Correlation between upper airway tract and lower airway tract in the break down of sinobronchiectasis

A retrospective study of 44 patients who were involved in combination with chronic sinusitis and bronchiectasis provided better understanding of the etiology in the relationship between upper air ways tract and lower air way tract. The incidence of bronchictasis was found in 5%, 3 out of 60 cases with chronic sinusitis and that of chronic sinusitis in 45%, 44 out of 98 cases with idiopathic bronchiectasis. Both side involvements of the paranasal sinus and the lung were statistically high in sinobronchiectasis compared to chronic sinusitis or bronchiectasis involved alone. The past history of the patients with sinobronchiectasis showed high occurrence of bronchial asthma or allergic rhinitis, habitual angina of the throat, acute otitis media and pneumonia. A chest X. Ray evaluation of 70 patients with chronic sinusitis alone revealed relatively high incidence of abnormal fibro-nodular shadow in the lung compared to 70 patients without chronic sinusitis. It was thought that weakness of air-way tract to infection in the patients with sinobronchiectasis might play some role on break down of sino-bronchial syndrome, a combination disease of chronic sinusitis and chronic bronchitis.     

Oropharyngeal surgery in the management of upper airway obstruction during sleep.

In the surgical management of snoring and sleep apnea, surgery to the oropharynx was the initial procedure used to treat sleep-related disorders. This article reviews both the various procedures available for this and the benefits and drawbacks of these procedures so the practitioner may be able to choose which type would be most beneficial for a particular patient.     

Treatment of dysarthria: a case report.

There is little information available to the speech clinician on management of dysarthria. This article presents the rationale, procedural outline, and results of an approach to communication training for one dysarthic subject in view of suggestions made by Darley et al. (1975).     

下颌逐步前伸中上气道形状改变的磁共振研究

目的 研究下颌逐步前伸过程中上气道形状的变化规律，了解藉改变颌位而改善通气的疗法的机制。方法 对14例无鼾成年男性，使用特制口腔装置将下颌依次前伸，从初始咬合位0(F0)，前伸50％(F50)、75％(F75)，至前伸最大量100％(F100)。在此4个位置上行上气道磁共振扫描。测量和分析上气道各段轴截面矢向径／横向径的比值、矢向径和横向径相对于初始位置的改变百分率。结果 随下颌逐步前伸，上气道轴截面矢向径／横向径的比值依次减小(P=0．0001)，横向径变化率逐步增加(P=0．0023)，而矢向径变化率的变化无统计学意义。结论 在下颌逐步前伸过程中，上气道形状有更加横向扁圆的倾向，说明下颌前伸主要横向扩张上气道。     

Endoscopic treatment of upper airway and digestive tract lesions caused by caustic agents

We present our experience in the endoscopic management of upper aerodigestive tract lesions caused by caustic agents. Between 1985 and 2000, 112 patients with upper airway and digestive tract lesions due to caustic agents were treated at the Airways Endoscopic Surgery Unit of Padua Hospital: 44 were male and 68 were female, and the median age was 42.6 years. A retrospective statistical analysis of our case series was made to evaluate the factors that most influenced the severity of injuries and the outcome of treatment. All of the patients underwent videoendoscopic assessment. In 79 cases, the patients came under our observation in the acute phase, whereas 33 presented a picture of chronic lesions. Acute lesions were classified into 3 grades. All acute grade 1 lesions healed spontaneously. In the 32 patients with grade 2 lesions, endoscopic treatment based on removal of necrotic tissue, dilations, and cleansing of abnormal fibrin adhesions resolved the disease in 30 cases (94%). Nine patients (43%) with acute grade 3 lesions developed severe chronic lesions that required subsequent treatments. Rigid endoscopy with diode laser-assisted radial lysis was performed in 32 patients with chronic cicatricial lesions and was successful in 30 cases (94%). We reiterate the need for a standardized multidisciplinary protocol for treating lesions caused by caustic agents and emphasize the essential role of airway and digestive canal videoendoscopy in the diagnosis and treatment of both the acute lesions and chronic cicatricial sequelae.     

