Background and Objectives : Glottal area waveform(GAW) shows the plot of glottal area versus time through the 1 cycle. This study is designed to see how it can be applied to laryngeal patients. Material and Methods : A GAW analysis was peformed on 11 patients before and after surgery and 22 persons without laryngeal problems were recruited for control. Acoustic and aerodynamic analysis with VHI(voice handicap index) evaluation were performed. Results. Significant changes in baseline offset, gross closing rate and VHI were observed postoperatively. Other parameters were changed but insignificant. Conclusion : GAW maybe used to evaluate patient with voice problems.

Background and Objectives : Vowels are characterized on the basis of formant patterns. The first formant(F1) is determined by high-low placement of the tongue, and the second formant (F2) by front-back placement of the tongue. The fundamental frequency(F0) of a soprano often exceed the normal frequency of the first formant. And the vocal intensity is boosted when F0 is high and a harmonic coincides with a formant. This is called a formant tuning. Experienced singers thus learned how to tune their formants over a resonable range by lowering the tongue to maximize their vocal intensity. So, the current study aimed to identify the formant tuning in one experienced soprano by comparing the first formants of vowel [i] in three different voice production : speech, ascending scale, and vocalize. Materials and Method : All voices recordings of vowel [i] in speech, ascending scale (from F4 note to A4 note), and vocalize(:Ridente la calam") were made with digital audio tape-corder in a sound treated room. And the captured data were analyzed by the long term average(LTA) power spectrum using the FFT algorithm of the Computerized Speech Lab(CSL, Kay elementrics, Model, 4300B). Results : Although the first formant of vowel [i] in speech was 238Hz, those of ascending scale [i] were 377Hz, 405Hz, 453Hz respectively in F4(349z), G4(392Hz), A4(440Hz) note, and 722Hz, 820Hz, 918Hz respectively in F5 (698Hz), G5(784Hz), A5(880Hz) note. In vocalize, first formants of [i] were 380Hz, 398Hz, 453Hz respectively in F4, G4, A4 note, and 720Hz, 821Hz, 890Hz respectively in F5, G5, A5 note. Conclusion : These results showed that the first formant of ascending scale and vocalize sustained higher frequency than fundamental frequency in high pitch. This finding implicates that the formant tuning of vowel [i] in ascending scale was also noted in vocalize.

Background and Objectives : To determine the changes of reflux symptoms and laryngoscopic findings of patients with laryngopharyngeal reflux (LPR) on the duration of proton pump inhibitor medication. Materials and Methods : From Feb 2003 to Nov 2004, 58 patients who were diagnosed with LPR by 24-hour double-probe pH monitoring were enrolled. All patients were treated with proton pump inhibitor and followed up for 8 weeks at least. The response of symptoms and laryngoscopic findings of patients were assessed with reflux symptom index (RSI) and reflux finding score (RFS) before treatment and 2, 4, 8, 12, 16, 20 weeks after treatment. Results : The symptoms of patients with LPR were improved significantly at 2, 4, 8 weeks of treatment. The laryngoscopic findings of patients with LPR were improved significantly at 4 and 12 weeks of treatment. There was no correlation between improvement of reflux symptoms and laryngoscopic findings. Conclusions : The laryngoscopic findings of LPR patients were improved more slowly than reflux symptoms. Based on our results, anti-reflux therapy might be continued at least for 3 months until the improvement of laryngoscopic findings.

Background and Objectives : While considerable progress has been made in enhancing the quality of laryngoscopy and image processing, the evaluation of laryngeal erythema is still based on the clinician's judgement. The purpose of this study is to quantitatively measure the degree of erythema and to examine the relationship with clinical grading. Materials and Methods : Color images of larynx from 100 subjects were captured from video-documented examinations of laryngoscopy. The amount of erythema within the digitized larynx image was quantified using software developed and was compared with a grading system (0 to 3 scale) based on visual inspection by 4 experienced clinicians. The results were compared by deriving Kappa, Kendall and Spearman statistic. Results : There was high intra-observer(R=0.402-0.755) and inter-observer correlation (R=0.789). Among parameters, the red composite value had most remarkable agreement with clinical grading(R=0.827). Conclusion : The result suggest that the computer based analysis of laryngeal erythema can provide quantiative data on degree of erythema and the basis for further development of an expert system.

