Monthly Archives: February 2008

History of Voice Rehabilitation Following Laryngectomy

from Laryngoscope

Introduction: The history of voice rehabilitation following laryngectomy is as long as the history of laryngectomy itself. The multitude of methods which have been employed to reduce the disability associated with the loss of the larynx, illustrate the difficulty of finding an optimal method of reestablishing verbal communication while preserving the ability to breathe and swallow.

Material and Methods: The world literature was reviewed using various Internet and medical search engines and library facilities. Landmark articles were identified and summarized.

Results: A coherent history of voice rehabilitation following laryngectomy was constructed.

Discussion: The methods employed to reestablish voice after extirpation of the larynx may be grouped into the categories of: esophageal speech, surgical methods of creating competent tracheo-pharyngeal shunts to create lung powered voice with and without the use of prosthetic devices to prevent aspiration, “near-total” resection of the larynx with dynamic phonatory shunt, and the use of external pneumatic or electrical devices to create sound which is then transmitted through the oral cavity and pharynx.

Conclusion: For the past two decades, simple shunt devices inserted either primarily, at the time of laryngectomy, or later as a secondary procedure, have mainly supplanted the other methods of voice rehabilitation, with the exception of an occasional patient who has acquired good esophageal speech, or for whom external devices may be the only practical method of voice production.

Direct Electrical Stimulation of Heschl’s Gyrus for Tinnitus Treatment

from Laryngoscope

Objectives/Hypothesis: The purpose of the study was to determine the effect of electrical stimulation of the auditory cortex in patients with tinnitus.

Study Design: Nonrandomized clinical trial.

Methods: Two patients with debilitating tinnitus refractory to conventional therapies were treated. Patients were evaluated with validated questionnaires and psychoacoustic measures to determine the frequency and pitch of their tinnitus. Tones at these frequencies were then presented to the first patient (RP) under magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) to determine the tonotopic map for these frequencies in Heschl’s gyrus. These tonotopic sites were targeted for implant with a quadripolar electrode. In the second patient (MV), only the fMRI tonotopic map was performed. These fMRI results detected an area of increased activity, which was selected as the site for the implanted bipolar electrode.

Results: Patient RP (bilateral tinnitus for 2 years) has experienced a sustained reduction to near elimination of tinnitus with intracerebral implanted electrodes, whereas patient MV (unilateral tinnitus for 7 years) had an unsustained reduction in her tinnitus.

Conclusion: These findings suggest that the perception and annoyance of tinnitus may be modulated or reduced through electrical stimulation of the auditory cortex. These unsustained effects for patient MV may have been influenced by the longstanding nature of her tinnitus or by another reason as yet undetermined.

Changes in Speaking Fundamental Frequency Characteristics with Aging

from Folia Phoniatrica et Logopaedica

Changes in speaking fundamental frequency (SFF) associated with aging were studied in a total of 374 healthy normal speakers (187 males and 187 females) from adolescent to older age groups. Participants were asked to read a sample passage aloud, and acoustic analysis was performed. The main results were as follows: (1) Males exhibited no significant trend for SFF changes in aging. However, a slight increase was observed in participants aged 70 years or older. (2) Females in their 30s and 40s showed obviously lower frequencies than those in their 20s. Across all age groups, including the 80s, SFF tended to decrease markedly in association with aging. (3) The degree of SFF change in association with aging was much larger in females than in males. In addition, reference intervals (mean ± 1.96 SD) obtained for males and females in each age group are considered useful for clinical detection of abnormalities of SFF, as well as for detection of laryngeal diseases causing SFF abnormality.

Linguistic Profile of Individuals with Down Syndrome: Comparing the Linguistic Performance of Three Developmental Disorders

from Child Neuropsychology

An increasing number of studies, addressing the linguistic abilities of individuals with Down syndrome (DS) suggest that they exhibit strengths and weaknesses within the linguistic domain. This article critically reviews the literature on the linguistic profile of individuals with DS, with particular emphasis on the expression and reception of vocabulary and grammar, including nonverbal linguistic expression during infant development. In doing so, attention is given to recent comparative studies of the linguistic abilities of individuals with DS, Specific Language Impairment (SLI), and Williams syndrome (WS). The possibility that deficits in one cognitive system may have consequences in another cognitive system, and that these consequences may define the nature of the impairment in each clinical syndrome is further discussed with suggestions for future research.

Tympanic Membrane Collagen Fibers: A Key to High-Frequency Sound Conduction

from Laryngoscope

Objective: To investigate the significance of tympanic membrane collagen fiber layers in high frequency sound transmission.

