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Introduction Coexistence of dysphagia with voice disorders is a topic rarely raised in the literature. Particular attention is paid to the aspect of dysfunction of laryngeal and pharyngeal muscles. Aim The aim of the study was to analyse cases of patients with dysphonia in relation to coexistence of swallowing disorder. Material and method The material of the study included 515 patients hospitalised due to dysphonia in 2018. Patients whose interview indicated swallowing difficulties were subjected to additional diagnosis for dysphagia (FEES, extended speech therapy test, SEMG). R esults: 11.8% of people requiring treatment for voice disorders reported coexistence of swallowing difficulties. Dysphagia was diagnosed in 9.3%. The percentage of respondents diagnosed with swallowing disorder differed depending on the type of underlying disease and was the highest in the group with neurological disorders. Analysis of the correlation between the severity of dysphagia (according to the assessed grade, DHI, EAT-10 results) and the severity of VHI showed a weak correlation between VHI and EAT-10 (p = 0.1), statistically significant correlations (p l 0,05) between the value of VHI and RSI in people with diagnosed neurological disease, between the value of VHI and DHI in people with hyperfunctional dysphonia and the value of VHI and BMI and EAT- 10 in people with chronic laryngitis. Moreover, statistically significant correlations were found between the severity of dysphagia and EAT-10 and DHI (p l 0.05). The speech therapy test indicated the co-existing problem of non-normative swallowing pattern. The electromyographic study showed the largest asymmetries in recording the average and maximum amplitude from masseters. C onclusions: Treatment of patients with voice disorders requires interdisciplinary care. A history of dysphagia in these patients should complement the medical history of voice disorders. The characteristics of swallowing disorders vary depending on the cause of the voice disorder and their co-occurrence affects on average 9.3% of patients. Coexistence of muscle tension dysphagia with voice disorder requires separate diagnostic protocol. Logopaedic procedure ought to be a key element in the interdisciplinary care of patients suffering from muscle tension dysphagia.

ntroduction: The publication describes the characteristics of the glottis in FDs objectified by OQ, measured with VSK and EGG. Aim: The aim of the study was to objectify glottal function in different types of FDs. The scope was to use open quotients gained from various mucosal wave imaging techniques for differential diagnosis of FDs. Material and Method: The study included 204 individuals. In the study, each patient underwent otolaryngological and phoniatric examination. LVS, EGG and VSK were conducted, their results were recorded and stored using an EndoSTROB-DX- -Xion GmbH (Berlin) device with DIVAS software. Results: All patients with FDs had abnormalities in LVS. A statistical analysis showed differences in LVS characteristics according to the type of FD. The mean value of OQVSK was 0.521 in the control group and 0.565 in the study group (P < 0.05). Significant differences were found between patients with hypofunctional – 0.584 and hyperfunctional dysphonia – 0.55. The QOQEGG mean value in patients with FDs was 0.581 and in the control group 0.549 (P < 0.01). There were statistically significant differences between groups of patients with hyper- and hypofunctional dysphonias. Medians amounted to 0.574 and 0.604, respectively. Authors observed different relations of OQ with the type of FD. They decided to introduce a new parameter, illustrating the proportion of QOQEGG/OQVSK. Conclusions: Videostrobokymographic and electroglottographic open quotients differentiate euphony from dysphony. The value of OQVSK and QOQEGG and their proportion varies depending on different types of functional dysphonias. The OQVSK and QOQEGG should be included in the diagnostic algorithm of voice.

Traditional voice evaluations, including imaging techniques, auditory-perceptual ratings, and acoustic and aerodynamic analyses, fail to assess the global handicap that a patient experiences as a result of a voice disorder. The Voice Handicap Index (VHI) is currently one of the most widely used and psychometrically robust instruments for measuring voice disability. The aim of the study is to translate and validate a Polish version of the VHI. The original English-language version of VHI-30 was translated into Polish. We enrolled 188 subjects—123 patients (91 women and 32 men) with voice disorders and 65 controls (53 women and 12 men) without voice disorders. Results obtained by the patients were significantly higher than those obtained by the controls on the Emotional subscale (U = 519.0; p < 0.001), Functional (U = 829.0; p < 0.001), Physical (U = 331.0; p < 0.001), and the global score (U = 390.0; p < 0.001). There were statistically significant negative correlations between maximum phonation time and global score (rho = −0.31; p < 0.01) as well as all three subscales. Shimmer and Smoothed Amplitude Perturbation Quotient were correlated positively with the global score (rho = 0.22; p < 0.05; rho = 0.25; p < 0.01, respectively) and with all three subscales. There were also statistically significant correlations between VHI scores and auditory perceptual evaluation. In the patient group, there was excellent internal consistency (α = 0.97) and strong test–retest reliability (intraclass correlation = 0.94). The cut-off value equal to 17 points was estimated. The Polish VHI showed excellent internal consistency, good test–retest reproducibility, and clinical validity. It is a useful tool for evaluating the voice disability perceived by a patient.

