• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.1
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• pp.11-15
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• 2008

Endoscopic laser cordectomy is known as an oncologically sound procedure for T1 and selected T2 glottic carcinoma ; it has comparable local control rate and better long-term laryngeal preservation rate when compared with those of radiotherapy. Even if results of the reported voice outcome studies after surgery or radiotherapy are diverse and controversial, resection deeper than the body layer of the vocal fold (type III, IV, V cordectomy) usually leads to aerodynamic insufficiency during phonation and results in poor voice quality. A keyhole defect or development of synechiae at the anterior commissure after type VI cordecomy may also result in unsatisfactory vocal outcome. However, many advances in phonosurgical techniques are reported to be successfully applied in the reconstruction of glottal defect that is subsequent to endoscopic laser cordectomy. In case of glottal insufficiency, voice restoration can be achieved by means of augmentation of the paraglottic space or medialization of the excavated vocal fold. Injection laryngoplasty with synthetic materials or autologous fat is gaining its popularity for restoring minor glottal volume defect because of its convenience. Laryngeal framework surgery, especially type I thyroplasty with premade implant systems or Gore-Tex, is most frequently used to correct larger glottic volume defect. In case of anterior commissural keyhole defect, additional procedure including laryngofissure may be required. For anterior commissural synechiae, laryngeal keel may be inserted for several weeks or mitomycin-C may be repeatedly applied after the division of adhesive scar to prevent restenosis. In this paper, current concepts and the authors' experiences of phonosurgical reconstruction of vocal function after endoscopic cordectomy will be introduced.

• Phonetics and Speech Sciences
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• v.9 no.4
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• pp.99-106
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• 2017

Clinical data about vocal nodules have seldom been reported, even though vocal nodules are commonly diagnosed in outpatient speech and voice clinic. This study aims to investigate clinical characteristics of the patients who are diagnosed with vocal nodules. This study analyzed the data for 10 years from the 319 patients diagnosed with vocal nodules (45 males and 274 females with the mean age of 39.4 ranging from 2 to 83) in terms of gender, age, occupation, voice change initiation pattern, change with time, throat clearing, smoking history, type of voice abuse, acoustic analysis, maximum phonation time, GRBAS, and VHI. Thirteen patients (4.08%) had unilateral vocal nodule and 306 patients (95.9%) had bilateral vocal nodule, the majority of which had a pattern of asymmetry (73.9%). The glottal closure pattern was hourglass in 72.1% of patients, posterior chink in 17.9% of patients, and irregular in 7.9% of patients. The most common occupational category was professional voice users (43.4%). The voice abuse pattern included excessive talking in 96 patients (76.8%), loud voice in 78 (62.4%) patients, and excessive singing in 17 patients (21.6%). The patients showed worse scores in G, B, and S than in R and A for the GRBAS evaluation. The most recommended treatment for vocal nodules was voice therapy. The current clinical data will be helpful for treatment planning for the patients of vocal nodule.

• Phonetics and Speech Sciences
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• v.12 no.1
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• pp.65-74
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• 2020

This study aims to compare the acoustic characteristics of vowel phonation in children with spastic and dyskinetic cerebral palsy (CP). Thirty-four children aged 4-12 years with CP participated in the study (spastic 26, dyskinetic 8). Voice samples for the acoustic analysis were extracted from a sustained vowel /a/. All acoustic measures were made using Praat. Group differences were compared by an independent t-test or Welch-Aspin test, if the equivalence assumption was not met. The results of this study are as follow. First, maximum phonation time(MPT) was significantly shorter for the dyskinetic CP than for the spastic CP. Second, shimmer percent was significantly increased in the dyskinetic CP than in the spastic CP. Lastly, there were no significant group differences in both the first formant and the second formant. These findings indicate that the dyskinetic CP has a poorer respiratory capacity and poorer laryngeal function than the spastic CP. On the other hand, both groups have a comparable ability to articulate the vowel /a/. The results of the present study help speech language pathologists identify the speech motor control ability of children with two types of CP (spastic and dyskinetic) and help to make an intervention plan associated with a specific type of CP.

