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Biomedical subjects

C G Reed

Publications and source records attributed to C G Reed.

14 recordsLinked to original sources
PubMed2000

Prevention of pharyngoesophageal spasm after laryngectomy with a half-muscle closure technique.

Because pharyngoesophageal spasm can limit successful voice restoration after total laryngectomy, 24 patients underwent a modified pharyngeal closure in an effort to avoid this problem. All patients underwent total laryngectomy with appropriate neck dissections and pharyngeal closure with a half-muscle closure technique in which only one side of the remnant constrictor muscles was used to reinforce the primary closure. Twenty-three patients underwent voice restoration. Twenty-two (96%) had a functional voice, and 1 patient (4%) had pharyngoesophageal spasm that required a secondary myotomy. One fistula (4%) occurred and resolved with conservative measures. Quantitative voice analysis demonstrated no significant differences between half-closure patients and control patients for fundamental frequency (96 Hz versus 101 Hz) or intensity (57 dB versus 64 dB). Extensive qualitative analysis by trained and naive listeners revealed no differences. This preliminary report indicates the half-muscle closure modification of the pharyngeal closure at primary laryngectomy may provide a simple and effective means of avoiding pharyngoesophageal spasm and maintaining an effective voice without increased complications.

Esophageal Spasm, Diffuse↗
PubMed1999

Effects of sound pressure levels on fundamental frequency in tracheoesophageal speakers.

The quality of tracheoesophageal (TE) voice after laryngectomy is dependent on numerous factors. The relative contribution of specific variables is not well described. To evaluate the modulation of fundamental frequency (F0) pitch in TE speakers after total laryngectomy and voice restoration, we instructed 11 TE speakers to complete a series of vocal tasks under standardized conditions. All patients underwent standard laryngectomy with appropriate neck dissection and full-course radiation therapy. Each speaker produced 4 sustained phonations at distinct levels. Sound pressure level (SPL) intensity and F0 measurements were taken for each level. Statistical analysis to assess the relative effect of SPL on F0 demonstrated a statistically significant effect. However, the knowledge of SPL allowed only a 9% greater prediction of F0, indicating that factors other than SPL are integral to the modulation of F0 by TE speakers. These data lend further support to the theory that TE voice is an active process incorporating the myoelastic properties of the pharyngoesophageal segment as well as the properties of aerodynamic flow.

Biomechanical Phenomena↗
PubMed1998

Quantitative and qualitative analysis of tracheoesophageal voice after pectoralis major flap reconstruction of the neopharynx.

Although tracheoesophageal voice restoration is accepted after reconstruction of the neopharynx with the pectoralis major myocutaneous flap, the character of such voice is not well described. Six patients reconstructed with the pectoralis major flap after laryngopharyngectomy underwent successful voice restoration with the Blom-Singer prosthesis. Voice was evaluated by a standardized protocol and compared with voices of control subjects treated with total laryngectomy and similar voice restoration. The patients with pectoralis major flaps produced similar intensity levels for soft voice (53.7 dB vs. 55.6 dB) and loud voice (61.3 dB vs. 65.3 dB) when compared with controls (p > 0.05). No significant differences (p > 0.05) were noted for fundamental frequency (F0) between patients with pectoralis major flaps and controls for soft (62.3 Hz vs. 85.4 Hz) and loud (109.8 Hz vs. 133.8 Hz) voice. Jitter was also comparable. Trained and naive listeners completed qualitative analyses for 10 parameters and judged that control patients had significantly better voice for most parameters. This finding demonstrates that dependable voice is attainable after pectoralis major flap reconstruction of the neopharynx. Although this voice does not differ significantly from voice after standard laryngectomy for acoustic parameters, perceptual analysis does reveal significant differences.

Carcinoma, Squamous Cell↗
PubMed1994

Problems with tracheoesophageal fistula voice restoration in totally laryngectomized patients. A review of 95 cases.

