NORMAL PHYSIOLOGY, PATHOPHYSIOLOGY AND TREATMENT OF VOICE DISORDERS

研究检查：（a）正常的神经生理控制 在呼吸、吞咽和言语中的喉功能;（B） 发声障碍中喉功能的病理生理学;以及（c） 开发和评估新的嗓音治疗方法 紊乱 a）高碳酸血症对安静时喉肌激活的影响 在6名正常志愿者中研究了呼吸， 内收肌、张肌和喉外展肌的激活水平。在 另一项对正常人的研究发现， 同侧内收肌和张肌之间的发声 喉之间的距离大于喉两侧相同肌肉之间的距离。等 喉的每一侧上的喉肌之间的协调可以 提供相似的长度、张力和内收特征， 左右声带的解剖学不对称 B）在症状复发的患者中使用双极针EMG电极 喉返神经切除后， 在甲杓肌之间的激活百分比被发现， 手术和非手术侧。此外， 在这些患者中， 呼吸和语言表明，神经再支配和高张力的 甲杓状软骨可能与症状复发有关， 痉挛性发音困难 c）完成的三项研究表明，单侧肉毒杆菌 毒素注射对特定类型的患者有益： 复发性喉返肌痉挛性发音困难 声带震颤主要发生在呼气时; 以及那些在说话时声带不断过度内收的人。 那些只有痉挛性运动，没有持续过度内收的人， 单侧注射肉毒杆菌毒素获益最少

The research examines: (a) the neurophysiological control of normal laryngeal functioning in respiration, swallow, and speech; (b) the pathophysiology of laryngeal function in voice disorders; and (c) the development and evaluation of new treatment approaches for voice disorders. a) The effects of hypercapnia on laryngeal muscle activation during quiet respiration was studied in 6 normal volunteers and found to increase activation levels in adductor, tensor and abductor laryngeal muscles. In another study in normals, higher cross correlations were found during phonation between adductor and tensor muscles on the same side of the larynx than between the same muscle on opposite sides of the larynx. Such coordination between laryngeal muscles on each side of the larynx may provide similar length, tension and adduction characteristics regardless of probable anatomical asymmetry between the right and left vocals folds. b) Using bipolar needle EMG electrodes in patients with symptom recurrence following recurrent laryngeal nerve resection, no significant difference in percent activation were found between the thyroarytenoid muscles on the surgical and nonsurgical sides. Also, the percent activation levels in both thyroarytenoid were greater than normal in these patients during respiration and speech suggesting that reinnervation and hypertonicity of the thyroarytenoids might be associated with symptom recurrence in spasmodic dysphonia. c) Three studies were completed demonstrating that unilateral botulinum toxin injections were beneficial in particular types of patients: those with spasmodic dysphonia symptom recurrence following recurrent laryngeal nerve resection; those with vocal fold tremor primarily during exhalation; and, those with constant overadduction on the vocal folds during speech. Those with only spasmodic movements and no constant over-adduction were least benefitted by unilateral injections of botulinum toxin.