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Purpose The purpose of this study was to obtain a more comprehensive understanding of the pathophysiology and impact on daily voice use of nonphonotraumatic vocal hyperfunction (NPVH). Method An ambulatory voice monitor collected 1 week of data from 36 patients with NPVH and 36 vocally healthy matched controls. A subset of 11 patients with NPVH were monitored after voice therapy. Daily voice use measures included neck-skin acceleration magnitude, fundamental frequency ( f o ), cepstral peak prominence (CPP), and the difference between the first and second harmonic magnitudes (H1–H2). Additional comparisons included 118 patients with phonotraumatic vocal hyperfunction (PVH) and 89 additional vocally healthy controls. Results The NPVH group, compared to the matched control group, exhibited increased f o (Cohen's d = 0.6), reduced CPP ( d = −0.9), and less positive H1–H2 skewness ( d = −1.1). Classifiers used CPP mean and H1–H2 mode to maximally differentiate the NPVH and matched control groups (area under the receiver operating characteristic curve of 0.78). Classifiers performed well on unseen data: the logit decreased in patients with NPVH after therapy; ≥ 85% of the control and PVH groups were identified as “normal” or “not NPVH,” respectively. Conclusions The NPVH group's daily voice use is less periodic (CPP), is higher pitched ( f o ), and has less abrupt vocal fold closure (H1–H2 skew) compared to the matched control group. The combination of CPP mean and H1–H2 mode appears to reflect a pathophysiological continuum in NPVH patients of inefficient phonation with minimal potential for phonotrauma. Further validation of the classification model is needed to better understand potential clinical uses. Supplemental Material https://doi.org/10.23641/asha.14390771

The acoustic measure, relative fundamental frequency (RFF), has been proposed as an objective metric for assessing vocal hyperfunction; however, its underlying physiological mechanisms have not yet been fully characterized. This study aimed to characterize the relationship between RFF and vocal fold kinematics. Simultaneous acoustic and high-speed videoendoscopic (HSV) recordings were collected as younger and older speakers repeated the utterances /ifi/ and /iti/. RFF values at voicing offsets and onsets surrounding the obstruents were estimated from acoustic recordings, whereas glottal angles, durations of voicing offset and onset, and a kinematic estimate of laryngeal stiffness (KS) were obtained from HSV images. No differences were found between younger and older speakers for any measure. RFF did not differ between the two obstruents at voicing offset; however, fricatives necessitated larger glottal angles and longer durations to devoice. RFF values were lower and glottal angles were greater for stops relative to fricatives at voicing onset. KS values were greater in stops relative to fricatives. The less adducted vocal folds with greater KS and lower RFF at voicing onset for stops relative to fricatives in this study were in accordance with prior speculations that decreased vocal fold contact area and increased laryngeal stiffness may decrease RFF.

Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls. Each week was represented by the DPI, standard deviation of the difference between the first and second harmonic amplitudes (H1–H2). Results Compared to pretreatment, the DPI significantly decreased in the patient group after surgery (Cohen's d effect size = −0.86) and voice therapy ( d = −1.06). The patient group DPI only normalized after voice therapy. Conclusions The DPI produced the expected pattern of improved ambulatory voice use across laryngeal surgery and postsurgical voice therapy in a group of patients with PVH. The results were interpreted as providing new objective information about the role of daily voice use in the etiology and pathophysiology of PVH. The DPI is viewed as an estimate of potential vocal fold trauma that relies on combining the long-term distributional characteristics of two parameters representing the magnitude of phonatory forces (neck-surface acceleration magnitude) and vocal fold closure dynamics (H1–H2). Further validation of the DPI is needed to better understand its potential clinical use.

