To assess dynamic brain function in adults who had stuttered since childhood, regional cerebral blood flow (rCBF) was measured with H2O and PET during a series of speech and language tasks designed to evoke or attenuate stuttering. Speech samples were acquired simultaneously and quantitatively compared with the PET images. Both hierarchical task contrasts and correlational analyses (rCBF versus weighted measures of dysfluency) were performed. rCBF patterns in stuttering subjects differed markedly during the formulation and expression of language, failing to demonstrate left hemispheric lateralization typically observed in controls; instead, regional responses were either absent, bilateral or lateralized to the right hemisphere. Significant differences were detected between groups when all subjects were fluent-during both language formulation and non-linguistic oral motor tasks-demonstrating that cerebral function may be fundamentally different in persons who stutter, even in the absence of stuttering. Comparison of scans acquired during fluency versus dysfluency-evoking tasks suggested that during the production of stuttered speech, anterior forebrain regions-which play an a role in the regulation of motor function-are disproportionately active in stuttering subjects, while post-rolandic regions-which play a role in perception and decoding of sensory information-are relatively silent. Comparison of scans acquired during these conditions in control subjects, which provide information about the sensorimotor or cognitive features of the language tasks themselves, suggest a mechanism by which fluency-evoking maneuvers might differentially affect activity in these anterior and posterior brain regions and may thus facilitate fluent speech production in individuals who stutter. Both correlational and contrast analyses suggest that right and left hemispheres play distinct and opposing roles in the generation of stuttering symptoms: activation of left hemispheric regions appears to be related to the production of stuttered speech, while activation of right hemispheric regions may represent compensatory processes associated with attenuation of stuttering symptoms.

Intralesional injection of cidofovir is an excellent treatment option with limited local and systemic toxicities. The injection therapy regimen requires perseverance from both patient and surgeon. Remission of disease can be achieved in adults with laryngeal papilloma.

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Specific LEMG patterns are related to the etiology of the UVFP and time course since recurrent laryngeal nerve injury. LEMG appears to reflect vocal fold muscle tone as seen on laryngeal function studies. In combination, these studies provide a cohesive assessment of laryngeal function in patients with UVFP.

For estimating supraglottic compression in disordered voice production, categorical rating scales of true vocal fold coverage by supraglottic structures are the current standard. Quantification of change in the position of supraglottic structures compared to no supraglottic activity would be a better method for distinguishing between and within voice-disordered groups. This study developed a method for quantifying static supraglottic activity and extent of false vocal fold (FVF) motion during dynamic supraglottic activity. Twelve control participants and 12 individuals with voice disorders (6 with complaints of vocal fatigue and 6 with vocal fold nodules) were enrolled in the study. These individuals participated in a transnasal fiberoptic laryngeal examination in which various speech tasks were recorded. Single-frame images were selected to represent the positions of minimum and maximum supraglottic compression for each speech task. Two individuals rated these single-frame images using a categorical rating scale. Two other individuals measured the anterior-to-posterior (A-P) distance, vocal fold length, and vocal fold area. A-P and FVF compression were derived from these three measures. Reliability was demonstrated between judges for the ratings and between and within judges for the measures. Significant differences in normalized static supraglottic compression measures corresponded to the rating scale categories. Significant differences in normalized dynamic supraglottic compression measures corresponded to the differences in category ratings between minimum and maximum compression. Using the normalized measures, the voice-disordered groups demonstrated significantly greater static A-P compression (t test, p< .03) than did the control participants. These results suggest that static supraglottic activity may be diagnostic of voice disorder. Normalized dynamic FVF compression ratios were not significantly different between groups. This supports a previous hypothesis that dynamic supraglottic activity serves as an articulatory function at the level of the larynx and is part of the linguistic/phonemic system, rather than evidence of disordered laryngeal function.