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Ambulatory voice monitoring is a promising tool for investigating phonotraumatic vocal hyperfunction (PVH), associated with the development of vocal fold lesions. Since many patients with PVH are professional vocalists, a classifier was developed to better understand phonatory mechanisms during speech and singing. Twenty singers with PVH and 20 matched healthy controls were monitored with a neck-surface accelerometer–based ambulatory voice monitor. An expert-labeled ground truth data set was used to train a logistic regression on 15 subject-pairs with fundamental frequency and autocorrelation peak amplitude as input features. Overall classification accuracy of 94.2% was achieved on the held-out test set.Ambulatory voice monitoring is a promising tool for investigating phonotraumatic vocal hyperfunction (PVH), associated with the development of vocal fold lesions. Since many patients with PVH are professional vocalists, a classifier was developed to better understand phonatory mechanisms during speech and singing. Twenty singers with PVH and 20 matched healthy controls were monitored with a neck-surface accelerometer–based ambulatory voice monitor. An expert-labeled ground truth data set was used to train a logistic regression on 15 subject-pairs with fundamental frequency and autocorrelation peak amplitude as input features. Overall classification accuracy of 94.2% was achieved on the held-out test set.

Summary Objective Obtain aerodynamic vocal measurements of dysphonic female teachers from two groups, before and after a brief and intensive short-term voice therapy using the finger kazoo technique, compare to the respective control groups, and compare between the two study groups. Study design A randomized blind controlled clinical trial. Methods A randomized blind controlled clinical trial. Measurements of maximum phonation time and sound pressure level (dB SPL) were measured before and after intensive short-term vocal therapy in 24 teachers with and without structural laryngeal disorders and 17 controls with and without structural laryngeal disorder. Results There was significant reduction in the maximum phonation time of /e/ for the group with no structural laryngeal disorder, and a significant reduction of the maximum sound pressure level for the group with structural laryngeal disorder. Conclusions Based on the observed results, a significant reduction in the maximum phonation time of /e/ for the group with no structural laryngeal disorder, and a significant reduction of the maximum sound pressure level for the group with structural laryngeal disorder, it is possible that finger kazoo reduced the glottal hyperfunction by improving the balance between the respiratory and the glottal vocal production levels during speech.

Classical theory maintains that ageing evolves via energy trade-offs between reproduction and survival leading to accumulation of unrepaired cellular damage with age. In contrast, the emerging new theory postulates that ageing evolves because of deleterious late-life hyper-function of reproduction-promoting genes leading to excessive biosynthesis in late-life. The hyper-function theory uniquely predicts that optimizing nutrient-sensing molecular signalling in adulthood can simultaneously postpone ageing and increase Darwinian fitness. Here we show that reducing evolutionarily conserved insulin/IGF-1 nutrient-sensing signalling viadaf-2RNA interference (RNAi) fulfils this prediction inCaenorhabditis elegansnematodes. Long-liveddaf-2RNAi parents showed normal fecundity as self-fertilizing hermaphrodites and improved late-life reproduction when mated to males. Remarkably, the offspring ofdaf-2RNAi parents had higher Darwinian fitness across three different genotypes. Thus, reduced nutrient-sensing signalling in adulthood improves both parental longevity and offspring fitness supporting the emerging view that sub-optimal gene expression in late-life lies at the heart of ageing.Impact StatementUnderstanding mechanisms underpinning ageing is fundamental to improving quality of life in an increasingly long-lived society. Recent breakthroughs have challenged the long-standing paradigm that the energy trade-off between reproduction and somatic maintenance causes organismal senescence via slow accumulation of unrepaired cellular damage with age. The emerging new theory of ageing provides a conceptually novel framework by proposing that ageing is a direct consequence of physiological processes optimized for early-life function, such as growth and early-life reproduction, that are running ‘too high’ (i.e. at hyperfunction) in late adulthood. Contrary to the classic view based on damage accumulation, the hyperfunction theory proposes that suboptimal gene expression in late-life causes ageing via excessive biosynthesis. Thus, the hyperfunction theory uniquely predicts that longevity and Darwinian fitness can be simultaneously increased by reducing unnecessarily high levels of nutrient-sensing signalling in adulthood. Here we show that reducing evolutionarily conserved nutrient-sensing signalling pathway fulfils this prediction inCaenorhabditis elegansnematodes. We found that downregulation of the insulin/IGF-1 signalling in adultC. elegansnematodes not only improves longevity but, most intriguingly, increases fitness of the resulting offspring in the next generation. We found support for increase in offspring fitness across different genetic backgrounds. Our findings contradict the theoretical conjecture that energy trade-offs between growth, reproduction and longevity is the universal cause of senescence and provide strong experimental support for the emerging hyperfunction theory of ageing.

Purpose Vocal fold nodules are usually caused by voice overuse or vocal hyperfunction, and their symptoms include persistent hoarseness – a disturbance in the vocal fold vibrations which results in a turbulent passage of air in the glottis, manifested as a raspy, rough voice. The aim of the study was to present data concerning voice quality in patients with vocal nodules and to compare electroglottographic analysis (EGG) with acoustic analysis. Methods The study examined 57 children with vocal fold nodules (Group 1). Each patient underwent a phoniatric evaluation of the vocal tract, a videolaryngoscopic examination, and a voice quality assessment, employing electroglottographic and acoustic analyses. The control group consisted of 37 healthy children (Group 2). The following parameters were analyzed: Closed Quotient (EGG signal), Peak Slope, Normalized Amplitude Quotient and Cepstral Peak Prominence (acoustic signal - waveform). Results Changes in the EGG signal could be detected in 95% of the patients with vocal nodules, indicating the occurrence of vocal nodules and glottal insufficiency. The acoustic analysis confirmed breathy phonation in 63% of the patients. The Closed Quotient parameter proved to be more effective than Peak Slope. Closed Quotient, Peak Slope and Normalized Amplitude Quotient allowed for the differentiation of the EGG signal and the acoustic signal in groups 1 and 2 in a statistically significant way. Conclusions The results of electroglottographic and acoustic analysis show incorrect voice parameters in patients with vocal nodules with reference to the control group. At the same time, the EGG analysis proved to be more effective than the analysis of the acoustic signal.