Hyperfunctions are functions that are defined on a finite set and return all non-empty subsets of the considered set as their values. This paper deals with the classification of hyperfunctions on a two-element set. We consider the composition and the closure operator with the equality predicate branching (E-operator). E-closed sets of hyperfunctions are sets that are obtained using the operations of adding dummy variables, identifying variables, composition, and E-operator. It is shown that the considered classification leads to a finite set of closed classes. The paper presents all 78 E-closed classes of hyperfunctions, among which there are 28 pairs of dual classes and 22 self-dual classes. The inclusion diagram of the E-closed classes is constructed, and for each class, its generating system is obtained

Purpose This study examined vocal hyperfunction (VH) using voice onset time (VOT). We hypothesized that speakers with VH would produce shorter VOTs, indicating increased laryngeal tension, and more variable VOTs, indicating disordered vocal motor control. Method We enrolled 32 adult women with VH (aged 20–74 years) and 32 age- and sex-matched controls. All were speakers of American English. Participants produced vowel–consonant–vowel combinations that varied by vowel (ɑ/u) and plosive (p/b, t/d, k/g). VOT—measured at the release of the plosive to the initiation of voicing—was averaged over three repetitions of each vowel–consonant–vowel combination. The coefficient of variation (CoV), a measure of VOT variability, was also computed for each combination. Results The mean VOTs were not significantly different between the two groups; however, the CoVs were significantly greater in speakers with VH compared to controls. Voiceless CoV values were moderately correlated with clinical ratings of dysphonia ( r = .58) in speakers with VH. Conclusion Speakers with VH exhibited greater variability in phonemic voicing targets compared to vocally healthy speakers, supporting the hypothesis for disordered vocal motor control in VH. We suggest future work incorporate VOT measures when assessing auditory discrimination and auditory–motor integration deficits in VH.

Purpose: The aim of this study was to describe a simple, accessible, and reliable method using a smartphone for evaluating oblique muscle dysfunctions. Methods: The photograph rotation tool in the iPhone PHOTO app was used by 75 examiners to evaluate 22 photographs from only 9 patients, captured in infra- and supra-dextroversion, and infra- and supra-levoversion, as not all the patients were photographed in the 4 positions mentioned. Each patient received a score for the superior and inferior oblique muscle functions, ranging from -4 (hypofunction) to 4 (hyperfunction) or 0 (normal function), using preediting and postediting photographs. These values were compared with the scores previously given by trained personnel in strabismus screening. The difference in score between the two groups was expressed in natural (whole and non-negative) numbers. The mean and pattern deviation were then calculated. Results: The scores of most of the edited photos showed a lower mean than those of the unedited ones, except for a patient with left superior oblique hyperfunction. The patients with no oblique dysfunction and those with right superior oblique hyperfunction demonstrated (after editing the photograph) scores with greater similarity with their initial scores (p

Purpose. To develop a technology for dosed surgical treatment of vertical strabismus caused by hyperfunction of the inferior oblique muscle of varying severity, using the technique of anterior transposition of the inferior oblique muscle and to ev aluate its effectiveness. Material and methods. The study included 228 patients (228 eyes) with vertical strabismus caused by hyperfunction of the inferior oblique muscle. Depending on the method of surgical treatment, the patients were divided into two groups. Group 1 (core group) included 112 patients (112 eyes) who underwent surgical treatment using our modified dosing technique for the degree of anterior transposition of the inferior oblique muscle. Group 2 (control group) included 116 patients (116 eyes) who were treated according to the classical method of dosed recession with degrees from «+1» to «+3» and transposition of the inferior oblique muscle with a degree of «+4». In each group, two subgroups were distinguished: subgroup a (with hypertrophy in adduction less than 7° according to Girshberg) and subgroup b (with hypertropy in adduction more than 7°). The follow-up was 1 day, 1, 3, 6, 12, 24 months after sur gery. Results. At the end of the observation period in all patients of group 1 Bilshovsky’s test w as negative. In group 2, in cases of persisting hypertropia in the primary position of the eye, in subgroup 2A (6.4%) and subgroup 2B (10.1%), a positive Bilshovsky test on the side of the hypertropic eye was detected, which indicated a hypoeffect of surgical treatment. The frequency of binocular vision formation was higher in subgroup 1a (68%) than in subgroup 2a (42.5%). Similar results were obtained in subgroups b: the frequency of binocular vision formation at the end of the observation period in subgroup 1b was 59.7%, in subgroup 2b it was 46.4%. Conclusion. The developed modification of the surgical treatment of hyperfunction of the inferior oblique muscle depending on the magnitude of the angle of vertical deviation using the method of dosed anterior transposition of the inferior oblique muscle allows to achieve high anatomical and functional results at vertical angles of deviation in adduction over 7° in Girshberg, as well as in cases of small angles to 7° across Girshberg.

