Otorhinolaryngology is a surgical subspecialty within medicine that deals with conditions of the ear and throat and related structures of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, ENT doctors, ENT surgeons, or head and neck surgeons. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, throat, base of the skull, for the surgical management of cancers and benign tumors of the head and neck; the term is a combination of New Latin combining forms derived from four Ancient Greek words: οὖς ous, "ear", ῥίς rhis, "nose", λάρυγξ larynx, "larynx" and -λογία logia, "study". Otorhinolaryngologists are physicians who, in the United States, complete at least five years of surgical residency training; this is composed of six months of general surgical training and four and a half years in specialist surgery. In Canada and the United States, practitioners complete a five-year residency training after medical school.
Following residency training, some otolaryngologist-head & neck surgeons complete an advanced sub-specialty fellowship, where training can be one to two years in duration. In the United States and Canada, otorhinolaryngology is one of the most competitive specialties in medicine in which to obtain a residency position following medical school. In the United Kingdom entrance to otorhinolaryngology higher surgical training is competitive and involves a rigorous national selection process; the training programme consists of 6 years of higher surgical training after which trainees undertake fellowships in a sub-speciality prior to becoming a consultant. In this type of surgery, a surgeon harvests a muscle from the back or from the abdominal region for reconstruction of the skull or the cranial vault. Latissimus is another word for back in the medical field as well as rectus abdominis, your abdominal area; the muscle is sometimes useful for sealing off the central nervous system in ones body and allowing it to heal the complex wounds.
A study was down with five patients who underwent the free muscle transfer for a smile reconstruction. Two of the five patients prior to this surgery had failed their first free muscle transfer; the next two patients had vascular anomalies and one had a previous distal ligation of the facial vessels. In three of the cases, they used a submental vein, in all the cases they used a donor submental artery. “In all 5 the gracilis vascular pedicle comprised a muscular branch of the profunda femoris together with its venae comitantes, with the artery and vein ranging in size from 1.0 to 1.5 mm and 2.0 to 2.5 mm, respectively. The submental artery provided an excellent size match in all cases, ranging in size from 1.0 to 1.5 mm”. The first patient was a 45 year old woman who developed a dense flaccid right facial paralysis at the age of 33; the second patient was an 8 year old girl who had developed dense flaccid left facial paralysis after a laser treatment at four weeks for, “bilateral infantile segmental hemangiomas in the distribution of the mandibular division of the trigeminal nerve.
“. The third case was a 19 year old male who had developed a segmental right facial paralysis after a excision of a infantile parotid hemangioma at the age of 2; the fourth case was a 20 year old woman who had developed dense flaccid right facial paralysis after a biopsy of a pontomedullary junction tumor at the age of 2. Lastly, case five was a 19 year old woman. Bone defects are the most difficult reconstructions as it requires precise alignment. Bone transfer is used for the mandibular reconstruction, but it now allows surgeons to use it for the midface and the orbito maxillary. If for some reason the fibula is not available for transfer, another option the team may go is using the back rib free flap; this allows the transfer to give the bone volume for the patients. The earliest first bone transfer was done all the way back in 2000 BCE when the Peruvian priest implanted a metallic plate to reconstruct the contour defects of the religious trephination. In 1668, a man by the name of Jobs van Meekeren reported the use of dog bone grafts to reconstruct the calvarium in the soldier.
“…the ideal of the future: the insertion of a piece of living bone which will fill the gap and will continue to live without absorption.”. The radial forearm is the most dominant use of flap to be used to coverage up damages. Today, the anterolateral thigh flap is being used on patients for the head and the neck because it has an ideal match for the site and it is easy to harvest. If a surgeon chose to remove/harvest the tissue, safe places are the following. Microvascular reconstruction repair is a common operation, done on patients who see a Otorhinolaryngologist. Microvascular reconstruction repair is a surgical procedure that involves moving a composite piece of tissue from the patient's body and moves it to the head and or neck. Microvascular head and neck reconstruction is used to treat head and neck cancers, including those of the larynx and pharynx, oral cavity, salivary glands, calvarium, sinuses and skin; the tissue, most common moved during this procedure is from the arms, legs and can come from the skin, fat, or muscle.
