Egypt: Four Decades of Voice Research and Clinical Application The activities of the Ain Shams group in Cairo in the field of vocology represent a notable struggle that began when we decided to lay the foundations of the field of vocology and human communication disorders. The mere focus on the needs of people with vocal and communication disorders was ... World Beat
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World Beat  |   May 01, 2006
Egypt: Four Decades of Voice Research and Clinical Application
Author Notes
  • M. Nasser Kotby, professor at Ain Shams University, established the specialty of Phoniatrics and Logopedics (medical and non-medical speech pathology) at Ain Shams University and Egypt in 1974 and chaired the unit until 1998. He is president of The Egyptian Association of Phoniatrics and Logopedics. Contact him at nkotby@cng.com.eg.
    M. Nasser Kotby, professor at Ain Shams University, established the specialty of Phoniatrics and Logopedics (medical and non-medical speech pathology) at Ain Shams University and Egypt in 1974 and chaired the unit until 1998. He is president of The Egyptian Association of Phoniatrics and Logopedics. Contact him at nkotby@cng.com.eg.×
Article Information
International & Global / Speech, Voice & Prosody / World Beat
World Beat   |   May 01, 2006
Egypt: Four Decades of Voice Research and Clinical Application
The ASHA Leader, May 2006, Vol. 11, 30-32. doi:10.1044/leader.WB3.11072006.30
The ASHA Leader, May 2006, Vol. 11, 30-32. doi:10.1044/leader.WB3.11072006.30
The activities of the Ain Shams group in Cairo in the field of vocology represent a notable struggle that began when we decided to lay the foundations of the field of vocology and human communication disorders. The mere focus on the needs of people with vocal and communication disorders was a matter of debate and the atmosphere did not help prioritize funding. Despite this attitude, services were initiated and have reached a very effective level in a region that earlier was totally deprived.
Our understanding of the term vocology is that it includes all aspects of human voice from basic sciences to clinical and surgical management to the science and art of singing and singers’ training.
Research
The interest of our team in vocology started in 1965 with a question raised about the action/function of the small internal laryngeal muscles and the relation of the various groups of muscles to each other. The tool to investigate and answer the question was laryngeal electromyography (LEMG). A PhD dissertation was written with description of a standardized method for per-cutaneous LEMG reports on the action of the internal laryngeal muscles in health and disease (Kotby, 1967, 1975).
Further studies were later carried out on specific aspects of the subject (Kotby and Haugen, 1970a, b, c, d). After a period of three decades of applying LEMG, our team felt it necessary to share their concern regarding some remaining difficulties in the technique. These points were discussed in a state-of-the-art article (Kotby et al., 1992a).
The interest in the larynx continued in the field of structure and function. The pattern of attachment of the laryngeal muscles at the base of the arytenoid cartilage was studied in an attempt to explain some of the controversial findings resulting from the studies on LEMG. A proposed mechanism/mode of action of the various small internal laryngeal muscles individually and in combinations was presented (El-Sammaa, 1980; Mossallam et al., 1986a; Mossallam et al., 1987).
The same group investigated the branching and the fiber distribution as well as the fiber size spectrum of the inferior laryngeal nerve, aiming to relate the neural and muscular structure to the functional outcome illustrated in their LEMG studies (Kotby and El-Sammaa, 1981). Further investigations in the structure and function of the vocal folds and ventricular bands were carried out (Kotby et al., 1991a; Kotby et al., 1992b; Riad & Kotby, 1995).
A program of research was launched to investigate the histo-pathological nature of the small mucosal benign lesions of the vocal folds as polyps, nodules, Reinke’s edema, and contact granulomas. Both light microscopy and ultra structure studies support the notion that these lesions are non-neoplastic, non-inflammatory, probably arising as a result of vocal trauma. The commonalities between these lesions, histologically and clinically, allowed the team to propose grouping them under one group referred to as Minimal Associated Pathological Lesions (MAPLs) of the vocal fold (Kotby et al., 1980; Kotby & Ghali, 1983; Kotby et al., 1983; Mossallam et al., 1986b; Kotby et al., 1988).
