후두전적출술 52 례에 대한 임상통계학적 고찰

왕수건(Wang Soo Geun),전경명(Chon Kyong Myong),이종담(Lee Jong Dam) 대한두경부종양학회 1987 대한두경부 종양학회지 Vol.3 No.1

A retrospective investigation of 52 cases of carcinoma of the larynx, who underwent total laryngectomy c(-) or s(-) neck dissection at Pusan National University Hospital from 1978 to 1985, was performed. The results obtained were as follows: 1) There were 32 glottic(62.7%), 18 supraglottic(35.3%) and 1 subglottic(2.0%) carcinoma. 2) In stage grouping, stage III was the most(64.7%) and then stage II, stagelV, stage I in order. 3) Overall rate of cervical metastasis was 29.4%. In glottic carcinoma, 0% of T1, 40% of T2 , 18% of T3 and 25% of T4. In supraglottic carcinoma, there was 0% of Tl' 29% of Tv 56% of T3 and 50% of T4. 4) The incidence of postoperative complication was 31.4% and stomal stenosis was the most (13.7%) 5) There were 8 cases of local recurrence and 3 cases of distant metastasis (2 cases in lung, 1 case in esophagus) among 40 cases which were able to follow up. 6) 3 year estimated survival rate for glottic and supraglottic carcinoma were 73.3% and 85.7% respectively.

후두 전 절제 환자에서 음성재활을 위한 기관식도발성

왕수건,장선미,Wang, Soo-Geun,Jang, Sun-Mi 대한후두음성언어의학회 2008 대한후두음성언어의학회지 Vol.19 No.1

Total laryngectomy is the most useful procedure tor advanced laryngopharyngeal cancer, but it remains the major problem such as loss of voice. Voice restoration is essential for every patients who undergo a total laryngectomy. Ideal voice rehabilitation methods can resolve three factors. First, every laryngectomee can produce voice sufficient for communication, second every patient should be allowed to use both hands freely during phonation, and last, the voice restoration methods should be easy and safe without complication during and after treatment. Among various voice rehabilitation procedures during or after total laryngectomy, it can be divided electronic and pneumatic methods. In pneumatic methods, there are also divided both pulmonary air and non-pulmonary air methods. The non-pulmonary air methods include esophageal speech, buccal speech, and pharyngeal speech. Pulmonary air methods are divided into surgical and non-surgical such as pneumatic speech aid. In the surgical methods, there are neoglottic operation, tracheopharyngeal shunt, and tracheopharyngeal shunt operations. Recently, tracheoesophageal shunt with or without prosthesis are being recognized the most effective method. Blom-Singer low pressure prosthesis, Panje button, and Provox are well known types of prosthesis in the tracheoesophageal shunt operation. Amatsu method is a kind of famous tracheoesophageal shunt method without using prosthesis. Authors tried to review the published articles for evaluation of effectiveness and problems of tracheoesophageal shunt operation with or without prosthesis. In conclusion, indwelling type of prosthesis and pharyngeal myotomy and plexus neurectomy are recommended for higher success rate during tracheoesophageal puncture procedure. More over, Amatsu method is also one of the recommended voice rehabilitation procedure during total laryngectomy. In this situation, pharyngeal myotomy and plexus neurectomy may be helpful for better fluent communication.

성대진동검사

왕수건,Wang, Soo-Geun 대한후두음성언어의학회 2013 대한후두음성언어의학회지 Vol.24 No.1

Because the human voice is produced through vibration of the vocal cords during the exhalation of airflow, it is important to observe the vibration pattern of the vocal cords in patients complaining of voice changes. However, it is not easy to observe the actual vibration pattern of the vocal cord because it vibrates so fast that it cannot be observed by the naked eye and it is located deep in the throat. Recently, with advances in instruments, including laryngoscopes and video camera systems, the vibration pattern of the vocal cords can now be observed. However, considering that present video camera systems can detect 30-60 images per second and the vocal cord vibrates at 100-200 and 200-300 times per second in men and women, respectively, it is not possible to record the whole mucosal wave of the vocal cord in real time. To overcome this limitation, a stroboscope, which converts fast movements of the vocal cord into slower images, has been developed. Since then, several instruments were developed to examine vocal vibration pattern. However, each instruments have advantages and disadvantages. Therefore, we should know about these things to apply them in patients with voice problem.

