Dysphonia and vocal fold telangiectasia in hereditary hemorrhagic telangiectasia.

PubMed

Chang, Joseph; Yung, Katherine C

2014-11-01

This case report is the first documentation of dysphonia and vocal fold telangiectasia as a complication of hereditary hemorrhagic telangiectasia (HHT). Case report of a 40-year-old man with HHT presenting with 2 years of worsening hoarseness. Hoarseness corresponded with a period of anticoagulation. Endoscopy revealed vocal fold scarring, vocal fold telangiectasias, and plica ventricular is suggestive of previous submucosal vocal fold hemorrhage and subsequent counterproductive compensation with ventricular phonation. Hereditary hemorrhagic telangiectasia may present as dysphonia with vocal fold telangiectasias and place patients at risk of vocal fold hemorrhage. © The Author(s) 2014.

The Risk of Vocal Fold Atrophy after Serial Corticosteroid Injections of the Vocal Fold.

PubMed

Shi, Lucy L; Giraldez-Rodriguez, Laureano A; Johns, Michael M

2016-11-01

The aim of this study was to illustrate the risk of vocal fold atrophy in patients who receive serial subepithelial steroid injections for vocal fold scar. This study is a retrospective case report of two patients who underwent a series of weekly subepithelial infusions of 10 mg/mL dexamethasone for benign vocal fold lesion. Shortly after the procedures, both patients developed a weak and breathy voice. The first patient was a 53-year-old man with radiation-induced vocal fold stiffness. Six injections were performed unilaterally, and 1 week later, he developed unilateral vocal fold atrophy with new glottal insufficiency. The second patient was a 67-year-old woman with severe vocal fold inflammation related to laryngitis and calcinosis, Raynaud's phenomenon, esophagean dysmotility, sclerodactyly, and telangiectasia (CREST) syndrome. Five injections were performed bilaterally, and 1 week later, she developed bilateral vocal fold atrophy with a large midline glottal gap during phonation. In both cases, the steroid-induced vocal atrophy resolved spontaneously after 4 months. Serial subepithelial steroid infusions of the vocal folds, although safe in the majority of patients, carry the risk of causing temporary vocal fold atrophy when given at short intervals. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Histopathologic investigations of the unphonated human child vocal fold mucosa.

PubMed

Sato, Kiminori; Umeno, Hirohito; Nakashima, Tadashi; Nonaka, Satoshi; Harabuchi, Yasuaki

2012-01-01

Vocal fold stellate cells (VFSCs) in the maculae flavae (MFe) located at both ends of the vocal fold mucosa are inferred to be involved in the metabolism of extracellular matrices. MFe are also considered to be an important structure in the growth and development of the human vocal fold mucosa. Tension caused by phonation (vocal fold vibration) is hypothesized to stimulate VFSCs to accelerate production of extracellular matrices. Human child vocal fold mucosae unphonated since birth were investigated histologically. Histologic analysis of human child vocal fold mucosa. Vocal fold mucosae, which have remained unphonated since birth, of two children (7 and 12 years old) with cerebral palsy were investigated by light and electron microscopy and compared with normal subjects. Vocal fold mucosae and MFe were hypoplastic and rudimentary and did not have a vocal ligament, Reinke's space, or the layered structure. The lamina propria appeared as a uniform structure. Some VFSCs in the MFe showed degeneration and not many vesicles were present at the periphery of the cytoplasm. The VFSCs synthesized fewer extracellular matrices, such as fibrous protein and glycosaminoglycan. The VFSCs appeared to have decreased activity. Vocal fold vibration (phonation) after birth is an important factor in the growth and development of the human vocal fold mucosa. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Altered vocal fold kinematics in synthetic self-oscillating models that employ adipose tissue as a lateral boundary condition.

NASA Astrophysics Data System (ADS)

Saidi, Hiba; Erath, Byron D.

2015-11-01

The vocal folds play a major role in human communication by initiating voiced sound production. During voiced speech, the vocal folds are set into sustained vibrations. Synthetic self-oscillating vocal fold models are regularly employed to gain insight into flow-structure interactions governing the phonation process. Commonly, a fixed boundary condition is applied to the lateral, anterior, and posterior sides of the synthetic vocal fold models. However, physiological observations reveal the presence of adipose tissue on the lateral surface between the thyroid cartilage and the vocal folds. The goal of this study is to investigate the influence of including this substrate layer of adipose tissue on the dynamics of phonation. For a more realistic representation of the human vocal folds, synthetic multi-layer vocal fold models have been fabricated and tested while including a soft lateral layer representative of adipose tissue. Phonation parameters have been collected and are compared to those of the standard vocal fold models. Results show that vocal fold kinematics are affected by adding the adipose tissue layer as a new boundary condition.

Interstitial protein alterations in rabbit vocal fold with scar.

PubMed

Thibeault, Susan L; Bless, Diane M; Gray, Steven D

2003-09-01

Fibrous and interstitial proteins compose the extracellular matrix of the vocal fold lamina propria and account for its biomechanic properties. Vocal fold scarring is characterized by altered biomechanical properties, which create dysphonia. Although alterations of the fibrous proteins have been confirmed in the rabbit vocal fold scar, interstitial proteins, which are known to be important in wound repair, have not been investigated to date. Using a rabbit model, interstitial proteins decorin, fibromodulin, and fibronectin were examined immunohistologically, two months postinduction of vocal fold scar by means of forcep biopsy. Significantly decreased decorin and fibromodulin with significantly increased fibronectin characterized scarred vocal fold tissue. The implications of altered interstitial proteins levels and their affect on the fibrous proteins will be discussed in relation to increased vocal fold stiffness and viscosity, which characterizes vocal fold scar.

[Temperament of children with vocal fold nodules].

PubMed

Wei, Youhua; Wang, Zhinan; Xu, Zhongqiang; Chen, Ping; Hao, Lili

2009-11-01

To examine the temperament of children with vocal fold nodules. To compare the temperament dimension and temperamental types of 42 children with vocal fold nodules with 46 vocally normal children, using Chinese children's Temperament Problem Screening system (CCTPSs). The children with vocal fold nodules differed significantly from the comparison group in their temperament dimension's adaptability, intensity of reaction, mood value, persistency and temperamental types. There are more difficult and slow-to-warm-up children in patients with vocal fold nodules than vocally normal children.

FE Modelling of the Fluid-Structure-Acoustic Interaction for the Vocal Folds Self-Oscillation

NASA Astrophysics Data System (ADS)

Švancara, Pavel; Horáček, J.; Hrůza, V.

The flow induced self-oscillation of the human vocal folds in interaction with acoustic processes in the simplified vocal tract model was explored by three-dimensional (3D) finite element (FE) model. Developed FE model includes vocal folds pretension before phonation, large deformations of the vocal fold tissue, vocal folds contact, fluid-structure interaction, morphing the fluid mesh according the vocal folds motion (Arbitrary Lagrangian-Eulerian approach), unsteady viscous compressible airflow described by the Navier-Stokes equations and airflow separation during the glottis closure. Iterative partitioned approach is used for modelling the fluid-structure interaction. Computed results prove that the developed model can be used for simulation of the vocal folds self-oscillation and resulting acoustic waves. The developed model enables to numerically simulate an influence of some pathological changes in the vocal fold tissue on the voice production.

Mesenchymal Stem Cell Therapy for the Treatment of Vocal Fold Scarring: A Systematic Review of Preclinical Studies

PubMed Central

Wingstrand, Vibe Lindeblad; Jensen, David H.; Bork, Kristian; Sebbesen, Lars; Balle, Jesper; Fischer-Nielsen, Anne; von Buchwald, Christian

2016-01-01

Objectives Therapy with mesenchymal stem cells exhibits potential for the development of novel interventions for many diseases and injuries. The use of mesenchymal stem cells in regenerative therapy for vocal fold scarring exhibited promising results to reduce stiffness and enhance the biomechanical properties of injured vocal folds. This study evaluated the biomechanical effects of mesenchymal stem cell therapy for the treatment of vocal fold scarring. Data Sources PubMed, Embase, the Cochrane Library and Google Scholar were searched. Methods Controlled studies that assessed the biomechanical effects of mesenchymal stem cell therapy for the treatment of vocal fold scarring were included. Primary outcomes were viscoelastic properties and mucosal wave amplitude. Results Seven preclinical animal studies (n = 152 single vocal folds) were eligible for inclusion. Evaluation of viscoelastic parameters revealed a decreased dynamic viscosity (η’) and elastic modulus (G’), i.e., decreased resistance and stiffness, in scarred vocal folds treated with mesenchymal stem cells compared to non-treated scarred vocal folds. Mucosal wave amplitude was increased in scarred vocal folds treated with mesenchymal stem cells vs. non-treated scarred vocal folds. Conclusion The results from these studies suggest an increased regenerative effect of therapy with mesenchymal stem cells for scarred vocal folds and are encouraging for further clinical studies. PMID:27631373

Mesenchymal Stem Cell Therapy for the Treatment of Vocal Fold Scarring: A Systematic Review of Preclinical Studies.

PubMed

Wingstrand, Vibe Lindeblad; Grønhøj Larsen, Christian; Jensen, David H; Bork, Kristian; Sebbesen, Lars; Balle, Jesper; Fischer-Nielsen, Anne; von Buchwald, Christian

2016-01-01

Therapy with mesenchymal stem cells exhibits potential for the development of novel interventions for many diseases and injuries. The use of mesenchymal stem cells in regenerative therapy for vocal fold scarring exhibited promising results to reduce stiffness and enhance the biomechanical properties of injured vocal folds. This study evaluated the biomechanical effects of mesenchymal stem cell therapy for the treatment of vocal fold scarring. PubMed, Embase, the Cochrane Library and Google Scholar were searched. Controlled studies that assessed the biomechanical effects of mesenchymal stem cell therapy for the treatment of vocal fold scarring were included. Primary outcomes were viscoelastic properties and mucosal wave amplitude. Seven preclinical animal studies (n = 152 single vocal folds) were eligible for inclusion. Evaluation of viscoelastic parameters revealed a decreased dynamic viscosity (η') and elastic modulus (G'), i.e., decreased resistance and stiffness, in scarred vocal folds treated with mesenchymal stem cells compared to non-treated scarred vocal folds. Mucosal wave amplitude was increased in scarred vocal folds treated with mesenchymal stem cells vs. non-treated scarred vocal folds. The results from these studies suggest an increased regenerative effect of therapy with mesenchymal stem cells for scarred vocal folds and are encouraging for further clinical studies.

Hoarseness caused by arytenoid dislocation after surgery for lung cancer.

PubMed

Kurihara, Nobuyasu; Imai, Kazuhiro; Minamiya, Yoshihiro; Saito, Hajime; Takashima, Shinogu; Kudo, Satoshi; Kawaharada, Yasushi; Ogawa, Jun-Ichi

2014-12-01

The patient was a 64-year-old woman with no history of laryngeal disorders. She underwent video-assisted right lower lobectomy and node dissection for lung cancer. Using a stylet while the patient was under general anesthesia, tracheal intubation with a 35-French gauge left-sided double-lumen endobronchial tube was successfully performed on the first attempt. The patient developed slight hoarseness on postoperative day 1, and we initially suspected recurrent laryngeal nerve paralysis caused by the surgery, which we elected to treat conservatively. However, because her hoarseness had not improved 4 months after surgery, we evaluated her vocal cords using laryngoscopy. This revealed severe dysfunction of the right vocal cord and arytenoid dislocation, which we treated through reduction using a balloon catheter. By 6 months, the patient's vocal cord mobility had improved. Arytenoid dislocation is a rare complication, but should be suspected when patients have right vocal fold paralysis after lung cancer surgery.

A Rat Excised Larynx Model of Vocal Fold Scar

ERIC Educational Resources Information Center

Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.

2009-01-01

Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…

Influence of the ventricular folds on a voice source with specified vocal fold motion1

PubMed Central

McGowan, Richard S.; Howe, Michael S.

2010-01-01

The unsteady drag on the vocal folds is the major source of sound during voiced speech. The drag force is caused by vortex shedding from the vocal folds. The influence of the ventricular folds (i.e., the “false” vocal folds that protrude into the vocal tract a short distance downstream of the glottis) on the drag and the voice source are examined in this paper by means of a theoretical model involving vortex sheets in a two-dimensional geometry. The effect of the ventricular folds on the output acoustic pressure is found to be small when the movement of the vocal folds is prescribed. It is argued that the effect remains small when fluid-structure interactions account for vocal fold movement. These conclusions can be justified mathematically when the characteristic time scale for change in the velocity of the glottal jet is large compared to the time it takes for a vortex disturbance to be convected through the vocal fold and ventricular fold region. PMID:20329852

Adapted to Roar: Functional Morphology of Tiger and Lion Vocal Folds

PubMed Central

Klemuk, Sarah A.; Riede, Tobias; Walsh, Edward J.; Titze, Ingo R.

2011-01-01

Vocal production requires active control of the respiratory system, larynx and vocal tract. Vocal sounds in mammals are produced by flow-induced vocal fold oscillation, which requires vocal fold tissue that can sustain the mechanical stress during phonation. Our understanding of the relationship between morphology and vocal function of vocal folds is very limited. Here we tested the hypothesis that vocal fold morphology and viscoelastic properties allow a prediction of fundamental frequency range of sounds that can be produced, and minimal lung pressure necessary to initiate phonation. We tested the hypothesis in lions and tigers who are well-known for producing low frequency and very loud roaring sounds that expose vocal folds to large stresses. In histological sections, we found that the Panthera vocal fold lamina propria consists of a lateral region with adipocytes embedded in a network of collagen and elastin fibers and hyaluronan. There is also a medial region that contains only fibrous proteins and hyaluronan but no fat cells. Young's moduli range between 10 and 2000 kPa for strains up to 60%. Shear moduli ranged between 0.1 and 2 kPa and differed between layers. Biomechanical and morphological data were used to make predictions of fundamental frequency and subglottal pressure ranges. Such predictions agreed well with measurements from natural phonation and phonation of excised larynges, respectively. We assume that fat shapes Panthera vocal folds into an advantageous geometry for phonation and it protects vocal folds. Its primary function is probably not to increase vocal fold mass as suggested previously. The large square-shaped Panthera vocal fold eases phonation onset and thereby extends the dynamic range of the voice. PMID:22073246

Numerical Simulation of the Self-Oscillations of the Vocal Folds and of the Resulting Acoustic Phenomena in the Vocal Tract

NASA Astrophysics Data System (ADS)

Švancara, P.; Horáček, J.; Švec, J. G.

The study presents a three-dimensional (3D) finite element (FE) model of the flow-induced self-oscillation of the human vocal folds in interaction with acoustics of simplified vocal tract models. The 3D vocal tract models of the acoustic spaces shaped for simulation of phonation of Czech vowels [a:], [i:] and [u:] were created by converting the data from the magnetic resonance images (MRI). For modelling of the fluid-structure interaction, explicit coupling scheme with separated solvers for fluid and structure domain was utilized. The FE model comprises vocal folds pretension before starting phonation, large deformations of the vocal fold tissue, vocal-fold collisions, fluid-structure interaction, morphing the fluid mesh according to the vocal-fold motion (Arbitrary Lagrangian-Eulerian approach), unsteady viscous compressible airflow described by the Navier-Stokes equations and airflow separation. The developed FE model enables to study the relationship between flow-induced vibrations of the vocal folds and acoustic wave propagation in the vocal tract and can also be used to simulate for example pathological changes in the vocal fold tissue and their influence on the voice production.

Current Understanding and Future Directions for Vocal Fold Mechanobiology

PubMed Central

Li, Nicole Y.K.; Heris, Hossein K.; Mongeau, Luc

2013-01-01

The vocal folds, which are located in the larynx, are the main organ of voice production for human communication. The vocal folds are under continuous biomechanical stress similar to other mechanically active organs, such as the heart, lungs, tendons and muscles. During speech and singing, the vocal folds oscillate at frequencies ranging from 20 Hz to 3 kHz with amplitudes of a few millimeters. The biomechanical stress associated with accumulated phonation is believed to alter vocal fold cell activity and tissue structure in many ways. Excessive phonatory stress can damage tissue structure and induce a cell-mediated inflammatory response, resulting in a pathological vocal fold lesion. On the other hand, phonatory stress is one major factor in the maturation of the vocal folds into a specialized tri-layer structure. One specific form of vocal fold oscillation, which involves low impact and large amplitude excursion, is prescribed therapeutically for patients with mild vocal fold injuries. Although biomechanical forces affect vocal fold physiology and pathology, there is little understanding of how mechanical forces regulate these processes at the cellular and molecular level. Research into vocal fold mechanobiology has burgeoned over the past several years. Vocal fold bioreactors are being developed in several laboratories to provide a biomimic environment that allows the systematic manipulation of physical and biological factors on the cells of interest in vitro. Computer models have been used to simulate the integrated response of cells and proteins as a function of phonation stress. The purpose of this paper is to review current research on the mechanobiology of the vocal folds as it relates to growth, pathogenesis and treatment as well as to propose specific research directions that will advance our understanding of this subject. PMID:24812638

Variability of normal vocal fold dynamics for different vocal loading in one healthy subject investigated by phonovibrograms.

PubMed

Doellinger, Michael; Lohscheller, Joerg; McWhorter, Andrew; Kunduk, Melda

2009-03-01

We investigate the potential of high-speed digital imaging technique (HSI) and the phonovibrogram (PVG) analysis in normal vocal fold dynamics by studying the effects of continuous voice use (vocal loading) during the workday. One healthy subject was recorded at sustained phonation 13 times within 2 consecutive days in the morning before and in the afternoon after vocal loading, respectively. Vocal fold dynamics were extracted and visualized by PVGs. The characteristic PVG patterns were extracted representing vocal fold vibration types. The parameter values were then analyzed by statistics regarding vocal load, left-right PVG asymmetries, anterior-posterior PVG asymmetries, and opening-closing differences. For the first time, the direct impact of vocal load could be determined by analyzing vocal fold dynamics. For same vocal loading conditions, equal dynamical behavior of the vocal folds were confirmed. Comparison of recordings performed in the morning with the recordings after work revealed significant changes in vibration behavior, indicating impact of occurring vocal load. Left-right asymmetries in vocal fold dynamics were found confirming earlier assumptions. Different dynamics between opening and closing procedure as well as for anterior and posterior parts were found. Constant voice usage stresses the vocal folds even in healthy subjects and can be detected by applying the PVG technique. Furthermore, left-right PVG asymmetries do occur in healthy voice to a certain extent. HSI in combination with PVG analysis seems to be a promising tool for investigation of vocal fold fatigue and pathologies resulting in small forms of dynamical changes.

Preservation of viscoelastic properties of rabbit vocal folds after implantation of hyaluronic Acid-based biomaterials.

PubMed

Choi, Jeong-Seok; Kim, Nahn Ju; Klemuk, Sarah; Jang, Yun Ho; Park, In Suh; Ahn, Kyung Hyun; Lim, Jae-Yol; Kim, Young-Mo

2012-09-01

To compare the rheological characteristics of structurally different hyaluronic acid (HA)-based biomaterials that are presently used for phonosurgery and to investigate their influence on the viscoelastic properties of vocal folds after implantation in an in vivo rabbit model. In vitro and in vivo rheometric investigation. Experimental laboratory, Inha and Seoul National Universities. Viscoelastic shear properties of 3 HA-based biomaterials (Rofilan, Restylane, and Reviderm) were measured with a strain-controlled rheometer. These biomaterials were injected into the deep layers of rabbit vocal folds, and viscoelastic moduli of the injected vocal folds were determined 2 months after the injection. The vocal fold specimens were observed using a light microscope and a transmission electron microscope. All HA-based biomaterials showed similar levels of shear viscosity, which were slightly higher than that of human vocal folds reported in previous studies. Compared with noninjected control vocal folds, there were no significant differences in the magnitudes of both elastic shear modulus (G') and viscous modulus (G") of injected vocal folds among all of the materials. Light microscopic images showed that all materials were observed in the deep layers of vocal folds and electron scanning images revealed that injected HA particles were homogeneously distributed in regions of collagenous fibers. HA-based biomaterials could preserve the viscoelastic properties of the vocal folds, when they were injected into vocal folds in an in vivo rabbit model. However, further studies on the influence of the biomaterials on the viscoelasticity of human vocal folds in ECM surroundings are still needed.

A case of bilateral vocal fold mucosal bridges, bilateral trans-vocal fold type III sulci vocales, and an intracordal polyp.

PubMed

Tan, Melin; Pitman, Michael J

2011-07-01

We present a patient with a novel finding of bilateral mucosal bridges, bilateral type III trans-vocal fold sulci vocales, and a vocal fold polyp. Although sulci and mucosal bridges occur in the vocal folds, it is rare to find multiples of these lesions in a single patient, and it is even more uncommon when they occur in conjunction with a vocal fold polyp. To our knowledge, this is the first description of a vocal fold polyp in combination with multiple vocal fold bridges and multiple type III sulci vocales in a single patient. To describe and visually present the diagnosis and treatment of a patient with an intracordal polyp, bilateral mucosal bridges, as well as bilateral type III trans-vocal fold sulci vocales. Presentation of a set of high definition intraoperative photos displaying the extent of the vocal fold lesions and the resection of the intracordal polyp. This patient presented with only 6 months of significant dysphonia. It was felt that the recent change in voice was because of the polyp and not the bridges or sulci vocales. Considering the patient's presentation and the possible morbidity of resection of mucosal bridges and sulci, only the polyp was excised. Postoperatively, the patient's voice returned to his acceptable mild baseline dysphonia, and the benefit has persisted 6 months postoperatively. The combination of bilateral mucosal bridges, bilateral type III sulcus vocalis, and an intracordal polyp in one patient is rare if not novel. Treatment of the polyp alone returned the patient's voice to his lifelong baseline of mild dysphonia. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Collagen Content Limits Optical Coherence Tomography Image Depth in Porcine Vocal Fold Tissue.

PubMed

Garcia, Jordan A; Benboujja, Fouzi; Beaudette, Kathy; Rogers, Derek; Maurer, Rie; Boudoux, Caroline; Hartnick, Christopher J

2016-11-01

Vocal fold scarring, a condition defined by increased collagen content, is challenging to treat without a method of noninvasively assessing vocal fold structure in vivo. The goal of this study was to observe the effects of vocal fold collagen content on optical coherence tomography imaging to develop a quantifiable marker of disease. Excised specimen study. Massachusetts Eye and Ear Infirmary. Porcine vocal folds were injected with collagenase to remove collagen from the lamina propria. Optical coherence tomography imaging was performed preinjection and at 0, 45, 90, and 180 minutes postinjection. Mean pixel intensity (or image brightness) was extracted from images of collagenase- and control-treated hemilarynges. Texture analysis of the lamina propria at each injection site was performed to extract image contrast. Two-factor repeated measure analysis of variance and t tests were used to determine statistical significance. Picrosirius red staining was performed to confirm collagenase activity. Mean pixel intensity was higher at injection sites of collagenase-treated vocal folds than control vocal folds (P < .0001). Fold change in image contrast was significantly increased in collagenase-treated vocal folds than control vocal folds (P = .002). Picrosirius red staining in control specimens revealed collagen fibrils most prominent in the subepithelium and above the thyroarytenoid muscle. Specimens treated with collagenase exhibited a loss of these structures. Collagen removal from vocal fold tissue increases image brightness of underlying structures. This inverse relationship may be useful in treating vocal fold scarring in patients. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Dependence of phonation threshold pressure on vocal tract acoustics and vocal fold tissue mechanics.

PubMed

Chan, Roger W; Titze, Ingo R

2006-04-01

Analytical and computer simulation studies have shown that the acoustic impedance of the vocal tract as well as the viscoelastic properties of vocal fold tissues are critical for determining the dynamics and the energy transfer mechanism of vocal fold oscillation. In the present study, a linear, small-amplitude oscillation theory was revised by taking into account the propagation of a mucosal wave and the inertive reactance (inertance) of the supraglottal vocal tract as the major energy transfer mechanisms for flow-induced self-oscillation of the vocal fold. Specifically, analytical results predicted that phonation threshold pressure (Pth) increases with the viscous shear properties of the vocal fold, but decreases with vocal tract inertance. This theory was empirically tested using a physical model of the larynx, where biological materials (fat, hyaluronic acid, and fibronectin) were implanted into the vocal fold cover to investigate the effect of vocal fold tissue viscoelasticity on Pth. A uniform-tube supraglottal vocal tract was also introduced to examine the effect of vocal tract inertance on Pth. Results showed that Pth decreased with the inertive impedance of the vocal tract and increased with the viscous shear modulus (G") or dynamic viscosity (eta') of the vocal fold cover, consistent with theoretical predictions. These findings supported the potential biomechanical benefits of hyaluronic acid as a surgical bioimplant for repairing voice disorders involving the superficial layer of the lamina propria, such as scarring, sulcus vocalis, atrophy, and Reinke's edema.

Predicting Achievable Fundamental Frequency Ranges in Vocalization Across Species

PubMed Central

Titze, Ingo; Riede, Tobias; Mau, Ted

2016-01-01

Vocal folds are used as sound sources in various species, but it is unknown how vocal fold morphologies are optimized for different acoustic objectives. Here we identify two main variables affecting range of vocal fold vibration frequency, namely vocal fold elongation and tissue fiber stress. A simple vibrating string model is used to predict fundamental frequency ranges across species of different vocal fold sizes. While average fundamental frequency is predominantly determined by vocal fold length (larynx size), range of fundamental frequency is facilitated by (1) laryngeal muscles that control elongation and by (2) nonlinearity in tissue fiber tension. One adaptation that would increase fundamental frequency range is greater freedom in joint rotation or gliding of two cartilages (thyroid and cricoid), so that vocal fold length change is maximized. Alternatively, tissue layers can develop to bear a disproportionate fiber tension (i.e., a ligament with high density collagen fibers), increasing the fundamental frequency range and thereby vocal versatility. The range of fundamental frequency across species is thus not simply one-dimensional, but can be conceptualized as the dependent variable in a multi-dimensional morphospace. In humans, this could allow for variations that could be clinically important for voice therapy and vocal fold repair. Alternative solutions could also have importance in vocal training for singing and other highly-skilled vocalizations. PMID:27309543

Mechanical properties of the vocal fold. Stress-strain studies.

PubMed

Haji, T; Mori, K; Omori, K; Isshiki, N

1992-01-01

The viscoelasticity of the vocal and ventricular folds was experimentally assessed by analyzing the stress-strain relationships obtained using a newly developed measuring system. The degree of stiffness of the mid-membranous portion of the vocal fold was less than that near the anterior commissure or the vocal process. The ventricular fold was much less stiff and significantly more viscous than the vocal fold. At the membranous portion of the vocal fold, the degree of stiffness was less and that of viscosity greater at 2 mm above and below the free margin than at the free margin itself.

Retention of Human-Induced Pluripotent Stem Cells (hiPS) With Injectable HA Hydrogels for Vocal Fold Engineering.

PubMed

Imaizumi, Mitsuyoshi; Li-Jessen, Nicole Y K; Sato, Yuka; Yang, David T; Thibeault, Susan L

2017-04-01

One prospective treatment option for vocal fold scarring is regeneration with an engineered scaffold containing induced pluripotent stem cells (iPS). In the present study, we investigated the feasibility of utilizing an injectable hyaluronic acid (HA) scaffold encapsulated with human-iPS cell (hiPS) for regeneration of vocal folds. Thirty athymic nude rats underwent unilateral vocal fold injury. Contralateral vocal folds served as uninjured controls. Hyaluronic acid hydrogel scaffold, HA hydrogel scaffold containing hiPS, and HA hydrogel scaffold containing hiPS with epidermal growth factor (EGF) were injected in both vocal folds immediately after surgery. One and 2 weeks after injection, larynges were excised for histology, immunohistochemistry, and fluorescence in situ hybridization (FISH). Presence of HA hydrogel was confirmed in vocal folds 1 and 2 weeks post injection. The FISH analysis confirmed the presence and viability of hiPS in the injected vocal folds. Histological results demonstrated that vocal folds injected with HA hydrogel scaffold containing EGF demonstrated less fibrosis than those with HA hydrogel only. Human-iPS survived in injured rat vocal folds. The HA hydrogel with hiPS and EGF ameliorated the fibrotic response. Additional work is necessary to optimize hiPS differentiation and further confirm the safety of hiPS for clinical applications.

Relation of structural and vibratory kinematics of the vocal folds to two acoustic measures of breathy voice based on computational modeling

PubMed Central

Samlan, Robin A.; Story, Brad H.

2011-01-01

Purpose To relate vocal fold structure and kinematics to two acoustic measures: cepstral peak prominence (CPP) and the amplitude of the first harmonic relative to the second (H1-H2). Method A computational, kinematic model of the medial surfaces of the vocal folds was used to specify features of vocal fold structure and vibration in a manner consistent with breathy voice. Four model parameters were altered: degree of vocal fold adduction, surface bulging, vibratory nodal point, and supraglottal constriction. CPP and H1-H2 were measured from simulated glottal area, glottal flow and acoustic waveforms and related to the underlying vocal fold kinematics. Results CPP decreased with increased separation of the vocal processes, whereas the nodal point location had little effect. H1-H2 increased as a function of separation of the vocal processes in the range of 1–1.5 mm and decreased with separation > 1.5 mm. Conclusions CPP is generally a function of vocal process separation. H1*-H2* will increase or decrease with vocal process separation based on vocal fold shape, pivot point for the rotational mode, and supraglottal vocal tract shape, limiting its utility as an indicator of breathy voice. Future work will relate the perception of breathiness to vocal fold kinematics and acoustic measures. PMID:21498582

Vocal cord dysfunction in children.

PubMed

Noyes, Blakeslee E; Kemp, James S

2007-06-01

Vocal cord dysfunction is characterised by paradoxical vocal cord adduction that occurs during inspiration, resulting in symptoms of dyspnoea, wheeze, chest or throat tightness and cough. Although the condition is well described in children and adults, confusion with asthma often triggers the use of an aggressive treatment regimen directed against asthma. The laryngoscopic demonstration of vocal cord adduction during inspiration has been considered the gold standard for the diagnosis of vocal cord dysfunction, but historical factors and pulmonary function findings may provide adequate clues to the correct diagnosis. Speech therapy, and in some cases psychological counselling, is often beneficial in this disorder. The natural course and prognosis of vocal cord dysfunction are still not well described in adults or children.

Pulsed dye laser-induced inflammatory response and extracellular matrix turnover in rat vocal folds and vocal fold fibroblasts.

PubMed

Lin, Ya; Yamashita, Masaru; Zhang, Jingxian; Ling, Changying; Welham, Nathan V

2009-10-01

Disruption of the vocal fold extracellular matrix (ECM) can induce a profound and refractory dysphonia. Pulsed dye laser (PDL) irradiation has shown early promise as a treatment modality for disordered ECM in patients with chronic vocal fold scar; however, there are limited data addressing the mechanism by which this laser energy might induce cellular and extracellular changes in vocal fold tissues. In this study, we examined the inflammatory and ECM modulating effects of PDL irradiation on normal vocal fold tissues and cultured vocal fold fibroblasts (VFFs). We evaluated the effects of 585 nm PDL irradiation on inflammatory cytokine and collagen/collagenase gene transcription in normal rat vocal folds in vivo (3-168 hours following delivery of approximately 39.46 J/cm(2) fluence) and VFFs in vitro (3-72 hours following delivery of 4.82 or 9.64 J/cm(2) fluence). We also examined morphological vocal fold tissue changes 3 hours, 1 week, and 1 month post-irradiation. PDL irradiation altered inflammatory cytokine and procollagen/collagenase expression at the transcript level, both in vitro and in vivo. Additionally, PDL irradiation induced an inflammatory repair process in vivo that was completed by 1 month with preservation of normal tissue morphology. PDL irradiation can modulate ECM turnover in phenotypically normal vocal folds. Additional work is required to determine if these findings extend to disordered ECM, such as is seen in vocal fold scar. Lasers Surg. Med. 41:585-594, 2009. (c) 2009 Wiley-Liss, Inc.

Experimental analysis of the characteristics of artificial vocal folds.

PubMed

Misun, Vojtech; Svancara, Pavel; Vasek, Martin

2011-05-01

Specialized literature presents a number of models describing the function of the vocal folds. In most of those models, an emphasis is placed on the air flowing through the glottis and, further, on the effect of the parameters of the air alone (its mass, speed, and so forth). The article focuses on the constructional definition of artificial vocal folds and their experimental analysis. The analysis is conducted for voiced source voice phonation and for the changing mean value of the subglottal pressure. The article further deals with the analysis of the pressure of the airflow through the vocal folds, which is cut (separated) into individual pulses by the vibrating vocal folds. The analysis results show that air pulse characteristics are relevant to voice generation, as they are produced by the flowing air and vibrating vocal folds. A number of artificial vocal folds have been constructed to date, and the aforementioned view of their phonation is confirmed by their analysis. The experiments have confirmed that man is able to consciously affect only two parameters of the source voice, that is, its fundamental frequency and voice intensity. The main forces acting on the vocal folds during phonation are as follows: subglottal air pressure and elastic and inertia forces of the vocal folds' structure. The correctness of the function of the artificial vocal folds is documented by the experimental verification of the spectra of several types of artificial vocal folds. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Viscoelastic and histologic properties in scarred rabbit vocal folds after mesenchymal stem cell injection.

PubMed

Hertegård, S; Cedervall, J; Svensson, B; Forsberg, K; Maurer, F H J; Vidovska, D; Olivius, P; Ahrlund-Richter, L; Le Blanc, K

2006-07-01

The aim of this study was to analyze the short-term viscoelastic and histologic properties of scarred rabbit vocal folds after injection of human mesenchymal stem cells (MSC) as well as the degree of MSC survival. Because MSCs are antiinflammatory and regenerate mesenchymal tissues, can MSC injection reduce vocal fold scarring after injury? Twelve vocal folds from 10 New Zealand rabbits were scarred by a localized resection and injected with human MSC or saline. Eight vocal folds were left as controls. After 4 weeks, 10 larynges were stained for histology and evaluation of the lamina propria thickness. Collagen type I content was analyzed from six rabbits. MSC survival was analyzed by fluorescent in situ hybridization staining from three rabbits. Viscoelasticity for 10 vocal folds was analyzed in a parallel-plate rheometer. The rheometry on fresh-frozen samples showed decreased dynamic viscosity and lower elastic modulus (P<.01) in the scarred samples injected with MSC as compared with the untreated scarred group. Normal controls had lower dynamic viscosity and elastic modulus as compared with the scarred untreated and treated vocal folds (P<.01). Histologic analysis showed a higher content of collagen type 1 in the scarred samples as compared with the normal vocal folds and with the scarred folds treated with MSC. MSCs remained in all samples analyzed. The treated scarred vocal folds showed persistent MSC. Injection of scarred rabbit vocal folds with MSC rendered improved viscoelastic parameters and less signs of scarring expressed as collagen content in comparison to the untreated scarred vocal folds.

Modeling the biomechanical influence of epilaryngeal stricture on the vocal folds: a low-dimensional model of vocal-ventricular fold coupling.

PubMed

Moisik, Scott R; Esling, John H

2014-04-01

PURPOSE Physiological and phonetic studies suggest that, at moderate levels of epilaryngeal stricture, the ventricular folds impinge upon the vocal folds and influence their dynamical behavior, which is thought to be responsible for constricted laryngeal sounds. In this work, the authors examine this hypothesis through biomechanical modeling. METHOD The dynamical response of a low-dimensional, lumped-element model of the vocal folds under the influence of vocal-ventricular fold coupling was evaluated. The model was assessed for F0 and cover-mass phase difference. Case studies of simulations of different constricted phonation types and of glottal stop illustrate various additional aspects of model performance. RESULTS Simulated vocal-ventricular fold coupling lowers F0 and perturbs the mucosal wave. It also appears to reinforce irregular patterns of oscillation, and it can enhance laryngeal closure in glottal stop production. CONCLUSION The effects of simulated vocal-ventricular fold coupling are consistent with sounds, such as creaky voice, harsh voice, and glottal stop, that have been observed to involve epilaryngeal stricture and apparent contact between the vocal folds and ventricular folds. This supports the view that vocal-ventricular fold coupling is important in the vibratory dynamics of such sounds and, furthermore, suggests that these sounds may intrinsically require epilaryngeal stricture.

Quantitative Analysis of Vocal Fold Vibration in Vocal Fold Paralysis With the Use of High-speed Digital Imaging.

PubMed

Yamauchi, Akihito; Yokonishi, Hisayuki; Imagawa, Hiroshi; Sakakibara, Ken-Ichi; Nito, Takaharu; Tayama, Niro

2016-11-01

The goal of this work was to objectively elucidate the vibratory characteristics of vocal fold paralysis (VFP) using high-speed digital imaging (HSDI). HSDI was performed in 29 vocally healthy subjects (12 women and 17 men) and in 107 patients with VFP (40 women and 67 men). Then, the HSDI data were evaluated by visual-perceptual rating, single-line kymography, multiline kymography, laryngotopography, and glottal area waveform analysis. Patients with VFP compared with vocally healthy subjects revealed more frequent incomplete glottal closure, greater asymmetry in amplitude, mucosal wave, frequency, and phase, as well as larger open quotient, smaller speed index, larger maximal and minimal glottal area, and smaller glottal area difference. Paralyzed vocal folds in VFP revealed reduced mucosal wave than nonparalyzed vocal folds in VFP or in intact vocal folds in vocally healthy subjects. HSDI was effective in documenting the characteristics of vocal fold vibrations in patients with VFP and in exploring the vibratory disturbance for estimating the severity of dysphonia. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Visualizing Collagen Network Within Human and Rhesus Monkey Vocal Folds Using Polarized Light Microscopy

PubMed Central

Julias, Margaret; Riede, Tobias; Cook, Douglas

2014-01-01

Objectives Collagen fiber content and orientation affect the viscoelastic properties of the vocal folds, determining oscillation characteristics during speech and other vocalization. The investigation and reconstruction of the collagen network in vocal folds remains a challenge, because the collagen network requires at least micron-scale resolution. In this study, we used polarized light microscopy to investigate the distribution and alignment of collagen fibers within the vocal folds. Methods Data were collected in sections of human and rhesus monkey (Macaca mulatta) vocal folds cut at 3 different angles and stained with picrosirius red. Results Statistically significant differences were found between different section angles, implying that more than one section angle is required to capture the network’s complexity. In the human vocal folds, the collagen fiber distribution continuously varied across the lamina propria (medial to lateral). Distinct differences in birefringence distribution were observed between the species. For the human vocal folds, high birefringence was observed near the thyroarytenoid muscle and near the epithelium. However, in the rhesus monkey vocal folds, high birefringence was observed near the epithelium, and lower birefringence was seen near the thyroarytenoid muscle. Conclusions The differences between the collagen networks in human and rhesus monkey vocal folds provide a morphological basis for differences in viscoelastic properties between species. PMID:23534129

Vocal fold motion outcome based on excellent prognosis with laryngeal electromyography.

PubMed

Smith, Libby J; Rosen, Clark A; Munin, Michael C

2016-10-01

As laryngeal electromyography (LEMG) becomes more refined, accurate predictions of vocal fold motion recovery are possible. Focus has been on outcomes for patients with poor prognosis for vocal fold motion recovery. Limited information is available regarding the expected rate of purposeful vocal fold motion recovery when there is good to normal motor recruitment, no signs of denervation, and no signs of synkinetic activity with LEMG, termed excellent prognosis. The objective of this study is to determine the rate of vocal fold motion recovery with excellent prognosis findings on LEMG after acute recurrent laryngeal nerve injury. Retrospective review. Patients undergoing a standardized LEMG protocol, consisting of qualitative (evaluation of motor recruitment, motor unit configuration, detection of fibrillations, presence of synkinesis) and quantitative (turns analysis) measurements were evaluated for purposeful vocal-fold motion recovery, calculated after at least 6 months since onset of injury. Twenty-three patients who underwent LEMG for acute vocal fold paralysis met the inclusion criteria of excellent prognosis. Eighteen patients (78.3%) recovered vocal fold motion, as determined by flexible laryngoscopy. Nearly 80% of patients determined to have excellent prognosis for vocal fold motion recovery experienced return of vocal fold motion. This information will help clinicians not only counsel their patients on expectations but will also help guide treatment. 4. Laryngoscope, 126:2310-2314, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Vocal Dose Measures: Quantifying Accumulated Vibration Exposure in Vocal Fold Tissues

PubMed Central

Titze, Ingo R.; Švec, Jan G.; Popolo, Peter S.

2011-01-01

To measure the exposure to self-induced tissue vibration in speech, three vocal doses were defined and described: distance dose, which accumulates the distance that tissue particles of the vocal folds travel in an oscillatory trajectory; energy dissipation dose, which accumulates the total amount of heat dissipated over a unit volume of vocal fold tissues; and time dose, which accumulates the total phonation time. These doses were compared to a previously used vocal dose measure, the vocal loading index, which accumulates the number of vibration cycles of the vocal folds. Empirical rules for viscosity and vocal fold deformation were used to calculate all the doses from the fundamental frequency (F0) and sound pressure level (SPL) values of speech. Six participants were asked to read in normal, monotone, and exaggerated speech and the doses associated with these vocalizations were calculated. The results showed that large F0 and SPL variations in speech affected the dose measures, suggesting that accumulation of phonation time alone is insufficient. The vibration exposure of the vocal folds in normal speech was related to the industrial limits for hand-transmitted vibration, in which the safe distance dose was derived to be about 500 m. This limit was found rather low for vocalization; it was related to a comparable time dose of about 17 min of continuous vocalization, or about 35 min of continuous reading with normal breathing and unvoiced segments. The voicing pauses in normal speech and dialogue effectively prolong the safe time dose. The derived safety limits for vocalization will likely require refinement based on a more detailed knowledge of the differences in hand and vocal fold tissue morphology and their response to vibrational stress, and on the effect of recovery of the vocal fold tissue during voicing pauses. PMID:12959470

Vocal dose measures: quantifying accumulated vibration exposure in vocal fold tissues.

PubMed

Titze, Ingo R; Svec, Jan G; Popolo, Peter S

2003-08-01

To measure the exposure to self-induced tissue vibration in speech, three vocal doses were defined and described: distance dose, which accumulates the distance that tissue particles of the vocal folds travel in an oscillatory trajectory; energy dissipation dose, which accumulates the total amount of heat dissipated over a unit volume of vocal fold tissues; and time dose, which accumulates the total phonation time. These doses were compared to a previously used vocal dose measure, the vocal loading index, which accumulates the number of vibration cycles of the vocal folds. Empirical rules for viscosity and vocal fold deformation were used to calculate all the doses from the fundamental frequency (F0) and sound pressure level (SPL) values of speech. Six participants were asked to read in normal, monotone, and exaggerated speech and the doses associated with these vocalizations were calculated. The results showed that large F0 and SPL variations in speech affected the dose measures, suggesting that accumulation of phonation time alone is insufficient. The vibration exposure of the vocal folds in normal speech was related to the industrial limits for hand-transmitted vibration, in which the safe distance dose was derived to be about 500 m. This limit was found rather low for vocalization; it was related to a comparable time dose of about 17 min of continuous vocalization, or about 35 min of continuous reading with normal breathing and unvoiced segments. The voicing pauses in normal speech and dialogue effectively prolong the safe time dose. The derived safety limits for vocalization will likely require refinement based on a more detailed knowledge of the differences in hand and vocal fold tissue morphology and their response to vibrational stress, and on the effect of recovery of the vocal fold tissue during voicing pauses.

Relation of structural and vibratory kinematics of the vocal folds to two acoustic measures of breathy voice based on computational modeling.

PubMed

Samlan, Robin A; Story, Brad H

2011-10-01

To relate vocal fold structure and kinematics to 2 acoustic measures: cepstral peak prominence (CPP) and the amplitude of the first harmonic relative to the second (H1-H2). The authors used a computational, kinematic model of the medial surfaces of the vocal folds to specify features of vocal fold structure and vibration in a manner consistent with breathy voice. Four model parameters were altered: degree of vocal fold adduction, surface bulging, vibratory nodal point, and supraglottal constriction. CPP and H1-H2 were measured from simulated glottal area, glottal flow, and acoustic waveforms and were related to the underlying vocal fold kinematics. CPP decreased with increased separation of the vocal processes, whereas the nodal point location had little effect. H1-H2 increased as a function of separation of the vocal processes in the range of 1.0 mm to 1.5 mm and decreased with separation > 1.5 mm. CPP is generally a function of vocal process separation. H1*-H2* (see paragraph 6 of article text for an explanation of the asterisks) will increase or decrease with vocal process separation on the basis of vocal fold shape, pivot point for the rotational mode, and supraglottal vocal tract shape, limiting its utility as an indicator of breathy voice. Future work will relate the perception of breathiness to vocal fold kinematics and acoustic measures.

Vocal fold contact patterns based on normal modes of vibration.

PubMed

Smith, Simeon L; Titze, Ingo R

2018-05-17

The fluid-structure interaction and energy transfer from respiratory airflow to self-sustained vocal fold oscillation continues to be a topic of interest in vocal fold research. Vocal fold vibration is driven by pressures on the vocal fold surface, which are determined by the shape of the glottis and the contact between vocal folds. Characterization of three-dimensional glottal shapes and contact patterns can lead to increased understanding of normal and abnormal physiology of the voice, as well as to development of improved vocal fold models, but a large inventory of shapes has not been directly studied previously. This study aimed to take an initial step toward characterizing vocal fold contact patterns systematically. Vocal fold motion and contact was modeled based on normal mode vibration, as it has been shown that vocal fold vibration can be almost entirely described by only the few lowest order vibrational modes. Symmetric and asymmetric combinations of the four lowest normal modes of vibration were superimposed on left and right vocal fold medial surfaces, for each of three prephonatory glottal configurations, according to a surface wave approach. Contact patterns were generated from the interaction of modal shapes at 16 normalized phases during the vibratory cycle. Eight major contact patterns were identified and characterized by the shape of the flow channel, with the following descriptors assigned: convergent, divergent, convergent-divergent, uniform, split, merged, island, and multichannel. Each of the contact patterns and its variation are described, and future work and applications are discussed. Copyright © 2018 Elsevier Ltd. All rights reserved.

Shear properties of vocal fold mucosal tissues and their effect on vocal fold oscillation

NASA Astrophysics Data System (ADS)

Chan, Roger Wai Kai

Viscoelastic shear properties of vocal fold mucosal tissues and phonosurgical biomaterials were measured with a parallel-plate rotational rheometer. Elastic, viscous and damping properties were quantified as a function of frequency (0.01 Hz to 15 Hz) for human vocal fold mucosal tissues (N = 15), implantable biomaterials commonly used in the treatment of vocal fold paralysis (Teflon, gelatin, and collagen) (the non-mucosal group), and biomaterials currently or potentially useful in the treatment of vocal fold mucosal defects (adipose tissue or fat, hyaluronic acid, and fibronectin) (the mucosal group). It was found that intersubject differences as large as an order of magnitude were often observed for the shear properties of vocal fold mucosal tissues, part of which may be age- and gender-related. Shear properties of the non-mucosal group biomaterials were often much higher than those of the mucosal group biomaterials, which were relatively close to the shear properties of mucosal tissues. Viscoelastic and rheological modeling showed that shear properties of human vocal fold mucosa may be described by a quasi-linear viscoelastic theory and a statistical network theory, based upon which extrapolations to audio frequencies were possible. A theory of small-amplitude vocal fold oscillation was revisited to describe the effects of tissue shear properties on vocal fold oscillation and phonation threshold pressure, a measure of the 'ease' of phonation and an objective indication of vocal function. It was found that phonation threshold pressure is directly related to the viscous shear modulus or the 'effective damping modulus', a concept proposed to quantify the effective amount of damping in vocal fold oscillation. The mucosal group biomaterials were incorporated into the artificial vocal fold mucosa of a physical model in order to empirically assess their effects on phonation threshold pressure. Results showed that higher threshold pressures were consistently observed for higher concentrations of hyaluronic acid and for hyaluronic acid mixed with fibronectin, in correlation with their differences in viscous shear modulus and effective damping modulus. Implications for phonosurgery were discussed in terms of the choice of optimal biomaterials for the surgical management of vocal fold mucosal defects and lamina propria deficiencies.

