Psychogenic voice disorders.

INTRODUCTION: Voice express the psyche and personality of a person. Psychogenic dysphonia is called Phononeurosis. Neurosis, depression or family, occupational and social conflicts are the cause of voice disturbances. The most frequent type of dysphonia is hyperfunctional dysphonia, rarer - hypofunctional type. AIM: The aim of this study is an analysis of voice quality and diagnosis of clinical type of psychogenic dysphonia. MATERIAL AND METHODS: The analyzed group consisted of 50 patients with voice disorders treated in 2017 and the control group - 30 people with physiological voice. In the diagnosed group 60% of patients were treated for neurosis, 12% due to depression, the others reported conflict situations. In the diagnosis of clinical type of psychogenic dysphonia GRBAS scale was used, maximum phonation time (MPT) and type of breathing were assessed. The visualisation of the larynx was performed using High Speed Digital Imaging (HSDI) technique. The parametric acoustic evaluation of voice was conducted. RESULTS: The most often clinical type of psychogenic dysphonia was hyperfunctional dysphonia, rarer hypofunctional type and vestibular voice. Dysphonia occurred the most often in women during the highest professional activity period. In the diagnosis of clinical type HSDI technique was especially useful allowing to visualization of the real vocal fold vibration and objective differentiation of hyper- and hypofunctional dysphonia. The acoustic analysis of the voice objectively confirmed the presence non-harmonic components - noise generated in the glottis in hypofunctional dysphonia. Disturbances in the way and breathing type caused irregularities in respiratory-phonic and articulation coordination.

Usefulness of high-speed digital imaging (HSDI) in the diagnosis of oedematous - hypertrophic changes of the larynx in people using voice occupationally.

INTRODUCTION: The aim of the study is the evaluation of the usefulness of High-Speed Digital Imaging (HSDI) in the diagnosis of organic dysphonia in a form of oedematous-hypertrophic changes of vocal fold mucosa, morphologically confirmed by Transmission Electron Microscopy (TEM) method in patients working with voice occupationally. MATERIAL AND METHODS: The group consisted of 30 patients working with voice occupationally with oedematous-hypertrophic changes of vocal fold mucosa. Parameters of vocal folds vibrations were evaluated using HSDI technique with a digital HS camera, HRES Endocam Richard Wolf GmbH. The image of vocal folds was recorded with a rate of 4000 frames per second. Postoperative material of the larynx was prepared in a routine way and observed in transmission electron microscope OPTON 900-PC. RESULTS: HSDI technique allows to assess the real vibrations of vocal folds and determine many parameters. The results of TEM in the postoperative material showed destruction of epithelial cells with severe vacuolar degeneration, the enlargement of intercellular spaces and a large number of blood vessels in the stroma, which indicates the presence of oedematous-hypertrophic changes of the larynx. DISCUSSION: The ultrastructural assessment confirm the particular usefulness of HSDI method in the diagnosis of organic dysphonia in a form of oedematous-hypertrophic changes. Key words: High-Speed Digital Imaging, oedematous-hypertrophic changes, vocal fold mucosa, larynx.

Clinical usefulness of videocapillaroscopy and selected endothelial cell activation markers in people with Type 1 diabetes mellitus complicated by microangiopathy.

PURPOSE: Microvascular abnormalities are one of the most important causes of persistent diabetic complications. The aim of our study was to compare microvascular changes examined by nailfold videocapillaroscopy (NVC) examination with serum concentrations of vascular endothelial growth factor (VEGF), soluble thrombomodulin (sTM) and endothelin-1 (ET-1) in people with Type 1 diabetes with and without microangiopathy. MATERIAL/METHODS: The study included 106 people with Type 1 diabetes and 40 healthy controls. All participants were evaluated by extensive clinical, laboratory and capillaroscopic studies. NVC was performed using a stereomicroscope SZ 4045 (Olympus, Germany). The intensity of morphological changes was graded from 0 to 3. Serum levels of VEGF, sTM and ET-1 were determined by an enzyme-linked immunosorbent assay (ELISA). RESULTS: Morphological changes were observed by NVC in 86 out of 106 (81%) people with Type 1 diabetes mellitus. Severe capillaroscopic changes (score 3) were seen in 32 out of 54 (59%) people with microangiopathy, but in only seven out of 52 (13%) individuals without microangiopathy. Higher serum concentration of VEGF (p<0.001), ET-1 (p<0.001) and sTM (p<0.05) were demonstrated in people with diabetes complicated with microangiopathy compared to healthy controls. Moreover, comparison between people with and without microangiopathic complications showed a significantly higher capillaroscopic score and sTM serum concentration in the group with retinopathy (p<0.001) nephropathy (p<0.001) and neuropathy (p<0.01). CONCLUSIONS: Our results suggest that abnormalities in NVC may reflect the extent of microvascular involvement and associated with higher VEGF, sTM and ET-1 serum levels, as well as with microangiopathic complications in diabetic people.

