A study of voice quality in a group of irradiated laryngeal cancer patients tumour stages T1 and T2.

This is a longitudinal study of voice quality in a group of 35 patients irradiated for early vocal fold tumours, stages T1 and T2. Electrolaryngograph (ELG) based analyses were used to obtain objective measurements of speaking fundamental frequency parameters over a wide range of time intervals following radiotherapy. Lx waveforms were also analysed. Perceptual evaluation of voice quality and patients' self assessments of their experience of vocal symptoms and limitations in vocal function after radiotherapy, were carried out. The relationship between perceptual and self assessment parameters and objective voice quality measurements was determined. A few patients underwent periods of voice therapy. A comparison is made of their voice measurements before and after therapy intervention with a group of patients, who did not receive voice therapy. The findings in this study show that, contrary to some early reports that the voice returns to normal in the majority of patients after radiotherapy, most patients' show evidence of residual abnormal voice quality and symptoms as measured and as rated by clinicians and by patients themselves. The majority of patients do not consider these a major problem, however. Evidence is presented of the beneficial effect of voice therapy to help patients compensate for the inevitable tissue damage caused by radiotherapy to the larynx. Electrolaryngograph generated objective measures and Lx waveforms proved sensitive, reliable and clinically applicable for objective voice analysis

Acoustic measurement of overall voice quality in sustained vowels and continuous speech

Measurement of dysphonia severity involves auditory-perceptual evaluations and acoustic analyses of sound waves. Meta-analysis of proportional associations between these two methods showed that many popular perturbation metrics and noise-to-harmonics and others ratios do not yield reasonable results. However, this meta-analysis demonstrated that the validity of specific autocorrelation- and cepstrum-based measures was much more convincing, and appointed ‘smoothed cepstral peak prominence’ as the most promising metric of dysphonia severity. Original research confirmed this inferiority of perturbation measures and superiority of cepstral indices in dysphonia measurement of laryngeal-vocal and tracheoesophageal voice samples. However, to be truly representative for daily voice use patterns, measurement of overall voice quality is ideally founded on the analysis of sustained vowels ánd continuous speech. A customized method for including both sample types and calculating the multivariate Acoustic Voice Quality Index (i.e., AVQI), was constructed for this purpose. Original study of the AVQI revealed acceptable results in terms of initial concurrent validity, diagnostic precision, internal and external cross-validity and responsiveness to change. It thus was concluded that the AVQI can track changes in dysphonia severity across the voice therapy process. There are many freely and commercially available computer programs and systems for acoustic metrics of dysphonia severity. We investigated agreements and differences between two commonly available programs (i.e., Praat and Multi-Dimensional Voice Program) and systems. The results indicated that clinicians better not compare frequency perturbation data across systems and programs and amplitude perturbation data across systems. Finally, acoustic information can also be utilized as a biofeedback modality during voice exercises. Based on a systematic literature review, it was cautiously concluded that acoustic biofeedback can be a valuable tool in the treatment of phonatory disorders. When applied with caution, acoustic algorithms (particularly cepstrum-based measures and AVQI) have merited a special role in assessment and/or treatment of dysphonia severity

Update On Hearing Loss

Update on Hearing Loss encompasses both the theoretical background on the different forms of hearing loss and a detailed knowledge on state-of-the-art treatment for hearing loss, written for clinicians by specialists and researchers. Realizing the complexity of hearing loss has highlighted the importance of interdisciplinary research. Therefore, all the authors contributing to this book were chosen from many different specialties of medicine, including surgery, psychology, and neuroscience, and came from diverse areas of expertise, such as neurology, otolaryngology, psychiatry, and clinical and experimental audiology

Combined brain language connectivity and intraoperative neurophysiologic techniques in awake craniotomy for eloquent-area brain tumor resection