Purpose: Voice ambulatory biofeedback (VAB) has potential to improve carryover of therapeutic voice use into daily life. Previous work in vocally healthy participants demonstrated that motor learning inspired variations to VAB produced expected differences in acquisition and retention of modified daily voice use. This proof-of-concept study was designed to evaluate whether these VAB variations have the same desired effects on acquisition and retention in patients with phonotraumatic vocal hyperfunction (PVH). Method: Seventeen female patients with PVH wore an ambulatory voice monitor for 6 days: three baseline days, one biofeedback day, one short-term retention day, and one long-term retention day. Short- and long-term retention were 1- and 7-days postbiofeedback, respectively. Patients were block-randomized to receive one of three types of VAB: 100%, 25%, and Summary. Performance was measured in terms of adherence time below a subject-specific vocal intensity threshold. Results: All three types of VAB produced a biofeedback effect with 13 out of 17 patients displaying an increase in adherence time compared to baseline days. Additionally, multiple patients from each VAB group increased their adherence time during short- and/or long-term retention monitoring compared to baseline. Conclusions: These findings show that VAB can be associated with acquisition and retention of desired voice use in patients with PVH. Specifically, all three feedback types improved multiple patients' performance and retention for up to 1 week after biofeedback removal. Future work can investigate the impact of incorporating VAB into voice therapy.

Failure of rapamycin to extend lifespan in DNA repair mutant and telomerase-knockout mice, while extending lifespan in normal mice, indicates that neither DNA damage nor telomere shortening limits normal lifespan or causes normal aging.

Let [Formula: see text] be a minimal parabolic subgroup of a real reductive Lie group [Formula: see text] and [Formula: see text] a closed subgroup of [Formula: see text]. Then it is proved by Kobayashi and Oshima that the regular representation [Formula: see text] contains each irreducible representation of [Formula: see text] at most finitely many times if the number of [Formula: see text]-orbits on [Formula: see text] is finite. Moreover, they also proved that the multiplicities are uniformly bounded if the number of [Formula: see text]-orbits on [Formula: see text] is finite, where [Formula: see text] are complexifications of [Formula: see text], respectively, and [Formula: see text] is a Borel subgroup of [Formula: see text]. In this paper, we prove that the multiplicities of the representations of [Formula: see text] induced from a parabolic subgroup [Formula: see text] in the regular representation on [Formula: see text] are uniformly bounded if the number of [Formula: see text]-orbits on [Formula: see text] is finite. For the proof of this claim, we also show the uniform boundedness of the dimensions of the spaces of group invariant hyperfunctions using the theory of holonomic [Formula: see text]-modules.

This computational study aims to identify vocal tract adjustments that minimize the peak vocal fold contact pressure during phonation and thus should be targeted in voice therapy treating phonotraumatic vocal hyperfunction. The results showed that for a given subglottal pressure, the effect of vocal tract adjustments on the peak vocal fold contact pressure was generally small except when such adjustments caused noticeable changes in the glottal flow amplitude. In this study, this occurred mainly when the lip opening was reduced and at conditions of large initial glottal angles or high subglottal pressures, which decreased the peak contact pressure but also significantly reduced the output sound pressure level (SPL). On the other hand, increasing lip opening significantly increased sound radiation efficiency from the mouth and reduced the subglottal pressure required to produce a target SPL. Because of the large effect of the subglottal pressure on the peak contact pressure, increasing lip opening thus was able to significantly reduce the peak contact pressure in voice tasks targeting a specific SPL. In contrast, the effect of pharyngeal expansion alone had only a small effect on the peak contact pressure, whether controlling for the subglottal pressure or targeting a specific SPL.

