Colin Painter

The transformation of laryngeal keratosis into invasive carcinoma.

Although 93.0% to 97.0% of all laryngeal carcinomas are diagnosed on the first biopsy, 3.0% to 6.7% of them occur in patients who have what is initially diagnosed as laryngeal keratosis. To study this phenomenon, we examined data from 1,019 patients with laryngeal keratosis seen between 1962 and 1981. Eleven patients with keratosis and initially undetected cancer at different laryngeal sites were excluded, as were 87 outside referrals for whom no records were available beyond the histologic report. The remaining 921 patients were classified on the basis of the initial histologic findings into groups comprising 604 patients with keratosis without atypia (group 1), 204 patients with mild atypia (group 2), 23 patients with moderate atypia (group 3), and 90 patients with severe atypia (group 4). All 921 were followed for from 5 to 25 years. Invasive carcinoma of the larynx developed in 18 patients from group 1 (3.0%), 15 from group 2 (7.4%), four from group 3 (17.4%), and 25 from group 4 (27.8%). Fifty-seven patients (91.9%) developed invasive carcinoma after less than 10 years but only five (8.1%) did so after 10 years or more.

Assessment of Two Objective Voice Function Indices

In the care of patients with voice disorders, physicians, speech pathologists, and other health care professionals routinely make diagnoses, recommend treatment, and evaluate outcomes. Although objective and subjective measures exist, unfortunately, there is no widely accepted, valid method for classifying voice disorders and assessing outcome after voice treatment. In the present research, the relationship between two previously created multivariate objective voice function indices, the weighted odds ratio index and the multivariate logistic regression index, and subjective assessment of voice function was evaluated. Twenty-three adult patients presenting to a speech science laboratory for evaluation of voice disorders were studied in this prospective observational study together with 12 normal volunteers as controls. Vocal function was measured on 14 different parameters with a protocol that included a multichannel input for simultaneous assessment of acoustic and physiological parameters. Each patient was recorded reading the standard passage “The North Wind and the Sun,” and recordings were then evaluated by the GRBAS scale. Overall, there was a statistically significant relationship between the weighted odds ratio index and multivariate logistic regression index and mean GRBAS scores. This research demonstrates that the voice function values calculated from two different multivariate objective voice function indices are significantly associated with subjective voice assessments. These multivariate objective voice indices may be appropriate for use in clinical trials and outcomes research on treatment effectiveness for voice disorders.

Multivariate analysis of objective vocal function.

No standard and valid multidimensional index of objective voice function has been developed that integrates the information generated from the multiple objective parameters of voice function. The goals of this research were 1) to identify important objective voice parameters and 2) to create a multidimensional voice function index by combining relevant parameters. We evaluated 97 dysphonic patients and 35 normal volunteers on 14 objective voice parameters. Three multidimensional voice indices were created and evaluated: 1) nonweighted univariate index, 2) weighted odds ratio index, and 3) weighted multivariate regression index. The univariate index required all 14 parameters, while the odds ratio and logistic regression models required only 4 parameters (frequency range, airflow at lips, maximum phonation time, and subglottic pressure). The χ2 values for the 3 models were 37.8, 37.6, and 46.0, respectively. All 3 indices were able to satisfactorily classify voice function as normal or abnormal. However, the regression index performed best.

Clinical and histopathological considerations for the diagnosis and treatment of verrucous carcinoma of the larynx

SummaryVerrucous carcinoma of the larynx is quite distinct from well-differentiated squamous cell carcinoma and has a characteristic morphology and specific clinical behavior. It accounts for approximately l%–2% of all laryngeal carcinomas. However, difficulties are encountered clinically in separating verrucous carcinomas from keratoses, verruca vulgaris and squamous cell carcinomas with a verrucous appearance. Between 1962 and 1982, 1504 patients with squamous cell carcinomas of the larynx were diagnosed and treated by staff physicians in the Department of Otolaryngology — Head and Neck Surgery, Washington University in St. Louis. Fifteen of these patients (1%) had verrucous carcinomas. These cases were studied in order to clarify any diagnostic problems, trace the biologic behavior of the tumors and report the results of the treatment used. Of these 15 patients, we were able to follow up 8. The latter had been treated only with surgery and none of them had received radiotherapy. One death occurred, but the patient died of other causes and remained free of cancer. Reports in the literature describe a high rate of recurrence of verrucous carcinomas following radiotherapy with occasional anaplastic transformation of tumors. No patients in our series developed a metastasis in the neck, indicating that neck dissection is not justified for patients with these neoplasms even though clinically enlarged neck nodes may be present.