Clinical Area
In the clinical domain, efforts focused on establishing a comprehensive protocol of assessment (diagnosis) of voice disorders. The protocol included the elementary qualitative bedside tools and extended to the more quantitative and quasi-objective measures (Kotby, 1986). Central in this protocol are: systematic patient interview, Auditory Perceptual Assessment of the patient’s voice by the expert clinician’s ears, video-stroboscopy, and standardized voice recording.
As the glottis is a transformer that changes aerodynamic energy into acoustic energy (voice), the instrumental measures for the assessment of voice have included aerodynamic and acoustic aspects. The aerodynamics of voice disorders were investigated and became part of the protocol (Kotby et al., 1990). Related to this domain is inverse filtering (Kotby et al., 1998a; Hegazi et al., 1999). In acoustics, certain perturbation measures were applied (Kotby et al., 1992c; Kotby et al, 1993a; Kotby et al, 1996).
A further study assessed critically the diagnostic value of the acoustic parameters (Kotby et al., 1998b). A related aspect in acoustics, Voice Range Profile, was applied (Kotby and Orabi, 1995). Video-kymography (Bassiouny et al., 2000), and voice quality in neurological disorders of the larynx (Kotby et al., 1995a) are additional areas our team studied as part of the assessment protocol.
Our team has a special interest in non-organic voice disorders as they represent a major category of the patient population we see. We investigated habitual aphonia early in our program (Kaiser et al., 1978). Out of clinical necessity, the team carried out a series of studies focused on the nature, development, and management of childhood dysphonias (Kotby et al., 1994; Kotby et al, 1998c). We planned a study to investigate the importance of psychogenic stress in the causation of non-organic voice disorders (Kotby et al., 2001).
The team has applied the Kleinsasser endolaryngeal microsurgical techniques for decades. The main surgical application is extirpation of the small benign mucosal lesions of the vocal folds using basically cold metal tools. Laser is applied in restricted indications.
Lately the team started the application of Botox injection in the thyro-arytenoid muscles in cases of spasmodic dysphonia. This condition is not common in Egypt. The results of Botox injections are promising but the recurrence of symptoms is, as expected, rather eminent. A re-injection within two to three months is the rule.
The team has special work in the management of paralytic glottal gaps. Small gaps up to 1.5 mm proved to respond favorably to conservative behavior re-adjustment voice therapy [BRAT] (Kotby et al., 1991b, Bassiouny, 1998). Gaps up to 3.5 mm respond well to vocal fold augmentation using autogenous fat (Kotby et al., 2003).
The team worked on one of the voice therapy methods, namely the Smith Accent Method, for several years. We applied the technique to a host of non-organic voice disorders as well as to some selected cases of organic voice ailments. Efficacy studies were published (Kotby et al., 1991b; Bassiouny, 1998). The Accent Method was presented in a comprehensive manner, in book form (Kotby, 1995), and as a summary, in the form of an article (Kotby & Fex, 1998). We carried out an attempt to study the mechanism of action of the accent exercises in improvement of the vocal function (Kotby et al., 1993b).
We also worked in the area of the singing voice. These concentrated on the traditional singing of the country (Kotby et al., 1992d; Kotby et al., 1995b).
After 33 years we have reached the stage that people with communication disorders (including voice disorders) are well-recognized and their needs are fulfilled as much as a developing economy and community can supply. Self-control, patience, endurance, persistence, perseverance, and tenacity are the attitudes that continue to guide our work.
References
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Kotby, M. N. (1967). Electromyography of the laryngeal muscles. PhD thesis presented to the Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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Kotby, M. N. & El-Sammaa, M. E. (1981). Observations on the pattern of the terminal branching of the recurrent laryngeal nerve and its internal topography. Presented to the Fourth Annual Ain Shams Medical Congress.
