H. Komatsuda, T. Kumai, K. Kishibe, M. Takahara, A. Katada, Tatsuya Hayashi, Y. Harabuchi
epiglottis. Because the patient developed stridor and shortness of breath, tracheostomy was performed to secure the airway. Contrast-enhanced computed tomography (CT) showed high-density areas in the epiglottis, base of the tongue, and aryepiglottic folds. The patient was positive for pro-teinase 3 (PR 3 )-antineutrophil cytoplasmic antibody (ANCA, 4 . 9 U/ml) and negative for myeloperoxidase (MPO)-ANCA. A histo-pathological examination of an epiglottis biopsy specimen showed geographic necrotiz-ing granuloma with a few scattered multinucleated giant cells. Transmural inflammation, luminal occlusion, and vessel disruption were observed on elastic staining. Based on these findings, the patient was diagnosed with granulomatosis with polyangiitis (GPA). Two months after the patient started therapy with high-dose steroids and cyclophosphamide, the epiglottic swelling improved. The level of PR3-ANCA returned to the normal range two months after starting treatment. Subglottic stenosis is reportedly a common clinical feature of GPA. Although the involvement of supraglottic structures, including the epiglottis, is rare in GPA, clinicians should in-clude GPA in the differential diagnosis of a life-threatening airway obstruction.
{"title":"A Case of Laryngeal Granulomatosis with Polyangiitis Simulating Acute Epiglottitis","authors":"H. Komatsuda, T. Kumai, K. Kishibe, M. Takahara, A. Katada, Tatsuya Hayashi, Y. Harabuchi","doi":"10.5426/larynx.33.31","DOIUrl":"https://doi.org/10.5426/larynx.33.31","url":null,"abstract":"epiglottis. Because the patient developed stridor and shortness of breath, tracheostomy was performed to secure the airway. Contrast-enhanced computed tomography (CT) showed high-density areas in the epiglottis, base of the tongue, and aryepiglottic folds. The patient was positive for pro-teinase 3 (PR 3 )-antineutrophil cytoplasmic antibody (ANCA, 4 . 9 U/ml) and negative for myeloperoxidase (MPO)-ANCA. A histo-pathological examination of an epiglottis biopsy specimen showed geographic necrotiz-ing granuloma with a few scattered multinucleated giant cells. Transmural inflammation, luminal occlusion, and vessel disruption were observed on elastic staining. Based on these findings, the patient was diagnosed with granulomatosis with polyangiitis (GPA). Two months after the patient started therapy with high-dose steroids and cyclophosphamide, the epiglottic swelling improved. The level of PR3-ANCA returned to the normal range two months after starting treatment. Subglottic stenosis is reportedly a common clinical feature of GPA. Although the involvement of supraglottic structures, including the epiglottis, is rare in GPA, clinicians should in-clude GPA in the differential diagnosis of a life-threatening airway obstruction.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124327023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Heterogeneity and Hierarchy of the Tissue Stem Cells in the Human Adult Vocal Fold Mucosa","authors":"Kiminori Sato, S. Chitose, F. Sato, Kiminobu Sato, T. Kurita, T. Ono, H. Umeno","doi":"10.5426/larynx.33.26","DOIUrl":"https://doi.org/10.5426/larynx.33.26","url":null,"abstract":"ヒト声帯粘膜の前後端に存在する声帯黄斑は,幹細胞ニッチであり,黄斑に分布する細胞は組織幹細胞である 可能性を我々は報告してきた.in vitroでは,黄斑内の細胞を培養すると異種性と多分化能を持った細胞が増殖し てくる.本研究では,in vivoでヒト声帯黄斑内の細胞に異種性と階層性があるのかを検討した. 病変がない成人の声帯 4 例である.方法としてヒト声帯黄斑部の細胞を電子顕微鏡下に,あるいは免疫組織化学 を用いて光学顕微鏡下に観察した. in vivoにおいても光顕下・電顕下に敷石様の多角形細胞,細胞質に脂肪を保持した星細胞様の細胞,線維芽細 胞様の紡錘形細胞が黄斑内に混在しており,生体内の黄斑内の細胞に異種性を認めた. ヒト胚性幹細胞のマーカーであるSSEA-3 は,敷石様の多角形細胞に強く発現しており,幹細胞性,異種性を 持った黄斑内の細胞の中で,敷石様の多角形細胞は最も分化が低い細胞,すなわち階層性の頂点にある幹細胞であ る可能性が示唆された. in vivoにおいても,ヒト声帯粘膜の黄斑内には異種性を持った幹細胞が混在しており,階層性を持っているこ とが示唆された.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115410619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bilateral vocal fold immobility influences not only vocal function but also the airway tract, possibly resulting in dyspnea. Pathophysiological diagnosis using electromyography of laryngeal muscles is also critical for pa-tients with bilateral vocal fold immobility to optimize the surgical procedures. Vocal fold lateralization, trans-verse cordotomy, and arytenoidectomy can be utilized for bilateral vocal fold paralysis and posterior glottic stenosis depending on the severity of stenosis and mobility of cricoarytenoid joints. A unilateral approach should be recommended for the initial surgery to reduce the risks of aspiration and hoarseness. Laryngofissure with cartilage grafting and T-tube stenting may be performed for severe posterior glottic stenosis, often coinciding with subglottic stenosis. Laryngeal stenosis due to the bilateral vocal fold immobility should be carefully evalu-ated and treated with appropriate surgical technique, thereby keeping adequate airway space with preventing severe postoperative swallowing and phonatory dysfunction.
