In patients with severe dysphagia, tracheostomy is a useful intervention for airway management. However, it is accompanied by some disadvantages such as an inhibition of laryngeal elevation. In this paper, we present a case of Wallenberg syndrome with prolonged dysphagia who was successfully treated by minor revision surgery of the tracheostoma. A 70-year-old male presented with severe dysphagia due to brainstem infarction. He had undergone a tracheostomy for airway management and was wearing a cuffed cannula. Despite intensive swallowing rehabilitation, his swallowing function showed insufficient improvement. The subject was treated with adjustment of the tracheostoma to a lower position and alteration of the cannula. These interventions resulted in improvement of laryngeal elevation and decrease in aspiration. He recovered sufficient oral feeding and the tracheostoma was successfully closed. Clinicians should be aware that tracheostoma may cause deterioration in or inhibit recovery of swallowing function.
The subjects were 262 healthy volunteers: 200 young and 62 elderly. Age-related changes in voice profile after adolescence were acoustically analyzed using the Multi-Dimensional Voice Program (MDVP) produced by KayPENTAX. The results were as follows: 1. Age-related changes in the voice profiles of the male subjects were as follows: fundamental frequency information measurements showed that T0 shortened and F0 increased; frequency perturbation measurements demonstrated that Jitt, RAP and PPQ increased; amplitude perturbation measurements showed that all parameters, including Shim and APQ, increased; noise-related measurements indicated that SPI increased; and tremor-related measurements demonstrated that ATRI increased. 2. Age-related changes in the voice profiles of the female participants were as follows: fundamental frequency information measurements demonstrated that T0 elongated and F0 decreased; frequency and amplitude perturbation measurements were mostly unchanged; noise-related measurements indicated that NHR increased and VTI decreased; and tremor-related measurements showed that ATRI increased. The above findings indicated that the normal range for each acoustic parameter needs to be set for each gender and age group. The data obtained from the present study and the data related to normal ranges are clinically significant for differentiating between normal age-related physiological changes in the voice and pathological voice.
In order to estimate the target pitch range in transsexual voice therapy, spoken sentences and sustained vowels /a/ and /i/ were recorded from 119 male-to-female transsexuals (MtF) and 32 biological females (F), and fundamental frequency (F0) was analyzed. The MtF speakers were classified into two groups: one perceptually judged as female, and those judged as male, based on perceptual judgments made by 100 listening subjects. The average F0 of sentences recorded from the MtFs perceived as female was 217 Hz, and that of vowels was 270 Hz. These values were comparable with those recorded from the biological female speakers, which were 217 Hz for sentences and 243 Hz for vowels. More than 70% of the MtFs were judged as male even though their F0 was in the same range of that produced by the biological female speakers. This result shows that F0 is an important but not sufficient factor for judging a voice as female.
This study reports on the progress of dysphagia therapy performed for an oldest-old patient who has been confined to bed over a long period, and who has contracted aspiration pneumonia repeatedly. As a result of the therapy, the patient became able to ingest and his swallowing function was preserved for about one year and a half after discharge. Progress pointed to three effective points: early beginning of the therapy; dysphagia therapy using the help method by elevating the larynx; explanation to his family before discharge. The therapy was begun on the third day after admission. If the therapy had not been introduced early, aspiration would have continued further and swallowing function would have worsened. The help method of elevating the larynx was useful for triggering the swallowing reflex in this case. This method preserves elevation of the larynx by pushing up the larynx transitively. As the swallowing reflex is a central pattern movement, it is suggested that preservation of larynx elevation triggers central pattern movement. Before discharge, it was necessary to explain to the patient’s family about oral motor exercise for muscular strength preservation, appropriate food texture, and help for feeding. These explanations were useful to preserve his swallowing function.
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