BACKGROUND AND OBJECTIVES: Various phonation patterns yield various voice characteristics. Voice therapy using nasal stimulatory sounds seems to facilitate phonation in voice disodered patients. Under the hypothesis that nasalance may be influenced by the pattern of phonation, we studied the relationship between nasalance and voice disorders by observing abnormal supraglottic movements and vocol cord gaps in phonation. SUBJECTS AND METHOD: There were 143 patients who complained of voice problems and showed abnormal false vocal cord movements under stroboscopy. In addition to the four previously described types of MTD (muscle tension dysphonia), we described two more types of MTD (V: false vocal cord contracted posteriorly, VI: false vocal cord dilated laterally). We measured the vocal cord gaps in phonation and analyzed nasalance. RESULTS: Among those groups showing the pattern of false vocal cord (MTD 1, 2, 4), the vocal cord gaps in phonation were increased and nasalance was significantly decreased in MTD types, III and IV, and showed a tendency to decrease in MTD types, II and V, compared to the normal group. CONCLUSION: The supraglottis has a tendency to contract as the vocal cord gap in phonation increases, and this movement reduces nasalance.
Dysphonia ; Humans ; Phonation* ; Stroboscopy ; Vocal Cords ; Voice ; Voice Disorders

BACKGROUND AND OBJECTIVES: Professional singers have a particular "ringing" sound quality during singing, so called singer's formant. Two types of professional singers in Korea that sound very different are classical (pansori) and western style performers. The purpose of this research was to systematically analyze and compare the acoustic sound structure of both the speaking and singing voices of Korean classical singers (pansori). We also investigated the morphologic and vibratory characteristics of vocal folds using videostroboscopy. MATERIALS AND METHODS: 24 classical singers and 29 western style singers were subjects. The formant frequencies, intensities and singing power ratio was evaluated for clarifying the existence of singing formant. Using laryngeal stroboscopy, the vibratory characteristics were evaluated. RESULTS: The all formant intensities were incraesed in the classical singers, but typical increase of third and fourth formant in the western style singers. The singing power ratio was smaller in the western style singers. Most of classical singers showed abnormal vibratory patterns. CONCLUSION: The western style singers have typical singing formant during singing, but not in the classical singers. Most of classical singers showed abnormal vibratory patterns of vocal folds during phonation, but usually normal vibration in the western style singers.
Acoustics ; Korea ; Music* ; Phonation ; Singing* ; Stroboscopy ; Vibration* ; Vocal Cords* ; Voice

BACKGROUND AND OBJECTIVES: Surgery is considered the primary treatment for intracordal cyst. However, patients who had undergone surgery are still subject to recurrence and continued voice changes. Intracordal cysts naturally disappear in some patient population. Cyst does not always recur in patients who had received partial surgical removal, too. Contradicting results raises a question whether complete surgical removal of intracordal cyst is necessary and demonstrate need for better treatment. Herein, the author proposes novel surgical method technique intralaryngeal needle technique (INT), a technique using surgical needle for not only injection but also for aspiration and excision of cyst. This study aims to examine the potential of intralaryngeal needle technique in treating intracordal cysts. MATERIALS AND METHODS: Surgical procedures were done on in-patients diagnosed with intracordal cyst. 23 patients received follow-up screening after the surgery for one year. Patients' subjective satisfaction levels, acoustic measures, aerodynamic measures, laryngeal stroboscopic results were compared before and after the treatment. RESULTS: Overall patients were satisfied with novel surgical excision method. In terms of aerodynamic measures, maximum phonation time, mean air flow rate improved after the surgery. In terms of acoustic measures, Jitter, Shimmer, NHR, and voice pitch changes after the treatment showed statistically significant differences. Laryngeal stroboscopy results showed significant decreases in cyst sizes. Post-surgery patients had improved mucosal waves and amplitudes values. CONCLUSION: The results show the validity of intralaryngeal needle technique in reducing intracordal cyst size by excision, aspiration, and injection. The author believes this novel technique can be used as an alternative surgical method for intracordal cysts.
Acoustics ; Follow-Up Studies ; Humans ; Mass Screening ; Methods ; Needles* ; Phonation ; Recurrence ; Stroboscopy ; Voice

