[Contact granuloma of the larynx].

The authors analyse the results of clinical examination of patients with contact granuloma of the larynx treated in Moscow and Erlangen (Germany) clinics. Etiology, pathogenesis of this disease and treatment policy are discussed.

[Most frequent errors in diagnosis and treatment of vocal dysfunction].

Vocal disturbances can be a symptom as laryngeal diseases, and a primary clinical manifestation of an endocrine, neurological or systemic disease, tumors located in the base of the skull, neck, chest. Main causes of the misdiagnosis of vocal disturbances lie in misinterpretation of the results of acoustic study of voice, incomplete case history and inadequately made laryngoscopy. Efficacy of vocal disturbance treatment depends on staged, etiopathogenetic approach with consideration of individual features of the patient. Patients with recurrent and lingering laryngeal diseases should be referred to specialized clinics.

[Complex rehabilitation of patients with vocal defects in sanatoria].

Basing on the experience of phoniatric sanatoria in Austria, Germany, Czech, the authors propose to set up such rehabilitation centers in sanatoria of the Russian Federation which may offer highly professional phoniatric and phonopedic aid basing on climate therapy, balneotherapy, physiotherapy, fangotherapy, spa factors.

[Vocal problems in children and adolescents].

The examination of 2000 children and adolescents diagnosed vocal problems in the form of functional and organic dysphonias in 3.5% cases. Mutational, hypotonic dysphonias occurred more frequently among functional diseases; nodules of the vocal cords, acute and chronic laryngitis -- among organic diseases. Causes of their development and therapeutic policy are specified.

[The effect of phonational load on parameters of cardiorespiratory system in hypotonic dysphonia].

Cardiointervalometry was used to investigate functional parameters of the cardiorespiratory system during text reading. A total of healthy women aged from 17 to 28 years and 11 women with hypotonic dysphonia 17 to 31 years of age entered the study. Both groups exhibited a low index of parasympathetic component of cardiorhythm regulation in shortening of the RR-interval. Correlation inhalation/expiration has changed with prolongation of inhalation and shortening of expiration in reading in women suffering from hypotonic dysphonia. Parameters of the respiratory cycle at rest did not correlate with relevant parameters in reading text in both groups.

[Rehabilitation of patients after laryngeal extirpation]. / Reabilitatsiia bol'nykh posle ékstirpatsii gortani.

Current rehabilitation opportunities for patients after laryngeal extirpation are described. In spite of much success in such rehabilitation many patients after discharge from ENT hospitals experience difficulties in communication, in control of a new voice. Patients with removed larynx need more attention from health and social services.

[Characteristics of respiratory pattern, voice production and conduction in persons of vocal professions]. / Osobennosti patterna dykhaniia, protsessov golosoobrazovaniia i golosovedeniia u lits rechevoi professii.

The authors studied external respiration, voice production and voice conduction in teachers. Occupation-specific compensatory features are described.

[Electrostimulation of laryngeal muscles with fluctuating currents in the treatment of patients with unilateral laryngeal paralysis]. / Primenenie élektrostimuliatsii myshts gortani fliuktuiruiushchimi tokami pri lechenii bol'nykh s odnostoronnim paralichom gortani.

Intralaryngeal electrostimulation of the laryngeal muscles with fluctuating currents with simultaneous mobilization of the arytenoid cartilage and paralysed vocal cord were used in 42 patients with unilateral laryngeal paralysis. The treatment was combined with phonopedic lessons. The control group consisted of 32 patients receiving standard electrostimulation with diadynamic currents. The effect was evaluated by changes in vocal acoustic parameters and stroboscopic parameters. In patients with paramedian fixation of the vocal cords voice improvement was obtained irrespective of electrostimulation type. For patients with intermedian and lateral fixation of the vocal cords more effective was intralaryngeal electrostimulation with fluctuating currents. A good therapeutic effect was achieved in patients with dislocation of the arytenoid cartilage.

[Analysis of the causes of vocal tract diseases in singers]. / Analiz prichin vozniknoveniia zabolevanii golosovogo apparata u pevtsov.

The etiology of vocal apparatus diseases in opera singers is due to both specific features of their theatrical activity and conventions of opera genre in particular. A hundred and twenty seven vocalists (soloists and choristers) aged 23 to 70 years with service length of 3 to 40 years were examined. Both the status of the vocal apparatus itself and comorbidity were found to affect the occurrence of occupational diseases of the larynx. Of great importance are the quality of vocal background of a singer, his/her age, length of service, the even distribution of vocal load during a month and a season, the volume of additional work (concert and pedagogical activities), the correspondence of parts to his/her techniques and actor's capacities, and living and social conditions. The pattern of vocal apparatus diseases also depends on the type of a singer's voice and on the status of his/her nervous system. This study-based recommendations for singers and theater managers administrators reduced the incidence rates of laryngeal diseases in the followed-up professional opera singers by 15-20%.

[The prevalence, causes and specific features of voice disturbances in teachers]. / Rasprostranennost', prichiny i osobennosti narushenii golosa u pedagogov.

The paper analyzes voice disturbances, their causes and specific features in teachers based on the questionnaires filled by 934 general educational school teachers. The teachers have been found to associate voice disturbances not only with changes in the voice timbre, but with different subjective feelings that make their professional activity difficult. The major factors that cause voice disturbances are the voice overloads that differ in teachers of different specialities, their inability to use the voice, psychoemotional stresses, and frequent colds, as well as a combination of several factors. The incidence of vocal apparatus diseases does not tend to decrease, which makes it necessary to implement combined medical and pedagogical prophylactic measures to prevent dysphonia.

