• The Journal of Internal Korean Medicine
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• v.44 no.2
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• pp.158-166
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• 2023

Background: Adductor spasmodic dysphonia (ASD) is caused by the involuntary contraction of laryngeal muscles due to dystonia localized to the larynx. In the case of ASD, conventional treatment is mainly performed with a botulinum toxin injection. However, the botulinum toxin injection has a short-lasting effect and requires repeated injections. Alternatives are needed due to concerns over adverse effects, such as general weakness and airway aspiration caused by the botulinum toxin injection. Case report: A 46-year-old female patient with ASD complained of voice tremor and hoarseness. The combined Korean medical treatments-Ukgan-san-gami, Jakyakgamcho-tang, acupuncture, and transcutaneous electrical nerve stimulation (TENS)-were administered on the first day the patient was hospitalized. The Voice Handicap Index (VHI) was evaluated during the treatment. The VHI taken on the second day totaled 92 points. On the ninth day, 81 points were recorded. Total score gradually improved, and on the 16th day, 62 points were recorded. Combined Korean medical treatment lasted 19 days. Conclusion: The present case report suggests that a combined Korean medical treatment approach with Ukgan-san-gami, Jakyakgamcho-tang, acupuncture, and TENS might be effective for symptoms such as voice tremors and hoarseness. Combined Korean medical treatment can be a therapeutic option for patients with ASD.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.30 no.1
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• pp.12-14
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• 2019

Functional dysphonia (FD) is a disease entity which includes various voice disorders in the absence of structural or neurologic laryngeal pathology. Muscle tension dysphonia (MTD), psychogenic dysphonia are representative FD with completely different pathogenesis. Therefore there is no standard treatment modality for FD, the first step of treatment of FD is differentiating patient's voice symptoms from other organic voice disorders and other functional voice problems. MTD is a functional voice disorder caused by hyperfunction of intrinsic and extrinsic laryngeal musculature. Symptoms include increased vocal effort, roughness, fatigue and odynophonia. First line for MTD is indirect or direct voice therapy. Unfortunately, many patients with MTD improve with voice therapy alone. For these patients, various modalities tried; lidocaine application, surgical excision of the false vocal folds, and botulinum toxin injection, etc. Botulinum toxin injections are widely used in the field of otolaryngology, especially for spasmodic dysphonia. However, its use in FD or MTD has only been described in few case reports. The aim of this lecture is to evaluate the feasibility of botulinum toxin injection for FD, especially MTD.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.10 no.1
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• pp.43-49
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• 1999

Objectives : The purpose of this study was to systematically analyze and compare e acoustic sound structure of vocal major student's singing voice. Materials and Methods : The nineteen vocal major students were the subject group and healthy nineteen females were the control group for this study. The subject group was taken a strobovideolaryngoscopy by the use of flexible nasopharyngoscopy. And acoustic analysis was taken between two groups. Additionally the inquiry on usual voice problems and management was performed by thirty-six vocal major students. Results : The subject group presents many functional voice disorder findings such as AP contraction(44%), phase difference(36%) tremor(25%), posterior gap(17%), hyperadduction of vestibular fold(6%), and anterior gap(3%) on strobovideolaryngoscopy. And the vocal major students did reveal an enhanced number of high frequency harmonic partials when singing compared to the control group in the narrow band spectrum study. But there was no significant difference in jitter, shimmer and noise to harmonic ratio in both groups. Almost all vocal major students present a lot of voice problems in singing such as loss of high note(17%), loss of quiet voice(17%), effortful and tired voice(36%) etc on inquiry. And they always effort to prevent vocal dysfunction by the use of various type of method such as voice rest(28%), hydration(28%), gargling with salt(11%) etc. Conclusions : The vocal major students always take care of maintaining a good voice condition, but a lot of vocal major students revealed abnormal strobovideolaryngoscopic findings and they are absent in the conception of systemic and scientific voice management. Therefore, the young singers need a good voice training and voice therapy Program under the good ralationship of laryngologist and voice training teacher.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.25 no.2
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• pp.82-85
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• 2014

Functional dysphonia is a specific voice disorder refers to dysphonia without abnormal anatomical vocal fold findings at larynx. The proportions of this disorder are estimated up to 40% of dysphonia patients at ENT clinics. In this article, we will discuss about other functional dysphonia and neurological dysphonia except for muslce tension dysphonia and spasmodic dysphonia. For details, will describe about phonatory charateristics and treatment options about paradoxical vocal fold motion disorder, mutational dysphonia, essential vocal tremor, conversion dysphonia, and vocal tremor related with parkinson's disease.

• Phonetics and Speech Sciences
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• v.1 no.1
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• pp.93-98
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• 2009

The aim of this study was to investigate voice characteristics of adductive spasmodic dysphonia(ADSD) by measuring electroglottal and acoustic examination at the sentence level. The clinical records of 86 ADSD female patients (age group of $20{\sim}50$ years) and the control records of 86 normal females (age group of $20{\sim}40$ years) were recorded by speech studio(Laryngograph Ltd., UK). An independent t-test was used to compare ADSD and normal group. Results were as follows. (1) Fundamental frequency($F_0$) was significantly decreased in ADSD compared with normal group. (2) Irregularity of frequency and closed quotient(CQ) was significantly increased in ADSD compared with normal group. (3) Voiceless duration increased and voiced duration was significantly decreased in ADSD compared with normal group. (4) Fricative duration was increased in ADSD compared with normal group but it wasn't significant. In conclusion, strained, tight and choked voice shows an increase of CQ, tremor voice shows an increase of irregularity of frequency and less feminine voice shows decrease of $F_0$. Increase of voiceless duration and fricative duration and decrease of voiced duration related with diminution speech intelligibility.

