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ZusammenfassungMit photoangiolytischen Lasern wie dem KTP (Kalium-Titanyl-Phosphat, 532 nm Wellenlänge) -Laser oder dem neuen „blauen“ Laser (445 nm Wellenlänge) können kleinste Gefäße innerhalb der Stimmlippen unter Schonung des darüberliegenden Epithels und der Lamina propria verödet werden. Dadurch kann jetzt noch besser der Forderung Rechnung getragen werden, bei der effektiven Behandlung von pathologischen Gewebeveränderungen, wie bspw. bei Papillomen, Ödemen, Polypen, Leukoplakien, Dysplasien und ektatischen Blutgefäßen, gleichzeitig die physiologische Schwingungsfähigkeit der Stimmlippe zu bewahren. Da das Laserlicht durch feinste Glasfasern in den Kehlkopf geleitet werden kann, sind schmerzfreie Eingriffe im Behandlungsstuhl mit indirekt transnasal eingeführten flexiblen Optiken (mit Arbeitskanal) wie auch Operationen in Vollnarkose während einer Mikrolaryngoskopie möglich. Ein neuer sog. „blauer“ Laser ermöglicht zusätzlich neben der Koagulation auch das Schneiden von Gewebe, dann meist in Mikrolaryngoskopie.

BACKGROUND: The purpose of the study was to assess glottal and supraglottal configurations during whispering in comparison to habitual phonation and to visually estimate to what extent force is exerted onto the vocal fold epithelium during whispering. Is whispering a good compromise between preservation of epithelium and permission to communicate orally, e. g. postoperatively? PATIENTS AND METHODS: We investigated on 100 patients with organic or non-organic voice disorders. Patients with vocal fold immobility and patients with organic lesions large enough to impede glottal closure were excluded. Videolaryngoscopy and stroboscopy was performed via flexible endoscopy. During fiberoscopy the patients were asked (i) to phonate and then whisper a series of vowels in various loudness levels and (ii) to count to 10 voiced and whispered in various loudness levels. The extent of vocal fold adduction and supraglottal configuration were assessed and whispering compared with voiced phonation. RESULTS: Interindividual differences in glottal and supraglottal configuration during whispering were seen. The two different and most frequently seen glottal area patterns were determined by the position of the vocal processes - either adducted or abducted. Adduction resulted in sole cartilaginous triangle formation or ’kissing processes’, abduction in ligamentous and cartilaginous triangle. Another surprising result was that with increasing loudness either a narrowing or widening of glottal and supraglottal structures was visible. CONCLUSIONS: There are different patterns of glottal and supraglottal configuration during whispering. Although the vocal folds can show partial or total contact over the membranous parts, the lack of additional vibration of the vocal folds suggests that epithelial forces are smaller than with additional vibratory shear stress. Thus, whispering may be considered and allowed for postoperative communication purposes, when patients follow instructions for low-effort whispering.

Introduction: In clinical routine we have notized a disagreement of ENT-specialists and phoniatricians in the division of the vocal folds in thirds. To show if there is consensus in this field by the german phoniatriciansthis study was done. Material and Methods: In two parts of a study, a pilot study and a follow up study, we sent twelve different images of the larynx to all german phoniatricians. In six of these images the physicians should set the marks of the ventral and dorsal limitation of the second third of the vocal folds. In six diffent images a mark should be related to the particular third of the vocal folds. The phoniatricians were asked to assess how certain they were in their valuation. They were asked either, how long they have been working as a physician and how long they have been specialized as a phoniatrician and as an ENT-surgeon. In the follow up study the phoniatricians were requested to first divide up the thirds in a way that the dorsal third corresponds to the cartilaginous part of the vocal folds (scheme 1) and second divide up the thirds in a way that all three thirds correspond to the ligamental part of the vocal folds. Discussion and Findings: In the pilot study, when no instructions for the division of the thirds were given, the data differed much more than in the follow up study, when the physicians were told to use scheme 1 and scheme 2. That was because some phoniatricians divided up just the ligamental part and others the ligamental plus the cartilaginous part of the vocal folds in thirds. The more the physicians could overlook the membrane-ous part of the vocal folds the more certain they were in their assessment. Conclusion: The assessment of the division of the vocal folds in thirds is more homogeneous when the phoniatricians were requested to divide up the thirds in a way that the dorsal third corresponds to the cartilaginous part of the vocal folds (scheme 1). Therefore we suggest that this way of division should be used further on.

