Tongue position in Mandarin Chinese voiceless stops.

The current study explores whether Mandarin initial and medial voiceless unaspirated and voiceless aspirated stops differ in their tongue positions and post-vocalic voicing during closure. Ultrasound tongue imaging and acoustic data from five Mandarin speakers revealed (1) no consistent pattern for tongue positions among speakers, and (2) no difference in degree of voicing during closure between the two stop series. These findings suggest that tongue position is not a reliable articulatory correlate for Mandarin laryngeal contrasts. This further suggests that aspiration is not correlated with tongue position differences, unlike the reported correlation between voicing and tongue root advancement.

The efficiency of the DoctorVox voice therapy technique in conversion dysphonia and aphonia.

OBJECTIVE: The main purpose of this study was to retrospectively evaluate the efficiency of DoctorVox voice therapy in psychogenic dysphonia or aphonia patients, and to share the mid- to long-term results of the method. METHODS: The study was carried out on patients who underwent DoctorVox voice therapy for psychogenic dysphonia or aphonia between January 2015 and September 2019. The evaluation methods used were: the Voice Handicap Index-10; the grade, roughness, breathiness, asthenia and strain ('GRBAS') scale; and videolaryngostroboscopy recordings. RESULTS: The mean Voice Handicap Index-10 values of the patients were 30.91 ± 2.97 before treatment, 8.14 ± 3.82 after treatment, and 3.36 ± 1.78 in the final follow-up examination. The grade, roughness, breathiness, asthenia and strain scale scores were: 9 ± 0.67 pre-treatment, 0.78 ± 0.80 post-treatment, and 0.57 ± 0.64 at the final follow up. CONCLUSION: DoctorVox voice therapy seems to be an efficient treatment method for psychogenic dysphonia or aphonia; it helps develop phonatory muscle functions, using multidimensional biofeedback mechanisms, and increases the patients' therapy adherence.

[Voice disorders associated with novel coronavirus infection]. / Narusheniya golosa u patsientov posle perenesennoi novoi koronavirusnoi infektsii.

OBJECTIVE: To evaluate the features of voice disorders associated with novel coronavirus infection and to develop the clinical algorithm for diagnostic and treatment these patients. MATERIAL AND METHODS: A prospective observational study was conducted in patients with dysphonia after COVID-19 (n=60). All patients underwent a comprehensive voice assessment before and after the proposed treatment. The follow-up period was 1 month. RESULTS: Functional dysphonia or aphonia with a stable (refractory) or recurrent course was diagnosed in 58 (97%) patients. A tendency to an increase in the value of the latent period of the P300 and MMN in patients with voice disorder was revealed. There was a significant decrease in supraglottic constriction and glottal insufficiency before and after the treatment. The mean VHI-10 decreased from 25.4 before treatment to 15.3 after treatment. The DSI which is based on the set of voice measurements, statistically significant improved from -5.2 to 2.6 in patients as a result of treatment. The average value of MFI-20 improved from 65.4 (8.7) at the beginning of the study to 20.3 (5.3) after treatment. CONCLUSION: In patients with dysphonia or aphonia associated with COVID-19 are indicated a refractory type of dysphonia. This was indicated by the study of AEPs of the brain. The clinical algorithm for treatment and diagnostic patients with voice disorders after COVID-19 has been developed. The treatment of this group of patients should be adjunct by the drug therapy, kinesiotaping method and psychotherapy.

Acoustic correlates of Burmese voiced and voiceless sonorants.

