S. Klajman

Temporal reconstruction of sonographic imaging of disturbed tongue movements

Documentation of tongue movement during swallowing has been restricted to the recording of fluorographic or ultrasound images on cineor videofilm. The new approach of temporal sonographic imaging with reconstruction of one single image for the total act of swallowing presents a direct approach to obtaining substantial information concerning tongue movements and motility. The applicability of this reconstructed image for the documentation, interpretation, and comparison of tongue movements is demonstrated using examples of normal and pathologic swallowing.

Sektorbezogene Grauwertanalyse videosonographisch aufgezeichneter Zungenbewegungen beim Schlucken

ZusammenfassungErkrankungen von Mundhöhle und Mundboden sowie Erkrankungen des Nervensystems können von Zungenbewegungsstörungen beim Schlucken begleitet werden. Derartige Störungen lassen sich videosonographisch diagnostizieren, wobei der Untersucher umfangreiches Bildmaterial zu beurteilen hat. Zielsetzung des vorliegenden Beitrags war es, diese Beurteilung durch Einsatz eines computergestützten, reproduzierbaren und quantitativen Auswertungsverfahrens zu erleichtern. Hierzu wurden Videosequenzen von 56 gesunden Erwachsenen und von 19 Patienten mit Schluckstörungen unterschiedlicher Genese analysiert. Für die numerische Analyse der Schluckbewegungen wurde, abstrahierend von den dargestellten Strukturen (Bolus, Luft, Zungen- und Mundbodenmuskulatur, Zungenoberflächenkontur, Hyoid u.a.), eine bildpunktbezogene Auswertung durchgeführt, indem die Graustufenintensitätsänderungen der Bildpunkte innerhalb zuvor definierter radiärer Bildausschnitte (Sektoren) im Zeitverlauf quantifiziert und in Kurvenform abgebildet wurden. Bei den gesunden Erwachsenen ließ sich im Regelfall ein charakteristisches Muster zweier Bewegungsmaxima erkennen. Diese Maxima waren in fast allen Sektorkurven vorhanden und entsprachen der Bolustransportbewegung der Zunge und ihrer Bewegung zur Ruhelage. Bei Patienten mit Erkrankungen der Zunge oder mit Bewegungsstörungen infolge von Erkrankungen des zentralen Nervensystems zeigten sich dagegen lokale oder generalisierte Bewegungsreduktionen, Bewegungsverlangsamungen, Mehrfachschluckbewegungen oder ungeordnete Zusatzbewegungen.SummaryDiseases of the oral cavity, floor of the mouth, and nervous system can be accompanied by disturbances in tongue movement during swallowing. These disturbances can be diagnosed by videosonography whereby the examiner has to evaluate extensive video documentation of lingual motion. It was the aim of this study to facilitate this evaluation by the application of a reproducible computer-assisted quantitative analysis procedure. Video sequences of 56 healthy adults and 19 patients with dysphagias of different etiologies were analysed. A numerical estimation of swallowing movements was carried out in abstraction from the structures imaged (bolus, air, muscles of the tongue, floor of the mouth, hyoid, etc.). Intensity changes of the pixels within previously defined radial image sectors were quantified in relationship to time and depicted as sector curves. The healthy adults demonstrated a characteristic pattern of two motion maxima that appeared within almost all sector curves. These maxima represented bolus transport movements and the reset movement of the tongue. Patients with diseases of the tongue or neuromuscular changes caused by disturbances of the central nervous system showed pathological deviations on videosonography. These appeared as local or general reductions in movement, slow speed motions, repetitive swallowing or unsorted additional movements of the tongue during swallowing.

Three-Dimensional Phonetographic Assessment of Voice Performance in Professional and Non-Professional Speakers

For the assessment of voice performance, three-dimensional (3D) phonetograms were constructed using mean values of vocal pitch, vocal intensity, and phonation time. They were built up for groups of professional and non-professional male and female speakers. The 3D phonetograms of the professional and non-professional groups were projected into one another for the female as well as for the male speakers to facilitate comparison of the professional and non-professional groups. In addition, pitch-related cross-sections of the 3D phonetograms were created. These cross-sections plotted as sequences are useful to evaluate changes in vocal dynamics and phonation time in relation to the course of vocal pitch. In this contribution, it could be demonstrated that the 3D phonetograms of the non-professional groups were completely enclosed by those of the professional groups who developed a greater vocal capacity. Furthermore, the cross-section sequences of the professional groups were obviously longer and broader than those of the non-professional groups. Details of group-specific differences with respect to the examined voice parameters are discussed.

