1/64. Botox for hyperadduction of the false vocal folds: a case report.We present a patient with severe hyperadduction of the false vocal folds (FVF) treated with Botulinum Toxin injections to each FVF. This patient presented with severe dysphonia and was found to demonstrate severe hyperadduction of the FVF's with all phonatory tasks. The patient was treated with extensive speech therapy without improvement in voice quality nor FVF motion pattern. He was then injected with Botox A bilaterally using a peroral approach to the FVFs. Shortly after treatment the patient experienced dramatic improvement in voice quality. Videolaryngoscopy revealed no adduction of the FVFs with phonation and essentially normal true vocal fold motion. He remained with normal voice quality one year after treatment without any further treatment. Possible mechanism of action of this type of treatment are discussed.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
2/64. Treatment of Parkinson hypophonia with percutaneous collagen augmentation.OBJECTIVES: It has been estimated that more than 70% of patients with parkinson disease experience voice and speech disorders characterized by weak and breathy phonation, and dysarthria. This study reports on the efficacy of treating Parkinson patients who have glottal insufficiency. STUDY DESIGN AND methods: Thirty-five patients underwent collagen augmentation of the vocal folds for hypophonia associated with parkinson disease, using a new technique of percutaneous injection with fiberoptic guidance. Patient response to the collagen augmentation was determined by telephone survey. RESULTS AND CONCLUSIONS: The procedure required minimal patient participation and was safely performed on all the patients who were studied. Results of the survey indicated that 75% of patient responses demonstrated satisfaction with the technique, compared with 16% of patient ratings reflecting dissatisfaction. These results were moderately correlated with the duration of improvement of the dysphonia. Results of this preliminary evaluation demonstrate that voice deficits in parkinson disease are amenable to vocal fold augmentation. Because this procedure requires minimal patient participation and can be safely performed in an office setting, it may also be useful in other severely debilitating neuromotor diseases that result in glottal insufficiency and hypophonia.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
3/64. Inspiratory pressure threshold training for glottal airway limitation in laryngeal papilloma.A single-subject design was used to determine if inspiratory pressure threshold training increases inspiratory muscle strength and reduces the sensation of dyspnea during exercise and speech. The subject was a 23-year-old female with congenital juvenile papilloma which has been in remission for 10 years. A 4-week inspiratory muscle training program was implemented using an inspiratory pressure threshold trainer. The pressure threshold of the trainer was set by the experimenter. The pressure threshold setting of the trainer was based on a percentage of the subject's maximum inspiratory pressure measured prior to training. The average range of the pressure threshold was 40 to 70 cmH2O. In order for inspiratory air to flow, the subject generated inspiratory pressure, independent of airflow rate. Maximum inspiratory pressure (MIP) was the dependent variable used as the index of inspiratory muscle strength. exercise dyspnea was a dependent variable rated by the subject during a progressive treadmill test. dyspnea associated with speech was rated following production of a comfortable and loud speech task. MIP increased by 57% following the training program with a 2-scale point reduction in the perception of dyspnea during exercise. dyspnea during loud speech decreased from moderate to mild. The changes in dyspnea, both during exercise and speech, are directly related to inspiratory muscle strengthening. The results suggest that inspiratory muscle training may improve respiratory related function in patients with restrictive upper airway disorders.- - - - - - - - - - ranking = 5keywords = speech (Clic here for more details about this article) |
4/64. Tracheo-oesophageal puncture by retrograde passage of a gastroscope via mini-laparotomy and gastrotomy.Secondary tracheo-oesophageal puncture is frequently used for voice restoration after laryngectomy. A method utilizing a flexible gastroscope passed via a mini-laparotomy and gastrotomy in a retrograde manner is described in a patient where extensive pharyngeal resection made it impossible to cannulate the upper aerodigestive tract. The patient suffered minimal morbidity and produced reasonable speech.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
5/64. A report on alterations to the speaking and singing voices of four women following hormonal therapy with virilizing agents.Four women aged between 27 and 58 years sought otolaryngological examination due to significant alterations to their voices, the primary concerns being hoarseness in vocal quality, lowering of habitual pitch, difficulty projecting their speaking voices, and loss of control over their singing voices. Otolaryngological examination with a mirror or flexible laryngoscope revealed no apparent abnormality of vocal fold structure or function, and the women were referred for speech pathology with diagnoses of functional dysphonia. Objective acoustic measures using the Kay Visipitch indicated significant lowering of the mean fundamental frequency for each woman, and perceptual analysis of the patients' voices during quiet speaking, projected voice use, and comprehensive singing activities revealed a constellation of features typically noted in the pubescent male. The original diagnoses of a functional dysphonia were queried, prompting further exploration of each woman's medical history, revealing in each case onset of vocal symptoms shortly after commencing treatment for conditions with medications containing virilizing agents (eg, Danocrine (danazol), Deca-Durabolin (nandrolene decanoate), and testosterone). Although some of the vocal symptoms decreased in severity with the influences from 6 months voice therapy and after withdrawal from the drugs, a number of symptoms remained permanent, suggesting each subject had suffered significant alterations in vocal physiology, including muscle tissue changes, muscle coordination dysfunction, and propioceptive dysfunction. This retrospective study is presented in order to illustrate that it was both the projected speaking voice and the singing voice that proved so highly sensitive to the virilization effects. The implications for future prospective research studies and responsible clinical practice are discussed.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