[Effects of electrostimulation therapy in selected cases of vocal fold paralysis]. / Efekty terapii elektrostymulacyjnej w wybranych przypadkach porazen faldów glosowych.

Paralytic dysphonia is the most serious neurogenic pathology of voice quality. An important issue is to identify methods which support routine treatment. AIM: The aim of the study is to assess voice quality after electrostimulation (ES) therapy in patients with paralytic dysphonia. MATERIALS AND METHODS: The group consisted of 40 patients diagnosed at the Department of Clinical Phonoaudiology and Logopedics and then treated at the Phoniatric Outpatient Clinic of the Medical University of Bialystok, Poland in years 2013-2015. In the assessment of voice quality GRBAS scale was used, it was determined voice attack, maximum phonation time (MPT), voice self-evaluation of patients were analyzed using a questionnaire Voice Handicap Index (VHI). Visualization of the vocal fold vibration was performed using High Speed Digital Imaging (HSDI) technique. The acoustic examination of voice was made during phonation of vowel "a" and continuous linguistic text. Electrostimulation (ES) therapy was performed after determining the ratio á, which conditioned the choice of set of voice exercises (VE) and duration of one-time electrical impulse stimulation. Subjective and objective evaluation was performed before and after ES therapy. The results were compared with a group of patients that received the routine therapy without ES. RESULTS: Subjective, objective and self-evaluation analysis of voice showed a improvement of its quality after ES. Increasing the mobility of vocal folds after ES resulted in an improvement of voice quality parameters in the acoustic assessment. Effectiveness of the ES therapy on the function of the vocal fold vibration was confirmed by HSDI technique. CONCLUSIONS: Studies have shown that ES therapy is a valuable addition to the routine method of treatment of paralytic dysphonia.

[High-speed digital imaging in the diagnosis of voice pathologies]. / Technika szybkiego filmu w sekwencji cyfrowej w diagnostyce patologii narzadu glosu.

Technique of high-speed digital imaging (HSDI) is unique technique, allowing for assessment of real vocal fold vibrations. AIM: The aim of the study is to present the usefulness of HSDI in the diagnosis of clinical type of dysphonia. MATERIALS AND METHODS: The study group was diagnosed at the Department of Clinical Phonoaudiology and Logopedics at the Medical University of Bialystok and treated at the Phoniatric Clinic in years 2012-2015. HSDI technique with a digital camera was used for visualization of the larynx. The rigid endoscope with 90° optics was used for visualizing the vocal folds vibrations during phonation of "e" vowel, at the rate of 4000 frames per second. Playback of recorded sequence set at 15 frames per second, what allowed to assess vocal folds vibrations in slow motion mode during over 8 minutes. Mucosal wave (MW), glottal closure, symmetry, regularity and synchrony of vocal fold vibration were analyzed. Digital kymography (DKG) of the larynx was made for analyzing the value of the Open Quotient (OQ) in the assessment of degree of glottal insufficiency. RESULTS: In the analyzed group of patients, the functional dysphonia was diagnosed in 71%, organic dysphonia in 29% patients. In 68%, glottal insufficiency was registered in the rear part at the glottis. The oedematous-hypertrophic changes were diagnosed in 21% of the cases, hypertrophic changes of larynx - in 6%, vocal fold polyps - in 3% and vocal fold nodules - in 2% of patients. CONCLUSIONS: Examination of the larynx by using HSDI technique is quick, non-invasive to patient. HSDI allows to objective assessment of the degree of severity of insufficiency of glottal closure, what is confirmed by the objective values of the OQ. Evaluation of MW allows for the differentiation of clinical type and severity of organic dysphonia.

