Arylhydrocarbonhydroxylase inducibility and smoking habits in patients with laryngeal carcinomas.

There is considerable evidence that the inducible enzyme aryl hydrocarbon hydroxylase (AHH) plays an important role in the activation of polycyclic aromatic hydrocarbons (PAH) to ultimate carcinogens. In man, a genetic heterogeneity of AHH inducibility has been demonstrated, and correlated to susceptibility to bronchogenic carcinomas following exposure to PAH. We assessed AHH inducibility in a control group of 102 healthy Swedish citizens and in 41 patients with laryngeal carcinomas. Frequencies of the three phenotypes of high, intermediate and low AHH inducibility in our control group; 8.8%, 42.2% and 49%, respectively, did not differ significantly from frequencies found in a white US population. In the laryngeal carcinoma group, there was a statistically highly significant overrepresentation of patients with high AHH inducibility, 36.6%, whereas 43.9% had an intermediate and 19.5% a low level. Most of the patients were heavy smokers. These findings add further support to the concept that susceptibility to PAH-induced carcinomas is associated with high levels of inducible AHH activity.

[Voice therapy according to Smith. Comments on the accent method of treating voice and speech disorders]. / La thérapie de la voix selon Smith. Commentaires sur la méthode des pulsions phonatoires accentuées (MPPA) pour traiter les troubles de la voix et du langage.

The accent method (A.M.) is based on the myoelastic and aerodynamic phonatory theory. The aim of the respiration exercises is to establish a predominantly abdominal respiration. Following the exercises of accentuated phonatory pulsations, patients work on reading special texts designed to enable them to become aware of the accentuated or unaccentuated sections. The AM is based on a holistic understanding of the voice and of speech. Whilst the exercise of AM is linked to a physiological phenomenon, such as phonatory aerodynamics and muscular function, the method is to be understood as a therapy aimed at producing an overall change in the behaviour related to oral communication disorders. The aim is not so much to eliminate a given particular defect, but rather to condition a subconscious automatism.

[The inverse filtering in the investigation of the laryngeal pathology:a quantitative study of the airflow of glottogram of various intensity]. / El filtrado inverso en la valoración de la patología laríngea: estudio cuantitativo del glotograma de flujo aéreo (GFA) a diferentes intensidades.

Inverse filtering is a method of investigate the larynx function that reflects the vibratory movement of the vocal folds by approximately reconstruct the glottal excitation wave. Basically the method creates a filter which characteristics revert the influence of the supraglottal tract and the radiation component on the glottal wave. In this report different quantitative parameters of the flow glottogram (FGG) are studied by means of a computer based program named Superscope in two subjects, one without pathology and another affected of a vocal polyp, at different intensities.

[Electroglottography in the research and physiology of larynx]. / La electroglotografía en la investigación y la clínica laríngea.

Electroglottography (EGG) is a noninvasive method of monitoring the movement of the vocal folds by measuring the variation of impedance to a weak alternating current through the tissues of the neck. Basically EGG is an index of the vocal fold contact area. Despite recent controversy EGG continues being an easy to handle method in larynx basic research, with increasing use in clinical diagnosis and rehabilitation of vocal pathology. EGG technique is described and some of its applications in clinical practice and voice research are pointed out.

Endoscopic findings of early stage vocal fold cancer.

To describe early cancerous and precancerous lesions of the laryngeal vocal folds as well as of the most common differential diagnoses, based on a series of microlaryngoscopic photographs. Some introductory remarks about terminology and the classification of epithelial lesions of the vocal folds are included. The paper ends with some comments as to the management of epithelial thickenings (or leukoplakias) of the vocal folds. Malignancy should be suspected as long as it has not been ruled out by histologic diagnosis on adequate biopsies, which is the only way to correctly evaluate the character of such lesions. Precancerous lesions should be controlled by regular follow up examinations as carefully as invasive carcinomas (posttreatment), because there is a high tendency for recurrences or for later development of malignancy in these cases.

Stroboscopy--a pertinent laryngological examination.