Speech processing can be disturbed by primary brain tumors (PBT). Improvement of presurgical planning techniques decrease neurological morbidity associated to tumor resection during awake craniotomy. The aims of this work were: 1. To perform Diffusion Kurtosis Imaging based tractography (DKI-tract) in the detection of brain tracts involved in language; 2. To investigate which factors contribute to functional magnetic resonance imaging (fMRI) maps in predicting eloquent language regional reorganization; 3. To determine the technical aspects of accelerometric (ACC) recording of speech during surgery. DKI-tracts were streamlined using a 1.5T magnetic resonance scanner. Number of tracts and fiber pathways were compared between DKI and standard Diffusion Tensor Imaging (DTI) in healthy subjects (HS) and PBT patients. fMRI data were acquired using task-specific and resting-state paradigms during language and motor tasks. After testing intraoperative fMRI’s influence on direct cortical stimulation (DCS) number of stimuli, graph-theory measures were extracted and analyzed. Regarding speech recording, ACC signals were recorded after evaluating neck positions and filter bandwidths. To test this method, language disturbances were recorded in patients with dysphonia and after applying DCS in the inferior frontal gyrus. In contrast, HS reaction time was recorded during speech execution. DKI-tract showed increased number of arcuate fascicle tracts in PBT patients. Lower spurious tracts were identified with DKI-tract. Intraoperative fMRI and DCS showed similar stimuli in comparison with DCS alone. Increased local centrality accompanied language ipsilateral and contralateral reorganization. ACC recordings showed minor artifact contamination when placed at the suprasternal notch using a 20-200 Hz filter bandwidth. Patients with dysphonia showed decreased amplitude and frequency in comparison with HS. ACC detected an additional 11% disturbances after DCS, and a shortening of latency within the presence of a loud stimuli during speech execution. This work improved current knowledge on presurgical planning techniques based on brain structural and functional neuroimaging connectivity, and speech recordingA função linguística do ser humano pode ser afetada pela presença de tumores cerebrais (TC) A melhoria de técnicas de planeamento pré-cirurgico diminui a morbilidade neurológica iatrogénica associada ao seu tratamento cirúrgico. O objetivo deste trabalho é: 1. Testar a fiabilidade da tractografia estimada por difusor de kurtose (tract-DKI), dos feixes cerebrais envolvidos na linguagem 2. Identificar os fatores que contribuem para o mapeamento linguagem por ressonância magnética funcional (RMf) na predição da neuroplasticidade. 3. Identificar aspetos técnicos do registo da linguagem por accelerometria (ACC). A DKI-tract foi estimada após realização de RM cerebral com 1.5T. O número e percurso das fibras foi avaliado. A RMf foi adquirida durante realização de tarefas linguísticas, motoras, e em repouso. Foi testada influência dos mapas de ativação calculados por RMf, no número de estímulos realizados durante a estimulação direta cortical (EDC) intraoperatória. Medidas de conectividade foram extraídas de regiões cerebrais. A posição e filtragem de sinal ACC foram estudadas após vocalização de palavras. O sinal ACC obtido em voluntários foi comparado com doentes disfónicos, após estimulação do giro inferior frontal, e após a adição de um estímulo sonoro perturbador durante vocalização. A tract-DKI estimou um elevado número de fascículos do feixe arcuato com menos falsos negativos. Os mapas linguísticos de RMf intraoperatória, não influenciou a EDC. Medidas de centralidade aumentaram após neuroplasticidade ipsilateral e contralateral. A posição supraesternal e a filtragem de sinal ACC entre 20-200Hz demonstrou menor ruido de contaminação. Este método identificou diminuição de frequência e amplitude em doentes com disfonia, 11% de erros linguísticos adicionais após estimulação e diminuição do tempo de latência quando presente o sinal sonoro perturbador. Este trabalho promoveu a utilização de novas técnicas no planeamento pré-cirúrgico do doente com tumor cerebral e alterações da linguagem através do estudo de conectividade estrutural, funcional e registo da linguagem

The Impact of ENT Diseases in Social Life

In the past several years, the otorhinolaryngology sector has had a significantimpact on social life. About 10% of the cancers that affect the populationannually concern the head and neck, and each year the guidelines evolve andchange.Emergencies of the otolaryngology sector are among the most common, withnumerous increases in hospitalizations in the ENT department (e.g., bleeding,abscesses, and dyspnoea). Interventions in the election can significantly improvepatients' quality of life and help avoid future complications.Given the importance of the medical and surgical branch of otorhinolaryngology,we want to underline the impact in social life of this important area

Medical-Data-Models.org:A collection of freely available forms (September 2016)

MDM-Portal (Medical Data-Models) is a meta-data repository for creating, analysing, sharing and reusing medical forms, developed by the Institute of Medical Informatics, University of Muenster in Germany. Electronic forms for documentation of patient data are an integral part within the workflow of physicians. A huge amount of data is collected either through routine documentation forms (EHRs) for electronic health records or as case report forms (CRFs) for clinical trials. This raises major scientific challenges for health care, since different health information systems are not necessarily compatible with each other and thus information exchange of structured data is hampered. Software vendors provide a variety of individual documentation forms according to their standard contracts, which function as isolated applications. Furthermore, free availability of those forms is rarely the case. Currently less than 5 % of medical forms are freely accessible. Based on this lack of transparency harmonization of data models in health care is extremely cumbersome, thus work and know-how of completed clinical trials and routine documentation in hospitals are hard to be re-used. The MDM-Portal serves as an infrastructure for academic (non-commercial) medical research to contribute a solution to this problem. It already contains more than 4,000 system-independent forms (CDISC ODM Format, www.cdisc.org, Operational Data Model) with more than 380,000 dataelements. This enables researchers to view, discuss, download and export forms in most common technical formats such as PDF, CSV, Excel, SQL, SPSS, R, etc. A growing user community will lead to a growing database of medical forms. In this matter, we would like to encourage all medical researchers to register and add forms and discuss existing forms

International Journal of Medical Students - Year 2015 - Volume 3 - Supplement 1

International Journal of Medical Students - Year 2015 - Volume 3 - Supplement

The Impact of Communication Impairments on the Social Relationships of Older Adults

Communication forms the foundation of social interaction. For older adults, however, there is known to be an increased risk of developing conditions that interfere with the ability to communicate. These conditions may occur for a variety of reasons, including age-related changes in physical or sensory functioning, injury, and disease. It is estimated that 55% of all Medicare beneficiaries have a communication impairment of some kind. Social contact is known to be vital for older adults\u27 mental and physical health but, because communication impairments often co-occur with other types of disability, it is difficult to generalize about the relative impact of a communication impairment on the social relationships of older adults. Specific aims of the study were to examine whether the severity of a communication impairment is associated with social measures, whether there is an interaction between communication impairments and physical disability, and to examine the role of relationship-control strategies in maintaining access to a larger or more supportive social network. A mixed-methods study design was employed. Community-dwelling older adults were surveyed about the size and diversity of their social networks, frequency of social interactions, and physical and mental health (n = 240) and qualitative data were collected from a smaller subsample. Findings demonstrated that communication impairment was a significant independent predictor for key characteristics of social relationships, including the composition of the social network, certain types of social support, the frequency of social participation, and social self-efficacy. Communication impairment was a significant predictor for higher levels of loneliness and depression. In addition two distinct pathways between communication impairment and psychological well-being were identified, with social self-efficacy and reassurance of worth as mediators. Additional insights were provided by the qualitative results. These findings may guide future clinical practice and research by providing a better understanding of the role of communication in health, disability, and the risk of social isolation