• Phonetics and Speech Sciences
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• v.10 no.4
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• pp.127-134
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• 2018

This study aims to explain the difficulties children with articulation and phonological disorders have in producing alveolar fricative sounds. The study will perform a comparative analysis revealing how ordinary children produce alveolar fricative sounds through five different acoustic variables, and consequently identifying objective differences, compared to children with articulation and phonological disorders. Therefore, this study compared and analyzed the differences between 10 children with articulation and phonological disorders and 10 ordinary children according to a phonation type of alveolar fricative sounds (/s/ and /$s^*$), a type of vowel (/i/, /ε/, /u/, /o/, /ɯ/, /ʌ/, /ɑ/), and a structure of syllables (CV, VCV) through acoustic variables including a central moment, skewness, kurtosis, a center of gravity and variance. That is, children with articulation and phonological disorders, when compared to ordinary children, have difficulties with concentrating an agile and momentary friction with strength when articulating alveolar fricative sounds, which uses strong energy and accompany tension. Furthermore, the values of alveolar fricative sounds of children with articulation and phonological disorders appeared to spread evenly over the average range, which means that the range of overall the standard deviation values for children with functional phonological disorders is wider than that of ordinary children. For a future study, if the mispronounced sounds relating to omission, substitution, and addition can be compared and analyzed for various target groups, it could be used effectively to help children with functional phonological disorders.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.14 no.2
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• pp.117-122
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• 2003

Background and Objectives : $VoCoM^{\circledR}$ is a commercialized set composed of prefabricated hydroxylapatite implants and shims of various sizes which are specially designed for the type I thyroplasty. Even though a previously published preliminary report showed that $VoCoM^{\circledR}$ is a convenient and safe product for the type I thyroplasty, further investigations or experiences are yet to be reported. Authors aimed to evaluate the efficacy of $VoCoM^{\circledR}$type I thyroplasty, and its advantage and/or disadvantage. Materials and Method : Twenty three consecutive patients with unilateral vocal cord palsy enrolled for the study, who received type I thyroplasty with $VoCoM^{\circledR}$ between July 2001 and June 2003. Acoustic, aerodynamic and stoboscopic analyses were performed prior to surgery and 1 to 3 months after surgery. Speech language pathologists evaluated their voice quality by GRBAS scale, and patients themselves reported subjective changes of their voice by visual analog scale. Results : The average time for the operation was 80 min, which is about 30 min less than other methods. Preoperative jitter was 3.25$\pm$1.65% and improved to 1.94$\pm$1.79% postoperatively (p<0.05). Preoperative shimmer was 9.72$\pm$6.56% and improved to 5.61 $\pm$3.76% (p<0.05), Maximal phonation time increased from 4.41$\pm$2.99 to 7.98$\pm$4.35 sec (p<0.05) The postoperative stroboscopy revealed an effective medialization in 91.3% of the patients. The subjective phonetic improvements were reported in 21 out of 23 patients. GRBAS scale improved from 2.71$\pm$0.46 to 1.47$\pm$1.12(p<0.05). Additional medialization with $Gore-Tex^{\circledR}$ was easily performed in two revision cases. Previously inserted $VoCoM^{\circledR}$ implant was hard to remove because of the tight integration of soft tissues around the implant. Side effects such as extrusion or foreign body reaction are not observed. $VoCoM^{\circledR}$ was relatively expensive and costed more than 10 times of $Gore-Tex^{\circledR}$. Conclusion : Prefabricated hydroxylapatitie implant($VoCoM^{\circledR}$) provides a convenient, safe and efficient way of vocal fold medialization. However it is relatively expensive and hard to remove.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.15 no.1
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• pp.16-20
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• 2004

