Wavelet packet transform and multilayer perceptron to identify voices with a mild degree of vocal deviation / Transformada Wavelet packet y Perceptrón Multicapa para identificación de voces con grado leve de desvío vocal

Introduction. Laryngeal disorders are characterized by a change in the vibratory pattern of the vocal folds. This disorder may have an organic origin described by anatomical fold modification, or a functional origin caused by vocal abuse or misuse. The most common diagnostic methods are performed by invasive imaging features that cause patient discomfort. In addition, mild voice deviations do not stop the in-dividual from using their voices, which makes it difficult to identify the problem and increases the possibility of complications. Aim. For those reasons, the goal of the present paper was to develop a noninvasive alternative for the identification of voices with a mild degree of vocal deviation ap-plying the Wavelet Packet Transform (WPT) and Multilayer Perceptron (MLP), an Artificial Neural Network (ANN). Methods. A dataset of 74 audio files were used. Shannon energy and entropy mea-sures were extracted using the Daubechies 2 and Symlet 2 families and then the processing step was performed with the MLP ANN. Results. The Symlet 2 family was more efficient in its generalization, obtaining 99.75% and 99.56% accuracy by using Shannon energy and entropy measures, re-spectively. The Daubechies 2 family, however, obtained lower accuracy rates: 91.17% and 70.01%, respectively. Conclusion. The combination of WPT and MLP presented high accuracy for the identification of voices with a mild degree of vocal deviation

ntroducción. Los trastornos laríngeos se caracterizan por un cambio en el patrón vibratorio de los pliegues vocales. Este trastorno puede tener un origen orgánico, descrito como la modificación anatómica de los pliegues vocales, o de origen fun-cional, provocado por abuso o mal uso de la voz. Los métodos de diagnóstico más comunes se realizan mediante procedimientos invasivos que causan malestar al pa-ciente. Además, los desvíos vocales de grado leve no impiden que el individuo utilice la voz, lo que dificulta la identificación del problema y aumenta la posibilidad de complicaciones futuras.Objetivo. Por esas razones, el objetivo de esta investigación es desarrollar una he-rramienta alternativa, no invasiva para la identificación de voces con grado leve de desvío vocal aplicando Transformada Wavelet Packet (WPT) y la red neuronal artifi-cial del tipo Perceptrón Mutlicapa (PMC). Métodos. Fue utilizado un banco de datos con 78 voces. Fueron extraídas las me-didas de energía y entropía de Shannon usando las familias Daubechies 2 y Symlet 2 para después aplicar la red neuronal PMC. Resultados. La familia Symlet 2 fue más eficiente en su generalización, obteniendo un 99.75% y un 99.56% de precisión mediante el uso de medidas de energía y en-tropía de Shannon, respectivamente. La familia Daubechies 2, sin embargo, obtuvo menores índices de precisión: 91.17% y 70.01%, respectivamente. Conclusión. La combinación de WPT y PMC presentó alta precisión para la iden-tificación de voces con grado leve de desvío vocal

Orientaciones filosóficas en la intervención fonoaudiológica de voz. El desafío actual de dar el alta / Philosophical orientations in voice therapy. The current challenge of discharge

El presente artículo corresponde a una reflexión sobre las orientaciones filosóficas en la terapia vocal actual. Cuando existe alguna alteración o trastorno vocal, se habla comunmente de un desequilibrio entre los subsistemas involucrados en el proceso fonatorio, es decir, fuelle (sistema respiratorio), fuente (pliegues vocales) y filtro (tracto vocal). Si no hay un correcto balance, entonces el sistema no tiene un correcto funcionamiento y pueden aparecer síntomas como ronquera, sensación de cuerpo extraño, prurito, fatiga vocal o bien disfonía o incluso afonía. Como con-secuencia de estas dificultades, se generan compensaciones que durante el proceso de la intervención fonoaudiológica el profesional debe volver a "equilibrar". Para lograr este objetivo, se desarrollan y analizan las diversas herramientas que entregan las filosofías de pensamiento a lo largo de la historia de la rehabilitación vocal, don-de se encuentran la orientación higiénica, psicológica, sintomatológica, fisiológica y ecléctica. En este mismo sentido, el profesional debe buscar lo que percibe como más idóneo para cada paciente o grupo a intervenir, centrado en mejorar la calidad vocal y las necesidades actuales de estos, basándose en el contexto mundial actual, con el objetivo de lograr un buen proceso de entrenamiento o rehabilitación y final-mente lograr el alta.

