Objective assessment of nasality in Flemish adults with neurofibromatosis type 1

When characterizing the speech of a patient with neurofibromatosis type 1 (NF1), hypernasality is often mentioned. As few studies applied technically assisted evaluations of nasality in NF1 patients, the aim of the present study was to document the nasal resonance of adults with NF1 using nasometry. The nasometric data obtained from the NF1 patients were compared with the nasalance scores of a healthy control group and with normative data. The final study group consisted of 24 adult NF1 patients and 16 controls, all living in the East Flemish part of Belgium. Nasalance scores were obtained while the participants sustained three vowels (/a:/, /i./, and /u./) and one consonant (/m/) and read three standard nasalance passages. Despite the inter- and intra-subject variability, we observed that NF1 patients as a group exhibited higher mean nasalance scores than controls. This finding was especially clear in males. Potential genotype-phenotype correlations between NF1 mutation type and hypernasality were examined but could not be demonstrated. Conversely, comparison of the nasometric data obtained from the NF1 patients with magnetic resonance imaging findings showed some degree of interesting correlation. We conclude that, notwithstanding the small sample size for some analyses, nasality is an area of interest in the NF1 population. As altered nasality influences speech intelligibility, nasality requires attention during follow-up visits, particularly when it concerns a male NF1 patient.     

A method for measurement of the vocal tract impedance at the mouth

In this contribution a method is presented for the measurement of vocal tract resonances. The technique uses a non-invasive acoustic excitation of the vocal tract and a fast and robust detection. The method is an alternative to the linear predictive coding (LPC) analysis for patients with voice and speech disorders. Sweep signals are emitted and recorded simultaneously from the small end of a tube placed in front of the mouth opening. The use of a pressure sensor and a velocity sensor provides a direct measurement of the vocal tract impedance at the mouth (VTMI). For selected sustained German vowels, and some consonants, a comparison of results from LPC analysis and VTMI measurements is given. The results indicate a good agreement in the frequency range from 500 to 5,000 Hz. The feasibility of the VTMI method for diagnostic and therapeutic applications is subject to current research.     

Computerized endopharyngeal myotonometry (CEM): a new method to evaluate the tissue tone of the soft palate in patients with obstructive sleep apnoea syndrome

This study compared the tissue tone of the soft palate in nonsnoring subjects and patients with obstructive sleep apnoea syndrome (OSAS) during wakefulness. Here, tissue tone means the biomechanical property of the tissue which can be characterized by two main parameters: stiffness and elasticity. Tissue tone includes both structural and neural components. A new method to evaluate the tissue tone of the soft palate was used - computerized endopharyngeal myotonometry (CEM). This method records and analyses the response of the soft palate tissues to a brief mechanical impact. The method enabled us to evaluate the most important parameters of tissue tone: stiffness, which is expressed as a frequency; and elasticity, expressed as a logarithmic decrement of the damped oscillation. First, a self-reported questionnaire was completed about the medical history of the subjects. Subjects then underwent a physical examination of the oropharynx and polysomnography with overnight pulse oximetry. The results of the CEM method indicated that patients with OSAS show an increased stiffness of the soft palate tissues (20.3, SD 4.7 Hz) compared with nonsnoring subjects (12.2, SD 1.8 Hz). In patients with sleep apnoea, elasticity is not increased in a similar way to stiffness. Thus, the disproportion between tissue stiffness and elasticity of the soft palate is a measure of the pathological changes in patients with sleep apnoea.     

Schmidt syndrome due to idiopathic accessory nerve paralysis

A patient with Schmidt syndrome due to idiopathic accessory neuropathy has had paralysis of soft palate and larynx as well as trapezius and sternocleidomastoid muscles, reflecting involvement of cranial and spinal roots, respectively. In addition to vocal cord paralysis on the laryngoscopy, videofluoroscopy confirmed diminished mobility of the soft palate. Electrodiagnosis showed accessory neuropathy at the proximal segment. Furthermore, the accessory nerve innervated not only upper but also middle and lower portions of the trapezius muscles.     

