Psychiatric comorbidity in patients with spasmodic dysphonia: a controlled study

OBJECTIVES: To study the prevalence of psychiatric comorbidity assessed by a structured clinical interview in patients with spasmodic dysphonia (SD) compared with patients suffering from vocal fold paralysis (VFP). METHODS: In 48 patients with SD and 27 patients with VFP, overall psychiatric comorbidity was studied prospectively using the Structured Clinical Interview for DSM-IV Axis I disorders. Physical disability and psychometric variables were assessed with standardised self-rating questionnaires. RESULTS: 41.7% of SD subjects and 19.5% of the control group met DSM-IV clinical criteria for current psychiatric comorbidity (p<0.05). Significant predictors of psychiatric comorbidity in SD were severity of voice impairment and subjective assessment of "satisfaction with health". As a limitation, the severity of voice impairment in patients with SD was nearly twice as high, and their illness had lasted nearly twice as long. CONCLUSIONS: We found a high prevalence of psychiatric comorbidity in patients with SD. The significant correlation between current psychiatric comorbidity and the extent of voice pathology may point to an especially strong interaction between somatic and psychiatric complaints in SD.

The use of polydimethylsiloxane for injection laryngoplasty

BACKGROUND: Injuries of the recurrent laryngeal nerve with consecutive vocal cord paralysis is a typical complication in chest, esophageal, thyroideal, and neck surgery. Glottic insufficiency secondary to such a lesion can be treated by endolaryngeal vocal cord augmentation (injection laryngoplasty). Many different substances have been used, often showing complications or disadvantages. This study reports on the use of injectable polydimethylsiloxane (PDMS), with special regard to the long-term results. METHODS: In this prospective study, 21 patients with unilateral vocal cord paralysis underwent injection laryngoplasty using PDMS at a volume of 0.5-1.0 ml. Preoperatively, 6 weeks and 12 months after the injection the following parameters concerning patients' voice were evaluated: Glottic closure by videolaryngostroboscopy, maximum phonation time, voice range, voice dynamic, jitter, shimmer, noise-to-harmonic-ratio, and roughness, breathiness, and hoarseness (RBH). In addition, patients were asked to give their own evaluation of how satisfied they felt with their voice and of the handicaps it caused them. RESULTS: Postoperatively an improvement was evident in all the parameters that were investigated, and this significant improvement was still in evidence for most of the parameters more than one year after the injection. In our study no complications were observed more than one year after injection. CONCLUSION: PDMS is a safe substance for injection laryngoplasty in unilateral vocal cord paresis. Objective and subjective parameters confirm its effectiveness. It is suitable for obtaining satisfying results in the reestablishment of the patient's voice and communication ability.

Microscopic wire guide-based orotracheal mouse intubation: description, evaluation and comparison with transillumination

Airway access is needed for a number of experimental animal models, and the majority of animal research is based on mouse models. Anatomical conditions in mice are small, and the narrow glottic opening allows intubation only with a subtle technique. We therefore developed a microscopic endotracheal intubation method with a wire guide technique in mice anaesthetized with halothane in oxygen. The mouse is hung perpendicularly with its incisors on a thread fixed on a vertical plate. The tongue is placed with a pair of forceps between the left hand's thumb and forefinger and slightly pulled, while the neck and thorax are positioned using the third and fourth fingers. By doing so, the neck can be slightly stretched, which allows optimal visualization of the larynx and the vocal cords. To ensure a safe intubation, a fine wire guide is placed under vision between the vocal cords and advanced about 5 mm into the trachea. An intravenous 22G x 1 in. plastic or Teflon catheter is guided over this wire. In a series of 41 mice, between 21 and 38 g, the success rate for the first intubation attempt was >95%. Certainty of the judgement procedure was 100% and success rate was higher using the described method when compared with a transillumination method in a further series. The technique is safe, less invasive than tracheostomy and suitable for controlled ventilation and pulmonary substance application.