Background and Objectives : Voice disorders can cause problems in patients with benign vocal cord lesions emotionally, physically, economically and functionally. Neither subjective nor objective voice examinations can evaluate such factors adequately. The Voice Handicap Index (VHI) subjectively evaluates voice disorders in terms of physical, functional, emotional factors and measures the patient's perception of the impact of voice disorder. The purpose of this study is to evaluate the usefulness of VHI in the patients with benign vocal cord lesions. Materials and Method : The authors evaluated 37 patients who experienced laryngeal microsurgery for benign vocal cord lesions from september 2003 to August 2004. The VHI was used to measure the postoperative changes of the patient's perception and acoustic analysis and aerodynamic tests were also done. Statistical analysis was done using paired t-test and Pearson's correlation. Results : The VHI scores showed statistically significant reductions postoperatively. In acoustic analysis, jitter and shimmer had statistically significant reductions after surgery but noise-to-harmonics ratio did not. A statistically significant change in the average MFR and MPT perioperatively was found. The relationship between VHI and acoustic, aerodynamic analysis attained statistical significance. Conclusion : The VHI is a useful assessment tool to monitor the patient's self-perception of voice change after the surgery of benign vocal cord lesions. The VHI measurement, when combined with acoustic and aerodynamic analyses, will be helpful in comparing functional outcomes after voice surgery.

Background and Objectives : The most important two factors of the voice production are the respiratory function which is the power source of voice and the glottic closure that transform the air flow into sound signals. The purpose of this study was to investigate the differences between trained singers and untrained controls under varying intensity at a constant vocal pitch by simulataneous using the airway interruption method and electroglottography(EGG). Materials and Methods : Under two different intensity condition at a constant vocal pitch(/G/), 20(Male 10, Female 10) trained singers were studied. Mean flow rate(MFR), subglottic pressure(Psub) and intensity were measured with aerodynamic test using the Phonatory function analyzer. Closed quotients(CQ), jitter and shimmer were also investigated by electroglottography using Lx speech studio. These data were compared with that of normal controls. Results : MFR and Psub were increased on high intensity condition in all subject groups but there was no statistically significance. Statistically significant increasing of CQ. were observed in male trained singers on high intensity condition (untrained male : 51.31${\pm}$3.70%, trained male :55.52${\pm}$6.07%, p=.039). Shimmer percent, one of the phonatory stability parameters, was also decreased statistically in all subject groups(p<.001). Conclusion : The trained singers' phonation was more efficient than untrained singers. The result means that the trained singers can increase the loudness with little changing of mean flow rate, subglottic pressure but more increasing of glottic closed quotients.

Differential diagnosis of articulation and resonance problems in the cleft lip and palate speech is required for evaluating various factors contribute to speech problems such as VPI, dental occlusion, palatal fistulae, learning. However, validity of speech stimuli is current issue to evaluate accurately each problem in cleft speech. This study was conducted to investigate speech stimuli using in the clinical setting and review the literatures and articles published 1990 to 2005 for helping develop standardized speech samples. The results were recommendation to evaluate properly velopharyngeal function when conducting a diagnostic evaluation as follows : 1) In identification hypernasality, the speech stimuli should be included low pressure consonants to eliminate effects of nasal emission, compensatory articulation. 2) Speech stimuli should be consist of visual, front sounds to eliminate compensatory articulation and to stimulate easily. 3) Regarding early diagnosis and treatment, speech stimuli need to develop for infants and preschooler. 4) Stimulus length on nasalance scores should be at least 6 syllables. 5) In phonetic context on nasalance scores, /i/ vowel should be take into consideration excluding paragraph. 6) Connected speech stimuli should be developed for evaluating intelligibility and VP function.

Background and Objectives : Children with cleft palate children may be imparied in articulation and resonance. This study examined the phonological process usage of 3-, 4- and 5- year old children with cleft palate. Materials and Method : Twenty seven children with cleft palat participated 3-, 4- and 5-year old children with cleft palate. The authors performed speech evaluation using picture consonants test for children with cleft palate. Percentage of consonants correct(PCC), mean value of each phoneme depends on articulation site and manner were evaluated. Results : In place of articulation, ommission of velar consonants were the most frequent. In manner of articulation, ommission of nasal consonants were the most frequent. Backing, glottal stop, was the most prominent phonological process children with cleft palate. Conclusion : These results may indicate that articulation disorder with cleft palate. and other articulation disorders differences should be considered in the interpretation of speech evaluations.

