[Impact of functional mass lesions in professional female singers : Biomechanics of vocal fold oscillation in the register transition regions]. / Auswirkungen von Phonationsverdickungen bei professionellen Sängerinnen : Biomechanik der Stimmlippenschwingungen in den Registerübergangsregionen.

BACKGROUND: The influence of functional mass lesions on vocal fold oscillation patterns in vocally challenging tasks is not yet understood in detail. MATERIALS UND METHODS: Glissandi on the vowel [a:] from 220 to 440 Hz and 440 to 880 Hz were analyzed in three groups of four professional female singers: without a mass lesion or dysphony (group A), with a functional mass lesion (swellings without a great impact on oscillation patterns during stroboscopy; group B), and with organic dysphony (group C). High-speed digital imaging (HSDI; 20,000 fps), and acoustic and electroglottographic (EGG) signals were used for analysis. Based on the EGG sample entropy, time windows for analysis of register transition phenomena were constructed. The voice signals (glottal area waveform, GAW; acoustic and EGG signals) were perceptually rated in terms of the noticeability of registration events. RESULTS: The absolute sample entropy revealed maxima in fundamental frequency regions where register transitions typically occur. Groups A and B could be distinguished neither by perceptual rating nor based on sample entropy values. In comparison to the other two groups, the absolute sample entropy values of group C were greater in the lower glissando. However, the larger vocal fold oscillatory irregularities were observable for the upper glissando in this group. CONCLUSION: Functional mass lesions do not influence biomechanics adversely in vocally challenging tasks such as register transitions. The use of sample entropy as a criterion for detection of register transitions is promising, but needs further validation.

[Psychological effects of preventive voice care training in student teachers]. / Psychologische Effekte eines präventiven Stimmtrainings im Lehramtsreferendariat.

BACKGROUND: Studies on the effectiveness of preventive voice care programs have focused mainly on voice parameters. Psychological parameters, however, have not been investigated in detail so far. OBJECTIVES: The effect of a voice training program for German student teachers on psychological health parameters was investigated in a longitudinal study. METHODS: The sample of 204 student teachers was divided into the intervention group (n = 123), who participated in the voice training program, and the control group (n = 81), who received no voice training. Voice training contained ten 90-min group courses and an individual visit by the voice trainer in a teaching situation with feedback afterwards. Participants were asked to fill out questionnaires (self-efficacy, Short-Form Health Survey, self-consciousness, voice self-concept, work-related behaviour and experience patterns) at the beginning and the end of their student teacher training period. RESULTS: The training program showed significant positive influences on psychological health, voice self-concept (i.e. more positive perception and increased awareness of one's own voice) and work-related coping behaviour in the intervention group. On average, the mental health status of all participants reduced over time, whereas the status in the trained group diminished significantly less than in the control group. Furthermore, the trained student teachers gained abilities to cope with work-related stress better than those without training. CONCLUSION: The training program clearly showed a positive impact on mental health. The results maintain the importance of such a training program not only for voice health, but also for wide-ranging aspects of constitutional health.

[Current methods for modelling voice production]. / Aktuelle Methoden zur Modellierung des Stimmgebungsprozesses.

BACKGROUND: Many details of the phonatory process are not yet fully understood. Besides observational research, scientists have long since been trying to explain the physical fundamentals of voicing using simulations. This approach is commonly called modeling. However, the knowledge gained often failed to find its way to professionals working with the voice, such as singing teachers, voice therapists, and voice coaches, and sometimes also to otorhinolaryngologists and phoniatricians. The reason for this is that scientific publications on this topic mostly contain very detailed mathematical and physical descriptions, which are often hard to understand. OBJECTIVE: A simplified presentation and explanation of current methods for modeling the phonatory process, which have contributed greatly to uncovering and understanding the relationships involved in voicing during recent years. METHODS: The presented methods cover a wide spectrum, ranging from numerically rather simple to mathematically highly complex models. Experimental models are based on self-oscillating silicon or static vocal folds. Cadaver models have the advantage of being representative of the natural phonation process. RESULTS: An overview of different kinds of models is given to show the diversity of modeling approaches without going into mathematical or physical details. CONCLUSION: Numerical and experimental models for simulating the phonatory process enable causalities and correlations to be uncovered, which can be used in the future to adapt conservative and surgical voice therapies, or even to suggest entire new treatment strategies.

[On the Evaluation of Therapeutic Success in Dysphonic Patients]. / Zur Beurteilung der Therapieerfolge bei dysphonen Patienten.

