Vibratory regime classification of infant phonation.
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Infant phonation is highly variable in many respects, including the basic vibratory patterns by which the vocal tissues create acoustic signals. Previous studies have identified the regular occurrence of nonmodal phonation types in normal infant phonation. The glottis is like many oscillating systems that, because of nonlinear relationships among the elements, may vibrate in ways representing the deterministic patterns classified theoretically within the mathematical framework of nonlinear dynamics. The infant's preverbal vocal explorations present such a variety of phonations that it may be possible to find effectively all the classes of vibration predicted by nonlinear dynamic theory. The current report defines acoustic criteria for an important subset of such vibratory regimes, and demonstrates that analysts can be trained to reliably use these criteria for a classification that includes all instances of infant phonation in the recorded corpora. The method is thus internally comprehensive in the sense that all phonations are classified, but it is not exhaustive in the sense that all vocal qualities are thereby represented. Using the methods thus developed, this study also demonstrates that the distributions of these phonation types vary significantly across sessions of recording in the first year of life, suggesting developmental changes. The method of regime classification is thus capable of tracking changes that may be indicative of maturation of the mechanism, the learning of categories of phonatory control, and the possibly varying use of vocalizations across social contexts. (+info)
Esophago-glottal closure reflex in human infants: a novel reflex elicited with concurrent manometry and ultrasonography.
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BACKGROUND AND AIMS: Our aims were to identify and characterize the glottal response to esophageal mechanostimulation in human infants. We tested the hypotheses that glottal response is related to the type of esophageal peristaltic response, stimulus volume, and respiratory phase. METHODS: Ten infants (2.8 kg, SD 0.5) were studied at 39.2 wk (SD 2.4). Esophageal manometry concurrent with ultrasonography of the glottis (USG) was performed. The sensory-motor characteristics of mechanostimulation-induced esophago-glottal closure reflex (EGCR, adduction of glottal folds upon esophageal provocation) were identified. Mid-esophageal infusions of air (N = 41) were given and the temporal relationships of glottal response with deglutition, secondary peristalsis (SP), and the respiratory phase were analyzed using multinomial logistic regression models. RESULTS: The frequency occurrence of EGCR (83%) was compared (P < 0.001) with deglutition (44%), SP (34%), and no esophageal responses (22%). The odds ratios (OR, 95% CI) for the coexistence of EGCR with SP (0.4, 0.06-2.2), deglutition (1.9, 0.1-26), and no response (1.9, 0.4-9.0) were similar. The response time for esophageal reflexes was 3.8 (SD 1.8) s, and for EGCR was 0.4 (SD 0.3) s (P < 0.001). Volume-response relationship was noted (1 mL vs 2 mL, P < 0.05). EGCR was noted in both respiratory phases; however, EGCR response time was faster during expiration (P < 0.05). CONCLUSION: The occurrence of EGCR is independent of the peristaltic reflexes or the respiratory phase of infusion. The independent existence of EGCR suggests a hypervigilant state of the glottis to prevent retrograde aspiration during GER events. (+info)
Value of computed tomography for evaluating the subglottis in laryngeal and hypopharyngeal squamous cell carcinoma.
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CONTEXT AND OBJECTIVE: Subglottic involvement in squamous cell carcinoma is a determining factor for contraindicating conservative partial surgery. The subglottis is easily identified by axial computed tomography sections. The present study aimed to evaluate the occurrence of false-negative and false-positive results, and the overall accuracy of staging by computed tomography, in order to detect the involvement of the subglottic laryngeal compartment, in cases of laryngeal and hypopharyngeal squamous cell carcinoma. DESIGN AND SETTING: Retrospective, non-randomized study of patients treated at Hospital Heliopolis, Sao Paulo, Brazil. METHODS: Computed tomography scans were performed on third-generation equipment with 5-mm slice thickness. Afterwards, all patients underwent surgical and anatomopathological examinations as the gold standard procedures. RESULTS: Among 60 patients, 14 were diagnosed with subglottic extension by surgical and histopathological examination. There were three false-negative and no false-positive results from computed tomography scans. The sensitivity and negative predictive value were 100.0%. Accuracy was 95.0%, specificity was 93.5% and positive predictive value was 82.4%. CONCLUSIONS: Computed tomography could serve as a powerful auxiliary method for staging laryngeal and hypopharyngeal cancer. However, precautions should be taken in analyzing computed tomography scan data, because vegetating lesions may also be projected into the subglottic compartment, without real involvement of the subglottis, which may cause a false-positive result. (+info)
A larynx area in the human motor cortex.