When observing the vocal fold movements in their laryngoscopic examination, most laryngologists seem to be trained to consider only the gross respiratory movements of the folds, i.e. abduction and adduction. these movements constitute an essential part of the vitally important valve function of the larynx, preventing aspiration and providing parts of the mechanisms for normal swallowing, coughing, and straining. The second important function of the larynx is to serve as a transducer of aerodynamic to acoustic energy; the voice function. Probably for reasons of tradition, the examination of the voice function is generally left to the speech pathologists, who can make an auditory perceptual evaluation of the voice qualities, possibly supplemented by electro-acoustic analyses. By focussing also on the small vibratory movements of the vocal folds during phonation, using laryngeal stroboscopy, the laryngologist can contribute considerably to the diagnosis of voice disorders. For the laryngeal surgeon stroboscopy should be of particular interest, as it is a useful tool for early detection of (cancerous) invasion and for the evaluation of laryngeal paresis. This paper describes the clinical procedure of laryngeal stroboscopy, based on some introductory remarks on vocal anatomy and function.

Glottography, the electrophysiological investigation of phonatory biomechanics.

Some details of phonatory biomechanics, meaning the vibratory movements of the vocal folds during phonation, are described in the introduction. Here a special emphasis is laid on the multicomponent structure of the vocal folds. Glottography is a general term used for methods to monitor the vibrations of the vocal folds. Four different types of glottography are generally recognized (fig. 2), viz. photoglottography, electroglottography, ultrasound glottography and glottography by inverse filtering the acoustic or laryngeal air flow signal. In the main part of the communication the four methods are described and their applicability is discussed.

[Differential diagnosis in phoniatrics and pediatric audiology. Language-aphasia]. / Differentialdiagnostik der Phoniatrie und Pädaudiologie Sprache - Aphasie.

The incidence of aphasia in a population of 100 000 is about 60 new cases a year. Although the aphasic patient represents a neurological problem, aphasia seems rather to be a linguistic one. Therefore, this report on the diagnosis of aphasia includes a comprehensive linguistic introduction on the function and structure of language. After a presentation of different aphasiologic schools and their classification of the aphasic syndromes, the differential diagnoses of other neurological disorders of verbal communication from aphasia are given. The subsequent section concerns the clinical investigation of aphasia. Finally, the most common tests for aphasia are reviewed.

Teflon paste injection into the paralytic vocal fold. A simple procedure to improve disturbed cough function.

Teflon paste injection into the paralytic vocal fold is a simple method for the relief of difficulties with insufficient expectoration and for the prevention of aspiration caused by laryngeal paralysis. The laryngeal valve and voice functions in three patients with unilateral laryngeal paralysis were studied before and after teflon paste injection. Aerodynamic registrations comprised subglottal and supraglottal air pressure and oral air flow during cough and phonation. The aerodynamic records, as well as the patients' own reports, all showed improved laryngeal valve function as a result of the treatment and these improvements were not accompanied by any deterioration in respiratory function as revealed by pre- and postoperative spirometry.

[Observations on the accent-method of Smith in the management of speech and voice disturbances. Part I (author's transl)]. / Bemerkungen zur Akzentmethode nach Smith für die Behandlung von Stimm- und Sprechstörungen, Teil I

One of the best known methods in northern Europe for the treatment of voice disorders is the "accent-method", which was devised by Svend Smith in Denmark. The method is based on the use of the stressed ("accentuated") syllable as a therapeutic tool to develop pronunciation and a natural attractive voice. Present theories of the physics and the physiology of voice function form the basis for the method, in addition to concepts from modern psychology and pedagogics. By using the technique, it is possible to develop a therapeutic field between patient and therapist within which voice and speech behavior can be treated as a whole. The method is described in detail in the present paper. In a forthcoming paper, the method will be discussed from the viewpoints of the physics and physiology of phonation as well as from pedagogical and psychological aspects,

[Observations on the accent-method of Smith in the management of voice and speech disturbances. Part II (author's transl)]. / Bemerkungen zur Akzentmethode nach Smith für die Behandlung von Stimm- und Sprechstörungen. Teil II.

In an earlier paper [HNO 25, 102 (1977)], the accent-method for the treatment of voice disorders has been described in detail. The rhythmical pronunciation of stressed ("accentuated") syllables with a physiologically correct phonatory respiration and a loose articulation form the basis for this method, and allow treatment of voice disorders as well as problems related to abnormal speech behavior. Further discussion is based on present theories of the physics and the physiology of voice function as well as on concepts from modern psychology and pedagogics.

