Measurements on the inverse filtered airflow waveform (the "glottal waveform") and of estimated average transglottal pressure and glottal airflow were made from noninvasive recordings of productions of syllable sequences in soft, normal, and loud voice for 25 male and 20 female speakers. Statistical analyses showed that with change from normal to loud voice, both males and females produced loud voice with increased pressure, accompanied by increased ac flow and increased maximum airflow declination rate. With change from normal voice, soft voice was produced with decreased pressure, ac flow and maximum airflow declination rate, and increased dc and average flow. Within the loudness conditions, there was no significant male-female difference in air pressure. Several glottal waveform parameters separated males and females in normal and loud voice. The data indicate higher ac flow and higher maximum airflow declination rate for males. In soft voice, the male and female glottal waveforms were more alike, and there was no significant difference in maximum airflow declination rate. The dc flow did not differ significantly between males and females. Possible relevance to biomechanical differences and differences in voice source characteristics between males and females and across loudness conditions is discussed.

The CAPE-V form and instructions, included as appendices to this article, enable clinicians to document perceived voice quality deviations following a standard (i.e., consistent and specified) protocol.

These preliminary results suggest a new role for chemotherapy in patients with advanced laryngeal cancer and indicate that a treatment strategy involving induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a high percentage of patients, without compromising overall survival.

Our observations revealed that the 532-nm pulsed KTP laser provided enhanced performance over the PDL laser in a number of ways. The ability to use smaller glass fibers precluded mechanical trauma to the channels of the flexible laryngoscopes and allowed for improved suctioning of secretions. Oxyhemoglobin absorbs energy better at 532 nm than at 585 nm, and the KTP laser can be delivered through a longer pulse width. These factors provide enhanced hemostasis and improved intralesional energy absorbance. Finally, unlike the PDL, the KTP laser is a solid-state laser and is not prone to mechanical failure.

This study investigated the relationship between acoustic spectral/cepstral measures and listener severity ratings in normal and disordered voice samples. CAPE-V sentence samples and the vowel /a/were elicited from eight normal speakers and 24 patients with varying degrees of dysphonia severity. Samples were analysed for measures of the cepstral peak prominence (CPP), the ratio of low-to-high spectral energy, and their respective standard deviations. Perceptual ratings of overall severity were also obtained for all samples. Results showed that all acoustic variables combined in a four-factor model which correlated with perceived severity with R = 0.81 (R(2) = 0.65). For the vowel /a/, a five-factor model incorporating all acoustic variables and gender correlated with perceived severity with R = 0.96 (R(2) = 0.91). Results indicate that a strong relationship between perceptual and acoustic estimates of dysphonia severity can be achieved in both continuous speech and vowel contexts using a model incorporating spectral/cepstral measures.

The recommended protocols for instrumental assessment of voice using laryngeal endoscopic imaging, acoustic, and aerodynamic methods will enable clinicians and researchers to collect a uniform set of valid and reliable measures that can be compared across assessments, clients, and facilities.

High-speed videoendoscopy (HSV) captures the true intracycle vibratory behavior of the vocal folds, which allows for overcoming the limitations of videostroboscopy for more accurate objective quantification methods. However, the commercial HSV systems have not gained widespread clinical adoption because of remaining technical and methodological limitations and an associated lack of information regarding the validity, practicality, and clinical relevance of HSV. The purpose of this article is to summarize the practical, technological and methodological challenges we have faced, to delineate the advances we have made, and to share our current vision of the necessary steps towards developing HSV into a robust tool. This tool will provide further insights into the biomechanics of laryngeal sound production, as well as enable more accurate functional assessment of the pathophysiology of voice disorders leading to refinements in the diagnosis and management of vocal fold pathology. The original contributions of this paper are the descriptions of our color high-resolution HSV integration, the methods for facilitative playback and HSV dynamic segmentation, and the ongoing efforts for implementing HSV in phonomicrosurgery, as well as the analysis of the challenges and prospects for the clinical implementation of HSV, additionally supported by references to previously reported data.

Treatment of glottal papillomatosis and dysplasia was mirror-guided and performed in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. Presently, the primary treatment goals, which are disease regression and voice restoration or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. In fact, general anesthesia has been appropriately considered to be an acceptable source of morbidity for the promise of a precise procedure, which usually ensures airway safety and an optimal vocal outcome. However, patients with recurrent glottal papillomatosis and keratosis with dysplasia are typically monitored with various degrees of watchful waiting until there is a subjective judgment (on the part of the patient and surgeon) that the disease is more of a liability than is the procedure to treat it. Innovations in the 585-nm pulsed dye laser delivery system have allowed for its use in the clinic with local anesthesia through the working channel of a flexible fiberoptic laryngoscope. A prospective assessment was done on 51 patients in 82 cases of recurrent glottal papillomatosis (30) and dysplasia (52). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Five procedures could not be completed because of impaired exposure (2) or discomfort (3). Of those patients who could be treated, there was at least a 50% disease involution in 68 of 77 cases (88%) and 25% to 50% disease regression in the remaining 9 (12%). Patient self-assessment of the voice revealed that 34 of 77 were improved, 39 were unchanged, 4 were slightly worse, and none were substantially worse. These data confirm that diseased mucosa can be normalized without resection or substantial loss of vocal function. The putative mechanisms, which vary according to the fluence (energy) delivered by the laser, are photoangiolysis of sublesional microcirculation. denaturing of epithelial basement membrane linking proteins, and cellular destruction. Furthermore, this relatively safe, effective technique allowed for treatment of many patients (in a clinic setting) in whom classic surgery-related morbidity would have often delayed intervention.