Introduction: Voice disorders in children especially in the school-age period comprise a major and challenging medical, social and educational issue. There is a lack of epidemiological data regarding children’s voice in Poland which limits the development of preventive and medical pediatric procedures in our country. Objective: The aim of study was to determine the prevalence of voice disorders in children starting school education in Mazovia. Material and method: The study was a retrospective analysis of survey data from parents of children attending the first grade of primary school. The survey consists of five questions describing the voice. A statistical analysis of 7891 questionnaires was carried out. Results: Analysis of the survey showed a prevalence of dysphonia in 12.8% children aged 7 starting primary school. In this study, voice disorders were observed more often in boys (14.6%) than girls (10.8%). The authors presented the correlation between voice disorders and the expression of emotions. Conclusions: Studies have shown that the percentage of children with voice disorders is significant in our country. The survey regarding voice in school children in Mazovia shows preliminary results of voice disorders in the pediatric population in Poland.

Introduction: Hyperfunctional dysfunction is one of the most common functional dysphonia, cha-racterized by voice insufficiency with excessive tightening of the muscles inside and outside the larynx during phonation. To make the treatment process more effective, new ways of rehabilitation are constantly being sought and developed. The aim of this work is to evaluate the effectiveness of laryngotaping - an innovative method of taping around the larynx and neck muscles. Material and method: 10 patients with diagnosed hyperfunctional dysphonia participated in the study. Using the kinesiotaping principles, for 7 days, the suprahyoid and infrahyoid muscles, ster-nocleidomastoid muscles as well as the thyroid cartilage were taped. Before and after the therapy, the patients completed the VHI voice self-evaluation questionnaire. The evaluation of the larynx according to the L. Mathienson scale was also assessed palpation. Results: Analyzing the results of the VHI questionnaire and evaluation of palpation evaluation of the larynx before and after the therapy, statistically significant differences were observed. The results on average decreased by half, which is the desired effect of therapy. Discussion: The results confirm the positive impact of kinesiotaping around the larynx. However, more research is needed on a larger group of patients to fully evaluate the therapeutic effect. Conclusions: 1. Laryngotaping is an effective way to normalize muscle tone, and thus to improve the quality of the voice. 2. The presented studies require continuation, however, positive reception of the introduced therapy by patients encourages further research on a larger group of patients.

Introduction Electroglottography (EGG) is the most commonly used method of indirect visual examination of vocal fold vibration. Aim The study was conducted with an aim of assessing EGG quasi open quotient (QOQEGG) in different functional dysphonias to develop a differential diagnosis. The second aim was to check the influence of articulation on QOQEGG values. Material and methods There were 20 people without voice problems, 20 patients with hypofunctional dysphonia and 20 patients with hyperfunctional dysphonia included in the study. Electroglottography was recorded during comfortable sustained phonation of [a], [e], [i], [o], [u]. Results There were no statistically significant differences in QOQEGG observed during phonation of different vowels in the control group and patients with hyperfunctional dysphonia. In patients with hypofunctional dysphonia, significantly higher values of QOQEGG were observed during [a] and [e]. Both in the control and in studied groups vowel [i] was vocalized significantly quieter. Conclusions To conclude, EGG can be useful in differential diagnosis of functional dysphonia. QOQEGG is a parameter differentiating hypofunctional dysphonia from hyperfunctional dysphonia. Dissimilarities in articulation of different vowels in patients with various types of dysphonia influence values of QOQEGG. EGG study protocol in cases of functional dysphonia should include a comparison of [a], [e], [i] vowels.

Introduction Laryngeal paralysis deteriorates all laryngeal functions. Therefore the therapeutic process must include restoration of respiratory, defensive and vocal function. Selection of a proper rehabilitation path plays a key role. Appropriate research protocol that includes objective methods of voice evaluation is an important element of monitoring the return of vocal efficiency. Voice efficiency is important for the patient particularly due to psychological and social reasons. Aim The aim of the study was the assessment of short-term functional voice therapy (FVT) in patients with unilateral paralysis of the larynx with the usage of objective parameters describing the glottis and voice quality. Material and Method During the last 10 years 355 patients with laryngeal paralysis were hospitalized in the Audiology and Phoniatrics Clinic due to dysphonia. All patients undergone 5-day FVT. From 2015 we unified diagnostic protocol measuring parameters obtained from videostrobokymography (VSK), electroglottography (EGG), perceptual and acoustic voice analysis before and after 5 day hospitalization. Results After FVT patients improved voice quality and glottal compensation. The majority of patients achieved a statistically significant improvement in the VSK, EGG, MDVP and perceptual analysis. Group of patients with unsatisfactory voice improvement after therapy required a prolonged rehabilitation or has been qualified for laryngeal microsurgery. Potential factors that could have cause insufficient effects of FVT were analysed. Conclusions The complexity of voice rehabilitation is crucial for the success of therapy. Interdisciplinary therapeutic team plays a significant role during voice rehabilitation in patients with vocal fold paralysis.