INTRODUCTION: Multidimensional voice evaluation is considered as gold standard in voice medicine. In this respect, the European Laryngological Society recommended a protocol for standardized evaluation (ELS-Protocol). However, there are only rare data analyzing changes during therapeutical follow-up. MATERIAL AND METHODS: Using this protocol, 276 patients (136 after phonosurgery, 81 after voice therapy and as a control group 59 patients without voice impairment) were evaluated with regard to their vocal capacity before and after voice therapy or phonosurgery, respectively. RESULTS: The parameters of the ELS-protocol showed significant improvement under therapy with respect to DSI, VHI, and RBH-scale. It has been confirmed, that these measurements are suitable for the assessment of dysphonic patients with organic as well as functional voice disorders. However, detailed analysis of all the obtained parameters showed only weak or no correlation between all regarding parameters, which should be expected to provide comparable information, such as perturbation parameters or such parameters, that are derived from the acoustical spectrum. DISCUSSION: Multidimensional evaluation of the voice as recommended by the ELS protocol is independent from the therapeutical approach able to document therapeutical success. The lack of sufficient correlations of values which should provide comparable information shows that an optimization or standardization of measuring instruments, computer hardware and software is necessary.

[Development of a questionnaire for the assessment of the voice self-concept]. / Entwicklung eines Fragebogens zur Erfassung des stimmlichen Selbstkonzepts.

BACKGROUND: Common self-assessment questionnaires on voice diagnostics focus mostly on functionality of the voice and the impact on the quality of life. Personal aspects such as the relationship with one's own voice and its self-perception are for the most part not taken into consideration. OBJECTIVES: In this article a questionnaire for the assessment of the voice self-concept (Fragebogen zur Erfassung des stimmlichen Selbstkonzepts, FESS) is introduced. MATERIALS AND METHODS: Reliability and validity were tested with a sample of 308 student teachers. For external validity, the scales were correlated with standardized questionnaires of vocal, physical, and mental health. The scale reliability was also retested in 94 participants. RESULTS: The principal component analysis confirmed the internal consistency of three subscales on the relationship with one's own voice, the awareness of the use of one's own voice, and the perception of the connection between voice and emotional changes. CONCLUSION: The FESS questionnaire was shown to be a reliable and valid instrument which supplements existing voice questionnaires by self-related aspects of the voice.

Motor functions in trumpet playing-a real-time MRI analysis.

INTRODUCTION: The function of the orofacial and pharyngeal musculature for sound generation in brass instruments is insufficiently investigated. The contribution of muscles defying direct observation remains poorly understood. Time-resolved magnetic resonance imaging (MRI) allows visualization of muscle function as well as changes of the oropharyngeal cavities during muscle activation. METHODS: We used fast 3-T MRI imaging to analyze motor activation during sound generation in brass instruments. Twelve professional trumpeters were analyzed at different pitch, loudness and dynamic. MR images were analyzed for position of the mouthpiece to lips and teeth, pivoting, nasopharyngeal closure and changes in the area of oral and pharyngeal cavity. RESULTS: Of the 12 subjects, eight positioned the mouthpiece mainly to the upper lip, three in equal parts to upper and lower lip, and only one mostly to the lower lip. The last turned out to be the only subject with upward pivoting. All subjects had a complete velopharyngeal closure. Measurements of the oral and pharyngeal cavities showed an increase when subjects were playing higher pitches. The increase in areas of oral and pharyngeal cavity was present also when switching from lower to higher loudness and when performing crescendo to decrescendo. Enlargement of the oral and pharyngeal cavity was less pronounced with increasing loudness. But no general difference in change of oral and pharyngeal cavity could be observed. CONCLUSIONS: The present study shows that it is possible to measure motor function and its implications on oral as well as pharyngeal cavities during sound generation in brass instruments. These changes seem to follow a reproducible pattern.

[Change of vocal capacity due to different vocal loading tests]. / Veränderung der stimmlichen Leistungsfähigkeit durch verschiedene Stimmbelastungstests.

BACKGROUND: Vocal loading tests are an important element in the evaluation of vocal function. In Germany mostly tests with changes of loading intensity between 75 and 80 dB(A) or tests with continuous intensity of 80 dB(C) are used. MATERIAL AND METHODS: 17 subjects with healthy vocal function were analyzed in 3 test conditions (1. continuous loading of 80 dB(A), 2. loading with changes of intensity between 75 and 80 dB(A) and 3. without loading for 10 min) concerning DSI and visual analog scale in their time course. The measurements were performed pre, directly after and 20, 40 and 60 min after the loading. The loading test was performed using the German text "Das tapfere Schneiderlein". RESULTS: The data show that the deviation and percentages of lower values of the intended dB loading were much greater for the test with changes of intensity compared to the test with continuous loading. There were no significant differences of the DSI between both loading conditions. After the loading there was a drop of the DSI followed by a short recovery and a drop after 60 min. CONCLUSION: The loading test with continuous intensity appears more stable for healthy subjects and can be fulfilled more easily. Both tests show comparable courses concerning the DSI after the loading tests.

