Seiji Niimi

Role of Laryngeal Movement and Effect of Aging on Swallowing Pressure in the Pharynx and Upper Esophageal Sphincter

Objectives Describe contribution of laryngeal movement to pressure changes at the upper esophageal sphincter (UES) and the effect of aging on the swallowing function.

Autologous transplantation of fascia into the vocal fold: A new phonosurgical technique for glottal incompetence

INTRODUCTION Glottal incompetence is one of the causative condition of hoarseness. There have been various methods to improve the glottal conditions. However, each method has advantages and disadvantages as well. Sulcus vocalis is one of the most difficult problems facing the laryngeal surgeon. Clinically, most authors have reported that laryngoscopy in cases of sulcus vocalis reveals bowed vocal folds,l,Z resulting in a spindle-shaped chink with glottal incompetence. The anatomic and functional problems and the resulting incomplete glottal closure during phonation lead to presenting symptoms of breathy hoarseness, decreases in maximum phonation time (MPT), and vocal fatigue.’ The ventricular folds are frequently overadducted during phonation in an attempt to compensate for the glottic incompetence.1 Many therapeutic methods have been reported for sulcus vocalis and glottal incompetence. The aim of surgical treatments reported by most authors has been to produce sufficient glottal closure in phonation. Techniques that have been used toward this end include injection of Teflon: collagen,u or autologous fascia9 into the vocal folds. To achieve satisfactory glottal closure to prevent breathy phonation in cases of sulcus vocalis, we have been trying a new surgical technique for this severe glottal incompetence, called “vocal fold autologous transplantation.”

Autologous transplantation of fascia into the vocal fold: long-term results of a new phonosurgical technique for glottal incompetence.

Objectives To study the long‐term results of autologous transplantation of fascia into the vocal fold, and to evaluate our use of autologous transplantation instead of bovine collagen injection in cases of glottal incompetence.

Autologous Transplantation of Fascia Into the Vocal Fold

INTRODUCTION Glottal incompetence is one of the causes of hoarseness. Various methods have been used to treat glottal incompetence, but disadvantages are associated with each one. We recently reported a new phonosurgical technique for glottal incompetence—autologous transplantation of fascia into the vocal fold. Because our technique does not use any synthetics or foreign tissues (we substitute autologous transplantation of fascia for bovine collagen injection), we assume it to be at low risk for infection as well as immunologically safe. The phonomicrosurgical technique for autologous transplantation of fascia into the vocal fold comprises three steps: 1) undermining the vocal fold mucosa to make a pocket, 2) preparing the fascia temporalis, and 3) transplanting the autologous fascia into the vocal fold. From April 1997 to March 1999 we performed our new surgical technique on more than 10 cases of glottal incompetence, with generally satisfactory results. Because maximum phonation time (MPT) is one of the representative parameters that indicate glottal competence, we measured it in all our patients and found that MPT increased in every case. Stroboscopy showed better glottal closure and improved vocal fold vibrations during phonation. Six months after surgery, the MPT remained at its highest level in all cases (Fig. 1). However, we did experience problems with some cases. In this paper, we report those problems and their solutions. CASE REPORTS

Vocal Fold Vibration and Voice Quality

There have been various methods proposed for diagnosing laryngeal pathology by analyzing the pathological voice. However, even if two diagnoses are the same, the voice quality might not be the same. In other words, it is difficult to diagnose laryngeal pathology only by acoustic parameters. In this study, we analyze the vibration patterns seen in various pathological cases to explain pathological voice quality.

Laryngeal gestures during stop production using high-speed digital images.

On acoustic and fiberscopic studies of stop consonants, voice onset time and glottal width have been shown to be greatest in heavily aspirated stops, next greater for slightly aspirated stops, and least for unaspirated stops. Integrated activity of the thyroarytenoid and posterior cricoarytenoid muscles has been reported to be involved in differentiating aspirate characteristics of the stops. However, the fine movement of mucosal edges of vocal folds during the production of stops has not been well documented. In recent years, a new method for high-speed digital recording of laryngeal dynamics has made this possible. In the current study, the movements of vocal fold edges were documented during the period of stop production using a fiberscopic system of high-speed digital images. By observing the glottal width and the visual vibratory movements of vocal folds before voice onset, the heavily aspirated stop was characterized as being more prominent and dynamic than the slightly aspirated and unaspirated stops.

Abnormal elevation of resting pressure at the upper esophageal sphincter of Parkinson’s disease patients

Abstract We investigated the oral and pharyngeal swallowing function in seven Parkinson’s disease (PD) patients, using videomanofluorometry, which is videofluorographic and manometric evaluation conducted simultaneously. Abnormal elevations of resting pressure were found at the upper esophageal sphincter (UES) in three of the seven cases, when they were asked to hold a bolus in the mouth and initiate swallowing. One of these three cases showed an abnormal elevation of resting pressure, intermingled with a normal pressure pattern. Since the UES showed complete relaxation in these three cases, it is inappropriate to suppose that irreversible pathophysiological changes at the level of peripheral nerves had occurred. Our results suggested that altered resting pressure resulted from dysfunction at a more central level, such as a lack of dopaminergic stimulation at the supramedullary level causing skeletal muscle rigidity. Since a tonic abnormality of the UES cannot be measured by only videofluorography, both videofluorographic and manometric evaluation will be necessary to assess the pharyngeal phase of swallowing in PD patients.

The Roles of the Posterior Cricoarytenoid and Thyropharyngeus Muscles in Whispered Speech

In order to clarify the nature of the physiological adjustment for the production of whispering, physiological studies were conducted on the glottal and supralaryngeal adjustments during whispering. The results indicate that for the production of whispering there is a necessary relationship between glottal adjustment and supralaryngeal adjustment in terms of the coordination between posterior cricoarytenoid muscle (PCA) and thyropharyngeus muscle (TP). Also, there might be a function switch in our brain which enables the speaking mode to change from ordinary to whispering, using the activation of PCA and TP, as a result of human evolution.

The Larynx During Exercise

Objectives To develop a system capable of observing the larynx during various body movements and to investigate the relation between upper limb movements and laryngeal closure, often referred as “airtrapping.”

The syllable method: proportion of impaired syllables as an indicator of spasmodic dysphonia severity.

We have previously proposed the ‘mora method’ to evaluate the degree of impairment in spasmodic dysphonia (SD) in Japanese-speaking patients. With this method, impairment is judged as the proportion of impaired morae in a 25-mora sentence in a longer passage read aloud. As the mora is the phonologically isochronic unit in Japanese, the proportion of impaired morae in speech can be used to represent the temporal proportion of impaired Japanese speech. This proportional measure of impairment reflects the perceived severity of the impairment, and is a more reliable measure than a 4-point perceptual rating scale completed either by patients or by voice professionals. In this paper, we propose a ‘syllable method’ to characterize the severity of impairment in English-speaking SD patients. Instead of morae, the severity of SD was represented by the proportion of impaired syllables. It should be possible to characterize SD impairments more reliably and precisely with this method than using a 4-point rating scale completed by voice professionals. Ultimately, the syllable method should become a simple and effective method for evaluating the severity of SD. Furthermore, such methods can be applied to other languages, using the appropriate phonological unit (either mora or syllable).