Strobovideolaryngoscopic Findings in Singing Teachers

Professional voice users often present to otolaryngologists and laryngologists with specific voice complaints. The contributions of pathologic lesions to the patients' vocal complaints are not always clear on examination, and often, premorbid examinations of the larynx are not available for review. This study examines the incidence of laryngeal pathology among singing teachers. At a national convention of singing teachers, volunteers were recruited for a "free strobovideolaryngoscopic examination." All volunteers completed a detailed questionnaire of their vocal and medical history and underwent strobovideolaryngoscopic examination. Strobovideolaryngoscopic examinations were completed in 20 volunteers, 7 of whom had voice complaints and 13 of whom perceived their voices to be normal. Vocal fold masses were common among the asymptomatic singing teachers. Evidence of reflux laryngitis was a common finding among both symptomatic and asymptomatic singing teachers. Asymmetries in vocal fold hypomobility were more common among those with voice complaints than was the presence of vocal fold masses in the population studied.     

Melting behavior of ethylene oxide–propylene oxide (sym-PEP) block copolymers

Melting points and lamellar thicknesses have been measured for ethylene oxide–propylene oxide block copolymers (sym-PEP) with central poly(ethylene oxide) block lengths of 70–100 chain units and end poly(propylene oxide) block lengths of 0–30 chain units. Melting points of the block copolymers are lower than those of the corresponding poly(ethylene oxide) homopolymer by an amount (up to 15°C) which increases as the poly(propylene oxide) block length increases. Most samples have more than one melting transition, which can be assigned to variously folded chain crystals. End interfacial free energies σ_e for the various crystals have been estimated by use of Flory's theory of melting of block copolymers. For a given crystal type (e.g., once-folded-chain) σ_e is higher the longer the chain length of the end poly(propylene oxide) blocks. For a given copolymer σ_e is lower, the more highly folded the poly(ethylene oxide) chain.     

The crystallization of poly(ethylene oxide) fractions: Temperature dependence of growth rate

The crystallization rates of fractions of poly(ethylene oxide) have been studied micro-scopically and dilatometrically. Nucleation theory has been adapted to take account of the finite molecular weight and the molecular weight distribution of the fractions. It is found that the free energy of formation of the end interface of the nucleus is practically independent of molecular weight over the range studied (1,500–600,000).     

A moments approach for omitted variables in residential histories and other panel data

This paper reviews the problems of omitted variables in panel data analysis. Results obtained from previous analyses have been shown to be sensitive to the particular parametric forms assumed for the distribution of omitted variables. An alternative non‐parametric approach is described in which the effects of omitted variables enter the model through the non‐central moments of an error term distribution. A reparametrisation ensures that the constraints on the moments of a probability distribution are not violated. The model is applied to data on the residential mobility history of a sample of households in Cardiff, Wales.     

Comparison between homotopy analysis method and optimal homotopy asymptotic method for nth‐order integro‐differential equation

This paper presents general framework for solving the nth‐order integro‐differential equation using homotopy analysis method (HAM) and optimal homotopy asymptotic method (OHAM). OHAM is parameter free and can provide better accuracy over the HAM at the same order of approximation. Furthermore, in OHAM the convergence region can be easily adjusted and controlled. Comparison, via two examples, between our solution using HAM and OHAM and the exact solution shows that the HAM and the OHAM are effective and accurate in solving the nth‐order integro‐differential equation. Copyright © 2011 John Wiley & Sons, Ltd.     

Harmful Substances on the Opera Stage: Possible Negative Effects on Singers'' Respiratory Tracts

Objective, quantitative information is lacking in the medical community about actual working conditions for professional singers onstage, and moreover, about which conditions are safe. Physicians, speech-language pathologists, and speech scientists focusing on laryngology should have relevant information about the opera as workplace and the medical sequelae of unhealthy environments. We describe five toxic substances to which singers presenting to our clinics were exposed while working professionally on the opera stage: (1) aromatic diisocyanates, (2) penicillium frequentans in cork granulate, (3) formaldehyde in cork granulate, (4) cobalt and aluminum (pigment components), and (5) quartz sand capable of entering the alveolae. Biological considerations and clinical data for some subjects suggest a direct causal link between the exposures and the patients' complaints and findings. Our observations suggest that whenever singers complain about deleterious conditions such as dry and hot onstage climate or suspicion of the presence of harmful substances, the specific conditions existing in the theater in question should be investigated. Harmful substances are not only poorly tolerated by singers, but also they should be preventable.     

Laryngeal and Vocal Changes During Vagus Nerve Stimulation in Epileptic Patients

Left vagus nerve stimulation (VNS) by means of an implanted electrode has proven to reduce seizure frequency in epileptic patients with medically refractory seizures. This technique is now widely applied over the world. Voice changes appear to be one of the major side effects. The morphodynamic changes in the larynx and the acoustic impacts have been analyzed in detail in 7 implanted patients. Basic vagus stimulation is well tolerated. Extra stimulation induces an adductory spasm of either the ipsilateral vocal fold or the vestibular fold. The result, when the patient phonates, consists of a slight increase of F0 as well as a moderate increase of random period perturbation, but there is no evidence for the occurrence of "bifurcations." Further, as the glottic closure remains sufficient, there is no increase in turbulent noise. The lack of increase in turbulent noise and the lack of "bifurcations" appears to clearly differentiate a spasmodic contraction of the vocal cord from a unilateral vocal fold paralysis.     

Bilateral Vocal Fold Posterior Glottic/Subglottic Stenotic Web Resected with Contact Tip Nd-YAG Laser

The standard treatment for respiratory failure remains endotracheal intubation, with periods of 22 or more days being commonplace. Posterior glottic stenotic web formation, from scarring in the posterior interarytenoid area, may occur after endotracheal intubation, thermal, corrosive, or direct surgical injury. A commonly used classification system for posterior glottic stenosis divides the occurrence into four types. Type I involves an interarytenoid scar band between the vocal folds that is anterior and separate from the posterior interarytenoid mucosa. Type II stenosis involves scarring of the mucosa or musculature of the posterior interarytenoid area. Types III and IV involve unilateral and bilateral cricoarytenoid joint fixation, respectively. Strobovideolaryngoscopy (SVL), rigid and flexible fiberoptic bronchoscopy, electromyography (EMG), radiologic imaging of the neck, larynx, and trachea as well as pulmonary function tests, including flow volume loops, provide important objective measurements of upper airway obstruction. A representative case of a professional voice user who suffered a Type II posterior glottic stenosis is presented. The treatment utilized a specific contact-tip neodymium-yttrium aluminum garnet (Nd-YAG) laser delivery system to achieve precise cutting, vaporization, and coagulation simultaneously, returning tactile touch technique to the airway/voice surgeon. Completely successful restoration of voice and airway have been maintained for 2 1/2 years postoperatively.