Difficulty producing high-pitched sounds in singing: correlations with laryngostroboscopy and electromyographic findings / Dificuldade na produção de sons agudos no canto: correlações com a laringoestroboscopia e achados eletromiográficos

Abstract Introduction: Difficulties or limitations in producing high-pitched sounds while singing may be due to the vocal technique used or organic factor. The observation of such difficulty or limitation by singing teachers is one of the main reasons affected individuals are referred to otolaryngologists. Objective: To evaluate the laryngostroboscopic and electromyographic changes in the cricothyroid muscles of singers with difficulties or limitations producing high-pitched sounds. Methods: This is a cross-sectional study. Ten singers with difficulty producing high-pitched sounds underwent voice, laryngostroboscopic, and electromyographic evaluations. Results: None of the evaluated singers presented signs of impairment of the superior laryngeal nerve on laryngostroboscopy. The electromyographic findings for the cricothyroid muscle were normal for all singers. Six singers presented vocal fold lesions, seven had signs suggestive of laryngopharyngeal reflux, and two presented vascular changes. Conclusion: No signs suggestive of superior laryngeal nerve paresis or paralysis were observed on laryngostroboscopy and electromyography of the cricothyroid muscle in singers with difficulties or limitations producing high-pitched sounds. The presence of vocal fold lesions should be investigated in this population.

Resumo Introdução: Dificuldades ou limitações na produção de sons agudos durante o canto podem ser decorrentes da técnica vocal utilizada ou de fatores orgânicos. A observação dessa dificuldade ou limitação pelos professores de canto é uma das principais razões pelas quais os indivíduos afetados são encaminhados aos otorrinolaringologistas. Objetivo: Avaliar as alterações laringoestroboscópicas e eletromiográficas no músculo cricotireóideo de cantores com dificuldades ou limitações na produção de sons agudos. Método: Estudo de coorte transversal. Dez cantores com dificuldade de produzir sons agudos foram submetidos a avaliações de voz, laringoestroboscópicas e eletromiográficas. Resultados: Nenhum dos cantores avaliados apresentou sinais de comprometimento do nervo laríngeo superior na laringoestroboscopia. Os achados eletromiográficos para o músculo cricotireóideo foram normais para todos os cantores. Seis cantores apresentaram lesões nas pregas vocais, sete apresentaram sinais sugestivos de refluxo laringofaríngeo e dois apresentaram alterações vasculares. Conclusão: Não foram observados sinais sugestivos de paresia ou paralisia do nervo laríngeo superior na laringoestroboscopia e eletromiografia do músculo cricotireóideo em cantores com dificuldades ou limitações na produção de sons agudos. A presença de lesões nas pregas vocais deve ser investigada nessa população.

Clinicopathological Evaluation of the Patients with Hoarseness of Voice.

Hoarseness is one of the commonest symptoms which brings the patient to physician. Any change in quality of voice must be evaluated thoroughly and promptly as it may underlie some infective or neoplastic lesion which can be managed better if diagnosed at an early stage.METHODSThe study was conducted in Pt. J.N.M. Medical College, Raipur, for period of 1.5 years in which 81 patients with hoarseness were selected. After complete general and ENT examination, required investigations were done. Data was collected, tabulated and compared. Out of the total of 81 patients, 58 were males and 23 were females. Carcinoma laryngo-pharynx was found to be the most common cause of hoarseness. Most of the cases were from middle age group i.e. 50 to 60 years. Associated tobacco addiction in any form was very common in all the patients.RESULTSHoarseness of voice can be an alarming symptom in adult patients, particularly when it is present in males with chronic history of addiction. One should be very cautious during investigations as it leads to malignancy most of the time. Early diagnosis and treatment give good prognosis and better outcome to the patient.CONCLUSIONSHoarseness of voice is just a symptom with a very diverse aetiology. Proper diagnosis through detailed history and prompt examination leads to early diagnosis and management as well.

