[High-speed digital imaging in the clinical analysis of voice change as a parameter of premenstrual syndrome]. / Technika szybkiego filmu w sekwencji cyfrowej w analizie zmian glosu w zespole napiecia przedmiesiaczkowego.

Technique of high-speed digital imaging (HSDI) is unique technology, allowing assessment of real vocal fold vibrations. AIM: The aim of the study is to present the usefulness of HSDI in the diagnosis of premenstrual dysphonia as a parameter of premenstrual syndrome (PMS). MATERIALS AND METHODS: In study conducted by Department of Clinical Phonoaudiology and Logopedics at the Medical University of Bialystok participated 21 women aged between 20-31 years old. HSDI technique with a digital High Speed HS camera was used for visualization of the larynx. The rigid endoscope with 90° optics was used for visualizing the vocal folds vibrations during phonation of "e" vowel, at the rate of 4000 frames per second. Playback of recorded sequence set at 15 frames per second, allowed to assess vocal folds vibrations in slow motion mode. Mucosal wave (MW), glottal closure (GTs), symmetry, regularity and synchrony of vocal fold vibration were analyzed. Kymography of the larynx was made for analyzing the value of the Open Quotient (OQ) in the assessment of degree of glottal insufficiency. Study was conducted in the follicular phase of the menstrual cycle and then repeated 2-3 days before menstruation. RESULTS: In the analyzed group of patients studied before menstruation only 19% of women complained of hoarseness and fatigue of voice, and 81% reported no problems with his voice but the edematous changes in the larynx was recorded by HSDI technique. No women had premenstrual dysphonia in the follicular phase of the menstrual cycle. CONCLUSIONS: HSDI allows objective assessment of the degree of severity of insufficiency of glottal closure and edematous changes in the vocal folds in premenstrual dysphonia, what is confirmed by the objective values of the OQ.

[Effects of electrostimulation therapy in selected cases of vocal fold paralysis]. / Efekty terapii elektrostymulacyjnej w wybranych przypadkach porazen faldów glosowych.

Paralytic dysphonia is the most serious neurogenic pathology of voice quality. An important issue is to identify methods which support routine treatment. AIM: The aim of the study is to assess voice quality after electrostimulation (ES) therapy in patients with paralytic dysphonia. MATERIALS AND METHODS: The group consisted of 40 patients diagnosed at the Department of Clinical Phonoaudiology and Logopedics and then treated at the Phoniatric Outpatient Clinic of the Medical University of Bialystok, Poland in years 2013-2015. In the assessment of voice quality GRBAS scale was used, it was determined voice attack, maximum phonation time (MPT), voice self-evaluation of patients were analyzed using a questionnaire Voice Handicap Index (VHI). Visualization of the vocal fold vibration was performed using High Speed Digital Imaging (HSDI) technique. The acoustic examination of voice was made during phonation of vowel "a" and continuous linguistic text. Electrostimulation (ES) therapy was performed after determining the ratio á, which conditioned the choice of set of voice exercises (VE) and duration of one-time electrical impulse stimulation. Subjective and objective evaluation was performed before and after ES therapy. The results were compared with a group of patients that received the routine therapy without ES. RESULTS: Subjective, objective and self-evaluation analysis of voice showed a improvement of its quality after ES. Increasing the mobility of vocal folds after ES resulted in an improvement of voice quality parameters in the acoustic assessment. Effectiveness of the ES therapy on the function of the vocal fold vibration was confirmed by HSDI technique. CONCLUSIONS: Studies have shown that ES therapy is a valuable addition to the routine method of treatment of paralytic dysphonia.

Application of High Speed Digital Imaging (HSDI) technique and voice acoustic analysis in the diagnosis of the clinical form of Presbyphonia in women.