The present article corresponds to a reflection about the philosophical orientations in the current vocal therapy. When there are some vocal alterations or disorders, we usually talk about an imbalance between the sub-sysmtems involved in the fonatory process, which are bellows (respiratory system), source (vocal folds) and filter (vocal tract). When there is not a correct balance, the system does not work properly and as a consequence, it is possible to experiment symptoms such as hoarseness, foreign body sensation, pruritus, vocal fatigue, dysphonia or even aphonia. As a result of these difficulties, it is possible to generate compensations through the intervention of speech therapy. By virtue of this therapy the professional must 'balance'. In order to achieve this, it is necessary to develop and analyze the different tools that philoso-phical studies offer through the history of vocal rehabilitation. Some of these tools are hygienic orientation, psychological, symptomatological, physiological and eclec-tic. Thinking on that, the professional must search what it is most suitable for every patient or group of people that he/she will be working with. This must be focus on improving vocal quality and the actual necessities of the patient, based on the current global context. The final purpose of the professional is to achieve a good and healthy process of training and/or rehabilitation to accomplish medical discharge.

Effects of Semi-Occluded Vocal Tract Exercise in Patients with Functional Aphonia

BACKGROUND AND OBJECTIVES: Functional aphonia is characterized by incomplete closure of the vocal folds. Semi-occluded vocal tract exercise (SOVTE) allows smoothly vocal folds collision without damage to the vocal folds tissues to produce normal vocal intensity. The purpose of this study is to report the effect of SOVTE in patients with functional aphonia. MATERIALS AND METHOD: Seven patients diagnosed with functional aphonia were treated with 1-3 voice therapy sessions using voiced lip-trill, humming, Lax Vox in SOVTE. To assess the effectiveness of semi-occluded vocal tract exercise, cepstral analysis and auditory perceptual assessment were performed before and after voice therapy. RESULTS: F0 (fundamental frequency), CPP (cepstral peak prominence) and L/H ratio (low/high spectral ratio) were significantly increased, while CPP Standard deviation, L/H ratio Standard deviation were decreased. In addition, ‘Grade’, ‘Breathiness’ and ‘Asthenia’ were significantly decreased in the GRBAS scale after SOVTE (p<0.05). CONCLUSIONS: In our study, SOVTE seemed to be effective to elicit voice quickly and promote vocal folds vibration without muscular effort in patients with functional aphonia.

A Missed and Delayed Detected Fish Bone Impaction in Subglottis / 대한이비인후과학회지

Laryngeal foreign body can be a life-threatening emergency. Respiratory distress, aphonia, and cyanosis may occur in quick succession. However, in case of a non-obstructive laryngeal foreign body, symptoms can be indolent, but the hazardous foreign body can nevertheless put the patient in danger. To prevent life-threatening consequences, early detection based on symptoms is imperative. This case, which presented with usual symptoms of anterior neck pain and throat discomfort without respiratory symptoms and an unusual site of laryngeal foreign body, finally turned out to be an impacted fish bone in the subglottis.

Crab shell impaction in the larynx with aphonia

Objective@#To report a case of crab shell impaction at the glottic level presenting only as aphonia and cough. @*Methods@#Design: Case Report. Setting: Tertiary Government Hospital. Patient: One (1). @*Results@#A 36-year-old male, who presented in emergency with sudden aphonia after a meal, was found to have crab shell with leg spines impacted at the glottic level. Due to its large size, ragged edges and the sharp spines stuck in the tissue, endoscopic removal needed a prior tracheostomy. All pieces were extracted, with no bleeding, laceration or tissue damage. The patient completely recovered with normal vocal folds and a normal voice at follow up.@*Conclusion@#Our experience suggests that an impacted foreign body may warrant a tracheostomy to secure the airway prior to extraction, and avoid any possible complications including laryngeal injury.

