Objective: To provide the normative values for laryngeal stroboscopy (LS) concerning amplitude, open quotient, asymmetry and phase difference in healthy, young subjects.Study design: Prospective case-control study. Setting: Patients treated at a single institute.Methods: A total of 68 healthy subjects were included in the study (35 women, 33 men), aged 18-35 years. After obtaining LS recordings, image processing was performed to attain parameters of vocal fold vibration. Results:In women, the location of the maximum vibration amplitude is approximately in the 1/3 posterior part of the glottis, while in men, the location is moved to the glottis centre. In males, the relative amplitude vibration of the vocal folds in the 1/3 anterior part of the glottis was significantly higher than in females (P = 0.029). Women showed significantly higher open quotients (OQ) at the posterior part of the glottis than the male subjects (P < 0.001) and men presented significantly higher OQ at the anterior part of the glottis than the females (P < 0.001).The average OQ values for both sexes were almost the same. Females showed significantly higher relative glottal gap area (P = 0.044). Women presented a significantly lower amplitude asymmetry than men (P = 0.002). The weighted absolute left-right phase difference reached up to 24°and remained insignificantly higher in the men than the women (P = 0.142). Conclusions:The study provides normative values for LS in young adults for the measurement of therapy outcomes in patients with voice disorders and realisation of evidence-based medicine. The LS parametrisation is easy to perform in clinical practice.
IntroductionInjection laryngoplasty (glottis augmentation) is the preferred method in surgical management of unilateral vocal fold paralysis (UVFP). Traditionally, these procedures are performed in the operating room. Nowadays, however, these procedures have moved into the office.AimTo evaluate the voice quality after transoral injection laryngoplasty under local anaesthesia in patients with unilateral vocal fold paralysis.Material and methodsFourteen subjects (5 women and 9 men) with unilateral vocal fold paresis (9 with right vocal fold paresis and 5 with left vocal fold paresis) were included in the study. The mean age of the group was 57.8 ±19.0 years (32–83 years). All of the injection laryngoplasties were performed transorally, under local anaesthesia. The injection material was calcium hydroxylapatite. Before and 1, 3 and 6 months after the procedure the following variables were evaluated: voice perception, videostroboscopy, acoustic analysis, aerodynamic evaluation, and the subjective rating of the voice quality by the patient.ResultsAfter injection laryngoplasty, complete glottal closure was achieved or there was a significant improvement in the glottal closure of each subject. We noted great improvement in the post-injection objective and subjective voice outcomes and patients reported improvement in the voice-related quality of life.ConclusionsThe transoral approach for injection laryngoplasty under local anaesthesia is an effective and safe way to treat incomplete glottal closure in patients with UVFP. The transoral approach is an efficient alternative to other surgical techniques used for vocal fold injection.
Anecdotal evidence suggests that high pitched voice may be a clinical symptom of hypoglycemia. We conducted a pioneer study aiming at assessing voice variables during hypoglycemia and hyperglycemia. We recruited 10 non-smoking individuals with type 1 diabetes (4 women, 6 men; mean [±SD] age 40.2±10.4 years, diabetes duration 21.4±9.9 years, HbA1c 8.0±1.8%) who were using real time continuous glucose monitoring system (rt-CGM, Guardian Connect, Medtronic) for mean 5.2±0.6 days in controlled hospital setting. At regular intervals during normoglycemia and additionally at blood glucose <70 mg/dl or >200 mg/dl each patient was instructed to record with a professional voice recorder (LS-14, Olympus) a standardized sentence and the sound of vowel ‘a’ for 3 seconds. The voice samples (n=177) were analyzed against CGMS data with the DiagnoScope software (DiagNova, Wroclaw, Poland). Number of fundamental PERiods (PER), time of fundamental PERiods (PERTime), fundamental frequency (F0), energy (E), amplitude of fundamental frequency (AF0), indicator of voiced/phonation probability (Voiced), simple voice quality (SimpleQ), relative