Robin A. Samlan

The utility of evaluating true vocal fold motion before thyroid surgery

Objective: The objective of this study was to evaluate the utility of screening laryngoscopic examination in evaluating vocal fold (VF) mobility before thyroid surgery.

Supracricoid partial laryngectomy: swallowing, voice, and speech outcomes.

Objectives: The purpose of the study was to describe the swallowing and vocal function of patients after supracricoid partial laryngectomy (SCPL) as they changed over the first postoperative year. Methods: Ten patients with laryngeal carcinoma underwent SCPL at Johns Hopkins Hospital between August 2003 and May 2005. Clinical and videofluoroscopic swallowing examinations and perceptual, acoustic, aerodynamic, and videostroboscopic voice evaluations were completed before operation and at 3 weeks (swallowing only) and 2 (voice only), 6, and 12 months after operation. Results: The mean time to gastrostomy tube removal was 82 days. The patients tolerated an increased variety of foods over the first postoperative year. All patients initially used therapeutic strategies to swallow safely, and some still required them at 1 postoperative year. Over the year, the perceptual ratings of voice quality improved significantly. There were no consistent changes in acoustic or aerodynamic measures. The number of patients who used multiple vibratory sources to phonate increased over the year. Conclusions: The patients tolerated regular diets, yet continued to exhibit silent aspiration and a variety of decompensations. Their voices were breathy, rough, and strained. Their voice quality ratings improved over the year. Group changes were not captured, and it appears that the changes in speech and voice 2 months after surgery were subtle.

Swallowing and speech therapy after definitive treatment for laryngeal cancer

As the trend in laryngeal cancer treatment shifts towards organ-conservation surgeries and organ-preservation protocols, patients will more often retain anatomy vital to communication and swallowing. Despite a conservative approach, results of treatment may have debilitating effects. Rehabilitation efforts are directed towards a return to functional, if not normal, status. Although there are predictable trends in voice and swallowing disorders of patients with laryngeal cancer, posttreatment dysphonia and dysphagia are diverse in presentation. Considering the significant diversity of this population, speech pathologists should work closely with otolaryngologists to determine the most appropriate treatment for each patient. As this article demonstrates, voice and swallowing therapy are necessary components of the rehabilitation process following treatment for head and neck cancers. As always, treatment is tailored to the specific individual and based on information obtained during a thorough evaluation by a speech pathologist. Fortunately, with the help of voice and swallowing therapy, many patients return to functional communication and oral feeding.

Inhaled triamcinolone with proton pump inhibitor for treatment of vocal process granulomas: a series of 67 granulomas.

Objectives We sought to analyze the outcomes of vocal process granulomas treated with proton pump inhibitors and inhaled triamcinolone acetonide. Methods We reviewed the medical records of patients with a diagnosis of contact granuloma or vocal process granuloma between 1995 and 2008. Data included age, gender, intubation history, reflux history, lesion location, previous treatment methods, treatment course, and recurrence. All patients were treated with daily or twice-daily protein pump inhibitors and inhaled triamcinolone acetonide (300 μg 3 times a day). Results Sixty-seven granulomas were diagnosed in 54 patients: 13 bilateral and 41 unilateral. Twenty patients, including all 11 women, had a recent history of intubation. Sixty-two granulomas in 50 patients were treated with triamcinolone and a proton pump inhibitor. Of the 57 granulomas that completed treatment, 5 (9%) did not respond (mean follow-up, 50 weeks; range, 30.3 to 78.3 weeks), 13 (22%) partially responded (mean follow-up, 11 weeks; range, 3 to 30 weeks), and 40 (69%) completely responded (mean follow-up, 21 weeks; range, 5.9 to 84.6 weeks). Three cases had recurrence: 2 nonresponders and 1 complete responder. One patient developed oral thrush. Conclusions In this study, vocal process granulomas occurred more frequently in men, whereas women developed granulomas only after intubation. The anti-inflammatory action of inhaled triamcinolone combined with antireflux proton pump inhibitors successfully treats most vocal process granulomas with low rates of side effects and recurrence.

The Relationship of Selected Perceptual Measures of Diadochokinesis to Speech Intelligibility in Dysarthric Speakers With Amyotrophic Lateral Sclerosis

The current experiment explored the relationship of two perceptual measures of diadochokinetic (DDK) performance to speech intelligibility in 15 men with amyotrophic lateral sclerosis (ALS). The pe...

Modeling the voice source in terms of spectral slopes.

