Analysis of Voice and Quantitative Measurement of Glottal Gap After Thyroplasty Type I in the Treatment of Unilateral Vocal Paralysis

Thyroplasty type I is one of several surgical treatments in which improving the voice of unilateral vocal fold paralysis is the ultimate objective. The goal of the surgery is the medialization of the paralyzed vocal fold. The purpose of this study is to evaluate the effectiveness of thyroplasty type I through acoustical analysis, aerodynamic measures, and quantitative videostroboscopic measurements. We report on 20 patients with unilateral vocal cord paralysis who underwent thyroplasty type I. We performed preoperative and postoperative video image analysis (normalized glottal gap area) and computer-assisted voice analysis (fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, mean phonation time, mean flow rate, mean subglottic pressure) in all patients. The glottal gap was significantly reduced after thyroplasty type I. Postoperative voice quality was characterized by an improved pitch and amplitude pertubation (jitter and shimmer), phonation time (mean phonation time), and subglottic pressure (mean subglottic pressure). Thyroplasty type I is an effective method for regaining glottal closure and vocal function.     

Vocal Nodules and Laryngeal Morphology

Our purpose was to study the occurrence of vocal fold nodules under conditions of habitual vocal abuse associated with increased laryngeal muscle tension, to identify the existence of a relationship between vocal nodules and laryngeal morphology. We studied one group of 30 subjects with vocal nodules, 18 to 50 years old, who were compared with two control groups, one of females and one of males, consisting of 30 subjects each. The parameters evaluated were: type of vocal folds coaptation, glottic proportion (GP) and abduction angle (AA), obtained by videotelelaryngoscopy. In the nodules group, the larynges presented a mean value of GP similar to that of the female group, both of which were lower than the mean GP value of the male group. On the other hand, the mean AA was lower than the one in the female group, and closer to the one in the male group. We concluded that vocal nodules were present only in larynges with a predominantly young female morphology, with functional limitations of abduction.     

Electrophysiologic monitoring of the recurrent laryngeal nerves may not predict bilateral vocal fold immobility after thyroid surgery

Two cases of bilateral vocal fold immobility (VFI) after identification and preservation of the recurrent laryngeal nerves (RLNs) required tracheotomy until vocal fold recovery. The first patient underwent thyroid surgery without preoperative or postoperative evaluation of the vocal folds, administration of postoperative intravenous steroids, or electrophysiologic monitoring of the RLNs, whereas the second patient underwent a thyroid procedure in which all of the aforementioned were executed. Preoperative and postoperative clinical evaluation of the RLNs is strongly suggested in patients undergoing thyroid surgery, especially revision surgery. Patients potentially undergoing total thyroidectomy should be counseled about the remote chance of airway obstruction and should be properly selected for this operation. Subclinical stretching of the RLNs or ischemia from the endotracheal tube cuff can result in unilateral VFI, and rarely bilateral VFI, requiring reintubation, tracheotomy, or vocal fold lateralization. Electrophysiologic monitoring may not always predict bilateral VFI.     

Laryngeal Gestures During Stop Production Using High-Speed Digital Images

On acoustic and fiberscopic studies of stop consonants, voice onset time and glottal width have been shown to be greatest in heavily aspirated stops, next greater for slightly aspirated stops, and least for unaspirated stops. Integrated activity of the thyroarytenoid and posterior cricoarytenoid muscles has been reported to be involved in differentiating aspirate characteristics of the stops. However, the fine movement of mucosal edges of vocal folds during the production of stops has not been well documented. In recent years, a new method for high-speed digital recording of laryngeal dynamics has made this possible. In the current study, the movements of vocal fold edges were documented during the period of stop production using a fiberscopic system of high-speed digital images. By observing the glottal width and the visual vibratory movements of vocal folds before voice onset, the heavily aspirated stop was characterized as being more prominent and dynamic than the slightly aspirated and unaspirated stops.     