Purpose : To assess perceptual, acoustic and aerodynamic measure of voice quality in patients with unilateral vocal cord paralysis before and after type I thyroplasty. Methods : The clinical records of patients operated type I thyroplasty in the Departement of otorhinoalryngolgy, Yongdong Severance hospital from November 2001 to November 2003 were reviewed. All patients uderwent a vocal function evaluation including perceptual, acoustic and aerodynamic measures of voice preoperative and on $60^{th}$ postoperative day. The perceptual and acoustic measures were obtained from recording of patients' reading a 'Sanchak' passage. The perceptual evaluation was performed by 2 speech pathologist using a 4-point rating scale. Acoustic parameters(voice range profile low(RAL), voice range profile high(RAH), average fundamental frequency(AFX), closed quotient, harmonic to noise ratio, jitter and shimmer) were investigated by Lx speech studio. Mean flow rate(MFR), subglottic pressure(Psub) and intensity were measured using the Phonatory function analyzer. The maximum phonation time was also measured. The data were statistically analyzed. A paired t-test (p<0.1) was used to compare preoperative and postoperative results. And multiple regression test was used to find which parameter was most correlated to improvement of postoperative voice quality. Results : Among aerodynamic parameters, Psub $(88.11mmH_2O{\rightarrow}58.7mmH_2O)$, MPT(7.87sec${\rightarrow}$12.53sec), MFR (359.8ml/sec${\rightarrow}$161.06ml/sec) were statistically improved. AFx(205.5Hz${\rightarrow}$163.27Hz), AQx(23.9%${\rightarrow}$48.3%), RAL, RAH. Jotter and shimmer were improved. In multiple regression test, AFx and AQx was noted as the two meost correlated parameters to improvement of postoperative breathiness. But general grade of voice quality was more correlated to Psub and shimmer. Conclusion : Vocal fold medialization procedures effectively reduce glottic gap. Increasing of contact area of both vocal folds induced improvement in aerodynamic parameters and leaded stabilizing of vocal fold vibration. That effect results in improvement in acoustic parameters (shimmer, jitter, signal-to-noise ratio, voice range profile) and voice quality.

• The Journal of the Acoustical Society of Korea
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• v.30 no.7
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• pp.390-395
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• 2011

This paper covers the studies on common voice parameters through the voice analysis of female main news anchors on weekday evening by the station, and differences of relative voices and sounds among stations. To examine voice characteristics, 6 voice parameters were analyzed and it showed anchors of each station had distinctive characteristics of voices and phonations over all fields except the speech rate, and there were also differences in sound systems. As major analysis parameters, basic pitch, tone of the 1st formant and pitch ratio, level of closeness by pitch bandwidth, type of sentence closing through average pitch position within pitch bandwidth, average speech rate, and acoustic tone analysis by energy distribution by frequency band were used. Analyzed values and results could be referred to and utilized in the criteria of phonation characteristics for domestic female news anchors.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.19 no.1
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• pp.21-27
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• 2008

Total laryngectomy is the most useful procedure tor advanced laryngopharyngeal cancer, but it remains the major problem such as loss of voice. Voice restoration is essential for every patients who undergo a total laryngectomy. Ideal voice rehabilitation methods can resolve three factors. First, every laryngectomee can produce voice sufficient for communication, second every patient should be allowed to use both hands freely during phonation, and last, the voice restoration methods should be easy and safe without complication during and after treatment. Among various voice rehabilitation procedures during or after total laryngectomy, it can be divided electronic and pneumatic methods. In pneumatic methods, there are also divided both pulmonary air and non-pulmonary air methods. The non-pulmonary air methods include esophageal speech, buccal speech, and pharyngeal speech. Pulmonary air methods are divided into surgical and non-surgical such as pneumatic speech aid. In the surgical methods, there are neoglottic operation, tracheopharyngeal shunt, and tracheopharyngeal shunt operations. Recently, tracheoesophageal shunt with or without prosthesis are being recognized the most effective method. Blom-Singer low pressure prosthesis, Panje button, and Provox are well known types of prosthesis in the tracheoesophageal shunt operation. Amatsu method is a kind of famous tracheoesophageal shunt method without using prosthesis. Authors tried to review the published articles for evaluation of effectiveness and problems of tracheoesophageal shunt operation with or without prosthesis. In conclusion, indwelling type of prosthesis and pharyngeal myotomy and plexus neurectomy are recommended for higher success rate during tracheoesophageal puncture procedure. More over, Amatsu method is also one of the recommended voice rehabilitation procedure during total laryngectomy. In this situation, pharyngeal myotomy and plexus neurectomy may be helpful for better fluent communication.

