Fundamental Frequency in Excised Human Larynges after Anterior Glottic Web Formation of Various Extents

2018 ◽  
Vol 160 (4) ◽  
pp. 672-678
Author(s):  
Thais Gonçalves Pinheiro ◽  
Camila Cristina Ishikawa ◽  
Rui Imamura ◽  
Ronaldo Frizzarini ◽  
Arlindo Neto Montagnoli ◽  
...  

Objective To determine the effect of vocal fold anterior web formation on fundamental frequency with a cadaveric excised larynx model. Study Design Experimental study with excised human larynges. Setting Academic tertiary care hospital. Subjects and Methods Sixteen freshly excised human larynges were evaluated with high-speed videoendoscopy and digital kymography during artificially produced vibration. Each larynx was assessed in 4 conditions: preoperative controls and after 25%, 33%, and 50% decreases in the vibratory portion of the vocal folds. The following parameters were evaluated: fundamental frequency, periodicity, vocal fold vibration amplitude, phase symmetry, and glottic closure. Results The mean fundamental frequencies were 208.87, 250.20, 292.37, and 342.67 Hz for preoperative controls and 25%, 33%, and 50% reductions in vibratory length of the vocal folds, respectively. Fundamental frequency increased with each increase in anterior glottic web extent, and the difference among the groups was statistically significant in absolute values in hertz and in semitone elevation. The mathematical models for estimating postoperative fundamental frequency had a statistically significant coefficient. The vibration of the vocal folds remained periodic in all larynges before and after the procedures. Conclusion There was a significant and progressive increase in the fundamental frequency with each enlargement of anterior glottic web. Based on the control frequency, mathematical models could estimate the value of the fundamental frequency after the procedure.

2014 ◽  
Vol 4 (2) ◽  
pp. 55-59 ◽  
Author(s):  
Baisakhi Bakat ◽  
Arunima Roy ◽  
Amitabha Roychoudhury ◽  
Barin Kumar Raychaudhuri

ABSTRACT Introduction Vocal nodules are known to be one of the most common benign lesions, commonly situated at the junction of anterior one third and posterior two third of vocal folds. Voice therapy is considered to be the gold standard of treatment of vocal fold nodule. Objectives To determine the efficacy of voice therapy in the treatment of vocal fold nodules and to identify any possible reason for failure to voice therapy in managing vocal fold nodules. Materials and methods A prospective study, conducted over a period of 6 months. Eighteen adult patients diagnosed with vocal fold nodules at a tertiary care hospital were subjected to 6 weeks of voice therapy. Pre and post therapy subjective (Voice Handicap Index-10) and objective (Rigid fiber optic laryngoscopy) evaluation was done. Patients with no improvement after 6 weeks of voice therapy underwent micro laryngeal surgery. All patients were followed up at 3 months and 6 months. Results In majority of patients, objective and subjective voice outcome parameters were significantly improved after voice therapy. Although a few cases showed no significant improvement after therapy, they recovered completely after microlaryngoscopic surgery. It was found that patients who required surgery even after voice therapy had hard nodules. How to cite this article Bakat B, Gupta A, Roy A, Roychoudhury A, Raychaudhuri BK. Does Voice Therapy Cure All Vocal Fold Nodules? Int J Phonosurg Laryngol 2014;4(2):55-59.


1996 ◽  
Vol 105 (12) ◽  
pp. 975-981 ◽  
Author(s):  
Dieter Maurer ◽  
Markus Hess ◽  
Manfred Gross

Theoretic investigations of the “source-filter” model have indicated a pronounced acoustic interaction of glottal source and vocal tract. Empirical investigations of formant pattern variations apart from changes in vowel identity have demonstrated a direct relationship between the fundamental frequency and the patterns. As a consequence of both findings, independence of phonation and articulation may be limited in the speech process. Within the present study, possible interdependence of phonation and phoneme was investigated: vocal fold vibrations and larynx position for vocalizations of different vowels in a healthy man and woman were examined by high-speed light-intensified digital imaging. We found 1) different movements of the vocal folds for vocalizations of different vowel identities within one speaker and at similar fundamental frequency, and 2) constant larynx position within vocalization of one vowel identity, but different positions for vocalizations of different vowel identities. A possible relationship between the vocal fold vibrations and the phoneme is discussed.


