Speech therapy in the management of male-to-female transsexuals

This article discusses communication problems of transsexuals and gives an example of phoniatric and logopedic assessment as well as a possible 'prototype' of speech therapy with male-to-female transsexuals.

Consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer: voice quality, vocal function, and vocal performance

PURPOSE

To assess consequences of voice impairment in daily life for patients following radiotherapy for early glottic cancer, by means of a multidimensional analysis protocol including voice quality, vocal function, and vocal performance measures.

METHODS AND MATERIALS

A total of 60 men treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30 fractions, 60 Gy/25 fractions) for early T1 glottic cancer and 20 matched control speakers filled in questionnaires on vocal performance. Furthermore, perceptual analyses of voice quality and stroboscopic measures of vocal function were performed. There was a longitudinal group of 10 patients from whom data were collected before, as well as 6 months and 2 years after, radiation. Furthermore, data were collected on 5 separate groups of 10 patients each: before, 6 months after, 2 years after, 3-7 years after, and 7-10 years after radiation.

RESULTS

High correlations were found between self-ratings of vocal performance and several voice measures. Patients before radiotherapy experienced poor voice characteristics that improved 6 months to 10 years after treatment, and became comparable to vocal performance of control speakers in 50% of the patients. Following radiotherapy, deviant voice characteristics and consequences in daily life occurred significantly more often for patients in whom initial diagnosis consisted of stripping the vocal cord instead of biopsies and for patients who continued smoking after treatment.

CONCLUSION

Voice characteristics of patients diagnosed with early glottic cancer improved after radiotherapy, and became normal in half of our patients. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased deviant voice characteristics.

Multidimensional assessment of voice characteristics after radiotherapy for early glottic cancer

OBJECTIVES/HYPOTHESIS

To assess voice characteristics of patients following radiotherapy for early glottic cancer through a multidimensional analysis protocol including vocal function and voice quality measures.

METHODS

Voice analyses were performed for 60 patients treated with radiotherapy (66 Gy/33 fractions, 60 Gy/30 fractions, or 60 Gy/25 fractions) for early T1 glottic cancer and 20 matched control speakers. There was a longitudinal group of 10 patients for whom data were collected before as well as 6 months and 2 years after radiation. Furthermore, data were collected for five separate groups of 10 patients each, before, 6 months after, 2 years after, 3 to 7 years after, and 7 to 10 years after radiation. Vocal function was investigated by means of videolaryngostroboscopy, phonetography, maximum phonation time, and phonation quotient measures. Voice quality was assessed by means of objective acoustical analysis and subjective perceptual ratings by trained raters.

RESULTS

Voice characteristics of patients were decreased before radiotherapy, improved after treatment, and became comparable to the voice characteristics of control speakers in at least 55% of the patients. Following radiotherapy, deviant voice quality was mainly negatively affected by increased age and stripping the vocal cord for initial diagnosis. Stroboscopy revealed that next to increasing age and stripping the vocal cord, continued smoking after treatment decreased vocal function following radiotherapy.

CONCLUSION

Voices of patients diagnosed with early glottic cancer improved but did not normalize fully after radiotherapy. Stripping the vocal cord for initial diagnosis and continued smoking after treatment decreased voice characteristics. A multidimensional analysis protocol including perceptual and acoustical analysis of voice quality and stroboscopic analysis of vocal function is recommended to investigate voice characteristics following treatment for early glottic cancer.

Articulation after total glossectomy: a clinical study of speech in six patients

In this study we investigated the speech of six patients after total glossectomy. After rehabilitation a reasonable function of speech was possible, as a result of compensatory mechanisms. Suggestions to improve the results of speech and language therapy are given.

Total glossectomy with laryngeal preservation

OBJECTIVE

To evaluate the results of a planned combined therapy with surgery and postoperative radiotherapy in the management of large (T3 to T4) squamous cell carcinomas of the tongue-tongue base in properly selected patients.

PATIENTS AND METHODS

Twenty-one patients underwent this procedure in a 4-year period. The selection criteria were directed to identify those patients in whom laryngeal preservation was feasible and who were motivated. Five categories of patients were included: those with (1) large primary tumors of the tongue-tongue base; (2) recurrence after initial radiotherapy, brachytherapy, chemotherapy, or a combination of these modalities; (3) recurrence after initial surgery and radiotherapy; (4) double primary tumors; and (5) second or third primary tumors arising in the tongue or base of the tongue. Preoperative investigation included examination under anesthetic and magnetic resonance imaging. Depending on the proximity of the primary tumor to the mandible, a mandibular split, a marginal resection, or a segmental resection was carried out. Soft-tissue replacement was achieved by a myocutaneous or a muscle flap of the pectoralis muscle with split skin. Whenever possible tissues of the contralateral floor of the mouth were also used. Laryngeal suspension was performed in all cases. Postoperative radiotherapy consisted of megavolt therapy, 66 Gy in 6 weeks to the primary site and both sides of the neck.

