Voice disorders are one of the major occupational hazards among school teachers. Despite many studies on this issue in Europe and North America, the prevalence of voice disorders in teachers is rarely reported in Japan. In this study, we investigated the prevalence of self-reported voice disorders and assessed subjective impairments in association with use of the Voice Handicap Index (VHI). Self-reported questionnaires were collected from 468 teachers (male: 178, female: 264, unknown: 26) in primary and junior high schools in Kochi Prefecture. Hoarseness and throat pain/discomfort were identified in 54.1% and 51.5% of the subjects, respectively. These symptoms were more likely in females and in teachers with careers spanning 11 or more years. Teachers who are in charge of after-school club activities more frequently complained of voice disorders. However, only a minority of teachers had visited otolaryngologists or received medical treatment. VHI was employed for subjective assessment of voice disorders. The mean VHI score was 14.7, with a significant variance. This might be due to the circumstance that a voice disorder varies greatly depending on individual awareness. Scores were high in female teachers and in those with careers of 11 years or longer. These results show the necessity of promoting early treatment and preventive education programs for voice disorders in teachers.
OBJECTIVES: During the past five years 108 patients with vocal fold cysts were examined and treated at the Tokyo Voice Center. In this presentation the clinical records of these 108 patients were studied statistically, especially to compare among different histological types. MATERIALS AND METHODS: The study involved analysis of 108 patients (53 males and 55 females). In all patients, otolaryngological, phoniatric and videostroboscopic examinations were completed. The clinical records of these patients were statistically studied with respect to distribution by age, sex, smoking, and professional voice usage, especially comparing among different histological types. Subsequently these statistical differences were compared with differences between vocal fold nodules and vocal fold polyps. RESULTS AND CONCLUSIONS: 49% of the cases were professional voice users and 15% were non-professional cases who had episodes of vocal abuse. There were significant differences between cases of epidermoid cyst and retention cyst with respect to distribution by age, sex, professional voice usage, and endoscopy findings, just as there were significant differences between vocal fold nodules and vocal fold polyps.
OBJECTIVES: During the 5-year period from 2001 to 2005, 4,075 patients with voice disorders were examined and treated at the Tokyo Voice Center. In this presentation the clinical records of these 4,075 patients were studied retrospectively. MATERIALS AND METHODS: The study involved an analysis of 4,075 patients (1,644 male, 2,400 female, 31 gender identity disorders (GID); 1 to 91 years of age; mean age, 44.1 years), mainly referred from other hospitals to the Tokyo Voice Center. In all patients, otolaryngologic, phoniatric and videostroboscopic examinations were completed. The clinical records of these patients were statistically studied with respect to distribution by age, sex, occupation, smoking, diagnosis, and relationship with vocal use as etiologic factors. RESULTS AND CONCLUSIONS: 1) Vocal fold nodules were most frequently diagnosed among organic diseases, followed by laryngitis and vocal fold polyps. Functional dysphonia was most frequently diagnosed among non-organic diseases, followed by epipharyngitis and spasmodic dysphonia. 2) Vocal fold nodules, laryngitis, vocal fold polyps, and vocal fold cysts were significantly related with vocal abuse. 3) Reinkeís edema, vocal fold leukoplakia, laryngeal cancers, vocal fold cysts, and vocal fold polyps were significantly related with smoking.
A communication study was conducted employing the Kanazawa Method on two children with multiple disabilities including hearing impairment and mental retardation. The process of acquiring means of communication is reported. Case 1 is a boy with hearing impairment, cerebral palsy, severe mental retardation and epilepsy who visited our institution at the age of 1 year and 6 months. His hearing threshold was 85 dB. Guidance employing the Kanazawa Method was initiated at the age of 3 years and 5 months. At the age of 6 years and 3 months, his active communication strategy was manipulating objects and pointing by written words. After entering school, he became accustomed to using a communication book. Case 2 is a girl with hearing impairment, moderate mental retardation and muscle hypotonia who visited our institution at the age of 1 year and 8 months. Her hearing threshold was 70 dB. Guidance employing the Kanazawa Method was initiated at the age of 2 years. At the age of 6 years and 9 months, she received primarily through hearing with lip reading and transmitted primarily through spontaneous speech. Both children became able to effectively use multiple communication modalities including written language as well as hearing in combination with lip reading and sign language, indicating that even children with moderate to severe mental retardation can process written language.