OBJECTIVES: Tracheoesophageal fistula (TEF) construction, performed during or after total laryngectomy, is used for voice and speech restoration but has been associated with mild to severe complications. Our goal was to study the successes and complications in the application of this technique to restore voice function after laryngectomy in 95 consecutive patients. RESEARCH DESIGN: Retrospective cohort study with a mean follow-up time of 3.5 years. SETTING: Five medical facilities in northern California: the Veterans Affairs Medical Centers in San Francisco and Martinez, the Kaiser Permanente Medical Center in Oakland, and private practice offices in San Francisco and Pinole. PATIENTS: Ninety-five patients (90 men and five women) who had undergone total laryngectomy with subsequent or primary TEF construction. Patients' ages ranged from 35 to 80 years. INTERVENTIONS: Three- or two-layer closure was used, depending on whether TEF construction was done as a secondary or a primary procedure. Most patients underwent radiation therapy, and most used surface or intraoral electrolarynx devices before TEF construction. Insufflation tests were performed by clinicians, or self-insufflation tests were performed by the patient. Patients' voices were recorded and analyzed. In many cases, respiratory and pulmonary function studies were performed before and after total laryngectomy or TEF. Blom-Singer and Groningen voice prostheses were used. MAIN OUTCOME MEASURES: Voice restoration was considered successful when the patient was able to communicate effectively via the TEF. RESULTS: Approximately 92% of patients who underwent TEF construction and had voice prostheses placed were considered to be successfully rehabilitated. Complications ranged from mild to severe and included problems with predictive values obtained during insufflation, fistula retention, TEF angulation shifts, fungal colonization of the prosthesis, valve retention problems, difficulty with digital occlusion, pressure necrosis, postradiation necrosis, dysphagia, phonatory gagging, emesis, gastric distention, pouching, stenosis, infection, hypertrophy, shunt insufficiency, persistent spasm, myotomy, inadvertent fistula closure, and aspiration of the prosthesis. CONCLUSIONS: Acoustic measures indicate that speech produced with the TEF compares better with normal laryngeal speech than does esophageal or electronic speech. Thus, TEF should remain the preferred procedure to rehabilitate patients undergoing total laryngectomy.

Adult↗
PubMed1994

Long-term functional results after pharyngoesophageal reconstruction with the radial forearm free flap.

For recovery to be deemed adequate, the laryngectomized patient requires restoration of both the ability to swallow and to speak. Immediate results and long-term functional recovery after pharyngoesophageal (PE) reconstruction with the radial forearm free flap were studied in 22 consecutive patients who had undergone primary (n = 3) or secondary (n = 19) reconstructions after total laryngectomy. Circumferential reconstructions were done in 13 patients (mean length 10 cm, range 6 to 16) and patch reconstructions in 9 patients (defect size range 4 x 4 cm to 8 x 7 cm). Flap leakage was evaluated for all patients, and postoperative diet and ability to swallow were evaluated for 16 patients with an intact tongue base. Voice was evaluated for 6 patients with circumferential reconstructions who had later undergone tracheoesophageal puncture with placement of a Blom-Singer voice prosthesis, and the results compared with those of a control group of 5 voice-restored patients who had undergone laryngectomy with primary closure of the pharyngoesophagus. All 22 flaps survived and none of the patients died. Although 7 (32%) reconstructions leaked, all but 1 closed spontaneously. Fourteen (88%) of the patients with an intact tongue base have no dysphagia and are on a regular diet, and 2 remain on an oral liquid diet. Compared with controls, patients with a radial free-flap reconstruction had similar loudness with soft speech (43 dB for controls versus 52 dB for radial patients) and loud speech (61 dB versus 63 dB), comparable fundamental frequencies (136 Hz versus 125 Hz), and increased jitter (2% versus 5%). Speech intelligibility was judged by untrained listeners as excellent for 4 of the patients with radial flaps and good for the other 2. The radial free flap offers the advantages of rapid harvest, high flap reliability, and minimal donor-site and patient morbidity. Leakage rate and deglutition restoration were similar to those of other reconstructions, including the free jejunal flap. Speech rehabilitation in patients secondarily reconstructed with the radial free flap was nearly equivalent to that of total laryngectomy patients who have primary closure of the pharynx and was superior to that reported with other popular PE reconstructions, including the gastric pull-up and the free jejunal flap.

