• 대한후두음성언어의학회지
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• 제24권1호
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• pp.13-17
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• 2013

Laser laryngeal microsurgery is currently the primary method of treatment of various laryngeal diseases. The development of laryngeal microsurgery came from the introduction of a small spot $CO_2$ laser micromanipulator and more precise microlaryngeal instruments. $CO_2$ laser laryngeal microsurgery has enabled very precise surgery because it has small focus size and hemostatic effect. There are some limitations to the use of the $CO_2$ Laser such as adjacent tissue damage and vocal fold scarring. These problems can be minimized through understanding the mechanisms by which lasers function and correctly manipulating the parameters under a surgeon's control. We should also recognize the safety of $CO_2$ laser for the surgeon to precisely perform the procedure.

• 대한후두음성언어의학회지
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• 제19권1호
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• pp.47-53
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• 2008

Background and Objectives : Benign neoplasms of the larynx are rare, and papillomas account for approximately 90% of these neoplasms. Other benign neoplasms of the larynx are very rare and form a hetergenous group. We present clinical manifestations of unusual benign neoplasms based on our experiences and review of literatures. Materials and Method : We reviewed retrospectively the clinical records of 14 patients with benign neoplasms of the larynx, excluding papillomas, that were examined in our department during 11-year period from 1995 to 2006. Results : The presenting symptom was most commonly progressive dysphonia. Pathologic diagnosis revealed 5 cases of hemangioma, 3 granular cell tumor, 2 amyloidosis, 2 laryngocele, 1 schwannoma, 1 chondroma. Subsites of the neoplasms were 5 in true vocal cord, 3 in arytenoids, 2 in false vocal cord, 2 in supraglottis, and others were subglottis ; aryepiglottic fold. Treatment was surgical, by a external approach in 1 case of chondroma, and by laryngoscopic approach in other cases. In laryngoscopic approach, carbon dioxide laser was used in 10 cases. Postoperative course was satisfactory. Recurrence was encountered in I case of amyloidosis and revision operation was done 3 times. No recurrence was encountered in other cases. Conclusion : Uncommon benign neoplasms of the larynx require high index of suspicion and histological confirmation. Complete excision with an attempt to maintain normal structures generally results in cure.

• 음성과학
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• 제1권
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• pp.153-200
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• 1997

In languages such as Japanese, it is very common to observe that short peripheral vowel are completely voiceless when surrounded by voiceless consonants. This phenomenon has been known as Montreal French, Shanghai Chinese, Greek, and Korean. Traditionally this phenomenon has been described as a phonological rule that either categorically deletes the vowel or changes the [+voice] feature of the vowel to [-voice]. This analysis was supported by Sawashima (1971) and Hirose (1971)'s observation that there are two distinct EMG patterns for voiced and devoiced vowel in Japanese. Close examination of the phonetic evidence based on acoustic data, however, shows that these phonological characterizations are not tenable (Jun & Beckman 1993, 1994). In this paper, we examined the vowel devoicing phenomenon in Korean using data from ENG fiberscopic and acoustic recorders of 100 sentences produced by one Korean speaker. The results show that there is variability in the 'degree of devoicing' in both acoustic and EMG signals, and in the patterns of glottal closing and opening across different devoiced tokens. There seems to be no categorical difference between devoiced and voiced tokens, for either EMG activity events or glottal patterns. All of these observations support the notion that vowel devoicing in Korean can not be described as the result of the application of a phonological rule. Rather, devoicing seems to be a highly variable 'phonetic' process, a more or less subtle variation in the specification of such phonetic metrics as degree and timing of glottal opening, or of associated subglottal pressure or intra-oral airflow associated with concurrent tone and stricture specifications. Some of token-pair comparisons are amenable to an explanation in terms of gestural overlap and undershoot. However, the effect of gestural timing on vocal fold state seems to be a highly nonlinear function of the interaction among specifications for the relative timing of glottal adduction and abduction gestures, of the amplitudes of the overlapped gestures, of aerodynamic conditions created by concurrent oral tonal gestures, and so on. In summary, to understand devoicing, it will be necessary to examine its effect on phonetic representation of events in many parts of the vocal tracts, and at many stages of the speech chain between the motor intent and the acoustic signal that reaches the hearer's ear.

• 대한후두음성언어의학회지
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• 제33권2호
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• pp.110-114
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• 2022

IgG4-related disease is a fibroinflammatory condition by infiltration of IgG4-positive plasma cells that often presents as a tumorous lesion. This disease can affect nearly every organ system. After the pancreas, the head and neck region is second most common site for presentation of IgG4-related disease such as Mikulicz's disease, Küttner tumor. The involvement of IgG4-related disease in laryngeal lesions is extremely rare. We have experienced a case of IgG4-related disease with pseudotumor formation in the larynx that is suggestive of malignancy in radiologic findings. But the pathology findings was finally confirmed as IgG4-related disease. Oral treatment with prednisolone was initiated, and the edematous mass reduced in size without permanent functional impairment of vocal fold mobility. We report our experience with a literature review.

