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1.
Sci Rep ; 14(1): 13132, 2024 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-38849382

RESUMO

Voice production of humans and most mammals is governed by the MyoElastic-AeroDynamic (MEAD) principle, where an air stream is modulated by self-sustained vocal fold oscillation to generate audible air pressure fluctuations. An alternative mechanism is found in ultrasonic vocalizations of rodents, which are established by an aeroacoustic (AA) phenomenon without vibration of laryngeal tissue. Previously, some authors argued that high-pitched human vocalization is also produced by the AA principle. Here, we investigate the so-called "whistle register" voice production in nine professional female operatic sopranos singing a scale from C6 (≈ 1047 Hz) to G6 (≈ 1568 Hz). Super-high-speed videolaryngoscopy revealed vocal fold collision in all participants, with closed quotients from 30 to 73%. Computational modeling showed that the biomechanical requirements to produce such high-pitched voice would be an increased contraction of the cricothyroid muscle, vocal fold strain of about 50%, and high subglottal pressure. Our data suggest that high-pitched operatic soprano singing uses the MEAD mechanism. Consequently, the commonly used term "whistle register" does not reflect the physical principle of a whistle with regard to voice generation in high pitched classical singing.


Assuntos
Canto , Prega Vocal , Humanos , Feminino , Canto/fisiologia , Fenômenos Biomecânicos , Prega Vocal/fisiologia , Adulto , Som , Voz/fisiologia , Fonação/fisiologia
2.
Langenbecks Arch Surg ; 409(1): 183, 2024 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-38861184

RESUMO

PURPOSE: Assessing vocal cord mobility is crucial for patients undergoing thyroid surgery. We aimed to evaluate the feasibility and efficacy of surgeon-performed transcutaneous laryngeal ultrasound (TLUS) compared to flexible nasolaryngoscopy. METHOD: From February 2022 to December 2022, we conducted a prospective observational study on patients scheduled for total thyroidectomy at our Institution. All patients underwent TLUS followed by flexible nasolaryngoscopy by a blinded otolaryngologist. Findings were classified as normal or vocal cord movement impairment and then compared. Patients evaluable on TLUS were included in Group A, while those not evaluable were included in Group B, and their features were compared. RESULTS: Group A included 180 patients, while Group B included 21 patients. Male sex (p < 0.001), age (p = 0.034), BMI (p < 0.001), thyroid volume (p = 0.038), and neck circumference (p < 0.001) were associated with Group B. TLUS showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 99.4%, 94.4%, 100%, and 99.4%, respectively. Cohen's K value was 0.984. CONCLUSION: TLUS is a valid, easy-to-perform, non-invasive, and painless alternative for evaluating vocal cords in selected patients. It can be used either as a first level exam and as screening tool for selecting cases for flexible nasolaryngoscopy. TLUS should be integrated into routine thyroid ultrasound examination.


Assuntos
Laringoscopia , Tireoidectomia , Ultrassonografia , Humanos , Masculino , Feminino , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto , Prega Vocal/diagnóstico por imagem , Idoso , Estudos de Viabilidade , Sensibilidade e Especificidade , Complicações Pós-Operatórias/diagnóstico por imagem , Paralisia das Pregas Vocais/diagnóstico por imagem
3.
ACS Biomater Sci Eng ; 10(6): 3909-3922, 2024 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-38783819

RESUMO

Tissue regeneration is intricately influenced by the dynamic interplay between the physical attributes of tissue engineering scaffolds and the resulting biological responses. A tunable microporous hydrogel system was engineered using gelatin methacryloyl (GelMA) and polyethylene glycol diacrylate (PEGDA), with polyethylene glycol (PEG) serving as a porogen. Through systematic variation of PEGDA molecular weights, hydrogels with varying mechanical and architectural properties were obtained. The objective of the present study was to elucidate the impact of substrate mechanics and architecture on the immunological and reparative activities of vocal fold tissues. Mechanical characterization of the hydrogels was performed using tensile strength measurements and rheometry. Their morphological properties were investigated using scanning electron microscopy (SEM) and confocal microscopy. A series of biological assays were conducted. Cellular morphology, differentiation, and collagen synthesis of human vocal fold fibroblasts (hVFFs) were evaluated using immunostaining. Fibroblast proliferation was studied using the WST-1 assay, and cell migration was investigated via the Boyden chamber assay. Macrophage polarization and secretions were also examined using immunostaining and ELISA. The results revealed that increasing the molecular weight of PEGDA from 700 Da to 10,000 Da resulted in decreased hydrogel stiffness, from 62.6 to 8.8 kPa, and increased pore dimensions from approximately 64.9 to 137.4 µm. Biological evaluations revealed that hydrogels with a higher stiffness promoted fibroblast proliferation and spreading, albeit with an increased propensity for fibrosis, as indicated by a surge in myofibroblast differentiation and collagen synthesis. In contrast, hydrogels with greater molecular weights had a softer matrix with expanded pores, enhancing cellular migration and promoting an M2 macrophage phenotype conducive to tissue healing. The findings show that the hydrogels formulated with a PEGDA molecular weight of 6000 Da are best among the hydrogels considered for vocal fold repair. The microporous hydrogels could be tuned to serve in other tissue engineering applications.