Medialization laryngoplasty has the potential for highly satisfactory results; however on occasion outcomes are subpar. Comprehensive evaluation of a patient with a less-than-satisfactory laryngoplasty outcome includes history, perceptual voice analysis, and examination emphasizing stroboscopy. Immediate failures may be due to undercorrection, overcorrection, failure to treat the contralateral vocal fold, or, most often, persistent posterior glottic insufficiency. Delayed failures may be caused by progressive atrophy of the vocal folds, progression of underlying disease, or implant displacement. Perceptual analysis and stroboscopy typically provide clues about the cause of a poor result – breathy voice, low volume, incongruously high pitch, persistent glottal gap, arytenoid instability, or ventricular hyperfunction suggest insufficiency, whereas a pressed voice quality, inspiratory stridor, contour abnormalities, or vocal fold stiffness indicate overcorrection. These clues become indispensable in the planning of additional therapeutic intervention. In patients with persistent insufficiency, injection augmentation can serve as a trial for revision laryngoplasty. Persistent posterior glottal gap or arytenoid instability with symptoms of insufficiency may be treated successfully with an arytenoid procedure. Patients who are overcorrected typically improve with implant downsizing. Other options for management include behavioral therapy alone, salvage framework surgery procedures such as cricothyroid subluxation, or laryngeal reinnervation. Although limited data exist, several studies report improvement in both subjective and objective measures following revision medialization laryngoplasty.

We develop a nonlinear theory for infrahyperfunctions (also referred to as quasianalytic (ultra)distributions by L. H\"{o}rmander). In the hyperfunction case our work can be summarized as follows. We construct a differential algebra that contains the space of hyperfunctions as a linear differential subspace and in which the multiplication of real analytic functions coincides with their ordinary product. Moreover, by proving an analogue of Schwartz's impossibility result for hyperfunctions, we show that this embedding is optimal. Our results fully solve an earlier question raised by M. Oberguggenberger., Comment: 24 pages

It is well known that with increasing age, the risk of acquiring certain age-related diseases – such as diabetes, cancer, cardiovascular disease and neurodegenerative diseases, increases. Several theories have been proposed to explain the reason why ageing leads to higher susceptibility to disease. Over time, many of these theories have been proven wrong. Currently, the two theories holding the interest of researchers in this field are the oxidative damage theory and hyperfunction theory of ageing. The former is an old theory which explains that ageing is as a result of oxidative damage (to macromolecular components of the cell) by reactive oxygen species produced as a normal part of metabolism. The hyperfunction theory is a much newer theory which explains that ageing is as a result of the unnecessary and unwanted continuation of certain metabolic processes at old age. In this review, we discuss the mechanisms which underlie the development of age-related cancer. We also discuss the aforementioned theories of ageing. We conclude by explaining the opposing views of proponents of both theories and provide a new viewpoint by revealing a point of synergy in the two theories.

Summary Objective The objective of this study was to evaluate the presence of habits and symptoms of vocal hyperfunction in the parents of children with attention deficit hyperactivity disorder (ADHD). Methods Parents of 24 children with ADHD and 30 children of a control group completed a specific questionnaire to detect the hyperfunctional use of the voice (excessive talking, excessive loudness, talking too fast, and shouting), hoarseness, vocal fatigue, mental and physical fatigue, and the degree of parental concern for the vocal health of their child. Results Parents of children with ADHD spoke more often, faster, and stronger than the parents of the control group; in addition, they also used a louder volume than they usually used when they spoke to their children. The parents manifested more vocal, mental, and physical fatigue than the parents of the control group. There was a significant correlation between the “concern” for the vocal health of their children with respect to vocal symptoms of the children, the habits of vocal hyperfunctioning, and the symptoms suffered by the parents. Conclusions These results suggest that the parents of children with ADHD change their vocal attitude when communicating with their children. Most likely, the increased concern of parents with ADHD children and their respective level of stress lead to hyperfunctional vocal usage. This subsequently leads to symptoms of vocal, physical, and mental fatigue at the end of the day.

We introduce a class of causal manifolds which contains the globally hyperbolic spacetimes and we prove global propagation theorems for sheaves on such manifolds. As an application, we solve globally the Cauchy problem for hyperfunction solutions of hyperbolic systems., v2: we added the hypothesis that the cone defining a causal manifold is nowhere empty and other minor corrections

We introduce formal symbols of product type and of minimumtype and show that the formal power series representation for e p is a formalsymbol of product type, where p is a formal symbol of minimum type. 1. IntroductionPseudodi erential operators are essential for studying the theory of partialdi erential equations and itself have been studied in various respects. A pseudo-di erential operator can be represented as an equivalent class of some functionde ned on the cotangent bundle. We call this function a symbol of pseudodi er-ential operator. We can represent the operations of addition, scalar multiplica-tion, composition, formal adjoint and change of variables of pseudodi erentialoperators by using these symbols and so can treat pseudodi erential operatorsconcretely. Symbolic calculus means calculating pseudodi erential operatorsby using symbols. Exponential calculus means symbolic calculus on pseudodif-ferential operators expressed as symbols of exponential functions. A symbol ofexponential function means that the symbol can be expressed as a form of expo-nential function. We can analyze (pseudo) di erential operators of in nite orderor (pseudo) di erential equations of in nite order by studying the pseudodi er-ential operators expressed as symbols of exponential functions. In particular,Sato, M., T. Kawai and M. Kashiwara (ref. [16]) won epoch-making results inthe theory of transformation of the system of linear partial (pseudo) di eren-tial equations by using pseudodi erential operators of in nite order. T. Aokiaccomplished exponential calculus of analytic pseudodi erential operators( ref.[1] { [8]). The author considers the case of a kind of the direct product structure(ref. [12] { [15]). That is, we introduce and study calculus of analytic pseudo-di erential operators of product type and generalize the theory of T. Aoki insome sense. This study is deeply connected with exponential calculus of posi-tive de nite operators of in nite order which have deep relation to the energymethod in the hyperfunction theory(ref. [9] { [11]). In this article, we introduce

Purpose. Randomized controlled trial aimed at comparing surgical outcomes in a group of patients suffering from hyperfunction of the inferior oblique (IO) muscle with abnormal head position (AHP). The surgical techniques being compared are Recession and (thread) Controlled Myotomy.Materials and Methods. The group of 20 patients suffering from medium-high hyperfunction of the IO was assessed through an ophthalmological and orthoptic examination. 10 patients underwent traditional Recession (Group A) and 10 were treated with Controlled Myotomy (Group B).Results. The average age was 19 years ± 10.7 SD. After 1 year, 20% of Group A showed a small Vertical Deviation associated with a small AHP, while 80% had orthophoria and 40% of them had a small AHP. 80% of Group B showed a small Vertical Deviation associated with an equally small AHP, while 20% had orthophoria with a full resolution of AHP.Conclusion. Based on the results obtained and the fewer intrasurgical risks involved, thread Controlled Myotomy proved to be a valid alternative to Recession. Furthermore, in case of Recession, over the long period a small residual AHP remained in the patients who had orthophoria, unlike Myotomy which led to a total resolution.