Hyaluronic Acid: Its Role in Voice

The extracellular matrix (ECM), once regarded simply as a structural scaffold, is now recognized as an important modulator of cellular behavior and function. One component that plays a prominent role in this process is hyaluronic acid (HA)--a molecule found in many different tissues. Research into the roles of HA indicates that it plays a key role in tissue viscosity, shock absorption, and space filling. Specifically, research into the role of HA in laryngology indicates that it has profound effects on the structure and viscosity of vocal folds. This article provides an introduction to the structure and biological functions of HA and its importance in voice. In addition, an overview of the pharmaceutical applications of HA is discussed.     

Tests of significance using selected sample quantiles

Large sample tests of significance for the location parameter, the scale parameter, and quantiles for a location-scale family of distributions based on a few optimally chosen sample quantiles are considered.     

Reactions of 4-chloroacetoacetic esters with thioureas

Several heterocyclic acetic acids and esters were synthesized by allowing the appropriate thiourea, ethylenethiourea or trimethylenethiourea to react with 4-chloroacetoacetic esters, followed by acid hydrolysis to the hydrochlorides of the free acids. Both esters and acids of 2-aminothiazole-4-acetic acid, 5,6-dihydro-imidazo[2,1-b]thiazole-3-acetic acid and 6,7-dihydro-5H-thiazolo[3,2-c]pyrimidine-3-acetic acid were obtained.     

Direct observation of the gas-phase Criegee intermediate (CH2OO)

Carbonyl oxide species play a key role in tropospheric oxidation of organic molecules and in low-temperature combustion processes. In the late 1940s, Criegee first postulated the participation of carbonyl oxides, now often called "Criegee intermediates," in ozonolysis of alkenes. However, despite decades of effort, no gas phase Criegee intermediate has before been observed. As a result, knowledge of gas phase carbonyl oxide reactions has heretofore been inferred by indirect means, with derived rate coefficients spanning orders of magnitude. We have directly detected the primary Criegee intermediate, formaldehyde oxide (CH2OO), in the chlorine-initiated gas-phase oxidation of dimethyl sulfoxide (DMSO). This work not only establishes that the Criegee intermediate is formed in DMSO oxidation also but opens the possibility for explicit kinetics studies on this critical atmospheric species.     

Synthesis, structures and reactivity of group 4 hydrazido complexes supported by calix[4]arene ligands

Reaction of TiCl(2)(Me(2)Calix) with 2 equiv of LiNHNRR' afforded the corresponding terminal hydrazido(2-) complexes Ti(NNRR')(Me(2)Calix) (R = Ph, R' = Ph (1) or Me; R = R' = Me (3)) which were all structurally characterized. The X-ray structure of Ph(2)NNH(2) is reported for comparison. Compound 1 was also prepared from Na(2)[Me(2)Calix] and Ti(NNPh(2))Cl(2)(py)(3). Reaction of ZrCl(2)(Me(2)Calix) with 2 equiv of LiNHNR(2) afforded only the bis(hydrazido(1-)) complexes Zr(NHNR(2))(2)(Me(2)Calix) (R = Ph or Me). Treatment of Ti(NNMe(2))(Me(2)Calix) (3) with MeI gave the zwitterionic hydrazidium species Ti(NNMe(3))(MeCalix) (6) via a net isomerization reaction which was found to be catalytic in MeI. The corresponding reaction of 3 with CD(3)I gave Ti(NNMe(2)CD(3))(MeCalix) (6-d(3)) with concomitant elimination of MeI. Reaction of 3 with 1 equiv of MeOTf gave [Ti(NNMe(3))(Me(2)Calix)][OTf] (7-OTf) which in turn reacted with (n)Bu(4)NI to form 6 and MeI. Addition of PhCHO to 3 gave the mu-oxo dimer [Ti(mu-O)(Me(2)Calix)](2) and benzaldehyde-dimethylhydrazone. Reaction of either 3 or 6 with (t)BuNCO gave the zwitterionic species Ti{(t)BuNC(NNMe(3))O}(MeCalix) (10) which has been crystallographically characterized. Compound 10 is the formal product of insertion of an isocyanate into the Ti=N(alpha) bond of a titanium hydrazide or hydrazidium species (Me(2)Calix or MeCalix = dianion or trianion of the di- or monomethyl ether of p-tert-butyl calix[4]arene, respectively).