{"title":"Surgical Treatment for Bilateral Vocal Fold Immobility","authors":"Y. Sugiyama","doi":"10.5426/larynx.33.16","DOIUrl":"https://doi.org/10.5426/larynx.33.16","url":null,"abstract":"Bilateral vocal fold immobility influences not only vocal function but also the airway tract, possibly resulting in dyspnea. Pathophysiological diagnosis using electromyography of laryngeal muscles is also critical for pa-tients with bilateral vocal fold immobility to optimize the surgical procedures. Vocal fold lateralization, trans-verse cordotomy, and arytenoidectomy can be utilized for bilateral vocal fold paralysis and posterior glottic stenosis depending on the severity of stenosis and mobility of cricoarytenoid joints. A unilateral approach should be recommended for the initial surgery to reduce the risks of aspiration and hoarseness. Laryngofissure with cartilage grafting and T-tube stenting may be performed for severe posterior glottic stenosis, often coinciding with subglottic stenosis. Laryngeal stenosis due to the bilateral vocal fold immobility should be carefully evalu-ated and treated with appropriate surgical technique, thereby keeping adequate airway space with preventing severe postoperative swallowing and phonatory dysfunction.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115846493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Clinical Analysis of Patients with Bilateral Vocal Cord Abductor Paralysis as an Early Manifestation of Multiple System Atrophy","authors":"Tatsuro Sekine, T. Ikezono, N. Tayama","doi":"10.5426/larynx.33.21","DOIUrl":"https://doi.org/10.5426/larynx.33.21","url":null,"abstract":"","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125236861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fibrous histiocytoma is a tumor mainly that occurs in the limbs and soft tissue, and rarely occurs in the head and neck region. We experienced a case of cellular fibrous histiocytoma of the larynx. The patient was a 36-year-old man who had complained of hoarseness. A hemorrhagic tumor was detected at the left subglottis by laryngoscopy. We initially suspected subglottic inflammatory granulation and treated the patient conserva-tively; however, this was ineffective. We performed microscopic laryngeal surgery for diagnostic and treatment purposes. A histopathological examination of the resected tumor, revealed spindle cells with a narrow nucleus and acidophilic cytoplasm that proliferated tightly in the tumor tissue. The number of mitotic cells was 6/10 high power field and the tumor was negative for malignancy. On immunostaining, most tumor cells were positive for CD68 and CD163, the histiocytes were positive for S-100, while staining of CD34 and α -smooth muscle actin was negative. Thus, the diagnosis was cellular fibrous histiocytoma. The tumor recurred after ten months, we performed transoral surgery with CO 2 laser, which is useful for coagulation and resection. No re-currence was detected at two years after the second surgery. To our knowledge, there are no previous reports of cellular fibrous histiocytoma of the larynx.
{"title":"A Case of Cellular Fibrous Histiocytoma of the Larynx","authors":"H. Hagiwara, T. Murata, M. Shino, K. Chikamatsu","doi":"10.5426/larynx.33.37","DOIUrl":"https://doi.org/10.5426/larynx.33.37","url":null,"abstract":"Fibrous histiocytoma is a tumor mainly that occurs in the limbs and soft tissue, and rarely occurs in the head and neck region. We experienced a case of cellular fibrous histiocytoma of the larynx. The patient was a 36-year-old man who had complained of hoarseness. A hemorrhagic tumor was detected at the left subglottis by laryngoscopy. We initially suspected subglottic inflammatory granulation and treated the patient conserva-tively; however, this was ineffective. We performed microscopic laryngeal surgery for diagnostic and treatment purposes. A histopathological examination of the resected tumor, revealed spindle cells with a narrow nucleus and acidophilic cytoplasm that proliferated tightly in the tumor tissue. The number of mitotic cells was 6/10 high power field and the tumor was negative for malignancy. On immunostaining, most tumor cells were positive for CD68 and CD163, the histiocytes were positive for S-100, while staining of CD34 and α -smooth muscle actin was negative. Thus, the diagnosis was cellular fibrous histiocytoma. The tumor recurred after ten months, we performed transoral surgery with CO 2 laser, which is useful for coagulation and resection. No re-currence was detected at two years after the second surgery. To our knowledge, there are no previous reports of cellular fibrous histiocytoma of the larynx.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"190 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132451349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Unilateral vocal fold paralysis (UVFP) is a common problem in the otolaryngology field. The most frequent cause is recurrent laryngeal nerve (RLN) injury due to an extra-laryngeal malignancy, such as a thyroid tumor or iatrogenic or idiopathic etiology. Regardless of the cause of nerve injury, The optimal management of UVFP to obtain a “normal” voice post-operatively is becoming an increasingly relevant issue. We herein review the history of the development of laryngeal reinnervation techniques, such as primary RLN anastomosis, Ansacervicalis-to-RLN neurorrhaphy and Ansa-cervicalis nerve-muscle pedicle implantation, verified with various experimental animal models. In addition, the treatment algorithm for UVFP is discussed.
