[Voice disorders in asthma]. / Stimmstörungen bei Asthma bronchiale.

Aasthma is one of the most common chronic diseases with a prevalence of 5% in Germany. Nearly half of the patients complain about permanent voice disorders. Mucosal changes due to the obstructive respiratory disease as well as mucus abnormalities and regularly accompanying chronic rhinosinusitis may explain these symptoms. The additional influence of laryngopharyngeal reflux is discussed controversially. Additionally, dysphonia may as well occur due to side effects of the therapy with inhaled corticosteroids: the ingredients as well as physical effects may be responsible for the development of chronic laryngitis. The concomitant therapy by an ENT specialist is important in asthma-related voice disorders to identify the basic cause of dysphonia systematically and to intervene at an early stage.

Dysphagia caused by ventral osteophytes of the cervical spine: clinical and radiographic findings.

The purpose of our study was to demonstrate the clinical and radiographic findings in patients with dysphagia and ventral osteophytes of the cervical spine due to degeneration or as a typical feature of diffuse idiopathic skeletal hyperostosis (DISH, Forestier Disease). Since 2003 we encountered 20 patients with such changes in the cervical spine causing an impairment of deglutition. A total of 12 patients had one solitary pair of osteophytes of neighboring vertebrae, 4 patients revealed two pairs and 4 patients had triple pairs of osteophytes. Thirty-two osteophytes were observed totally. A total of 14 of these arose from the right, 15 from the left side and 3 from the middle of the anterior face of the vertebra. Ten patients suffered from DISH, while ten patients revealed osteophytes as a part of a degenerative disorder of the cervical spine. The osteophytes had an average length of 19 mm maximum anterior posterior range. Most of the osteophytes (16) were found in the segments C5/6 and C6/7. Osteophytes of vertebrae C3/4/5 occurred in six cases. Only in one case C2/3 was affected. Functional endoscopic evaluation of swallowing (FEES) revealed an aspiration of thin liquids in seven patients with osteophytes arising from the anterior face of the vertebra C3/4/5 restricting the motility of the epiglottis, which seemed not to close the aditus laryngis. Retention of solids in the piriform sinus on the side obstructed by an osteophyte (C4/5) could also be repeatedly evidenced through FEES. In one case, a strong impairment of the voice because of an immobility of the right vocal cord due to mechanical obstruction by an osteophyte was the indication for surgical removal of the structure. Thus, the dysphagia of this patient was reduced and his voice turned to normal. The development of symptoms in patients with ventral osteophytes was very much related to the location of the structures. Moreover, the clinical symptoms were to some extent dependent on the size of the osteophytes, although there was no direct correlation between size of the structure and severity of the patient's complaint.

[Voice Handicap Index (VHI) in inpatient voice rehabilitation medicine]. / "Voice Handicap Index" (VHI) in der stationären Stimmrehabilitation.

BACKGROUND: The focus of this study was to determine if the Voice Handicap Index (VHI) is a valid tool for evaluating an inpatient voice rehabilitation program. PATIENTS AND METHODS: A total of 39 German-speaking patients were asked to complete a German version of the VHI questionnaire at the beginning and 3 months after attending a voice rehabilitation program on an inpatient basis at the Bad Gögging voice center. The data collected were documented and assessed using Microsoft Excel and MATLAB. RESULTS: A significant reduction of the VHI summary score was achieved by 10 of 39 patients. An increased number of voice therapy sessions before the program diminished (!) the VHI score 3 months after the program. Work disability because of the dysphonia before the beginning of the voice rehabilitation program showed no significant correlation with the VHI score. CONCLUSIONS: At present, the VHI cannot be regarded as a reliable measure to evaluate benefit derived from completing a voice rehabilitation program on an inpatient basis. Apparently, numerous prior treatment regimens constitute a negative prognostic criterion for rehabilitation success as measured subjectively by the VHI.

Vocal stability in functional dysphonic versus healthy voices at different times of voice loading.