Voiceless sonorant consonants are typologically rare segments, appearing in only a few of the world's languages, including Burmese. In this study, Burmese sonorants and their adjacent vowels are investigated in an attempt to (1) determine what acoustic correlates distinguish voiced and voiceless sonorants and (2) determine whether there are multiple realizations of voiceless sonorants and, if so, establish what acoustic correlates distinguish them. In order to pursue these questions, a production study was carried out and target words were analyzed, demonstrating that Burmese voiceless sonorants have a spread glottis period resulting in turbulent airflow 78 % of the time. Findings from linear mixed-effects models showed that voiced and voiceless sonorants are significantly different in terms of duration of the sonorant, F0 of the sonorant, and strength of excitation measured over the following vowel. A linear discriminant analysis was able to predict voicing category with 86.7 % accuracy, with the duration of the spread glottis period being the best indicator of voicelessness, followed by the cues that were significant in the linear mixed-effects models. In cases when the spread glottis period is absent from voiceless sonorants, the sonorant only has correlates that are associated with voicelessness (such as F0 and strength of excitation) but not correlates that are associated with the spread glottis gesture (such as duration and harmonics-to-noise ratio). These results have implications both for our understanding of the acoustics of Burmese sonorants and for our understanding of voiceless sonorants more generally.

A case of atopic cough with aphonia showed a prominent response to a histamine H1 receptor antagonist.

A 33-year-old woman admitted to our hospital for further examination of severe non-productive cough lasting for about two months. Her symptom did not ameliorate by treatments including long acting ß2 agonists. She had a medical history of drug allergy to non-steroidal anti-inflammatory drugs. At the initial visit, she could not speak at all and communicated with us in writing. Chest auscultation revealed no wheezes, rhonchi and other crackles. Laboratory findings showed a mild eosinophilia with normal total and specific serum immunoglobulin E. The results of an electrocardiogram, a chest X-ray and a chest CT were unremarkable. A fractional exhaled nitric oxide value was within normal limit. Based on these observations, a diagnosis of atopic cough (AC) was suspected, and we started treatment with a histamine H1 receptor antagonist (H1-RA). She had become able to speak again in association with complete disappearance of cough by eight-weeks after treatment initiation, and her symptoms did not recur even after cessation of treatment. By the confirmation of remarkable clinical improvement in response to a H1-RA, a diagnosis of AC was made. To the best of our knowledge, this is the first report of an AC patient who presented severe cough with aphonia. J. Med. Invest. 70 : 281-284, February, 2023.

Convergence to shortened and lengthened voice onset time in an imitation task.

Convergence to variation in voice onset time (VOT) of English voiceless stops is reported to be selective, with speakers adjusting their VOTs after exposure to stimuli with lengthened, but not shortened, VOT. The current study re-examined this proposed selectivity with an explicit imitation paradigm designed to maximize convergence, using stimuli with more extreme differences, and explored the perceptual salience of the differences in a discrimination task. Participants showed phonetic convergence to both shortened and lengthened VOT, and better discrimination of shortened than lengthened VOT. Results suggest that there is no general constraint against convergence to shortened VOT.

Post-Operative Conversion Aphonia in a Pediatric Patient: A Case Report.

We describe an unusual case of post-operative conversion aphonia in a pediatric patient. It indicates the importance of discussing its presentation, and amplifies the need for emotional support in the immediate post-operative period for young patients with heightened anxiety. Laryngoscope, 133:1737-1738, 2023.

[Case Report: Broca's Aphasia in a Left-Handed Patient with a Right Brain Infarction and Early Stage Aphonia].

We report a case of Broca's aphasia in a left-handed patient with a right brain infarction. The patient's speech is consistent with a particular type of aphemia, that is, without vocalization except for a few phonemes or words. The patient presented with aphonia in an early stage. The lack of speech could be due to the impairment of the phonological-speech process or speech initialization. This type of aphemia has been reported to involve the right inferior precentral gyrus or right middle and inferior frontal gyri. Our patient had both lesions. The symptom and the lesion of this type of aphemia could differ from those of another type of aphemia corresponding to apraxia of speech, and the speech of Broca's aphasia could have multiple mechanisms. Our case shows Alexander's anomalous type with atypical lateralization and distribution of the lesion. Verbal intrahemispheric dissociation apraxia was suspected in our patient. The coexistence of aphasia, anosodiaphoria of hemiplegia is a dual symptom in which bilateral hemispheric functions exist in a unilateral hemisphere. (Received 1 December, 2021; Accepted 1 February, 2022; Published 1 April, 2022).