Study Design: Human cadaver temporal bone study.

Methods: Laser Doppler vibrometry was used to measure stapes footplate movement in response to acoustic stimulation. The tympanic membrane was altered by creating a series of slits and applying paper patches to isolate the effects of specifically oriented collagen fibers. Three groups of membrane alterations were evaluated: 1) circumferentially oriented slits involving each quadrant to primarily disrupt radial fibers, made sequentially within superior-anterior, inferior-anterior, inferior-posterior, and superior-posterior quadrants; 2) the same slits made in the reverse order; and 3) radially oriented slits from the umbo to the annulus to primarily disrupt circumferential fibers. For each group, measurements of the middle-ear cavity pressure, ear canal pressure, and stapes velocity were made each time the tympanic membrane was altered.

Results: Regardless of the order in which the circumferentially oriented slits were made, there was a consistent decrease in stapes velocity above 4 kHz for the third and fourth cuts compared to the control. The mean decrease in the range of 4 to 12.5 kHz was 11 dB for the third patched slit and 14 dB for the fourth patched slit (P < .01). Radially oriented slits appear to produce smaller effects.

Conclusions: Radial collagen fibers in the tympanic membrane play an important role in the conduction of sound above 4 kHz.

A Guide for Monitoring Child Development in Low- and Middle-Income Countries

from Pediatrics

OBJECTIVE. In low- and middle-income countries, methods for clinicians to address difficulties in language, social-emotional, cognitive, behavioral, or neuromotor development during early childhood are lacking. To fill this gap, we designed, in Turkey, the Guide for Monitoring Child Development, which aims to aid clinicians in monitoring and supporting child development and the early detection and management of developmental difficulties. The Guide for Monitoring Child Development monitoring component is a practical, open-ended interview that catalyzes communication between clinicians and caregivers and obtains a portrayal of the child’s development. We report on the development and psychometric properties of the Guide for Monitoring Child Development monitoring component for children aged 0 to 24 months.

METHODS. We examined the ages of attainment of Guide for Monitoring Child Development milestones and internal consistency in a cross-sectional study of healthy children receiving well-child care (study 1). In 2 clinical samples, we studied the interrater reliability between medical students and a child development specialist administering the guide (study 2), as well as the concurrent validity of the guide administered during a health visit and a comprehensive developmental assessment (study 3).

RESULTS. In study 1 (N = 510), item-total scale correlations ranged from 0.28 to 0.91. An age-dependent attainment pattern was seen in all of the milestones. In study 2 (N = 92), interrater reliability between medical-student pairs and between the child development specialist and students was high (kappa scores were 0.83–0.88). In study 3 (N = 79), the sensitivity, specificity, and positive and negative predictive values were 0.88, 0.93, 0.84, and 0.94, respectively.

CONCLUSIONS. The Guide for Monitoring Child Development is an innovative method for monitoring child development that is designed specifically for use by health care providers in low- and middle-income countries. Studies in Turkey provide preliminary evidence for its reliability and validity.

Ethical, Legal, and Social Concerns About Expanded Newborn Screening: Fragile X Syndrome as a Prototype for Emerging Issues

from Pediatrics

Technology will make it possible to screen for fragile X syndrome and other conditions that do not meet current guidelines for routine newborn screening. This possibility evokes at least 8 broad ethical, legal, and social concerns: (1) early identification of fragile X syndrome, an “untreatable” condition, could lead to heightened anxiety about parenting, oversensitivity to development, alterations in parenting, or disrupted bonding; (2) because fragile X syndrome screening should be voluntary, informed consent could overwhelm parents with information, significantly burden hospitals, and reduce participation in the core screening program; (3) screening will identify some children who are or appear to be phenotypically normal; (4) screening might identify children with other conditions not originally targeted for screening; (5) screening could overwhelm an already limited capacity for genetic counseling and comprehensive care; (6) screening for fragile X syndrome, especially if carrier status is disclosed, increases the likelihood of negative self-concept, societal stigmatization, and insurance or employment discrimination; (7) screening will suggest risk in extended family members, raising ethical and legal issues (because they never consented to screening) and creating a communication burden for parents or expanding the scope of physician responsibility; and (8) screening for fragile X syndrome could heighten discrepancies in how men and women experience genetic risk or decide about testing. To address these concerns we recommend a national newborn screening research network; the development of models for informed decision-making; materials and approaches for helping families understand genetic information and communicating it to others; a national forum to address carrier testing and the disclosure of secondary or incidental findings; and public engagement of scientists, policy makers, ethicists, practitioners, and other citizens to discuss the desired aims of newborn screening and the characteristics of a system needed to achieve those aims.