Functional (nonorganic) dysphonia is often characterized by vocal instability. The purpose of the prospective study was to examine whether there is a difference in vocal instability of functional dysphonic voices compared with healthy ones, this means whether electroglottographic perturbation values differ (1) between healthy and dysphonic voices and (2) between two subgroups of the dysphponic voices (hypertonic and hypotonic dysphonic voices). Twenty-three patients with hypertonic functional dysphonia, 9 with hypotonic functional dysphonia and 31 healthy nonsmokers, were each examined electroglottographically before (Ex 1), immediately after (Ex 2), and 1 hour after (Ex 3) voice loading. Perturbations of frequency, amplitude, quasi-open-quotient, and contact-index were calculated from the EGG signal. At all three times of examination, hypertonic dysphonic voices showed higher perturbations than healthy voices, and they had higher perturbations than hypotonic dysphonic voices before and 1 hour after voice loading. Hypotonic dysphonic voices showed higher perturbations than healthy voices only 1 hour after voice loading. Voice loading induced different reactions in dysphonic voices: Some voices showed increased perturbations, and others exhibited normal or even decreased perturbation immediately after voice loading. Examination of electroglottographic-derived perturbations immediately after voice loading seems not to be useful. Differentiation of hypertonic and hypotonic dysphonic voices was possible with an estimated sensitivity of 88.9% and a specificity of 87.0% by using the sum of the amplitude-perturbation and the quasi-open-quotient-perturbation measured before voice loading.

[Endoscopic multi-color deglutition study]. / Endoskopische Mehrfarben-Schluckuntersuchung.

BACKGROUND: The complexity of the diagnostic/therapeutic problem in ENT-specific as well as in neurogenic dysphagia requires that test foods be offered in a variety of consistencies (viscosities), at different temperatures, and with various tastes. The swallowing assessment is undertaken with different head and trunk postures, using different swallowing techniques. METHODS: A series of test foods of varied viscosities is prepared with different food colorings. It is given to the patient according to an individually-tailored viscosity plan, but usually in the same (repeatable) color sequence of blue-yellow or blue-yellow-black, an order which offers optimal color contrasts. RESULTS, CONCLUSIONS: During repeated swallowing assessments, the "multicolor technique" is more useful for endoscopic observation of the pharyngolaryngeal route of the food bolus than the "methylene blue swallow". Food coloring is cheap and it changes neither the taste nor the pH of the food.

[Influence of neck soft tissue vibrations on the EGG-Lx signal]. / Schwingungen der Halsweichteile und das EGG-Lx-Signal.

An 3 männlichen und 2 weiblichen stimmgesunden Probanden wurde untersucht, ob sich Schwingungen der Halsweichteile im EGG-Lx-Signal nachweisen lassen. Im ersten Schritt wurde das <> bei am Hals positionierter, schwingender Stimmgabel ohne begleitende Phonation aufgezeichnet. Im zweiten Schritt wurde das EGG-Lx-Signal bei der Phonation des Vokales /a/ registriert; während der Messung war eine schwingende Stimmgabel am Hals plaziert. Im dritten Schritt wurde das EGG-Lx-Signal bei Phonation des Vokales /a/ aufgezeichnet, während eine nichtschwingende Stimmgabel am Hals positioniert war. Die Stimmgabelschwingung war im Spektrogramm der EGG-Lx-Signale als frequenzspezifischer Peak erkennbar, dagegen war dieser Peak im EGG-Lx-Spektrogramm des dritten Untersuchungsschrittes nicht nachweisbar. Dieses Ergebnis kann für die Interpretation des EGG-Lx-Signales von Bedeutung sein.

Development of the child's voice: premutation, mutation.

Voice range profile (VRP) measurement was used to evaluate the vocal capabilities of 180 children aged between 4 and 12 years without voice pathology. There were 10 boys and 10 girls in each age group. Using an automatic VRP measurement system, F0 and SPL dB (lin) were determined and displayed two-dimensionally in real time. The speaking voice, the shouting voice and the singing voice were investigated. The results show that vocal capabilities grow with advancing age, but not continuously. The lowering of the habitual pitch of the speaking voice as well as of the entire speaking pitch range occurs for girls between the ages of 7 and 8, for boys between 8 and 9. A temporary restriction of the minimum vocal intensity of the speaking voice (the ability to speak softly) as well as of the singing voice occurs for girls and for boys at the age of 7-8. A decrease of the maximum speech intensity is found for girls at the age of between 7 and 8, for boys between 8 and 9. A lowering of the pitch as well as of the intensity of the shouting voice occurs for both sexes from the age of 10. In contrast to earlier general opinion we note for girls a stage of premutation (between the age of 7 and 8) with essentially the same changes seen among boys, but 1 year earlier. The beginning of the mutation can be fixed at the age of 10-11 years.

[Indications for vocal cord augmentation with collagen]. / Indikationen zur Stimmlippenaugmentation mit Kollagen.

