Yanagisawa E

The contribution of aryepiglottic constriction to “ringing” voice quality—A videolaryngoscopic study with acoustic analysis*

Summary Fiberscopic video laryngoscopy was performed on five professional singers to determine the presence or absence of aryepiglottic narrowing as a function of voice quality. Each sang “Happy Birthday” and parts of the “Star Spangled Banner” in six different voice qualities: speech, falsetto, sob (a low larynx with a vocal tract expanded by relaxing the middle constrictors), twang, belting, and opera. Several features were found to be common among the subjects and related to specific qualities. Aryepiglottic constriction was present in all singers in twang, belting, and opera qualities. Spectrographic analysis related the constriction to the presence of the “singers formant.” The presence of this type of constrictive behavior will require further research to ascertain the possible benefits to those for whom a louder voice is essential and to understand the relationship of this constrictive maneuver to the natural closure functions of the larynx.

Documentation of Variations in Sinonasal Anatomy by Intraoperative Nasal Endoscopy

Objectives: Functional endoscopic sinus surgery (FESS) requires a thorough understanding of the variability in sinonasal anatomy. Previous reports have relied primarily on anatomic studies of cadaveric specimens or skulls, or on radiographic analysis. Relatively few comparative anatomic data have been accumulated with endoscopic examination of living patients.

Videolaryngoscopy A Comparison of Fiberscopic and Telescopic Documentation

Videolaryngoscopy is a most useful and effective method of evaluation and documentation of physiological and pathological conditions of the larynx. It is of great value for making accurate diagnosis and planning proper treatment. It permits instant and simultaneous voice and video recording and later analysis. Videolaryngoscopy can be accomplished with either a flexible fiberscope or a rigid right-angled telescope. Fiberscopic videolaryngoscopy is more useful for voice analysis of speech disorders and evaluation of such functions of the larynx as phonation, singing, and swallowing. Telescopic videolaryngoscopy is superior for critical evaluation of anatomical and pathological changes of the laryngeal structures as well as close-up examination of vocal cord function. While fiberscopic laryngoscopy is technically easy, fiberscopic video documentation is much more difficult than telescopic video documentation. Telescopic videolaryngoscopy provides clearer and sharper images of the larynx. Advantages and disadvantages of each method are discussed.Videolaryngoscopy is a most useful and effective method of evaluation and documentation of physiological and pathological conditions of the larynx. It is of great value for making accurate diagnosis and planning proper treatment. It permits instant and simultaneous voice and video recording and later analysis. Videolaryngoscopy can be accomplished with either a flexible fiberscope or a rigid right-angled telescope. Fiberscopic videolaryngoscopy is more useful for voice analysis of speech disorders and evaluation of such functions of the larynx as phonation, singing, and swallowing. Telescopic videolaryngoscopy is superior for critical evaluation of anatomical and pathological changes of the laryngeal structures as well as close-up examination of vocal cord function. While fiberscopic laryngoscopy is technically easy, fiberscopic video documentation is much more difficult than telescopic video documentation. Telescopic videolaryngoscopy provides clearer and sharper images of the larynx. Advantages and disadvantages of each method are discussed.

Videoendoscopic analysis of laryngeal function during laughter

Although commonly encountered in all human cultures, laughter remains poorly understood. In order to examine laryngeal function during laughter, telescopic and fiberscopic videolaryngoscopy was performed on five subjects, who laughed in the different vowels, at various frequencies, and in several voice qualities. During laughter, the vocal folds were found consistently to undergo rhythmic abduction and adduction. At the end of these specific phonation tasks, all subjects were able to gain voluntary control of paramedian vocal fold positioning. This study better defined laryngeal function during laughter. These results have important clinical implications. Voluntary vocal fold positioning has important applications in speech therapy for dysphonias, such as vocal fold nodules, in which the primary cause is vocal fold hyperadduction. Patients suffering from these hyperadductive dysphonias may be able to utilize laughter to correct them.

The importance of preoperative nasal endoscopy in patients with sinonasal disease

Functional endoscopic sinus surgery (FESS) has popularized the use of telescopes in sinus surgery and has emphasized the importance of nasal endoscopy and computed tomography (CT) in the evaluation of patients with diseases of the nose and paranasal sinuses. Variations in intranasal and sinus anatomy have been implicated in the etiology of chronic and recurrent sinusitis, and CT imaging has become an important diagnostic tool. Despite this, some patients present with symptoms and telescopic examination suggestive of sinonasal disease, yet demonstrate little abnormality on CT scan. The authors reviewed videoendoscopic and CT examinations of 100 consecutive patients with symptoms of sinus disease and found 9% of patients with abnormal telescopic examination in the context of negative CT findings. In those patients whose CT examinations were positive, telescopic nasal endoscopy was especially useful in delineating the type of soft tissue which obscured the area of the middle meatus. In those patients whose CT examinations were negative, telescopic examination demonstrated septal deflections, mucosal edema involving the middle meatus, as well as turbinate and adenoid hypertrophy. These findings demonstrate that telescopic nasal examination is an important diagnostic modality which often yields important information when evaluating patients with sinonasal disease.

