Injection laryngoplasty (IL) is one of the less invasive phonosurgical methods requiring no cervical incision. In our institution, transoral fat IL is performed under general anesthesia for patients with good prognosis and general condition. On the other hand, percutaneous IL under local anesthesia is performed for patients requesting office-based treatment or presenting emaciation; here, collagen material is normally used, except in patients with poor prognosis due to malignant diseases, in which case silicon material is used. Three intractable cases were described in this report. Case 1, with unilateral vocal fold paralysis caused by lung cancer, was treated by collagen IL twice. Case 2, with unilateral vocal fold paralysis caused by breast cancer, was treated by fat IL twice. Case 3, with vocal fold scarring, was treated by resection of the scar following fat IL. Each case presented particular issues: in case 1, absorption of the infused collagen; in case 2, effectiveness in adducting the arytenoid cartilage by IL; and in case 3, limitation of voice improvement for the scarred vocal fold even when using any of the injection materials. It is necessary to understand the mechanisms of IL usage, the characteristics of the injection materials, and the laryngeal pathologies that are difficult to improve by IL.
We examined the impact of voice therapy using vocal function exercise (VFE) on vocal fold atrophy. We also assessed the factors affecting the impact of VFE on vocal pathology. Thirty patients (male 73.2±3.58 years, female 76±8.35 years) who underwent voice therapy for vocal fold atrophy between July 2016 and November 2017 were incorporated in this study. Vocal hygiene instruction followed by 8 weeks of VFE was performed as the therapeutic option, and multiple vocal parameters were measured before and after VFE in all patients. Significant improvements in endoscopic glottal closure scoring, grade score of GRBAS scale, maximum phonation time, shimmer value, and VHI score were observed after voice therapy. Furthermore, both the age of the patient and duration of the disease significantly correlated with the number of improved vocal parameters. Patients having background diseases in respiratory and cardiovascular functions were incorporated in this study. However, these medical histories as well as the smoking histories of the patients did not negatively affect the impact of voice therapy. These results suggest that VFE might be effective on vocal fold atrophy as long as these background diseases are stabilized under proper management during voice therapy.
Children who stutter (CWS) face many difficulties and need environmental support in school or home activities. However, few studies have investigated the needs of CWS within the context of their environment. The present study aimed to elucidate the needs and requests for accommodation of CWS. Twenty-five CWS completed a free-description questionnaire about "the difficulties they experience," "what they want people in their environment to do," and "why they want such supports," with reference to their friends, schoolteachers, and parents. The data were analyzed using the KJ method and categories were identified. In all situations, "waiting until they start to speak" and "treating them as other children are treated" were extracted. However, the participants' support needs from schoolteachers and parents differed. Specifically, they wanted schoolteachers to "provide information about stuttering to other children in their classroom," while they wanted parents to "speak slowly and listen patiently." Additionally, they reported facing difficulties with "making a presentation" and "oral reading." In this regard, they wanted those around them to make some accommodations because "they wanted to speak by themselves" and "these accommodations enabled them to speak smoothly and comfortably." The results also suggested that CWS from middle or higher grades wanted more accommodations and their needs were more diverse as compared to those of CWS from lower grades.
Monopitch is one of the speech features frequently observed in patients with Parkinson's disease (PD). The systematic voice therapy program LSVT®LOUD (LOUD) is known to increase loudness of speech in PD patients and to have effect on monopitch in English-speaking patients. The aim of the current study was to examine whether LOUD would alter monopitch in Japanese-speaking patients with PD. Thirty-five patients (mean age: 66) and twenty-nine normal controls (mean age: 68) were included in this study. Speech signals for oral reading and monologue tasks were recorded, and acoustic-perceptual analyses were conducted. Speaking pitch range (SPR) in semitones (st) increased significantly (p<0.01) comparing pre-treatment (10.5st) with post-treatment (13.1st), relevant to the level of the normal controls (13.4st). The grade of monopitch, speech intelligibility, and speech naturalness all improved significantly (p<0.05). Increased vocal loudness was also observed after the treatment (p<0.01). Our findings suggest that LOUD has positive effects on not only vocal loudness but also pitch range, which are preferred as normal prosodic features, in Japanese-speaking patients with PD.
In tube phonation for voice therapy, sensation of the skin vibration around the lips is considered to be an important feedback for patients with voice disorders. However, this information has not been utilized effectively in vocal practice. In the present study, we thus developed a biofeedback (BF) system which can provide the amplitude of the skin vibration of the upper labial area as feedback visually and in real time. Effects of the system were evaluated in ten undergraduate students who have normal healthy voice. They were asked to increase the vibration amplitude of the upper labial area during 50 times of tube phonation under two conditions, with and without the BF. Changes of the subjective vibration sensation and the vibration amplitude were compared for each condition. The results showed that both the subjective sensation of vibration and the skin vibration amplitude increased significantly in the condition with the BF. In tube phonation for voice therapy, it is important to provide objective feedback appropriately for increasing the vibration amplitude.
Abductor spasmodic dysphonia is thought to be a form of dystonia. Its possible treatments include voice therapy and botulinum toxin injection to the posterior cricoarytenoid muscle. However, voice therapy in this instance has not been fully established, and previous reports indicate an efficacy rate of only about 30% with botulinum toxin injections. Here we report a new effective treatment for abductor spasmodic dysphonia using a sensory trick to press the back of the neck.