Fatih Ogut

A Multivariate Analysis of Objective Voice Changes After Thyroidectomy Without Laryngeal Nerve Injury

OBJECTIVE To evaluate the impact of thyroidectomy and the possible effects of factors such as patient sex, operation type, and surgeon experience on objective voice parameters of patients undergoing thyroidectomy without laryngeal nerve injury. DESIGN Prospective study. SETTING University hospital. PATIENTS Thirty-six patients undergoing primary thyroidectomy because of thyroid disease. MAIN OUTCOME MEASURES The effect of thyroidectomy on voice was examined by recording the voices of the patients before and 1 week after thyroidectomy. The Multi-Dimensional Voice Program was used for capturing and analyzing the voice samples. RESULTS On postoperative examination of objective voice changes, thyroidectomy had no multivariate effect on the combination of voice parameters. Patient sex, type of surgery, and surgeon experience had no effect on the combination of voice parameters before and after thyroidectomy. Regardless of within-patient factors (type of surgery, patient sex, and surgeon experience), 4 acoustic parameters (highest fundamental frequency, standard deviation of average fundamental frequency, phonatory average fundamental frequency range in semitones, and degree of subharmonics) significantly decreased after thyroidectomy (P < .05). Although they tended to be worse, none of the acoustic parameters showed significant changes in male patients. However, significant changes in some of the acoustic parameters of female patients were observed. Highest fundamental frequency, standard deviation of average fundamental frequency, phonatory average fundamental frequency range in semitones, absolute jitter, relative average perturbation, pitch perturbation quotient, shimmer in decibels, percentage of shimmer, amplitude perturbation quotient, noise to harmonic ratio, and degree of subharmonics values were all lower in female patients after thyroidectomy (P < .05). CONCLUSIONS Voice changes may occur after thyroidectomy without any evident laryngeal injury, and deterioration and amelioration of acoustic parameters can be observed to occur differently among male and female patients. Preoperative and postoperative objective voice analyses may be helpful in documenting voice changes.

Jugular Bulb Diverticula: Clinical and Radiologic Aspects

OBJECTIVE: This study was performed to determine the clinical presentation of jugular diverticulum and its relevance with the extension of the lesion. STUDY DESIGN: The records and high-resolution CT scans of 1474 patients, with otologic symptoms or related clinical findings, were evaluated retrospectively. In 17 cases in which CT scans revealed the presence of jugular diverticulum, sensorineural symptoms were evaluated with respect to a reference line, perpendicular to the basal turn of the cochlea and tangent to the vestibule in axial CT scan images. RESULTS: When the extension of jugular diverticulum was posterior to the reference line, sensorineural symptoms with vertigo were dominant in most patients (72.7%) in this group. On the other hand, for the patients with anterior-extending jugular diverticulum, sensorineural symptoms without vertigo were detected in 50% of patients, whereas 33.3% had sensorineural symptoms with vertigo. CONCLUSION: This study revealed a relationship between the extension of jugular diverticulum and clinical symptoms. However, this relationship lacks statistical evidence because of the limited number of patients.

A high unrounded vowel in Turkish: is it a central or back vowel?

The aim of this paper is to investigate the phonetic properties of a Turkish vowel in which its backness is indefinite. The five members ([2],[� ],[i],[u] and the high unrounded Turkish vowel, in short HUTV) of the Turkish vowel system were investigated in five adult native Turkish speaker males. For the articulatory analysis, midsagittal magnetic resonance images were obtained during sustained phonation of the vowels, and the distances of the main constrictions from the glottis and the areas of the oral and pharyngeal cavities were calculated. For the acoustic analysis, both the Turkish vowels’ and HUTV-like IPA vowels’ fundamental frequencies (f0) and the first three formants (F1, F2 and F3), were calculated. The acoustic parameters of HUTV were compared both with other vowels’ and with those of the IPA vowels’. For the auditory analysis, 220 synthetic stimuli and 26 IPA vowels were used in an identification test. Articulatory analyses revealed that there were no statistically significant differences between HUTV and [u], and HUTV and [� ]. Acoustic analyses revealed that there were no statistically significant differences between HUTV and [� ], and HUTV and phoneticians’ [v] and [ffl], and [q] vowels. Auditory investigation revealed that the [v] and [ffl], and [q] vowels perceived as HUTV. These results suggested that HUTV’s position in the vowel space was between the [� ] and [u] vowels, but its subarea was fairly wide. � 2004 Elsevier B.V. All rights reserved.