Aged↗
PubMed1994

Tracheoesophageal voice following tubed free radial forearm flap reconstruction of the neopharynx.

Tracheoesophageal voice restoration after laryngectomy is possible with a variety of neopharyngeal reconstructions. We have used the tubed radial forearm free flap for neopharyngeal reconstruction since 1991. Six patients have undergone voice restoration with the Blom-Singer prosthesis and were available for quantitative and qualitative speech analysis. These patients were compared to five laryngectomy patients with standard pharyngeal closures and similar voice restorations. The free flap patients produced similar loudness levels compared to the standards with soft speech (52.06 dB and 47.19 dB, respectively) and loud speech (62.66 dB and 60.91 dB, respectively). The free flap patients demonstrated adequate intelligibility, with fundamental frequencies comparable to standards (124.82 Hz and 135.66 Hz, respectively), although with increased jitter (5.00% versus 1.96%). No differences were statistically significant, but evaluation by trained and naive listeners demonstrated significant differences in voice quality. This quantitative and qualitative and qualitative analysis of tracheoesophageal speech after radial forearm free flap reconstruction of the neopharynx demonstrates that acceptable voice can be achieved, but with limitations.

Aged↗
PubMed1988

Listeners' perceptions of consonants produced by esophageal and tracheoesophageal talkers.

The purpose of this study was to investigate the consonant intelligibility of 3 esophageal (E) and 3 tracheoesophageal (TE) talkers, and 1 dual-mode (DM) talker proficient in both E and TE speech modes. Audio recordings of 24 English consonants produced by each talker in a consonant-vowel-consonant-vowel-consonant (CVCVC) context were presented in the sound field to 15 normal-hearing, naïve, young adult listeners who phonetically transcribed their responses using an open-response paradigm. Listeners' pooled responses were converted to confusion matrices and analyzed for overall intelligibility, voicing and manner features, and consonant omissions. Ratings of speech proficiency were also obtained. Overall, the intelligibility of the TE talkers was significantly better than that of the E talkers. The DM talker was also more intelligible in the TE mode. Voiced consonants, plosives, fricatives, nasals, and liquid-glides were significantly more intelligible when produced by TE talkers. Affricates were also more intelligible for the DM talker in his TE mode. The different patterns of intelligibility observed between the E and TE talkers studied may be due to temporal speech distinctions evolving from the influence of dissimilar driving sources upon the vibratory characteristics of the pharyngoesophageal segment. Clinical implications are presented.

Aged↗
PubMed1985

The ontogeny of shell secretion in Terebratalia transversa (Brachiopoda, Articulata). I. Development of the mantle.

The morphology of the mantle in free-swimming and metamorphosing larvae of the articulate brachiopod Terebratalia transversa has been examined by scanning and transmission electron microscopy. The mantle begins to form approximately 2 days after fertilization and subsequently develops into a skirtlike lobe that encircles the middle region of the larval body. A simple epithelium covers both the outer surface of the mantle lobe and the inner side situated next to the pedicle lobe of the larva. During metamorphosis, the mantle lobe is everted over the anterior end of the larva. Thus, the epithelium covering the outer part of the mantle lobe in the larva subsequently becomes the inner epithelium of the juvenile mantle. Similarly, the inner epithelium of the larval mantle lobe represents the future outer epithelium of the juvenile mantle. In free-swimming larvae, the prospective outer mantle epithelium contains two types of cells, called "lobate" and "vesicular" cells. Lobate cells initially deposit a thin layer of amorphous material, and vesicular cells produce ovoid multigranular bodies. Following settlement at about 5 days postfertilization, the vesicular cells secrete an electron-dense sheet that constitutes the basal layer of the developing periostracum. Within several hours to a day thereafter, reversal of the mantle lobe is rapidly effected, apparently by contractions of the pedicle adjustor muscles.