Background: Noncarious cervical lesions (NCCLs) are rarely described in the periodontal literature, perhaps because no direct link between NCCLs and periodontal lesions has been demonstrated. Aim: The aim of this study is to determine the stress and displacement produced in the tooth at different bone levels under different occlusal load using finite element model (FEM) study. Materials and Methods: Four FEMs of maxillary incisor were designed consisting of the tooth, pulp, periodontal ligament, and alveolar bone at the various level of bone height (25%, 50%, and 75%). Different occlusal load (5 kg, 15 kg, 24 kg, and 29 kg) at an angle of 50° to the long axis of the tooth was applied on the palatal surface at the level of middle third of the crown. All the models were assumed to be isotropic, linear and elastic, and the analysis was performed on a Pentium IV processor computer using the ANSYS software. Results: The maximum stress in the tooth was seen in the cervical region and to a greater extent at the apex for all models. The maximum tooth displacement for all the occlusal loads applied in this study was at the incisal edge with the minimum tooth displacement at the cervical third of the root which shifted apically with the reduction of alveolar bone support. Conclusion: The cumulative effect of increased stress and displacement at the cervical region of the tooth would result in abfraction as the age advances along with other wasting diseases.

Refractive error is one of the most actual problems of pediatric ophthalmology. Late and incomplete correction of refractive errors leading to amblyopia, the disruption of the formation of binocular vision, strabismus friendly. As a gross cosmetic defect and combined with violation of visual functions, strabismus in children presents as a psychophysical and social problem, making it difficult to establish social ties, often becoming an obstacle in acquiring the desired profession. A particularly difficult problem is forms of strabismus: paralytic, alphabetical (V, A, X) and other syndromes ( Duane, brown DVD, etc.) in which involved in the pathological process not only the muscles of the horizontal and vertical actions, but also one of the causes are functional disorders. In the syndrome of “V” and converging strabismus, the angle of deflection decreases when you look up and increases when looking down; in case of diverging strabismus, the deviation is more when you look up and less when looking down. A thorough examination of a comprehensive personalized treatment, including pleopto-orthope-diploptic, training accommodation and convergence allows to restore visual function and binocular vision and to avoid secondary deviance. One-stage surgical intervention in combined horizontal-vertical strabismus with hyperfunction of the lower oblique muscle on horizontal and vertical muscle groups is an effective method of treatment allows to increase the effectiveness of surgical treatment to reduce the frequency of anesthesia, to reduce the number of repeated operations. Appointment postoperative functional treatment is an integral component of the strabismus correction and allows to achieve stable binocular functions, and further stand orthophoria.

Summary Objectives Subglottal pressure ( P s ) is strongly correlated with sound pressure level (SPL) and is easy to measure by means of commonly available equipment. The SPL/Ps ratio is strongly dependent on the efficiency of the phonatory apparatus and should be of great relevance to clinical practice. However, published normative data are still missing. Method The subjects produced sequences of the syllable [pae], and P s was measured as the oral pressure during the [p] occlusion. The P s to SPL relationship was determined at four pitches produced by 16 female and 15 male healthy voices and analyzed by means of regression analysis. Average correlation between P s and SPL, average SPL produced with a P s of 10 cm H 2 O, and average SPL increase produced by a doubling of P s were calculated for the female and for the male subjects. The significance of sex and pitch conditions was analyzed by means of analysis of variance (ANOVA). Results Pitch was found to be an insignificant condition. The average correlation between P s and SPL was 0.83 and did not differ significantly between the female and male subjects. In female and male subjects, P s = 10 cm H 2 O produced 78.1 dB and 80.0 dB SPL at 0.3 m, and a doubling of P s generated 11.1 dB and 9.3 dB increase of SPL. Both these gender differences were statistically significant. Conclusions The relationship between P s and SPL can be reliably established from series of repetitions of the syllable [pae] produced with a continuously changing degree of vocal loudness. Male subjects produce slightly higher SPL for a given pressure than female subjects but gain less for a doubling of P s . As these relationships appear to be affected by phonation type, it seems possible that in the future, the method can be used for documenting degree of phonatory hypofunction and hyperfunction.

Disorders of the endocrine system including hormone hyperfunction and hypofunction have multiple effects on cardiovascular system. However, in clinical practice, there are many cases of delayed or overlooked diagnosis of underlying endocrine dysfunction in patients presenting chest pain or other cardiac symptoms. Herein, we report three cases of endocrine hyperfunction presenting as coronary spasm; Graves’ hyperthyroidism, pheochromocytoma, and primary hyperparathyroidism. Chest pains disappear after treatment for these endocrine diseases. Endocrine hyperfunctions such as the three cases described above should be considered as possible diagnosis in patients with complaint of chest pain. High index of suspicion are needed.

