Sjögren's Syndrome (SS) is an autoimmune disease that causes extreme dryness, or sicca,of the eyes and mouth, as well as other potential drying of the throat and intestines. Speech, voice, and swallowing problems are common in individuals with SS. Therefore, this study examined the possible changes in acoustic characteristics of monophthongs (/i, æ, α, u, ʌ/) in eight females with SS following laryngeal hydration treatments. An ABAB experimental design was implemented. Treatment consisted of nebulized isotonic saline immediately following completion of audio-recordings. Using acoustic analysis software the duration, formant frequencies, and vowel space area (VSA) was calculated for the participant's vowel productions. Overall the mean duration of the participant's vowel productions increased slightly from baseline measurements through the last treatment phase. Minimal deviations were observed in first and second formant frequency values throughout the study. Only minor differences were found in the participant's VSA from baseline phase of data collection through the final treatment phase, with most of these differences due to a change in the first formant of the /æ/ vowel. Despite the need for future research, the findings of this study increase understanding into how SS impacts speech production.

Experiencing respiratory symptoms in conjunction with exercise is common in children and adolescents and can have a negative impact on daily life. The aim of the thesis was to estimate the prevalence of exercise-induced dyspnoea, exercise-induced bronchoconstriction (EIB) and exercise-induced laryngeal obstruction (E-ILO) in a general adolescent population, and to explore factors associated with EIB. Methods: All 12-13-year-old adolescents in the city of Uppsala (n=3,838) participated in a survey on exercise-induced dyspnoea. A subsample of adolescents who answered the survey, 103 randomly selected adolescents reporting exercise-induced dyspnoea and 47 random adolescents who did not report exercise-induced dyspnoea underwent standardised treadmill exercise tests for EIB and E-ILO. The exercise test for EIB was performed while breathing dry air; a positive test was defined as a decrease ≥10% in FEV1 from baseline. E-ILO was investigated using continuous laryngoscopy during exercise. Health related quality of life (HRQoL), and objectively measured daily physical activity were investigated in those with (n=49) and without (n=91) a positive EIB-test. Results: The prevalence of exercise-induced dyspnoea was 14%, and the estimated prevalence of EIB and E-ILO in the total population was 19.2% and of 5.7%, respectively, with no gender differences. In adolescents with exercise-induced dyspnoea 40% had EIB, 6% had E-ILO, and 5% had both conditions. An increased baseline level of fraction of nitric oxide in exhaled air (FeNO), female gender, and exercise-induced dyspnoea were associated with a positive EIB test. Female adolescents with EIB had lower HRQoL and lower baseline lung function compared to females without EIB. These differences were not observed in male adolescents. There was no difference in time spent in moderate- to vigorous daily physical activity between adolescents with and without EIB.

Background: Cough Reflex Testing (CRT) has been shown to be useful in the challenging task of identifying silent aspiration (aspiration without a cough response). With the emergence of the routine clinical use of CRT in the acute stroke population, the following clinical conundrum often arises: Does passing a previously failed CRT mean the risk of silent aspiration has resolved? The purpose of this study was to evaluate the association between change in laryngeal cough threshold sensitivity and change in PAS (Penetration Aspiration Scale) score within the acute stage post-stroke. Methods: This was a prospective longitudinal pilot study of 20 acute stroke patients utilizing a Cough Reflex Threshold Test (CRTT) at 0.4M, 0.6M and 0.8M citric acid concentrations and Fiberoptic Endoscopic Evaluation of Swallowing (FEES). A cough response threshold was obtained from the CRTT and a PAS (penetration aspiration scale) score from FEES. Inclusion criteria required a PAS score of 4 or above on preliminary FEES or impaired CRT threshold as defined by weak or failed cough test result at 0.8M citric acid concentration. Both test methods were repeated every four days for 20 days or until the participant no longer aspirated/penetrated and had a normal result on CRTT on two consecutive assessment sessions. Agreement between changes in the two tests was evaluated using the Cohen’s Kappa statistic. Results: Eighteen of the twenty participants in this study aspirated on initial assessment, ten of which were silent. One participant continued to aspirate at study completion. On initial assessment eleven participants had a C2 response threshold at 0.4M citric acid concentration and three participants failed to reach threshold at 0.8M citric acid concentration. At study completion, 18 participants had a C2 response threshold at 0.4M citric acid concentration and one participant failed to reach threshold at 0.8M citric acid concentration. During the study, sixty-six re-assessments took place; there were fifteen incidences of improved cough response threshold on re-assessment and thirty-one incidences of improved PAS score. There was no significant agreement between improved laryngeal cough reflex threshold and improved PAS score during the acute stage Kappa = 0.0598 (p <.0.574), 95% CI (- 0.1496- 0.2692). Conclusion: Significant limitations of this study included small data set and potential flooring effect of the CRT. Due to the limitations of this study, no conclusions can be made as to the appropriateness of reinstating oral intake based on passing a previously failed CRT.

The vocal folds are important for protection of the airway during swallowing, the regulation of breathing and for voice production. Unilateral vocal fold paralysis (UVP) is caused by damage to the recurrent laryngeal nerve (RLN). Although surgery is most often linked to onset of UVP, the cause remains unknown in 12-42% of those with this disorder [1, 2]. At the level of the aortic arch the RLN branches from the vagus nerve and courses around the arch to ascend back toward the larynx. I hypothesize that an aneurysm of the aorta or alternatively changes in aortic arch compliance could impose increased stress and strain on the RLN where it is adjacent to the aorta resulting in impaired nerve function. The purpose of this research is to develop a computational model based on the biomechanical properties of the left RLN. This model is important for formulating predictions of the typical ranges of stress and strain responses of RLN tissue to forces imposed by surrounding structures (aortic arch). These predictions may be important for future investigations using an animal model to determine the amount of stretch necessary to cause onset of UVP. The first aim of this work was to identify differences in the biomechanical properties in the RLN of piglets between its location within the neck and the portion of the left RLN within the thorax, including the aortic arch region. The distal right RLN segment showed higher maximum tangential modulus (MTM) than the left. With the left nerve the proximal segment (aortic arch region) exhibited higher values of MTM and the stiffness parameter β than the distal segment. This increased stiffness of the proximal region may be in response to the pulsatile forces near the region of the aortic arch. The second aim of this work was to identify difference in the biomechanical properties in adolescent and piglet RLN specimens, between age and between the proximal and distal segments. Additionally the collagen structure of the RLN was imaged with two-photon microscopy to compare the microstructure with the biomechanical response of the RLN tissue. The tangential modulus (TM) and full width half maximum of the collagen fiber distribution (FWHM) was larger in the proximal segments than the distal segments. The strain energy and stiffness parameter α were larger in the piglet than the adolescent pigs while the stiffness parameter β was larger in the adolescent pigs. The purpose of the third aim was to use the material constants from the second aim to create a parametric computational model of the left RLN and the aortic arch. Results indicated that the parameters with the greatest sensitivity to left RLN maximum principal stress and strain are the material properties of the aortic arch. The maximum value of strain found in the RLN region of interest was 16.1%, which may indicate that some combination of aortic arch and RLN properties can elicit damage in the RLN.

Purpose: The purpose of this study was to determine if respiratory and laryngeal function during spontaneous speech production were different for teachers with voice disorders as compared to teachers without voice problems. The basic research questions posed in this study, as assessed during spontaneous speaking were: 1) Do subjects with a voice disorder show differences in lung volume patterns relative to control subjects? 2) Do subjects with a voice disorder show differences in vocal fold approximation as measured by contact quotient and contact index relative to control subjects? 3) Are these between-group differences most pronounced for mock teaching tasks versus a conversational speaking task? 4) Do subjects with a voice disorder rely more on laryngeal versus respiratory-based strategies for increasing loudness level as compared to control subjects?Method: Nine teachers with and nine teachers without voice problems were included in this study. Respiratory function was measured with magnetometry, and laryngeal function was measured with electroglottography. Respiratory and laryngeal function were measured during three spontaneous speaking tasks: a simulated teaching task at a typical and increased loudness level, and a conversational speaking task. Two structured speaking tasks were included for comparison of electroglottography measures: a paragraph reading task and a sustained vowel.Results: Lung volume termination level in spontaneous speaking was significantly lower for the teachers with voice disorders relative to teachers without voice problems. Lung volume initiation level was lower for the teachers with versus without voice problems during teaching-related speaking tasks. Laryngeal function as assessed with electroglottography did not show between-group differences. Across tasks, the measure of contact index was lower (more negative) during the conversational speaking task as compared to the sustained vowel task, indicating greater contact phase asymmetry during vocal fold vibration.Conclusions: These findings suggest that teachers with a voice disorder use different speech breathing strategies than teachers without voice problems. Management of teachers with voice problems may need to incorporate respiratory training that alters lung volume levels during speaking. Future research is needed to determine whether altering such patterns results in improved voice parameters and self-perceived improvement in vocal symptoms.

R??sum?? : INTRODUCTION : Il a ??t?? d??montr?? que la ventilation assist??e nasale (AIn) provoque la fermeture laryng??e active chez les agneaux nouveau-n??s sans s??dation. Ceci pourrait limiter la ventilation alv??olaire, entrainer l???air insuffl?? dans l???appareil digestif et provoquer des cons??quences d??l??t??res graves. Le neuro-asservissement de la ventilation assist??e nasale (NAVAn) et la ventilation nasale par oscillations ?? haute fr??quence (VOHFn) sont des modes de ventilation attractifs. La NAVA semble ??tre plus physiologique que l???AIn, car elle est synchronis??e avec le contr??le neural. Cependant, la VOHF ne n??cessite pas de synchronisation et diminue les l??sions pulmonaires provoqu??es par la ventilation m??canique conventionnelle. Le but de mon projet est d?????tudier l???effet de la NAVAn et de la VOHFn sur la dynamique laryng??e chez les agneaux nouveau-n??s sans s??dation, en testant l???hypoth??se que, contrairement ?? l???AIn, la fermeture laryng??e active n???apparait pas durant la NAVAn et la VOHFn. M??THODES : deux groupes d???agneaux n??s ?? terme (NAVAn : 8 agneaux ; et VOHFn : 7 agneaux) ont ??t?? instrument??s chirurgicalement ?? 2 jours de vie, afin de recueillir l?????lectromyogramme des muscles constricteur et dilatateur laryng??s, du diaphragme, les pressions au masque, trach??ale, pression de CO[indice inf??rieur 2] en fin d???expiration (P[indice inf??rieur ET]CO[indice inf??rieur 2]) et des gaz sanguins art??riels. 48h suivant l???instrumentation, un enregistrement polysomnographique a ??t?? r??alis?? pour chaque groupe (AIn / VOHFn et AIn / NAVAn) dans un ordre randomis??. La pression inspiratoire (AIn & NAVAn) et la puissance des oscillations (VOHFn) ont ??t?? progressivement augment??es. R??SULTATS : Les r??sultats d??montrent que l???augmentation des niveaux de NAVAn et de la puissance de VOHFn n???entraine pas de fermeture laryng??e active, contrairement ?? l???AIn. De plus, la diminution du PaCO[indice inf??rieur 2] provoqu??e par l???hyperventilation en AIn pourrait contribuer ?? la fermeture laryng??e active. En VOHFn, la diminution progressive de la fr??quence des oscillations jusqu????? 4 Hz induit des apn??es centrales. En revanche, aucune fermeture laryng??e active n???a ??t?? observ??e ?? 4 Hz. CONCLUSION : La NAVAn et la VOHFn ne provoquent pas la fermeture laryng??e active chez l???agneau nouveau-n??, et pourraient constituer des nouvelles alternatives dans le traitement des pathologies respiratoires en p??riode n??onatale. //Abstract : INTRODUCTION : We have previously shown that nasal pressure support ventilation (nPSV) can lead to an active laryngeal closure in non-sedated newborn lambs. This, in turn, can limit lung ventilation and divert air into the digestive system, with potentially deleterious consequences. Nasal neurally adjusted ventilator assist (nNAVA) and nasal high frequency oscillatory ventilation (nHFOV) are new attractive non-invasive ventilation modalities in newborns. Neurally adjusted ventilator assist (NAVA) seems to be a more physiological ventilator mode than PSV: it is more synchronized with neural control. However, HFOV is associated with less lung injury and does not require synchronization. Thus, the aim of the present study was to assess the effects of nNAVA and nHFOV on laryngeal dynamics in non-sedated newborn lambs, testing the hypothesis that active laryngeal closure does not develop during both nHFOV and nNAVA. METHODS : Polysomnographic recordings were performed in two groups of non-sedated chronically instrumented lambs (nHFOV, 7 lambs) and (nNAVA, 8 lambs), which were ventilated with progressively increased levels of nPSV and nHFOV or nNAVA, in random order. States of alertness, diaphragm and glottal muscle electrical activity, mask and tracheal pressure, tracheal end tidal CO[subscript 2] (P[subscript ET]CO[subscript 2]) and blood gases were continuously recorded in each group. RESULTS: While active laryngeal closure appeared with increasing levels of nPSV, it was never observed at any nHFOV power or nNAVA levels in any lamb. In addition, a decrease in PaCO[subscript 2] was neither necessary nor sufficient for the development of active laryngeal closure. nHFOV at 4Hz dramatically inhibited central respiratory drive. However, no active laryngeal closure was observed at 4 Hz. CONCLUSION: nHFOV and nNAVA does not induce active laryngeal closure in inspiration in non-sedated newborn lambs, in contrast to nPSV. nNAVA and nHFOV could be an alternatives in the treatment of neonatal respiratory disorders.

No description available.

The present study aims to resolve previous disputes about whether or not non-palatalized consonants exhibit secondary velarization in Russian, and if so what this corresponds to articulatorily. Three questions are asked: 1) are Russian non-palatalized consonants velarized or not? If so, 2) what are the articulatory properties of velarization? and 3) how is the presence or absence of secondary velarization affected by adjacent vowels? To answer these questions, laryngeal and lingual ultrasound investigations were conducted on a range of non-palatalized consonants across different vowel contexts. The results of the study show that 1) Russian non-palatalized consonants are not pharyngealized in the sense of Esling (1996, 1999, 2005), 2) /l/ and /f/ are uvularized, 3) /s/ and /ʂ/ can feature either uvularization or velarization. The study also shows that secondary articulations of Russian non-palatalized consonants are inherent rather than dependent on vowel context. / Graduate / 0290 / natallia@uvic.ca

This study explored the physiological adjustments made by the speech mechanism when sustained maximum phonations and sentences differing in vocal loudness were produced by typically developing children and children with cerebral palsy (CP). Respiratory adjustments (lung volume initiation, termination and excursions), chest wall muscular amplitude adjustments (intercostal, obliques), vocal fold adjustments (speed quotient), fundamental frequency of selected vowel nuclei and area of mouth opening were calculated. A total of eight children (4 typically developing children, 4 children with CP) were studied. Results indicated that overall typically developing children adjusted lung volume initiation, lung volume excursion, intercostal and oblique muscle activity, speed quotient, fundamental frequency, and area of mouth opening to meet vocal loudness targets. In contrast, children with CP primarily adjusted intercostal and oblique muscle activity, speed quotient, and fundamental frequency to meet vocal loudness targets. / Speech-Language Pathology

Submitted by Dândara Bernado Siqueira (dada_bs@yahoo.com.br) on 2018-03-13T14:31:53Z No. of bitstreams: 1 Dandara_Tese final.pdf: 9857869 bytes, checksum: 40f75a2d5e16a50c2c64d0caf112e97b (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-13T19:01:24Z (GMT) No. of bitstreams: 1 siqueira_db_me_bot.pdf: 9857869 bytes, checksum: 40f75a2d5e16a50c2c64d0caf112e97b (MD5) / Made available in DSpace on 2018-03-13T19:01:24Z (GMT). No. of bitstreams: 1 siqueira_db_me_bot.pdf: 9857869 bytes, checksum: 40f75a2d5e16a50c2c64d0caf112e97b (MD5) Previous issue date: 2018-02-27 / Introdução: A disfonia afeta 10% da população infantil, com pico de incidência entre cinco e dez anos, especialmente os meninos. Após essa faixa etária, observa-se uma mudança no comportamento com predomínio no sexo feminino. Os nódulos vocais são as lesões mais frequentes, seguidas pelos cistos. Além dessas, as alterações estruturais mínimas são alterações congênitas da laringe que também provocam disfonia, como por exemplo: sulco vocal, microweb, ponte de mucosa e cisto epidérmico. Não há consenso na literatura entre os autores quanto às indicações de microcirurgia de laringe em crianças, exceto nos casos de dispnéia e/ou estridor. Objetivos: Descrever nossa experiência com microcirurgia de laringe na infância e propor um protocolo de conduta terapêutica para as lesões mais prevalentes. Material e métodos: Estudo do tipo transversal que incluiu crianças de quatro a 18 anos atendidas em um hospital universitário nos últimos cinco anos com indicação de microcirurgia de laringe após um período de tratamento fonoterápico regular. Os critérios de exclusão foram: crianças que não permitiram videolaringoscopia, que perderam seguimento ou que realizaram fonoterapia irregular ou inconstante. Os resultados do tratamento foram avaliados após seis meses da cirurgia e classificados didaticamente em três tipos: melhora total (sem sintomas vocais e videolaringoscopia normal), melhora parcial (com algum grau de sintomas vocais e/ou lesões remanescentes ao exame videolaringoscópico) ou sem melhora (persistência de sintomas vocais na mesma intensidade e/ou lesão ao exame videolaringoscópico). Resultados: Foram selecionadas 119 crianças no estudo, com predomínio no sexo masculino até os 12 anos e do sexo feminino após essa idade. Destes, 29 pacientes foram submetidos à microcirurgia (M-14; F-15) com as seguintes indicações: cistos epidérmicos (n-12), nódulos vocais (n-12), sulco vocal (n-3), ponte de mucosa bilateral (n-1) e microweb (n-1). Todas as crianças foram previamente submetidas à fonoterapia de forma regular e a indicação cirúrgica se deu após o insucesso da mesma. Das crianças com nódulos vocais, houve indicação de microcirurgia em 15,38% dos casos com desfecho favorável em 75,00% deles. Dentre as crianças com cisto vocal, todas apresentavam o tipo epidérmico e nos casos cirúrgicos foi utilizada a técnica de microflap lateral. O sucesso da cirurgia nesses pacientes foi de 83,34%. Os casos de sulco vocal e ponte de mucosa realizaram microcirurgia somente após a puberdade e em nenhum caso foi observado resultado completamente satisfatório. Um único caso de microweb teve indicação cirúrgica com melhora apenas parcial. Conclusão: Apresentamos as principais indicações e os resultados da microcirurgia de laringe adotadas em nosso serviço em crianças disfônicas. Os resultados mais favoráveis foram observados nos casos de cistos e nódulos vocais e a partir deles elaboramos um fluxograma de condutas terapêuticas, que resultou em um protocolo que poderá ser compartilhado por outros autores, a fim de se determinar o melhor tratamento para as disfonias da infância. / Introduction: Dysphonia affects 10% of children, with a peak incidence of five to ten years, especially in boys. After this age group, there is a change in behaviour with predominance in females. Vocal nodules are the most frequent lesions, followed by cysts. In addition, minimal structural alterations are congenital alterations of the larynx that also causes dysphonia, such as: vocal sulcus, microweb, mucosal bridge and epidermal cyst. There is no consensus in the literature among the authors regarding indications for laryngeal microsurgery in children. Propose: To describe our experience with childhood laryngeal microsurgery and propound a protocol of therapeutic management for the most prevalent lesions. Material and methods: A cross-sectional study including children aged four to 18 years who were attended at a hospital university in the last five years with indication of laryngeal microsurgery after a period of regular voice therapy. The exclusion criteria were: children who did not allow videolaringoscopy, who lost follow-up or who performed irregular or inconstant voice therapy. The results for the treatment were evaluated after six months of surgery and didactically classified into three types: total improvement (without vocal symptoms and normal videolaryngoscopy), partial improvement (with some degree of vocal symptoms and/or remaining lesions at the videolaryngoscopyexam) or no improvement (persistence of vocal symptoms in the same intensity and/or lesion to the videolaringocopy exam). Results: 119 children were selected inthe study, with predominance in males up to 12 years and females after that age. Of these, 29 patients underwent microsurgery (M-14; F15) due to: epidermal cysts (n-12), vocal nodules (n-12), vocal sulcus (n-3), bilateral mucosal bridge (n-1) and microweb (n-1). All children were previously submitted to regular voice therapy and the surgical indication was given after their failure. Of the children with vocal nodules, microsurgery was indicated in 15.38% of the cases with a favorable outcome in 75.00% of them. Of the children with vocal cyst, all of them presented with an epidermal cyst and in the surgical cases the lateral microflap technique was used. The success of the surgery in these patients was 83.34%. The cases of vocal sulcus and mucosal bridge performed microsurgery only after puberty and in no case was observed completely satisfactory result. A single case of microweb had surgical indication with only partial improvement. Conclusion: We presented the main indications and results of laryngeal microsurgery adopted in our service in dysphonic children. The most favorable results were observed in cases of cysts and vocal nodules, and from them we developed a flowchart of therapeutic conducts, wich resulted in a protocol that could be shared by other authors in order to determine the best treatment for childhood dysphonia.