Assuntos
Proliferação de Células , Fibroblastos , Hidrogéis , Polietilenoglicóis , Prega Vocal , Prega Vocal/citologia , Prega Vocal/metabolismo , Prega Vocal/química , Hidrogéis/química , Humanos , Porosidade , Fibroblastos/citologia , Polietilenoglicóis/química , Elasticidade , Alicerces Teciduais/química , Engenharia Tecidual/métodos , Movimento Celular , Gelatina/química , Diferenciação Celular , Colágeno/química , Colágeno/metabolismo
4.
J Speech Lang Hear Res ; 67(6): 1660-1681, 2024 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-38758676

RESUMO

PURPOSE: Literature suggests a dependency of the acoustic metrics, smoothed cepstral peak prominence (CPPS) and harmonics-to-noise ratio (HNR), on human voice loudness and fundamental frequency (F0). Even though this has been explained with different oscillatory patterns of the vocal folds, so far, it has not been specifically investigated. In the present work, the influence of three elicitation levels, calibrated sound pressure level (SPL), F0 and vowel on the electroglottographic (EGG) and time-differentiated EGG (dEGG) metrics hybrid open quotient (OQ), dEGG OQ and peak dEGG, as well as on the acoustic metrics CPPS and HNR, was examined, and their suitability for voice assessment was evaluated. METHOD: In a retrospective study, 29 women with a mean age of 25 years (± 8.9, range: 18-53) diagnosed with structural vocal fold pathologies were examined before and after voice therapy or phonosurgery. Both acoustic and EGG signals were recorded simultaneously during the phonation of the sustained vowels /ɑ/, /i/, and /u/ at three elicited levels of loudness (soft/comfortable/loud) and unconstrained F0 conditions. RESULTS: A linear mixed-model analysis showed a significant effect of elicitation effort levels on peak dEGG, HNR, and CPPS (all p < .01). Calibrated SPL significantly influenced HNR and CPPS (both p < .01). Furthermore, F0 had a significant effect on peak dEGG and CPPS (p < .0001). All metrics showed significant changes with regard to vowel (all p < .05). However, the treatment had no effect on the examined metrics, regardless of the treatment type (surgery vs. voice therapy). CONCLUSIONS: The value of the investigated metrics for voice assessment purposes when sampled without sufficient control of SPL and F0 is limited, in that they are significantly influenced by the phonatory context, be it speech or elicited sustained vowels. Future studies should explore the diagnostic value of new data collation approaches such as voice mapping, which take SPL and F0 effects into account.


Assuntos
Disfonia , Acústica da Fala , Humanos , Feminino , Adulto , Disfonia/fisiopatologia , Disfonia/terapia , Estudos Retrospectivos , Adulto Jovem , Pessoa de Meia-Idade , Adolescente , Qualidade da Voz/fisiologia , Eletrodiagnóstico/métodos , Glote/fisiopatologia , Fonação/fisiologia , Prega Vocal/fisiopatologia , Treinamento da Voz , Medida da Produção da Fala/métodos
5.
Sci Rep ; 14(1): 10440, 2024 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-38714750

RESUMO

A wide variety of treatments have been developed to improve respiratory function and quality of life in patients with bilateral vocal fold paresis (BVFP). One experimental method is the electrical activation of the posterior cricoarytenoid (PCA) muscle with a laryngeal pacemaker (LP) to open the vocal folds. We used an ovine (sheep) model of unilateral VFP to study the long-term effects of functional electrical stimulation on the PCA muscles. The left recurrent laryngeal nerve was cryo-damaged in all animals and an LP was implanted except for the controls. After a reinnervation phase of six months, animals were pooled into groups that received either no treatment, implantation of an LP only, or implantation of an LP and six months of stimulation with different duty cycles. Automated image analysis of fluorescently stained PCA cross-sections was performed to assess relevant muscle characteristics. We observed a fast-to-slow fibre type shift in response to nerve damage and stimulation, but no complete conversion to a slow-twitch-muscle. Fibre size, proportion of hybrid fibres, and intramuscular collagen content were not substantially altered by the stimulation. These results demonstrate that 30 Hz burst stimulation with duty cycles of 40% and 70% did not induce PCA atrophy or fibrosis. Thus, long-term stimulation with an LP is a promising approach for treating BVFP in humans without compromising muscle conditions.