{"title":"Laryngeal Reinnervation for Unilateral Vocal Fold Paralysis","authors":"Y. Kumai","doi":"10.5426/larynx.33.12","DOIUrl":"https://doi.org/10.5426/larynx.33.12","url":null,"abstract":"Unilateral vocal fold paralysis (UVFP) is a common problem in the otolaryngology field. The most frequent cause is recurrent laryngeal nerve (RLN) injury due to an extra-laryngeal malignancy, such as a thyroid tumor or iatrogenic or idiopathic etiology. Regardless of the cause of nerve injury, The optimal management of UVFP to obtain a “normal” voice post-operatively is becoming an increasingly relevant issue. We herein review the history of the development of laryngeal reinnervation techniques, such as primary RLN anastomosis, Ansacervicalis-to-RLN neurorrhaphy and Ansa-cervicalis nerve-muscle pedicle implantation, verified with various experimental animal models. In addition, the treatment algorithm for UVFP is discussed.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114955939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Basic research involved in swallowing is critical not only for understanding the basic mechanisms underlying swallowing but also for making clinical advances in swallowing assessments and treatments in light of the aging of society. Animal models should be used to investigate the neuronal mechanisms underlying the generation of swallowing to help clarify the pathophysiological basis of dysphagia, particularly in the pharyngeal stage of swallowing. These neuronal networks are predominantly controlled by the swallowing central pattern generator (Sw-CPG) within the medulla by which the stereotyped and replicable movement of pharyngeal swallowing is generated. Previous studies have investigated brainstem mechanisms that control pharyngeal swallowing in various kinds of animals and experimental settings. In addition, an experimental model with an arterial perfused brainstem preparation has recently been preferred for analyzing the neuronal characteristics of swallowing interneurons as well as behavioral dynamics during swallowing. Further experiments are warranted to clarify the processing of neuronal signals within the Sw-CPG to facilitate the development of novel treatments for dysphagia.
{"title":"Recent Progress in Basic Research Concerning the Mechanisms Involved in Swallowing Using an Animal Model","authors":"Y. Sugiyama","doi":"10.5426/LARYNX.32.87","DOIUrl":"https://doi.org/10.5426/LARYNX.32.87","url":null,"abstract":"Basic research involved in swallowing is critical not only for understanding the basic mechanisms underlying swallowing but also for making clinical advances in swallowing assessments and treatments in light of the aging of society. Animal models should be used to investigate the neuronal mechanisms underlying the generation of swallowing to help clarify the pathophysiological basis of dysphagia, particularly in the pharyngeal stage of swallowing. These neuronal networks are predominantly controlled by the swallowing central pattern generator (Sw-CPG) within the medulla by which the stereotyped and replicable movement of pharyngeal swallowing is generated. Previous studies have investigated brainstem mechanisms that control pharyngeal swallowing in various kinds of animals and experimental settings. In addition, an experimental model with an arterial perfused brainstem preparation has recently been preferred for analyzing the neuronal characteristics of swallowing interneurons as well as behavioral dynamics during swallowing. Further experiments are warranted to clarify the processing of neuronal signals within the Sw-CPG to facilitate the development of novel treatments for dysphagia.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124998413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laryngeal cancer management must maintain a balance between improving the survival while preserving the function. Chemoradiotherapy has become the standard of care for larynx preservation in advanced laryngeal cancers. Recent data have shown faltering survival trends for patients with laryngeal cancer, calling for improvement through innovation. As chemoradiotherapy has been the prevailing management over the past two decades, cases receiving open laryngeal surgery have decreased. With contemporary trends toward minimally invasive surgery, it is imperative that head and neck surgeons improve partial laryngectomy procedures using recent medical innovations. Since 2016, our international collaboration team has conducted trials focused on blending transoral surgeries with conventional open laryngectomies. An innovative hybrid approach by blending transoral robotic surgery or endoscopic transoral surgery with limited open (6-cm skin incision) supracricoid partial laryngectomy may facilitate postoperative and functional recoveries. Head and neck surgeons are in an important position for improving partial laryngeal surgeries, which may offer survival benefits with functional improvements.
