Thesis (Sc. D.)—Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 1980. / Includes bibliographical references (p. 264-270). / This electronic version was scanned from a copy of the thesis on file at the Speech Communication Group. The certified thesis is available in the Institute Archives and Special Collections.

Orientador: Carlos Takahiro Chone / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T02:51:56Z (GMT). No. of bitstreams: 1 Rossi_VanelideCassiaColombo_M.pdf: 1971545 bytes, checksum: 76507557399a5e7e6017a3ddb0651662 (MD5) Previous issue date: 2013 / Resumo: OBJETIVO: Avaliar qualidade de vida e voz de pacientes tratados de câncer avançado de laringe por laringectomia total ou quimioradioterapia exclusiva com preservação de órgão. MATERIAL E MÉTODOS: 30 pacientes tratados de câncer avançado de laringe livres da doença há pelo menos quatro anos: dez laringectomizados totais sem produção de voz esofágica (SVE); dez laringectomizados totais com voz traqueoesofágica (VTE) e dez com voz laríngea. A qualidade de vida foi mensurada pelos protocolos SF-36; Qualidade de Vida em Voz (QVV) e Índice de Desvantagem Vocal (IDV), aplicados no mesmo dia. RESULTADOS: No SF-36, observou-se que pacientes que receberam quimioradioterapia exclusiva apresentam melhor qualidade de vida do que o grupo de VTE e SVE. No QVV observou-se que a qualidade de vida relacionada à voz é menor no grupo SVE. No IDV grupo SVE apresenta escore maior para IDV total, emocional, funcional e orgânica. DISCUSSÃO: Qualidade de vida e voz dos pacientes tratados com quimioradioterapia é melhor do que os pacientes tratados cirurgicamente. A qualidade de vida demonstrou-se alterada independente da modalidade de tratamento realizada. Pacientes com reabilitação vocal após cirurgia apresentaram qualidade de vida próxima àqueles pacientes com laringe preservada. CONCLUSÃO: Os resultados sugerem que o tratamento quimioradioterápico e a laringectomia total com prótese traqueoesofágica preservam melhor a qualidade de vida do que a laringectomia total sem prótese traqueosofágica. A laringectomia total sem prótese traqueoesofágica esta associada à menor qualidade de vida e maior índice de desvantagem vocal / Abstract: OBJECTIVE: To evaluate quality of life and voice in patients with advanced cancer of larynx treated with total laryngectomy or exclusive chemoradiotherapy with preservation of organs. MATERIAL AND METHODS: 30 patients treated for advanced cancer of larynx, free from disease there were at least four years: ten total laryngectomy patients without production of esophageal speech (EVS); ten total laryngectomy patients with tracheoesophageal voice (TEV) and ten with laryngeal voice. The quality of life was measured by SF-36; Voice-Related Quality of Life (V-RQOL) and Voice Handicap Index (VHI) protocols, applied on the same day. RESULTS: The SF-36 observed that patients treated with exclusive chemoradiotherapy present better quality of life than group of TEV and EVS. In V-RQOL it was observed that the quality of life related to voice is lower in the EVS group. In VHI group EVS presents higher scores for overall VHI, emotional, functional and organic. DISCUSSION: Quality of life and voice in patients treated with chemoradiation is better than the surgically treated patients. Quality of life was demonstrated altered independently of treatment modality performed. Patients with speech rehabilitation after surgery showed quality of life next to those patients with preserved larynx. CONCLUSION: The results suggest that chemoradiation and total laryngectomy with tracheoesophageal best preserve the quality of life than total laryngectomy without tracheoesophageal prosthesis. Total laryngectomy without tracheoesophageal prosthesis is associated with lower quality of life and greater voice handicap index / Mestrado / Ciencias Biomedicas / Mestra em Ciências Médicas