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The map of the human motor cortex has lacked a representation for the intrinsic musculature of the larynx ever since the electrical stimulation studies of Penfield. In addition, there has been no attempt to localize this area using neuroimaging techniques. Because of the central importance of laryngeal function to vocalization, we sought to localize an area controlling the intrinsic muscles of the larynx by using functional magnetic resonance imaging and to place this area in a somatotopic context. We had subjects perform a series of oral tasks designed to isolate elementary components of phonation and articulation, including vocalization of a vowel, lip movement, and tongue movement. In addition, and for the first time in a neuroimaging study, we had subjects perform "glottal stops," in other words forced closure of the glottis in the absence of vocalizing. The results demonstrated a larynx-specific area in the motor cortex that is activated comparably by vocal and nonvocal laryngeal tasks. Converging evidence suggests that this area is the principal vocal center of the human motor cortex. Finally, the location of this larynx area is strikingly different from that reported in the monkey. We discuss the implications of this observation for the evolution of vocal communication in humans. (+info)
A method of producing carcinoma in upper aerodigestive tree and esophagus of the Syrian golden hamster using wounding and instillation of N-methylnitrosourea.
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Details of a method for producing carcinoma of the aerodigestive tree of the Syrian golden hamster and the use of this model to evaluate putative agents for chemoprevention of these carcinomas are described. The method produces a majority of squamous carcinomas of the trachea and glottis that follow squamous metaplasia of respiratory epithelium. In addition, seen are adenocarcinomas arising in glands of the respiratory tree. Squamous carcinomas of the digestive epithelium arise in primary squamous epithelium. These tumors of digestive epithelium have a growth pattern that differs from that of the respiratory epithelium in that they grow and invade without filling the epithelial layer with tumor cells. (+info)
Subglottic MALT lymphoma of the larynx--more attention to the glottis.
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BACKGROUND: Mucosa-associated lymphoid tissue (MALT) lymphoma of the larynx is a rare but well-documented entity which may arise from chronic inflammatory process. Supraglottic left regions are predominant due to unknown reason. CASE REPORT: We present the case of a 62-year-old man with a dry cough, stridor and developing exertional dyspnea. This subglottic almost circumferential MALT lymphoma showed a temporary distinct disappearance after cortisone administration during the diagnostic process. Bronchoscopy confirmed the diagnosis of a primary MALT lymphoma of the larynx. The patient received chemotherapy according to CHOP scheme plus rituximab. A reliable post-treatment care period of 15 months showed no sign of recurrence. CONCLUSION: MALT lymphoma of the larynx are believed to arise from preexisting or acquired lymphoid tissue of the upper airway. Acquired lymphoid tissue is documented in the supraglottic region and may be associated with a chronic inflammatory process. However, in subglottic cases it is unclear whether the chronic inflammation arises from a local or systemic process. (+info)
Posterior glottic stenosis in adults.
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BACKGROUND: Posterior glottic stenosis is a complication of prolonged intubation, manifesting as airway stenosis that may mimic bilateral vocal cord paralysis. It presents a variety of features that mandate specific surgical interventions. OBJECTIVES: To summarize our experience with PSG and its working diagnosis. METHODS: We conducted a retrospective review of a cohort of adult patients with PGS operated at the Sheba Medical Center between 1994 and 2006. RESULTS: Ten patients were diagnosed with PGS, 6 of whom also had stenosis at other sites of the larynx and trachea. Since 2000, all patients underwent laryngeal electromyographic studies and direct laryngoscopy prior to surgery. Surgical interventions included endoscopic laser procedures (in 2 patients), laryngofissure and scar incision (in 1), laryngofissure with buccal mucosa grafting (in 3) or with costal cartilage grafting (in 1) and laryngofissure with posterior cricoid split and stenting (in 1); one patient was not suitable for surgery. Postoperative follow-up included periodic fiberoptic endoscopies. Voice analysis was evaluated by the GRBAS grading. Seven patients were successfully decannulated within one to three procedures. Voice quality was defined as good in 7 patients, serviceable in 2 and aphonic in 1. CONCLUSIONS: Posterior glottic stenosis may be isolated or part of complex laryngotracheal pathologies. Electromyographic studies and direct laryngoscopy must be included in the diagnostic workup. Costal cartilage or buccal mucosa grafts are reliable, safe and successful with respect to graft incorporation and subglottic remodeling. (+info)
Unsuspected swallowing of a partial denture.
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We report a case of a swallowed partial denture in a 51-year-old man who presented with progressive dysphagia, odynophagia, and fevers. Imaging studies were initially interpreted as supraglottitis with laryngeal inflammation, which was confirmed by direct visualization with flexible endoscopy. Despite appropriate therapy, the patient's symptoms persisted and rigid laryngoscopy was performed, which revealed a partial denture in the hypopharynx and upper esophagus. The subtle imaging appearance of a swallowed denture is discussed. (+info)