Effects of Bel Canto Training on Acoustic and Aerodynamic Characteristics of the Singing Voice.

OBJECTIVES: This study was designed to assess the impact of 2 years of operatic training on acoustic and aerodynamic characteristics of the singing voice. STUDY DESIGN: This is a longitudinal study. METHODS: Participants were 21 graduate students and 16 undergraduate students. They completed a variety of tasks, including laryngeal videostroboscopy, audio recording of pitch range, and singing of syllable trains at full voice in chest, passaggio, and head registers. Inspiration, intraoral pressure, airflow, and sound pressure level (SPL) were captured during the syllable productions. RESULTS: Both graduate and undergraduate students significantly increased semitone range and SPL. The contributions to increased SPL were typically increased inspiration, increased airflow, and reduced laryngeal resistance, although there were individual differences. Two graduate students increased SPL without increased airflow and likely used supraglottal strategies to do so. CONCLUSIONS: Students demonstrated improvements in both acoustic and aerodynamic components of singing. Increasing SPL primarily through respiratory drive is a healthy strategy and results from intensive training.

Vocal Assessment Before, After, and the Day After Opera Performance.

OBJECTIVE: To explore aerodynamic, acoustic, and laryngeal changes surrounding opera performance. STUDY DESIGN: Prospective preperformance, postperformance, and day after performance. METHODS: The laryngeal and vocal function of five male and five female classically trained singers was assessed immediately before, immediately after, and 1 day after an actual operatic performance. Phonatory threshold pressure was obtained. In addition, during a full-voice singing task, aerodynamic and acoustic measures included estimated subglottal pressure, airflow during voicing, laryngeal resistance, and sound pressure level (SPL). Expert listeners in the audience judged performers' voice quality at the beginning and the end of the performance. Laryngeal visualization was performed immediately before performance and the day after performance. RESULTS: Laryngeal stroboscopy revealed allergy symptoms with no change in vocal fold edges for all men. Women were less impacted by allergies. For all singers, perceptual judgments of expert listeners in the audience corresponded well with laryngeal findings. The men whose voices were perceived to be balanced and strong across the performance demonstrated increased airflow and reduced laryngeal resistance after performance. The two women who did not sing in church the morning after the performance demonstrated increased airflow and reduced laryngeal resistance. The two men who did sing in church the morning after the performance demonstrated noticeably reduced SPL and increased laryngeal resistance the day after performance. CONCLUSIONS: It appears most useful to describe the complexity of vocal performance with a variety of acoustic, aerodynamic, and perceptual measures. The findings further suggest that vocal rest the day after performance may facilitate recovery.

Singers' phonation threshold pressure and ratings of self-perceived effort on vocal tasks.

OBJECTIVES/HYPOTHESIS: This study was designed to determine if singers' self-ratings of vocal effort could predict phonation threshold pressure (PTP). It was hypothesized that effort ratings on the more complex task of singing "Happy Birthday" would best predict PTP. STUDY DESIGN: A multiple regression analysis was performed with PTP as the predicted variable and self-ratings on four phonatory tasks as the predictor variables. METHODS: Participants were 48 undergraduate and graduate students majoring in vocal performance. They produced /pi/ syllable trains as softly as possible for the measurement of PTP. They then rated their self-perceived vocal effort while softly producing the following: (1) sustained "ah" (comfortable, midrange pitch); (2) "ah" glide (chest to head voice); (3) Staccato "ah" in head voice (not falsetto); and (4) Happy Birthday in head voice (not falsetto). RESULTS: No ratings of vocal effort predicted PTP. The lack of correlation between PTP and ratings of Happy Birthday remained when separately evaluating graduate versus undergraduate students or males versus females. Informal evaluation of repeated ratings over time suggested the potential for effective self-monitoring. CONCLUSIONS: Students' ratings of self-perceived vocal effort were poor predictors of PTP. This may be because of the use of "effortless" imagery during singing instruction or consistent positive feedback regarding vocal performance. It is possible that self-rating could become an effective tool to predict vocal health if task elicitation instructions were more precise, and the student and voice teacher worked collaboratively to improve self-evaluation.

Liposarcoma of the larynx.

OBJECTIVES: The objective was to review the presentation, diagnosis, treatment, and prognosis of patients with laryngeal liposarcoma (LLS). A case is reported, and a retrospective review of the English-language literature is presented. METHODS: All published cases of LLS with adequate histopathologic documentation and clinical information were included for review. RESULTS: Thirty cases of LLS have been reported. A majority of these patients are men between 40 and 70 years of age. The most common location of the tumor is the supraglottis, and the presenting complaints are similar to those of other laryngeal neoplasms. Although these neoplasms recur often and can cause significant morbidity, they are typically of low grade and rarely metastasize. The outcomes of this disease are generally good when it is treated with wide surgical excision. CONCLUSIONS: Cases of LLS are extremely rare. Because the histologic changes are frequently subtle, LLS can be easily mistaken for a benign tumor. As a result, the diagnosis requires a high index of suspicion and diligence in examining biopsy specimens. Computed tomography and magnetic resonance imaging can assist in the diagnosis and surgical approach. Genetic and immunostaining analysis techniques may also prove to have valuable prognostic, diagnostic, and therapeutic implications for this disease. Wide surgical excision is the mainstay of treatment. The use of radiotherapy and chemotherapy in treating this cancer remains experimental, but might be considered on a case-to-case basis for palliation or to treat aggressive variants of the disease.