• 말소리와 음성과학
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• 제11권3호
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• pp.69-76
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• 2019

본 연구는 성대에어로빅치료법(vocal aerobic treatment, VAT)이 음성장애 환자의 음성 개선에 미치는 효과에 대해 알아보았다. 연구대상은 후두스트로보스코피, 음성검사 상 음성장애로 진단된 20명(남 13명, 여 7명)이었다. 음향학적 평가는 CSL(computerized speech lab)의 MDVP(Multi-Dimensional Voice Program)와 VRP(Voice Range Profile)를 통해 평가하였다. 공기역학적 평가는 PAS(Phonatory Aerodynamic System)를 통해 평가하였다. MDVP를 통해 치료 전 후 기본주파수(Fo), 주파수변동률(Jitter), 진폭변동률(Shimmer), 소음대배음비(NHR)의 변화를 측정하였고, VRP에서는 치료 전 후 주파수 범위(Fo range), 강도범위(Energy range)를 측정하였다. PAS에서는 치료 전 후 폐활량(FVC), 최대연장발성시간(PHOT), 평균호기류율(MEAF), 성문하압(MPAP), 음성효율성(AEFF)의 변화를 알아보았다. 후두스트로보스코피에서는 치료 전 후 양측 성대의 규칙성, 대칭성, 점막파동, 진폭 변화 소견을 알아보았다. 음성치료는 총체적 음성치료 접근법 중 하나인 VAT 프로그램을 환자별로 주 1회 실시하였다. 환자별 평균 치료 회기는 6.5회였다. 연구결과, MDVP에서는 Jitter, Shimmer, NHR이 통계적으로 유의하게 감소하였다(p<.001, p<.01, p<.05). VRP 결과, 주파수 범위에서 Hz와 Semitones이 치료 후 유의미하게 향상하였다(p<.01, p<.05). PAS 결과, FVC, PHOT에서 유의미한 향상이 나타났다(p<.01, p<.001). 후두스트로보스코피 결과 치료 후 기능적 음성장애, 인후두역류질환, 양성성대점막질환군에서 성대소견이 정상범주에 해당하였다. 따라서 VAT 프로그램은 음성장애환자의 음향학적 공기역학적 후두스트로보스코피 측면에서의 음성 개선에 효과적인 것으로 나타났다. 차후 연구에서는 동일 집단의 음성장애 환자에게 VAT 적용 연구가 필요하다고 생각된다. 또한 객관적인 음성 개선뿐만 아니라 주관적 음성 개선을 알아볼 필요가 있다. 나아가 직업적 음성사용자를 대상으로 VAT 효과에 대한 적용연구가 필요가 있다.

• 대한후두음성언어의학회지
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• 제14권2호
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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.

• 대한후두음성언어의학회지
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• 제14권1호
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• pp.16-25
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• 2003

후두암은 유병율이 높지만 조기에 발견하면 90% 이상의 치유율과 발성기능의 보존이 가능하며 현재 음성분석을 이용한 진단법이 시도되고 있으나 정립된 선별검사법은 없는 실정이다. 성문전도검사(electroglottography, EGG)는 성대의 진동양상을 알 수 있는 비침습적 검사로서 발성과 음성합성의 연구에 많이 사용되고 있다. 본 연구는 EGG에서 관찰되는 파라미터들을 다층 퍼셉트론(multilayer perceptron)구조의 신경회로망(artificial neural network)으로 감별하는 기법을 이용하여 후두암 감별법에 대한 연구로서 부산대학교병원을 내원한 후두암 환자 10명과 양성후두질환 26명을 대상으로 새로 고안한 Electroglottograph(v1.0)를 이용하여 검사하고 이의 임상적 유용성을 평가하였다. EGG 파라미터인 closed quotient(CQ), speed quotient(SQ), speed index(SI), fundamental frequency(F0), Jitter, Shimmer 등은 MATLAB 6.5 (Mathwork, Inc.)로 작성한 분석 프로그램을 이용하여 추출하였다. 각 환자에서 추출된 EGG 파라미터들을 다층 퍼셉트론 구조의 신경회로망으로 감별하였다. CQ는 각 질환군 간에 유의한 차이가 없었지만 SQ, SI, Jitter, Shimmer 등은 성대질환의 특성에 따라 유의한 차이를 보였다. 신경회로망에서 감별한 결과 CQ를 제외한 SQ, SI, Jitter, Shimmer 등에서 71.3-90%의 후두암의 감별율을 보였다. 또한 SQ, SI, Jitter, Shimmer를 3개씩 조합한 실험에서는 SQ-Jitter-Shimmer와 SQ-SI-Shimmer의 후두암의 감별율이 93%로 가장 높았고, SQ-SI-Jitter 90.9%, SI-Jitter-Shimmer 88.6%로 전체적으로 85% 이상의 높은 감별율을 나타내었다. 이러한 결과는 EGG검사와 신경회로망을 이용한 양성과 악성 후두질환의 감별이 가능함을 시사한다. 향후 성대 질환의 병태생리를 대변할 수 있는 파라미터가 추가로 개발되고 분류 알고리듬이 개선된다면 EGG를 이용한 성대질환의 감별 진단이 보다 정확해질 것으로 사료되었다.