Purpose The objective was to evaluate the long-term voice outcomes in pa-tients with unilateral vocal fold paralysis treated with injection laryngoplasty using either cal-cium hydroxylapatite (CaHA) or hyaluronic acid (HA). Methods A single-centre retrospective study was performed. There were 75 patients with dysphonia due to unilateral vocal fold paralysis: injected with CaHA or injected with HA. We analysed Voice Handicap Index-30 (VHI), videostroboscopic images, auditory-perceptual (GRBAS), and acoustic measures (MDVP) in 6, 12, and 24 months after augmentation. Results The mean change in VHI 24 months after augmentation was 29.14 in the CaHA group, and 22.88 in the HA group. There was an improvement of glottal gap 6, 12, and 24 months after augmentation in both groups. The GRBAS parameters were similar in both groups throughout the whole period. The MDVP pa-rameters decreased 6 and 12 months after augmentation and were similar in both groups. There were 4 patients augmented with CaHA (12.5%) who needed reintervention within 2 years of surgery and another 4 (9.3%) augmented with HA. Conclusion This study demonstrates that there are no long-term differences in voice outcomes or number of reaugmentations for injection laryn-goplasty with CaHA compared to HA.

RSI and RFS questionnaires are a basic and common method used for initial diagnosis of laryngopharyngeal reflux (LPR). However, they only measure symptoms which may or may not be concurrent with LPR. The severity of these symptoms is assessed either by the patients themselves (with the use of the Reflux Symptoms Index -RSI) or by the doctor specialising in the field (with the use of the Reflux Finding Score - RFS). Therefore, the findings of the questionnaire may to a large extent depend on the study population - its demographic and cultural characteristics; the extent to which the medical terms used in the questionnaires are understood; and on the linguistic aspects and translation choices. As for the Polish language versions of these questionnaires, there is no reliable analysis of their consistency and if they reach the assumed goal. The studies we have conducted on a group of 84 patients show that we encounter at least one of the above-mentioned problems. Therefore, to make the questionnaires reliable and useful for diagnosis, it is necessary to conduct a formal validation of their translation and to conduct studies on reference groups.

Introduction: Upper respiratory tract infections are common childhood diseases. Children are more susceptible to middle ear infections because their Eustachian tube is short, straight and wide. As a consequence of these inflammatory changes while impaired patency of the Eustachian tube often arises conductive hearing. Objective: The aim of this study was to Assessment effectiveness of treatment Eustachian tube dysfunction using inhaler AMSA. Material and Methods: The study group comprised 30 patients. Same was in the control group. All patients reported conductive hearing loss. Test group was treated as an inhaler AMSA. The control group was treated pharmacologically. Patients were examined with the use of pure-tone audiometry, and impedance at baseline, after one week and four weeks. Results: Statistical analysis showed improvement in the studied parameters in patients treated with inhaler AMSA in a much shorter time than patients treated with pharmacotherapy.

Introduction: Distorted processing of auditory information has a negative impact on the child’s cognitive development. There are only a few studies conducted by Polish researchers determining the normative values of psychoacoustic tests in auditory processing disorders. They are inconsistent due to different methodologies and different research protocols. Objective: The aim of the work was to determine the reference values of selected psychoacoustic tests for the population of Polish children between 7 and 12 years of age. Material and method: The study group consisted of 213 healthy children from 7 to 12 years of age. The condition for including the child in the study was an intellectual norm, proper sound sensitivity, proper development of children’s voice and speech. All children underwent two auditory temporal processing tests. The diagnostic procedure used a standardized Frequency Pattern Test (FPT) and Duration Pattern Test (DPT). The tests were carried out in accordance with the authors' recommendations, using the original versions available on the CD for 60 dB SL intensity, simultaneously for the right and left ear. Results: The reference values for FPT and DPT tests were determined at various age ranges in children aged 7-12. It has been shown that auditory functions change with age and development of the child. Reference values including age, language, cultural and educational differences were prepared. Conclusions: The development of reference values for individual tests for the Polish children population is a key element in the reliable diagnosis of auditory processing.

Objectives The aim of this study was to assess the usefulness of 24-h pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux (LPR) in children with voice disorders. Methods The study was conducted on 68 children aged 3–18 years old. In all cases, pH monitoring was successful; no child removed the probe from the nasal cavity or reported discomfort or other complaints. The following definitions were adopted: LPR in the upright position if Ryan Score upright >9.41; LPR in the supine position if there was at least one supine episode below pH 5.0 (equal to a Ryan Score supine >2.91). Results In 43 children (63%), vocal fold edema was strongly related to recorded reflux episodes, especially in the upright position. In 18 children (26%), vocal nodules were observed, but their occurrence did not significantly affect the Ryan Score, either upright or supine. The selected potential LPR markers were significantly correlated to all the pH monitoring variables and individual elements on the Reflux Symptoms Index and the Reflux Finding Score questionnaire. Conclusion Our findings indicate that, together with vocal fold edema, laryngeal edema and posterior commissure mucosal hypertrophy are important determinants of paediatric LPR. In fact, if LPR is suspected in a child, 24-h pharyngeal pH monitoring appears to be a valuable and welltolerated diagnostic tool. Vocal fold edema observed in laryngeal endoscopy can be considered a probable sign of LPR. The Reflux Finding Score appears to be helpful in diagnosing LPR in children, especially if a cut-off value of 4/5 is adopted.