RESULTS

Resumption of swallowing and speech was achieved in all patients. External deformity was slight. Patients were able to return to their families.

CONCLUSIONS

Total glossectomy with laryngeal preservation in properly selected patients provides local and regional control and preserves quality of life.

Total glossectomy: reconstruction and rehabilitation

Patients with carcinoma of the tongue including the base of the tongue who underwent total glossectomy in a period of just over ten years since January 1979 have been reviewed. Total glossectomy may be indicated as salvage surgery or as a primary procedure. The larynx may be preserved or may have to be sacrificed depending upon the site of the lesion. When the larynx is preserved the use of laryngeal suspension facilitates early rehabilitation and preserves the quality of life to a large extent. Cricopharyngeal myotomy seems unnecessary.

Caloric vestibular test in the weightless phase of parabolic flight

Twenty-four caloric vestibular tests were conducted in 20 test subjects during parabolic flight, in which weightless periods of about 10 seconds were elicited. The caloric nystagmus disappeared completely in all experiments in weightlessness, whereas in the higher G-periods the speed of the nystagmus increased. With regard to the modes of response during the periods with increased G-values prior to and following the weightlessness, four different types could be distinguished. In mode I the speed of the slow nystagmus phase increased in the higher G-periods, the nystagmus showed a prolonged duration, while in weightlessness it faded out completely. A reversed nystagmus appeared when the primary caloric nystagmus had disappeared. In modes II, III and IV the direction of the nystagmus reversed during weightlessness. In modes II and III this reversed nystagmus appeared even when the primary caloric nystagmus had disappeared. In mode III the nystagmus resembled the type of mode II, with the difference that it faded away much earlier than could be expected. In mode IV the primary nystagmus lasted rather briefly, while the reversed nystagmus during weightlessness was also much shorter. The experiments produced two remarkable facts: the appearance of a nystagmus reversal, a 'secondary nystagmus', in all experiments in weightlessness, and furthermore great differences in findings between the individuals as well as between experiments in the same person. The only explanation for the inconsistency in the findings is the assumption that effects on other canals, otoliths and vestibular nuclei are continuously changing and therefore interfere with the only endproduct measured, the horizontal nystagmus.(ABSTRACT TRUNCATED AT 250 WORDS)

Caloric vestibular test with the use of air

In a group of 28 test subjects the vestibular caloric test was performed with the aid of two different methods. In the first method the ears were irrigated for 30 sec with water with a temperature of 30 C and 44 C and later on with airstream with a temperature of 20 C and 50 C. The wet method proved to be a significant stronger stimulus than the dry method. The authors conclude that the water irrigation is the method of choice for the caloric test. The dry method is only useful when the wet method is undesirable.

The contralateral ear in Méniére disease

We conducted a survey of 292 patients who had Meniere disease to determine whether there was either some subjective complaint like tinnitus or hearing impairment or an objective symptom like hearing loss or recruitment of the contralateral ear. In 212 (73%) patients, signs of disturbed hearing in the second ear were present. If only the combination of sensorineural hearing loss, recruitment, and tinnitus is accepted as a definite proof of the diagnosis of Meniere disease, at least 10% of the patients we studied suffer from bilateral Meniere disease. Usually, there is an interval between the onset of the impairment in the first and in the second ear; an involvement of both ears from the first onset of the disease has been found in only six patients. We believe that involvement of the second ear in so many of the patients suggest that a conservative method of treatment should always be considered.

Flight behaviour of pigeons in the weightless phase of parabolic flight

Pigeons were subjected to changes in G-loading during parabolic flight with special attention to their flight behaviour in the weightless periods. Experiments were performed 1) with the eyes covered, 2) with the legs tied to the body, 3) with eyes covered and legs tied, and 4) with none of these handicaps. In all these situations the flight behaviour of the birds was observed. Special attention was paid to the tumble-phenomenon, which appeared birds with covered eyes. The results are discussed and comparisons are made with the behaviour of man and fish under similar conditions.

Flight behaviour of pigeons during weightlessness

Pigeons were subjected to weightlessness caused during parabolic flight in an airplane. Experiments were performed with these birds in their normal state, as well as in conditions with hooded eyes, with the legs bound, and a combination of both handicaps. In all these situations, the flight behaviour of the birds was observed. The results are discussed and comparisons are made with the behaviour of man and fish under similar conditions.