1/279. Effects of systematized vocal warm-up on voices with disorders of various etiologies. This investigation studied the effect of a systematized vocal warm-up procedure on voices with disorders. There were 4 subjects with voice disorders. To optimize vocal function a systematized vocal warm-up system was developed by the author for singers and nonsingers alike. Subjects were asked to practice the vocal warm-up exercises daily, with weekly monitoring in the studio. Data from independent raters and subjects' self-ratings were compared to and corroborated with computer analysis of audio samples. Results indicated significant improvement in subjects' voices that were increasingly maintained over time. ( info) |
2/279. diagnosis and physiopathology of laryngeal deposits in autoimmune disease. We report the clinical features and pathology of a previously unreported form of vocal fold disease seen in 4 patients, 3 of whom were diagnosed as autoimmune disease. The characteristic features of these lesions were found as bilateral transverse lesions in the mid portion of the vocal folds. The patients had dysphonia and diplophonia. Stroboscopic examinations showed 180-degree phase shifts between the anterior and posterior portion of the vocal folds. Case 1 had systemic lupus erythematosus, case 2 had Hashimoto's thyroiditis, and case 3 had progressive systemic sclerosis. Prior to the onset of hoarseness, autoimmune antibody titers were increased. These cases need differential diagnosis from vocal fold nodules and cysts. Two cases were recurrent after endoscopic surgery, 1 recurring 3 times. Glucocorticoid was effective in preventing the recurrence in the early phase. recurrence may have occurred because the surgical strategy was the same as that used for vocal fold nodules or cysts. ( info) |
3/279. Clinical course of acute laryngeal trauma and associated effects on phonation. We report the clinical course of blunt laryngeal trauma in three young patients. All three patients underwent several phoniatric examinations as well as indirect microlaryngoscopy and microstroboscopy. The follow-up period ranged from three to eight months. In the first case, there was isolated haemorrhage of the left vocal fold; in the second, dislocation of the arytenoid cartilage with formation of an adhesion in the area of the anterior commissure; and, in the third, non-dislocated fracture of the thyroid cartilage with development of haematoma in the right hemilarynx and transient vocal fold paralysis. One patient required surgical treatment; however, repositioning of the arytenoid cartilage, attempted seven weeks following the injury, proved unsuccessful. In conclusion, all three patients showed significant limitation of vocal fold vibration many months after trauma which was unrelated to the extent of resulting tissue damage. In all three cases, patients developed secondary posttraumatic functional dysphonia requiring treatment. ( info) |
4/279. Goitre presenting as an oropharyngeal mass: an unusual finding in the elderly. Thyroid goitre presentation in the neck with extension inferiorly to the mediastinum is well-known. Extension superiorly into the retropharyngeal space is very rare and may be accompanied by change in voice and/or airway compromise. A case is described of a patient with change in voice and mild airway compromise secondary to a goitre presenting in the oropharynx. Computed tomography (CT) and physical findings are discussed with the need to recognize this rare entity. ( info) |
5/279. Botox for hyperadduction of the false vocal folds: a case report. We present a patient with severe hyperadduction of the false vocal folds (FVF) treated with Botulinum Toxin injections to each FVF. This patient presented with severe dysphonia and was found to demonstrate severe hyperadduction of the FVF's with all phonatory tasks. The patient was treated with extensive speech therapy without improvement in voice quality nor FVF motion pattern. He was then injected with Botox A bilaterally using a peroral approach to the FVFs. Shortly after treatment the patient experienced dramatic improvement in voice quality. Videolaryngoscopy revealed no adduction of the FVFs with phonation and essentially normal true vocal fold motion. He remained with normal voice quality one year after treatment without any further treatment. Possible mechanism of action of this type of treatment are discussed. ( info) |
6/279. The effects of excessive vocalization on acoustic and videostroboscopic measures of vocal fold condition. Although dysphonia is a recognized consequence of acute vocal abuse, associated changes in vocal fold appearance and function are not well understood. To document these presumed effects of vocal abuse, audio recordings of sustained vowel production were obtained from 42 drill sergeants daily during the first 6 days of a vocally demanding training exercise. Acoustic analysis showed abnormal levels of jitter and shimmer on Day 1 in 16 of the 42 subjects. Considering only the 26 subjects who showed normal voice acoustics on Day 1, the median levels of jitter and shimmer varied little over the course of training, and significant increases in jitter and shimmer were not seen during the study period. However, the distributions for both jitter and shimmer became more positively skewed and showed a greater number of positive outliers over the course of training. This trend was attributed to 11 subjects who showed two or more instances of abnormal voice acoustics over Days 2 through 6. Laryngeal videostroboscopic recordings of sustained vowel production also were obtained prior to and following training. Perceptual ratings of these recordings by 2 observers revealed significant increases in vocal fold edema, erythema, and edge irregularity, and decreases in vocal fold mucosal wave and amplitude of excursion following the 5-day training period. In general, there was considerable intersubject variability in the extent of acoustic and videostroboscopic effects over the course of training. Of the two types of data, videostroboscopy appears to provide a more sensitive indication of the effects of excessive vocalization. ( info) |
7/279. Treatment of Parkinson hypophonia with percutaneous collagen augmentation. OBJECTIVES: It has been estimated that more than 70% of patients with parkinson disease experience voice and speech disorders characterized by weak and breathy phonation, and dysarthria. This study reports on the efficacy of treating Parkinson patients who have glottal insufficiency. STUDY DESIGN AND methods: Thirty-five patients underwent collagen augmentation of the vocal folds for hypophonia associated with parkinson disease, using a new technique of percutaneous injection with fiberoptic guidance. Patient response to the collagen augmentation was determined by telephone survey. RESULTS AND CONCLUSIONS: The procedure required minimal patient participation and was safely performed on all the patients who were studied. Results of the survey indicated that 75% of patient responses demonstrated satisfaction with the technique, compared with 16% of patient ratings reflecting dissatisfaction. These results were moderately correlated with the duration of improvement of the dysphonia. Results of this preliminary evaluation demonstrate that voice deficits in parkinson disease are amenable to vocal fold augmentation. Because this procedure requires minimal patient participation and can be safely performed in an office setting, it may also be useful in other severely debilitating neuromotor diseases that result in glottal insufficiency and hypophonia. ( info) |
8/279. Laryngeal scleroma. Respiratory scleroma is a chronic, progressive granulomatous disease of the respiratory tract. The causal organism is the klebsiella rhinoscleromatis. The disease has three stages: the initial catarrhal stage, granulomatous stage, and sclerotic stage. The object of this report was to determine the clinical behaviour of the laryngeal scleroma. The study included 17 patients with this manifestation characterized by airway obstruction and dysphonia. The report revealed that respiratory scleroma affected the larynx in 40%, and the principal findings were glottic/subglottic stenosis. ( info) |
| Currently there are several instruments that provide technological support for the treatment of patients with voice disorders. In this article, specific disorders are discussed along with the technologies that can be utilized to augment treatment. Not all forms of voice disorder can be covered, but representative samples from the major categories should provide sufficient information to encourage generalization to types that are not discussed. ( info) |
10/279. A deaf woman learning to control her excessive vocal loudness through a portable feedback system. A deaf woman learned to control her excessive vocal loudness through a portable feedback system, which provided vibratory stimulation when her voice was too loud. The mean percentage of excessively loud talking decreased from 45 prior to the use of feedback to 3 during the use of feedback. This improvement (documented by formal observation) was confirmed by normally hearing people sharing the work environment with the woman. The woman preferred a system with a contact microphone since this was virtually unaffected by environmental noise. ( info) |