Agata Szkiełkowska

Publications of Agata Szkiełkowska

• Immediate speech fluency improvement after application of the Digital Speech Aid in stuttering patients.

  Authors: Joanna Ratyńska, Agata Szkiełkowska, Renata Markowska, Marek Kurkowski, Marzena Mularzuk, Henryk Skarżyński

  Medical science monitor : international medical journal of experimental and clinical research. 12/2011; 18(1):CR9-12.

  The Digital Speech Aid (DSA) is a pocket-sized device used for speech correction in stutterers. The device modifies the patient's auditory feedback with the use of Delayed Auditory Feedback (DAF) andThe Digital Speech Aid (DSA) is a pocket-sized device used for speech correction in stutterers. The device modifies the patient's auditory feedback with the use of Delayed Auditory Feedback (DAF) and Frequency-shifted Auditory Feedback (FAF). Both methods are well-known to improve speech fluency in stuttering persons. The aim of this study was to assess immediate disfluency reduction after application of the DSA. The study included 335 patients aged 6-64 years with speech disfluency. DSA fitting was performed during 3-day hospitalization. Speech disfluency was assessed during reading, in dialogue and in monologue before fitting and after selection of optimal DAF and FAF parameters. Fluency improvement was assessed statistically with Student's t test for logarithms of the odds of disfluency presence without the DSA and with the DSA. For all speaking situations, statistically significant improvement was achieved, with p<0.005. Immediate fluency improvement was observed in 82.1% of patients during reading, in 84.5% during dialogue, and in 81.2% during monologue. Values different from placebo (reliable improvement) were obtained in 66.9% of patients during reading, in 66.6% during dialogue, and in 63.9% during monologue. The results show that the DSA is an effective tool for immediate disfluency reduction in stutterers.

• [Quality of voice after implantation of hyaluronic acid to the vocal folds - preliminary report].

  Authors: Agata Szkiełkowska, Beata Miaśkiewicz, Marc Remacle, Henryk Skarzyński

  Otolaryngologia polska. The Polish otolaryngology. 11/2011; 65(6):436-42.

  Method of vocal folds implantation with allogenic materials has been applied in medical centre all over the world for over 30 years. this voice improving method is usually applied in severalMethod of vocal folds implantation with allogenic materials has been applied in medical centre all over the world for over 30 years. this voice improving method is usually applied in several indications such as: presbyphonia, vocal folds paralysis, glottis insufficiency, vocal fold scars or sulcus vocalis. all of these illnesses prevent the patients to obtain full glottis closure and produce good quality voice. TO assess quality of voice after implantation of hyaluronic acid to the vocal folds. Consisted of 15 patients, who underwent surgical implantation of hyaluronic acid to the vocal folds. 10 patients had the procedure performed on both sides of the larynx, this group included 6 patients with vocal insufficiency of the glottis, 2 with scars and atrophy of the vocal folds and 2 with presbyphonia. In 5 cases the hyaluronic acid was applied on one side of the larynx. The group included 4 patients with vocal folds paralysis and one person with single sided scars and atrophy of the vocal fold. Each patient was examined with videostroboscopy and underwent objective and subjective assessment of voice. Hyaluronic acid was injected surgically under Jet Ventilation general anesthesia. In two cases during the procedure scars were removed from the vocal folds. All patients after hyaluronic acid augmentation took part in the rehabilitation program that included series of voice emission exercises before operation and up to 3 months after the procedure. Examination was performed 1, 3 and 6 months after injection. In all cases improvement of quality of voice was obtained which was stated by a physician and the patients subjectively. Improvement of harmonic voice structure was confirmed by spectrographic record. Acoustic examinations revealed that the improvement was obtained within parameters describing frequency, amplitude disturbance and noise existence. Injection of the hyaluronic acid to the vocal folds improves functional phonation and quality of voice in cases of patients with glottis insufficiency. Injection of the hyaluronic acid to the vocal folds is an efficient method improving quality of voice and can be safe alternative for no surgery method in rehabilitation of voice. This method is a simply, effective and quickly to improve of voice disorders.

• [Assessment of the efficiency of the auditory training in children with dyslalia and auditory processing disorders].