• 말소리와 음성과학
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• 제15권2호
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• pp.31-40
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• 2023

목적: 물 속에서 튜브 발성은 semi-occluded vocal tract(SOVT) 연습 중 하나로 환자가 튜브를 물 속에 잠기게 하여 거품을 내면서 발성을 하는 것으로 음성 훈련에 널리 사용되어 왔다. 본 연구는 과기능성 음성장애 환자를 대상으로 물저항발성 동안 튜브 직경과 튜브를 담그는 물 깊이가 물거품 높이와 최대발성지속시간(maximum phonation time, MPT)에 미치는 영향을 조사하는 것을 목적으로 한다. 방법: 과기능성 음성장애 환자 17명에게 튜브 직경(5, 7, 10 mm), 튜브를 담그는 물 깊이(4, 7, 10 cm)에 따라 지속적인 /u/발성을 하면서 거품을 내도록 하였다. 물거품 높이 및 MPT 기록을 위해 수위 센서를 이용한 물저항발성 바이오피드백 시스템을 사용하였다. 결과: 물거품 높이는 튜브 직경에 의해 유의하게 변화한 반면 MPT는 튜브 직경과 깊이에 따라 유의하게 변화하였다. 직경이 더 넓을수록 주어진 깊이에 대해 유의하게 낮은 물거품 높이를 나타냈지만, 상대적으로 일관된 버블 높이가 유지되었다. 물의 깊이에 따라 주어진 튜브 직경에서 물거품 높이는 유의한 차이가 없었으나, 물의 깊이에 따라 MPT는 유의하게 감소하였고 튜브가 넓을수록 MPT가 유의하게 감소하였다. 결론: 수위 센서 방식의 물저항 바이오피드백 시스템은 튜브 직경 및 수심에 따른 기포 특성 및 성대 진동에 대해 유용한 정보를 제공하였다. 또한, 수위센서를 이용한 물저항발성 바이오시스템은 과기능적 음성장애가 있는 환자의 물저항 발성 중 호흡 지지를 모니터링하는 데 유용하게 사용될 수 있다.

• 말소리와 음성과학
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• 제5권1호
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• pp.63-69
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• 2013

This study attempted to investigate the characteristics of Phonation Threshold Pressure and Phonation Threshold Airflow of Patients who have Functional voice disorder. 50 subjects participated in study (32 subjects were patients who had functional voice disorders and 20 subjects were normal adults). The PAS (Phonatory aerodynamic system, model 6600, KAY electronics, Inc.) was used to measure the data and to do the analysis. Data from the Phonation Threshold Pressure was measured using voicing efficiency of the PAS protocol. Data from the Phonation Threshold Airflow was measured using Maximum Sustained Phonation of the PAS protocol. Those were used because of the ease of phonation. The results of this study showed that the differences in Phonation Threshold Pressure and Phonation Threshold Airflow between patients who had functional voice disorder and normal adults could be significant index. Patients who had functional voice disorder showed more higher figures than normal adults. These results suggest that Phonation Threshold Pressure and Phonation Threshold Airflow are very useful in diagnosing the voice disorder. The measured data also provided useful information for diagnosing patients with vocal fold diseases.

• 대한음성학회:학술대회논문집
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• 대한음성학회 2007년도 한국음성과학회 공동학술대회 발표논문집
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• pp.292-294
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• 2007

This study was designed to compare the translated patient's subjective rating scales for voice evaluation (Voice Handicap Index; VHI, Voice-Related Quality of Life; V-RQOL, Voice Rating Score; VRS) into Korean, taken from 24 professional voice users diagnosed with organic voice disorders. First, the correlation amongh those scales were observed. Second, the correlation between the patient's subjective rating scales and acoustic measures (Jitter%, Shimmer%, NHR) were examined. Third, those scales were compared by clinician's objective scale (G in GRBAS scale). Results indicated that significant correlations among the patients' subjective rating scales and significant correlations of clinician's rating scale with jitter% and Shimmer%, but not with NHR were observed. In addition, there were significant correlations of G with VHI and VHI-P (one of subscale of VHI). However, none of acoustic measures were correlated with the patient's subjective rating scales.