Characteristics of tracheoesophageal voice and speech in laryngectomized patients after primary and secondary application of vocal prosthesis

Totalna laringektomija predstavlja radikalni zahvat koji dovodi do trajnog gubitka generatora i dela rezonatora glasa, larinksa u kom se stvara osnovni laringealni ton. Jedna od metoda rehabilitacije glasa i govora je ugradnja traheoezofagusnih proteza. Cilj rada je da se utvrde karakteristike traheoezofagusnog govora kod pacijenata sa primarno i sekundarno ugrađenim vokalnim protezama, analizira uticaj pola i starosti na karakteristike traheoezofagusnog govora, kao i samoprocena glasa i govora od strane samih pacijenata. Uzorak se sastojao od 48 laringektomisanih pacijenata starosti od 44 do 77 godina, kod kojih su ugrađene vokalne proteze u periodu od 2008. do 2010. godine na Klinici za bolesti uva, grla i nosa Kliničkog centra Vojvodine. Procena karakteristika glasa i govora obuhvatala je: maksimalno fonacijsko vreme za glas /a/, dužinu fraze, čitanje fonetski izbalansirane liste reči, razumljivost pročitanih reči, čitanje fonetski izbalansiranog teksta i samoprocenu kvaliteta govora pacijenata u odnosu na individualne komunikativne potrebe svakog pacijenta. Karakteristike glasa i govora kod pacijenata kod kojih je rađena primarna ugradnja vokalne proteze u odnosu na sekundarnu ugradnju ne pokazuje statistički značajnu razliku. Kod pacijenata mlađih od 60 godina postoji statistički značajno bolji rezultat u pogledu razumljivosti govora. Nisu nađene statistički značajne razlike u zavisnosti od pola pacijenata. Samo jedan pacijent (1/48) je svoj govor procenio kao nezadovoljavajući. Kako zemlje u razvoju ne mogu obezbediti adekvatan broj proteza i njihovu kontinuiranu nabavku za sve svoje laringektomisane pacijente, sekundarna ugradnja vokalne proteze bi mogla biti adekvatna metoda rehabilitacije. Veliki procenat uspešnosti u edukaciji traheoezofagusnog govora i preporučuje ugradnju vokalne proteze.Total laryngectomy is a radical procedure that leads to permanent loss of the voice generator and a part of the voice resonator, the larynx, where the basic laryngeal tone is created. One method of voice and speech rehabilitation is implantation of tracheoesophageal prosthesis. The aim of this study was to determine the characteristics of tracheoesophageal speech in patients with primary and secondary vocal prosthesis, to analyze the influence of gender and age on characteristics of the tracheoesophageal speech and self-assessment by patients themselves. This paper presents the results of voice and speech rehabilitation in 48 laryngectomized patients aged 44 to 77 years, with implanted vocal prosthesis during the period from 2008 to 2010 at the Clinic for Ear, Nose and Throat of the Clinical Centre of Vojvodina. The assessment of voice and speech characteristics included: maximum phonation time for the sound /a/, the length of phrases, reading of phonetically balanced word lists, intelligibility of words, reading phonetically balanced text and self-assessment of speech quality of patients referred to their communicative needs. Characteristics of voice and speech in patients who underwent primary vocal prosthesis in relation to secondary placement show no statistically significant difference. In patients under the age of 60, statistically significant better result in terms of speech intelligibility was found. There were no statistically significant differences depending on the patients’ gender. Only one patient (1/48) assessed his speech as unsatisfactory. As developing countries cannot provide adequate number of prostheses and their continuous supply for all laryngectomy patients, the installation of a secondary vocal prosthesis could be an adequate method of rehabilitation. A large percentage of success in education of tracheoesophageal speech recommends the placement of vocal prosthesis.[https://www.casopis.fasper.bg.ac.rs/

Excitatory-inhibitory balance within EEG microstates and resting-state fMRI networks: assessed via simultaneous trimodal PET-MR-EEG imaging