  Authors: Elżbieta Włodarczyk, Agata Szkiełkowska, Henryk Skarżyński, Adam Piłka

  Otolaryngologia polska. The Polish otolaryngology. 09/2011; 65(5):339-44.

  To assess effectiveness of the auditory training in children with dyslalia and central auditory processing disorders. Material consisted of 50 children aged 7-9-years-old. Children with articulationTo assess effectiveness of the auditory training in children with dyslalia and central auditory processing disorders. Material consisted of 50 children aged 7-9-years-old. Children with articulation disorders stayed under long-term speech therapy care in the Auditory and Phoniatrics Clinic. All children were examined by a laryngologist and a phoniatrician. Assessment included tonal and impedance audiometry and speech therapists' and psychologist's consultations. Additionally, a set of electrophysiological examinations was performed - registration of N2, P2, N2, P2, P300 waves and psychoacoustic test of central auditory functions: FPT - frequency pattern test. Next children took part in the regular auditory training and attended speech therapy. Speech assessment followed treatment and therapy, again psychoacoustic tests were performed and P300 cortical potentials were recorded. After that statistical analyses were performed. Analyses revealed that application of auditory training in patients with dyslalia and other central auditory disorders is very efficient. Auditory training may be a very efficient therapy supporting speech therapy in children suffering from dyslalia coexisting with articulation and central auditory disorders and in children with educational problems of audiogenic origin.

• [Assessment of voice in patients with Reinke's oedemas treated with laser microsurgery].

  Authors: Agata Szkiełkowska, Beata Miaśkiewicz, Elzbieta Włodarczyk, Anna Wakarowa, Henryk Skarziński

  Otolaryngologia polska. The Polish otolaryngology. 01/2008; 62(1):82-7.

  This investigation was undertaken for perceptual and acoustic analysis of voice in patients with Reinke's oedemas treated with laser microsurgery. Material of the study included 45 patients in theThis investigation was undertaken for perceptual and acoustic analysis of voice in patients with Reinke's oedemas treated with laser microsurgery. Material of the study included 45 patients in the age of 23 to 65 presenting to Foniatric Clinic with dysphonia in Reinke's oedemas. Patients were divided into 3 groups according to Yonakawa's classification of Reinke's oedemas. All patients were treated with CO2 laser microsurgery. Voice assessment was made subiectively with GRBAS scale and objectively using multidimensional voice parameters analysis (MDVP). The examination was undertaken preoperatively and 4 weeks after operation. The results of our study show relationship between quality of voice after surgery and the stage of evolution of Reinke's oedemas according to the applied classification.

• [Therapeutic difficulties in spasmodic dysphonia--case report]

  Authors: Agata Szkiełkowska, Beata Miaśkiewicz, Sylwia Baczyńska-Swierczyńska, Eliza Szymańska

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 06/2006; 20(119):557-9.

  Spasmodic dysphonia is a focal form of laryngeal dystonia that causes unintended contractions of vocal folds with speech interruptions and affecting the voice quality. There are adductor (82%),Spasmodic dysphonia is a focal form of laryngeal dystonia that causes unintended contractions of vocal folds with speech interruptions and affecting the voice quality. There are adductor (82%), abductor (36%), mixed (1%) types and reported by Blitzer--respiratory adductor type with paradoxical vocal fold movement and stidor. As an example of diagnostic and therapeutic difficulties in spasmodic dysphonia and its multidisciplinary approach with needed cooperation of many specialists we presented patient with adductor spasmodic dysphonia. In stroboscopic evaluation there were observed glottic overclosure and hyperaduction in supraglotic stuctures (sphincteric). During diagnostic procedures there was made acoustic analysis by digital spectrograph (by KAY Elmetrics Company). IV degree of hoarsness and voice breaks were observed in sonogram. In multidimentional analysis there were deviations of the frequency, amplitude, noise, tremor and voice break parameters. Treatment included regular speech therapy, relaxation- and psychotherapy. The results of treatment were very instable because every stress-related problem released symptoms. Botulinum toxin injections into thyro-arytenoid muscle which had made before our hospitalisation were also not succeeding. Because of lack of etiologic factor and plenty diseases that can mimic spasmodic dysphonia, close communication between many specialists is needed.