Giant laryngoceles: a cause of upper airway obstruction

Laryngoceles and saccular cysts, which are abnormal dilatations of the laryngeal saccule, are uncommon. The etiology is unknown but is probably related to both congenital and acquired factors. These structures are usually asymptomatic and are incidentally discovered through radiographic studies for unrelated symptoms. We describe two patients with upper airway obstruction, one caused by a giant laryngocele and the other by a large saccular cyst. In the former patient, acute tracheotomy had to be performed. The laryngocele and saccular cyst were removed surgically, which relieved patients’ symptoms of upper airway obstruction. Received: 19 September 2000 / Accepted: 28 December 2000     

Artificial restoration of voice. I: Experiments in phonatory control of the reinnervated canine larynx

Coordinated electronic pacing of implanted nerve pedicles into paralyzed laryngeal muscles has allowed selective dynamic control of abduction, adduction, and elongation of the vocal cords. Modifications of the original circuit in a cervical muscle model has added fine tuning to basic "all-or-none" pacing. Rehabilitation of phonation illustrated the sophisticated nature of voice and the need for restoration of fine tuning. Five mongrel dogs received nerve-muscle pedicles into the thyroarytenoideus, cricothyroideus, and posterior cricothyroideus after denervation of one hemilarynx. Following appropriate reinnervation time, pedicles and intact recurrent laryngeal nerves were injected with currents of variable amplitudes and pulse widths to achieve graded vocal fold control while air was blown intratracheally towards the glottic chink. Videoscopic and spectral analyses indicated that artificial phonation could be restored to frequencies measured in the normal state. These experiments suggested that rehabilitation of the impaired voice by servocontrol might eventually be feasible.     

Age-related changes in motor control during articulator visuomotor tracking.

The present study provides normative data on changes in visuomotor control of the oral-facial system across the lifespan. Control of the lower lip, jaw, and larynx (i.e., fundamental frequency) was examined using a nonspeech visuomotor tracking (VMT) task, where subjects move the articulator of interest to track a moving target on an oscilloscope screen. This task examines articulator motor control during movements that are similar to speech but that do not impose linguistic units or the demands of coordinating multiple structures. Accuracy and within- and between-subject variability in tracking performance were measured by cross correlation, gain ratio, phase shift, and target-tracker amplitude difference. Cross-correlation analyses indicated that performance of children (aged 8;2 to 17;0 [years;months]) and older adults (aged 45;1 to 84;3) is poorer than that of younger adults (aged 17;1 to 45;0). Accuracy of movement amplitude tended to increase during development and decline with aging, whereas age did not appear to influence accuracy of temporal parameters in lip and jaw tracking. In contrast, age tended to influence individual variability in temporal but not amplitude parameters. Differences were noted between articulators. The data complement previous studies that considered accuracy and variability of articulator movement during speech. The VMT method and the data provided may be applied to assessment of impairments in the motor speech system and to differential diagnosis of motor speech versus linguistically based disorders.     

Prosodic control in severe dysarthria: preserved ability to mark the question-statement contrast.

Speakers with severe dysarthria are known to have reduced range in prosody. Consistent control within that range, however, has largely been ignored. In earlier investigations speakers with severe dysarthria were able to control pitch and duration for sustained vowel production despite reduced flexibility of control (Patel, 1998). The present experiment examined whether 8 speakers with severe dysarthria due to cerebral palsy used prosodic parameters of pitch contour and syllable duration for phrase-level productions. Speakers with dysarthria (N = 8) produced 3-syllable phrases as questions and statements. Na?ve listeners (N = 48) classifed dysarthric productions as either questions or statements. Listeners were able to distinguish questions from statements with accuracy levels ranging from 81% to 98%. We were also interested in studying how dysorthric speakers marked the question-statement contrast. Prosodic features of pitch contour and syllable duration were systematically removed from the original recorded vocalizations to examine the salience of these features on listener classification. Removal of pitch contour cues dramatically reduced listener accuracy scores to almost chance performance. Listeners found pitch contour cues to be information-bearing cues in dysarthric vocalizations even though the range of frequency control in these speakers may be reduced. That speakers with dysarthria were able to exert sufficient control to signal the question-statement contrast has implications for diagnostic and intervention practices aimed to optimally exploit prosodic control for enhancing communication efficiency.     

