Journal of voice : official journal of the Voice Foundation
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Sarcoidosis with cranial polyneuritis and mediastinal granulomatous compression as a cause of unilateral left vocal fold paralysis has been reported infrequently. No case of sarcoidosis causing bilateral vocal fold paralysis in the abducted position has been reported in the Otolaryngology/Voice literature. ⋯ This patient had a dramatic response to treatment with steroids. Sarcoidosis should be included in the differential diagnosis of unilateral or bilateral vocal fold paralysis.
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According to experience in voice therapy and singing pedagogy, breathing habits can be used to modify phonation, although this relationship has never been experimentally demonstrated. In the present investigation we examine if lung volume affects phonation. Twenty-four untrained subjects phonated at different pitches and degrees of vocal loudness at different lung volumes. ⋯ The main results were that with decreasing lung volume, the closed quotient increased, while subglottal pressure, peak-to-peak flow amplitude, and glottal leakage tended to decrease. In addition, some estimates of the amount of the glottal adduction force component were examined. Possible explanations of the findings are discussed.
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Biography Historical Article
Chevalier Jackson's contributions to direct laryngoscopy.
Chevalier Jackson championed rigid endoscopy of the upper aerodigestive tract and facilitated its development and popularity at the beginning of the 20th century. He realized that endoscopy and open surgery are inextricably linked for effective management of diseases of the upper air and food passages. Toward this end, Jackson contributed a number of important innovations to direct laryngoscopy, while developing a unique mastery of the technique. Ultimately, he combined this endoscopic proficiency with open surgical techniques.
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Case Reports
Episodic paroxysmal laryngospasm: voice and pulmonary function assessment and management.
Episodic paroxysmal laryngospasm (EPL) is a sign of laryngeal dysfunction, often without a specific organic etiology, which can masquerade as asthma, vocal fold paralysis, or a functional voice disorder. The intermittent respiratory distress of EPL may precipitate an apparent upper airway obstructive emergency, resulting in unnecessary endotracheal intubation, cardiopulmonary resuscitation, or tracheostomy. During 27 months, seven women and three men, age 30-76 years, were assessed by a high diagnostic index of suspicion, an intensive history including psychosocial factors, physical examination of the airways, provocative asthma testing, and swallowing studies. ⋯ Hallmarks of management include patient and family education by observation of laryngoscopic videos, a specific speech therapy program, psychotherapy, and medical treatment of associated disorders. Electromyography may become a valuable future adjunct. Unlike laryngeal dystonia, patients with EPL do not benefit from botulinum toxin type A.
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A difficult laryngeal exposure is made easier by placement of the patient's head and neck into the Boyce-Jackson "sniffing position" and then flexing them further if necessary, by selection of a laryngoscope appropriate to the patient and to the triangular glottic shape, by placement of the laryngoscope along the path of least resistance, by use of a true suspension device in order to apply the force for laryngoscopy towards the larynx and away from the teeth and gums, and by allowing time for the force to work. With these techniques, an easy exposure is made almost perfect. The true vocal folds are exposed from vocal process to anterior commissure without the need for external pressure, the endotracheal tube remains out of sight between the arytenoids, and there is no risk to the teeth, gums, and cervical spine.