{"title":"Laryngeal Cancer : A Recent Paradigm Shift in Larynx Preservation","authors":"M. Nakayama, D. Sano, N. Oridate","doi":"10.5426/LARYNX.32.151","DOIUrl":"https://doi.org/10.5426/LARYNX.32.151","url":null,"abstract":"Laryngeal cancer management must maintain a balance between improving the survival while preserving the function. Chemoradiotherapy has become the standard of care for larynx preservation in advanced laryngeal cancers. Recent data have shown faltering survival trends for patients with laryngeal cancer, calling for improvement through innovation. As chemoradiotherapy has been the prevailing management over the past two decades, cases receiving open laryngeal surgery have decreased. With contemporary trends toward minimally invasive surgery, it is imperative that head and neck surgeons improve partial laryngectomy procedures using recent medical innovations. Since 2016, our international collaboration team has conducted trials focused on blending transoral surgeries with conventional open laryngectomies. An innovative hybrid approach by blending transoral robotic surgery or endoscopic transoral surgery with limited open (6-cm skin incision) supracricoid partial laryngectomy may facilitate postoperative and functional recoveries. Head and neck surgeons are in an important position for improving partial laryngeal surgeries, which may offer survival benefits with functional improvements.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123584571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Posterior glottic, subglottic and tracheal stenoses are uncommon delayed complications of burn and inhalation injury. The treatment varies based on the individual severity, but some patients need permanent tracheostomy. A 38-year-old-man with a tracheostomy after burn and inhalation injury four years ago had undergone Ejinell’s laterofixation three times. He still had narrowing of the airway due to bilateral vocal fold immobility. We diagnosed the immobility as having caused the posterior glottic stenosis. Bilateral Ejinell’s laterofixation was performed, and the buccal mucosa was grafted to avoid scarring. The patient successfully underwent decannulation.
{"title":"Use of a Buccal Mucosa Graft for Bilateral Ejinell’s Laterofixation of the Vocal Fold to Successfully Treat Posterior Glottic Stenosis","authors":"Y. Nakanishi, T. Yoshizaki","doi":"10.5426/LARYNX.32.184","DOIUrl":"https://doi.org/10.5426/LARYNX.32.184","url":null,"abstract":"Posterior glottic, subglottic and tracheal stenoses are uncommon delayed complications of burn and inhalation injury. The treatment varies based on the individual severity, but some patients need permanent tracheostomy. A 38-year-old-man with a tracheostomy after burn and inhalation injury four years ago had undergone Ejinell’s laterofixation three times. He still had narrowing of the airway due to bilateral vocal fold immobility. We diagnosed the immobility as having caused the posterior glottic stenosis. Bilateral Ejinell’s laterofixation was performed, and the buccal mucosa was grafted to avoid scarring. The patient successfully underwent decannulation.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129496943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Voice therapy is a tool for treating voice disorders in singers. It has been widely accepted as a valid method for improving singing voice disorders worldwide. However, despite its wide acceptance for singers with dysphonia, little research exists to support the utility of voice therapy for singers with dysphonia as an intervention with measurable treatment outcomes. A forward focused voice has long been used in voice clinics throughout the world as a therapeutic approach for singers and nonsingers with dysphonia to reduce excessive tension on the vocal tract and facilitate a resonant voice quality and vocal fold vibration. However, the effects of a forward focused voice in singers compared to nonsingers with dysphonia have not been sufficiently evaluated. The cur-rent review evaluated the vocal tract function and voice quality in singers and nonsingers with dysphonia after undergoing therapy with a forward focused voice.
{"title":"Voice Therapy for Singers with Dysphonia","authors":"M. Kaneko","doi":"10.5426/LARYNX.32.125","DOIUrl":"https://doi.org/10.5426/LARYNX.32.125","url":null,"abstract":"Voice therapy is a tool for treating voice disorders in singers. It has been widely accepted as a valid method for improving singing voice disorders worldwide. However, despite its wide acceptance for singers with dysphonia, little research exists to support the utility of voice therapy for singers with dysphonia as an intervention with measurable treatment outcomes. A forward focused voice has long been used in voice clinics throughout the world as a therapeutic approach for singers and nonsingers with dysphonia to reduce excessive tension on the vocal tract and facilitate a resonant voice quality and vocal fold vibration. However, the effects of a forward focused voice in singers compared to nonsingers with dysphonia have not been sufficiently evaluated. The cur-rent review evaluated the vocal tract function and voice quality in singers and nonsingers with dysphonia after undergoing therapy with a forward focused voice.","PeriodicalId":338069,"journal":{"name":"Koutou (THE LARYNX JAPAN)","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128677248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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