Neurodegenerative motor disorders affect the neuromuscular system challenging daily life and normal activity. Parkinson's Disease (PD) is among the most prevalent ones, with a large impact and rising prevalence rates. Speech is most affected by PD as far as phonatory and articulatory performance is concerned. Neuromotor activity (NMA) alterations have an impact on larynx muscles responsible for vocal fold adduction and abduction, hampering phonation stability and regularity. The main muscular articulators involved in phonation control are the cricothyroid (tensor) and thyroarytenoid (relaxer) systems, regulated by two distinct direct neuromotor pathways, activated by the precentral gyrus laryngeal control areas. These articulations control the musculus vocalis, directly responsible for regular vocal fold vibration. An indirect estimation of the muscular tension produced by inverse filtering may split into two independent channels, assumed to be the tensor and relaxer neuromotor pathways such as the differential neuromotor activity (DNMA). The amplitude distributions of both DNMA channels allow comparing phonations from PD-affected persons (PDPs) and age-matched healthy control participants (HCPs) with respect to a set of reference mid-age normative participants (RSPs). The comparisons are carried out by Jensen-Shannon distributions of PDP and HCP phonations with respect to those of RSPs. A dataset of 96 phonation samples from participants balanced by gender is used to train a set of decision tree classifiers (DTCs) to distinguish PDP from HCP phonation. The best results from 10-fold cross-validation offered accumulated mismatches of 0.09 and 0.1292 for male and female subsets. The sensitivity, specificity, and accuracy of the classification results when separating PDP from HCP phonatios were 93.33%, 88.23%, and 90.63% (male PDP versus HCP) and 92.86%, 83.33%, and 87.50% (female PDP versus HCP), providing a stratification of PDPs and HCPs by objective disease grading from explainable AI (XAI) methods.

• MeSH
• Adult MeSH
• Phonation * physiology   MeSH
• Laryngeal Muscles * physiopathology   MeSH
• Larynx * physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Parkinson Disease * physiopathology   complications   MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Estill Voice Training TM (EVT) je hlasová tréninková metoda založená na podrobném porozumění anatomii a fyziologii hlasového aparátu. Tato metoda nabízí efektivní přístup ke kultivaci, reedukaci a rehabilitaci hlasu, což ji činí zajímavou i pro logopedickou praxi. Článek představuje základy EVT, její principy a přínosy a poskytuje stručný přehled klíčových technik.

Estill Voice TrainingTM (EVT) is a voice training method based on the understanding of how the vocal mechanism works. This method offers an effective approach to voice development, re-education, and rehabilitation, making it valuable also in speech therapy practice. This article introduces the fundamentals of EVT, its principles and benefits, and provides a brief overview of the key techniques.

• MeSH
• Phonation physiology   MeSH
• Voice MeSH
• Voice Training * MeSH
• Larynx anatomy & histology   MeSH
• Humans MeSH
• Voice Disorders prevention & control   MeSH
• Check Tag
• Humans MeSH

Zachování funkčního hrtanu a dosažení dlouhodobé remise je základním postulátem léčby pacientů s maligními nádory hrtanu, a to i pokročilých stadií. Rozvíjeny jsou proto nechirurgické protokoly léčby a hrtan zachovávající chirurgické postupy. Totální laryngektomie je historicky základní výkon laryngeální chirurgie, jehož význam s rozvojem výše uvedených postupů klesá. Přesto jsou stále skupiny nemocných, kteří mohou profitovat z jejího provedení. Rozhodující jsou lokální i celkové charakteristiky tumoru a pacienta. Velikost tumoru, destrukce a nefunkčnost struktur hrtanu, infiltrace štítné chrupavky včetně zevního perichondria případně extralaryngeální propagace jsou faktory, kdy je předpokládaný efekt nechirurgické léčby nedostatečný nebo by vedl k zachování nefunkčního hrtanu. K výkonu také indikujeme pacienty, u nichž pro kontraindikace nemůžeme využít orgán šetřicí protokoly nebo je vysoké riziko komplikací této léčby. Totální laryngektomie má stále své místo v rámci záchranné chirurgie a u specifických malignit, u nichž není efektivní nechirurgická léčba (nejčastěji sarkomy). V této práci je představen náš pohled na indikaci totální laryngektomie v současnosti, který vychází z doporučených postupů a zkušeností s multidisciplinárním klinickým rozhodováním.