<b>Introduction:</b> The aging process of voice begins after the age of 60 and has an individually variable course. Voice quality disorders at this age are called senile voice (Presbyphonia or Vox Senium). Voice pathology is particularly severe in women. The aim of the study was to diagnose the clinical form of Presbyphonia in elderly women using High Speed Digital Imaging (HSDI) and acoustic voice analysis. <br><b>Material and methods:</b> Study included 50 elderly women (average age 69) with dysphonia (Group I). Control group (Group II) included 30 women (average age 71) without voice quality disorders. Visualization assessment has been conducted with High Speed Digital Imaging (HSDI) with High Speed camera (HS). Acoustic evaluation of voice included analysis isolated vowel "a" and continuous linguistic text with Diagnoscope Specialista software. Maximum Phonation Time (MPT) has been determined. <br><b>Results:</b> In Group I, 78% of women revealed vocal folds vibrations asymmetry, vibration amplitude increase, Mucousal Wave (MW) limitation and Type D glottal insufficiency (GTs). Acoustic voice analysis proved decrease in F0, increase in Jitter, Shimmer, NHR. In 22% of women, next to vibrations asymmetry, vibration amplitude reduction and MW limitation, Type E glottal insufficiency (GTs) have been found. Acoustic voice analysis revealed slight decrease in F0 and the presence of numerous non-harmonic components in the glottis region. <br><b>Conclusions:</b> Vocal folds visualization with HSDI showed edema, less often atrophy in elderly women. Both forms of dysphonia were caused abnormal values of F0, Jitter, Shimmer, NHR in the acoustic voice evaluation and significant reduction of MPT.

Perceptual and acoustic voice analysis in patients with glottis cancer after endoscopic laser cordectomy.

<b>Introduction:</b> Treatment of glottis cancer, despite oncological safety, should consider postoperative voice quality. CO₂ laser endoscopic cordectomy allows radical removal of the tumor while maintaining respiratory, defensive and phonatory functions. <br><b>The aim:</b> The aim of the study is perceptual and acoustic evaluation of voice in patients after endoscopic CO2 III-Va laser cordectomy due to glottis cancer. <br><b>Material and method:</b> The study included 30 men after CO₂ cordectomy. 13 (43%) patients underwent type III cordectomy, 6 (20%) - type IV; 11 (37%) - type Va. Voice quality has been assessed 6 months after the surgery. Control group included 30 healthy men of the same age. GRBAS scale has been used in perceptual evaluation of voice. Acoustic analysis has been performed using DiagnoScope Specjalista software. Narrowband spectrography and Maximum Phonation Time (MPT) measure has been performed. <br><b>Results:</b> In study group, voice has been classified as G₁R₁B₀A₀S₀ after type III cordectomy; as G₁R₁B₁A₁S₂ in type IV and as G₂R₁B₁A₀S₃ in type Va. Acoustic evaluation revealed the highest values of F0, Jitter, Shimmer and NHR after Va cordectomy as well as non-harmonic components in narrowband spectrography and reduction of MPT. <br><b>Conclusions:</b> Postoperative voice quality depends on the type of cordectomy. Perceptual assessment indicates that type IV and Va cordectomy cause intensification of voice disorders. Parameters of acoustic evaluation increase with the extent of the procedure. The presence of non-harmonic components in narrowband spectrography increases with the extent of cordectomy, such as the reduction of MPT. Preservation of anterior commissure influences good voice quality in perceptual and acoustic assessment.

Verbal communication disorders in psychogenic dysphonia.

Psychogenic dysphonia is defined as disturbances in voice and speech quality with emotional background with lack of organic changes in the larynx. Mental condition has significant impact on the process of producing voice, functioning of respiratoryphonatory- articulation mechanism and speech prosody. The aim of the study was visual, acoustic, perceptual assessment as well as self-assessment of voice and speech quality using subjective and objective methods in patients with psychogenic dysphonia. The study included 50 patients with psychogenic dysphonia diagnosed in the Department of Clinical Fonoaudiology and Logopedics, Medical University of Bialystok and treated at the Foniatric Outpatient Clinic, University Hospital in Bialystok in 2017-2018. The control group consisted of 30 subjects with euphonic voice. All patients underwent subjective and objective assessment of voice and speech quality. The GRBAS scale, breathing pathway assessment, respiratory-phonatory-articulation analysis, voice and speech intensity evaluation have been performed. Speech prosody has also been examined. Patient selfassessment of voice has been conducted using Voice Handicap Index (VHI). Objective evaluation of larynx included vibrations of vocal folds visualization using High Speed Digital Imaging (HSDI). Acoustic analysis of voice quality has been performed using DiagNova Technologies. The maximum phonation time (MPT) has been determined. Hyperfunctional dysphonia is the most common clinical form of psychogenic dysphonia. Abnormal breathing pathway influence the reduction of MPT and disturbance of respiratory-phonatory-articulation coordination in patients with psychogenic dysphonia. In psychogenic dysphonia intonation and speech rate disorders are observed. Results of voice self-assessment in the majority of examined patients indicates a mild voice disability.

