Cases reported "Aphonia"

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1/9. aphonia and dysphagia after gastrectomy.

    A 67-year-old male was referred to our otolaryngological clinic because of aphonia and dysphagia. His voice was breathy and he could not even swallow saliva following a total gastrectomy for gastric carcinoma performed 2 weeks previously. Laryngeal fiberscopy revealed major glottal incompetence when he tried to phonate. However, both vocal folds abducted over the full range during inhalation. The patient could not swallow saliva because of a huge glottal chink, even during phonation. Based on these findings, he was diagnosed as having bilateral incomplete cricoarytenoid dislocation after intubation. The patient underwent speech therapy; within 1 min his vocal fold movement recovered dramatically and he was able to phonate and swallow. There have been few case reports of bilateral cricoarytenoid dislocation, and no effective rehabilitation has been reported. We believe that our method of vocal rehabilitation serves as a useful reference for physicians and surgeons worldwide.
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keywords = voice
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2/9. Vocal fold polyp in a professional brass/wind instrumentalist and singer.

    wind instrumentalists, especially brass players, and singers share common factors, including vocal tract shape, function and pressure, vocal fold opening and closure, breath vector of force and air flow rates. To understand the mechanism and function of the vocal folds with a pathological lesion, it is necessary to visualize the differing interactions of the vocal tract during wind and brass instrument playing and in singing. A school band director, singer, wind and brass instrumentalist, was referred by musician colleagues with intermittent dysphonia, aphonia, and inability to sing high notes. Simultaneous videolaryngoscopy, with and without stroboscopy, and external video examination were documented. An hourglass glottis with a sessile, cystic polyp of the left vocal fold were recorded and studied during phonation and the playing of 3 instruments. The techniques of glottic opening, closure, configuration and function varied with the type of instrument and phonatory function. singing was adversely affected by the vocal fold polyp but no harmful interaction occurred during wind/brass instrument playing. Down-stream loading in singers is at the laryngeal level and in wind/brass instrumentalists is at the embouchure. Preoperative voice therapy, phonomicrosurgery, and postoperative voice rest followed by voice therapy, succeeded in restoring her combined wind/brass instrumental and singing career.
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ranking = 3
keywords = voice
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3/9. Semi-automated voice evaluation.

    This report describes a voice evaluation procedure that in some way parallels the audiologic tests used for hearing and has multiple uses both clinically and in research. It uses a simultaneous eight-channel input, is not difficult to use, requiring between 12 and 25 minutes to administer, and provides the physician with a printout in standardized form before the patient leaves the room. This three-page report includes 15 abstracted or calculated values, normal ranges by sex for each value, notes that draw attention to deviations from the normal, a summary profile, a graphic representation of the evaluation, and raw data waveforms.
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ranking = 5
keywords = voice
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4/9. aphonia due to paramedian thalamo-subthalamic infarction. Remarks on two cases.

    We describe two patients in whom CT brain scans imaged paramedian thalamo-subthalamic infarcts in the territory of the thalamo-mesencephalic arteries. Such infarcts give rise to a complex syndrome marked by disturbances of consciousness and of eye movement and neuropsychological disorders, including attentional, memory and, more rarely, language deficits. A loss of voice volume may accompany aphasic disturbances but is exceedingly rare in isolation. In the cases described the aphonia, total but transient, was the only language disorder. The physiopathological mechanisms involved in aphonia are complex and controversial.
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ranking = 1
keywords = voice
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5/9. Psychogenic aphonia masking mutational falsetto.

    aphonia, originally due to laryngeal inflammation, became psychogenic and superimposed on the unstable pitch of adolescent voice change. We presumed that the aphonia was adopted as a means of dealing with peer pressure to maintain a high preadolescent pitch as well. Voice therapy was effective in alleviating both the aphonia and mutational falsetto. Clinicians should be alert to underlying mutational falsetto when confronted with an aphonic or dysphonic adolescent patient with no organic laryngeal pathologic condition.
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6/9. cough offset schwa as a means of eliciting initial phonation in functional aphonia: two case reports.

    The use of the schwa vowel at cough offset is an automatic production that can be easily prolonged and modified as a phonation-producing device without requesting initial voluntary phonation on the part of the patient. It is presented as a clinical method that was successful for the author with two female patients presenting functional aphonia. The technique lends support to the suggestions by Aronson (1969) and Boone (1971) that the symptomatic approach can be successful with the functional aphonic patient. The clinician should be mindful of the fact that in certain cases of functional aphonia an appropriate referral might be needed to deal with emotional aspects after voice is regained.
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ranking = 1
keywords = voice
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7/9. Voice, speech, and language habilitation in young children without laryngeal function.

    We discuss aphonia in children, secondary to laryngeal obstruction, with regard to the development of a voice, speech, and language system that can be an effective and efficient means of communication while obstruction persists and a precursor to good voice and speech habits if and when the laryngeal function is reestablished. Several methods were considered. A technique of esophageal voice training for children was developed and implemented, which combined the aspects of normal language learning with the mechanical aspects of esophageal voice production. Results showed rapid learning in a 2 1/2-year-old child with severe juvenile laryngeal papillomatosis and normal speech and language at the age of 4 years when laryngeal function returned. A second technique, a communication board, was used with a 4-year-old child with total subglottic stenosis and brain damage.
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ranking = 4
keywords = voice
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8/9. The long-term period measurement, an instrumental method in phoniatry.

    With the help of an Analog to Digital Converter we are able to perform serial and statistical analysis in the time domain. The difficulty in those long-term period measurements consists in the correct extraction of the periodicity in human voice. A simple method is the electroglottography, which, however, is not applicable in all cases. The analysis of the acoustic wave (translated via microphone) demands a lot of electronics if to be precise. Our investigation consists of a compromise between precision and amount of instrumentation, and we only took one parameter as a criterion. The possible error is negligible. We present the results of this measurement type using the patterns of one normal voice and eight different kinds of voice disorders.
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ranking = 3
keywords = voice
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9/9. Spectrographic comparison of two types of spastic dysphonia.

    A spectrographic comparison of the voices of two patients with spastic dysphonia demonstrated differences in vocal characteristics. The voice of one patient was characterized by intermittent breathiness which appeared spectrographically as a breakdown in formant structure or as the addition of fricative fill superimposed upon resonance bars. The voice of the second patient was characterized by strain-strangle phonation which appeared spectrographically as widely and irregularly spaced vertical striations. The contrasting vocal characteristics of the two patients are compatible with the viewpoint that there may be two types of spastic dysphonia.
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ranking = 3
keywords = voice
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