Folia phoniatrica最新文献

Tongue thrusting, deviate swallowing, mouth breathing, orofacial muscle imbalance, deviate mandibular movement and malocclusion are the most important orofacial dysfunctions underlying disorders of articulation. Their development is linked to early bottle feeding and sucking habits. The phoniatrician is charged with the early detection of orofacial dysfunctions affecting speech. Early correction of habits and retraining by speech therapy are important preventive measures. Case histories, phoniatric and myofunctional diagnoses and dental/orthodontic findings were compiled for a total of 103 patients aged 3-30 years (11 +/- 4 years). Forty-five patients have completed a regimen of myofunctional therapy. For these patients highly significant improvements in lip strength, lip closure, breathing and tongue placement as well as in the swallowing pattern and orofacial muscle balance have been observed. Concomitantly, two thirds of the patients (66%) attained normal articulation. Speech defects were resistant to therapy in only 2 cases. In dental/orthodontic practice myofunctional therapy is used for retraining abnormal positions and functions of the orofacial muscles so as to create a normal occlusal relationship. The results of this study show that myofunctional therapy is highly instrumental also in phoniatrics as a special form of treatment for disorders of articulation.

This report summarises the joint experience of a surgeon and a phoniatrician, working as a team over a period of 20 years, carrying out 2,552 microsurgical operations on 2,334 patients with benign vocal fold lesions. The authors first present their procedure and then examine indications for surgery, surgical technique, postoperative follow-up and results for each pathology concerned. Phonosurgery with children (191 cases) and singers (128 cases) is given separate consideration. This work demonstrates the great interest of teamwork between phoniatrician and surgeon in phonosurgery.

The increasing diversity of purpose-built, synthetic and biogenetically engineered pharmaceuticals has led to a revival of interest in the pharmacological possibilities for the treatment of voice disorders. Where dysphonias arise as a part of a pathophysiological process, the pharmacological treatment of either the pathology or its associated symptoms may improve dysphonic voicing patterns. The treatment of symptoms such as cough and vocal fatigue are discussed together with treatment of allergic and other causes of inflammation or stiffening of the vocal tract. The pharmacological logical treatment of dysphonia due to defective neuromuscular control in dyskinetic and dystonic conditions is also discussed. Dysphonic voicing patterns are commonly multifactorial, and the author wishes to highlight problems encountered when attempting to adjust the performance of the vocal tract: imprecise targeting of the pathophysiological problems either by the physician or by the drug employed, and the systemic and attendant side-effects of drugs which may be thought to be appropriate.

An electrolaryngograph has been used to investigate the fundamental frequency of neoglottal speech produced by patients who have undergone near-total (parsimonious) laryngectomy. The resulting estimates of fundamental frequency were compared with the fundamental frequency of normal and oesophageal speakers of a similar age and Scottish dialect. It was found that the average fundamental frequencies of neoglottal and oesophageal male speakers were higher than those in the normal group, though many fall into the normal range. The fundamental frequency of the single neoglottal female speaker was higher than the normal average, but the fundamental frequencies of all of the oesophageal female speakers were lower than those of the normal female speakers. The 80 and 90% ranges of the alaryngeal speakers were wider than those of the normal speakers, but the average range of neoglottals was narrower than that of the oesophageals for the male speakers.

Nasalance scores were obtained for hearing-impaired children. Data speech samples obtained with and without personal amplification were compared for differences between gender and chronological age. Statistical comparisons are presented for each amplification condition. Significant differences for nasalance in the aided and unaided conditions were not evident although a high, positive correlation between conditions was reported. Nasalance, age and gender were not positively related. Dispersion of the nasalance scores for the two speech conditions was suggestive of persisting difficulties with velopharyngeal control during speech activities; mean scores revealed objective evidence of hypernasality.

In patients with dysphonia, an increased tension of the muscles of the neck as well as of the prelaryngeal muscles is well known to all phoniatrists. Usually the cause of this tension is only seen in pathological phonation or in a psychic base. In the present report it could be demonstrated that this tension causes itself a functional dysphonia. This tension is produced by a functional deficit of the upper cervical spine. Chiropractic manipulation of the cervical spine can unlock the stiffness of the spine and normalize the voice within a few minutes.