average perturbation (RAP), shimmer (Shimm), amplitude perturbation quotient (APQ), four formant frequencies (F1-F4), harmonic perturbation quotients (HPQ), residual to harmonic ratio (R2H), unharmonic to harmonic ratios (U2H), subharmonic to harmonic ratio (S2H), noise to harmonics ratio (NHR), 1st to 4th harmonic to all energy ratio (Fx1-Fx4) were analyzed. In women during hypoglycemia E, AF0, Voiced, F1, F4, R2H, Fx3, Fx4, while in hyperglycemia - RAP and F2 were significantly altered when compared to normoglycemia. In men in hypoglycemia the differences were found in PER, PERTime, Voiced, SimpleQ, Shimm, APQ, F2, U2H, S2H, Fx2, NHR, while in hyperglycemia - PERTime, F1, HPQ, U2H, Fx2 (all p<0.05). We report for the first time that hypoglycemia and hyperglycemia modulate human voice. This phenomenon may offer potential for early detection and prevention of hypoglycemia. Disclosure L. Czupryniak: None. E. Sielska-Badurek: None. A. Niebisz: None. M. Sobol: None. M. Kmiecik: None. K. Jedra: None. E. Szymanska-Garbacz: None. K. Niemczyk: None. Funding Polish Ministry of Science and Higher Education
STRESZCZENIE:Współczesna foniatria dysponuje coraz nowocześniejszymi metodami, które pozwalają na dokładniejszą i obiektywniejszą ocenę drgań fonacyjnych fałdów głosowych. Poza oceną wideostroboskopową zaliczają się do nich wideostrobokimografia oraz fonowibrogram. Oba badania można wykonać na podstawie powszechnie wykonywanych nagrań wideolaryngostroboskopowych dobrej jakości.Wynikiem wideostrobokimografii są przekroje kimograficzne oraz wykresy obrazujące drgania fałdów głosowych. Umożliwiają one przede wszystkim ocenę: przesunięcia brzeżnego, drgań fonacyjnych fałdów głosowych, stosunku czasu trwania zwarć do rozwarć fonacyjnych oraz obecności i dokładnej lokalizacji ewentualnej niedomykalności.Fonowibrogram jest metodą, która za pomocą pojedynczego diagramu przedstawia kształt całej szpary głośni w trakcie drgań fonacyjnych. Uwidacznia momenty zwarć i rozwarć fonacyjnych oraz struktury, które przysłaniają światło głośni.Kimografia oraz fonowibrogram mogą być wykorzystywane w diagnostyce zaburzeń głosu o różnym podłożu czynnościowym i organicznym. Do nieprawidłowości dotyczących drgań fonacyjnych fałdów głosowych, które mogą być przedstawione za pomocą powyższych badań, zaliczają się: niejednoczasowe drgania fałdów głosowych, obecność niedomykalności fonacyjnej szpary głośni, ograniczony lub całkowity brak przesunięcia brzeżnego, a także obecność różnego rodzaju zmian organicznych zlokalizowanych na fałdach głosowych. Oba badania umożliwiają ocenę subtelnych zaburzeń drgań fonacyjnych, które nierzadko trudno dostrzec w trakcie oglądania nagrania wideolaryngostroboskopowego.Zarówno przekroje kimograficzne, jak i fonowibrogram mogą zostać wydrukowane i przechowywane w formie papierowej. Poprawne wykonanie opisanych badań oraz ich prawidłowa interpretacja stanowią wartościowe uzupełnienie klasycznej wideolaryngostroboskopii.SŁOWA KLUCZOWE: kimografia, wideostrobokimografia, fonowibrogram, wideolaryngostroboskopia, drgania fonacyjne fałdów głosowych WYKAZ SKRÓTÓW: SVKG -wideostrobokimografia, PVG -fonowibrogram ABSTRACT:Modern phoniatry is equipped with a number of increasingly more advanced technologies allowing for more precise and objective evaluation of vocal fold vibratory patterns during phonation. Aside from videostroboscopic assessment, these diagnostic methods include videostrobokymography and phonovibrography. Both examinations may be conducted based on common videolaryngostroboscopic recordings of good quality.Results of videostrobokymography are presented as kymographic cross-sections and graphs representing vocal fold vibrations. They primarily enable assessment of mucosal edge movements, phonatory vibrations, and vocal fold closingto-opening time ratio, as well as presence and precise location of possible insufficiency.artykuł poglądowy / review article
Based on the videolaryngostroboscopy, phonatory insufficiency and asymmetrical vocal fold vibration were observed. On perception assessment with GRBAS scale, we noticed slight to mild degree hoarseness, breathiness of sound and weakened voice. In majority of patients, the maximal phonation time of [a] sound was significantly reduced. All patients showed abnormal acoustic parameters. None of them rated their voice as perfectly normal on VAS scale.
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