Phonatory compensation in patients with larynx cancer after CO2 laser cordectomy.

INTRODUCTION: CO2 laser endoscopic cordectomy is the method of laryngeal cancer treatment. The type of cordectomy (I-VI) depends on the extent of the tumor. Endoscopic laser surgery provides more satisfactory phonation conditions in comparison to open surgical procedures. THE AIM: The aim of the study was to classify phonatory compensation mechanisms after CO2 laser cordectomy using the HSDI. M aterial and methods: The study included 30 men treated and diagnosed at the Department of Otolaryngology and Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok. The control included 30 men with no pathological changes in the larynx. Type III, IV and Va CO2 laser cordectomy have been for glottis cancer treatment. Postoperative evaluation has been conducted 6 months after the surgery. HSDI has been used in larynx visualization. R esults: Type I compensation occurs most frequently in patients after type III cordectomy. Advanced glottis cancer, as an indication for type IV and V cordectomy, leads to epiglottic hyperfunction and phonation involving vestibular folds - type II and III compensation. Type IV compensation is most frequent in type IV cordectomy. C onclusions: The type compensation is connected with the extent of glottis resection. In cordectomy including anterior commissure and the part of opposite fold (type Va), supraglottic hyperfunction with the participation of vestibular folds (type II and III compensation) has been recorded. Transmuscular cordectomy (type III) most often resulted in type I compensation. Type III-Va cordectomy caused reduction or absence of MW, decrease in amplitude and aperiodicity of vibrations in HSDI.

Analysis of voice quality parameters in patients with vestibular voice.

Vestibular voice includes participation of larynx structures which are absent in physiological process. Vestibular phonation may be desired when vocal folds are damaged as in paralytic dysphonia, or undesired in marginal hyperfunction. Vestibular voice may result from psychogenic dysphonia - phononeurosis. The aim of the study is perceptive evaluation of vestibular voice, objective larynx visualization, acoustic and aerodynamic examination. The study included 40 patients: 20 with vestibular voice, 20 with euphonic voice. Voice quality has been evaluated using perceptual GRBAS scale. Endoscopic and stroboscopic larynx examination used Endo-STROB-EL-Xion GmbH with visual tract. High-Speed Digital Imaging (HSDI) and High Speed (HS) camera registered true vocal folds vibrations. Acoustic evaluation of voice with DiagnoScope Specjalista, DiagNova Technologies included analysis of F0, Jitter, Shimmer, NHR, nonharmonic components. MPT has been analyzed. In examined group, hoarseness (95%), roughness (75%) and voice strain (55%) have been recorded. Endoscopy revealed edema of vestibular folds with dilation of vessels covering glottis. Stroboscopy and HSDI confirmed coexistence of hyperfunctional (95%) or paralytic (5%) dysphonia. Acoustic assessment revealed increase in Jitter, Shimmer, NHR and decrease in F0 and MPT. The vestibular voice is observed most frequently in women with hyperfunctional dysphonia (phononeuroses) or in paralytic dysphonia. Visualization techniques confirm the coexistence of vestibular folds hypertrophy and edema with vibration disorders. In the perceptual assessment, vestibular voice was hoarse, rough and strained. Acoustic examination showed increase of Jitter, Shimmer, NHR, presence of nonharmonic components and decrease of F0 and MPT.

