NORMAL PHYSIOLOGY, PATHOPHYSIOLOGY AND TREATMENT OF VOICE DISORDERS

研究考察：(A)正常人的神经生理控制 喉的呼吸、吞咽和说话功能；(B) 嗓音障碍的喉功能的病理生理学；及 嗓音治疗新方法的发展与评价 精神错乱。 A)安静时高碳酸血症对喉部肌肉活动的影响 对6名正常志愿者的呼吸进行了研究，发现呼吸增加 喉内收肌、张肌和外展肌的激活水平。在……里面 在正常人群中的另一项研究发现，在 同侧内收肌和张肌之间的发声 喉部比喉部两侧的同一块肌肉之间的距离更大。是这样的 喉两侧的喉肌之间的协调可以 提供相似的长度、张力和内收特性 可能是左、右声带折叠的解剖不对称。 B)在症状复发的患者中使用双极针状肌电电极 喉返神经切除后，差异无统计学意义 在甲状旁肌之间发现了激活的百分比 手术侧和非手术侧。此外，中的百分比激活级别 在这些患者中，两个甲状旁骨都比正常大 呼吸和言语提示神经再支配和高张力 甲状旁腺可能与临床症状复发有关。 痉挛性发音困难。 C)已完成三项研究，证明单侧肉毒杆菌 注射毒素对特定类型的患者是有益的：那些 喉部复发后再发痉挛性发音困难症状 神经切除；以呼气时声带震颤者为主； 以及那些在说话过程中声带持续过度内收的人。 那些只有痉挛运动和没有持续过度内收的人是 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.