Long-time average spectrograms of dysphonic voices before and after therapy.

Tape recordings before and after successful voice therapy from 174 subjects with non-organic voice disorders (functional dysphonia) were analysed by long-time averaged voice spectrograms (LTAS). In female as well as in male voices there was a statistically significant increase in level in the first formant region of the spectra. In the female voices there was also an increase in level in the region of the fundamental. The LTAS were compared to the results of a perceptual evaluation of the voice qualities by a small group of expert listeners. There was no significant change of the LTAS in voices with negligible amelioration after therapy. In the voices, where the change after therapy was perceptually rated to be considerable, the LTAS showed only an increase in intensity, but the general configuration of the spectral envelope remained unchanged. There was only a weakly positive correlation between the quality ratings and parameters of the spectra.

Cranial nerve injuries after carotid artery surgery. A prospective study of 663 operations.

OBJECTIVE: To establish the incidence of cranial nerve injuries caused by carotid artery surgery. METHODS: During the years 1982 to 1992, 689 carotid artery operations were performed at Malmö General Hospital. Of these 656 were pre- and postoperatively examined at the Department of Phoniatrics concerning the function of the cranial nerves IX, X, and XII. RESULTS: There was injury to one or more of the examined nerves after 75 operations (11.4%). In 70 (10.7%) operations the hypoglossal nerve was injured, in eight (1.2%) the recurrent laryngeal nerve, in two (0.3%) the glossopharyngeal nerve and in two (0.3%) the superior laryngeal nerve. Seven patients complained of postoperative hoarseness, but had no injuries. One hypoglossal and one recurrent nerve injury was permanent. Nerve injury was more frequent in operations performed with a shunt (p = 0.05), with patch closure (p = 0.01) and by a junior surgeon (p = 0.05). CONCLUSION: In a prospective series, the incidence of cranial nerve injuries after carotid surgery was significant but the vast majority were reversible.

Initial validation of an indirect measure of subglottal pressure during vowels.

Some methods for direct measurement of subglottal pressure during speech are invasive and thus cannot be used on a routine basis. The development of noninvasive techniques is thus desirable, and a simple indirect method for measuring subglottal pressure from records of oral pressure during consonants has recently been proposed and applied to studies of glottal resistance during phonation. In order to bae useful, indirect measurement procedures should be validated by comparisons with direct measurements, and the present experiment was designed for such a comparison. Miniature pressure transducers were used to obtain records of pressure below and above the glottis. Results showed nonsignificant differences and a high correlation between the direct and indirect measurements. This indirect method for measuring subglottal pressure thus appears to provide valid results.

A comparison of contact microphone and electroglottograph for the measurement of vocal fundamental frequency.

Signals from a throat contact microphone or an electroglottograph often are more suited for fundamental frequency measurements with simple analog circuits than the radiated speech signal. This report compares a contact (accelerometer) microphone placed on the neck below the cricoid cartilage and an electroglottograph for measurement of fundamental frequency in connected speech. The advantages and drawbacks of the two methods are discussed.

[Smoking and induction of the enzyme aryl hydrocarbon hydroxylase in patients with laryngeal carcinomas and precancerous conditions]. / Rauchen und Induktion des Enzyms Arylhydroxkarbonhydroxylase bei Patienten mit Karzinomen und Präkanzerosen des Larynx.

The risk for a smoker of developing cancer of the larynx depends on the activity of the enzyme arylhydroxcarbonhydroxylase in his cells. The higher the genetically determined arylhydroxcarbonhydroxylase activity, the higher is the probability of developing the disease.

Cranial nerve injuries associated with carotid endarterectomy. A prospective study.

To determine the incidence and nature of cranial nerve damage in connection with carotid artery surgery, 139 patients were studied before and after 162 operations. Nerve damage was detected in association with 19.8% of the operations. The hypoglossal nerve was most commonly affected. The injuries were of benign character and usually resolved within 4 to 6 weeks. Apart from damage to the great auricular nerve, all lesions resolved within 5 months. The incidence of nerve disturbance was greater than that found in a retrospective study from the same hospital. Gentleness of technique is important in carotid artery surgery, in order to avoid nerve damage.