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Effects of acute vocal abuse on vocal coro anatomy and voice quality in U.S. army drill instructors
Ototaryngology Head and Neck Surgery P 100
August 1997
ResearchForum - - Monday
tive contribution of specific variables is not well described. To evaluate the modulation of fundamental frequency (pitch) in tracheoesophageal (TE) speakers following total laryngectomy and voice restoration, 1 l TE speakers completed a series of vocal tasks under standardized conditions. All patients underwent standard laryngectomy with appropriate neck dissection and fullcourse radiation therapy. Each speaker produced four sustained phonations at distinct levels. Sound pressure level (intensity), fundamental frequency, pitch perturbation (jitter), and intensity perturbation (shimmer) measurements were taken for each level. A multiple regression analysis program to assess the relative effect of several variables on predicting fundamental frequency demonstrated that only sound pressure level provided a statistically significant effect. Yet the knowledge of sound pressure level only allowed a 9% greater prediction of fundamental frequency, indicating that factors other than sound pressure level are integral in the modulation of fundamental frequency by tracheoesophageal speakers. The data lend further support to the theory that tracheoesophageal voice is an active process incorporating the myoelastic properties of the pharyngoesophageal segment, as well as the properties of aerodynamics of flow. Poster 50
A Study of Age- and Gender-related Elastin Distribution Changes in Human Vocal Folds THOMAS H. HAMMOND, BS (presenter), and STEVEN D. GRAY, MD, Salt Lake City, Utah
(Winner, Medical Student Research Award) The composition of the lamina propria in human vocal folds has been shown to affect vocal performance. Elastin plays a significant role in the biomechanical effects of the lamina propria. We obtained 19 larynges from the State Medical Examiner from subjects whose cause of death was unrelated to the trachea and laryngeal regions. The sample contained male and female subjects in infant, adult, and geriatric age groups. We stained the vocal folds for elastin using Verhoeff's elastic tissue stain (EVG) and studied them using an image analysis system configured for light microscopy. Distributions of elastin were measured from superficial to deep within the lamina propria (from epithelium to vocalis muscle). These elastin distributions were then compared with statistical software. The data showed that there was an increase in elastin content from infant through geriatric stages. No gender-related differences were found. Infant folds had about 23% of the elastin found in adults, and geriatric subjects had about 879% of the elastin found in adults. Both of these results were statistically significant (p < 0.05). The distributions were consistent with previous observations that the lamina propria is a layered structure with most of the elastin present in the intermediate layer. This layer was larger in geriatric subjects than in adult and pediatric subjects. We observed that the fiber diameter appeared to be larger in geriatric subjects
(this observation is currently being verified with electron microscopy) while smaller, spiraled fibers appeared in pediatric subjects. Poster 51
Effects of Acute Vocal Abuse on Vocal Cord Anatomy and Voice Quality in U.S. Army Drill Instructors ERIC A. MANN, MD, PhD (presenter), MICHAEL D. McCLEAN, PhD, JOYCE GUREVICH-UVENA, MS, JULIE BARKMEIER, PhD, PEARLINE MCKENZlE-GARNER, MD, JEFFREYPAFFRATH, MD, and CARL PATOW, MD, Washington, D.C., Bethesda and Baltimore, Md,, and Fort Campbell, Ky.
Although dysphonia is a recognized consequence of acute vocal abuse, associated changes in vocal cord anatomy and function are not well understood. To document these presumed effects of acute vocal abuse, we prospectively obtained videostroboscopic exams and serial voice recordings on U.S. Army drill sergeants during a vocally demanding training exercise. High-quality digital audio recordings of sustained vowel production were obtained from 36 drill sergeants at baseline (following a 2-week period of relative voice rest) and daily during the first 5 days of a new training cycle. Computer-based acoustical analyses of the recorded voice signal were performed by using Kay Elemetrics Multidimensional Voice Analysis System (MVAS). Laryngeal videostroboscopic exams were also obtained at baseline and following 5 days of training and were rated independently by two experienced speech pathologists. Voice questionnaires outlining individual vocal hygiene characteristics and pertinent medical history were completed by all subjects. Analysis of videostroboscopic recordings revealed significant increases in vocal fold edema (p < 0.004), erythema (p < 0.02), edge irregularity (p < 0.002), and decreases in vocal fold mucosal wave (p < 0.05) and amplitude of excursion (p < 0.004) following the 5-day training period. Although the majority of subjects demonstrated no consistent alterations in vocal acoustic parameters, a subgroup of drill instructors exhibited significantly increased measures of vocal perturbation (shimmer, jitter). The association of abnormal videostroboscopic exams and acoustic analysis findings with various patient demographics and vocal hygiene characteristics will be discussed. Poster 52
Comparative Histology and Vibration of the Vocal Folds: Implications for Experimental Studies in Laryngeal Microflap Surgery C. GAELYN GARREI-I, MD (presenter), MARK S. COUREY, MD, JOHN R. COLEMAN, MD, and ROBERT H. OSSOFF, DMD, MD, Nashville, Tenn.
The unique layered structure of the human vocal fold (VF) has been well described. The goals of this study were to determine how the layered VF structure in humans and different animal species affects dissection within the lamina propria and to determine the most suitable animal model for experimental studies on vocal fold surgery and function.