Kotby, M. N. & El-Sammaa, M. E. (1981). Observations on the pattern of the terminal branching of the recurrent laryngeal nerve and its internal topography. Presented to the Fourth Annual Ain Shams Medical Congress.×
Kotby, M. N. & Fex, B. (1998). The accent method: Behavior readjustment voice therapy. Scandinavian Journal of Logopedics, Phoniatrics and Vocology, 23, 30–43. [Article]
Kotby, M. N. & Fex, B. (1998). The accent method: Behavior readjustment voice therapy. Scandinavian Journal of Logopedics, Phoniatrics and Vocology, 23, 30–43. [Article] ×
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Kotby, M. N. & Haugen, L. K. (1970c). Attempts at evaluation of the function of various laryngeal muscles in the light of muscle and nerve stimulation in man. Acta Otolaryngologica (Stockholm), 70, 419–427. [Article]
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Kotby, M. N., & Haugen, L. K. (1970d). Clinical application of electromyography in vocal cord mobility disorders. Acta Otolaryngologica (Stockholm), 70, 428–437. [Article]
Kotby, M. N., & Haugen, L. K. (1970d). Clinical application of electromyography in vocal cord mobility disorders. Acta Otolaryngologica (Stockholm), 70, 428–437. [Article] ×
Kotby, M. N., & Orabi, A. A. (1995). Voice range profile as a quantitative measure of vocal function in some pathological voices. Proceedings of the XXIII World Congress of the IALP. Kotby, M. N. (ed.), pp. 50–53, Cairo, Aug. 6–10.
Kotby, M. N., & Orabi, A. A. (1995). Voice range profile as a quantitative measure of vocal function in some pathological voices. Proceedings of the XXIII World Congress of the IALP. Kotby, M. N. (ed.), pp. 50–53, Cairo, Aug. 6–10.×
Kotby, M. N., Abdel-Rahman, A. G., Saleh, M. M., El-Assal, N. N., & Al-Malki, K. H. (2003). Evaluation of vocal fold fat augmentation in management of paralytic glottal gap. PhD thesis presented to the Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Kotby, M. N., Abdel-Rahman, A. G., Saleh, M. M., El-Assal, N. N., & Al-Malki, K. H. (2003). Evaluation of vocal fold fat augmentation in management of paralytic glottal gap. PhD thesis presented to the Faculty of Medicine, Ain Shams University, Cairo, Egypt.×
Kotby, M. N., Aref, E. M., El Sady, S., Aboul Ella, M. Y., Bassiouny, S. E., & Abou-Ras, Y. (1996). Acoustic and aerodynamic correlates of normal voice quality. 3rd European Congress of the European Federation of Oto-Rhino-Laryngological Societies, Budapest, Hungary, June 9–14.
Kotby, M. N., Aref, E. M., El Sady, S., Aboul Ella, M. Y., Bassiouny, S. E., & Abou-Ras, Y. (1996). Acoustic and aerodynamic correlates of normal voice quality. 3rd European Congress of the European Federation of Oto-Rhino-Laryngological Societies, Budapest, Hungary, June 9–14.×
Kotby, M. N., Barakah, M., Abou El-Ella, M. Y., Khidr, A., & Hegazi, M. (1990). Aerodynamic analysis of voice disorders. Proceedings of the XIV World Congress of Otorhinolaryngology, Head and Neck Surgery, Madrid, Spain, Sept. 10–15, 1989, Edited by Sacristan, T., Alvarez-Vicent, J. J., Bartual, J., Antoli-Candela, F.. Kugler and Ghedini Publications, Amsterdam, pp. 2041–2047.
Kotby, M. N., Barakah, M., Abou El-Ella, M. Y., Khidr, A., & Hegazi, M. (1990). Aerodynamic analysis of voice disorders. Proceedings of the XIV World Congress of Otorhinolaryngology, Head and Neck Surgery, Madrid, Spain, Sept. 10–15, 1989, Edited by Sacristan, T., Alvarez-Vicent, J. J., Bartual, J., Antoli-Candela, F.. Kugler and Ghedini Publications, Amsterdam, pp. 2041–2047.×
Kotby, M. N., Bassiouny, S., Amin, M., Garrett, D., Kirchner, J., & Kahane, J. (1992b). Pattern of gross displacement of the vocal fold in adduction and abduction movements. Acta Otolaryngologica (Stockholm), 112, 349–352.