[Vocal tract disorders in women with hormonal gynecological diseases]. / Narusheniia golosovogo apparata pri disgormonal'nykh ginekologicheskikh zabolevaniiakh.

The paper analyzes the incidence rates and specific features of vocal apparatus disorders in dyshormonal gynecological diseases in the reproductive and menopausal periods. It presents a complex procedure for diagnosis and treatment, which includes the management of the patient by a phoniatrist jointly with an endocrinological gynecologist, a psychoneurologist, and a phonopedist. Drugs for correcting sexual hormone levels, psychoemotional status, venous tone, breathing exercises and phonopedic classes by using biological feedback, and physiotherapeutical methods of treatment have been used. Indications and contraindications for the use of hormonal drugs in the treatment of dyshormonal gynecological diseases in individuals of voice-and-speech professions are considered.

[Clinical and functional studies of patients with unilateral laryngeal paralysis]. / Kliniko-funktsional'noe obsledovanie bol'nykh s odnostoronnim paralichom gortani.

Unilateral laryngeal paralysis (ULP) involves all three functions (defensive, phonating, and respiratory) of the larynx. It is necessary to make comprehensive clinical studies in patients with ULP of unknown etiology to elucidate the causes of the paralysis. The study involved X-ray tomography of the larynx, lung, and mediastinum, ultrasonography of the thyroid, X-ray study of the skull and the cervical part of the vertebral column, and barium X-ray study of the esophagus. A hundred and twenty patients with ULP underwent clinical and functional studies of the vocal apparatus, with microlaryngoscopy with palpation of the arytenocricoid joint, studies of external respiratory function and the acoustic parameters of their voice. The examination has ascertained that the clinicofunctional status of the larynx in unilateral laryngoparalysis depends on the degree of approach and the quality of closure of the vocal cords (VC) and it is determined by the position of the paralyzed VC in horizontal and vertical planes, by the degree of paralyzed VC atrophy, and by the position and mobility of the arytenoid cartilage.

[Clinical and morphological aspects of benign tumor-like growths in the vocal cords]. / Kliniko-morfologicheskaia kharakteristika dobrokachestvennykh opukholepodobnykh obrazovanii golosovykh skladok.

The structure of the nasal septum was studied on 34 samples obtained from dead bodies of children aged 3 to 14. The septums were removed from the skull cavity. The morphometric studies consisted of measurements of the anteroposerior, superior-inferior, septum and its area, as well as composite anatomical structures. It is shown that the size and area of the septum and its anatomical structures undergo age-specific changes which are not regular. The data should be accounted for in correction of nasal septum structural defects in children of different age.

[Vibrometry of the vocal cords in healthy patients and in patients with nasal and paranasal sinus diseases]. / Vibrometriia golosovogo apparata zdorovykh lits i pri zabolevaniiakh polosti nosa i okolonosovykh pazukh.

The paper presents vibrometry data on resonance function of the vocal apparatus in healthy subjects and patients suffering from nasal and paranasal sinus diseases. It is shown that changes in the resonance function promote negative trends in development of dysphonia.

[Clinical features of spastic dysphonia]. / Klinicheskie osobennosti spasticheskoi disfonii.

Clinical, neurological, endoscopic, psychological findings, questionnaire data on vegetative sphere, diaphragm x-ray, articulation test and Viene test system evidence obtained on 25 patients with phonic spasm confirm organic neurological nature of spastic dysphonia as focal muscular dystonia. This condition can be accompanied with tremor, rotatory, winking and writers' spasms, oromandibular dystonia. As indicated by positive treatment outcomes, combined treatment of phonic spasm with GABA-ergic drugs of clonazepam (antelepsin) and baclofen, orthophonic voice correction, physiotherapy is pathogenetically justified.

[Implantation microsurgery in the phoniatric practice]. / Primenenie implantatsionnoi mikrokhirurgii v foniatricheskoi praktike.

The paper reports the results of teflon paste implantation into the vocal folds of 368 patients with laryngeal unilateral paralysis and scar deformities, atrophy of vocal muscles. Implantation of teflon paste polytef produces a high functional effect in unilateral laryngeal paralysis. 38 patients underwent implantation with collagen. The response of the adjacent tissues to collagen injection is minimal positively comparing to teflon. However, 10 patients needed more injections of liquid collagen 6-18 months following the initial administration because of collagen metabolism.

[Videolaryngoscopy and videolaryngostroboscopy in phoniatrics]. / Primenenie videolaringoskopii i videolaringostroboskopii v foniatricheskoi.

Clinical applications of videolaryngoscopy (VLS) and videolaryngostroboscopy (VLSS) in phoniatrics were investigated. Altogether 150 patients with functional and organic lesions of the larynx and 50 normal subjects representing "voice" specialties were examined. Measurements of vibration, amplitude, frequency and oscillation asynchronicity of vocal cords yielded objective information about vibration in the norm and at pathology. VLS and VLSS can help identify functional and organic diseases of the larynx, document various pathological processes, evaluate the condition of the vocal apparatus, and compare pre- and postoperative laryngoscopic pictures. These methods can find application in training and therapeutic procedures for biofeedback purposes.