[Idiopathic facial palsy during pregnancy]. / Periphere Fazialisparese in der Schwangerschaft.

BACKGROUND: Idiopathic facial (Bell's) palsy occurring during pregnancy or post partum is a rare disease. Reports regarding incidence, prognosis and associated risk factors are still inconsistent. MATERIAL AND METHODS: We performed a retrospective analysis of patients presenting with idiopathic facial palsy who had been treated in cooperation between obstetric and otorhinolaryngological departments (tertiary referral centers). The time of onset of paralysis, grading according to House and Brackman, treatment modalities and results were analyzed for the years 1999-2010. RESULTS: The incidence of Bell's palsy in pregnancy was 56 in 100,000 live births. Preeclampsia was reported in one case only. Therapy included prednisolone, methylprednisolone and/or pentoxifylline (up to 2005). All results were favorable (House-Brackman 1-2). CONCLUSION: The incidence of Bell's palsy in pregnancy within our cohort is not increased with regard to the international reports. Early treatment with corticosteroids in consultation with the treating obstetrician is indicated in both pregnant and post-partum patients to achieve optimal results.

[Medical treatment of singers' voices]. / Stimmärztliche Betreuung und Behandlung von Sängern.

ENT/phoniatrics specialists are frequently the primary reference persons for patients who have problems with the professional use of their voice. Singers show the highest risk factors for voice disorders among all professional voice users. The treatment and care of singers requires specific knowledge and competence of the physician, as well as a treatment setting adapted to the needs of this special group of patients, whose existence depends on the use of their voice. To some extent, evidence based concepts can be taken into account when treating professional singers. In cases for which no concepts have yet been developed and evaluated, recourse to clinical experience is necessary. In the present paper, current concepts for the treatment of singers are discussed on the basis of scientific publications and on long-standing experience of consultations in musician's medicine and ENT, under the aspects of diagnosis, therapy as well as prevention, taking into account the most frequent voice problems in professional singers.

[Laryngeal alterations following endotracheal intubation and use of larynx masks]. / Laryngeale Veränderungen nach endotrachealer Intubation und Anwendung der Larynxmaske.

After endotracheal intubation patients most frequently report pharyngolaryngeal complaints. Subsequent impairment of vocal performance might lead to general impairment of communication and job-related performance. Most prevalently, swollen mucosa, hematomas, granuloma and edema in the larynx can be observed after intubation. Limitations of respiratory vocal fold mobility appear less frequently. Knowledge of the pathophysiological aspects and causative factors associated with laryngopharyngeal morbidity are essential cornerstones of quality assurance in perioperative respiratory tract management. This review describes the effects of endotracheal intubation and application of larynx masks in relation to laryngeal morbidity.

Vocal cord dysfunction without end?

Vocal cord dysfunction (VCD) is an important differential diagnosis in acute dyspnoea. VCD is caused by adduction of the vocal folds during respiration typically leading to attacks of dyspnoea, stridor and coughing. Here we present an extraordinary case of an untypical paradoxical vocal fold adduction in a 15-year-old girl with stridor persisting over several weeks.

[Diagnostics and therapy in professional voice-users]. / Stimmdiagnostik und -therapie bei Angehörigen stimmintensiver Berufe.

Voice is one of the most important instruments for expression and communication in humans. Dysphonia remains very frequent. Generally people in voice-intensive professions, such as teachers, call center employees, singers and actors suffer from these complaints. In recent years methods have been developed which facilitate appropriate diagnosis and therapy, based on the criteria of evidence based medicine, in voice patients appropriate to their degree of disease. The basic protocol of the European Laryngological Society offers a standardized evaluation of multidimensional voice parameters. In our own patient collective there were statistically significant improvements in voice quality, according to a pre/post mean value comparison, in both phonomicrosurgical (n=45) and voice therapy (n=30) patients in relation to RBH, DSI and VHI.

[Voice diagnostics in professional sopranos: application of the protocol of the European Laryngological Society (ELS)]. / Stimmdiagnostik bei professionellen Sopranistinnen: anwendung des Protokolls der Europäischen Laryngologischen Gesellschaft (ELS).