Objectives/Hypothesis To test the assumption that voice is changed in polycystic ovary syndrome (PCOS) and identify changes that occur. Study Design Cross-sectional pilot study. Methods Thirty patients with PCOS and a control group of 22 age-matched and body mass index-matched healthy women were included. Demographic data, anthropometric measurement, serum androgens, and Voice Handicap Index-10 were determined. Transnasal fiberoptic laryngoscopy and rigid stroboscopy were performed. Supraglottic hyperfunction was assessed during fiberoptic laryngoscopy. Presence of supraglottic hyperfunction was interpreted as abnormal muscle tension pattern. Glottal closure configuration and vibratory wave characteristics were evaluated via stroboscopy. Acoustic analysis was performed with the Dr. Speech software program version 4 (Tiger DRS Inc., Seattle, WA). Results Voice complaints and acoustic parameters were similar between groups, whereas serum androgens were significantly higher in patients (P < 0.001). Laryngeal examination detected pathology in 17 (56.7%) patients and two (9.1%) controls (P < 0.001). Fiberoptic examination determined supraglottic hyperfunction in 11 patients but in only two controls (P = 0.023). In stroboscopy, incomplete glottal closure configuration and impaired vocal fold vibration were present in 10 and 11 patients, respectively, whereas only one control had glottal closure abnormality and none of the controls had abnormal vibration (P = 0.028 and P = 0.001, respectively). Conclusion Abnormal muscle tension patterns and impaired vocal fold vibration are frequent among patients with PCOS; but they are not accompanied by increased vocal symptoms or deteriorated acoustic voice parameters. This may be important for professional voice users or in extensive or extraordinary voice use demands in patients with PCOS. Level of Evidence 3b. Laryngoscope, 2015

In this paper, we propose a numerical method for calculating Fourier transforms based on hyperfunction theory, a theory of generalized functions based on complex function theory. In the proposed method, we first obtain analytic functions giving the desired Fourier transform as a hyperfunction, and, then, we compute the Fourier transform by using continued fractions to determine the analytic continuation of these analytic functions onto the real axis. Using the proposed method, we can evaluate Fourier transforms that are difficult to evaluate using the conventional numerical integration rules. In addition, we can use the proposed method to evaluate Fourier transforms of hyperfunctions. Numerical examples show the efficiency of the presented method compared to previous methods.

The X-linked immunoglobulin superfamily, member 1 (IGSF1), gene is highly expressed in the hypothalamus and in pituitary cells of the POU1F1 lineage. Human loss-of-function mutations in IGSF1 cause central hypothyroidism, hypoprolactinemia, and macroorchidism. Additionally, most affected adults exhibit higher than average IGF-1 levels and anecdotal reports describe acromegaloid features in older subjects. However, somatotrope function has not yet been formally evaluated in this condition.We aimed to evaluate the role of IGSF1 in human and murine somatotrope function.We evaluated 21 adult males harboring hemizygous IGSF1 loss-of-function mutations for features of GH excess, in an academic clinical setting.We compared biochemical and tissue markers of GH excess in patients and controls, including 24-hour GH profile studies in 7 patients. Parallel studies were undertaken in male Igsf1-deficient mice and wild-type littermates.IGSF1-deficient adult male patients demonstrated acromegaloid facial features with increased head circumference as well as increased finger soft-tissue thickness. Median serum IGF-1 concentrations were elevated, and 24-hour GH profile studies confirmed 2- to 3-fold increased median basal, pulsatile, and total GH secretion. Male Igsf1-deficient mice also demonstrated features of GH excess with increased lean mass, organ size, and skeletal dimensions and elevated mean circulating IGF-1 and pituitary GH levels.We demonstrate somatotrope neurosecretory hyperfunction in IGSF1-deficient humans and mice. These observations define a hitherto uncharacterized role for IGSF1 in somatotropes and indicate that patients with IGSF1 mutations should be evaluated for long-term consequences of increased GH exposure.

Treatment of vertical strabismus will almost inevitably involve surgery when it is associated with hyperfunction of the inferior oblique muscle due to the weakness of vertical fusion (3.0-4.0 ave dptr), the presence of cyclotropy and torsional diplopia. Many operations aimed at weakening the lower oblique muscle have been described. However, they have a number of negative aspects associated with high invasiveness, difficulty of technical implementation due to the need for manipulations in the inaccessible area of the eye in proximity to the optic nerve, macular area, large vessels, as well as long duration of the operation, inability to dosage the result of the operation, low functional results. They are, to a large extent, absent in the operation of anterior transposition in which the neurofibrovascular bundle serves as the axis of rotation of the lower oblique muscle changing the vector of its action and increasing the effectiveness of treatment. Despite all the advantages of that technique, its use is still limited due to the lack of methods for controlling the amount of anterior transposition for the treatment of hyperfunction of the inferior oblique muscle, especially of small degrees.В лечении вертикального косоглазия, связанного с наличием гиперфункции (ГФ) нижней косой мышцы (НКМ), из-за слабости вертикальной фузии (3,0—4,0 пр. дптр), наличия циклотропии и торзионной диплопии хирургический этап практически неизбежен. К настоящему времени описано множество операций по ослаблению НКМ. Однако они характеризуются целым рядом отрицательных моментов, связанных с высокой травматичностью, трудностью технического выполнения из-за необходимости манипулировать в труднодоступной области глаза вблизи зрительного нерва, макулярной зоны, крупных сосудов, с большой длительностью проведения операции, невозможностью дозировать результат операции, низкими функциональными результатами. В значительной степени этих недостатков лишена операция передней транспозиции, при которой нейрофиброваскулярный пучок служит осью поворота НКМ, вследствие чего изменяется вектор ее действия и повышается эффективность лечения. Но, несмотря на все преимущества описанной методики, ее применение по-прежнему ограничено. Это связано с отсутствием способов дозирования объема передней транспозиции для лечения ГФ НКМ, особенно малых степеней.