Preserving a functional larynx and achieving long-term control is the basic postulate of treating patients with malignant tumors of the larynx, even in advanced stages. Therefore, non-surgical treatment protocols and larynx-preserving surgical procedures are preferred. Total laryngectomy is historically the basic procedure of laryngeal surgery still with the best survival outcomes in advanced laryngeal cancer, but with significantly lower quality of life following surgery. Nevertheless, there are still groups of patients who can benefit from this implementation. Local and overall characteristics are important for the recommendation of treatment. Tumor size, destruction and dysfunction of laryngeal structures, infiltration of the thyroid cartilage including the external perichondrium, or extralaryngeal extent are local factors when the expected effect of non-surgical treatment is insufficient or would only lead to the preservation of a non-functional larynx. We also recommend patients in whom organ-saving protocols are not suitable due to contraindications or there is a high risk of complications. Total laryngectomy still has its place as part of salvage surgery in failure of non-surgical treatment and for specific malignancies for which a non-surgical approach is not effective (most often sarcomas). We present our current view on the indications of total laryngectomy, which is based on international recommendations and our experience with multidisciplinary clinical decision-making.

• MeSH
• Laryngectomy * history   methods   statistics & numerical data   MeSH
• Larynx, Artificial MeSH
• Larynx surgery   pathology   MeSH
• Organ Sparing Treatments methods   MeSH
• Humans MeSH
• Laryngeal Neoplasms surgery   diagnosis   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

U pacientů s časným karcinomem hrtanu je v současnosti chirurgická léčba zachovávající funkci hrtanu preferovanou primární léčebnou modalitou. Cílem je odstranění karcinomu hrtanu s negativními okraji se současným zachováním přiměřené kvality hlasu a dýchání bez nutnosti tracheostomie. Mezi chirurgické postupy šetřící hrtan patří transorální endoskopická chirurgie, robotická mikrochirurgie hrtanu a vertikální parciální laryngektomie ze zevního přístupu (VPL). Cíl: Cílem studie bylo analyzovat faktory, které jsou zohledňovány při současných indikacích parciálních laryngektomií prováděných ze zevního přístupu pro glotický karcinom a zhodnotit chirurgické a onkologické výsledky těchto operací. Materiál a metodika: Do retrospektivní studie bylo zařazeno 18 pacientů, u nichž byla od 1. 1. 2012 do 31. 12. 2022 na Klinice otorinolaryngologie a chirurgie hlavy a krku FN u sv. Anny v Brně provedena VPL pro glotický spinocelulární karcinom. U 12 (67 %) pacientů byla předléčebná klasifikace nádoru cT1, u 6 (33 %) pacientů cT2. Nejčastěji prováděným výkonem byla laryngofi sura s rozšířenou chordektomií, která byla indikována u 17 (94 %) pacientů; frontální parciální laryngektomie byla provedena u jednoho pacienta (6 %). Nejčastější indikací k VPL byla konverze původně zvoleného endoskopického přístupu u 10 (56 %) pacientů, u 3 (17 %) pacientů se jednalo o revizní výkon po neradikálním endoskopické operaci a v 5 (28 %) případech byla VPL indikována z jiných důvodů. Výsledky: Mezi nejvýznamnější klinické rizikové faktory zohledněné při indikaci VPL patřily: omezená expozice nitra hrtanu v 11 případech, infiltrace přední komisury v 10 případech, šíření nádoru do paraglotického prostoru v 5 případech, subglotická propagace ve 4 případech, postižení processus vocalis ve 3 případech a nádorové šíření do laryngeálního ventrikulu ve 3 případech. Hodnocení resekčních okrajů prokázalo negativní resekční okraje (R0) u 8 (44 %) pacientů, blízké okraje (R0) u 6 (33 %) pacientů a pozitivní resekční okraje (R1) u 4 (22 %) pacientů. Pooperační průběh byl u většiny pacientů příznivý, přičemž u 15 (71 %) pacientů nenastaly žádné komplikace. Mírné lokální komplikace se vyskytly u 5 (24 %) pacientů, zatímco závažné komplikace nebyly zaznamenány u žádného z nich. Medián doby sledování činil 3,0 roku s interkvartilovým rozptylem 2,0 až 5,0 let. U jednoho pacienta byla dia- gnostikována recidiva karcinomu po VPL a adjuvantní radioterapii. U tohoto pacienta byla finálně indikována záchranná totální laryngektomie. Pravděpodobnost přežití byla stanovena Kaplan-Meierovou analýzou: 1 rok 90,5 %; 2 roky 85,7 %; 3 roky 85,7 %; 4 roky 77,1 %; 5 let 66,1 %. Závěr: Ačkoli jsou indikace pro zevní přístupy v současnosti velmi omezené, VPL stále představují záložní chirurgickou variantu u pacientů s omezenou expozicí vnitra hrtanu a u glotických nádorů postihujících rizikové anatomické sublokality, především přední komisuru a paraglotický prostor. I s ohledem na naše výsledky lze laryngofisuru s rozšířenou chordektomií považovat za hrtan šetřicí postup, který nabízí funkčně přijatelné a onkologicky srovnatelné výsledky léčby časného glotického karcinomu v porovnání s preferovanými endoskopickými přístupy a radioterapií.

