Laryngeal fractures: clinical findings and considerations on suboptimal outcome.

CONCLUSION: We recommend early surgical exploration and fixation for patients with dislocated or comminuted laryngeal fractures to avoid long-term voice complications. One-third of 33 fracture patients rated their voice after the fracture had healed as fair but altered. OBJECTIVES: To examine the indications for and the outcome of surgical management in patients with laryngeal fractures. PATIENTS AND METHODS: The study was carried out in a tertiary care referral university hospital and was a retrospective study of case series. Thirty-three consecutive patients, aged 14-84 years, presented with various types of laryngeal fractures. Patients were staged according to the type of the fracture and surgical correction was performed when indicated. Voice outcome was documented and patients with subjectively suboptimal result were further evaluated by phoniatric specialist. RESULTS: In all, 32 of 33 laryngeal fracture patients had blunt trauma and the main causative factors were sport injuries (39%) and physical assault (33%). All of the 33 laryngeal fracture patients had a good airway outcome. The subjective voice outcome was good for 20 (61%) and fair for 13 (39%) patients. The mean follow-up time was 39.5 months (range 2-114 months). In phoniatric evaluation most (six of eight) patients with fair voice outcome could not produce high pitched voices because of inability to stretch the vocal folds.

Dynamic extremes of voice in the light of time domain parameters extracted from the amplitude features of glottal flow and its derivative.

In the first part of the study, the subjects (4 females, 4 males) produced sustained breathy, normal and pressed types of phonation. The maximum AC flow (f(ac)) and the negative peak amplitude (d(min)) of the first derivative of the glottal flow were extracted from glottal volume velocity waveforms estimated by inverse filtering. The ratio between f(ac) and d(min) (amplitude quotient, AQ), which gives an estimate of the closing time of the glottal flow, and its normalised version (NAQ) were computed. The NAQ values correlated strongly with the closing quotient of glottal flow. In the second part of the study, the aim was to investigate the dynamic extremes of the human voice in terms of F(0), SPL, f(ac), d(min), AQ and NAQ as well as the intraoral pressure (p) used for subglottal pressure estimation. Eleven normal subjects (5 females, 6 males) participated in this experiment. The subjects started with the production of soft phonation (approximately 55 dB at 40 cm) and increased their vocal intensity at 5-dB steps up to the level of 105 dB. At the analysis stage, the voice samples were divided into three categories: soft (<70 dB), normal (70-90 dB) and loud (>90 dB). In soft and normal phonation, intensity change was correlated with changes in the shape of the glottal flow waveform, whereas the loud voice samples showed a large increase in F(0) and p values. At the loudest extreme, d(min) approached its maximum and AQ its minimum values and NAQ started to rise. In terms of the NAQ values of stressed syllables, the type of phonation was breathy in the soft intensity category, whereas in the normal and loud intensity categories it was within the range of the pressed type of phonation of sustained phonation samples.

Loading-related subjective symptoms during a vocal loading test with special reference to gender and some ergonomic factors.

Vocal loading-related subjective symptoms were studied in a day-long vocal loading test. The voices of 40 female and 40 male voluntary young students were loaded by having them read aloud a novel for five times 45 min. The subjective symptoms that occurred during the vocal loading session were reported by filling in a questionnaire after each session. The responses loaded on five factors in a factor analysis: (1) 'central fatigue'; (2) 'symptoms of the neck, shoulders and back'; (3) 'drying in the mouth and throat'; (4) 'symptoms of the throat'; (5) 'symptoms of the voice'. The exposure groups (5 females and 5 males per cell) consisted of eight combinations of the following factors: (1) low (25 +/- 5%) or high (65 +/- 5%) relative humidity of ambient air; (2) low [<65 dB(SPL)] or high [>65 dB(SPL)] speech output level of vocal loading; (3) sitting or standing posture during vocal loading. The lowest mean score for symptoms pooled over the test were found in 'symptoms of the neck, shoulders and back' and the highest mean symptom score in 'drying in the mouth and throat' and 'symptoms of the throat'. Most symptoms were at their minimum during the first loading session and increased statistically significantly to a peak mean value after three or five vocal loading sessions. Statistically significant differences in the mean level between the gender or exposure groups emerged for 'central fatigue' (humidity had clear effects) and 'symptoms of the neck, shoulders and back' (gender, humidity and posture had clear effects). In these cases, females had more symptoms than males; the low-humidity group had more symptoms than the high-humidity group, and the standing subjects had more symptoms than the sitting subjects.