Summary Objective Adductor spasmodic dysphonia (AdSD) is a challenging voice disorder to diagnose, often erroneously diagnosed as muscle tension dysphonia (MTD) or vocal tremor, due to its similarity in auditory and perceptual presentation. Assessments using laryngoscopy or strobolaryngoscopy procedures have demonstrated limited utility in the diagnosis of spasmodic dysphonia. High-speed videoendoscopy (HSV) provides visualization of the precise vibratory pattern of phonatory onset and thus, offers an alternative to previous diagnostic strategies for visual diagnosis of AdSD. The purpose of this study was to examine vibratory onset of patients with AdSD and patients with MTD using HSV methodology. Methods HSV of six adults with AdSD and five adults with MTD were captured during sustained phonation. Digital kymography was used to obtain precise vibrogram data at the mid-membranous region of the vocal fold prior to and at the onset of phonation. Voice onset delay was examined by (1) quantifying timing of prephonatory delay and steady state delay and (2) describing vocal fold onset movements qualitatively in each diagnosis. Results HSV adequately captured the phonatory onset of the vocal folds. Voice onset delay was not significantly different between AdSD and MTD. However, there were distinct differences in voice onset gestures. Both AdSD and MTD patients presented with vocal hyperfunction during the onset of phonation. In a subset of AdSD patients, a rapid sustained adduction occurred following the initial vibratory motion. Vocal fold vibration then continued until steady phonation was achieved. This oscillatory break pattern was not observed in patients with MTD. Therefore, there appears to be differences in vocal fold vibratory onset motion between MTD and AdSD. Conclusion HSV captures the precise vibratory onset in patients with MTD and AdSD. Differences were most notable after vibratory onset as opposed to vibratory delay measurements. Examination of voice onset gesture may offer an additional laryngeal parameter to assist in the differential diagnosis of spasmodic dysphonia.

Tyrimo probleminis klausimas. Koks propolio koncentrato poveikis riebiai veido odai taikant jonoforezės metodą? Tyrimo objektas. Propolio koncentrato poveikis riebiai veido odai, taikant jonoforezės metodą. Tyrimo tikslas. Įvertinti propolio koncentrato poveikį riebiai veido odai, taikant jonoforezę. Tyrimo metodai. Mokslinės literatūros šaltinių analizė, apklausa žodžiu, vizualinė apžiūra, testavimas, matavimas stebėjimo protokolas, statistinė duomenų analizė. Tyrimo rezultatai. Siekiant įvertinti riebios veido odos pokyčius prieš ir po procedūrų kurso, taikant propolio koncentrato įvedimą jonoforezės metodu, buvo atliekamas odos riebalų kiekio vertinimas Callgari Soft plus diagnostikos aparatu, taip pat odos būklės pasikeitimai fiksuojami fotonuotraukomis prieš ir po. Odos riebalų kiekis kaktoje sumažėjo 31, kairiąjame skruoste 20, dešiniąjame skruoste 16, smakro srityje – 37 skalės vienetais. Oda po procedūrų vizualiai tapo šviesesnė, skaistesnė, lygesnė, pašviesėjo pigmentinės dėmės. Išvados. Įvertinus tiriamosios veido odos būklę prieš ir po procedūrų kurso, siekiant sumažinti sebumo sekrecijos kiekį ir pagerinti bendrą odos būklę, taikant propolio koncentrato riebiai veido odai įvedimą jonoforezės metodu, prieinama išvada, jog procedūros buvo veiksmingos ir pasiekta gerų rezultatų., Research subject. Effect of propolis concentrate for oily facial skin using the method of iontophoresis. Research aim. To evaluate effect of propolis concentrate for oily facial skin using the method of iontophoresis. Research methods. Analysis of scientific sources, oral interview, visual examination, testing, measurement, tracking protocol, analysis of statistical data. Research results. In order to evaluate the changes in oily facial skin before and after the course of procedures, using propolis concentrate via the iontophoresis method, the skin sebum quantity was evaluated using the Callegari Soft Plus diagnostic apparatus. Other changes in the skin condition were evaluated using photographs before and after. The amount of skin sebum in the forehead decreased by 31, the left cheek 20, the right cheek 16, and the chin area - 37 scale units. The skin after the procedures visually became brighter, smoother, hyperpigmentation has lightened. Conclusions. After evaluating the condition of the respondents facial skin before and after the course of the procedures, in order to reduce the amount of sebum secretion and improve the general condition of the skin, using the propolis concentrate for oily facial skin via the method of ionophoresis, it is concluded that the procedures were effective and achieved good results.

Phonotraumatic vocal hyperfunction (PVH) is associated with chronic misuse and/or abuse of voice that can result in lesions such as vocal fold nodules. The clinical aerodynamic assessment of vocal function has been recently shown to differentiate between patients with PVH and healthy controls to provide meaningful insight into pathophysiological mechanisms associated with these disorders. However, all current clinical assessment of PVH is incomplete because of its inability to objectively identify the type and extent of detrimental phonatory function that is associated with PVH during daily voice use. The current study sought to address this issue by incorporating, for the first time in a comprehensive ambulatory assessment, glottal airflow parameters estimated from a neck-mounted accelerometer and recorded to a smartphone-based voice monitor. We tested this approach on 48 patients with vocal fold nodules and 48 matched healthy-control subjects who each wore the voice monitor for a week. Seven glottal airflow features were estimated every 50 ms using an impedance-based inverse filtering scheme, and seven high-order summary statistics of each feature were computed every 5 minutes over voiced segments. Based on a univariate hypothesis testing, eight glottal airflow summary statistics were found to be statistically different between patient and healthy-control groups. L1-regularized logistic regression for a supervised classification task yielded a mean (standard deviation) area under the ROC curve of 0.82 (0.25) and an accuracy of 0.83 (0.14). These results outperform the state-of-the-art classification for the same classification task and provide a new avenue to improve the assessment and treatment of hyperfunctional voice disorders.

Purpose This study investigated the use of neck-skin acceleration for relative fundamental frequency (RFF) analysis. Method Forty individuals with voice disorders associated with vocal hyperfunction and 20 age- and sex-matched control participants were recorded with a subglottal neck-surface accelerometer and a microphone while producing speech stimuli appropriate for RFF. Rater reliabilities, RFF means, and RFF standard deviations derived from the accelerometer were compared with those derived from the microphone. Results RFF estimated from the accelerometer had slightly higher intrarater reliability and identical interrater reliability compared with values estimated with the microphone. Although sensor type and the Vocal Cycle × Sensor and Vocal Cycle × Sensor × Group interactions showed significant effects on RFF means, the typical RFF pattern could be derived from either sensor. For both sensors, the RFF of individuals with vocal hyperfunction was lower than that of the controls. Sensor type and its interactions did not have significant effects on RFF standard deviations. Conclusions RFF can be reliably estimated using an accelerometer, but these values cannot be compared with those collected via microphone. Future studies are needed to determine the physiological basis of RFF and examine the effect of sensors on RFF in practical voice assessment and monitoring settings.