Strangulation signs: initial correlation of MRI, MSCT, and forensic neck findings

PURPOSE: To evaluate multislice spiral computed tomography (MSCT) and magnetic resonance imaging (MRI) findings in hanging and manual strangulation cases and compare them with forensic autopsy results. MATERIALS AND METHODS: Postmortem MSCT and MRI of nine persons who died from hanging or manual strangulation were performed. The neck findings were compared with those discovered during forensic autopsy. In addition, two living patients underwent imaging and clinical examination following severe manual strangulation and near-hanging, respectively. For evaluation, the findings were divided into "primary" (strangulation mark and subcutaneous desiccation (i.e., soft-tissue thinning as a result of tissue fluids being driven out by mechanical compression) in hanging, and subcutaneous and intramuscular hemorrhage in manual strangulation) and "collateral" signs. The Wilcoxon two-tailed test was used for statistical analysis of the lymph node and salivary gland findings. RESULTS: In hanging, the primary and most frequent collateral signs were revealed by imaging. In manual strangulation, the primary findings were accurately depicted, with the exception of one slight hemorrhage. Apart from a vocal cord hemorrhage, all frequent collateral signs could be diagnosed radiologically. Traumatic lymph node hemorrhage (P = 0.031) was found in all of the manual strangulation cases. CONCLUSION: MSCT and MRI revealed strangulation signs concordantly with forensic pathology findings. Imaging offers a great potential for the forensic examination of lesions due to strangulation in both clinical and postmortem settings.

Functional hoarseness in children: short-term play therapy with family dynamic counseling as therapy of choice

Children with nonorganic voice disorders (NVDs) are treated mainly using direct voice therapy techniques such as the accent method or glottal attack changes and indirect methods such as vocal hygiene and voice education. However, both approaches tackle only the symptoms and not etiological factors in the family dynamics and therefore often enjoy little success. The aim of the "Bernese Brief Dynamic Intervention" (BBDI) for children with NVD was to extend the effectiveness of pediatric voice therapies with a psychosomatic concept combining short-term play therapy with the child and family dynamic counseling of the parents. This study compares the therapeutic changes in three groups where different procedures were used, before intervention and 1 year afterward: counseling of parents (one to two consultations; n = 24), Brief Dynamic Intervention on the lines of the BBDI (three to five play therapy sessions with the child plus two to four sessions with the parents; n = 20), and traditional voice therapy (n = 22). A Voice Questionnaire for Parents developed by us with 59 questions to be answered on a four-point Likert scale was used to measure the change. According to the parents' assessment, a significant improvement in voice quality was achieved in all three methods. Counseling of parents (A) appears to have led parents to give their child more latitude, for example, they stopped nagging the child or demanding that he/she should behave strictly by the rules. After BBDI (B), the mothers were more responsive to their children's wishes and the children were more relaxed and their speech became livelier. At home, they called out to them less often at a distance, which probably improved parent-child dialog. Traditional voice therapy (C) seems to have had a positive effect on the children's social competence. BBDI seems to have the deepest, widest, and therefore probably the most enduring therapeutic effect on children with NVD.

Altered structure of cortical sulci in gilles de la Tourette syndrome: Further support for abnormal brain development.

Gilles de la Tourette syndrome is a neurodevelopmental disorder characterized by the presence of motor and vocal tics. We hypothesized that patients with this syndrome would present an aberrant pattern of cortical formation, which could potentially reflect global alterations of brain development. Using 3 Tesla structural neuroimaging, we compared sulcal depth, opening, and length and thickness of sulcal gray matter in 52 adult patients and 52 matched controls. Cortical sulci were automatically reconstructed and identified over the whole brain, using BrainVisa software. We focused on frontal, parietal, and temporal cortical regions, in which abnormal structure and functional activity were identified in previous neuroimaging studies. Partial correlation analysis with age, sex, and treatment as covariables of noninterest was performed amongst relevant clinical and neuroimaging variables in patients. Patients with Gilles de la Tourette syndrome showed lower depth and reduced thickness of gray matter in the pre- and post-central as well as superior, inferior, and internal frontal sulci. In patients with associated obsessive-compulsive disorder, additional structural changes were found in temporal, insular, and olfactory sulci. Crucially, severity of tics and of obsessive-compulsive disorder measured by Yale Global Tic severity scale and Yale-Brown Obsessive-Compulsive scale, respectively, correlated with structural sulcal changes in sensorimotor, temporal, dorsolateral prefrontal, and middle cingulate cortical areas. Patients with Gilles de la Tourette syndrome displayed an abnormal structural pattern of cortical sulci, which correlated with severity of clinical symptoms. Our results provide further evidence of abnormal brain development in GTS. © 2015 International Parkinson and Movement Disorder Society.

Postmortem diagnostics using MSCT and MRI of a lethal streptococcus group A infection at infancy: a case report.

Postmortem cross-sectional imaging using multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) was considered as a base for a minimal invasive postmortem investigation in forensic medicine such as within the Virtopsy approach. We present the case of a 3-year-old girl with a lethal streptococcus group A infection and the findings of postmortem imaging in this kind of natural death. Postmortem MSCT and MRI revealed an edematous occlusion of the larynx at the level of the vocal cords, severe pneumonia with atelectatic parts of both upper lobes and complete atelectasis of both lower lobes, purulent fluid-filled right main bronchus, enlargement of cervical lymph nodes and pharyngeal tonsils, and additionally, a remaining glossopharyngeal cyst as well as an ureter fissus of the right kidney. All relevant autopsy findings could be obtained and visualized by postmortem imaging and confirmed by histological and microbiological investigations supporting the idea of a minimal invasive autopsy technique.