• [Plan of therapy and rehabilitation in stuttering patients]

  Authors: Agata Szkiełkowska, Joanna Ratyńska, Andrzej Czyzewski, Henryk Skarzyński, Marek Kurkowski, Marzena Mularzuk, Renata Markowska

  Otolaryngologia polska. The Polish otolaryngology. 02/2003; 57(4):555-9.

  The aim of the paper is to present the program of therapy and rehabilitation in stuttering patients based of the digital speech aid. The device has been applied to 130 patients aged 6-47 y.o. 85% ofThe aim of the paper is to present the program of therapy and rehabilitation in stuttering patients based of the digital speech aid. The device has been applied to 130 patients aged 6-47 y.o. 85% of the patients had statistically significant instant improvement of speech fluency after application of digital speech aid. After completing diagnostic process, the patients were enrolled for the rehabilitation program which comprised of training with the use of speech aid, speech therapy, psychotherapy, audio-psycho-linguistic stimulation with the use of the Tomatis Method, physiotherapy, relaxation exercises, phoniatric rehabilitation and medical therapy. After 6 months of therapy and rehabilitation a statistically significant improvement of speech fluency was found in 124 patients, i.e. in 96%. The therapeutic programme based on the use of digital speech aid proves effective for majority of stuttering patients.

• [Physiotherapy of Eustachian tube dysfunction in adults--preliminary report]

  Authors: Renata Markowska, Agata Szkiełkowska, Joanna Ratyńska, Henryk Skarzyński

  Otolaryngologia polska. The Polish otolaryngology. 02/2003; 57(2):277-81.

  The paper presents preliminary results of Eustachian tube dysfunction treatment with the use of vibroaerosols in adult patients. 21 patients aged 16-73 y.o. (mean age 49 y.o) have been included inThe paper presents preliminary results of Eustachian tube dysfunction treatment with the use of vibroaerosols in adult patients. 21 patients aged 16-73 y.o. (mean age 49 y.o) have been included in the study. The treatment included inhalation of medicines individually selected for the patient, based on the results of the physical examination. The patients have been divided into 2 groups, depending on the type of tympanogram. Group I included patients with type A tympanogram and abnormal Eustachian tube patency test result. Group II comprised of patients with type B or C tympanogram and abnormal Eustachian tube patency test result. After treatment, subjective improvement has been observed in 88.9% of the ears, objective improvement in 61.5% of the ears. In group II, objective improvement observed by the change of tympanogram has been observed in 85% of ears. Lack of correlation between objective and subjective improvement have been observed in 26% of the ears. In 11.1% of the ears no benefit from treatment has been observed. The correlation between subjective and objective improvement has been observed in 74% of ears. It appears that treatment with the use of vibroaerosols is beneficial for patients with Eustachian tube dysfunction.

• [Phoniatric and laryngologic symptoms in motor neuron disease (MND)].

  Authors: Beata Miśkiewicz, Agata Szkiełkowska, Joanna Ratyńska, Anna Skoczylas, Henryk Skarzyński

  Otolaryngologia polska. The Polish otolaryngology. 64(3):171-6.

  Motor neuron disease is a progressive neurologic disorder characterized by degeneration of motor neurons in the cerebral cortex, brain stem and spinal cord. Was to present methods of therapy andMotor neuron disease is a progressive neurologic disorder characterized by degeneration of motor neurons in the cerebral cortex, brain stem and spinal cord. Was to present methods of therapy and rehabilitation in patients with MND and the role of phoniatrician and otolaryngologist in diagnostic and therapeutic process. MATERIAL AND METHOD, RESULTS: The material of present study consists of 3 patients in the age of 38 to 55 who were admitted to The Institute of Physiology and Pathology of Hearing in Warsaw, Poland. Patients underwent laryngological, phoniatric and neurologopedics examinations. They were treated with phoniatric and logopedics rehabilitation strategy applying manual therapy of voice, speech exercises and courses of physiotherapy. As a result of therapeutical management, quality of speech and voice were improved. 1. Disorders of voice and speech may be early symptoms of motor neuron disease; 2. Patients with motor neuron disease require multidisciplinary therapy, including otolaryngologists and phoniatricians; 3. Acoustic analysis of voice (MDVP) presents more often disorders in frequency range than amplitude changes; 4. Intensive and regular excercises are crucial for the improvement in speech communication.