Use of formoterol in the treatment of stuttering. A pilot study.

AIMS: Stuttering is a serious health and social problem that can distinctively affect not only the mental development of an individual but also his life possibilities, including social fulfilment and his general life prospects. The etiology of stuttering is however unknown and that is why it is not possible to treat it causally. This pilot study takes into account the hypothesis of bronchial constriction as a negative factor in stuttering and investigates the effect of the long-acting bronchodilator formoterol fumarate on stuttering in 42 patients. METHODS: Patients were divided in 2 groups - A (school children and juveniles) and B (adults 18-25 resistant to other treatment). The medicine was administered once a day in the morning in a dose of 12 microg for the total period of 6 months. The prime outcome parameter - severity of stuttering - was evaluated using the ordinary scale (McGill Pain Questionnaire). The evaluation was done by an examining physician during visits to the centres and by the patients themselves (in cases of the youngest with the assistance of a parent) in a daily diary. RESULTS: A non-parametric pair test (Wilcoxon signed rank test) was used to compare the average marks in the whole set of patients. During the six moth period of administration of Foradil the speech fluency improved. The average number of dysfluent words decreased from 10.5 +/- 1.3 to 6.6 +/-0.97. CONCLUSION: The average mark of speech fluency evaluated by the physicians between the period of non use of Foradil and the six month period after the use of Foradil improved from 2.95 +/- 0.76 to 1.95 +/- 0.56 (as proved by the chi-square test, p<0.0001). The evaluation of speech fluency of balbuties uses the logopedic practices. Other clinical evaluations of speech fluency are not known.

The F1-F2 vowel chart for Czech whispered vowels a, e, i, o, u.

AIM: The aim of this contribution is to present the formant chart of the Czech vowels a, e, i, o, u and show that this can be achieved by means of digital methods of sound processing. METHOD: A group of 35 Czech students of the Pedagogical Faculty of Palacky University was tested and a record of whispered vowels was taken from each of them. The record was digitalized and processed by the Discrete Fourier Trasform. The result is the power spectrum of the individual vocals - the graphic output consists of a plot of the relative power of individual frequencies in the original sound. The values of the first two maxima which represent the first and the second formants were determined from the graph. The values were plotted on a formant chart. RESULTS: Altogether, 175 spectral analyses of individual vowels were performed. In the resulting power spectrum, the first and the second formant frequencies were identified. The first formant was plotted against the second one and pure vocal formant regions were identified. CONCLUSION: Frequency bands for the Czech vowel "a" were circumscribed between 850 and 1150 Hz for first formant (F1) and between 1200 and 2000 Hz for second formant (F2). Similarly, borders of frequency band for vowel "e" they were 700 and 950 Hz for F1 and 1700 and 3000 Hz for F2. For vowel "i" 300 and 450 Hz for F1 and 2000 and 3600 Hz for F2, for vowel "o" 600 and 800 Hz for F1 and 600 and 1400 Hz for F2, for vowel "u" 100 and 400 Hz for F1 and 400 and 1200 Hz for F2. DISCUSSION: At low frequencies it is feasible to invoke the source-filter model of voice production and associate vowel identity with frequencies of the first two formants in the voice spectrum. On the other hand, subject to intonation, singing or other forms of exposed voice (such as emotional speech, focused speech), the formant regions tend to spread. In spectral analysis other frequencies dominate, so specific formant frequency bands are not easily recognizable. Although the resulting formant map is not much different from the formant map of Peterson, it carries basic information about specific Czech vowels. The results may be used in further research and in education.

Report on the course of study BZ-1003-BR following the changes in airways in stutterers with the help of pulse oscillometry (MasterScreen IOS).

Stuttering affects people all over the world. At the age of six years, about 1.5 percent of children suffers from stuttering. Although stuttering resolves spontaneously upon reaching adulthood in approximately 80% of those affected, it continues to have significant health and social consequences. So far, its etiology remains unknown. The organic differences in those with stuttering and those free of speech problems have been evaluated. As a result of these examinations, it has been hypothesized that stuttering results from functional pneumoobstruction of the tracheobronchial tree in the peripheral respiratory passages. As for now, no similar therapeutic procedure, using a bronchodilating agent in the treatment of stuttering, has been described. Preliminary findings of a pilot study are surprisingly positive. In October of 2003, a multicenter open clinical trial (Stage III) to verify the effect of a sympathomimetic agent formoterol was initiated. The study is being realized in six centers in Moravia and enrolls approx. 40 patients (children, adolescents and young adults). First experience and initial evaluation of the cohort are presented here.