2020 ◽  
pp. 36-38
Author(s):  
Indranil Khatua ◽  
Alokendu Bose ◽  
Indranath Kundu ◽  
Debarshi Jana

Background: Vocal fold nodules (VFNs), are localized, benign, superficial growths on the medial surface of the true vocal folds (TVFs) that are commonly believed to result from phonotrauma. Nodules are bilateral with a classic location at the junction of the anterior and middle third of the vocal fold (ie, the midpoint of the membranous vocal fold). AIMS: Correlation between response of treatment (as evident by post-treatment and post follow up GRBAS score), in each group. MATERIAL AND METHODS: Outpatient department and Indoor wards of Department of ENT and Head Neck surgery, R. G Kar Medical College. Patients attending ENT OPD of R G Kar Medical College during the Study period were the study population. Sample size was atleast 50 Patients. RESULT: In group-A, the mean Pre Rx GRBAS (mean±s.d.) of the patients was 11.4118 ± 2.0018. In group-B, the mean Pre Rx GRBAS (mean±s.d.) of the patients was 11.1818 ± 2.5794.Distribution of mean Pre Rx GRBAS vs. group was not statistically significant (p=0.7499). CONCLUSION: Vocal fold nodule is one of the most frequent benign laryngeal lesions, influencing the quality of life of those affected by them, primarily the vocal production. Despite being a well-established therapy in conjunction with surgery, speech therapy alone may also be effective in treating these lesions.


2017 ◽  
Vol 09 (05) ◽  
pp. 1750064 ◽  
Author(s):  
A. Van Hirtum ◽  
X. Pelorson

Experiments on mechanical deformable vocal folds replicas are important in physical studies of human voice production to understand the underlying fluid–structure interaction. At current date, most experiments are performed for constant initial conditions with respect to structural as well as geometrical features. Varying those conditions requires manual intervention, which might affect reproducibility and hence the quality of experimental results. In this work, a setup is described which allows setting elastic and geometrical initial conditions in an automated way for a deformable vocal fold replica. High-speed imaging is integrated in the setup in order to decorrelate elastic and geometrical features. This way, reproducible, accurate and systematic measurements can be performed for prescribed initial conditions of glottal area, mean upstream pressure and vocal fold elasticity. Moreover, quantification of geometrical features during auto-oscillation is shown to contribute to the experimental characterization and understanding.


1997 ◽  
Vol 106 (7) ◽  
pp. 533-543 ◽  
Author(s):  
Steven M. Zeitels ◽  
Glenn W. Bunting ◽  
Robert E. Hillman ◽  
Traci Vaughn

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.


2021 ◽  
pp. 71-74
Author(s):  
Neha Gupta ◽  
Vijay Paliwal ◽  
Kanchan Kumawat ◽  
Narendra Kumar ◽  
Imran Khan ◽  
...  