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A study was performed to establish the appearance of normal equine laryngeal cartilages using magnetic resonance imaging. Specimens were acquired from clinically normal horses that were euthanized for reasons other than respiratory disease. Three in situ and 5 ex vivo larynges were imaged using a 0.3 Tesla system. Images were obtained in the transverse plane using T1-weighted 3D spin echo, T2-weighted 3D spin echo, T2-weighted gradient echo, short tau inversion recovery (STIR), and proton density spin echo sequences. Five ex vivo larynges were also imaged in the transverse plane using a 1.5 Tesla system, sequences included T1-weighted 3D spin echo, T2-weighted 3D turbo-spin echo, turbo inversion recovery (TIRM), and proton density spin echo sequences. A frozen gross laryngeal specimen was sliced in 5-mm transverse sections for comparison to the MR images. Excellent correlation was found between MR images and the gross transverse sections. Successful imaging was accomplished using both imaging systems; however, the 1.5 Tesla system yielded superior image resolution. The 0.3 Tesla imaging system would accommodate the intact equine head, which was not possible using the 1.5 Tesla MRI system. The internal morphology of the laryngeal cartilages was clearly identified in all imaging sequences obtained. Cartilages were found to differ in signal intensity based on the tissue composition and imaging sequences performed. MRI was determined to be a useful imaging modality for evaluating the cartilage morphology of the equine larynx. Further investigation is required to document pathologic morphology. / Master of Science

Résumé : L’hémiplégie laryngée (HP) est une affection courante et une cause majeure de contre-performances dans l’espèce équine. Plusieurs études ont montré que la prévalence était variable selon les races et les disciplines étudiées. De plus, un développement important des techniques chirurgicales peu invasives ont émergé ces dernières années. Les objectifs de ce travail étaient de 1) déterminer la prévalence de l’HL chez une population de Trotteurs Français (TF) à l’entrainement et son impact sur les performances, 2) évaluer la pertinence des protocoles actuels de sédanalgésie utilisés lors d’interventions chirurgicales sur cheval debout.Deux études ont été réalisées pour répondre aux objectifs. La première étude portait sur 112 TF en situation d’entrainement. La prévalence a été calculée sur l’ensemble de l’effectif puis une étude longitudinale sur l’évolution du grade HL a été réalisée sur 18 chevaux. La prévalence de l’HL chez ces chevaux était relativement importante mais aucune corrélation avec les performances, ni le sexe ou l’âge des animaux n’a pu être montrée. Une large proportion de chevaux voit son grade d’abduction se dégrader avec le temps. La deuxième étude a comparé 4 protocoles de sédanalgésie. Huit juments saines ont été utilisées et les effets des protocoles ont été notés. Les protocoles testés étaient adéquats pour les interventions envisagées mais des différences notoires ont été démontrées. L’utilisation du butorphanol entrainait des mouvements involontaires et brusques de la tête, tandis que la lidocaïne pouvait engendrer un collapsus pharyngé. Des recommandations pour l’utilisation de ces protocoles ont été émises. / Abstract : Laryngeal hemiplegia (LH) is a common disease in sport- and racehorses, but also a frequent cause of poor performance. Several studies have shown that the prevalence of the disease is rather variable among the different breeds and disciplines. Furthermore, minimally invasive surgical therapies to correct this condition have recently gained popularity. The objectives of our work were to 1) determine the prevalence of LH in a population of French Trotters in training and 2) assess the efficacy of sedation and analgesia protocols in minimally invasive upper airway surgery. Two experiments were conducted. The first experiment investigated the prevalence of LH in 112 French Trotters horses in training, showing that a large number of horses were affected but it did not severely impact their performance. A longitudinal study was performed in 18 of these horses showing that the LH grade decreased with time in a large proportion of horses. The second study compared 4 sedation/analgesia protocols used in upper airway standing surgery. All protocols tested were adequate to provide sedation and analgesia of the pharynx and larynx but there were some important differences between protocols. Butorphanol induced frequent head jerking as lidocaine caused pharyngeal collapse, which can impair proper surgical accuracy. Recommandations were made for the use of these protocols in upper airway surgery.