Introduction. Bone density measurements during the last decade have demonstrated that bone loss is common in patients with overt hyperthyroidism and to a lesser extent in those with subclinical hyperthyroidism, whether caused by nodular goiter or excessive doses of thyroid hormone. Overt hyperthyroidism is associated with accelerated bone remodeling, reduced bone density, osteoporosis, and an increase in fracture rate. The bone density changes may or may not be reversible with therapy. These changes in bone metabolism are associated with negative calcium balance, hypercalciuria and, rarely, hypercalcemia. Aim. To investigate frequency and structure of bone disease in patients with thyrotoxicosis, and also to find out the features of clinical manifestations of osteoporosis, taking into account the duration of disease. Materials and methods. 65 patients with thyrotoxicosis syndrome were included. The bone density based on the T-score of femoral neck and lumbar vertebrae were compared between three groups. For densitometry, dual-energy X-ray absorptiometry was used to measure the bone density in lumbar vertebrae (L1–L4, anterior-posterior measurements) and femoral neck. The measurement was performed by an expert technician using densitometer Lunar Prodigy Primo, General Electric, USA. A complete set of data was collected for each patient and include: Patient’s age, history of hypothyroidism or other chronic diseases, weight, height, body mass index (BMI), T-score data of lumbar, and femoral neck densitometry, calcium, phosphorus, alkaline phosphatase, Vitamin D and TSH levels and duration of hypothyroidism. The Ethics Committee of the Bukovinian State Medical University approved this study, and a written informed consent was obtained from all study participants. Data of 65 individuals was analyzed using the regression analysis, analysis of variances and Mann-Whitney (for non-parametric quantitative data) tests. Continuous variables were summarized using means and standard deviation; frequencies and percentages were used to summarize categorical variables. A p < 0,05 was considered statistically significant. Results and discussion. Indexes of bone mineral density was decreased, and frequency of osteoporosis and osteopenia was higher as compared to population indexes in persons of corresponding age. Osteoporosis in one of two basic localizations is lumbar department (L1–L4) and proximal femur was found in 4 patients (6.2 %), osteopenia – in 29 (44.6 %). On the whole the decline of bone mineral density was observed in 33 (50.8 %) patients. Correlation analysis showed statistically significant negative correlation between mineral bone density and age of patients (r = -0.42, р < 0.05), and also weak correlation with the thyrotoxicosis duration (r = -0.18; р < 0.05). Positive correlation was found between mineral bone density and height (r = 0.27; р < 0.05), body mass index (r = 0.29; р < 0.05), and also between the free thyroxine level and mineral bone density (r = 0.19). Conclusions. The expressed unfavorable influence of thyroid hormones high levels is set on bone mineral density. Analysis of bone metabolism markers showed the acceleration of bone resorption. There were significant correlation between the free thyroxine high levels and the markers of bone mineral density. Duration of thyrotoxicosis syndrome had negative correlation with indexes of bone mineral density. During thyrotoxicosis decompensation there is an acceleration of bone exchange, that was.

This case report describes a 5-year-old girl with chronic dysphonia and high-pitched voice since birth. Vocal quality was noted to be harsh. Videostroboscopy revealed significant hyperfunction and a Type II congenital anterior glottic web. Endoscopic division of the anterior glottic web was performed with significant improvement in vocal quality and quality of life. This paper describes methods of analyzing, diagnosing, and treating anterior glottic web with a focus on quality of life. Also, unique acoustic and aerodynamic voice features are identified. No other descriptions of a voice characteristic for anterior glottic web currently exist in the literature.

Purpose. We evaluated a sample of individuals with retinitis pigmentosa (RP) with the aim of assessing the presence or absence of ocular motility (OM) disorders.Materials and Methods. We included 23 out of the 25 individuals from the sample (9 females and 14 males) with an average visual acuity of 6/10.Results. The cover test about the vertical deviation in near distance showed an r/l in 3.45% and an l/r in 6.9%. The assessment of OM showed that 39.1% of the sample had a severe hyperfunction of the IO of the right eye and a severe hyperfunction (34.5%) of the SO of the left eye; 21.8% had a moderate hypofunction of right SO with a moderate percentage of hypofunction of 17.5% for the SO of the left eye; 30.5%, however, showed a serious hypofunction of the SR of both eyes; 21.7% of the sample showed a hyperfunction in both eyes of the IR.Conclusion. This alteration, however, is not attributable to either a high refractive defect (medium-low myopia: −1 diopter±3 SD) or to a severely impaired binocular vision (visual acuity, motor fusion, and stereopsis are normal or within a range of values commonly accepted). Therefore, the disorders of OM lead to a genetic origin.

Despite the frequent observation of a persistent opening in the posterior cartilaginous glottis in normal and pathological phonation, its influence on the self-sustained oscillations of the vocal folds is not well understood. The effects of a posterior gap on the vocal fold tissue dynamics and resulting acoustics were numerically investigated using a specially designed flow solver and a reduced-order model of human phonation. The inclusion of posterior gap areas of 0.03-0.1 cm(2) reduced the energy transfer from the fluid to the vocal folds by more than 42%-80% and the radiated sound pressure level by 6-14 dB, respectively. The model was used to simulate vocal hyperfucntion, i.e., patterns of vocal misuse/abuse associated with many of the most common voice disorders. In this first approximation, vocal hyperfunction was modeled by introducing a compensatory increase in lung air pressure to regain the vocal loudness level that was produced prior to introducing a large glottal gap. This resulted in a significant increase in maximum flow declination rate and amplitude of unsteady flow, thereby mimicking clinical studies. The amplitude of unsteady flow was found to be linearly correlated with collision forces, thus being an indicative measure of vocal hyperfunction.