Aphonia after shoulder surgery: case report / Afonia após cirurgia do ombro: relato de caso

ABSTRACT In this case report we highlight the uniqueness of aphonia as, to the best of our knowledge, cases of aphonia related to interscalene brachial plexus block (IBPB) are not described in the literature. Although hoarseness is a common complication of IBPB, aphonia is not. Therefore, we think it is important to publicize the first case of aphonia after IBPB, which may have arisen only because of a recurrent laryngeal nerve chronic injury contralateral to the IBPB site.

RESUMO Relativamente a este relato de caso destacamos a sua singularidade, uma vez que não se encontram descritos na literatura, tanto ou quanto os autores puderam investigar, casos de afonia após uma anestesia combinada com bloqueio do plexo braquial via interescalénica (BPBI). Embora a rouquidão seja uma complicação frequente do BPBI, a afonia não o é. Desse modo, pensamos ser importante dar a conhecer o primeiro caso de afonia após o BPBI, que na opinião dos autores surgiu apenas por causa de uma lesão crônica do nervo laríngeo recorrente contralateral ao local do BPBI.

Voz e trabalho: estudo dos condicionantes das mudanças a partir do discurso de docentes / Voice and work: a study of determinants of changes through teachers’ discourse

O objetivo deste estudo é analisar, a partir da manifestação de piora ou melhora de capacidade para o trabalho, os aspectos condicionantes de mudanças na relação entre trabalho e voz, segundo o discurso de docentes da rede municipal de ensino de São Paulo. Participaram as professoras que, em comparação com pesquisa anterior, apresentaram maior diferença tanto para piora (Grupo A) como para melhora (Grupo B) nos resultados do Índice de Capacidade para o Trabalho. Elas foram convidadas a discutir quais aspectos poderiam explicar a melhora ou piora desses resultados, em um contexto de grupo focal. Os relatos foram transcritos e analisados qualitativamente, segundo a recorrência dos enunciados. Constatou-se que o grupo A apresentou condição mais adoecida e maior necessidade de falar sobre as dificuldades no trabalho. O Grupo B apresentou mais força para enfrentar os problemas referentes ao trabalho, inclusive propostas criativas. A favor do Grupo B, também foram registradas melhores relações no trabalho quanto ao apoio social e autonomia...

This study aims to analyze, by means of manifestation of worsening or improvement in work ability, the aspects conditioning changes in the relation between work and voice, according to the discourse of teachers working at the municipal education network of São Paulo, Brazil. The participants were female teachers who, when comparing with a previous research, had greater difference both in terms of worsening (Group A) and improvement (Group B) in the results of the Work Ability Index. They were invited to discuss which aspects could explain the improvement or worsening in these results, in a focus group context. The reports were transcribed and qualitatively analyzed, according to the recurrence of utterances. We found out that group A showed a worse health status and it had a greater need to talk about difficulties at work. Group B showed more strength to face problems related to work, including creative proposals. In favor of Group B, better work relationships were also registered concerning social support and autonomy...

A Case of Arisaematis Rhizoma Poisoning

Due to increasing participation in outdoor activities, many people visit the emergency room for various symptoms after mistaking poisonous plants for medicinal herbs. The toxicity of Arisaematis rhizome is due to its content of calcium oxalate, which causes painful oropharyngeal edema, hypersalivation, aphonia, oral ulceration, esophageal erosion, and hypocalcemia. We report a case of accidental poisoning after chewing and spitting of the root of A. rhizome, resulting in focal symptoms-such as oral pain, swelling and drooling-that required only conservative management. A 54-year-old male and his 58-year-old wife developed oral pain, swelling and drooling after accidentally chewing and spitting the root of the A. rhizome plant as a medicinal herb. Their symptoms started immediately after chewing on and spitting out the root of A. rhizome, and they were unable to speak due to oral pain, swelling, and hypersalivation on arrival at the emergency department. They were treated with antihistamines and corticosteroids and painkillers. A few hours after treatment, they had improved and were discharged from the hospital.