Assuntos
Modelos Animais de Doenças , Terapia por Estimulação Elétrica , Músculos Laríngeos , Paralisia das Pregas Vocais , Animais , Ovinos , Paralisia das Pregas Vocais/terapia , Paralisia das Pregas Vocais/fisiopatologia , Terapia por Estimulação Elétrica/métodos , Músculos Laríngeos/fisiopatologia , Humanos , Marca-Passo Artificial/efeitos adversos , Prega Vocal/fisiopatologia , Prega Vocal/patologia , Feminino
6.
J Nippon Med Sch ; 91(2): 249-251, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38777786

RESUMO

Stridor is caused by oscillation of the narrowed upper airway. The most common cause of neonatal stridor is laryngomalacia, followed by vocal fold abduction dysfunction. Herein, we present two neonatal cases of idiopathic dysfunction of vocal fold abduction. A neonate was admitted to the neonatal intensive care unit (NICU) on day 4 of life for inspiratory stridor, intermittent subcostal retraction, and cyanosis. A second neonate was admitted to the NICU on day 7 of life for inspiratory stridor and cyanosis when crying. Neither patient had dysmorphic features or unusual cardiac ultrasonography findings. The diagnosis was confirmed by laryngo-bronchoscopy. Conservative treatment with biphasic positive airway pressure was effective in both cases and symptoms resolved within a few months. Resolution of vocal fold abduction dysfunction was confirmed by repeat endoscopy. Clinical manifestations of vocal fold abduction dysfunction vary widely. Although most cases resolve spontaneously, prolonged tube feeding, or even tracheostomy, is needed in some severe cases. Diagnosis of vocal fold abduction dysfunction requires a laryngo-bronchoscopy study; thus, there may be a large number of undiagnosed patients. Vocal fold abduction dysfunction should be considered in the differential diagnosis for neonatal inspiratory stridor.


Assuntos
Sons Respiratórios , Disfunção da Prega Vocal , Humanos , Recém-Nascido , Sons Respiratórios/etiologia , Disfunção da Prega Vocal/etiologia , Disfunção da Prega Vocal/diagnóstico , Disfunção da Prega Vocal/fisiopatologia , Disfunção da Prega Vocal/terapia , Masculino , Prega Vocal/fisiopatologia , Prega Vocal/diagnóstico por imagem , Laringoscopia , Feminino , Broncoscopia , Resultado do Tratamento , Diagnóstico Diferencial , Tratamento Conservador
7.
Am J Otolaryngol ; 45(4): 104342, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38703609

RESUMO

OBJECTIVE: To develop a multi-instance learning (MIL) based artificial intelligence (AI)-assisted diagnosis models by using laryngoscopic images to differentiate benign and malignant vocal fold leukoplakia (VFL). METHODS: The AI system was developed, trained and validated on 5362 images of 551 patients from three hospitals. Automated regions of interest (ROI) segmentation algorithm was utilized to construct image-level features. MIL was used to fusion image level results to patient level features, then the extracted features were modeled by seven machine learning algorithms. Finally, we evaluated the image level and patient level results. Additionally, 50 videos of VFL were prospectively gathered to assess the system's real-time diagnostic capabilities. A human-machine comparison database was also constructed to compare the diagnostic performance of otolaryngologists with and without AI assistance. RESULTS: In internal and external validation sets, the maximum area under the curve (AUC) for image level segmentation models was 0.775 (95 % CI 0.740-0.811) and 0.720 (95 % CI 0.684-0.756), respectively. Utilizing a MIL-based fusion strategy, the AUC at the patient level increased to 0.869 (95 % CI 0.798-0.940) and 0.851 (95 % CI 0.756-0.945). For real-time video diagnosis, the maximum AUC at the patient level reached 0.850 (95 % CI, 0.743-0.957). With AI assistance, the AUC improved from 0.720 (95 % CI 0.682-0.755) to 0.808 (95 % CI 0.775-0.839) for senior otolaryngologists and from 0.647 (95 % CI 0.608-0.686) to 0.807 (95 % CI 0.773-0.837) for junior otolaryngologists. CONCLUSIONS: The MIL based AI-assisted diagnosis system can significantly improve the diagnostic performance of otolaryngologists for VFL and help to make proper clinical decisions.


