노인성 음성에 대한 최신 연구동향

임재열,Lim, Jae-Yol 대한후두음성언어의학회 2014 대한후두음성언어의학회지 Vol.25 No.1

Aging causes a variety of changes in the structure of the vocal fold (VF), resulting in aging-induced dysphonia (presbyphonia). Several studies have investigated the structure of the VF of elderly people from autopsy as well as animal studies. There is an increasing evidence on correlation of structural changes of VF with deteriorated voice in elderly. Although the cellular mechanisms of aging VF have only partially been elucidated, there are many recent advances in biological treatment on aging VF using bioactive molecules such as growth factors. In this study, I'd like to address aging-related structural, biological, and physiological changes in previous literature about human and rodent aging VFs, to provide further insight into the mechanisms responsible for presbyphonia and to translate the basic researches for future clinical trials.

편측 성대마비에서 Restylane을 이용한 성대내 주입치료 1예 -증 례 보 고-

박태준,임재열,서형석,최홍식,Park, Tae-Joon,Lim, Jae-Yol,Seo, Hyung-Seok,Choi, Hong-Shik 대한후두음성언어의학회 2004 대한후두음성언어의학회지 Vol.15 No.1

When a person was suffered from vocal cord paralysis or glottic insufficiency, injection materials (e.g Teflon, Bovine collagen, Autologous fat & tendon, Gelfoam) into the vocal cord have been widely used. But each injection material has some disadvantage. We introduce the Restylane which is composed of a hyaluronic acid, artificially producted. It has advantage of rate foreign body reaction, proper endurance, easy to injection. The patient was 55-year-old woman who showed left vacal cord paralysis after pneumonectomy due to aspergillosis, taken the type I thyroplasty and arytenoid adduction. The middle portion of left vocal cord has some atropic mucosal change, slight chink was noted. The restylane injection into vocal cord was done with suspension laryngoscopy under general anesthesia. In the 3 month follow-up after Restylane injection, the quality of voice has been better progressively. We report a case of Restylane injection as a new method for the improvement of quality of voice.

혈관용해 레이저를 이용한 후두미세수술 최신 지견

강민석,임재열,Kang, Min Seok,Lim, Jae-Yol 대한후두음성언어의학회 2021 대한후두음성언어의학회지 Vol.32 No.2

There are several lasers available for office-based or suspension microlaryngoscopy laser procedures in the treatment of laryngeal diseases. Each has advantages and disadvantages given the depth of penetration per unit of power, absorption in water, spectral absorption characteristics, mode of delivery, safety, and cost. It is important to note that while the proper selection of indication of treatment based on a laser wavelength is critical, of equal importance is selecting the appropriate power setting, focal length (or spot size), and time of exposure. The photoangiolytic lasers precisely target hemoglobin within the microcirculation of the highly vascularized tissue and may have better hemostatic effects and preservation of surrounding normal tissue than the CO₂ laser. Although the choice of laser is purely theoretical and cannot be accurately concluded which parameters of laser (wattage and pulse width) were best to use, photoangiolytic laser surgery is safe and effective for specific laryngeal lesions. In this review, indications for photoangiolytic laser procedures for various laryngeal diseases, laser settings and surgical techniques for specific laryngeal lesions including sulcus vocalis, laryngeal dysplasia, and recurrent respiratory papillomatosis will be introduced. Pros and cons of in-office laser surgery using photoangiolytic laser and flexible CO₂ laser will also be addressed.

직업적 음성사용자의 특징

최정석,임재열,김영모,Choi, Jeong-Seok,Lim, Jae-Yol,Kim, Young-Mo 대한후두음성언어의학회 2013 대한후두음성언어의학회지 Vol.24 No.1

The population of professional voice users is increasing in Korea, nowadays. Voice problems in professional voice users cause more negative impact to have their ability to work and maintain their well-being life. In this article, the authors reviewed the characteristics of professional voice users and described the evaluation methods, treatment option and managements in professional voice users.