BACKGROUND: Vocal fold augmentation through an indirect laryngoscopic injection has been largely supplanted by the external approach of vocal fold medialization. Vocal fold augmentation with collagen is still of clinical importance for the temporary treatment of glottic insufficiencies. The different elimination time of certain collagen compounds in the vocal fold tissue enables individual therapeutic applications. PATIENTS AND METHODS: The collagen compounds Zyderm I and II and Zyplast were injected into the vocal fold in 37 patients with neurogenic glottic insufficiency and 2 patients with vocal fold atrophy during indirect laryngoscopy. The choice of compound was made depending on the case, prognosis, severity of the disorder, the persistence of the glottic insufficiency, and the patient's age and condition. RESULTS: Thirty-three patients showed an significant improvement of the glottic closure. However, 6 patients showed hardly any change. CONCLUSION: Collagen augmentation can be used for the temporary medialization of the vocal fold. It is a suitable method for the treatment of vocal fold paralysis a) within the neural regeneration time, and b) in patients with reduced condition and/or a short life expectancy due to severe diseases.

[Comparative voice quality evaluation after laser surgical versus fronto-lateral partial laryngectomy in T1b and T2 vocal cord carcinoma]. / Vergleichende Stimmuntersuchung nach laserchirurgischer versus fronto-lateraler Kehlkopfteilresektion bei T1b- und T2-Stimmlippencarcinom.

BACKGROUND: We conducted a study to compare the voice quality after transoral endolaryngeal laser surgery versus anterolateral partial laryngectomy in terms of ability to communicate effectively. MATERIAL AND METHODS: Two groups each of 8 patients were reexamined at least 6 months after either a laser surgical or a partial anterolateral laryngectomy for a T1b or T2 vocal chord carcinoma was performed by the same surgeon. The following examinations were conducted: video-laryngoscopy, video-stroboscopy, phonetogram when reading a standard text or when speaking and shouting, voice load test, respiratory flow measurement, auditive voice rating following the RBH model, and auditive rating of the voice by the patients according to a questionnaire. RESULTS: A voice disorder with a medium-grade dysphony and an essential limitation of the speaking and shouting voice function and voice quality was detected in both groups of patients. No significant differences were observed in any of the parameters evaluation in both groups of patients. CONCLUSIONS: Both surgical techniques appear to be equivalent in terms of postoperative voice function. However, the tracheotomy was avoided in the patients undergoing laser surgery.

[Vocal capabilities of nonprofessional singers evaluated by measurement and superimposition of their speaking, shouting and singing voice range profiles]. / Tonhöhen- und Intensitätsbefunde bei Stimmgeübten.Vergleichende Sprechstimmfeld-, Rufstimmfeld- und Singstimmfeldmessung.

Voice range profile(VRP) measurement (Phonetography) was used for the evaluation of the vocal capabilities of 41 female (F) and 50 male (M) members of a nonprofessional choir. By means of an automatic VPR measurement system F0 and SPL dB(A) were determined and displayed real time, two-dimensionally. The speaking voice (reading a standard passage as well as counting from the softest to the loudest intensity), the shouting voice (3-4 times shouting a standard sentence) and the singing voice (sustained phonation / la:/ at minimum and maximum intensity level) were measured. The VRPs of these voice modalities were superimposed on the screen and the plot. The averaged values for the speaking VRP: intensity range (F): 48 dB (range 46 soft to 94 dB loud phonation), (M): 52 dB (range 46-98). Pitch range (F): 15 semitones (ST) (Cis3, 138-E4, 329 Hz), (M): 19 ST (E2, 82 Hz-H3, 246 Hz). The average slope for the speaking voice (F): 0,31 ST/dB, (M): 0,36 ST/dB. Shouting VRP highest intensity (F): 106,5 dB, (M): 108,5 dB, highest pitch (F): between Ais4, 466 and H4, 493 Hz. (M): E4, 329 Hz. Average slope for speaking and shouting voice (F): 0,36 ST/dB, (M): 0,39 ST/dB. Singing VRP pitch range (F): 34,6 ST, (M): 37 ST, intensity range (F): 60 dB, (M): 58 dB. The pitch extension of the speaking VRP ranges from 2,9 to 46,2%, speaking and shouting VRPs together with 2,9 to 65% of the pitch range of the singing VRP (F), (M) 2,7-54% and 2,7-67,5% accordingly. The average values for nonprofessional singers reflect an effective but not special use of the phonatory system for the speaking, shouting and singing voice functions with respect to pitch and intensity.

[Voice disorder and bulimia]. / Stimmstörung und Bulimie.