Diagnostic and therapeutic pitfalls in benign vocal fold diseases

PubMed Central

Bohlender, Jörg

2013-01-01

More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis. PMID:24403969

Sarcoidosis Presenting as Bilateral Vocal Fold Immobility.

PubMed

Hintze, Justin M; Gnagi, Sharon H; Lott, David G

2018-05-01

Bilateral true vocal fold paralysis is rarely attributable to inflammatory diseases. Sarcoidosis is a rare but important etiology of bilateral true vocal fold paralysis by compressive lymphadenopathy, granulomatous infiltration, and neural involvement. We describe the first reported case of sarcoidosis presenting as bilateral vocal fold immobility caused by direct fixation by granulomatous infiltration severe enough to necessitate tracheostomy insertion. In addition, we discuss the presentation, the pathophysiology, and the treatment of this disease with a review of the literature of previously reported cases of sarcoidosis-related vocal fold immobility. Sarcoidosis should therefore be an important consideration for the otolaryngologist's differential diagnosis of true vocal fold immobility. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Vocal fold paralysis secondary to phonotrauma.

PubMed

Klein, Travis A L; Gaziano, Joy E; Ridley, Marion B

2014-01-01

A unique case of acute onset vocal fold paralysis secondary to phonotrauma is presented. The cause was forceful vocalization by a drill instructor on a firearm range. Imaging studies revealed extensive intralaryngeal and retropharyngeal hemorrhage. Laryngoscopy showed a complete left vocal fold paralysis. Relative voice rest was recommended, and the patient regained normal vocal fold mobility and function after approximately 12 weeks. Copyright © 2014 The Voice Foundation. All rights reserved.

The importance of hyaluronic acid in vocal fold biomechanics.

PubMed

Chan, R W; Gray, S D; Titze, I R

2001-06-01

This study examined the influence of hyaluronic acid (HA) on the biomechanical properties of the human vocal fold cover (the superficial layer of the lamina propria). Vocal fold tissues were freshly excised from 5 adult male cadavers and were treated with bovine testicular hyaluronidase to selectively remove HA from the lamina propria extracellular matrix (ECM). Linear viscoelastic shear properties (elastic shear modulus and dynamic viscosity) of the tissue samples before and after enzymatic treatment were quantified as a function of frequency (0.01 to 15 Hz) by a parallel-plate rotational rheometer at 37 degrees C. On removing HA from the vocal fold ECM, the elastic shear modulus (G' ) or stiffness of the vocal fold cover decreased by an average of around 35%, while the dynamic viscosity (eta') increased by 70% at higher frequencies (>1 Hz). The results suggested that HA plays an important role in determining the biomechanical properties of the vocal fold cover. As a highly hydrated glycosaminoglycan in the vocal fold ECM, it likely contributes to the maintenance of an optimal tissue viscosity that may facilitate phonation, and an optimal tissue stiffness that may be important for vocal fundamental frequency control. HA has been proposed as a potential bioimplant for the surgical repair of vocal fold ECM defects (eg, vocal fold scarring and sulcus vocalis). Our results suggested that such clinical use may be potentially optimal for voice production from a biomechanical perspective.

Quantitative Study of Vibrational Symmetry of Injured Vocal Folds via Digital Kymography in Excised Canine Larynges

ERIC Educational Resources Information Center

Krausert, Christopher R.; Ying, Di; Zhang, Yu; Jiang, Jack J.

2011-01-01

Purpose: Digital kymography and vocal fold curve fitting are blended with detailed symmetry analysis of kymograms to provide a comprehensive characterization of the vibratory properties of injured vocal folds. Method: Vocal fold vibration of 12 excised canine larynges was recorded under uninjured, unilaterally injured, and bilaterally injured…

Functional assessment of the ex vivo vocal folds through biomechanical testing: A review

PubMed Central

Dion, Gregory R.; Jeswani, Seema; Roof, Scott; Fritz, Mark; Coelho, Paulo; Sobieraj, Michael; Amin, Milan R.; Branski, Ryan C.

2016-01-01

The human vocal folds are complex structures made up of distinct layers that vary in cellular and extracellular composition. The mechanical properties of vocal fold tissue are fundamental to the study of both the acoustics and biomechanics of voice production. To date, quantitative methods have been applied to characterize the vocal fold tissue in both normal and pathologic conditions. This review describes, summarizes, and discusses the most commonly employed methods for vocal fold biomechanical testing. Force-elongation, torsional parallel plate rheometry, simple-shear parallel plate rheometry, linear skin rheometry, and indentation are the most frequently employed biomechanical tests for vocal fold tissues and each provide material properties data that can be used to compare native tissue verses diseased for treated tissue. Force-elongation testing is clinically useful, as it allows for functional unit testing, while rheometry provides physiologically relevant shear data, and nanoindentation permits micrometer scale testing across different areas of the vocal fold as well as whole organ testing. Thoughtful selection of the testing technique during experimental design to evaluate a hypothesis is important to optimizing biomechanical testing of vocal fold tissues. PMID:27127075

The impact of intraglottal vortices on vocal fold dynamics

NASA Astrophysics Data System (ADS)

Erath, Byron; Pirnia, Alireza; Peterson, Sean

2016-11-01

During voiced speech a critical pressure is produced in the lungs that separates the vocal folds and creates a passage (the glottis) for airflow. As air passes through the vocal folds the resulting aerodynamic loading, coupled with the tissue properties of the vocal folds, produces self-sustained oscillations. Throughout each cycle a complex flow field develops, characterized by a plethora of viscous flow phenomena. Air passing through the glottis creates a jet, with periodically-shed vortices developing due to flow separation and the Kelvin-Helmholtz instability in the shear layer. These vortices have been hypothesized to be a crucial mechanism for producing vocal fold vibrations. In this study the effect of vortices on the vocal fold dynamics is investigated experimentally by passing a vortex ring over a flexible beam with the same non-dimensional mechanical properties as the vocal folds. Synchronized particle image velocimetry data are acquired in tandem with the beam dynamics. The resulting impact of the vortex ring loading on vocal fold dynamics is discussed in detail. This work was supported by the National Science Foundation Grant CBET #1511761.

Bicarbonate availability for vocal fold epithelial defense to acidic challenge.

PubMed

Durkes, Abigail; Sivasankar, M Preeti

2014-01-01

Bicarbonate is critical for acid-base tissue homeostasis. In this study we investigated the role of bicarbonate ion transport in vocal fold epithelial defense to acid challenges. Acidic insults to the larynx are common in gastric reflux, carcinogenesis and metastasis, and acute inflammation. Ion transport was measured in viable porcine vocal fold epithelium. First, 18 vocal folds were exposed to either the carbonic anhydrase antagonist acetazolamide or to vehicle. Second, 32 vocal folds were exposed to either a control buffer or a bicarbonate-free buffer on their luminal or basolateral surface or both. Third, 32 vocal folds were challenged with acid in the presence of bicarbonate-free or control buffer. The vocal fold transepithelial resistance was greater than 300 Ω*cm(2), suggesting robust barrier integrity. Ion transport did not change after exposure to acetazolamide (p > 0.05). Exposure to bicarbonate-free buffer did not compromise vocal fold ion transport (p > 0.05). Ion transport increased after acid challenge. This increase approached statistical significance and was the greatest for the control buffer and for the bicarbonate-free buffer applied to the basolateral surface. Bicarbonate secretion may contribute to vocal fold defense against acid challenge. Our data offer a potential novel role for bicarbonate as a therapeutic agent to reduce pH abnormalities in the larynx and prevent associated pathological changes.

Biomechanical effects of hydration in vocal fold tissues.

PubMed

Chan, Roger W; Tayama, Niro

2002-05-01

It has often been hypothesized, with little empirical support, that vocal fold hydration affects voice production by mediating changes in vocal fold tissue rheology. To test this hypothesis, we attempted in this study to quantify the effects of hydration on the viscoelastic shear properties of vocal fold tissues in vitro. Osmotic changes in hydration (dehydration and rehydration) of 5 excised canine larynges were induced by sequential incubation of the tissues in isotonic, hypertonic, and hypotonic solutions. Elastic shear modulus (G'), dynamic viscosity eta' and the damping ratio zeta of the vocal fold mucosa (lamina propria) were measured as a function of frequency (0.01 to 15 Hz) with a torsional rheometer. Vocal fold tissue stiffness (G') and viscosity (eta) increased significantly (by 4 to 7 times) with the osmotically induced dehydration, whereas they decreased by 22% to 38% on the induced rehydration. Damping ratio (zeta) also increased with dehydration and decreased with rehydration, but the detected differences were not statistically significant at all frequencies. These findings support the long-standing hypothesis that hydration affects vocal fold vibration by altering tissue rheologic (or viscoelastic) properties. Our results demonstrated the biomechanical importance of hydration in vocal fold tissues and suggested that hydration approaches may potentially improve the biomechanics of phonation in vocal fold lesions involving disordered fluid balance.

The Effect of Surface Electrical Stimulation on Vocal Fold Position

PubMed Central

Humbert, Ianessa A.; Poletto, Christopher J.; Saxon, Keith G.; Kearney, Pamela R.; Ludlow, Christy L.

2008-01-01

Objectives/Hypothesis Closure of the true and false vocal folds is a normal part of airway protection during swallowing. Individuals with reduced or delayed true vocal fold closure can be at risk for aspiration and benefit from intervention to ameliorate the problem. Surface electrical stimulation is currently used during therapy for dysphagia, despite limited knowledge of its physiological effects. Design Prospective single effects study. Methods The immediate physiological effect of surface stimulation on true vocal fold angle was examined at rest in 27 healthy adults using ten different electrode placements on the submental and neck regions. Fiberoptic nasolaryngoscopic recordings during passive inspiration were used to measure change in true vocal fold angle with stimulation. Results Vocal fold angles changed only to a small extent during two electrode placements (p ≤ 0.05). When two sets of electrodes were placed vertically on the neck the mean true vocal fold abduction was 2.4 degrees; while horizontal placements of electrodes in the submental region produced a mean adduction of 2.8 degrees (p=0.03). Conclusions Surface electrical stimulation to the submental and neck regions does not produce immediate true vocal fold adduction adequate for airway protection during swallowing and one position may produce a slight increase in true vocal fold opening. PMID:18043496

Current treatment of vocal fold scarring.

PubMed

Hirano, Shigeru

2005-06-01

Vocal fold scarring still remains a therapeutic challenge, with the most problematic issue being the histologic changes that are primarily responsible for altering the viscoelasticity of the vocal fold mucosa. Optimal treatment for vocal fold scarring has not yet been established. To restore or regenerate damaged vocal folds, it is important to investigate the changes to the layer structure of the lamina propria. Tissue engineering and regenerative medicine may provide new strategies for the prevention and treatment of vocal fold scarring. Recent developments in this field are reviewed in the present article. Histologic studies have revealed that hyaluronic acid, fibronectin, decorin, and various other extracellular matrix components, as well as collagen, may contribute to determining the vibratory properties of the vocal fold mucosa. Changes of these molecules are thought to affect the viscoelasticity of the scarred vocal folds. Based on such histologic findings, innovative approaches have been developed, including administration of hyaluronic acid into injured or scarred vocal folds. Other strategies that have recently shown advances include growth factor therapy and cell therapy using stem cells or mature fibroblasts. The effects of these new treatments have not fully been confirmed clinically, but there seems to be great therapeutic potential in such regenerative medical strategies. Recent research has revealed the detailed histologic and rheologic changes related to vocal fold scarring. Based on these findings, various new therapeutic strategies have been developed in animal models using tissue engineering and regenerative medicine. However, no clinical trials have been performed, and more studies are necessary to establish the optimum modality.

A new approach to geometrical measurements in an animal model of vocal fold scar.

PubMed

Jabbour, Noel; Krishna, Priya D; Osborne, James; Rosen, Clark A

2009-01-01

A standard method for quantifying the geometric properties of vocal folds has not been widely adopted. An ideal method of geometrical measurement should effectively quantify the dimensions of the medial vibratory portion of the vocal fold, should be easily performed, should yield consistent results, and should be readily available at little to no cost. We have developed a new approach for geometrical measurements to meet these goals. The objective of this study is to describe this new approach and to assess its effectiveness in a canine model of vocal fold scar. One hundred thirty-five mid-membranous coronal sections of vocal folds from 10 canines (five with unilateral surgical scarring) were examined by light microscopy; digital images were captured. ImageJ was used to measure a variety of described parameters. Comparison between scarred vocal folds and control vocal folds was made. At least 20% of the slides for each vocal fold were randomly selected (n=42) for repeat measurements of interrater and intrarater reliability. A statistically significant difference between scarred and control vocal folds was obtained for horizontal distance (P<0.001), vertical distance (P=0.005), area (P<0.001), mean optical density (OD) (P<0.001), and OD at defined points along the length of the vocal fold (P< or =0.009). Reliability calculations for intrarater and interrater measurements ranged from r=0.845 to r=0.994 and from r=0.734 to r=0.976, respectively. The proposed approach for geometrical measurements meets the intended objectives in a canine model of vocal fold scar. Future work is needed to apply this approach to other model systems.

Side population cells in the human vocal fold.

PubMed

Yamashita, Masaru; Hirano, Shigeru; Kanemaru, Shin-ichi; Tsuji, Shunichiro; Suehiro, Atsushi; Ito, Juichi

2007-11-01

The regenerative processes of the vocal fold, or the existence of stem cells in the folds, are unknown. Side population (SP) cells are defined as cells that have the ability to exclude the DNA binding dye, Hoechst 33342. They are regarded as a cell population enriched with stem cells and can be isolated from non-SP cells by a fluorescence-activated cell sorter. This study was designed to determine whether SP cells exist in the human vocal fold, as a first step in elucidating the regenerative mechanisms of the vocal fold. Seven human excised larynges were used in this study. Two were used for fluorescence-activated cell sorter analysis, and 5 were subjected to immunohistochemical analysis with antibodies against an adenosine triphosphate binding cassette transporter family member, ABCG2, which is expressed in SP cells. The number of SP cells in the human vocal fold was about 0.2% of the total number of cells. ABCG2-positive cells were identified in both the epithelium and subepithelial tissue throughout the entire vocal fold. This preliminary study demonstrated the existence of SP cells in the human vocal fold. Further studies are warranted to clarify how these cells work in the vocal fold, particularly in the regenerative process.

Improvement of Vocal Pathologies Diagnosis Using High-Speed Videolaryngoscopy

PubMed Central

Tsuji, Domingos Hiroshi; Hachiya, Adriana; Dajer, Maria Eugenia; Ishikawa, Camila Cristina; Takahashi, Marystella Tomoe; Montagnoli, Arlindo Neto

2014-01-01

Introduction The study of the dynamic properties of vocal fold vibration is important for understanding the vocal production mechanism and the impact of organic and functional changes. The advent of high-speed videolaryngoscopy (HSV) has provided the possibility of seeing the real cycle of vocal fold vibration in detail through high sampling rate of successive frames and adequate spatial resolution. Objective To describe the technique, advantages, and limitations of using HSV and digital videokymography in the diagnosis of vocal pathologies. Methods We used HSV and digital videokymography to evaluate one normophonic individual and four patients with vocal fold pathologies (nodules, unilateral paralysis of the left vocal fold, intracordal cyst, and adductor spasmodic dysphonia). The vocal fold vibration parameters (glottic closure, vibrational symmetry, periodicity, mucosal wave, amplitude, and glottal cycle phases) were assessed. Results Differences in the vocal vibration parameters were observed and correlated with the pathophysiology. Conclusion HSV is the latest diagnostic tool in visual examination of vocal behavior and has considerable potential to refine our knowledge regarding the vocal fold vibration and voice production, as well as regarding the impact of pathologic conditions have on the mechanism of phonation. PMID:25992109

Vocal fold hemorrhage associated with coumadin therapy in an opera singer.

PubMed

Neely, J L; Rosen, C

2000-06-01

Vocal fold hemorrhage can represent a disastrous and potentially career ending injury to a singer or professional voice user. The risk factors of vocal fold hemorrhage, including laryngeal trauma, phonotrauma, aspirin and nonsteroidal antiinflammatories, and hormonal imbalances are well known. We present a case of an opera singer who developed recurrent vocal fold hemorrhage associated with coumadin anticoagulation therapy. This case highlights the importance of the risk of vocal fold hemorrhage to professional singers and professional voice users and offers an alternative to long-term coumadin therapy in this select population.

A Computational Study of Vocal Fold Dehydration During Phonation.

PubMed

Wu, Liang; Zhang, Zhaoyan

2017-12-01

While vocal fold dehydration is often considered an important factor contributing to vocal fatigue, it still remains unclear whether vocal fold vibration alone is able to induce severe dehydration that has a noticeable effect on phonation and perceived vocal effort. A three-dimensional model was developed to investigate vocal fold systemic dehydration and surface dehydration during phonation. Based on the linear poroelastic theory, the model considered water resupply from blood vessels through the lateral boundary, water movement within the vocal folds, water exchange between the vocal folds and the surface liquid layer through the epithelium, and surface fluid accumulation and discharge to the glottal airway. Parametric studies were conducted to investigate water loss within the vocal folds and from the surface after a 5-min sustained phonation under different permeability and vibration conditions. The results showed that the dehydration generally increased with increasing vibration amplitude, increasing epithelial permeability, and reduced water resupply. With adequate water resupply, a large-amplitude vibration can induce an overall systemic dehydration as high as 3%. The distribution of water loss within the vocal folds was non-uniform, and a local dehydration higher than 5% was observed even under conditions of a low overall systemic dehydration (<1%). Such high level of water loss may severely affect tissue properties, muscular functions, and phonations characteristics. In contrast, water loss of the surface liquid layer was generally an order of magnitude higher than water loss inside the vocal folds, indicating that the surface dehydration level is likely not a good indicator of the systemic dehydration.

Vocal Fold Epithelial Barrier in Health and Injury A Research Review

PubMed Central

Levendoski, Elizabeth Erickson; Leydon, Ciara; Thibeault, Susan L.

2015-01-01

Purpose Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment. This barrier provides structural stability to the vocal folds and protects underlying connective tissue from injury while being nearly continuously exposed to potentially hazardous insults including environmental or systemic-based irritants such as pollutants and reflux, surgical procedures, and vibratory trauma. Small disruptions in the epithelial barrier may have a large impact on susceptibility to injury and overall vocal health. The purpose of this article is to provide a broad-based review of our current knowledge of the vocal fold epithelial barrier. Methods A comprehensive review of the literature was conducted. Details of the structure of the vocal fold epithelial barrier are presented and evaluated in the context of function in injury and pathology. The importance of the epithelial-associated vocal fold mucus barrier is also introduced. Results/Conclusions Information presented in this review is valuable for clinicians and researchers as it highlights the importance of this understudied portion of the vocal folds to overall vocal health and disease. Prevention and treatment of injury to the epithelial barrier is a significant area awaiting further investigation. PMID:24686981

Effect of level difference between left and right vocal folds on phonation: Physical experiment and theoretical study.

PubMed

Tokuda, Isao T; Shimamura, Ryo

2017-08-01

As an alternative factor to produce asymmetry between left and right vocal folds, the present study focuses on level difference, which is defined as the distance between the upper surfaces of the bilateral vocal folds in the inferior-superior direction. Physical models of the vocal folds were utilized to study the effect of the level difference on the phonation threshold pressure. A vocal tract model was also attached to the vocal fold model. For two types of different models, experiments revealed that the phonation threshold pressure tended to increase as the level difference was extended. Based upon a small amplitude approximation of the vocal fold oscillations, a theoretical formula was derived for the phonation threshold pressure. This theory agrees with the experiments, especially when the phase difference between the left and right vocal folds is not extensive. Furthermore, an asymmetric two-mass model was simulated with a level difference to validate the experiments as well as the theory. The primary conclusion is that the level difference has a potential effect on voice production especially for patients with an extended level of vertical difference in the vocal folds, which might be taken into account for the diagnosis of voice disorders.

Augmentation surgery on the cartilaginous portion of the vocal fold in a patient with cricoarytenoid joint ankylosis.

PubMed

Fukahori, Mioko; Chitose, Shun-Ichi; Sato, Kiminori; Kamimura, Hiroyuki; Sato, Kiminobu; On, Ririko; Umeno, Hirohito

2018-08-01

Surgical management of cricoarytenoid joint (CAJ) ankylosis is challenging and has the risk of worsening voice quality. In the present case, augmentation surgery was performed on the cartilaginous portion of the vocal fold in a patient with CAJ ankylosis. A 24-year-old man sustained blunt trauma to the anterior neck three years prior to developing severe breathiness. Posterior glottal insufficiency resulting from lateral fixation of the right vocal fold was observed during phonation under laryngoscopy. In addition, electromyography and CT scan revealed severe ankylosis of the right CAJ. Type I thyroplasty performed on the right vocal fold did not improve postoperative vocal function. Therefore, augmentation surgery on the cartilaginous portion of the right vocal fold was performed via endolaryngeal microsurgery under general anesthesia with jet ventilation. A piece of temporalis fascia was autotransplanted into the submucosal space created at the posterior cartilaginous portion of the right vocal fold. This resulted in the narrowing of the posterior glottal gap during phonation, leading to improvement in hoarseness. Microsurgical management with autologous fascia augmentation of the cartilaginous portion of the vocal fold can be effective in patients with lateral vocal fold fixation due to CAJ ankylosis. Copyright © 2017 Elsevier B.V. All rights reserved.

Regulation of glottal closure and airflow in a three-dimensional phonation model: Implications for vocal intensity control

PubMed Central

Zhang, Zhaoyan

2015-01-01

Maintaining a small glottal opening across a large range of voice conditions is critical to normal voice production. This study investigated the effectiveness of vocal fold approximation and stiffening in regulating glottal opening and airflow during phonation, using a three-dimensional numerical model of phonation. The results showed that with increasing subglottal pressure the vocal folds were gradually pushed open, leading to increased mean glottal opening and flow rate. A small glottal opening and a mean glottal flow rate typical of human phonation can be maintained against increasing subglottal pressure by proportionally increasing the degree of vocal fold approximation for low to medium subglottal pressures and vocal fold stiffening at high subglottal pressures. Although sound intensity was primarily determined by the subglottal pressure, the results suggest that, to maintain small glottal opening as the sound intensity increases, one has to simultaneously tighten vocal fold approximation and/or stiffen the vocal folds, resulting in increased glottal resistance, vocal efficiency, and fundamental frequency. PMID:25698022

Homeostasis of Hyaluronic Acid in Normal and Scarred Vocal Folds

PubMed Central

Tateya, Ichiro; Tateya, Tomoko; Watanuki, Makoto; Bless, Diane M.

2015-01-01

Summary Objectives/Hypothesis Vocal fold scarring is one of the most challenging laryngeal disorders to treat. Hyaluronic acid (HA) is the main component of lamina propria, and it plays an important role in proper vocal fold vibration and is also thought to be important in fetal wound healing without scarring. Although several animal models of vocal fold scarring have been reported, little is known about the way in which HA is maintained in vocal folds. The purpose of this study was to clarify the homeostasis of HA by examining the expression of hyaluronan synthase (Has) and hyaluronidase (Hyal), which produce and digest HA, respectively. Study Design Experimental prospective animal study. Methods Vocal fold stripping was performed on 38 Sprague-Dawley rats. Vocal fold tissue was collected at five time points (3 days–2 months). Expression of HA was examined by immunohistochemistry, and messenger RNA (mRNA) expression of Has and Hyal was examined by real-time polymerase chain reaction and in-situ hybridization. Results In scarred vocal folds, expression of Has1 and Has2 increased at day 3 together with expression of HA and returned to normal at 2 weeks. At 2 months, Has3 and Hyal3 mRNA showed higher expressions than normal. Conclusions Expression patterns of Has and Hyal genes differed between normal, acute-scarred, and chronic-scarred vocal folds, indicating the distinct roles of each enzyme in maintaining HA. Continuous upregulation of Has genes in the acute phase may be necessary to achieve scarless healing of vocal folds. PMID:25499520

Radiation Fibrosis of the Vocal Fold: From Man to Mouse

PubMed Central

Johns, Michael M.; Kolachala, Vasantha; Berg, Eric; Muller, Susan; Creighton, Frances X.; Branski, Ryan C.

2013-01-01

Objectives To characterize fundamental late tissue effects in the human vocal fold following radiation therapy. To develop a murine model of radiation fibrosis to ultimately develop both treatment and prevention paradigms. Design Translational study using archived human and fresh murine irradiated vocal fold tissue. Methods 1) Irradiated vocal fold tissue from patients undergoing laryngectomy for loss of function from radiation fibrosis were identified from pathology archives. Histomorphometry, immunohistochemistry, and whole-genome microarray as well as real-time transcriptional analyses was performed. 2) Focused radiation to the head and neck was delivered to mice in a survival fashion. One month following radiation, vocal fold tissue was analyzed with histomorphometry, immunohistochemistry, and real-time PCR transcriptional analysis for selected markers of fibrosis. Results Human irradiated vocal folds demonstrated increased collagen transcription with increased deposition and disorganization of collagen in both the thyroarytenoid muscle and the superficial lamina propria. Fibronectin were increased in the superficial lamina propria. Laminin decreased in the thyroarytenoid muscle. Whole genome microarray analysis demonstrated increased transcription of markers for fibrosis, oxidative stress, inflammation, glycosaminoglycan production and apoptosis. Irradiated murine vocal folds demonstrated increases in collagen and fibronectin transcription and deposition in the lamina propria. Transforming growth factor (TGF)-β increased in the lamina propria. Conclusion Human irradiated vocal folds demonstrate molecular changes leading to fibrosis that underlie loss of vocal fold pliability that occurs in patients following laryngeal irradiation. Irradiated murine tissue demonstrates similar findings, and this mouse model may have utility in creating prevention and treatment strategies for vocal fold radiation fibrosis. PMID:23242839

Rheometric properties of canine vocal fold tissues: Variation with anatomic location

PubMed Central

Kimura, Miwako; Mau, Ted; Chan, Roger W.

2010-01-01

Objective To evaluate the in vitro rheometric properties of the canine vocal fold lamina propria and muscle at phonatory frequencies, and their changes with anatomic location. Methods Six canine larynges were harvested immediately postmortem. Viscoelastic shear properties of anterior, middle, and posterior portions of the vocal fold cover (lamina propria) as well as those of the medial thyroarytenoid (TA) muscle (vocalis muscle) were quantified by a linear, controlled-strain simple-shear rheometer. Measurements of elastic shear modulus (G’) and dynamic viscosity (η’) of the specimens were conducted with small-amplitude sinusoidal shear deformation over a frequency range of 1 Hz to 250 Hz. Results All specimens showed similar frequency dependence of the viscoelastic functions, with G’ gradually increasing with frequency and η’ decreasing with frequency monotonically. G’ and η’ of the canine vocalis muscle were significantly higher than those of the canine vocal fold cover, and η’ of the canine vocal fold cover was significantly higher than that of the human vocal fold cover. There were no significant differences in G’ and in η’ between different portions of the canine vocal fold cover. Conclusion These preliminary data based on the canine model suggested that the vocalis muscle, while in a relaxed state in vitro, is significantly stiffer and more viscous than the vocal fold cover during vibration at phonatory frequencies. For large-amplitude vocal fold vibration involving the medial portion of the TA muscle, such distinct differences in viscoelastic properties of different layers of the vocal fold should be taken into account in multi-layered biomechanical models of phonation. PMID:21035291

Videostrobolaryngoscopy of mucus layer during vocal fold vibration in patients with laryngeal tension-fatigue syndrome.

PubMed

Hsiao, Tzu-Yu; Liu, Chia-Ming; Lin, Kai-Nan

2002-06-01

The mucus layer on the vocal folds was examined by videostrobolaryngoscopy in patients with laryngeal tension-fatigue syndrome, a chronic functional dysphonia due to vocal abuse and misuse. Besides the findings in previous reports (such as abnormal glottal closure, phase or amplitude asymmetry, and the irregular mucosal wave), the vocal folds during vibration had an uneven mucus surface. The occurrence of an uneven mucus layer on vocal folds was significantly greater in subjects with this voice disorder (83% or 250 of 301 patients in this series) than in those without voice disorders (18.5% or 5 of 27). The increase of mucus viscosity, mucus aggregation, and the formation of rough surfaces on the vocal folds alter the mechanical properties that contribute to vibration of the cover of the vocal folds, and thereby worsen the symptoms of dysphonia in patients with laryngeal tension-fatigue syndrome.

Biomechanics of fundamental frequency regulation: Constitutive modeling of the vocal fold lamina propria.

PubMed

Chan, Roger W; Siegmund, Thomas; Zhang, Kai

2009-12-01

Accurate characterization of biomechanical characteristics of the vocal fold is critical for understanding the regulation of vocal fundamental frequency (F(0)), which depends on the active control of the intrinsic laryngeal muscles as well as the passive biomechanical response of the vocal fold lamina propria. Specifically, the tissue stress-strain response and viscoelastic properties under cyclic tensile deformation are relevant, when the vocal folds are subjected to length and tension changes due to posturing. This paper describes a constitutive modeling approach quantifying the relationship between vocal fold stress and strain (or stretch), and establishes predictions of F(0) with the string model of phonation based on the constitutive parameters. Results indicated that transient and time-dependent changes in F(0), including global declinations in declarative sentences, as well as local F(0) overshoots and undershoots, can be partially attributed to the time-dependent viscoplastic response of the vocal fold cover.

Bicarbonate Availability for Vocal Fold Epithelial Defense to Acidic Challenge

PubMed Central

Durkes, Abigail; Sivasankar, M. Preeti

2014-01-01

Objectives Bicarbonate is critical for acid-base tissue homeostasis. In this study we investigated the role of bicarbonate ion transport in vocal fold epithelial defense to acid challenges. Acidic insults to the larynx are common in gastric reflux, carcinogenesis and metastasis, and acute inflammation. Methods Ion transport was measured in viable, porcine vocal fold epithelium. First, 18 vocal folds were exposed to either the carbonic anhydrase antagonist acetazolamide or to vehicle. Second, 32 vocal folds were exposed to either a control buffer or a bicarbonate-free buffer on their luminal or basolateral surface or both. Third, vocal folds were challenged with acid in the presence of bicarbonate-free or control buffer. Results The vocal fold transepithelial resistance was greater than 300 Ω*cm2, suggesting robust barrier integrity. Ion transport did not change after exposure to acetazolamide (p > 0.05). Exposure to bicarbonate-free buffer did not compromise vocal fold ion transport (p > 0.05). Ion transport increased after acid challenge. This increase approached statistical significance and was the greatest for the control buffer and for the bicarbonate-free buffer applied to the basolateral surface. Conclusions Bicarbonate secretion may contribute to vocal fold defense against acid challenge. Our data offer a potential novel role for bicarbonate as a therapeutic agent to reduce pH abnormalities in the larynx and prevent associated pathological changes. PMID:24574427

Three-dimensional biomechanical properties of human vocal folds: parameter optimization of a numerical model to match in vitro dynamics.

PubMed

Yang, Anxiong; Berry, David A; Kaltenbacher, Manfred; Döllinger, Michael

2012-02-01

The human voice signal originates from the vibrations of the two vocal folds within the larynx. The interactions of several intrinsic laryngeal muscles adduct and shape the vocal folds to facilitate vibration in response to airflow. Three-dimensional vocal fold dynamics are extracted from in vitro hemilarynx experiments and fitted by a numerical three-dimensional-multi-mass-model (3DM) using an optimization procedure. In this work, the 3DM dynamics are optimized over 24 experimental data sets to estimate biomechanical vocal fold properties during phonation. Accuracy of the optimization is verified by low normalized error (0.13 ± 0.02), high correlation (83% ± 2%), and reproducible subglottal pressure values. The optimized, 3DM parameters yielded biomechanical variations in tissue properties along the vocal fold surface, including variations in both the local mass and stiffness of vocal folds. That is, both mass and stiffness increased along the superior-to-inferior direction. These variations were statistically analyzed under different experimental conditions (e.g., an increase in tension as a function of vocal fold elongation and an increase in stiffness and a decrease in mass as a function of glottal airflow). The study showed that physiologically relevant vocal fold tissue properties, which cannot be directly measured during in vivo human phonation, can be captured using this 3D-modeling technique. © 2012 Acoustical Society of America

Three-dimensional biomechanical properties of human vocal folds: Parameter optimization of a numerical model to match in vitro dynamics

PubMed Central

Yang, Anxiong; Berry, David A.; Kaltenbacher, Manfred; Döllinger, Michael

2012-01-01

The human voice signal originates from the vibrations of the two vocal folds within the larynx. The interactions of several intrinsic laryngeal muscles adduct and shape the vocal folds to facilitate vibration in response to airflow. Three-dimensional vocal fold dynamics are extracted from in vitro hemilarynx experiments and fitted by a numerical three-dimensional-multi-mass-model (3DM) using an optimization procedure. In this work, the 3DM dynamics are optimized over 24 experimental data sets to estimate biomechanical vocal fold properties during phonation. Accuracy of the optimization is verified by low normalized error (0.13 ± 0.02), high correlation (83% ± 2%), and reproducible subglottal pressure values. The optimized, 3DM parameters yielded biomechanical variations in tissue properties along the vocal fold surface, including variations in both the local mass and stiffness of vocal folds. That is, both mass and stiffness increased along the superior-to-inferior direction. These variations were statistically analyzed under different experimental conditions (e.g., an increase in tension as a function of vocal fold elongation and an increase in stiffness and a decrease in mass as a function of glottal airflow). The study showed that physiologically relevant vocal fold tissue properties, which cannot be directly measured during in vivo human phonation, can be captured using this 3D-modeling technique. PMID:22352511

Pipette aspiration applied to the characterization of nonhomogeneous, transversely isotropic materials used for vocal fold modeling.

PubMed

Weiß, S; Thomson, S L; Lerch, R; Döllinger, M; Sutor, A

2013-01-01

The etiology and treatment of voice disorders are still not completely understood. Since the vibratory characteristics of vocal folds are strongly influenced by both anatomy and mechanical material properties, measurement methods to analyze the material behavior of vocal fold tissue are required. Due to the limited life time of real tissue in the laboratory, synthetic models are often used to study vocal fold vibrations. In this paper we focus on two topics related to synthetic and real vocal fold materials. First, because certain tissues within the human vocal folds are transversely isotropic, a fabrication process for introducing this characteristic in commonly used vocal fold modeling materials is presented. Second, the pipette aspiration technique is applied to the characterization of these materials. By measuring the displacement profiles of stretched specimens that exhibit varying degrees of transverse isotropy, it is shown that local anisotropy can be quantified using a parameter describing the deviation from an axisymmetric profile. The potential for this technique to characterize homogeneous, anisotropic materials, including soft biological tissues such as those found in the human vocal folds, is supplemented by a computational study. Copyright © 2012 Elsevier Ltd. All rights reserved.

Velocity field measurements in oblique static divergent vocal fold models

NASA Astrophysics Data System (ADS)

Erath, Byron

2005-11-01

During normal phonation, the vocal fold cycle is characterized by the glottal opening transitioning from a convergent to a divergent passage and then closing before the cycle is repeated. Under ordinary phonatory conditions, both vocal folds, which form the glottal passage, move in phase with each other, creating a time-varying symmetric opening. However, abnormal pathological conditions, such as unilateral paralysis, and polyps, can result in geometrical asymmetries between the vocal folds throughout the phonatory cycle. This study investigates pulsatile flow fields through 7.5 times life-size vocal fold models with included divergence angles of 5 to 30 degrees, and obliquities between the vocal folds of up to 15 degrees. Flow conditions were scaled to match physiological parameters. Data were taken at the anterior posterior mid-plane using phase-averaged Particle Image Velocimetry (PIV). Viscous flow phenomena including the Coanda effect, flow separation points, and jet "flapping" were investigated. The results are compared to previously reported work of flow through symmetric divergent vocal fold models.

PubMed Central

LAURIELLO, M.; ANGELONE, A.M.; RIENZO BUSINCO, L.; PASSALI, D.; BELLUSSI, L.M.; PASSALI, F.M.

2011-01-01

SUMMARY Aim of the present study was to investigate the prevalence of allergy in patients affected by both organic and/or functional vocal fold disorders. The secondary aim was to assess the correlation between sex and allergy in dysphonic patients. A retrospective chart review was performed on dysphonic patients. A total of 76 patients underwent fiberoptic endoscopy to assess the objective picture. Logistic regression analyses have been conducted to assess the association between sex and the outcome variables. The laryngoscopic examination revealed the presence of poor glottic closure in 32.9%, hyperkinesias in 11.8%, redness in 11.84%, polyps in 5.3%, oedema in 3.95%, vocal fold hypertrophy in 5.3%, nodules in 42.1%, cordectomy in 2.6%. Allergic rhinitis was present in 56.6%, milk intolerance in 13.2%, asthma in 9.2%, atopic dermatitis in 3.9%, drugs intolerance in 11.8%. A total of 76.32% patients presenting with dysphonia were allergic. A statistically significant association was found between female sex and presence of allergy. In conclusion, allergy testing should be performed routinely on female professional voice users. Mild respiratory disorders must be taken into serious consideration in female professional voice users, who may primarily complain of vocal dysfunction rather than upper and lower respiratory diseases. PMID:22064840

Magnetic resonance imaging findings in pediatric bilateral vocal fold dysfunction.

PubMed

Steiner, Joel I; Fink, A Michelle; Berkowitz, Robert G

2013-07-01

We studied the findings of brain magnetic resonance imaging (MRI) in infants with idiopathic congenital bilateral vocal fold dysfunction (CBVFD). We performed a retrospective investigation of a case series. We identified 26 children (14 male, 12 female) over 11 years. Three children were excluded. Thirteen patients required airway interventions, including continuous positive airway pressure (4 patients), endotracheal intubation (1), and tracheostomy (8). The findings on brain MRI were abnormal in 8 patients (35%). Tracheostomy was required in 3 patients (38%) with abnormal MRI findings, as compared with 5 of 15 patients (33%) with normal MRI findings. The MRI abnormalities involved evidence of white matter injury (2), abnormal white matter signal (1), subdural blood (3), cerebral swelling (1), and perisylvian polymicrogyria (1). The cranial ultrasound findings were abnormal in 4 of 11 patients. The MRI findings were abnormal in 2 of 7 children in whom the cranial ultrasound findings were normal, and in 2 of the 4 patients in whom the cranial ultrasound findings were abnormal. The MRI abnormalities were nonspecific; however, they may indicate unrecognized perinatal intracranial injury as being related to CBVFD. In addition, MRI may reveal an underlying structural brain anomaly. Cranial ultrasound has poor sensitivity and specificity. Hence, MRI should be considered as part of the routine assessment of neonates with CBVFD.

A rabbit vocal fold laser scarring model for testing lamina propria tissue engineering therapies

PubMed Central

Mau, Ted; Du, Mindy; Xu, Chet C.

2015-01-01

Objectives/Hypothesis To develop a vocal fold scarring model using an ablative laser in the rabbit as a platform for testing bioengineered therapies for missing or damaged lamina propria. Study Design Prospective controlled animal study. Methods An optimal laser energy level was first determined by assessing the depths of vocal fold injury created by a Holmium:YAG laser at various energy levels on fresh cadaveric rabbit larynges. The selected energy level was then used to create controlled unilateral injuries in vocal folds of New Zealand white rabbits, with the contralateral folds serving as uninjured controls. After 4 weeks, the larynges were harvested and subjected to excised-larynx phonation with high-speed imaging and immunohistochemical staining for collagen types I and III, elastin, and hyaluronic acid (HA) with quantitative histological analysis. Results 1.8 joules produced full-thickness injury of the lamina propria without extensive muscle injury. After 4 weeks, the injured vocal folds vibrated with reduced amplitude (P = 0.036) in excised-larynx phonation compared to normal vocal folds. The injured vocal folds contained a higher relative density of collagen type I (P = 0.004), higher elastin (P = 0.022), and lower HA (P = 0.030) compared to normal controls. Collagen type III was unchanged. Conclusions With its potential for higher precision of injury, this laser vocal fold scarring model may serve as an alternative to scarring produced by cold instruments for studying the effects of vocal fold lamina propria bioengineered therapies. Level of Evidence N/A. PMID:24715695

Measurement of Young's modulus in the in vivo human vocal folds.

PubMed

Tran, Q T; Berke, G S; Gerratt, B R; Kreiman, J

1993-08-01

Currently, surgeons have no objective means to evaluate and optimize results of phonosurgery intraoperatively. Instead, they usually judge the vocal folds subjectively by visual inspection or by listening to the voice. This paper describes a new device that measures Young's (elastic) modulus values for the human vocal fold intraoperatively. Physiologically, the modulus of the vocal fold may be important in determining the nature of vocal fold vibration in normal and pathologic states. This study also reports the effect of recurrent laryngeal nerve stimulation on Young's modulus of the human vocal folds, measured by means of transcutaneous nerve stimulation techniques. Young's modulus increased with increases in current stimulation to the recurrent laryngeal nerve. Ultimately, Young's modulus values may assist surgeons in optimizing the results of various phonosurgeries.

Occupational vocal cord dysfunction due to exposure to wood dust and xerographic toner.

PubMed

Muñoz, Xavier; Roger, Alex; De la Rosa, David; Morell, Ferran; Cruz, Maria J

2007-04-01

Vocal cord dysfunction is a poorly understood entity that is often misdiagnosed as asthma. Both irritant and non-irritant vocal cord dysfunction have been described. This report presents two cases of irritant vocal cord dysfunction secondary to specific environmental exposure, the first to iroko and western red cedar wood (a carpenter) and the second to xerographic printing toner (a secretary). Several tests were performed, including chest radiographs, measurements of total serum immunoglobulin E, skin prick tests with common pneumoallergens (as well as iroko and western red cedar in the first case), pulmonary function studies, methacholine challenge testing, specific inhalation challenge performed with suspected agents in a single-blinded fashion, and peak expiratory flow testing and fiberoptic rhinolaryngoscopy (in case 1). During the specific inhalation challenge, the patients showed dysphonia, chest tightness, inspiratory stridor, and flattening of the inspiratory limb of the maximum flow-volume loop in spirometry, with no significant decreases in the level of forced expiratory volume in 1 second; fiberoptic rhinolaryngoscopy confirmed the diagnosis of vocal cord dysfunction in case 1. It is important to know that agents that can cause occupational asthma can also cause vocal cord dysfunction. The mechanisms by which these agents produce vocal cord dysfunction are unknown. The differences in the clinical presentation of the patients described relative to the reported cases suggest that more than one pathophysiological mechanism may be implicated in the genesis of this entity.

Kinematic Measurements of the Vocal-Fold Displacement Waveform in Typical Children and Adult Populations: Quantification of High-Speed Endoscopic Videos

ERIC Educational Resources Information Center

Patel, Rita; Donohue, Kevin D.; Unnikrishnan, Harikrishnan; Kryscio, Richard J.

2015-01-01

Purpose: This article presents a quantitative method for assessing instantaneous and average lateral vocal-fold motion from high-speed digital imaging, with a focus on developmental changes in vocal-fold kinematics during childhood. Method: Vocal-fold vibrations were analyzed for 28 children (aged 5-11 years) and 28 adults (aged 21-45 years)…

A report on alterations to the speaking and singing voices of four women following hormonal therapy with virilizing agents.

PubMed

Baker, J

1999-12-01

Four women aged between 27 and 58 years sought otolaryngological examination due to significant alterations to their voices, the primary concerns being hoarseness in vocal quality, lowering of habitual pitch, difficulty projecting their speaking voices, and loss of control over their singing voices. Otolaryngological examination with a mirror or flexible laryngoscope revealed no apparent abnormality of vocal fold structure or function, and the women were referred for speech pathology with diagnoses of functional dysphonia. Objective acoustic measures using the Kay Visipitch indicated significant lowering of the mean fundamental frequency for each woman, and perceptual analysis of the patients' voices during quiet speaking, projected voice use, and comprehensive singing activities revealed a constellation of features typically noted in the pubescent male. The original diagnoses of a functional dysphonia were queried, prompting further exploration of each woman's medical history, revealing in each case onset of vocal symptoms shortly after commencing treatment for conditions with medications containing virilizing agents (eg, Danocrine (danazol), Deca-Durabolin (nandrolene decanoate), and testosterone). Although some of the vocal symptoms decreased in severity with the influences from 6 months voice therapy and after withdrawal from the drugs, a number of symptoms remained permanent, suggesting each subject had suffered significant alterations in vocal physiology, including muscle tissue changes, muscle coordination dysfunction, and propioceptive dysfunction. This retrospective study is presented in order to illustrate that it was both the projected speaking voice and the singing voice that proved so highly sensitive to the virilization effects. The implications for future prospective research studies and responsible clinical practice are discussed.

Human Adipose Tissue Derived Extracellular Matrix and Methylcellulose Hydrogels Augments and Regenerates the Paralyzed Vocal Fold

PubMed Central

Kim, Eun Na; Sung, Myung Whun; Kwon, Tack-Kyun; Cho, Yong Woo; Kwon, Seong Keun

2016-01-01

Vocal fold paralysis results from various etiologies and can induce voice changes, swallowing complications, and issues with aspiration. Vocal fold paralysis is typically managed using injection laryngoplasty with fat or synthetic polymers. Injection with autologous fat has shown excellent biocompatibility. However, it has several disadvantages such as unpredictable resorption rate, morbidities associated with liposuction procedure which has to be done in operating room under general anesthesia. Human adipose-derived extracellular matrix (ECM) grafts have been reported to form new adipose tissue and have greater biostability than autologous fat graft. Here, we present an injectable hydrogel that is constructed from adipose tissue derived soluble extracellular matrix (sECM) and methylcellulose (MC) for use in vocal fold augmentation. Human sECM derived from adipose tissue was extracted using two major steps—ECM was isolated from human adipose tissue and was subsequently solubilized. Injectable sECM/MC hydrogels were prepared by blending of sECM and MC. Sustained vocal fold augmentation and symmetric vocal fold vibration were accomplished by the sECM/MC hydrogel in paralyzed vocal fold which were confirmed by laryngoscope, histology and a high-speed imaging system. There were increased number of collagen fibers and fatty granules at the injection site without significant inflammation or fibrosis. Overall, these results indicate that the sECM/MC hydrogel can enhance vocal function in paralyzed vocal folds without early resorption and has potential as a promising material for injection laryngoplasty for stable vocal fold augmentation which can overcome the shortcomings of autologous fat such as unpredictable duration and morbidity associated with the fat harvest. PMID:27768757

Shortening of the front vibrating part of the vocal folds in phonation.