Measurement of vocal fold collision forces during phonation: methods and preliminary data.

Forces applied to vocal fold tissue as the vocal folds collide may cause tissue injury that manifests as benign organic lesions. A novel method for measuring this quantity in humans in vivo uses a low-profile force sensor that extends along the length and depth of the glottis. Sensor design facilitates its placement and stabilization so that phonation can be initiated and maintained while it is in place, with minimal interference in vocal fold vibration. In 2 individuals with 1 vibrating vocal fold and 1 nonvibrating vocal fold, peak collision force correlates more strongly with voice intensity than pitch. Vocal fold collision forces in 1 individual with 2 vibrating vocal folds are of the same order of magnitude as in previous studies. Correlations among peak collision force, voice intensity, and pitch were indeterminate in this participant because of the small number of data points. Sensor modifications are proposed so that it can be used to reliably estimate collision force in individuals with 2 vibrating vocal folds and with changing vocal tract conformations.     

Articulatory movements during vowels in speakers with dysarthria and healthy controls.

PURPOSE: This study compared movement characteristics of markers attached to the jaw, lower lip, tongue blade, and dorsum during production of selected English vowels by normal speakers and speakers with dysarthria due to amyotrophic lateral sclerosis (ALS) or Parkinson disease (PD). The study asked the following questions: (a) Are movement measures different for healthy controls and speakers with ALS or PD, and (b) Are articulatory profiles comparable for speakers with ALS and speakers with PD? METHOD: Nineteen healthy controls and 15 speakers with dysarthria participated in this study. The severity of dysarthria varied across individuals and between the 2 disorder groups. The stimuli were 10 words (i.e., seed, feed, big, dish, too, shoo, bad, cat, box, and dog) embedded into sentences read at a comfortable reading rate. Movement data were collected using the X-ray microbeam. Movement measures included distances, durations, and average speeds of vowel-related movement strokes. RESULTS: Differences were found (a) between speakers with ALS and healthy controls and (b) between speakers with ALS and PD, particularly in movement speed. Tongue movements in PD and ALS were more consistently different from healthy controls than jaw and lower lip movements. This study showed that the effects of neurologic disease on vowel production are often articulator-, vowel-, and context-specific. CONCLUSIONS: Differences in severity between the speakers with PD and ALS may have accounted for some of the differences in movement characteristics between the groups. These factors need to be carefully considered when describing the nature of speech disorder and developing empirically based evaluation and treatment strategies for dysarthria.     

Determination of phonation instability pressure and phonation pressure range in excised larynges.

PURPOSE: The present study was a methodological study designed to reveal the dynamic mechanisms of phonation instability pressure (PIP) using bifurcation analysis. Phonation pressure range (PPR) was also proposed for assessing the pressure range of normal vocal fold vibrations. METHOD: The authors first introduced the concept of bifurcation on the basis of a symmetric vocal fold model and then applied the bifurcation analysis to data from excised larynges. By recording acoustic signals from 10 excised larynges, the authors measured phonation threshold pressure (PTP), PIP, and PPR at the bifurcation pressure points from the spectrograms as subglottal pressure was progressively increased. Furthermore, to investigate the effects of vocal fold elongation on PTP, PIP, and PPR, the authors manipulated the elongation of the vocal folds at 0%, 5%, 10%, and 15% of the resting vocal fold length. RESULTS: The authors found that PTP, PIP, and PPR were effectively determined using the bifurcation analysis. When vocal fold elongation was increased from 0% to 15%, PTP was significantly increased (p < .001), PIP was not significantly changed (p = .54), and PPR was significantly decreased (p = .003). CONCLUSION: PIP and PPR represent important parameters to assess phonation instability. Bifurcation analysis represents a valuable procedure for revealing the mechanisms behind PTP, PIP, and PPR and for investigating the effects of vocal fold biomechanical parameters on these 3 pressure parameters.     

