There are three methods conventionally used for treating vocal disorders: medical therapy, such as drugs and/or inhaler; phonosurgery, such as laryngomicrosurgery; and voice therapy by a speech-language-hearing therapist (ST). We treat vocal disorders by a combination of these three methods. In our hospital, a medical doctor and ST together examine patients with vocal disorders. We perform a medical interview and observation of the vocal cords, then perform the trial voice therapy under endoscopy in these cases. When we believe there is a need for voice therapy, in addition to the vocal examination, we also undertake, for example aerodynamic inspection and recording of the patient's voice, and then start the voice therapy on the same day as the examination. We determine when the voice therapy should end based on the following three improvements: (1) disappearance of the patient's chief complaint, (2) the patient's laryngeal findings, and (3) a functional examination of the voice. In the approximately two years since the voice clinic opened, we have performed voice therapy in 101 cases: 48 cases finished the therapy and 28 cases dropped out.
We have provided voice therapy at our clinic since 1999. We currently perform treatment once a week with a medical doctor and three speech-language-hearing therapists (ST). Diagnosis, treatment, and timing of completion are all decided through mutual consultation by the doctor and STs. At the initial visit, the patient's vocal cords and state of voice production are precisely assessed in the presence of the ST, after which phonation, Voice Handicap Index, etc. are investigated. The medical doctor and ST assess the patient's state, complaint, and wishes, and discuss the most appropriate treatment option through mutual consultation. Here we report disorders and therapeutic indications; how we decide the timing to complete the voice therapy; and discuss why the therapy was not prolonged. Finally, we discuss the roles of the medical doctor and ST in completing voice therapy.
Swallowing difficulties are a common occurrence in elderly patients. Dysphagia arises from difficulties in swallowing dynamics related to medical diseases, while swallowing functions can also be affected by physical and mental conditions as well as social factors. In addition, swallowing difficulty can be associated with changes in swallowing function along with normal aging. In general, studies of swallowing functions in the elderly present laryngeal penetration and aspiration associated with delay of swallowing reflex and pharyngeal residue. Reduced cough with decreasing airway defense reflex is also frequently observed. The following factors have been pointed out as changes in the mechanisms of swallowing associated with aging: 1. Structural changes and muscle weakness associated with aging 2. Decreased functioning of motor and sensory nerves that are related to swallowing 3. Changes in central control of swallowing mechanisms 4. Reduced physical, mental and respiratory functions. This paper presents abnormal findings observed with swallowing examinations and an overview of changes in the mechanisms behind swallowing functions with aging.
In order to facilitate acquisition of language in language-delayed children, it is necessary to understand the characteristics of language acquisition of typically developing children. The purpose of this study was to investigate the order of acquisition of four types of verb forms (the past-tense form V-ta, the non-past tense form V-ru, the aspectual form V-teru, and the negative marker V-nai). We used elicited production tasks for 95 typically developing children aged 1:09 to 2:11. The results were as follows. In the youngest group (1:09-1:11), the percentage of children who used V-ta was the highest, followed by V-nai, V-teru, and V-ru. Children who produced only one form used V-ta, and children who produced two forms tended to use V-nai in addition to V-ta. Children who produced three forms used V-teru or V-ru in addition to two other forms. Some children used all four forms, and while the percentage of children who used four forms was only 9.1% in the youngest group, it increased to 76.2% in the group aged 2:03-2:05. These results suggest that children acquire V-ta first, then V-nai, followed by V-teru and V-ru, and that these four forms are all acquired before the age of 2 years and 6 months.
Objective: To evaluate the timing and structural displacement of swallowing in patients with Parkinson's disease in a quantitative manner. Subjects and methods: The subjects consisted of 7 patients (2 males, 5 females) with idiopathic Parkinson's disease, all of whom were capable of total oral ingestion without aspiration. The timing and structural displacement of swallowing in lateral videofluoroscopic views during the swallowing of a 5-ml bolus were analyzed using the UC Davis Dynamic Swallow Study (DSS) with reference to the normative values for a 3-ml bolus. Results: Hypopharyngeal transit time was not delayed in any patient, although oropharyngeal transit time was delayed in 3 patients. Bolus arrival at the Upper Esophageal Sphincter (UES) occurred prior to supraglottic closure in 5 patients. Pharyngeal constriction was decreased in 3 cases. Motor disturbance of the oral phase, airway protection defense function, and decrease in pharyngeal constriction were seen in half the patients. Discussion: This study indicated the usefulness of DSS analysis for dysphagia in Parkinson's disease patients. In order to evaluate the diagnostic utility of DSS, the swallowing patterns of various neurodegenerative diseases need to be evaluated quantitatively using this analytical tool.
Appropriate vocal skills for singing and speaking are important as a therapeutic tool for music therapists. We developed a preliminary voice training program for music therapists with perspectives including music therapy, musicology, phonetics, acoustics, speech-language pathology, and vocal pedagogy. Two music therapists agreed to participate in the study. The one-week program consisted of an introductory vocal workshop, including physical warm-ups, vocal warm-ups, and vocal hygiene. This was followed by a one-week homework training, and subsequently by a final workshop. As the results, extension of MPT (maximum phonation time) and expansion of vocal range were observed. Improvement of vocal qualities was identified in speaking voices; in singing voices, emergence and stability of vibrato were observed but there were no significant changes in the LTAS (long-term average spectrum). In future studies, laryngeal inspections will be necessary to confirm the effects of this preliminary voice training program.
Forty-seven professional singers who complained of voice disorders were examined. 1) The singers complained of singing voice disorders even though their vocal fold lesions were minute and did not influence speaking. 2) Their chief complaints were not always hoarseness (altered voice quality) but rather more often alteration of the singing voice in terms of sound pitch. They complained of various kinds of singing voice disorders, including artistic. 3) Intervention treatment should be considered based not only on the severity and pathogenesis of the singing voice disorder but also on the vocal emergency. 4) Appropriate antibiotics, steroid or antihistamine should be prescribed by oral or intravenous methods according to the pathogenesis of the singing voice disorder to facilitate performances in acute settings. 5) Precise surgical procedures under endolaryngeal microsurgery are necessary for organic lesions in professional singers. 6) Understanding of the physiology, pathology and pathogenesis of phonation, including singing, and of the clinical histoanatomy of the vocal folds, and skilled surgical techniques are necessary for treating voice disorders in professional singers.