The work assessed the clinical utility of open quotients measured during laryngovideostroboscopy and electroglottography. Values of the parameters were analyzed according to clinical diagnosis. An algorithm based on direct and indirect mucosal wave measurement is presented, which allows for differentiation of voice disorders. The method developed for the objectification of glottal functions in various voice pathologies is characterized by high sensitivity and specificity.

The proper course of speech development heavily influences the cognitive and personal development of children. It is a condition for achieving preschool and school successes – it facilitates socializing and expressing feelings and needs. Impairment of language and its development in children represents a major diagnostic and therapeutic challenge for physicians and therapists. Early diagnosis of coexisting deficits and starting the therapy influence the therapeutic success. One of the basic diagnostic tests for children suffering from specific language impairment (SLI) is audiometry, thus far referred to as a hearing test. Auditory processing is just as important as a proper hearing threshold. Therefore, diagnosis of central auditory disorder may be a valuable supplementation of diagnosis of language impairment. Early diagnosis and implementation of appropriate treatment may contribute to an effective language therapy.

UNLABELLED Sulcus vocalis is one of the most difficult to treat benign vocal fold pathologies. Ford distinguished three types of sulci: I- superficial, II- vergeture and III- true sulcus vocalis. The aim of the study was to assess the results of surgical treatment in patients with sulcus vocalis. Material of the study consisted of 24 patients with type II (16 subjects) and type III sulcus (8 subjects). METHODS Videostroboscopy, perceptual voice assessment and objective acoustic voice analysis were performed before surgery and at 8 months of follow-up. All patients underwent surgical treatment as well as pre- and postsurgical voice therapy. RESULTS Postsurgical stroboscopic examination showed statistically significant differences in symmetry and regularity of vibrations. Subjective perceptual voice assessment showed improvement in the grade of voice hoarseness, roughness, breathiness and strain. Objective voice analysis showed statistically significant difference only in jita parameter, in contrast to other examined parameters--although their values decreased after surgery, the change was not statistically significant. CONCLUSIONS Surgical treatment of sulcus should be considered in patients with severe voice problems; however, the end results are not always entirely satisfactory.

Specific Language Impairment (SLI) affects about 7-15 % of children of school age and according to the currently accepted diagnostic criteria, it is presumed that these children do not suffer from hearing impairment. The goal of this work was to assess anomalies of central auditory processes in a group of children diagnosed with specific language impairment. Material consisted of 200 children aged 7-10 years (100 children in the study group and 100 hundred in the control group). Selected psychoacoustic tests (Frequency Pattern Test - FPT, Duration Pattern Test - DPT, Dichotic Digit Test - DDT, Time Compressed Sentence Test - CST, Gap Detection Test - GDT) were performed in all children. Results were subject to statistical analysis. It was observed that mean results obtained in individual age groups in the study group are significantly lower than in the control group. Based on the conducted studies we may conclude that children with SLI suffer from disorders of some higher auditory functions, which substantiates the diagnosis of hearing disorders according to the AHSA (American Hearing and Speech Association) guidelines. Use of sound-based, not verbal tests, eliminates the probability that observed problems with perception involve only perception of speech, therefore do not signify central hearing disorders, but problems with understanding of speech. Lack of literature data on the significance of FPT, DPT, DDT, CST and GDT tests in children with specific language impairment precludes comparison of acquired results and makes them unique.

INTRODUCTION The diagnostic procedure of phonation is dominated by subjective assessment tools. It seems reasonable to seek methods of quantitative glottal cycle assessment. OBJECTIVE The aim of our study was the analysis of open quotients (OQ) of the glottis. METHODS One hundred and twenty-four people were included in the study. Methodology was based on tools available in everyday phoniatrics practice - laryngovideostroboscopy (LVS) and electroglottography (EGG). There were statistically significant differences between control and studied group. Vocal fold polyps, nodules and edema influence glottal function in a different manner, what can be illustrated by objective glottal function parameters. Establishing Videostroboscopic Open Quotient values from three parts of glottis and Electroglottographic Quasi Open Quotient (QOQ) value, can help in dividing patients with benign lesions of vocal folds according to the type of disease. RESULTS AND CONCLUSIONS Measurement of the open quotient from three parts of the glottis helps to differentially diagnose and localize glottal vocal fold lesions. Videostroboscopic Open Quotient and Electroglottographic QOQ values can be used to quantify the glottal cycle. Videostroboscopic Open Quotient, Electroglottographic QOQ and their ratio varies depending on the type of organic dysphonia.