When doing this procedure, the decision on, moved is determined on the reconstructive needs. T
Speech is human vocal communication using language. Each language uses phonetic combinations of a limited set of articulated and individualized vowel and consonant sounds that form the sound of its words, using those words in their semantic character as words in the lexicon of a language according to the syntactic constraints that govern lexical words' function in a sentence. In speaking, speakers perform many different intentional speech acts, e.g. informing, asking, persuading and can use enunciation, degrees of loudness and other non-representational or paralinguistic aspects of vocalization to convey meaning. In their speech speakers unintentionally communicate many aspects of their social position such as sex, place of origin, physical states, psychic states, physico-psychic states, education or experience, the like. Although people ordinarily use speech in dealing with other persons, when people swear they do not always mean to communicate anything to anyone, sometimes in expressing urgent emotions or desires they use speech as a quasi-magical cause, as when they encourage a player in a game to do or warn them not to do something.
There are many situations in which people engage in solitary speech. People talk to themselves sometimes in acts that are a development of what some psychologists have maintained is the use in thinking of silent speech in an interior monologue to vivify and organize cognition, sometimes in the momentary adoption of a dual persona as self addressing self as though addressing another person. Solo speech can be used to memorize or to test one's memorization of things, in prayer or in meditation. Researchers study many different aspects of speech: speech production and speech perception of the sounds used in a language, speech repetition, speech errors, the ability to map heard spoken words onto the vocalizations needed to recreate them, which plays a key role in children's enlargement of their vocabulary, what different areas of the human brain, such as Broca's area and Wernicke's area, underlie speech. Speech is the subject of study for linguistics, cognitive science, communication studies, computer science, speech pathology and acoustics.
Speech compares with written language, which may differ in its vocabulary and phonetics from the spoken language, a situation called diglossia. The evolutionary origins of speech are subject to much debate and speculation. While animals communicate using vocalizations, trained apes such as Washoe and Kanzi can use simple sign language, no animals' vocalizations are articulated phonemically and syntactically, do not constitute speech. Speech production is a multi-step process. Production involves the selection of appropriate words and the appropriate form of those words from the lexicon and morphology, the organization of those words through the syntax; the phonetic properties of the words are retrieved and the sentence is uttered through the articulations associated with those phonetic properties. In linguistics, articulation refers to how the tongue, jaw, vocal cords, other speech organs used to produce sounds are used to make sounds. Speech sounds are categorized by manner of place of articulation.
Place of articulation refers to. Manner of articulation refers to the manner in which the speech organs interact, such as how the air is restricted, what form of airstream is used, whether or not the vocal cords are vibrating, whether the nasal cavity is opened to the airstream; the concept is used for the production of consonants, but can be used for vowels in qualities such as voicing and nasalization. For any place of articulation, there may be several manners of articulation, therefore several homorganic consonants. Normal human speech is pulmonic, produced with pressure from the lungs, which creates phonation in the glottis in the larynx, modified by the vocal tract and mouth into different vowels and consonants; however humans can pronounce words without the use of the lungs and glottis in alaryngeal speech, of which there are three types: esophageal speech, pharyngeal speech and buccal speech. Speech production is a complex activity, as a consequence errors are common in children. Speech errors come in many forms and are used to provide evidence to support hypotheses about the nature of speech.