Purpose The aim of this study was to use the Daily Phonotrauma Index (DPI) to quantify group-based changes in the daily voice use of patients with phonotraumatic vocal hyperfunction (PVH) after receiving voice therapy as the sole treatment. This is part of an ongoing effort to validate an updated theoretical framework for PVH. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and posttreatment data from 52 female patients with PVH. Normative weeklong data were also obtained from 52 matched controls. Each week was represented by the DPI, which is a combination of neck-surface acceleration magnitude skewness and the standard deviation of the difference between the first and second harmonic magnitudes. Results Compared to pretreatment, the DPI statistically decreased towards normal in the patient group after treatment (Cohen's d = −0.25). The posttreatment patient group's DPI was still significantly higher than the control group ( d = 0.68). Conclusions The DPI showed the pattern of improved ambulatory voice use in a group of patients with PVH following voice therapy that was predicted by the updated theoretical framework. Per the prediction, voice therapy was associated with a decreased potential for phonotrauma in daily voice use, but the posttreatment patient group data were still significantly different from the normative control group data. This posttreatment difference is interpreted as reflecting the impact on voice use of the persistence of phonotrauma-induced structural changes to the vocal folds. Further validation of the DPI is needed to better understand its potential clinical use.

The process of senescence (aging) is largely determined by the action of wild-type genes. For most organisms, this does not reflect any adaptive function of senescence, but rather evolutionary effects of declining selection against genes with deleterious effects later in life. To understand aging requires an account of how evolutionary mechanisms give rise to pathogenic gene action and late-life disease, that integrates evolutionary (ultimate) and mechanistic (proximate) causes into a single explanation. A well-supported evolutionary explanation by G.C. Williams argues that senescence can evolve due to pleiotropic effects of alleles with antagonistic effects on fitness and late-life health (antagonistic pleiotropy, AP). What has remained unclear is how gene action gives rise to late-life disease pathophysiology. One ultimate-proximate account is T.B.L. Kirkwood’s disposable soma theory. Based on the hypothesis that stochastic molecular damage causes senescence, this reasons that aging is coupled to reproductive fitness due to preferential investment of resources into reproduction, rather than somatic maintenance. An alternative and more recent ultimate-proximate theory argues that aging is largely caused by programmatic, developmental-type mechanisms. Here ideas about AP and programmatic aging are reviewed, particularly those of M.V. Blagosklonny (the hyperfunction theory) and J.P. de Magalhães (the developmental theory), and their capacity to make sense of diverse experimental findings is described.

We investigate the connection between the autonomic nervous system and the voice in patients with vocal hyperfunction and healthy-control groups. We present a methodology and preliminary results of two multi-modal measurement streams that capture this relationship. Subjects were instrumented for daily, ambulatory collection of their voice and wrist-based electrodermal activity. Measures of vocal function (e.g., fundamental frequency) were computed, as well as measures of autonomic function (e.g., skin conductance response). Spearman correlation coefficients were calculated to measure the relationship between vocal and autonomic function over sliding windows throughout each observation day. We found preliminary evidence that patients with a subtype of vocal hyperfunction (non-phonotraumatic vocal hyperfunction) exhibit a coupling between the autonomic nervous system and the vocal system. Understanding how the autonomic nervous system interacts with the voice may provide new insights into the etiology/pathophysiology of vocal hyperfunction and improve prevention, diagnosis and treatment of these disorders.

Glottal resistance plays an important role in airflow conservation, especially in the context of high vocal demands. However, it remains unclear if laryngeal strategies most effective in controlling airflow during phonation are consistent with clinical manifestations of vocal hyperfunction. This study used a previously validated three-dimensional computational model of the vocal folds coupled with a respiratory model to investigate which laryngeal strategies were the best predictors of lung volume termination (LVT) and how these strategies' effects were modulated by respiratory parameters. Results indicated that the initial glottal angle and vertical thickness of the vocal folds were the best predictors of LVT regardless of subglottal pressure, lung volume initiation, and breath group duration. The effect of vertical thickness on LVT increased with the subglottal pressure—highlighting the importance of monitoring loudness during voice therapy to avoid laryngeal compensation—and decreased with increasing vocal fold stiffness. A positive initial glottal angle required an increase in vertical thickness to complete a target utterance, especially when the respiratory system was taxed. Overall, findings support the hypothesis that laryngeal strategies consistent with hyperfunctional voice disorders are effective in increasing LVT, and that conservation of airflow and respiratory effort may represent underlying mechanisms in those disorders.