Pattern of causes and management of permanent loss of voice studied at a tertiary care hospital

To determine the frequency of causes of hoarseness leading to permanent loss of voice and discuss their management. This descriptive study was carried out at the department of ENT, Head and Neck Surgery, Lady Reading Hospital Peshawar from January 2009 to December 2011. All these patients were evaluated in terms of detailed history, thorough examination and relevant investigations. Biopsy from laryngeal mass was taken in case of tumours. Total laryngectomy was performed in patients with advanced laryngeal tumours provided with preoperative counseling regarding postoperative handicaps. The patients with laryngeal narrowing due to trauma were subjected to laryngeal stenting. The data was analyzed using SPSS 15. Out of 16 patients 10 were male and 6 were female with male: female ratio of 1.6:1. The ages ranged from 09-75 years with mean age of 43.68 +/- S.D 18.65 years. Majority of patients [68.75%] had low socioeconomic status. Main presentation of these patients was hoarseness [100%]. The commonest cause of change of voice was laryngeal carcinoma [n-6, 37.5%], followed by blast injury [25%].Endolaryngeal stenting was the commonest [43.75%] procedure performed for traumatic laryngeal stenosis followed by total laryngectomy. Most of the patients gained good esophageal speech. It is concluded that beside laryngeal cancer, trauma to the larynx is a common cause of permanent loss of voice resulting due to increased incidence of violence in our set up. Esophageal speech can be easily and successfully instituted in laryngectomized patients among other voice rehabilitative options

Quadriplegia e afonia após punção epidural: relato de caso / Quadriplegia and aphonia after epidural puncture: a case report

Justificativa e objetivos: complicações de anestesia epidural são pouco frequentes, principalmente aquelas que levam à perda de funções sensoriais com envolvimento de áreas cognitivas. Diversas hipóteses podem ser aventadas, entretanto, não se pode afirmar com exatidão o diagnóstico que levou ao transcurso clínico. Medidas simples e eficazes odem contornar a intercorrência com segurança. Relato do caso: paciente de 36 anos ASA I, submeteu-se à anestesia epidural para procedimento em membro inferior D, desenvolveu após 15 min quadriplegia e afonia, com agitação moderada. (AU)

Justification and objectives: Complications upon epidural anesthesia are rare, specially those leading to loss of sensory functions and compromise of cognitive areas. Several hypotheses can be formulated, but no diagnosis is precise enough to explain the cause of such incidences. Simple and efficient measures may help overcome the intercurrence safely. Case report: A 36-year-old ASA I patient that had epidural anesthesia applied for a procedure in the right lower limb developed quadriplegia and aphonia with mild agitation upon 15 minutes.(AU)

Aphonia induced by block anesthesia of inferior alveolar nerve: a case report / 华西口腔医学杂志

Block anesthesia of inferior alveolar nerve is commonly used in oral clinic service, but aphonia is rare. A case of aphonia induced by block anesthesia of inferior alveolar nerve was reported and the relevant literatures were reviewed.

Surgical voice restoration after total laryngectomy: An overview.

Total laryngectomy is potentially a debilitative surgery resulting in compromise of some of the most basic functions of life including speech and swallowing. This may have a profound adverse effect on the patient's physical, functional, and emotional health, and may result in a decreased quality of life (QOL). Until the 1980s, total laryngectomy was regarded as a dreadful, but often, life-saving procedure for which there was little alternative, and was used as a last resort. At that time survival at any cost in terms of QOL was paramount and many laryngectomies were forced into an isolated life as a mute and dysphasic recluse. Most attempts at voice restoration produced inconsistent results and often techniques were laborious, expensive, and ineffective, particularly when carried out as a salvage procedure after failed radiotherapy. Progress in voice rehabilitation, following total laryngectomy, over the last 30 years, has made an enormous difference in the whole concept of the management of laryngeal cancers. Currently there are several options available for these patients, namely, esophageal speech, artificial larynx, and tracheoesophageal speech. The choice of speech rehabilitation varies from patient to patient, but tracheoesophageal voice has become the preferred method. This article provides a brief account of surgical voice restoration after total laryngectomy. Special emphasis has been given to the surgical technique, special considerations, complications, and the prevention / treatment of tracheoesophageal voice restoration.