PubMed

Pesák, J; Jindra, P

2005-01-01

We have tried to make use of the opportunity of repeated observations through the analysis of the recorded movements of the phonating vocal folds by means of the phonating vocal folds through indirect videolaryngostroboscopic technique. The results of our investigation correspond, among others, with Hála and Sovák's diagrammatic description of continual and gradual changes in the vibration of the vocal folds in an uninterrupted sequence of tones of the human voice. In the initial chapter mention has been made of Hála and Honty's works and of Pressmann's work dealing with the described behaviour of the glottis when phonating high-pitched tones. The conclusions analogous to our findings have also been described by means of stereoscopically measuring the length of the phonating vocal folds. In conclusion, by measuring the distances between the anterior commissure and the junction between the membranous part of the vocal fold and vocal process of the arytenoid and the anterior commissure to the posterior nodal point of the vibrating part of the vocal folds we have verified the correctness of the findings published by Czermak, Hála and Honty, Pressmann, and Sovák, who pointed out the phenomenon of the shortening of the front vibrating part of the vocal folds in phonating high-pitched tones of the human voice. Copyright 2005 S. Karger AG, Basel.

Multi-parameter analysis of titanium vocal fold medializing implant in an excised larynx model

PubMed Central

Witt, Rachel E.; Hoffman, Matthew R.; Friedrich, Gerhard; Rieves, Adam L.; Schoepke, Benjamin J.; Jiang, Jack J.

2010-01-01

Objective Evaluate the efficacy of the titanium vocal fold medializing implant (TVFMI) for the treatment of unilateral vocal fold paralysis (UVFP) based on acoustic, aerodynamic, and mucosal wave measurements in an excised larynx setup. Methods Measurements were recorded on eight excised canine larynges with simulated UVFP before and after medialization with the TVFMI. Results Phonation threshold flow (PTF) and phonation threshold power (PTW) decreased significantly after medialization (p<0.001; p=0.008). Phonation threshold pressure (PTP) also decreased, but this difference was not significant (p=0.081). Percent jitter and percent shimmer decreased significantly after medialization (p=0.005; p=0.034). Signal to noise ratio (SNR) increased significantly (p=0.05). Differences in mucosal wave characteristics were discernable, but not significant. Phase difference between the normal and paralyzed vocal fold and amplitude of the paralyzed vocal fold decreased (p=0.15; p=0.78). Glottal gap decreased significantly (p=0.004). Conclusions The TVFMI was effective in achieving vocal fold medialization, improving vocal aerodynamic and acoustic characteristics of phonation significantly and mucosal wave characteristics discernibly. This study provides objective, quantitative support for the use of the TVFMI in improving vocal function in patients with unilateral vocal fold paralysis. PMID:20336924

“Finding a Voice”: Imaging Features after Phonosurgical Procedures for Vocal Fold Paralysis

PubMed Central

Vachha, B.A.; Ginat, D.T.; Mallur, P.; Cunnane, M.; Moonis, G.

2017-01-01

SUMMARY Altered communication (hoarseness, dysphonia, and breathy voice) that can result from vocal fold paralysis, secondary to numerous etiologies, may be amenable to surgical restoration. In this article, both traditional and cutting-edge phonosurgical procedures targeting the symptoms resulting from vocal fold paralysis are reviewed, with emphasis on the characteristic imaging appearances of various injectable materials, implants, and augmentation procedures used in the treatment of vocal fold paralysis. In addition, complications of injection laryngoplasty and medialization laryngoplasty are illustrated. Familiarity with the expected imaging changes following treatment of vocal fold paralysis may prevent the misinterpretation of posttreatment changes as pathology. Identifying common complications related to injection laryngoplasty and localization of displaced implants is crucial in determining specific management in patients who have undergone phonosurgical procedures for the management of vocal fold paralysis. PMID:27173367

Nonlinear vocal fold dynamics resulting from asymmetric fluid loading on a two-mass model of speech

NASA Astrophysics Data System (ADS)

Erath, Byron D.; Zañartu, Matías; Peterson, Sean D.; Plesniak, Michael W.

2011-09-01

Nonlinear vocal fold dynamics arising from asymmetric flow formations within the glottis are investigated using a two-mass model of speech with asymmetric vocal fold tensioning, representative of unilateral vocal fold paralysis. A refined theoretical boundary-layer flow solver is implemented to compute the intraglottal pressures, providing a more realistic description of the flow than the standard one-dimensional, inviscid Bernoulli flow solution. Vocal fold dynamics are investigated for subglottal pressures of 0.6 < ps < 1.5 kPa and tension asymmetries of 0.5 < Q < 0.8. As tension asymmetries become pronounced the asymmetric flow incites nonlinear behavior in the vocal fold dynamics at subglottal pressures that are associated with normal speech, behavior that is not captured with standard Bernoulli flow solvers. Regions of bifurcation, coexistence of solutions, and chaos are identified.

Non-invasive In vivo measurement of the shear modulus of human vocal fold tissue

PubMed Central

Kazemirad, Siavash; Bakhshaee, Hani; Mongeau, Luc; Kost, Karen

2014-01-01

Voice is the essential part of singing and speech communication. Voice disorders significantly affect the quality of life. The viscoelastic mechanical properties of the vocal fold mucosa determine the characteristics of the vocal folds oscillations, and thereby voice quality. In the present study, a non-invasive method was developed to determine the shear modulus of human vocal fold tissue in vivo via measurements of the mucosal wave propagation speed during phonation. Images of four human subjects’ vocal folds were captured using high speed digital imaging (HSDI) and magnetic resonance imaging (MRI) for different phonation pitches, specifically fundamental frequencies between 110 to 440 Hz. The MRI images were used to obtain the morphometric dimensions of each subject's vocal folds in order to determine the pixel size in the high-speed images. The mucosal wave propagation speed was determined for each subject and at each pitch value using an automated image processing algorithm. The transverse shear modulus of the vocal fold mucosa was then calculated from a surface (Rayleigh) wave propagation dispersion equation using the measured wave speeds. It was found that the mucosal wave propagation speed and therefore the shear modulus of the vocal fold tissue were generally greater at higher pitches. The results were in good agreement with those from other studies obtained via in vitro measurements, thereby supporting the validity of the proposed measurement method. This method offers the potential for in vivo clinical assessments of vocal folds viscoelasticity from HSDI. PMID:24433668

Adipose-Derived Mesenchymal Stem Cells in the Regeneration of Vocal Folds: A Study on a Chronic Vocal Fold Scar

PubMed Central

Vassiliki, Kalodimou; Irini, Messini; Nikolaos, Psychalakis; Karampela, Eleftheria; Apostolos, Papalois

2016-01-01

Background. The aim of the study was to assess the histological effects of autologous infusion of adipose-derived stem cells (ADSC) on a chronic vocal fold scar in a rabbit model as compared to an untreated scar as well as in injection of hyaluronic acid. Study Design. Animal experiment. Method. We used 74 New Zealand rabbits. Sixteen of them were used as control/normal group. We created a bilateral vocal fold wound in the remaining 58 rabbits. After 18 months we separated our population into three groups. The first group served as control/scarred group. The second one was injected with hyaluronic acid in the vocal folds, and the third received an autologous adipose-derived stem cell infusion in the scarred vocal folds (ADSC group). We measured the variation of thickness of the lamina propria of the vocal folds and analyzed histopathologic changes in each group after three months. Results. The thickness of the lamina propria was significantly reduced in the group that received the ADSC injection, as compared to the normal/scarred group. The collagen deposition, the hyaluronic acid, the elastin levels, and the organization of elastic fibers tend to return to normal after the injection of ADSC. Conclusions. Autologous injection of adipose-derived stem cells on a vocal fold chronic scar enhanced the healing of the vocal folds and the reduction of the scar tissue, even when compared to other treatments. PMID:26933440

Cyclic Adenosine Monophosphate Regulation of Ion Transport in Porcine Vocal Fold Mucosae

PubMed Central

Sivasankar, Mahalakshmi; Nofziger, Charity; Blazer-Yost, Bonnie

2012-01-01

Objectives/Hypothesis Cyclic adenosine monophosphate (cAMP) is an important biological molecule that regulates ion transport and inflammatory responses in epithelial tissue. The present study examined whether the adenylyl cyclase activator, forskolin, would increase cAMP concentration in porcine vocal fold mucosa and whether the effects of increased cAMP would be manifested as a functional increase in transepithelial ion transport. Additionally, changes in cAMP concentrations following exposure to an inflammatory mediator, tumor necrosis factor-α (TNFα) were investigated. Study Design In vitro experimental design with matched treatment and control groups. Methods Porcine vocal fold mucosae (N = 30) and tracheal mucosae (N = 20) were exposed to forskolin, TNFα, or vehicle (dimethyl sulfoxide) treatment. cAMP concentrations were determined with enzyme-linked immunosorbent assay. Ion transport was measured using electrophysiological techniques. Results Thirty minute exposure to forskolin significantly increased cAMP concentration and ion transport in porcine vocal fold and tracheal mucosae. However, 30-minute and 2-hour exposure to TNFα did not significantly alter cAMP concentration. Conclusions We demonstrate that forskolin-sensitive adenylyl cyclase is present in vocal fold mucosa, and further, that the product, cAMP increases vocal fold ion transport. The results presented here contribute to our understanding of the intracellular mechanisms underlying vocal fold ion transport. As ion transport is important for maintaining superficial vocal fold hydration, data demonstrating forskolin-stimulated ion transport in vocal fold mucosa suggest opportunities for developing pharmacological treatments that increase surface hydration. PMID:18596479

Vocal fold ion transport and mucin expression following acrolein exposure

PubMed Central

Levendoski, Elizabeth Erickson; Sivasankar, M. Preeti

2014-01-01

The vocal fold epithelium is exposed to inhaled particulates including pollutants during breathing in everyday environments. Yet, our understanding of the effects of pollutants on vocal fold epithelial function is extremely limited. The objective of this study was to investigate the effect of the pollutant acrolein on two vocal fold epithelial mechanisms: ion transport and mucin synthesis. These mechanisms were chosen as each plays a critical role in vocal defense and in maintaining surface hydration which is necessary for optimal voice production. Healthy, native porcine vocal folds (N=85) were excised and exposed to an acrolein or sham challenge. A 60 minute acrolein, but not sham challenge significantly reduced ion transport and inhibited cyclic adenosine monophosphate-dependent increases in ion transport. Decreases in ion transport were associated with reduced sodium absorption. Within the same timeline, no significant acrolein-induced changes in mucin gene or protein expression were observed. These results improve our understanding of the effects of acrolein on key vocal fold epithelial functions and inform the development of future investigations that seek to elucidate the impact of a wide range of pollutant exposures on vocal fold health. PMID:24648011

Material parameter computation for multi-layered vocal fold models.

PubMed

Schmidt, Bastian; Stingl, Michael; Leugering, Günter; Berry, David A; Döllinger, Michael

2011-04-01

Today, the prevention and treatment of voice disorders is an ever-increasing health concern. Since many occupations rely on verbal communication, vocal health is necessary just to maintain one's livelihood. Commonly applied models to study vocal fold vibrations and air flow distributions are self sustained physical models of the larynx composed of artificial silicone vocal folds. Choosing appropriate mechanical parameters for these vocal fold models while considering simplifications due to manufacturing restrictions is difficult but crucial for achieving realistic behavior. In the present work, a combination of experimental and numerical approaches to compute material parameters for synthetic vocal fold models is presented. The material parameters are derived from deformation behaviors of excised human larynges. The resulting deformations are used as reference displacements for a tracking functional to be optimized. Material optimization was applied to three-dimensional vocal fold models based on isotropic and transverse-isotropic material laws, considering both a layered model with homogeneous material properties on each layer and an inhomogeneous model. The best results exhibited a transversal-isotropic inhomogeneous (i.e., not producible) model. For the homogeneous model (three layers), the transversal-isotropic material parameters were also computed for each layer yielding deformations similar to the measured human vocal fold deformations.

Relation of Structural and Vibratory Kinematics of the Vocal Folds to Two Acoustic Measures of Breathy Voice Based on Computational Modeling

ERIC Educational Resources Information Center

Samlan, Robin A.; Story, Brad H.

2011-01-01

Purpose: To relate vocal fold structure and kinematics to 2 acoustic measures: cepstral peak prominence (CPP) and the amplitude of the first harmonic relative to the second (H1-H2). Method: The authors used a computational, kinematic model of the medial surfaces of the vocal folds to specify features of vocal fold structure and vibration in a…

Experimental and Theoretical Investigations of Phonation Threshold Pressure as a Function of Vocal Fold Elongation

PubMed Central

Tao, Chao; Regner, Michael F.; Zhang, Yu; Jiang, Jack J.

2014-01-01

Summary The relationship between the vocal fold elongation and the phonation threshold pressure (PTP) was experimentally and theoretically investigated. The PTP values of seventeen excised canine larynges with 0% to 15% bilateral vocal fold elongations in 5% elongation steps were measured using an excised larynx phonation system. It was found that twelve larynges exhibited a monotonic relationship between PTP and elongation; in these larynges, the 0% elongation condition had the lowest PTP. Five larynges exhibited a PTP minimum at 5% elongation. To provide a theoretical explanation of these phenomena, a two-mass model was modified to simulate vibration of the elongated vocal folds. Two pairs of longitudinal springs were used to represent the longitudinal elastin in the vocal folds. This model showed that when the vocal folds were elongated, the increased longitudinal tension would increase the PTP value and the increased vocal fold length would decrease the PTP value. The antagonistic effects contributed by these two factors were found to be able to cause either a monotonic or a non-monotonic relationship between PTP and elongation, which were consistent with experimental observations. Because PTP describes the ease of phonation, this study suggests that there may exist a nonzero optimal vocal fold elongation for the greatest ease for phonation in some larynges. PMID:25530744

In Vivo Engineering of the Vocal Fold ECM with Injectable HA Hydrogels -- Late Effects on Tissue Repair and Biomechanics in a Rabbit Model

PubMed Central

Klemuk, Sarah A.; Chen, Xia; Quinchia Johnson, Beatriz H.

2009-01-01

Objectives To determine if the utilization of injectable chemically-modified hyaluronan (HA) derivative at the time of intentional vocal fold resection may facilitate wound repair and preserve the unique viscoelastic properties of the extracellular matrix and lamina propria 6 months after treatment. Study Design Prospective, controlled animal study. Methods Twelve rabbit vocal folds were biopsied bilaterally, and the left side of vocal fold was treated with Extracel, an injectable, chemically-modified HA derivative, and the right side of vocal fold was injected with saline as control at the time of resection. Animals were sacrificed six months after biopsy and injection. Outcomes measured include transcription levels for procollagen, fibronectin, fibromodulin, TGF-β1, hyaluronan synthase and hyaluronidase and tissue biomechanics -- viscosity and elasticity. Results Extracel treated vocal folds were found to have significantly less fibrosis than saline treated controls. Extracel treated vocal folds had significantly improved biomechanical properties of elasticity and viscosity. Significantly decreased levels of fibronectin, fibromodulin, TGF-β1, procollagen I and hyaluronan synthase were measured. Conclusions Prophylactic in vivo manipulation of the extracellular matrix with an injectable HA hydrogel appears to induce vocal fold tissue regeneration to yield improved tissue composition and biomechanical properties at 6 months. PMID:20456912

Role for ion transport in porcine vocal fold epithelial defense to acid challenge.

PubMed

Erickson-Levendoski, Elizabeth; Sivasankar, M Preeti

2012-02-01

The vocal fold epithelium is routinely exposed to gastric contents, including acid and pepsin, during laryngopharyngeal reflux events. The epithelium may possess intrinsic defenses to reflux. The first objective of the current study was to examine whether vocal fold epithelial ion transport is one potential mechanism of defense to gastric contents. The second objective was to determine whether ion transport in response to gastric contents is associated with the secretion of bicarbonate. Prospective design in excised porcine larynges. Laboratory. Porcine vocal folds (N = 56) were exposed on the luminal surface to acid, pepsin, or sham challenges. Ion transport at baseline and following challenge exposure was measured using electrophysiological techniques. To examine specific ion transport mechanisms, vocal folds were pretreated with either a sodium channel blocker or bicarbonate channel blocker. Within 60 seconds of acid but not pepsin exposure, there was a significant increase in ion transport. This rapid increase in ion transport was transient and related to bicarbonate secretion. The current data suggest that porcine vocal folds immediately increase bicarbonate secretion following exposure to acid. Bicarbonate secretion may act to neutralize acid. These findings contribute to the identification of the mechanisms underlying vocal fold defense to reflux and offer implications for the development of treatments for reflux-induced vocal fold injury.

Functional morphology of the Alligator mississippiensis larynx with implications for vocal production.

PubMed

Riede, Tobias; Li, Zhiheng; Tokuda, Isao T; Farmer, Colleen G

2015-04-01

Sauropsid vocalization is mediated by the syrinx in birds and the larynx in extant reptiles; but whereas avian vocal production has received much attention, the vocal mechanism of basal reptilians is poorly understood. The American alligator (Alligator mississippiensis) displays a large vocal repertoire during mating and in parent-offspring interactions. Although vocal outputs of these behaviors have received some attention, the underlying mechanism of sound production remains speculative. Here, we investigate the laryngeal anatomy of juvenile and adult animals by macroscopic and histological methods. Observations of the cartilaginous framework and associated muscles largely corroborate earlier findings, but one muscle, the cricoarytenoideus, exhibits a heretofore unknown extrinsic insertion that has important implications for effective regulation of vocal fold length and tension. Histological investigation of the larynx revealed a layered vocal fold morphology. The thick lamina propria consists of non-homogenous extracellular matrix containing collagen fibers that are tightly packed below the epithelium but loosely organized deep inside the vocal fold. We found few elastic fibers but comparatively high proportions of hyaluronan. Similar organizational complexity is also seen in mammalian vocal folds and the labia of the avian syrinx: convergent morphologies that suggest analogous mechanisms for sound production. In tensile tests, alligator vocal folds demonstrated a linear stress-strain behavior in the low strain region and nonlinear stress responses at strains larger than 15%, which is similar to mammalian vocal fold tissue. We have integrated morphological and physiological data in a two-mass vocal fold model, providing a systematic description of the possible acoustic space that could be available to an alligator larynx. Mapping actual call production onto possible acoustic space validates the model's predictions. © 2015. Published by The Company of Biologists Ltd.

Vocal Fold Surface Hydration: A review

PubMed Central

Leydon, Ciara; Sivasankar, Mahalakshmi; Falciglia, Danielle Lodewyck; Atkins, Christopher; Fisher, Kimberly V.

2009-01-01

Vocal fold surface liquid homeostasis contributes to optimal vocal physiology. In this paper we review emerging evidence that vocal fold surface liquid is maintained in part by salt and water fluxes across the epithelium. Based on recent immunolocalization and electrophysiological findings, we describe a transcellular pathway as one mechanism for regulating superficial vocal fold hydration. We propose that the pathway includes the sodium-potassium pump, sodium-potassium-chloride cotransporter, epithelial sodium channels, cystic fibrosis transmembrane regulator chloride channels, and aquaporin water channels. By integrating knowledge of the regulating mechanisms underlying ion and fluid transport with observations from hydration challenges and treatments using in vitro and in vivo studies, we provide a theoretical basis for understanding how environmental and behavioral challenges and clinical interventions may modify vocal fold surface liquid composition. We present converging evidence that clinical protocols directed at facilitating vocal fold epithelial ion and fluid transport may benefit healthy speakers, those with voice disorders, and those at risk for voice disorders. PMID:19111440

Tissue engineering therapies for the vocal fold lamina propria.

PubMed

Kutty, Jaishankar K; Webb, Ken

2009-09-01

The vocal folds are laryngeal connective tissues with complex matrix composition/organization that provide the viscoelastic mechanical properties required for voice production. Vocal fold injury results in alterations in tissue structure and corresponding changes in tissue biomechanics that reduce vocal quality. Recent work has begun to elucidate the biochemical changes underlying injury-induced pathology and to apply tissue engineering principles to the prevention and reversal of vocal fold scarring. Based on the extensive history of injectable biomaterials in laryngeal surgery, a major focus of regenerative therapies has been the development of novel scaffolds with controlled in vivo residence time and viscoelastic properties approximating the native tissue. Additional strategies have included cell transplantation and delivery of the antifibrotic cytokine hepatocyte growth factor, as well as investigation of the effects of the unique vocal fold vibratory microenvironment using in vitro dynamic culture systems. Recent achievements of significant reductions in fibrosis and improved recovery of native tissue viscoelasticity and vibratory/functional performance in animal models are rapidly moving vocal fold tissue engineering toward clinical application.

In vivo engineering of the vocal fold extracellular matrix with injectable hyaluronic acid hydrogels: early effects on tissue repair and biomechanics in a rabbit model.

PubMed

Hansen, Jennifer K; Thibeault, Susan L; Walsh, Jennifer F; Shu, Xiao Zheng; Prestwich, Glenn D

2005-09-01

A prospective, controlled animal study was performed to determine whether the use of injectable, chemically modified hyaluronic acid (HA) derivatives at the time of intentional vocal fold resection might facilitate wound repair and preserve the unique viscoelastic properties of the vocal fold extracellular matrix. We performed bilateral vocal fold biopsies on 33 rabbits. Two groups of rabbits were unilaterally treated with 2 different HA derivatives--Carbylan-SX and HA-DTPH-PEGDA--at the time of resection. Saline was injected as a control into the contralateral fold. The animals were painlessly sacrificed 3 weeks after biopsy and injection. The outcomes measured included histologic fibrosis level, tissue HA level, and tissue viscosity and elasticity. The Carbylan-SX-treated vocal folds were found to have significantly less fibrosis than the saline-treated controls. The levels of HA in the treated vocal folds were not significantly different from those in the controls at 3 weeks as measured by enzyme-linked immunosorbent assay. The Carbylan-SX-treated vocal folds had significantly improved biomechanical properties of elasticity and viscosity. The HA-DTPH-PEGDA injections yielded significantly improved viscosity, but not elasticity. Prophylactic in vivo manipulation of the extracellular matrix with an injectable Carbylan-SX hydrogel appears to induce vocal fold tissue regeneration to yield optimal tissue composition and biomechanical properties favorable for phonation.

Vocal fold hemorrhage: factors predicting recurrence.

PubMed

Lennon, Christen J; Murry, Thomas; Sulica, Lucian

2014-01-01

Vocal fold hemorrhage is an acute phonotraumatic injury treated with voice rest; recurrence is a generally accepted indication for surgical intervention. This study aims to identify factors predictive of recurrence based on outcomes of a large clinical series. Retrospective cohort. Retrospective review of cases of vocal fold hemorrhage presenting to a university laryngology service. Demographic information was compiled. Videostroboscopic exams were evaluated for hemorrhage extent, presence of varix, mucosal lesion, and/or vocal fold paresis. Vocal fold hemorrhage recurrence was the main outcome measure. Follow-up telephone survey was used to complement clinical data. Forty-seven instances of vocal fold hemorrhage were evaluated (25M:22F; 32 professional voice users). Twelve of the 47 (26%) patients experienced recurrence. Only the presence of varix demonstrated significant association with recurrence (P = 0.0089) on multivariate logistic regression. Vocal fold hemorrhage recurred in approximately 26% of patients. Varix was a predictor of recurrence, with 48% of those with varix experiencing recurrence. Monitoring, behavioral management and/or surgical intervention may be indicated to treat patients with such characteristics. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Adipose stromal cells improve healing of vocal fold scar: Morphological and functional evidences.

PubMed

de Bonnecaze, Guillaume; Chaput, Benoit; Woisard, Virginie; Uro-Coste, Emmanuelle; Swider, Pascal; Vergez, Sebastien; Serrano, Elie; Casteilla, Louis; Planat-Benard, Valerie

2016-08-01

Adipose derived stromal cells (ASCs) are abundant and easy to prepare. Such cells may be useful for treating severe vocal disturbance caused by acute vocal fold scars. Prospective animal experiments with controls. Twenty New-Zealand white rabbits were used in the present study. We evaluated vocal fold healing, with or without injection of autologous ASCs, after acute scarring. A defined lesion was created and the ASCs were immediately injected. Vocal fold regeneration was evaluated histomorphometrically and via viscoelastic analysis using an electrodynamic shaker. Six weeks after ASC injection, vocal folds exhibited significantly less inflammation than control folds (P < 0.005). In addition, hypertrophy of the lamina propria and fibrosis were significantly reduced upon ASC injection (P < 0.02). The decrease in viscoelastic parameters was less important in the ASC injected group compared to the noninjected group (P = 0.08). Injection of autologous ASCs improved vocal fold healing in our preclinical model. Further studies are needed, but this method may be useful in humans. NA. Laryngoscope, 126:E278-E285, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Three-dimensional optical reconstruction of vocal fold kinematics using high-speed video with a laser projection system

PubMed Central

Luegmair, Georg; Mehta, Daryush D.; Kobler, James B.; Döllinger, Michael

2015-01-01

Vocal fold kinematics and its interaction with aerodynamic characteristics play a primary role in acoustic sound production of the human voice. Investigating the temporal details of these kinematics using high-speed videoendoscopic imaging techniques has proven challenging in part due to the limitations of quantifying complex vocal fold vibratory behavior using only two spatial dimensions. Thus, we propose an optical method of reconstructing the superior vocal fold surface in three spatial dimensions using a high-speed video camera and laser projection system. Using stereo-triangulation principles, we extend the camera-laser projector method and present an efficient image processing workflow to generate the three-dimensional vocal fold surfaces during phonation captured at 4000 frames per second. Initial results are provided for airflow-driven vibration of an ex vivo vocal fold model in which at least 75% of visible laser points contributed to the reconstructed surface. The method captures the vertical motion of the vocal folds at a high accuracy to allow for the computation of three-dimensional mucosal wave features such as vibratory amplitude, velocity, and asymmetry. PMID:26087485

[Basic research on vocal fold dynamics: three-dimensional vibration analysis of human and canine larynges].

PubMed

Döllinger, M; Rosanowski, F; Eysholdt, U; Lohscheller, J

2008-12-01

The understanding of normal and pathological vocal fold dynamics is the basis for a pathophysiological motivated voice therapy. Crucial vocal fold dynamics concerning voice production occur at the medial part of the vocal fold which is seen as the most critical region of mucosal wave propagation. Due to the limited size of the larynx the possibilities of laryngeal imaging by endoscopic techniques are limited. This work describes an experimental set-up that enables quantification of the entire medial and superior vocal fold surface using excised human and in vivo canine larynges. The data obtained enable analysis of vocal fold deflections, velocities, and mucosal wave propagation. The reciprocal dependencies can be examined and different areas of vocal fold dynamics located. The vertical components obscured in clinical endoscopy can be visualized. This is not negligible. In particular it is shown that the vertical deflection, which cannot be observed by clinical examination, plays an important part in the dynamics and therefore cannot be omitted for therapeutic procedures. The theoretically assumed entrainment and influence of the two main vibration modes enabling normal phonation is confirmed.

Botulinum toxin in the treatment of vocal fold nodules.

PubMed

Allen, Jacqui E; Belafsky, Peter C

2009-12-01

Promising new techniques in the management of vocal fold nodules have been developed in the past 2 years. Simultaneously, the therapeutic use of botulinum toxin has rapidly expanded. This review explores the use of botulinum toxin in treatment of vocal nodules and summarizes current therapeutic concepts. New microsurgical instruments and techniques, refinements in laser technology, radiosurgical excision and steroid intralesional injections are all promising new techniques in the management of vocal nodules. Botulinum toxin-induced 'voice rest' is a new technique we have employed in patients with recalcitrant nodules. Successful resolution of nodules is possible with this technique, without the risk of vocal fold scarring inherent in dissection/excision techniques. Botulinum toxin usage is exponentially increasing, and large-scale, long-term studies demonstrate its safety profile. Targeted vocal fold temporary paralysis induced by botulinum toxin injection is a new, well tolerated and efficacious treatment in patients with persistent vocal fold nodules.

Nonlinear dynamic mechanism of vocal tremor from voice analysis and model simulations

NASA Astrophysics Data System (ADS)

Zhang, Yu; Jiang, Jack J.

2008-09-01

Nonlinear dynamic analysis and model simulations are used to study the nonlinear dynamic characteristics of vocal folds with vocal tremor, which can typically be characterized by low-frequency modulation and aperiodicity. Tremor voices from patients with disorders such as paresis, Parkinson's disease, hyperfunction, and adductor spasmodic dysphonia show low-dimensional characteristics, differing from random noise. Correlation dimension analysis statistically distinguishes tremor voices from normal voices. Furthermore, a nonlinear tremor model is proposed to study the vibrations of the vocal folds with vocal tremor. Fractal dimensions and positive Lyapunov exponents demonstrate the evidence of chaos in the tremor model, where amplitude and frequency play important roles in governing vocal fold dynamics. Nonlinear dynamic voice analysis and vocal fold modeling may provide a useful set of tools for understanding the dynamic mechanism of vocal tremor in patients with laryngeal diseases.

Effects of Vocal Fold Nodules on Glottal Cycle Measurements Derived from High-Speed Videoendoscopy in Children

PubMed Central

2016-01-01

The goal of this study is to quantify the effects of vocal fold nodules on vibratory motion in children using high-speed videoendoscopy. Differences in vibratory motion were evaluated in 20 children with vocal fold nodules (5–11 years) and 20 age and gender matched typically developing children (5–11 years) during sustained phonation at typical pitch and loudness. Normalized kinematic features of vocal fold displacements from the mid-membranous vocal fold point were extracted from the steady-state high-speed video. A total of 12 kinematic features representing spatial and temporal characteristics of vibratory motion were calculated. Average values and standard deviations (cycle-to-cycle variability) of the following kinematic features were computed: normalized peak displacement, normalized average opening velocity, normalized average closing velocity, normalized peak closing velocity, speed quotient, and open quotient. Group differences between children with and without vocal fold nodules were statistically investigated. While a moderate effect size was observed for the spatial feature of speed quotient, and the temporal feature of normalized average closing velocity in children with nodules compared to vocally normal children, none of the features were statistically significant between the groups after Bonferroni correction. The kinematic analysis of the mid-membranous vocal fold displacement revealed that children with nodules primarily differ from typically developing children in closing phase kinematics of the glottal cycle, whereas the opening phase kinematics are similar. Higher speed quotients and similar opening phase velocities suggest greater relative forces are acting on vocal fold in the closing phase. These findings suggest that future large-scale studies should focus on spatial and temporal features related to the closing phase of the glottal cycle for differentiating the kinematics of children with and without vocal fold nodules. PMID:27124157

High-speed imaging of vocal fold vibrations and larynx movements within vocalizations of different vowels.

PubMed

Maurer, D; Hess, M; Gross, M

1996-12-01

Theoretic investigations of the "source-filter" model have indicated a pronounced acoustic interaction of glottal source and vocal tract. Empirical investigations of formant pattern variations apart from changes in vowel identity have demonstrated a direct relationship between the fundamental frequency and the patterns. As a consequence of both findings, independence of phonation and articulation may be limited in the speech process. Within the present study, possible interdependence of phonation and phoneme was investigated: vocal fold vibrations and larynx position for vocalizations of different vowels in a healthy man and woman were examined by high-speed light-intensified digital imaging. We found 1) different movements of the vocal folds for vocalizations of different vowel identities within one speaker and at similar fundamental frequency, and 2) constant larynx position within vocalization of one vowel identity, but different positions for vocalizations of different vowel identities. A possible relationship between the vocal fold vibrations and the phoneme is discussed.

Microvascular lesions of the true vocal fold.

PubMed

Postma, G N; Courey, M S; Ossoff, R H

1998-06-01

Microvascular lesions, also called varices or capillary ectasias, in contrast to vocal fold polyps with telangiectatic vessels, are relatively small lesions arising from the microcirculation of the vocal fold. Varices are most commonly seen in female professional vocalists and may be secondary to repetitive trauma, hormonal variations, or repeated inflammation. Microvascular lesions may either be asymptomatic or cause frank dysphonia by interrupting the normal vibratory pattern, mass, or closure of the vocal folds. They may also lead to vocal fold hemorrhage, scarring, or polyp formation. Laryngovideostroboscopy is the key in determining the functional significance of vocal fold varices. Management of patients with a varix includes medical therapy, speech therapy, and occasionally surgical vaporization. Indications for surgery are recurrent hemorrhage, enlargement of the varix, development of a mass in conjunction with the varix or hemorrhage, and unacceptable dysphonia after maximal medical and speech therapy due to a functionally significant varix.

Influence of Left-Right Asymmetries on Voice Quality in Simulated Paramedian Vocal Fold Paralysis

ERIC Educational Resources Information Center

Samlan, Robin A.; Story, Brad H.

2017-01-01

Purpose: The purpose of this study was to determine the vocal fold structural and vibratory symmetries that are important to vocal function and voice quality in a simulated paramedian vocal fold paralysis. Method: A computational kinematic speech production model was used to simulate an exemplar "voice" on the basis of asymmetric…

Computation of the three-dimensional medial surface dynamics of the vocal folds.

PubMed

Döllinger, Michael; Berry, David A

2006-01-01

To increase our understanding of pathological and healthy voice production, quantitative measurement of the medial surface dynamics of the vocal folds is significant, albeit rarely performed because of the inaccessibility of the vocal folds. Using an excised hemilarynx methodology, a new calibration technique, herein referred to as the linear approximate (LA) method, was introduced to compute the three-dimensional coordinates of fleshpoints along the entire medial surface of the vocal fold. The results were compared with results from the direct linear transform. An associated error estimation was presented, demonstrating the improved accuracy of the new method. A test on real data was reported including computation of quantitative measurements of vocal fold dynamics.

Phonotrauma associated with crying.

PubMed

Murry, T; Rosen, C A

2000-12-01

Vocal fold hemorrhage often results in a sudden change in voice quality. Traumatic use of the voice (phonation or singing) is generally thought to be the cause of the vocal fold hemorrhage. The current report reviews three cases in which the traumatic event was crying. In one case, the patient's voice was only used for crying. All three patients were female and all were professional singers. The treatment of these individuals consisted of voice rest and subsequent phonomicrosurgery for lesions associated with the vocal fold hemorrhage. These case studies suggest that crying as a traumatic vocal behavior may result in vocal fold hemorrhage.

Impacts and limitations of medialization thyroplasty on swallowing function of patients with unilateral vocal fold paralysis.

PubMed

Tateya, Ichiro; Hirano, Shigeru; Kishimoto, Yo; Suehiro, Atsushi; Kojima, Tsuyohi; Ohno, Satoshi; Ito, Juichi

2010-11-01

Medialization thyroplasty was effective in improving swallowing function as well as vocal function in most cases with unilateral vocal fold paralysis. The impact of medialization thryoplasty was insufficient for the case with severe atrophy and that in which the vocal fold was fixed in the lateral position. To evaluate the impacts and limitations of medialization thyroplasty on swallowing function of the patients with unilateral vocal fold paralysis. Eight cases (mean age 68.5 years) with unilateral vocal fold paralysis chiefly complaining of swallowing disturbance were studied. All patients underwent thyroplasty type I. The causes of the paralysis were lung cancer in four cases, esophageal cancer in one case, aortic aneurysm in one case, subarachnoid hemorrhage in one case, and unknown in one case. Subjective swallowing function score, maximum phonation time (MPT), mean flow rate (MFR), amplitude perturbation quotient (APQ), and pitch perturbation quotient (PPQ) were examined pre- and postoperatively. The swallowing score improved in all except two cases. However, bilateral thryoplasty was necessary for the case with severe vocal fold atrophy and arytenoid adduction was needed for the case in which the vocal fold was fixed in the lateral position. The swallowing score, MPT, and MFR showed significant improvement after surgery.

Effects of Asymmetric Superior Laryngeal Nerve Stimulation on Glottic Posture, Acoustics, Vibration

PubMed Central

Chhetri, Dinesh K.; Neubauer, Juergen; Bergeron, Jennifer L.; Sofer, Elazar; Peng, Kevin A.; Jamal, Nausheen

2013-01-01

Objectives Evaluate the effects of asymmetric superior laryngeal nerve stimulation on the vibratory phase, laryngeal posture, and acoustics. Study Design Basic science study using an in vivo canine model. Methods The superior laryngeal nerves were symmetrically and asymmetrically stimulated over eight activation levels to mimic laryngeal asymmetries representing various levels of superior laryngeal nerve paresis and paralysis conditions. Glottal posture change, vocal fold speed, and vibration of these 64 distinct laryngeal activation conditions were evaluated by high speed video and concurrent acoustic and aerodynamic recordings. Assessments were made at phonation onset. Results Vibratory phase was symmetric in all symmetric activation conditions but consistent phase asymmetry towards the vocal fold with higher superior laryngeal nerve activation was observed. Superior laryngeal nerve paresis and paralysis conditions had reduced vocal fold strain and fundamental frequency. Superior laryngeal nerve activation increased vocal fold closure speed, but this effect was more pronounced for the ipsilateral vocal fold. Increasing asymmetry led to aperiodic and chaotic vibration. Conclusions This study directly links vocal fold tension asymmetry with vibratory phase asymmetry; in particular the side with greater tension leads in the opening phase. The clinical observations of vocal fold lag, reduced vocal range, and aperiodic voice in superior laryngeal paresis and paralysis is also supported. PMID:23712542

Quantification of change in vocal fold tissue stiffness relative to depth of artificial damage.

PubMed

Rohlfs, Anna-Katharina; Schmolke, Sebastian; Clauditz, Till; Hess, Markus; Müller, Frank; Püschel, Klaus; Roemer, Frank W; Schumacher, Udo; Goodyer, Eric

2017-10-01

To quantify changes in the biomechanical properties of human excised vocal folds with defined artificial damage. The linear skin rheometer (LSR) was used to obtain a series of rheological measurements of shear modulus from the surface of 30 human cadaver vocal folds. The tissue samples were initially measured in a native condition and then following varying intensities of thermal damage. Histological examination of each vocal fold was used to determine the depth of artificial alteration. The measured changes in stiffness were correlated with the depth of cell damage. For vocal folds in a pre-damage state the shear modulus values ranged from 537 Pa to 1,651 Pa (female) and from 583 Pa to 1,193 Pa (male). With increasing depth of damage from the intermediate layer of the lamina propria (LP), tissue stiffness increased consistently (compared with native values) following application of thermal damage to the vocal folds. The measurement showed an increase of tissue stiffness when the depth of tissue damage was extending from the intermediate LP layer downwards. Changes in the elastic characteristics of human vocal fold tissue following damage at defined depths were demonstrated in an in vitro experiment. In future, reproducible in vivo measurements of elastic vocal fold tissue alterations may enable phonosurgeons to infer the extent of subepithelial damage from changes in surface elasticity.

Contribution to the understanding of the etiology of vocal fold cysts: a functional and histologic study.

PubMed

Milutinović, Z; Vasiljević, J

1992-05-01

The etiological theories of vocal fold cysts can be divided into two basic groups: those of congenital and acquired cysts. In ongoing practice, the authors had noted that the greater number of cysts appeared at the functionally most active segment of the vocal folds which, on the other hand, has the least number of glands. Also, it had been noted that patients with vocal fold cysts tended to have hyperkinetic patterns of voice production. These observations indicated the possibility of a functional aspect in the etiology of vocal fold cysts, and consideration of such a possibility was the aim of this work. In 37 cases, the exact location of the cyst was established. In addition, the muscular activity of the phonatory apparatus was estimated, patient self-descriptions with respect to talkativeness were taken into account, and histological evaluations were made. The cysts were most frequently found in the area of the junction of the anterior and middle thirds of the free edge of the vocal fold. Muscular activity during speech and phonation was increased in study patients. Sixty-five percent of patients had epidermoid cysts and 35% had retention cysts of the vocal fold. According to study results, the functional aspect of cyst genesis has a marked role in the etiology of vocal fold cysts, which points to the great importance of functional care for cyst patients.

In Vivo engineering of the vocal fold ECM with injectable HA hydrogels-late effects on tissue repair and biomechanics in a rabbit model.

PubMed

Thibeault, Susan L; Klemuk, Sarah A; Chen, Xia; Quinchia Johnson, Beatriz H

2011-03-01

To determine if the utilization of injectable chemically modified hyaluronan (HA) derivative at the time of intentional vocal fold resection may facilitate wound repair and preserve the unique viscoelastic properties of the extracellular matrix (ECM) and lamina propria 6 months after treatment. Prospective, controlled animal study. Twelve rabbit vocal folds were biopsied bilaterally, and the left side of vocal fold was treated with Extracel, an injectable, chemically modified HA derivative, and the right side of vocal fold was injected with saline as control at the time of resection. Animals were sacrificed 6 months after biopsy and injection. Outcomes measured include transcription levels for procollagen, fibronectin, fibromodulin, transforming growth factor beta one (TGF-β1), HA synthase, and hyaluronidase, and tissue biomechanics-viscosity and elasticity. Extracel-treated vocal folds were found to have significantly less fibrosis than saline-treated controls. Extracel-treated vocal folds had significantly improved biomechanical properties of elasticity and viscosity. Significantly decreased levels of fibronectin, fibromodulin, TGF-β1, procollagen I, and HA synthase were measured. Prophylactic in vivo manipulation of the ECM with an injectable HA hydrogel appears to induce vocal fold tissue regeneration to yield improved tissue composition and biomechanical properties at 6 months. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

[3D visualization and analysis of vocal fold dynamics].

PubMed

Bohr, C; Döllinger, M; Kniesburges, S; Traxdorf, M

2016-04-01

Visual investigation methods of the larynx mainly allow for the two-dimensional presentation of the three-dimensional structures of the vocal fold dynamics. The vertical component of the vocal fold dynamics is often neglected, yielding a loss of information. The latest studies show that the vertical dynamic components are in the range of the medio-lateral dynamics and play a significant role within the phonation process. This work presents a method for future 3D reconstruction and visualization of endoscopically recorded vocal fold dynamics. The setup contains a high-speed camera (HSC) and a laser projection system (LPS). The LPS projects a regular grid on the vocal fold surfaces and in combination with the HSC allows a three-dimensional reconstruction of the vocal fold surface. Hence, quantitative information on displacements and velocities can be provided. The applicability of the method is presented for one ex-vivo human larynx, one ex-vivo porcine larynx and one synthetic silicone larynx. The setup introduced allows the reconstruction of the entire visible vocal fold surfaces for each oscillation status. This enables a detailed analysis of the three dimensional dynamics (i. e. displacements, velocities, accelerations) of the vocal folds. The next goal is the miniaturization of the LPS to allow clinical in-vivo analysis in humans. We anticipate new insight on dependencies between 3D dynamic behavior and the quality of the acoustic outcome for healthy and disordered phonation.

Role for Ion Transport in Porcine Vocal Fold Epithelial Defense to Acid Challenge

PubMed Central

Erickson-Levendoski, Elizabeth; Sivasankar, M. Preeti

2012-01-01

Objective The vocal fold epithelium is routinely exposed to gastric contents, including acid and pepsin, during laryngopharyngeal reflux events. The epithelium may possess intrinsic defenses to reflux. The first objective of the current study was to examine whether vocal fold epithelial ion transport is one potential mechanism of defense to gastric contents. The second objective was to determine whether ion transport in response to gastric contents is associated with the secretion of bicarbonate. Study Design Prospective design in excised porcine larynges. Setting Laboratory. Subjects and Methods Porcine vocal folds (N = 56) were exposed on the luminal surface to acid, pepsin, or sham challenges. Ion transport at baseline and following challenge exposure was measured using electrophysiological techniques. To examine specific ion transport mechanisms, vocal folds were pretreated with either a sodium channel blocker or bicarbonate channel blocker. Results Within 60 seconds of acid but not pepsin exposure, there was a significant increase in ion transport. This rapid increase in ion transport was transient and related to bicarbonate secretion. Conclusion The current data suggest that porcine vocal folds immediately increase bicarbonate secretion following exposure to acid. Bicarbonate secretion may act to neutralize acid. These findings contribute to the identification of the mechanisms underlying vocal fold defense to reflux and offer implications for the development of treatments for reflux-induced vocal fold injury. PMID:22086905

Tissue Engineering-based Therapeutic Strategies for Vocal Fold Repair and Regeneration

PubMed Central

Li, Linqing; Stiadle, Jeanna M.; Lau, Hang K.; Zerdoum, Aidan B.; Jia, Xinqiao; L.Thibeault, Susan; Kiick, Kristi L.

2016-01-01

Vocal folds are soft laryngeal connective tissues with distinct layered structures and complex multicomponent matrix compositions that endow phonatory and respiratory functions. This delicate tissue is easily damaged by various environmental factors and pathological conditions, altering vocal biomechanics and causing debilitating vocal disorders that detrimentally affect the daily lives of suffering individuals. Modern techniques and advanced knowledge of regenerative medicine have led to a deeper understanding of the microstructure, microphysiology, and micropathophysiology of vocal fold tissues. State-of-the-art materials ranging from extracecullar-matrix (ECM)-derived biomaterials to synthetic polymer scaffolds have been proposed for the prevention and treatment of voice disorders including vocal fold scarring and fibrosis. This review intends to provide a thorough overview of current achievements in the field of vocal fold tissue engineering, including the fabrication of injectable biomaterials to mimic in vitro cell microenvironments, novel designs of bioreactors that capture in vivo tissue biomechanics, and establishment of various animal models to characterize the in vivo biocompatibility of these materials. The combination of polymeric scaffolds, cell transplantation, biomechanical stimulation, and delivery of antifibrotic growth factors will lead to successful restoration of functional vocal folds and improved vocal recovery in animal models, facilitating the application of these materials and related methodologies in clinical practice. PMID:27619243

Nonlinear viscoelastic characterization of human vocal fold tissues under large-amplitude oscillatory shear (LAOS)

PubMed Central

Chan, Roger W.

2018-01-01

Viscoelastic shear properties of human vocal fold tissues were previously quantified by the shear moduli (G′ and G″). Yet these small-strain linear measures were unable to describe any nonlinear tissue behavior. This study attempted to characterize the nonlinear viscoelastic response of the vocal fold lamina propria under large-amplitude oscillatory shear (LAOS) with a stress decomposition approach. Human vocal fold cover and vocal ligament specimens from eight subjects were subjected to LAOS rheometric testing with a simple-shear rheometer. The empirical total stress response was decomposed into elastic and viscous stress components, based on odd-integer harmonic decomposition approach with Fourier transform. Nonlinear viscoelastic measures derived from the decomposition were plotted in Pipkin space and as rheological fingerprints to observe the onset of nonlinearity and the type of nonlinear behavior. Results showed that both the vocal fold cover and the vocal ligament experienced intercycle strain softening, intracycle strain stiffening, as well as shear thinning both intercycle and intracycle. The vocal ligament appeared to demonstrate an earlier onset of nonlinearity at phonatory frequencies, and higher sensitivity to changes in frequency and strain. In summary, the stress decomposition approach provided much better insights into the nonlinear viscoelastic behavior of the vocal fold lamina propria than the traditional linear measures. PMID:29780189

Nonlinear viscoelastic characterization of human vocal fold tissues under large-amplitude oscillatory shear (LAOS).