Assuntos
Inteligência Artificial , Laringoscopia , Leucoplasia , Prega Vocal , Humanos , Prega Vocal/diagnóstico por imagem , Prega Vocal/patologia , Laringoscopia/métodos , Masculino , Leucoplasia/diagnóstico , Leucoplasia/patologia , Feminino , Pessoa de Meia-Idade , Idoso , Diagnóstico por Computador/métodos , Aprendizado de Máquina , Diagnóstico Diferencial , Adulto , Algoritmos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/diagnóstico por imagem
8.
Artigo em Chinês | MEDLINE | ID: mdl-38561259

RESUMO

Objective: To investigate the clinical characteristics and voice outcomes after laryngeal microsurgery for vocal fold epidermoid cysts coexisting with sulcus vocalis. Methods: The clinical data of 115 vocal fold epidermoid cysts coexisting with sulcus vocalis patients in Shandong provincial ENT hospital, were retrospectively analyzed, including 49 males and 66 females, aged 17-70 years old, and the duration of hoarseness ranged from 6 months to 30 years. All patients underwent surgery through suspension laryngoscope and microscope under general anestgesia. Ninety-four patients were treated with microflap excision of sulcus vocalis, cyst wall, and contents.And 21 patients that occulted with mucosal bridges were applied mucosal bridges resection (2 cases) and mucosal bridges reconstruction (19 cases) respectively. Videolaryngoscopy, subjective voice evaluation (GRBAS), objective voice evaluation, and Voice Handicap Index(VHI) were performed before and after surgery. All patients underwent histopathologic examination and follow-up after the procedure. The preoperative acoustic parameters of patients with vocal fold epidermoid cysts coexisting with sulcus vocalis were compared with those of vocal fold mucus retention cysts and simple vocal fold epidermoid cysts by independent samples t-test. The patients were compared by paired t-test for preoperative and postoperative parameters. Results: Significant reduction or lack of mucosal waves were shown via videolaryngostroboscopy in all 115 cases.In addition, vascular changes including dilation, tortuousness, increased branches, and abrupt direction change were shown on the cystic area. Eighty-one patients were detected cysts and/or sulcus vocalis by preoperative laryngoscopy, and intraoperative microscopic findings in the remaining 34 patients. The intraoperative microscopic examination revealed a focal pouch-like deficit plunging into the vocal ligament or muscle. The deep surface of the mucosal bridges was sulcus vocalis, and that in 89 cysts was lined with caseous content. Histopathology demonstrated a cystic cavity structure lined with squamous epithelium and caseous keratin desquamation inside the cystic cavity. Four of 115 patients were lost at follow-up and excluded from the analysis of voice outcomes after surgery. There was no significant mucosal wave and the voice quality in all but 14 patients 1month after surgery. Except for the fundamental frequency and noise harmonic ratio, all other voice parameters[ G, R, B, A, VHI-10, jitter, shimmer, maximum phonatory time (MPT) ]showed a significant improvement 3 months after surgery(t=15.82, 20.82, 17.61, 7.30, 38.88, 7.84, 5.88, -6.26, respectively, P<0.05). Then mucosal waves and the voice quality were gradually improved and became steady in 6 months after surgery. The subjective and objective voice parameters[G, R, B, A, VHI-10, jitter, shimmer, noise to harmonic ratio(NHR), MPT], except for the fundamental frequency, were all significantly improved(t=23.47, 25.79, 18.37, 9.84, 54.45, 10.68, 8.07, 3.24, -9.08, respectively, P<0.05). In addition, there were 2 patients with no significant improvement after the operation. Steady function with no complications was observed during the 12 months (up to 3 years in 34 patients) follow-up period in 111 patients. Conclusion: Ruptured vocal fold epidermoid cysts can result in sulcus vocalis and mucosal bridges. Characteristics changes in preoperative videolaryngoscopy are effective diagnostic tools. The complete excision of the cyst wall and repair of the lamina propria can lead to satisfactory long-term effects.