Diagnostic value of narrow-band imaging in detection of recurrent nasopharyngeal carcinoma / 中华耳鼻咽喉头颈外科杂志

Objective@#To evaluate the diagnostic value and feasibility of narrow-band imaging in detection of recurrent nasopharyngeal carcinoma (NPC).@*Methods@#One thousand three hundred and sixty-four NPC patients who had completed NPC treatment were enrolled. All patients were followed-up with imaging, serological examination of EB virus and nasopharyngeal endoscopy(WL and NBI mode), in which (1) both white light (WL) and NBI modes were done; (2) positive endoscopic patients were given nasopharyngeal biopsy; (3) using histologic finding as criterion standard, the sensitivity, specificity, accuracy and Yonden′s index of two modes were compared. Kappa index was used to evaluate the consistency between the two modes and pathological results respectively; (4) the positive rates of WL and NBI in patients with early recurrent (stage Ⅰ+ Ⅱ) were compared.@*Results@#A total of 265 cases were suspected as having recurrent lesions by endoscopy in WL mode and 68 cases of them were pathologically diagnosed as having NPC; and 82 cases were suspected as having recurrent lesions by endoscopy in NBI mode and 74 cases of them were pathologically diagnosed as having NPC. The sensitivity, specificity, accuracy and Yonden′s index of WL mode were 91.89%, 0, 25.09% and -0.0811, respectively, with a kappa of -0.045; the sensitivity, specificity, accuracy and Yonden′s index of NBI mode were 100.00%, 95.94%, 97.05% and 0.9594, respectively.@*Conclusion@#NBI has higher sensitivity, specificity, early diagnosis rate and Yonden′s index than WL.

Application of stroboscopy and narrow band imaging endoscopy in the diagnosis of vocal cord leukoplakia / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the value of stroboscopy and narrow band imaging (NBI)endoscopy in the diagnosis of vocal cord leukoplakia.@*Methods@#Two hundred and forty-six patients with vocal cord leukoplakia who underwent laryngeal microsurgery and diagnosed by histopathology were recruited between August 2014 and July 2016 in this retrospective study. The diagnostic accuracy of stroboscopy and narrow band imaging endoscopy in the diagnosis of vocal cord leukoplakia was compared. SPSS21.0 software was used to analyze the data.@*Results@#A significantly positive correlation was found between the decrease grade of mucosal wave and the histopathological diagnosis(Spearman r=0.526, P<0.01). A significantly positive correlation was found between the lesion classified by detailed morphologic findings of epithelial microvessel and the histopathological diagnosis(Spearman r=0.480, P<0.01). The sensitivity of stroboscopy for detecting severe dysplasia, carcinoma and invasive carcinoma was 92.73%, higher than NBI endoscopy. The specificity of NBI endoscopy was 90.55%, higher than stroboscopy. The results of logistic regression analysis showed: the positive pathological type risk in the group with mucosal waves severely reduced and absent was 3.906 and 19.737 times higher than the group with mucosal waves slightly reduced. In the group with mucosal waves severely reduced and absent, significant difference was observed when combined use of NBI endoscopy(P<0.001, P=0.047).@*Conclusions@#In the diagnosis of vocal cord leukoplakia, stroboscopy is useful for detecting severe dysplasia, carcinoma and invasive carcinoma with high sensitivity. In the group with mucosal waves severely reduced and absent, combined use of NBI endoscopy was able to improve the diagnostic accuracy.

Improvement of Vocal Pathologies Diagnosis Using High-Speed Videolaryngoscopy

Introduction The study of the dynamic properties of vocal fold vibration is important for understanding the vocal production mechanism and the impact of organic and functional changes. The advent of high-speed videolaryngoscopy (HSV) has provided the possibility of seeing the real cycle of vocal fold vibration in detail through high sampling rate of successive frames and adequate spatial resolution. Objective To describe the technique, advantages, and limitations of using HSV and digital videokymography in the diagnosis of vocal pathologies. Methods We used HSV and digital videokymography to evaluate one normophonic individual and four patients with vocal fold pathologies (nodules, unilateral paralysis of the left vocal fold, intracordal cyst, and adductor spasmodic dysphonia). The vocal fold vibration parameters (glottic closure, vibrational symmetry, periodicity, mucosal wave, amplitude, and glottal cycle phases) were assessed. Results Differences in the vocal vibration parameters were observed and correlated with the pathophysiology. Conclusion HSV is the latest diagnostic tool in visual examination of vocal behavior and has considerable potential to refine our knowledge regarding the vocal fold vibration and voice production, as well as regarding the impact of pathologic conditions have on the mechanism of phonation...

