Changes in Vocal Fold Morphology During Singing Over Two Octaves

OBJECTIVE

Vocal folds are widely assumed to only elongate to raise vocal pitch. However, the mechanisms seem to be more complex and involve both elongation and tensioning of the vocal folds in series. The aim of the present study was to show that changes in vocal fold morphology depend on vocal fold elongation and tensioning during singing.

STUDY DESIGN

This was a prospective study.

METHODS

Forty-nine professional female singers (25 sopranos, 24 altos) were recruited and three-dimensional laryngeal images analyzed in a coronal view derived from high-resolution computed tomography scans obtained at the mean speaking fundamental frequency (ƒ₀) and one (2ƒ₀) and two octaves (4ƒ₀) above ƒ₀.

RESULTS

The vocal fold angle, defined by a tangent above and below the vocal folds, was 58° at ƒ₀, 47° at 2ƒ₀, and 59° at 4ƒ₀.

CONCLUSION

The decreased caudomedial angle of the vocal fold from ƒ₀ to 2ƒ₀ (change in muscle belly from ";fat" to "thin") and increased angle from 2ƒ₀ to 4ƒ₀ (from "thin" to "fat") strongly supports the hypothesis that the vocal folds elongate and then tension when singing from ƒ₀ to 4ƒ₀. This is the first study to show this relationship in vivo.

A transthyroidal method for arytenoid adduction: a basic anatomical study

INTRODUCTION

Arytenoid adduction is a very effective procedure for medializing the posterior part of the vocal fold in vocal fold paralysis. Major drawback of the method is the technically sometimes-difficult access to the arytenoid with increased postoperative morbidity. Aim of this study was to provide basic anatomical data regarding the accessibility of the arytenoid cartilage through a thyroplasty window. Furthermore, to investigate the feasibility of an arytenoid adduction by fixation of a surgical screw to the arytenoid cartilage by using this approach.

MATERIALS AND METHODS

10 cadaver larynges, six female and four male, were dissected and measured for our points of interest. A standard manufacture-made surgical screw attached to a suture was anchored to the fovea oblonga of the arytenoid cartilage.

RESULTS

Our anatomical measurements proved a mean distance from the posterior edge of the thyroid window to the arytenoid of about 8-9 mm in male larynges and 7-8 mm in female larynges. The distances did not differ significantly between the sexes. Pulling the anchored surgical screw medializes the posterior part of the vocal fold.

DISCUSSION

Our data showed that there is a very constant morphometric relation between the thyroplasty window and the arytenoid cartilage. It is known that gender-related differences result in a veritable laryngeal dimorphism in nearly all absolute laryngeal dimensions. These differences appear to a much lesser extend in the distances from the surface to the depth, as was confirmed in our series. Using these findings led us to identification of the fovea oblonga near the muscular process as the most favorable point for fixation of a surgical screw through a conventional thyroplasty window. Pulling the attached suture medializes the arytenoid cartilage.

[Granular cell tumor of the larynx: a case report]

Granular cell tumors are benign subcutaneous or submucosal lesions of neurogenic origin. They are quite commonly found in the head and neck region, particularly in the tongue. However, only about 200 cases of laryngeal granular cell tumors have been reported so far. Most laryngeal granular cell tumors are located in the posterior part of the vocal fold and in the posterior commissure. Differentiation from inflammatory as well as from malignant lesions is possible only by biopsy. The treatment of choice is complete excision. However, tumor extension and expected morbidity of the surgery will inevitably influence the extent of the resection. Recurrences after complete excision are rare.

[Dysphagia: clinical management in diagnostics and therapy]

The oral nutrition is a complex procedure of different mechanisms. It saves the survival and is part of the social integration. That's why dysphagia seems to be a serious symptom. The aetiology is multiple and is often not recognized. With a profound diagnostic algorithm a lot of aetiologies can be discovered. Treatments can be conservative or surgical. The aim of therapy is to develop techniques of swallowing to reach an oral nutrition and to reintegrate patients in their social net. It is important to recognize early signs. The general practicer is an important initiator to introduce a differential diagnostic procedure.