Assuntos
Cisto Epidérmico , Doenças da Laringe , Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Prega Vocal/patologia , Cisto Epidérmico/complicações , Cisto Epidérmico/cirurgia , Cisto Epidérmico/patologia , Estudos Retrospectivos , Doenças da Laringe/cirurgia , Doenças da Laringe/patologia , Qualidade da Voz , Resultado do Tratamento
9.
Int J Pediatr Otorhinolaryngol ; 179: 111922, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38574651

RESUMO

BACKGROUND: Neonatal unilateral vocal fold paralysis may arise iatrogenically, idiopathically, or in the context of an underlying neurologic disorder. Management is often supportive, focusing on diet modification to allow for safe oral feeding. We describe the clinical course of six infants with unilateral vocal fold paralysis who developed predominantly unilateral laryngomalacia ipsilateral to the affected vocal fold with associated severe respiratory symptoms and feeding difficulty. METHODS: Retrospective review of six infants with unilateral vocal fold paralysis and predominantly unilateral laryngomalacia. Charts were reviewed for etiology of vocal fold paralysis, presenting symptoms, operative details, postoperative course, and outcomes for breathing and swallowing. RESULTS: Etiology of vocal fold paralysis included cardiac surgery in four patients, intubation-related in one, and idiopathic in one. Presenting symptoms included increased work of breathing, stridor, feeding difficulty, respiratory failure requiring noninvasive respiratory support, and weak cry. All infants were on nasogastric tube feedings. Direct microlaryngoscopy with unilateral or predominantly unilateral (conservative contralateral aryepiglottic fold division) supraglottoplasty was performed. Stridor and work of breathing improved in all six patients within 1 week postoperatively. Oral feeding improved in three patients within 2 weeks. Three patients had persistent feeding impairment with improvement within one year. CONCLUSIONS: Predominantly unilateral laryngomalacia may arise in the context of unilateral vocal fold paralysis. Addressing the ipsilateral cuneiform collapse can improve breathing and feeding. This may be an under-described phenomenon and represents an additional reason to include the otolaryngologist early in the care of infants with suspected possible new unilateral vocal fold paralysis. Breathing and swallow can improve post-operatively, but feeding may remain limited by the vocal fold paralysis and any medical comorbidities. Ongoing follow-up and collaboration with speech-language pathology to optimize feeding are important.


Assuntos
Laringomalácia , Paralisia das Pregas Vocais , Lactente , Recém-Nascido , Humanos , Prega Vocal , Laringomalácia/complicações , Laringomalácia/diagnóstico , Laringomalácia/cirurgia , Sons Respiratórios/etiologia , Paralisia das Pregas Vocais/complicações , Paralisia das Pregas Vocais/diagnóstico , Deglutição , Estudos Retrospectivos
10.
Otolaryngol Pol ; 78(2): 18-22, 2024 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-38623857

RESUMO

<b><br>Introduction:</b> Electromyography (EMG) of the larynx provides information on the electrophysiological condition of laryngeal muscles and innervation. Integration of information obtained from the EMG exams with the clinical parameters as obtained by other methods for laryngeal assessment (endoscopy, perceptual and acoustic analysis, voice self-assessment) provides a multidimensional picture of dysphonia, which is of particular importance in patients with vocal fold (VF) mobility disorders accompanied by glottic insufficiency.</br> <b><br>Aim:</b> The aim of this study was to evaluate laryngeal EMG records acquired in subjects with unilateral vocal fold immobilization with signs of atrophy and glottic insufficiency.</br> <b><br>Material and methods:</b> From the available material of 74 EMG records of patients referred for the exam due to unilateral laryngeal paralysis, records of 17 patients with endoscopic features suggestive of complete laryngeal muscle denervation were selected. The EMG study of thyroarytenoid muscles of mobile and immobile VFs was evaluated qualitatively and quantitatively at rest and during volitional activity involving free phonation of vowel /e/ [ε].</br> <b><br>Results:</b> In all patients, the EMG records from mobile VFs were significantly different from those from immobile VFs. Despite endoscopic features of paralysis, no VF activity whatsoever was observed in as few as 2 patients so as to meet the neurophysiological definition of paralysis. In 88% of cases, electromyographic activity of the thyroarytenoid muscle was observed despite immobilization and atrophy of the vocal fold. In these patients, neurogenic type of record was observed with numerous high- -amplitude mobility units. On the basis of the results, quantitative features of EMG records indicative of paralysis and residual activity of the thyroarytenoid muscle were determined.</br> <b><br>Conclusions:</b> Qualitative and quantitative analysis of laryngeal EMG records provides detailed information on the condition of vocal fold muscles and innervation. EMG records of mobile vs immobile VFs differ significantly from each other. Endoscopic evaluation does not provide sufficient basis for the diagnosis of complete laryngeal muscle denervation.</br>.