Emotional speech in Parkinson’s disease

from Movement Disorders

Patients with Parkinson’s disease (PD) tend to speak monotonously with minor modulation of pitch and intensity. The goal of this study was to find out whether these speech changes can be explained mainly by motor impairment, i.e. akinesia and rigidity of the articulatory apparatus, or whether alterations of emotional processing play an additional role. Sixteen patients with mild PD and 16 healthy controls (HC) were compared. Fundamental frequencies (pitch) and intensities (loudness) were determined as (1) maximal upper and lower values achieved in nonemotional speech (phonation capacity), (2) upper and lower values used when speaking Anna in emotional intonation (neutral, sad, happy) as requested (production task), or (3) when imitating a professional speaker (imitation task). Although groups did not significantly differ in their phonation capacity, patients showed a significantly smaller pitch and intensity range than HC in the production task. In the imitation task, however, ranges were again similar. These results suggest that alterations of emotional processing contribute to speech changes in PD, especially regarding emotional prosody, in addition to motor impairment. © 2008 Movement Disorder Society

Fine structure of distortion product otoacoustic emissions: its dependence on age and hearing threshold and clinical implications

from the European Archives of Oto-Rhino-Laryngology

Abstract Distortion product otoacoustic emissions (DPOAE) are routinely used in audiological diagnostics. When the stimulus frequencies f1 and f2 are varied in small steps, distinct non-monotonicities (peaks and valleys) in DPOAE level versus frequency functions can be observed. This so-called DPOAE fine structure (FS) is supposed to be the result of physiological interferences between two different cochlear sources which generate the DPOAE signal. Although FS can complicate interpretations with respect to cochlear functional status at the primary source near f2, its presence might also be relevant in clinical audiological diagnostics. It is therefore of interest to determine FS prevalence and its dependence on age, frequency and hearing threshold. First, it was screened for FS using two tone stimulation (L1/L2 = 55/45 dB SPL, f2/f1 = 1.22) and frequency steps of 40 Hz in the frequency range of 1.8–4.2 kHz. DPOAE (2f1 − f2) were then recorded in 1/3 octave-bands centered around f2 = 2, 3 and 4 kHz with a frequency resolution of 12.5, 20 and 25 Hz, respectively, both with and without a third stimulus (L3 = 45 dB SPL, f3 = 2f1 − f2 + 25 Hz) which was supposed to act as a suppressor of FS. Results of measurements in 102 human individuals from a mixed patient population are reported. Prevalence of DPOAE and FS in a specific frequency range, (i.e. 2, 3, or 4 kHz) was classified into five categories: I) distinct FS within the respective frequency range, II) “single dip” in DP-gram, III) “flat” DP-gram well above noise floor but no distinct FS, IV) DPOAE near noise floor with “irregular responses”, and V) no DPOAE measurable. The prevalence of the categories was set in relation to the subject’s age and the audiometric threshold at the corresponding center frequency. The estimated probability for a FS (category I and II) was 50–80% if hearing threshold was better than 10 dB HL at the corresponding center frequency. FS prevalence strongly decreased with increasing hearing loss (P < 0.0001). There was no statistically significant age effect (P = 0.088). In more than 50% of the subjects with a behavioral hearing threshold of 10 dB HL or better, a distinct FS near the according frequency was detected, given the presented measurement conditions. While further research is directed at optimal suppression of the second cochlear source of DPOAE and thereby of FS in order to obtain information about the cochlear status near f2 only, the evaluation of FS itself may be clinically useful for monitoring subtle cochlear changes, e.g. during exposure to ototoxic substances or noise.

Situating language production within the matrix of human cognition: The state of the art in language production research

from Language and Cognitive Processes

A summary of recent work in language production is presented, focusing on the Third International Workshop on Language Production (Chicago, USA, August 2006). The articles included in this special issue focus on three overlapping themes: language production in dialogue (Arnold; Costa, Pickering, & Sorace); multilingual language production (Costa et al.; Abutalebi & Green); and control processes in production (Abutalebi & Green; Dell, Oppenheim, & Kittredge). Points of convergence and divergence between these contributions are discussed.

