• 대한후두음성언어의학회지
• /
• 제30권2호
• /
• pp.132-135
• /
• 2019

Spasmodic dysphonia is a focal laryngeal dystonia that results in involuntary spasms during speech. The etiology of spasmodic dysphonia is not yet defined, but it is presumed to be a neurological abnormality of central nervous system motor function. The treatment of choice for spasmodic dysphonia is botulinum toxin injection directly at the laryngeal muscles. However botulinum toxin injection requires repeated procedures. Many different kinds of surgical treatments have been introduced but the recurrence rate is still high. So we performed myomectomy with LASER and neurectomy with specially designed electrical surgical knife which can cut recurrent laryngeal nerve branch selectively with its noble curved section. We report a case of a 43-year-old male patient with spasmodic dysphonia treated by thyroarytenoid myoneurectomy.

• 대한음성언어의학회:학술대회논문집
• /
• 대한음성언어의학회 2002년도 제16회 학술대회
• /
• pp.75-82
• /
• 2002

Botulinum toxin-A, a neurotoxin derived from Clostridia Botulinum, has been injected into the laryngeal muscle(s) for the treatment of the spasmodic dysphonia at the Voice Clinic, Yonsei Institute of Logopedics and phoniatrics since December 1995. We analyzed 355 patients with spasmodic dysphonia, using Botox register review. In the 355 patients, female is 86.8%. male is 13.2%. 305 patients (85.9%) had adductor type of spasmodic dysphonia and 35 patients (9.9%) were vocal tremor type and 15 patients were abduction and mixed type. Botulinum toxin type-A (Botox) injection using EMG was most frequently conducted as 587 cases, comparing with flexible nasopharyngoscopy gudied injection (68cases) and tele- laryn-goscopy guided injection (31cases). In the respect of frequency of Botox injection, 137 patients(38.6%) were injected one time but 1 patient was injected 17times. The mean dose of Botox is 6.2U. Clinically, initial dose of Botulinum toxin-A was high dose (7-8U) but current dose is small dose (3U). And the mean duration of Botox injection is 6.4 month. In conclusion, to optimize effect of the treatment for spasmodic dysphonia, Botulinum toxin-A injection is combined with voice therapy.

• 대한후두음성언어의학회지
• /
• 제17권2호
• /
• pp.146-148
• /
• 2006

Spasmodic dysphonia is a voice disorder characterized by involuntary voice breaks during speech. Adductor spasmodic dysphonia is most common and characterized by strained and strangled voice breaks. The current standard of treatment of therapy for adductor spasmodic dysphonia is chemodenervation of thyroarytenoid muscle with botulinum toxin(Botox). However, Botox is a temporary treatment with each injection lasting approximately 3 months on average and require repeated injections. In this study, we report our experience with surgical treatment for adductor spasmodic dysphonia. In this procedure, the thyroarytenoid branch and lateral cricoarytenoid branch of recurrent laryngeal nerve is selectively denervated unilaterally, and its distal nerve stump of thyroarytenoid branch is reinnervated with branch of the usa cervicalis nerve. And lateral cricoarytenoid muscle partial myotomy was done unilaterally. After 6 months of treatment, voice fluency had improved and no period of breathiness or dysphagia was noted.

• 대한후두음성언어의학회지
• /
• 제32권1호
• /
• pp.9-14
• /
• 2021

Spasmodic dysphonia, essential tremor, and vocal tremor related with Parkinson's disease are different disorders showing fairly similar symptoms such as difficulty in the speech onset, and tremble in the voice. However, the cause and the resulting treatment of these diseases are different. Spasmodic dysphonia is a vocal disorder characterized by spasms of the laryngeal muscles during a speech, invoking broken, tense, forced, and strangled voice patterns. Such difficult-to-treat dysphonia disease is classified as central-origin-focal dystonia, of a yet unknown etiology. Its symptoms arise because of intermittent and involuntary muscle contractions during speech. Essential tremor, on the other hand, is characterized by a rhythmic laryngeal movement, resulting in alterations of rhythmic pitch and loudness during speech or even at rest. Severe cases of tremor may cause speech breaks like those of adductor spasmodic dysphonia. In the case of hyper-functional tension of vocal folds and accompanying tremors, it is necessary to distinguish these disorders from muscular dysfunction. A diversified assessment through the performance of specific speech tasks and a thorough understanding for the identification of the disorder is necessary for accurate diagnosis and effective treatment of patients with vocal tremors.

• 대한후두음성언어의학회지
• /
• 제10권1호
• /
• pp.17-23
• /
• 1999

Vocal hyperfunction is considered to be the most significant characteristic in larynx disorders which is found among many patients presenting hoarseness Primarily as chief complaint. In Pusan National University Hospital, we executed the voice therapy to 28 patients being 17 female and 11 male patients who visited the Voice ＆ Speech Therapy Clinic, due to the voice disorder, and then compared and analysed the voice before and after its therapy using acoustic and aerodynamic test. The obtained results were as follows. In the analysis by the local findings, it was improved to 88% in the patients of vocal nodule, 75% in mutational falsetto, 75% in the functional dysphonia, 75% in the vocal cord palsy, 50% in the vocal polyp and 50% in dysphonia plica ventricularis. For the acoustic analysis, Fo, litter, Shimmer and NHR were measured. In the patients of mutational falsetto, Fo, Jitter and NHR were shown to be improved significantly and in the patients of vocal nodule, Shimmer was shown to be improved significantly. In the patients of vocal polyp, Fo was significantly improved. In the patients of vocal cord palsy in litter and NHH were significantly improved. In the patients of dysphonia plica ventricularis, Shimmer and NHR were significantly improved and the patients of functional dysphonia were more improved in Fo, litter and Shimmer. For the aerodynamic analysis, MPT was measured. In particular, it was shown to be improved significantly in the patients of vocal nodule, improved in the vocal polyp, vocal cord palsy, functional dysphonia patients.