• Journal of Korean Neurosurgical Society
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• v.29 no.11
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• pp.1415-1420
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• 2000

Essential tremor(ET) is the most common movement disorder however there has been little agreement in the neurologic literature regarding diagnostic criteria for ET. Familial ET is an autosomal dominant disorder presenting as an isolated postural tremor. The main feature of ET is postural tremor of the arms with later involvement of the head, voice, or legs. In previous studies, it was reported that ET susceptibility was inherited in an autosomal dominant inheritance. As with previous results, it would suggest that ET might be associated with defect of mitochondrial or nuclear DNA. Recent studies are focusing molecular genetic detection of movement disorders, such as essential tremor and restless legs syndrome. Parkinson's disease(PD) is a neurodegenerative disease involving mainly the loss of dopaminergic neurons in substantia nigra by several factors. The cause of dopaminergic cell death is unknown. Recently, it has been suggested that Parkinson's disease many result from mitochondrial dysfunction. The authors have analysed mitochondrial DNA(mtDNA) from the blood cell of PD and ET patients via long and accurate polymerase chain reaction(LA PCR). Blood samples were collected from 9 PD and 9 ET patients. Total DNA was extracted twice with phenol followed by chloroform : isoamylalcohol. For the analysis of mtDNA, LA PCR was performed by mitochondrial specific primers. With LA PCR, 1/3 16s rRNA~1/3 ATPase 6/8 and COI~3/4 ND5 regions were observed in different patterns. But, in the COI~1/3 ATPase 6/8 region, the data of PCR were observed in same pattern. This study supports the data that ET and PD are genentic disorders with deficiency of mitochondrial DNA multicomplexes.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.8 no.1
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• pp.12-17
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• 1997

Measuring phonatory stability using MDVP(Multi-dimensional voice program, Kay Elemetrics Corp., NJ, USA) are becoming popular in many Korean clinics and laboratories, yet questions about standardization and reference values have remained. The purpose of present study was to examine the effects of frequency and intensity variation on the results of acoustic analysis related to phonatory stability. Twenty young adults(ten females and ten males) were asked to sustain vowel /a/ for more than 3 seconds under 9 different pitch and loudness conditions. Using MDVP, nine voice samples were analyzed, and jitter percent, fundamental frequency variation, shimmer percent, peak amplitude variation, noise to harmonic ratio, amplitude tremor intensity index, and degree of subharmonics were compared. The results showed that intensity changes can significantly affect various phonatory stability measures, and the lowest perturbation values can be obtained from slightly louder(10dB) phonatory condition than comfortable level phonation.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.14 no.7
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• pp.3218-3222
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• 2013

Pansori is our traditional vocal sound, originality and excellence in the art of conversation, gesture general became a globally recognized world intangible heritage. Especially, Pansori as shrews and humorous representation of audience participation with a high degree of artistic value and enjoy the arts throughout all layers to be responsible for the social integration of functions is evaluated. Therefore, in this paper, Pansori five yard target speech signal analysis techniques applied to analyze the Pansori acoustic features of a representation of a society and era correlation extraction studies were performed. Pansori on the five yard spectrogram, pitch, stability and strength analysis for this experiment. Pansori through experimental results Comical story while keeping the audience focused and interested to better reflect the characteristics of energy for the wave of voice and vocal cord tremor change the width of a large, stable and voice with a loud voice, that expresses were analyzed.

• Proceedings of the KSLP Conference
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• 2002.04a
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• pp.75-82
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• 2002

Botulinum toxin-A, a neurotoxin derived from Clostridia Botulinum, has been injected into the laryngeal muscle(s) for the treatment of the spasmodic dysphonia at the Voice Clinic, Yonsei Institute of Logopedics and phoniatrics since December 1995. We analyzed 355 patients with spasmodic dysphonia, using Botox register review. In the 355 patients, female is 86.8%. male is 13.2%. 305 patients (85.9%) had adductor type of spasmodic dysphonia and 35 patients (9.9%) were vocal tremor type and 15 patients were abduction and mixed type. Botulinum toxin type-A (Botox) injection using EMG was most frequently conducted as 587 cases, comparing with flexible nasopharyngoscopy gudied injection (68cases) and tele- laryn-goscopy guided injection (31cases). In the respect of frequency of Botox injection, 137 patients(38.6%) were injected one time but 1 patient was injected 17times. The mean dose of Botox is 6.2U. Clinically, initial dose of Botulinum toxin-A was high dose (7-8U) but current dose is small dose (3U). And the mean duration of Botox injection is 6.4 month. In conclusion, to optimize effect of the treatment for spasmodic dysphonia, Botulinum toxin-A injection is combined with voice therapy.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.21 no.1
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• pp.22-26
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• 2010

Neuromuscular Disorders Affecting the Larynx are steadily important topics at laryngology. Physiology of larynx is controlled by the frame structure and neuromuscular dynamics to acting on the specialized soft tissue, Therefore, for a proper understanding of the larynx, it is needed the voice and swallowing, a series of prayers on the regulation of neurologic function and the correlation between systemic neuromuscular disease and laryngeal symptoms and clinical knowledge, We described that clinical findings and treatments of the 3 neurological diseases causing dysphonia well (Parkinson's disease, laryngeal tremor, spasmodic dysphonia) and vocal impairments for stoke patients.