ABSTRACT
A case of severe chronic dysphagia lasting more than 1 year after long-term ventilation due to sepsis is presented. Fiber optic endoscopic examination of swallowing (FEES) revealed retention of food on both sides of the base of the tongue and in both valleculae combined with severe penetration and postglutitive aspiration into the larynx. The reason was a broad-based scarred adhesion between the lingual side of the epiglottis and the tongue base. The adhesion was resected using a CO(2) laser. The final examination 3 months later showed complete recovery of normal swallowing function.
Subject(s)
Deglutition Disorders/etiology , Multiple Organ Failure/therapy , Respiration, Artificial , Sepsis/therapy , Critical Care , Deglutition Disorders/surgery , Epiglottis/pathology , Female , Humans , Laryngoscopy , Laser Therapy , Long-Term Care , Microsurgery , Middle Aged , Shock, Septic/therapy , Tissue Adhesions/etiology , Tissue Adhesions/surgery , Tracheostomy , Video RecordingABSTRACT
An objective method for the diagnosis of functional dysphonias is presented. The mathematically motivated approach was evaluated on 71 female subjects with normal voice or functional dysphonia. Using digital high-speed recordings, the phonation onset process was recorded in real-time for 8-10 different sound pressure levels for each subject. From these recordings two parameters were mathematically estimated, reflecting the phonation onset dynamics. The growth of the vocal fold amplitudes during the phonation onset process was described by a parameter a for which its lower threshold value a(th) was extrapolated. This threshold reflects the myoelastic tonus within the vocal folds. The second parameter was the maximum sound pressure level L(max). It allows conclusions on voice efficiency with respect to the necessary subglottal pressure and the myoelastic forces. Due to the significant differences of these parameters between the pathological groups and normal voices, the presented method is a stable and objective tool for medical diagnosis.
Subject(s)
Phonation/physiology , Signal Processing, Computer-Assisted , Stroboscopy/methods , Vocal Cords/physiology , Voice Disorders/diagnosis , Air Pressure , Case-Control Studies , Elasticity , Elasticity Imaging Techniques/methods , Female , Glottis/physiopathology , Humans , Laryngoscopy/methods , Speech Acoustics , Vibration , Voice Disorders/physiopathology , Voice QualityABSTRACT
INTRODUCTION: Malfunctions of the human voice with unknown causes are denoted by "functional voice disorders". The high speed video imaging technique (HVT) allows the recording of the oscillating vocal folds in real time. A new method is presented, describing different types of oscillation and their onset mathematically. A precise classification of the kind of functional voice disorders is possible. METHODS: For 71 young women, from the HVT recordings two parameters were mathematically estimated, reflecting the phonation onset dynamics: The threshold value A(th), corresponding with the myoelastic tone of the vocal folds and a maximum sound pressure level of speech L(max), characterising the efficiency of voice. RESULTS: Both values are sensitive for functional voice disorders and enable a differentiation between these pathologies. DISCUSSION: Significant differences of the computed parameters between the pathological groups and normal voices substantiate the presented method as a stable and objective tool for medical diagnosis.
Subject(s)
Image Processing, Computer-Assisted/instrumentation , Phonation/physiology , Sound Spectrography/instrumentation , Video Recording/instrumentation , Vocal Cords/physiopathology , Voice Disorders/diagnosis , Adult , Elasticity , Equipment Design , Female , Humans , Reference Values , Sensitivity and Specificity , Software , Voice Disorders/etiology , Voice Disorders/physiopathologyABSTRACT
BACKGROUND: Cochlear implants (CI) convert acoustic events into electrical pulses. The auditory nerve picks these tiny electrical pulses up and sends them to the brain. The dynamics of the audible sound is compressed considerably. The limits for stimulation are determined with the patient. A map law determines which sound pressure level is assigned to which stimulation level. A sufficient speech understanding requests an allocation of high stimulation levels for weak sound signals. The higher the sound level, the lower the increase. Unfortunately, with such kind of map law unwanted background noise is also presented as well audible stimulation. These stimuli are often annoying to CI users in everyday situations. PATIENTS AND METHOD: The possibility to give an s-shaped course to these map laws was examined in 9 patients. After the fitting procedure their speech understanding were tested. The results were compared with the results of former tests. RESULTS: 8 patients reported definite improvement of their hearing situation. Such map laws seem, therefore, suitable to optimise speech processor programming.