Afonia com etiologia desconhecida: relato de caso / Aphonia with unknown etiology: a case report

Introdução: A afonia de conversão é definida como a perda total da voz, é uma doença rara que acomete frequentemente as mulheres. O diagnóstico é clínico, pois não há alterações nas estruturas laríngeas. Objetivo: Descrever um caso de afonia de conversão, atendida em um hospital público no Centro-Oeste do Brasil. Relato do Caso: Paciente de 32 anos, sexo feminino, com queixa de afonia há dois dias, sem outros sintomas aparentes. Os exames não revelaram alterações nas estruturas laríngeas e/ou extralaríngeas. As etapas do atendimento foram descritas desde a consulta inicial até a recuperação da paciente. Comentários Finais: É importante considerar os aspectos psicoemocionais que envolvem os pacientes com alterações vocais, uma vez que os mesmos podem originar ou alterar os sintomas e comprometer o prognóstico da doença.

Introduction: The conversion aphonia is defined as the total loss of voice, is a rare disease that often affects women. The diagnosis is clinical, because there are no changes in the laryngeal structures. Objective: To describe a case of conversion aphonia, seen in a public hospital in the Midwest of Brazil. Case Report: Patient 32 years old female, complaining of hoarseness for two days without other apparent symptoms. The examinations revealed no changes in the laryngeal structures and / or extra laryngeal. Stages of care have been described since the initial consultation to the recovery of the patient. Final Comments: It is important to consider the psycho-emotional aspects involving patients with voice disorders since they may cause or modify the symptoms and affect the prognosis.

Spasmodic Dysphonia / 대한이비인후과학회지

Spasmodic dysphonia is a primary task specific focal dystonia affecting the laryngeal muscle during speech. Adductor spasmodic dysphonia (ADSD) affects close to 90% of spasmodic dysphonia patients is characterized by voice breaks during vowels during speech due to intermittent hyperadduction of the vocal folds. Abcuctor spasmodic dysphonia (ABSD) is relatively rare and involves intermittent voiceless voice breaks due to prolonged voiceless consonants before initiation of the following vowels. Treatment for spasmodic dysphonia has been aimed at denervation or adjustment of the larynx to prevent the uncontrolled spasms in the laryngeal muscles from interfering with voice production. As a result there is a risk-benefit ratio in that the denervation must be adequate to reduce the detection of symptoms whereas at the same time not producing aphonia, breathiness and swallowing difficulties. This article summarizes the pathogenesis, diagnosis and treatment of the spasmodic dysphonia.

Diagnosis and treatment and prevention of iatrogenic functional aphonia / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To discuss the diagnosis, treatment and prevention of iatrogenic functional aphonia.</p><p><b>METHODS</b>Twenty three patients who either lost their voice or only could whisper after surgery in other hospitals were included in this study as the first group, history was well collected and laryngostroboscopy performed. All cases were confirmed as iatrogenic functional aphonia patients and received phonation therapy. In another group of patients who received vocal cord surgery in our hospital from 2003 to 2005, speaking was restricted while not prohibited after surgery, voice quality was closely observed, and 1028 cases were included.</p><p><b>RESULTS</b>All 23 cases of functional aphonia were cured with phonation therapy. No iatrogenic functional aphonia occurred in the second group of patients.</p><p><b>CONCLUSIONS</b>The iatrogenic functional aphonia can be caused by post operative mistreatment and could be cured with phonation therapy, and it is preventable if speaking is not strictly prohibited after surgery.</p>