• 말소리와 음성과학
• /
• 제8권2호
• /
• pp.57-63
• /
• 2016

Recently, the Lax Vox voice therapy has been used as one of the SOVTE(Semi-Occluded Vocal Tracts Exercise). The purpose of this study was to explore the effect of Lax Vox voice therapy for a patient with Spasmodic dysphonia on voice improvement. One female spasmodic dysphonia patient(age=27) who had been diagnosed by a laryngologist received Lax Vox voice therapy. The Lax Vox protocol was configured as 5 steps (1 warm-up and 4 steps : bubbling without / with phonation/ gliding with phonation/ generalization) in this study. A total of 11 sessions were performed by a certified speech language pathologist. The present study evaluated the acoustic, aerodynamic, auditory perceptual, and patient's self-rating between pre-, mid-, and post- voice therapy. All objective and subjective parameters were improved after voice therapy; Reduced frequency variation, increased maximum phonation time, enlarged voice range, improved 'G' and 'S' in GRBAS & USDRS, and reduced VHI were observed. Especially, decreased $f_0$ and remarkably reduced voice tremor were also demonstrated following Lax Vox voice therapy. Accordingly, Lax Vox voice therapy technique can be useful for improving voice and quality of life in patients with spasmodic dysphonia.

• 말소리와 음성과학
• /
• 제2권2호
• /
• pp.117-121
• /
• 2010

The This study aimed to evaluate the effects of the voice therapy we operated to the patients with age-related dysphonia. Thirty four participants who were diagnosed as age-related dysphonia in laryngoscopic finding from January, 2009 to December, 2009 completed the study. The participants were aged from 60 to 82 years old with a mean age of 70.6. All participants had received the abdominal breath technique, SKHPIP with laughter, and basic vocal training with description of their problem, the length of which ranged from four sessions to twelve sessions. We executed the videostroboscopy to compare the aspect of voicing change and the perceptual assessment, voice range profile, acoustic and aerodynamic measures to identify change of voice. Participants had glottal gap due to incomplete glottic closure during voicing on the pretest. After they took the voice therapy, the glottic gap became narrow and rough and breathy voice was reduced. There were significant difference in acoustic and aerodynamic measures. Jitter, Shimmer, MFR were reduced and MPT, Psub were increased(p<.05). Participants' pitch range and intensity range were increased on the posttest performance after taking voice therapy. Especially, most of them were showed that pitch range was increased significantly in high frequency area. The results of this investigation indicate that the voice therapy using abdominal breath, SKHPIP, and exercise together is effective for the patients who have age-related dysphonia to improve their voice quality. We recommend to apply this technique to functional voice disorders who are showed glottal gap.

• 말소리와 음성과학
• /
• 제1권4호
• /
• pp.165-170
• /
• 2009

This study was to investigate for comparison between single rating and average ratings from multiple presentations of the same stimulus for measuring the voice quality of dysphonia using 7-point equal-appearing interval (EAI) rating scale. Overall severity of voice quality for 46 /a/ vowel stimuli (23 stimuli from dysphonia, 23 stimuli from control) was rated by 3 experienced speech-language pathologists (averaged 19 years; range = 7 to 40 years). For average ratings, each stimulus was rated five times in random order and averaged from two to five times. Although higher inter-rater reliability was found in average ratings than in single rating, there were no significant differences in rating scores between single and multiple average ratings judged by experienced listeners, suggesting that auditory perceptual ratings judged by well-trained listeners have relatively good agreement with the same stimulus across the judgment. Larger variations in perceptual ratings were observed for moderate voices than for mild or severe voices, even in the average ratings.

• 말소리와 음성과학
• /
• 제5권1호
• /
• pp.55-62
• /
• 2013

This study compared the aerodynamic multiparameters of whispers and phonation in patients with muscle misuse dysphonia(MMD) to evaluate the voice aerodynamic analysis for discrimination between whispers and phonation. Eleven patients with muscle misuse dysphonia were examined. Whispers were shorter with a maximum phonation time(MPT; p<.01), a lower phonatory sound pressure level(SPLp; p<.01), a higher phonatory flow rate (PFR; p<01), lower phonatory efficiency(PE; p<.01), and a lower phonatory resistance (PR; p<.05) than phonation. The subglottal pressure level was not significantly different between whispers and phonation. (Psub; p>.05). The ROC analysis showed that the threshold of 23.83 ppm for PE achieved a good classification for whispers, with the perfect sensitivity(100%) and specificity(100%). Those results indicate PE reliably distinguished between whispers and phonation. The results also suggest that PE may provide a useful tool for studying the laryngeal source.

• 음성과학
• /
• 제9권4호
• /
• pp.27-38
• /
• 2002

The purpose of this article is to present the acoustic parameters (VOT, jitter, shimmer, vF0, vAm, NHR, SPI, VTI, DVB, DSH) for consonants (/pipi/, /$p^{h}ip^{h}i$/, /p'ip'i/) and sustained vowels (/a/, /e/, /i/) produced by normal subjects and dysphonia patients at two vocal effort(normal, high) by Lombard effect using 60dB white noise. Lombard effect indicates the vocal effort increase in noisy situation. At normal vocal effort, in general the acoustic parameter values of patients are greater than normal. And in noisy situation, significant decrease of acoustic values is seen in normal compared with in dysphonia patients. The clinical implication of this finding, the vocal quality in dysphonia is not compensated by vocal effort as well as normal subjects because of the inefficiency caused by abnormal vocal fold appearance and function. And with this result, we can counsel that the voice quality can not be improved as well as the patient expect.