성문암과 후두백반증 음성의 켑스트럼 분석 및 청지각적 평가

김근효(Geun Hyo Kim),이연우(Yeon Woo Lee),배인호(In Ho Bae),박희준(Hee June Park),이재석(Jae Seok Lee),왕수건(Soo Geun Wang),권순복(Soon Bok Kwon) 한국언어치료학회 2016 言語治療硏究 Vol.25 No.3

Purpose : Time-based acoustic perturbation has limitations because it cannot accurately extract the cycle of voice signals in non-periodic, rough, breathy voices. The purpose of this study is to compare the cepstral analysis between glottic cancer and laryngeal leukoplakia. Methods: Fifty male glottic cancer patients and fifty male vocal fold leukoplakia patients were evaluated. After their criteria were confirmed, signal analysis was performed using Analysis of Dysphonia in Speech and Voice (ADSV) and SpeechTool software. This study confirmed the correlation of the cepstral measures and GRBAS scale. Individuals were recorded reading a standard passage ('Sanchaek') and sustaining the vowel /A/. Cepstral measures were obtained for CPP (dB), L/H Spectral Ratio (dB), Mean CPP F0 (Hz), SpeechTool's CPPs, and Mean CPP F0 (Hz). Statistical analyses were applied to Independent-samples t-test in SPSS 19.0 and receiver operating characteristic in Med Calc. Results: The results revealed a significant result on measures of CPP (dB), L/H Spectral Ratio (dB), and Mean CPP F0 (Hz) in both groups. In a sample of glottic cancer speakers versus leukoplakia speakers, cepstral measures of CPP, L/H ratio, Mean CPP F0 were able to differentiate these groups from one another in both sustained vowel phonation and continuous speech contexts with high sensitivity and specificity. Conclusions: The results of this study support the growing body of literature documenting the significant value of cepstral based acoustic measures to the clinical evaluation and management processes.

역류증상지수와 역류소견점수의 타당성과 신뢰도

이병주,왕수건,이진춘,Lee, Byung-Joo,Wang, Soo-Geun,Lee, Jin-Choon 대한후두음성언어의학회 2007 대한후두음성언어의학회지 Vol.18 No.2

Laryngopharyngeal reflux (LPR) is the retrograde movement of gastric contents into the larynx, pharynx, and upper aero-digestive tract. LPR differs from gastroesophageal reflux in that it is often not associated with heartburn and regurgitation symptoms. Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms. Belafsky et al. developed a useful self-administered tool, the reflux symptom index (RSI), for assessing the degree of LPR symptoms. Patients are asked to use a 0 to 5 point scale to grade the following symptoms: 1) hoarseness or voice problems; 2) throat clearing; 3) excess throat mucus or postnasal drip ; 4) difficulty swallowing; 5) coughing after eating or lying down; 6) breathing difficulties ; 7) troublesome or annoying cough; 8) sensation of something sticking or a lump in the throat; 9) heartburn, chest pain, indigestion or stomach acid coming up. A RSI score greater than 13 is considered abnormal. As there is no validated instrument to document the physical findings and severity of LPR, Belafsky et al. developed an eight-item clinical severity scale for judging laryngoscopic finding, the reflux finding score (RFS). They rated eight LPR-associated findings on a scale from 0 to 4 : subglottic edema, ventricular obliteration, erythema/hyperemia, vocal-fold edema, diffuse laryngeal edema, posterior commissure hypertrophy, granuloma/granulation tissue, and thick endolaryngeal mucus. A RFS score of greater than 7 was found to suggest LPR-associated laryngitis. Although both indices (RSI and RFS) are widely used, there is some controversy about their validity (sensitivity and specificity) and reliability (intra-rater and inter-rater) in LPR diagnosis and treatment. We discuss the validity and reliability of RSI and RFS with literature review.