Impact of Laryngeal Findings on Acoustic Parameters of Patients with Laryngopharyngeal Reflux

Objectives: To identify the effects of laryngopharyngeal reflux (LPR)-related laryngeal findings on objective voice parameters. Methods: Two hundred and thirty patients clinically diagnosed as having LPR and 48 healthy controls were included. The reflux finding score was determined for each subject via videolaryngoscopy. The acoustic parameters evaluated were jitter, shimmer, noise-to-harmonic ratio and Voice Turbulence Index (VTI). Results: Shimmer and VTI showed statistically significant differences between the LPR and control groups among males (p < 0.05). For females, all of the 4 acoustic voice parameters were significantly different between the two groups (p < 0.05). Erythema/hyperemia was found to affect the highest number of voice parameters. VTI was found to be affected by the highest number of laryngeal findings. Conclusion: Objective voice changes were documented in LPR patients, with VTI being the most affected parameter, and therefore it should be considered in the acoustic analysis of patients with LPR in addition to the conventional parameters. With hyperemia in the first rank, ventricular obliteration, pseudosulcus and vocal fold edema are found to have an impact on voice, suggesting that these should be concentrated on in the diagnosis and follow-up of LPR patients with voice disorders.

Results of multiple-frequency tympanometry measures in normal and otosclerotic middle ears

Tympanometry is a non-invasive, quick, and inexpensive method for examining the middle-ear function. Its limited value in differentiating otosclerotic from normal middle ears caused researchers to develop new methods for evaluation of middle ears. Resonant frequency had been found to be higher in otosclerotic middle ears than normals. We conducted multiple-frequency tympanometry measurements in 25 surgically confirmed otosclerotic ears and 100 normal ears. Mean middle-ear resonant frequency for the otosclerotic group was found to be 1190 Hz and mean middle-ear resonant frequency of the control group was 934.6 Hz (p<0.001). With a cut off value of 1025 Hz (based on 95% confidence interval), sensitivity was 80% and specificity was 82%. The present findings confirm the advantage of the resonant frequency estimation over conventional tympanometry in detecting middle-ear status and mechanics in patients with otosclerosis. As a conclusion, detecting resonant frequency when evaluating patients for otosclerosis must be an essential part of examination. Nevertheless, further investigation is necessary for better diagnosis of otosclerosis preoperatively.

Predictive value of esophageal motility test in the proficiency of esophageal speech

One method of speech rehabilitation following total laryngectomy surgery is esophageal speech therapy (EST). In this method, which has witnessed relatively low success rates at the end of therapy, identification of patients who can benefit from EST beforehand will be important for determining the appropriate method for alaryngeal speech rehabilitation and might be cost-effective, saving time and labor. To this end, this study conducted research on the feasibility of manometric data measured prior to therapy using an esophageal motility test (EMT) in order to determine the candidates most suitable for esophageal speech (ES) beforehand. A total of 51 total laryngectomy male patients who had never been subject to any kind of speech rehabilitation and had always been articulate were included in the study. Data were collected from 44 patients who completed EST, lasting for 6 months in total and consisting of 11 sessions. Manometric measures were obtained through EMT using a water-perfusion system with a Dent sleeve catheter on the patients prior to the therapy. Wepmans scale was used in order to evaluate ES proficiency. Following the therapy, in accordance with this scale, while patients whose scores was 1, 2, or 3 were considered as adequate, those whose scores were 4, 5, 6, or 7 were considered inadequate and were divided into two groups. Manometric correlations were analyzed between 17 patients (group I) who were able to perform ES at an adequate level and 27 patients (group II) who could not. No statistically significant difference between the groups could be observed in terms of average pressure generated within the upper and lower esophageal sphincters obtained through EMT, peak amplitude of esophageal body contraction pressure, contraction duration time, onset velocity, or peak velocity values. EMT conducted prior to application of EST to total laryngectomized patients did not have any value in determining the level of ES that a patient could reach. Our results also suggest that sphincter pressures or esophageal motility patterns do not have any predictive value and should not be performed.

The effect of stimulus duration on perception of Turkish vowels in normal-hearing and hearing-impaired children