PubMed

Chan, Roger W

2018-05-01

Viscoelastic shear properties of human vocal fold tissues were previously quantified by the shear moduli ( G' and G″ ). Yet these small-strain linear measures were unable to describe any nonlinear tissue behavior. This study attempted to characterize the nonlinear viscoelastic response of the vocal fold lamina propria under large-amplitude oscillatory shear (LAOS) with a stress decomposition approach. Human vocal fold cover and vocal ligament specimens from eight subjects were subjected to LAOS rheometric testing with a simple-shear rheometer. The empirical total stress response was decomposed into elastic and viscous stress components, based on odd-integer harmonic decomposition approach with Fourier transform. Nonlinear viscoelastic measures derived from the decomposition were plotted in Pipkin space and as rheological fingerprints to observe the onset of nonlinearity and the type of nonlinear behavior. Results showed that both the vocal fold cover and the vocal ligament experienced intercycle strain softening, intracycle strain stiffening, as well as shear thinning both intercycle and intracycle. The vocal ligament appeared to demonstrate an earlier onset of nonlinearity at phonatory frequencies, and higher sensitivity to changes in frequency and strain. In summary, the stress decomposition approach provided much better insights into the nonlinear viscoelastic behavior of the vocal fold lamina propria than the traditional linear measures.

Cause-effect relationship between vocal fold physiology and voice production in a three-dimensional phonation model

PubMed Central

Zhang, Zhaoyan

2016-01-01

The goal of this study is to better understand the cause-effect relation between vocal fold physiology and the resulting vibration pattern and voice acoustics. Using a three-dimensional continuum model of phonation, the effects of changes in vocal fold stiffness, medial surface thickness in the vertical direction, resting glottal opening, and subglottal pressure on vocal fold vibration and different acoustic measures are investigated. The results show that the medial surface thickness has dominant effects on the vertical phase difference between the upper and lower margins of the medial surface, closed quotient, H1-H2, and higher-order harmonics excitation. The main effects of vocal fold approximation or decreasing resting glottal opening are to lower the phonation threshold pressure, reduce noise production, and increase the fundamental frequency. Increasing subglottal pressure is primarily responsible for vocal intensity increase but also leads to significant increase in noise production and an increased fundamental frequency. Increasing AP stiffness significantly increases the fundamental frequency and slightly reduces noise production. The interaction among vocal fold thickness, stiffness, approximation, and subglottal pressure in the control of F0, vocal intensity, and voice quality is discussed. PMID:27106298

Reinke Edema: Watch For Vocal Fold Cysts.

PubMed

Tüzüner, Arzu; Demirci, Sule; Yavanoglu, Ahmet; Kurkcuoglu, Melih; Arslan, Necmi

2015-06-01

Reinke edema is one of the common cause of dysphonia middle-aged population, and severe thickening of vocal folds require surgical treatment. Smoking plays a major role on etiology. Vocal fold cysts are also benign lesions and vocal trauma blamed for acquired cysts. We would like to present 3 cases with vocal fold cyst related with Reinke edema. First case had a subepidermal epidermoid cyst with Reinke edema, which could be easily observed before surgery during laryngostroboscopy. Second case had a mucous retention cyst into the edematous Reinke tissue, which was detected during surgical intervention, and third case had a epidermoid cyst that occurred 2 months after before microlaryngeal operation regarding Reinke edema reduction. These 3 cases revealed that surgical management of Reinke edema needs a careful dissection and close follow-up after surgery for presence of vocal fold cysts.

Management of vocal fold scar with autologous fat implantation: perceptual results.

PubMed

Neuenschwander, M C; Sataloff, R T; Abaza, M M; Hawkshaw, M J; Reiter, D; Spiegel, J R

2001-06-01

Vocal fold scar disrupts the mucosal wave and interferes with glottic closure. Treatment involves a multidisciplinary approach that includes voice therapy, medical management, and sometimes surgery. We reviewed the records of the first eight patients who underwent autologous fat implantation for vocal fold scar. Information on the etiology of scar, physical findings, and prior interventions were collected. Videotapes of videostroboscopic findings and perceptual voice ratings [Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS)] were randomized and analyzed independently by four blinded observers. Etiology of scar included mass excision (7), vocal fold stripping (3), congenital sulcus (2), and hemorrhage (1). Prior surgical procedures performed included thyroplasty (1), autologous fat injection (9), excision of scar (2), and lysis of adhesions (2). Strobovideolaryngoscopy: Statistically significant improvement was found in glottic closure, mucosal wave, and stiffness (P = 0.05). Perceptual ratings (GRBAS): Statistically significant improvement was found in all five parameters, including overall Grade, Roughness, Breathiness, Asthenia, and Strain (P = 0.05). Patients appear to have improved vocal fold function and quality of voice after autologous fat implantation in the vocal fold. Autologous fat implantation is an important adjunctive procedure in the management of vocal fold scar, and a useful addition to the armamentarium of the experienced phonomicrosurgeon.

Vocal fold tissue failure: preliminary data and constitutive modeling.

PubMed

Chan, Roger W; Siegmund, Thomas

2004-08-01

In human voice production (phonation), linear small-amplitude vocal fold oscillation occurs only under restricted conditions. Physiologically, phonation more often involves large-amplitude oscillation associated with tissue stresses and strains beyond their linear viscoelastic limits, particularly in the lamina propria extracellular matrix (ECM). This study reports some preliminary measurements of tissue deformation and failure response of the vocal fold ECM under large-strain shear The primary goal was to formulate and test a novel constitutive model for vocal fold tissue failure, based on a standard-linear cohesive-zone (SL-CZ) approach. Tissue specimens of the sheep vocal fold mucosa were subjected to torsional deformation in vitro, at constant strain rates corresponding to twist rates of 0.01, 0.1, and 1.0 rad/s. The vocal fold ECM demonstrated nonlinear stress-strain and rate-dependent failure response with a failure strain as low as 0.40 rad. A finite-element implementation of the SL-CZ model was capable of capturing the rate dependence in these preliminary data, demonstrating the model's potential for describing tissue failure. Further studies with additional tissue specimens and model improvements are needed to better understand vocal fold tissue failure.

Material and shape optimization for multi-layered vocal fold models using transient loadings.

PubMed

Schmidt, Bastian; Leugering, Günter; Stingl, Michael; Hüttner, Björn; Agaimy, Abbas; Döllinger, Michael

2013-08-01

Commonly applied models to study vocal fold vibrations in combination with air flow distributions are self-sustained physical models of the larynx consisting of artificial silicone vocal folds. Choosing appropriate mechanical parameters and layer geometries for these vocal fold models while considering simplifications due to manufacturing restrictions is difficult but crucial for achieving realistic behavior. In earlier work by Schmidt et al. [J. Acoust. Soc. Am. 129, 2168-2180 (2011)], the authors presented an approach in which material parameters of a static numerical vocal fold model were optimized to achieve an agreement of the displacement field with data retrieved from hemilarynx experiments. This method is now generalized to a fully transient setting. Moreover in addition to the material parameters, the extended approach is capable of finding optimized layer geometries. Depending on chosen material restriction, significant modifications of the reference geometry are predicted. The additional flexibility in the design space leads to a significantly more realistic deformation behavior. At the same time, the predicted biomechanical and geometrical results are still feasible for manufacturing physical vocal fold models consisting of several silicone layers. As a consequence, the proposed combined experimental and numerical method is suited to guide the construction of physical vocal fold models.

Phonomicrosurgery in singers and performing artists: treatment outcomes, management theories, and future directions.

PubMed

Zeitels, Steven M; Hillman, Robert E; Desloge, Rosemary; Mauri, Marcello; Doyle, Patricia B

2002-12-01

Phonomicrosurgery in performing artists has historically been approached with great trepidation, and vocal outcome data are sparse. The vocal liability of surgically disturbing the superficial lamina propria (SLP) and epithelium must be balanced with the inherent detrimental vocal effect of the lesion(s). A prospective investigation was performed on 185 performing artists who underwent phonomicrosurgical resection of 365 lesions: 201 nodules, 71 polyps, 66 varices and ectasias, 13 cysts, 8 keratotic lesions, 2 granulomas, 2 Reinke's edema, and 2 papillomas. Nearly all patients with SLP lesions reported improvement in their postsurgical vocal function. This subjective result was supported by objective acoustic and aerodynamic measures. All postsurgical objective vocal function measures fell within normal limits, including a few that displayed presurgical abnormalities. However, given the relative insensitivity of standard objective measures to assess higher-level vocal performance-related factors, it is even more noteworthy that 8 of 24 objective measures displayed statistically significant postsurgical improvements in vocal function. Such changes in objective measures mostly reflect overall enhancement in the efficiency of voice production. Phonomicrosurgical resection of vocal fold lesions in performing artists is enjoying an expanding role because of a variety of improvements in diagnostic assessment, surgical instrumentation and techniques, and specialized rehabilitation. Most of these lesions are the result of phonotrauma and arise within the SLP. Successful management depends on prudent patient selection and counseling, ultraprecise technique, and vigorqus vocal rehabilitation. Furthermore, an understanding of the vocal function and dysfunction of this high-performance population provides all otolaryngologists who manage laryngeal problems with valuable information that they can extrapolate for use in their practices.

Periodic botulinum toxin injections for paradoxical vocal fold motion in a child with cerebral palsy: a case study.

PubMed

Cheng, Yew Song; Bhutta, Mahmood F; Ramsden, James D; Lennox, Penny

2014-03-01

We describe an unusual case of paradoxical vocal fold motion in a child with cerebral palsy. Clinically, the child presented with mild stridor, which worsened over months, eventually requiring emergency intubation. After an unsuccessful trial of medical management, microlaryngoscopy revealed abnormal adduction of the vocal folds during inspiration. This was successfully treated with periodic type A botulinum toxin injections to the vocal folds, sparing the child from tracheostomy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Epidemiology of Vocal Fold Paralyses After Total Thyroidectomy for Well-Differentiated Thyroid Cancer in Medicare Population

PubMed Central

Francis, David O.; Pearce, Elizabeth C.; Ni, Shenghua; Garrett, C. Gaelyn; Penson, David F.

2014-01-01

Objectives Population-level incidence of vocal fold paralysis after thyroidectomy for well-differentiated thyroid carcinoma (WDTC) is not known. This study aimed to measure longitudinal incidence of post-operative vocal fold paralyses and need for directed interventions in the Medicare population undergoing total thyroidectomy for WDTC. Study Design Retrospective Cohort Study Setting United States Population Subjects Medicare Beneficiaries Methods SEER-Medicare data (1991 – 2009) were used to identify beneficiaries who underwent total thyroidectomy for WDTC. Incident vocal fold paralyses and directed interventions were identified. Multivariate analyses were used to determine factors associated with odds of developing these surgical complications. Results Of 5,670 total thyroidectomies for WDTC, 9.5% were complicated by vocal fold paralysis [8.2% unilateral vocal fold paralysis (UVFP); 1.3% bilateral vocal fold paralysis (BVFP)]. Rate of paralyses decreased 5% annually from 1991 to 2009 (OR 0.95, 95% CI 0.93 – 0.97; p<0.001). Overall, 22% of patients with vocal fold paralysis required surgical intervention (UVFP 21%, BVFP 28%). Multivariate logistic regression revealed odds of post-thyroidectomy paralysis increased with each additional year of age, with non-Caucasian race, particular histologic types, advanced stage, and in particular registry regions. Conclusions Annual rates of post-thyroidectomy vocal fold paralyses are decreasing among Medicare beneficiaries with WDTC. High incidence in this aged population is likely due to a preponderance of temporary paralyses, which is supported by the need for directed intervention in less than a quarter of affected patients. Further population-based studies are needed to refine the population incidence and risk factors for paralyses in the aging population. PMID:24482349

Proton density-weighted laryngeal magnetic resonance imaging in systemically dehydrated rats.

PubMed

Oleson, Steven; Lu, Kun-Han; Liu, Zhongming; Durkes, Abigail C; Sivasankar, M Preeti

2018-06-01

Dehydrated vocal folds are inefficient sound generators. Although systemic dehydration of the body is believed to induce vocal fold dehydration, this causative relationship has not been demonstrated in vivo. Here we investigate the feasibility of using in vivo proton density (PD)-weighted magnetic resonance imaging (MRI) to demonstrate hydration changes in vocal fold tissue following systemic dehydration in rats. Animal study. Sprague-Dawley rats (n = 10) were imaged at baseline and following a 10% reduction in body weight secondary to withholding water. In vivo, high-field (7 T), PD-weighted MRI was used to successfully resolve vocal fold and salivary gland tissue structures. Normalized signal intensities within the vocal fold decreased postdehydration by an average of 11.38% ± 3.95% (mean ± standard error of the mean [SEM], P = .0098) as compared to predehydration levels. The salivary glands experienced a similar decrease in normalized signal intensity by an average of 10.74% ± 4.14% (mean ± SEM, P = .0195) following dehydration. The correlation coefficient (percent change from dehydration) between vocal folds and salivary glands was 0.7145 (P = .0202). Ten percent systemic dehydration induced vocal fold dehydration as assessed by PD-weighted MRI. Changes in the hydration state of vocal fold tissue were highly correlated with that of the salivary glands in dehydrated rats in vivo. These preliminary findings demonstrate the feasibility of using PD-weighted MRI to quantify hydration states of the vocal folds and lay the foundation for further studies that explore more routine and realistic magnitudes of systemic dehydration and rehydration. NA. Laryngoscope, 128:E222-E227, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Evaluation of the Grafted Fascia in the Vocal Fold of Dogs: A Histologic Study.

PubMed

Carvalho, Eduardo G B; Pauna, Henrique F; Machado, Almiro J; Nicola, Ester M D; Altemani, Albina M A M; Crespo, Agrício N

2017-09-01

There is no consensus on the ideal graft for medialization surgery of the vocal folds in the literature. One of the most favorable proposals is the use of autologous fascia, which seems limited by the lack of information regarding the integration of grafted tissue. Our study aims to evaluate the degree of fully engrafted fascia integration in the vocal fold lamina propria of dogs. Fourteen adult mongrel dogs that underwent intravenous general anesthesia were selected and kept under spontaneous ventilation. A fascia lata fragment of 4 cm 2 was obtained from the right leg of each dog. The dogs underwent laryngoscopy; a 3 mm incision was made in the vocal process, next to the vestibular process, and the fascia was grafted into the right vocal fold. The left vocal fold was used as a control. The animals were divided into two groups: group A, evaluated after 2 months of the procedure, and group B, evaluated after 6 months of the procedure. Histologic analysis was made semiquantitatively regarding the presence of inflammatory reaction, fibrosis, and neovascularization. Our final studied group comprised 12 dogs. Microscopic examination of the larynx revealed the absence of any detectable inflammation in the incision site. The lamina propria of the grafted vocal fold showed identifiable compact, thick, and eosinophilic collagen bands. The surrounding tissue showed thin collagen bands with some organization, similar to the contralateral vocal fold. The grafted fascia integrates into the vocal fold lamina propria and seems not to cause inflammatory reaction response. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Vocalization Subsystem Responses to a Temporarily Induced Unilateral Vocal Fold Paralysis

ERIC Educational Resources Information Center

Croake, Daniel J.; Andreatta, Richard D.; Stemple, Joseph C.

2018-01-01

Purpose: The purpose of this study is to quantify the interactions of the 3 vocalization subsystems of respiration, phonation, and resonance before, during, and after a perturbation to the larynx (temporarily induced unilateral vocal fold paralysis) in 10 vocally healthy participants. Using dynamic systems theory as a guide, we hypothesized that…

Voice Disorder in Cystic Fibrosis Patients

PubMed Central

Lourenço, Bruna Mendes; Costa, Kauê Machado; da Silva Filho, Manoel

2014-01-01

Cystic fibrosis is a common autosomal recessive disorder with drastic respiratory symptoms, including shortness of breath and chronic cough. While most of cystic fibrosis treatment is dedicated to mitigating the effects of respiratory dysfunction, the potential effects of this disease on vocal parameters have not been systematically studied. We hypothesized that cystic fibrosis patients, given their characteristic respiratory disorders, would also present dysphonic symptoms. Given that voice disorders can severely impair quality of life, the identification of a potential cystic fibrosis-related dysphonia could be of great value for the clinical evaluation and treatment of this disease. We tested our hypothesis by measuring vocal parameters, using both objective physical measures and the GRBAS subjective evaluation method, in male and female cystic fibrosis patients undergoing conventional treatment and compared them to age and sex matched controls. We found that cystic fibrosis patients had a significantly lower vocal intensity and harmonic to noise ratio, as well as increased levels of jitter and shimmer. In addition, cystic fibrosis patients also showed higher scores of roughness, breathiness and asthenia, as well as a significantly altered general grade of dysphonia. When we segregated the results according to sex, we observed that, as a group, only female cystic fibrosis patients had significantly lower values of harmonic to noise ratio and an abnormal general grade of dysphonia in relation to matched controls, suggesting that cystic fibrosis exerts a more pronounced effect on vocal parameters of women in relation to men. Overall, the dysphonic characteristics of CF patients can be explained by dysfunctions in vocal fold movement and partial upper airway obstruction, potentially caused by the accumulation of mucus and chronic cough characteristic of CF symptomatology. Our results show that CF patients exhibit significant dysphonia and suggest they may potentially benefit from voice therapy as a parallel treatment strategy. PMID:24796691

Acute vocal fold hemorrhage caught on video during office exam.

PubMed

Carroll, Thomas L; Smith, Libby J

2009-03-01

This article presents a unique video of a laryngeal exam during which a vocal fold hemorrhage occurs. This patient had likely been suffering from intermittent vocal fold hemorrhages for the last decade due to a persistent vascular lesion and an underlying chronic cough.

Optical coherence tomography monitoring of vocal fold femtosecond laser microsurgery

NASA Astrophysics Data System (ADS)

Wisweh, Henning; Merkel, Ulrich; Hüller, Ann-Kristin; Lüerßen, Kathrin; Lubatschowski, Holger

2007-07-01

Surgery of benign pathological alterations of the vocal folds results in permanent disphonia if the bounderies of the vocal fold layers are disregarded. Precise cutting with a femtosecond laser (fs-laser) combined with simultanous imaging of the layered structure enables accurate resections with respect to the layer boundaries. Earlier works demonstrated the capability of optical coherence tomography (OCT) for utilization on vocal folds. The layered structure can be imaged with a spatial resolution of 10-20μm up to a depth of 1.5mm. The performance of fs-laser cutting was analyzed on extracted porcine vocal folds with OCT monitoring. Histopathological sections of the same processed samples could be well correlated with the OCT images. With adequate laser parameters thermal effects induced only negligable damage to the processed tissue. The dimensions of the thermal necrosis were determined to be smaller than 1μm. OCT contolled fs-laser cutting of porcine vocal fold tissue in the μm range with minimal tissue damage is presented.

A biorobotic model of the human larynx.

PubMed

Manti, M; Cianchetti, M; Nacci, A; Ursino, F; Laschi, C

2015-08-01

This work focuses on a physical model of the human larynx that replicates its main components and functions. The prototype reproduces the multilayer vocal folds and the ab/adduction movements. In particular, the vocal folds prototype is made with soft materials whose mechanical properties have been obtained to be similar to the natural tissue in terms of viscoelasticity. A computational model was used to study fluid-structure interaction between vocal folds and the airflow. This tool allowed us to make a comparison between theoretical and experimental results. Measurements were performed with this prototype in an experimental platform comprising a controlled air flow, pressure sensors and a high-speed camera for measuring vocal fold vibrations. Data included oscillation frequency at the onset pressure and glottal width. Results show that the combination between vocal fold geometry, mechanical properties and dimensions exhibits an oscillation frequency close to that of the human vocal fold. Moreover, computational results show a high correlation with the experimental one.

Measurement of flow separation in a human vocal folds model

NASA Astrophysics Data System (ADS)

Šidlof, Petr; Doaré, Olivier; Cadot, Olivier; Chaigne, Antoine

2011-07-01

The paper provides experimental data on flow separation from a model of the human vocal folds. Data were measured on a four times scaled physical model, where one vocal fold was fixed and the other oscillated due to fluid-structure interaction. The vocal folds were fabricated from silicone rubber and placed on elastic support in the wall of a transparent wind tunnel. A PIV system was used to visualize the flow fields immediately downstream of the glottis and to measure the velocity fields. From the visualizations, the position of the flow separation point was evaluated using a semiautomatic procedure and plotted for different airflow velocities. The separation point position was quantified relative to the orifice width separately for the left and right vocal folds to account for flow asymmetry. The results indicate that the flow separation point remains close to the narrowest cross-section during most of the vocal fold vibration cycle, but moves significantly further downstream shortly prior to and after glottal closure.

Time-Varying Vocal Folds Vibration Detection Using a 24 GHz Portable Auditory Radar

PubMed Central

Hong, Hong; Zhao, Heng; Peng, Zhengyu; Li, Hui; Gu, Chen; Li, Changzhi; Zhu, Xiaohua

2016-01-01

Time-varying vocal folds vibration information is of crucial importance in speech processing, and the traditional devices to acquire speech signals are easily smeared by the high background noise and voice interference. In this paper, we present a non-acoustic way to capture the human vocal folds vibration using a 24-GHz portable auditory radar. Since the vocal folds vibration only reaches several millimeters, the high operating frequency and the 4 × 4 array antennas are applied to achieve the high sensitivity. The Variational Mode Decomposition (VMD) based algorithm is proposed to decompose the radar-detected auditory signal into a sequence of intrinsic modes firstly, and then, extract the time-varying vocal folds vibration frequency from the corresponding mode. Feasibility demonstration, evaluation, and comparison are conducted with tonal and non-tonal languages, and the low relative errors show a high consistency between the radar-detected auditory time-varying vocal folds vibration and acoustic fundamental frequency, except that the auditory radar significantly improves the frequency-resolving power. PMID:27483261

Time-Varying Vocal Folds Vibration Detection Using a 24 GHz Portable Auditory Radar.

PubMed

Hong, Hong; Zhao, Heng; Peng, Zhengyu; Li, Hui; Gu, Chen; Li, Changzhi; Zhu, Xiaohua

2016-07-28

Time-varying vocal folds vibration information is of crucial importance in speech processing, and the traditional devices to acquire speech signals are easily smeared by the high background noise and voice interference. In this paper, we present a non-acoustic way to capture the human vocal folds vibration using a 24-GHz portable auditory radar. Since the vocal folds vibration only reaches several millimeters, the high operating frequency and the 4 × 4 array antennas are applied to achieve the high sensitivity. The Variational Mode Decomposition (VMD) based algorithm is proposed to decompose the radar-detected auditory signal into a sequence of intrinsic modes firstly, and then, extract the time-varying vocal folds vibration frequency from the corresponding mode. Feasibility demonstration, evaluation, and comparison are conducted with tonal and non-tonal languages, and the low relative errors show a high consistency between the radar-detected auditory time-varying vocal folds vibration and acoustic fundamental frequency, except that the auditory radar significantly improves the frequency-resolving power.

Electroglottogram waveform types of untrained speakers.

PubMed

Painter, C

1990-01-01

Electroglottography is a useful, non-invasive technique that can assist in the assessment of vocal fold dysfunction. However, if it is to become a useful clinical tool, there is a need for normative studies of the electroglottogram waveform types that characterize different groups of speakers. This report compares the electroglottogram waveform types characterizing one trained professional voice user phonating in 15 experimental sessions under various fundamental frequencies, intensities and voice qualities with those obtained from 52 untrained non-professional speakers.

Botulinum toxin injection in laryngeal dyspnea.

PubMed

Woisard, Virginie; Liu, Xuelai; Bes, Marie Christine Arné; Simonetta-Moreau, Marion

2017-02-01

Data, regarding the use of botulinum toxin (BT-A) in laryngeal dyspnea, are scarce, coming from some cases reports in the literature, including Vocal fold paralysis, laryngeal dystonia, vocal cord dysfunction also called paradoxical motion of the vocal fold (PMVF), and post-neuroleptic laryngeal dyskinesia. There is no consensus regarding the muscles and the doses to inject. The aim of this study is to present a retrospective review of patients treated in our ENT Department by BT-A injection in this indication. This study is a retrospective study describing patients who underwent an injection of botulinum toxin for laryngeal dyspnea in the ENT Department from 2005 to 2015 years. The inclusion criteria were a dyspnea associated with a laryngeal dysfunction, confirmed by flexible fiberoptic nasopharyngolaryngoscopy. Information concerning the causes of the dyspnea, the botulinum toxin BT-A injections procedure, post-injection follow-up, and respiratory outcome were collected for all patients included. In the group of 13 patients included, the main cause identified as principal factor linked with the short breath was: a bilateral VF paralysis (Patel et al., Otolaryngol Head Neck Surg 130:686-689, 7), laryngeal dystonia (Balkissoon and Kenn, Semin Respir Crit Care Med 33:595-605, 2), Anxiety syndrome associated with unilateral vocal fold paralysis or asthma (Marcinow et al., Laryngoscope 124:1425-1430, 3), and an isolated asthma (Zwirner et al., Eur Arch Otorhinolaryngol 254:242-245, 1). Nine out of the thirteen patients were improved by the injections. A BT-A-induced stable benefit for four patients led them to stop the injections in the follow-up. Good outcome was observed in five other patients (main cause: bilateral VP paralysis), allowing a progressive lengthening of the delay between BT-A injections. Four patients did not report a positive risk/benefit ratio after BT-A injections; two of them (with bilateral VF paralysis), because of respiratory side effects and lack of benefit without the side effects for the two others. This failure of effect was not related with BT-A doses injected. This study provides support for using BT-A injections as a symptomatic treatment of periodic laryngeal dyspnea, regardless of the etiologic context. From our data, we suggest that a small starting dose (of around 4 U BT-A Botox ® ) could be enough for a first injection to obtain a good benefit. The target muscle should be determined by the EMG analysis.

Asymmetric spatiotemporal chaos induced by a polypoid mass in the excised larynx

PubMed Central

Zhang, Yu; Jiang, Jack J.

2008-01-01

In this paper, asymmetric spatiotemporal chaos induced by a polypoid mass simulating the laryngeal pathology of a vocal polyp is experimentally observed using high-speed imaging in an excised larynx. Spatiotemporal analysis reveals that the normal vocal folds show spatiotemporal correlation and symmetry. Normal vocal fold vibrations are dominated mainly by the first vibratory eigenmode. However, pathological vocal folds with a polypoid mass show broken symmetry and spatiotemporal irregularity. The spatial correlation is decreased. The pathological vocal folds spread vibratory energy across a large number of eigenmodes and induce asymmetric spatiotemporal chaos. High-order eigenmodes show complicated dynamics. Spatiotemporal analysis provides a valuable biomedical application for investigating the spatiotemporal chaotic dynamics of pathological vocal fold systems with a polypoid mass and may represent a valuable clinical tool for the detection of laryngeal mass lesion using high-speed imaging. PMID:19123612

Insights Into the Role of Collagen in Vocal Fold Health and Disease.

PubMed

Tang, Sharon S; Mohad, Vidisha; Gowda, Madhu; Thibeault, Susan L

2017-09-01

As one of the key fibrous proteins in the extracellular matrix, collagen plays a significant role in the structural and biomechanical characteristics of the vocal fold. Anchored fibrils of collagen create secure structural regions within the vocal folds and are strong enough to sustain vibratory impact and stretch during phonation. This contributes tensile strength, density, and organization to the vocal folds and influences health and pathogenesis. This review offers a comprehensive summary for a current understanding of collagen within normal vocal fold tissues throughout the life span as well as vocal pathology and wound repair. Further, collagen's molecular structure and biosynthesis are discussed. Finally, collagen alterations in tissue injury and repair and the incorporation of collagen-based biomaterials as a method of treating voice disorders are reviewed. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Ectasias and varices of the vocal fold: clearing the striking zone.

PubMed

Hochman, I; Sataloff, R T; Hillman, R E; Zeitels, S M

1999-01-01

Vascular malformations such as ectasias and varices (Es and Vs) are frequently encountered in patients who present with recurrent vocal fold hemorrhage and/or other traumatic vocal fold lesions. This study examined Es and Vs with regard to their anatomic presentation, phonomicrosurgical management, and treatment outcome. Forty-two patients (39 of them singers) were treated for a total of 87 Es and Vs: 67 of 87 (77%) were on the superior surface of the vocal fold and 20 of 87 (23%) were on the medial surface of the vocal fold. Eighty-three percent were located in the middle musculomembranous region (the striking zone), where the greatest aerodynamically induced shearing stresses occur during phonation. Treatment was performed with carbon dioxide laser cauterization (13 patients), or a new technique utilizing cold instrument excision by means of epithelial cordotomies (23 patients), while a combined approach was employed in 6 patients. Comparisons of preoperative and postoperative stroboscopy revealed improvement or no significant change in all patients in whom the cold instrument technique was used, and increased epithelial stiffness was noted in 4 of 19 patients in whom the carbon dioxide laser was used. Clearing the striking zone appears to have halted further hemorrhages by removing the the fragile Es and Vs from this injury-prone region of the vocal fold. Interpretations of stroboscopic examinations were directed at providing new insights into the biomechanical forces of vocal fold vibration that probably contribute to the genesis of Es and Vs in the vocal folds.

Morphological properties of collagen fibers in porcine lamina propria

PubMed Central

Johanes, Iecun; Mihelc, Elaine; Sivasankar, Mahalakshmi; Ivanisevic, Albena

2009-01-01

Objectives Collagen influences the biomechanical properties of vocal folds. Altered collagen morphology has been implicated in dysphonia associated with aging and scarring. Documenting the morphological properties of native collagen in healthy vocal folds is essential to understand the structural and functional alterations to collagen with aging and disease. Our primary objective was to quantify the morphological properties of collagen in the vocal fold lamina propria. Our secondary exploratory objective was to investigate the effects of pepsin exposure on the morphological properties of collagen in the lamina propria. Design Experimental, in vitro study with porcine model. Methods Lamina propria was dissected from 26 vocal folds and imaged with Atomic Force Microscopy (AFM). Morphological data on d-periodicity, diameter, and roughness of collagen fibers were obtained. To investigate the effects of pepsin exposure on collagen morphology, vocal fold surface was exposed to pepsin or sham challenge prior to lamina propria dissection and AFM imaging. Results The d-periodicity, diameter, and roughness values for native vocal fold collagen are consistent with literature reports for collagen fibers in other body tissue. Pepsin exposure on vocal fold surface did not appear to change the morphological properties of collagen fibers in the lamina propria. Conclusions Quantitative data on collagen morphology were obtained at nanoscale resolution. Documenting collagen morphology in healthy vocal folds is critical for understanding the physiological changes to collagen with aging and scarring, and for designing biomaterials that match the native topography of lamina propria. PMID:20171830

Flow-structure interaction simulation of voice production in a canine larynx

NASA Astrophysics Data System (ADS)

Jiang, Weili; Zheng, Xudong; Xue, Qian; Oren, Liran; Khosla, Sid

2017-11-01

Experimental measurements conducted on a hemi-larynx canine vocal fold showed that negative pressures formed in the glottis near the superior surface of the vocal fold in the closing phase even without a supra-glottal vocal tract. It was hypothesized that such negative pressures were due to intraglottal vortices caused by flow separation in a divergent vocal tract during vocal fold closing phase. This work aims to test this hypothesis from the numerical aspect. Flow-structure interaction simulations are performed in realistic canine laryngeal shapes. In the simulations, a sharp interface immersed boundary method based incompressible flow solver is utilized to model the air flow; a finite element based solid mechanics solver is utilized to model the vocal fold vibration. The geometric structure of the vocal fold and vocal tract are based on MRI scans of a mongrel canine. The vocal fold tissue is modeled as transversely isotropic nonlinear materials with a vertical stiffness gradient. Numerical indentation is first performed and compared with the experiment data to obtain the material properties. Simulation setup about the inlet and outlet pressure follows the setup in the experiment. Simulation results including the fundamental frequency, air flow rate, the divergent angle will be compared with the experimental data, providing the validation of the simulation approach. The relationship between flow separation, intra-glottal vortices, divergent angle and flow rate will be comprehensively analyzed.

Bilateral Vocal Fold Paralysis After Surgery Immediately in Adult Patient With Chiari Malformation.

PubMed

Chen, Yan; Yue, Jianhong; Yuan, Weixiu

2016-06-01

The authors report the case of a 50-year-old woman with a bilateral vocal fold paralysis after foramen magnum decompression and resection of partial cerebellar tonsil for Chiari malformation. The possible mechanisms of postoperative bilateral vocal fold paralysis are discussed.

Modeling the Biomechanical Influence of Epilaryngeal Stricture on the Vocal Folds: A Low-Dimensional Model of Vocal-Ventricular Fold Coupling

ERIC Educational Resources Information Center

Moisik, Scott R.; Esling, John H.

2014-01-01

Purpose: Physiological and phonetic studies suggest that, at moderate levels of epilaryngeal stricture, the ventricular folds impinge upon the vocal folds and influence their dynamical behavior, which is thought to be responsible for constricted laryngeal sounds. In this work, the authors examine this hypothesis through biomechanical modeling.…

Protective Effect of Astaxanthin on Vocal Fold Injury and Inflammation Due to Vocal Loading: A Clinical Trial.

PubMed

Kaneko, Mami; Kishimoto, Yo; Suzuki, Ryo; Kawai, Yoshitaka; Tateya, Ichiro; Hirano, Shigeru

2017-05-01

Professional voice users, such as singers and teachers, are at greater risk of developing vocal fold injury from excessive use of voice; thus, protection of the vocal fold is essential. One of the most important factors that aggravates injury is the production of reactive oxygen species at the wound site. The purpose of the current study was to assess the effect of astaxanthin, a strong antioxidant, on the protection of the vocal fold from injury and inflammation due to vocal loading. This study is an institutional review board-approved human clinical trial. Ten male subjects underwent a 60-minute vocal loading session and received vocal assessments prior to, immediately after, and 30 minutes postvocal loading (AST(-) status). All subjects were then prescribed 24 mg/day of astaxanthin for 28 days, after which they received the same vocal task and assessments (AST(+) status). Phonatory parameters were compared between both groups. Aerodynamic assessment, acoustic analysis, and GRBAS scale (grade, roughness, breathiness, asthenia, and strain) were significantly worse in the AST(-) status immediately after vocal loading, but improved by 30 minutes after loading. In contrast, none of the phonatory parameters in the AST(+) status were statistically worse, even when measured immediately after vocal loading. No allergic responses or adverse effects were observed after administration of astaxanthin. The current results suggest that astaxanthin can protect the vocal fold from injury and inflammation caused by vocal loading possibly through the regulation of oxidative stress. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Vocal Fold Epithelial Barrier in Health and Injury: A Research Review

ERIC Educational Resources Information Center

Levendoski, Elizabeth Erickson; Leydon, Ciara; Thibeault, Susan L.

2014-01-01

Purpose: Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment. This barrier provides structural stability to the vocal folds and protects underlying connective tissue from injury while being nearly continuously exposed to potentially…

Endoscopic vocal fold injection using a 25-gauge butterfly needle.

PubMed

Buchanan, M A; Riffat, F; Palme, C E

2016-04-01

To describe a useful technique for infiltrating a bulking agent using a butterfly needle, as part of a transoral endoscopic vocal fold medialisation procedure. This paper describes the procedure of grasping the needle with phonosurgery forceps and administering the injectate to the vocal fold through careful application of the syringe plunger via a length of rubber tubing from outside the mouth. This procedure is performed routinely in our institution without complication. The advantages of this technique are discussed. This is a safe and easy method of injecting into a vocal fold.

Histological changes in vocal fold growth and aging.

PubMed

Kuhn, Maggie A

2014-12-01

Sophisticated descriptions of the highly specialized vocal fold microarchitecture have been available for over three decades, but how this anatomy evolves with growth and aging remains an area of active investigation and, at times, a source of controversy. As our aging population expands and interest in pediatric voice disorders blossoms, it is timely to consider our contemporary understanding of evolving vocal fold histology and its implications for voice production. Novel applications of existing and emerging biotechnology, development of animal models and skillful use of human specimens have afforded greater insights into the histologic vocal fold changes seen throughout the lifespan in health and disease. Burgeoning knowledge has laid the foundation for more comprehensive models of vocal fold histology and has led to the development of innovative therapies for challenging voice disorders.

Hyaluronic acid (with fibronectin) as a bioimplant for the vocal fold mucosa.

PubMed

Chan, R W; Titze, I R

1999-07-01

To measure the viscoelastic shear properties of hyaluronic acid, with and without fibronectin, and to compare them with those of the human vocal fold mucosa and other phonosurgical biomaterials. Viscoelastic shear properties of various implantable biomaterials (Teflon, gelatin, collagen, fat, hyaluronic acid, and hyaluronic acid with fibronectin) were measured with a parallel-plate rotational rheometer. Elastic and viscous shear properties were quantified as a function of oscillation frequency (0.01-15 Hz) at 37 degrees C. The shear properties of hyaluronic acid were relatively close to those of human vocal fold mucosal tissues reported previously. Hyaluronic acid at specific concentrations (0.5%-1%), with or without fibronectin, was found to exhibit viscous shear properties (viscous shear modulus and dynamic viscosity) similar to those of the average male and female vocal fold mucosa. According to a theory that establishes the effects of tissue shear properties on vocal fold oscillation, phonation threshold pressure (a measure of the ease of phonation) is directly related to the viscous shear modulus of the vibrating vocal fold mucosa. Therefore, our findings suggest that hyaluronic acid, either by itself or mixed with fibronectin, may be a potentially optimal bioimplant for the surgical management of vocal fold mucosal defects and lamina propria deficiencies (e.g., scarring) from a biomechanical standpoint.

The influence of material anisotropy on vibration at onset in a three-dimensional vocal fold model

PubMed Central

Zhang, Zhaoyan

2014-01-01

Although vocal folds are known to be anisotropic, the influence of material anisotropy on vocal fold vibration remains largely unknown. Using a linear stability analysis, phonation onset characteristics were investigated in a three-dimensional anisotropic vocal fold model. The results showed that isotropic models had a tendency to vibrate in a swing-like motion, with vibration primarily along the superior-inferior direction. Anterior-posterior (AP) out-of-phase motion was also observed and large vocal fold vibration was confined to the middle third region along the AP length. In contrast, increasing anisotropy or increasing AP-transverse stiffness ratio suppressed this swing-like motion and allowed the vocal fold to vibrate in a more wave-like motion with strong medial-lateral motion over the entire medial surface. Increasing anisotropy also suppressed the AP out-of-phase motion, allowing the vocal fold to vibrate in phase along the entire AP length. Results also showed that such improvement in vibration pattern was the most effective with large anisotropy in the cover layer alone. These numerical predictions were consistent with previous experimental observations using self-oscillating physical models. It was further hypothesized that these differences may facilitate complete glottal closure in finite-amplitude vibration of anisotropic models as observed in recent experiments. PMID:24606284

Proposal for a descriptive guideline of vascular changes in lesions of the vocal folds by the committee on endoscopic laryngeal imaging of the European Laryngological Society.

PubMed

Arens, Christoph; Piazza, Cesare; Andrea, Mario; Dikkers, Frederik G; Tjon Pian Gi, Robin E A; Voigt-Zimmermann, Susanne; Peretti, Giorgio

2016-05-01

In the last decades new endoscopic tools have been developed to improve the diagnostic work-up of vocal fold lesions in addition to normal laryngoscopy, i.e., contact endoscopy, autofluorescence, narrow band imaging and others. Better contrasted and high definition images offer more details of the epithelial and superficial vascular structure of the vocal folds. Following these developments, particular vascular patterns come into focus during laryngoscopy. The present work aims at a systematic pathogenic description of superficial vascular changes of the vocal folds. Additionally, new nomenclature on vascular lesions of the vocal folds will be presented to harmonize the different terms in the literature. Superficial vascular changes can be divided into longitudinal and perpendicular. Unlike longitudinal vascular lesions, e.g., ectasia, meander and change of direction, perpendicular vascular lesions are characterized by different types of vascular loops. They are primarily observed in recurrent respiratory papillomatosis, and in pre-cancerous and cancerous lesions of the vocal folds. These vascular characteristics play a significant role in the differential diagnosis. Among different parameters, e.g., epithelial changes, increase of volume, stiffness of the vocal fold, vascular lesions play an increasing role in the diagnosis of pre- and cancerous lesions.

Impact of Cricothyroid Muscle Contraction on Vocal Fold Vibration: Experimental Study with High-Speed Videoendoscopy.

PubMed

Ishikawa, Camila Cristina; Pinheiro, Thais Gonçalves; Hachiya, Adriana; Montagnoli, Arlindo Neto; Tsuji, Domingos Hiroshi

2017-05-01

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. This was an experimental study employing excised human larynges. 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. 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. Our results suggest that differences in vibration amplitude and phase symmetry between vocal folds are not reliable indicators of unilateral cricothyroid muscle paralysis. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Improvement of a Vocal Fold Imaging System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krauter, K. G.

Medical professionals can better serve their patients through continual update of their imaging tools. A wide range of pathologies and disease may afflict human vocal cords or, as they’re also known, vocal folds. These diseases can affect human speech hampering the ability of the patient to communicate. Vocal folds must be opened for breathing and the closed to produce speech. Currently methodologies to image markers of potential pathologies are difficult to use and often fail to detect early signs of disease. These current methodologies rely on a strobe light and slower frame rate camera in an attempt to obtain imagesmore » as the vocal folds travel over the full extent of their motion.« less

Hypnosis for Asthma and Vocal Cord Dysfunction in a Patient With Autism.

PubMed

Kaslovsky, Robert; Gottsegen, David

2015-10-01

Wheezing in children often is the result of asthma, but vocal cord dysfunction (VCD) may cause stridor or sounds that sometimes are misattributed to the wheezing of asthma. The frequent comorbidity of asthma and VCD also adds to the difficulty in making a clear diagnosis. The challenges of evaluating and treating wheezing are complicated further in children with developmental disorders, such as autism, because of the difficulties of obtaining an adequate history and assessing the clinical response to treatment. This article presents a patient with multiple psychiatric problems, including autism, with severe recurrent wheezing as a result of vocal cord dysfunction and asthma. Hypnosis has previously proven efficacious for treating vocal cord dysfunction, and in this case, hypnotic techniques were major factors in successful symptom control.

Repairing the vibratory vocal fold.

PubMed

Long, Jennifer L

2018-01-01

A vibratory vocal fold replacement would introduce a new treatment paradigm for structural vocal fold diseases such as scarring and lamina propria loss. This work implants a tissue-engineered replacement for vocal fold lamina propria and epithelium in rabbits and compares histology and function to injured controls and orthotopic transplants. Hypotheses were that the cell-based implant would engraft and control the wound response, reducing fibrosis and restoring vibration. Translational research. Rabbit adipose-derived mesenchymal stem cells (ASC) were embedded within a three-dimensional fibrin gel, forming the cell-based outer vocal fold replacement (COVR). Sixteen rabbits underwent unilateral resection of vocal fold epithelium and lamina propria, as well as reconstruction with one of three treatments: fibrin glue alone with healing by secondary intention, replantation of autologous resected vocal fold cover, or COVR implantation. After 4 weeks, larynges were examined histologically and with phonation. Fifteen rabbits survived. All tissues incorporated well after implantation. After 1 month, both graft types improved histology and vibration relative to injured controls. Extracellular matrix (ECM) of the replanted mucosa was disrupted, and ECM of the COVR implants remained immature. Immune reaction was evident when male cells were implanted into female rabbits. Best histologic and short-term vibratory outcomes were achieved with COVR implants containing male cells implanted into male rabbits. Vocal fold cover replacement with a stem cell-based tissue-engineered construct is feasible and beneficial in acute rabbit implantation. Wound-modifying behavior of the COVR implant is judged to be an important factor in preventing fibrosis. NA. Laryngoscope, 128:153-159, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

In Vivo Measurement of Pediatric Vocal Fold Motion Using Structured Light Laser Projection

PubMed Central

Patel, Rita R.; Donohue, Kevin D.; Lau, Daniel; Unnikrishnan, Harikrishnan

2013-01-01

Summary Objective The aim of the study was to present the development of a miniature structured light laser projection endoscope and to quantify vocal fold length and vibratory features related to impact stress of the pediatric glottis using high-speed imaging. Study Design The custom-developed laser projection system consists of a green laser with a 4-mm diameter optics module at the tip of the endoscope, projecting 20 vertical laser lines on the glottis. Measurements of absolute phonatory vocal fold length, membranous vocal fold length, peak amplitude, amplitude-to-length ratio, average closing velocity, and impact velocity were obtained in five children (6–9 years), two adult male and three adult female participants without voice disorders, and one child (10 years) with bilateral vocal fold nodules during modal phonation. Results Independent measurements made on the glottal length of a vocal fold phantom demonstrated a 0.13 mm bias error with a standard deviation of 0.23 mm, indicating adequate precision and accuracy for measuring vocal fold structures and displacement. First, in vivo measurements of amplitude-to-length ratio, peak closing velocity, and impact velocity during phonation in pediatric population and a child with vocal fold nodules are reported. Conclusion The proposed laser projection system can be used to obtain in vivo measurements of absolute length and vibratory features in children and adults. Children have large amplitude-to-length ratio compared with typically developing adults, whereas nodules result in larger peak amplitude, amplitude-to-length ratio, average closing velocity, and impact velocity compared with typically developing children. PMID:23809569

Strain Modulations as a Mechanism to Reduce Stress Relaxation in Laryngeal Tissues

PubMed Central

Hunter, Eric J.; Siegmund, Thomas; Chan, Roger W.

2014-01-01

Vocal fold tissues in animal and human species undergo deformation processes at several types of loading rates: a slow strain involved in vocal fold posturing (on the order of 1 Hz or so), cyclic and faster posturing often found in speech tasks or vocal embellishment (1–10 Hz), and shear strain associated with vocal fold vibration during phonation (100 Hz and higher). Relevant to these deformation patterns are the viscous properties of laryngeal tissues, which exhibit non-linear stress relaxation and recovery. In the current study, a large strain time-dependent constitutive model of human vocal fold tissue is used to investigate effects of phonatory posturing cyclic strain in the range of 1 Hz to 10 Hz. Tissue data for two subjects are considered and used to contrast the potential effects of age. Results suggest that modulation frequency and extent (amplitude), as well as the amount of vocal fold overall strain, all affect the change in stress relaxation with modulation added. Generally, the vocal fold cover reduces the rate of relaxation while the opposite is true for the vocal ligament. Further, higher modulation frequencies appear to reduce the rate of relaxation, primarily affecting the ligament. The potential benefits of cyclic strain, often found in vibrato (around 5 Hz modulation) and intonational inflection, are discussed in terms of vocal effort and vocal pitch maintenance. Additionally, elderly tissue appears to not exhibit these benefits to modulation. The exacerbating effect such modulations may have on certain voice disorders, such as muscle tension dysphonia, are explored. PMID:24614616

Strain modulations as a mechanism to reduce stress relaxation in laryngeal tissues.

