Biomedical subjects

L A Rammage

Publications and source records attributed to L A Rammage.

6 recordsLinked to original sources

PubMed1993

Interdisciplinary approach to functional voice disorders: the psychiatrist's role.

A review is given of the experience obtained over 6 years of having a psychiatric consultant available as part of the staff of the Voice Clinic, to which more than a thousand patients have been referred. The presenting features in a case that should alert the otolaryngologist to the need for psychiatric consultation and possible treatment are noted. Suggestions are made as to how to prepare the patient for the referral to a psychiatrist with the appropriate interests and willingness to collaborate closely with the otolaryngologist and the speech pathologist.

Humans↗

PubMed1993

Muscle misuse voice disorders: description and classification.

It is apparent that voice disorders frequently labelled "functional" are associated with laryngeal muscle misuse. This use of the word "functional" is, however, intrinsically ambiguous, and so we propose an alternative term based on descriptive features of dysfunction: "muscle misuse voice disorders". Persistent phonation with an abnormal laryngeal posture can lead to organic changes such as nodules or polyps, particularly in females with posterior glottic chink. We hypothesized that the chink was related to an overall increase in laryngeal muscle tension, and more directly due to inadequate relaxation of the posterior crico-arytenoid muscle during phonation. We employed the term "muscular tension dysphonia" (MTD) to note this condition, but it may be that the term "laryngeal isometric" is superior since there are other misuses of the larynx that obviously are manifestations of abnormalities of muscular tension. With this in mind we have evolved a new classification based on the laryngeal isometric, glottic and supraglottic lateral contraction states, antero-posterior contraction states, conversion aphonia, psychogenic bowing, and adolescent transitional dysphonia.

Female↗

PubMed1991

A modified neoglottis procedure: update and analysis.

In recent years, various techniques have been introduced for construction of an epithelium-lined shunt between the trachea and the esophagus or hypopharynx. We described a rigid neoglottis in a preliminary report of 12 cases in which the upper tracheal rings were used to construct the epithelium-lined tract. This study reports the cases of 22 additional patients and offers an in-depth analysis of additional demographics, complications, and long-term speech results that quantify the vocal characteristics of neoglottic speakers. Results indicate rapid postoperative speech rehabilitation in nearly all patients, good long-term speech results (mean followup, 52 months), and low morbidity. There was a low incidence of local recurrence and stenosis, and 26 of 34 patients had either no aspiration or occasional asymptomatic aspiration of small amounts of liquid. This modified neoglottis procedure should be considered for patients who need voice restoration after laryngectomy.

Adult↗

PubMed1986

Diagnostic criteria in functional dysphonia.

One thousand consecutive patients seen in a multidisciplinary voice clinic are reviewed. The incidence and relative severity of diagnostic features in each of five assessment areas are calculated and compared. The five areas include: 1. history, 2. laryngoscopic examination, 3. perceptual-acoustic assessment, 4. voice related musculoskeletal, and 5. psychological evaluations. Feature prevalence is presented for patients we have classified as having muscular tension dysphonia, which can be primary, or associated with vocal nodules, chronic laryngitis, or polypoidal degeneration; or as having a psychogenic "functional" dysphonia. Following review of the data, we present a suggested list of diagnostic criteria that should be present before using a specific diagnostic label. These criteria have been further broken down into those that will be present to make a diagnosis, and those that may be present.

Adult↗

PubMed1983

The voice clinic: an interdisciplinary approach.

The University of British Columbia Voice Clinic provides care to patients with various types of voice disorder, and the effectiveness of therapy is enhanced by an interdisciplinary approach. The Voice Clinic team includes an otolaryngologist, speech pathologist, psychiatrist, and singing teacher consultant. This paper particularly highlights the interactions between the speech pathologist and psychiatrist in their therapy programs for voice disordered patients.

British Columbia↗

PubMed1983

Muscular tension dysphonia.

Muscular tension dysphonia (MTD) is a condition commonly seen in young and middle aged females. It is manifest by excess tension in the paralaryngeal and suprahyoid muscles, an open posterior glottic chink, larynx rise, and frequently mucosal changes on the vocal cords. These mucosal changes are usually fleshy vocal nodules. About 8% of vocal nodules are found in patients not exhibiting features of MTD. The two types of vocal nodules require different therapeutic approaches. One hundred patients out of 500 seen consecutively at the Voice Clinic at the University of British Columbia exhibited the features of MTD. These patients are discussed and an etiology hypothesis is presented.

Adolescent↗