DOMINGOS HIROSHI TSUJI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
53 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 53
- Perturbation Measurements on the Degree of Naturalness of Synthesized Vowels(2017) YAMASAKI, Rosiane; MONTAGNOLI, Arlindo; MURANO, Emi Z.; GEBRIM, Eloisa; HACHIYA, Adriana; SILVA, Jorge Vicente Lopes da; BEHLAU, Mara; TSUJI, DomingosObjective. To determine the impact of jitter and shimmer on the degree of naturalness perception of synthesized vowels produced by acoustical simulation with glottal pulses (GP) and with solid model of the vocal tract (SMVT). Study Design. Prospective study. Methods. Synthesized vowels were produced in three steps: 1. Eighty GP were developed (20 with jitter, 20 with shimmer, 20 with jitter+shimmer, 20 without perturbation); 2. A SMVT was produced based on magnetic resonance imaging (MRI) from a woman during phonation-/epsilon/ and using rapid prototyping technology; 3. Acoustic simulations were performed to obtain eighty synthesized vowels-/epsilon/. Two experiments were performed. First Experiment: three judges rated 120 vowels (20 humans+80 synthesized+20% repetition) as ""human"" or ""synthesized"". Second Experiment: twenty PowerPoint slide sequences were created. Each slide had 4 synthesized vowels produced with the four perturbation condition. Evaluators were asked to rate the vowels from the most natural to the most artificial. Results. First Experiment: all the human vowels were classified as human; 27 out of eighty synthesized vowels were rated as human, 15 of those were produced with jitter+shimmer, 10 with jitter, 2 without perturbation and none with shimmer. Second Experiment: Vowels produced with jitter+shimmer were considered as the most natural. Vowels with shimmer and without perturbation were considered as the most artificial. Conclusions. The association of jitter and shimmer increased the degree of naturalness of synthesized vowels. Acoustic simulations performed with GP and using SMVT demonstrated a possible method to test the effect of the perturbation measurements on synthesized voices.
- The Influence of Auditory Feedback and Vocal Rehabilitation on Prelingual Hearing-Impaired Individuals Post Cochlear Implant(2019) UBRIG, Maysa Tiberio; TSUJI, Robinson Koji; WEBER, Raimar; MENEZES, Marcia H. Moreira; BARRICHELO, Viviane M. O.; CUNHA, Maria Gabriela B. da; TSUJI, Domingos Hiroshi; GOFFI-GOMEZ, Maria Valeria S.Objective. To verify changes in the perceptual and acoustic vocal parameters in prelingual hearing-impaired adults with cochlear implants after vocal rehabilitation. Hypothesis. Auditory feedback restoration alone after cochlear implant is not enough for vocal adjustments. A targeted and specific voice therapy intervention is required. Study Design. Prospective and pre-post repeated measures design. Methods. Twenty literate adults with severe to profound prelingual bilateral sensorineural hearing loss participated in the study; individuals were implanted late and were fluent users of oral language. Ages ranged from 17 to 48 years. All individuals presented normal results in laryngoscopy, and hearing thresholds with the cochlear implant were over 40 dB HL. Individuals were randomly distributed into two groups: Group 1 (treatment group) and Group 2 (control group), both with ten patients each, five men and five women, matching mean age and hearing deprivation time before the cochlear implantation. Patients from Group 1 underwent a protocol of vocal therapy including 12 individual sessions with the same clinician. Group 2 only underwent vocal recordings. The vocal recordings occurred before and after the participation in the therapy protocol for Group 1 and after the same period, 3 months later, without any intervention, for Group 2. The recording sessions used the Consensus Auditory-Perceptual Evaluation of Voice protocol sentence reading and emission of sustained vowel /a/. Auditory-perceptual evaluation of voices was performed by three judges, and the acoustical analysis used the Praat program. Results. Statistically significant reductions in the overall vocal degree, vocal instability, and degree of resonance change were observed after vocal rehabilitation in Group 1. Statistically, individuals from Group 1 did not differ in regard to the modification of acoustic parameters. Group 2 did not present significant changes in any of the analyzed parameters. Conclusions. The cochlear implanted adults submitted to vocal rehabilitation presented changes in the auditory-perceptual parameters, with reduction of the overall voice severity, vocal instability, and degree of resonance after vocal intervention. There were no changes in the acoustic parameters in the implanted prelingual hearing-impaired adult subjects.
- Effects of Superomedial Partial Arytenoidectomy on Incomplete Posterior Glottal Closure Caused by Arytenoid Positional Asymmetry in Excised Human Larynges(2023) ENOKI, A. M.; IMAMURA, R.; TSUJI, D. H.Objectives: To analyze the effects that arytenoid positional asymmetry has on posterior glottic closure and to determine whether superomedial partial arytenoidectomy (SPA) can provide a benefit in cases of such asymmetry. Methods: In this experimental study, we evaluated posterior glottic closure in 10 larynges freshly excised from human cadavers, measuring the distance between the vocal processes before and after artificially simulated positional asymmetry of the arytenoid cartilages. We then performed SPA, after which we again measured the distance between the vocal processes. Results: In all of the larynges studied, the posterior glottic closure went from complete to incomplete after simulation of arytenoid positional asymmetry, the median distance observed between the vocal processes being 1.74mm (interquartile range 0.22). The SPA performed after arytenoid asymmetry caused the posterior glottic closure to return from incomplete to complete in all of the larynges studied. Conclusion: Our results suggest that arytenoid positional asymmetry impairs posterior glottic closure and that SPA improves posterior glottic closure in such cases of arytenoid asymmetry. © 2021 The Voice Foundation
- Variant of the Technique for Laryngeal Microsurgery in Cases of Difficult Laryngoscopy(2019) SETTON, Antonio Roberto Ferreira; D'AVILA, Jeferson Sampaio; GURGEL, Ricardo Queiroz; TSUJI, Domingos Hiroshi; D'AVILA, Daniel Vasconcelos; GOIS, Carlos Rodolfo Tavares de; MEURER, Ana Taise de Oliveira; GURGEL, Helaina PeixotoIntroduction Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical took. Objective To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure. Methods This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015. Results The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures. Conclusion The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution.