복식호흡 훈련과 Self Voice Feedback 프로그램이 성대결절 환자의 음성개선에 미치는 효과

권순복,왕수건,양병곤,전계록,Kwon, Soon-Bok,Wang, Soo-Geun,Yang, Byung-Gon,Jeon, Gye-Rok 한국음성학회 2006 음성과학 Vol.13 No.3

This study attempted to compare acoustic parameters, physiological observation and perceptual evaluation values obtained from the treatment and control groups in order to find out which of the self voice feedback therapies was better and which methods to train them were more effective. The experimental group carried out various self voice feedback therapies while the control group did only vocal hygiene. The acoustic measurement and voice manipulation for providing the patients visual, auditory feedback were done by a speech analysis software, Praat. The authors designed vocal hygiene, abdominal respiration and Praat self voice feedback therapies and applied them to 15 patients while applying only one vocal hygiene to 15 of the control group. For the purpose of examining the degree of their voice improvement after the treatment, pre- mid- and final evaluations were made for the two groups at the beginning, the 6th week and immediately after the 8th treatment session. Results of this study were as follows: The treatment group showed much improvement after receiving the voice treatment. In particular, acoustical and physiological indices from the optical endoscopy, pitch variation(Jitter), amplitude variation (Shimmer), maximum phonation time(MPT), and psychoacoustic evaluation showed statistically significant improvements over the control groups.

Motor Speech Profile을 통한 한국 정상화자의 말수행력 특성 분석

김근효(Geun Hyo Kim),박희준(Hee June Park),배인호(In Ho Bae),이연우(Yeon Woo Lee),왕수건(Soo Geun Wang),권순복(Soon Bok Kwon) 한국언어치료학회 2015 言語治療硏究 Vol.24 No.2

Purpose: It is critical to implement objective analyses and comparison regarding speech performance in order to assess and understand sub-optimal verbal motor functions. So far, the Motor Speech Profile, a CSL sub program of KayPentax, has been widely utilized for objective speech performance analyses. It is however, difficult to adopt to make comparisons for normal Korean speakers given the threshold and reference values of the program were based on results obtained from foreign speakers. Thus, in the present study, speech performance of normal Korean speakers was analyzed using the Motor Speech Profile thereby providing/establish reference values for Korean. Methods: A total of 334 Korean adults (136 male and 198 female subjects) were enrolled for the study and categorized by age: 20-39 year old, 40-59 year old, and older than 60 year old. Within a normal range of pitch and strength, subject's voice was obtained while phonating vowel /a/ and then, repetition of vowel phonating (i-u), and diadochokinetic assessment (pa, ta, ka, a) were performed. Two experienced examiner edited for ranges of stable voice for further analyses. Results: When compared between sexes, 10 parameters showed statistical significant whilst it was demonstrated that multiple parameters were statistically reduced by each group. Variables related to the vF0, vAm, F2rate, /pa/DDKavp, /pa/DDKjit, /ta/DDKavr were more influenced by the group yet the F0, F2magn, F2aver related variables were rather impacted by subjects' gender. Conclusion: It is significant to establish reference values for speech performance through objective assessment tools. Given the scant information available, further investigations with regards to speech performance in normal Korean speakers may provide objective database to distinguish impaired speech performances resulted by normal aging processes from pathological consequences.

Post-Processing of High-Speed Video-Laryngoscopic Images to Two-Dimensional Scanning Digital Kymographic Images

차원재,왕수건,장전엽,김근효,이연우,Cha, Wonjae,Wang, Soo-Geun,Jang, Jeon Yeob,Kim, Geun-Hyo,Lee, Yeon-Woo The Korean Society of Laryngology 2017 대한후두음성언어의학회지 Vol.28 No.2