PubMed

Hunter, Eric J; Siegmund, Thomas; Chan, Roger W

2014-01-01

Vocal fold tissues in animal and human species undergo deformation processes at several types of loading rates: a slow strain involved in vocal fold posturing (on the order of 1 Hz or so), cyclic and faster posturing often found in speech tasks or vocal embellishment (1-10 Hz), and shear strain associated with vocal fold vibration during phonation (100 Hz and higher). Relevant to these deformation patterns are the viscous properties of laryngeal tissues, which exhibit non-linear stress relaxation and recovery. In the current study, a large strain time-dependent constitutive model of human vocal fold tissue is used to investigate effects of phonatory posturing cyclic strain in the range of 1 Hz to 10 Hz. Tissue data for two subjects are considered and used to contrast the potential effects of age. Results suggest that modulation frequency and extent (amplitude), as well as the amount of vocal fold overall strain, all affect the change in stress relaxation with modulation added. Generally, the vocal fold cover reduces the rate of relaxation while the opposite is true for the vocal ligament. Further, higher modulation frequencies appear to reduce the rate of relaxation, primarily affecting the ligament. The potential benefits of cyclic strain, often found in vibrato (around 5 Hz modulation) and intonational inflection, are discussed in terms of vocal effort and vocal pitch maintenance. Additionally, elderly tissue appears to not exhibit these benefits to modulation. The exacerbating effect such modulations may have on certain voice disorders, such as muscle tension dysphonia, are explored.

Oral Breathing Challenge in Participants with Vocal Attrition

ERIC Educational Resources Information Center

Sivasankar, Mahalakshmi; Fisher, Kimberly V.

2003-01-01

Vocal folds undergo osmotic challenge by mouth breathing during singing, exercising, and loud speaking. Just 15 min of obligatory oral breathing, to dry the vocal folds, increases phonation threshold pressure (P[subscript th]) and expiratory vocal effort in healthy speakers (M. Sivasankar & K. Fisher, 2002). We questioned whether oral breathing is…

Vocal fold immobility: a longitudinal analysis of etiology over 20 years.

PubMed

Rosenthal, Laura H Swibel; Benninger, Michael S; Deeb, Robert H

2007-10-01

To determine the current etiology of vocal fold immobility, identify changing trends over the last 20 years, and compare results to historical reports. The present study is a retrospective analysis of all patients seen within a tertiary care institution between 1996 and 2005 with vocal fold immobility. The results were combined with a previous study of patients within the same institution from 1985 through 1995. Results were compared to the literature. The medical records of all patients assigned a primary or additional diagnostic code for vocal cord paralysis were obtained from the electronic database. Eight hundred twenty-seven patients were available for analysis (435 from the most recent cohort), which is substantially larger than any reported series to date. Vocal fold immobility was most commonly associated with a surgical procedure (37%). Nonthyroid surgeries (66%), such as anterior cervical approaches to the spine and carotid endarterectomies, have surpassed thyroid surgery (33%) as the most common iatrogenic causes. These data represent a change from historical figures in which extralaryngeal malignancies were considered the major cause of unilateral immobility. Thyroidectomy continues to cause the majority (80%) of iatrogenic bilateral vocal fold immobility and 30% of all bilateral immobility. This 20-year longitudinal assessment revealed that the etiology of unilateral vocal fold immobility has changed such that there has been a shift from extralaryngeal malignancies to nonthyroid surgical procedures as the major cause. Thyroid surgery remains the most common cause of bilateral vocal fold immobility.

Effects of long-acting beta adrenergic agonists on vocal fold ion transport.

PubMed

Sivasankar, Mahalakshmi; Blazer-Yost, Bonnie

2009-03-01

Inhaled medications prescribed for the hypersensitive airway typically combine corticosteroids and long-acting beta2 adrenergic agonists (LABAs). The phonatory side effects of these combination treatments are widely recognized. However, there is limited understanding of the physiological changes induced by these medications that underlie the phonatory side effects. The objective of this study was to investigate the distinct effects of corticosteroids and LABAs on vocal fold mucosal physiology. Understanding the physiological changes to the vocal folds after corticosteroid and LABA treatments is necessary to prevent the prevalent vocal decrement associated with these medications. Experimental in vitro design with treatment and control groups. Native porcine vocal fold mucosae (N = 38) were exposed to corticosteroid or LABA treatments. Ion transport was measured continuously at baseline and after treatment. To quantify the nature of ion transport, vocal folds were also treated with chloride and sodium channel inhibitors. Corticosteroid treatment did not alter ion transport. Conversely, exposure to LABAs significantly increased ion transport. This increase in ion transport was transient, observed immediately after treatment in all tissue and associated with increased chloride secretion. The distinct effects of corticosteroids and LABAs on vocal fold physiology have not been examined to date. This study demonstrates that short-term treatment with LABAs, but not corticosteroids, significantly increases ion transport. These findings suggest that one underlying physiological mechanism for phonatory changes associated with inhaled treatments may be related to acute alterations in vocal fold ion transport and surface hydration.

Synthetic, multi-layer, self-oscillating vocal fold model fabrication.

PubMed

Murray, Preston R; Thomson, Scott L

2011-12-02

Sound for the human voice is produced via flow-induced vocal fold vibration. The vocal folds consist of several layers of tissue, each with differing material properties. Normal voice production relies on healthy tissue and vocal folds, and occurs as a result of complex coupling between aerodynamic, structural dynamic, and acoustic physical phenomena. Voice disorders affect up to 7.5 million annually in the United States alone and often result in significant financial, social, and other quality-of-life difficulties. Understanding the physics of voice production has the potential to significantly benefit voice care, including clinical prevention, diagnosis, and treatment of voice disorders. Existing methods for studying voice production include in vivo experimentation using human and animal subjects, in vitro experimentation using excised larynges and synthetic models, and computational modeling. Owing to hazardous and difficult instrument access, in vivo experiments are severely limited in scope. Excised larynx experiments have the benefit of anatomical and some physiological realism, but parametric studies involving geometric and material property variables are limited. Further, they are typically only able to be vibrated for relatively short periods of time (typically on the order of minutes). Overcoming some of the limitations of excised larynx experiments, synthetic vocal fold models are emerging as a complementary tool for studying voice production. Synthetic models can be fabricated with systematic changes to geometry and material properties, allowing for the study of healthy and unhealthy human phonatory aerodynamics, structural dynamics, and acoustics. For example, they have been used to study left-right vocal fold asymmetry, clinical instrument development, laryngeal aerodynamics, vocal fold contact pressure, and subglottal acoustics (a more comprehensive list can be found in Kniesburges et al.) Existing synthetic vocal fold models, however, have either been homogenous (one-layer models) or have been fabricated using two materials of differing stiffness (two-layer models). This approach does not allow for representation of the actual multi-layer structure of the human vocal folds that plays a central role in governing vocal fold flow-induced vibratory response. Consequently, one- and two-layer synthetic vocal fold models have exhibited disadvantages such as higher onset pressures than what are typical for human phonation (onset pressure is the minimum lung pressure required to initiate vibration), unnaturally large inferior-superior motion, and lack of a "mucosal wave" (a vertically-traveling wave that is characteristic of healthy human vocal fold vibration). In this paper, fabrication of a model with multiple layers of differing material properties is described. The model layers simulate the multi-layer structure of the human vocal folds, including epithelium, superficial lamina propria (SLP), intermediate and deep lamina propria (i.e., ligament; a fiber is included for anterior-posterior stiffness), and muscle (i.e., body) layers. Results are included that show that the model exhibits improved vibratory characteristics over prior one- and two-layer synthetic models, including onset pressure closer to human onset pressure, reduced inferior-superior motion, and evidence of a mucosal wave.

Mechanical and dynamic aspects of voice production as related to voice therapy and phonosurgery.

PubMed

Isshiki, N

2000-06-01

Laryngeal framework surgery can change the position and tension of the vocal folds safely without direct surgical intervention in the vocal fold proper. Some 23 years of experience with phonosurgery have proved its usefulness in treating dysphonia related to unilateral vocal fold paralysis, vocal fold atrophy, and pitch-related dysphonias. Meanwhile, much information about the mechanism of voice production has been obtained through intraoperative findings of voice and fiberscopic examination of the larynx. Based on such knowledge together with information obtained through model experiments, the human vocal organ was reconsidered mainly from the mechanical view point, and the roles of voice therapy and singing pedagogy were discussed in relation to phonosurgery. The vocal organ may not be an ideal musical organ and is rather vulnerable, but its potential is enormous.

Mechanical and dynamic aspects of voice production as related to voice therapy and phonosurgery.

PubMed

Isshiki, N

1998-06-01

Laryngeal framework surgery can change the position and tension of the vocal folds safely without direct surgical intervention in the vocal fold proper. Some 23 years of experience with phonosurgery have proved its usefulness in treating dysphonia related to unilateral vocal fold paralysis, vocal fold atrophy, and pitch-related dysphonias . Meanwhile, much information about the mechanism of voice production has been obtained through intraoperative findings of voice and fiberscopic examination of the larynx . Based on such knowledge together with information obtained through model experiments, the human vocal organ was reconsidered mainly from the mechanical view point, and the roles of voice therapy and singing pedagogy were discussed in relation to phonosurgery. The vocal organ may not be an ideal musical organ and is rather vulnerable, but its potential is enormous.

Vocal Fold Mucus Aggregation in Persons with Voice Disorders

ERIC Educational Resources Information Center

Bonilha, Heather Shaw; White, Lisa; Kuckhahn, Kelsey; Gerlach, Terri Treman; Deliyski, Dimitar D.

2012-01-01

Mucus aggregation on the vocal folds is a common finding from laryngeal endoscopy. Patients with voice disorders report the presence of mucus aggregation. Patients also report that mucus aggregation causes them to clear their throat, a behavior believed to be harmful to vocal fold mucosa. Even though clinicians and patients report and discuss…

The Cystic Fibrosis Transmembrane Conductance Regulator and Chloride-Dependent Ion Fluxes of Ovine Vocal Fold Epithelium

ERIC Educational Resources Information Center

Leydon, Ciara; Fisher, Kimberly V.; Lodewyck-Falciglia, Danielle

2009-01-01

Purpose: Ion-driven transepithelial water fluxes participate in maintaining superficial vocal fold hydration, which is necessary for normal voice production. The authors hypothesized that Cl[superscript -] channels are present in vocal fold epithelial cells and that transepithelial Cl[superscript -] fluxes can be manipulated pharmacologically.…

Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review

PubMed Central

Li, Yike; Garrett, Gaelyn; Zealear, David

2017-01-01

Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position. The primary objective of intervention for BVFP is to relieve patients’ dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP. PMID:28669149

Effect of topical mitomycin-C on total collagen deposits on the submucosa of intact vocal folds in swine.

PubMed

Pereira, Marcelo Charles; Repka, Carlos Domingues; Camargo, Paulo Antonio Monteiro; Rispoli, Daniel Zeni; Campos, Antônio Carlos Ligocki; Matias, Jorge Eduardo Fouto

2009-07-01

To compare the effects of topical mitomycin-C at different concentrations on submucosal collagen deposition on the vocal folds of swine. The animals were divided into three groups according to the composition of the topical solution to be applied to the vocal folds: 0.9% saline solution (control group); 4 mg/ml mitomycin-C (group 1) and 8 mg/ml mitomycin-C (group 2). Thirty days after the application, all animals were sacrificed, their vocal folds were collected and stained by the picrosirius red technique, and submucosal collagen deposition areas were estimated by the Image Pro Plus 4.5 software. Mann-Whitney test was used to compare differences between parameters of each group. The means of the areas of submucosal collagen deposits on vocal folds were 3110.44 square micrometers (microm(2)), 3115.98 microm(2) and 3105.78 microm(2) for groups control, 1 and 2, respectively. There were no statistical differences across the three groups (p>0.05). Mitomycin-C topically applied to intact vocal folds of swine did not alter submucosal collagen deposition.

Interactions of hyaluronan grafted on protein surfaces studied using a quartz crystal microbalance and a surface force balance.

PubMed

Jiang, Lei; Han, Juan; Yang, Limin; Ma, Hongchao; Huang, Bo

2015-10-07

Vocal folds are complex and multilayer-structured where the main layer is widely composed of hyaluronan (HA). The viscoelasticity of HA is key to voice production in the vocal fold as it affects the initiation and maintenance of phonation. In this study a simple layer-structured surface model was set up to mimic the structure of the vocal folds. The interactions between two opposing surfaces bearing HA were measured and characterised to analyse HA's response to the normal and shear compression at a stress level similar to that in the vocal fold. From the measurements of the quartz crystal microbalance, atomic force microscopy and the surface force balance, the osmotic pressure, normal interactions, elasticity change, volume fraction, refractive index and friction of both HA and the supporting protein layer were obtained. These findings may shed light on the physical mechanism of HA function in the vocal fold and the specific role of HA as an important component in the effective treatment of the vocal fold disease.

Modeling coupled aerodynamics and vocal fold dynamics using immersed boundary methods.

PubMed

Duncan, Comer; Zhai, Guangnian; Scherer, Ronald

2006-11-01

The penalty immersed boundary (PIB) method, originally introduced by Peskin (1972) to model the function of the mammalian heart, is tested as a fluid-structure interaction model of the closely coupled dynamics of the vocal folds and aerodynamics in phonation. Two-dimensional vocal folds are simulated with material properties chosen to result in self-oscillation and volume flows in physiological frequency ranges. Properties of the glottal flow field, including vorticity, are studied in conjunction with the dynamic vocal fold motion. The results of using the PIB method to model self-oscillating vocal folds for the case of 8 cm H20 as the transglottal pressure gradient are described. The volume flow at 8 cm H20, the transglottal pressure, and vortex dynamics associated with the self-oscillating model are shown. Volume flow is also given for 2, 4, and 12 cm H2O, illustrating the robustness of the model to a range of transglottal pressures. The results indicate that the PIB method applied to modeling phonation has good potential for the study of the interdependence of aerodynamics and vocal fold motion.

Evaluation of injection augmentation treatment of hyaluronic acid based materials on rabbit vocal folds viscoelasticity.

PubMed

Borzacchiello, A; Mayol, L; Gärskog, O; Dahlqvist, A; Ambrosio, L

2005-06-01

The viscoelastic properties of vocal folds after injection of hyaluronic acid (hyaluronan, HA) based materials have been studied in an animal model (rabbit) six months after injection. The results indicate that the viscoelastic properties of the vocal folds injected with the HA based materials are similar to the healthy vocal folds (non-injected samples) used as control. Histological analysis has been also performed to investigate on the fate of the injected materials after six months from the implant. The HA based materials remain up to six months and they recruited fibroblasts that induce the ingrowth of new connective tissue resulting in an endogenous soft tissue augmentation. The HA based compounds are good candidate for further studies aimed at restoring/preserving the vibratory capacity of the vocal folds with injection treatment in glottal insufficiency.

Application of motion analysis in the study of the effect of botulinum toxin to rat vocal folds

NASA Astrophysics Data System (ADS)

Saadah, Abdul K.; Galatsanos, Nikolas P.; Inagi, K.; Bless, D.

1997-05-01

In the past we have proposed a system that measures the deformations of the vocal folds from videostroboscopic images of the larynx, in that system: (1) we extract the boundaries of the vocal folds, (2) we register elastically the vocal fold boundaries in successive frames. This yields the displacement vector field (DVF) between adjacent frames, and (3) we fit using a least-squares approach an affine transformation model to succinctly describe the deformations between adjacent frames. In this paper, we present as an example of the capabilities of this system, an initial study of the deformation changes in rat vocal folds pre and post injection with Botulinum toxin. For this application the generated DVF was segmented into right DVF and left DVF and the deformation of each segment is studied separately.

Short term effect of hubble-bubble smoking on voice.

PubMed

Hamdan, A-L; Sibai, A; Mahfoud, L; Oubari, D; Ashkar, J; Fuleihan, N

2011-05-01

To investigate the short term effect of hubble-bubble smoking on voice. Prospective study. Eighteen non-dysphonic subjects (seven men and 11 women) with a history of hubble-bubble smoking and no history of cigarette smoking underwent acoustic analysis and laryngeal video-stroboscopic examination before and 30 minutes after hubble-bubble smoking. On laryngeal video-stroboscopy, none of the subjects had vocal fold erythema either before or after smoking. Five patients had mild vocal fold oedema both before and after smoking. After smoking, there was a slight increase in the number of subjects with thick mucus between the vocal folds (six, vs four before smoking) and with vocal fold vessel dilation (two, vs one before smoking). Acoustic analysis indicated a drop in habitual pitch, fundamental frequency and voice turbulence index after smoking, and an increase in noise-to-harmonics ratio. Even 30 minutes of hubble-bubble smoking can cause a drop in vocal pitch and an increase in laryngeal secretions and vocal fold vasodilation.

A systematic review of psychological interventions for adult and pediatric patients with vocal cord dysfunction.

PubMed

Guglani, Loveleen; Atkinson, Sarah; Hosanagar, Avinash; Guglani, Lokesh

2014-01-01

Vocal cord dysfunction (VCD) or paradoxical vocal-fold motion (PVFM) is a functional disorder of the vocal cords that requires multidisciplinary treatment. Besides relaxation techniques, the use of psychological interventions can help treat the underlying psychological co-morbidities. There is currently no literature that examines the effectiveness of psychological interventions for VCD/PVFM. To review the evidence for psychological interventions used for the treatment of patients with VCD/PVFM. We searched electronic databases for English medical literature using Pubmed (Medline), PsycInfo, Cochrane Database of Systematic Reviews, Cochrane Central Registry of Controlled Trials, and Clinicaltrials.gov. The date range for our search is from June 1964 to June 2014. We included studies that reported the use of psychological interventions in both adults and children diagnosed with VCD/PVFM. We included randomized controlled trials, case-control studies, retrospective chart reviews, prospective case series, and individual case reports. Most reported studies are small case series or individual case reports that have described the use of interventions such as psychotherapy, behavioral therapy, use of anti-anxiety and anti-depressant medications, and hypnotherapy in conjunction with breathing exercises taught by speech therapists for symptomatic relief. Among the various psychological interventions that have been reported, there is no data regarding effectiveness and/or superiority of one approach over another in either adult or pediatric patients. Psychological interventions have a role to play in the management of adult and pediatric patients with VCD/PVFM. Future prospective studies using uniform approaches for treatment of associated psychopathology may help address this question.

How small could a pup sound? The physical bases of signaling body size in harbor seals

PubMed Central

Gross, Stephanie; Garcia, Maxime; Rubio-Garcia, Ana; de Boer, Bart

2017-01-01

Abstract Vocal communication is a crucial aspect of animal behavior. The mechanism which most mammals use to vocalize relies on three anatomical components. First, air overpressure is generated inside the lower vocal tract. Second, as the airstream goes through the glottis, sound is produced via vocal fold vibration. Third, this sound is further filtered by the geometry and length of the upper vocal tract. Evidence from mammalian anatomy and bioacoustics suggests that some of these three components may covary with an animal’s body size. The framework provided by acoustic allometry suggests that, because vocal tract length (VTL) is more strongly constrained by the growth of the body than vocal fold length (VFL), VTL generates more reliable acoustic cues to an animal’s size. This hypothesis is often tested acoustically but rarely anatomically, especially in pinnipeds. Here, we test the anatomical bases of the acoustic allometry hypothesis in harbor seal pups Phoca vitulina. We dissected and measured vocal tract, vocal folds, and other anatomical features of 15 harbor seals post-mortem. We found that, while VTL correlates with body size, VFL does not. This suggests that, while body growth puts anatomical constraints on how vocalizations are filtered by harbor seals’ vocal tract, no such constraints appear to exist on vocal folds, at least during puppyhood. It is particularly interesting to find anatomical constraints on harbor seals’ vocal tracts, the same anatomical region partially enabling pups to produce individually distinctive vocalizations. PMID:29492005

Flow fields and acoustics in a unilateral scarred vocal fold model.

PubMed

Murugappan, Shanmugam; Khosla, Sid; Casper, Keith; Oren, Liran; Gutmark, Ephraim

2009-01-01

From prior work in an excised canine larynx model, it has been shown that intraglottal vortices form between the vocal folds during the latter part of closing. It has also been shown that the vortices generate a negative pressure between the folds, producing a suction force that causes sudden, rapid closing of the folds. This rapid closing will produce increased loudness and increased higher harmonics. We used a unilateral scarred excised canine larynx model to determine whether the intraglottal vortices and resulting acoustics were changed, compared to those of normal larynges. Acoustic, flow field, and high-speed imaging measurements from 5 normal and 5 unilaterally scarred canine larynges are presented in this report. Scarring was produced by complete resection of the vocal fold mucosa and superficial layer of the lamina propria on the right vocal fold only. Two months later, these dogs were painlessly sacrificed, and testing was done on the excised larynges during phonation. High-speed video imaging was then used to measure vocal fold displacement during different phases. Particle image velocimetry and acoustic measurements were used to describe possible acoustic effects of the vortices. A higher phonation threshold was required to excite the motion of the vocal fold in scarred larynges. As the subglottal pressure increased, the strength of the vortices and the higher harmonics both consistently increased. However, it was seen that increasing the maximum displacement of the scarred fold did not consistently increase the higher harmonics. The improvements that result from increasing subglottal pressure may be due to a combination of increasing the strength of the intraglottal vortices and increasing the maximum displacement of the vocal fold; however, the data in this study suggest that the vortices play a much more important role. The current study indicates that higher subglottal pressures may excite higher harmonics and improve loudness for patients with unilateral vocal fold scarring. This finding implies that therapies that raise the subglottal pressure may be helpful in improving voice quality.

Electroglottographic parameterization of the effects of gender, vowel and phonatory registers on vocal fold vibratory patterns: an Indian perspective.

PubMed

Paul, Nilanjan; Kumar, Suman; Chatterjee, Indranil; Mukherjee, Biswarup

2011-01-01

In-depth study on laryngeal biomechanics and vocal fold vibratory patterns reveal that a single vibratory cycle can be divided into two major phases, the closed and open phase, which is subdivided into opening and closing phases. Studies reveal that the relative time course of abduction and adduction, which in turn is dependent on the relative relaxing and tensing of the vocal fold cover and body, to be the determining factor in production of a particular vocal register like the modal (or chest), falsetto, glottal fry registers. Studies further point out Electroglottography to be particularly suitable for the study of vocal vibratory patterns during register changes. However, to date, there has been limited study on quantitative parameterization of EGG wave form in vocal fry register. Moreover, contradictory findings abound in literature regarding effects of gender and vowel types on vocal vibratory patterns, especially during phonation at different registers. The present study endeavors to find out the effects of vowel and gender differences on the vocal fold vibratory patterns in different registers and how these would be reflected in standard EGG parameters of Contact Quotient (CQ) and Contact Index (CI), taking into consideration the Indian sociolinguistic context. Electroglottographic recordings of 10 young adults (5 males and 5 females) were taken while the subjects phonated the three vowels /a/,/i/,/u/ each in two vocal registers, modal and vocal fry. Obtained raw EGG were further normalized using the Derived EGG algorithm and theCQ and CI values were derived. Obtained data were subject to statistical analysis using the 3-way ANOVA with gender, vowel and vocal register as the three variables. Post-hoc Dunnett C multiple comparison analysis were also performed. Results reveal that CQ values are significantly higher in vocal fry than modal phonation for both males and females, indicating a relatively hyperconstricted vocal system during vocal fry. The males have significantly greater CQ values than females both at modal and vocal fry phonations which indicate that the males are predisposed to greater vocal fold constriction. Females demonstrated no significant increase in CI values in vocal fry state; and in some cases actually decrease in the CI values which suggest an inherently distinct vocal fold physiological adjustment from that in males. No vowel effects were found in any conditions. Perturbation values (CQP and CIP) are significantly more in vocal fry register than in modal register, and the increase was more in case of females than males. The findings give strong evidence to certain hypotheses in literature regarding effects of vowel, gender and phonatory register on vocal fold vibratory patterns.

What happens during vocal warm-up?

PubMed

Elliot, N; Sundberg, J; Gramming, P

1995-03-01

Most singers prefer to warm up their voices before performing. Although the subjective effect is often considerable, the underlying physiological effects are largely unknown. Because warm-up tends to increase blood flow in muscles, it seems likely that vocal warm-up might induce decreased viscosity in the vocal folds. According to the theory of vocal-fold vibration, such a decrease should lead to a lower phonation threshold pressure. In this investigation the effect of vocal warm-up on the phonation threshold pressure was examined in a group of male and female singers. The effect varied considerably between subjects, presumably because the vocal-fold viscosity was not a dominating factor for the phonation-threshold pressure.

Microstructural and mechanical characterization of scarred vocal folds.

PubMed

Heris, Hossein K; Miri, Amir K; Ghattamaneni, Nageswara R; Li, Nicole Y K; Thibeault, Susan L; Wiseman, Paul W; Mongeau, Luc

2015-02-26

The goal of this study was to characterize the vocal folds microstructure and elasticity using nonlinear laser scanning microscopy and atomic force microscopy-based indentation, respectively. As a pilot study, the vocal folds of fourteen rats were unilaterally injured by full removal of lamina propria; the uninjured folds of the same animals served as controls. The area fraction of collagen fibrils was found to be greater in scarred tissues two months after injury than the uninjured controls. A novel mathematical model was also proposed to relate collagen concentration and tissue bulk modulus. This work presents a first step towards systematic investigation of microstructural and mechanical characteristics in scarred vocal fold tissue. Copyright © 2015 Elsevier Ltd. All rights reserved.

Classification for animal vocal fold surgery: resection margins impact histological outcomes of vocal fold injury.

PubMed

Imaizumi, Mitsuyoshi; Thibeault, Susan L; Leydon, Ciara

2014-11-01

Extent of vocal fold injury impacts the nature and timing of wound healing and voice outcomes. However, depth and extent of the lesion created to study wound healing in animal models vary across studies, likely contributing to different outcomes. Our goal was to create a surgery classification system to enable comparison of postoperative outcomes across animal vocal fold wound-healing studies. Prospective, controlled animal study. Rats underwent one of three types of unilateral vocal fold surgeries classified by depth and length of resection. The surgeries were: for subepithelial injury, resection of epithelium and superficial layer of the lamina propria at the midmembranous portion of the vocal fold; for transmucosal injury, resection of epithelium and lamina propria; and for transmuscular injury, resection of epithelium, lamina propria, and superficial portion of the vocalis muscle. Wound healing was evaluated histologically at various time points up to 35 days postinjury. Complete healing occurred by 14 days postsurgery for subepithelial injury, and by day 35 for transmucosal injury. Injury remained present at day 35 for transmuscular injury. Timing and completeness of healing varied by extent and depth of resection. Scarless healing occurred rapidly following subepithelial injury, whereas scarring was observed at 5 weeks after transmuscular injury. The proposed classification system may facilitate comparison of surgical outcomes across vocal fold wound-healing studies. N/A. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

The relation of vocal fold lesions and voice quality to voice handicap and psychosomatic well-being.

PubMed

Smits, R; Marres, H; de Jong, Felix

2012-07-01

Voice disorders have a multifactorial genesis and may be present in various ways. They can cause a significant communication handicap and impaired quality of life. To assess the effect of vocal fold lesions and voice quality on voice handicap and psychosomatic well-being. Female patients, aged 18-65 years, who were referred to the outpatient clinic with voice problems were subsequently assessed. Laryngostroboscopic examination and acoustic voice analysis were carried out, and the patients were asked to fill in the Voice Handicap Index (VHI) and Symptom Check List-90 questionnaires. Eighty-two patients were included. In 43 patients (52.4%), a vocal fold lesion was observed. The VHI and psychosomatic well-being did not differ significantly between patients with and without a vocal fold lesion. The patients with a vocal fold lesion showed lower scores on the Dysphonia Severity Index (DSI) compared with those without a vocal fold lesion. However, the DSI was not correlated with voice handicap and psychosomatic well-being, except for the VHI physical subscale. Objective measurement does not necessarily correlate with the subjective appraisal of the patient's voice handicap and psychosomatic well-being. Furthermore, the criterion of the presence of a vocal fold lesion as the base of indemnity that is applied by health insurance institutions should be questioned. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Detection of the Vibration Signal from Human Vocal Folds Using a 94-GHz Millimeter-Wave Radar

PubMed Central

Chen, Fuming; Li, Sheng; Zhang, Yang; Wang, Jianqi

2017-01-01

The detection of the vibration signal from human vocal folds provides essential information for studying human phonation and diagnosing voice disorders. Doppler radar technology has enabled the noncontact measurement of the human-vocal-fold vibration. However, existing systems must be placed in close proximity to the human throat and detailed information may be lost because of the low operating frequency. In this paper, a long-distance detection method, involving the use of a 94-GHz millimeter-wave radar sensor, is proposed for detecting the vibration signals from human vocal folds. An algorithm that combines empirical mode decomposition (EMD) and the auto-correlation function (ACF) method is proposed for detecting the signal. First, the EMD method is employed to suppress the noise of the radar-detected signal. Further, the ratio of the energy and entropy is used to detect voice activity in the radar-detected signal, following which, a short-time ACF is employed to extract the vibration signal of the human vocal folds from the processed signal. For validating the method and assessing the performance of the radar system, a vibration measurement sensor and microphone system are additionally employed for comparison. The experimental results obtained from the spectrograms, the vibration frequency of the vocal folds, and coherence analysis demonstrate that the proposed method can effectively detect the vibration of human vocal folds from a long detection distance. PMID:28282892

Apoptosis and Vocal Fold Disease: Clinically Relevant Implications of Epithelial Cell Death

ERIC Educational Resources Information Center

Novaleski, Carolyn K.; Carter, Bruce D.; Sivasankar, M. Preeti; Ridner, Sheila H.; Dietrich, Mary S.; Rousseau, Bernard

2017-01-01

Purpose: Vocal fold diseases affecting the epithelium have a detrimental impact on vocal function. This review article provides an overview of apoptosis, the most commonly studied type of programmed cell death. Because apoptosis can damage epithelial cells, this article examines the implications of apoptosis on diseases affecting the vocal fold…

Mechanomimetic hydrogels for vocal fold lamina propria regeneration.

PubMed

Kutty, Jaishankar K; Webb, Ken

2009-01-01

Vocal fold injury commonly leads to reduced vocal quality due to scarring-induced alterations in matrix composition and tissue biomechanics. The long-term hypothesis motivating our work is that rapid restoration of phonation and the associated dynamic mechanical environment will reduce scarring and promote regenerative healing. Toward this end, the objective of this study was to develop mechanomimetic, degradable hydrogels approximating the viscoelastic properties of the vocal ligament and mucosa that may be photopolymerized in situ to restore structural integrity to vocal fold tissues. The tensile and rheological properties of hydrogels (targeting the vocal ligament and mucosa, respectively) were varied as a function of macromer concentration. PEG diacrylate-based hydrogels exhibited linear stress-strain response and elastic modulus consistent with the properties of the vocal ligament at low strains (0-15%), but did not replicate the non-linear behavior observed in native tissue at higher strains. Methacrylated hyaluronic acid hydrogels displayed dynamic viscosity consistent with native vocal mucosa, while elastic shear moduli values were several-fold higher. Cell culture studies indicated that both hydrogels supported spreading, proliferation and collagen/proteoglycan matrix deposition by encapsulated fibroblasts throughout the 3D network.

Three-Dimensional Flow Separation Induced by a Model Vocal Fold Polyp

NASA Astrophysics Data System (ADS)

Stewart, Kelley C.; Erath, Byron D.; Plesniak, Michael W.

2012-11-01

The fluid-structure energy exchange process for normal speech has been studied extensively, but it is not well understood for pathological conditions. Polyps and nodules, which are geometric abnormalities that form on the medial surface of the vocal folds, can disrupt vocal fold dynamics and thus can have devastating consequences on a patient's ability to communicate. A recent in-vitro investigation of a model polyp in a driven vocal fold apparatus demonstrated that such a geometric abnormality considerably disrupts the glottal jet behavior and that this flow field adjustment was a likely reason for the severe degradation of the vocal quality in patients. Understanding of the formation and propagation of vortical structures from a geometric protuberance, and their subsequent impact on the aerodynamic loadings that drive vocal fold dynamic, is a critical component in advancing the treatment of this pathological condition. The present investigation concerns the three-dimensional flow separation induced by a wall-mounted prolate hemispheroid with a 2:1 aspect ratio in cross flow, i.e. a model vocal fold polyp. Unsteady three-dimensional flow separation and its impact of the wall pressure loading are examined using skin friction line visualization and wall pressure measurements. Supported by the National Science Foundation, Grant No. CBET-1236351 and GW Center for Biomimetics and Bioinspired Engineering (COBRE).

Automated measurement of vocal fold vibratory asymmetry from high-speed videoendoscopy recordings.

PubMed

Mehta, Daryush D; Deliyski, Dimitar D; Quatieri, Thomas F; Hillman, Robert E

2011-02-01

In prior work, a manually derived measure of vocal fold vibratory phase asymmetry correlated to varying degrees with visual judgments made from laryngeal high-speed videoendoscopy (HSV) recordings. This investigation extended this work by establishing an automated HSV-based framework to quantify 3 categories of vocal fold vibratory asymmetry. HSV-based analysis provided for cycle-to-cycle estimates of left-right phase asymmetry, left-right amplitude asymmetry, and axis shift during glottal closure for 52 speakers with no vocal pathology producing comfortable and pressed phonation. An initial cross-validation of the automated left-right phase asymmetry measure was performed by correlating the measure with other objective and subjective assessments of phase asymmetry. Vocal fold vibratory asymmetry was exhibited to a similar extent in both comfortable and pressed phonations. The automated measure of left-right phase asymmetry strongly correlated with manually derived measures and moderately correlated with visual-perceptual ratings. Correlations with the visual-perceptual ratings remained relatively consistent as the automated measure was derived from kymograms taken at different glottal locations. An automated HSV-based framework for the quantification of vocal fold vibratory asymmetry was developed and initially validated. This framework serves as a platform for investigating relationships between vocal fold tissue motion and acoustic measures of voice function.

Simulations of temporal patterns of oral airflow in men and women using a two-mass model of the vocal folds under dynamic control

NASA Astrophysics Data System (ADS)

Lucero, Jorge C.; Koenig, Laura L.

2005-03-01

In this study we use a low-dimensional laryngeal model to reproduce temporal variations in oral airflow produced by speakers in the vicinity of an abduction gesture. It attempts to characterize these temporal patterns in terms of biomechanical parameters such as glottal area, vocal fold stiffness, subglottal pressure, and gender differences in laryngeal dimensions. A two-mass model of the vocal folds coupled to a two-tube approximation of the vocal tract is fitted to oral airflow records measured in men and women during the production of /aha/ utterances, using the subglottal pressure, glottal width, and Q factor as control parameters. The results show that the model is capable of reproducing the airflow records with good approximation. A nonlinear damping characteristics is needed, to reproduce the flow variation at glottal abduction. Devoicing is achieved by the combined action of vocal fold abduction, the decrease of subglottal pressure, and the increase of vocal fold tension. In general, the female larynx has a more restricted region of vocal fold oscillation than the male one. This would explain the more frequent devoicing in glottal abduction-adduction gestures for /h/ in running speech by women, compared to men. .

Bi-stable vocal fold adduction: a mechanism of modal-falsetto register shifts and mixed registration.

PubMed

Titze, Ingo R

2014-04-01

The origin of vocal registers has generally been attributed to differential activation of cricothyroid and thyroarytenoid muscles in the larynx. Register shifts, however, have also been shown to be affected by glottal pressures exerted on vocal fold surfaces, which can change with loudness, pitch, and vowel. Here it is shown computationally and with empirical data that intraglottal pressures can change abruptly when glottal adductory geometry is changed relatively smoothly from convergent to divergent. An intermediate shape between large convergence and large divergence, namely, a nearly rectangular glottal shape with almost parallel vocal fold surfaces, is associated with mixed registration. It can be less stable than either of the highly angular shapes unless transglottal pressure is reduced and upper stiffness of vocal fold tissues is balanced with lower stiffness. This intermediate state of adduction is desirable because it leads to a low phonation threshold pressure with moderate vocal fold collision. Achieving mixed registration consistently across wide ranges of F0, lung pressure, and vocal tract shapes appears to be a balancing act of coordinating laryngeal muscle activation with vocal tract pressures. Surprisingly, a large transglottal pressure is not facilitative in this process, exacerbating the bi-stable condition and the associated register contrast.

Bi-stable vocal fold adduction: A mechanism of modal-falsetto register shifts and mixed registration

PubMed Central

Titze, Ingo R.

2014-01-01

The origin of vocal registers has generally been attributed to differential activation of cricothyroid and thyroarytenoid muscles in the larynx. Register shifts, however, have also been shown to be affected by glottal pressures exerted on vocal fold surfaces, which can change with loudness, pitch, and vowel. Here it is shown computationally and with empirical data that intraglottal pressures can change abruptly when glottal adductory geometry is changed relatively smoothly from convergent to divergent. An intermediate shape between large convergence and large divergence, namely, a nearly rectangular glottal shape with almost parallel vocal fold surfaces, is associated with mixed registration. It can be less stable than either of the highly angular shapes unless transglottal pressure is reduced and upper stiffness of vocal fold tissues is balanced with lower stiffness. This intermediate state of adduction is desirable because it leads to a low phonation threshold pressure with moderate vocal fold collision. Achieving mixed registration consistently across wide ranges of F0, lung pressure, and vocal tract shapes appears to be a balancing act of coordinating laryngeal muscle activation with vocal tract pressures. Surprisingly, a large transglottal pressure is not facilitative in this process, exacerbating the bi-stable condition and the associated register contrast. PMID:25235006

Characterization of chronic vocal fold scarring in a rabbit model.

PubMed

Rousseau, Bernard; Hirano, Shigeru; Chan, Roger W; Welham, Nathan V; Thibeault, Susan L; Ford, Charles N; Bless, Diane M

2004-03-01

The purpose of the current study was to assess the histologic and rheologic properties of the scarred vocal fold lamina propria during a chronic phase of wound repair in a rabbit model. Eighteen rabbit larynges were scarred using a procedure that involved stripping the vocal fold lamina propria down to the thyroarytenoid muscle, using 3-mm microforceps. The approximate dimension of injury to the vocal fold was 3 x 1.5 x 0.5 mm [length x width x depth]. At 6 months postoperatively, histologic analysis of the scarred and control lamina propria in eight of these rabbits was completed for collagen, procollagen, elastin, and hyaluronic acid. Compared with control samples, scarred tissue samples revealed fragmented and disorganized elastin fibers. Additionally, collagen was significantly increased, organized, and formed thick bundles in the scarred vocal fold lamina propria. Measurements of the viscoelastic shear properties of the scarred and control lamina propria in the remaining 10 rabbits revealed increased elastic shear modulus (G') in 8 of 10 scarred samples and increased dynamic viscosity (eta') in 9 of 10 scarred samples. Although rheologic differences were not statistically significant, they revealed that on average, scarred samples were stiffer and more viscous than the normal controls. Histologic data are interpreted as indicating that by 6 months postinjury, the scarred rabbit vocal fold has reached a mature phase of wound repair, characterized by an increased, organized, and thick bundle collagen matrix. Rheologic data are interpreted as providing support for the potential role of increased, thick bundle collagen, and a disorganized elastin network on shear stiffness and dynamic viscosity in the chronic vocal fold scar. Based on these results, a 6-month postoperative time frame is proposed for future studies of chronic vocal fold scarring using the rabbit animal model.

A Detailed Motion Analysis of the Angular Velocity Between the Vocal Folds During Throat Clearing Using High-speed Digital Imaging.

PubMed

Iwahashi, Toshihiko; Ogawa, Makoto; Hosokawa, Kiyohito; Kato, Chieri; Inohara, Hidenori

2016-11-01

To assess the angular velocity between the vocal folds just before the compression phase of throat clearing (TC) using high-speed digital imaging (HSDI) of the larynx. Twenty normal healthy adults (13 males and seven females) were enrolled in the study. Each participant underwent transnasal laryngo-fiberscopy, and was asked to perform weak/strong TC followed by a comfortable, sustained vowel phonation while recording an HSDI movie (4000 frames/s) of the larynx. Using a motion analysis, the changes in the vocal fold angle and angular velocity during vocal fold adduction were assessed. Subsequently, we calculated the average angular velocities in the ranges of 100-80%, 80-20%, and 20-0% from all of the angular changes. The motion analysis demonstrated that the changes in the angular velocity resulted in polynomial-like and sigmoid curves during TC and vowel phonation, respectively. The angular velocities during weak TC were significantly higher in the 20-0%, 80-20%, and 100-80% regions (in order); the 80-20% angular velocity in vocal fold adduction during phonation was highest. The 20-0% angular velocity during strong TC was more than twofold higher than 20-0% angular velocity during phonation. The present results confirmed that the closing motions of the vocal folds accelerate throughout the precompression closing phase of a TC episode, and decelerate just before the impact between the vocal folds at the onset of phonation, suggesting that the vocal fold velocity generated by TC is sufficient to damage the laryngeal tissues. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

In Vivo measurement of pediatric vocal fold motion using structured light laser projection.

PubMed

Patel, Rita R; Donohue, Kevin D; Lau, Daniel; Unnikrishnan, Harikrishnan

2013-07-01

The aim of the study was to present the development of a miniature structured light laser projection endoscope and to quantify vocal fold length and vibratory features related to impact stress of the pediatric glottis using high-speed imaging. The custom-developed laser projection system consists of a green laser with a 4-mm diameter optics module at the tip of the endoscope, projecting 20 vertical laser lines on the glottis. Measurements of absolute phonatory vocal fold length, membranous vocal fold length, peak amplitude, amplitude-to-length ratio, average closing velocity, and impact velocity were obtained in five children (6-9 years), two adult male and three adult female participants without voice disorders, and one child (10 years) with bilateral vocal fold nodules during modal phonation. Independent measurements made on the glottal length of a vocal fold phantom demonstrated a 0.13mm bias error with a standard deviation of 0.23mm, indicating adequate precision and accuracy for measuring vocal fold structures and displacement. First, in vivo measurements of amplitude-to-length ratio, peak closing velocity, and impact velocity during phonation in pediatric population and a child with vocal fold nodules are reported. The proposed laser projection system can be used to obtain in vivo measurements of absolute length and vibratory features in children and adults. Children have large amplitude-to-length ratio compared with typically developing adults, whereas nodules result in larger peak amplitude, amplitude-to-length ratio, average closing velocity, and impact velocity compared with typically developing children. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

The role of adjustment of expiratory effort in the control of vocal intensity: clinical assessment of phonatory function.

PubMed

Makiyama, Kiyoshi; Yoshihashi, Hidetaka; Mogitate, Manabu; Kida, Akinori

2005-04-01

To determine the role of the adjustment of expiratory effort in the control of vocal intensity. An intensity-loading test was performed by using the airway interruption method. Three groups of subjects were used: a control group thought to resemble normal vocal fold closure, a group of patients with Reinke's edema thought to represent increased mass at the level of the vocal folds, and a group with vocal fold paralysis that was thought to represent a group with lack of adequate vocal fold closure. In the control group, expiratory lung pressure and airway resistance slightly increased. In the patients with Reinke's edema, expiratory lung pressure, and airway resistance significantly increased. In this group, the voice intensity was controlled by laryngeal adjustment, but a greater expiratory effort was needed because of a greater increase in glottal resistance. In the patients with vocal cord paralysis, airway resistance did not increase even with a high-intensity voice. Vocal intensity was controlled by expiratory effort. If there is sufficient ability for laryngeal adjustment, vocal intensity is controlled primarily by laryngeal adjustment and by expiratory adjustment in response to increased glottal resistance. However, vocal intensity is controlled by expiratory effort when laryngeal adjustment ability is poor.

Evolving role of mitomycin-C laryngology

NASA Astrophysics Data System (ADS)

Richards, Steven V.; Garrett, C. Gaelyn

2001-05-01

Topical mitomycin-C, a chemotherapeutic agent and a fibroblast inhibitor, has been successfully used in larynx, primarily to treat stenosis. Subglottic, tracheal, and anterior glottic stenosis have all shown promising results in a canine model. Less favorable results have been obtained when topical mitomycin-C is used on the vocal folds following surgical excision of mucosa. In the vocal fold studies, laryngeal videostroboscopy revealed diminished mucosal wave vibration in the vocal folds treated with mitomycin-C as well as a more atrophic appearance to the vibratory surface. The tissue treated with mitomycin-C showed fewer fibroblasts and less collagen. However, inflammatory infiltrate was not significantly different between the treated and untreated tissue. These results are consistent with the known suppression of fibroblast proliferation by mitomycin-C. In contrast to the positive effects of mitomycin-C on stenosis, the observed decrease in the healing response in the vocal fold had negative consequences on vocal fold vibratory pattern.

Trends in Utilization of Vocal Fold Injection Procedures.

PubMed

Rosow, David E

2015-11-01

Office-based vocal fold injections have become increasingly popular over the past 15 years. Examination of trends in procedure coding for vocal fold injections in the United States from 2000 to 2012 was undertaken to see if they reflect this shift. The US Part B Medicare claims database was queried from 2000 through 2012 for multiple Current Procedural Terminology codes. Over the period studied, the number of nonoperative laryngoscopic injections (31513, 31570) and operative medialization laryngoplasties (31588) remained constant. Operative vocal fold injection (31571) demonstrated marked linear growth over the 12-year study period, from 744 procedures in 2000 to 4788 in 2012-an increase >640%. The dramatic increased incidence in the use of code 31571 reflects an increasing share of vocal fold injections being performed in the operating room and not in an office setting, running counter to the prevailing trend toward awake, office-based injection procedures. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

A budget of energy transfer in a sustained vocal folds vibration in glottis

NASA Astrophysics Data System (ADS)

Zhang, Lucy; Yang, Jubiao; Krane, Michael

2016-11-01

A set of force and energy balance equations using the control volume approach is derived based on the first principles of physics for a sustained vocal folds vibration in glottis. The control volume analysis is done for compressible airflow in a moving and deforming control volume in the vicinity of the vocal folds. The interaction between laryngeal airflow and vocal folds are successfully simulated using the modified Immersed Finite Element Method (mIFEM), a fully coupled approach to simulate fluid-structure interactions. Detailed mathematical terms are separated out for deeper physical understanding and utilization of mechanical energy is quantified with the derived equation. The results show that majority of energy input is consumed for driving laryngeal airflow, while a smaller portion is for compensating viscous losses in and sustaining the vibration of the vocal folds. We acknowledge the funding support of NIH 2R01DC005642-10A1.

Irregular vocal fold dynamics incited by asymmetric fluid loading in a model of recurrent laryngeal nerve paralysis

NASA Astrophysics Data System (ADS)

Sommer, David; Erath, Byron D.; Zanartu, Matias; Peterson, Sean D.

2011-11-01

Voiced speech is produced by dynamic fluid-structure interactions in the larynx. Traditionally, reduced order models of speech have relied upon simplified inviscid flow solvers to prescribe the fluid loadings that drive vocal fold motion, neglecting viscous flow effects that occur naturally in voiced speech. Viscous phenomena, such as skewing of the intraglottal jet, have the most pronounced effect on voiced speech in cases of vocal fold paralysis where one vocal fold loses some, or all, muscular control. The impact of asymmetric intraglottal flow in pathological speech is captured in a reduced order two-mass model of speech by coupling a boundary-layer estimation of the asymmetric pressures with asymmetric tissue parameters that are representative of recurrent laryngeal nerve paralysis. Nonlinear analysis identifies the emergence of irregular and chaotic vocal fold dynamics at values representative of pathological speech conditions.

Effects of poroelastic coefficients on normal vibration modes in vocal-fold tissues.

