Paradoxical vocal fold movement: A case report

We present a case of one patient with respiratory stridor that was resolved by speech therapy. Paradoxical vocal fold movements were observed by flexible fiberoptic videolaryngoscopy in this patient during episodes of wheezing and dyspnea. Otherwise, normal vocal fold movement was observed in normal conditions of breathing (out of the crisis) and during phonation. Many different terms have been used to describe this entity in the literature, and it is crucial that clinicians recognize the subtle signs of functional stridor. Paradoxical vocal fold motion has to be considered as an important cause of respiratory disease. Its recognition and treatment are discussed in this report.     

Permanent medialization of the paralyzed vocal fold utilizing botulinum toxin and Gelfoam

The clinical picture of a paralyzed vocal fold often has the same appearance as a subluxated arytenoid, with anterior and medial displacement of the arytenoid and a foreshortened and lax vocal fold. Previous work by the authors has shown that a subluxated arytenoid may be permanently repositioned by reduction and selective injection of the intrinsic laryngeal musculature with botulinum toxin. The injection changes the forces within the larynx, allowing the arytenoid to be brought back to proper position on the cricoid cartilage. This concept has been extended to the paralyzed vocal fold. It has been noted that even a clinically paralyzed vocal fold has voluntary motor units that may still act on the arytenoid through residual action from the interarytenoid and synkinesis. These forces are significant enough to manipulate the arytenoid and, thus, the vocal fold, into its correct, adducted position. In this paper, the arytenoid is mobilized to free any fibrosis. The thyroarytenoid and lateral cricoarytenoid muscles are then injected to prevent any forward synkinetic pull on the arytenoid. Next, a Gelfoam injection medializes the vocal fold to create glottic closure. This rebalancing sufficiently positions the arytenoid, so that valvular function is permanently restored. In the ten patients studied for over 1 year, there was a 90% success rate as measured by videostroboscopy, phonation time, and V-RQOL analysis. There were no untoward complications. All the materials used are nonpermanent. The procedure does not limit other techniques from being performed at a later time.     

Discretizing the fold bifurcation—A conjugacy result

In the vicinity of fold bifurcation points, the time-h exact and the stepsize-h discretized dynamics are shown to be equivalent via a two-parameter family of conjugacies. The problem of optimal conjugacy estimates remains open. Dedicated to the memory of Professor Miklós Farkas     

Presentation of problem: Performance of jitter in discriminating between normal and dysphonic speakers

The data we deal with are acoustic feature values computed from speech signals produced by normal control speakers and speakers suffering from a laryngeal pathology. The problem is (i) to compare the discriminatory performance of a given acoustic feature with other features of the same family; (ii) to compare the performance of corresponding features in studies carried out on corpora which were not identical and which did not contain the same number of speakers; (iii) to express quantitatively the share of laryngeal pathologies which could be detected reliably by acoustic means alone. We propose to accomplish tasks (i) to (iii) by separating pooled control and risk groups on the basis of the acoustic feature values alone and by evaluating the quality of approximation of the original groups so realized. In order to evaluate this quality we compute a merit factor satisfying the following properties: (1) to be independent of the number of speakers contained in the pooled control and risk groups; (2) to increase and decrease linearly with the detection and false alarm rates, respectively; (3) to take on values between 0 (no discrimination at all) and 1 (perfect discrimination). We also address the question of the confidence one may have in the merit factor values so achieved, i.e. we describe a method of computing the probability that a merit factor value might have been realized by chance alone.     

Vocal fold nodules in adult singers: Regional opinions about etiologic factors, career impact, and treatment. A survey of otolaryngologists, speech pathologists, and teachers of singing

This study was undertaken to better understand current regional opinions regarding vocal fold nodules in adult singers. A questionnaire was sent to 298 persons representing the 3 professional groups most involved with the care of singers with vocal nodules: otolaryngologists, speech pathologists, and teachers of singing. The questionnaire queried respondents about their level of experience with this problem, and their beliefs about causative factors, career impact, and optimum treatment. Responses within and between groups were similar, with differences between groups primarily in the magnitude of positive or negative responses, rather than in the polarity of the responses. Prevailing opinions included: recognition of causative factors in both singing and speaking voice practices, optimism about responsiveness to appropriate treatment, enthusiasm for coordinated voice therapy and voice training as first-line treatment, and acceptance of microsurgical management as appropriate treatment if behavioral management fails.     

基于大鼠背部视窗显微观测的微血管网的三维重建

微循环是循环系统中最基层的结构和功能单位,它在保持人体正常生理功能中占有突出地位,许多疾病的发生也是从微循环开始. 因此,利用脊背视窗技术,并通过体视显微镜观察视窗内的血管结构, 进一步对所获血管图像进行一系列图像处理,得到了血管边界和中心线等结构信息. 同时,根据血管分叉处相贯线的信息确定分叉血管的连接方式. 在网格划分时,采用了改进的超限插值算法,构建了三维血管网的有限元网格模型,实现了对任意分支血管网的三维重建. 为微循环的体外实验和数值分析奠定基础.      

Phonomicrosurgical management of vocal fold polyps: The subepithelial microflap resection technique

Vocal fold polyps are typically caused by acute and chronic trauma to the microvasculature of the superficial lamina propria (SLP). Shearing stresses that are induced by hyperfunctional glottal sound production lead to bleeding into the SLP and malformed neo-vascularized masses. Because the primary process does not involve the epithelium, the authors designed a technique to resect hemorrhagic polyps by epithelial cordotomy with partial or complete preservation of the vocal fold epithelium. This approach is different from the traditional microsurgical resection of hemorrhagic polyps by amputation with or without the carbon dioxide laser. Forty patients who underwent microlaryngoscopic resection of hemorrhagic polyps from 1996 through 1998 were reviewed retrospectively. Thirty-six of the 40 procedures were by epithelial cordotomy and subepithelial removal of the polyp contents. Sixteen of 36 were assisted by a subepithelial infusion of saline and epinephrine, and all were 3 mm to 6 mm. Four of 40 polyps were amputated; all of these were less than 3 mm and were pedicled on a narrow base. Cold instruments were used exclusively in all 40 patients. Postoperative laryngeal stroboscopy within 2 weeks revealed improved mucosal wave propagation and improved glottal closure in all 33 patients in whom postoperative strobovideolaryngoscopy was available. The epithelial cordotomy technique was introduced to minimize disturbance of normal SLP and epithelium. Despite the hemorrhagic nature of these lesions, cold instruments could be used exclusively with facility due to careful microdissection between the polyp and the residual normal SLP and the enhanced hemostasis provided by the subepithelial infusion of saline and epinephrine. The rapid return to improved glottal function is the result of this ultra tissue-sparing technique.     

Non-covalent Surface Interactions between Silicone and Biological Macromolecules Yield Bioreactive Substances

While most organometallics enter the en- vironment through their industrial release, silicones are organometallic compounds purposefully introduced in high volume directly into healthy humans. A chemically centered study of the behavior of silicones in the biological environment reveals numerous de- gradative reactions and surface interactions that can produce bioreactive substances. Data from a variety of disciplines suggest that the preponderance of evidence supports the argument that silicone is a toxic organometallic. © 1997 by John Wiley & Sons, Ltd.