The use of voice is an integral part of communication; our voice is one of the defining features of our individuality, and it shares a lot of information about you, your voice tells others if you are happy or sad, healthy or unwell, young or old. Our voice can also reveal to others our background, such as the region of the world where we live, and even our social economic status, when a voice produced that perceived by others as unusual or strange and draws attention to the person who is speaking, it is quite likely the person is demonstrating a voice disorder.
So, I am happy to introduce this presentation about Pubertal voice disorders & Puberphonia, I would like this presentation to be useful and add a lot of information on this topic.
Auditory brainstem response (ABR)
Approximately 1 of every 1000 children is born deaf. Many more are born with less severe degrees of hearing impairment, while others may acquire hearing loss during early childhood.
combination of technological advances in ABR and otoacoustic emissions (OAE) testing methods are used for evaluation of hearing in newborns.
ECochG is a variant of brainstem audio evoked response (ABR) where the recording electrode is placed as close as practical to the cochlea. We will use the abbreviation ECOG and ECochG interchangeably below. ECOG is preferable to us as it is shorter.
ECOG is intended to diagnose Meniere's disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula, and in superior canal dehiscence. The common feature connecting these illnesses is an imbalance in pressure between the endolymphatic and perilymphatic compartment of the inner ear.
ECOG can also be used to show that the cochlea is normal, in persons who are deaf. The cochlear microphonic of ECOG may be normal in auditory neuropathy (Santarelli and Arslan 2002) as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged (Yokoyama, Nishida et al. 1999).
Finally, ECOG's have also been used to as a indicator of the temporary threshold shift that may follow noise injury (Nam et al, 2004).
Voice therapy to treat voice disorders, basics , different techniques, methods advantages and disadvantages, where and what method to choose? otorhinolaryngology ent
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
Auditory brainstem response (ABR)
Approximately 1 of every 1000 children is born deaf. Many more are born with less severe degrees of hearing impairment, while others may acquire hearing loss during early childhood.
combination of technological advances in ABR and otoacoustic emissions (OAE) testing methods are used for evaluation of hearing in newborns.
ECochG is a variant of brainstem audio evoked response (ABR) where the recording electrode is placed as close as practical to the cochlea. We will use the abbreviation ECOG and ECochG interchangeably below. ECOG is preferable to us as it is shorter.
ECOG is intended to diagnose Meniere's disease, and particular, hydrops (swelling of the inner ear). ECOG may also be abnormal in perilymph fistula, and in superior canal dehiscence. The common feature connecting these illnesses is an imbalance in pressure between the endolymphatic and perilymphatic compartment of the inner ear.
ECOG can also be used to show that the cochlea is normal, in persons who are deaf. The cochlear microphonic of ECOG may be normal in auditory neuropathy (Santarelli and Arslan 2002) as well as other disorders in which the cochlea is preserved but the auditory nerve is damaged (Yokoyama, Nishida et al. 1999).
Finally, ECOG's have also been used to as a indicator of the temporary threshold shift that may follow noise injury (Nam et al, 2004).
Voice therapy to treat voice disorders, basics , different techniques, methods advantages and disadvantages, where and what method to choose? otorhinolaryngology ent
Perilymph Fistula can be difficult to diagnose as a standalone condition. Post-trauma symptoms such as dizziness, headache, etc. can be linked to other conditions like a traumatic brain injury with a concussion.
Teachers: Voice disorders (and what to do about them)David Kinnane
Compared to the general population, teachers are at a heightened risk of developing voice disorders. In these slides, we review some of the recent evidence about likely contributing factors, and steps teachers can take to reduce their risk of developing voice disorders.
VOICE is considered one of the most important instruments Teahcers have to carry out effectively the teaching-learning process. For this reason, it turns out to be determinant to take care of our voices since the beginning of our Teaching Career. The following presentation aims at providing Teachers with special & easy tips for the taking care of the voice as well as raising awareness about the importance of this fundamental instrument within the ELT field.
Fluency disorder (Stuttering also known as stammering)Emmanuel Raj
Introduction, aetiology, Epidemiology, Clinical features, Theories, Scale, Diagnosis, Assessment, management of stuttering.
Fluency: continuity, smoothness, rate, and effort in speech production.
All speakers are disfluent at times. They may hesitate when speaking, use fillers (“like” or “uh”), or repeat a word or phrase. These are called typical disfluencies or non-fluencies (ASHA - American Speech-Language-Hearing Association).