Background and Objectives : High-speed videolaryngoscopy (HSV) is the only technique that captures the true intra-cycle vibratory behavior of the vocal folds by capturing full images of the vocal folds. However, it has problems of no immediate feedback during examination, considerable waiting time for digital kymography (DKG), recording duration limited to a few seconds, and extreme demands for storage space. Herein, we demonstrate a new post-processing method that converts HSV images to two-dimensional digital kymography (2D-DKG) images, which adopts the algorithm of 2D videokymography (2D VKG). Materials and Methods : HSV system was used to capture images of vocal folds. HSV images were post-processed in Kay image-process software (KIPS), and conventional DKG images were retrieved. Custom-made post-processing system was used to convert HSV images to 2D-DKG images. The quantitative parameters of the post-processed 2D-DKG images was validated by comparing these parameters with those of the DKG images. Results : Serial HSV images for all phases of vocal fold vibratory movement are included. The images were converted by the scanning method using U-medical image-process software. Similar to conventional DKG, post-processed 2D DKG image from the HSV image can provide quantitative information on vocal fold mucosa vibration, including the various vibratory phases. Differences in amplitude symmetry index, phase symmetry index, open quotient, and close quotient between 2D-DKG and DKG were analyzed. There were no statistical differences between the quantitative parameters of vocal fold vibratory movement in 2D-DKG and DKG. Conclusion : The post-processing method of converting HSV images to 2D DKG images could provide clinical information and storage economy.

우측 반회후두신경을 침범한 갑상선 유두상암 환자의 수술 후 발생한 양측 성대 마비의 회복 1예

문미진,왕수건,이윤세,임윤성,이진춘,강양호,손석만,김인주,Mun, Mi Jin,Wang, Soo Geun,Lee, Yoon Se,Lim, Yun-Sung,Lee, Jin Chun,Kang, Yang Ho,Son, Seok Man,Kim, In Joo 대한기관식도과학회 2011 大韓氣管食道科學會誌 Vol.17 No.1

Vocal cord paralysis (VCP) is a common complication after thyroidectomy despite the continuity of the recurrent laryngeal nerve (RLN) is preserved. Much efforts have been made into preventing VCP, but few of them focuses on the treatment strategies and prognosis after VCP take place. In this case, patient visited the clinic for papillary thyroid cancer in Rt. thyroid gland without VCP. She underwent total thyroidectomy with central neck dissection. During dissection, Rt main mass was encircling Rt. RLN. To make matters worse, Lt. RLN was severed due to tight attachment with Berry's ligament. After that, intratumoural dissection of Rt. RLN and end to end anastomosis of Lt. RLN were performed with microscopy to preserve the functions of RLNs as much as possible, otherwise permanent bilateral VCPs were inevitable. We report this case, since both vocal cords recovered from VCPs with symmetric, synchronous movements at postoperative follow up.

후두 스트로보스코프 검사의 신호 동기화를 위한 진동 검출기의 유용성

이진춘,이병주,왕수건,노정훈,권순복,조철우,Lee, Jin-Choon,Lee, Byung-Joo,Wang, Soo-Geun,Roh, Jung-Hoon,Kwon, Sun-Bok,Jo, Cheol-Woo 대한후두음성언어의학회 2007 대한후두음성언어의학회지 Vol.18 No.1

Objective and Background: Laryngeal stroboscope is an useful equipment in evaluation of vocal cord vibration and in early detection of mucosal lesion including invasive cancer of the vocal cord. Recently Lee et al. (2006) developed portable stroboscope using voice as synchronization signal. It has been frequently impaired ability to synchronize the flashes even in normal female. Authors tried to investigate various methods including vibration pick-up, microphone, laryngeal microphone, and contact microphone for development of simple and accurate method like electroglottograph signal. The purpose of this study was to estimate wheher the vibration pick-up is available and is consistent with the signal of EGG. Subjects and Methods: Authors compared the signals between EGG and noncontact method such as voice, contact methods including vibration pick-up, laryngeal microphone, and contact microphone in normal twenty adults (male 10 and female 10). The number of peak in one cycle was compared with the number of the peak in EGG, and the percent of phase difference in the peak was compared with EGG Also, authors tried to investigate which site of vibration pick-up was most effective for synchronization of stobo flashes. Three site including anterior neck below the cricoid cartilage, thyroid ala, and suprahyoid region were analysed. Results: Among various methods for synchronization of strobo flashes, vibration pick-up was most effective method in peak detection. And anterior neck below cricoid cartilage was the most available site of the vibration pick-up. Conclusion: Authors suggest that vibration pick-up is most available and effective method for synchronization of strobo flashes.