As a result, speech errors are used in the construction of models for language production and child language acquisition. For example, the fact that children make the error of over-regularizing the -ed past tense suffix in English shows that the regular forms are acquired earlier. Speech errors associated with certain kinds of aphasia have been used to map certain components of speech onto the brain and see the relation between different aspects of production: for example, the difficulty of expressive aphasia patients in producing regular past-tense verbs, but not irregulars like'sing-sang' has been used to demonstrate that regular inflected forms of a word are not individually stored in the lexicon, but produced from affixation of the base form. Speech perception re
The human voice consists of sound made by a human being using the vocal tract, such as talking, laughing, screaming, etc. The human voice frequency is a part of human sound production in which the vocal folds are the primary sound source. Speaking, the mechanism for generating the human voice can be subdivided into three parts; the lung, the "pump" must produce adequate air pressure to vibrate vocal folds. The vocal folds vibrate to use airflow from the lungs to create audible pulses that form the laryngeal sound source; the muscles of the larynx adjust the length and tension of the vocal folds to ‘fine-tune’ pitch and tone. The articulators articulate and filter the sound emanating from the larynx and to some degree can interact with the laryngeal airflow to strengthen it or weaken it as a sound source; the vocal folds, in combination with the articulators, are capable of producing intricate arrays of sound. The tone of voice may be modulated to suggest emotions such as anger, fear, happiness or sadness.
The human voice is used to express emotion, can reveal the age and sex of the speaker. Singers use the human voice as an instrument for creating music. Adult men and women have different sizes of vocal fold. Adult male voices are lower-pitched and have larger folds; the male vocal folds, are between 17 25 mm in length. The female vocal folds are between 17.5 mm in length. The folds are within the larynx, they are attached at the back to the arytenoids cartilages, at the front to the thyroid cartilage. They have no outer edge as they blend into the side of the breathing tube while their inner edges or "margins" are free to vibrate, they have a three layer construction of an epithelium, vocal ligament muscle, which can shorten and bulge the folds. They are pearly white in color. Above both sides of the vocal cord is the vestibular fold or false vocal cord, which has a small sac between its two folds; the difference in vocal folds size between men and women means that they have differently pitched voices.
Additionally, genetics causes variances amongst the same sex, with men's and women's singing voices being categorized into types. For example, among men, there are bass, baritone and countertenor, among women, mezzo-soprano and soprano. There are additional categories for operatic voices; this is not the only source of difference between male and female voice. Men speaking, have a larger vocal tract, which gives the resultant voice a lower-sounding timbre; this is independent of the vocal folds themselves. Human spoken language makes use of the ability of all people in a given society to dynamically modulate certain parameters of the laryngeal voice source in a consistent manner; the most important communicative, or phonetic, parameters are the voice pitch and the degree of separation of the vocal folds, referred to as vocal fold adduction or abduction. The ability to vary the ab/adduction of the vocal folds has a strong genetic component, since vocal fold adduction has a life-preserving function in keeping food from passing into the lungs, in addition to the covering action of the epiglottis.
The muscles that control this action are among the fastest in the body. Children can learn to use this action during speech at an early age, as they learn to speak the difference between utterances such as "apa" as "aba". Enough, they can learn to do this well before the age of two by listening only to the voices of adults around them who have voices much different from their own, though the laryngeal movements causing these phonetic differentiations are deep in the throat and not visible to them. If an abductory movement or adductory movement is strong enough, the vibrations of the vocal folds will stop. If the gesture is abductory and is part of a speech sound, the sound will be called voiceless. However, voiceless speech sounds are sometimes better identified as containing an abductory gesture if the gesture was not strong enough to stop the vocal folds from vibrating; this anomalous feature of voiceless speech sounds is better understood if it is realized that it is the change in the spectral qualities of the voice as abduction proceeds, the primary acoustic attribute that the listener attends to when identifying a voiceless speech sound, not the presence or absence of voice.
An adductory gesture is identified by the change in voice spectral energy it produces. Thus, a speech sound having an adductory gesture may be referred to as a "glottal stop" if the vocal fold vibrations do not stop. Other aspects of the voice, such as variations in the regularity of vibration, are used for communication, are important for the trained voice user to master, but are more used
Mucus is a polymer. It is a slippery aqueous secretion produced by, covering, mucous membranes, it is produced from cells found in mucous glands, although it may originate from mixed glands, which contain both serous and mucous cells. It is a viscous colloid containing inorganic salts, antiseptic enzymes and glycoproteins such as lactoferrin and mucins, which are produced by goblet cells in the mucous membranes and submucosal glands. Mucus serves to protect epithelial cells in the respiratory, urogenital and auditory systems. Most of the mucus produced is in the gastrointestinal tract. Bony fish, snails and some other invertebrates produce external mucus. In addition to serving a protective function against infectious agents, such mucus provides protection against toxins produced by predators, can facilitate movement and may play a role in communication. In the human respiratory system, mucus known as airway surface liquid, aids in the protection of the lungs by trapping foreign particles that enter them, in particular, through the nose, during normal breathing.