BACKGROUND AND OBJECTIVES: Non-organic voice disorders are very difficult to diagnose. The authors attempted to find out the efficiency of videokymography (VKG) which has been newly developed to evaluate the vibratory characteristics of the vocal folds in non-organic voice disorders. MATERIALS AND METHODS: Eighty-seven patients who had voice changes without organic laryngeal pathology were evaluated. We ascertained the larynx to be free of organic disorders using the stroboscopy, following which the VKG examination was performed. The results of VKG were classified according to the common features. RESULTS: Type I showed the normal findings. Asymmetry in the amplitude of upper lips was seen in the type II. Type III showed thick glottal contact. Type IV showed level difference, thick glottal contact and asymmetry in the amplitude of upper lips. Type V had several different amplitudes of the upper lip seen in one cycle of the mucosal wave. Type VI had level difference with thin glottal contact and asymmetry in the amplitude of upper. CONCLUSIONS: Based on these results, we were able to see the different types of VKG and that VKG could be used as a supplementary diagnostic tool in the non-organic voice disorders.
Humans ; Kymography ; Larynx ; Lip ; Pathology ; Stroboscopy ; Vocal Cords ; Voice Disorders* ; Voice*

BACKGROUND AND OBJECTIVES: The two most important methods for voice rehabilitation after total laryngectomy are tracheoesophageal speech and esophageal speech. The former can be obtained in several ways, for example, by the primary Amatsu tracheoesophageal (T-E) shunt operation or by the use of a low-resistance valve such as the Provox prosthesis. The purpose of this investigation was to study the anatomy and physiology of the neoglottis and to evaluate the vocal quality of tracheoesophageal speech. MATERIALS AND METHODS: A total of 12 patients, who had undergone the Amatsu T-E shunt operation after total laryngectomy, were analyzed using the stroboscopy, laryngofiberscopy, videofluoroscopy, and computerized speech lab. RESULTS: With stroboscopy, the neoglottis was split from left to right in 3 patients and in 9 patients, the direction of opening and closure of rheeoglottis was anterior-posterior. The regular vibratory features were observed in patients with a shortened visible vibratorvsegment. The results of videofluoroscopy indicate that the location of the vibration was mostly situated between C3 and C5. The cervical esophagus closure during tracheoesophageal phonation was located at a level between C7-T2. CONCLUSION: The anatomical and morphological characteristics of the neoglottis was related to the healing process after operation. The neoglottis was considered to be formed by the thyropharyngeal muscle, and concentric contraction under subneoglottic extension was formed by the contraction of the cervical esophagus.
Acoustics* ; Esophagus ; Humans ; Laryngectomy ; Phonation ; Physiology ; Prostheses and Implants ; Rehabilitation ; Speech, Esophageal ; Stroboscopy ; Vibration ; Voice

BACKGROUND AND OBJECTIVES: Decrease in mucosal waves and diplophonia are known as main diagnostic criteria of vocal cysts. However, preoperative differential diagnosis of intracordal retention cyst (IRC) over vocal polyp and/or edema is not infrequently challenging even with those criteria. Authors aimed to evaluate the efficacy of laryngeal stroboscopy and acoustic analyses for the proper diagnosis of IRC. MATERIALS AND METHOD: We reviewed medical records of 30 patients who were initially diagnosed as having IRC either through laryngeal endoscopy or stroboscopy. Endoscopic and/or stroboscopic findings, acoustic and perceptual parameters were analyzed in comparison to the final pathologic diagnosis. RESULTS: Only 70% of the subjects were correctly diagnosed with laryngeal stroboscopy, which suggested the need of reconsideration of current diagnostic criteria. Decrease in mucosal waves was a frequently observable but not a specific finding confined to IRC. Diplophonia was neither a common nor a specific finding of IRC. Acoustic evaluation was not helpful for the differential diagnosis of IRC over vocal polyp. Hemorrhagic changes around the lesion were observed in some of vocal polyps but not in any of IRC. CONCLUSION: Decreased or absent mucosal wave is one of the characteristics of IRC, but is a not absolute criterion for the differential diagnosis between IRC and vocal polyp. Diplophonia and other acoustic parameters are not helpful for the differential diagnosis of those lesions. A careful endoscopic or stroboscopic evaluation of general contour, mucosal change and any surrounding hemorrhage will help in the proper differential diagnosis of IRC over vocal polyp. Decrease in mucosal waves will also help the diagnosis of IRC but not when it is overemphasized as an absolute criterion.
Acoustics* ; Diagnosis* ; Diagnosis, Differential ; Edema ; Endoscopy ; Hemorrhage ; Humans ; Medical Records ; Polyps ; Stroboscopy* ; Vocal Cords