[Rehabilitation of phonosurgically treated patients with edematous-hypertrophic changes of larynx]. / Rehabilitacja pacjentów leczonych fonochirurgicznie z powodu zmian obrzekowo-przerostowych krtani.

UNLABELLED: Advanced change of organic dysphonia are an indication for phonosurgery. Edematous-hypertrophic changes are cause of serious disturbances of voice. High-speed digital imaging (HSDI) technique is the unique method, allowing for assessment the effects of therapy and rehabilitation. AIM: The aim of the study is evaluation the usefulness of vibratory method in voice rehabilitation of patients with edematous-hypertrophic changes treated phonosurgically. MATERIALS AND METHODS: The group I contained 40 patients with edematous-hypertrophical changes phonosurgically treated. Type of clinical dysphonia was diagnosed with HSDI technique. Glottal closure was evaluated according to Committee on Phoniatrics of the European Laryngological Society (ELS) classification, postoperative material was pathomorphologically verified by Transmission Electron Microscopy (TEM). Patients with hyperfunction of larynx were rehabilitated for 21 days using massage device and after that visualization of larynx by HSDI technique was made again. Control group contains people with physiological voice. RESULTS: Severe dysphonia with oedematous-hypertrophic changes was found by HSDI technique in group I. Postoperative material was evaluated histopathological by TEM and confirmed the existing clinical morphological changes of larynx. Hyperfunction of phonation organ were diagnosed in 30 patients (75%). After 21 days of rehabilitation using massage device, hyperfunction was reduced as confirmed by HSDI. Normalization of amplitude, regularity, synchrony of vibration and physiological glottal closure were found at 67% cases. CONCLUSIONS: HSDI technique in digital sequence is useful in the diagnosis of edematous-hypertrophic changes of the larynx and monitoring the effects of the rehabilitation. Pathomorphological evaluation of postoperative material made by TEM confirmed the rightness of clinical diagnosis of the edematous-hypertrophic changes by HSDI. The consequence of phonosurgical procedures in edematous-hypertrophic changes of larynx is hyperfunction of larynx, confirmed objectively by HSDI technique. The use of massage device causes relaxation of laryngeal structures, normalizing parameters of visualizing evaluation.

Parameters of the assessment of voice quality and clinical manifestation of rheumatoid arthritis.

PURPOSE: The aim of the study was to investigate the voice quality parameters in 72 rheumatoid arthritis (RA) patients and their relationships with the clinical manifestations and disease activity. The control group consisted of 30 healthy subjects. MATERIAL AND METHODS: All RA patients were evaluated by extensive clinical, laboratory and radiographic studies. The phoniatric assessment included the analysis of vocal folds vibrations by digital stroboscopy (DS) of the larynx using HRES ENDOCAM 5562 system, digital kymography (DKG) and High-Speed Digital Imaging (HSDI) technique. The acoustic voice analysis was conducted using DiagnoScope Specialist program. RESULTS: Voice quality disorders were registered in 32 (44.44%) RA patients and observed more frequently in patients with moderate and severe activity (DAS28≥3.2) than in mild RA. In digital stroboscopy, confirmed by digital kymography, the hypofunctional dysphonia was observed especially in patients with DAS28≥3.2. Outcomes of the subjective assessment of voice quality were in accordance with the objective parameters and acoustic voice examination. CONCLUSIONS: In RA patients the most frequent voice quality disorders with hypofunctional dysphonia were registered. The relationships between voice quality disorders, clinical activity and radiographic progression of RA patients were observed. Digital stroboscopy, digital kymography, High-Speed Digital Imaging and acoustic voice analysis used in the complex diagnosis of RA confirmed the presence of pathological changes in the larynx. There is a need of cooperation between rheumatologists and phoniatricians in the diagnosis and treatment of dysphonia in RA patients.

