Combined surgical medialization and nerve-muscle pedicle reinnervation for unilateral vocal fold paralysis: Improved functional results and prevention of long-term deterioration of voice

Including those patients that were the subject of our previous report in 1990 (1) a total of 52 patients with unilateral vocal fold paralysis have been managed by combined surgical medialization and nerve-muscle pedicle reinnervation. The technique has been modified only slightly since 1985, when the first such surgery was performed. Short- and long-term voice results determined by a panel of sophisticated listeners are reported, as well as details of patient selection and complications. Better functional results were noted than were observed with surgical medialization alone, and long-term deterioration of the voice improvement initially achieved was prevented with this technique.     

Clinical applications of electroglottography

Electroglottography (EGG) is a method to monitor the vibrations of the vocal folds by measuring the varying impedance to a weak alternating current through the tissues of the neck. The paper is an attempt to give a state-of-the-art report of how electroglottography is used in the clinic. It is based on a search of the pertinent literature was well as on an inquiry to 17 well known specialists in the field. The EGG techniques are described and limitations to the method are pointed out. Attempts to document voice quality by EGG are recognized and computerized methods to obtain information about vibratory perturbations and/or the vibratory frequency of the vocal folds are described. The author's personal conclusion is that the EGG signal is especially well suited for measurements of the glottal vibratory period. In the clinic such measurements are useful for periodicity analysis, as a basis for recording intonation contours, and to establish the characteristics of the voice fundamental frequency.     

Semi-invariants in surgery

A semi-invariant in surgery is an invariant of a quadratic Poincaré complex which is defined in terms of a null-cobordism. We define five such gadgets: the semicharacteristic, the semitorsion, the cross semitorsion, the torsion semicharacteristic, and the cross torsion semicharacteristic. We describe applications to the evaluation of surgery obstructions, especially in the odd-dimensional case.     

Is There an Effect of Dysphonic Teachers' Voices on Children's Processing of Spoken Language?

There is a vast body of literature on the causes, prevalence, implications, and issues of vocal dysfunction in teachers. However, the educational effect of teacher vocal impairment is largely unknown. The purpose of this study was to investigate the effect of impaired voice quality on children's processing of spoken language. One hundred and seven children (age range, 9.2 to 10.6, mean 9.8, SD 3.76 months) listened to three video passages, one read in a control voice, one in a mild dysphonic voice, and one in a severe dysphonic voice. After each video passage, children were asked to answer six questions, with multiple-choice answers. The results indicated that children's perceptions of speech across the three voice qualities differed, regardless of gender, IQ, and school attended. Performance in the control voice passages was better than performance in the mild and severe dysphonic voice passages. No difference was found between performance in the mild and severe dysphonic voice passages, highlighting that any form of vocal impairment is detrimental to children's speech processing and is therefore likely to have a negative educational effect. These findings, in light of the high rate of vocal dysfunction in teachers, further support the implementation of specific voice care education for those in the teaching profession.     

The effects of time constraints on phonatory stability in normally speaking adult women

Forty normally speaking women sustained /a/ five times in two conditions,untimed and timed. In the untimed condition, phonation began whenever the subject felt ready. The timed task required subjects to begin phonation as quickly as possible after the examiner's signal. Conditions were counterbalanced across subjects. Jitter and shimmer values were obtained on a Kay Elemetrics Computerized Speech Lab (Pine Brook, NJ). Three distinct patterns of change emerged for fitter and shimmer from the untimed to the timed condition, reflecting either decreases, increases, or no change in values. These changes in jitter and shimmer values across conditions are related to a reaction time model of “bias toward accuracy.”     

Arytenoid Cartilage Dislocation: A 20-year Experience

SUMMARY: Arytenoid cartilage dislocation is an infrequently diagnosed cause of vocal fold immobility. Seventy-four cases have been reported in the literature to date. Intubation is the most common origin, followed by external laryngeal trauma. Decreased volume and breathiness are the most common presenting symptoms. We report on 63 patients with arytenoid cartilage dislocation treated by the senior author (RTS) since 1983. Significantly more posterior than anterior dislocations were represented. Although reestablishing joint mobility is difficult, endoscopic reduction should be considered to align the heights of the vocal processes. This process may result in significant voice improvement even long after the dislocation. Strobovideolaryngoscopy, laryngeal electromyography, and laryngeal computed tomography (CT) imaging are helpful in the evaluation of patients with vocal fold immobility to help distinguish arytenoid cartilage dislocation from vocal fold paralysis. Familiarity with signs and symptoms of arytenoid cartilage dislocation and current treatment techniques improves the chances for optimal therapeutic results.     

The singing/acting voice in the mature adult

With years of training and performance, the mature vocal performer experiences less vocal changes with aging than does his/her age peer who is not a performer. We have considered, some physical problems that may adversely influence the voice of the older performer. With some awareness and effective management of these possible problems, the negative effects on the older performer's voice can be minimized.     

Genetics of Vocal Quality Characteristics in Monozygotic Twins: A Multiparameter Approach

The main purpose of this study was to determine the vocal quality characteristics among the 45 monozygotic cotwins (MT). As the performance of the voice is related to several genetically determined anatomical and physiological factors, the authors hypothesized that the vocal characteristics and the overall vocal quality by means of the Dysphonia Severity Index (DSI) will be identical in MT. An additional objective of this study was to determine whether sex and age influence vocal similarities in MT and to compare the voice characteristics of MT with the normative data of unrelated peers. As more environmental factors influence the aging of the voice, age-related differences were expected. No sex-related differences were expected. Subjective and objective assessment techniques determined the vocal quality. No significant differences were obtained, and most comparisons resulted in significant correlation coefficients. For the acoustic parameters jitter and shimmer only, no significant correlation coefficients could be obtained. It is clear that the perceptual voice characteristics, the laryngeal aerodynamic measurements of maximum phonation time (MPT), the vocal performances, and the overall vocal quality by means of the DSI are similar in MT. These vocal characteristics are not influenced either by the subjects' age or sex and are situated within the normative range of unrelated peers. To what extent other aspects (environment, anxiety, tension, etc) might play a role in the acoustical dimensions regarding frequency and amplitude perturbation, which were in the normal range, is a subject of further research.     

Functional impact of nodules: A case-comparison study

Patients diagnosed with nodules (NO = 40) in a large university hospital clinic and an age-stratum matched nondiseased group (ND = 200) described adverse outcomes of vocal impairment on work and work-related communications. NOs were significantly more likely than NDs to report symptoms of hoarseness (73% vs. 26%), high-note difficulty (70% vs. 20%), difficulty speaking with a lower voice (53% vs. 13%) and a tired voice (50% vs. 10%), and their greatest source of physical discomfort was associated with scratchiness (61% vs. 3%). The average number of symptoms was four in NOs and less than one in NDs. Nodule patients were most concerned about the effects their voice problem would have on their future career (78% vs. 24%) and 49% of NOS reported their voice problem had an adverse work effect in the past compared with 4% of NDs. Having a voice condition limited current job performance in 39% of the NO group but only in 2% of the ND group. The results suggest that a diagnosis of nodules plays a major role in disrupting careers and work activities and that available educational programs and additional research are needed for improving their functional ability and preventing adverse outcomes in the lives of individuals with voice disorders.     

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.