Aphonia Following Bilateral Cervical Plexus Blocks for an Awake Hemithyroidectomy: A Case Report.

A 35-year-old female patient was scheduled for a left hemithyroidectomy. We performed bilateral cervical plexus blocks with ultrasound guidance for an awake thyroidectomy. Soon after the blocks, she developed a weak voice, which gradually progressed to complete aphonia. Due to her apprehension, general anesthesia was administered. After an uneventful surgery, the patient spontaneously regained her normal voice in the postoperative period. The case report describes a previously unreported complication of aphonia presumably due to bilateral recurrent laryngeal nerve blocks, which might have occurred from the infiltrated local anesthetic extravasating to the deeper planes through the cervical fascia.

The use of predefined scales and scores with eye-tracking devices for symptom identification in critically ill nonverbal patients.

BACKGROUND: Eye tracking (ET) may be a novel tool to enable nonverbal communication. We hypothesized that ET could be used successfully by intensive care unit (ICU) patients with artificial airways to express their levels of pain and mood, quality of life, and self-esteem with predefined scales and scores. METHODS: Prospective, monocentric, observational study, including patients with an endotracheal tube or tracheostomy tube and a history of mechanical ventilation for more than 48 hours without delirium, and inadequate nonverbal communication skills. The ICU patients' pain was assessed with a numeric rating scale, their mood was tested with a smiley analog scale. Quality of life and self-esteem were measured with the European quality of life-5 dimensions-5 levels-score and the visual analog self-esteem scale. RESULTS: A total of 75 patients with a mean age of 58.3 years were included. Main diagnoses for ICU admission were major trauma (45.3%), nonabdominal sepsis (22.6%), and acute abdomen (13.3%). Patients showed moderate levels of pain and sadness with a median of 4 (interquartile range, 3-5.5) on the numeric rating scale and a median of 4 (interquartile range, 3-4) on the smiley analog scale. The general health status on the European quality of life-5 dimensions-5 levels-score was rated as poor. Reporting on the visual analog self-esteem scale, most of the included patients felt trapped (90.7%) and not confident (72%), were frustrated (64%) or did not feel understood (56%). However, despite their severe illness, many patients classified themselves as intelligent (30.6%), not mixed up (38.6%), outgoing (38.6%), and optimistic (44%). CONCLUSION: Eye tracking enables symptom identification in critically ill voiceless patients with impaired communication options. The results of our study may provide guidance for improvement measures in the care of voiceless ICU patients. We believe that ET is useful for symptom identification and therefore may be capable of improving patient-medical team interaction and patient satisfaction. LEVEL OF EVIDENCE: Diagnostic Test or Criteria, Level III.

CoblationTM-assisted excision of suprastomal granulation tissue.

BACKGROUND: Suprastomal granulation tissue is a common complication of long-term tracheostomy. It may be associated with bleeding, aphonia, airway obstruction and delayed decannulation. METHODS: This study describes the experience of a tertiary paediatric medical centre with CoblationTM-assisted suprastomal granulation tissue excision. RESULTS: Thirteen children (mean age, 5.7 years) who underwent the procedure from 2013 to 2019 because of delayed decannulation or aphonia were included. Lumen obstruction ranged from 50 to 90 per cent, with a mean of 68.8 per cent. After the procedure, decannulation was successfully performed in 7 patients, and voice quality improved in 10 patients. There were no peri- or post-operative complications. CONCLUSION: This is the largest series to date that describes Coblation used for the treatment of suprastomal granuloma. Coblation has advantages of high precision, relatively low temperature (thereby avoiding thermal injury to adjacent tissue), haemostatic resection and feasibility for use for even large granulomas. The promising results should prompt further studies in larger samples.

Voice onset time and constriction duration in Warlpiri stops (Australia).

