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Biomedical subjects

M I Singer

Publications and source records attributed to M I Singer.

At least 73 records · Page 4Linked to original sources
PubMed1987

A biracial comparison of adolescent alcohol use.

This study used a survey design to compare the drinking behaviors of Black and White students from two urban high schools in the city of Cleveland. Data are presented from 1,096 students who completed a 28-item self-report questionnaire measuring adolescent alcohol use and several factors which influence it. White males demonstrated the highest amount of alcohol use on all measures, while White females demonstrated drinking rates comparable to Black males. Blacks of both sexes exhibited the highest percentage of nondrinkers and the highest lifetime abstention rates. White respondents tended to have their initial drinking experiences almost a year earlier than their Black counterparts and perceived greater parental permissiveness regarding drinking. Relaxation was the most popular reason given for drinking by all groups of students. Higher percentages of White than Black students felt that conviviality and problem avoidance were benefits associated with drinking. Subcultural variations were also seen in the perceptions about parental influences on drinking. Implications for service delivery are discussed.

Adolescent↗
PubMed1987

Sternocleidomastoid myocutaneous flap.

The sternocleidomastoid myocutaneous flap has several applications for reconstruction of defects about the head and neck. It is used for augmentation of facial defects, carotid artery protection, and repair of oral cavity defects. Additional reconstructive efforts suggest the sternocleidomastoid myocutaneous flap can be used for facial reanimation and as an osteomyocutaneous flap incorporating the clavicle for mandibular reconstruction. Reports of unreliable viability and resection of the sternocleidomastoid muscle during neck dissection decreases the applicability of the flap. Twenty-seven sternocleidomastoid flaps were used in 26 patients for head and neck reconstruction. In contrast to the reported 40% to 50% incidence of superficial slough or total flap necrosis, three (11%) flaps developed superficial (cutaneous) slough while two patients developed inclusion cysts. The technique includes elevation of the sternocleidomastoid muscle with the overlying platysma and skin originally described by Owens. The procedure is modified by removing the epithelium on the tunneled portion of the flap. This allows the flap to be used as a one-stage method of reconstruction without sacrificing the additional blood supply from the platysma and overlying dermis.

Humans↗
PubMed1986

Irradiated mandibular autografts update.

Nineteen patients underwent primary mandibular reconstruction with irradiated mandibular autografts. Ten were successful, with the longest follow-up being 7 1/2 years; nine failed within six months. Although an excellent graft for size and contour, a 53% success rate is no better than any other primary grafting technique. We have abandoned this technique in most situations and presently are evaluating split-rib grafts and intraoperative radiation to in situ mandibles.

Carcinoma, Squamous Cell↗
PubMed1986

A prospective study of tracheoesophageal speech.

Gates et al suggested that commonly accepted statistics on esophageal speech acquisition may be inflated because they are compiled from retrospective observations that tend to exclude high-risk or poor-outcome patients who are unavailable or unwilling to be assessed. Using a multi-institution prospective study design, they demonstrated that at six months following laryngectomy only 12 (26%) of their 47 patients used esophageal speech. We prospectively assessed a group of 47 laryngectomees' pretracheoesophageal puncture and posttracheoesophageal puncture to determine the efficacy of this speech-rehabilitation method. Forty-four patients (94%) achieved good to superior tracheoesophageal speech, and, at one year, 39 patients (83%) continued to use their voice prosthesis. Results of this study reveal (1) preoperative speech intelligibility and acceptability, (2) predictive value of the preoperative esophageal insufflation test, (3) speech intelligibility and acceptability four days following initial voice prosthesis placement, (4) cost profiles, and (5) results and experiences at one year.

Adult↗
PubMed1986

Pharyngeal plexus neurectomy for alaryngeal speech rehabilitation.

Pharyngeal constrictor and cricopharyngeal spasm have been implicated as deterrants to esophageal speech acquisition as well as tracheoesophageal phonation. Recent efforts to reduce the resultant hypertonicity include pharyngeal constrictor myotomies and modifications of pharyngeal reconstruction during laryngectomy. Investigation of the innervation of the muscular wall of the pharynx led to the development of a pharyngeal plexus neurectomy technique to alter the tonicity of the pharynx without myotomy. The resultant alaryngeal speech is fluent, and acoustic parameters compare favorably to esophageal speech.

Adult↗
PubMed1985

Primary voice restoration at laryngectomy.

The tracheoesophageal puncture techniques of secondary voice restoration have been applied to primary restoration at laryngectomy. Satisfactory speech resulted in 48 patients (69%). This figure was improved by revision surgery to 75% and case selection may produce even higher success rates.

Esophagus↗
PubMed1985

An improved esophageal insufflation test.

Previous investigations identified that insufflation of the esophagus may elicit reflex pharyngoesophageal closure, impeding airflow and subsequent voice production. A simplified method for esophageal insufflation consistently evaluates the capacity for alaryngeal speech acquisition. Although primarily a method for predicting tracheoesophageal speech, it may also be an important prognostic indicator for traditional esophageal speech development.

