ABSTRACT
PURPOSE: The present study aimed to observe the effect of two types of tubes on vocal tract bidimensional and tridimensional images. METHODS: Ten participants with hyperfunctional dysphonia were included. Computerized tomography was performed during production of sustained [a:], followed by sustained phonation into a drinking straw, and then repetition of sustained [a:]. A similar procedure was performed with a stirring straw after 15 minutes of vocal rest. Anatomic distances and area measures were obtained from computerized tomography midsagittal and transversal images. Vocal tract total volume was also calculated. RESULTS: During tube phonation, increases were measured in the vertical length of the vocal tract, oropharyngeal area, hypopharyngeal area, outlet of the epilaryngeal tube, and inlet to the lower pharynx. Also, the larynx was lower, and more closure was noted between the velum and the nasal passage. CONCLUSION: Tube phonation causes an increased total vocal tract volume, mostly because of the increased cross-sectional areas in the pharyngeal region. This change is more prominent when the tube offers more airflow resistance (stirring straw) compared with less airflow resistance (drinking straw). Based on our data and previous studies, it seems that vocal tract changes are not dependent on the voice condition (vocally trained, untrained, or disordered voices), but on the exercise itself and the type of instructions given to subjects. Tube phonation is a good option to reach therapeutic goals (eg, wide pharynx and low larynx) without giving biomechanical instructions, but only asking patients to feel easy voice and vibratory sensations.
Subject(s)
Dysphonia/diagnostic imaging , Dysphonia/therapy , Larynx/diagnostic imaging , Pharynx/diagnostic imaging , Phonation , Tomography, X-Ray Computed , Voice Training , Voice , Adult , Biomechanical Phenomena , Dysphonia/physiopathology , Equipment Design , Female , Humans , Laryngoscopy , Larynx/physiopathology , Male , Pharynx/physiopathology , Predictive Value of Tests , Vibration , Young AdultABSTRACT
BACKGROUND: The purpose of the study was to analyze the characteristics and evolution of non-invasive mechanical ventilation (NIV) in the postoperative period of heart surgery in children. METHODS: Retrospective observational study including all children requiring NIV after heart surgery in a single center pediatric intensive care unit (PICU) between 2001 and 2012. Demographic characteristics, ventilation parameters and outcomes were registered, comparing the first 6 years of the study with the last 6 years. RESULTS: 935 children required invasive or non-invasive mechanical ventilation, of which 200 (21.4) received NIV. The median duration of NIV was 3 days. Mortality rate was 3.9%. The use of NIV increased from 13.2% in the first period to 29.2% in the second period (p <0.001). Continuous positive airway pressure (CPAP) was the most common modality of NIV (65.5%). The use of bilevel positive airway pressure mode (BIPAP) increased from 15% in the first period to 42.9% in the second period (p < 0.001). The nasopharyngeal tube was the most common interface (66%), but the use of nasal cannula increased from 3.3 to 41.4% in the second period (p < 0.001). NIV failed in 15% of patients. The mortality rate did not change, the duration of NIV decreased and the PICU length of stay increased throughout the study. CONCLUSIONS: NIV is increasingly being used in the postoperative period of heart surgery in our center with an 85% success rate and is associated with a lesser need for invasive mechanical ventilation. CPAP was the most common modality and the "nasopharyngeal tube" was the most common interface in our study although, in the latter years, the use of BIPAP and nasal cannula has increased significantly.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Continuous Positive Airway Pressure/statistics & numerical data , Noninvasive Ventilation/trends , Cardiac Surgical Procedures/mortality , Child, Preschool , Female , Humans , Infant , Intensive Care Units, Pediatric/organization & administration , Length of Stay , Male , Postoperative Complications/epidemiology , Postoperative Period , Respiratory Insufficiency/epidemiology , Retrospective Studies , SpainABSTRACT
OBJECTIVE: The purpose of this study was to investigate the effect of phonation into tubes in air and tubes submerged in water on air pressure variables and vocal fold adduction in subjects with different voice conditions. METHODS: Forty-five participants representing four vocal conditions were included: (1) subjects diagnosed with normal voice and without voice training, (2) subjects with normal voice with voice training, (3) subjects with muscle tension dysphonia, and (4) subjects with unilateral vocal fold paralysis. Participants phonated into different kinds of tubes (drinking straw, 5 mm in inner diameter; stirring straw, 2.7 mm in inner diameter; silicon tube, 10 mm in inner diameter) with the free end in air and in water. Aerodynamic, acoustic, and electroglottographic signals were captured simultaneously. Mean values of the following variables were considered: glottal contact quotient (CQ) measured by electroglottograph, fundamental frequency, subglottic pressure (Psub), oral pressure (Poral), and transglottal pressure. RESULTS: All exercises had a significant effect on Psub, Poral, transglottal pressure, and CQ (P < 0.05). Phonation into a 55-cm silicon tube submerged 10 cm in water and phonation into a stirring straw resulted in the highest values for CQ, Psub, and Poral compared with baseline (repetition of syllable [pa:]) for all vocal status. Poral and Psub correlated positively. CONCLUSION: During semioccluded exercises, most variables behaved in a similar way (same trend with a quite large individual variation) regardless of the vocal status of the participants.