Relative fundamental frequency (RFF) is a promising assessment technique for vocal pathologies. Herein, we explore the underlying laryngeal factors dictating RFF behaviours during phonation offset. To gain physical insights, we analyze a simple impact oscillator model and follow that with a numerical study using the well-established body-cover model of the vocal folds (VFs). Study of the impact oscillator suggests that the observed decrease in fundamental frequency during offset is due, at least in part, to the increase in the neutral gap between the VFs during abduction and the concomitant decrease in collision forces. Moreover, the impact oscillator elucidates a correlation between sharper drops in RFF and increased stiffness of the VFs, supporting experimental RFF studies. The body-cover model study further emphasizes the correlation between the drops in RFF and collision forces. The numerical analysis also illustrates the sensitivity of RFF to abduction initiation time relative to the phase of the phonation cycle, and the abduction period length. In addition, the numerical simulations display the potential role of the cricothyroid muscle to mitigate the RFF reduction. Last, simplified models of phonotraumatic vocal hyperfunction are explored, demonstrating that the observed sharper drops in RFF are associated with increased pre-offset collision forces.

Background: The impact of estrogen deficiency and occlusion in the matrix metalloproteinases (MMPs) expression in dental tissues has not yet been elucidated. Objective: To evaluate the influence of estrogen deficiency and occlusal hypofunction and hyperfunction on the gene expression of MMP1, MMP8 and MMP13 in the odontogenic region of teeth in continuous growth, in the murine model. Material and methods: Rats (Wistar Hannover lineage) were divided into two groups according to the intervention received: Hypoestrogenism Group - ovariectomy surgery and Control Group - fictitious surgery. Occlusal hypofunction and hyperfunction conditions were also established in all animals (each animal presented both conditions). After euthanasia, the hemimandibles were removed to evaluate the gene expression through real time PCR. T-test was used to compare the mean differences between groups (P0.05). A statistically significant difference of the relative MMP13 expression between the occlusal hypofunction and hyperfunction tooth was observed (P=0.03). In the hypoestrogenism group, MMP13 was overexpressed in hypofunction tooth (P=0.045). Conclusion: Occlusal function affects MMP13 expression in the odontogenic region, in murine model. Antecedentes: El impacto de la deficiencia de estrógeno y oclusión dentaria sobre la expresión de metaloproteinasas de la matriz (MMPs) en los tejidos dentales aún no ha sido suficientemente estudiada. Objetivo: Evaluar la influencia de la deficiencia de estrógeno y función oclusal (hipo- e hiperfunción) sobre la expresión génica de MMP1, MMP8 y MMP13 en la región odontogénica de dientes con erupción continua, usando un modelo murino. Materiales y métodos: Ratas del linaje Wistar-Hannover fueron divididas en dos grupos de acuerdo a la intervención recibida: grupo con hipoestrogenismo - cirugía de ovariectomía, y grupo control - cirugía ficticia. Fueron creadas condiciones de hipo- e hiperfunción oclusal en los animales (cada animal presentó ambas condiciones). Una vez realizada la eutanasia, las hemimandíbulas fueron separadas para evaluar la expresión génica por medio de PCR en tiempo real. Se utilizó la prueba t para comparación entre los grupos (P=0,05). Resultados: No hubo diferencia estadísticamente significativa en la expresión genética relativa de MMP1, MMP8 y MMP13 entre el grupo con hipoestrogenismo y el grupo control (P>0,05). Se observó una diferencia estatísticamente significativa en la expresión de MMP13 entre los grupos con hipo- e hiperfunción oclusal (P=0,03). MMP13 fue sobre expresada en los dientes con hipofunción del grupo de animales con hipoestrogenismo (P=0,045). Conclusión: La función oclusal afecta la expresión de MMP13 en la región odontogénica, en modelo murino. Introdução: O impacto da deficiência de estrógeno e da oclusão na expressão das metaloproteinases da matriz (MMPs) nos tecidos dentários ainda não foi elucidado. Objetivo: Avaliar a influência da deficiência de estrógeno e da hipofunção e hiperfunção oclusal na expressão gênica de MMP1, MMP8 e MMP13 na região odontogênica de dentes em crescimento contínuo, no modelo murino. Material e métodos: Ratas (linhagem Wistar Hannover) foram divididas em dois grupos de acordo com a intervenção recebida: Grupo Hipoestrogenismo - cirurgia de ovariectomia e Grupo Controle - cirurgia fictícia. Condições de hipofunção e hiperfunção oclusal também foram estabelecidas em todos os animais (cada animal apresentava ambas as condições). Após a eutanásia, as hemimandíbulas foram retiradas para avaliação da expressão gênica por meio de PCR em tempo real. O teste t foi usado para comparar as diferenças médias entre os grupos (P0,05). Foi observada uma diferença estatisticamente significativa da expressão relativa de MMP13 entre a hipofunção oclusal e a hiperfunção dentária (P=0,03). No grupo de hipoestrogenismo, MMP13 foi superexpresso no dente com hipofunção (P=0,045). Conclusão: A função oclusal afeta a expressão de MMP13 na região odontogênica, em modelo murino.