Purpose This is a retrospective study to evaluate the results of surgical treatment of patients with pathological sulcus vocalis. Methods Thirty-six patients with pathological sulcus underwent surgery and in 33 cases were performed additional injection laryngoplasty. The pre- and postoperative evaluation of patients included the GRBAS scale, stroboscopic, and objective acoustic voice assessment. The Voice Handicap Index questionnaire (VHI-30) was also used and the scores were obtained from 33 patients. Results The stroboscopic evaluation showed significant improvement of amplitude, mucosal wave, and glottal closure after treatment (p

According to the severity, Reinke's edema (RE) of the vocal folds can be divided into three stages as classified by Yonekawa. We evaluated open and closed quotients of vocal folds vibratory cycles using Videostrobokymography (VSK) in a cohort of patients with RE. Parameters were measured from the anterior, medial and posterior third of the vocal folds. Mean values from RE group were OQ (0.44; 0.46; 0.52); CQ (0.56; 0.54; 0.48). Results from the whole glottis OQ and CQ in RE were: OQ = 0.48 and CQ = 0.52. Significant differences were found for OQ and CQ mean values as well as values measured from each third of the glottis between the control group and patients with RE. In the first Yonekawa group no statistically significant differences were found compared to the control group, but there were significant differences in the remaining two groups. The correlation between the stage of edema on the Yonekawa classification and the mean values of OQ and CQ was 70%.

BackgroundGood hearing is a fundamental skill that allows children to develop properly, both socially and intellectually. In contrast to defects in inner ear function, however, auditory processing disorders (APDs)-which can affect up to 2-3% of school-children-are not easily identified with basic screening programs and must be diagnosed using special tests. Although such psychoacoustic tests are available, the scores achieved depend highly on the social, cultural, and linguistic characteristics of the population, and norms must be established for each population separately. Reference values are still lacking for the Polish population, especially for children in school-age, so that practitioners must interpret test scores themselves, often intuitively or using potentially biased thresholds from other countries.Materials and methodsWe investigated a sample of 94 Polish schoolchildren with normal hearing, divided into four age groups: from 7 years-olds to 10 years-olds. All children had no speech or language development disorder, learning problem, or symptom of APD. Participants were volunteers who had previously taken part in a large screening study. The group consisted of 56 girls (60%) and 38 boys (40%) with an average age of 8.6 years (SD = 1.1). The test battery included the Duration Pattern Test (DPT), Frequency Pattern Test (FPT), Time-Compressed Speech Test (CST), and Dichotic Digit Test (DDT).ResultsThe scores on all tests increased consistently with age. The difference between each age-group for DPT, CST, and left- and right-ear DDT tests was significant (Kruskal-Wallis test, p-values = 0.002, 0.006, 0.005, 0.020, respectively), but the effect of age on the FPT test was not (p-value = 0.143). The analysis showed a clear and significant separation between a merged group of ages 7 and 8 and another of ages 9 and 10. We, therefore, propose, for each test, separate reference values for these two particular age-groups. Using thresholds based on a 10% quantile, we offer the following reference values for ages 7-8 and 9-10 respectively: DPT, 28.5% and 53.8%; FPT, 18.5% and 27.5%; CST, 68.6% and 77.2%; left-ear DDT, 34.3% and 52.5%; right-ear DDT, 56% and 72.5%.ConclusionThe scores on psychoacoustic tests to diagnose APD differ between cultures and linguistic backgrounds. Clinicians should, therefore, use norms that have been designed for the population most similar to their patients. Here, we report the use of a test battery designed for the Polish language that accounts for various aspects of APD when screening school children. Together with a full methodology of those tests, we provide norms that can be used as cut-offs in clinical diagnosis. Practitioners are invited to use them to obtain more accurate, evidence-based decisions.

Background: Voice disorders resulting from glottic insufficiency are a significant clinical problem in everyday phoniatric practice. One method of treatment is injection laryngoplasty. Our study aimed to assess the voice quality of patients treated with hyaluronic acid injection into the vocal fold. Material/Method: We studied 25 patients suffering from dysphonia, conducting laryngological and phoniatric examination, including videostroboscopy and acoustic voice analysis, before the operation and 1, 3, and 6 months later. Results: In all cases there was complete or almost complete glottic closure after the operation. One month after the procedure, videostroboscopic examination revealed reappearance of vocal fold vibration in 8 cases; after 3 months this had risen to 15 cases. Perceptual voice quality (as assessed by the GRBAS scale) in patients with glottic insufficiency was improved. The most significant improvement was obtained 1 month after surgery (p=0.0002), and within the next months further statistically significant improvements (p=0.000002) were noted. Multidimensional voice analysis showed statistically significant and rapid improvement in frequency parameters, especially vFo. Other parameters were also improved 3 and 6 months after surgery. Conclusions: Injection of hyaluronic acid into the vocal fold improves phonatory functions of the larynx and the quality of voice in patients with glottic insufficiency. It may be a safe and conservative method for treatment of voice disorders. Hyaluronic acid injection to the vocal fold is an easy, effective, and fast method for restoration of good voice quality. © Med Sci Monit.