Types of fluency disorders
Stuttering
Cluttering
Normal Non-fluency
Stuttering (Stammering) the most common fluency disorder, is an interruption in the flow of speaking characterised by specific types of disfluencies, including:
Prolongations unnatural stretching of a sound (e.g., “Ssssssssometimes we stay home”);
Repetitions of sounds, syllables, and monosyllabic words (e.g., “Look at the b-b-baby,” “Let’s go out-out-out”);
Hesitations usage of fillers (“like” or “uh”),
Blocks inability to initiate speech sounds/difficulty getting a word/pausing in between words
CLASSIFICATION OF STUTTERING:
DEVELOPMENTAL STUTTERING:
It is initially noted in children between three and eight years of age
Approx. 75 % of pre-schoolers with developmental stuttering spontaneously recover within 4 years.
Normal non fluency:
As children pass through normal language development they will be disfluent in certain period when compared to others.
ACQUIRED STUTTERING:
Neurogenic stuttering: usually follows a neurologic event, such as traumatic brain injury, stroke, or other brain damage.
stuttering occurs at the beginning of the words and the secondary behaviours are more obvious than with acquired stuttering.
Cause:
Cerebrovascular accident (stroke), with or without aphasia, Head trauma, Ischemic attacks (temporary obstruction of blood flow in the Brain)
Signs and symptoms:
Repetitions, Excessive levels of normal disfluencies , Extraneous movements
Psychogenic stuttering: It is rare and usually occurs in adults with a history of psychiatric problems following a psychological event or emotional trauma; there may be no other known aetiology.
Causes:
Depression, Emotional responses to traumatic events, Anxiety
Signs and symptoms:
Rapid repetitions of initial sounds
Epidemiology:
The prevalence of stuttering over the whole population was 0.72%, with higher prevalence rates in younger children (1.4–1.44) and lowest rates in adolescence (0.53).
Male-to-female ratios ranged from 2.3:1 in younger children to 4:1 in adolescence, with a ratio of 2:1 across all ages according to ASHA
In India it is estimated that approx. 10% of cases with communication disorders may have stuttering according to AIISH.
Aetiology:
A variety of factors may influence stuttering events, although the etiology of the condition is unclear
Possible contributing factors include cognitive processing abilities, genetics, gender of the patient, and environmental influences.
A speech disorder is a condition in which a person has problems creating or forming the speech sounds needed to communicate with others. This can make the child's speech difficult to understand.
Common speech disorders are:
1. Articulation disorders
2. Phonological disorders
3. Disfluency
4. Voice disorders or resonance disorders
Pre malignant lesions of vocal cords and principles of phonomicrosurgery.
Slide notes included.
(videos in presentation, taken from youtube). No copyright infringement intended.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. pubertal voice disorders
Literature Review of Pubertal Voice Disorders & Puberphonia
Prepared by
Mahmoud Ali Fadaly
MBBS Candidate at Damietta Faculty of Medicine, AL-Azhar University, Egypt
Under supervision of
Otorhinolaryngology department
Damietta Faculty of Medicine
AL-Azhar University
3. • What is the voice?
• What is a voice disorder?
• How are voice disorders classified?
• What are the defining characteristics
of voice disorders?
• How are voice disorders identified?
• How are voice disorders treated?
Focus Questions
4. Over view
The use of voice is an integral part of communication; our voice is
one of the defining features of our individuality, and it shares a lot of
information about you, your voice tells others if you are happy or
sad, healthy or unwell, young or old. Our voice can also reveal to
others our background, such as the region of the world where we
live, and even our social economic status.
5. when a voice produced that perceived by others as unusual or
strange and draws attention to the person who is speaking, it is
quite likely the person is demonstrating a voice disorder.
A voice disorder occurs when voice quality, pitch, and loudness differ or ar
e inappropriate for an individual's age, gender, cultural background, or
geographic location.
A voice disorder is present when an individual
expresses concern about having an abnormal voice that does not meet daily
needs even if others do not perceive it as different or deviant.
6. Anatomy & Physiology behind Voice Production
The generation of vocal sounds is generally referred to as “phonation,” while the action of
generating word sounds is referred to as “speech” or “articulation”.
The organs involved in phonation and/or speech are
oral cavity nasal cavity pharynx larynx trachea
bronchus lungs thorax diaphragm
these multiple organs work in a coordinated manner to perform complex integrated
movement, to produce vocal sound.
7. The "spoken word" results from three components of voice production: voiced sound,
resonance, and articulation.
• Voiced sound: The basic sound produced by vocal fold vibration is called "voiced
sound." This is frequently described as a "buzzy" sound. Voiced sound for singing
differs significantly from voiced sound for speech.
