OBJECTIVES: We aimed to describe objectively the voice features of sulcus vocalis, thereby setting up some useful guidelines for its treatment. MATERIALS AND METHODS: The voices of thirty-seven sulcus vocalis pateints were analyzed. RESULTS: In the acoustic analysis, the fundamental frequency, jitter, and shimmer were significantly increased. Noise to harmonic ratio was also increased although it was not statistically significant. In the aerodynamic study, we found that maximal phonation time was decreased, whereas the mean air flow rate and subglottic pressure were increased. The glottic insuffiency on phonation, small vibratory mucosal wave and amplitude were frequently observed by videostroboscopy. CONCLUSION: The bowing of vocal fold edge results in an incomplete glottic closure during vibratory cycles. The increase in stiffness of the vocal fold edge during phonation results in small mucosal wave and small vibratory amplitude. Glottic insufficiency and stiffness of vibratory movement contribute to dysphonia of sulcus vocalis.
Acoustics ; Dysphonia ; Noise ; Phonation ; Vocal Cords ; Voice*

BACKGROUND AND OBJECTIVES: Sulcus vocalis is not an uncommon cause of breathy dysphonia. One of the treatment options may be the slicing mucosa surgical technique which has been met with some criticism. This study was designed to investigate the efficiency of slicing mucosa surgical technique for the treatment of sulcus vocalis with voice and stroboscopic analysis. MATERIALS AND METHODS: In 18 sulcus vocalis patients (10 males, 8 females), the slicing mucosa surgical technique was performed followed by voice therapy for 4 weeks. Postoperative parameters of perceptual analysis, acoustic analysis, aerodynamic study, and videostroboscopy after 6 months were compared with those of preoperative results. RESULTS: In the perceptual analysis, the rough component of dysphonia was improved in 71.4% of patients, whereas the breathy component was improved in 25.0% of patients. Fundamental frequency, jitter, shimmer of acoustic analysis were significantly improved, but MPT, MFR of aerodynamic study showed no changes. There was anatomical evidences of sulcus in 4 of 18 patients postoperatively. Videostroboscopy mucosa waves during phonation showed improvement in 72.2% of patients, but glottic insufficiencies showed improvement only in 38.9%. CONCLUSION: The results of this study indicate that the slicing mucosa surgical technique is effective in improving the anatomical abnormality and stiffness of vocal cord mucosa, but unsatisfactory in improving glottic insufficiency of sulcus vocalis. It may be helpful to develop a new or an additional technique that can simultaneously promote improved rnucosa vibration and glottic closure.
Acoustics ; Dysphonia ; Humans ; Male ; Mucous Membrane* ; Phonation ; Vibration ; Vocal Cords ; Voice*

BACKGROUND AND OBJECTIVES: Amyotropic lateral sclerosis (ALS) is a progressive neuromuscular disease that involves degeneration of upper motor neurons in the cortex and lower motor neurons in the brain stem and spinal cord. Although there is a decline in the articulatory dysfunction, respiratory, and phonatory dysfunctions are known to occur in ALS. However, the pattern of disease progression and early identification of phonatory changes are not well documented. The purpose of this study was to compare selected acoustic parameters of voice in the normal control group to the ALS group who were perceptually free of vocal symptoms. Significant differences between the two groups could indicate that signs of bulbar degeneration in ALS may be present even when the voice is clinically perceived as normal. MATERIALS AND METHODS: The authors used a computerized acoustic analysis program (CSL-MDVP) to measure mean fundamental frequency (Fo), jitter, shimmer, and noise to harmonics ratio (NHR) from voice samples of ALS patients and compared this results with the acoustic parameters of 60 control subjects (men: 30, women: 30) who have no history of neurologic disease and were over 60 years old. RESULTS: There were significant group differences for jitter, shimmer, and NHR in male ALS. There was significant group difference for jitter in female ALS. CONCLUSION: Certain acoustic measures of voice may be sensitive indicators of early laryngeal deterioration in ALS. Acoustic analysis of voice may be one way of detecting aberrant vocal features before the human ear detects dysphonia, and jitter may be the most sensitive acoustic variable.
Acoustics* ; Amyotrophic Lateral Sclerosis* ; Brain Stem ; Disease Progression ; Dysphonia ; Ear ; Female ; Humans ; Male ; Middle Aged ; Motor Neuron Disease ; Motor Neurons ; Neuromuscular Diseases ; Noise ; Spinal Cord ; Voice*