Supraglottic Contributions to Pitch Raising Videoendoscopic Study with Spectroanalysis

Several questions pertaining to pitch raising recur frequently. Does the larynx rise with the production of higher frequencies? What happens to the pharyngeal walls between the soft palate and the larynx when the fundamental frequency is raised? How does the soft palate participate in pitch raising? To answer these questions, the present study was undertaken with the recently described simultaneous velolaryngeal endoscopy technique. Nine professional singers were asked to find the limits of their vocal range in any of six voice qualities: Speech, falsetto, cry/sob, twang, belting, and opera. Simultaneous activities of the larynx, the pharyngeal walls, and the soft palate were submitted to videoendoscopy with synchronous voice recording and studied with spectroanalysis of discrete segments of the total phonation range. Our dual endoscopic study showed that 1) the larynx rose in all subjects with the production of higher frequencies, 2) with the highest fundamental frequency, the lateral pharyngeal walls significantly contracted toward the midline in an “upside-down V shape,” creating a very narrow pharyngeal tube, and 3) the soft palate lifted and the velopharyngeal port narrowed considerably with higher frequencies.

Videoendoscopic diagnosis and correction of velopharyngeal stress incompetence in a bassoonist.

Musicians who play woodwind or brass instruments must generate extremely high intraoral pressures to achieve normal tone and volume in their music. Intraoral pressures of 130 mm Hg can be reached, while normal speech rarely exceeds 6 mm Hg. The inability to maintain an effective seal between the soft palate and the pharyngeal wall can manifest as difficulty in holding high notes or in playing sustained music compositions, or noise production from turbulent nasal cavity emissions. Throughout the literature, there are few reports of these entities. We will present the case of a 31 -year-old concert bassoonist who complained of “noise from her head” only when she played the bassoon. This resulted in numerous failed auditions and threatened her professional career. The diagnosis of velopharyngeal stress incompetence, as well as the Teflon injection augmentation procedure, was done under local anesthesia with the subject playing the bassoon. The use of videoendoscopic techniques allowed accurate, reproducible assessment of the defect and the operative procedure, and assisted in postoperative evaluation.

Video Laryngoscopy Using a Rigid Telescope and Video Home System Color Camera A Useful Office Procedure

A simple but reliable method of videotaping the larynx using the Nagashima rigid laryngoscope (telescope) and a low-cost home video color camera is described. Video laryngoscopy using this technique is a useful office procedure. The video material obtained was of high quality and of great value for teaching, voice analysis, preoperative and postoperative evaluation and documentation of various laryngeal disorders.

Comparison of New Telescopic Video Microlaryngoscopic and Standard Microlaryngoscopic Techniques

A new approach to microlaryngeal surgery using a specially designed video microlaryngoscope with a rigid endoscopic telescope and an attached video camera was introduced by Kantor et al in 1990. The ability to video document and perform surgery of the larynx by viewing a high-resolution television image was demonstrated. This method was recommended over the standard microscopic technique for increased visibility with greater depth of field, unimpeded instrument access, instant documentation, and superior teaching value. The authors tried this new method and the standard microscopic technique at the same sitting on a series of patients. This paper will compare these two different techniques and discuss their advantages and disadvantages. Although the new method has many advantages, the standard microscopic technique remains as a valuable method in laryngeal surgery.

Role of the Soft Palate in Laryngeal Functions and Selected Voice Qualities

The role of the soft palate in normal laryngeal functions and in the production of selected voice qualities was studied by a simultaneous velolaryngeal videoendoscopy technique. For this technique, the Olympus ENF-P flexible nasopharyngolaryngoscope was passed via one nostril to study the function of the larynx, while the Hopkins 70° rhinoscopic telescope was passed via the other nostril to study the function of the soft palate and velopharyngeal closure. A Kay Elemetrics DSP Sona-Graph, model 5500, was used to analyze a complex vocal figure of five consecutive voice qualities, three of which were nasal, and two, oral. Simultaneous velolaryngeal videoendoscopy proved to be of great value for the understanding of the interaction of velar and laryngeal functions and for clarifying the mechanisms of nasal and twang qualities.