Further distinction exists between the superficial and cell-lining layers of ASL, which are known as mucus layer and pericilliary liquid layer, respectively. "Phlegm" is a specialized term for mucus, restricted to the respiratory tract, whereas the term "nasal mucus" describes secretions of the nasal passages. Nasal mucus is produced by the nasal mucosa. Small particles such as dust, particulate pollutants, allergens, as well as infectious agents and bacteria are caught in the viscous nasal or airway mucus and prevented from entering the system; this event along with the continual movement of the respiratory mucus layer toward the oropharynx, helps prevent foreign objects from entering the lungs during breathing. This explains why coughing occurs in those who smoke cigarettes; the body's natural reaction is to increase mucus production. In addition, mucus aids in moisturizing the inhaled air and prevents tissues such as the nasal and airway epithelia from drying out. Nasal and airway mucus is produced continuously, with most of it swallowed subconsciously when it is dried.
Increased mucus production in the respiratory tract is a symptom of many common illnesses, such as the common cold and influenza. Hypersecretion of mucus can occur in inflammatory respiratory diseases such as respiratory allergies and chronic bronchitis; the presence of mucus in the nose and throat is normal, but increased quantities can impede comfortable breathing and must be cleared by blowing the nose or expectorating phlegm from the throat. In general, nasal mucus is thin, serving to filter air during inhalation. During times of infection, mucus can change color to yellow or green either as a result of trapped bacteria or due to the body's reaction to viral infection; the green color of mucus comes from the heme group in the iron-containing enzyme myeloperoxidase secreted by white blood cells as a cytotoxic defense during a respiratory burst. In the case of bacterial infection, the bacterium becomes trapped in already-clogged sinuses, breeding in the moist, nutrient-rich environment. Sinusitis is an uncomfortable condition.
A bacterial infection in sinusitis will cause discolored mucus and would respond to antibiotic treatment. All sinusitis infections are viral and antibiotics are ineffective and not recommended for treating typical cases. In the case of a viral infection such as cold or flu, the first stage and the last stage of the infection cause the production of a clear, thin mucus in the nose or back of the throat; as the body begins to react to the virus, mucus may turn yellow or green. Viral infections cannot be treated with antibiotics, are a major avenue for their misuse. Treatment is symptom-based. Increased mucus production in the upper respiratory tract is a symptom of many common ailments, such as the common cold. Nasal mucus may be removed by using nasal irrigation. Excess nasal mucus, as with a cold or allergies, due to vascular engorgement associated with vasodilation and increased capillary permeability caused by histamines, may be treated cautiously with decongestant medications. Thickening of mucus as a "rebound" effect following overuse of decongestants may produce nasal or sinus drainage problems and circumstances that promote infection.
During cold, dry seasons, the mucus lining nasal passages tends to dry out, meaning that mucous membranes must work harder, producing more mucus to keep the cavity lined. As a result, the nasal cavity can fill up with mucus. At the same time, when air is exhaled, water vapor in breath condenses as the warm air meets the colder outside temperature near the nostrils; this causes an excess amount of water to build up inside nasal cavities. In these cases, the excess fluid spills out externally through the nostrils. Excess mucus production in the bronchi and bronchioles, as may occur in asthma, bronchitis or influenza, results from chronic airway inflammation, hence may be treated with anti-inflammatory medications. Impaired mucociliary clearance due to conditions such as primary ciliary dyskinesia may result in its accumulation in the bronchi; the dysregulation of
International Standard Serial Number
An International Standard Serial Number is an eight-digit serial number used to uniquely identify a serial publication, such as a magazine. The ISSN is helpful in distinguishing between serials with the same title. ISSN are used in ordering, interlibrary loans, other practices in connection with serial literature; the ISSN system was first drafted as an International Organization for Standardization international standard in 1971 and published as ISO 3297 in 1975. ISO subcommittee TC 46/SC 9 is responsible for maintaining the standard; when a serial with the same content is published in more than one media type, a different ISSN is assigned to each media type. For example, many serials are published both in electronic media; the ISSN system refers to these types as electronic ISSN, respectively. Conversely, as defined in ISO 3297:2007, every serial in the ISSN system is assigned a linking ISSN the same as the ISSN assigned to the serial in its first published medium, which links together all ISSNs assigned to the serial in every medium.