High-resolution computed tomography of temporal bone: Part IV: Coronal postoperative anatomy.

The purpose of this 4-part series is to illustrate the nuances of temporal bone anatomy using a high-resolution (200 micro isotropic) prototype volume computed tomography (CT) scanner. The normal anatomy in axial and coronal sections is depicted in the first and second parts. In this, the fourth part, and the third part, the structures that are removed and/or altered in 9 different surgical procedures are color coded and inscribed in the same coronal (article IV) and axial (article III) sections. The text stresses clinically important imaging features, including the normal postoperative appearance, and common complications after these operations. The superior resolution of the volume CT images is vital to the comprehensive and accurate representation of these operations. Minuscule intricate structures that are currently only localized in the mind's eye because of the resolution limit of conventional CT are clearly seen on these scans. This enhanced visualization, together with the information presented in the text, should assist in interpreting temporal bone scans, communicating with surgeons, and teaching this complex anatomy.

High-resolution computed tomography of temporal bone: Part III: Axial postoperative anatomy.

The purpose of this 4-part series is to illustrate the nuances of temporal bone anatomy using a high-resolution (200-mu isotropic) prototype volume computed tomography (CT) scanner. The normal anatomy in axial and coronal sections is depicted in the first and second parts. In this and the subsequent part, the structures that are removed and/or altered in 9 different surgical procedures are color coded and inscribed in the same axial (article III) and coronal (article IV) sections. The text stresses clinically important imaging features, including the normal postoperative appearance, and common complications after these operations. The superior resolution of the volume CT images is vital to the comprehensive and accurate representation of these operations. Minuscule intricate structures that are currently only localized in the mind's eye because of the resolution limit of conventional CT are clearly seen on these scans. This enhanced visualization, together with the information presented in the text, should assist in interpreting temporal bone scans, communicating with surgeons, and teaching this complex anatomy.

Symptoms, quality of life, videolaryngoscopy, and twenty-four-hour triple-probe pH monitoring in patients with typical and extraesophageal reflux.

A prospective study was designed to characterize patients with typical and extraesophageal reflux (EER) symptoms and seek predictive patterns for each group. Fifteen subjects without symptoms, 16 patients with symptomatic gastroesophageal reflux disease (GERD), and 37 patients with symptomatic EER were evaluated with outcomes tools, videolaryngoscopy, and 24-hour triple-probe pH monitoring. Higher symptom scores, Voice Handicap Index scores, and Gastrointestinal Symptom Rating Scale scores, as well as similarly decreased quality of life as measured by the Short Form 36, were noted among the two symptomatic groups. Patients with clinically diagnosed EER were more likely to have multiple abnormalities on laryngoscopy. There was a trend toward more pharyngeal reflux episodes in EER patients (6.9 +/- 8.9) as compared to GERD patients (6.0 +/- 9) and asymptomatic subjects (1.1 +/- 1.9). On the basis of the pH monitoring of asymptomatic subjects, we define pathological pharyngeal reflux as more than 5 episodes in 24 hours. Pharyngeal acid exposure is more common in patients presumed to have EER, but some pharyngeal reflux does occur in asymptomatic subjects. Neither symptom scores nor videolaryngoscopic findings were predictive of pathological EER as indicated by pH monitoring.

Clinical outcomes for the surgical treatment of sinonasal headache.

OBJECTIVE: This study was designed to explore the changes in patient-relevant clinical outcomes in a selected group undergoing surgery for nasal septal and turbinate abnormalities. Study design Seventy-nine consecutive patients with headache and correctable anatomic nasal obstruction were seen at the study institution from March 1998 to May 2000. These patients were evaluated for changes in patient-relevant clinical outcomes measures after surgical correction of their anatomic abnormalities. RESULTS: Seventy-one patients underwent surgical correction of nasal obstruction. More than half of these patients had contact points preoperatively. Statistically significant improvements were observed in the patient population with respect to 8 of the 10 clinical outcomes measures. Importantly, a decrease in the severity and frequency of headaches was noted after surgery, especially after the correction of contact points. CONCLUSION: The surgical correction of the septum and turbinates resulted in predictable improvement in headache and a majority of other important outcomes measures. Clinical significance Pain may improve after surgical correction of septal and turbinate abnormalities in a properly selected group.