Catheterization↗
PubMed1985

Pharyngeal reconstruction after total laryngectomy with preservation of phonation.

The goal of pharyngeal reconstruction after laryngectomy is to prevent fistulization and to permit rapid resumption of satisfactory deglutition. Alaryngeal speech acquisition by the traditional method of esophageal speech is effective if insufflation is rapidly learned and tolerated by the pharyngoesophageal segment. Experience with tracheoesophageal phonation revealed an incidence of pharyngoesophageal spasm in 40% of an esophageal speech failure population which prevented useful air flow for speech production. This is related to esophageal distention and reflexive upper esophageal sphincter hypertension. It is suggested that pharyngeal reconstruction after total laryngectomy may permit higher wall tension than is desirable for speech acquisition. The problem of post laryngectomy pharyngoesophageal spasm may be reduced by myotomy of the pharyngeal constrictors with resultant higher air flows in the residual vocal tract for speech. Alterations in the pharyngeal wall tonicity will affect the pitch of the speech and listener acceptability. Recently identification and division of the pharyngeal plexus has produced a similar result in improved phonatory air flows with subjective vocal pitch approximating more normal voices. The above mentioned techniques are readily applied to the laryngectomy procedure and enhance the likelihood of alaryngeal speech acquisition.

Humans↗
PubMed1985

Restoration of the airway following bilateral recurrent laryngeal nerve paralysis.

Bilateral recurrent laryngeal nerve paralysis has been treated by a number of ingenious techniques that include arytenoidectomies, vocal cord lateralizations, cordectomies, and, recently, reinnervation procedures and laser arytenoidectomies. An arytenoidectomy is recommended by a thyrotomy approach without lateralization of the vocal cord. The resulting airway is adequate for decannulation by expansion of the posterior glottic aperture, with preservation of the anterior glottis for phonation.

Arytenoid Cartilage↗
PubMed1985

Vocal rehabilitation after laryngectomy.

The evolution of treatment of laryngeal cancer has passed a number of milestones. The maintenance of useful communication is of paramount importance in all cases and, with the newer modalities of tracheoesophageal phonation and voice prostheses, the quality of life after laryngectomy is clearly improved. Future advances may restore continuity of the upper respiratory tract with resumption of normal nasal function, humidification of the lower respiratory tract, and elimination of the permanent tracheostoma.

Humans↗
PubMed1984

Selected acoustic features of tracheoesophageal, esophageal, and laryngeal speech.

Voice samples of 15 laryngeal, esophageal, and tracheoesophageal speakers using the Blom-Singer voice prosthesis were analyzed for intensity, frequency, and rate. Results indicate that characteristic values for tracheoesophageal speech are more similar to laryngeal speech than esophageal speech, demonstrating the powerful advantage of this pulmonary-supported method of alaryngeal voice.

Acoustics↗
PubMed1984

A comparative acoustic study of normal, esophageal, and tracheoesophageal speech production.

Acoustic characteristics of two types of alaryngeal speech were quantified and compared to normal speech production. High-quality audio recordings were obtained from 15 subjects who had undergone the tracheoesophageal puncture method of postlaryngectomy vocal rehabilitation (Singer & Blom, 1980), 15 esophageal speakers, and 15 laryngeal talkers as they sustained the vowel /alpha/ and read a standard paragraph. Ten frequency, 7 intensity, and 13 duration variables were quantified. Central tendency and variability measures of frequency and duration for the three speaker groups indicated that tracheoesophageal speech is more similar to normal speech than is esophageal speech. Intensity measures indicated that tracheoesophageal speech is more intense than normal and esophageal speech.

Aged↗
PubMed1983

Irradiated mandibular autografts.

The cosmetic and functional disability associated with mandibular resection has been a major problem to the patient with direct invasion of the mandible by oral cancer. Marginal resections with combined postoperative radiation therapy have frequently been substituted for the more preferred segmental resections and resultant deformities. Presented are 15 cases of oral cavity cancer involving resection of the mandible, immediate radiation to 10,000 rad, and primary reconstruction as irradiated mandibular autografts. The longest following is 4 years and 3 months, with a success rate of 66%. Morbidity is minimal as compared to autogenous bone grafting. Tumor size, previous radiation, or use of regional flaps have not been a factor in the success of this method in reconstruction of the mandible primarily.

Adult↗
PubMed1983

Role of needle biopsy in thyroid nodules.

The role of fine-needle aspiration cytology of thyroid nodules is analyzed in 116 cases. Forty-six percent of the patients with "cold" solid nodules were operated on with a 1% known false-negative and a 5% false-positive result. Ninety-four percent of the aspirations provided adequate cytologic material for evaluation. A new approach to the assessment and management of the thyroid nodule with fine-needle aspiration is proposed as the initial step in the evaluation.

Biopsy, Needle↗