The format of the ISSN is an eight digit code, divided by a hyphen into two four-digit numbers. As an integer number, it can be represented by the first seven digits; the last code digit, which may be 0-9 or an X, is a check digit. Formally, the general form of the ISSN code can be expressed as follows: NNNN-NNNC where N is in the set, a digit character, C is in; the ISSN of the journal Hearing Research, for example, is 0378-5955, where the final 5 is the check digit, C=5. To calculate the check digit, the following algorithm may be used: Calculate the sum of the first seven digits of the ISSN multiplied by its position in the number, counting from the right—that is, 8, 7, 6, 5, 4, 3, 2, respectively: 0 ⋅ 8 + 3 ⋅ 7 + 7 ⋅ 6 + 8 ⋅ 5 + 5 ⋅ 4 + 9 ⋅ 3 + 5 ⋅ 2 = 0 + 21 + 42 + 40 + 20 + 27 + 10 = 160 The modulus 11 of this sum is calculated. For calculations, an upper case X in the check digit position indicates a check digit of 10. To confirm the check digit, calculate the sum of all eight digits of the ISSN multiplied by its position in the number, counting from the right.
The modulus 11 of the sum must be 0. There is an online ISSN checker. ISSN codes are assigned by a network of ISSN National Centres located at national libraries and coordinated by the ISSN International Centre based in Paris; the International Centre is an intergovernmental organization created in 1974 through an agreement between UNESCO and the French government. The International Centre maintains a database of all ISSNs assigned worldwide, the ISDS Register otherwise known as the ISSN Register. At the end of 2016, the ISSN Register contained records for 1,943,572 items. ISSN and ISBN codes are similar in concept. An ISBN might be assigned for particular issues of a serial, in addition to the ISSN code for the serial as a whole. An ISSN, unlike the ISBN code, is an anonymous identifier associated with a serial title, containing no information as to the publisher or its location. For this reason a new ISSN is assigned to a serial each time it undergoes a major title change. Since the ISSN applies to an entire serial a new identifier, the Serial Item and Contribution Identifier, was built on top of it to allow references to specific volumes, articles, or other identifiable components.
Separate ISSNs are needed for serials in different media. Thus, the print and electronic media versions of a serial need separate ISSNs. A CD-ROM version and a web version of a serial require different ISSNs since two different media are involved. However, the same ISSN can be used for different file formats of the same online serial; this "media-oriented identification" of serials made sense in the 1970s. In the 1990s and onward, with personal computers, better screens, the Web, it makes sense to consider only content, independent of media; this "content-oriented identification" of serials was a repressed demand during a decade, but no ISSN update or initiative occurred. A natural extension for ISSN, the unique-identification of the articles in the serials, was the main demand application. An alternative serials' contents model arrived with the indecs Content Model and its application, the digital object identifier, as ISSN-independent initiative, consolidated in the 2000s. Only in 2007, ISSN-L was defined in the
Mixed transcortical aphasia
Mixed transcortical aphasia is the least common of the three transcortical aphasias. This type of aphasia can be referred to as "Isolation Aphasia"; this type of aphasia is a result of damage that isolates the language areas from other brain regions. Broca’s, Wernicke’s, the arcuate fasiculus are left intact. A stroke is one of the leading causes of disability in the United States. Following a stroke, 40% of stroke patients are left with moderate functional impairment and 15% to 30% have a severe disability as a result of a stroke. A neurogenic cognitive-communicative disorder is one result of a stroke. Neuro- meaning related to nerves or the nervous system and -genic meaning resulting from or caused by. Aphasia is one type of a neurogenic cognitive-communicative disorder which presents with impaired comprehension and production of speech and language caused by damage in the language-dominant, left hemisphere of the brain. Aphasia is any disorder of language that causes the patient to have the inability to communicate, whether it is through writing, speaking, or sign language.