[Tinnitus--classification, causes, diagnosis, treatment and prognosis]

Up to 45% of all adults in the industrialized countries are afflicted by noises in the ears--approximately one million people require treatment in Germany alone. Classification of tinnitus is oriented to the duration of symptoms and their severity, the latter taking into account the victim's distress both at work and during leisure time. Acute tinnitus is often caused by an ear condition or psychosocial stress. Chronic tinnitus can be caused by persistent exposure to noise, whiplash injuries or functional disorders of the cervical spine. The diagnosis is based on audiometric and otoneurologic investigations, possibly magnetic resonance tomography and serology when an infection is suspected. Acute tinnitus is treated with infusions--mostly with cortisone or pentoxifylline--or a short-term oral medication with these substances. Since no causal therapy is available for chronictinnitus, therapeutic counseling has a particular role to play with emphasis on informing the patient on the results of investigations and suggesting coping strategies. Following an appropriate diagnostic work-up, the patient should be advised of the harmless nature of the noises and encouraged to adopt a positively motivated approach to the symptoms. Tinnitus retraining therapy aims to permanently suppress conscious awareness of the noises in the ear. For this purpose, a noise generator, generally worn within the ear auricle, is employed among other things. The prognosis is dependent not only on the presence or otherwise of organic disease but also--almost always--on such aspects as perception and coping by the individual patient.

Variability in glucose transporter-1 levels and hexokinase activity in human melanoma

Melanoma exhibits heterogeneous growth patterns and widely varying sensitivities to multiple treatment modalities. This variability may reflect intrinsic genetic differences in factors giving rise to altered metabolism. Glucose is the primary energy source of tumours, including melanoma, and glucose transporter isoform 1 (Glut-1) and hexokinase are key rate-limiting factors in glucose metabolism. The levels of Glut-1 and total hexokinase activity were measured in 31 melanoma biopsies to determine the extent of tumour-to-tumour variability in these parameters. Relative Glut-1 levels were determined by Western immunoblot analysis using human anti-Glut-1 rabbit polyclonal antibody, and hexokinase activity was measured in the same samples by an enzymatic assay monitoring the reduction in the oxidized form of nicotinamide adenine dinucleotide phosphate (NADP+) (in nmol NADP+ reduced/min per mg protein). All melanomas were from patients who had received no therapy prior to surgery. Immediately after excision, tumour biopsies were disaggregated to single cells by collagenase and DNase and frozen in liquid nitrogen. Thirty human melanomas exhibited a 22-fold variation in levels of Glut-1 and 29 exhibited a nine-fold variation in total cellular hexokinase activity. Glut-1 levels and hexokinase activity were not correlated with one another. The broad range in Glut-1 levels and hexokinase activity observed between melanomas suggests that these glycolytic rate-limiting parameters that influence the rate of glucose metabolism may contribute to the variability in melanoma response to treatment modalities.

[Aphthae of the oral cavity: differential diagnostic considerations concerning a case report]

INTRODUCTION

Oral aphthae which are very commonly seen in an ENT practice should trigger a detailed investigation of the patient's history and a wide variety of differential diagnoses.

CASE REPORT

A 32-year-old male patient was admitted suffering from aphthous ulcers, fever, painful ankles and dysuria. Treatment with antibiotics was not successful. In addition to the above mentioned symptoms an exanthema and genital lesions arose during the hospital stay. After having excluded differential diagnoses a Morbus Behçet was diagnosed. The patient recovered after treatment with steroids and NSAIDs.

DISCUSSION AND CONCLUSION

Patients suffering from aphthae in the oral cavity are common and need to be precisely questioned about their history with an assessment of the frequency, morphology, localisation, number and type of systemic symptoms. M. Behçet is a non-infectious progressive chronic systemic vasculitis of unknown aetiology. Autoimmune, viral or genetic factors are possible. An HLA-association has already been proven. M. Behçet can be diagnosed by excluding all the other possible differential diagnoses.

Human immunodeficiency virus (HIV) subtype surveillance of African-born persons at risk for group O and group N HIV infections in the United States

A population-based surveillance registry was used to identify human immunodeficiency virus (HIV)-infected persons in the United States at increased risk for group O and group N infections (those born in or near African countries where group O infection has been reported). Of 155 eligible subjects, 37 gave samples. By phylogenetic and serologic analysis, 32 were infected with group M (16 with subtype A, 5 with B, 7 with C, and 1 each with subtypes D, F2, G, and recombinant A/J) and 2 with group O but none with group N virus. For 3, samples could not be typed by serology or amplified by polymerase chain reaction using group M-, O-, or N-specific primers. In the United States, group O HIV infection is uncommon; no case of group N infection was found. African-born persons may have HIV strains typical of their birth country. Ongoing subtype surveillance may allow early identification of novel or emerging HIV strains.

Mammalian cells adapted to growth at pH 6.7 have elevated HSP27 levels and are resistant to cisplatin

HSP27 levels are elevated in two Chinese hamster cell lines and in a human melanoma cell line adapted to growth at pH 6.7. The level of HSP72 is elevated in the melanoma cell line but not in the hamster cell lines adapted to growth at pH 6.7. HSC73 levels are not elevated in any of the adapted cell lines. Low pH adapted cells from all cell lines are resistant to cisplatin. It is proposed that elevated HSP27 levels in low pH-adapted cells may play a role in resistance to hyperthermia and resistance to cisplatin.