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Biomedical subjects

D M Bless

Publications and source records attributed to D M Bless.

36 records · Page 2Linked to original sources
PubMed1994

Anterior commissure microwebs associated with vocal nodules: detection, prevalence, and significance.

Vocal fold nodules are a common cause of dysphonia generally attributed to vocal abuse. Anterior commissure microwebs have been reported as an incidental finding in surgical patients with nodules. In a series of 105 nodule patients evaluated at the University of Wisconsin Clinical Science Center voice laboratory (1987-1992), 11 microwebs were identified. Ten of these microweb patients were among the 20 nodule patients who did not respond to voice therapy and underwent microsurgery. In patients with nodules whose hoarseness is refractory to voice therapy, symptoms that occur early in life suggest the presence of occult vocal fold pathology. Microweb detection requires a high index of suspicion, observation during maximal vocal fold abduction, and clearance of secretions from the anterior commissure. Definitive identification is facilitated by gentle separation of the anterior vocal folds during direct microlaryngoscopy. The presence of these tiny shelves of tissue might be coincidental, or they might represent another expression of the tissue response to traumatic factors known to produce vocal nodules. We found little difference in vocal function parameters between two similar groups of nodule patients, one with and one without associated microwebs. Further work is needed to determine the significance of microwebs.

Adolescent↗
PubMed1993

Pushing exercise program to correct glottal incompetence.

A voice therapy program using pushing exercises to correct glottal incompetence is described. The program utilizes various types of instrumentation to determine whether or not a given patient is likely to benefit from the treatment. The program also provides feedback of target voices. Three cases with incomplete glottal closure and subsequent vocal dysphonia characterized by an asthenic breathy quality are used to illustrate the program. Details of the program, termination criteria, and problems and precautions learned from treating 29 patients over a 3-year period are presented.

Aged↗
PubMed1993

Teflon vocal fold augmentation: failures and management in 28 cases.

Although vocal fold augmentation by Teflon injection has been the mainstay of treatment for glottic insufficiency for three decades, the success and safety of this treatment have been overstated. Twenty-eight patients who manifested poor or complicated Teflon results between 1984 and 1991 were evaluated using acoustic, aerodynamic, videostroboscopic, perceptual, and subjective patient self-evaluation of voice, both before and after our management of these complications. Most of these had Teflon granulomas; subglottic overfilling was the most common condition. In most instances such management included microsurgical removal of the Teflon granuloma. Voice measures that were abnormal before correction tended to improve and move into the normal range, although the resultant voices were not totally normal. Degree of improvement varied depending on the Teflon-induced tissue changes and the methods of correction subsequently used. The worst results were in patients with scarring, atrophy, and bilaterally mobile vocal folds, for whom Teflon should never have been injected. Teflon injection should be reserved for those instances in which it is clearly indicated and the surgeon is skilled in the technique of intrafold injection.

Adult↗
PubMed1992

Role of injectable collagen in the treatment of glottic insufficiency: a study of 119 patients.

Injectable bovine collagen has been used for treatment of glottic insufficiency at the University of Wisconsin Clinical Science Center since 1983. This report reviews our experience in treating 119 patients with a variety of vocal fold disorders manifested by glottic insufficiency. Many of the patients were referred because of prior treatment failures or problems that were impossible to treat with other modalities. Results were assessed by comprehensive voice evaluations using subjective patient self-assessments, perceptual judgments made by a panel of experts who had no prior knowledge of the study, objective assessments, and videostroboscopy. Objective assessment included vocal function measures and acoustic analysis. Results indicate that collagen not only is comparable to other injection filler substances but also has unique advantages as a bioimplant. Collagen injection seems uniquely suited for treatment of several problems, including vocal fold atrophy, focal defects, minimal glottic insufficiency, and scarred vocal folds that are not managed optimally with Teflon injection. Overall there were no serious complications and treatment was effective for a broad spectrum of problems. In most instances the correction persisted, and in those instances in which injected collagen seemed improperly distributed, the vocal fold was recontoured or the implant removed without appreciable damage to the surrounding tissues. Injectable collagen has been extensively studied and deserves to be included in the armamentarium of the laryngeal surgeon.

Adolescent↗
PubMed1992

[Use of standard protocols in the evaluation of voice disorders].