Assuntos
Disfonia , Paralisia das Pregas Vocais , Humanos , Prega Vocal , Paralisia das Pregas Vocais/diagnóstico , Eletromiografia/métodos , Músculos Laríngeos , Endoscopia , Atrofia
11.
Trop Doct ; 54(3): 268-271, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38654398

RESUMO

Can a smart phone application be reliably used for laryngoscopy? This thesis was tested for peri-operative evaluation of vocal cords in patients undergoing thyroid and parathyroid surgery.


Assuntos
Laringoscopia , Smartphone , Prega Vocal , Humanos , Laringoscopia/métodos , Projetos Piloto , Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto
12.
Artigo em Chinês | MEDLINE | ID: mdl-38686482

RESUMO

Objective:To analyze the characteristics of vocal fold movement and glottic closure in patients with laryngeal neurogenic injury. Methods:A total of 185 patients with vocal fold paralysis diagnosed by laryngeal electromyography as neurogenic damage to cricothyroid muscle, thyreoarytenoid muscle and posterior cricoarytenoid muscle were enrolled, they were divided into unilateral vocal fold paralysis group and bilateral vocal fold paralysis group, respectively, and superior laryngeal paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group according to nerve injury. The characteristics of vocal fold movement and glottic closure were analyzed under strobe laryngoscope. The qualitative evaluation of vocal fold movement was fixed vocal fold, reduced vocal fold movement and normal vocal fold movement, and the qualitative evaluation of glottic closure was glottic closure and glottic imperfection. The results were analyzed statistically. Results:The proportion of normal, reduced and fixed vocal fold motion in bilateral vocal fold paralysis group was significantly different from that in unilateral vocal fold paralysis group(P<0.05), the composition of normal and reduced vocal fold motion in bilateral vocal fold paralysis group(47.70%) was significantly greater than that in unilateral vocal fold paralysis group(12.27%). There was no significant difference between the proportion of glottic closure and glottic imperfecta in bilateral vocal fold paralysis group and unilateral vocal fold paralysis group(P<0.05). The proportion of decreased vocal fold motion in superior laryngeal nerve paralysis group(50.00%) was higher than that in recurrent laryngeal nerve paralysis group(9.32%) and vagal nerve paralysis group(9.00%). The proportion of decreased and fixed vocal fold motion in superior laryngeal nerve paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group was statistically significant(P<0.05).There was no significant difference in glottic closure among the three groups(P<0.05). Conclusion:Vocal fold movement characteristics of patients with laryngeal neurogenic injury were mainly vocal fold fixation, or normal or weakened vocal fold movement. There may be missed diagnosis of unilateral vocal fold paralysis in clinical practice. In half of the patients with superior laryngeal nerve palsy, vocal fold movement is characterized by vocal fold fixation.


Assuntos
Paralisia das Pregas Vocais , Prega Vocal , Humanos , Paralisia das Pregas Vocais/fisiopatologia , Paralisia das Pregas Vocais/etiologia , Prega Vocal/fisiopatologia , Masculino , Feminino , Eletromiografia , Músculos Laríngeos/fisiopatologia , Músculos Laríngeos/inervação , Pessoa de Meia-Idade , Adulto , Glote/fisiopatologia , Laringoscopia , Idoso , Adulto Jovem , Adolescente
13.
Sci Rep ; 14(1): 9297, 2024 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-38654036

RESUMO

Voice change is often the first sign of laryngeal cancer, leading to diagnosis through hospital laryngoscopy. Screening for laryngeal cancer solely based on voice could enhance early detection. However, identifying voice indicators specific to laryngeal cancer is challenging, especially when differentiating it from other laryngeal ailments. This study presents an artificial intelligence model designed to distinguish between healthy voices, laryngeal cancer voices, and those of the other laryngeal conditions. We gathered voice samples of individuals with laryngeal cancer, vocal cord paralysis, benign mucosal diseases, and healthy participants. Comprehensive testing was conducted to determine the best mel-frequency cepstral coefficient conversion and machine learning techniques, with results analyzed in-depth. In our tests, laryngeal diseases distinguishing from healthy voices achieved an accuracy of 0.85-0.97. However, when multiclass classification, accuracy ranged from 0.75 to 0.83. These findings highlight the challenges of artificial intelligence-driven voice-based diagnosis due to overlaps with benign conditions but also underscore its potential.