Final Syllable Lengthening (FSL) in Infant Vocalizations

Final Syllable Lengthening (FSL) has been extensively examined in infant vocalizations in order to determine whether its basis is biological or learned. Findings suggest there may be a U-shaped developmental trajectory for FSL. The present study sought to verify this pattern and to determine whether vocal maturity and deafness influence FSL. Eight normally hearing infants, aged 0 ; 3 to 1 ; 0, and eight deaf infants, aged 0 ; 8 to 4 ; 0, were examined at three levels of prelinguistic vocal development: precanonical, canonical, and postcanonical. FSL was found at all three levels suggesting a biological basis for this phenomenon. Individual variability was, however, considerable. Reduction in the magnitude of FSL across the three sessions provided some support for a downward trend for FSL in infancy. Findings further indicated that auditory deprivation can significantly affect temporal aspects of infant speech production.

El niño cantor : aspectos musicales y fisiológicos de la voz cantada infantil

La necesidad de estudiar la voz infantil se desprende del reconocimiento de las características anatómicas y fisiológicas distintivas del órgano vocal de los niños y su relación con el entrenamiento vocal. En el presente trabajo intentaremos describir dichas peculiaridades en la voz infantil cantada y hablada para obtener una serie de pruebas objetivas que sirvan como medio de evaluación de la voz de los niños de Mendoza.

La preciosura del canto : análisis del pasaje de la voz cantada

Se analiza el denominado "pasaje de la voz cantada" en cantantes medianamente entrenados y muy entrenados con el objeto de descubrir el mecanismo laríngeo de producción del mismo e intentando determinar cuál es el pasaje principal de la voz cantada. A tal fin se analiza la extensión vocal de los cantantes a partir de la producción de Escalas ascendentes y descendentes y se somete este estudio a un análisis perceptual realizado por un profesor de canto. Se analizan objetivamente la producción de glissandos ascendentes y descendentes extrayendo de ellos las componentes armónicas, las curvas de frecuencia y las curvas de intensidad. Posteriormente se analiza la vibración cordal en toda la extensión vocal a través de una electroglotografía laringea. Se comparan los resultados objetivos y subjetivos entre sí.

El signo interpretativo en las obras para canto y piano mendocinas : abordaje interdisciplinario

Fil: Poblet de Merenda, María Mirtha. Universidad Nacional de Cuyo. Facultad de Artes y Diseño

La integración cuerpo-voz en la formación universitaria del actor

Esta publicación se encuadra dentro de la investigación “Análisis del desarrollo vocal de los alumnos de Arte Dramático", efectuada durante cuatro años a los alumnos de la Licenciatura en Arte Dramático y Profesorado de Teatro de la Facultad de Artes y Diseño de la UnCuyo. Consistió en el seguimiento de las actividades de aprendizaje en las materias Corporales, Vocales y Actuación con la finalidad de encontrar las relaciones intrincadas entre el cuerpo y la voz en el actor para la elaboración de un marco teórico referente. El diseño de investigación se inscribe en el estudio de casos múltiples dentro de la metodología cualitativa. Los métodos de recolección de información fueron la observación no participante de videos de procesos y exámenes de los alumnos y las entrevistas a profesores y personas clave. Se efectuó una triangulación en el proceso de análisis entre los profesores de Vocales y Corporales logrando determinar una serie de indicadores que se consideran fundamentales para la integración cuerpo- voz en el actor.

Actividad antioxidante de los compuestos fenólicos contenidos en las semillas de la vid (vitis vinifera l.)