August 1997
ResearchForum - - Monday
tive contribution of specific variables is not well described. To evaluate the modulation of fundamental frequency (pitch) in tracheoesophageal (TE) speakers following total laryngectomy and voice restoration, 1 l TE speakers completed a series of vocal tasks under standardized conditions. All patients underwent standard laryngectomy with appropriate neck dissection and fullcourse radiation therapy. Each speaker produced four sustained phonations at distinct levels. Sound pressure level (intensity), fundamental frequency, pitch perturbation (jitter), and intensity perturbation (shimmer) measurements were taken for each level. A multiple regression analysis program to assess the relative effect of several variables on predicting fundamental frequency demonstrated that only sound pressure level provided a statistically significant effect. Yet the knowledge of sound pressure level only allowed a 9% greater prediction of fundamental frequency, indicating that factors other than sound pressure level are integral in the modulation of fundamental frequency by tracheoesophageal speakers. The data lend further support to the theory that tracheoesophageal voice is an active process incorporating the myoelastic properties of the pharyngoesophageal segment, as well as the properties of aerodynamics of flow. Poster 50
A Study of Age- and Gender-related Elastin Distribution Changes in Human Vocal Folds THOMAS H. HAMMOND, BS (presenter), and STEVEN D. GRAY, MD, Salt Lake City, Utah
(Winner, Medical Student Research Award) The composition of the lamina propria in human vocal folds has been shown to affect vocal performance. Elastin plays a significant role in the biomechanical effects of the lamina propria. We obtained 19 larynges from the State Medical Examiner from subjects whose cause of death was unrelated to the trachea and laryngeal regions. The sample contained male and female subjects in infant, adult, and geriatric age groups. We stained the vocal folds for elastin using Verhoeff's elastic tissue stain (EVG) and studied them using an image analysis system configured for light microscopy. Distributions of elastin were measured from superficial to deep within the lamina propria (from epithelium to vocalis muscle). These elastin distributions were then compared with statistical software. The data showed that there was an increase in elastin content from infant through geriatric stages. No gender-related differences were found. Infant folds had about 23% of the elastin found in adults, and geriatric subjects had about 879% of the elastin found in adults. Both of these results were statistically significant (p < 0.05). The distributions were consistent with previous observations that the lamina propria is a layered structure with most of the elastin present in the intermediate layer. This layer was larger in geriatric subjects than in adult and pediatric subjects. We observed that the fiber diameter appeared to be larger in geriatric subjects
(this observation is currently being verified with electron microscopy) while smaller, spiraled fibers appeared in pediatric subjects. Poster 51
Effects of Acute Vocal Abuse on Vocal Cord Anatomy and Voice Quality in U.S. Army Drill Instructors ERIC A. MANN, MD, PhD (presenter), MICHAEL D. McCLEAN, PhD, JOYCE GUREVICH-UVENA, MS, JULIE BARKMEIER, PhD, PEARLINE MCKENZlE-GARNER, MD, JEFFREYPAFFRATH, MD, and CARL PATOW, MD, Washington, D.C., Bethesda and Baltimore, Md,, and Fort Campbell, Ky.
Although dysphonia is a recognized consequence of acute vocal abuse, associated changes in vocal cord anatomy and function are not well understood. To document these presumed effects of acute vocal abuse, we prospectively obtained videostroboscopic exams and serial voice recordings on U.S. Army drill sergeants during a vocally demanding training exercise. High-quality digital audio recordings of sustained vowel production were obtained from 36 drill sergeants at baseline (following a 2-week period of relative voice rest) and daily during the first 5 days of a new training cycle. Computer-based acoustical analyses of the recorded voice signal were performed by using Kay Elemetrics Multidimensional Voice Analysis System (MVAS). Laryngeal videostroboscopic exams were also obtained at baseline and following 5 days of training and were rated independently by two experienced speech pathologists. Voice questionnaires outlining individual vocal hygiene characteristics and pertinent medical history were completed by all subjects. Analysis of videostroboscopic recordings revealed significant increases in vocal fold edema (p < 0.004), erythema (p < 0.02), edge irregularity (p < 0.002), and decreases in vocal fold mucosal wave (p < 0.05) and amplitude of excursion (p < 0.004) following the 5-day training period. Although the majority of subjects demonstrated no consistent alterations in vocal acoustic parameters, a subgroup of drill instructors exhibited significantly increased measures of vocal perturbation (shimmer, jitter). The association of abnormal videostroboscopic exams and acoustic analysis findings with various patient demographics and vocal hygiene characteristics will be discussed. Poster 52
Comparative Histology and Vibration of the Vocal Folds: Implications for Experimental Studies in Laryngeal Microflap Surgery C. GAELYN GARREI-I, MD (presenter), MARK S. COUREY, MD, JOHN R. COLEMAN, MD, and ROBERT H. OSSOFF, DMD, MD, Nashville, Tenn.
The unique layered structure of the human vocal fold (VF) has been well described. The goals of this study were to determine how the layered VF structure in humans and different animal species affects dissection within the lamina propria and to determine the most suitable animal model for experimental studies on vocal fold surgery and function.