This paper presents a first detailed analysis of the Voice Onset Time (VOT) and Constriction Duration (CD) of stops /p t ʈ c k/ and flap /ɽ/ in the Indigenous Australian language Warlpiri as spoken in Lajamanu Community, in Australia's Northern Territory. The results show that Warlpiri stops are realised as voiceless, long-lag stops word-initially, as well as word-medially, where /p t k/ are also characterised by CDs in excess of 100 ms. This is similar to what has been reported for Kriol, and for the emerging mixed language Light Warlpiri, also spoken in the community, and by some of the participants. The results indicate that Warlpiri does not obligatorily make a word-medial distinction between stops orthographically represented by 'rt' and 'rd', which have previously been argued to be realised as /ʈ/ and /ɽ/, respectively, at least in some varieties of Warlpiri. Finally, the results also suggest that the realisation of word-initial Warlpiri flap /ɽ/ is highly variable, potentially resulting in a near-merger with /É»/.

THE TERMINAL APHONIA OF ALEXANDER THE GREAT, A SILENT HERALD OF AN ORDINARY DEATH

Even though the absence of the body prevents sure conclusions, the death of Alexander the Great remains a hot topic of retrospective diagnosis. Due to the serious mishandling of ancient sources, the scientific literature had Alexander dying of every possible natural cause. In previous works, the hypothesis that typhoid fever killed Alexander was proposed, based on the presence of the remittent fever typical of this disease in the narrations of Plutarch and Arrian. Here we provide additional evidence for the presence of stupor, the second distinctive symptom of typhoid fever. In fact, based on the authority of Caelius Aurelianus and Galen, we demonstrate that the word ἄφωνος, used to describe the last moments of Alexander, is a technical word of the lexicon of the pathology of Hippocrates. Used by him, the word defines a group of diseases sharing a serious depression of consciousness and motility. The association of stupor with the remittent fever strengthens the typhoid fever hypothesis.

Challenging Ethical Scenarios in the Surgical Treatment of Erectile Dysfunction: A Survey of High-Volume Penile Prosthesis Surgeons.

OBJECTIVE: To investigate how surgeons approach ethically challenging scenarios that arise in penile prosthesis surgery and identify patient-related factors that impact their approach. METHODS: A survey was distributed to the Society for Urologic Prosthetic Surgeons membership consisting of 6 ethically challenging scenarios: an HIV+ patient, a patient with cognitive disability, a registered sex offender, a nonverbal patient, a litigious patient, and an uncontrolled diabetic patient whose insurance will lapse soon. Additional clinical information was provided to assess how the likelihood to offer surgery might change. The primary outcome was the likelihood of offering surgery in each scenario. RESULTS: The response rate was 15.6% (n = 29). When compared to the baseline patient, respondents had a lower likelihood of offering surgery in all scenarios except the HIV+ patient, with the lowest likelihood of offering surgery to a sex offender (P < .01). Within each scenario, factors associated with an increased odds of offering surgery included knowledge that a patient with Down Syndrome is high functioning (odds ratio [OR] 5.0, confidence interval [CI]: 1.4-17.8), that a prior sex offender is currently married (OR 16.5, CI:3.5-99.8), that a litigious patient sued a surgeon for a retained sponge (OR 6.3, CI:1.7-24.3), and that a nonverbal patient had expressed prior interest in penile prosthesis surgery (OR 4.5, CI: 1.3-16.2). CONCLUSION: Ethical principles, including respect for autonomy, nonmaleficence, beneficence, and justice, are appropriately applied by urological prosthetic surgeons when ethical challenges arise. While the likelihood of offering penile prosthesis surgery is decreased with most ethical dilemmas, specific clinical factors often augment decision-making.

Rehabilitation Therapy for Vocal Fold Paralysis Caused by Lung Cancer: A Case Report.

