Michael P. Karnell

A classification scheme for paradoxical vocal cord motion

Paradoxical vocal cord motion (PVCM) is characterized by the inappropriate adduction of the true vocal cords during inspiration. Multiple causes have been proposed for this group of disorders, which share the common finding of mobile vocal cords that adduct inappropriately during inspiration and cause stridor by approximation. Management of this group of disorders has been complicated by the lack of a classification scheme to include all types of PVCM. We propose that PVCM be classified according to its underlying etiology and recognize the following causes of the disorder: 1 . brainstem compression; 2 . cortical or upper motor neuron injury; 3 . nuclear or lower motor neuron injury; 4 . movement disorder; 5 . gastroesophageal reflux; 6 . factitious or malingering disorder; 7 . somatization/conversion disorder. Case reports are presented to illustrate the characteristic features and diagnostic evaluation used in assessing patients with PVCM. Management varies depending on the cause of PVCM and entails speech therapy, pharmacologic therapy, behavioral modification, and/or surgical intervention. Recognition of the multiple causes of PVCM allows otolaryngologists to formulate well‐directed diagnostic evaluation and treatment.

Arytenoid adduction combined with Gore-Tex medialization thyroplasty.

Objective To describe the technique of combined Gore‐Tex medialization thyroplasty with arytenoid adduction and to determine the long‐term vocal outcome of patients treated for unilateral vocal cord paralysis with this procedure.

Long‐Term Follow‐up of Fat Injection Laryngoplasty for Unilateral Vocal Cord Paralysis

Objective The objective of the study was to evaluate the results of autologous fat injection laryngoplasty in the long‐term management of unilateral vocal cord paralysis.

Comparison of fundamental frequency and perturbation measurements among three analysis systems.

The need for standardization of procedures in approaches to voice measurement has been recently emphasized. The purpose of this study was to determine the extent to which the acoustic perturbation measurements from three different analysis systems agree when standardized recording and analysis procedures are used. High-quality acoustic voice recordings from 20 patients were analyzed. The results showed that, although fundamental frequency measurements were in strong agreement among the three systems tested, frequency and amplitude perturbation measurements were not in agreement. The underlying approaches to perturbation measurement appeared to be sufficiently different to produce different results. An argument is made for a standardized set of acoustic signals representing normal, dysphonic, and synthesized voices with known characteristics to facilitate testing of new acoustic analysis systems and confirm measurement accuracy and sensitivity.

Pharyngeal flap surgery: long-term outcomes at the University of Iowa.

The pharyngeal flap is the most often used surgical approach to treat the problem of velopharyngeal insufficiency, a common challenge encountered in cleft palate and craniofacial clinics. The authors retrospectively reviewed short-term and long-term measures of children treated with the pharyngeal flap at the University of Iowa Cleft and Craniofacial Center. All patients who underwent pharyngeal flap surgery between January of 1970 and December of 2000, with at least one postoperative speech assessment between 2 and 5 years after the operation, were identified. Both hypernasality and hyponasality were evaluated on a scale from 1 to 6, with 1 indicating no involvement and 6 indicating severe effect on resonance. Velopharyngeal competence was also rated on a scale of 1 to 3, with 1 indicating competence and 3 indicating incompetence. These short-term data were then compared. The results showed that overall resonance performance continues to be adequate and may even improve as the patient continues to grow and mature. These findings support the use of the pharyngeal flap in the treatment of children with velopharyngeal insufficiency.

Health-Related Quality of Life Among Preadolescent Children With Oral Clefts: The Mother's Perspective

OBJECTIVE. The purpose of this study was to evaluate the factors that affect the health-related quality of life of preadolescent children with nonsyndromic oral clefts using the Pediatric Quality of Life Inventory instrument and to evaluate whether there were any differences related to the type of cleft or other factors. METHODS. Data for this study were derived from telephone interviews with the parents of a statewide population of children who were in the Iowa Registry for Congenital and Inherited Disorders, were aged 2 to 12 years, had nonsyndromic oral clefts, and were born in Iowa between January 1, 1990, and December 31, 2000. Twenty-minute interviews were conducted with mothers of 104 children in the spring and summer of 2003; respondents then completed and mailed back Pediatric Quality of Life Inventory surveys 2 to 3 weeks after the interviews (69% participation rate). RESULTS. After controlling for demographic characteristics, children with less severe speech problems had higher total Pediatric Quality of Life Inventory scores as well as higher physical and psychosocial health domain scores. Age and cleft type interacted, with younger children (aged 2–7 years) with a cleft lip or cleft lip and palate having higher health-related quality of life scores than children with an isolated cleft palate; however, this pattern was reversed for older children (aged 8–12 years). CONCLUSIONS. Speech and aesthetic concerns seem to have been important factors affecting the health-related quality of life for children with oral clefts. These factors seem to be more important as children get closer to adolescence (ages 8–12 years) when acceptance by peers becomes more critical.

Nasometric Discrimination of Hypernasality and Turbulent Nasal Airflow

Agreement between nasalance measures and perception of nasality during speech is not consistently strong. A possible reason may be the complicating combined effects of nasal turbulent airflow and nasal resonance. The purpose of this preliminary study was to examine nasalance measures obtained during production of a low pressure speech sample designed to minimize or eliminate the effects of turbulent nasal airflow. The results showed that nasalance measures obtained as some of the subjects produced the new speech sample were significantly different from those obtained when the standard high pressure speech sample was used. Use of both the new low pressure samples and the standard high pressure samples may result in improved agreement between nasalance measures and ratings of speech nasality as well as assist in the identification of subgroups of patients with marginal velopharyngeal insufficiency.

A Database Information Storage and Reporting System for Videofluorographic Oropharyngeal Motility (OPM) Swallowing Evaluations

This article describes a computer database system for standardized recording and reporting of information regarding videofluorographic oropharyngeal motility (OPM) evaluations of swallowing. The sy...

Pharyngeal Flap Surgery: Protocols, Complications, and Outcomes at the University of Iowa

OBJECTIVE We sought to assess complication rates and speech outcomes in patients undergoing pharyngeal flap surgery. Study design and setting We conducted a retrospective chart and database review at a tertiary craniofacial center. PATIENTS Eighty-seven patients were identified as having pharyngeal flaps between January 1990 and December 2000. RESULTS Complications were rare, with an overall rate of 3.4% for all children. Craniofacial database records were identified with a follow-up examination between 2 and 5 years. Forty-four patients were identified. Of this group, 81.8% demonstrated no evidence of hypernasality or mild hypernasality, and 84.1% demonstrated no evidence of hyponasality or only mild hyponasality. Preoperative and postoperative assessments showed a statistically significant difference in hypernasality at P < 0.001 with no significant difference in hyponasality. CONCLUSIONS Although sphincter pharyngoplasty procedures have gained a great deal of attention in the recent otolaryngologic literature, pharyngeal-flap procedures remain a valuable tool in the hands of surgeons dealing with velopharyngeal incompetence.

ASSOCIATION BETWEEN SEVERITY OF DYSPHAGIA AND SURVIVAL IN PATIENTS WITH HEAD AND NECK CANCER

This study examined risk factors for dysphagia, a common and serious condition in patients with head and neck cancer, and the association between severity of dysphagia and survival.