bookPart Paralisias laringeas(2018) IMAMURA, Rui; TSUJI, Domingos Hiroshi; COSTA, Luciana FernandesbookPart Avaliação endoscópica faringolaríngea(2022) KINCHOKU, Vanessa Mika; HACHIYA, Adriana; TSUJI, Domingos HiroshibookPart Tireoplastias: princípios e técnicas(2022) TSUJI, Domingos Hiroshi; IMAMURA, Rui; SENNES, Luiz Ubirajara- Impact of Cricothyroid Muscle Contraction on Vocal Fold Vibration: Experimental Study with High-Speed Videoendoscopy(2017) ISHIKAWA, Camila Cristina; PINHEIRO, Thais Goncalves; HACHIYA, Adriana; MONTAGNOLI, Arlindo Neto; TSUJI, Domingos HiroshiObjectives. The aim of this study was to evaluate the effects of cricothyroid muscle contraction on vocal fold vibration, as evaluated with high-speed videoendoscopy, and to identify one or more aspects of vocal fold vibration that could be used as an irrefutable indicator of unilateral cricothyroid muscle paralysis. Study Design. This was an experimental study employing excised human larynges. Methods. Twenty freshly excised human larynges were evaluated during artificially produced vibration. Each larynx was assessed in three situations: bilateral cricothyroid muscle contraction, unilateral cricothyroid muscle contraction, and no contraction of either cricothyroid muscle. The following parameters were evaluated by high-speed videoendoscopy: fundamental frequency, periodicity, amplitude of vocal fold vibration, and phase symmetry between the vocal folds. Results. Although neither unilateral nor bilateral cricothyroid muscle contraction altered the periodicity of vibration or the occurrence of phase asymmetry, there was a significant decrease in fundamental frequency in parallel with decreasing longitudinal tension. We also found an increase in vibration amplitude of right and left vocal folds, which were similar in terms of their behavior for this parameter in the various situations studied. Conclusion. Our results suggest that differences in vibration amplitude and phase symmetry between vocal folds are not reliable indicators of unilateral cricothyroid muscle paralysis.
- Bipedicled Vocal Fold Mucosal Flap Use in Phonomicrosurgery: Case Series(2021) TSUJI, Domingos Hiroshi; KINCHOKU, Vanessa Mika; IMAMURA, Rui; HACHIYA, Adriana; YAMASAKI, Rosiane; MARINHO, Guilherme Rodrigues; SENNES, Luiz UbirajaraObjectives. The objective of this study was to present a novel surgical technique involving the use of a ""bipedicled vocal fold mucosal flap"" to repair a mucosal defect and to evaluate the outcomes of patients in whom it was used. Material and methods. This was a retrospective study of 6 clinical cases. All patients underwent surgery between November 2000 and July 2018, and all procedures were performed by the same surgeon. For the auditory-perceptual assessment, the Grade-Roughness-Breathiness-Asthenia-Strain hoarseness scale was used. We based the stroboscopic evaluation on the European Laryngological Society protocol, analyzing the parameters glottal closure, mucosal wave, and phase symmetry. Results. Ages at the time of surgery ranged from 10 to 52 years, and all of the patients were male. Preexisting vocal fold lesions included polyps, cysts, a sulcus, and mucosal bridges. Among the stroboscopic parameters, only the mucosal wave differed significantly between the preoperative and postoperative periods (P = 0.046). There were also significant postoperative improvements in the overall grade of dysphonia (P = 0.025) and in the degree of breathiness (P = 0.025). Conclusions. The use of a bipedicled vocal fold mucosal flap appears to promote significant improvements in the mucosal wave and in voice quality. In the patients evaluated here, the technique was used without preoperative planning. However, it proved to be a safe and appropriate means of repairing mucosal defects in the vocal folds, with the potential to preserve rheological properties and promote healing with less chance of fibrosis.
- Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and Gender in Brazilians With and Without Voice Disorders(2016) NEMR, Katia; SIMOES-ZENARI, Marcia; SOUZA, Glaucia S. de; HACHIYA, Adriana; TSUJI, Domingos H.Objectives. This study aims to analyze the Dysphonia Severity Index (DSI) in Brazilians with or without voice disorders and investigate DSI's correlation with gender and auditory-perceptual evaluation data obtained via the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol. Study Design. A total of 66 Brazilian adults from both genders participated in the study, including 24 patients with dysphonia confirmed on laryngeal examination (dysphonic group [DG]) and 42 volunteers without voice or hearing complaints and without auditory-perceptual voice disorders (nondysphonic group [NDG]). Methods. The vocal tasks included in CAPE-V and DSI were performed and recorded. Data were analyzed by means of the independent t test, the Mann-Whitney U test, and Pearson correlation at the 5% significance level. Results. Differences were found in the mean DSI values between the DG and the NDG. Differences were also found in all DSI items between the groups, except for the highest frequency parameter. In the DG, a moderate negative correlation was detected between overall dysphonia severity (CAPE-V) and DSI value, and between breathiness and DSI value, and a weak negative correlation was detected between DSI value and roughness. In the NDG, the maximum phonation time was higher among males. In both groups, the highest frequency parameter was higher among females. Conclusions. The DSI discriminated among Brazilians with or without voice disorders. A correlation was found between some aspects of the DSI and the CAPE-V but not between DSI and gender.