Summary Objectives There is a necessity to include objective methods to the study protocol of voice. Such procedure will help not only in diagnosing and monitoring the course of treatment, but also in comparing the results of studies between research centers. Methods Vocal fold mucosal wave characteristics of 70 healthy people were made using videostrobokymographic open quotient (VSK OQ ) and electroglottographic quasi-open quotient (EGG QOQ ). Results Statistically significant differences were achieved regarding gender for the averaged values of VSK OQ as well as for values calculated from the posterior part of the vocal folds. A statistically significant correlation between the value of VSK OQ and age was observed for the posterior part of the glottis. Differences between gender and the value of EGG QOQ were observed. No statistically significant correlation between EGG QOQ and age was obtained. Conclusions VSK OQ and EGG QOQ are parameters characterizing glottal function in a coherent manner. These parameters can be included easily in phoniatric examination and help to objectify glottal function.

Background Glottal incompetence is one of the most common contributing factors in patients who suffer from dysphonia. One of the different treatment approaches is injection laryngoplasty. The aim of the study was to assess the quality of voice in patients who were treated with hyaluronic acid injection into the vocal fold in the long-term follow-up. Material and methods The material included 39 patients with dysphonia who were referred for injection augmentation. The studied group included patients with presbyphonia, scar, sulcus, unilateral vocal fold paralysis and with atrophy of the vocal fold. Preoperative and postoperative examination was based on laryngovideostroboscopy. Patients' voice was assessed using the subjective GRBAS scale, and objective evaluation provided by Multidimensional Voice Program (MDVP) was applied. All the patients underwent injection laryngoplasty with hyaluronic acid into the vocal folds. Follow-up examinations were conducted 6, 12 and 24 months postoperatively. Results Perceptual voice quality assessed with the GRBAS scale was improved and the results were stable in the long-term follow-up periods. MDVP showed a significant statistical improvement within the group of frequency, amplitude and noise parameters. The differences in value between follow-up periods were not statistically significant. Conclusions Acoustic analysis of voice is a reliable method for objective assessment of voice quality after applied treatment. Injection of the hyaluronic acid into the vocal fold improves the quality of voice in patients suffering from glottic insufficiency.

Aim: The main goal of the present study was to assess the feasibility of using evoked stapedius reflex (eSR) and evoked compound action potential (eCAP) thresholds to create speech processor programs for children using Med-El Maestro software. The secondary goals were (1) to compare the eSR and eCAP thresholds recorded using charge units in experienced adults fitted with Med-El Pulsar CI100 cochlear implants with most comfortable loudness levels (MCLs) obtained for the apical, medial and basal electrodes, and (2) to compare eSR and eCAP thresholds for the apical, medial and basal electrodes between adults and children. Methods: Fourteen children and 16 adults participated in the study. eSR and eCAP thresholds were measured in both groups using the auditory nerve response telemetry algorithm, with MCL being behaviourally measured only in the adult group. Results: In the adult population, the correlation between eSR threshold and MCL was better for apical, medial and basal electrodes than that between eCAP threshold and MCL. There was no significant difference in the means obtained for eCAP and eSR thresholds in children and adults for any of the electrodes tested. This finding suggests that in children, the correlations between eCAP thresholds and MCL values, and those between eSR thresholds and MCL values are not lower than those generally found in adults. Conclusions: Although the eSR threshold is a better predictor of MCL values, both eSR and eCAP thresholds can be useful tools for assisting with map creation for children.

Tornwald's cyst is a recess in the midline of the nasopharynx, which is produced by persistent notochord remnants. The aim of the study was to present difficulties in diagnostic procedures in patients with Tornwald's cyst suspicion.Authors present 2 cases of patients being treated for Tornwald's cyst in the Audiology and Phoniatrics Clinic of Institute of Physiology and Pathology of Hearing in Warsaw.Discussed patients complained fullness in ears, hearing disorders, tinnitus, dysphagia, occipital headaches and balance problem. Both patients underwent ENT examination with endoscopic examination of nasopharynx and hearing assessment tests(pure tone audiometry, impedance audiometry). Magnetic resonance imaging and computer tomography were also performed. Surgery of nasopharyngeal cyst and tympanotomy with drainage of middle ear were performed in one patient. Second patient was treated with TRT therapy for her tinnitus.Tornwald's cyst should be remembered as an uncommon cause of hearing problems, tinnitus, fullness in ears, dysphagia, occipital headaches and balance problem. Magnetic resonance imaging seems to be the most specific method in Tornwald's cyst diagnosis.