For patients with early-stage laryngeal carcinoma, function-preserving surgical treatment is currently the preferred primary therapeutic modality. The goal is to achieve complete tumor removal with negative margins while preserving adequate voice quality and respiration without the need for a tracheostomy. Larynx-preserving surgical approaches include transoral endoscopic surgery, robotic microlaryngeal surgery, and external vertical partial laryngectomy (VPL). Objective: The aim of this study was to analyze the factors influencing current indications for open partial laryngectomies for glottic carcinoma and to evaluate the surgical and oncological outcomes of these procedures. Materials and methods: 18 patients who underwent VPL for glottic squamous cell carcinoma from 1. 1. 2012 to 31. 12. 2022 at the Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne‘s Hospital in Brno were included in the retrospective study. Pre-treatment tumor classification was cT1 in 12 (67%) patients and cT2 in 6 (33%) patients. The most commonly performed procedure was laryngofissure with extended chordectomy in 17 (94%) patients; frontal partial laryngectomy was performed in one patient (6%). The most frequent indication for VPL was conversion of the initially chosen endoscopic approach in 10 (56%) patients, revision surgery following a non-radical endoscopic procedure in 3 (17%) patients, and other indications in 5 (28%) cases. Results: The most significant clinical risk factors considered in the indication for VPL included: limited exposure of the larynx in 11 cases, anterior commissure infiltration in 10 cases, tumor spread to the paraglottic space in 5 cases, subglottic extension in 4 cases, involvement of the vocal process in 3 cases, and tumor spread to the laryngeal ventricle in 3 cases. Evaluation of resection margins showed negative resection margins (R0) in 8 (44%) patients, close margins (R0) in 6 (33%) patients, and positive resection margins (R1) in 4 (22%) patients. Postoperative course was favorable in most patients, with no complications in 15 (71%) patients. Mild local complications occurred in 5 (24%) patients, while no severe complications were noted in any of them. The median follow-up period was 3.0 years, with an interquartile range of 2.0 to 5.0 years. Recurrence of carcinoma after VPL and adjuvant radiotherapy was diagnosed in one patient, who ultimately underwent salvage total laryngectomy. Survival probability was estimated using the Kaplan-Meier analysis: 1-year survival at 90.5%, 2-year survival at 85.7%, 3-year survival at 85.7%, 4-year survival at 77.1%, and 5-year survival at 66.1%. Conclusion: Although indications for external approaches are currently very limited, VPL still represents a salvage surgical option for patients with limited laryngeal exposure and for glottic tumors affecting high-risk anatomical subsites, particularly the anterior commissure and paraglottic space. Even considering our results, laryngofissure with extended cordectomy can be regarded as a larynx-preserving procedure that offers functionally acceptable and oncologically comparable treatment outcomes for early glottic carcinoma in comparison with preferred endoscopic approaches and radiotherapy.