일측 성대마비 환자에서 성대내전술 후 성대접촉율의 증가가 음질 개선에 미치는 영향

김한수,최성희,임재열,최홍식,Kim, Han-Su,Choi, Seung-Hee,Lim, Jae-Yol,Choi, Hong-Shik 대한후두음성언어의학회 2004 대한후두음성언어의학회지 Vol.15 No.1

Purpose : To assess perceptual, acoustic and aerodynamic measure of voice quality in patients with unilateral vocal cord paralysis before and after type I thyroplasty. Methods : The clinical records of patients operated type I thyroplasty in the Departement of otorhinoalryngolgy, Yongdong Severance hospital from November 2001 to November 2003 were reviewed. All patients uderwent a vocal function evaluation including perceptual, acoustic and aerodynamic measures of voice preoperative and on $60^{th}$ postoperative day. The perceptual and acoustic measures were obtained from recording of patients' reading a 'Sanchak' passage. The perceptual evaluation was performed by 2 speech pathologist using a 4-point rating scale. Acoustic parameters(voice range profile low(RAL), voice range profile high(RAH), average fundamental frequency(AFX), closed quotient, harmonic to noise ratio, jitter and shimmer) were investigated by Lx speech studio. Mean flow rate(MFR), subglottic pressure(Psub) and intensity were measured using the Phonatory function analyzer. The maximum phonation time was also measured. The data were statistically analyzed. A paired t-test (p<0.1) was used to compare preoperative and postoperative results. And multiple regression test was used to find which parameter was most correlated to improvement of postoperative voice quality. Results : Among aerodynamic parameters, Psub $(88.11mmH_2O{\rightarrow}58.7mmH_2O)$, MPT(7.87sec${\rightarrow}$12.53sec), MFR (359.8ml/sec${\rightarrow}$161.06ml/sec) were statistically improved. AFx(205.5Hz${\rightarrow}$163.27Hz), AQx(23.9%${\rightarrow}$48.3%), RAL, RAH. Jotter and shimmer were improved. In multiple regression test, AFx and AQx was noted as the two meost correlated parameters to improvement of postoperative breathiness. But general grade of voice quality was more correlated to Psub and shimmer. Conclusion : Vocal fold medialization procedures effectively reduce glottic gap. Increasing of contact area of both vocal folds induced improvement in aerodynamic parameters and leaded stabilizing of vocal fold vibration. That effect results in improvement in acoustic parameters (shimmer, jitter, signal-to-noise ratio, voice range profile) and voice quality.

성대구증에서 KTP Laser를 사용한 수술적 치료 1례

정찬민,김지형,임재열,최홍식,Jung, Chan Min,Kim, Jihyung,Lim, Jae-Yol,Choi, Hong-Shik 대한후두음성언어의학회 2017 대한후두음성언어의학회지 Vol.28 No.2

Sulcus vocalis remains a surgical challenge despite many recent advances in laryngomicrosurgeries. We previously reported that 585-nm Pulsed dye laser (PDL) exerts favorable outcome in treatment of sulcus vocalis due to its therapeutic effects of collagen rearrangement and improved wound remodeling. In spite of the usefulness of PDL glottoplasty for treating sulcus vocalis, the device is no more available in the country. It prompted us to focus another angiolytic laser ; 532-nm KTP laser which has similar mechanisms of action and has been used for treatment of other laryngeal lesions elsewhere. Herein, we present a case of sulcus vocalis successfully treated with KTP laser. A patient underwent laryngomicrosurgery with angiolytic KTP laser (KTP glottoplasty) by the same surgical procedure with PDL glottoplasty. After the surgery, the patient presented improved voice outcome in time without complications.

전기성문파형검사를 이용한 모음과 공명 자음의 발성특성

최성희,남도현,임재열,임성은,최홍식,Choi, Seong-Hee,Nam, Do-Hyun,Lim, Jae-Yol,Lim, Sung-Eun,Choi, Hong-Shik 대한후두음성언어의학회 2004 대한후두음성언어의학회지 Vol.15 No.2