Summary Background The aim of this study was to evaluate distortion product otoacoustic emissions (DPOAEs) and extended high-frequency (EHF) thresholds in a control group and in patients with normal hearing sensitivity in the conventional frequency range and reporting unilateral tinnitus. Material/Methods Seventy patients were enrolled in the study: 47 patients with tinnitus in the left ear (Group 1) and 23 patients with tinnitus in the right ear (Group 2). The control group included 60 otologically normal subjects with no history of pathological tinnitus. Pure-tone thresholds were measured at all standard frequencies from 0.25 to 8 kHz, and at 10, 12.5, 14, and 16 kHz. The DPOAEs were measured in the frequency range from approximately 0.5 to 9 kHz using the primary tones presented at 65/55 dB SPL. Results The left ears of patients in Group 1 had higher median hearing thresholds than those in the control subjects at all 4 EHFs, and lower mean DPOAE levels than those in the controls for almost all primary frequencies, but significantly lower only in the 2-kHz region. Median hearing thresholds in the right ears of patients in Group 2 were higher than those in the right ears of the control subjects in the EHF range at 12.5, 14, and 16 kHz. The mean DPOAE levels in the right ears were lower in patients from Group 2 than those in the controls for the majority of primary frequencies, but only reached statistical significance in the 8-kHz region. Conclusions Hearing thresholds in tinnitus ears with normal hearing sensitivity in the conventional range were higher in the EHF region than those in non-tinnitus control subjects, implying that cochlear damage in the basal region may result in the perception of tinnitus. In general, DPOAE levels in tinnitus ears were lower than those in ears of non-tinnitus subjects, suggesting that subclinical cochlear impairment in limited areas, which can be revealed by DPOAEs but not by conventional audiometry, may exist in tinnitus ears. For patients with tinnitus, DPOAE measures combined with behavioral EHF hearing thresholds may provide additional clinical information about the status of the peripheral hearing.

Thanks to videostrobokymography the vocal fold vibration from particular area of glottal chink, can be assessed in an objective way.Evaluation of objective parameters of vocal fold vibration with the usage of videostrobokymography in patients with different voice disorders.Material of the study included patients treated in the Institute of Physiology and Pathology of Hearing, Audiology and Phoniatrics Clinic. 82 patients with normal voices, vocal fold nodules, polyps, Reinke edema, vocal cord paralysis and functional dysphonia were enrolled into the study. Open Quotient (OQ) from frontal, middle and dorsal third of vocal folds were measured. T-Student test was used for statistical analysis.The study revealed differences of OQ in control group and patients with organic or functional dysphonia. Differences in parameters were calculated for each vocal fold region. The mean value of OQ in control group was 0.56 (frontal third), 0.55 (middle third), 0.597 (dorsal third). Statistical significant differences of OQ calculated from separate glottal chink areas, were observed in Reinke edema (from frontal and middle third) and vocal cord paralysis (from frontal third).Videostrobokymography is an useful complement to classical stroboscopy. Objective parameters enables the objectification of vibratory activities. Videostrobokymography is helpful in differential diagnosis of voice disorders.

Method of vocal folds implantation with allogenic materials has been applied in medical centre all over the world for over 30 years. this voice improving method is usually applied in several indications such as: presbyphonia, vocal folds paralysis, glottis insufficiency, vocal fold scars or sulcus vocalis. all of these illnesses prevent the patients to obtain full glottis closure and produce good quality voice.TO assess quality of voice after implantation of hyaluronic acid to the vocal folds.Consisted of 15 patients, who underwent surgical implantation of hyaluronic acid to the vocal folds. 10 patients had the procedure performed on both sides of the larynx, this group included 6 patients with vocal insufficiency of the glottis, 2 with scars and atrophy of the vocal folds and 2 with presbyphonia. In 5 cases the hyaluronic acid was applied on one side of the larynx. The group included 4 patients with vocal folds paralysis and one person with single sided scars and atrophy of the vocal fold.Each patient was examined with videostroboscopy and underwent objective and subjective assessment of voice. Hyaluronic acid was injected surgically under Jet Ventilation general anesthesia. In two cases during the procedure scars were removed from the vocal folds. All patients after hyaluronic acid augmentation took part in the rehabilitation program that included series of voice emission exercises before operation and up to 3 months after the procedure. Examination was performed 1, 3 and 6 months after injection.In all cases improvement of quality of voice was obtained which was stated by a physician and the patients subjectively. Improvement of harmonic voice structure was confirmed by spectrographic record. Acoustic examinations revealed that the improvement was obtained within parameters describing frequency, amplitude disturbance and noise existence.Injection of the hyaluronic acid to the vocal folds improves functional phonation and quality of voice in cases of patients with glottis insufficiency. Injection of the hyaluronic acid to the vocal folds is an efficient method improving quality of voice and can be safe alternative for no surgery method in rehabilitation of voice. This method is a simply, effective and quickly to improve of voice disorders.

This study shows that by using the round window approach and deep insertion, it is possible to reduce electrode insertion trauma (EIT), as indicated by the results of the hearing preservation marker.In this prospective study EIT was evaluated in 42 subjects with low frequency hearing before surgery with 28 mm round window deep insertion.The degree of hearing preservation was a marker of EIT. Pure tone audiometry, monosyllable testing was conducted preoperatively and then at 3, 6, and 13 months after surgery.Immediate hearing preservation (3 months postoperatively) was 92.9% (39/42). The surgery-related hearing preservation 13 months after surgery varied from 85% (34/40) to 90% (36/40). The ipsilateral implanted ear showed significant differences between preoperative and postoperative hearing thresholds (p0.005). Comparisons of thresholds for the control ear showed a significant difference between preoperative and postoperative thresholds tested 13 months after surgery (p0.05). When the subtraction factor of the mean contralateral hearing loss for each tested frequency for the same time interval was applied to the implanted ear, no significant hearing loss was found, showing that postoperative ipsilateral progressive hearing loss was caused by etiology rather than surgery.