• MeSH
• Laryngectomy * classification   methods   statistics & numerical data   MeSH
• Larynx surgery   pathology   MeSH
• Humans MeSH
• Laryngeal Neoplasms surgery   diagnosis   MeSH
• Otorhinolaryngologic Surgical Procedures methods   MeSH
• Retrospective Studies MeSH
• Carcinoma, Squamous Cell surgery   diagnosis   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH

BACKGROUND: The canonical Wnt signaling pathway controls the continuous renewal of the intestinal epithelium and the specification of epithelial cell lineages. Tcf4, a nuclear mediator of Wnt signaling, is essential for the differentiation and maintenance of Paneth cells in the small intestine. Its deficiency is associated with reduced expression of key α-defensins, highlighting its role in host-microbe interactions. However, the exact function of Tcf4 in specifying the secretory lineage and its contribution to antimicrobial peptide production remain incompletely understood. Remarkably, α-defensin expression has also been detected in human colon adenomas, where aberrant Wnt signaling is a hallmark. This raises important questions: What is the role of these Paneth-like cells in tumor biology, and how does Tcf4 influence their identity and function? METHODS: We investigated cell specification in small intestinal crypts and colon tumors using conditional Tcf7l2 deletion, cell type-specific Cre recombinases, and reporter alleles in mice. Transcriptomic (single-cell and bulk RNA sequencing) and histological analyses were performed and complemented by microbiome profiling, antibiotic treatment, and intestinal organoids to functionally validate the main findings. RESULTS: The inactivation of Tcf4 depletes Paneth cells and antimicrobial peptides, disrupting the gut microbiota balance. In secretory progenitors, loss of Tcf4 shifts differentiation toward goblet cells. In the small intestine, alternative secretory progenitors produce Wnt ligands to support stem cells and epithelial renewal in the absence of Paneth cells. In colon tumors, Paneth-like cells form a tumor cell population, express Wnt ligands, and require Tcf4 for their identity. Loss of Tcf4 redirects their differentiation toward goblet cells. CONCLUSIONS: Tcf4 controls the balance between Paneth and goblet cells and is essential for antimicrobial peptide production in the small intestine. In colon adenomas, Paneth-like tumor cells drive antimicrobial gene expression and provide Wnt3 ligands, which may have implications for cancer therapy.

• MeSH
• alpha-Defensins metabolism   MeSH
• Cell Differentiation MeSH
• Humans MeSH
• Mice MeSH
• Colonic Neoplasms * pathology   genetics   microbiology   metabolism   MeSH
• Organoids metabolism   MeSH
• Paneth Cells metabolism   MeSH
• Goblet Cells metabolism   MeSH
• Wnt Signaling Pathway MeSH
• Gastrointestinal Microbiome * MeSH
• Intestine, Small * metabolism   pathology   microbiology   MeSH
• Transcription Factor 4 * metabolism   genetics   MeSH
• Transcriptome * MeSH
• Animals MeSH
• Check Tag
• Humans MeSH
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: The objective of this work was to gather an international consensus group to propose a global definition and diagnostic approach of laryngopharyngeal reflux (LPR) to guide primary care and specialist physicians in the management of LPR. METHODS: Forty-eight international experts (otolaryngologists, gastroenterologists, surgeons, and physiologists) were included in a modified Delphi process to revise 48 statements about definition, clinical presentation, and diagnostic approaches to LPR. Three voting rounds determined a consensus statement to be acceptable when 80% of experts agreed with a rating of at least 8/10. Votes were anonymous and the analyses of voting rounds were performed by an independent statistician. RESULTS: After the third round, 79.2% of statements (N = 38/48) were approved. LPR was defined as a disease of the upper aerodigestive tract resulting from the direct and/or indirect effects of gastroduodenal content reflux, inducing morphological and/or neurological changes in the upper aerodigestive tract. LPR is associated with recognized non-specific laryngeal and extra-laryngeal symptoms and signs that can be evaluated with validated patient-reported outcome questionnaires and clinical instruments. The hypopharyngeal-esophageal multichannel intraluminal impedance-pH testing can suggest the diagnosis of LPR when there is >1 acid, weakly acid or nonacid hypopharyngeal reflux event in 24 h. CONCLUSION: A global consensus definition for LPR is presented to improve detection and diagnosis of the disease for otolaryngologists, pulmonologists, gastroenterologists, surgeons, and primary care practitioners. The approved statements are offered to improve collaborative research by adopting common and validated diagnostic approaches to LPR. LEVEL OF EVIDENCE: 5 Laryngoscope, 134:1614-1624, 2024.