Mixed transcortical aphasia is characterized by severe speaking and comprehension impairment, but with preserved repetition. People who suffer mixed transcortical aphasia struggle to produce propositional language or to understand what is being said to them, yet they can repeat long, complex utterances or finish a song once they hear the first part. Persons with mixed transcortical aphasia are nonfluent, in most cases do not speak unless they are spoken to, do not comprehend spoken language, cannot name objects, cannot read or write. However, they have the ability to repeat what is said to them. In fact, persons with mixed transcortical aphasia repeat in a parrot-like fashion; some patients with this disorder can experience many different types neurological symptoms including, bilateral paralysis, lack of voluntary speech, difficulty with producing spontaneous speech. A conversation between a clinician and person with transcortical mixed aphasia would have similar characteristics to the conversation below: Clinician: Hello, Mrs. Fenton Patient: Mrs. Fenton.
Yes. Clinician: How are you doing today? Patient: How are you doing today? Clinician: I’m fine, thank you. How are you doing? Patient: I’m fine, thank you. Clinician: My name is Mary. I’ll be working with you today. Patient: My name is Mary. I’m working today. In this rare type of aphasia, Broca's area, Wernicke's area, the arcuate fasciculus are intact but the watershed region around them is damaged; this damage isolates these areas from the rest of the brain. The most frequent etiology of mixed transcortical aphasia is stenosis of the internal carotid artery. Mixed transcortical aphasia can occur after cerebral hypoxia, cerebral swelling, any stroke that affects the cerebral artery. Lesions that cause mixed transcortical aphasia affect both the anterior and posterior perisylvian border zones; some times the type of aphasia can be determined just by knowing the lesion location. In order for a patient to be diagnosed with mixed transcortical aphasia all other forms of transcortical must be ruled out. Using WAB or the BDAE can rule out global aphasia.
If verbal fluency is depressed transcortical aphasia gets ruled out and if auditory processing and comprehension is weak it cannot be transcortical motor aphasia. After a stroke, many patients feel the devastating impacts of the loss of language. Studies have looked into ways to enhance verbal communication with therapy, one of the treatment approaches that proved to be successful is "Drawing Therapy". Drawing offers an alternative route to access semantic information; because of this, it provides adults who have lost language with a means to access and express their ideas and feelings. Drawing has been shown to activate right hemisphere regions; this makes drawing a non-linguistic intervention that can access semantic knowledge in the right hemisphere. The study conducted on drawing therapy found that it increased naming abilities in patients with acute and chronic aphasia, it produced fewer error attempts during naming tasks. The study found that the act of drawing itself, not the quality, was critical for the activation of the semantic-lexical network required for naming tasks.
Other studies have reported that family members have seen the effects of therapy at home. The gains made from drawing therapy were not ones that could have been made from spontaneous recovery. Drawing therapy was found to be useful in individuals with global and anomic aphasia. Both of these individuals were found to have produced more verbalizations post-therapy; this reinforces the idea that drawing provides a mean of recruiting areas or networks that were not otherwise sufficient for producing speech. Across the majority of patients, the quality of drawing improved as well as written output and sentence structure. Drawing therapy has proved to be effective after a few periods of therapy. Although this therapy is aimed at patients with aphasia, it can be implemented for any patient with expressive deficits. Drawing therapy can be implemented in the following hierarchy: 1. Clinician gives patient a prompt and asks them to draw a response 2. Clinician asks for clarification of drawing if it is unclear 3.
If possible, patient verbalizes about their drawing and assigns language Drawing therapy can be made harder through the type of prompt given a