El propósito de este trabajo es obtener un antioxidante natural a partir de las semillas de uva (Vitis vinifera L.), para emplear en alimentos. Para ello se compararon distintos solventes para la extracción de fenoles de las semillas de la uva, de modo de obtener el extracto más concentrado en compuestos activos con la mínima degradación de su poder antioxidante durante el proceso de obtención. La concentración de fenoles totales de los extractos se determinó por el método Folin Ciocalteu. El poder reductor de los extractos se midió empleando el método de Oyaizu. Una vez seleccionado el solvente más adecuado para la extracción, se analizó la cinética de extracción, optimizando el tiempo de tratamiento. El extracto fue concentrado al vacío, y se veríficó la conservación del poder reductor en el extracto concentrado, por el método de Oyaizu. El extracto de semillas concentrado y sin concentrar se empleó en un sistema real sujeto a oxidación, tal como el jugo de manzanas. El grado de oxidación del jugo se midió por el método de Özoglu. El extracto concentrado fue deshidratado por secado en lecho de espuma y por liofilizado. En ambos casos se verificó el efecto del tratamiento de secado sobre el poder reductor. Finalmente, se evaluó la actividad antioxidante del extracto líquido concentrado de semillas de vid, respecto de otros antioxidantes comerciales como ácido ascórbico y dióxido de azufre. El sustrato oxidable fue el jugo de manzanas, y el grado de oxidación se midió por el método de Özoglu. El análisis estadístico de los datos se realizó mediante el análisis de la varianza; cuando no fue posible emplear el mencionado análisis, debido a que no se verificaban los supuestos básicos para su aplicación, se empleó la prueba de Kruskal –Wallis. En todos los casos, se utilizó el programa Statgraphics plus ®4.0. Para obtener un extracto antioxidante a partir de semillas de vid se utilizó una ex-tracción con agua a 90ºC, durante 4 horas. La relación sólido- líquido empleada fue de 1g de semillas enteras por 10 ml de solvente. El extracto obtenido presentaba una concentración de 12,587 mg de fenoles totales por gramo de semillas de uva extractadas y un poder reductor de 1,290 unidades. Como consecuencia del análisis de la cinética de extracción, el tiempo de tratamiento se redujo de 4 horas a 3 horas. La concentración del extracto se realizó al vacío a 60ºC, verificándose un aumen-to del poder reductor en el extracto concentrado, comprobado sobre jugo de manzanas. Comparando el extracto concentrado y el extracto sin concentrar se observa que la concentración de fenoles totales aumentó 29,57 veces, mientras que el poder reductor aumentó 37,39 veces. El deshidratado del extracto por medio del lecho de espuma permitió conservar el poder reductor del mismo, no ocurrió lo mismo en el deshidratado por liofilizado, donde se produjo un deterioro del poder reductor. Para un mismo contenido de fenoles totales agregado al jugo de manzanas, el ex-tracto líquido sin concentrar produjo un 28,4% de inhibición de la oxidación, mientras que el de extracto líquido concentrado produjo un 51,5 % de inhibición de la oxidación del jugo de manzanas. El extracto de semillas de vid, aplicado como antioxidante en jugo de manzanas, inhibió el desarrollo de la oxidación en un 31,51%, considerando 24 horas el tiempo de tratamiento. Este desempeño supera al ácido ascórbico, que en iguales condiciones, inhibió el desarrollo de la oxidación en un 2,6%. Pero en las condiciones de tra-bajo, el dióxido de azufre resulta mejor antioxidante que ambos, ya que logró inhibir el desarrollo de la oxidación en un 97,40 %.

La muda de la voz en niños cantores y no cantores : análisis de la rotura de registros

La mayor parte de los estudios sobre la mutación vocal se ha focalizado sobre las variaciones de la frecuencia fundamental del habla en relación con la edad, el peso, la altura, el vello axilar y pubiano y el nivel de testosterona en sangre. Los maestros de canto y los vocólogos que trabajan con voces infantiles, ya sean cantadas o habladas, deberían conocer profundamente las características de la mutación vocal. Con esa finalidad, llevamos a cabo un estudio de seguimiento longitudinal de 18 niños (9 cantores y 9 no cantores) durante 18 meses. Efectuamos,además, un estudio transversal por rangos de edad a 98 niños y jóvenes. Todos los sujetos fueron examinados a través de un examen perceptual y de un examen acústico luego de un examen ORL normal. Los resultados muestran que las roturas de registro desde el falsete al modal, a través de la producción de un glissando descendente, son el signo más importante de mutación desde un punto de vista perceptual. Estas roturas son independientes del entrenamiento vocal y ocurren tanto en cantores como en no cantores de la misma manera. Las roturas de registro determinan otra serie de características como el estrechamiento del rango fonacional, las roturas de voz y el descenso excesivo de la frecuencia fundamental del habla. Las roturas de registro producidas a través de un glissando descendente son muy llamativas durante el período crítico de mutación. No aparecen en las voces infantiles ni en las voces adultas saludables, sean estas voces con o sin entrenamiento. La mutación vocal de los niños varones atraviesa los siguientes estadíos: período pre-mutacional, comienzos de mutación, período crítico y período fi nal; cada estadio evidencia sus características distintivas tanto desde el punto de vista perceptual como acústico.