Savannah roars: The vocal anatomy and the impressive rutting calls of male impala (Aepyceros melampus) – highlighting the acoustic correlates of a mobile larynx

A retractable larynx and adaptations of the vocal folds in the males of several polygynous ruminants serve for the production of rutting calls that acoustically announce larger than actual body size to both rival males and potential female mates. Here, such features of the vocal tract and of the sound source are documented in another species. We investigated the vocal anatomy and laryngeal mobility including its acoustical effects during the rutting vocal display of free-ranging male impala (Aepyceros melampus melampus) in Namibia. Male impala produced bouts of rutting calls (consisting of oral roars and interspersed explosive nasal snorts) in a low-stretch posture while guarding a rutting territory or harem. For the duration of the roars, male impala retracted the larynx from its high resting position to a low mid-neck position involving an extensible pharynx and a resilient connection between the hyoid apparatus and the larynx. Maximal larynx retraction was 108 mm based on estimates in video single frames. This was in good concordance with 91-mm vocal tract elongation calculated on the basis of differences in formant dispersion between roar portions produced with the larynx still ascended and those produced with maximally retracted larynx. Judged by their morphological traits, the larynx-retracting muscles of male impala are homologous to those of other larynx-retracting ruminants. In contrast, the large and massive vocal keels are evolutionary novelties arising by fusion and linear arrangement of the arytenoid cartilage and the canonical vocal fold. These bulky and histologically complex vocal keels produced a low fundamental frequency of 50 Hz. Impala is another ruminant species in which the males are capable of larynx retraction. In addition, male impala vocal folds are spectacularly specialized compared with domestic bovids, allowing the production of impressive, low-frequency roaring vocalizations as a significant part of their rutting behaviour. Our study expands knowledge on the evolutionary variation of vocal fold morphology in mammals, suggesting that the structure of the mammalian sound source is not always human-like and should be considered in acoustic analysis and modelling.     

Analysis of human soft palate morphogenesis supports regional regulation of palatal fusion

It is essential to complete palate closure at the correct time during fetal development, otherwise a serious malformation, cleft palate, will ensue. The steps in palate formation in humans take place between the 7th and 12th week and consist of outgrowth of palatal shelves from the paired maxillary prominences, reorientation of the shelves from vertical to horizontal, apposition of the medial surfaces, formation of a bilayered seam, degradation of the seam and bridging of mesenchyme. However, in the soft palate, the mechanism of closure is unclear. In previous studies it is possible to find support for both fusion and the alternative mechanism of merging. Here we densely sample the late embryonic‐early fetal period between 54 and 74 days post‐conception to determine the timing and mechanism of soft palate closure. We found the epithelial seam extends throughout the soft palates of 57‐day specimens. Cytokeratin antibody staining detected the medial edge epithelium and distinguished clearly that cells in the midline retained their epithelial character. Compared with the hard palate, the epithelium is more rapidly degraded in the soft palate and only persists in the most posterior regions at 64 days. Our results are consistent with the soft palate following a developmentally more rapid program of fusion than the hard palate. Importantly, the two regions of the palate appear to be independently regulated and have their own internal clocks regulating the timing of seam removal. Considering data from human genetic and mouse studies, distinct anterior‐posterior signaling mechanisms are likely to be at play in the human fetal palate.     

Velo-facio-skeletal syndrome in a mother and daughter

We present a woman and her daughter with an apparently new short stature syndrome associated with facial and skeletal anomalies and hypernasality. Manifestations included hypertelorism with broad and high nasal bridge, epicanthal folds, narrow and high arched palate, mild mesomelic brachymelia, short broad hands, prominent finger pads, hyperextensibility of hand joints, small feet, nasal voice, and normal intelligence. The mother had short stubby thumbs and the daughter had posteriorly angulated ears and delayed bone age. The morphology of the nose and the hypernasality are reminiscent to those in the velo-cardio-facial syndrome. High resolution banding and fluorescent in situ hybridization studies showed no evidence of 22q11 deletions. Differentiation from Aarskog syndrome and Robinow syndrome is discussed. © 1995 Wiley-Liss, Inc.     

Hyoid Bone Development: An Assessment Of Optimal CT Scanner Parameters and Three‐Dimensional Volume Rendering Techniques

The hyoid bone anchors and supports the vocal tract. Its complex shape is best studied in three dimensions, but it is difficult to capture on computed tomography (CT) images and three‐dimensional volume renderings. The goal of this study was to determine the optimal CT scanning and rendering parameters to accurately measure the growth and developmental anatomy of the hyoid and to determine whether it is feasible and necessary to use these parameters in the measurement of hyoids from in vivo CT scans. Direct linear and volumetric measurements of skeletonized hyoid bone specimens were compared with corresponding CT images to determine the most accurate scanning parameters and three‐dimensional rendering techniques. A pilot study was undertaken using in vivo scans from a retrospective CT database to determine feasibility of quantifying hyoid growth. Scanning parameters and rendering technique affected accuracy of measurements. Most linear CT measurements were within 10% of direct measurements; however, volume was overestimated when CT scans were acquired with a slice thickness greater than 1.25 mm. Slice‐by‐slice thresholding of hyoid images decreased volume overestimation. The pilot study revealed that the linear measurements tested correlate with age. A fine‐tuned rendering approach applied to small slice thickness CT scans produces the most accurate measurements of hyoid bones. However, linear measurements can be accurately assessed from in vivo CT scans at a larger slice thickness. Such findings imply that investigation into the growth and development of the hyoid bone, and the vocal tract as a whole, can now be performed using these techniques. Anat Rec, 298:1408–1415, 2015. © 2015 Wiley Periodicals, Inc.     