Assuntos
Inteligência Artificial , Doenças da Laringe , Estroboscopia , Prega Vocal , Qualidade da Voz , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Estudos de Casos e Controles , Saúde , Doenças da Laringe/classificação , Doenças da Laringe/diagnóstico , Doenças da Laringe/fisiopatologia , Neoplasias Laríngeas/diagnóstico , Redes Neurais de Computação , Carcinoma de Células Escamosas de Cabeça e Pescoço , Máquina de Vetores de Suporte , Paralisia das Pregas Vocais/diagnóstico , Prega Vocal/patologia , Prega Vocal/fisiopatologia , Distúrbios da Voz/classificação , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/fisiopatologia
14.
J Speech Lang Hear Res ; 67(5): 1324-1338, 2024 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-38592964

RESUMO

PURPOSE: Surface electromyography (sEMG) has been used to evaluate extrinsic laryngeal muscle activity during swallowing and phonation. In the current study, sEMG amplitudes were measured from the infrahyoid and suprahyoid muscles during phonation through a tube submerged in water. METHOD: The sEMG amplitude values measured from the extrinsic laryngeal muscles and the electroglottographic contact quotient (CQ) were obtained simultaneously from 62 healthy participants (31 men, 31 women) during phonation through a tube at six different depths (2, 4, 7, 10, 15, and 20 cm) while using two tubes with different diameters (1 and 0.5 cm). RESULTS: With increasing depth, the sEMG amplitude for the suprahyoid muscles increased in men and women. However, sEMG amplitudes for the infrahyoid muscles increased significantly only in men. Tube diameter had a significant effect on the suprahyoid sEMG amplitudes only for men, with higher sEMG amplitudes when phonating with a 1.0-cm tube. CQ values increased with submerged depth for both men and women. Tube diameter affected results such than CQ values were higher for men when using the wider tube and for women with the narrower tube. CONCLUSIONS: Vocal fold vibratory patterns changed with the depth of tube submersion in water for both men and women, but the patterns of muscle activation differed between the sexes. This suggests that men and women use different strategies when confronted with increased intraoral pressure during semi-occluded vocal tract exercises. In this study, sEMG provided insight into the mechanism for differences between vocally normal individuals and could help detect compensatory muscle activation during tube phonation in water for people with voice disorders.


Assuntos
Eletromiografia , Músculos Laríngeos , Fonação , Água , Humanos , Masculino , Feminino , Fonação/fisiologia , Músculos Laríngeos/fisiologia , Adulto , Adulto Jovem , Prega Vocal/fisiologia , Deglutição/fisiologia , Vibração
15.
J UOEH ; 46(1): 1-8, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38479863

RESUMO

Every finding during a neck autopsy may be essential for accurately diagnosing and explaining the mechanism of death. In this prospective study in the Department of Forensic Medicine and Toxicology of Jordan University Hospital, 17 out of 95 neck autopsies revealed contusions of the laryngeal mucosa in the vocal or perivocal area. These contusions were found to be associated with various causes of death, including mechanical asphyxia (such as throttling, ligature strangulation, hanging, smothering, choking, plastic bag asphyxia, gagging, and inhalation of blood) and other causes (such as atypical drowning, carbon monoxide poisoning, head injury due to a road traffic accident, burns, electrocution, and brain edema). This study provides insight into the mechanisms of this important lesion and may contribute to a better understanding of the cause of death.


Assuntos
Asfixia , Contusões , Humanos , Asfixia/etiologia , Asfixia/diagnóstico , Asfixia/patologia , Prega Vocal/patologia , Estudos Prospectivos , Autopsia
16.
Nat Commun ; 15(1): 1873, 2024 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-38472193

RESUMO

Voice disorders resulting from various pathological vocal fold conditions or postoperative recovery of laryngeal cancer surgeries, are common causes of dysphonia. Here, we present a self-powered wearable sensing-actuation system based on soft magnetoelasticity that enables assisted speaking without relying on the vocal folds. It holds a lightweighted mass of approximately 7.2 g, skin-alike modulus of 7.83 × 105 Pa, stability against skin perspiration, and a maximum stretchability of 164%. The wearable sensing component can effectively capture extrinsic laryngeal muscle movement and convert them into high-fidelity and analyzable electrical signals, which can be translated into speech signals with the assistance of machine learning algorithms with an accuracy of 94.68%. Then, with the wearable actuation component, the speech could be expressed as voice signals while circumventing vocal fold vibration. We expect this approach could facilitate the restoration of normal voice function and significantly enhance the quality of life for patients with dysfunctional vocal folds.