OBJECTIVE: Cepstrum-based voice measures, such as smoothed cepstral peak prominence (CPPS), are influenced by voice sound pressure level (SPL) in vocally healthy adults. Since it is unclear if similar effects hold in voice disordered adults and how these interact with natural fundamental frequency (f(o)) changes, this study examines voice SPL and f(o) effects on CPPS in women with vocal hyperfunction and vocally healthy controls. STUDY DESIGN: Retrospective matched case-control study METHODS: Fifty-eight women with vocal hyperfunction were individually matched with 58 vocally healthy women for occupation and approximate age. The patient group comprised women exhibiting phonotraumatic vocal hyperfunction associated with vocal fold nodules (n=39) or polyps (n=5), and non-phonotraumatic vocal hyperfunction associated with primary muscle tension dysphonia (n=14). All participants sustained the vowel /a/ at soft, comfortable, and loud loudness conditions. Voice SPL, f(o), and CPPS (dB) were computed from acoustic voice recordings using Praat. The effects of loudness condition, measured voice SPL, and f(o) on CPPS were assessed with linear mixed models. Pairwise correlations among voice SPL, f(o), and CPPS were assessed using multiple regression analysis. RESULTS: Increasing voice SPL correlated significantly (p

Let u(x, y) be a generalized function which satisfies a holonomic system M of linear differential equations with polynomial coefficients. Suppose that u(x, y) is integrable with respect to x and let v(y) be its integral. We give asufficient condition for v(y) to satisfy the D - module theoretic integration module of M, which can be computed algorithmically. We present some examples related to oscillatory integrals and Cutkosky - type phase space integrals associated with Feynman diagrams, "New development of microlocal analysis and singular perturbation theory". October 3-7, 2016. edited by Naofumi Honda and Yasunori Okada. The papers presented in this volume of RIMS Kôkyûroku Bessatsu are in final form and refereed.

In the context of the development of modern strabismology debatable issues still remain, among which the most important and long-term is the choice of tactics for the treatment of primary hyperfunction of the inferior oblique muscle. This article presents a literature review of the most significant publications of national and foreign authors concerning this topic. Criteria of differential diagnostics of primary and secondary hyperfunction of the inferior oblique muscle are presented. The main pathophysiological mechanisms of its occurrence are identified: imbalance between the superior and inferior oblique muscles, horizontal muscle dystopia, as well as prolonged occlusion and prismatic correction. The epidemiology of primary hyperfunction of the inferior oblique muscle, which develops in patients under the age of 4 years in more than half of cases, is summarized. Congenital esotropia operated on toddlers is not a clear guarantee of success in the prevention of the development of the current pathology. Primary hyperfunction occurs equally in patients with accommodative and intermittent forms of esotropia, less often in cases of acquired esotropia. The analysis of different classifications of primary hyperfunction is provided. The indications for surgical treatment and the criteria for evaluation of its efficiency are considered. The mono- or bilaterality of hyper-elevation in adduction, its symmetry, the presence of a V pattern determine the tactics and methods of treatment, the choice of which depends on the degree of hypertropy in combination with horizontal deviation. Positive and negative aspects of the most frequently performed surgical interventions on the inferior oblique muscle; technical features of marginal myotomy, myoectomy, recession and anteriorization were evaluated.