[Actinomycosis of sinus maxillaris--case report]. / Aktinomykoza zatoki szczekowej--opis przypadku.

The authors present the case of primary actinomycosis of maxillary sinus. The frequency of the disease, differential diagnosis and treatment we present.

Psychogenic voice disorders.

INTRODUCTION: Voice express the psyche and personality of a person. Psychogenic dysphonia is called Phononeurosis. Neurosis, depression or family, occupational and social conflicts are the cause of voice disturbances. The most frequent type of dysphonia is hyperfunctional dysphonia, rarer - hypofunctional type. AIM: The aim of this study is an analysis of voice quality and diagnosis of clinical type of psychogenic dysphonia. MATERIAL AND METHODS: The analyzed group consisted of 50 patients with voice disorders treated in 2017 and the control group - 30 people with physiological voice. In the diagnosed group 60% of patients were treated for neurosis, 12% due to depression, the others reported conflict situations. In the diagnosis of clinical type of psychogenic dysphonia GRBAS scale was used, maximum phonation time (MPT) and type of breathing were assessed. The visualisation of the larynx was performed using High Speed Digital Imaging (HSDI) technique. The parametric acoustic evaluation of voice was conducted. RESULTS: The most often clinical type of psychogenic dysphonia was hyperfunctional dysphonia, rarer hypofunctional type and vestibular voice. Dysphonia occurred the most often in women during the highest professional activity period. In the diagnosis of clinical type HSDI technique was especially useful allowing to visualization of the real vocal fold vibration and objective differentiation of hyper- and hypofunctional dysphonia. The acoustic analysis of the voice objectively confirmed the presence non-harmonic components - noise generated in the glottis in hypofunctional dysphonia. Disturbances in the way and breathing type caused irregularities in respiratory-phonic and articulation coordination.

Subjective and objective assessment of voice quality in pregnancy.

During pregnancy, voice quality disorders may occur in form of: edema, dryness, nervousness. The aim of the study is subjective and objective evaluation of voice quality in pregnant women. The study included 20 women in the third trimester of pregnancy, age of 20-31 diagnosed at the Department of Clinical Phonoaudiology and Logopedics, Medical University of Bialystok. Subjective assessment has been based on the GRBAS scale. Objective assessment of the vocal organ used the HSDI technique (High Speed Digital Imaging). In the laryngeal visualization, high-speed camera (HS) using rigid endoscope with 90 ° optics has been used. Vibration of vocal folds has been recorded during phonation of vowel "e" at 4000 frames / sec. The glottal closure (GTs), symmetry, regularity and synchronization of vocal folds vibration have been assessed. In estimating the degree of glottal insufficiency, kymography of the larynx has been performed by analyzing the value of Open Quotient (OQ). Objective acoustic evaluation of voice has been also conducted using DiagnoScope Specjalista Program. Hoarseness has been observed in 15 pregnant women, whereas voice fatigability in 20 patients. Using HSDI, the edema of vocal folds in part of the group has been observed. Decreased MPT has been found in all examined women in the third trimester of pregnancy. Hoarseness and fatigability of voice are the most frequent subjective symptoms of voice organ in the third trimester of pregnancy. Decreased MPT is recorded objectively, as well as edema and insufficiency of vocal folds using HSDI technique.

[Progression of larynx and hypopharynx cancer in the last ten years]. / Zaawansowanie raka krtani i gardla dolnego w ostatnim dziesiecioleciu.

Epidemiological analysis of patients with the larynx and hypopharynx cancer, who were treated in the Department of Otolaryngology in Bialystok from 1999 to 2004 was performed. The following aspect were assessed: (1) number of patients, (2) sex, (3) profession and place of living, (4) primary site of the tumour, (5) clinical advancement stage of the disease. The study was of 676 patients. The majority--92.2%--were males but an increase in number of female patients was found. The most common site of the primary tumour was the supraglottic region (56.9%). The analysis showed that the numbers of patients with T3/T4 clinical advancement stage of the tumour was larger (64.9%).