Background: Keloids are benign proliferative condition of dermal broblast. Intralesional corticosteroid improves keloid but associated with signicant adverse effects like dyspigmentation, tissue atrophy and telengectasia and contraindicated in certain conditions like hypertension and diabetes. 5-Fluorouracil (5-FU), a pyrimidine analogue with an inhibitory effect on TGF-β induced broblast proliferation is useful in treatment of keloids but is associated with ulceration and pain. A low dose of Triamcinolone if added to 5-FU injection overcomes these issues. Approach: This study was conducted in a tertiary care hospital. Sixty patients; thirty in each group were included. In group A, once weekly intralesional Triamcinolone and in group B, intralesional injection of Triamcinolone mixed with 5-Flurouracil in 1: 9 dilution were injected for 8 sessions. Parameters of Vancouver scale were noted at the baseline and at the end of treatment. Results: Out of 60 patients enrolled in this study. The combination group was better in improving height (62.11% vs 78%), pliability (44.14% vs 8.81%), and vascularity (55.78% vs 61.30%) and results were statistically signicant (P valve <0.05) however it was not better in improving pigmentation (43.47% vs 20%) and volume (69.79% vs 80.76%) (P valve > 0.05). Pain and pruritus improved completely (100%) in both the groups at the end of the treatment. Excellent improvement in patient and observer assessment score was seen in 96.67% vs 3.33% in combination group and TAC group respectively. The difference was statistically signicant (P valve<0.05). Combination was better irrespective of age of the patient, duration, site, and origin of keloid. All patients treated with 5 FU develop ulceration and pain. Conclusion: Both the therapies are effective but combination is superior to TAC alone. We advocate that 5-FU should be used alone, addition of TCA does not have any added advantage in therapeutic outcome rather it increases the cost of treatment.


Author(s):  
S. Mantha ◽  
L. Mongeau ◽  
T. Siegmund

An experimental study of the vibratory deformation of the human vocal folds was conducted. Experiments were performed using model vocal folds [1, 2], Fig. 1, made of silicone rubber implemented into an air supply system, Fig. 2. The material used to cast the model is an isotropic homogeneous material, [3] with a tangent modulus E=5 kPa at ε = 0, i.e. elastic properties similar to those of the human vocal fold cover [4]. The advantages of the use of model larynx systems over the use of excised larynges include easy accessibility to fundamental studies of the vocal fold vibration without invasive testing. Acoustic analysis of voice or electroglottography provide certain insight into voice production processes but optical techniques for the study of vocal fold vibrations have drawn considerable attention. Videoendoscopy, stroboscopy, high-speed photography, and kymography have shown to provide a visual impression of vocal fold dynamics but are limited in providing insight into the fundamental deformation processes of the vocal folds. Quantitative measures of deformation have been conducted through micro-suture techniques but are invasive and allows for measurements of only view image points. Laser triangulation is non-invasive but is limited to only one local measurement point. Here, digital image correlation technique with the software VIC 3D [5] is applied. For the experimental set-up see Fig. 2. The analysis consists of (1) stereo correlation to obtain in-plane displacements and (2) stereo triangulation step to obtain out-of-plane deformation. For the stereo correlation images of the object at two different stages of deformation are compared. A point in the image of the undeformed object is matched with the corresponding point in the deformed stage. “Subsets” of digital images are traced via their gray value distribution from the undeformed reference image to the deformed image. The uniqueness of the matching is enabled by the creation of a speckle pattern on the object’s surface. Here, a white pigment is mixed into the silicone rubber and subsequently black enamel paint is sprayed onto the superior surface of the vocal folds. The stereo triangulation requires two images of the object at each stage of deformation. These are obtained in a single CCD frame by placing a beam splitter in the optical axis between camera and object. These images provide a “left” and “right” view of the model larynx. Thus, the deformed shape of the vocal folds can be obtained. The method allows for noninvasive measurement of the full-field displacement fields. Images of the superior surface of the model larynx are obtained by the use of a high speed digital camera with a frame rate of 3000 frames per second allowing for more than 30 image frames for each vibration cycle. For the 3D digital image correlation analysis two images of the object are obtained for each time instance as a beam splitter is placed in the optical axis between the camera and the model larynx. Phonation frequencies and onset pressure are given in Fig. 3, showing that the model larynx behavior is close to actual physiological data. Figs 4(a) and (b) provide superior views of the model larynx at maximum glottal opening and at glottal closure, respectively. As one example of measured strain fields, Figs 5(a) and (b) depict the distributions of the transverse strain component, on the glottal surface in a contour plot on the deformed superior surface. The knowledge of the distribution of this strain component is relevant to the assessment of the impact of vocal fold collision on potential tissue damage. In the position of maximum opening the vocal folds are deformed by a combination of a bulging-type deformation and the opening movement. At this time instance, the transverse strains at the medial surface are found to be negative, an indication of Poisson’s deformation. During the closing stage, vocal folds collide and simultaneously a mode 3 vibration pattern emerges. Closure of the glottal opening is not complete and two incomplete closure areas are formed during the closure stage. These open areas are located at the anterior and posterior ends of the model larynx, see Fig. 4(b). The finding of this type of incomplete closure is agreement with both actual glottal measurements [6] and 3D finite element simulations of [7]. Transverse strains during that stage are now positive and considerably larger that during the opening stage. Finally, Fig. 6 depicts the time evolution of the out of plane displacements along the medial surface for the closing phase and Fig. 7 depicts the maximum values of the longitudinal strain (at the coronal section of the medial surface) in dependence of the flow rate. These examples of measurements indicate that the DIC method is promising for studies of vocal fold dynamics.