Vestibular voice includes participation of larynx structures which are absent in physiological process. Vestibular phonation may be desired when vocal folds are damaged as in paralytic dysphonia, or undesired in marginal hyperfunction. Vestibular voice may result from psychogenic dysphonia – phononeurosis. The aim of the study is perceptive evaluation of vestibular voice, objective larynx visualization, acoustic and aerodynamic examination. The study included 40 patients: 20 with vestibular voice, 20 with euphonic voice. Voice quality has been evaluated using perceptual GRBAS scale. Endoscopic and stroboscopic larynx examination used Endo-STROB-EL-Xion GmbH with visual tract. High-Speed Digital Imaging (HSDI) and High Speed (HS) camera registered true vocal folds vibrations. Acoustic evaluation of voice with DiagnoScope Specjalista, DiagNova Technologies included analysis of F0, Jitter, Shimmer, NHR, nonharmonic components. MPT has been analyzed. In examined group, hoarseness (95%), roughness (75%) and voice strain (55%) have been recorded. Endoscopy revealed edema of vestibular folds with dilation of vessels covering glottis. Stroboscopy and HSDI confirmed coexistence of hyperfunctional (95%) or paralytic (5%) dysphonia. Acoustic assessment revealed increase in Jitter, Shimmer, NHR and decrease in F0 and MPT. The vestibular voice is observed most frequently in women with hyperfunctional dysphonia (phononeuroses) or in paralytic dysphonia. Visualization techniques confirm the coexistence of vestibular folds hypertrophy and edema with vibration disorders. In the perceptual assessment, vestibular voice was hoarse, rough and strained. Acoustic examination showed increase of Jitter, Shimmer, NHR, presence of nonharmonic components and decrease of F0 and MPT.

We present some examples of holonomic systems for Feynman integrals associated with Feynman diagrams by using integration algorithms for D-modules.

The patient with complete edentulous maxillary arch and partially edentulous mandibular arch poses certain complication in the form of syndrome which was described by Kelly in 1972. There is flabby tissue in the anterior maxilla and posterior occlusal plane slope-down. There is supraeruption of lower anterior teeth, fibrous growth of tuberosity area, resorption of bone in the posterior mandibular ridges, and loss of vertical dimension of occlusion. The treatment varies from patient to patient to develop this syndrome and also varies from condition of the remaining teeth. Best treatment option is to use dental implants, but conventional prostheses are used in complex cases. This clinical report presents the prosthetic rehabilitation of a patient exhibiting combination syndrome.

We derive necessary and sufficient criteria for the uniqueness and existence of solutions of the abstract Cauchy problem in locally convex Hausdorff spaces. Our approach is based on a suitable notion of an asymptotic Laplace transform and extends results of Langenbruch beyond the class of Fréchet spaces.

We study functions related to the classical Brjuno function, namely $k$-Brjuno functions and the Wilton function. Both appear in the study of boundary regularity properties of (quasi) modular forms and their integrals. We consider various possible versions of them, based on the $\alpha$-continued fraction developments. We study their BMO regularity properties and their behaviour near rational numbers of their finite truncations., Comment: 64 pages, comments welcome

Purpose Successful voice therapy requires the patient to learn new vocal behaviors, but little is currently known regarding how vocal motor skills are improved and retained. To quantitatively characterize the motor learning process in a clinically meaningful context, a virtual task was developed based on the Vocal Function Exercises. In the virtual task, subjects control a computational model of a ball floating on a column of airflow via modifications to mean airflow (L/s) and intensity (dB-C) to keep the ball within a target range representing a normative ratio (dB × s/L). Method One vocally healthy female and one female with nonphonotraumatic vocal hyperfunction practiced the task for 11 days and completed retention testing 1 and 6 months later. The mapping between the two execution variables (airflow and intensity) and one error measure (proximity to the normative ratio) was evaluated by quantifying distributional variability (tolerance cost and noise cost) and temporal variability (scaling index of detrended fluctuation analysis). Results Both subjects reduced their error over practice and retained their performance 6 months later. Tolerance cost and noise cost were positively correlated with decreases in error during early practice and late practice, respectively. After extended practice, temporal variability was modulated to align with the task's solution manifold. Conclusions These case studies illustrated, in a healthy control and a patient with nonphonotraumatic vocal hyperfunction, that the virtual floating ball task produces quantitative measures characterizing the learning process. Future work will further investigate the task's potential to enhance clinical assessment and treatments involving voice control. Supplemental Material https://doi.org/10.23641/asha.13322891

