to have been paid to the problem of vocal cord stiffness in dysphonia, because it is extremely difficult to assess and to treat. Four illustrative cases are presented where the stiffness deviation was apparently involved in the dysphonia and successfully treated by laryngeal framework surgery. A breathy, high-pitched, and strained voice may be suggestive of very stiff vocal cords. Manual pressure on the thyroid cartilage in various manners during phonation can provide us with useful information about the stiffness of the cords, and indication for surgery. Surgical A-P shortening of the thyroid ala reduces the stiffness, while cricothyroid approximation increases it.- - - - - - - - - - ranking = 0.083333333333333keywords = pressure (Clic here for more details about this article) |
9/10. Psychogenic aphonia masking mutational falsetto.aphonia, originally due to laryngeal inflammation, became psychogenic and superimposed on the unstable pitch of adolescent voice change. We presumed that the aphonia was adopted as a means of dealing with peer pressure to maintain a high preadolescent pitch as well. Voice therapy was effective in alleviating both the aphonia and mutational falsetto. Clinicians should be alert to underlying mutational falsetto when confronted with an aphonic or dysphonic adolescent patient with no organic laryngeal pathologic condition.- - - - - - - - - - ranking = 0.083333333333333keywords = pressure (Clic here for more details about this article) |
10/10. Muscle tension dysphonia and spasmodic dysphonia: the role of manual laryngeal tension reduction in diagnosis and management.Excessive activity of the extralaryngeal muscles affects laryngeal function and contributes to a spectrum of interrelated symptoms and syndromes including muscle tension dysphonia and spasmodic dysphonia. Recognition of the role of extralaryngeal tension is helpful in ensuring proper diagnosis and selection of appropriate treatment. This report demonstrates the application of manual laryngeal musculoskeletal tension reduction techniques in the diagnosis and management of laryngeal hyperfunction syndromes. The manual technique consists of focal palpation to determine 1) extent of laryngeal elevation, 2) focal tenderness, 3) voice effect of applying downward pressure over the superior border of the thyroid lamina, and 4) extent of sustained voice improvement following circum-laryngeal massage. The clinical utility of this innovative approach is discussed.- - - - - - - - - - ranking = 0.083333333333333keywords = pressure (Clic here for more details about this article) |
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