Central timing deficits in subtypes of primary speech disorders

from Clinical Linguistics and Phonetics

Childhood apraxia of speech (CAS) is a proposed speech disorder subtype that interferes with motor planning and/or programming, affecting prosody in many cases. Pilot data (Peter & Stoel-Gammon, 2005) were consistent with the notion that deficits in timing accuracy in speech and music-related tasks may be associated with CAS. This study replicated and expanded earlier findings. Eleven children with speech disorders and age-and gender-matched controls participated in non-word imitation, clapped rhythm imitation, and paced repetitive tapping tasks. Results suggest a central timing deficit, expressed in both the oral and the limb modality, and observable in two different types of timing measures, overall rhythmic structures and small-scale durations. Associations among timing measures were strongest in the participants with speech disorders, who also showed lower timing accuracy than the controls in all measures. The number of observed CAS characteristics was associated with timing deficits.

An investigation of voice quality in individuals with inherited elastin gene abnormalities

from Clinical Linguistics and Phonetics

The human elastin gene (ELN) is responsible for the generation of elastic fibres in the extracellular matrix of connective tissue throughout the body, including the vocal folds. Individuals with Supravalvular aortic stenosis (SVAS) and Williams syndrome (WS) lack one normal ELN allele due to heterozygous ELN abnormalities, resulting in a haploinsufficiency. We measured perceptual and acoustic characteristics of voice quality in individuals with SVAS and WS to investigate the consequences to vocal function secondary to ELN haploinsufficiency. Results indicated that the voice quality of individuals with SVAS/WS was rated as significantly more abnormal, rough, and hoarse compared to normal controls, and that adults with SVAS/WS were rated as significantly lower in pitch. Acoustic measures indicated that individuals with SVAS/WS produced greater instability of fundamental frequency during phonation (as reflected via increased pitch sigma and increased jitter). These findings support the possibility that heterozygous ELN abnormalities negatively influence vocal fold biomechanics and the resulting sound produced by the vibrating glottis.

Fortition and lenition patterns in the acquisition of obstruents by children with cochlear implants

from Clinical Linguistics and Phonetics

This paper investigates patterns of error production in 10 children who use cochlear implants, focusing specifically on the acquisition of obstruents. Two broad patterns of production errors are investigated, fortition (or strengthening) errors and lenition (or weakening) errors. It is proposed that fortition error patterns tend to be related to the process of phonological development, because they are involved with universal implications and notions of markedness. Lenition error patterns, on the other hand, show more context-sensitive effects and reflect properties related to minimization of articulatory effort. The relationship between fortition and markedness is demonstrated in an optimality theoretic analysis, and it is further demonstrated that the observed characteristics of phonological development in children with cochlear implants are similar to those exhibited by children with normal hearing.

Prosodic boundaries in alaryngeal speech

from Clinical Linguistics and Phonetics

Alaryngeal speakers (speakers in whom the larynx has been removed) have inconsistent control over acoustic parameters such as F0 and duration. This study investigated whether proficient tracheoesophageal and oesophageal speakers consistently convey phrase boundaries. It was further investigated if these alaryngeal speakers used the same hierarchy of acoustic boundary cues that is found in normal speakers. A perception experiment revealed that listeners identified prosodic boundaries less accurately in oesophageal speakers. Acoustic analyses showed that laryngeal speakers used pre-boundary lengthening and pitch movements at phrase boundaries, as expected. Tracheoesophageal speakers used pre-boundary-lengthening and pauses and oesophageal speakers used pauses to convey phrase boundaries. Two oesophageal speakers also paused inappropriately, within phrases. Although these two speakers differentiated between air-injection and prosodic pauses, listeners were unable to tell the two types of pauses apart. Alaryngeal speakers might benefit from therapy that specifically teaches them how to optimize their prosodic abilities.

A comparison between the feeling of ear fullness and tinnitus in acute sensorineural hearing loss

from the International Journal of Audiology

The feeling of ear fullness (FEF) occurs frequently in patients with acute sensorineural hearing loss; the same is true for tinnitus (TIN). However, the cause of FEF in these patients is unclear. This study included 171 ears of patients admitted with unilateral sudden deafness to the ENT division of Fukuoka University Hospital between January 2001 and December 2004. The results showed TIN was mainly associated with worse high-frequency hearing thresholds, where hearing loss was relatively severe, and this association became stronger after the hearing threshold stabilized. FEF was associated with the low-frequency region, where hearing loss was relatively mild, and this association disappeared after the hearing threshold stabilized. In conclusion, TIN is thought to originate in the region where hair cells are impaired; in contrast, FEF may originate from some functional factor rather than an organic lesion of the cochlea.