Cáncer de lengua: reporte de un caso / Tongue cancer: case report

El cáncer de lengua es una entidad oncológica de baja incidencia; a nivel de cavidad bucal representa la segunda neoplasia más frecuente, luego del cáncer de labio. En el rabdomiosarcoma embrionario, los factores concurrentes son la predisposición genética y las alteraciones cromosómicas. El objetivo de este trabajo es presentar un paciente con un tipo histológico infrecuente en adultos como es el rabdomiosarcoma embrionario de lengua, pero de gran agresividad y capacidad de invasión local, el cual antes del año, posterior a la terapia, recidiva en el mismo sitio; a pesar de no invadir ganglios, es de alta morbilidad por el deterioro del habla y de la deglución, además del riesgo permanente de fístulas oro-traqueales.

Tongue cancer is an oncological entity of low incidence; it represents the second more frequent neoplasia in oral cavity, after lip cancer. In the embryonic rabdomyosarcome the concurrent factors are the genetic basis and the cromosomic disorders. The objective of this work is to present a patient with an uncommon histological type for adults, such as the embryonic tongue rabdomyosarcome, but very aggressive and highly capable of local invasion, which, one year post therapy, relapses in the same site in less than in spite of not invading ganglion, it is of high morbility the deterioration of speech and deglution, due to besides the permanent risk of traqueobroncheal fistulas.

Transpondo a barreira do silência e da solidão do cliente laringectomizado através das ações de enfermagem / Transporting the obstacle of silence and loneliness of the client with laryngectomy through nursing care actions / Transponiendo la barrera del silencio y de la soledad del cliente sometido à retirada quirúrgica de la laringe a través de los cuidados de enfermería

Relato de experiência baseado na prática cotidiana da ações de enfermagem desenvolvidas junto a clientes laringectomizados em um ambulatório de pós-operatório, cujo principal obejtivo é enumerar essas ações, analisando-as de acordo com a sua singularidade, tendo em vista o caráter mutilador físico e funcional dessa cirurgia. Entre as disfunções citadas, é enfatizada a afonia, que interfere na comunicação oral do cliente, fato que contribui para o seu isolamento social. A metodologia utilizada para a consecução do obejtivo proposto baseou-se na consulta de enfermagem, considerando que é durante este procedimento que a aproximação do cliente e sua família é realizada junto a esta equipe...

Wilson's disease--unusual features.

Two cases of Wilson's disease with unusual features are reported. In one case neurological abnormality was the presenting feature without any clinical involvement of the liver. In the other case, neurologic manifestations were associated with rickets and cholelithiasis, a result of chronic hemolytic state. Apart from clinical profile both the cases were diagnosed by grossly reduced serum ceruloplasmin level. However, Kayser-Fleischer rings were found in each case.

Paralisia do musculo cricoaritenóideo lateral: relato de caso como contribuição ao estudo da anatomia funcional da laringe / Paralysis of the lateral cricoarytenoid muscle: a case report as a contribution to the understanding of the functional anatomy of the larynx

A eletromiografia da laringe (EMG) vem sendo útil nas avaliações das alterações de mobilidade das pregas vocais, sobretudo diferenciando as paralisias das fixações, e também fornecendo dados para o prognóstico e localização de lesões neuromusculares. Com base na EMG e na telelaringoscopia buscamos entender o papel dos músculos intrínsecos da laringe a partir de um caso de paralisia de músculo cricoaritenoideo lateral, confirmado por estudo eletromiográfico, em uma paciente com história de afonia e perda de mobilidade da prega vocal esquerda, fixa na posição lateral

Is hysteria still prevailing? A retrospective study of sociodemographic and clinical characteristics.

A retrospective study was conducted in a psychiatric setup of S.P. Medical College, Bikaner (Raj.) to assess the social demographic and clinical characteristics of hysterical patients. The illness was more common in female patients. Most of the patients were young, married and illiterate. Nearly half of them had faced some stress prior to onset of their illness. Fits of unconsciousness and aphonia were the commonest presentation in female and male patients respectively. Duration of stay was 2-3 days and most of the patient responded well to different treatment modalities.