Semi-automated voice evaluation

This report describes a voice evaluation procedure that in some way parallels the audiologic tests used for hearing and has multiple uses both clinically and in research. It uses a simultaneous eight-channel input, is not difficult to use, requiring between 12 and 25 minutes to administer, and provides the physician with a printout in standardized form before the patient leaves the room. This three-page report includes 15 abstracted or calculated values, normal ranges by sex for each value, notes that draw attention to deviations from the normal, a summary profile, a graphic representation of the evaluation, and raw data waveforms.

Laryngeal configuration of 99 dysphonic patients

SummaryThe aim of this investigation was to study a wide range of dysphonic patients and determine the best matches among the laryngeal configurations on phonation for each patient and those previously established for control data, which were obtained from a professional voice user producing the whole range of voice qualities. Ninety-nine patients were selected and laryngeal photographs were produced for each patient. Fifteen laryngeal parameters were quantified and normalized. The data were sorted, scalar values assigned and a measure of similarity between configurations applied. The best, second-best, third-best and worst matches between each patient separately and the control data were then examined. Although 41% of the patients did not have particularly unusual configurations, 59% exhibited a narrowing of the laryngeal vestibule caused by epiglottic retraction, cuneiform fronting and/or false fold adduction. This suggests that clinical reports for patients with dysphonia should contain information not only on any lesions present but also on laryngeal configurations and, in particular, vestibular narrowing.

The incidence of voice disorders.

SummaryThis report summarizes the log book for patients with voice disorders treated at Washington University in St. Louis between 1984 and 1988. Our experience with these 764 patients is expressed as the number of visits for each problem type.

Human Speech Development for an Implantable Artificial Larynx

An electromagnetic artificial larynx was implanted in two volunteer laryngectomees. Both patients were able to communicate well, but the voice quality still needed improving. Therefore, in this investigation, listener judgments were obtained of 22 different sound sources with a view to incorporating the preferred speech sound in a new version of the device. Electroglottograms were used as sound sources in a speech synthesizer and sentences were produced with different voice qualities for judgmental tests. The results of the listening tests showed a distinct preference for waveforms corresponding to a long completely open phase, a very brief completely closed phase, and an abrupt closing gesture. The optimum acoustic characteristics for the device will be used by electrical engineers to manufacture a new version of the artificial larynx with an improved voice quality.

The laryngeal vestibule, voice quality and paralinguistic markers.

SummaryThe laryngeal component of voice quality markers has been quantified in the present study, suggesting that the laryngeal vestibule and lower pharynx play an important role in voice quality. Findings also show that voice quality can be partly described in terms of laryngeal configurations and that a knowledge of these configurations may be useful to the laryngologist, speech pathologist and singer. Twenty-five voice qualities were videorecorded, using a nasal fiberscope. Still photographs were taken for each voice quality and distance measurements made on each one for 15 laryngeal parameters. The raw data were normalized, sorted from high to low, turned into scalar values and processed to establish which parameters exhibited similar functions, which photographs were essentially identical, and in what respect any two photographs were different. Each voice quality was seen to be associated with a different, describable and quantifiable laryngeal configuration.

Electroglottogram waveform types of untrained speakers.

SummaryElectroglottography is a useful, non-invasive technique that can assist in the assessment of vocal fold dysfunction. However, if it is to become a useful clinical tool, there is a need for normative studies of the electroglottogram waveform types that characterize different groups of speakers. This report compares the electroglottogram waveform types characterizing one trained professional voice user phonating in 15 experimental sessions under various fundamental frequencies, intensities and voice qualities with those obtained from 52 untrained non-professional speakers.