Kotby, M. N., Bassiouny, S., Amin, M., Garrett, D., Kirchner, J., & Kahane, J. (1992b). Pattern of gross displacement of the vocal fold in adduction and abduction movements. Acta Otolaryngologica (Stockholm), 112, 349–352.×
Kotby, M. N., Chinski, A., Mocellin, M., Simasko, N., & Staffiri, A. (1998c). Medical treatment of dysphonias: Round table. In Pediatric otolaryngology: An update. Passali, D. (Ed.), p. 277, Kugler Publications, The Hague, The Netherlands.
Kotby, M. N., Chinski, A., Mocellin, M., Simasko, N., & Staffiri, A. (1998c). Medical treatment of dysphonias: Round table. In Pediatric otolaryngology: An update. Passali, D. (Ed.), p. 277, Kugler Publications, The Hague, The Netherlands.×
Kotby, M. N., El Sady, S. R., & Hegazi, M.A. (1998a). Vibratory and acoustic correlates of perceived voice quality. Proceedings of the XXI International Ain Shams Medical Congress, 91–97.
Kotby, M. N., El Sady, S. R., & Hegazi, M.A. (1998a). Vibratory and acoustic correlates of perceived voice quality. Proceedings of the XXI International Ain Shams Medical Congress, 91–97.×
Kotby, M. N., El Sady, S. R., Abdel Rahman, A. G., Abdel Nasser, N. H., Dawood, A. A., & Helal, E. (1994). Pediatric vocal fold nodules: Diagnostic profile and alternative lines of management. In Infections in childhood, ear, nose and throat aspects. Sadé, J. (Ed.), pp. 354–361. Excerpta, Medica, Amsterdam, the Netherlands.
Kotby, M. N., El Sady, S. R., Abdel Rahman, A. G., Abdel Nasser, N. H., Dawood, A. A., & Helal, E. (1994). Pediatric vocal fold nodules: Diagnostic profile and alternative lines of management. In Infections in childhood, ear, nose and throat aspects. Sadé, J. (Ed.), pp. 354–361. Excerpta, Medica, Amsterdam, the Netherlands.×
Kotby, M. N., El Sady, S. R., Alloush, T., Khidr, A., Abdel Nasser, N. H., Gamal, N., El Sharkawy, A., Mahmoud, H., & Kamal, A. (1995a). Voice quality in neurological disorders of the larynx. Pathological correlates. In Vocal fold physiology. Voice quality control. Fujimara, O. and Hirano, M. (Eds.), pp. 249–267. San Diego , CA : Singular Publishing Group, Inc.
Kotby, M. N., El Sady, S. R., Alloush, T., Khidr, A., Abdel Nasser, N. H., Gamal, N., El Sharkawy, A., Mahmoud, H., & Kamal, A. (1995a). Voice quality in neurological disorders of the larynx. Pathological correlates. In Vocal fold physiology. Voice quality control. Fujimara, O. and Hirano, M. (Eds.), pp. 249–267. San Diego , CA : Singular Publishing Group, Inc.×
Kotby, M. N., El-Sady, S. R., Bassiouny, S. E., Abou Rass, Y., & Hegazi, M. (1991b). Efficacy of the accent method of voice therapy. Journal of Voice, 5(4), 316–320. [Article]
Kotby, M. N., El-Sady, S. R., Bassiouny, S. E., Abou Rass, Y., & Hegazi, M. (1991b). Efficacy of the accent method of voice therapy. Journal of Voice, 5(4), 316–320. [Article] ×
Kotby, M. N., Erian, N., Bassiouny, S., Saleh, M., Khidr, A., Orabi, A., & Aref, E. (1995b). Coptic chanting: Perceptual, laryngoscopic, aerodynamic, acoustic and musical aspects. Proceedings of the XXIII World Congress of the IALP. Kotby, M. N. (Ed.), pp. 97–99, Cairo, Aug. 6–10.