Background and Objectives : Vowels and resonant including nasals and liquid are produced with vocal folds vibration have been used for voice therapy of hyperadduction patients. This study was conducted to investigate phonatory characteristics of vowels and resonant consonants through the EGG measures from Lx. Speech studio (Laryngograph Ltd, UK). Materials and Method : 7 male adults produced sustained vowel /a/, /i/, /u/, nasals /m/, /n/, /${\eta}$/and liquid /I/ and read the sentences (1nasals-liquid sentence, 1 non-nasals-liquid sentence) and tongue-tip trill and humming. Fx(Hz), Ox(%) were obtained of vowels, nasals, liquid and each of the posterior vowel /a/ of /ma/, /na/, /la/, /ha/ with same F0(around F#165Hz) and amplitude (75${\pm}$5db). And also DFx(Hz), DQx(%), CFx(%) and CAx(%) were obtained from reading two kinds of sentences. Results : Qx(%) was the highest in /u/ of vowels, and nasal/n/ of the resonant consonants and nasals-liquid sentence was higher Qx than non-nasals-liquid sentence but significant differences were not found. Qx(%) of the posterior vowel /a/ of nasal consonants/n/ was higher than in the isolated vowel/a/ and other posterior vowel of resonant consonants and fricatives /h/. Regularity or periodicity and higher Qx were observed in the nasals-liquid sentence than non-nasals-liquid sentence in graphs of QxFx & CFx produced by Quantiative analysis. In the nasalance score, /u/vowel was significant higher among the vowels and /I/ liquid was significant lower among the resonant consonants and nasals-liquid sentence is higher than non-nasals -liquid sentence. CQ(%) was not significantly correlated with nasalance(%). Conclusion : These findings might signify resonant phonation was not correlated with nasalance.

양성 갑상선 질환으로 편측 갑상선 절제술을 시행한 후 발생되는 갑상선 기능 저하증에 대한 위험인자

이석재(Seok-Jae Lee),김경태(Kyung-Tae Kim),조병한(Byung Han Cho),임재열(Jae-Yol Lim),김영모(Young-Mo Kim) 대한두경부종양학회 2010 대한두경부 종양학회지 Vol.26 No.2

Objectives :There are various reports for incidence and risk factors of hypothyroidism after hemithyroi-dectomy for benign thyroid disease. The reported incidence rate varies from 5.0 to 41.9%. Moreover, there are few reports about this in Korea. So, our objective is to identify the incidence and possible factors contributing to hypothyroidism after hemithyroidectomy in Korea. Subjectives and Methods :We reviewed medical re-cords of patients who underwent hemithyroidectomy between 1999 and 2007 years. We enrolled 80 patients. The incidence of postoperative hypothyroidism was based on thyrotropin values and clinical symptoms. And all patients were evaluated for age, gender, serum thyrotropin(TSH) levels, serum free T4, weight of resected thyroid tissue and associated thyroiditis. Results :Nine of 80 patients(11.3%) became biochemically hypothyroid postoperatively. Six of 9 hypothyroid patients were diagnosed within 2 months of operation. The mean preope-rative TSH level was 2.12±0.96mIU/L in hypothyroid and significantly different from 1.33±0.77mIU/L in euthyroid patients(p<0.05). There were no significant differences in age, gender, weight of resected thyroid tissue, preoperative free T4 and associated thyroiditis. Conclusion :A minority of patients became hypothyroid after hemithyroidectomy. Hypothyroidism following hemithyroidectomy occurred in patients with higher preo-perative TSH levels.. The screening test for postoperative hypothyroidism should be performed from month to year after operation.

후두에 발생한 방추세포암종 1예

홍기민,정기화,임재열,최정석,Hong, Ki-Min,Jung, Gi-Hwa,Lim, Jae-Yol,Choi, Jeong-Seok 대한후두음성언어의학회 2014 대한후두음성언어의학회지 Vol.25 No.1

Spindle cell carcinoma is an uncommon type of squamous cell carcinoma characterized by a mixture of malignant epithelial and mesenchymal cells. Most spindle cell tumors are polypoid and pedunculated. It is usually detected at an early stage, removed by laryngoscope guided polypectomy at the time of diagnosis, and seems to have good prognosis. The tools for diagnosing spindle cell carcinoma are histopathological analysis and immunohistochemical analysis. With reviews of literature, we report a 72-year-old patient complaining of hoarseness and dysphagia who was later diagnosed as spindle cell carcinoma.

변형된 Fish-Mouth Technique을 이용한 새로운 기관공성형술식

백승재(Seung Jae Baek),임재열(Jae-Yol Lim),홍현준(Hyun Jun Hong),최홍식(Hong-Shik Choi) 대한두경부종양학회 2010 대한두경부 종양학회지 Vol.26 No.1

Tracheostomal stenosis after total laryngectomy is brothersome problem to surgeon and patient. To prevent tracheostomal stenosis, tension around the tracheostoma must be released. Advancement flap, V-Y inset and Z-plasty were suggested as solution to tracheostomal stenosis. But such methods need elevation of superior flap and it is very difficult when the patients received radiotherapy and has high change of developing pharyngo-cutaneous fistula. We suggested new stomaplasty technique which named “Modified Fish-Mouth Technique” that does not need to elevate superior skin flap.