The purpose of the present study was to investigate 1) the development of voluntary speech rate control, and 2) whether it differs from the development of voice loudness control. The participants were 81 typically developing children aged 3 to 6. They were shown a picture of an animation character and given instructions to say the name of the character. Two types of instruction —“speak slowly” and “speak fast”— were used in the speech rate control task, and two types of instruction —“speak in a loud voice” and “speak in a small voice”— were used in the voice loudness task. In the speech rate control task, the percentages of children who could control their speech rate were 10.0% and 14.3% at ages 3 and 4, and 63.6% and 88.9% at ages 5 and 6, respectively. In the voice loudness control task, the rates were 35.0% and 61.9% at ages 3 and 4, and 77.3% and 94.4% at ages 5 and 6, respectively. These results suggest that voluntary control of speech rate is more difficult than that of voice loudness at ages 3 and 4. They also indicate that the ability to voluntarily control speech rate develops abruptly from age 4 to 5, and almost all children can control both their speech rate and voice loudness at age 6.
Arytenoid adduction is a well-known surgical procedure for unilateral vocal fold paralysis. The procedure is associated with the risk of a compromised airway post-operatively caused by narrowing of the glottis due to pharyngolaryngeal swelling. Because of this, a tracheostomy may be necessary. To our knowledge, no previous report has identified the characteristics of swelling after arytenoid adduction. In this study, videolaryngoscopic images of 8 patients with unilateral vocal fold paralysis who underwent arytenoid adduction in our hospital were assessed to determine the peak swelling time and to describe the characteristics of swelling, with special attention given to the following points: (1) membranous portion of the vocal fold, (2) arytenoid, and (3) pyriform sinus. The reliability of the method and the factors which seem to affect the swelling are also discussed. In all patients, pharyngolaryngeal swelling got harder from the 2nd post-operative day and average peak swelling time was noted on the 3rd and 4th days post-operatively. The method was reliable based on a statistical examination.
Language is something that is unconsciously acquired. In the case of hearing-impaired children, acquisition of speech and language is said to be delayed because their hearing inputs are limited. However, few studies have been able to explain the relationship between language acquisition and hearing level. This study analyzed the relationships between hearing discrimination of accents and intonations, and hearing levels in 64 hearing-impaired children. The results revealed that most of the children with less than about 85 dBHL could discriminate intonations, and children with less than about 70 dBHL could distinguish accents. The average gap in hearing level between children who could hear accents and those who could hear intonations was about 15 dBHL. The hearing level of children who could hear accents was lower than the hearing level of children who could hear intonations. In other words, severely hearing-impaired children could discriminate intonations more than accents. It is generally thought that intonations and accents in Japanese are distinguished by voice pitch variation, but this study suggests that some children discriminate intonations through information other than voice pitch (for example, utterance continuance time). The results indicate that intonations include various signals such as sound duration or shifts in sound pressures, and some hearing-impaired children can utilize this information when listening.
Speech dysfunction after resection of the tongue due to cancer is a troublesome problem, even in reconstructed cases. We studied speech function in 9 cases of tongue cancer in which a hemiglossectomy was performed and reconstruction carried out by pectoralis major myocutaneous (PM-MC) flap. The relation between speech intelligibility and the shape or mobility of the reconstructed tongue was analyzed. Speech intelligibility was assessed using a test consisting of 25 Japanese syllables. We classified the reconstructed tongues into 3 types according to their superficial shape, i.e. upheaval, flat and dip types. Tongue mobility with respect to front-rear and right-left movement was scored. Speech intelligibility with the upheaval type (71.6%) and flat type (84.4%) was better than that with the dip type (34.1%). Tongue mobility was related to speech intelligibility with the upheaval and flat types, but not with the dip type. In conclusion, optimal speech function is seen with upheaval and flat type reconstructions, suggesting possible association with good mobility when the tongue is reconstructed with a PM-MC flap.
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