• MeSH
• Electric Impedance MeSH
• Laryngopharyngeal Reflux * diagnosis   MeSH
• Larynx * MeSH
• Humans MeSH
• Esophageal pH Monitoring MeSH
• Otolaryngologists MeSH
• Surveys and Questionnaires MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

• MeSH
• Cysts * surgery   diagnostic imaging   classification   congenital   MeSH
• Diagnosis, Differential MeSH
• Larynx * abnormalities   surgery   diagnostic imaging   MeSH
• Humans MeSH
• Laryngeal Neoplasms surgery   diagnostic imaging   classification   congenital   MeSH
• Infant, Newborn MeSH
• Prognosis MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Review MeSH

• MeSH
• Respiratory System Abnormalities * surgery   diagnosis   epidemiology   classification   MeSH
• Diagnosis, Differential MeSH
• Larynx abnormalities   surgery   MeSH
• Humans MeSH
• Laryngeal Diseases * surgery   diagnosis   epidemiology   congenital   MeSH
• Infant, Newborn MeSH
• Prognosis MeSH
• Congenital Abnormalities surgery   diagnosis   epidemiology   classification   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Review MeSH

We present a case of a preterm neonate with a type IV laryngo-tracheo-oesophageal cleft, an uncommon congenital malformation, resulting from the failure of separation of the trachea and the oesophagus during fetal development, often associated with other deformities as well. Data in the literature shows that the long-term morbidity from the entity has declined over the last decades, even though prognosis remains unfavourable for types III and IV. This report emphasizes the complex issues neonatologists are faced with, when treating neonates with this rare disorder in the first days of life, what will raise suspicion of this rare medical entity, and that direct laryngoscopy/bronchoscopy finally depicts the exact extension of the medical condition. At the same time extensive evaluation for coexisting congenital anomalies should be performed. For all the above reasons, these neonates should be treated in specialized tertiary pediatric centers for multidisciplinary prompt management, which may improve, the outcome.

• MeSH
• Child MeSH
• Esophagus diagnostic imaging   surgery   abnormalities   MeSH
• Laryngoscopy MeSH
• Larynx * diagnostic imaging   surgery   abnormalities   MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Trachea diagnostic imaging   surgery   abnormalities   MeSH
• Congenital Abnormalities * MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Review MeSH

Voice registers are assumed to be related to different laryngeal adjustments, but objective evidence has been insufficient. While chest register is usually associated with the lower pitch range, and head register with the higher pitch range, here we investigated a professional singer who claimed an ability to produce both these registers at every pitch, throughout her entire singing range. The singer performed separated phonations alternating between the two registers (further called chest-like and head-like) at all pitches from C3 (131 Hz) to C6 (1047 Hz). We monitored the vocal fold vibrations using high-speed video endoscopy and electroglottography. The microphone sound was recorded and used for blind listening tests performed by the three authors (insiders) and by six "naive" participants (outsiders). The outsiders correctly identified the registers in 64% of the cases, and the insiders in 89% of the cases. Objective analysis revealed larger closed quotient and vertical phase differences for the chest-like register within the lower range below G4 (<392 Hz), and also a larger closed quotient at the membranous glottis within the higher range above Bb4 (>466 Hz), but not between Ab4-A4 (415-440 Hz). The normalized amplitude quotient was consistently lower in the chest-like register throughout the entire range. The results indicate that that the singer employed subtle laryngeal control mechanisms for the chest-like and head-like phonations on top of the traditionally recognized low-pitched chest and high-pitched head register phenomena. Across all pitches, the chest-like register was produced with more rapid glottal closure that was usually, but not necessarily, accompanied also by stronger adduction of membranous glottis. These register changes were not always easily perceivable by listeners, however.

• MeSH
• Acoustics * MeSH
• Video Recording MeSH
• Biomechanical Phenomena MeSH
• Adult MeSH
• Electrodiagnosis MeSH
• Phonation * MeSH
• Vocal Cords physiology   MeSH
• Voice Quality * MeSH
• Laryngoscopy MeSH
• Larynx physiology   MeSH
• Humans MeSH
• Vibration MeSH
• Singing * MeSH
• Sound Spectrography MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH