Clinical and Phonetic Studes of Specific Voice Disorders (Ⅱ~Ⅳ)

This 3-year-period proposal contains a series of further researches involving the clinical and phonetic studies of three specific voice disorders. One of the disorders is abnormally tight speech due to shunt stenosis in near-total laryngectomy. Abnormal shunt speech may be due to stenosis of the speech shunt and granulation or fibrotic bands in the shunt. The previous NSC study (Clinical and Phonetic Studies of specific voice disorders–I) revealed that near-total laryngectomy patients with a normal, fluent shunt speech presented their subglottic pressures (SP) ranged between 30 to 79 mmH2O. SP in mildly stenotic speaking shunts ranged between 80 to 95 mmH2O, SP in moderately stenotic shunts ranged between 96 to 110 mmH2O, and a severely stenotic shunt had the SP above 111 mmH2O. This proposal includes 3 projects in a 3-year period. The first-year study(Aug. 2007 ~ July 2008) will evaluate the effectiveness of transoral laser and dilatation for a mild to moderate shunt stenosis (due to granulation or fibrotic band in the shunt lumen) in near-total laryngectomy patients. Pre- and post-operative voice assessments (GRBAS, patient self-rating, acoustic and aerodynamic analyses) will be performed. The pre- and post-op subglottic pressures during phonation will also be measured by using a microtip pressure sensor (Microtip Transducer Catheter, ups-2020), via the permanent tracheostoma.Pre-＆post-operative 3D imagings of the speech shunt will be carried out. The above parameters and the surgical outcome will be analyzed and evaluated. The second-year study (Aug. 2008 ~ July 2009) will focus on a new approach to laser myoneurectomy of thyroarytenoid muscles on the spasmodic dysphonia patients who had poorly responded to the traditional managements. The effectiveness of this surgical procedure will be evaluated based on analyses of the parameters of the preand post-operative vocal function studies and videolaryngostroboscopy. To evaluate the long-term outcome of this technique, a further 3-year follow up of these patients will be performed. The third-year study (Aug. 2009 ~ July 2010) will involve the development of transoral laser surgery for the false cord bulging in glottal incompetent patients who had undergone a strap muscle transposition laryngoplasty. The routine voice assessments and video laryngeal stroboscopy will be carried out. The preoperative data will be compared with those measured at 6 months or more after surgery and the efficacy of this surgical technique will be evaluated. To the best of our knowledge, the above three subjects in this proposal have not been previously reported in the literature. The native data of these three issues are still lacking.

Project ID:PC9706-0788
External Project ID:NSC96-2628-B182A-125-MY3