Evaluation of expiratory effort on dysphonic patients on increasing vocal intensity.

It is conceivable that the subjects who have phonatory disorders, in comparison with normal individuals, exert a greater expiratory effort when phonating loudly. Furthermore, we presume that the extent and pattern of the changes in the expiratory effort for increasing vocal intensity may vary according to the types of laryngeal lesions. To prove these hypotheses, we investigated the changes in expiratory effort for increments of the vocal intensity by measuring the expiratory lung pressure. The subjects included 10 each of normal controls, patients with Reinke's edema, and those with recurrent laryngeal nerve paralysis. For the normal controls, the increase in vocal intensity was achieved by slightly increasing the expiratory lung pressure. The patients with Reinke's edema showed a greater increase in expiratory lung pressure, as compared with the normal group. The patients with recurrent laryngeal nerve paralysis exhibited greater expiratory effort with extreme increases in airflow than normal group for louder phonation. It was concluded that the subjects who have phonatory disorders, in comparison with normal individuals, require a greater expiratory effort. This phonatory function test with an increase in voice intensity made the aerodynamic pathologic condition clearer.

[Otitis media with effusion in patients with cleft palate and congenital velopharyngeal insufficiency].

The incidences of otitis media with effusion (OME), otoscopic findings of the ear drum, hearing acuity and tympanometric findings were evaluated in 56 cases of cleft palate (CP), 33 cases of submucous cleft palate (SMCP) and 25 cases of congenital velopharyngeal insufficiency without cleft (CVPI). In all the cases, the incidences of OME, the pathological findings in otoscopy and the hearing test were far poorer in the group 8 years old and up than in the younger group. In the younger age group, the incidence of OME was 69% among the CP group, 62% in the SMCP group and showed significantly less incidence in the CVPI group (28%). The incidence of pathological findings in the ear drum was significantly less in the CVPI group than in either the CP group or the SMCP group. Hearing impairment was more frequent in the CP group than in both the SMPC and CVPI groups, while fewer incidences of abnormal tympanogram were found in the CVPI group than in the other two groups. Nearly 14% of the younger CP group developed pathological findings after surgery for velopharyngeal improvement. Most cases were found after push back operations, but rare after pharyngeal flap operations.

Velar Movements during speech in two Wernicke aphasic patients.

The articulatory gestures of the velum in two Wernicke aphasic patients were examined to compare their performances with those of an apraxic patient by means of the fiberoptic technique. In contrast to the marked variability in the apraxic performance in terms of velum height and segmental duration, the two fluent aphasic subjects showed a relatively high degree of consistency in velar movements throughout several repetitions of nonsense syllables and meaningful words. In addition, both patients exhibited a normal pattern of anticipatory coarticulation. Analyses of the velar movement patterns during the speech-sound error processes of both patients suggested that these errors were not due to an impairment at the level of articulatory programming but to an error in the selection of a target phoneme.

Interaction between articulatory movements and vocal pitch control in Japanese word accent.

In order to investigate the interaction between articulatory and vocal pitch controls, EMGs of the cricothyroid (CT) and sternohyoid (SH) muscles were recorded during utterances of two-mora Japanese words with rising and falling accent types in the Tokyo dialects. The test words consisted of combinations of open and closed vowels. It was revealed that the changes in CT activity were consistently observed in correspondence with the F0 shift according to the accent types, while the SH muscle was observed to be active both for jaw opening and F0 lowering, with some subject-to-subject difference. It was also observed that the time lag between the decrease in CT activity and the F0 fall varied with a shift in the relative timing of SH activity in one subject, but not in the other. Articulatory jaw opening with SH activation was considered to positively contribute to F0 lowering, but the use of this mechanism appeared to be optional at least in the Tokyo accent.

Analysis of abnormal articulatory dynamics in two dysarthric patients.

By means of pellet tracking techniques using an X-ray microbeam system, observations of the articulatory movements of various types of dysarthric subjects were conducted. In selected cases, electromyography (EMG) was also performed. The data were specifically examined for range, velocity, and consistency (reproducibility) of the movements of the articulators, as well as the pattern of coordination of the different articulators involved. It was found in the case of ataxic dysarthria of cerebellar origin, for example, that the dynamic patterns were best represented as a difficulty in the initiation of purposeful movements and an inconsistency of articulatory movements, particularly in the repetitive production of a monosyllable. On EMG, breakdown of the rhythmical patterns in the articulatory muscles was quite obvious in the repetition of a monosyllable. In the case of amyotrophic lateral sclerosis (ALS), decrease in the range and velocity of movements was noted. This resulted from reduced neuromuscular units (NMU) activities manifested in clinical EMG. Analysis of the dynamic aspects of the dysarthrias is a promising approach for elucidating the nature of central problems of speech production and for a differential diagnosis of various types of dysarthrias.