PubMed

Tao, Chao; Liu, Xiaojun

2011-02-01

The vocal-fold tissue is treated as a transversally isotropic fluid-saturated porous material. Effects of poroelastic coefficients on eigenfrequencies and eigenmodes of the vocal-fold vibration are investigated using the Ritz method. The study demonstrates that the often-used elastic model is only a particular case of the poroelastic model with an infinite fluid-solid mass coupling parameter. The elastic model may be considered appropriate for the vocal-fold tissue when the absolute value of the fluid-solid mass coupling parameter is larger than 10(5) kg/m(3). Otherwise, the poroelastic model may be more accurate. The degree of compressibility of the vocal tissue can also been described by the poroelastic coefficients. Finally, it is revealed that the liquid and solid components in a poroelastic model could have different modal shapes when the coupling between them is weak. The mode decoupling could cause desynchronization and irregular vibration of the folds.

Voice Signals Produced With Jitter Through a Stochastic One-mass Mechanical Model.

PubMed

Cataldo, Edson; Soize, Christian

2017-01-01

The quasiperiodic oscillation of the vocal folds causes perturbations in the length of the glottal cycles, which are known as jitter. The observation of the glottal cycles variations suggests that jitter is a random phenomenon described by random deviations of the glottal cycle lengths in relation to a corresponding mean value and, in general, its values are expressed as a percentage of the duration of the glottal pulse. The objective of this paper is the construction of a stochastic model for jitter using a one-mass mechanical model of the vocal folds, which assumes complete right-left symmetry of the vocal folds, and which considers motions of the vocal folds only in the horizontal direction. The jitter has been the subject for researchers due to its important applications such as the identification of pathological voices (nodules in the vocal folds, paralysis of the vocal folds, or even, the vocal aging, among others). Large values for jitter variations can indicate a pathological characteristic of the voice. The corresponding stiffness of each vocal fold is considered as a stochastic process, and its modeling is proposed. The probability density function of the fundamental frequency related to the voice signals produced are constructed and compared for different levels of jitter. Some samples of synthesized voices in these cases are obtained. It is showed that jitter could be obtained using the model proposed. The Praat software was also used to verify the measures of jitter in the synthesized voice signals. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A meta-analysis of outcomes of hydration intervention on phonation threshold pressure.

PubMed

Leydon, Ciara; Wroblewski, Marcin; Eichorn, Naomi; Sivasankar, Mahalakshmi

2010-11-01

Vocal fold hydration is purported to promote optimal biomechanical characteristics of vocal fold mucosa, increase efficiency of vocal fold oscillation, and enhance voice quality. The purpose of this work was to determine the magnitude and consistency of the effect of vocal fold hydration on vocal fold function across published clinical studies. We completed a comprehensive meta-analysis of the effects of superficial and systemic vocal fold hydration on phonation threshold pressure (PTP), a measure of efficiency of voice production. We identified 34 studies that examined the effects of hydration on vocal function. Of these studies, 14 examined the effects of hydration on PTP. Nine of these articles met the criteria for inclusion in this analysis. We observed an average effect size of 0.33, indicating that, overall, hydration treatment demonstrated a tendency to reduce PTP. However, this decrease in phonatory effort did not reach significance at the 95% confidence level. The effects of hydration intervention varied considerably across studies (-0.19 to 3.96). We considered that two factors, pitch level of the task and vocal health of participants, may have contributed to this variability in findings. However, our analysis found that these factors could not account for differences in effect size. To understand the variability in outcomes across studies, the role of factors that may impact the effects of hydration, such as the amount, type, and duration of intervention, must be determined. Only then can we obtain data to guide best clinical practice for protecting and rehabilitating vocal function. Copyright © 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Characterization of Vocal Fold Vibration in Sulcus Vocalis Using High-Speed Digital Imaging

ERIC Educational Resources Information Center

Yamauchi, Akihito; Yokonishi, Hisayuki; Imagawa, Hiroshi; Sakakibara, Ken-Ichi; Nito, Takaharu; Tayama, Niro; Yamasoba, Tatsuya

2017-01-01

Purpose: The aim of the present study was to qualitatively and quantitatively characterize vocal fold vibrations in sulcus vocalis by high-speed digital imaging (HSDI) and to clarify the correlations between HSDI-derived parameters and traditional vocal parameters. Method: HSDI was performed in 20 vocally healthy subjects (8 men and 12 women) and…

[Surgery of benign vocal fold lesions].

PubMed

Olthoff, A

2016-09-01

Surgical treatment of benign vocal fold lesions can be indicated for clinical or functional reasons. The principles of phonosurgery have to be maintained in either case. The appropriate phonosurgical technique depends on the type of vocal fold lesion. Depending on the findings, phonosurgery aims to maintain or improve voice quality. The evaluation of clinical and functional results includes indirect laryngoscopy, videostroboscopy, and voice analysis.

Modal response of a computational vocal fold model with a substrate layer of adipose tissue.

PubMed

Jones, Cameron L; Achuthan, Ajit; Erath, Byron D

2015-02-01

This study demonstrates the effect of a substrate layer of adipose tissue on the modal response of the vocal folds, and hence, on the mechanics of voice production. Modal analysis is performed on the vocal fold structure with a lateral layer of adipose tissue. A finite element model is employed, and the first six mode shapes and modal frequencies are studied. The results show significant changes in modal frequencies and substantial variation in mode shapes depending on the strain rate of the adipose tissue. These findings highlight the importance of considering adipose tissue in computational vocal fold modeling.

Laryngeal videostroboscopy in the dog model: a simplified technique and applications

NASA Astrophysics Data System (ADS)

Coleman, John R., Jr.; Reinisch, Lou; Smith, Shane; Deriso, Walter; Ossoff, Jacob; Huang, Shan; Garrett, C. Gaelyn

1998-07-01

Laryngeal videostroboscopy (LVS) allows the physician to examine the vibratory free edge of the vocal fold providing direct visualization of the vocal fold surface and indirect visualization of the substance of the vocal fold. Previously in dog LVS, electrical stimulation of the superior and recurrent laryngeal nerves or painful stimuli in the lightly anesthetized animal provided the impetus for glottic closure. In this paper we present a new technique for LVS in the dog model that involves mechanical traction on arytenoid adduction sutures to achieve vocal fold adduction. This method is safe, effective, and reproducible, and the potential applications are numerous.

Silastic injection for vocal fold medialization resulting in a false-positive finding on F18 FDG-PET/CT.

PubMed

Mahfouz, Ayman; Naji, Meeran; Mok, Wing Yan; Taghi, Ali S; Win, Zarni

2015-09-01

A false-positive uptake of F18-fluorodeoxyglucose (FDG) on positron-emission tomography/computed tomography (PET/CT) can result in confusion and misinterpretation of scans. Such uptakes have been previously described after injection of polytetrafluoroethylene (Teflon) into the vocal folds. Similarly, vocal fold injection of silicone elastomer (Silastic) can result not only in a false-positive FDG uptake on PET/CT, but also in chronic inflammation. We report a case of increased FDG uptake in a vocal fold after Silastic injection that was misinterpreted as a malignancy in a 70-year-old woman who had metastatic carcinoma of the stomach.

Performance of a reduced-order FSI model for flow-induced vocal fold vibration

NASA Astrophysics Data System (ADS)

Chang, Siyuan; Luo, Haoxiang; Luo's lab Team

2016-11-01

Vocal fold vibration during speech production involves a three-dimensional unsteady glottal jet flow and three-dimensional nonlinear tissue mechanics. A full 3D fluid-structure interaction (FSI) model is computationally expensive even though it provides most accurate information about the system. On the other hand, an efficient reduced-order FSI model is useful for fast simulation and analysis of the vocal fold dynamics, which is often needed in procedures such as optimization and parameter estimation. In this work, we study the performance of a reduced-order model as compared with the corresponding full 3D model in terms of its accuracy in predicting the vibration frequency and deformation mode. In the reduced-order model, we use a 1D flow model coupled with a 3D tissue model. Two different hyperelastic tissue behaviors are assumed. In addition, the vocal fold thickness and subglottal pressure are varied for systematic comparison. The result shows that the reduced-order model provides consistent predictions as the full 3D model across different tissue material assumptions and subglottal pressures. However, the vocal fold thickness has most effect on the model accuracy, especially when the vocal fold is thin. Supported by the NSF.

Factors associated with the improvement of vocal fold movement: an analysis of LEMG and laryngeal CT parameters.

PubMed

Mengsteab, Paulos Y; Kwon, Jeong-Yi; Han, Tai Ryoon; Kwon, Tack Kyun; Kim, Deok-Ho; Kim, Sang Jun

2015-02-01

The aim of this study is to elucidate the relationship of laryngeal electromyography (LEMG) and computed tomographic (CT) parameters to improve the prognosis of recurrent laryngeal nerve injury. 22 patients clinically suspected of having recurrent laryngeal nerve injury were examined with LEMG and CT studies. Bilateral thyroarytenoid (TA) muscles were examined and findings were interpreted by a single blind technique. Laryngeal CT image analysis of the ventricle dilation symmetry determined TA muscle atrophy. Finally, a follow-up laryngoscopic examination determined improvement of vocal fold movement. Ventricle dilation symmetry and the dichotomized TA muscle atrophy parameter significantly relate to the improvement of vocal fold movement (χ(2)=4.029, P=0.039, and χ(2)=3.912, P=0.048, respectively). When the severity of vocal fold impairment was classified as severe TA muscle atrophy or none/discrete MUAP recruitment, it was found to significantly relate with the improvement of vocal fold movement (χ(2)=6.712, P=.010). From this study, image analysis of the ventricle dilation symmetry to determine the severity of TA muscle atrophy shows promise for the improved prognosis of vocal fold immobility. Copyright © 2014 Elsevier Ltd. All rights reserved.

Histologic and rheologic characterization of vocal fold scarring.

PubMed

Thibeault, Susan L; Gray, Steven D; Bless, Diane M; Chan, Roger W; Ford, Charles N

2002-03-01

Scarring of the vocal fold causes considerable dysphonia and presents significant treatment challenges. A rabbit model was developed to investigate the histologic ultrastructure and rheologic properties of the scarred vocal fold lamina propria. Eleven rabbit larynges were scarred by means of forcep biopsy. Sixty days postoperatively, the rabbits were sacrificed and their vocal folds were harvested. Histological analysis of the scarred and normal lamina propria was completed for collagen, procollagen, elastin, and hyaluronic acid. Linear viscoelastic shear properties of the tissues were also measured, including elastic shear modulus and dynamic viscosity. Compared to normal vocal fold lamina propria, scarred tissues demonstrated significantly less collagen, an increase in procollagen, and a decrease in elastin. Rheologically, both elastic shear modulus and dynamic viscosity were significantly higher for the scarred tissues. Increased stiffness and viscosity do not appear to result from an increase in collagen, but rather appear to be related to the presence of new, disorganized collagen scaffolding. Results are interpreted in terms of the possible role of interstitial proteins in the etiology of increased stiffness and viscosity, which requires further investigation. This animal model should allow for systematic future investigations of vocal fold scarring and its treatment.

Effect of growth factors on hyaluronan production by canine vocal fold fibroblasts.

PubMed

Hirano, Shigeru; Bless, Diane M; Heisey, Dennis; Ford, Charles N

2003-07-01

Hyaluronan (HYA) is considered to be a crucial factor in scarless wound healing and in maintaining tissue viscosity of the vocal fold lamina propria. In this study focusing on the effects of growth factors, we examined how HYA is produced and controlled in canine cultured vocal fold fibroblasts. Fibroblasts were taken from the lamina propria of the vocal folds of 8 dogs and cultured with and without growth factors. The production of HYA in the supernatant culture was quantitatively examined by enzyme-linked immunosorbent assay. Hepatocyte growth factor, epidermal growth factor, basic fibroblast growth factor, and transforming growth factor beta1 all stimulated HYA synthesis from vocal fold fibroblasts. These effects differed with the concentration of growth factors and the incubation period. We also examined how frequently the growth factors had to be administered in order to maintain appropriate levels of HYA. A single administration was sufficient to maintain appropriate HYA levels for at least 7 days. The present studies have demonstrated positive effects of growth factors in stimulating HYA production. Further in vivo study is needed to clarify the usefulness of these growth factors in the management of vocal fold scarring.

Characteristics of phonation onset in a two-layer vocal fold model.

PubMed

Zhang, Zhaoyan

2009-02-01

Characteristics of phonation onset were investigated in a two-layer body-cover continuum model of the vocal folds as a function of the biomechanical and geometric properties of the vocal folds. The analysis showed that an increase in either the body or cover stiffness generally increased the phonation threshold pressure and phonation onset frequency, although the effectiveness of varying body or cover stiffness as a pitch control mechanism varied depending on the body-cover stiffness ratio. Increasing body-cover stiffness ratio reduced the vibration amplitude of the body layer, and the vocal fold motion was gradually restricted to the medial surface, resulting in more effective flow modulation and higher sound production efficiency. The fluid-structure interaction induced synchronization of more than one group of eigenmodes so that two or more eigenmodes may be simultaneously destabilized toward phonation onset. At certain conditions, a slight change in vocal fold stiffness or geometry may cause phonation onset to occur as eigenmode synchronization due to a different pair of eigenmodes, leading to sudden changes in phonation onset frequency, vocal fold vibration pattern, and sound production efficiency. Although observed in a linear stability analysis, a similar mechanism may also play a role in register changes at finite-amplitude oscillations.

High-speed digital phonoscopy images analyzed by Nyquist plots

NASA Astrophysics Data System (ADS)

Yan, Yuling

2012-02-01

Vocal-fold vibration is a key dynamic event in voice production, and the vibratory characteristics of the vocal fold correlate closely with voice quality and health condition. Laryngeal imaging provides direct means to observe the vocal fold vibration; in the past, however, available modalities were either too slow or impractical to resolve the actual vocal fold vibrations. This limitation has now been overcome by high-speed digital imaging (HSDI) (or high-speed digital phonoscopy), which records images of the vibrating vocal folds at a rate of 2000 frames per second or higher- fast enough to resolve a specific, sustained phonatory vocal fold vibration. The subsequent image-based functional analysis of voice is essential to better understanding the mechanism underlying voice production, as well as assisting the clinical diagnosis of voice disorders. Our primary objective is to develop a comprehensive analytical platform for voice analysis using the HSDI recordings. So far, we have developed various analytical approaches for the HSDI-based voice analyses. These include Nyquist plots and associated analysese that are used along with FFT and Spectrogram in the analysis of the HSDI data representing normal voice and specific voice pathologies.

The role of finite displacements in vocal fold modeling.

PubMed

Chang, Siyuan; Tian, Fang-Bao; Luo, Haoxiang; Doyle, James F; Rousseau, Bernard

2013-11-01

Human vocal folds experience flow-induced vibrations during phonation. In previous computational models, the vocal fold dynamics has been treated with linear elasticity theory in which both the strain and the displacement of the tissue are assumed to be infinitesimal (referred to as model I). The effect of the nonlinear strain, or geometric nonlinearity, caused by finite displacements is yet not clear. In this work, a two-dimensional model is used to study the effect of geometric nonlinearity (referred to as model II) on the vocal fold and the airflow. The result shows that even though the deformation is under 1 mm, i.e., less than 10% of the size of the vocal fold, the geometric nonlinear effect is still significant. Specifically, model I underpredicts the gap width, the flow rate, and the impact stress on the medial surfaces as compared to model II. The study further shows that the differences are caused by the contact mechanics and, more importantly, the fluid-structure interaction that magnifies the error from the small-displacement assumption. The results suggest that using the large-displacement formulation in a computational model would be more appropriate for accurate simulations of the vocal fold dynamics.

[Vascular lesions of vocal folds--part 1: horizontal vascular lesions].

PubMed

Voigt-Zimmermann, S; Arens, C

2014-12-01

In recent decades, the endoscopic methods and technologies for laryngeal examination have improved so much that not only epithelial changes, but also vascular changes are recognizable at earlier stages. When comparing newer and older literature, the associated increasingly differentiated descriptions of such visible vascular changes of the vocal folds lead to terminological blurring and shifts of meaning. This complicates the technical-scientific discourse. The aim of the present work is a theoretical and conceptual clarification of early vascular changes of vocal folds. Horizontal changes of benigne vascular diseases, e. g. vessel ectasia, meander, increasing number and branching of vessels, change of direction may develop in to manifest vascular lesions, like varicosis, polyps and in case of ruptures to haemorrhages of vocal folds. These beginning and reversible vascular changes, when early detected and discussed basing on etiological knowledge, may lead to more differentiated prognostic statements and adequate therapeutic decisions, e. g. phonosurgery, functional voice therapy, voice hygiene and voice rest. Vertical vascular changes, like vessel loops, occur primarily in laryngeal papilloma, pre-cancerous and cancerous changes of the vocal folds. Already in small cancerous lesions of the vocal folds the vascular architecture is completely destroyed. © Georg Thieme Verlag KG Stuttgart · New York.

Day surgery for vocal fold lesions using a double-bent 60-mm Cathelin needle.

PubMed

Toyomura, Fumimasa; Tokashiki, Ryoji; Hiramatsu, Hiroyuki; Tsukahara, Kiyoaki; Motohashi, Ray; Sakurai, Eriko; Nomoto, Masaki; Suzuki, Mamoru

2014-11-01

Day surgery for vocal cord lesions overcomes the disadvantages of laryngomicrosurgery under general anesthesia. We present our experience with treatment of vocal fold lesions using a long double-bend Cathelin needle that can access all parts of the vocal cords. A 23G, 60-mm-long Cathelin needle was bent twice by 45(o) at a distance of 1 and 2 cm from the tip, and was attached to a syringe. Under topical anesthesia and nasal endoscopy of the laryngopharynx, the needle was inserted percutaneously perpendicular to the skin, the direction of insertion being altered when the bends in the needle reached the skin surface. This allows the tip of the needle to access all parts of the glottis, allowing the performance of procedures such as biopsies, excision of lesions, and injection into the vocal folds. Between January 2011 and December 2013, we used this technique to perform vocal fold procedures in 566 patients presenting for treatment of spasmodic dysphonia (412 cases, 73 %) and other vocal fold lesions. Only minor complications, such as hematoma (3 patients, 0.5 %) and slight bleeding from the puncture site in the epiglottic vallecula (all patients, 100 %), which ceased spontaneously within 10 min, were seen. Erroneous puncture occurred in three patients (0.5 %) and the puncture had to be repeated in 38 patients (6.7 %). The procedure was completed successfully in all cases (100 %). Surgery for vocal fold lesions under topical anesthesia using our double-bend Cathelin needle technique is simple, safe, and useful.

Voice-related quality of life (V-RQOL) following type I thyroplasty for unilateral vocal fold paralysis.

PubMed

Hogikyan, N D; Wodchis, W P; Terrell, J E; Bradford, C R; Esclamado, R M

2000-09-01

Unilateral vocal fold paralysis is a common clinical problem which frequently causes severe dysphonia. Various treatment options exist for this condition, with the type I thyroplasty being one of the more commonly performed surgical procedures for vocal rehabilitation. The Voice-Related Quality of Life (V-RQOL) Measure is a validated outcomes instrument for voice disorders. This study measured the V-RQOL of patients with unilateral vocal fold paralysis who had undergone a type I thyroplasty and compared these scores to those of patients with untreated and uncompensated unilateral vocal fold paralysis and to normals. Treated patients had significantly higher domain and overall V-RQOL scores than untreated patients, but also scored lower than normals. These differences were true across gender and age. Patients who were more distant from surgery had lower V-RQOL scores than those who had more recently been treated. It is concluded that type I thyroplasty leads to a significantly higher V-RQOL for patients with unilateral vocal fold paralysis. This study also demonstrates further the utility of patient-oriented measures of treatment outcome.

Injection laryngoplasty as miniinvasive office-based surgery in patients with unilateral vocal fold paralysis - voice quality outcomes.

PubMed

Sielska-Badurek, Ewelina M; Sobol, Maria; Jędra, Katarzyna; Rzepakowska, Anna; Osuch-Wójcikiewicz, Ewa; Niemczyk, Kazimierz

2017-09-01

Injection laryngoplasty (glottis augmentation) is the preferred method in surgical management of unilateral vocal fold paralysis (UVFP). Traditionally, these procedures are performed in the operating room. Nowadays, however, these procedures have moved into the office. To evaluate the voice quality after transoral injection laryngoplasty under local anaesthesia in patients with unilateral vocal fold paralysis. Fourteen subjects (5 women and 9 men) with unilateral vocal fold paresis (9 with right vocal fold paresis and 5 with left vocal fold paresis) were included in the study. The mean age of the group was 57.8 ±19.0 years (32-83 years). All of the injection laryngoplasties were performed transorally, under local anaesthesia. The injection material was calcium hydroxylapatite. Before and 1, 3 and 6 months after the procedure the following variables were evaluated: voice perception, videostroboscopy, acoustic analysis, aerodynamic evaluation, and the subjective rating of the voice quality by the patient. After injection laryngoplasty, complete glottal closure was achieved or there was a significant improvement in the glottal closure of each subject. We noted great improvement in the post-injection objective and subjective voice outcomes and patients reported improvement in the voice-related quality of life. The transoral approach for injection laryngoplasty under local anaesthesia is an effective and safe way to treat incomplete glottal closure in patients with UVFP. The transoral approach is an efficient alternative to other surgical techniques used for vocal fold injection.

Effects of dehydration on the viscoelastic properties of vocal folds in large deformations.

PubMed

Miri, Amir K; Barthelat, François; Mongeau, Luc

2012-11-01

Dehydration may alter vocal fold viscoelastic properties, thereby hampering phonation. The effects of water loss induced by an osmotic pressure potential on vocal fold tissue viscoelastic properties were investigated. Porcine vocal folds were dehydrated by immersion in a hypertonic solution, and quasi-static and low-frequency dynamic traction tests were performed for elongations of up to 50%. Digital image correlation was used to determine local strains from surface deformations. The elastic modulus and the loss factor were then determined for normal and dehydrated tissues. An eight-chain hyperelastic model was used to describe the observed nonlinear stress-stretch behavior. Contrary to the expectations, the mass history indicated that the tissue absorbed water during cyclic extension when submerged in a hypertonic solution. During loading history, the elastic modulus was increased for dehydrated tissues as a function of strain. The response of dehydrated tissues was much less affected when the load was released. This observation suggests that hydration should be considered in micromechanical models of the vocal folds. The internal hysteresis, which is often linked to phonation effort, increased significantly with water loss. The effects of dehydration on the viscoelastic properties of vocal fold tissue were quantified in a systematic way. A better understanding of the role of hydration on the mechanical properties of vocal fold tissue may help to establish objective dehydration and phonotrauma criteria. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Aeroelastic Model of Vocal-Fold Vibrating Element for Studying the Phonation Threshold

NASA Astrophysics Data System (ADS)

Horáček, J.; Švec, J. G.

2002-10-01

An original theoretical model for vibration onset of the vocal folds in the air-flow coming from the human subglottal tract is designed, which allows studying the influence of the physical properties of the vocal folds (e.g., geometrical shape, mass, viscosity) on their vibration characteristics (such as the natural frequencies, mode shapes of vibration and the thresholds of instability). The mathematical model of the vocal fold is designed as a simplified dynamic system of two degrees of freedom (rotation and translation) vibrating on an elastic foundation in the wall of a channel conveying air. An approximate unsteady one-dimensional flow theory for the inviscid incompressible fluid is presented for the phonatory air-flow. A generally defined shape of the vocal-fold surface is considered for expressing the unsteady aerodynamic forces in the glottis. The parameters of the mechanical part of the model, i.e., the mass, stiffness and damping matrices, are related to the geometry and material density of the vocal folds as well as to the fundamental natural frequency and damping known from experiments. The coupled numerical solution yields the vibration characteristics (natural frequencies, damping and mode shapes of vibration), including the instability thresholds of the aeroelastic system. The vibration characteristics obtained from the coupled numerical solution of the system appear to be in reasonable qualitative agreement with the physiological data and clinical observations. The model is particularly suitable for studying the phonation threshold, i.e., the onset of vibration of the vocal folds.

Design of a mechanical larynx with agarose as a soft tissue substitute for vocal fold applications.

PubMed

Choo, J Q; Lau, D P C; Chui, C K; Yang, T; Chng, C B; Teoh, S H

2010-06-01

Mechanical and computational models consisting of flow channels with convergent and oscillating constrictions have been applied to study the dynamics of human vocal fold vibration. To the best of our knowledge, no mechanical model has been studied using a material substitute with similar physical properties to the human vocal fold for surgical experimentation. In this study, we design and develop a mechanical larynx with agarose as a vocal fold substitute, and assess its suitability for surgical experimentation. Agarose is selected as a substitute for the vocal fold as it exhibits similar nonlinear hyperelastic characteristics to biological soft tissue. Through uniaxial compression and extension tests, we determined that agarose of 0.375% concentration most closely resembles the vocal fold mucosa and ligament of a 20-year old male for small tensile strain with an R(2) value of 0.9634 and root mean square error of 344.05±39.84 Pa. Incisions of 10 mm lengthwise and 3 mm in depth were created parallel to the medial edge on the superior surface of agar phantom. These were subjected to vibrations of 80, 130, and 180 Hz, at constant amplitude of 0.9 mm over a period of 10 min each in the mechanical larynx model. Lateral expansion of the incision was observed to be most significant for the lower frequency of 80 Hz. This model serves as a basis for future assessments of wound closure techniques during microsurgery to the vocal fold.

Permanent medialization of the paralyzed vocal fold utilizing botulinum toxin and Gelfoam.

PubMed

Rontal, Eugene; Rontal, Michael

2003-09-01

The clinical picture of a paralyzed vocal fold often has the same appearance as a subluxated arytenoid, with anterior and medial displacement of the arytenoid and a foreshortened and lax vocal fold. Previous work by the authors has shown that a subluxated arytenoid may be permanently repositioned by reduction and selective injection of the intrinsic laryngeal musculature with botulinum toxin. The injection changes the forces within the larynx, allowing the arytenoid to be brought back to proper position on the cricoid cartilage. This concept has been extended to the paralyzed vocal fold. It has been noted that even a clinically paralyzed vocal fold has voluntary motor units that may still act on the arytenoid through residual action from the interarytenoid and synkinesis. These forces are significant enough to manipulate the arytenoid and, thus, the vocal fold, into its correct, adducted position. In this paper, the arytenoid is mobilized to free any fibrosis. The thyroarytenoid and lateral cricoarytenoid muscles are then injected to prevent any forward synkinetic pull on the arytenoid. Next, a Gelfoam injection medializes the vocal fold to create glottic closure. This rebalancing sufficiently positions the arytenoid, so that valvular function is permanently restored. In the ten patients studied for over 1 year, there was a 90% success rate as measured by videostroboscopy, phonation time, and V-RQOL analysis. There were no untoward complications. All the materials used are nonpermanent. The procedure does not limit other techniques from being performed at a later time.

Injection laryngoplasty as miniinvasive office-based surgery in patients with unilateral vocal fold paralysis – voice quality outcomes

PubMed Central

Sielska-Badurek, Ewelina M.; Jędra, Katarzyna; Rzepakowska, Anna; Osuch-Wójcikiewicz, Ewa; Niemczyk, Kazimierz

2017-01-01

Introduction Injection laryngoplasty (glottis augmentation) is the preferred method in surgical management of unilateral vocal fold paralysis (UVFP). Traditionally, these procedures are performed in the operating room. Nowadays, however, these procedures have moved into the office. Aim To evaluate the voice quality after transoral injection laryngoplasty under local anaesthesia in patients with unilateral vocal fold paralysis. Material and methods Fourteen subjects (5 women and 9 men) with unilateral vocal fold paresis (9 with right vocal fold paresis and 5 with left vocal fold paresis) were included in the study. The mean age of the group was 57.8 ±19.0 years (32–83 years). All of the injection laryngoplasties were performed transorally, under local anaesthesia. The injection material was calcium hydroxylapatite. Before and 1, 3 and 6 months after the procedure the following variables were evaluated: voice perception, videostroboscopy, acoustic analysis, aerodynamic evaluation, and the subjective rating of the voice quality by the patient. Results After injection laryngoplasty, complete glottal closure was achieved or there was a significant improvement in the glottal closure of each subject. We noted great improvement in the post-injection objective and subjective voice outcomes and patients reported improvement in the voice-related quality of life. Conclusions The transoral approach for injection laryngoplasty under local anaesthesia is an effective and safe way to treat incomplete glottal closure in patients with UVFP. The transoral approach is an efficient alternative to other surgical techniques used for vocal fold injection. PMID:29062449

Videolaryngostroboscopic observation of mucus layer during vocal cord vibration in patients with vocal nodules before and after surgery.

PubMed

Hsiung, Ming-Wang

2004-03-01

Under normal conditions, the vocal fold mucus layer is too thin to permit observation using videolaryngostroboscopy (VLS) during phonation. However, vocal nodules (VNs) typically cause congealed and sticky mucus to appear on the vocal fold. Reports in the literature regarding this phenomenon are limited. The aim of this study was to review VLS recordings of VN patients, analyzing changes that occurred in the mucus layer that covers the vocal fold during vibration following VN surgery. Using VLS, we studied the occurrence of, and changes in, vocal fold mucus layers in 160 VN patients before and after surgery. Eighty-eight patients (55%) were found to have a mucus layer during preoperative examinations. Of these mucus layers, 21 (13%) were located on the anterior commissure or anterior third of the vocal fold (A), 58 (36.3%) on the junction of the anterior and middle thirds (M), 1 (0.6%) on the posterior third (P), 5 (3.1%) on both A and M and 3 (1.9%) on both M and P. Fifty-six (35%) cases were found to have a mucus layer during postoperative examinations. Of these, 44 (27.5%) were located on A, 8 (5%) on M, 1 (0.6%) on P and 3 (1.9%) on both A and M. These results indicate that changes in the mechanical force on the vocal fold, alteration of the laryngeal secretory gland and improper aerodynamic airflow result in increased mucus viscosity and aggregation in VN patients and that the combination of these factors further increases the severity of dysphonia. Surgery to remove vocal nodes may be an effective method to eliminate both vocal bumps and aggregated mucus. Based on the present results, it is recommended that future research should compare surgery to remove VN against other mucus layer reduction methods in order to determine which is the most effective.

Phonation threshold pressure predictions using viscoelastic properties up to 1,400 Hz of injectables intended for Reinke's space.

PubMed

Klemuk, Sarah A; Lu, Xiaoying; Hoffman, Henry T; Titze, Ingo R

2010-05-01

Viscoelastic properties of numerous vocal fold injectables have been reported but not at speaking frequencies. For materials intended for Reinke's space, ramifications of property values are of great concern because of their impact on ease of voice onset. Our objectives were: 1) to measure viscoelastic properties of a new nonresorbing carbomer and well-known vocal fold injectables at vocalization frequencies using established and new instrumentation, and 2) to predict phonation threshold pressures using a computer model with intended placement in Reinke's space. Rheology and phonation threshold pressure calculations. Injectables were evaluated with a traditional rotational rheometer and a new piezo-rotary vibrator. Using these data at vocalization frequencies, phonation threshold pressures (PTP) were calculated for each biomaterial, assuming a low dimensional model with supraglottic coupling and adjusted vocal fold length and thickness at each frequency. Results were normalized to a nominal PTP value. Viscoelastic data were acquired at vocalization frequencies as high as 363 to 1,400 Hz for six new carbomer hydrogels, Hylan B, and Extracel intended for vocal fold Reinke's space injection and for Cymetra (lateral injection). Reliability was confirmed with good data overlap when measuring with either rheometer. PTP predictions ranged from 0.001 to 16 times the nominal PTP value of 0.283 kPa. Accurate viscoelastic measurements of vocal fold injectables are now possible at physiologic frequencies. Hylan B, Extracel, and the new carbomer hydrogels should generate easy vocal onset and sustainable vocalization based on their rheologic properties if injected into Reinke's space. Applications may vary depending on desired longevity of implant. Laryngoscope, 2010.

The Vocal Cord Dysfunction Questionnaire: Validity and Reliability of the Persian Version.

PubMed

Ghaemi, Hamide; Khoddami, Seyyedeh Maryam; Soleymani, Zahra; Zandieh, Fariborz; Jalaie, Shohreh; Ahanchian, Hamid; Khadivi, Ehsan

2017-12-25

The aim of this study was to develop, validate, and assess the reliability of the Persian version of Vocal Cord Dysfunction Questionnaire (VCDQ P ). The study design was cross-sectional or cultural survey. Forty-four patients with vocal fold dysfunction (VFD) and 40 healthy volunteers were recruited for the study. To assess the content validity, the prefinal questions were given to 15 experts to comment on its essential. Ten patients with VFD rated the importance of VCDQ P in detecting face validity. Eighteen of the patients with VFD completed the VCDQ 1 week later for test-retest reliability. To detect absolute reliability, standard error of measurement and smallest detected change were calculated. Concurrent validity was assessed by completing the Persian Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) by 34 patients with VFD. Discriminant validity was measured from 34 participants. The VCDQ was further validated by administering the questionnaire to 40 healthy volunteers. Validation of the VCDQ as a treatment outcome tool was conducted in 18 patients with VFD using pre- and posttreatment scores. The internal consistency was confirmed (Cronbach α = 0.78). The test-retest reliability was excellent (intraclass correlation coefficient = 0.97). The standard error of measurement and smallest detected change values were acceptable (0.39 and 1.08, respectively). There was a significant correlation between the VCDQ P and the CAT total scores (P < 0.05). Discriminative validity was significantly different. The VCDQ scores in patients with VFD before and after treatment was significantly different (P < 0.001). The VCDQ was cross-culturally adapted to Persian and demonstrated to be a valid and reliable self-administered questionnaire in Persian-speaking population. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Influence of Embedded Fibers and an Epithelium Layer on the Glottal Closure Pattern in a Physical Vocal Fold Model

ERIC Educational Resources Information Center

Xuan, Yue; Zhang, Zhaoyan

2014-01-01

Purpose: The purpose of this study was to explore the possible structural and material property features that may facilitate complete glottal closure in an otherwise isotropic physical vocal fold model. Method: Seven vocal fold models with different structural features were used in this study. An isotropic model was used as the baseline model, and…

Ventricular-Fold Dynamics in Human Phonation

ERIC Educational Resources Information Center

Bailly, Lucie; Bernardoni, Nathalie Henrich; Müller, Frank; Rohlfs, Anna-Katharina; Hess, Markus

2014-01-01

Purpose: In this study, the authors aimed (a) to provide a classification of the ventricular-fold dynamics during voicing, (b) to study the aerodynamic impact of these motions on vocal-fold vibrations, and (c) to assess whether ventricular-fold oscillations could be sustained by aerodynamic coupling with the vocal folds. Method: A 72-sample…

A study of vocal nonlinearities in humpback whale songs: from production mechanisms to acoustic analysis.

PubMed

Cazau, Dorian; Adam, Olivier; Aubin, Thierry; Laitman, Jeffrey T; Reidenberg, Joy S

2016-10-10

Although mammalian vocalizations are predominantly harmonically structured, they can exhibit an acoustic complexity with nonlinear vocal sounds, including deterministic chaos and frequency jumps. Such sounds are normative events in mammalian vocalizations, and can be directly traceable to the nonlinear nature of vocal-fold dynamics underlying typical mammalian sound production. In this study, we give qualitative descriptions and quantitative analyses of nonlinearities in the song repertoire of humpback whales from the Ste Marie channel (Madagascar) to provide more insight into the potential communication functions and underlying production mechanisms of these features. A low-dimensional biomechanical modeling of the whale's U-fold (vocal folds homolog) is used to relate specific vocal mechanisms to nonlinear vocal features. Recordings of living humpback whales were searched for occurrences of vocal nonlinearities (instabilities). Temporal distributions of nonlinearities were assessed within sound units, and between different songs. The anatomical production sources of vocal nonlinearities and the communication context of their occurrences in recordings are discussed. Our results show that vocal nonlinearities may be a communication strategy that conveys information about the whale's body size and physical fitness, and thus may be an important component of humpback whale songs.

A study of vocal nonlinearities in humpback whale songs: from production mechanisms to acoustic analysis

NASA Astrophysics Data System (ADS)

Cazau, Dorian; Adam, Olivier; Aubin, Thierry; Laitman, Jeffrey T.; Reidenberg, Joy S.

2016-10-01

Although mammalian vocalizations are predominantly harmonically structured, they can exhibit an acoustic complexity with nonlinear vocal sounds, including deterministic chaos and frequency jumps. Such sounds are normative events in mammalian vocalizations, and can be directly traceable to the nonlinear nature of vocal-fold dynamics underlying typical mammalian sound production. In this study, we give qualitative descriptions and quantitative analyses of nonlinearities in the song repertoire of humpback whales from the Ste Marie channel (Madagascar) to provide more insight into the potential communication functions and underlying production mechanisms of these features. A low-dimensional biomechanical modeling of the whale’s U-fold (vocal folds homolog) is used to relate specific vocal mechanisms to nonlinear vocal features. Recordings of living humpback whales were searched for occurrences of vocal nonlinearities (instabilities). Temporal distributions of nonlinearities were assessed within sound units, and between different songs. The anatomical production sources of vocal nonlinearities and the communication context of their occurrences in recordings are discussed. Our results show that vocal nonlinearities may be a communication strategy that conveys information about the whale’s body size and physical fitness, and thus may be an important component of humpback whale songs.

Optoreflectometry determination of the resonance properties of a vocal fold.

PubMed

Garrel, Renaud; Nicollas, Richard; Giovanni, Antoine; Ouaknine, Maurice

2007-09-01

A new method of measuring the resonance properties of a vocal fold using electromagnetic excitation and laser optoreflectometry for response monitoring is described. Two resonance peaks were experimentally identified with one magnet stuck on the vocal fold at frequencies F0(1m)=54.7 Hz and F0'(1m)=35.8 Hz. The addition of a second magnet allowed calculation of the actual viscoelastic properties of the vocal fold: F0=71.8 Hz; quality factor Q=8.03; mass m=0.057 g; stiffness k=11.6 Nm; and damping zeta=0.0032 Nm(-1). A numerical simulation of a two-layered model verified the experimental data.

Lubrication mechanism of the larynx during phonation: an experiment in excised canine larynges.

PubMed

Nakagawa, H; Fukuda, H; Kawaida, M; Shiotani, A; Kanzaki, J

1998-01-01

To evaluate how the viscosity of the laryngeal mucus influences vocal fold vibration, two fluids of differing viscosity were applied separately to excised canine larynges and experimental phonation was induced. Vibration of the vocal folds was measured by use of a laryngostroboscope and an X-ray stroboscope. With the high viscosity fluid, the amplitude of vibration of the free edge and the peak glottal area was decreased while the open quotient was increased. Because the viscosity of this fluid affected the wave motion of the vocal fold mucosa, changes in viscosity of the mucus may be involved in causing such disorders as hoarseness, in the absence of apparent changes in the vocal folds themselves.

An optical flow-based state-space model of the vocal folds.

PubMed

Granados, Alba; Brunskog, Jonas

2017-06-01

High-speed movies of the vocal fold vibration are valuable data to reveal vocal fold features for voice pathology diagnosis. This work presents a suitable Bayesian model and a purely theoretical discussion for further development of a framework for continuum biomechanical features estimation. A linear and Gaussian nonstationary state-space model is proposed and thoroughly discussed. The evolution model is based on a self-sustained three-dimensional finite element model of the vocal folds, and the observation model involves a dense optical flow algorithm. The results show that the method is able to capture different deformation patterns between the computed optical flow and the finite element deformation, controlled by the choice of the model tissue parameters.

Empirical Measurements of Biomechanical Anisotropy of the Human Vocal Fold Lamina Propria

PubMed Central

Kelleher, Jordan E.; Siegmund, Thomas; Du, Mindy; Naseri, Elhum; Chan, Roger W.

2013-01-01

The vocal folds are known to be mechanically anisotropic due to the microstructural arrangement of fibrous proteins such as collagen and elastin in the lamina propria. Even though this has been known for many years, the biomechanical anisotropic properties have rarely been experimentally studied. We propose that an indentation procedure can be used with uniaxial tension in order to obtain an estimate of the biomechanical anisotropy within a single specimen. Experiments were performed on the lamina propria of three male and three female human vocal folds dissected from excised larynges. Two experiments were conducted: each specimen was subjected to cyclic uniaxial tensile loading in the longitudinal (i.e. anterior-posterior) direction, and then to cyclic indentation loading in the transverse (i.e. medial-lateral) direction. The indentation experiment was modeled as contact on a transversely isotropic half-space using the Barnett-Lothe tensors. The longitudinal elastic modulus EL was computed from the tensile test, and the transverse elastic modulus ET and longitudinal shear modulus GL were obtained by inverse analysis of the indentation force-displacement response. It was discovered that the average of EL/ET was 14 for the vocal ligament and 39 for the vocal fold cover specimens. Also, the average of EL/GL, a parameter important for models of phonation, was 28 for the vocal ligament and 54 for the vocal fold cover specimens. These measurements of anisotropy could contribute to more accurate models of fundamental frequency regulation and provide potentially better insights into the mechanics of vocal fold vibration. PMID:22886592

Quantifying the influence of flow asymmetries on glottal sound sources in speech

NASA Astrophysics Data System (ADS)

Erath, Byron; Plesniak, Michael

2008-11-01

Human speech is made possible by the air flow interaction with the vocal folds. During phonation, asymmetries in the glottal flow field may arise from flow phenomena (e.g. the Coanda effect) as well as from pathological vocal fold motion (e.g. unilateral paralysis). In this study, the effects of flow asymmetries on glottal sound sources were investigated. Dynamically-programmable 7.5 times life-size vocal fold models with 2 degrees-of-freedom (linear and rotational) were constructed to provide a first-order approximation of vocal fold motion. Important parameters (Reynolds, Strouhal, and Euler numbers) were scaled to physiological values. Normal and abnormal vocal fold motions were synthesized, and the velocity field and instantaneous transglottal pressure drop were measured. Variability in the glottal jet trajectory necessitated sorting of the data according to the resulting flow configuration. The dipole sound source is related to the transglottal pressure drop via acoustic analogies. Variations in the transglottal pressure drop (and subsequently the dipole sound source) arising from flow asymmetries are discussed.

Evaluation of Dying Vocal Fold Epithelial Cells by Ultrastructural Features and TUNEL Method

PubMed Central

Novaleski, Carolyn K.; Mizuta, Masanobu; Rousseau, Bernard

2016-01-01

Cell death is a regulated mechanism of eliminating cells to maintain tissue homeostasis. This study described two methodological procedures for evaluating cell death in the epithelium of immobilized, approximated, and vibrated vocal folds from 12 New Zealand white breeder rabbits. The gold standard technique of transmission electron microscopy evaluated high-quality ultrastructural criteria of cell death and a common immunohistochemical marker, terminal deoxynucleotidyl transferase dUTP nick end labeling method, to confirm cell death signaling. Results revealed that ultrastructural characteristics of apoptotic cell death, specifically condensed chromatin and apoptotic bodies, were observed after vocal fold vibration and approximation. Although episodes of necrotic cell death were rare, few enlarged cell nuclei were present after vibration and approximation. The vocal fold expresses an immunohistochemical marker for apoptosis along the apical surface of the epithelium. This study provides a solid foundation for future investigations regarding the role of cell death in vocal fold health and disease. PMID:27537846

Evaluation of Dying Vocal Fold Epithelial Cells by Ultrastructural Features and TUNEL Method.

PubMed

Novaleski, Carolyn K; Mizuta, Masanobu; Rousseau, Bernard

2016-01-01

Cell death is a regulated mechanism of eliminating cells to maintain tissue homeostasis. This study described 2 methodological procedures for evaluating cell death in the epithelium of immobilized, approximated and vibrated vocal folds from 12 New Zealand white breeder rabbits. The gold standard technique of transmission electron microscopy evaluated high-quality ultrastructural criteria of cell death and a common immunohistochemical marker, the terminal deoxynucleotidyl transferase dUTP nick end labeling method, to confirm cell death signaling. Results revealed that ultrastructural characteristics of apoptotic cell death, specifically condensed chromatin and apoptotic bodies, were observed after vocal fold vibration and approximation. Although episodes of necrosis were rare, few enlarged cell nuclei were present after vibration and approximation. The vocal fold expresses an immunohistochemical marker for apoptosis along the apical surface of the epithelium. This study provides a solid foundation for future investigations regarding the role of cell death in vocal fold health and disease. © 2016 S. Karger AG, Basel.

Vocal fold fixation caused by penetration of a high-velocity steel projectile.

PubMed

Guo, Chau-Shiang; Ho, Chi-Kung; Hsu, Ruey-Fen

2014-01-01

Vocal fold fixation as a result of trauma caused by a foreign body is rare. We report a unique case of vocal fold fixation caused by traumatic penetration of a shard of steel in a 31-year-old steelworker. While the patient was at work, an airborne projectile suddenly pierced his neck and entered his larynx, causing progressive hoarseness and dyspnea. Flexible laryngoscopy detected no obvious foreign body, but it did reveal that the right vocal fold had become immobile. Computed tomography revealed that a 2.5-cm sliver of steel had become impacted in the right cricoarytenoid joint, which made the arytenoid cartilage unable to rotate. An emergency tracheostomy was performed with local anesthesia to construct a functioning airway, and then rigid laryngoscopy was performed with general anesthesia. The foreign body was removed with the assistance of a microscope and microscissors. Postoperatively, the patient immediately regained control of his right vocal fold, and he experienced no permanent injury.

Treatment of vocal fold scarring: rheological and histological measures of homologous collagen matrix.

PubMed

Kriesel, Kevin J; Thiebault, Susan L; Chan, Roger W; Suzuki, Tatsutoshi; VanGroll, Patrick J; Bless, Diane M; Ford, Charles N

2002-10-01

The current treatment options for dysphonia secondary to vocal fold scarring are limited. Few studies address changes in the lamina propria, which is critical to vocal fold biomechanical properties and voice production. Using rheological and histological measures of homologous collagen matrix (HCM)-injected vocal folds, we assessed HCM's potential for providing bulk and restoring biomechanical performance. Twenty rabbits underwent bilateral vocal fold scarring. After 10 weeks of scar maturation, the rabbits had unilateral injections of HCM or saline solution. Ten weeks after the injections, histological studies revealed well-defined collagen globules distributed throughout the lamina propria and underlying muscular tissue. Significantly more procollagen was observed in the HCM-treated group. No significant differences in elastic shear modulus or dynamic viscosity were found between the treatment groups. This study demonstrates that HCM is an inert, relatively stable injectate that may serve well for medialization but does not appear to improve the dynamic properties of the lamina propria.

In vivo cross-sectional imaging of the phonating larynx using long-range Doppler optical coherence tomography

NASA Astrophysics Data System (ADS)

Coughlan, Carolyn A.; Chou, Li-Dek; Jing, Joseph C.; Chen, Jason J.; Rangarajan, Swathi; Chang, Theodore H.; Sharma, Giriraj K.; Cho, Kyoungrai; Lee, Donghoon; Goddard, Julie A.; Chen, Zhongping; Wong, Brian J. F.

2016-03-01

Diagnosis and treatment of vocal fold lesions has been a long-evolving science for the otolaryngologist. Contemporary practice requires biopsy of a glottal lesion in the operating room under general anesthesia for diagnosis. Current in-office technology is limited to visualizing the surface of the vocal folds with fiber-optic or rigid endoscopy and using stroboscopic or high-speed video to infer information about submucosal processes. Previous efforts using optical coherence tomography (OCT) have been limited by small working distances and imaging ranges. Here we report the first full field, high-speed, and long-range OCT images of awake patients’ vocal folds as well as cross-sectional video and Doppler analysis of their vocal fold motions during phonation. These vertical-cavity surface-emitting laser source (VCSEL) OCT images offer depth resolved, high-resolution, high-speed, and panoramic images of both the true and false vocal folds. This technology has the potential to revolutionize in-office imaging of the larynx.