It is known that gastroesophageal reflux disease is one of the causal agents for pathological changes in the larynx. The following case report reveals the relation between chronically habitual vomiting (bulimia) and alterations in the larynx, representing the findings typically seen in reflux laryngitis. The case describes the history of a 29-year-old female patient who has suffered from bulimia for years and consequently developed a disorder in her singing voice and irritation of the throat. The medical history, laryngeal findings and the results obtained in examination of the voice indicate that possible causes typical of gastroesophageal reflux disease can be detected in patients with a matching history, corresponding age and gender; bulimia should be considered as one of the causes.

Electroglottographic Quasi-open quotient and amplitude in crescendo phonation.

Crescendo phonation (swelltone) was used to evaluate the laryngeal tensioning behavior of seven normal speakers and of 12 dysphonic patients. EGG quasi-open quotient (qOq), stroboscopic open quotient, and vocal sound pressure level (SPL) were measured, and EGG amplitude and the mucosal wave were assessed qualitatively. For normal speakers, the qOq decreased greatly as vocal intensity increased. The same tendency was observed, but to a lesser extent, among hyperfunctional dysphonics. In contrast, qOq increased with vocal intensity among the hypofunctional dysphonics. The crescendo task combined with EGG assessment appears to offer a valid approach to the classification of laryngeal dysfunctions.

[Reconstruction of speech and chewing function after extensive tumor resection in the area of the jaw and face]. / Wiederherstellung der Sprech- und Kaufunktion nach ausgedehnten Tumorresektionen im Kiefer-Gesichtsbereich.

BACKGROUND: Following extensive resections of head and neck tumors, re-establishing speech and masticatory function are of crucial importance for the patient. METHODS: In 23 patients with vascularised jejunal grafts for reconstruction of the intraoral mucosa, tongue and floor of mouth, a speech intelligibility test was performed, tongue and floor of mouth mobility was investigated using a 3.5 MHz ultrasound scanner. In another 18 patients with vascularised bone grafts for reconstruction of the mandible, masticatory function was analysed using a T-scan system and a miniature pressure transducer. RESULTS: Speech results with jejunal grafts in the lateral floor of mouth/tongue region may attain 91.4%, in anterior floor of mouth reconstructions 63.4%. Patients with implant-bone dentures and vascularised bone grafts prefer the non-reconstructed side for chewing. Masticatory force is significantly diminished compared to a control group. DISCUSSION: Lack of neurosensitive feedback mechanisms may be responsible for diminished chewing pressure and also for inferior speech results despite good floor-of-mouth/tongue mobility. CONCLUSIONS: Despite complex microvascular tissue reconstructions, severe functional impairments remain and necessitate further investigations on improvement of postoperative speech, swallowing and chewing function.

Herpes simplex virus type I reactivation as a cause of a unilateral temporary paralysis of the vagus nerve.

Infection by neurotropic viruses, as exemplified by the herpes family, is universally accepted as a cause of palsies of the cochleo-vestibular and facial nerve. Palsies of the vagus nerve with a possible viral etiology have been described, although viruses have been identified in only a few selected cases. We report a 52-year-old man with unilateral otalgia, hoarseness and dysphagia. Examination revealed unilateral (left-sided) pharyngeal dysfunction, and paralysis of the left vocal cord fixed in the paramedian position. A barium swallow documented dysfunction of the left pharyngeal constrictor muscles. These findings suggested the lesion to be located either at the inferior ganglion of the vagus nerve or cranially. At direct laryngoscopy a smear was obtained from a 4-mm mucosal ulcer at the region of the left arytenoid cartilage. This smear demonstrated antibodies to herpes simplex virus (HSV) type I by immunofluorescence. On follow-up 19 months after the initial infection there was complete remission of the paralysis of the left vocal cord and normal pharyngeal function. The demonstration of HSV type 1 antibodies from a mucosal lesion in the distribution of the superior laryngeal nerve suggests that reactivation of HSV type I was the most likely explanation for the temporary nerve palsy seen.

Comparative speaking, shouting and singing voice range profile measurement: physiological and pathological aspects.