6/64. Bilateral subthalamic nucleus stimulation in a parkinsonian patient with preoperative deficits in speech and cognition: persistent improvement in mobility but increased dependency: a case study.We report a patient with advanced Parkinson's disease, including severe and frequent off periods with freezing of gait, moderate dysphonia, and some cognitive impairment, who underwent bilateral subthalamic nucleus (STN) stimulation. The patient was followed for 1 year after surgery, showing persistent good mobility without off periods and without freezing, which reverted completely when stopping the stimulation. There was deterioration of cognition as well as increased aphonia and drooling, all of which remained when the stimulation was turned off. The striking improvement in motor symptoms following STN stimulation was not paralleled by improvement in disability, probably as a result of a cognitive decline, suggesting a diagnosis of Parkinson's disease with dementia. We conclude that chronic STN stimulation is efficient in alleviating akinetic motor symptoms including gait freezing; this surgery should be offered before patients start to exhibit speech or cognitive disturbances.- - - - - - - - - - ranking = 5keywords = speech (Clic here for more details about this article) |
7/64. The association of laryngoceles with ventricular phonation.Laryngoceles represent dilatations of the laryngeal saccule that may extend internally into the airway, or externally through the thyrohyoid membrane. Unilateral laryngoceles are uncommon clinical entities and bilateral laryngoceles are rare. Certain activities like glass blowing and playing a wind instrument are associated with laryngocele development, as is laryngeal carcinoma in the ventricular area. This case describes development of bilateral laryngoceles in a patient who chronically uses ventricular phonation during speech. The pathogenesis involves repetitive elevation of intralaryngeal pressure during false vocal cord approximation, exposing the ventricles to abnormally high air pressures. The pathogenesis in this case, as well as in laryngoceles associated with occupational or anatomic risk factors, is discussed.- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
8/64. Hypernasality--a rare initial symptom of a cerebellar astrocytoma.Nasality is a disorder due to nasal resonance, which may be induced by a variety of etiologies. Transitional hypernasality is frequently seen in children after adenoidectomy. The alleged post-surgical hypernasality in the case presented was shown to be related to the late detection of an astrocytoma of the cerebellum and the brain stem in a 6-year-old boy. This case was characterized by increased hypernasality which failed speech therapy. A developing one-sided vocal fold palsy in combination with an ipsilateral soft-palate palsy indicated further investigation. Computerized tomography (CT) and magnetic resonance imaging (MRI) revealed a brain stem-tumor with a maximum size of 6 cm involving parts of the cerebellum. These findings demonstrated the need for a strict follow-up, even after adenoidectomy, in the presence of hypernasality for identifying concurrent etiologies as well as cases suitable for speech therapy.- - - - - - - - - - ranking = 2keywords = speech (Clic here for more details about this article) |
9/64. Simultaneous vocal fold and tongue paresis secondary to Epstein-Barr virus infection.dysphonia is a common presenting symptom in cases referred for otolaryngologic evaluation. Similarly, primary care physicians frequently see adolescents or young adults with symptomatic Epstein-Barr virus infection. Some of the patients with active Epstein-Barr virus infection who have severe clinical manifestations of infectious mononucleosis will be referred for otolaryngologic evaluation. Voice abnormalities in these patients, though, are usually limited to altered resonance due to pharyngeal crowding by hyperplastic lymphoid tissue. We describe a patient with infectious mononucleosis who was referred for evaluation of dysphonia and was diagnosed with unilateral tongue and vocal fold paresis. We also discuss the patient's clinical course and review the related literature. Although uncommon, cranial nerve palsies must be considered in the patient with Epstein-Barr virus infection who presents with voice or speech disturbance. Arch Otolaryngol head neck Surg. 2000;126:1491-1494- - - - - - - - - - ranking = 1keywords = speech (Clic here for more details about this article) |
10/64. Speech patterns in children with velo-cardio-facial syndrome. Two case studies.The purpose of this study was to document the articulation patterns in children with velo-cardio-facial syndrome. The subjects were 2 children with this syndrome, aged 6 years 6 months and 3 years 11 months. Phonetically transcribed speech samples collected by means of a picture naming test formed the basis for this study. The speech samples were subjected to two types of analyses: independent analyses describing the children's sound productions regardless of their relation to the adult targets and relational analyses comparing the children's productions with the adult standard form. It was found that the articulatory problems in velo-cardio-facial syndrome are not simply due to a delay in speech sound acquisition. Articulation errors found in this syndrome are uncharacteristic of normal speech development. Whether errors are syndrome-specific awaits further investigation.- - - - - - - - - - ranking = 4keywords = speech (Clic here for more details about this article) |
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