Eberhard Kruse

Stroboscopy versus high-speed glottography: a comparative study.

Objectives: To evaluate and to compare the diagnostic value of videostroboscopy (VS) and high‐speed glottography (HGG) in dysphonic patients.

Human Cortical Motor Representation of the Larynx as Assessed by Transcranial Magnetic Stimulation (TMS)

Objectives: To analyze characteristic features and details on motor‐evoked potentials (MEPs) of the cricothyroid and vocalis muscles from single‐pulse cortical transcranial magnetic stimulation (TMS) in normal subjects to characterize cortical motor representation of laryngeal muscles.

Do Women's Voices Provide Cues of the Likelihood of Ovulation? The Importance of Sampling Regime

The human voice provides a rich source of information about individual attributes such as body size, developmental stability and emotional state. Moreover, there is evidence that female voice characteristics change across the menstrual cycle. A previous study reported that women speak with higher fundamental frequency (F0) in the high-fertility compared to the low-fertility phase. To gain further insights into the mechanisms underlying this variation in perceived attractiveness and the relationship between vocal quality and the timing of ovulation, we combined hormone measurements and acoustic analyses, to characterize voice changes on a day-to-day basis throughout the menstrual cycle. Voice characteristics were measured from free speech as well as sustained vowels. In addition, we asked men to rate vocal attractiveness from selected samples. The free speech samples revealed marginally significant variation in F0 with an increase prior to and a distinct drop during ovulation. Overall variation throughout the cycle, however, precluded unequivocal identification of the period with the highest conception risk. The analysis of vowel samples revealed a significant increase in degree of unvoiceness and noise-to-harmonic ratio during menstruation, possibly related to an increase in tissue water content. Neither estrogen nor progestogen levels predicted the observed changes in acoustic characteristics. The perceptual experiments revealed a preference by males for voice samples recorded during the pre-ovulatory period compared to other periods in the cycle. While overall we confirm earlier findings in that women speak with a higher and more variable fundamental frequency just prior to ovulation, the present study highlights the importance of taking the full range of variation into account before drawing conclusions about the value of these cues for the detection of ovulation.

Cortical Sensorimotor Control in Vocalization : A Functional Magnetic Resonance Imaging Study

Background: Verbal communication is a human feature and volitional vocalization is its basis. However, little is known regarding the cortical areas involved in human vocalization.

Spasmodic laryngeal dyspnea: a rare manifestation of laryngeal dystonia

We describe clinical experiences in the management of three patients with laryngopharyngeal dystonia causing severe breathing problems. In contrast to spasmodic dysphonia, which presents with action-induced involuntary spasms of laryngeal muscles during speaking, all three patients showed laryngopharyngeal spasms primarily during respiration. In analogy to spasmodic dysphonia we propose the term spasmodic laryngeal dyspnea for this rare condition. Localized unilateral botulinum toxin injected into the thyroarytenoid muscle and /or ventricular folds reduced the quantity and quality of spasms and led to a pronounced improvement of breathing problems.

Objektive Beschreibung der Stimmgüte unter Verwendung des Heiserkeits-Diagramms

ZusammenfassungDie Bedeutung der objektivierbaren Stimmgütebeschreibung spiegelt sich im zunehmendem Einsatz akustischer Analsyemethoden in der klinischen Diagnostik und Forschung wider. Das Heiserkeits-Diagramm ermöglicht die akustische Stimmgütebeschreibung auch hochgradig gestörter Stimmen bis hin zur Aphonie. Die Objektivierbarkeit der Stimmqualitätsverbesserung bei postoperativer Stimmtherapie wird an 3 Fallbeispielen verdeutlicht. Des weiteren wird die Differenzierbarkeit pathophysiologisch definierter Gruppen basierend auf den Ergebnissen der akustischen Analyse untersucht. Dabei werden einerseits verschiedene Phonationsmechanismen nach Tumorresektion, andererseits verschiedene laryngeale Lähmungsformen einander gegenübergestellt. Die Ergebnisse führen zu der Interpretation, daß die Koordination des Heiserkeits-Diagramms direkt die Irregularität der Stimmlippenschwingung einerseits und die Qualität des glottalen Schlusses andererseits widerspiegeln. In diesem Zusammenhang ist auch der potentielle Nutzen des Heiserkeits-Diagramms in der klinischen Anwendung und Forschung zu sehen.SummaryThe need for an objective assessment of voice quality can be seen in the increasing use of acoustic analysis methods for clinical diagnosis and research. The hoarseness diagram allows clinicians to objectively describe even highly disturbed or aphonic voices. Its application possibilities are illustrated in three case studies in which changes in voice quality were monitored during voice rehabilitation. The distributions of voice groups that were defined on the basis of specific pathophysiological phonation conditions were then compared for their acoustic differences. The groups comprised various phonation conditions after the resections of laryngeal tumors and different types of laryngeal paralyses. Interpretation of the results suggests a direct correspondence of the hoarseness diagram coordinates and the irregularity of vibration on the one side and the degree of glottal closure on the other. This illustrates the potential usefulness of the hoarseness diagram in a clinical context.