Speech Viewer and ultrasonograph as a combined speech therapy instrument for deaf children

The Speech Viewer, a computer-assisted tool for speech and voice training, and ultrasonography of the tongue were used for rehabilitation of five deaf children aged three to six years. Three of these children underwent cochlear implantation before, two were supported with hearing aids. While the Speech Viewer presented audio-visual feedback connecting audible sounds with computer-generated visualizations, ultrasonography presented kinesthetic-visual feedback, since the sounds were associated with kinesthetic perception of the tongue and shape visualization of the tongue dorsum. The children practised the combined speech and voice training with high motivation and efficiency.

Die kernspintomographische Untersuchung der Pseudoglottis bei Laryngektomierten

Die kernspintomographische Darstellung der Pseudoglottis Laryngektomierter wird vorgestellt. Die Pseudoglottis wurde bei Ruheatmung, in der prAphonatorischen Phase und wAhrend der Ruktusphon

Die Phasendarstellung velopharyngealer Sphinkterbewegungen

The velopharyngeal function while swallowing water was studied on a healthy volunteer patient with velopharyngeal closure and on a patient with velopharyngeal insufficiency. This patient suffers from open hypernasality as a result of shortened velum. Both subjects underwent nasoendoscopy with a flexible fiber glass optical device while swallowing water and while articulating the plosive consonant /k/. Velopharyngeal function was documented by means of videotaping and then the single video images were placed together along a time scale to form a new temporal image. This image makes possible a quick and comprehensive differentiation between physiological and disturbed motion patterns as demonstrated in this study using velopharyngeal function as the example. The videotaping in lapse time of such disordered movements can provide indicators of the therapeutical steps to be taken.ZusammenfassungDie velopharyngeale Funktion beim Wasserchlucken und beim Artikulieren des Verschlußlautes /k/ wurde beispielhaft an einem gesunden Probanden mit komplettem Gaumen-Rachen-Abschluß und an einem Patienten mit velopharyngealer Bewegungsstörung untersucht. Der Patient litt an einem offenen Näseln bei verkürztem Velum. Die Endoskopie erfolgte jeweils transnasal mit einer flexiblen Glasfaseroptik Die Gaumen-Rachen-Übergangsregion wurde dabei videodokumentiert, die einzelnen Videobilder wurden entlang der Zeitachse zu einer einzigen Abbildung zusammengefügt. Proband und Patient zeigten jeweils drei zeitlich aufeinanderfolgenden Phasen der velopharyngealen Sphinkterbewegungen, nämlich die Verschluß-, die Abschluß-und die Öffnungsphase. Diese Phasendarstellung ermöglicht übersichtlich eine Differenzierung physiologischer und gestörter Bewegungsmuster, hier am Beispiel der velopharyngealen Sphinkterfunktion demonstriert. Solche Aufzeichnungen gestörter Bewegungsvorgänge im Zeitverlauf lassen auch Hinweise, auf Behandlungsmöglichkeiten und-resultate erhoffen. Sie können für Verlaufskontrollen nützlich sein.SummaryThe velopharyngeal function while swallowing water was studied on a healthy volunteer patient with velopharyngeal closure and on a patient with velopharyngeal insufficiency. This patient suffers from open hypernasality as a result of shortened velum. Both subjects underwent nasoendoscopy with a flexible fiber glass optical device while swallowing water and while articulating the plosive consonant /k/. Velopharyngeal function was documented by means of videotaping and then the single video images were placed together along a time scale to form a new temporal image. This image makes possible a quick and comprehensive differentiation between physiological and disturbed motion patterns as demonstrated in this study using velopharyngeal function as the example. The videotaping in lapse time of such disordered movements can provide indicators of the therapeutical steps to be taken.