The influence of Multiwave Locked System (MLS) laser therapy on clinical features, microcirculatory abnormalities and selected modulators of angiogenesis in patients with Raynaud's phenomenon.

The aim of this study was to investigate the influence of the Multiwave Locked System (MLS) laser therapy on clinical features, microvascular changes in nailfold videocapillaroscopy (NVC) and circulating modulators releasing as a consequence of vascular endothelium injury such as vascular endothelial growth factor (VEGF) and angiopoietin 2 (Ang-2) in patients with primary and secondary Raynaud's phenomenon. Seventy-eight RP patients and 30 healthy volunteers were recruited into the study. All patients with RP received MLS laser irradiation for 3 weeks. Clinical, NVC and laboratory investigations were performed before and after the MLS laser therapy. The serum concentration of VEGF and Ang-2 were determined by an enzyme-linked immunosorbent assay (ELISA). After 3 weeks of MLS laser therapy, the clinical improvement manifested by decreasing of the number of RP attacks, mean duration of Raynaud's attack and pain intensity in RP patients was observed. After MLS laser therapy in 65% of patients with primary and in 35% with secondary RP, an increase in the loop number and/or a reduction in avascular areas in NVC were observed. In comparison with a control group, higher serum concentration of VEGF and Ang-2 in RP patients was demonstrated. After MLS laser therapy, a reduction of Ang-2 in both groups of RP patients was found. Our results suggest that NVC may reflect microvascular changes associated with clinical improvement after MLS laser therapy in patients with primary and secondary RP. Ang-2 serum levels may be a useful marker of microvascular abnormalities in RP patients treated with MLS laser therapy.

Visual assessment of voice disorders in patients with occupational dysphonia.

INTRODUCTION: In a group of persons using the voice occupationally, the frequent symptoms are hoarseness, voice fatigability and aphonia. Pathological changes in the larynx may have organic or functional character which require different methods of treatment and rehabilitation. Visualization of vibrations of the vocal folds is an essential condition for an appropriate assessment of the causes of dysphonia. OBJECTIVE: The purpose of the study is assessment of the usefulness of a high-speed imaging (HSI) system in the diagnosis of functional and organic dysphonia of occupational character, compared with digital kymography (DKG) and digital stroboscopy (DS) with a high resolution module. MATERIAL AND METHODS: The study group consisted of 64 patients with voice quality disorders with features of occupational dysphonia. The control group consisted of 15 patients with euphonic voice. Analysis of the voice quality parameters during phonation of the 'e' vowel was performed using HSI, DKG and stroboscopy of high resolution, by means of a digital HS camera (HRES Endocam, Richard Wolf GmbH, Knittlingen, Germany). Vocal folds vibrations were registered at the rate of 4,000 frames per second. RESULTS: HSI is the most reliable diagnostic tool giving the possibility of an analysis of the true vibrations of the vocal folds. It also enables an observation of the aperiodicity of vibrations of the vocal folds, while DS with high resolution allows diagnosis of the periodicity of the vibrations. CONCLUSIONS: HSI is particularly useful in the diagnosis of neurologically-based pathology of the voice (paralytic dysphonia) and organic dysphonia. The quickest method of diagnosing the phonatory paresis of the glottis is DKG. The advantage of both HSI and DKG is the non-invasiveness of examinations; however, their limitations are time-consuming and the high cost of equipment.

[The usage of modern physioterapeutic methods of rehabilitation in treatment of chosen kinds of dysphonia]. / Zastosowanie nowoczesnych fizjoterapeutycznych metod rehabilitacji w leczeniu wybranych postaci dysfonii.