鼻腔结构矫正手术对OSAHS患者上气道流场影响的数值分析

目的研究伴鼻腔结构异常的OSAHS患者经鼻腔结构矫正手术后,气道结构形态的改变对患者整个上气道流场分布以及软腭运动姿态的影响。方法基于患者手术前后CT影像学数据,建立上气道及软腭三维有限元模型,采用流固耦合的方法模拟手术前后上气道流场特性及软腭的运动情况。结果手术矫正了异常的鼻腔结构形态,鼻腔及整个上气道阻力明显下降。术后软腭的肥厚水肿明显缓解,其游离缘的运动幅度减小。软腭运动幅度随弹性模量的减小而增大。术后的模拟结果与文献报道的正常人实验与模拟结果接近。结论鼻腔结构矫正手术改变了上气道结构,影响了气流流场的分布和软腭的运动姿态;不同病理生理状态下,软腭弹性模量的变化对其运动姿态有影响。     

腭帆提肌重建术对学龄前不完全性腭裂患儿的整复

目的：探讨Sommerlad腭帆提肌重建术对学龄前不完全性腭裂患儿整复的临床效果。方法：41例学龄前不完全性腭裂患儿采用Sommerlad腭帆提肌重建术,23例（56％）分别行两侧1、5cm的松弛切口,18例（44％）未做松弛切口。术后应用口腔和腭咽部的常规检查,汉语语音清晰度测定法,吹水泡试验。结果：本组患者术后均达Ⅰ期愈合。其中32例术后6—18个月复诊,其语言清晰度,高鼻音及鼻漏气都得到明显改善,7例患儿术后18个月复诊,语言清晰度与同龄儿童无明显差异。结论：Sommerlad腭帆提肌重建术可有效恢复腭帆提肌正常解剖结构和位置,重建腭帆吊带,获得良好的腭咽闭合;手术较传统术式进一步简化,损伤小,操作精细,避免或减少硬腭裸露骨面对上颌发育造成的不利影响,是临床上值得推荐的功能性腭裂整复术。     

The Anatomy of the Dog Soft Palate. III. Histological Evaluation of the Caudal Soft Palate in Brachycephalic Neonates

A thickened and abnormally long soft palate is mostly involved in the pathogenesis of both nasopharyngeal and oropharyngeal narrowing, affecting the respiratory activity in virtually all of the brachycephalic dogs suffering from Brachycephalic Airway Obstructive Syndrome (BAOS). The morphology of the soft palate in adult mesaticephalic and brachycephalic dogs has been previously described. In this article specimens from brachycephalic dog neonates (N = 10) dead from one to 3 hr after birth of unrelated conditions were collected and histologically evaluated at three transverse levels to describe the microscopic aspect of the caudal part of the soft palate. The soft palate of neonate brachycephalic dogs was histologically characterized by a musculo‐connective axis containing salivary glands and coated by a mucosal layer on both the nasopharyngeal and the oral side. Quali‐quantitative features, such as thickened superficial epithelium, broad oedema of the lamina propria, mucous gland hyperplasia and diverse muscular modifications described in adult brachycephalic dogs, were not observed in the soft palate of brachycephalic neonate dogs. The lack of tissue lesions in the soft palate of newborn brachycephalic dogs further supports the hypothesis that inspiratory depression during the inspiratory phase causes chronic vibration and microtrauma, which lead to soft palate alterations in adult brachycephalic dogs starting from the earliest grade of the respiratory syndrome. Overall, this study provides baseline information for the comprehension of the pathogenesis of BAOS. Anat Rec, 298:618–623, 2015. © 2014 Wiley Periodicals, Inc.     