It is known that Korean stop consonants in syllable-initial position are of three types : lax, aspirated and forced (or unaspirated). In syllable-final position, however, these three different types are merged to a single type with the same place of articulation, although the original three-way distinction is preserved in Korean orthographic (Hangul) system. Thus the syllable-final stops are phonetically realized as voiceless "applosives" which are characterized by the absence of oral release. The aim of the present study is to investigate the laryngeal adjustments for these syllable-final stops in various phonological conditions by using fiberscope, and, is to further investigate electromyographically the laryngeal adjustments for Korean stops both in the syllable-initial and final positions in various phonological conditions. The results can be summarized as follows : 1. In the case of syllable-initial stops, the glottal widths in each three types of the Korean stops during the articulatory closure are clearly different. And the pattern of thyroarytenoid(VOC) activity appeared to characterize the three different types of Korean stops. 2. The basic laryngeal feature of the Korean syllable-final applosives is characterized by a small degree of glottal opening which begins at or slightly after the oral closure. 3. In the case, syllable-final stop followed by the copula "ita", the syllable- final stop is pronounced as the stop consonant at the initial position of the following syllable containing the vowel[i], the underlying features of three-way distinction for the stops in the Korean orthographic(Hangul) system being manifested at the laryngeal adjustment. 4. In the case of the final applosives followed by the initial stops and fricatives, the laryngeal feature of the final applosives appears to be assimilated by that of the following consonant irrespective of the difference in the place of articulation, as far as the glottal abduction/adduction is concerned. It is clearly demonstrated in the case of syllable-initial stop that thyoarytenoid(VOC) activity is suppressed for the production of the stop consonants in question, the degree of which is slightest for the forced type and most marked for the aspirated type, while it is moderate for the lax type.

The treatment of sulcus vocalis and vocal bowing has been commonly used Thyroplasty Type surgery or injection within vocal folds such as Teflon, silicone, collagen. However, and treatment has not been acquired satisfactory treatment effect. This study was conducted to demonstrate voice therapy effect using singer's vocal technique and respiratory training. 4 patients (1 male, 3 females) with sulcus vocalis or bowing, with or without scar were selected for this study and we compared with acoustic, aerodynamic measures and stroboscopy observation before and after voice therapy. The results showed that 1) case 1 (48yr, male) with sulcus vocalis decreased F0 (Fundamental Frequency), increase CQ(Close Quotient) and high degree of satisfaction but not improved voice quality after voice therapy. 2) case 2(19yrs, femal) with mild sulcus vocalis improved as normal voice quality after voice therapy. 3) case 3(38yrs, female) with functional bowing showed abnormalvocal contact before therapy whereas CQ was increased after voice therapy. 4) case 4(27yrs, female) with vocal atrophy and vocal bowing changed normal range of Fo and increased CQ after voice therapy. Even though contact area of both vocal folds was increased and lowered F0 after voice therapy, current outcomes revealed that normal voice quality was not regained. These results might signify that it was difficult that vocal folds couldn't be recovery of symmetry and viscoelastic property of mucosal wave through voice therapy. However, it was difficult for this study to maintain voice therapy so that evaluate effect of voice therapy for long-term. Further study will be needed to long-term follow-up for voice therapy with these patients.

Although primary neuroendocrine carcinomas(NEC) are uncommon tumors of the larynx, they represent the most common nonepidermoid malignancy of this organ. Whereas typical carcinoid tumors and small-cell carcinomas occur very rarely in the larynx, the majority of laryngeal NEC belong to a broad intermediate group between these two extremes of NEC. Through many case studies, a major protion of clinicopathologic characteristics of laryngeal NEC have been revealed; however, the gistogenesis of laryngeal NEC is still unknown. The only well-documented normal neuroendocrine structures of the larynx are paraganglions, but the incidence of laryngeal paragangliomas are much lower than that of NEC. Here, we report on three cases of NEC affecting the larynx and the results of searching for neuroendocriene cells in non-neoplastic larynx tissue.

Vagus nerve palsy caused by herpes virus infection is rare. Here, the author presents a 65-year-old woman with acute onset of right side otalgia and sore throat, followed by delayed vocal fold paralysis on the same side. Vesicles were also found on the posterior wall of ear canal but the tympanic membrane was not involved. Laryngoscopy revealed multiple ulcerative lesions on the pharyngeal and laryngeal mucosa exclusively on the right side. One month later, she noticed dyshonia which turned out right vocal fold paralysis. Skull base to upper chest CT did not reveal local lesion. Three months after finishing the acyclovir, her symptoms were almost gone and vocal fold movement has almost completely improved. Vagus nerve involvement of herpes infection should be considered as a differential diagnosis for patients with herpes zoster oticus with sore throat.

The pyriform sinus fistula can cause a recurrent abscess in the neck and the current treatment of choice involves complete excision of the sinus tract. But, because of excisional difficult, chemical cautery has been intermittently used as a successful substitute. Recently we experienced a case of pyriform sinus fistula of 9 year-old female who was successfully treated with chemocauterization with trichloroacetic acid(TCA) and ligation of the internal opening of the fistula tract on suspension laryngoscopy. So we report this rate case with review of literatures.