The purpose of this paper is to present a protocol for the use of standard forms in the evaluation of laryngeal structure and function in patients with voice disorders. The forms are designed to cover all the essential parameters needed to reach an accurate descriptive diagnosis which allows us to have an appropriate therapy plan according to the individual's detailed observations. It also gives us a consistent standardized evaluation form to measure changes after therapy whether behavioral, medical or surgical, and to compare different observations across patients. Reporting observations in this consistent manner will make characteristic patterns of different vocal behaviors readily obvious to the researcher or the clinician and reduce the possibility of missing any important details. The protocols are: indirect laryngoscopy, video-stroboscopic-evaluation form, functional voice and auditory perceptual voice evaluation.

Adult↗
PubMed1991

Measurement of vocal function.

Objective measurement of vocal function, e.g., acoustical analysis, is emerging as a necessity in clinical practice. Voice data assist in determining the diagnosis and prognosis of many voice disorder patients and provide documentation of the vocal quality before, during, and after treatment.

Humans↗
PubMed1990

Indirect laryngoscopic approach for injection of botulinum toxin in spasmodic dysphonia.

Spasmodic dysphonia is a focal dystonia that causes a loss of the fine control of intrinsic laryngeal muscles and produces a strained staccato voice. Temporary relief from symptoms has been reported in patients treated with botulinum toxin percutaneously injected into the thyroarytenoid muscle. A newly developed method of treatment differs from reported methods by increasing the accuracy of botulinum toxin placement, reducing soft tissue trauma, and applying basic scientific information about the functional histology of intrinsic laryngeal musculature. Sixteen patients with primarily adductor spasmodic dysphonia were treated. Initial assessment included laryngeal examination by indirect laryngoscopy, videoendoscopy, and stroboscopy, neurology examination (including laryngeal EMG), and vocal function studies with acoustic analysis and aerodynamic studies. A device originally designed for collagen injection allowed the precise microdelivery of toxin to the thyroarytenoid muscle. Indirect laryngoscopy was used to direct the needle, in an attempt to cover a broad area of motor end plates. The minimally effective dose was titrated for each patient, to avoid paralysis and preserve laryngeal function. All patients showed improved voices after treatment. There were no major complications. The basic technique can be performed in the otolaryngologist's office and does not require electromyography equipment or expertise.

Adult↗
PubMed1988

An objective assessment of voice production after radiation therapy for stage I squamous cell carcinoma of the glottis.

Radiation therapy has been the primary treatment for early glottic carcinoma, especially when restoration of normal voice is essential; yet objective evidence of the status of vocal function after treatment is lacking. The purpose of this study was to assess vocal characteristics of patients with glottic carcinoma after they had undergone radiation therapy. Twenty males, who had previously been treated with external beam irradiation for T1N0M0 squamous cell carcinoma with no subsequent evidence of recurrence, volunteered for this study. Laryngovideostroboscopic, acoustic, aerodynamic, and perceptual measures of vocal function were used to determine the characteristics of voice production. Acoustic indices were compared to those of a normal group of 30 age-matched volunteers, and the other measures were compared to established values reported in the literature. On acoustic analysis, the study group was characterized by significantly worse voice production than their counterparts. A high degree of intersubject variability was noted that could not be accounted for in terms of variables in treatment and medical history. The aerodynamic, spectral, and video-stroboscopic findings correlated well; this indicated a poor vibratory source, characterized by diffuse stiffness. Further work is necessary in order to compare vocal function after endoscopic laser and conventional conservative excision.

Aged↗
PubMed1986

Clinical experience with injectable collagen for vocal fold augmentation.

Injectable collagen appears to be safe and effective in treating glottic insufficiency. Fifty-four patients received vocal-fold injections of Zyderm Collagen Implant and their responses were followed for as long as 2 years. Videostroboscopy affords the best assessment of glottic function and correlates well with vocal quality. Maximum phonation time and transglottic airflow are the most sensitive measures of glottic efficiency; follow-up studies indicate that responses to treatment vary at 1 week, tend to stabilize by 3 months, and show only slight decrement over 1 year. One patient experienced a delayed hypersensitivity reaction, but it did not adversely affect his result. The use of cross-linked preparations of collagen should decrease the incidence of such responses. Treated patients were divided into diagnostic groups. Patients with bilaterally scarred vocal folds did not appear to respond optimally to collagen injection. Vocal rehabilitation was better if patients had at least one normal vocal fold. The best results occurred in patients with unilateral vocal fold paralysis and pre-existent bowing or atrophy did not affect these results. Collagen should be injected in the plane of the vocal ligament for best results; if the injection is too deep the implant is resorbed, and if too superficial, vocal-fold vibration is impaired.