A psychoacoustic model of the voice source spectrum is proposed. The model is characterized by four spectral slope parameters: the difference in amplitude between the first two harmonics (H1-H2), the second and fourth harmonics (H2-H4), the fourth harmonic and the harmonic nearest 2 kHz in frequency (H4-2 kHz), and the harmonic nearest 2 kHz and that nearest 5 kHz (2 kHz-5 kHz). As a step toward model validation, experiments were conducted to establish the acoustic and perceptual independence of these parameters. In experiment 1, the model was fit to a large number of voice sources. Results showed that parameters are predictable from one another, but that these relationships are due to overall spectral roll-off. Two additional experiments addressed the perceptual independence of the source parameters. Listener sensitivity to H1-H2, H2-H4, and H4-2 kHz did not change as a function of the slope of an adjacent component, suggesting that sensitivity to these components is robust. Listener sensitivity to changes in spectral slope from 2 kHz to 5 kHz depended on complex interactions between spectral slope, spectral noise levels, and H4-2 kHz. It is concluded that the four parameters represent non-redundant acoustic and perceptual aspects of voice quality.

Toward a unified theory of voice production and perception

At present, two important questions about voice remain unanswered: When voice quality changes, what physiological alteration caused this change, and if a change to the voice production system occurs, what change in perceived quality can be expected? We argue that these questions can only be answered by an integrated model of voice linking production and perception, and we describe steps towards the development of such a model. Preliminary evidence in support of this approach is also presented. We conclude that development of such a model should be a priority for scientists interested in voice, to explain what physical condition(s) might underlie a given voice quality, or what voice quality might result from a specific physical configuration.

Perceptual consequences of changes in epilaryngeal area and shape

The influence of epilaryngeal area on glottal flow and the acoustic signal has been described [Titze, J. Acoust. Soc. Am. 123, 2733-2749 (2008)], but it is not known how (or whether) changes in epilaryngeal area influence perceived voice quality. This study examined these relationships in a kinematic vocal tract model. Epilaryngeal constrictions and expansions were simulated at the levels of the aryepiglottic folds and the ventricular folds in the context of four glottal configurations representing normal vibration to severe vocal fold paralysis, for the three corner vowels /a/, /i/, and /u/. Minimum and maximum glottal flow, maximum flow declination rate, spectral slope, cepstral peak prominence, and the harmonics-to-noise ratio were measured, and listeners completed a perceptual sort-and-rate task for all samples. Epilaryngeal constriction and expansion caused salient differences in voice quality. The location of constriction was also perceivable. Vowels simulated with aryepiglottic constriction demonstrated lower maximum airflow and less noise than the other epilaryngeal shapes, and listeners consistently perceived them as distinct from other stimuli. Acoustic differences decreased with increasing severity of simulated paralysis. Results of epilaryngeal constriction and expansion were similar for /a/ and /i/, and produced slightly different patterns for /u/.

High efficiency gene delivery into laryngeal muscle with bidirectional electroporation

Objective The impact of polarity change on the efficiency of in vivo electroporative (EP) gene transfection was assessed in rat laryngeal muscle. Study Design and Setting High (HV) and low field voltage (LV) were combined with polarity changes to determine transfection in 5 different conditions: 1) without EP (EP[-]), 2) HV+LV (HL), 3) HV+LV followed by HV+LV with no change in polarity (HLHL unidirectional), 4) HV+LV followed by HV+LV with opposite polarity (HLHL bidirectional), 5) HV+LV followed by LV with opposite polarity (HLL bidirectional). Results HLL bidirectional sequence showed the best result with less interindividual variability and extended expression period. With the exception of repeated high voltage sequences, EP parameters were not likely to induce cell injury or inflammation. Conclusion HLL bidirectional electroporative gene delivery produces high transfection rates with limited tissue trauma. Significance Bidirectional EP provides a safe and highly efficient method for therapeutic gene delivery into skeletal muscle.

Perceptual sensitivity to a model of the source spectrum

A psychoacoustic model of the source spectrum has been proposed in which four spectral slope parameters describe perception of overall voice quality: H1-H2 (the difference in amplitude between the first and second harmonics), H2-H4, H4-2000 Hz (i.e., the harmonic nearest 2000 Hz), and 2000–5000 Hz. The goals of this study are to evaluate perceptual sensitivity in the mid-to-high frequency range of the model and determine how sensitivity to one parameter varies as a function of another. To determine listener sensitivity to slope changes for each parameter, just-noticeable differences were obtained for series of stimuli based on synthetic copies of one male and one female voice. Twenty listeners completed an adaptive up-down paradigm. To provide a baseline of listener sensitivity to each spectral slope parameter, the synthetic voices were manipulated so that spectral slope varied by 0.5 dB increments for each parameter while other parameters remained constant. We then assessed how listener sensitivity to a ...