To assess effectiveness of the auditory training in children with dyslalia and central auditory processing disorders.Material consisted of 50 children aged 7-9-years-old. Children with articulation disorders stayed under long-term speech therapy care in the Auditory and Phoniatrics Clinic. All children were examined by a laryngologist and a phoniatrician. Assessment included tonal and impedance audiometry and speech therapists' and psychologist's consultations. Additionally, a set of electrophysiological examinations was performed - registration of N2, P2, N2, P2, P300 waves and psychoacoustic test of central auditory functions: FPT - frequency pattern test. Next children took part in the regular auditory training and attended speech therapy. Speech assessment followed treatment and therapy, again psychoacoustic tests were performed and P300 cortical potentials were recorded. After that statistical analyses were performed.Analyses revealed that application of auditory training in patients with dyslalia and other central auditory disorders is very efficient.Auditory training may be a very efficient therapy supporting speech therapy in children suffering from dyslalia coexisting with articulation and central auditory disorders and in children with educational problems of audiogenic origin.

Motor neuron disease is a progressive neurologic disorder characterized by degeneration of motor neurons in the cerebral cortex, brain stem and spinal cord.Was to present methods of therapy and rehabilitation in patients with MND and the role of phoniatrician and otolaryngologist in diagnostic and therapeutic process. MATERIAL AND METHOD, RESULTS: The material of present study consists of 3 patients in the age of 38 to 55 who were admitted to The Institute of Physiology and Pathology of Hearing in Warsaw, Poland. Patients underwent laryngological, phoniatric and neurologopedics examinations. They were treated with phoniatric and logopedics rehabilitation strategy applying manual therapy of voice, speech exercises and courses of physiotherapy. As a result of therapeutical management, quality of speech and voice were improved.1. Disorders of voice and speech may be early symptoms of motor neuron disease; 2. Patients with motor neuron disease require multidisciplinary therapy, including otolaryngologists and phoniatricians; 3. Acoustic analysis of voice (MDVP) presents more often disorders in frequency range than amplitude changes; 4. Intensive and regular excercises are crucial for the improvement in speech communication.

Spasmodic dysphonia is a focal form of laryngeal dystonia that causes unintended contractions of vocal folds with speech interruptions and affecting the voice quality. There are adductor (82%), abductor (36%), mixed (1%) types and reported by Blitzer--respiratory adductor type with paradoxical vocal fold movement and stidor. As an example of diagnostic and therapeutic difficulties in spasmodic dysphonia and its multidisciplinary approach with needed cooperation of many specialists we presented patient with adductor spasmodic dysphonia. In stroboscopic evaluation there were observed glottic overclosure and hyperaduction in supraglotic stuctures (sphincteric). During diagnostic procedures there was made acoustic analysis by digital spectrograph (by KAY Elmetrics Company). IV degree of hoarsness and voice breaks were observed in sonogram. In multidimentional analysis there were deviations of the frequency, amplitude, noise, tremor and voice break parameters. Treatment included regular speech therapy, relaxation- and psychotherapy. The results of treatment were very instable because every stress-related problem released symptoms. Botulinum toxin injections into thyro-arytenoid muscle which had made before our hospitalisation were also not succeeding. Because of lack of etiologic factor and plenty diseases that can mimic spasmodic dysphonia, close communication between many specialists is needed.

The aim of the paper is to present the program of therapy and rehabilitation in stuttering patients based of the digital speech aid. The device has been applied to 130 patients aged 6-47 y.o. 85% of the patients had statistically significant instant improvement of speech fluency after application of digital speech aid. After completing diagnostic process, the patients were enrolled for the rehabilitation program which comprised of training with the use of speech aid, speech therapy, psychotherapy, audio-psycho-linguistic stimulation with the use of the Tomatis Method, physiotherapy, relaxation exercises, phoniatric rehabilitation and medical therapy. After 6 months of therapy and rehabilitation a statistically significant improvement of speech fluency was found in 124 patients, i.e. in 96%. The therapeutic programme based on the use of digital speech aid proves effective for majority of stuttering patients.

The paper presents preliminary results of Eustachian tube dysfunction treatment with the use of vibroaerosols in adult patients. 21 patients aged 16-73 y.o. (mean age 49 y.o) have been included in the study. The treatment included inhalation of medicines individually selected for the patient, based on the results of the physical examination. The patients have been divided into 2 groups, depending on the type of tympanogram. Group I included patients with type A tympanogram and abnormal Eustachian tube patency test result. Group II comprised of patients with type B or C tympanogram and abnormal Eustachian tube patency test result. After treatment, subjective improvement has been observed in 88.9% of the ears, objective improvement in 61.5% of the ears. In group II, objective improvement observed by the change of tympanogram has been observed in 85% of ears. Lack of correlation between objective and subjective improvement have been observed in 26% of the ears. In 11.1% of the ears no benefit from treatment has been observed. The correlation between subjective and objective improvement has been observed in 74% of ears. It appears that treatment with the use of vibroaerosols is beneficial for patients with Eustachian tube dysfunction.