The symbiosis of neuronal activities and glucose energy metabolism is reflected in the generation of functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) signals. However, their association with the balance between neuronal excitation and inhibition (E/I-B), which is closely related to the activities of glutamate and γ-aminobutyric acid (GABA) and the receptor availability (RA) of GABAA and mGluR5, remains unexplored. This research investigates these associations during the resting state (RS) condition using simultaneously recorded PET/MR/EEG (trimodal) data. The trimodal data were acquired from three studies using different radio-tracers such as, [11C]ABP688 (ABP) (N = 9), [11C]Flumazenil (FMZ) (N = 10) and 2-[18F]fluoro-2-deoxy-D-glucose (FDG) (N = 10) targeted to study the mGluR5, GABAA receptors and glucose metabolism respectively. Glucose metabolism and neuroreceptor binding availability (non-displaceable binding potential (BPND)) of GABAA and mGluR5 were found to be significantly higher and closely linked within core resting-state networks (RSNs). The neuronal generators of EEG microstates and the fMRI measures were most tightly associated with the BPND of GABAA relative to mGluR5 BPND and the glucose metabolism, emphasising a predominance of inhibitory processes within in the core RSNs at rest. Changes in the neuroreceptors leading to an altered coupling with glucose metabolism may render the RSNs vulnerable to psychiatric conditions. The paradigm employed here will likely help identify the precise neurobiological mechanisms behind these alterations in fMRI functional connectivity and EEG oscillations, potentially benefitting individualised healthcare treatment measures

mGluR5 receptor availability is associated with lower levels of negative symptoms and better cognition in male patients with chronic schizophrenia

Consistent findings postulate disturbed glutamatergic function (more specifically a hypofunction of the ionotropic NMDA receptors) as an important pathophysiologic mechanism in schizophrenia. However, the role of the metabotropic glutamatergic receptors type 5 (mGluR5) in this disease remains unclear. In this study, we investigated their significance (using [11 C]ABP688) for psychopathology and cognition in male patients with chronic schizophrenia and healthy controls. In the patient group, lower mGluR5 binding potential (BPND ) values in the left temporal cortex and caudate were associated with higher general symptom levels (negative and depressive symptoms), lower levels of global functioning and worse cognitive performance. At the same time, in both groups, mGluR5 BPND were significantly lower in smokers (F[27,1] = 15.500; p = .001), but without significant differences between the groups. Our findings provide support for the concept that the impaired function of mGluR5 underlies the symptoms of schizophrenia. They further supply a new perspective on the complex relationship between tobacco addiction and schizophrenia by identifying glutamatergic neurotransmission-in particularly mGluR5-as a possible connection to a shared vulnerability. Keywords: chronic schizophrenia; cognition; mGluR5 receptor; negative symptoms; positron emission tomography

Progress and Pitfalls in Developing Agents to Treat Neurocognitive Deficits Associated with Schizophrenia

Cognitive impairments associated with schizophrenia (CIAS) represent a central element of the symptomatology of this severe mental disorder. CIAS substantially determine the disease prognosis and hardly, if at all, respond to treatment with currently available antipsychotics. Remarkably, all drugs presently approved for the treatment of schizophrenia are, to varying degrees, dopamine D(2)/D(3) receptor blockers. In turn, rapidly growing evidence suggests the immense significance of systems other than the dopaminergic system in the genesis of CIAS. Accordingly, current efforts addressing the unmet needs of patients with schizophrenia are primarily based on interventions in other non-dopaminergic systems. In this review article, we provide a brief overview of the available evidence on the importance of specific systems in the development of CIAS. In addition, we describe the promising targets for the development of new drugs that have been used so far. In doing so, we present the most important candidates that have been investigated in the field of the specific systems in recent years and present a summary of the results available at the time of drafting this review (May 2022), as well as the currently ongoing studies