• Phonetics and Speech Sciences
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• v.7 no.2
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• pp.19-28
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• 2015

This study investigated final consonant error characteristics at word-medial position in children with functional articulation disorder. Data was collected from 11 children with functional articulation and 11 normal children, ages 4 to 5. The speech samples were collected from a naming test. Seventy-five words with every possible bi-consonants matrix at the word-medial position were used. The results of this study were as follows : First, percentage of correct word-medial final consonants of functional articulation disorder was lower than normal children. Second, there were significant differences between two groups in omission, substitution and assimilation error. Children with functional articulation disorder showed a high frequency of omission and regressive assimilation error, especially alveolarization in regressive assimilation error most. However, normal children showed a high frequency of regressive assimilation error, especially bilabialization in regressive assimilation error most. Finally, the results of error analysis according to articulation manner, articulation place and phonation type of consonants of initial consonant at word-medial, both functional articulation disorder and normal children showed a high error rate in stop sound-stop sound condition. The error rate of final consonant at word-medial position was high when initial consonant at word-medial position was alveolar sound and alveopalatal sound. Futhermore, when initial sounds were fortis and aspirated sounds, more errors occurred than linis sound was initial sound. The results of this study provided practical error characteristics of final consonant at word-medial position in children with speech sound disorder.

• Phonetics and Speech Sciences
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• v.3 no.3
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• pp.133-140
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• 2011

Muscle misuse dysphonia (MMD) is defined as a behavioral voice disorder resulting from inappropriate contractions of intrinsic and/or extrinsic laryngeal muscles. The purpose of this study was to investigate the effect of motor learning guided laryngeal motor control therapy (MLG-LMCT) which is designed to improve an existing LMT and further the effective voice treatment on people with muscle misuse dysphonia. Forty-six people with MMD (M:F=16:30) participated in this study. The voice samples of the participants were recorded to investigate the effect of MLG-LMCT before and after the voice therapy. Voice samples were analyzed via electro-glotto-graph (EGG). Contact quotient (CQ), speed quotient (SQ), and waveform were reported. In addition, perceptual and acoustical evaluation were conducted to determine the change of voice improvement after treatment. The experimenter massaged the tensioned muscles around the neck. In order to find more proper phonation the experimenter showed the subjects their EGG wave forms as to whether or not they are moving the vocal folds to the appropriate position. Therefore, the EGG wave forms were used as a type of visual feedback. With the wave form, the experimenter helped subjects move the vocal folds and laryngeal muscles to find more proper voice production. The sensory stimuli from the experimenter gradually faded out. A paired dependent t- test revealed that there was significant differences in CQ between pre- and post-therapy. Perceptually, overall, rough, breathy, strain, and transition were significantly reduced. Acoustically, there were significant differences in Fo, jitter, shimmer, and NHR. After using MLG-LMCT, most of the subjects showed improvements in voice quality. The results from this study led us to the following conclusions: Motor learning guided laryngeal motor control therapy (MLG-LMCT) has reduces muscle misuse dysphonia. These results may occur because a visual feedback from EGG wave form can maintain the effect of the muscle tension reduction from laryngeal manual therapy. In case of people with MMD who reduced muscle tension from the therapy (LMT) but, not appropriately manipulating the location of larynx or adducting the vocal folds, MLG-LMCT might be an alternative therapy approach.