Avances tecnolóiicos recientes en el diagnóstic y tratamiento de las enfermedaades de la laringe y el tracto aerodigestivo superior / Recent technlogiical advance in diagnosis and treatment of the larynx and uupper aerodigestive trcct / Avanços ecnológiicos recentes no diagnósico e tratamento das doenças daa laringe e do trato aerodigestivo superior

Los continuos desarrollos tecnológicos, en los años recientes, han permitido un mejor entendimiento de la anatomía y fisiología de los pliegues vocales y del tracto digestivo superior. Técnicas de diagnóstico como la laringoscopia de alta velocidad, la videoquimografía, la laringoscopia de acercamiento de alta resolución en la oficina y la impedanciometría esofágica con manometría, son herramientas muy importantes en la práctica clínica moderna. En lo que respecta a tratamiento, el desarrollo de equipos de láser acoplados a sistemas robóticos, fibras para la aplicación de rayos láser de diferentes longitudes de onda a sitios específicos, e instrumentos para ser usados a través de endoscopios flexibles, ampliaron las posibilidades terapéuticas, y, en casos seleccionados, las perspectivas para la ejecución de procedimientos mínimamente invasivos sin necesidad de hospitalización. El proposito de este estudio es realizar una revision y un análisis de los avances tecnológicos dirigidos al diagnóstico y tratamiento de las enfermedades del tracto aerodigestivo superior, sus posibles aplicaciones y limitaciones. Es un estudio descriptivo de una revisión de la literatura concerniente al tema. Se presenta una monografía y una revisión de la literatura relevante, disponible en publicaciones indexadas, con respecto a los diferentes métodos actualmente disponibles para el estudio de las enfermedades del tracto aerodigestivo superior, así como de las nuevas alternativas desde el punto de vista de posibilidades terapéuticas. Se hace un análisis de los aspectos técnicos importantes de cada una de las opciones, tanto diagnósticas como terapéuticas, con el fin de tener claridad sobre sus posibles aplicaciones clínicas, ventajas, desventajas y contraindicaciones.

Continuous technological developments in recent years have allowed a better understanding of the anatomy and physiology of the vocal folds and the upper digestive tract. Diagnostic techniques such as high speed laryngoscopy, videokymography, in office high resolution close up laryngoscopy and esophageal impedance with manometry are very important tools in modern day clinical practice. As far as treatment is concerned, development of laser equipments coupled to robotic systems, fibers to deliver different laser wavelengths to specific places, and instruments to be used through flexible scopes, broadened therapeutic possibilities and, in selected cases, have made it possible to perform minimally invasive procedures with no need for hospitalization. The purpose of this study is to review and analyze technological advancements for diagnosis and treatment of the diseases of the upper aerodigestive tract, their feasible applications and limitations. It is a descriptive study of literature review regarding the topic. A monograph and a revision of relevant literature accessible on indexed publications related to different currently available methods for studying the upper aerodigestive tract diseases, as well as new alternatives from the therapeutic point of view are presented. An analysis of important technical aspects of each option, either diagnostic or therapeutic is performed with the aim of elucidating their possible clinical applications, advantages, disadvantages and contraindications.