An In Vivo Study of Composite Microgels Based on Hyaluronic Acid and Gelatin for the Reconstruction of Surgically Injured Rat Vocal Folds

ERIC Educational Resources Information Center

Coppoolse, Jiska M. S.; Van Kooten, T. G.; Heris, Hossein K.; Mongeau, Luc; Li, Nicole Y. K.; Thibeault, Susan L.; Pitaro, Jacob; Akinpelu, Olubunm; Daniel, Sam J.

2014-01-01

Purpose: The objective of this study was to investigate local injection with a hierarchically microstructured hyaluronic acid-gelatin (HA-Ge) hydrogel for the treatment of acute vocal fold injury using a rat model. Method: Vocal fold stripping was performed unilaterally in 108 Sprague-Dawley rats. A volume of 25 µl saline (placebo controls),…

Destiny of autologous bone marrow-derived stromal cells implanted in the vocal fold.

PubMed

Kanemaru, Shin-ichi; Nakamura, Tatsuo; Yamashita, Masaru; Magrufov, Akhmar; Kita, Tomoko; Tamaki, Hisanobu; Tamura, Yoshihiro; Iguchi, Fuku-ichiro; Kim, Tae Soo; Kishimoto, Masanao; Omori, Koichi; Ito, Juichi

2005-12-01

The aim of this study was to investigate the destiny of implanted autologous bone marrow-derived stromal cells (BSCs) containing mesenchymal stem cells. We previously reported the successful regeneration of an injured vocal fold through implantation of BSCs in a canine model. However, the fate of the implanted BSCs was not examined. In this study, implanted BSCs were traced in order to determine the type of tissues resulting at the injected site of the vocal fold. After harvest of bone marrow from the femurs of green fluorescent transgenic mice, adherent cells were cultured and selectively amplified. By means of a fluorescence-activated cell sorter, it was confirmed that some cells were strongly positive for mesenchymal stem cell markers, including CD29, CD44, CD49e, and Sca-1. These cells were then injected into the injured vocal fold of a nude rat. Immunohistologic examination of the resected vocal folds was performed 8 weeks after treatment. The implanted cells were alive in the host tissues and showed positive expression for keratin and desmin, markers for epithelial tissue and muscle, respectively. The implanted BSCs differentiated into more than one tissue type in vivo. Cell-based tissue engineering using BSCs may improve the quality of the healing process in vocal fold injuries.

Performance of a reduced-order FSI model for flow-induced vocal fold vibration

NASA Astrophysics Data System (ADS)

Luo, Haoxiang; Chang, Siyuan; Chen, Ye; Rousseau, Bernard; PhonoSim Team

2017-11-01

Vocal fold vibration during speech production involves a three-dimensional unsteady glottal jet flow and three-dimensional nonlinear tissue mechanics. A full 3D fluid-structure interaction (FSI) model is computationally expensive even though it provides most accurate information about the system. On the other hand, an efficient reduced-order FSI model is useful for fast simulation and analysis of the vocal fold dynamics, which can be applied in procedures such as optimization and parameter estimation. In this work, we study performance of a reduced-order model as compared with the corresponding full 3D model in terms of its accuracy in predicting the vibration frequency and deformation mode. In the reduced-order model, we use a 1D flow model coupled with a 3D tissue model that is the same as in the full 3D model. Two different hyperelastic tissue behaviors are assumed. In addition, the vocal fold thickness and subglottal pressure are varied for systematic comparison. The result shows that the reduced-order model provides consistent predictions as the full 3D model across different tissue material assumptions and subglottal pressures. However, the vocal fold thickness has most effect on the model accuracy, especially when the vocal fold is thin.

Simultaneous temporally resolved DPIV and pressure measurements of symmetric oscillations in a scaled-up vocal fold model

NASA Astrophysics Data System (ADS)

Ringenberg, Hunter; Rogers, Dylan; Wei, Nathaniel; Krane, Michael; Wei, Timothy

2017-11-01

The objective of this study is to apply experimental data to theoretical framework of Krane (2013) in which the principal aeroacoustic source is expressed in terms of vocal fold drag, glottal jet dynamic head, and glottal exit volume flow, reconciling formal theoretical aeroacoustic descriptions of phonation with more traditional lumped-element descriptions. These quantities appear in the integral equations of motion for phonatory flow. In this way time resolved velocity field measurements can be used to compute time-resolved estimates of the relevant terms in the integral equations of motion, including phonation aeroacoustic source strength. A simplified 10x scale vocal fold model from Krane, et al. (2007) was used to examine symmetric, i.e. `healthy', oscillatory motion of the vocal folds. By using water as the working fluid, very high spatial and temporal resolution was achieved. Temporal variation of transglottal pressure was simultaneously measured with flow on the vocal fold model mid-height. Experiments were dynamically scaled to examine a range of frequencies corresponding to male and female voice. The simultaneity of the pressure and flow provides new insights into the aeroacoustics associated with vocal fold oscillations. Supported by NIH Grant No. 2R01 DC005642-11.

Visualizing the movement of the contact between vocal folds during vibration by using array-based transmission ultrasonic glottography

PubMed Central

Jing, Bowen; Chigan, Pengju; Ge, Zhengtong; Wu, Liang; Wang, Supin; Wan, Mingxi

2017-01-01

For the purpose of noninvasively visualizing the dynamics of the contact between vibrating vocal fold medial surfaces, an ultrasonic imaging method which is referred to as array-based transmission ultrasonic glottography is proposed. An array of ultrasound transducers is used to detect the ultrasound wave transmitted from one side of the vocal folds to the other side through the small-sized contact between the vocal folds. A passive acoustic mapping method is employed to visualize and locate the contact. The results of the investigation using tissue-mimicking phantoms indicate that it is feasible to use the proposed method to visualize and locate the contact between soft tissues. Furthermore, the proposed method was used for investigating the movement of the contact between the vibrating vocal folds of excised canine larynges. The results indicate that the vertical movement of the contact can be visualized as a vertical movement of a high-intensity stripe in a series of images obtained by using the proposed method. Moreover, a visualization and analysis method, which is referred to as array-based ultrasonic kymography, is presented. The velocity of the vertical movement of the contact, which is estimated from the array-based ultrasonic kymogram, could reach 0.8 m/s during the vocal fold vibration. PMID:28599522

Characterization of vocal fold scar formation, prophylaxis, and treatment using animal models.

PubMed

Bless, Diane M; Welham, Nathan V

2010-12-01

To review recent literature on animal models used to study the pathogenesis, detection, prevention, and treatment of vocal fold scarring. Animal work is critical to studying vocal fold scarring because it is the only way to conduct systematic research on the biomechanical properties of the layered structure of the vocal fold lamina propria, and therefore develop reliable prevention and treatment strategies for this complex clinical problem. During the period of review, critical anatomic, physiologic, and wound healing characteristics, which may serve as the bases for selection of a certain species to help answer a specific question, have been described in mouse, rat, rabbit, ferret, and canine models. A number of different strategies for prophylaxis and chronic scar treatment in animals show promise for clinical application. The pathways of scar formation and methods for quantifying treatment-induced change have become better defined. Recent animal vocal fold scarring studies have enriched and confirmed earlier work indicating that restoring pliability to the scarred vocal fold mucosa is challenging but achievable. Differences between animal models and differences in outcome measurements across studies necessitate considering each study individually to obtain guidance for future research. With increased standardization of measurement techniques it may be possible to make more inter-study comparisons.

Modulating Phonation Through Alteration of Vocal Fold Medial Surface Contour

PubMed Central

Mau, Ted; Muhlestein, Joseph; Callahan, Sean; Chan, Roger W.

2012-01-01

Objectives 1. To test whether alteration of the vocal fold medial surface contour can improve phonation. 2. To demonstrate that implant material properties affect vibration even when implant is deep to the vocal fold lamina propria. Study Design Induced phonation of excised human larynges. Methods Thirteen larynges were harvested within 24 hours post-mortem. Phonation threshold pressure (PTP) and flow (PTF) were measured before and after vocal fold injections using either calcium hydroxylapatite (CaHA) or hyaluronic acid (HA). Small-volume injections (median 0.0625 mL) were targeted to the infero-medial aspect of the thyroarytenoid (TA) muscle. Implant locations were assessed histologically. Results The effect of implantation on PTP was material-dependent. CaHA tended to increase PTP, whereas HA tended to decrease PTP (Wilcoxon test P = 0.00013 for onset). In contrast, the effect of implantation on PTF was similar, with both materials tending to decrease PTF (P = 0.16 for onset). Histology confirmed implant presence in the inferior half of the vocal fold vertical thickness. Conclusions Taken together, these data suggested the implants may have altered the vocal fold medial surface contour, potentially resulting in a less convergent or more rectangular glottal geometry as a means to improve phonation. An implant with a closer viscoelastic match to vocal fold cover is desirable for this purpose, as material properties can affect vibration even when the implant is not placed within the lamina propria. This result is consistent with theoretical predictions and implies greater need for surgical precision in implant placement and care in material selection. PMID:22865592

Identification of Distinct Layers Within the Stratified Squamous Epithelium of the Adult Human True Vocal Fold

PubMed Central

Dowdall, Jayme R.; Sadow, Peter M.; Hartnick, Christopher; Vinarsky, Vladimir; Mou, Hongmei; Zhao, Rui; Song, Phillip C.; Franco, Ramon A.; Rajagopal, Jayaraj

2016-01-01

Objectives/Hypothesis A precise molecular schema for classifying the different cell types of the normal human vocal fold epithelium is lacking. We hypothesize that the true vocal fold epithelium has a cellular architecture and organization similar to that of other stratified squamous epithelia including the skin, cornea, oral mucosa, and esophagus. In analogy to disorders of the skin and gastrointestinal tract, a molecular definition of the normal cell types within the human vocal fold epithelium and a description of their geometric relationships should serve as a foundation for characterizing cellular changes associated with metaplasia, dysplasia, and cancer. Study Design Qualitative study with adult human larynges. Methods Histologic sections of normal human laryngeal tissue were analyzed for morphology (hematoxylin and eosin) and immunohistochemical protein expression profile, including cytokeratins (CK13 and CK14), cornified envelope proteins (involucrin), basal cells (NGFR/p75), and proliferation markers (Ki67). Results We demonstrated that three distinct cell strata with unique marker profiles are present within the stratified squamous epithelium of the true vocal fold. We used these definitions to establish that cell proliferation is restricted to certain cell types and layers within the epithelium. These distinct cell types are reproducible across five normal adult larynges. Conclusion We have established that three layers of cells are present within the normal adult stratified squamous epithelium of the true vocal fold. Furthermore, replicating cell populations are largely restricted to the parabasal strata within the epithelium. This delineation of distinct cell populations will facilitate future studies of vocal fold regeneration and cancer. Level of Evidence N/A. PMID:25988619

Assessment of canine vocal fold function after injection of a new biomaterial designed to treat phonatory mucosal scarring.

PubMed

Karajanagi, Sandeep S; Lopez-Guerra, Gerardo; Park, Hyoungshin; Kobler, James B; Galindo, Marilyn; Aanestad, Jon; Mehta, Daryush D; Kumai, Yoshihiko; Giordano, Nicholas; d'Almeida, Anthony; Heaton, James T; Langer, Robert; Herrera, Victoria L M; Faquin, William; Hillman, Robert E; Zeitels, Steven M

2011-03-01

Most cases of irresolvable hoarseness are due to deficiencies in the pliability and volume of the superficial lamina propria of the phonatory mucosa. By using a US Food and Drug Administration-approved polymer, polyethylene glycol (PEG), we created a novel hydrogel (PEG30) and investigated its effects on multiple vocal fold structural and functional parameters. We injected PEG30 unilaterally into 16 normal canine vocal folds with survival times of 1 to 4 months. High-speed videos of vocal fold vibration, induced by intratracheal airflow, and phonation threshold pressures were recorded at 4 time points per subject. Three-dimensional reconstruction analysis of 11.7 T magnetic resonance images and histologic analysis identified 3 cases wherein PEG30 injections were the most superficial, so as to maximally impact vibratory function. These cases were subjected to in-depth analyses. High-speed video analysis of the 3 selected cases showed minimal to no reduction in the maximum vibratory amplitudes of vocal folds injected with PEG30 compared to the non-injected, contralateral vocal fold. All PEG30-injected vocal folds displayed mucosal wave activity with low average phonation threshold pressures. No significant inflammation was observed on microlaryngoscopic examination. Magnetic resonance imaging and histologic analyses revealed time-dependent resorption of the PEG30 hydrogel by phagocytosis with minimal tissue reaction or fibrosis. The PEG30 hydrogel is a promising biocompatible candidate biomaterial to restore form and function to deficient phonatory mucosa, while not mechanically impeding residual endogenous superficial lamina propria.

Intraoperative handheld probe for 3D imaging of pediatric benign vocal fold lesions using optical coherence tomography (Conference Presentation)

NASA Astrophysics Data System (ADS)

Benboujja, Fouzi; Garcia, Jordan; Beaudette, Kathy; Strupler, Mathias; Hartnick, Christopher J.; Boudoux, Caroline

2016-02-01

Excessive and repetitive force applied on vocal fold tissue can induce benign vocal fold lesions. Children affected suffer from chronic hoarseness. In this instance, the vibratory ability of the folds, a complex layered microanatomy, becomes impaired. Histological findings have shown that lesions produce a remodeling of sup-epithelial vocal fold layers. However, our understanding of lesion features and development is still limited. Indeed, conventional imaging techniques do not allow a non-invasive assessment of sub-epithelial integrity of the vocal fold. Furthermore, it remains challenging to differentiate these sub-epithelial lesions (such as bilateral nodules, polyps and cysts) from a clinical perspective, as their outer surfaces are relatively similar. As treatment strategy differs for each lesion type, it is critical to efficiently differentiate sub-epithelial alterations involved in benign lesions. In this study, we developed an optical coherence tomography (OCT) based handheld probe suitable for pediatric laryngological imaging. The probe allows for rapid three-dimensional imaging of vocal fold lesions. The system is adapted to allow for high-resolution intra-operative imaging. We imaged 20 patients undergoing direct laryngoscopy during which we looked at different benign pediatric pathologies such as bilateral nodules, cysts and laryngeal papillomatosis and compared them to healthy tissue. We qualitatively and quantitatively characterized laryngeal pathologies and demonstrated the added advantage of using 3D OCT imaging for lesion discrimination and margin assessment. OCT evaluation of the integrity of the vocal cord could yield to a better pediatric management of laryngeal diseases.

Identification of distinct layers within the stratified squamous epithelium of the adult human true vocal fold.

PubMed

Dowdall, Jayme R; Sadow, Peter M; Hartnick, Christopher; Vinarsky, Vladimir; Mou, Hongmei; Zhao, Rui; Song, Phillip C; Franco, Ramon A; Rajagopal, Jayaraj

2015-09-01

A precise molecular schema for classifying the different cell types of the normal human vocal fold epithelium is lacking. We hypothesize that the true vocal fold epithelium has a cellular architecture and organization similar to that of other stratified squamous epithelia including the skin, cornea, oral mucosa, and esophagus. In analogy to disorders of the skin and gastrointestinal tract, a molecular definition of the normal cell types within the human vocal fold epithelium and a description of their geometric relationships should serve as a foundation for characterizing cellular changes associated with metaplasia, dysplasia, and cancer. Qualitative study with adult human larynges. Histologic sections of normal human laryngeal tissue were analyzed for morphology (hematoxylin and eosin) and immunohistochemical protein expression profile, including cytokeratins (CK13 and CK14), cornified envelope proteins (involucrin), basal cells (NGFR/p75), and proliferation markers (Ki67). We demonstrated that three distinct cell strata with unique marker profiles are present within the stratified squamous epithelium of the true vocal fold. We used these definitions to establish that cell proliferation is restricted to certain cell types and layers within the epithelium. These distinct cell types are reproducible across five normal adult larynges. We have established that three layers of cells are present within the normal adult stratified squamous epithelium of the true vocal fold. Furthermore, replicating cell populations are largely restricted to the parabasal strata within the epithelium. This delineation of distinct cell populations will facilitate future studies of vocal fold regeneration and cancer. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Biomechanical simulation of vocal fold dynamics in adults based on laryngeal high-speed videoendoscopy

PubMed Central

Gómez, Pablo; Patel, Rita R.; Alexiou, Christoph; Bohr, Christopher; Schützenberger, Anne

2017-01-01

Motivation Human voice is generated in the larynx by the two oscillating vocal folds. Owing to the limited space and accessibility of the larynx, endoscopic investigation of the actual phonatory process in detail is challenging. Hence the biomechanics of the human phonatory process are still not yet fully understood. Therefore, we adapt a mathematical model of the vocal folds towards vocal fold oscillations to quantify gender and age related differences expressed by computed biomechanical model parameters. Methods The vocal fold dynamics are visualized by laryngeal high-speed videoendoscopy (4000 fps). A total of 33 healthy young subjects (16 females, 17 males) and 11 elderly subjects (5 females, 6 males) were recorded. A numerical two-mass model is adapted to the recorded vocal fold oscillations by varying model masses, stiffness and subglottal pressure. For adapting the model towards the recorded vocal fold dynamics, three different optimization algorithms (Nelder–Mead, Particle Swarm Optimization and Simulated Bee Colony) in combination with three cost functions were considered for applicability. Gender differences and age-related kinematic differences reflected by the model parameters were analyzed. Results and conclusion The biomechanical model in combination with numerical optimization techniques allowed phonatory behavior to be simulated and laryngeal parameters involved to be quantified. All three optimization algorithms showed promising results. However, only one cost function seems to be suitable for this optimization task. The gained model parameters reflect the phonatory biomechanics for men and women well and show quantitative age- and gender-specific differences. The model parameters for younger females and males showed lower subglottal pressures, lower stiffness and higher masses than the corresponding elderly groups. Females exhibited higher subglottal pressures, smaller oscillation masses and larger stiffness than the corresponding similar aged male groups. Optimizing numerical models towards vocal fold oscillations is useful to identify underlying laryngeal components controlling the phonatory process. PMID:29121085

Vocal fold self-disruption after phonotrauma on a lead actor: a case presentation.

PubMed

Behlau, Mara; Oliveira, Gisele; Pontes, Paulo

2009-11-01

It is well known that phonotraumatic events may produce laryngeal inflammation, vocal fold hemorrhage and different types of mass lesions. This study describes a vocal fold self-disruption that occurred on stage to a lead actor in the role of Richard III. The study design is as case presentation. A 43-year-old actor presented with a sudden voice loss that first occurred on stage after a series of presentations. He also had a cold-like condition that had not been treated. His past medical history included an average of ten cigarettes per day for ten years and a 10-year history of gastritis and stomach ulcer. Perceptual, acoustic, and laryngeal analyses were performed following pharmacological and voice therapy. Perceptual and acoustic analyses showed mild deviations whereas laryngeal visual examination revealed a complete right vocal fold detachment from the anterior commissure to the vocal process, with generalized hyperemia. A mild diffuse Reinke's edema was observed on the left vocal fold. Mild discomfort was present only during the first day of the acute period. Modified vocal rest was recommended and a series of vocal exercises were administered. The patient performed again 4 days later, after following a series of behavioral modification techniques that included casting guidelines during the subsequent 15 days. Healing was exceptional and his voice returned to normal. This unique case with an exceptional recovery emphasizes the etiological aspects of scar formation after phonotrauma. Positive contributing factors may include a good vocal technique and adequate training as well as the protective upregulated genes present in Reinke's edema.

Vascular lesions of the vocal fold.

PubMed

Gökcan, Kürşat Mustafa; Dursun, Gürsel

2009-04-01

The aim of the study was to present symptoms, laryngological findings, clinical course, management modalities, and consequences of vascular lesions of vocal fold. This study examined 162 patients, the majority professional voice users, with vascular lesions regarding their presenting symptoms, laryngological findings, clinical courses and treatment results. The most common complaint was sudden hoarseness with hemorrhagic polyp. Microlaryngoscopic surgery was performed in 108 cases and the main indication of surgery was the presence of vocal fold mass or development of vocal polyp during clinical course. Cold microsurgery was utilized for removal of vocal fold masses and feeding vessels cauterized using low power, pulsed CO(2) laser. Acoustic analysis of patients revealed a significant improvement of jitter, shimmer and harmonics/noise ratio values after treatment. Depending on our clinical findings, we propose treatment algorithm where voice rest and behavioral therapy is the integral part and indications of surgery are individualized for each patient.

Inducible laryngeal obstruction during exercise: moving beyond vocal cords with new insights.

PubMed

Olin, James Tod; Clary, Matthew S; Deardorff, Emily H; Johnston, Kristina; Morris, Michael J; Sokoya, Mofiyinfolu; Staudenmayer, Herman; Christopher, Kent L

2015-02-01

Exercise as an important part of life for the health and wellness of children and adults. Inducible laryngeal obstruction (ILO) is a consensus term used to describe a group of disorders previously called vocal cord dysfunction, paradoxical vocal fold motion, and numerous other terms. Exercise-ILO can impair one's ability to exercise, can be confused with asthma, leading to unnecessary prescription of asthma controller and rescue medication, and results in increased healthcare resource utilization including (rarely) emergency care. It is characterized by episodic shortness of breath and noisy breathing that generally occurs at high work rates. The present diagnostic gold standard for all types of ILO is laryngoscopic visualization of inappropriate glottic or supraglottic movement resulting in airway narrowing during a spontaneous event or provocation challenge. A number of different behavioral techniques, including speech therapy, biofeedback, and cognitive-behavioral psychotherapy, may be appropriate to treat individual patients. A consensus nomenclature, which will allow for better characterization of patients, coupled with new diagnostic techniques, may further define the epidemiology and etiology of ILO as well as enable objective evaluation of therapeutic modalities.

Vocal fold submucosal infusion technique in phonomicrosurgery.

PubMed

Kass, E S; Hillman, R E; Zeitels, S M

1996-05-01

Phonomicrosurgery is optimized by maximally preserving the vocal fold's layered microstructure (laminae propriae). The technique of submucosal infusion of saline and epinephrine into the superficial lamina propria (SLP) was examined to delineate how, when, and why it was helpful toward this surgical goal. A retrospective review revealed that the submucosal infusion technique was used to enhance the surgery in 75 of 152 vocal fold procedures that were performed over the last 2 years. The vocal fold epithelium was noted to be adherent to the vocal ligament in 29 of the 75 cases: 19 from previous surgical scarring, 4 from cancer, 3 from sulcus vocalis, 2 from chronic hemorrhage, and 1 from radiotherapy. The submucosal infusion technique was most helpful when the vocal fold epithelium required resection and/or when extensive dissection in the SLP was necessary. The infusion enhanced the surgery by vasoconstriction of the microvasculature in the SLP, which improved visualization during cold-instrument tangential dissection. Improved visualization facilitated maximal preservation of the SLP, which is necessary for optimal pliability of the overlying epithelium. The infusion also improved the placement of incisions at the perimeter of benign, premalignant, and malignant lesions, and thereby helped preserve epithelium uninvolved by the disorder.

Factors associated with vocal fold pathologies in teachers.

PubMed

Souza, Carla Lima de; Carvalho, Fernando Martins; Araújo, Tânia Maria de; Reis, Eduardo José Farias Borges Dos; Lima, Verônica Maria Cadena; Porto, Lauro Antonio

2011-10-01

To analyze factors associated with the prevalence of the medical diagnosis of vocal fold pathologies in teachers. A census-based epidemiological, cross-sectional study was conducted with 4,495 public primary and secondary school teachers in the city of Salvador, Northeastern Brazil, between March and April 2006. The dependent variable was the self-reported medical diagnosis of vocal fold pathologies and the independent variables were sociodemographic characteristics; professional activity; work organization/interpersonal relationships; physical work environment characteristics; frequency of common mental disorders, measured by the Self-Reporting Questionnaire-20 (SRQ-20 >7); and general health conditions. Descriptive statistical, bivariate and multiple logistic regression analysis techniques were used. The prevalence of self-reported medical diagnosis of vocal fold pathologies was 18.9%. In the logistic regression analysis, the variables that remained associated with this medical diagnosis were as follows: being female, having worked as a teacher for more than seven years, excessive voice use, reporting more than five unfavorable physical work environment characteristics and presence of common mental disorders. The presence of self-reported vocal fold pathologies was associated with factors that point out the need of actions that promote teachers' vocal health and changes in their work structure and organization.

Predicted singers' vocal fold lengths and voice classification-a study of x-ray morphological measures.

PubMed

Roers, Friederike; Mürbe, Dirk; Sundberg, Johan

2009-07-01

Students admitted to the solo singing education at the University of Music Dresden, Germany have been submitted to a detailed physical examination of a variety of factors with relevance to voice function since 1959. In the years 1959-1991, this scheme of examinations included X-ray profiles of the singers' vocal tracts. This material of 132 X-rays of voice professionals was used to investigate different laryngeal morphological measures and their relation to vocal fold length. Further, the study aimed to investigate if there are consistent anatomical differences between singers of different voice classifications. The study design used was a retrospective analysis. Vocal fold length could be measured in 29 of these singer subjects directly. These data showed a strong correlation with the anterior-posterior diameter of the subglottis and the trachea as well as with the distance from the anterior contour of the thyroid cartilage to the anterior contour of the spine. These relations were used in an attempt to predict the 132 singers' vocal fold lengths. The results revealed a clear covariation between predicted vocal fold length and voice classification. Anterior-posterior subglottic-tracheal diameter yielded mean vocal fold lengths of 14.9, 16.0, 16.6, 18.4, 19.5, and 20.9mm for sopranos, mezzo-sopranos, altos, tenors, baritones, and basses, respectively. The data support the assumption that there are consistent anatomical laryngeal differences between singers of different voice classifications, which are of relevance to pitch range and timbre of the voice.

[Phoniatric surgery and conservative treatment of vocal cord hematoma].

PubMed

Milutinović, Z

1997-01-01

Functional-traumatic lesions of the vocal fold include mucous stranding, "nodular" lesions, polyps, cysts, contact hyperplasia and haematoma of the vocal fold. An acute voice overuse may result in bleeding (haematoma) within the vocal fold. This may be in the form of petechial bleeding, or a genuine haematoma develops within the tissues of the vocal fold. Haematoma may also arise as a consequence of prolonged cough, forceful vomiting, lifting of a heavy weight, various effortful activities, etc. Haematoma is usually located close to the vocal fold free edge and therefore disturbs the glottic closure during phonation. The treatment is adapted to the size and localization of haematoma, as well as to the time elapsed from onset of the lesion. Phonosurgery can be used in therapy, as well as corticosteroid treatment. A series of 102 vocal fold haematomas has been treated by phonosurgery (39) and conservative therapy (63). Phonosurgical interventions were performed by an indirect approach, by use of microstroboscopy (28 patients) and videostroboscopy (11 causes). Conservative treatment consisted of corticosteroid therapy. During a 10-year period 1550 phonosurgical operations were performed for benign lesions of the vocal fold, including 39 haematomas (2.5%). It was established that recovery of vibration pattern was significantly faster in the surgery group in comparison to the group of patients treated conservatively. All surgical patients were operated within the first several days after the onset of symptoms. In case of a vocal fold haematoma, it is very important to establish the diagnosis as soon as possible in order to start with the therapy early enough. Within the first several days after the onset (the best within 24-48 hours) a phonosurgical treatment is indicated, preferably by the use of indirect videostroboscopy. If the treatment is started later we use corticoids. However, the results are inferior as compared to surgery. We did not perform direct microlaryngoscopy in these cases, for a lack of function monitoring and possible local trauma to the tissues. In the majority of cases the voice therapy is required as well.

Vibrational dynamics of vocal folds using nonlinear normal modes.

PubMed

Pinheiro, Alan P; Kerschen, Gaëtan

2013-08-01

Many previous works involving physical models, excised and in vivo larynges have pointed out nonlinear vibration in vocal folds during voice production. Moreover, theoretical studies involving mechanical modeling of these folds have tried to gain a profound understanding of the observed nonlinear phenomena. In this context, the present work uses the nonlinear normal mode theory to investigate the nonlinear modal behavior of 16 subjects using a two-mass mechanical modeling of the vocal folds. The free response of the conservative system at different energy levels is considered to assess the impact of the structural nonlinearity of the vocal fold tissues. The results show very interesting and complex nonlinear phenomena including frequency-energy dependence, subharmonic regimes and, in some cases, modal interactions, entrainment and bifurcations. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

[Vocal cord paralysis associated with tracheal intubation: incidence, risk analysis, and classification of severity].

PubMed

Kikura, Mutsuhito; Suzuki, Yuji; Itagaki, Taiga; Sato, Tsunehisa; Nishino, Junko

2015-01-01

Vocal cord paralysis after tracheal intubation is rare. It causes severe hoarseness and aspiration, and delays recovery and discharge. Arytenoid cartilage dislocation and recurrent nerve paralysis are main causes of vocal cord paralysis. Physical stimulation of the tracheal tube as well as patient and surgical characteristics also contribute. Vocal cord paralysis occurs in 1 (0.07%) of 1,500 general surgery patients and on the left side in 70% of cases. It is associated with surgery/anesthesia time (two-fold, 3-6 hours; 15-fold, over 6 hours), age (three-fold, over 50 years), and diabetes mellitus or hypertension (two-fold). Symptoms resolve in 2-3 months. In adult cardiovascular surgery, vocal cord paralysis occurs in 1 (0.7-2%) of 50-100 cardiac surgery patients and 1 (8.6-32%) of 3-10 thoracic aortic surgery patients. In pediatric cardiac surgery, vocal cord paralysis occurs in 1 (0.1-0.5%) of 200-1,000 patients. We classified the severity of vocal cord paralysis as I, severe hoarseness; II, aspiration or dysphagia; and III, bilateral vocal cord paralysis, aspiration pneumonia, or the need for tracheal re-intubation or tracheotomy. We discuss the importance of informed consent for the patient and family.

Examining diseased states in a scaled-up vocal fold model using simultaneous temporally resolved DPIV and pressure measurements

NASA Astrophysics Data System (ADS)

Rogers, Dylan; Wei, Nathaniel; Ringenber, Hunter; Krane, Michael; Wei, Timothy

2017-11-01

This study builds on the parallel presentation of Ringenberg, et al. (APS-DFD 2017) involving simultaneous, temporally and spatially resolved flow and pressure measurements in a scaled-up vocal fold model. In this talk, data from experiments replicating characteristics of diseased vocal folds are presented. This begins with vocal folds that do not fully close and continues with asymmetric oscillations. Data are compared to symmetric, i.e. `healthy', oscillatory motions presented in the companion talk. Having pressure and flow data for individual as well as phase averaged oscillations for these diseased cases highlights the potential for aeroacoustic analysis in this complex system. Supported by NIH Grant No. 2R01 DC005642-11.

Change to earlier surgical interventions: contemporary management of unilateral vocal fold paralysis.

PubMed

Costello, Declan

2015-06-01

The management of unilateral vocal fold paralysis has undergone significant changes in the last 2 decades. This has largely been made possible by advances in endoscope technology and new injectable materials. This article will cover the main changes in management of patients with unilateral vocal fold paralysis and summarize the recent literature in relation to early intervention in this group. Several recent studies have suggested that early vocal fold injection medialization reduces the likelihood of needing open laryngeal framework surgery in future. Early injection medialization appears to give good long-term results with few complications and minimizes the need for future laryngeal framework surgery. It should be considered in centres wherein the equipment and trained staff are available.

Human mutant huntingtin disrupts vocal learning in transgenic songbirds.

PubMed

Liu, Wan-Chun; Kohn, Jessica; Szwed, Sarah K; Pariser, Eben; Sepe, Sharon; Haripal, Bhagwattie; Oshimori, Naoki; Marsala, Martin; Miyanohara, Atsushi; Lee, Ramee

2015-11-01

Speech and vocal impairments characterize many neurological disorders. However, the neurogenetic mechanisms of these disorders are not well understood, and current animal models do not have the necessary circuitry to recapitulate vocal learning deficits. We developed germline transgenic songbirds, zebra finches (Taneiopygia guttata) expressing human mutant huntingtin (mHTT), a protein responsible for the progressive deterioration of motor and cognitive function in Huntington's disease (HD). Although generally healthy, the mutant songbirds had severe vocal disorders, including poor vocal imitation, stuttering, and progressive syntax and syllable degradation. Their song abnormalities were associated with HD-related neuropathology and dysfunction of the cortical-basal ganglia (CBG) song circuit. These transgenics are, to the best of our knowledge, the first experimentally created, functional mutant songbirds. Their progressive and quantifiable vocal disorder, combined with circuit dysfunction in the CBG song system, offers a model for genetic manipulation and the development of therapeutic strategies for CBG-related vocal and motor disorders.

Singers' interest and knowledge levels of vocal function and dysfunction: survey findings.

PubMed

Braun-Janzen, Colleen; Zeine, Lina

2009-07-01

A questionnaire investigating the levels of interest in and knowledge of vocal function and dysfunction was completed by 129 singers. Those with professional singing experience indicated significantly greater interest and higher perceived knowledge levels than amateurs in areas of vocal anatomy and physiology, vocal hygiene, and functional vocal pathologies. Greater interest levels, but not higher perceived knowledge levels were reported by professional singers (PSs) in the area of the role of the speech-language pathologist (SLP) and the voice. Professionals answered significantly more knowledge-based questions correctly than amateurs in all areas except the role of the SLP and the voice. However, findings indicated wide variability in knowledge levels of both groups. Singing teachers (STs) within the group significantly outperformed the remainder of the group in areas of vocal anatomy and physiology, vocal hygiene, and functional vocal pathologies. Scores of the choir directors (CDs) within the group were not significantly superior to the remainder of the group except in the area of functional vocal pathologies. Implications for a preventative approach to vocal health are discussed.

Effect of artificially lengthened vocal tract on vocal fold oscillation's fundamental frequency.

PubMed

Hanamitsu, Masakazu; Kataoka, Hideyuki

2004-06-01

The fundamental frequency of vocal fold oscillation (F(0)) is controlled by laryngeal mechanics and aerodynamic properties. F(0) change per unit change of transglottal pressure (dF/dP) using a shutter valve has been studied and found to have nonlinear, V-shaped relationship with F(0). On the other hand, the vocal tract is also known to affect vocal fold oscillation. This study examined the effect of artificially lengthened vocal tract length on dF/dP. dF/dP was measured in six men using two mouthpieces of different lengths. The dF/dP graph for the longer vocal tract was shifted leftward relative to the shorter one. Using the one-mass model, the nadir of the "V" on the dF/dP graph was strongly influenced by the resonance around the first formant frequency. However, a more precise model is needed to account for the effects of viscosity and turbulence.

Viscosities of implantable biomaterials in vocal fold augmentation surgery.

PubMed

Chan, R W; Titze, I R

1998-05-01

Vocal fold vibration depends critically on the viscoelasticity of vocal fold tissues. For instance, phonation threshold pressure, a measure of the "ease" of phonation, has been shown to be directly related to the viscosity of the vibrating mucosa. Various implantable biomaterials have been used in vocal fold augmentation surgery, with implantation sites sometimes close to or inside the mucosa. Yet their viscosities or other mechanical properties are seldom known. This study attempts to provide data on viscosities of commonly used phonosurgical biomaterials. Using a parallel-plate rotational rheometer, oscillatory shear experiments were performed on implantable polytetrafluoroethylene (Teflon or Polytef; Mentor Inc., Hingham, MA), collagen (Zyderm; Collagen Corp., Palo Alto, CA), glutaraldehyde crosslinked (GAX) collagen (Phonagel or Zyplast; Collagen Corp.), absorbable gelatin (Gelfoam; Upjohn Co., Kalamazoo, MI), and human abdominal subcutaneous fat. Samples of human vocal fold mucosal tissues were also tested. Under sinusoidal oscillatory shear at 10 Hz and at 37 degrees C, the dynamic viscosity was 116 Pascal-seconds (Pa-s) for polytetrafluoroethylene, 21 Pa-s for gelatin, 8-13 Pa-s for the two types of collagen, 3 Pa-s for fat, and 1 to 3 Pa-s for vocal fold mucosa. Results extrapolated to 100 Hz also show similar differences among the biomaterials, but all values are an order of magnitude lower because of the typical inverse frequency relation (shear thinning effect) for polymeric and biologic materials. The data suggest that the use of fat for vocal fold augmentation may be more conducive to the "ease" of phonation because of its relatively low viscosity, which is closest to physiologic levels. This implication is probably the most relevant in predicting initial outcome of the postoperative voice before there is any significant assimilation (e.g., resorption and fibrosis) of the implanted biomaterial.

Nonlinear laser scanning microscopy of human vocal folds.

PubMed

Miri, Amir K; Tripathy, Umakanta; Mongeau, Luc; Wiseman, Paul W

2012-02-01

The purpose of this work was to apply nonlinear laser scanning microscopy (NLSM) for visualizing the morphology of extracellular matrix proteins within human vocal folds. This technique may potentially assist clinicians in making rapid diagnoses of vocal fold tissue disease or damage. Microstructural characterization based on NLSM provides valuable information for better understanding molecular mechanisms and tissue structure. Experimental, ex vivo human vocal fold. A custom-built multimodal nonlinear laser scanning microscope was used to scan fibrillar proteins in three 4% formaldehyde-fixed cadaveric samples. Collagen and elastin, key extracellular matrix proteins in the vocal fold lamina propria, were imaged by two nonlinear microscopy modalities: second harmonic generation (SHG) and two-photon fluorescence (TPF), respectively. An experimental protocol was introduced to characterize the geometrical properties of the imaged fibrous proteins. NLSM revealed the biomorphology of the human vocal fold fibrous proteins. No photobleaching was observed for the incident laser power of ∼60 mW before the excitation objective. Types I and III fibrillar collagen were imaged without label in the tissue by intrinsic SHG. Imaging while rotating the incident laser light-polarization direction confirmed a helical shape for the collagen fibers. The amplitude, periodicity, and overall orientation were then computed for the helically distributed collagen network. The elastin network was simultaneously imaged via TPF and found to have a basket-like structure. In some regions, particularly close to the epithelium, colocalization of both extracellular matrix components were observed. A benchmark study is presented for quantitative real-time, ex vivo, NLSM imaging of the extracellular macromolecules in human vocal fold lamina propria. The results are promising for clinical applications. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Modeling the Pathophysiology of Phonotraumatic Vocal Hyperfunction with a Triangular Glottal Model of the Vocal Folds

ERIC Educational Resources Information Center

Galindo, Gabriel E.; Peterson, Sean D.; Erath, Byron D.; Castro, Christian; Hillman, Robert E.; Zañartu, Matías

2017-01-01

Purpose: Our goal was to test prevailing assumptions about the underlying biomechanical and aeroacoustic mechanisms associated with phonotraumatic lesions of the vocal folds using a numerical lumped-element model of voice production. Method: A numerical model with a triangular glottis, posterior glottal opening, and arytenoid posturing is…

The effect of a voiced lip trill on estimated glottal closed quotient.

PubMed

Gaskill, Christopher S; Erickson, Molly L

2008-11-01

The use of lip trills has been advocated for both vocal habilitation and rehabilitation. A voiced lip trill requires continuous vibration of the lips while simultaneously maintaining phonation. The mechanism of any effects of a lip trill on vocal fold vibration is still unknown. While other techniques that either constrict or artificially lengthen the vocal tract have been investigated, no studies thus far have systematically examined the effect of lip trills on vocal fold vibration. Classically trained singers and vocally untrained participants produced a lip trill for approximately 1 minute, and vocal fold closed quotient (CQ) was calculated both during the lip trill and on a sustained spoken vowel before and after the trill. Data are reported for both a group design and a single-subject design. Most participants showed a tendency for a reduction in CQ during the lip trill, with a more pronounced change in the untrained participants.

A bioreactor for the dynamic mechanical stimulation of vocal-fold fibroblasts based on vibro-acoustography

NASA Astrophysics Data System (ADS)

Chan, Roger W.; Rodriguez, Maritza

2005-09-01

During voice production, the vocal folds undergo airflow-induced self-sustained oscillation at a fundamental frequency of around 100-1000 Hz, with an amplitude of around 1-3 mm. The vocal-fold extracellular matrix (ECM), with appropriate tissue viscoelastic properties, is optimally tuned for such vibration. Vocal-fold fibroblasts regulate the gene expressions for key ECM proteins (e.g., collagen, fibronectin, fibromodulin, and hyaluronic acid), and these expressions are affected by the stress fields experi- enced by the fibroblasts. This study attempts to develop a bioreactor for cultivating cells under a micromechanical environment similar to that in vivo, based on the principle of vibro-acoustography. Vocal-fold fibroblasts from primary culture were grown in 3D, biodegradable scaffolds, and were excited dynamically by the radiation force generated by amplitude modulation of two confocal ultrasound beams of slightly different frequencies. Low-frequency acoustic radiation force was applied to the scaffold surface, and its vibratory response was imaged by videostroboscopy. A phantom tissue (standard viscoelastic material) with known elastic modulus was also excited and its vibratory frequency and amplitude were measured by videostroboscopy. Results showed that the bioreactor was capable of delivering mechanical stimuli to the tissue constructs in a physiological frequency range (100-1000 Hz), supporting its potential for vocal-fold tissue engineering applications. [Work supported by NIH Grant R01 DC006101.

Pulsed dye laser application in ablation of vascular ectasias of the larynx: a preliminary animal study

NASA Astrophysics Data System (ADS)

Woo, Peak; Wang, Zhi; Perrault, Donald F., Jr.; McMillan, Kathleen; Pankratov, Michail M.

1995-05-01

Vascular ectasias (dilatation) and vascular lesions of the larynx are difficult to treat with exciting modalities. Varix (enlarged vessel) of the vocal folds, vocal fold hemorrhage, vascular polyp, hemangioma, intubation or contact granuloma are common problems which disturb voice. Current applications of CO2 laser and cautery often damage the delicate vocal fold cover. The 585 nm dermatologic pulsed dye laser may be an ideal substitute. Two adult canines were examined under anesthesia via microlaryngoscopy technique. Pulsed dye laser (SPTL-1a, Candela Laser Corp., Wayland, MA) energy was delivered via the micromanipulator with the 3.1-mm spot size in single pulses of 6, 8, and 10 Joules/cm2 and applied to the vessels of the vocal folds, epiglottis, and arytenoid cartilage. Endoscopic examination was carried out immediately after the treatment and at 4 weeks postoperatively. The animals were sacrificed at 3 weeks, larynges excised, and whole organ laryngeal section were prepared for histology. Pulsed dye laser thrombosed vessels of the vocal fold using 6 or 8 Joules/cm2. Vascular break and leakage occurred at 10 Joules/cm2. Follow up examination showed excellent vessel obliteration or thrombosis without scarring or injury to the overlying tissues. Histologic examination shows vascular thrombosis without inflammation and fibrosis in the vocal fold cover. Pulsed dye laser may have promise in treatment of vascular lesions of the larynx and upper airway.

Modified arytenoid adduction for cancer-related unilateral vocal fold paralysis.

PubMed

Shi, J; Chen, S; Chen, D; Wang, W; Xia, S; Zheng, H

2011-02-01

(1) To evaluate the efficacy of modified arytenoid adduction in the management of patients with symptomatic cancer-related unilateral vocal fold paralysis, and (2) to assess the impact of this treatment on patients' quality of life. Forty-two patients with cancer-related unilateral vocal fold paralysis underwent modified arytenoid adduction between February 2001 and December 2008. Of these, 37 patients were enrolled in this retrospective study (one patient died of primary disease and four were lost to follow up). Laryngostroboscopy was performed to evaluate vocal fold orientation and mobility. Pre- and post-operative assessment of subjective and objective voice, aerodynamic parameters, and quality of life were also undertaken, and aspiration was subjectively rated. Laryngostroboscopic findings indicated a significant post-operative improvement in vocal fold posterior glottal closure and vertical gap. Significant improvements in voice quality, aerodynamic parameters and quality of life were noted three months post-operatively in all patients (p < 0.01). The overall success rate for swallowing rehabilitation was 94.6 per cent (35/37). Subjective aspiration ratings decreased significantly post-operatively, compared with pre-operative values (p < 0.01). No major complication occurred in any patient, except for dyspnoea in one patient. Modified arytenoid adduction is an effective and reliable medialisation technique which can restore satisfactory voice quality, prevent aspiration and lead to a better quality of life for patients with cancer-related unilateral vocal fold paralysis.

Effects of Dehydration on the Viscoelastic Properties of Vocal Folds in Large Deformations

PubMed Central

Miri, Amir K.; Barthelat, François; Mongeau, Luc

2012-01-01

Summary Dehydration may alter vocal fold viscoelastic properties, which may hamper phonation. The effects of water loss induced by an osmotic-pressure potential on vocal fold tissue viscoelastic properties were investigated. Porcine vocal folds were dehydrated by immersion in a hypertonic solution, and quasi-static and low-frequency dynamic traction tests were performed for elongations of up to 50%. Digital image correlation was used to determine local strains from surface deformations. The elastic modulus and the loss factor were then determined for normal and dehydrated tissues. An eight-chain hyperelastic model was used to describe the observed nonlinear stress-stretch behavior. Contrary to expectations, the mass history indicated that the tissue absorbed water during cyclic extension when submerged in a hypertonic solution. During loading history, the elastic modulus was increased for dehydrated tissues as a function of strain. The response of dehydrated tissues was much less affected when the load was releasing. This calls more attention to the modeling of vocal folds in micromechanics modeling. The internal hysteresis, which is often linked to phonation effort, increased significantly with water loss. The effects of dehydration on the viscoelastic properties of vocal fold tissue were quantified in a systematic way. The results will contribute to a better understanding of the basic biomechanics of voice production and ultimately will help establish objective dehydration and phonotrauma criteria. PMID:22483778

Fully-coupled aeroelastic simulation with fluid compressibility — For application to vocal fold vibration

PubMed Central

Yang, Jubiao; Wang, Xingshi; Krane, Michael; Zhang, Lucy T.

2017-01-01

In this study, a fully-coupled fluid–structure interaction model is developed for studying dynamic interactions between compressible fluid and aeroelastic structures. The technique is built based on the modified Immersed Finite Element Method (mIFEM), a robust numerical technique to simulate fluid–structure interactions that has capabilities to simulate high Reynolds number flows and handles large density disparities between the fluid and the solid. For accurate assessment of this intricate dynamic process between compressible fluid, such as air and aeroelastic structures, we included in the model the fluid compressibility in an isentropic process and a solid contact model. The accuracy of the compressible fluid solver is verified by examining acoustic wave propagations in a closed and an open duct, respectively. The fully-coupled fluid–structure interaction model is then used to simulate and analyze vocal folds vibrations using compressible air interacting with vocal folds that are represented as layered viscoelastic structures. Using physiological geometric and parametric setup, we are able to obtain a self-sustained vocal fold vibration with a constant inflow pressure. Parametric studies are also performed to study the effects of lung pressure and vocal fold tissue stiffness in vocal folds vibrations. All the case studies produce expected airflow behavior and a sustained vibration, which provide verification and confidence in our future studies of realistic acoustical studies of the phonation process. PMID:29527067

Subglottal pressure and fundamental frequency control in contact calls of juvenile Alligator mississippiensis

PubMed Central

Riede, Tobias; Tokuda, Isao T.; Farmer, C. G.