An excised animal larynx model has been used in many studies to better understand the physiological and anatomical properties of the human larynx. One difference between an ex vivo model and an in vivo model is that ion loss occurs postmortem. To compensate for this in the excised model, researchers most commonly use a preservation method that includes completely submerging the specimen in isotonic saline (0.9% Na+Cl-) and then flash freezing it in liquid nitrogen. The flash freezing method allows researchers to maintain the integrity of the structures while also being able to gather specimens as they become available. Not enough research has been done to understand the effects of a preservation method on the outcomes of the study. Additionally, no common method has been established for preservation across studies to ensure that results are not being influenced by this variable. This prospective, mixed experimental design study includes three groups, a control group and two experimental groups. The control group consisted of 10 bench-mounted porcine larynges that were soaked in isotonic saline and flash frozen with liquid nitrogen. Prior to the experiment, the frozen larynges were thawed overnight before trials. The other two groups consisted of 10 bench-mounted porcine larynges each; these larynges were soaked in either isotonic saline or Ringer’s solution, a balanced fluid used in vivo to counteract dehydration. Larynges from these two groups were kept fresh and stored in a refrigerator overnight before trials. On the day of experimentation, each larynx was mounted on a bench top setup including three micropositioners to stabilize, adduct, and elongate the vocal folds. All the larynges were connected to a pseudolung via the trachea and humidified air was passed through to the vocal folds until phonation was achieved. Phonatory trials consisted of brief phonation followed by 5-minute desiccation intervals until phonation was no longer achieved. Phonation threshold flow (PTF), defined as the flow observed at the onset of phonation, was observed during each phonation trial; and flow values were compared within and between groups. Statistically significant differences were found between the Ringer’s group and the fresh saline group as well as between the Ringer’s group and the frozen saline group, indicating that PTF is influenced by the larynx preservation method.

The recurrent laryngeal nerve (RLN) innervates all the intrinsic muscles of the larynx that are responsible for human vocalization and language. The RLN runs along the tracheoesophageal groove bilaterally and is often accidentally damaged or transected during head and neck surgical procedures. RLN palsy and vocal cord paralysis are the most common and serious post op complications of thyroid surgeries. Patients who suffer from RLN injury can develop unilateral or bilateral vocal fold paralysis (BVFP). Theoretically, selective reinnervation of the posterior cricoarytenoid muscle would be the best treatment for BVFP. The phrenic nerve has been shown in several studies to be the best candidate to anastomose to the distal end of a severed RLN to restore glottal abduction. Successful PCA reinnervation has been sporadically achieved in both human patients and in animal models. Another notable ramification of recurrent laryngeal nerve injury is vocal instability caused by the alteration of mechanical properties within the larynx. In phonosurgery, alterations to the position and framework of the laryngeal apparatus are made to improve voice quality. Accurate and realistic synthetic models are greatly needed to predict the outcome of various adjustments to vocal cord tension and position that could be made surgically. Despite the sporadically successful attempts at PCA reinnervation, thus far, there are still several deficits in our anatomical familiarity and technological capability, which hinder the regularity of successful PCA reinnervation surgeries and our capacity to generate synthetic models of the human larynx that are both realistic and functional. We will address three of these deficits in this project using the porcine larynx as a model. Firstly, we will identify the anatomical variations of the porcine recurrent laryngeal nerve branches. A microscribe digitizer will be used to create three-dimensional mapping of the recurrent laryngeal nerve branches that are relevant to the posterior cricoarytenoid muscle and the abduction of the vocal folds. Secondly, we will develop a magnetic resonance imaging technique to correlate recurrent laryngeal nerve branching patterns with high-resolution MR images that can be used to determine the branching patterns present in a given specimen without surgery. Lastly, we will determine the distribution and composition of different tissue types found within human vocal folds. High resolution MRI, and Mallory's trichrome and H&E histological staining will be used to distinguish and identify the tissue composition of the vocal folds and surrounding laryngeal structures. Detailed information regarding vocal fold tissue composition and histological geometry will enable laryngeal modelers to select more sophisticated and life-like materials with which to construct synthetic vocal fold models.

The purpose of the present study was to examine the effects of external laryngeal vibration on voice function. The current study was based on a recent pilot study using silicone vocal folds that demonstrated a decrease in phonation threshold pressure (PTP; cmH2O) when an external oscillation was applied to the vocal folds. Using a within-subjects experimental design, a custom external oscillatory device was fitted to the posterior portion of 12 excised pig larynges using a traditional benchtop phonation setup. For each larynx, phonation was elicited during 30 repeated trials, including 15 with and 15 without external oscillation. During the phonation trials, aerodynamic measures were collected. The outcome measure for this study was PTP, which has been established in the literature as being correlated with physiologic and self-perceived vocal effort. Furthermore, PTP is used routinely as an aerodynamic indicator of voice function, vocal efficiency, and the nature and severity of voice disorders. Although the aim was to quantify either positive (i.e., PTP decrease) or negative (i.e., PTP increase) effects of external oscillation on PTP, it was hypothesized that external oscillation would result in a reduction in average PTP values. The results of the study indicate that application of an external oscillatory device results in significantly lower PTP. These findings have important clinical implications for PTP signal acquisition and the potential use of external oscillation as a therapeutic tool to improve voice function.