Subject(s)
Dysphonia/therapy , Glottis/physiopathology , Patient Positioning , Vocal Cord Paralysis/therapy , Voice Quality , Voice Training , Acoustics , Adult , Air Pressure , Airway Resistance , Biomechanical Phenomena , Case-Control Studies , Dysphonia/diagnosis , Dysphonia/physiopathology , Electrodiagnosis , Female , Humans , Immersion , Male , Middle Aged , Phonation , Time Factors , Treatment Outcome , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/physiopathology , Vocal Cords/physiopathology , Water , Young AdultABSTRACT
OBJECTIVE: To observe the possible differential effects of 8 different semi-occluded vocal tract exercises on glottal contact quotient (CQ) as a measure of vocal fold impact stress. PATIENTS AND METHODS: Eighty participants were divided into two groups: an experimental group with hyperfunctional dysphonia and a control group of vocally healthy subjects. The participants were recorded before, during and after the exercises. Electroglottographic samples were analyzed to obtain CQ. RESULTS: For the experimental group, all exercises, except lip trills and tongue trills, had an overall significant effect when conditions before, during and after the exercises were compared. The CQ presented differently across the 8 semi-occluded postures during exercise for both groups. For the experimental group, most exercises increased the CQ during practice. Only lip and tongue trills demonstrated lower CQ during exercise. CONCLUSIONS: Different semi-occluded exercises differentially affect vocal fold adduction. Lip and tongue trills produced the lowest CQ. Therefore, they may be recommended for decreasing glottal adduction. A straw submerged 10 cm below the water surface presented the greatest CQ. A shallower depth led to a lower CQ, while deeper submersion produced a higher CQ.
Subject(s)
Dysphonia/physiopathology , Dysphonia/therapy , Vocal Cords/physiopathology , Voice Training , Dysphonia/diagnosis , Humans , Reference Values , Voice QualityABSTRACT
El hombre siempre ha estado preocupado del proceso de la concepción de su propia especie, sea para favorecerla como también para evitarla. En todas las culturas, desde las más antiguas hasta las presentes, encontramos evidencias documentadas sobre este asunto. No siempre el proceso de concepción y contraconcepción fue visto con una connotación moral. Hubo distintas ópticas para evaluar la licitud o ilicitud de estos actos. Este artículo examinará la contraconcepción en las culturas que precedieron a la nuestra...
Man has always worried about the process of conception in his own species, whether it be to favor it or to prevent it. In all cultures, from the most ancient up to the present ones, we find documented evidence on this matter. The process of conception and contraception was not always seen as having moral connotations. Different perspectives were used to evaluate the legality or illegality of these acts. This article will examine contraception in the cultures that preceded ours...
O homem sempre esteve preocupado com o processo da concepção de sua própria espécie, seja para favorecê-la ou para evitá-la. Em todas as culturas, desde as mais antigas até as presentes, encontramos evidências documentadas sobre este assunto. Nem sempre o processo de concepção e anticoncepção foi visto com uma conotação moral. Existiram diferentes óticas para avaliar a licitude destes atos. Este artigo examinará a anticoncepção nas culturas que precederam a nossa...
Subject(s)
Humans , Abortion , Ethics , Ethics/historyABSTRACT
Replanteo de la propuesta 87: categorización, planificación y organización del Hospital San Juan Bautista de Santo Tomé, provincia de Corrientes
Subject(s)
Job Description , Economics, Hospital/legislation & jurisprudence , Hospitals, State/organization & administration , Hospitals, General/organization & administration , Health Care Levels , Public HealthABSTRACT
Replanteo de la propuesta 87: categorización, planificación y organización del Hospital San Juan Bautista de Santo Tomé, provincia de Corrientes