Collagen↗
PubMed1986

A preliminary study of injectable collagen in human vocal fold augmentation.

Soluble bovine collagen was injected for vocal fold augmentation in 27 patients with glottic insufficiency. Preliminary observations show that glottic closure was enhanced in all patients with no serious complications. Subjective and objective measures of vocal efficiency indicated improvement with reduction in airflow, improved glottic closure, and increased vocal intensity. Recent studies that reveal distant migration of injected Teflon suggest the need for the development of a safe biologic material for soft tissue augmentation. Collagen appears to satisfy criteria as an ideal bioimplant, tends to soften scar tissue, and is structurally similar to natural collagen in the human vocal fold. Further longitudinal studies and the development of potentially more stable cross-linked collagen preparations seem indicated.

Adult↗
PubMed1980

A technique for temporary obturation of fistulae.

We devised a simple technique to differentiate the contribution of the oronasal fistula from that of the velopharyngeal port when abnormal nasal air flow is present. Temporary obturators were constructed from a thin sheet of dental wax and retained by a dental adhesive. Speech samples collected for aerodynamic analysis, both with and without the appliance, included both fricatives and plosives in single words and connected speech. Our results indicate that this temporary obturator, used in conjunction with aerodynamic studies, can be used to determine the etiology of abnormal nasal flows in speakers with oronasal fistulae.

Child↗
PubMed1976

A new technique for measuring velopharyngeal orifice area during sustained vowel production: an application of aerodynamic forced oscillation principles.

A new technique for measuring velopharyngeal orifice area during sustained vowel production is described. The technique is based on a simple oscillatory flow balancing procedure between two aerodynamic branches, a mechanical model of the human upper airway and the subject's upper airway. The area of the velopharyngeal orifice in the model is adjusted until identical oscillatory flows traverse it and the subject's velopharyngeal orifice in response to a common forced oscillatory pressure. When identical oscillatory flows are observed, the area of the adjusted orifice is taken as a measure of the area of the subject's velopharyngeal orifice.

Humans↗
PubMedDate not supplied

Selected problems treated by vocal fold injection of collagen.

INTRODUCTION: This study evaluates the results of vocal fold injection of bovine collagen. METHODS: A group of patients were selected because they were not good candidates for other forms of treatment. This included patients with scarred vocal folds, bilateral vocal fold pathology with a small glottic gap, and unilateral vocal fold pathology with atrophy. Assessment used patient self-evaluation, perceptual judgments of voice recordings, laboratory data based on acoustic signal analysis, and aerodynamic measures during voice production. Vocal folds were also studied by videostroboscopy. RESULTS: Most of the 45 patients treated with collagen injection were helped. In some cases, the improvement was marginal but documented using a variety of measures. Significant improvement was noted in jitter (P = .002), shimmer (P = .002), and maximum intensity (P = .026). There were no major complications and no hypersensitivity reaction. CONCLUSION: This study demonstrates the potential usefulness of collagen injection in the treatment of a selected group of patients with glottic insufficiency who are not good candidates for other forms of therapy. Objective analysis of results suggest improved function in this difficult to treat patient population. Further clinical investigation is warranted.

Animals↗
PubMedDate not supplied

Electromyographic assessment of spasmodic dysphonia patients prior to botulinum toxin injection.

Electromyographic (EMG) evidence of inappropriate muscle activity (IMA) in the cricothyroid (CT) and vocalis (V) (thyroarytenoid) muscles was correlated with clinical voice measures in 32 patients with spasmodic dysphonia (SD). Subjective voice rating and quantified fluency and laryngeal diadochokinesis measures were obtained prior to botulinum toxin (Botox) injection into the V muscles. Pre-Botox EMG was performed using a monopolar needle electrode. Each muscle was sequentially examined at rest, during vocal click, scale, sustained "E" at different pitches, and repeated "E" voicings for brief periods. A three point EMG severity scale was used to grade the amount of IMA seen in each muscle. EMG evaluation showed no evidence of lower motor neuron involvement but did reveal IMA in 81.3% of the subjects. There were no significant correlations for the patients between different EMG-based IMA severity scales and the measures of voice quality and sound production. EMG did discriminate between predominantly adductor and abductor SD pattern types, but could not correctly differentiate a mixed SD group. Those patients with adductor SD displayed IMA in the V and CT muscles, while those with abductor SD displayed more IMA in the CT than the V muscles. Sequential EMG assessment of CT and V IMA in SD did not predict clinical severity or outcome following Botox injection into the V muscles.

Adult↗