Kotby, M. N., Erian, N., Bassiouny, S., Saleh, M., Khidr, A., Orabi, A., & Aref, E. (1995b). Coptic chanting: Perceptual, laryngoscopic, aerodynamic, acoustic and musical aspects. Proceedings of the XXIII World Congress of the IALP. Kotby, M. N. (Ed.), pp. 97–99, Cairo, Aug. 6–10.×
Kotby, M. N., Fadly, E., Barakah, M., Alloush, T., Khidr, A., Madkour, O., & Saleh, M. (1992a). Electromyography and neurogrophy in voice neurolaryngology. Journal of Voice, 6, 159–187. [Article]
Kotby, M. N., Fadly, E., Barakah, M., Alloush, T., Khidr, A., Madkour, O., & Saleh, M. (1992a). Electromyography and neurogrophy in voice neurolaryngology. Journal of Voice, 6, 159–187. [Article] ×
Kotby, M. N., Fadly, M. E., & Alloush, T. (1992d). Singing technique in the Arabic musical culture. In The new frontiers of oto-rhino-laryngology in Europe. Motta, G. (Ed.). Part IV, p. 129, Monduzzi, Bologna.
Kotby, M. N., Fadly, M. E., & Alloush, T. (1992d). Singing technique in the Arabic musical culture. In The new frontiers of oto-rhino-laryngology in Europe. Motta, G. (Ed.). Part IV, p. 129, Monduzzi, Bologna.×
Kotby, M. N., Ghali, A. F., & Barakah, M. (1980). Recategorization of non-malignant organic vocal fold changes in dysphonia. Proceedings of the 18th Congress of the International Association of Logopedics and Phoniatrics, Vol. I, pp. 37. Washington DC, Aug. 4–7.
Kotby, M. N., Ghali, A. F., & Barakah, M. (1980). Recategorization of non-malignant organic vocal fold changes in dysphonia. Proceedings of the 18th Congress of the International Association of Logopedics and Phoniatrics, Vol. I, pp. 37. Washington DC, Aug. 4–7.×
Kotby, M. N., Ghali, A. F., & Barakah, M. (1983). Vocal fold cysts. Proceedings of the Sixth Annual Ain Shams Medical Congress, pp. 1–10.
Kotby, M. N., Ghali, A. F., & Barakah, M. (1983). Vocal fold cysts. Proceedings of the Sixth Annual Ain Shams Medical Congress, pp. 1–10.×
Kotby, M. N., Ghoneim, M. H., El Sady, S. R., & Shoeib, R. (2001). Aetiological background of non-organic voice disorders. PhD thesis presented to the Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Kotby, M. N., Ghoneim, M. H., El Sady, S. R., & Shoeib, R. (2001). Aetiological background of non-organic voice disorders. PhD thesis presented to the Faculty of Medicine, Ain Shams University, Cairo, Egypt.×
Kotby, M. N., Hegazi, M. A., & El Assal, A. (1998b). Of what value are the acoustic measures of voice? Proceedings of the XXI International Ain Shams Medical Congress, 75–82.