Os contínuos desenvolvimentos tecnológicos, nos anos recentes, permitiram um melhor entendimento da anatomia fisiologia das pregas vocais e do trato digestivo superior. Técnicas de diagnóstico como a laringoscopia de alta velocidade, a vídeoquimografia, a laringoscopia de aproximação de alta resolução e a impedânciometria esofágica com manometria, são ferramentas muito importantes na prática clínica moderna. No que diz respeito ao tratamento, o desenvolvimento de equipamentos de laser acoplados a sistemas robóticos, fibras para a aplicação de raios laser de diferentes longitudes de onda em locais específicos, e instrumentos para ser usados através de endoscópios flexíveis, ampliaram as possibilidades terapêuticas, e, em casos selecionados, as perspectivas para a execução de procedimentos minimamente invasivos sem a necessidade de hospitalização. O propósito deste estudo é realizar uma revisão e uma análise dos avanços tecnológicos dirigidos ao diagnóstico e tratamento das doenças do trato aerodigestivo superior, suas possíveis aplicações e limitações. É um estudo descritivo de uma revisão da literatura concernente ao tema. Apresenta-se uma monografia e una revisão da literatura relevante, disponível em publicações indexadas, com respeito aos diferentes métodos disponíveis atualmente para o estudo das doenças do trato aerodigestivo superior, bem como das novas alternativas desde o ponto de vista de possibilidades terapêuticas. É feita uma análise dos aspectos técnicos importantes de cada uma das opções, tanto diagnósticas como terapêuticas, com o fim de ter claridade sobre suas possíveis aplicações clínicas, vantagens, desvantagens e contraindicações.

Manejo del sulcus vocalis con injerto de fascia temporal / Sulcus vocalis management with fascia temporal graft

El sulcus vocalis es una lesión en la cual el epitelio del pliegue vocal tiende a invaginarse y adherirse al ligamento y/o músculo resultando en disfonía. Existen múltiples tratamientos descritos ninguno con resultados ideales. Este es un estudio descriptivo-prospectivo en el Hospital Militar Central en pacientes operados por sulcus vocalis tipos II y III e implantados con fascia autóloga entre junio de 2006 y diciembre de 2008. De 17 pacientes operados cumplieron los criterios de inclusión 11. Edad promedio 32 años. 9 presentaron mejoría del análisis acústico de la voz con una tendencia a la mejoría en todas las variables, particularmente en el Shimmer y la frecuencia fundamental. En la estroboscopia, 10 pacientes presentaron recuperación de la onda mucosa y en 5 del cierre glótico. Ningún paciente presentó reacciones adversas al procedimiento. Del presente estudio se puede considerar que el manejo del sulcus vocalis con injerto autólogo de fascia temporal es un procedimiento seguro que en la mayoría de los casos representa una mejoría subjetiva y objetiva de la calidad de voz. Es necesario aumentar el tamaño de la muestra para obtener resultados de mayor poder estadístico y definir los criterios de éxito.

Sulcus vocalis is an injury in which the epithelium of the vocal fold tends to invaginate and attach to the ligament and / or muscle resulting in dysphonia. There are multiple treatments as described but none has ideal results. This is a descriptive – prospective study carried out at the Hospital Militar Central in patients that had been operated on due to sulcus vocalis of the type II and III and who have been given implants with autologous fascia between June, 2006 and December, 2008. Out of 17 patients that were operated on, 11 complied with the inclusion criteria. The average age was 32 years old. 9 of them exhibited an improvement on the acoustic analysis of the voice with a tendency to improvement in all variables, especially in Shimmer and the basic frequency. 10 patients exhibited a recovery of the mucous wave in the stroboscope analysis and 5 in the glottal closure. Not one patient showed adverse reactions to the procedure. It can be considered from this study that managing sulcus vocalis with a temporalis fascia autologous graft is a safe procedure that represents a subjective and an objective improvement of the quality of the voice. It is necessary to increase the size of the simple in order to obtain results with a greater statistical power and be able to define the criteria for success.