Vocal therapy of hyperkinetic dysphonia

Introduction. Hyperkinetic (hyperfunctional) dysphonia is a common pathology. The disorder is often found in vocal professionals faced with high vocal requirements. Objective. The objective of this study was to evaluate the effects of vocal therapy on voice condition characterized by hyperkinetic dysphonia with prenodular lesions and soft nodules. Methods. The study included 100 adult patients and 27 children aged 4-16 years with prenodular lesions and soft nodules. A subjective acoustic analysis using the GIRBAS scale was performed prior to and after vocal therapy. Twenty adult patients and 10 children underwent objective acoustic analysis including several acoustic parameters. Pathological vocal qualities (hoarse, harsh and breathy voice) were also obtained by computer analysis. Results. The subjective acoustic analysis revealed a significant (p<0.01) reduction in all dysphonia parameters after vocal treatment in adults and children. After treatment, all levels of dysphonia were lowered in 85% (85/100) of adult patients and 29% (29/100) had a normal voice. Before vocal therapy 9 children had severe, 13 had moderate and 8 slight dysphonia. After vocal therapy only 1 child had severe dysphonia, 7 had moderate, 10 had slight levels of dysphonia and 9 were without voice disorder. The objective acoustic analysis in adults revealed a significant improvement (p≤0.025) in all dysphonia parameters except SD F0 and jitter %. In children, the acoustic parameters SD F0, jitter % and NNE (normal noise energy) were significantly improved (p=0.003-0.03). Pathological voice qualities were also improved in adults and children (p<0.05). Conclusion. Vocal therapy effectively improves the voice in hyperkinetic dysphonia with prenodular lesions and soft nodules in both adults and children, affecting diverse acoustic parameters

Group treatment for esophageal speech education

Totalna laringektomija je radikalna hirurška metoda koja, između ostalog, podrazumeva trajni gubitak larinksa u kome se generiše osnovni laringealni ton. Sa aspekta komunikacije operacija ima za posledicu gubitak sposobnosti vokalnog komunikaciranja. Edukacija ezofagusnog glasa i govora je, u zemljama u razvoju, metod izbora u rehabilitaciji govora laringektomisanog pacijenta. Dugi niz godina je individualni pristup u rehabilitaciji govorno-jezičkih poremećaja bio jedini pristup, što se odrazilo i na pristup u edukaciji ezofagusnog glasa i govora. Pedesetih godina prošlog veka logopedi Backus i Beasley su dali smernice za uvođenje grupog tretmana u proces rehabilitacije. Danas većina autora smatra da grupna rehabilitacija daje bolje rezultate u edukaciji ezofagusnog glasa. U grupi se stvara povoljna klima koja podstiče na edukaciju i manje motivisane pacijente.Total laryngectomy is a radical surgical procedure which, among others, as a result brings permanent loss of basic laryngeal tone generator – larynx. Normal communication is greatly affected by this operation due to consequential loss of ability to communicate vocally. In developing countries, esophageal speech education is a method of choice in speech rehabilitation of laryngectomized patient. For a long time, the only approach in rehabilitation of speech and voices disorders was the individual approach, and that affected esophageal speech education. In early fifties, speech pathologists Backus and Beasley published guidelines for introduction of group treatment into rehabilitation process. Nowadays most of the authors agrees that group rehabilitation produces better results in esophageal speech education. Group creates advantageous environment that instigate even the less motivated patients

Karakteristike traheoezofagusnog glasa i govora laringektomisanih pacijenata posle primarne i sekundarne ugradnje vokalne proteze