UNLABELLED: Voice quality disorders--dysphonias are the significant problem from therapeutic, social and economic point of view. The routine therapy does not always bring spectacular effects. The important role play the innovative methods supporting therapy of voice quality disorders. PURPOSE: The aim of the study is to assess the effects of vibratory therapy of the larynx (Medical VR) in patients with hyperfunctional dysphonia and stimulating currents in phonatory exercises (VocaStim-Master) in paralytic dysphonia based on the analysis of parameters of objective assessment of voice quality. MATERIAL AND METHODS: Forty patients with hyperfunctional dysphonia treated routinely were included in the study. 20 patients apart from the routine therapy were additionally treated using the vibratory therapy of regions of the larynx (Medical VR, CyberBioMed LLC). In group of 40 patients with paralytic dysphonia, in 20 patients the adjuvant therapy by stimulating currents in phonatory exercises (VocaStim-Master, Physiomed) was used. The results of treatment and adjuvant therapy in hyperfunctional and paralytic dysphonia were analyzed based on: MPT, parameters of stroboscopic and acoustic evaluation (F(0), Jitter, Shimmer, NHR) and narrow-band spectrography. RESULTS AND CONCLUSIONS: : The analysis of the results indicated the usefulness of used parameters of objective assessment of voice quality taking into consideration the diagnostic and therapeutic aspect in hyperfunctional and paralytic dysphonia. Adjuvant vibratory therapy of the larynx in hyperfunctional dysphonia and stimulating currents in phonatory exercises in paralytic dysphonia improved the effectiveness of the therapy, what was confirmed by the analysis of parameters of objective assessment of voice quality.

[The impact of cochlear implant (CI) on the process of phonation and quality of life of patients with pre- and postlingual deafness]. / Wplyw implantu slimakowego (CI) na proces fonacji i komfort zycia pacjentów z gluchota pre- i postlingwalna.

UNLABELLED: Cochlear Implant (CI) is the most advanced method of treatment in receptive type of deafness and profound hearing loss. Good functioning auditory organ plays a significant role not only in auditory perception but also in the process of phonation, giving the possibility of good realization of the process of verbal communication. The aim of the study is to assess the quality of voice and life in adults with pre- and postlingual deafness treated using cochlear implant. MATERIAL AND METHODS: Twenty six patients with pre- (group I) and postlingual (group II) deafness deriving no benefit from hearing aids were included into the study. Voice quality was assessed using subjective and objective methods. The endoscopic (VLS) and stroboscopic (VLSS) examination of the larynx and the acoustic voice analysis were carried out. The quality of life was assessed using the Nijmegen Cochlear Implant Questionnaire (NCIQ). Examinations were conducted before implantation and 6 months after activation of speech processor. RESULTS: In the subjective and objective assessment of voice quality the improvement was registered in both groups. The effects were less spectacular in prelingual patients. In this group of patients the subjective assessment of voice quality and stroboscopic examination confirmed the hypofunctional type of dysphonia. In postlingual patients the hyperfunctional type of dysphonia was registered what was confirmed by the analysis of acoustic parameters of voice. The improvement of quality of life was observed in both groups of patients after implantation. CONCLUSIONS: The voice quality was improved after implantation in both analyzed groups. In patients with postlingual deafness values of parameters of voice quality assessment were closed to physiological. Results of the subjective assessment of voice quality were confirmed by objective examinations and the acoustic voice analysis. Rehabilitation with cochlear implant gave the opportunity for active participation in private and social life, improving the quality of life in patients with pre- and postlingual deafness.

[The impact of vibratory stimulation therapy on voice quality in hyperfunctional occupational dysphonia]. / Wplyw wibracyjnej terapii stymulujacej na jakosc glosu w postaci hiperfunkcjonalnej dysfonii zawodowej.

UNLABELLED: Hyperfunctional dysphonia is the most frequent type of occupational functional dysphonia. Pharmacotherapy, physiotherapy and psychotherapy are used in the treatment of occupational dysphonia. Vibratory massages of the regions of the larynx relax the external muscles of neck, which have an indirect impact on the tension of the vocal folds. PURPOSE: The aim of the study is to assess the impact of vibratory stimulation therapy on voice quality in patients with hyperfunctional occupational dysphonia treated pharmacologically. MATERIAL AND METHODS: Forty patients with hyperfunctional occupational dysphonia treated phoniatrically in the Phoniatric Outpatient Clinic were included in the study. Patients were divided into two groups. Group I consisted of 20 patients treated pharmacologically. In group II, including 20 patients, apart from pharmacotherapy the vibratory stimulation therapy by the device of VR type (CyberBioMed LLC) was used. In the analysis of voice quality the evaluation of the vocal folds vibration using videolaryngostroboscopy and acoustic assessment of voice were conducted. RESULTS AND CONCLUSIONS: The perceptual assessment of voice, the visualization of the vocal folds vibration in stroboscopic examination of the larynx and the acoustic assessment of voice enable the appropriate diagnostics of the clinical type and voice quality in hyperfunctional dysphonia. The tension of superficial and deep muscles of neck has the impact on the phonatory function of the larynx. Pharmacological treatment improves the voice quality in hyperfunctional occupational dysphonia. Pharmacological treatment combines with the relaxation of muscles of neck using the device of VR type significantly improve voice quality in hyperfunctional occupational dysphonia.