Purpose The purpose of this viewpoint article is to facilitate research on vocal hyperfunction (VH). VH is implicated in the most commonly occurring types of voice disorders, but there remains a pressing need to increase our understanding of the etiological and pathophysiological mechanisms associated with VH to improve the prevention, diagnosis, and treatment of VH-related disorders. Method A comprehensive theoretical framework for VH is proposed based on an integration of prevailing clinical views and research evidence. Results The fundamental structure of the current framework is based on a previous (simplified) version that was published over 30 years ago (Hillman et al., 1989). A central premise of the framework is that there are two primary manifestations of VH—phonotraumatic VH and nonphonotraumatic VH—and that multiple factors contribute and interact in different ways to cause and maintain these two types of VH. Key hypotheses are presented about the way different factors may contribute to phonotraumatic VH and nonphonotraumatic VH and how the associated disorders may respond to treatment. Conclusions This updated and expanded framework is meant to help guide future research, particularly the design of longitudinal studies, which can lead to a refinement in knowledge about the etiology and pathophysiology of VH-related disorders. Such new knowledge should lead to further refinements in the framework and serve as a basis for improving the prevention and evidence-based clinical management of VH.

Purpose The purpose of this study was to determine whether estimates of glottal aerodynamic measures based on neck-surface vibration are comparable to those previously obtained using oral airflow and air pressure signals (Espinoza et al., 2017) in terms of discriminating patients with phonotraumatic and nonphonotraumatic vocal hyperfunction (PVH and NPVH) from vocally healthy controls. Method Consecutive /pae/ syllables at comfortable and loud level were produced by 16 women with PVH (organic vocal fold lesions), 16 women with NPVH (primary muscle tension dysphonia), and 32 vocally healthy women who were each matched to a patient according to age and occupation. Subglottal impedance-based inverse filtering of the anterior neck-surface accelerometer (ACC) signal yielded estimates of peak-to-peak glottal airflow, open quotient, and maximum flow declination rate. Average subglottal pressure and microphone-based sound pressure level (SPL) were also estimated from the ACC signal using subject-specific linear regression models. The ACC-based measures of glottal aerodynamics were normalized for SPL and statistically compared between each patient and matched-control group. Results Patients with PVH and NPVH exhibited lower SPL-normalized glottal aerodynamics values than their respective control subjects ( p values ranging from < .01 to .07) with very large effect sizes (1.04–2.16), regardless of loudness condition or measurement method (i.e., ACC-based values maintained discriminatory power). Conclusions The results of this study demonstrate that ACC-based estimates of most glottal aerodynamic measures are comparable to those previously obtained from oral airflow and air pressure (Espinoza et al., 2017) in terms of differentiating between hyperfunctional (PVH and NPVH) and normal vocal function. ACC-based estimates of glottal aerodynamic measures may be used to assess vocal function during continuous speech and enables this assessment of daily voice use during ambulatory monitoring to provide better insight into the pathophysiological mechanisms associated with vocal hyperfunction.

BACKGROUND Although there are articles and studies that associate postural changes with changes in vocal quality, to the best of our knowledge, this was the first study investigating the association between balance disorders and voice. OBJECTIVE This study aimed to determine whether patients with balance disorders present any clinical, acoustic, or endoscopic vocal changes, and if the correction of balance impairments, such as through vestibular rehabilitation, lead to improvement in vocal quality. METHODS This was a prospective cohort study that analyzed vocal differences (clinical, videoendostroboscopic, audio-perceptual, and acoustic vocal parameters) in a sample of 43 patients with vestibular dysfunction at three different time points (pre-treatment, post-treatment, and 3 months' post-treatment) diagnosed by videonystagmography with changes in computerized dynamic posturography who were treated with vestibular rehabilitation. RESULTS In pre-treatment, all of the patients presented supraglottic hyperfunction during videoendoscopic examination and abnormal values in the audio-perceptual scale. After treatment for balance disorders, there was a statistically significant improvement in some parameters of the videoendoscopic and audio-perceptual measures. These improvements were detected immediately after treatment and remained present until at least three months after treatment. CONCLUSIONS The results suggested that the treatment for balance disorders results in changes in posture and consequently in voice quality.