Total laryngectomy is a radical procedure that leads to permanent loss of the voice generator and a part of the voice resonator, the larynx, where the basic laryngeal tone is created. One method of voice and speech rehabilitation is implantation of tracheoesophageal prosthesis. The aim of this study was to determine the characteristics of tracheoesophageal speech in patients with primary and secondary vocal prosthesis, to analyze the influence of gender and age on characteristics of the tracheoesophageal speech and self-assessment by patients themselves. This paper presents the results of voice and speech rehabilitation in 48 laryngectomized patients aged 44 to 77 years, with implanted vocal prosthesis during the period from 2008 to 2010 at the Clinic for Ear, Nose and Throat of the Clinical Centre of Vojvodina. The assessment of voice and speech characteristics included: maximum phonation time for the sound /a/, the length of phrases, reading of phonetically balanced word lists, intelligibility of words, reading phonetically balanced text and self-assessment of speech quality of patients referred to their communicative needs. Characteristics of voice and speech in patients who underwent primary vocal prosthesis in relation to secondary placement show no statistically significant difference. In patients under the age of 60, statistically significant better result in terms of speech intelligibility was found. There were no statistically significant differences depending on the patients' gender. Only one patient (1/48) assessed his speech as unsatisfactory. As developing countries cannot provide adequate number of prostheses and their continuous supply for all laryngectomy patients, the installation of a secondary vocal prosthesis could be an adequate method of rehabilitation. A large percentage of success in education of tracheoesophageal speech recommends the placement of vocal prosthesis.Totalna laringektomija predstavlja radikalni zahvat koji dovodi do trajnog gubitka generatora i dela rezonatora glasa, larinksa u kom se stvara osnovni laringealni ton. Jedna od metoda rehabilitacije glasa i govora je ugradnja traheoezofagusnih proteza. Cilj rada je da se utvrde karakteristike traheoezofagusnog govora kod pacijenata sa primarno i sekundarno ugrađenim vokalnim protezama, analizira uticaj pola i starosti na karakteristike traheoezofagusnog govora, kao i samoprocena glasa i govora od strane samih pacijenata. Uzorak se sastojao od 48 laringektomisanih pacijenata starosti od 44 do 77 godina, kod kojih su ugrađene vokalne proteze u periodu od 2008. do 2010. godine na Klinici za bolesti uva, grla i nosa Kliničkog centra Vojvodine. Procena karakteristika glasa i govora obuhvatala je: maksimalno fonacijsko vreme za glas /a/, dužinu fraze, čitanje fonetski izbalansirane liste reči, razumljivost pročitanih reči, čitanje fonetski izbalansiranog teksta i samoprocenu kvaliteta govora pacijenata u odnosu na individualne komunikativne potrebe svakog pacijenta. Karakteristike glasa i govora kod pacijenata kod kojih je rađena primarna ugradnja vokalne proteze u odnosu na sekundarnu ugradnju ne pokazuje statistički značajnu razliku. Kod pacijenata mlađih od 60 godina postoji statistički značajno bolji rezultat u pogledu razumljivosti govora. Nisu nađene statistički značajne razlike u zavisnosti od pola pacijenata. Samo jedan pacijent (1/48) je svoj govor procenio kao nezadovoljavajući. Kako zemlje u razvoju ne mogu obezbediti adekvatan broj proteza i njihovu kontinuiranu nabavku za sve svoje laringektomisane pacijente, sekundarna ugradnja vokalne proteze bi mogla biti adekvatna metoda rehabilitacije. Veliki procenat uspešnosti u edukaciji traheoezofagusnog govora i preporučuje ugradnju vokalne proteze

Application of advanced technologies in shade matching: A spectrophotometer

One of many challenges in cosmetic dentistry is to accomplish appropriate and satisfactory reproduction of natural shade of teeth and in that way to make successful restoration. The procedure of choosing a shade can be performed using visual method or by an instrument. The kind of shade guide, individual ability to choose shades and conditions the choice is made under, all have influence on reliability and accuracy of the procedure. Therefore, it is necessary to introduce instrumental color determination in everyday work. The instrumental color determination method considers use of a spectrophotometer, a colorimeter and a digital camera or even the combination of all three in shade matching. The purpose of this article was to present all amenities and advantages of the instrumental color determination in shade matching through the demonstration of the clinical performances of an intraoral spectrophotometer VITA Easyshade Compact device. VITA Easyshade Compact device provides fast and reliable measuring and gives results that are not influenced by the conditions under which the shade was chosen or by the person who made choice. Shade matching using a spectrophotometer meets all the requirements for choosing the shade by vision, therefore it is recommended for clinical work

7T ultra-high-field neuroimaging for mental health: an emerging tool for precision psychiatry?

Given the huge symptom diversity and complexity of mental disorders, an individual approach is the most promising avenue for clinical transfer and the establishment of personalized psychiatry. However, due to technical limitations, knowledge about the neurobiological basis of mental illnesses has, to date, mainly been based on findings resulting from evaluations of average data from certain diagnostic groups. We postulate that this could change substantially through the use of the emerging ultra-high-field MRI (UHF-MRI) technology. The main advantages of UHF-MRI include high signal-to-noise ratio, resulting in higher spatial resolution and contrast and enabling individual examinations of single subjects. Thus, we used this technology to assess changes in the properties of resting-state networks over the course of therapy in a naturalistic study of two depressed patients. Significant changes in several network property measures were found in regions corresponding to prior knowledge from group-level studies. Moreover, relevant parameters were already significantly divergent in both patients at baseline. In summary, we demonstrate the feasibility of UHF-MRI for capturing individual neurobiological correlates of mental diseases. These could serve as a tool for therapy monitoring and pave the way for a truly individualized and predictive clinical approach in psychiatric care