Effects of Voice Therapy Using Gliding and Humming in Dysphonic Patients With Glottal Gap

Background and Objectives Therapies have been reported to treat the glottal gap previously. However, these voice therapies showed the limits because many techniques focused only on one among breathing, resonance and phonation. In addition patients often have difficulties visiting hospital frequently. ‘Gliding and humming’ is vocal training technique that readjusts total vocal patterns such as breathing, resonance and phonation. This technique can be easily applied during short term sessions. The purpose of this study is to evaluate the efficiency of voice therapy with ‘gliding and humming’ for patients with glottic gap during short-term treatment sessions.Materials and Method Twenty-three patients with glottal gap were selected. Of all patients, 14 patients had sulcus vocalis and 12 patients had muscle tension dysphonia (MTD). Voice therapies were performed 1.9 sessions in average. GRBAS, jitter, shimmer, noise to harmonic ratio, semitone range, closed quotient_vowel and maximum phonation time were compared before and after the therapies. In addition, changes of glottal gap and MTD severity were evaluated.Results Statistically significant improvement was observed. MTD improvement was observed only among the patients with glottal gap improvement. Also sulcus vocalis group showed the statistically significant improvement.Conclusion ‘Gliding and humming’ was effective to the patients with glottic gap and sulcus vocalis. Also, among patients who have both glottic gap and MTD, the data suggests that voice therapy for glottic gap also makes improvement in MTD.

Effects of Sulcus Vocalis Depth on Phonation in Three-Dimensional Fluid-Structure Interaction Laryngeal Models

Sulcus vocalis is an indentation parallel to the edge of vocal fold, which may extend into the cover and ligament layer of the vocal fold or deeper. The effects of sulcus vocalis depth d on phonation and the vocal cord vibrations are investigated in this study. The three-dimensional laryngeal models were established for healthy vocal folds (0 mm) and different types of sulcus vocalis with the typical depth of 1 mm, 2 mm, and 3 mm. These models with fluid-structure interaction (FSI) are computed numerically by sequential coupling method, which includes an immersed boundary method (IBM) for modelling the glottal airflow, a finite-element method (FEM) for modelling vocal fold tissue. The results show that a deeper sulcus vocalis in the cover layer decreases the vibrating frequency of vocal folds and expands the prephonatory glottal half-width which increases the phonation threshold pressure. The larger sulcus vocalis depth makes vocal folds difficult to vibrate and phonate. The effects of sulcus vocalis depth suggest that the feature such as phonation threshold pressure could assist in the detection of healthy vocal folds and different types of sulcus vocalis.

Outcomes versus complications in patients undergoing different modalities of injection laryngoplasty

Background Glottal insufficiency results in glottal gap between the two vocal folds, which in turn might cause dysphonia, dysphagia, and breathing problems. Vocal fold injection is considered a safe, reliable, and highly effective method of treatment. The purpose of the present study was to assess voice outcomes and complication rates in patients with glottal insufficiency undergoing injection laryngoplasty (IL) under local versus general anesthesia before, 1 week then 1 month after IL. Results Examined patients were 13 males and 12 females, suffering from dysphonia due to glottal insufficiency with mean age 43.68 ± SD 14.55. Unilateral vocal fold paralysis (UVFP) was diagnosed in seventeen cases, vocal fold scarring in six cases, presbylarynx in one case, and sulcus vocalis in one case. IL was performed in 18 cases under local anesthesia, and 7 under general anesthesia. Hyaluronic acid was injection material in 23 cases and calcium hydroxylapatite in two cases. IL by either local or general anesthesia has improved the patients’ auditory perceptual analysis of voice quality as assessed by “GRBAS” scale and Voice Handicap Index (VHI). There were four (16% of all injections) minor and self-limited complications (12% under local and 4% under general anesthesia). Conclusion Injection laryngoplasty performed under local and general anesthesia offers similar voice outcomes, but with slightly higher self-limited complications in IL under local anesthesia.