The European Laryngological Society (ELS) has published a protocol for the evaluation of vocal function. Using this protocol, we evaluated 17 female sopranos, of whom 11 had laryngostroboscopic findings of organic alterations and six did not. Singers with increased subjective impressions of hoarseness, or of whom the examiner had increased perceptions of hoarseness, showed significant differences regarding impairment of the maximum phonation time, the frequency range, and the dysphonia severity index. No such differences were found regarding the presence of alterations of the vocal folds. These data suggest that organic alterations in professional singers are not necessarily associated with impaired vocal performance or vocal function or with measured values of the ELS protocol. For professional singers, therapy should be indicated not just on the basis of stroboscopy but on a broader basis using multifactorial voice analysis such as the ELS protocol.

[Expiratory vocal cord dysfunction? Case report and review of the literature]. / Exspiratorische Vocal Cord Dysfunction? Falldarstellung und Literaturübersicht.

Wood and Milgrom defined vocal cord dysfunction (VCD) as paradoxical adduction of the vocal folds during inspiration or during inspiration and expiration. We describe the case of a patient with attacks of dyspnea with an isolated expiratory paradoxical adduction of the vocal folds. A review of the literature reveals many factors associated with VCD. Because of the similar risk factors and order of events concerning VCD, we believe that even expiratory laryngeal dysfunctions could be denoted as subtypes of VCD.

[Laryngeal lead shot injury: therapy and follow-up]. / Laryngeale Schrotschussverletzung : Therapie und Verlauf.

Laryngeal shot injuries are rare. The case of a 65-year-old man who suffered from an injury with lead pellets is reported. After exploration with removal of the pellet from the lateral cricoarytenoid muscle, an immobility of the vocal fold developed, accompanied by impaired vocal function. Despite persisting immobility of the vocal fold, after 12 weeks voice compensation was achieved by voice therapy.

[Acquired laryngomalacia of the epiglottis: case report and review of the literature]. / Erworbene Laryngomalazie der Epiglottis : Fallbeschreibung und Literaturübersicht.

Reports on acquired traumatic laryngomalacia appear only rarely in the literature. We report a case of a 47-year-old patient with breathlessness after a transcervical approach to the spine during general anesthesia with intubation. Laryngostroboscopy revealed a smooth and, during inspiration, retroflexed epiglottis at the posterior pharyngeal wall. Additionally, dynamic magnetic resonance imaging for the first time showed hypermobility of the upper edge of the epiglottis. After partial laser epiglottectomy, the patient's complaints disappeared.

[Malignant rhino- and otobasal mucosal melanomas--therapy and outcome]. / Maligne rhino- und otobasale Schleimhautmelanome - Therapieaspekte und Prognose.

BACKGROUND: Malignant melanoma of the rhinobasal mucosa is very rare and makes up less than one percent of all malignant melanomas. Symptoms are unspecific in most cases, and patients often present with large tumours. During the past two decades, a variety of therapeutic modalities has been proposed. MATERIALS AND METHODS: In a retrospective quality assessment, we analysed the charts of fifteen consecutive patients suffering from malignant melanoma of the skull base who where treated in our department since 1993. The influence of specific surgical and adjuvant therapy on recurrence and outcome was evaluated. RESULTS: Initial symptoms were unspecific in all patients. Thus, melanoma was an accidental finding of a biopsy or sinus surgery in most patients, including all cases with amelanotic melanoma. All patients underwent surgery as the initial treatment, in 8 cases followed by adjuvant therapy. In these patients the disease specific survival was slightly better than in patients treated with surgery only. When recurrence was treated by radical mutilating surgery, this did not influence the overall prognosis. CONCLUSION: We conclude from our data and analysis of literature that the prognosis of MM has not developed favourably during the past two decades. Radiation therapy and adjuvant immuno- or chemotherapy seems to have a positive impact. Mutilating surgery is usually not indicated nor is it associated with an improvement of outcome.

[Laryngopharyngeal morbidity following general anaesthesia. Anaesthesiological and laryngological aspects]. / Pharyngolaryngeale Beschwerden nach Allgemeinanästhesien. Anästhesiologische und laryngologische Aspekte.

Laryngeal and pharyngeal complaints are among the subjective problems most frequently reported by patients after general anaesthesia involving endotracheal intubation, others being pain, nausea and vomiting. Hoarseness, sore throat, and vocal cord injuries restrict patients' social lives, and in some cases also their working lives. The most frequent types of laryngeal injury are swollen mucosa and haematoma of the vocal cords. Vocal cord paralysis occurs much less frequently. Knowledge of the pathophysiological aspects and other relevant factors associated with laryngopharyngeal morbidity are essential cornerstones of quality assurance in perioperative respiratory tract management. In this review specific sections are devoted to the implications of anaesthesia involving endotracheal intubation and laryngeal masks for laryngopharyngeal morbidity, and also particular aspects of thyroid gland surgery, cardiothoracic and bariatric surgery and obstetric and paediatric anaesthesia, and medicolegal aspects.