OBJECTIVE: Unilateral vocal fold paralysis (UVFP) can be caused by iatrogenic injury or tumor-induced damage to the recurrent laryngeal nerve. Studies of comprehensive rehabilitation therapies for patients suffering from severe UVFP are limited. The purpose of this case report is to describe an improvement in complete aphonia after comprehensive rehabilitation therapies in a patient with severe UVFP due to a lung tumor. METHODS: An 81-year-old woman with a history of bronchial adenoma had complete aphonia due to compression of the left recurrent laryngeal nerve by the tumor. Dynamic fibrolaryngoscope revealed paralysis of the left vocal fold. The patient was treated with interferential current therapy, vocal training, and kinesiology taping. Indicators of voice recovery were scored according to the grade, roughness, breathiness, asthenia, strain scale, and the voice handicap index. RESULTS: After 10 days of comprehensive rehabilitation treatment, the patient recovered from complete aphonia to normal communication. The hoarseness and breathiness of patient were significantly improved. In addition, the grade, roughness, breathiness, asthenia, strain, and the voice handicap index scores changed from severe to mild or absent. CONCLUSION: This case provided a novel comprehensive treatment for a patient with UVFP, which was safe, cost-effective, and easy to implement in clinic.

"Lost Your Superpower"? Graphic Medicine, Voicelessness, and Georgia Webber's Dumb.

Unlike deafness and disability, speech-related disorders-voluntary/involuntary voicelessness, mutism, and their imperatives-have largely remained undertheorized both as scholarship and praxis. Given the primacy and over-privileging of vision, a consideration of the nature of voice/voicelessness is critical and urgent. Framed in metaphysical, metaphorical, and existential terms, Georgia Webber's graphic memoir Dumb (2018), which narrates the protagonist's temporary loss of voice, is perhaps the first graphic medical text that coheres around issues related to voice/voicelessness in its entirety. Taking these cues, the present article, after briefly reviewing the significance of voice in human life and the relationship between voice and identity, provides a close reading of how Webber negotiates her lost acoustical agency in an otherwise abundant soundscape. Intriguingly, Webber also utilizes her voicelessness as a metaphor to reflect on her own marginality in an ableist society. Finally, the essay explores how Dumb projects drawing/comics-making and self-care as recuperative projects that not only help Webber to process her suffering caused by voicelessness but also aid her in reclaiming her lost voice and to acuminate practices of self-preservation.

[Psychogenic Aphonia - Succesfull Multiprofessional Treatment of a 13-Year-Old Girl - A Case Report]. / Psychogene Aphonie ­ erfolgreiche multiprofessionelle Behandlung eines 13-jährigen Mädchens ­ ein Kurzbeitrag aus der Praxis.

Psychogenic Aphonia - Succesfull Multiprofessional Treatment of a 13-Year-Old Girl - A Case Report Psychogenic aphonia is a rather rare disorder with a point prevalence of 0.4 %. It appears more frequently in females than in males. There are only few reports in the scientific literature about children affected by psychogenic aphonia. The diagnostical and therapeutical approach must be multimodal. The case reported here describes a 13 year-old girl with a psychogenic aphonia, the course of her illness und the efforts of treatment until full recovery of voice and speech.

Cytoskeleton of cells in vocal fold macula flava unphonated for a long period.

Cells in the maculae flavae (MFe) are inferred to be involved in the metabolism of extracellular matrices of the human vocal fold mucosa. The latest research has supported the hypothesis that the tension caused by phonation (vocal fold vibration) regulates the behavior of these cells in the MFe of the human vocal fold. Tensile and compressive strains have direct effects on cell morphology and structure including changes in cytoskeletal structure and organization. Cytoskeletons are one of the structures which play a role as mechanoreceptors for the cells. The microstructure of the intermediate filaments and the expression of their proteins were investigated regarding the cells in the MFe of the human vocal fold unphonated over a decade. The adult vocal fold mucosa of a 64-year-old male with cerebral hemorrhage unphonated for 11 years was investigated by immunohistochemistry and electron microscopy. The intermediate filaments in the cytoplasm of the cells had become fewer in number. And the expression of their characteristic proteins (vimentin, desmin, GFAP) was also reduced. The results of this study are consistent with the hypothesis that mechanotransduction caused by vocal fold vibration could possibly be a factor in regulating the function and fate of the cells in the MFe.