Laryngeal Changes Research Articles

Morfologia głośni w reumatoidalnym zapaleniu stawów

Rheumatoid arthritis (RA) is an inflammatory disease of the connective tissue, which can affect larynx and cricoarytenoid (CA) joints, as well. The AIM of this study was assessment of 1) glottis morphology and frequency of laryngeal structures involvement in RA of peripheral joints and 2) evaluation of rheumatoid patients' complaints which can indicate the laryngeal involvement. 77 patients were examined (71 women and 16 men) in the age from 19 to 77 (mean 56,69). RA duration was from 1 month to 29 years (mean 9,38). RA was active in 61% of patients. Anamnesis, physical examination, videolaryngoscopy, computer tomography, electromyography. The most frequent complaints were: foreign body sensation in the throat (51%), hoarseness (47%) with accompanying weakness of voice and dysphagia. In videolaryngoscopic examination swelling and/or redness of mucosal tissue in CA area was observed in 45% of patients. In 3 women impairment of vocal folds was stated, in 1 it was limitation of right vocal fold mobility and in 2 bilateral vocal folds immobility and tracheotomy was necessary. In patients with active RA and with foreign body sensation in the throat significantly more often inflammatory changes in larynx were visible. 1. Rheumatoid inflammation in the larynx is demonstrated by swelling and/or redness of mucosal tissue in CA area and in some individuals by its immobilization. 2. In the periods of RA intensification complains of foreign body sensation in the throat and hoarseness may indicate on laryngeal involvement. Our study results justify a suggestion of continuation of the morphological and functional changes estimation in patients with peripheral RA.

Laryngeal collapse in seven brachycephalic puppies

To document the histories, clinical findings, and management of seven puppies with laryngeal collapse occurring secondarily to brachycephalic airway syndrome. Seven brachycephalic puppies aged between 4.5 and six months underwent surgery for management of brachycephalic airway syndrome following presentation for exercise intolerance and increased respiratory noise and effort. Stenotic nares of varying severity and an elongated soft palate were common to all dogs. All dogs had tracheal hypoplasia and this was severe in four dogs. Laryngeal collapse was present in all dogs. Two dogs had stage I, four dogs stage II, and one dog stage III laryngeal collapse. The dog with stage III laryngeal collapse and one dog with stage II laryngeal collapse died. There was no apparent association between the changes evident on thoracic radiographs or the degree of tracheal hypoplasia and postoperative outcome. The development of severe secondary laryngeal changes in dogs aged six months or less supports the suggestion that immature brachycephalic dogs should undergo assessment and, if indicated, surgery as soon as any clinical signs of BAS are apparent.

Acoustic-perceptual correlates of voice quality in elderly men and women

Common perceptual characteristics of the elderly voice include hoarseness, breathiness, instability, and a change in the pitch of the voice. Although research is available concerning changes in the elderly voice, little research has been completed to examine the relationship between the perception of voice quality and acoustic measures. The purpose of this study was to examine the relationship between perceived breathiness and hoarseness and selected acoustic variables. The results of the study revealed significant age-related differences in fundamental frequency standard deviation, amplitude perturbation quotient, and noise-to-harmonic ratio. No significant difference in perceived hoarseness was found between the young and elderly speakers. However, the young women were perceived as significantly more breathy than the elderly women. Moderate correlations were found between the perceptions of hoarseness and breathiness and the acoustic measures. These findings are discussed relative to age-related laryngeal changes that may contribute to the perception of aging. Learning outcomes (1) To understand the perceptual attributes of the aging voice in men and women. (2) To understand the relation between the perception of voice quality and acoustic measures of voice production in the aging voice.

The Aged Voice: A New Hypothesis

The anatomical changes in the senescent larynx are presented, with particular reference to the nonlinearity model of laryngeal biomechanics. The behavior of the Ishizaka-Flanagan 2-mass model in geriatric phonation suggests that an increase in nonlinearity can explain a number of disparate observations about the aged voice. Biomechanical assessment of real laryngeal tissue and experimentation in vivo is needed to confirm the hypothesis, leading to better paradigms of some phonatory disorders and perhaps to novel treatments.

Fundoplication for laryngopharyngeal reflux disease.

Laryngopharyngeal reflux (LPR) disease arises from the effects of refluxed gastric contents on the proximal aerodigestive tract. LPR patients are often lumped into the category of "atypical" reflux. LPR symptoms are hoarseness, globus, cough, and pharyngitis. Severe disease is associated with subglottic stenosis and laryngeal cancer. Treatment includes lifestyle modifications and medications. The role of fundoplication for LPR has yet to be defined. Forty-one patients underwent fundoplication for LPR. They were prospectively followed with three outcomes measures: The Reflux Symptom Index, a laryngoscopic grading scale (Reflux Finding Score), and a reflux-based specific quality-of-life scale. Average early followup was at 4 months and late followup was at 14 months. The Reflux Symptom Index improved by 5.4 early (p < 0.05) and 6.5 late (p < 0.05). Improvement between early and late periods approached significance (p < 0.09). Reflux Finding Score improved 3.8 (p < 0.05) early and 4.4 (p < 0.05) late. The Quality of Life Index improved 0.6 early and 2.3 (p < 0.05) late. By Reflux Symptom Index criteria, 26 patients were improved early versus 35 late (p < 0.05). Factors associated with poor outcomes were structural laryngeal changes in five patients (p < 0.05) and no response to proton pump inhibitors in six patients (p < 0.05). Fundoplication augments treatment of LPR. Improvement of symptoms continues past the first 4 months. Laryngoscopy is critical in patient selection because selected findings are associated with outcomes, diagnosis, and management.

The impact of hormonal fluctuations on female vocal folds.

Sex hormone fluctuations were shown to affect female vocal folds and laryngeal function. Laryngeal changes are evident throughout the span of life, starting at puberty with the arousal of the hormonal system, fluctuating systematically during the reproductive years with the menstrual cycle, and then changing again with the decline of hormonal activity at menopause. This paper reviews recent developments in this field. Early studies that explored this relation were based merely on subjective impressions of voice quality, recent studies have used more objective tools for examining this relation, including histologic observations, stroboscope, electroglottography (EGG), and computerized acoustic analyses. In these studies, the larynx was shown to be a hormonal target organ and, as such, sex hormones affect its morphology, histology, and function, similar to their effect on the genitals and other organs. Examining the relation between sex hormones and the larynx could assist in understanding the mechanisms of voice production, and it could provide the clinician with supplemental diagnostic information on different medical conditions.

Prolonged Intubation: An Alternative to Tracheosto my in Infants

In 12 patients, ranging in age from newborn to 4 years, endotracheal intubation has been used as a substitute for tracheostomy. Using plastic tubes it was possible to maintain a good airway for periods of up to 7 weeks. Painstaking care was necessary to prevent the tubes becoming blocked or malpositioned. The tubes were tolerated well. Good laryngeal function has been regained by all 9 survivors. If permanent laryngeal changes have occurred, they show no signs of being severe. It is concluded that many cases customarily managed with tracheostomy can be equally well managed with intubation. Intubation may prove to be the preferred management in some cases of laryngeal oedema.

Histologic changes in human vocal folds correlated with aging: a histomorphometric study.

The voice of aged persons is usually different from that of younger adults--a fact indicating that aging induces changes in the human larynx. The aim of this study was to perform a histomorphometric analysis of the vocal fold and of a fragment of skin in order to determine the modifications related to aging and possible differences between genders. Twenty cadavers, 10 men and 10 women, were studied. Stereological methods were used for histologic analysis. In the vocal folds, we observed a reduction of the lamina propria thickness (p < .001) and of epithelial cell density (p < .001) as a function of age. In the skin, there was a reduction of chorion thickness (p = .02) and of epithelial cell density (p = .01). The decrease in the thickness of the lamina propria of the vocal folds with aging may contribute to the vocal pattern present in the elderly. These changes were more evident in men.

Inhalation toxicity of dimethyl piperidinone

A mixture of 1,3-dimethyl-2-piperidinone and 1,5-dimethyl-2-piperidinone (DMPD) (approximately 63–37 parts by weight) was tested for its inhalation toxicity in rats following 90-day repeated exposures. Male and female rats were exposed whole-body to either 0, 51, 230, or 310 mg/m 3 DMPD for 6 h/day, 5 days/weak for 90 days. Clinical signs, growth, clinical pathology, tissue pathology, neurobehavior, neuropathology, and semen quality were evaluated. No compound-related adverse effects were noted in clinical signs, body weights, food consumption, clinical laboratory evaluations, neurobehavioral evaluations, neuropathology, or sperm counts. Laryngeal changes consisting of minimal squamous epithelial hyperplasia and degeneration/necrosis of the cartilage were present in male and female rats exposed to 310 mg/m 3 both immediately following exposure and after the 1-month recovery period Male rats exposed to DMPD had increased relative kidney weights, increased formation of hyaline droplets and granular casts, and increased incidence of chronic progressive nephropathy. These kidney effects are consistent with increased accumulation of the urinary protein alpha 2μ-globulin, which has been well essential for several xenobiotics. The subsequent increased incidence of progressive nephropathy was specific to male rats with the alpha 2μ syndrome. Male and female rats exposed to 230 or 310 mg/m 3 had centrilobular hepatocellular hypertrophy, and male rats exposed to 310 mg/m 3 had increased relative liver weights. These liver changes were reversible following the recovery period and were considered not to represent adverse toxicological effects of treatment. Since the male rat-specific renal findings do not connote adversity for man and are net considered relevant to human hazard assessment, the no-observed-effect level in male and female rats was 230 mg/m 3, based on the microscopic changes in the larynx exposed to 310 mg/m 3.

Laryngeal Manifestations of Postpoliomyelitis Syndrome

Postpoliomyelitis syndrome (PPS) is a disease that may occur in survivors of acute poliomyelitis several decades after their initial infection. It can present as dysphonia, with vocal weakness and fatigue. Swallowing, respiratory, and other laryngopharyngeal symptoms may be manifestations of the disease or they may represent worsening of previously stable and compensated deficits. Three cases of laryngeal changes in PPS with videostroboscopic and laryngeal electromyography findings highlight the features of this disorder. We review possible etiologies of laryngeal PPS, diagnostic criteria, and treatment, as well as the current literature.

Role of laryngoscopy, dual pH probe monitoring, and laryngeal mucosal biopsy in the diagnosis of pharyngoesophageal reflux.

There is no standard for determining significant pharyngoesophageal reflux. This prospective blind comparison study compared dual pH probe studies, direct laryngoscopy, and mucosal biopsy in children without symptoms of gastroesophageal reflux who underwent airway evaluation. Significant reflux to the lower esophageal probe did not correlate with statistical significance with reflux to the upper probe. In this group of asymptomatic patients, a positive lower pH probe finding did not correlate with upper or lower esophageal mucosal inflammation. Eosinophilia in the esophageal mucosa is diagnostic of gastroesophageal reflux disease, and was seen in 5 of the laryngeal biopsies. A weak correlation was seen between positive findings at laryngoscopy and positive posterior cricoid biopsy in this group. There may be no consistent way to predict significant pharyngoesophageal reflux in asymptomatic patients. Single-probe pH testing will not predict significant pharyngoesophageal reflux with mucosal changes. Laryngoscopy and upper pH probe findings only weakly correlate with significant histologic findings. Laryngeal and posterior cricoid biopsy may be the only sensitive test for mucosal injury. Clinical trials of empiric antireflux therapy should be used to determine whether the laryngeal changes seen in these patients are reversible.

Paradoxical vocal cord dysfunction in juveniles.

To evaluate demographic and videolaryngoscopic features in a large series of juveniles with paradoxical vocal cord dysfunction (PVCD). Case series data from videolaryngoscopic tapes retrospectively evaluated in a masked, controlled fashion, and demographic data collected via retrospective medical chart review. A tertiary care otolaryngology and speech pathology referral center. Twenty-two patients with PVCD aged 18 years and younger diagnosed as having PVCD at The Ohio State University Voice Institute, Columbus. Age, sex, social history, and medical history (demographic); epiglottic position, arytenoid and interarytenoid appearance, phase 0 stability, true vocal cord respiratory motion, degree of anteroposterior (AP) constriction, and false vocal cord adduction (videolaryngoscopic). Of 22 patients, 18 were girls, and 12 had significant social stressors, particularly organized sports. Nineteen patients had posterior laryngeal changes commonly found in gastroesophageal reflux disease. Twelve patients demonstrated abnormal true vocal cord adduction during quiet respiration. Seven patients demonstrated supraglottic anteroposterior constriction and false vocal cord approximation during phonation. Juvenile PVCD is more common in girls and is associatedwith social stresses. Anatomic laryngeal changes typically associated with gastroesophageal reflux disease are extremely common in these patients. Juveniles with PVCD frequently demonstrate abnormal true vocal cord adduction during quiet respiration. We recommend that initial evaluation of juvenile patients for possible PVCD be conducted via transnasal fiberoptic laryngoscopy while the patient is asymptomatic, and that strong consideration be given to empiric pharmacological treatment of gastroesophageal reflux disease in juveniles diagnosed as having PVCD.

喉頭の年齢変化研究における分子生物学的手法の応用

喉頭の年齢変化研究における分子生物学的手法の応用

Speaking fundamental frequency and resonance characteristics of young children with Class III lmalocclusions in North China

AbstractTwelve girls and nine boys with Class III malocclusions, and 12 girls and nine boys with normal occlusions (all between age 7 and 8 years) were chosen as subjects from Shaanxi in North China. Speaking fundamental frequency measurements (speaking Fo, Fo standard deviations, maximum and minimum speaking Fos and speaking Fo ranges in semitones) and resonance characteristics (the first three formants of vowel /a/) of Class III malocclusion children were compared with those of normal occlusion children. The findings of this study seem to support the hypothesis that Class III malocclusions may not cause significant laryngeal and/or pharyngeal functional changes.

Airway Morphology and Function of Rats Following Dermal Sensitization and Respiratory Challenge with Low Molecular Weight Chemicals

Local lymph node activation and increased total serum IgE levels are suggested to be predictive parameters of airway hypersensitivity caused by low molecular weight (LMW) chemicals. Whether increases of total serum IgE are indicative of actual induction of specific airway reactions (morphological and functional) after inhalation challenge was examined in the present study. In Brown Norway (BN) and Wistar rats, serum IgE concentrations were examined following topical exposure of chemicals with known diverse sensitization potential in humans: trimellitic anhydride (TMA), a dermal and respiratory sensitizer; dinitrochlorobenzene (DNCB), a dermal sensitizer with no known potential to cause respiratory allergy; and methyl salicylate, a skin irritant devoid of sensitizing properties. Functional and histopathological changes in the respiratory tract were examined after subsequent inhalatory challenge with these chemicals. Of the three tested chemicals, only topical exposure to TMA resulted in a significant increase in total serum IgE concentrations in the high-IgE-responding BN rat. Upon subsequent inhalatory challenge of these rats, TMA induced specific airway reactions which included a sharp decrease in respiratory rate during challenge, followed by an increase in breathing rate with a concomitant decrease in tidal volume 24 and 48 h after inhalatory challenge, and histopathological changes in the larynx and lungs of animals necropsied 48 h after challenge. Interestingly, despite low IgE levels, TMA induced histopathological changes in the larynx and lungs of Wistar rats too. Laryngeal changes were also observed in Wistar rats upon sensitization and challenge with DNCB. These data suggest that increased total serum IgE after topical sensitization is associated with immediate-type specific airway reactivity after inhalation challenge in BN rats and thus may be a valuable parameter in testing for respiratory sensitization potential of LMW compounds. Histopathological examination upon subsequent inhalation challenge of sensitized low-IgE-responders may provide information on other allergic inflammatory airway reactions.

Widespread Application of Topical Steroids to Decrease Sore Throat, Hoarseness, and Cough After Tracheal Intubation

Widespread Application of Topical Steroids to Decrease Sore Throat, Hoarseness, and Cough After Tracheal Intubation

Fundamental frequency during phonetically governed devoicing in normal young and aged speakers

Age-related changes in the laryngeal system can be perceived as altered vocal pitch and increased pitch variability. However, reports vary as to the nature and extent of an age effect on fundamental frequency (F0) for analyses taken over long segments of connected speech. Analysis of F0 across a smaller time frame may be more informative. Young speakers show an increase in F0 associated with phonetically governed devoicing gestures that is likely mediated by increased vocal fold stiffness. Anatomic and neurophysiologic changes in the aged larynx may limit the role of increased vocal fold stiffness in the devoicing gesture. This study tests the hypothesis that aged speakers show a smaller increase in F0 in association with the devoicing gesture for production of an intervocalic voiceless obstruent than do young speakers. Normal young and aged speakers produced a short sentence containing an intervocalic voiceless obstruent. Measures of F0 were obtained for ten cycles before voice offset and ten cycles after voice onset. Young speakers showed a small increase in F0 during devoicing whereas aged speakers showed a decrease in F0 during devoicing. Aged speakers seem to rely more on vocal fold abduction rather than a combination of abduction and tensing to achieve devoicing.

Efficacy of repeated botulinum toxin injections as a function of timing.

This pilot study was designed to determine if the interval between repeated botulinum toxin injections influenced physiologic and histologic effects on laryngeal muscles in a rat model. The physiologic measurements included digitized videomicroscopic recording of vocal fold movement and electromyography. The histologic measurements included muscle fiber size and digitized optical density of laryngeal muscles after glycogen depletion by electrical stimulation. The results demonstrated that the effect of timing of the second injection was strongly correlated to laryngeal changes. Most notable were results in the subjects that underwent injections 6 weeks apart. We hypothesize that these findings might be related to terminal axonal sprouting with reinnervation. The results from this study help confirm and expand the validity of using the rat laryngeal model to understand the effect of botulinum toxin. Moreover, we believe that the data might be extrapolated to prove useful in predicting human responses to botulinum toxin treatment for functional dystonias such as spasmodic dysphonia.

Psychiatric disturbance and personality traits in dysphoric patients

A study of 68 consecutive attendees at a voice clinic revealed that 51 (75%) were female. Personality characteristics and the incidence of minor psychiatric disturbances were studied in the 51 female patients with dysphonia and in 42 female ENT outpatient control subjects. Personality was assessed by use of the Eysenck Personality Questionnaire (EPQ) and the Hysteroid-Obsessoid Questionnaire (HOQ), and psychiatric disturbance was assessed by use of the General Health Questionnaire (GHQ), 60-item version. Whereas the 18 patients who were diagnosed as having psychogenic dysphonia had, overall, a greater degree of mild psychiatric disturbance, the 33 patients whose dysphonia was associated with structural laryngeal abnormality were also significantly more disturbed than control subjects (p < 0.01). There were no significant differences in personality traits among the three groups. Ten of the 18 patients with psychogenic dysphonia had evidence of significant psychiatric symptomatology on GHQ testing. More unexpectedly, one in three of the women with structural laryngeal changes showed similar psychiatric disturbance. Such psychological distress cannot therefore be detected solely on laryngeal appearances and voice characteristics. We propose the GHQ to be a quick, simple screening tool to identify those patients who might benefit from a more psychologically based approach to therapy.

Endoscopic evolution of laryngeal injuries caused by translaryngeal intubation

Despite improvements in tube design and materials, the longer survival rates of critically ill patients make laryngeal and tracheal lesions still common following prolonged translaryngeal intubation. The time of intubation is almost the only factor employed in deciding whether or not tracheotomy has to be performed. Some patients will not develop laryngeal lesions afer long intubation periods, whereas some already have clinical symptoms after short periods of time. If the conditions of the larynx and trachea could be assessed before irreversible complications take place, then timing of tracheotomy could be individualized to avoid laryngeal stenosis as well as unnecessary tracheostomies. We present the preliminary results of an endoscopic study of the early laryngeal changes that take place during translaryngeal intubation. The method of exploration is explained and tissue changes seen and their evolution after extubation are described, emphasizing those that could have a predictive value.