• Resonance: Voice sound is amplified and modified by the vocal tract resonators (the
throat, mouth cavity, and nasal passages). The resonators produce a person's
recognizable voice.
• Articulation: The vocal tract articulators (the tongue, soft palate, and lips) modify
the voiced sound. The articulators produce recognizable words.
17. Puberphonia
Definition:
The persistence of adolescent voice even after
puberty in the absence of organic cause.
It is either:
o Mutational Falsetto: a post- adolescent
male continuing to have a preadolescent
voice.
o Juvenile Voice: a post-adolescent female
having the vocal qualities of a child.
18. Kind of Voice Disorder
Puberphonia
Functional voice disorder (FVD) and
Psychogenic voice disorder because:
o There are typically no physical anomalies.
o Often it is related to emotional or
psychological factors.
Incidence of puberphonia
• Male Dominance, Young men
between age 11-15.
• 1/900,000 men per year.
• Juvenile Voice is very rare.
19. Puberphonia
Signs and Symptoms
o Increased pitch or fundamental frequency.
o Weak, breathy, hoarse voice Pitch breaks.
o Low intensity.
o Inability to shout or compete with
background noise.
o Psychological symptoms.
20. Etiology
Puberphonia
o Resisting change of puberty
oHabitual pitch
o Dislike new pitch after puberty (New
pitch does not match personality).
o Want to remain young
oMore identification with females.
oSinging voice
oEmbarrassment.
oAnatomical differences.
21. Pathophysiology of Puberphonia
When the adolescent child is not able to adapt to the newer lower-pitched voice that develops at
puberty following the rapid descent of the larynx, the problem of mutational falsetto manifests.
Since the brain is more accustomed to the higher pitched voice of the infant, it refuses to accept
the pitch lowering that is taking place naturally. The high-pitched voice characteristic of
puberphonia is caused by increased tension and contraction of the muscles in the larynx causing
it to elevate. However, the fact of the matter is that the laryngeal capability to produce normal
low-pitched voice is present. Hence, the origin of the problem is mainly psychogenic and
behavioral.
24. Surgical
Subjects: 24-year-old male.
Method: They mobilized the hyoid bone by dissecting supra-hyoid musculature and upper
half of thyroid cartilage, and reduced crico-thyroid distance by opposing mobile hyoid to
fixed cricoid cartilage by 2 non- absorbable figure of eight sutures.
Results: 6 weeks post-surgery went from 175Hz to 142Hz= successful surgical lowering of
pitch.
Validity: Clinical Case Study: No comparison studies available, first ever case of surgically
corrected falsetto Unknown Validity/EBP (Pau, H. & Murty, G.E. (2001). First case of surgically corrected puberphonia.
The Journal of Laryngology & Otology, 115, 60-61).
25. Laryngoscope Procedure
Subjects: 26 males... Ages 14 to 20 years.
Method: Pressure applied to valleculae internally by laryngoscope and
externally on thyroid cartilage by digital manipulation.
Results: Immediate improvement from child pitch to male pitch.
Validity: No statistical information provided Unknown Validity/EBP
(Vaidya, S. & Vyas, G. (2006). Puberphonia: A Novel Approach to Treatment. Indian Journal of Otolaryngology and Head and
Neck Surgery, 58).
26. Voice Therapy
Treatment hierarchy:
1. Demonstrate appropriate pitch using Direct Vocal Manipulation.
2. Allow client to hear difference in their habitual pitch and the lower
pitch Single phonemes, simple sounds, words, phrases, sentences,
conversational level.
3. Train family.
27. Manual Manipulation and Compression of the Larynx:
Subjects: 44 males, 1 female Ages 13 to 40 years.
Method: Manual manipulation of larynx, larynx depressing exercises, vegetative voice
(coughing, yawning, etc.).
Result: All patients lowered speaking voice to appropriate pitch for their age and gender.
Validity: p < 0.05 for all measures of voice= statistically significant findings Good
Validity/EBP (Dagli et al., 2008).
28. Manual Manipulation and Compression of the Larynx:
Subjects: 15 males Ages 15 to 27 years.
Method: Manual compression of the larynx (Thyroid cartilage area is pressed downward
with the fingers to hold the larynx down and prevent it from moving upward during
phonation), prolongation of phonation at a lower pitch (syllables, words, sentences,
paragraphs, conversation).
Result: Decrease in pitch from average of 193.41Hz to 113.49Hz, improved vocal efficiency,
no significant changes in the intensity of voice.
Validity: P<0.05 for most vocal measures= statistically significant findings Good
Validity/EBP (Lim et al., 2007).