Animals↗
PubMed1985

The ontogeny of shell secretion in Terebratalia transversa (Brachiopoda, Articulata). II. Formation of the protegulum and juvenile shell.

The fine structure of the shell and underlying mantle in young juveniles of the articulate brachiopod Terebratalia transversa has been examined by electron microscopy. The first shell produced by the mantle consists of a nonhinged protegulum that lacks concentric growth lines. The protegulum is secreted within a day after larval metamorphosis and typically measures 140-150 micron long. A thin organic periostracum constitutes the outer layer of the protegulum, and finely granular shell material occurs beneath the periostracum. Protegula resist digestion in sodium hypochlorite and are refractory to sectioning, suggesting that the subperiostracal portion of the primordial shell is mineralized. The juvenile shell at 4 days postmetamorphosis possesses incomplete sockets and rudimentary teeth that consist of nonfibrous material. The secondary layer occuring in the inner part of the juvenile shell contains imbricated fibers, whereas the outer portion of the shell comprises a bipartite periostracum and an underlying primary layer of nonfibrous shell. Deposition of the periostracum takes place within a slot that is situated between the so-called lobate and vesicular cells of the outer mantle lobe. Vesicular cells deposit the basal layer of the periostracum, while lobate cells contribute materials to the overlying periostracal superstructure. Cells with numerous tonofibrils and hemidesmosomes differentiate in the outer mantle epithelium at sites of muscle attachments, and unbranched punctae that surround mantle caeca develop throughout the subperiostracal portion of the shell. Three weeks after metamorphosis, the juvenile shell averages about 320 micron in length and is similar in ultrastructure to the shells secreted by adult articulates.

Animals↗
PubMed1981

Disfluencies in the speech of language-delayed children.

This study attempted to determine whether language-delayed children receiving language therapy and language-delayed children not receiving language therapy differed from each other and from normal controls in the amount and type of disfluencies in their speech. Comparison of disfluencies in tape-recorded speech samples of three groups indicated that the one group of language-delayed children who received language therapy had significantly more word and part-word repetitions than the other two groups.

Child↗
PubMed1980

Voice therapy: a need for research.

Studies concerning the effectiveness of voice are lacking. There is little experimental verification that therapy techniques actually achieve specific change in abusive vocal function. Guidelines are presented regarding conceptual and methodological consideration for future investigations. Divergent terminology, philosophy, and issues of voice therapy are presented to serve as an overview and as a basis for research direction. Suggestions are offered for selecting experimental designs.

Humans↗
PubMed1980

Conditioned stimulus effects on stuttering and GSRs.

The simultaneous effects of a conditioned stimulus on the frequency of autonomic arousal responses (GSRs) and stuttering for ten subjects were investigated. GSR and stuttering responses were recorded during baserate, treatment, and extinction conditions for three sessions. A face slide was presented continuously for treatment conditions of all sessions. Recorded laughter was presented contingent upon each moment of suttering during the treatment condition of session two. Stuttering frequency was suppressed during session three demonstrating that the face slide was functioning as a discriminative stimulus. During the treatment portion of session three, GSRs increased for four subjects and decreased for six subjects. Autonomic arousal as a response to the conditioned stimulus did not demonstrate a consistent pattern across subjects.

Adult↗
PubMed1976

Some relationships between punishment, stuttering, and galvanic skin responses.

The simultaneous effects of response-contingent punishment on stuttering behaviors and the frequency of galvanic skin response (GSR) deflections for 10 subjects were investigated. GSR's and stuttering responses were recorded during base rate, treatment, and extinction conditions. The subjects demonstrated a 50% or greater decrease in stuttering frequency during the treatment condition. Combined data for all subjects indicated that the mean frequency of GSR deflections remained stable or declined across conditions of the study. Analysis of individual data revealed that GSR deflections during treatment as compared with base rate increased for four subjects, remained essentially the same in two subjects, and decreased for four subjects. These results suggest that experimental procedures which result in functional punishment effects on stuttering frequency may not be associated with any predictable pattern on concomitant autonomic arousal.

Adult↗