BACKGROUND AND OBJECTIVES: The purpose of this study is to describe the objective features of vocal cysts and to assess the ability to differentiate vocal cysts from other vocal cord lesions on the basis of voice and stroboscopic analyses. We hope that present study will contribute toward improving the preoperative diagnosis rate. MATERIALS AND METHOD: The voice analysis was pre-and post-operatively in 12 vocal cyst patients, and the resulting data was compared with those of 12 vocal polyp patients, RESULTS: In pre-operative voice analyses, fundamental frequency, jitter, shimmer, noise to harmonic ratio were significantly decreased. In stroboscopic findings, mucosal waves were absent or diminished 100% in the vocal cyst patients. Acoustic parameters of vocal cyst patients, however, were not significantly different from those of vocal polyp patients. Post- operative voice analyses and all acoustic parameters were improved. Pre-operative diagnosis rate was 75.0% when voice and stroboscopic examinations were performed, but 42.9% when voice and stroboscopic examinations were not performed. CONCLUSION: Vocal cysts show absent ordecreased mucosal waves, but show similar acoustic values to other vocal cord lesions. This study finds that voice analysis and stroboscopic examinations are valuable tools in the diagnosis of vocal cord cysts.
Acoustics ; Diagnosis* ; Hope ; Humans ; Noise ; Polyps ; Vocal Cords ; Voice*

BACKGROUND: Reinkes edema is characterized by swelling of the vocal folds, and its etiology and pathogenesis have not yet been established. OBJECTS AND METHODS: We reviewed medical records of 25 patients (14 male and 11 female) who had undergone operation from 1996 to 1998. Post-operative voice lab and skin prick tests were done after 3 months when patients visited hospital. Telephone questionnaires were carried out about smoking and laryngopharyngeal reflux. RESULTS: In the smoking pattern, most patients (18/25) smoked more than 10 packs a year. Twelve patients (48%) complained of laryngopharyngeal reflux symptoms and 4 patients were positive for the skin prick test, Pre- and post-operative voice lab results showed that shimmer and phonation time changed significantly in women patients. Jitter, shimmer, phonation time, mean flow rate, vocal efficiency and subglottic pressure changed significantly in men patients. CONCLUSION: Smoking and laryngopharyngeal reflux may play an important role in developing Reinkes edema and phonatory quality will be improved after proper surgical procedure.
Edema* ; Female ; Humans ; Laryngeal Edema ; Laryngopharyngeal Reflux ; Male ; Medical Records ; Phonation ; Surveys and Questionnaires ; Skin ; Smoke ; Smoking ; Telephone ; Vocal Cords ; Voice*

BACKGROUND AND OBJECTIVES: Injury of recurrent laryngeal nerve is one of the major complications of thyroidectomy. One of the treatment options, which has met with some criticism, may be the repair of the injured nerve. This study was designed to investigate the efficiency of the neurorrhaphy of the injured recurrent laryngeal nerve with voice and videostroboscopic analysis. MATERIALS AND METHODS: For the injured recurrent laryngeal nerve, ansa hypoglossi-recurrent laryngeal nerve anastomosis has been performed in 6 patients, and direct end to end anastomosis has been performed in 4 patients. Postoperative parameters of perceptual analysis, acoustic analysis, aerodynamic study, and videostroboscopy after 6 months were compared with those of 11 patients whose recurrent laryngeal nerves were resected and left without neurorrhaphy. RESULTS: Perceptual breathy vocal quality and the aerodynamic parameters were better in anastomosed group, but there were no differences in the acoustic parameters. Medialization of vocal cord and the glottic closure was better in anastomosed group. No patient of the anastomosed group experienced dyspnea due to synkinesis. CONCLUSION: The results of this study indicates that the neurorrhaphy of injured recurrent laryngeal nerve is effective in improving the glottic closure, but unsatisfactory in achieving symmetric glottic tension and mucosa wave during phonation.
Acoustics ; Dyspnea ; Humans ; Laryngeal Nerves ; Mucous Membrane ; Phonation ; Recurrent Laryngeal Nerve* ; Synkinesis ; Thyroidectomy* ; Vocal Cords ; Voice*

OBJECTIVES: The purpose of this study is to evaluate the incidence of complications accompanying tracheostomy, and in addition, to suggest ways to prevent serious complications. MATERIALS AND METHODS: We performed tracheostomy in 168 patients and their data were analyzed retrospectively. RESULTS: Twenty one patients (12.5%) had complications directly related to tracheostomy. The most common complication was postoperative bleeding which accounted for 11 cases (6.7%). Others complications included pneumothorax which claimed 3 cases (1.8%) with reduced morbidity, cannula dislodgment claimed 3 cases (1.8%), cannula obstruction 2, wound infection 2 and tracheal stenosis 2. Among them, two patients died of tracheostomy complications. Decannulation was tried in 44 patients, but it fell short since only 11 patients were decannulated without difficulty. The rest of patients could not be decannulated because of various reasons including death, underlying disease, subglottic stenosis, tracheal stenosis or vocal cord palsy. CONCLUSION: In order to avoid complications of tracheostomy, it is important to treat preoperatively the tendency to bleeding, and meticulously control it during the operation as well. Also, the use of longer cannulas and tracheal fenestration technique is helpful for patients with short and stocky neck. Positive pressure applied through the cannula can make serious complications such as pneumothorax when cannula-obstruction or cannuladislodgment is suspected and the high volume-low pressure cuff is useful to prevent the decannulation difficulties by longterm cannulation, especially in patients using ventilator.
Catheterization ; Catheters ; Constriction, Pathologic ; Hemorrhage ; Humans ; Incidence ; Neck ; Pneumothorax ; Retrospective Studies ; Tracheal Stenosis ; Tracheostomy* ; Ventilators, Mechanical ; Vocal Cord Paralysis ; Wound Infection