Morphological aspects of the euphonic voice.

The high quality of a euphonic voice is the result of complex interactions between many organs and systems. Vibrating vocal folds play a crucial role in this process. Their physiological motion is conditioned by the presence of the layered structure of laryngeal mucosa. In this study, we assessed the degree of dysphonia according to the Union of European Phoniatrics (UEP) scale. Videoendoscopy (VLS) and videostroboscopic (VLSS) examination of the larynx was used to visualize the vibration of the vocal folds. Morphological assessment of the inter-membranous part of the vocal fold mucosa was carried out using material collected after surgical treatment (60%) or obtained from autopsy (40%). The samples were examined by light microscopy and transmission electron microscopy. In euphonic voices, 1° of dysphonia (UEP) and the physiological endoscopic (VLS) and stroboscopic (VLSS) findings of vocal folds were registered. No morphological or ultramorphological changes were observed in the cells of the multilayered flat epithelium, basal membrane or in the stroma. Unchanged epithelial cells were situated on the basal membrane with folds. Moreover, numerous pericytes, vessels with multiplication of basal membranes, scanty collagenous fibers, plasmatic cells and lymphocytes were seen. Morphological changes with signs of atrophy and polypoid degeneration of the vocal fold mucosa were found in only 3 (15%) patients.

Videostroboscopic and morphological aspects of voice disturbances in patients with larynx atrophy and coexisting hypopharynx cancer.

Vocal folds play a crucial role in voice production. The physiological vibrations of vocal folds depend on the unchanged multilayered structure of the vocal folds mucosa. Morphological changes of mucosa are the cause of voice quality disorders - dysphonia. The aim of this study was to determine the morphological base of dysphonia in patients with vocal folds atrophy. A group of 24 patients with larynx atrophy confirmed by endoscopic (VLS) and stroboscopic (VLSS) examination of the larynx was included in the study. The morphological assessment of the larynx mucosa was carried out with the use of the transmission electron microscopy (TEM). Ultramorphological examinations revealed changes in the epithelium, basal membrane and lamina propria of the vocal folds mucosa. An increased number of collagenous fibers, fibroblasts with signs of vacuolar degeneration inflammatory cells and a decreased number of blood vessels and pericytes were observed. Morphological changes found in the epithelium, basal membrane and lamina propria of the vocal folds mucosa were the cause of disorders of vocal folds vibrations registered in the stroboscopic examination of the larynx (VLSS).

[Morphological conditions of dysphonia in patients with vocal folds edema]. / Morfologiczne uwarunkowania dysfonii u chorych z obrzekiem faldów glosowych.

UNLABELLED: Disorders of voice quality are mostly influenced by organic changes in larynx. In the assessment of ultrastructure of vocal fold mucosa the most useful is the technique of transmission electron microscopy (TEM). The organic dysphonia is diagnosed by the perceptual, endoscopic (VLS) and stroboscopic (VLSS) assessment of larynx and acoustic assessment. The aim of the study was to determine morphological changes and voice quality disorders in patients with edema of larynx. MATERIAL AND METHODS: 40 patients with vocal folds edema (I group) and 10 patients with no pathological changes of larynx (II group) were included in the study. The morphological assessment of vocal folds mucosa was carried out with the usage of transmission electron microscopy (TEM). The voice quality was examined by the subjective and objective methods. The endoscopic and stroboscopic (VLS and VLSS) examination of larynx and acoustic analysis of voice were carried out. RESULTS: Morphological changes of vocal folds mucosa were observed. Epithelial cells showed features of vacuolar degeneration. Moreover enlargement of intercellular spaces, small rugosity of basal membrane and inflammatory infiltration of stroma, a large number of blood vessels and a cumulation of elastic and collagenous fibers were observed. CONCLUSIONS: Stillness of vocal folds influenced disorders of voice quality with features of dysphonia. The endoscopic and stroboscopic examination of larynx clinically shows the morphological changes of vocal folds mucosa. Simple and non-invasive acoustic examination of voice in patients with edema of larynx objectively confirms the subjectively registered dysphonia.