Dynamic movement of air tract fluid in lubrication of the larynx during phonation: a basic study using excised canine larynges and experimental air tract fluid by means of X-ray stroboscope system

Experiments using excised canine larynges and experimental air tract fluid were conducted to clarify the movement of air tract fluid in association with vocal fold vibration by means of X-ray stroboscope system. It was thought that the movement of air tract fluid in lubricating of the larynx during phonation was closely correlated to vocal fold vibration, especially the wave motion of the mucous membrane of the vocal folds and the movement of air tract fluid on the glottis might be one of parameters to evaluate the flexibility of the mucous membrane of the vocal folds.     

儿童上气道咳嗽综合征临床诊疗现状

儿童上气道咳嗽综合征(UACS)是临床较为常见的慢性疾病,是引起儿童慢性咳嗽的主要原因之一。由于病因复杂,发病机制尚不明确,病症、病理又牵涉儿科、耳鼻咽喉科、呼吸科及免疫科等多个学科,因此应加强科室相互合作。针对儿童UACS的流行病学状况、发病机制的最新研究、诊疗指南和治疗方案的最新进展进行综述,并对今后规范、科学、有效地诊治儿童UACS提出了新的思路和方法。     

Objective sizing of upper airway stenosis: a quantitative endoscopic approach

OBJECTIVE: In patients with airway stenosis, anatomy of the lesion determines the magnitude of the biomechanical ventilatory disturbance and thus the nature and severity of symptoms. It also gives information about biology, likelihood of response to treatment, and prognosis of laryngotracheal lesions. Accurate airway sizing throughout treatment is therefore central to managing this condition. We developed a method for objective assessment of airway lesions during endoscopy. METHODS: We used airway simulations to investigate the effects of endoscope tilt and lens distortions on measurement accuracy, devising and validating clinical rules for quantitative airway endoscopy. A calibrator was designed to assess lesion length, location, and cross-section during tracheoscopy. RESULTS: It proved possible to calculate the length and location of the stenosis using simple mathematics. Cross-section measurements were more than 95% accurate, independent of endoscope tilt and without making assumptions about endoscope optics and visuospatial distortion, for both pediatric and adult airway dimensions. The technique was used to characterize airway lesions in 10 adult patients with an average age of 48 years undergoing therapeutic laryngotracheoscopy. Lesions occurred on average 36 mm below the glottis (range, 21-54 mm) and were 9.3 mm long (5-17 mm). The average pretreatment airway cross-section was 48.3 mm, increasing to 141.1 mm after laser therapy. Two independent observers calculated airway cross-sections, achieving an interobserver concordance of 0.98. CONCLUSIONS: This method can be used to objectively and precisely determine the anatomy of airway lesions, allowing accurate documentation of lesion characteristics and surgical results, serial monitoring throughout treatment, and comparison of outcomes between different centers.     

Breath-group intelligibility in dysarthria: characteristics and underlying correlates.

PURPOSE: This study was designed to determine whether within-speaker fluctuations in speech intelligibility occurred among speakers with dysarthria who produced a reading passage, and, if they did, whether selected linguistic and acoustic variables predicted the variations in speech intelligibility. METHOD: Participants with dysarthria included a total of 10 persons with Parkinson's disease and amyotrophic lateral sclerosis; a control group of 10 neurologically normal speakers was also studied. Each participant read a passage that was subsequently separated into consecutive breath groups for estimates of individual breath group intelligibility. Sixty listeners participated in 2 perceptual experiments, generating intelligibility scores across speakers and for each breath group produced by speakers with dysarthria. RESULTS: Individual participants with dysarthria had fluctuations in intelligibility across breath groups. Breath groups of participants with dysarthria had fewer average words and reduced interquartile ranges for the 2nd formant, the latter a global measure of articulatory mobility. Regression analyses with intelligibility measures as the criterion variable and linguistic and acoustic measures as predictor variables produced significant functions both within and across speakers, but the solutions were not the same. CONCLUSIONS: Linguistic or acoustic variables that predict across-speaker variations in speech intelligibility may not function in the same way when within-speaker variations in intelligibility are considered.