OBJECTIVE: To evaluate aging and smoking effects on acoustic characteristics of voice. MATERIALS AND METHODS: Sixty men and sixty women representing two chronological age Groups(young and elderly, i.e. 20-35 and over 60). A computerized acoustic analysis program(CSL-MDVP) was used to measure mean fundamental frequency(Fo), jitter, shimmer, and noise to harmonics ratio(NHR) from voice samples of sustained phonation of vowel /a/. RESULTS: The elderly females showed lower Fo than young females, but produced similar jitter, shimmer and NHR. In male groups, the elderly had about 10Hz higher voice than young males and produced more jitter and shimmer. And multiple regression analysis showed both aging and smoking had significant correlation with increase of jitter and shimmer. The values of NHR showed no significant difference between any groups. Intersubject difference was larger in elderly groups, and was most apparent in the elderly-smoking group. CONCLUSION: While chronological aging is undoubtedly a contributor to such changes in the characteristics of voice, these results suggest that the onset of vocal aging could be different between the subjects of same age and the effect of smoking must be considered in the acoustic analysis of voice.
Acoustics* ; Aged ; Aging* ; Female ; Humans ; Male ; Noise ; Phonation ; Smoke* ; Smoking* ; Voice*

BACKGROUND AND OBJECTIVES: The majority of laryngeal tumors are known to be SCC (squamous cell carcinoma). Non-SCC (non-squamous cell cancers) of the larynx represent a diverse spectrum of diseases with different prognosis and ratio-nales of management from SCC. Therapeutic options to these tumors depend on their histopathological characteristics and clinical behaviors. The purpose of this study was to assess the unique aspects of the non-SCC and to draw diagnosis and provide management options and prognostic variables. MATERIALS AND METHOD: Eleven non-SCC of the larynx from the 212 patients who were diagnosed with larynx cancer during their 3-year visits from 1997 to 2000 were reviewed retrospectively. RESULTS: The incidence of non-SCC was 5.2%. Pathology of non-SCC revealed 3 cases of malignant lymphoma, 2 cases of verrucous cell carcinoma and neuroendocrine carcinoma one case each of basaloid squamous cell carninoma, salivary duct carcinoma, adenocarcinoma, and spindle cell carcinoma. The most common site of origin was supraglottis (6 case, 56.5%), followed by glottis (4 cases, 36.4%) and subglottis (2 cases, 17.2%). Non-Hodgkin's lymphomas and basaloid squamous cell carninoma were treated by chemotherapy. The remaining cases were treated with surgery followed by postoperative radio-therapy or postoperative chemotherapy. The mean follow-up period was 26.8 months (12-43 months). CONCLUSION: Non-SCC accounts for approximately 5.2% of all malignancies of the larynx. Tissue biopsy is the most important diagnostic tool for the non-SCC of the larynx and the tissue sample must be obtained from the deep portion of the submucosal layer. Except for malignant lymphomas, the combined therapy that includes surgery would be the best method of treatment for non-SCC.
Adenocarcinoma ; Biopsy ; Carcinoma, Neuroendocrine ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Glottis ; Humans ; Incidence ; Laryngeal Neoplasms ; Larynx* ; Lymphoma ; Lymphoma, Non-Hodgkin ; Pathology ; Prognosis ; Retrospective Studies ; Salivary Ducts

BACKGROUND: As methods of improving the airway insufficiency of patients with bilateral vocal cord paralysis, a variety of procedures have been developed such as tracheostomy and endoscopic arytenoidectomy. OBJECTIVES: Our objective was to assess the effectiveness of laser arytenoidectomy in a view to decannulation, aspiration, pulmonary function, and voice analysis in a retrospective study. MATERIALS AND METHODS: Five patients with bilateral vocal cord paralysis had been performed laser arytenoidectomy. Postoperatively, presence of aspiration, decannulation timing and complications were evaluated. The pulmonary function tests were performed preoperatively and postoperatively, while voice analysis was performed only postoperatively. RESULTS: Aspiration was not noticed in all patients after arytenoidectomy, and four patients were decannulated within three months after surgery. Endotracheal tube was ignited in one patient. The results of pulmonary function tests and voice analysis were satisfactory. CONCLUSION: We concluded that laser arytenoidectomy was reliable in the management of the bilateral vocal cord palsy.
Humans ; Respiratory Function Tests ; Retrospective Studies ; Tracheostomy ; Vocal Cord Paralysis ; Voice