Assuntos
Distúrbios da Voz , Voz , Dispositivos Eletrônicos Vestíveis , Humanos , Prega Vocal/fisiologia , Qualidade de Vida , Voz/fisiologia
17.
Science ; 383(6687): eadi8081, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38452069

RESUMO

Phonation critically depends on precise controls of laryngeal muscles in coordination with ongoing respiration. However, the neural mechanisms governing these processes remain unclear. We identified excitatory vocalization-specific laryngeal premotor neurons located in the retroambiguus nucleus (RAmVOC) in adult mice as being both necessary and sufficient for driving vocal cord closure and eliciting mouse ultrasonic vocalizations (USVs). The duration of RAmVOC activation can determine the lengths of both USV syllables and concurrent expiration periods, with the impact of RAmVOC activation depending on respiration phases. RAmVOC neurons receive inhibition from the preBötzinger complex, and inspiration needs override RAmVOC-mediated vocal cord closure. Ablating inhibitory synapses in RAmVOC neurons compromised this inspiration gating of laryngeal adduction, resulting in discoordination of vocalization with respiration. Our study reveals the circuits for vocal production and vocal-respiratory coordination.


Assuntos
Tronco Encefálico , Fonação , Respiração , Prega Vocal , Animais , Masculino , Camundongos , Tronco Encefálico/fisiologia , Bulbo/fisiologia , Neurônios/fisiologia , Fonação/fisiologia , Prega Vocal/inervação , Prega Vocal/fisiologia , Camundongos Endogâmicos C57BL , Feminino , Proteínas Proto-Oncogênicas c-fos/genética
18.
J Cancer Res Ther ; 20(1): 493-495, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38554374

RESUMO

Extramedullary plasmacytoma of the larynx is an extremely rare entity accounting for 0.04-0.45% of malignant tumours of the larynx. The objective of this clinical case report is to highlight the diagnosis and management of a unique case such as this. A 77-year-old gentleman presented with complaints of hoarseness for 1 year. Computed tomography image revealed a soft tissue mass lesion involving the right true vocal cord. Direct laryngoscopic biopsy was performed and subjected to histopathological examination, which showed collection of plasma cells. Immunohistochemistry confirmed the presence of Kappa and Lambda cells. Multiple myeloma (MM) was ruled out. The patient received radical intent radiation therapy using 3DCRT technique with a dose of 50Gy in 25# over 5 weeks. He experienced improvement in hoarseness on subsequent follow-up visits. At 1-year follow up, positron emission tomography computed tomography showed near total resolution of disease with no progression to MM. Radiation therapy alone is known to achieve good local control, recurrence free survival, and organ preservation in such cases.


Assuntos
Neoplasias Laríngeas , Laringe , Mieloma Múltiplo , Plasmocitoma , Masculino , Humanos , Idoso , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/radioterapia , Rouquidão/etiologia , Rouquidão/patologia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/radioterapia , Laringe/patologia , Prega Vocal , Mieloma Múltiplo/patologia
19.
J Cancer Res Ther ; 20(1): 469-471, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38554367

RESUMO

Kaposi's sarcoma (KS) is an angiogenic tumor. KS lesions frequently develop in the skin and oral cavity mucosa in the head and neck regions, and pure laryngeal localization is extremely rare. We reported a 64-year-old male patient without HIV, HBV, and HCV positivity presented with a hemangiomatous lesion detected incidentally in the right vocal cord. Biopsy was taken for histopathological and immunohistochemical evaluation. Examination revealed that spindle cells were of vascular origin and expressed HHV-8, a specific marker associated with Kaposi's sarcoma-associated herpesvirus. Positron emission tomography-computed tomography (PET/CT) demonstrated an increased fluorodeoxyglucose (FDG) uptake in the vocal cord. The patient was treated with a 30 Gy volumetric arc plan. Disease-free follow-up continues in the first year after low-dose definitive RT. This is the first case report of KS in the vocal cord in which the most detailed data about RT were shared.


Assuntos
Herpesvirus Humano 8 , Sarcoma de Kaposi , Masculino , Humanos , Pessoa de Meia-Idade , Sarcoma de Kaposi/diagnóstico , Sarcoma de Kaposi/radioterapia , Prega Vocal , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Pele/patologia
20.
JASA Express Lett ; 4(3)2024 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-38426891

RESUMO

Previous experimental studies suggested that restraining the vocal fold vertical motion may reduce the coupling strength between the voice source and vocal tract. In this study, the effects of vocal fold vertical motion on source-filter interaction were systematically examined in a two-dimensional two-mass model coupled to a compressible flow simulation. The results showed that when allowed to move vertically, the vocal folds exhibited subharmonic vibration due to entrainment to the first vocal tract acoustic resonance. Restraining the vertical motion suppressed this entrainment. This indicates that the vertical mobility of the vocal folds may play a role in regulating source-filter interaction.


Assuntos
Acústica , Prega Vocal , Prega Vocal/fisiologia , Movimento (Física) , Vibração
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