Purpose The aim of this study was to establish reliability and validity for self-ratings of vocal status obtained during the daily activities of patients with vocal hyperfunction (VH) and matched controls. Method Eight-four patients with VH and 74 participants with normal voices answered 3 vocal status questions—difficulty producing soft, high-pitched phonation (D-SHP); discomfort; and fatigue—on an ambulatory voice monitor at the beginning, 5-hr intervals, and the end of each day (7 total days). Two subsets of the patient group answered the questions during a 2nd week after voice therapy (29 patients) or laryngeal surgery (16 patients). Results High reliability resulted for patients (Cronbach's α = .88) and controls (α = .95). Patients reported higher D-SHP, discomfort, and fatigue (Cohen's d = 1.62–1.92) compared with controls. Patients posttherapy and postsurgery reported significantly improved self-ratings of vocal status relative to their pretreatment ratings ( d = 0.70–1.13). Within-subject changes in self-ratings greater than 20 points were considered clinically meaningful. Conclusions Ratings of D-SHP, discomfort, and fatigue have adequate reliability and validity for tracking vocal status throughout daily life in patients with VH and vocally healthy individuals. These questions could help investigate the relationship between vocal symptom variability and putative contributing factors (e.g., voice use/rest, emotions).

In this paper, there is described a consideration of the functions to explain the new information system and the neural and brain functional system models. In this consideration it is proposed to introduce the hyperfunction as the base functions to explain the new information system and the neural and brain functional system model. For this proposal here firstly the brief history of this research is described and in this description the philosophical methods of this research are discussed and the adaption of interpretant (the element of Peirce’s Semiotics) is explained as the philosophical existence. Secondly the compartment system is described as a basic system for synthesizing the new information system model and the neural and brain functional system model. And there the consideration of functions to explain these systems is extended and the meaning of hyperfunction is expressed and as a result the proposal that on analyzing these systems the introduction of the hyperfuctions as the explaining functions of these systems is useful and should be used is described. And finally, the conclusion and future works are described.

Summary Objective To multidimensionally investigate common vocal effects in experienced professional nonclassical singers, to examine their mechanism of production and reproducibility, to demonstrate the existence of partial glottal vibration, and to assess the potential of damage to the voice from nonclassical singing. Study Design Individual cohort study. Methods Ten male singers aged between 25 and 46 years (34 ± 7 years [mean ± SD]) with different stylistic backgrounds were recruited (five pop/rock/metal, five musical theater). Participants repeatedly presented the usual nonclassical vocal effects and techniques in their repertoire. All performances were documented and analyzed using established instruments (eg, auditory-perceptual assessment, videolaryngostroboscopy, electroglottography, voice function diagnostics). Results The vocal apparatus of all singers was healthy and capable of high performance. Typical nonclassical vocal effects were breathy voice, creaky voice, vocal fry, grunting, distortion, rattle, belt, and twang. All effects could be easily differentiated from each other. They were intraindividually consistently repeatable and also interindividually produced in a similar manner. A special feature in one singer was the first evidence of partial glottal vibration when belting in the high register. The unintended transition to this reduced voice quality was accompanied by physical fatigue and inflexible respiratory support. Conclusion The long-lasting use of the investigated nonclassical vocal effects had no negative impact on trained singers. The possibility of long-term damage depends on the individual constitution, specific use, duration, and extent of the hyperfunction. The incidence of partial glottal vibration and its consequences require continuing research to learn more about efficient and healthy vocal function in nonclassical singing.

Voice disorders are medical conditions that often result from vocal abuse/misuse which is referred to generically as vocal hyperfunction. Standard voice assessment approaches cannot accurately determine the actual nature, prevalence, and pathological impact of hyperfunctional vocal behaviors because such behaviors can vary greatly across the course of an individual's typical day and may not be clearly demonstrated during a brief clinical encounter. Thus, it would be clinically valuable to develop noninvasive ambulatory measures that can reliably differentiate vocal hyperfunction from normal patterns of vocal behavior. As an initial step toward this goal we used an accelerometer taped to the neck surface to provide a continuous, noninvasive acceleration signal designed to capture some aspects of vocal behavior related to vocal cord nodules, a common manifestation of vocal hyperfunction. We gathered data from 12 female adult patients diagnosed with vocal fold nodules and 12 control speakers matched for age and occupation. We derived features from weeklong neck-surface acceleration recordings by using distributions of sound pressure level and fundamental frequency over 5-min windows of the acceleration signal and normalized these features so that intersubject comparisons were meaningful. We then used supervised machine learning to show that the two groups exhibit distinct vocal behaviors that can be detected using the acceleration signal. We were able to correctly classify 22 of the 24 subjects, suggesting that in the future measures of the acceleration signal could be used to detect patients with the types of aberrant vocal behaviors that are associated with hyperfunctional voice disorders., National Library of Medicine (U.S.). Biomedical Informatics Research Training Program, Intel Corporation. Science and Technology Center, National Institute on Deafness and Other Communication Disorders (U.S.) (Grant t R33 DC011588), Comision Nacional de Investigacion Ciencia y Tecnologia (Chile) (Grant FONDECYT 11110147), MIT International Science and Technology Initiatives. MIT-Chile Seed Fund (Grant 2745333)

We solve the Ulam problem for the sine addition formula in the spaces of Schwartz distributions and Gelfand hyperfunctions with respect to bounded distributions and bounded hyperfunctions.

AIM To evaluate long term follow-up (10y) of 6 muscle surgical approach in essential infantile esotropia (EIE). METHODS A 6 muscle approach to EIE was retrospectively evaluated in patients with inferior oblique (IO) hyperfunction and lateral rectus (LR) pseudoparalysis, who underwent surgery at different ages. Different clinical characters were analyzed pre- and postoperatively, in patients who underwent a 6 muscles approach ≤4 years of age. All patients underwent a multiple muscles approach: bilateral medial recti (MR) recession (4-5 mm), bilateral LR resection (lower than 7 mm) and bilateral IO recession and anteroposition. Of 108 children with preoperative angle ≥+30 prism diopters (PD) and IO hyperfunction were selected from larger cohort of patients (n=213, 103 females and 110 males) after excluding patients with: angle variability, who underwent reoperation and with incomplete follow up. Preoperative assessment and complete orthoptic examination were performed. Follow-up was performed 3mo, 2, 5 and 10y after surgery. Statistical analysis was performes using SAS statistical software package (version 9.1, SAS Institute Inc., Cary, NC, USA). RESULTS Ten years follow up data analysis showed the following percentage of orthotropic patients: (0 PD): 3mo, 22.2%; 2y, 16.7%; 5y, 25.0% and 10y, 27.8%. A slight, significant (P