Descended and mobile larynx, vocal tract elongation and rutting roars in male goitred gazelles (Gazella subgutturosa Güldenstaedt, 1780)

Similar to male humans, Homo sapiens, the males of a few polygynous ruminants - red deer Cervus elaphus, fallow deer Dama dama and Mongolian gazelle Procapra gutturosa- have a more or less enlarged, low-resting larynx and are capable of additional dynamic vocal tract elongation by larynx retraction during their rutting calls. The vocal correlates of a large larynx and an elongated vocal tract, a low fundamental frequency and low vocal tract resonance frequencies, deter rival males and attract receptive females. The males of the polygynous goitred gazelle, Gazella subgutturosa, provide another, independently evolved, example of an enlarged and low-resting larynx of high mobility. Relevant aspects of the rutting behaviour of territorial wild male goitred gazelles are described. Video and audio recordings served to study the acoustic effects of the enlarged larynx and vocal tract elongation on male rutting calls. Three call types were discriminated: roars, growls and grunts. In addition, the adult male vocal anatomy during the emission of rutting calls is described and functionally discussed using a 2D-model of larynx retraction. The combined morphological, behavioural and acoustic data are discussed in relation to the hypothesis of sexual selection for male-specific deep voices, resulting in convergent features of vocal anatomy in a few polygynous ruminants and in human males.     

Interactions between auditory and somatosensory feedback for voice <Emphasis Type="Italic">F</Emphasis><Subscript>0</Subscript> control

Previous studies have demonstrated the importance of both kinesthetic and auditory feedback for control of voice fundamental frequency (F ₀). In the present study, a possible interaction between auditory feedback and kinesthetic feedback for control of voice F ₀ was tested by administering local anesthetic to the vocal folds in the presence of perturbations in voice pitch feedback. Responses to pitch-shifted voice feedback were larger when the vocal fold mucosa was anesthetized than during normal kinesthesia. A mathematical model incorporating a linear combination of kinesthesia and pitch feedback simulated the main aspects of our experimental results. This model indicates that a feasible explanation for the increase in response magnitude with vocal fold anesthesia is that the vocal motor system uses both pitch and kinesthesia to stabilize voice F ₀ shortly after a perturbation of voice pitch feedback has been perceived.     

Roars,groans and moans: Anatomical correlates of vocal diversity in polygynous deer

Eurasian deer are characterized by the extraordinary diversity of their vocal repertoires. Male sexual calls range from roars with relatively low fundamental frequency (hereafter f_o) in red deer Cervus elaphus, to moans with extremely high f_o in sika deer Cervus nippon, and almost infrasonic groans with exceptionally low f_o in fallow deer Dama dama. Moreover, while both red and fallow males are capable of lowering their formant frequencies during their calls, sika males appear to lack this ability. Female contact calls are also characterized by relatively less pronounced, yet strong interspecific differences. The aim of this study is to examine the anatomical bases of these inter-specific and inter-sexual differences by identifying if the acoustic variation is reflected in corresponding anatomical variation. To do this, we investigated the vocal anatomy of male and female specimens of each of these three species. Across species and sexes, we find that the observed acoustic variability is indeed related to expected corresponding anatomical differences, based on the source-filter theory of vocal production. At the source level, low f_o is associated with larger vocal folds, whereas high f_o is associated with smaller vocal folds: sika deer have the smallest vocal folds and male fallow deer the largest. Red and sika deer vocal folds do not appear to be sexually dimorphic, while fallow deer exhibit strong sexual dimorphism (after correcting for body size differences). At the filter level, the variability in formants is related to the configuration of the vocal tract: in fallow and red deer, both sexes have evolved a permanently descended larynx (with a resting position of the larynx much lower in males than in females). Both sexes also have the potential for momentary, call-synchronous vocal tract elongation, again more pronounced in males than in females. In contrast, the resting position of the larynx is high in both sexes of sika deer and the potential for further active vocal tract elongation is virtually absent in both sexes. Anatomical evidence suggests an evolutionary reversal in larynx position within sika deer, that is, a secondary larynx ascent. Together, our observations confirm that the observed diversity of vocal behaviour in polygynous deer is supported by strong anatomical differences, highlighting the importance of anatomical specializations in shaping mammalian vocal repertoires. Sexual selection is discussed as a potential evolutionary driver of the observed vocal diversity and sexual dimorphisms.     

A new approach to detect congestive heart failure using Teager energy nonlinear scatter plot of R-R interval series

A novel approach to distinguish congestive heart failure (CHF) subjects from healthy subjects is proposed. Heart rate variability (HRV) is impaired in CHF subjects. In this work hypothesizing that capturing moment to moment nonlinear dynamics of HRV will reveal cardiac patterning, we construct the nonlinear scatter plot for Teager energy of R-R interval series. The key feature of Teager energy is that it models the energy of the source that generated the signal rather than the energy of the signal itself. Hence, any deviations in the genesis of HRV, by complex interactions of hemodynamic, electrophysiological, and humoral variables, as well as by the autonomic and central nervous regulations, get manifested in the Teager energy function. Comparison of the Teager energy scatter plot with the second-order difference plot (SODP) for normal and CHF subjects reveals significant differences qualitatively and quantitatively. We introduce the concept of curvilinearity for central tendency measures of the plots and define a radial distance index that reveals the efficacy of the Teager energy scatter plot over SODP in separating CHF subjects from healthy subjects. The k-nearest neighbor classifier with RDI as feature showed almost 100% classification rate.     