Histology and Stroboscopic Findings after Injection of Artecoll(R) and Restylane(R) into Paralyzed Canine Vocal Fold: in vivo Canine Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aims of this study are to introduce Artecoll and Restaylane, that have been available for facial augmentation, as new materials for injection laryngoplasty, to investigate the mucosal wave of true vocal folds after the injection of these two materials into the true vocal fold, and to assess its biocompatibility and durability. SUBJECTS AND METHOD: After complete paralysisof the right recurrent laryngeal nerve of 6 Beagle dogs, the dogs were divided into the Artecoll injection group and the Restylane injection group, and Artecoll or Restylane was injected into vocalis muscle and vocal ligament. The recurrent laryngeal nerve of the opposite side was stimulated, the posterior commissure was sutured, and the mucosal wave of true vocal folds was examined by stroboscopy in in vivo canine study 1, 3, and 6 months after the injection. And, histopathological change of the injected materials after total laryngectomy was examined by hematoxylin and eosin (H & E) staining and masson trichrome staining. RESULTS: In both the Artecoll injection and the Restylane injection groups, the mucosal wave of true vocal folds was detected by stroboscopic examination until 6 months after the injection, and the difference of the mucosal wave of true vocal folds between these two groups was difficult to detect. Histological studies revealed that the injected materials remained in the vocal ligament and vocalis muscle and theses two materials were resorbed with time, Artecoll showing less resorption. These two materials were biocompatible and, particularly, Restylane showed less foreign body reaction. CONCLUSION: Since both Artecoll and Restylane are biocompatible and durable, they areconsidered as the suitable material for injection larygoplasty, and additional long-term studies are required.

The Correlation of GRBAS Scales and Laryngeal Stroboscopic Findings for the Assessment of Voice Therapy Outcome in the Patients with Vocal Nodules / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The size of nodule is generally known as a main criterion for the evaluation of voice improvement in the patients with vocal nodules. However, the patients who are receiving voice therapy for their vocal nodules frequently report variable degree of improvement in their voice quality even though the size of nodules remain unchanged during the stroboscopic evaluation. We aimed to define valuable parameters of laryngeal stroboscopy in evaluating the efficacy of voice therapy for vocal nodules. SUBJECTS AND METHOD: We reviewed the medical records of twenty adult women with bilateral vocal nodules. They received 4 to 8 sessions of voice therapy and reported variable degree of their voice improvement. Laryngeal stroboscopy (nodule size, glottal closure, vocal fold vibration, laryngeal tension), acoustic analysis (jitter, shimmer), perceptual parameters (GRBAS) were evaluated before and after voice therapy. Laryngeal stroboscopic gradings and GRBAS gradings were matched and analyzed for their correlation. RESULTS: There were significant correlations between R and vocal fold vibration; between B and nodule size and glottal closure; between S and laryngeal tension; between G and glottal closure, vocal fold vibration and laryngeal tension. CONCLUSION: Among laryngeal stroboscopic findings, improved glottal closure, vocal fold vibration and decreased laryngeal tension as well as decreased nodule size are proved to be useful parameters to evaluate the effectiveness of voice therapy in the patients with vocal nodules.

The Phonetic Characteristics in the Types of Reinke's Edema / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Reinke's edema has shown different voice qualities and different mucosal waves according to the degree of swelling in the vocal folds. The subjects were classified into three types : waterish, mixed, and gelatinous type according to the consistency of fluid in the Reinke's space. We compared voice parameters of different types of Reinke's edema. MATERIALS AND METHODS: All of the subjects were classified according to the laryngoscopic findings and operation findings. History for duration of disease, smoking histories, and the severity of laryngopharyngeal reflux were evaluated. Stroboscopy and videokymography were used for the assessment of mucosal waves. Voice parameters were obtained and compared from all subjects to assess acoustic and aerodynamic factors. RESULTS: Vocal fold vibrations of waterish type was more active than the gelatinous type or mixed type in the stroboscopic findings and videokymography. The fundamental frequency of gelatinous type was significantly lower compared to other types: however, subglottic pressure was significantly higher compared to other types. CONCLUSIONS: Reinke's edema was classified according to the gelatinous type, mixed type and waterish type according to the consistency of fluid in the vocal folds. There were typically acoustic and stroboscopic findings in each type.

Clinical Application of Videokymography / 听力学及言语疾病杂志

Objective To study the results of clinical application of videokymography. Methods 50 patients with voice pathology and 5 normal voice persons were studied with videokymography. Results With videokymography, left - right asymme- tries, close or open quotient differences, abnormal periocity and mucosal waves were visualized in 50 patients. The vibration of vo- cal folds was slight asymmetry in 1 normal voice person and normal in other 4 normal voice persons. Conclusion Videokymography provides a simple way to study irregular vibrations of the vocal folds. It is helpful for a more accurate diagnosis of the vocal folds. Information obtained allows a first time quantification of vibrations registered.