[Assessment of speech and linguistic disorders in patients with cochlear implant--preliminary results]. / Ocena mowy i zaburzen jezykowych u chorych z implantem slimakowym--doniesienie wstepne.

UNLABELLED: Cochlear Implant (CI) is the most advanced technical solution in the treatment of profound hearing loss and deafness in patients of all age groups. The aim of the study was to analyse the speech and linguistic disorders in adults with pre- and postlingual deafness rehabilitated with Cochlear implant (CI). MATERIAL AND METHODS: 21 adults with pre- (I group) and postlingual (II group) deafness deriving no benefit from hearing aids participated in this study. Phonatory organ was examined by endoscopy (VLS) and stroboscopy (VLSS). Test of Auditory Perception (TSS) was conducted directly after the activation of speech processor and after rehabilitation. The logopedic assessment before and after CI was based on the examination of motoric activity of articulatory organs, type of respiration, loudness of speech and the assessment of articulation. The linguistic assessment of grammatical and lexical aspect was carried out. The prosodic elements of speech were also analysed. RESULTS: Stroboscopic examination pointed to hypofunction of larynx in patients with prelingual deafness and hyperfunction--in postlingual deafness. The values of TSS were improved after CI, especially in patients with postlingual deafness. The most severe disorders of the efficiency of articulatory organs were observed in patients with prelingual deafness before CI. In the group of prelingually deaf patients disorders of the articulation of vowels and consonants as well as the lexical and grammatical aspect of speech were improved after CI. The correctness of syntax and inflection, development of active vocabulary, improvement of prosodic elements of speech were noticed in patients with postlingual deafness after CI. CONCLUSIONS. Patients with postlingual deafness achieved better results of rehabilitation in auditory perception than prelingually deaf patients. The linguistic improvement of grammatical and lexical aspect was noticed especially in prelingually deaf patients after implantation. This group of patients achieved also the significant progress in prosodic elements of speech in comparison with the results before implantation.

[Analysis of comparison between different kinds of alaryngeal speech in laryngectomized patients with euphonic speech]. / Porównanie rodzajów mowy alaryngealnej chorych po usunieciu krtani z mowa eufoniczna.

UNLABELLED: The aim of the rehabilitation in laryngectomized patients is to produce phonatory communication. It is important to choose the optimal method of rehabilitation. Most of the patients use the oesophageal or pharyngeal speech as an effect of natural rehabilitation with vocalistic method. Another group of larygectomized patients is rehabilitated with surgical method which leads to shunt speech. THE AIM OF STUDY was to compare the quality of oesophageal and shunt speech with euphonic voice to choose the optimal method of rehabilitation in laryngectomized patients. MATERIAL AND METHODS: The quality of vicarious phonation was examined in 30 patients with shunt speech and in 20 patients with oesophageal speech. Examination results of the subjective, objective and acoustic assessment were compared with values registered in physiological (euphonic) speech. The results of objective assessment were statistically analysed. RESULTS: The shunt and oesophageal speech enabled effective verbal communication of laryngectomized patients. The parameters of clinical subjective and objective assessment of shunt speech pointed to its high quality which is similar to physiological phonation. CONCLUSIONS: The acoustic analysis of voice confirmed the results of subjective and objective assessment of quality of shunt voice and speech in laryngectomized patients. In conclusion, the surgical rehabilitation of voice after total laryngectomy gave patients the great opportunity for a remarkable improvement in vicarious phonation.