Summary Objective To investigate the immediate effects of the Finnish resonance tube method for teachers with behavioral dysphonia. Methods Twenty-five female teachers (m = 39.9 years of age) with at least a 5-year history of dysphonia were included. Additional inclusion criteria were the diagnosis of chronic behavioral dysphonia with an indication for speech therapy and the absence of any prior speech therapy. Subjects produced three sets of 10 tokens of sustained phonation with a 1-minute rest interval between tokens into a 27-cm glass tube immersed in at least 2 cm of water. Voice samples were recorded before and after these sets. The effects of these exercises were evaluated by self-assessment, auditory perceptual analysis, and acoustic evaluation involving extraction of fundamental frequency and visual spectrographic analysis. Results Sixty-eight percent of the teachers reported increased phonatory comfort and 52% reported improved voice quality after performing the exercises. Perceptual analysis indicated improved voice quality in the samples of counting numbers, confirmed by decreased instability, subharmonics, noise in high frequencies, and the tendency for reduced low frequency noise on spectrographic evaluation. Additionally, mean fundamental frequency decreased. Conclusion The Finnish resonance tube method increased phonatory comfort and vocal changes suggestive diminished hyperfunction.

Objectives/Hypothesis The present study aims to evaluate the degree of anterior–posterior and medial supraglottic laryngeal compression in healthy singers of different voice classifications while singing different pitches, loudness, and phonatory tasks. Study Design Prospective study. Methods Thirty-six classically trained singers (11 sopranos, 11 mezzo-sopranos, six tenors, and eight baritones) with at least 5 years of voice training and absence of any voice pathology within the past year were included. Flexible endoscopic voice evaluations were recorded and edited to include samples of different pitches, levels of loudness, and phonatory tasks. Sound was removed from the video samples. Two blinded laryngologists were asked to assess medial and anterior–posterior supraglottic compression using a visual analog scale for each sample. Results Medial compression was significantly greater in male subjects and specifically tenors during loud phonation, during high pitch, and while phonating the vowel /a/. Anterior–posterior compression was also significantly greater in males and specifically baritones during loud voice production and with phonation of the vowel /a/. No difference was noted in relation to pitch. Correlation between anterior–posterior and medial compression was demonstrated. Medial compression was less severe than anterior–posterior compression. Conclusions Supraglottic hyperfunction is present in healthy singers. Recognizing factors that might affect supraglottic hyperfunction in the healthy voice may help us to understand when hyperfunction is truly contributing to a patient's vocal pathology. Level of Evidence 4. Laryngoscope, 124:504–509, 2014

Objective: Excessive supraglottic and abnormal fine vibratory characteristics associated with vocal hyperfunction are identified even in individuals with normal laryngeal structure, function and vocal quality when they undergo stroboscopy, possibly due to anxiety. The purpose of this study is to (a) test for vocal hyperfunction in individuals with normal laryngeal structure and function and if present, (b) to track changes in vocal hyperfunction associated with anxiety when stroboscopy is repeated within 24-48 h. Participants and Methods: Thirty participants, naïve to stroboscopy, underwent the procedure and completed the State-Trait Anxiety Inventory 3 times over 24-48 h. Results: 41.4% of participants demonstrated vocal hyperfunction in supraglottic and fine vibratory characteristics after the first trial. Vocal hyperfunction decreased to 27.6% after the third trial. Results showed a significant main effect of time indicating that vocal hyperfunction decreased as participants repeated stroboscopy. Although the average anxiety score decreased across trials, state (anxiety) had no significant effect on change in vocal hyperfunction. Conclusions: In the real world, true representation of vocal function can be achieved by getting a patient acquainted to the presence of strobe in the oral cavity and practice the tasks that will be attempted during the procedure without introducing vocal hyperfunction and most importantly, without the use of a topical anesthetic.

Factors influencing the outcome of intermittent exotropia surgery Objective: This study aims at the evaluation of factors influencing the outcome of intermittent exotropia surgery. Material and Methods: Sixty-seven patients with intermittent exotropia were included. The patient files were retrospectively evaluated for the factors influencing the postoperative outcome. Among these evaluated factors are age, the age at onset of strabismus, type of deviation (convergence insufficiency, divergence excess or simple exotropia), age at operation, amount of preoperative misalignment, the time between the age of onset of deviation and age at operation, the refraction defect, presence of anisometropia or amblyopia and A-V pattern, hyperfunction of oblique muscles, binocular single vision and amount resection and recession. The outcome was assigned as successful operation (ortophoric or residual deviation below 10 pd) and unsuccessful operation (residual deviation above 10 pd). Results: Mean age of onset of deviation was 4.46±3.94 (min:0, max:15) and mean age at operation was 21.14±12.13 (min:2, max:47). At the last visit of their follow-up 42 patients (62.7%) were assigned as successful operation whereas 25 patients (37.3%) were as unsuccessful. There was no significant relation between the age at onset of strabismus, type of deviation, age at operation, the time between the age of onset of deviation and age at operation, the refraction defect, presence of amblyopia and A-V pattern, oblique muscle dysfunction and binocular single vision with postoperative outcome (p=0.121). Operational success was better for the patients without anisometropia (p=0.042). There was a negative relation between the exchanged muscle amount and the success (p=0.012). The success rate was lower as the amount of exchanged muscles elevated. Conclusion: It has been found that the most important factors influencing the outcome of strabismus surgery are the presence of anisometropia and the amount of preoperative deviation.

Purpose In this study, the authors aimed to determine the relationship between relative fundamental frequency (RFF) and listener perception of vocal effort in individuals with varying degrees of vocal hyperfunction. Method Thirty women diagnosed with voice disorders commonly associated with vocal hyperfunction and 10 healthy women provided speech samples that were used to obtain parameters of RFF. Twelve listeners judged the speech samples for overall severity and vocal effort (VE) using rating scales. Results Significant but relatively weak negative correlations were found between perceptual measures and offset RFF parameters. Although offset RFF was increased in healthy participants relative to speakers with voice disorders, no differences were seen in RFF as a function of severity of VE in individuals with voice disorders. Conclusions Although a statistically significant correlation between offset RFF and VE was found, examination of data as a function of both VE and health status indicated that RFF more accurately classifies the presence of a voice disorder than does severity of voice quality or VE. There is a need for further research to investigate the clinical utility of RFF measures for assessment of rehabilitation progress.