Dominant inheritance of velopharyngeal incompetence

A family is described in which a girl, two boys and their father showed speech hypernasality. A half-sib, a grandfather, a great-aunt, and a cousin of these sibs also showed a similar speech defect. Analysis of recorded speech of the father and three sibs revealed articulation deficiencies in addition to hypernasality. Intra-oral examination and neurologic evaluation of the cranial nerves failed to reveal any abnormality in palate morphology or cranial nerve function. Psychometric and audiometric studies of affecteds did not contribute to an explanation of the defect. Speech cinefluoroscopy and cephalometric radiographs confirmed that the speech defect involved velopharyngeal incompetence resulting from an anatomic disproportion of the velopharyngeal structures. The family pedigree supports the concept that this type of nasal speech, resulting from disproportion of velopharyngeal structures, is transmitted as an autosomal dominant trait.     

软腭后推结合带蒂颊脂垫转移修复腭裂的临床应用

目的:探讨软腭后推结合带蒂颊脂垫转移修复腭裂的效果。方法:对裂隙较大或复裂病例采用软腭后推术后,遗留的腭前部创面用带蒂颊脂垫的颊突及体部转移覆盖,碘纺纱条打包固定,术后预防感染处理。结果:5例病人,术后颊脂垫完全成活,无复裂,无颊间隙感染。随访3～6月无复裂,发音改善。结论:颊脂垫血供丰富,带蒂转移结合软腭后推可修复裂隙较大的腭裂或复裂后局部可利用组织较少的腭裂。     

Система датчиков и электронных устройств для непреревной регистрации и оБраБотки информации, получаемой при исследовании речевой артикуляции

A system of electrical transducers has been worked out. This system permits analog recording of basic data concerning speech generating. This system consists of: (a) a sensing device representing an artificial plastic palate with a network of contacts for recording tongue movements during speech articulation; the electric circuit is linked up by touch of the tongue; (b) contact transducers recording the closing of lips; (c) sensing devices recording the smallest air movements in mouth or nostrils; (d) a laryngo-phonic transducer, in the fossa jugularis, recording simultaneously the onset of vocal cord vibration and the acoustic speech signals. The whole signal complex is recorded by a pen writing oscillograph and transmitted to a series of electronic devices permitting automatic signal measurement of certain statistical data (e.g. time parameters), as well as of data corresponding to particular phonetic phenomena occurring during continuous speech.     

Subglottal pressure, tracheal airflow, and intrinsic laryngeal muscle activity during rat ultrasound vocalization

Vocal production requires complex planning and coordination of respiratory, laryngeal, and vocal tract movements, which are incompletely understood in most mammals. Rats produce a variety of whistles in the ultrasonic range that are of communicative relevance and of importance as a model system, but the sources of acoustic variability were mostly unknown. The goal was to identify sources of fundamental frequency variability. Subglottal pressure, tracheal airflow, and electromyographic (EMG) data from two intrinsic laryngeal muscles were measured during 22-kHz and 50-kHz call production in awake, spontaneously behaving adult male rats. During ultrasound vocalization, subglottal pressure ranged between 0.8 and 1.9 kPa. Pressure differences between call types were not significant. The relation between fundamental frequency and subglottal pressure within call types was inconsistent. Experimental manipulations of subglottal pressure had only small effects on fundamental frequency. Tracheal airflow patterns were also inconsistently associated with frequency. Pressure and flow seem to play a small role in regulation of fundamental frequency. Muscle activity, however, is precisely regulated and very sensitive to alterations, presumably because of effects on resonance properties in the vocal tract. EMG activity of cricothyroid and thyroarytenoid muscle was tonic in calls with slow or no fundamental frequency modulations, like 22-kHz and flat 50-kHz calls. Both muscles showed brief high-amplitude, alternating bursts at rates up to 150 Hz during production of frequency-modulated 50-kHz calls. A differentiated and fine regulation of intrinsic laryngeal muscles is critical for normal ultrasound vocalization. Many features of the laryngeal muscle activation pattern during ultrasound vocalization in rats are shared with other mammals.