The objective of the study was to examine the effects of stimulus duration on vowel perception in normal-hearing and hearing-impaired children. For this purpose, 80 semisynthetic vowel stimuli consisting of eight different Turkish vowels with ten different durations were presented to 14 normal-hearing and 15 hearing impaired children, and they were asked to identify the vowel they heard. Thirteen normal-hearing adults served as speaker subjects to get normative data on mean durations of the Turkish vowels. While there was no significant effect of duration on perception in normal-hearing children, perception errors for very short and very long vowels were observed in hearing-impaired children. The most frequent responses as a function of duration showed four different patterns: (1) three vowels were perceived correctly in all durations; (2) two were perceived correctly in middle and longer durations; (3) two were perceived correctly in middle duration; and (4) only one was perceived correctly in short duration. It was concluded that the effects of stimulus duration on vowel perception were determined by natural duration of the vowel in a given language, and unnaturally short and long vowels were misperceived by hearing impaired subjects. Sumario El objetivo del estudio fue examinar el efecto de la duración del estimulo en la percepción de las vocales en niños normoyentes e hipoacúsicos. Para ello, 80 estímulos vocálicos semisintéticos consistentes en ocho diferentes vocales turcas, con 10 duraciones diferentes, fueron presentados a 14 niños normoyentes y 15 hipoacúsicos; se les pidió que identificaran la vocal escuchada. Trece adultos normoyentes sirvieron como hablantes para obtener datos normativos sobre el promedio de duración de las vocales turcas. Aunque que no hubo efecto significativo de la duración en la percepción en los normoyentes, se observaron errores de percepción para vocales muy cortas y muy largas en los hipoacúsicos. Las respuestas más frecuentes en función de la duración presentaron cuatro patrones diferentes: (1) tres vocales fueron percibidas correctamente con todas las duraciones, (2) dos fueron percibidas correctamente con duración media y prolongada, (3) dos fueron percibidas correctamente con duración media y (4) sólo una fue percibida correctamente con duración corta. Se concluyó que los efectos de la duración del estimulo en la percepción de las vocales se determinan por la duración natural de la vocal en una lengua dada y las vocales artificialmente cortas y largas son percibidas erróneamente por los sujetos hipoacúsicos.

Electromyography-Guided Botulinum Toxin Injection Into the Cricothyroid Muscles in Bilateral Vocal Fold Abductor Paralysis

Objectives Bilateral vocal fold abductor paralysis (BVFAP) both deteriorates quality of life and may cause life-threatening respiratory problems. The aim of this study was to reduce respiratory symptoms in BVFAP patients using cricothyroid (CT) botulinum toxin (BTX) injection. Methods Before and 2 weeks and 4 months after bilateral BTX injection into the CT muscles under electromyography; alterations in respiratory, acoustic, aerodynamic and quality of life parameters were evaluated in BVFAP patients with respiratory distress. For the respiratory evaluation modified Borg scale and spirometry, for the voice and aerodynamic evaluations Voice Handicap Index-30 (VHI-30), GRBAS, acoustic analysis (sound pressure level, F0, jitter%, shimmer%, noise-to-harmonic ratio) and maximum phonation time and for the quality of life assessment Short Form-36 (SF-36) form were used. Results All patients were female with a mean age of 47±8.1 years. There was a mean time of 11.8±5.5 (minimum 2, maximum 23) months between BVFAP development and BTX injection. In all cases, other than one case with unknown aetiology, the cause of vocal fold paralysis was prior thyroid surgery. In total 18.6±3.1 units of BTX were applied to the CTs. In the preinjection period, and the 2nd week and 4th month after injection, the Borg dyspnea scale was 7.3/5.3/5.0, FIV1 (forced inspiratory volume in one second) was 1.7/1.7/1.8 L, peak expiratory flow (PEF) was 1.4/1.7/2.1 L/sec, maximum phonation time was 7.0/6.4/6.2 seconds and VHI-30 was 63.2/52.2/61.7 respectively. There was no significant alteration in acoustic analysis parameters. Many of the patients reported transient dysphagia within the first week. There were insignificant increases in SF-36 sub-scale values. Conclusion After BTX injection, improvements in the mean Borg score, PEF and FIV1 values and SF-36 sub-scale scores showed the restricted success of this approach. This modality may be kept in mind as a transient treatment option for patients refused persistent tracheotomy or ablative airway surgeries.

LittlEARS ® early speech production questionnaire validation in hearing Turkish infants

Abstract Aim The LEESPQ validated on hearing, German infants is a standardized tool examining preverbal speech development. This study aims to validate the LEESPQ on hearing, Turkish infants. Materials and methods This is a prospective, cross-sectional validation study using the LEESPQ in Turkish. The LEESPQ was filled in once for each hearing infant. Data for ≥10 infants was collected at 19 test intervals, ≥0–1, ≥1–2……, ≥18–19 months. Psychometric validation was performed through confirmatory factor analysis, item response analysis, item analysis, and analysis of reliability and validity. Results The LEESPQ was found to be gender independent, have high predictive accuracy and almost exclusively assess speech production ability. A very high correlation between total score and chronological age means score can be interpreted as childs speech production developmental age. Expected and minimum scores were defined for each monthly interval. Conclusion The LEESPQ (Turkish) has clinical value to confirm typical speech production development and detect potential problems.