[Assessment of autonomous reactivity at stuttering treated in bronchodilatation therapy]. / Hodnocení autonomní reaktivity u balbuties pri bronchodilatacní terapii.

By the measurement of autonomous reactivity according to the variability of heart frequency we get a picture that describes the activity of autonomous nervous system and stuttering at bronchodilatal therapy.

In reference to phonation larynx fixation: computer graphic record.

The vocal apparatus serves phonation. It represents a biocybernetic self-regulating system, disposing of a feedback network of the central nervous system. The larynx is a self-induced vibrating system. The larynx, functioning as the phonation apparatus of the vocal apparatus, is a source of human voice. In every individual its frequency range corresponds to about eight semitones in speech and about two octaves of the so-called chest register in singing, denoted also as a thoracic or modal voice. This is followed by one more octave of the so-called cranial register or falsetto voice. We were interested in changes of the larynx positions at intonation in the fundamental singing registers, both modal and falsetto, in professional male singers. At our disposal were 11 professional male singers. We investigated changes in the position of the laryngeal structures simultaneously with the aid of an X-ray apparatus, the acoustic and mechanical signals registered by means of the B & K 4369 acceleration recorder. It has been found that at phonation with the modal voice a change in the position of the laryngeal structures takes place in two different ways, whereas the larynx movements at falsetto remain the same. It has been suggested that a complex fixation apparatus participates in the phonation larynx movements. Of the same complex character are also the problems connected with the examination of the entire vocal apparatus. For the purpose of compiling the present pieces of knowledge in the field of human voice studies, we have made the most advantageous use of the presently most complex system Authorware for the production of some interactive multimedial programmes on personal computers.

Analysis of articulation of fricative praealveolar sibilant "S" in control population.

Defective pronunciation of one or more mother language phones, i.e. dyslalia, represents the most frequent speech impairment both in children and adult people. Cases of persisting speech disorder need professional approach and help. The aim of the study was to obtain a model of physiological articulation of the sibilant "s" in children. The method of FFT spectral analysis was made use of. Results will serve for further use in evaluation of speech impairment.

Pneumoobstruction of the tracheobronchial tree as a hypothetical cause of balbuties.

The occurrence of balbuties is a common phenomenon. Balbuties is defined as frequent repetition and lengthening of syllables and words, alternatively frequent halting with pauses impairing the rhythmic flow of speech. Balbuties may have a negative influence upon the psychic as well as social development of an individual. Psychiatric co-morbidity of balbuties usually includes some other defects in behaviour, such as states of anxiety, depression, etc. The ethiology of balbuties has not yet been discovered, neither its casual therapy is possible. The phonating apparatus is formed by: the lungs with the trachea, the larynx, and the vocal tract. The source of the expired air flow is given by the expiring lungs. In balbuties the fatal defect probably results from a pneumoobstruction of the tracheobronchial tree in the peripheral respiratory passages. The present paper gives a hypothetical explanation of the cause.

The spectral analysis of syllables in patients using dentures.

Changes in the oral cavity resulting from the loss of teeth and the ensuing reconstruction of a set of teeth by dentures (partial or complete) may cause changes in the speech and voice of the patient. The aim of the present investigation was to study the changes in speech and voice in patients suffering from teeth loss and the degree of speech improvement using dentures. Voice and speech parameters of a set of tested syllables were analysed in 10 patients at the 2nd Clinic of Stomatology. The analysis was carried out by means of an FFT, SoundForge 5.0 programme. Differently expressed acoustic changes in both consonants and vowels were ascertained in a percentage of the patients under examination. These concerned especially the sibilant ("s", "(see text)"), labiodental ("f", "v") and vibrating ("r", "(see text)") consonants. Changes in the FFT spectrum and air leakage in constrictive consonants were also found. In some patients the vowels, especially the closed ones ("i", "u"), may change their fundamental frequency and show noise admixture manifested as a blurred delimitation of the formants. A denture should, inter alia, render it possible for the patient to produce the same articulation to which he/she had been accustomed before the loss of teeth. For the construction of dentures the most important factors from a phonetic point of view appear to be the following: overbite, overjet, the height of the plate, the thickness of the palatal material, the incisor position, and the modelling of the ruga palatina on the hard palate. In case of wrong denture construction the acoustic changes may continue, resulting in the patient's stress load dependent upon sex, age, psychic condition and seriousness of the problem.