[Quality of life for patients with laryngeal cancer]. / Jakosc zycia chorych na raka krtani.

The number of diagnosed instances of larynx cancer is systematically increasing, especially in men. Treatment, in the majority of cases, is undertaken at an advanced stage of the disease. This is the major factor determining the outcome of therapy and the patients' quality of life. The aim of this paper is to estimate the environmental and occupational risk factors as well as to evaluate the quality of life of patients before they were diagnosed with larynx cancer and after the treatment was completed. The analysis involved 82 patients after total laryngectomy due to squamous cell carcinoma. A vast majority of the patients (96%) abused alcohol and were heavy smokers (95%). 76% were exposed to harmful environmental conditions and 56%--to harmful conditions at workplace. After treatment, which was accepted by over 96% of the patients, many of them quit using alcohol (57%) and quit smoking (73%). Because of difficult economic situation only few of them decided to change their working or living conditions. 47% of patients judged that after the diagnosis and consequently after undergoing complete treatment, the quality of their life deteriorated. Their awareness of the health-threatening factors had however grown.

[Assessment of the hearing organ in the patients with allergic perennial and seasonal allergic rhinitis]. / Ocena narzadu sluchu u pacjentów z alergicznym calorocznym i sezonowym niezytem nosa.

We studied 60 patients with allergic rhinitis (30 with seasonal and 30 with perennial rhinitis). Assessment of atopic status was based on medical history, physical examination, skin-prick testing, total IgE levels and nasal smears. Audiometry and tympanometry have been performed. Audiometric conductive hearing loss was found in 26.7% patients with perennial rhinitis and in 10% patients with seasonal rhinitis. Type B tympanogram were found in 20% of the patients with perennial rhinitis and in 3.33% of the patients with seasonal rhinitis. Type C tympanogram were found in 20% of the patients with perennial and in 6.67% with seasonal rhinitis. Secretory otitis media and retraction pockets were more common in patients with perennial rhinitis allergy. Local allergic reaction in the middle ear and dysfunction of the Eustachian tube can be the most responsible for these disorders. Tympanostomy and ventilation tubes were needed in secretory otitis and myringoplasty in the cases of the retraction pockets. Appropriate treatment of allergic rhinitis may decrease the need and frequency of surgical procedures and may reduce costs associated with hospitalization.

[Epidemiology of laryngeal and hypopharyngeal cancer in the period 1988-2012 in the material of the Otolaryngology Clinic of the Bialystok Medical University]. / Epidemiologia raka krtani i gardla dolnego w latach 1988-2012 w materiale Kliniki Otolaryngologii Uniwersytetu Medycznego w Bialymstoku.

UNLABELLED: Malignant tumour is the second cause of death in Poland, behind cardiovascular disease. 26% of men and 23% of women die of it. Head and neck tumours are the fifth most frequent group of malignant tumours. These are mostly squamous cell carcinomas. The carcinogenic factors of tobacco smoke play an indisputable role in the pathogenesis of these tumours. AIM OF WORK: Analysis comprising: number of patients, sex and age, site and stage of the primary tumour (T), clinical assessment of neck lymph nodes (N). The results underwent statistical analysis. MATERIALS AND METHODS: The study involved 1313 patients who underwent surgery in the period 1988-2012 in the Otolaryngology Clinic in Bialystok (1199 men and 114 women, aged 32-86 years). RESULTS: In the study group the proportion of men was 91.3% and women 8.7%. Histopathological verification confirmed squamous cell carcinomas in 99%. The primary tumour was most often located in the supraglottic area of the larynx (48.0%) and its clinical stage was T3 (33.5%). T1 tumours were statistically significantly more frequently found in the glottis and T4 tumours - in the hypopharynx and in the transglottic area. Swollen lymph nodes in the neck were found in 52.4% of the patients, most often N2 (37.4%). The highest percentage of patients with lymph node reaction was found in the youngest group (76.6%) and the lowest - in the eldest group (30.0%). Swollen lymph nodes were statistically relevantly more frequent in patients with supraglottic or hypopharynx tumour.