Kotby, M. N., Hegazi, M. A., & El Assal, A. (1998b). Of what value are the acoustic measures of voice? Proceedings of the XXI International Ain Shams Medical Congress, 75–82.×
Kotby, M. N., Kirchner, J. A., Kahane, J. C., & Bassiouny, S. S. (1991a). Histo-anatomical structure of the human laryngeal ventricle. Acta Otolaryngologica (Stockholm), 111, 396–402. [Article]
Kotby, M. N., Kirchner, J. A., Kahane, J. C., & Bassiouny, S. S. (1991a). Histo-anatomical structure of the human laryngeal ventricle. Acta Otolaryngologica (Stockholm), 111, 396–402. [Article] ×
Kotby, M. N., Nassar, A. M., Seif, E. I., Helal, E. H., & Saleh, M. N. (1988). Ultrastructural features of vocal fold nodules and polyps. Acta Otolaryngologica (Stockholm), 105, 477–482. [Article]
Kotby, M. N., Nassar, A. M., Seif, E. I., Helal, E. H., & Saleh, M. N. (1988). Ultrastructural features of vocal fold nodules and polyps. Acta Otolaryngologica (Stockholm), 105, 477–482. [Article] ×
Kotby, M. N., Shiromoto, O., & Hirano, M. (1993). Accent method: Effect on F0, SPL and U. Journal of Voice, 7(2), 319–325. [PubMed]
Kotby, M. N., Shiromoto, O., & Hirano, M. (1993). Accent method: Effect on F0, SPL and U. Journal of Voice, 7(2), 319–325. [PubMed]×
Kotby, M. N., Titze, I. R., Saleh, M., & Berry, D. A. (1993a). Fundamental frequency stability in functional dysphonia. Acta Otolaryngologica (Stockholm), 113, 439–444. [Article]
Kotby, M. N., Titze, I. R., Saleh, M., & Berry, D. A. (1993a). Fundamental frequency stability in functional dysphonia. Acta Otolaryngologica (Stockholm), 113, 439–444. [Article] ×
Kotby, M. N., Titze, I. R., Saleh, M., & Youssef, M. (1992c). Perturbation measures in different types of dysphonia. Proceedings of the XXII World Congress of IALP, Loebell, E. (Ed.). Med. Hochschule, Hannover, No. 15.
Kotby, M. N., Titze, I. R., Saleh, M., & Youssef, M. (1992c). Perturbation measures in different types of dysphonia. Proceedings of the XXII World Congress of IALP, Loebell, E. (Ed.). Med. Hochschule, Hannover, No. 15.×
Mossallam, I., Kotby, M. N., & Abd-El Rahman, S. (1987). Attachment of some internal laryngeal muscles at the base of the arytenoid. Acta Otolaryngologica (Stockholm), 103(5 & 6), 649–656.
Mossallam, I., Kotby, M. N., & Abd-El Rahman, S. (1987). Attachment of some internal laryngeal muscles at the base of the arytenoid. Acta Otolaryngologica (Stockholm), 103(5 & 6), 649–656.×
Mossallam, I., Kotby, M. N., & El-Sammaa, M. (1986a). Attachment of the posterior cricoarytenoid muscle and ligament at the base of the arytenoid cartilage. Proceedings of International Symposium on Voice: A Satellite Meeting of XXth Congress of IALP, pp. 350–351, Kurume, Japan, July 28–29.
Mossallam, I., Kotby, M. N., & El-Sammaa, M. (1986a). Attachment of the posterior cricoarytenoid muscle and ligament at the base of the arytenoid cartilage. Proceedings of International Symposium on Voice: A Satellite Meeting of XXth Congress of IALP, pp. 350–351, Kurume, Japan, July 28–29.×
Mossallam, I., Kotby, M. N., Ghaly, A. F., Nassar, A. M., & Barakah, M. (1986b). Histopathological aspects of benign vocal fold lesions associated with dysphonia. In Vocal fold physiology A symposium (Chap. 9). Kirchner, J. A. (Ed.), pp. 65–80. San Diego, CA: College Hill Press.
Mossallam, I., Kotby, M. N., Ghaly, A. F., Nassar, A. M., & Barakah, M. (1986b). Histopathological aspects of benign vocal fold lesions associated with dysphonia. In Vocal fold physiology A symposium (Chap. 9). Kirchner, J. A. (Ed.), pp. 65–80. San Diego, CA: College Hill Press.×
Riad, M. A., & Kotby, M. N. (1995). Mechanism of glottic closure in a model of unilateral vocal fold palsy. Acta Otolaryngologica (Stockholm), 115, 311–313. [Article]
Riad, M. A., & Kotby, M. N. (1995). Mechanism of glottic closure in a model of unilateral vocal fold palsy. Acta Otolaryngologica (Stockholm), 115, 311–313. [Article] ×
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May 2006
Volume 11, Issue 7