2012 ◽  
Vol 33 (9) ◽  
pp. 865-868 ◽  
Author(s):  
Megan J. DiGiorgio ◽  
Cynthia Fatica ◽  
Mary Oden ◽  
Brian Bolwell ◽  
Mikkael Sekeres ◽  
...  

Objective.To develop a modified surveillance definition of central line-associated bloodstream infection (mCLABSI) specific for our population of patients with hematologic malignancies to better support ongoing improvement efforts at our hospital.Design.Retrospective cohort study.Patients.Hematologic malignancies population in a 1,200-bed tertiary care hospital on a 22-bed bone marrow transplant (BMT) unit and a 22-bed leukemia unit.Methods.An mCLABSI definition was developed, and pathogens and rates were compared against those determined using the National Healthcare Safety Network (NHSN) definition.Results.By the NHSN definition the CLABSI rate on the BMT unit was 6.0 per 1,000 central line-days, and by the mCLABSI definition the rate was 2.0 per 1,000 line-days (P < .001). On the leukemia unit, the NHSN CLABSI rate was 14.4 per 1,000 line-days, and the mCLABSI rate was 8.2 per 1,000 line-days (P = .009). The top 3 CLABSI pathogens by the NHSN definition were Enterococcus species, Klebsiella species, and Escherichia coli. The top 3 CLABSI pathogens by the mCLABSI definition were coagulase-negative Staphylococcus (CONS), Pseudomonas aeruginosa, and Staphylococcus aureus. The difference in the incidence of CONS as a cause of CLABSI under the 2 definitions was statistically significant (P < .001).Conclusions.A modified surveillance definition of CLABSI was associated with an increase in the identification of staphylococci as the cause of CLABSIs, as opposed to enteric pathogens, and a decrease in CLABSI rates.


2007 ◽  
Vol 122 (8) ◽  
pp. 824-828 ◽  
Author(s):  
E J Damrose ◽  
J F Damrose

AbstractObjective:This study evaluated the role of botulinum toxin type A in the treatment of refractory laryngeal granulomas.Study design and setting:Retrospective clinical review at a tertiary care hospital. Seven patients with vocal process granulomas underwent percutaneous injection of botulinum toxin into both vocal folds, performed in an office setting. Total doses ranged from 10 to 25 U, divided between both vocal folds.Results:All patients experienced resolution of their granulomas over two to seven weeks. No patient developed aspiration pneumonia. All patients experienced hoarseness secondary to the injections, but voice quality returned to baseline in all patients as the toxin was degraded.Conclusions:Botulinum toxin is safe and effective therapy in resolving vocal process granulomas in patients refractory to traditional therapy. The optimal treatment dose remains to be determined.Significance:Percutaneous botulinum toxin injection is helpful in resolving laryngeal granulomas.


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