Functional anatomy of the recurrent and superior laryngeal nerve

Background and aimsThe purpose of this study was to present the current topographic and anatomical knowledge in neurolaryngology, with special regard to laryngeal paralyses as a major complication in thyroid surgery.Patients and methodsMicroscopic anatomical preparation of 22 human hemilarynges was accomplished.ResultsDue to their neuroanatomical courses, the following extralaryngeal nerves may be at risk in thyroid surgery: the external branch of the superior laryngeal nerve, the paralaryngeal part of the vagal nerve, the Ansa Galeni, the trunk of the recurrent laryngeal nerve (RLN) and the delicate branches of the RLN to the posterior cricoarytaenoid muscle. The anterior and posterior branches of the RLN (antRLN and postRLN) are less endangered by thyroid surgery because they are covered by the thyroid cartilage and posterior cricoarytaenoid muscle (PCA), respectively. In contrast, the antRLN is vulnerable if a ventilation tube is dislocated, with cuff-induced pressure to the glottic level.ConclusionThe increased knowledge in neurolaryngology provides the basis for a selective neuromonitoring to lower the risk of laryngeal paralyses after thyroid surgery.

Successful treatment of autophonia with botulinum toxin: case report.

Objectives: We sought to treat autophonia due to a patulous eustachian tube using botulinum toxin. Methods: Because we assumed that the patulous eustachian tube was caused by abnormal activity of paratubal muscles (tensor and levator veli palatini muscles and salpingopharyngeus muscle), paralysis was performed via injection of botulinum toxin type A in a 45-year-old female professional musician who had had chronic unilateral autophonia for 20 years. In addition to a patient interview, an endoscopic examination of the nasopharynx (posterior rhinoscopy), ear microscopy, and impedance audiometry were performed to verify the diagnosis and the outcome after treatment. Results: The autophonia disappeared 1 week after treatment. Normalized tympanic ventilation was verified by impedance audiometry after 8 weeks. The period of symptom relief was 9 months. Conclusions: The administration of botulinum toxin type A provides a new option in the treatment of patulous eustachian tube. The reliability of this method and the effect of repeated injections remains to be proved in future studies.

Psychological profiles of patients with laryngeal contact granulomas

Abstract The association between laryngeal contact granuloma and demographic/psychological variables was examined by using a psychosomatic approach to health research. A stepwise procedure of logistic regression analyses was utilized to get a final multivariate model of variables associated with the clinical finding of a laryngeal contact granuloma. The subjects consisted of 47 patients with contact granulomas and 110 patients with voice disorders due to other causes. Our analysis of 22 variables uncovered the following statistically significant factors for developing a contact granuloma: male gender (P = 0.0001), low achievement orientation (P = 0.0007), fear of physical lesions (P = 0.0038), impulsiveness (P = 0.0016), age > 60 years (P = 0.0012), low extraversion (P = 0.004), high achievement orientation (P = 0.0079), fear of appearing in public (P = 0.0216) and strain (P = 0.03). These results show that a variety of variables are important for predicting the development of a laryngeal contact granuloma. The usefulness of this set of risk variables for predicting a contact granuloma remains to be proved in a prospective study. It is possible that not only the nature but the number of risk factors are the prime determinants of outcome.

The Supraglottic Nerve Supply: An Anatomic Study With Clinical Implications

Objectives: To describe the course of the superior laryngeal nerve (SLN) and its branches, in particular, with regard to supraglottic motor and sensory functions.