Background: In this study we compared the perceived diameter of the vocal tract's oropharyngeal part with the diameter that was determined endoscopically. Methods: 28 singers (13 male, 15 female) were examined with transnasal fiberscopic pharyngoscopy while singing the vowels /a/, /i/ and /u/ in 4 different timbres (normal, opened, covered, dumpled) and 3 different pitches (chest/modal register, subjective comfortable pitch for singing, head/falsetto register). The tactile-kinesthetic and auditive rating of the singers, the auditive rating of a singing teacher and the visual-endoscopic analysis of three laryngologists were compared. Results: The tactile-kinesthetic and auditory self-perception of the singers was quite different from the auditive perception of a singing teacher and visual endoscopic findings of the laryngologists. The singers had the impression that the different singing timbres (normal, opened, covered, dumpled) influence oropharyngeal vocal tract space during singing. They judged the vowel itself and the pitch as having very little influence. Based on his auditory perception, the singing teacher also rated that the timbre plays an important role for the oropharyngeal vocal tract space but he found vowels to be the parameter with the greatest impact. Via visual endoscopic examination we found that, among the three parameters (vowel, timbre, pitch), the different vowels are most influential on the oropharyngeal vocal tract space. Analysis of video sequences revealed that pitch and timbre are less important. Conclusion: Subjective tactile-kinesthetic and auditory perception of the singers differs from auditory perception of the singing teacher as well as from endoscopic findings. The endoscopically determined oropharyngeal vocal tract space during singing the vowels /i/ or /u/ tends to be larger compared to the oropharyngeal vocal tract space while singing the vowel /a/.

Background Approximately 1 out of 1000 children is affected by severe or profound hearing impairment at birth. In the last years it has been shown that more than 50 % of inherited prelingual, sensorineural hearing impairment may be attributed to genetic defects. Most commonly, the GJB2 gene (chromosome 13q11) that encodes connexin 26 (Cx26) is affected. Cx26 is crucial for the formation of gap junctions which play an important role in the intercellular exchange of electrolytes. A variety of autosomal recessive GJB2 mutations associated with inherited hearing impairment has meanwhile been identified. The most common GJB2 mutation in Caucasian populations, 35delG accounts for the majority of cases and has a carrier frequency of more than 2.5 %. Other distinct mutations account for hearing impairment in other parts of the world. Material and methods We examined in 59 Caucasian and Ghanaian individuals whether DNA recovered from buccal smears was appropriate for genetic testing by polymerase-chain reaction (PCR) based DNA-sequencing. Results Buccal smears could be taken conveniently in all cases, even from small babies. In 53 out of 59 samples the material recovered from buccal smears could be subjected to PCR of the second exon of the GJB2 gene and subsequent DNA-sequencing. GJB2 mutations were identified in 34 patients. 13 Caucasian individuals exhibited the most common mutation 35delG. In addition, four cases of the rare W24X and each one heterozygous case of the V153I- and the L90P mutation were found. In two African individuals the 35insG mutation was detected. All other African patients had mutations exclusively identified in Ghana so far with the exception of R143W. R143W accounts for most cases of profound deafness in Ghana and has been identified in low frequencies in other ethnic groups as well. Conclusion Screening for GJB2 mutations in DNA recovered from buccal smears of individuals with inherited hearing impairment offers an easy, non-invasive method for early diagnosis and a basis of genetic counselling.

BACKGROUND: The purpose of the study was to analyze if perceptual voice quality ratings of the well-known RBH rating procedure (a 4-point scale of roughness, breathiness, and hoarseness) covary with acoustical voice parameters. METHODS: 120 voice samples from subjects with healthy and hoarse voices were rated on the RBH-index in a multicenter study with 31 raters. Multivariate regression tree analysis classified the perceptual ratings as "gold standard". Voice samples were acoustically analyzed with a feature extraction method. Feedforward-networks were trained to selected acoustical parameters having highest "relative importance" in the regression trees. Based on the best classifier, a computer program consisting of 50 simultaneous working networks was developed. RESULTS: Mean probabilities for correct classifications were found at 0.65-0.85, implying a significance level over chance (0.25). Classifications of the program matched in 40% with a priori values in the categories roughness combined with breathiness, and in 65% in at least one domain. CONCLUSIONS: The new method described here provides a psychoacoustically based "objective" classification of hoarse voices, which seems to enable future analysis of new parameters (like GNE), which may even improve the present results.

Airflow patterns of nasal cavities in a human nasal fossa model were examined in this study. Our 1:1 model of the whole nose (both nasal fossae were moulded) gives a good insight into all parts of the nasal cavities. Staining of flow paths visualised that the main stream of air flow passes through the inferior nasal duct in inspiration and expiration. All regions of the nasal fossa were reached by fluid movements and could be marked with staining solution. Under static conditions laminar flow without turbulent profiles was seen in all sections of the nasal cavities. This technique of detection of flow characteristics in the nasal cavities provides a good tool for further research on flow and deposition characteristics of aerosols.

The implications of bacterial colonization and distribution patterns in the nasopharynx and nasal cavities of children with adenoidal hypertrophy without clinical signs of acute infection are to be determined. We examined the spectrum and distribution of the facultative pathogenic bacterial flora in nasal cavities and nasopharynx of children with clinical apparent symptoms or signs of adenoid hypertrophy in an infection free interval. Compared with the nasal cavity we found an accumulation of pathogenic bacteria in the nasopharynx. A transnasal single swab from the nasopharynx showed to be the most effectively practical way to detect clinically relevant pathogenic bacteria. A thin flexible calcium-alginate swab was used in our experiments. Swabbing from the anterior nasal cavities proved to be a minor successful diagnostic method.