BACKGROUND AND OBJECTIVES: The aim of this study was to verify that voice analysis could be an alternate tool for the evaluation of proton pump inhibitor treatment of laryngopharyngeal reflux (LPR). SUBJECTS AND METHOD: Twenty-two patients with LPR symptoms underwent laryngoscopy, stroboscopy and their reflux finding index (RFI) were evaluated. Subjective reflux symptom scores (RSS) and voice handicap index (VHI) were completed at the baseline. All patients underwent voice analysis. Thereafter, patients had short-term proton pump inhibitor therapy for 6 weeks. The RFI, RSS, VHI and voice analysis were repeated during the last week of the treatment. RESULTS: RFI was improved and both RSS and VHI were improved after the treatment. RSS and VHI were significantly correlated. In voice analysis, shimmer significantly improved and harmony to noise ratio (HNR) also improved. CONCLUSION: Voice analysis can be indicators of treatment results of laryngopharyngeal reflux disease.
Hoarseness ; Humans ; Laryngopharyngeal Reflux* ; Laryngoscopy ; Noise ; Proton Pumps* ; Stroboscopy ; Voice ; Voice Quality*

BACKGROUND AND OBJECTIVES: Reinke's edema has shown different voice qualities and different mucosal waves according to the degree of swelling in the vocal folds. The subjects were classified into three types : waterish, mixed, and gelatinous type according to the consistency of fluid in the Reinke's space. We compared voice parameters of different types of Reinke's edema. MATERIALS AND METHODS: All of the subjects were classified according to the laryngoscopic findings and operation findings. History for duration of disease, smoking histories, and the severity of laryngopharyngeal reflux were evaluated. Stroboscopy and videokymography were used for the assessment of mucosal waves. Voice parameters were obtained and compared from all subjects to assess acoustic and aerodynamic factors. RESULTS: Vocal fold vibrations of waterish type was more active than the gelatinous type or mixed type in the stroboscopic findings and videokymography. The fundamental frequency of gelatinous type was significantly lower compared to other types: however, subglottic pressure was significantly higher compared to other types. CONCLUSIONS: Reinke's edema was classified according to the gelatinous type, mixed type and waterish type according to the consistency of fluid in the vocal folds. There were typically acoustic and stroboscopic findings in each type.
Acoustics ; Edema* ; Gelatin ; Laryngopharyngeal Reflux ; Smoke ; Smoking ; Stroboscopy ; Vibration ; Vocal Cords ; Voice ; Voice Quality

BACKGROUND AND OBJECTIVES: Vocal nodules are the most common voice disorder due to vocal misuses. Vocal nodules are primarily treated with voice therapy and are rarely removed through laryngomicrosurgery. Although the rate of recovery for individual patients may vary, 60-70% of them are fully treated. Because vocal nodules have many possible causes, 30-40% of patients remain untreated. Also, vocal nodules recurrence after the surgical treatment is sometimes observed. The author claims that incomplete contact between vocal cords during phonation is a major cause of the vocal nodules. Most vocal nodules do occur from incomplete contact between vocal cords during phonation, and various voice therapies are designed to improve habitual misuses of the vocal cords. However, vocal nodules tend to remain unhealed unless patients change their habitual misuses of the vocal cords. The cricothyroid muscle tension is known to hinder the contact between vocal cords. The author injected a restricted amount of botulinium toxin to the cricothyroid muscle to reduce the muscle tension and observed changes in vocal cords' movement. SUBJECTS AND METHOD: In this study, the author injected botulinium toxin to the cricothyroid muscle of 21 patients. For 2-4 weeks, we observed patients' responses to the treatment, by measuring changes in subglottal pressure, mean air flow rate, maximum phonation time, jitter, shimmer, noise-to-harmonic ration of patients and subjective evaluation of voice changes. In addition, the author conducted stroboscopy to evaluate the usefulness of the treatment. RESULTS: The improvement was in the subjective evaluation of voice changes and stroboscopic findings. CONCLUSION: The observation demonstrated a great improvement in vocal nodules after the injection of botulinium toxin into the cricothyroid muscle.
Humans ; Laryngeal Muscles ; Muscle Tonus ; Phonation ; Recurrence ; Stroboscopy ; Vocal Cords ; Voice ; Voice Disorders

After thyroid surgery, voice change occurs very frequently, in more than 30% of cases. In addition to injury to the recurrent laryngeal nerve (RLN) or the external branch of superior laryngeal nerve (EBSLN), vocal fold edema due to excessive tracheal traction or disrupted laryngeal venous drainage, and laryngotracheal fixation following injury to extralaryngeal musculature can cause post-thyroidectomy voice change. Although complete recovery can be expected mostly in 3 months, dysphonic patients should be evaluated pre and postoperatively by laryngoscopy or laryngeal stroboscopy. The present review discusses the evaluation of voice change, the anatomy of RLN and EBSLN and common cause of voice change after thyroid surgery. Furthermore, we represent how to preserve RLN, SLN including intraoperative nerve monitoring.
Drainage ; Edema ; Humans ; Laryngeal Nerves* ; Laryngoscopy ; Recurrent Laryngeal Nerve ; Stroboscopy ; Thyroid Gland ; Thyroidectomy ; Traction ; Vocal Cords ; Voice*