The Voice Range Profile (VRP) measurement offers a method for the investigation of voice modalities i.e. speaking voice, shouting voice and singing voice in their mutual pitch and intensity relations. The parameters FO and SPL are evaluated by means of automatic pitch and SPL measurements from (1) sustained phonation /a:/ in the speaker's natural pitch and intensity range, (2) the continuous speaking voice beginning with Pianissimo up to Fortissimo, (3) the shouting voice. Vocal intensity is plotted vertically, vocal pitch horizontally. The displays of the vocal intensity versus fundamental frequency are defined as singing voice range profile (VRP), speaking VRP and shouting VRP. The VRPs are superimposed on the same plot. Their form, their shape and their position to each other are analysed. The physiological relationships between the VRPs of the different voice modalities to each other are defined. The pathological relationships between the VRPs (i.e. reduction, shifting) give information about etiology and pathomechanism of voice disorders.

Functional effects of a free jejunum flap used for reconstruction in the oropharyngeal region.

Postoperative articulatory function was assessed in 5 patients who had had radical operations for cancers of the oropharyngeal region with surgical reconstruction using free jejunum flaps. A patient with total resection of the soft palate had the lowest scores of 39.9%. 4 patients with less resection than total removal of the soft palate had good scores (86.0%), and the articulatory dysfunction was limited only in plosive sounds produced in the velar region. A comparative study with glossectomized patients revealed that those who had had resection of the oropharynx achieved excellent articulation except for sounds produced in the velar region. The importance of operative function was stressed, to evaluate indications for the surgical technique for reconstruction of large tissue defects after ablation of head and neck cancers, and to improve the quality of life of those patients.

Long-term results following velopharyngoplasty with a cranially based pharyngeal flap.

Between 1980 and 1989, 82 velopharyngoplasties have been carried out in the Department of Oral and Maxillofacial Surgery at the Medical University of Hannover. Speech results of 51 of these patients, including 39 patients with cleft lip and palate, could be followed up in the context of a clinical follow-up examination. Besides evaluation of speech results by two senior speech pathologists and two untrained listeners, a frequency analysis of the speech results with a sonograph was obtained. Nasal air loss was documented with a fogged-mirror test and computer aerometry. Whereas in 37 of 51 patients a normal or almost normal colloquial speech could be demonstrated, 30 of 39 patients with cleft lip and palate showed a normal or almost normal realization of the test sentences. Thirty of the 37 patients (81.08 percent) with normal or almost normal colloquial speech showed extensive mobility of the lateral pharyngeal wall. Symmetry of the velopharyngeal flaps seemed to have no influence on the speech result. With a fogged-mirror test, an average reduction of mirror fogging from 2.0 rings preoperatively to 0.9 rings postoperatively could be shown. In 31 patients, there was no longer any air loss postoperatively. Besides one rupture of a flap, two flaps had to be diminished in their lateral dimensions because of excessive size. We regard the cranially pedicled pharyngeal flap as an important operative procedure for improving speech results, especially in cleft lip and palate patients.

Articulatory function in glossectomized patients with immediate reconstruction using a free jejunum flap.

Postoperative articulation in 18 glossectomized patients was investigated. The subjects were: 5 cases of tongue tumour, 7 cases of tumour of the anterior part of the floor of the mouth and 6 cases of tumour of the lateral part. A new modification of the Freiburger test for speech audiometry was used as test material. Then the articulatory function was assessed according to an overall score based on 180 monosyllables, the manner of production of 171 initial consonants and the place of production of 85 glossal sounds. The cases of tumour of the tongue and the lateral part of the floor of the mouth had excellent scores in all classes of sounds, which were compatible with the normative data. The subjects of tumour of the anterior part of the floor of the mouth had low overall scores, low scores for plosive and affricative sounds, and very low scores for sounds produced with the rear of the tongue. The relation between the site or amount of resection and subsequent articulation was significantly poor in all categories of sounds for the cases of anterior tumour, particularly in the movement of the posterior portion of the tongue even though it was not involved in the operation. In all groups there was a weak negative relation between the amount of resection and postoperative articulation. In reviewing the literature, reconstruction with a free jejunum flap was considered to lead to better articulation than reconstruction by other techniques. The need to assess postoperative function objectively was stressed, to compare the postoperative functions and to determine the indications for the reconstructive technique.

[Pharmacotherapy of voice and articulation disorders in aphasia]. / Pharmakotherapie von Stimm- und Artikulationsstörungen bei Aphasie.

The phonation and articulation disorders in a group of aphasics with aphonia/dysarthrophonia could be considerably reduced by the use of medication. The group consisted of 10 apoplectic patients whose resulting aphasia could not be classified because of the vocal impairment. Extrapyramidal motion disorders were proved by laryngoscopy and stroboscopy. A definite improvement of phonation and articulation was observed after L-dopa medication.