2011-01-01

SUMMARY Vocalization is rare among non-avian reptiles, with the exception of the crocodilians, the sister taxon of birds. Crocodilians have a complex vocal repertoire. Their vocal and respiratory system is not well understood but appears to consist of a combination of features that are also found in the extremely vocal avian and mammalian taxa. Anatomical studies suggest that the alligator larynx is able to abduct and adduct the vocal folds, but not to elongate or shorten them, and is therefore lacking a key regulator of frequency, yet alligators can modulate fundamental frequency remarkably well. We investigated the morphological and physiological features of sound production in alligators. Vocal fold length scales isometrically across a wide range of alligator body sizes. The relationship between fundamental frequency and subglottal pressure is significant in some individuals at some isolated points, such as call onset and position of maximum fundamental frequency. The relationship is not consistent over large segments of the call. Fundamental frequency can change faster than expected by pressure changes alone, suggesting an active motor pattern controls frequency and is intrinsic to the larynx. We utilized a two-mass vocal fold model to test whether abduction and adduction could generate this motor pattern. The fine-tuned interplay between subglottal pressure and glottal adduction can achieve frequency modulations much larger than those resulting from subglottal pressure variations alone and of similar magnitude, as observed in alligator calls. We conclude that the alligator larynx represents a sound source with only two control parameters (subglottal pressure and vocal fold adduction) in contrast to the mammalian larynx in which three parameters can be altered to modulate frequency (subglottal pressure, vocal fold adduction and length/tension). PMID:21865521

Vocal Fold Pathologies and Three-Dimensional Flow Separation Phenomena

NASA Astrophysics Data System (ADS)

Apostoli, Adam G.; Weiland, Kelley S.; Plesniak, Michael W.

2013-11-01

Polyps and nodules are two different pathologies, which are geometric abnormalities that form on the medial surface of the vocal folds, and have been shown to significantly disrupt a person's ability to communicate. Although the mechanism by which the vocal folds self-oscillate and the three-dimensional nature of the glottal jet has been studied, the effect of irregularities caused by pathologies is not fully understood. Examining the formation and evolution of vortical structures created by a geometric protuberance is important, not only for understanding the aerodynamic forces exerted by these structures on the vocal folds, but also in the treatment of the above-mentioned pathological conditions. Using a wall-mounted prolate hemispheroid with a 2:1 aspect ratio in cross flow, the present investigation considers three-dimensional flow separation induced by a model vocal fold polyp. Building on previous work using skin friction line visualization, both the velocity flow field and wall pressure measurements around the model polyp are presented and compared. Supported by the National Science Foundation, Grant No. CBET-1236351 and GW Center for Biomimetics and Bioinspired Engineering (COBRE).

A mixed-effects model approach for the statistical analysis of vocal fold viscoelastic shear properties.

PubMed

Xu, Chet C; Chan, Roger W; Sun, Han; Zhan, Xiaowei

2017-11-01

A mixed-effects model approach was introduced in this study for the statistical analysis of rheological data of vocal fold tissues, in order to account for the data correlation caused by multiple measurements of each tissue sample across the test frequency range. Such data correlation had often been overlooked in previous studies in the past decades. The viscoelastic shear properties of the vocal fold lamina propria of two commonly used laryngeal research animal species (i.e. rabbit, porcine) were measured by a linear, controlled-strain simple-shear rheometer. Along with published canine and human rheological data, the vocal fold viscoelastic shear moduli of these animal species were compared to those of human over a frequency range of 1-250Hz using the mixed-effects models. Our results indicated that tissues of the rabbit, canine and porcine vocal fold lamina propria were significantly stiffer and more viscous than those of human. Mixed-effects models were shown to be able to more accurately analyze rheological data generated from repeated measurements. Copyright © 2017 Elsevier Ltd. All rights reserved.

Biosimulation of Inflammation and Healing in Surgically Injured Vocal Folds

PubMed Central

Li, Nicole Y. K.; Vodovotz, Yoram; Hebda, Patricia A.; Abbott, Katherine Verdolini

2010-01-01

Objectives The pathogenesis of vocal fold scarring is complex and remains to be deciphered. The current study is part of research endeavors aimed at applying systems biology approaches to address the complex biological processes involved in the pathogenesis of vocal fold scarring and other lesions affecting the larynx. Methods We developed a computational agent-based model (ABM) to quantitatively characterize multiple cellular and molecular interactions involved in inflammation and healing in vocal fold mucosa after surgical trauma. The ABM was calibrated with empirical data on inflammatory mediators (eg, tumor necrosis factor) and extracellular matrix components (eg, hyaluronan) from published studies on surgical vocal fold injury in the rat population. Results The simulation results reproduced and predicted trajectories seen in the empirical data from the animals. Moreover, the ABM studies suggested that hyaluronan fragments might be the clinical surrogate of tissue damage, a key variable that in these simulations both is enhanced by and further induces inflammation. Conclusions A relatively simple ABM such as the one reported in this study can provide new understanding of laryngeal wound healing and generate working hypotheses for further wet-lab studies. PMID:20583741

Correlation of phonatory behavior with vocal fold structure, observed in a physical model

NASA Astrophysics Data System (ADS)

Krane, Michael; Walters, Gage; McPhail, Michael

2017-11-01

The effect of vocal fold shape and internal structure on phonation was studied experimentally using a physical model of the human airway. Model folds used a ``M5'' or a swept ellipse coronal cross-section shape. Models were molded in either 2 or three layers. Two-layer models included a more stiff ``body'' layer and a much softer ``cover'' layer, while the 3-layer models also incorporated an additional, thin, ``ligament/conus'' layer stiffer than the body layer. The elliptical section models were all molded in 3 such layers. Measurements of transglottal pressure, volume flow, mouth sound pressure, and high-speed imaging of vocal fold vibration were performed. These show that models with the ``ligament'' layer experienced much attenuated vertical deformation, that glottal closure was more likely, and that phonation was much easier to initiate. These findings suggest that the combination of the vocal ligament and the conus elasticus stabilize the vocal fold for efficient phonation by limiting vertical deformation, while allowing transverse deformations to occur. Acknowledge support from NIH DC R01005642-11.

Combining Multiobjective Optimization and Cluster Analysis to Study Vocal Fold Functional Morphology

PubMed Central

Palaparthi, Anil; Riede, Tobias

2017-01-01

Morphological design and the relationship between form and function have great influence on the functionality of a biological organ. However, the simultaneous investigation of morphological diversity and function is difficult in complex natural systems. We have developed a multiobjective optimization (MOO) approach in association with cluster analysis to study the form-function relation in vocal folds. An evolutionary algorithm (NSGA-II) was used to integrate MOO with an existing finite element model of the laryngeal sound source. Vocal fold morphology parameters served as decision variables and acoustic requirements (fundamental frequency, sound pressure level) as objective functions. A two-layer and a three-layer vocal fold configuration were explored to produce the targeted acoustic requirements. The mutation and crossover parameters of the NSGA-II algorithm were chosen to maximize a hypervolume indicator. The results were expressed using cluster analysis and were validated against a brute force method. Results from the MOO and the brute force approaches were comparable. The MOO approach demonstrated greater resolution in the exploration of the morphological space. In association with cluster analysis, MOO can efficiently explore vocal fold functional morphology. PMID:24771563

Biosimulation of inflammation and healing in surgically injured vocal folds.

PubMed

Li, Nicole Y K; Vodovotz, Yoram; Hebda, Patricia A; Abbott, Katherine Verdolini

2010-06-01

The pathogenesis of vocal fold scarring is complex and remains to be deciphered. The current study is part of research endeavors aimed at applying systems biology approaches to address the complex biological processes involved in the pathogenesis of vocal fold scarring and other lesions affecting the larynx. We developed a computational agent-based model (ABM) to quantitatively characterize multiple cellular and molecular interactions involved in inflammation and healing in vocal fold mucosa after surgical trauma. The ABM was calibrated with empirical data on inflammatory mediators (eg, tumor necrosis factor) and extracellular matrix components (eg, hyaluronan) from published studies on surgical vocal fold injury in the rat population. The simulation results reproduced and predicted trajectories seen in the empirical data from the animals. Moreover, the ABM studies suggested that hyaluronan fragments might be the clinical surrogate of tissue damage, a key variable that in these simulations both is enhanced by and further induces inflammation. A relatively simple ABM such as the one reported in this study can provide new understanding of laryngeal wound healing and generate working hypotheses for further wet-lab studies.

Aerodynamically and acoustically driven modes of vibration in a physical model of the vocal folds.

PubMed

Zhang, Zhaoyan; Neubauer, Juergen; Berry, David A

2006-11-01

In a single-layered, isotropic, physical model of the vocal folds, distinct phonation types were identified based on the medial surface dynamics of the vocal fold. For acoustically driven phonation, a single, in-phase, x-10 like eigenmode captured the essential dynamics, and coupled with one of the acoustic resonances of the subglottal tract. Thus, the fundamental frequency appeared to be determined primarily by a subglottal acoustic resonance. In contrast, aerodynamically driven phonation did not naturally appear in the single-layered model, but was facilitated by the introduction of a vertical constraint. For this phonation type, fundamental frequency was relatively independent of the acoustic resonances, and two eigenmodes were required to capture the essential dynamics of the vocal fold, including an out-of-phase x-11 like eigenmode and an in-phase x-10 like eigenmode, as described in earlier theoretical work. The two eigenmodes entrained to the same frequency, and were decoupled from subglottal acoustic resonances. With this independence from the acoustic resonances, vocal fold dynamics appeared to be determined primarily by near-field, fluid-structure interactions.

PubMed Central

SCHINDLER, A.; MOZZANICA, F.; GINOCCHIO, D.; MARUZZI, P.; ATAC, M.; OTTAVIANI, F.

2012-01-01

SUMMARY Benign vocal fold lesions are common in the general population, and have important public health implications and impact on patient quality of life. Nowadays, phonomicrosurgery is the most common treatment of these lesions. Voice therapy is generally associated in order to minimize detrimental vocal behaviours that increase the stress at the mid-membranous vocal folds. Nonetheless, the most appropriate standard of care for treating benign vocal fold lesion has not been established. The aim of this study was to analyze voice changes in a group of dysphonic patients affected by benign vocal fold lesions, evaluated with a multidimensional protocol before and after voice therapy. Sixteen consecutive patients, 12 females and 4 males, with a mean age of 49.7 years were enrolled. Each subject had 10 voice therapy sessions with an experienced speech/language pathologist for a period of 1-2 months, and was evaluated before and at the end of voice therapy with a multidimensional protocol that included self-assessment measures and videostroboscopic, perceptual, aerodynamic and acoustic ratings. Videostroboscopic examination did not reveal resolution of the initial pathology in any case. No improvement was observed in aerodynamic and perceptual ratings. A clear and significant improvement was visible on Wilcoxon signed-rank test for the mean values of Jitt%, Noise to Harmonic Ratio (NHR) and Voice Handicap Index (VHI) scores. Even if it is possible that, for benign vocal fold lesions, only a minor improvement of voice quality can be achieved after voice therapy, rehabilitation treatment still seems useful as demonstrated by improvement in self-assessment measures. If voice therapy is provided as an initial treatment to the patients with benign vocal fold lesions, this may lead to an improvement in the perceived voice quality, making surgical intervention unnecessary. This is one of the first reports on the efficacy of voice therapy in the management of benign vocal fold lesions; further studies are needed to confirm these preliminary data. PMID:23326009

Resonance tube phonation in water: High-speed imaging, electroglottographic and oral pressure observations of vocal fold vibrations--a pilot study.

PubMed

Granqvist, Svante; Simberg, Susanna; Hertegård, Stellan; Holmqvist, Sofia; Larsson, Hans; Lindestad, Per-Åke; Södersten, Maria; Hammarberg, Britta

2015-10-01

Phonation into glass tubes ('resonance tubes'), keeping the free end of the tube in water, has been a frequently used voice therapy method in Finland and more recently also in other countries. The purpose of this exploratory study was to investigate what effects tube phonation with and without water has on the larynx. Two participants were included in the study. The methods used were high-speed imaging, electroglottographic observations of vocal fold vibrations, and measurements of oral pressure during tube phonation. Results showed that the fluctuation in the back pressure during tube phonation in water altered the vocal fold vibrations. In the high-speed imaging, effects were found in the open quotient and amplitude variation of the glottal opening. The open quotient increased with increasing water depth (from 2 cm to 6 cm). A modulation effect by the water bubbles on the vocal fold vibrations was seen both in the high-speed glottal area tracings and in the electroglottography signal. A second experiment revealed that the increased average oral pressure was largely determined by the water depth. The increased open quotient can possibly be explained by an increased abduction of the vocal folds and/or a reduced transglottal pressure. The back pressure of the bubbles also modulates glottal vibrations with a possible 'massage' effect on the vocal folds. This effect and the well-defined average pressure increase due to the known water depth are different from those of other methods using a semi-occluded vocal tract.

Real-time, high-resolution ultrasonography of the vocal folds--a prospective pilot study in patients before and after thyroidectomy.

PubMed

Dedecjus, Marek; Adamczewski, Zbigniew; Brzeziński, Jan; Lewiński, Andrzej

2010-09-01

The aim of the study was to evaluate the functionality of vocal folds (VF) by real-time, high-resolution ultrasonography (US) and to correlate the imaged features to results of laryngological examination (LE). The study group comprised 50 patients (41 females and nine males), qualified to thyroidectomy. All the patients had LE and US examination before and 2 days, 2 months, and 3 months after the surgery. We used high-resolution US imaging to identify VFs and, subsequently, a pulsed Doppler and Doppler gate to quantify the tissue displacement velocity in the vibrating VF section. LE revealed unilateral VF paralysis in two patients. VF dysfunction was diagnosed in other four subjects. In simultaneously performed US examination, changes in VF displacement velocity (VFDV) were observed in ten patients. In two subjects, VFDV was below 30 cm/s- patients with VF paralysis, diagnosed in LE. In a further eight cases, we observed VFDV decrease by 50%, comparing to preoperative values. Both US-imaging and LE, performed after the 3-month follow-up, confirmed the transitional character of the above-mentioned pathologies. US imaging of the VFs correlated with LE results, while being a minimally invasive, easily reproducible, and inexpensive method of examining VF functionality. Thanks to many recording options, it may soon become a perfect tool for an early identification of postoperative VF dysfunction with its later monitoring. To our knowledge, it is the first application of US and Doppler gate modes for VFDF quantification; however, an analysis on a larger group of patients is necessary to standardize the technique.

Cricothyroid Muscle Botulinum Toxin Injection to Improve Airway for Bilateral Recurrent Laryngeal Nerve Paralysis, A Case Series.

PubMed

Benninger, Michael S; Hanick, Andrea; Hicks, Douglas M

2016-01-01

Bilateral vocal fold paralysis most commonly results from iatrogenic trauma to the recurrent laryngeal nerve during surgical procedures in the anterior neck. Patients may require tracheostomy because of acute or gradual onset of dyspnea and airway compromise. The intralaryngeal injection of Botox has been considered as a possible therapy for these airway symptoms of bilateral vocal fold paralysis. Chronic unopposed activity of intact cricothyroid muscles could potentially result in gradual medialization of the vocal folds in patients with bilateral recurrent laryngeal nerve paralysis. This case series describes three patients who successfully underwent injections of botulinum toxin into the bilateral cricothyroid muscles to offer sustained relief of dyspnea resulting from bilateral vocal fold paralysis. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Bipedicled strap muscle transposition for vocal fold deficit after laser cordectomy in early glottic cancer patients.

PubMed

Su, Chih-Ying; Chuang, Hui-Ching; Tsai, Shang-Shyue; Chiu, Jeng-Fen

2005-03-01

In treating early glottic carcinomas, the outcomes of endoscopic laser cordectomy have been proven to be valuable in local control, survival, and vocal function preservation. In some extended cases, however, laser cordectomy may leave patients with poor vocal function because of vocal fold deficit. This work assesses the vocal outcome of medialization laryngoplasty with bipedicled strap muscle transposition for vocal fold deficit resulting from laser cordectomy in early glottic cancer patients. A prospective clinical series. Thirteen early glottic cancer patients who had vocal fold deficit caused by previous laser cordectomy underwent medialization laryngoplasty with bipedicled strap muscle transposition. The thyroid lamina on the cordectomy side was paramedially separated. The inner perichondrium was circumspectly raised from the overlying thyroid cartilage. After separating the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally. A bipedicled strap muscle flap was then transposed into the area between the lamina and the paraglottic soft tissue. The thyroid cartilages were carefully sutured back in position. All patients received pre- and postoperative voice assessments comprising laryngostroboscopy and vocal function studies. Vocal enhancement was present in 92% (12/13) of patients after medialization laryngoplasty with strap muscle transposition. The glottal closure and maximal phonation time were noticeably improved by surgery. No dyspnea or other significant complications were observed in any patients. The outcomes show that bipedicled strap muscle transposition is a prosthesis-free, safe, and valuable laryngoplastic technique for correcting glottal incompetence caused by endoscopic laser cordectomy in early glottic cancer patients.

A two-layer composite model of the vocal fold lamina propria for fundamental frequency regulation.

PubMed

Zhang, Kai; Siegmund, Thomas; Chan, Roger W

2007-08-01

The mechanical properties of the vocal fold lamina propria, including the vocal fold cover and the vocal ligament, play an important role in regulating the fundamental frequency of human phonation. This study examines the equilibrium hyperelastic tensile deformation behavior of cover and ligament specimens isolated from excised human larynges. Ogden's hyperelastic model is used to characterize the tensile stress-stretch behaviors at equilibrium. Several statistically significant differences in the mechanical response differentiating cover and ligament, as well as gender are found. Fundamental frequencies are predicted from a string model and a beam model, both accounting for the cover and the ligament. The beam model predicts nonzero F(0) for the unstretched state of the vocal fold. It is demonstrated that bending stiffness significantly contributes to the predicted F(0), with the ligament contributing to a higher F(0), especially in females. Despite the availability of only a small data set, the model predicts an age dependence of F(0) in males in agreement with experimental findings. Accounting for two mechanisms of fundamental frequency regulation--vocal fold posturing (stretching) and extended clamping--brings predicted F(0) close to the lower bound of the human phonatory range. Advantages and limitations of the current model are discussed.

Air pulse deformation measurement: a preliminary method for noninvasive vocal fold pliability analysis.

PubMed

Larsson, Hans; Lindestad, P Å; Hertegård, S

2011-01-01

A new method, air pulse pliability measurement, is presented, with which the pliability and elasticity of the vocal folds was measured in vitro and in vivo using air pulses. The size of the mucosal movements induced by air pulse stimulation was measured with a laser-based technique. The air pulses fed via a 2-mm tubing, introduced through the working channel of a flexible endoscope. Both in vitro and in vivo tests were performed. Nine normal, vocally healthy subjects were examined by air pulse stimulations of the vocal folds, of the skin (cheek and dorsum of the hand) and of the inside of the lips. The in vitro tests showed a coefficient of variation of 5% within a range of 1-5 mm from the probe to the surface. The elasticity data showed no differences between vocal folds, lips or cheek. The hand data showed a significantly higher stiffness as compared to the other 3 measuring points (p < 0.001). The coefficient of variation was about 35% for all measuring points, but in ideal conditions on skin it was 9%. The results show that the technique allows automatic, quantitative, noninvasive vocal fold pliability measurements on awake subjects. Copyright © 2010 S. Karger AG, Basel.

Expression and distribution of hyaluronic acid and CD44 in unphonated human vocal fold mucosa.

PubMed

Sato, Kiminori; Umeno, Hirohito; Nakashima, Tadashi; Nonaka, Satoshi; Harabuchi, Yasuaki

2009-11-01

The tension caused by phonation (vocal fold vibration) is hypothesized to stimulate vocal fold stellate cells (VFSCs) in the maculae flavae (MFe) to accelerate production of extracellular matrices. The distribution of hyaluronic acid (HA) and expression of CD44 (a cell surface receptor for HA) were examined in human vocal fold mucosae (VFMe) that had remained unphonated since birth. Five specimens of VFMe (3 adults, 2 children) that had remained unphonated since birth were investigated with Alcian blue staining, hyaluronidase digestion, and immunohistochemistry for CD44. The VFMe containing MFe were hypoplastic and rudimentary. The VFMe did not have a vocal ligament, Reinke's space, or a layered structure, and the lamina propria appeared as a uniform structure. In the children, HA was distributed in the VFMe containing MFe. In the adults, HA had decreased in the VFMe containing MFe. In both groups, the VFSCs in the MFe and the fibroblasts in the lamina propria expressed little CD44. This study supports the hypothesis that the tensions caused by vocal fold vibration stimulate the VFSCs in the MFe to accelerate production of extracellular matrices and form the layered structure. Phonation after birth is one of the important factors in the growth and development of the human VFMe.

Modeling the Pathophysiology of Phonotraumatic Vocal Hyperfunction With a Triangular Glottal Model of the Vocal Folds

PubMed Central

Galindo, Gabriel E.; Peterson, Sean D.; Erath, Byron D.; Castro, Christian; Hillman, Robert E.

2017-01-01

Purpose Our goal was to test prevailing assumptions about the underlying biomechanical and aeroacoustic mechanisms associated with phonotraumatic lesions of the vocal folds using a numerical lumped-element model of voice production. Method A numerical model with a triangular glottis, posterior glottal opening, and arytenoid posturing is proposed. Normal voice is altered by introducing various prephonatory configurations. Potential compensatory mechanisms (increased subglottal pressure, muscle activation, and supraglottal constriction) are adjusted to restore an acoustic target output through a control loop that mimics a simplified version of auditory feedback. Results The degree of incomplete glottal closure in both the membranous and posterior portions of the folds consistently leads to a reduction in sound pressure level, fundamental frequency, harmonic richness, and harmonics-to-noise ratio. The compensatory mechanisms lead to significantly increased vocal-fold collision forces, maximum flow-declination rate, and amplitude of unsteady flow, without significantly altering the acoustic output. Conclusion Modeling provided potentially important insights into the pathophysiology of phonotraumatic vocal hyperfunction by demonstrating that compensatory mechanisms can counteract deterioration in the voice acoustic signal due to incomplete glottal closure, but this also leads to high vocal-fold collision forces (reflected in aerodynamic measures), which significantly increases the risk of developing phonotrauma. PMID:28837719

Discriminating Simulated Vocal Tremor Source Using Amplitude Modulation Spectra

PubMed Central

Carbonell, Kathy M.; Lester, Rosemary A.; Story, Brad H.; Lotto, Andrew J.

2014-01-01

Objectives/Hypothesis Sources of vocal tremor are difficult to categorize perceptually and acoustically. This paper describes a preliminary attempt to discriminate vocal tremor sources through the use of spectral measures of the amplitude envelope. The hypothesis is that different vocal tremor sources are associated with distinct patterns of acoustic amplitude modulations. Study Design Statistical categorization methods (discriminant function analysis) were used to discriminate signals from simulated vocal tremor with different sources using only acoustic measures derived from the amplitude envelopes. Methods Simulations of vocal tremor were created by modulating parameters of a vocal fold model corresponding to oscillations of respiratory driving pressure (respiratory tremor), degree of vocal fold adduction (adductory tremor) and fundamental frequency of vocal fold vibration (F0 tremor). The acoustic measures were based on spectral analyses of the amplitude envelope computed across the entire signal and within select frequency bands. Results The signals could be categorized (with accuracy well above chance) in terms of the simulated tremor source using only measures of the amplitude envelope spectrum even when multiple sources of tremor were included. Conclusions These results supply initial support for an amplitude-envelope based approach to identify the source of vocal tremor and provide further evidence for the rich information about talker characteristics present in the temporal structure of the amplitude envelope. PMID:25532813

Numerical solution of fluid-structure interaction represented by human vocal folds in airflow

NASA Astrophysics Data System (ADS)

Valášek, J.; Sváček, P.; Horáček, J.

2016-03-01

The paper deals with the human vocal folds vibration excited by the fluid flow. The vocal fold is modelled as an elastic body assuming small displacements and therefore linear elasticity theory is used. The viscous incompressible fluid flow is considered. For purpose of numerical solution the arbitrary Lagrangian-Euler method (ALE) is used. The whole problem is solved by the finite element method (FEM) based solver. Results of numerical experiments with different boundary conditions are presented.

Therapeutic potential of gel-based injectables for vocal fold regeneration

PubMed Central

Bartlett, Rebecca S.; Thibeault, Susan L.; Prestwich, Glenn D.

2012-01-01

Vocal folds are anatomically and biomechanically unique, thus complicating the design and implementation of tissue engineering strategies for repair and regeneration. Integration of an enhanced understanding of tissue biomechanics, wound healing dynamics and innovative gel-based therapeutics has generated enthusiasm for the notion that an efficacious treatment for vocal fold scarring could be clinically attainable within several years. Fibroblast phenotype and gene expression are mediated by the three-dimensional mechanical and chemical microenvironment at an injury site. Thus, therapeutic approaches need to coordinate spatial and temporal aspects of the wound healing response in an injured vocal tissue to achieve an optimal clinical outcome. Successful gel-based injectables for vocal fold scarring will require a keen understanding of how the native inflammatory response sets into motion the later extracellular matrix remodeling, which in turn will determine the ultimate biomechanical properties of the tissue. We present an overview of the challenges associated with this translation as well as the proposed gel-based injectable solutions. PMID:22456756

Modulation of voice related to tremor and vibrato

NASA Astrophysics Data System (ADS)

Lester, Rosemary Anne

Modulation of voice is a result of physiologic oscillation within one or more components of the vocal system including the breathing apparatus (i.e., pressure supply), the larynx (i.e. sound source), and the vocal tract (i.e., sound filter). These oscillations may be caused by pathological tremor associated with neurological disorders like essential tremor or by volitional production of vibrato in singers. Because the acoustical characteristics of voice modulation specific to each component of the vocal system and the effect of these characteristics on perception are not well-understood, it is difficult to assess individuals with vocal tremor and to determine the most effective interventions for reducing the perceptual severity of the disorder. The purpose of the present studies was to determine how the acoustical characteristics associated with laryngeal-based vocal tremor affect the perception of the magnitude of voice modulation, and to determine if adjustments could be made to the voice source and vocal tract filter to alter the acoustic output and reduce the perception of modulation. This research was carried out using both a computational model of speech production and trained singers producing vibrato to simulate laryngeal-based vocal tremor with different voice source characteristics (i.e., vocal fold length and degree of vocal fold adduction) and different vocal tract filter characteristics (i.e., vowel shapes). It was expected that, by making adjustments to the voice source and vocal tract filter that reduce the amplitude of the higher harmonics, the perception of magnitude of voice modulation would be reduced. The results of this study revealed that listeners' perception of the magnitude of modulation of voice was affected by the degree of vocal fold adduction and the vocal tract shape with the computational model, but only by the vocal quality (corresponding to the degree of vocal fold adduction) with the female singer. Based on regression analyses, listeners' judgments were predicted by modulation information in both low and high frequency bands. The findings from these studies indicate that production of a breathy vocal quality might be a useful compensatory strategy for reducing the perceptual severity of modulation of voice for individuals with tremor affecting the larynx.

Asthma mimic: Case report and literature review of vocal cord nodule associated with wheezing.

PubMed

Kashif, Muhammad; Singh, Tushi; Aslam, Ahsan; Khaja, Misbahuddin

2017-01-01

Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Various clinical conditions can mimic asthma, such as foreign body aspiration, subglottic stenosis, congestive heart failure, diffuse panbronchiolitis, aortic arch anomalies, reactive airway dysfunction syndrome, chronic obstructive pulmonary disease, retrosternal goiter, vocal cord tumors, other airway tumors, and vocal cord dysfunction. Upper airway obstruction can be a life-threatening emergency. Here, we present the case of a 58-year-old female with recurrent hospital visits for wheezing and exacerbations of asthma, who was later found to have a vocal cord nodule confirmed to be squamous cell carcinoma, which was mimicking like asthma.

Evaluation of vocal fold vibration with an assessment form for high-speed digital imaging: comparative study between healthy young and elderly subjects.

PubMed

Yamauchi, Akihito; Imagawa, Hiroshi; Yokonishi, Hisayuki; Nito, Takaharu; Yamasoba, Tatsuya; Goto, Takao; Takano, Shingo; Sakakibara, Ken-Ichi; Tayama, Niro

2012-11-01

We conducted a prospective study with a subjective assessment form for high-speed digital imaging (HSDI) to elucidate the features of vocal fold vibrations in vocally healthy subjects and to clarify gender- and age-related differences. Healthy adult volunteers participated in this study. They were divided into young (aged 35 and younger) and elderly (aged 65 and older) groups, and the scores of an assessment form for HSDI characteristics elaborated at our institution were statistically analyzed. Twenty-six young subjects (males: 9, females: 17; mean age: 27 years) and 20 elderly subjects (males: 8, females: 12; mean age: 72 years) were assigned to our study. Posterior gap and posterior-to-anterior longitudinal phase difference were characteristic to young females, whereas in young males, mucosal wave, anterior-to-posterior longitudinal phase difference, and supraglottic hyperactivity were frequent. In elderly males, axis shift, asymmetry, supraglottic hyperactivity, increased mucosal wave, lateral phase difference, and anterior-to-posterior longitudinal phase difference were frequent; and in elderly females, high incidence of lateral phase difference, atrophic change, anterior gap, and asymmetry were observed. The results show that the behaviors of vocal fold vibrations were diverse even in healthy subjects with no vocal complaints or history of laryngeal diseases, and hence, the diversity of vocal fold vibrations in normal subjects must be taken into account in evaluating vocal fold vibrations. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Construction and Characterization of a Novel Vocal Fold Bioreactor

PubMed Central

Zerdoum, Aidan B.; Tong, Zhixiang; Bachman, Brendan; Jia, Xinqiao

2014-01-01

In vitro engineering of mechanically active tissues requires the presentation of physiologically relevant mechanical conditions to cultured cells. To emulate the dynamic environment of vocal folds, a novel vocal fold bioreactor capable of producing vibratory stimulations at fundamental phonation frequencies is constructed and characterized. The device is composed of a function generator, a power amplifier, a speaker selector and parallel vibration chambers. Individual vibration chambers are created by sandwiching a custom-made silicone membrane between a pair of acrylic blocks. The silicone membrane not only serves as the bottom of the chamber but also provides a mechanism for securing the cell-laden scaffold. Vibration signals, generated by a speaker mounted underneath the bottom acrylic block, are transmitted to the membrane aerodynamically by the oscillating air. Eight identical vibration modules, fixed on two stationary metal bars, are housed in an anti-humidity chamber for long-term operation in a cell culture incubator. The vibration characteristics of the vocal fold bioreactor are analyzed non-destructively using a Laser Doppler Vibrometer (LDV). The utility of the dynamic culture device is demonstrated by culturing cellular constructs in the presence of 200-Hz sinusoidal vibrations with a mid-membrane displacement of 40 µm. Mesenchymal stem cells cultured in the bioreactor respond to the vibratory signals by altering the synthesis and degradation of vocal fold-relevant, extracellular matrix components. The novel bioreactor system presented herein offers an excellent in vitro platform for studying vibration-induced mechanotransduction and for the engineering of functional vocal fold tissues. PMID:25145349

Construction and characterization of a novel vocal fold bioreactor.

PubMed

Zerdoum, Aidan B; Tong, Zhixiang; Bachman, Brendan; Jia, Xinqiao

2014-08-01

In vitro engineering of mechanically active tissues requires the presentation of physiologically relevant mechanical conditions to cultured cells. To emulate the dynamic environment of vocal folds, a novel vocal fold bioreactor capable of producing vibratory stimulations at fundamental phonation frequencies is constructed and characterized. The device is composed of a function generator, a power amplifier, a speaker selector and parallel vibration chambers. Individual vibration chambers are created by sandwiching a custom-made silicone membrane between a pair of acrylic blocks. The silicone membrane not only serves as the bottom of the chamber but also provides a mechanism for securing the cell-laden scaffold. Vibration signals, generated by a speaker mounted underneath the bottom acrylic block, are transmitted to the membrane aerodynamically by the oscillating air. Eight identical vibration modules, fixed on two stationary metal bars, are housed in an anti-humidity chamber for long-term operation in a cell culture incubator. The vibration characteristics of the vocal fold bioreactor are analyzed non-destructively using a Laser Doppler Vibrometer (LDV). The utility of the dynamic culture device is demonstrated by culturing cellular constructs in the presence of 200-Hz sinusoidal vibrations with a mid-membrane displacement of 40 µm. Mesenchymal stem cells cultured in the bioreactor respond to the vibratory signals by altering the synthesis and degradation of vocal fold-relevant, extracellular matrix components. The novel bioreactor system presented herein offers an excellent in vitro platform for studying vibration-induced mechanotransduction and for the engineering of functional vocal fold tissues.

Mesenchymal stromal cell injection promotes vocal fold scar repair without long-term engraftment

PubMed Central

BARTLETT, R.S.; GUILLE, J.T.; CHEN, X.; CHRISTENSEN, M.B.; WANG, S.F.; THIBEAULT, S.L.

2016-01-01

Background Regenerative medicine holds promise for restoring voice in patients with vocal fold scarring. As experimental treatments approach clinical translation, several considerations remain. Our objective was to evaluate efficacy and biocompatibility of four bone marrow mesenchymal stromal cell (BM-MSC) and tunable hyaluronic acid based hydrogel (HyStem-VF) treatments for vocal fold scar using clinically acceptable materials, a preclinical sample size and a dosing comparison. Methods Vocal folds of 84 rabbits were injured and injected with four treatment variations (BM-MSC, HyStem-VF, and BM-MSC in HyStem-VF at two concentrations) 6 weeks later. Efficacy was assessed with rheometry, real-time polymerase chain reaction (PCR) and histology at 2, 4 and 10 weeks following treatment. Lung, liver, kidney, spleen and vocal folds were screened for biocompatibility by a pathologist. Results and discussion Persistent inflammation was identified in all hydrogel-injected groups. The BM-MSC alone treatment appeared to be the most efficacious and safe, providing an early resolution of viscoelasticity, gene expression consistent with desirable extracellular matrix remodeling (less fibronectin, collagen 1α2, collagen 3, procollagen, transforming growth factor [TGF]β1, alpha smooth muscle actin, interleukin-1β, interleukin-17β and tumor necrosis factor [TNF] than injured controls) and minimal inflammation. Human beta actin expression in BM-MSC–treated vocal folds was minimal after 2 weeks, suggesting that paracrine signaling from the BM-MSCs may have facilitated tissue repair. PMID:27637759

Mesenchymal stromal cell injection promotes vocal fold scar repair without long-term engraftment.

PubMed

Bartlett, R S; Guille, J T; Chen, X; Christensen, M B; Wang, S F; Thibeault, S L

2016-10-01

Regenerative medicine holds promise for restoring voice in patients with vocal fold scarring. As experimental treatments approach clinical translation, several considerations remain. Our objective was to evaluate efficacy and biocompatibility of four bone marrow mesenchymal stromal cell (BM-MSC) and tunable hyaluronic acid based hydrogel (HyStem-VF) treatments for vocal fold scar using clinically acceptable materials, a preclinical sample size and a dosing comparison. Vocal folds of 84 rabbits were injured and injected with four treatment variations (BM-MSC, HyStem-VF, and BM-MSC in HyStem-VF at two concentrations) 6 weeks later. Efficacy was assessed with rheometry, real-time polymerase chain reaction (RT-PCR) and histology at 2, 4 and 10 weeks following treatment. Lung, liver, kidney, spleen and vocal folds were screened for biocompatibility by a pathologist. Persistent inflammation was identified in all hydrogel-injected groups. The BM-MSC alone treatment appeared to be the most efficacious and safe, providing an early resolution of viscoelasticity, gene expression consistent with desirable extracellular matrix remodeling (less fibronectin, collagen 1α2, collagen 3, procollagen, transforming growth factor [TGF]β1, alpha smooth muscle actin, interleukin-1β, interleukin-17β and tumor necrosis factor [TNF] than injured controls) and minimal inflammation. Human beta actin expression in BM-MSC-treated vocal folds was minimal after 2 weeks, suggesting that paracrine signaling from the BM-MSCs may have facilitated tissue repair. Copyright © 2016 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Tissue-Engineered Vocal Fold Mucosa Implantation in Rabbits.

PubMed

Shiba, Travis L; Hardy, Jordan; Luegmair, Georg; Zhang, Zhaoyan; Long, Jennifer L

2016-04-01

To assess phonatory function and wound healing of a tissue-engineered vocal fold mucosa (TE-VFM) in rabbits. An "artificial" vocal fold would be valuable for reconstructing refractory scars and resection defects, particularly one that uses readily available autologous cells and scaffold. This work implants a candidate TE-VFM after resecting native epithelium and lamina propria in rabbits. Prospective animal study. Research laboratory. Rabbit adipose-derived stem cells were isolated and cultured in three-dimensional fibrin scaffolds to form TE-VFM. Eight rabbits underwent laryngofissure, unilateral European Laryngologic Society type 2 cordectomy, and immediate reconstruction with TE-VFM. After 4 weeks, larynges were excised, phonated, and examined by histology. Uniform TE-VFM implants were created, with rabbit mesenchymal cells populated throughout fibrin hydrogels. Rabbits recovered uneventfully after implantation. Phonation was achieved in all, with mucosal waves evident at the implant site. Histology after 4 weeks showed resorbed fibrin matrix, continuous epithelium, and mildly increased collagen relative to contralateral unoperated vocal folds. Elastic fiber appearance was highly variable. Inflammatory cell infiltrate was limited to animals receiving sex-mismatched implants. TE-VFMs were successfully implanted into 8 rabbits, with minor evidence of scar formation and immune reaction. Vibration was preserved 4 weeks after resecting and reconstructing the complete vocal fold cover layer. Further studies will investigate the mechanism and durability of improvement. TE-VFM with autologous cells is a promising new approach for vocal fold reconstruction. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Bilateral Vocal Fold Medialization: A Treatment for Abductor Spasmodic Dysphonia.

PubMed

Dewan, Karuna; Berke, Gerald S

2017-11-10

Abductor spasmodic dysphonia, a difficult-to-treat laryngologic condition, is characterized by spasms causing the vocal folds to remain abducted despite efforts to adduct them during phonation. Traditional treatment for abductor spasmodic dysphonia-botulinum toxin injection into the posterior cricoarytenoid muscle-can be both technically challenging and uncomfortable. Due to the difficulty of needle placement, it is often unsuccessful. The purpose of this investigation is to present a previously undescribed treatment for abductor spasmodic dysphonia-bilateral vocal fold medialization. A retrospective case review of all cases of abductor spasmodic dysphonia treated in a tertiary care laryngology practice with bilateral vocal fold medialization over a 10-year period was performed. The Voice Handicap Index and the Voice-Related Quality of Life surveys were utilized to assess patient satisfaction with voice outcome. Six patients with abductor spasmodic dysphonia treated with bilateral vocal fold medialization were identified. Disease severity ranged from mild to severe. All six patients reported statistically significant improvement in nearly all Voice Handicap Index and Voice-Related Quality of Life parameters. They reported fewer voice breaks and greater ease of communication. Results were noted immediately and symptoms continue to be well controlled for many years following medialization. Bilateral vocal fold medialization is a safe and effective treatment for abductor spasmodic dysphonia. It is performed under local anesthesia and provides phonation improvement in the short and long term. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Fluid-Structure Interactions as Flow Propagates Tangentially Over a Flexible Plate with Application to Voiced Speech Production

NASA Astrophysics Data System (ADS)

Westervelt, Andrea; Erath, Byron

2013-11-01

Voiced speech is produced by fluid-structure interactions that drive vocal fold motion. Viscous flow features influence the pressure in the gap between the vocal folds (i.e. glottis), thereby altering vocal fold dynamics and the sound that is produced. During the closing phases of the phonatory cycle, vortices form as a result of flow separation as air passes through the divergent glottis. It is hypothesized that the reduced pressure within a vortex core will alter the pressure distribution along the vocal fold surface, thereby aiding in vocal fold closure. The objective of this study is to determine the impact of intraglottal vortices on the fluid-structure interactions of voiced speech by investigating how the dynamics of a flexible plate are influenced by a vortex ring passing tangentially over it. A flexible plate, which models the medial vocal fold surface, is placed in a water-filled tank and positioned parallel to the exit of a vortex generator. The physical parameters of plate stiffness and vortex circulation are scaled with physiological values. As vortices propagate over the plate, particle image velocimetry measurements are captured to analyze the energy exchange between the fluid and flexible plate. The investigations are performed over a range of vortex formation numbers, and lateral displacements of the plate from the centerline of the vortex trajectory. Observations show plate oscillations with displacements directly correlated with the vortex core location.

Intraoperative laryngeal electromyography in children with vocal fold immobility: a simplified technique.

PubMed

Scott, Andrew R; Chong, Peter Siao Tick; Randolph, Gregory W; Hartnick, Christopher J

2008-01-01

The primary objective of this study was to determine whether a simplified technique for intraoperative laryngeal electromyography was feasible using standard nerve integrity monitoring electrodes and audiovisual digital recording equipment. Our secondary objective was to determine if laryngeal electromyography data provided any additional information that significantly influenced patient management. Between February 2006 and February 2007, 10 children referred to our institution with vocal fold immobility underwent intraoperative laryngeal electromyography of the thyroarytenoid muscles. A retrospective chart review of these 10 patients was performed after institutional review board approval. Standard nerve integrity monitoring electrodes can be used to perform intraoperative laryngeal electromyography of the thyroarytenoid muscles in children. In 5 of 10 cases reviewed, data from laryngeal electromyography recordings meaningfully influenced the care of children with vocal fold immobility and affected clinical decision-making, sometimes altering management strategies. In the remaining 5 children, data supported clinical impressions but did not alter treatment plans. Two children with idiopathic bilateral vocal fold paralysis initially presented with a lack of electrical activity on one or both sides but went on to develop motor unit action potentials that preceded recovery of motion in both vocal folds. Our findings suggest that standard nerve monitoring equipment can be used to perform intraoperative laryngeal electromyography and that electromyographic data can assist clinicians in the management of complex patients. Additionally, there may be a role for the use of serial intraoperative measurements in predicting recovery from vocal fold paralysis in the pediatric age group.

In vivo comparison of biomimetic approaches for tissue regeneration of the scarred vocal fold.

PubMed

Thibeault, Susan L; Klemuk, Sarah A; Smith, Marshall E; Leugers, Cecilia; Prestwich, Glenn

2009-07-01

The objective of this study was to determine if three different biomimetic approaches could facilitate tissue regeneration and improve viscoelastic properties in the scarred vocal fold lamina propria extracellular matrix (ECM). Twenty rabbit vocal folds were biopsied bilaterally; 2 months postinjury rabbits were unilaterally treated with (i) autologous fibroblasts, (ii) a semisynthetic ECM (sECM), or (iii) autologous fibroblasts encapsulated in sECM. Saline was injected as a control into the contralateral fold. Animals were sacrificed 2 months after treatment. Outcomes measured were procollagen, collagen, and fibronectin levels in the lamina propria, and tissue viscosity and elasticity across three frequency decades. All treatment groups demonstrated accelerated proliferation of the ECM. Vocal fold lamina propria treated with autologous fibroblasts were found to have significantly improved viscosity (p = 0.0077) and elasticity (p = 0.0081) compared to saline. This treatment group had significantly elevated fibronectin levels. sECM and autologous fibroblasts/sECM groups had significantly elevated levels of procollagen, collagen, and fibronectin, indicating abundant matrix production as compared to saline with viscoelastic measures that did not differ statistically from controls. The use of autologous fibroblasts led to better restoration of the vocal fold lamina propria biomechanical properties. Optimization of cell-scaffold interactions and subsequent cell behavior is necessary for utilization of scaffold and scaffold-cell approaches.

A theoretical study of F0-F1 interaction with application to resonant speaking and singing voice.

PubMed

Titze, Ingo R

2004-09-01

An interactive source-filter system, consisting of a three-mass body-cover model of the vocal folds and a wave reflection model of the vocal tract, was used to test the dependence of vocal fold vibration on the vocal tract. The degree of interaction is governed by the epilarynx tube, which raises the vocal tract impedance to match the impedance of the glottis. The key component of the impedance is inertive reactance. Whenever there is inertive reactance, the vocal tract assists the vocal folds in vibration. The amplitude of vibration and the glottal flow can more than double, and the oral radiated power can increase up to 10 dB. As F0 approaches F1, the first formant frequency, the interactive source-filter system loses its advantage (because inertive reactance changes to compliant reactance) and the noninteractive system produces greater vocal output. Thus, from a voice training and control standpoint, there may be reasons to operate the system in either interactive and noninteractive modes. The harmonics 2F0 and 3F0 can also benefit from being positioned slightly below F1.

Behavioral Voice Therapy in School-Age Children with Vocal Fold Nodules. EBP Briefs. Volume 6, Issue 5

ERIC Educational Resources Information Center

Watts, Christopher R.

2012-01-01

Does behavioral voice therapy effectively improve voice quality and eliminate or reduce the size of vocal fold pathology in school-age children who have vocal nodules? An evidence-based practice intervention review was conducted to answer this research question. The following resources were searched: Cumulative Index to Nursing and Allied Health…

Computation of physiological human vocal fold parameters by mathematical optimization of a biomechanical model

PubMed Central

Yang, Anxiong; Stingl, Michael; Berry, David A.; Lohscheller, Jörg; Voigt, Daniel; Eysholdt, Ulrich; Döllinger, Michael

2011-01-01

With the use of an endoscopic, high-speed camera, vocal fold dynamics may be observed clinically during phonation. However, observation and subjective judgment alone may be insufficient for clinical diagnosis and documentation of improved vocal function, especially when the laryngeal disease lacks any clear morphological presentation. In this study, biomechanical parameters of the vocal folds are computed by adjusting the corresponding parameters of a three-dimensional model until the dynamics of both systems are similar. First, a mathematical optimization method is presented. Next, model parameters (such as pressure, tension and masses) are adjusted to reproduce vocal fold dynamics, and the deduced parameters are physiologically interpreted. Various combinations of global and local optimization techniques are attempted. Evaluation of the optimization procedure is performed using 50 synthetically generated data sets. The results show sufficient reliability, including 0.07 normalized error, 96% correlation, and 91% accuracy. The technique is also demonstrated on data from human hemilarynx experiments, in which a low normalized error (0.16) and high correlation (84%) values were achieved. In the future, this technique may be applied to clinical high-speed images, yielding objective measures with which to document improved vocal function of patients with voice disorders. PMID:21877808

HUMAN SPEECH: A RESTRICTED USE OF THE MAMMALIAN LARYNX

PubMed Central

Titze, Ingo R.

2016-01-01

Purpose Speech has been hailed as unique to human evolution. While the inventory of distinct sounds producible with vocal tract articulators is a great advantage in human oral communication, it is argued here that the larynx as a sound source in speech is limited in its range and capability because a low fundamental frequency is ideal for phonemic intelligibility and source-filter independence. Method Four existing data sets were combined to make an argument regarding exclusive use of the larynx for speech: (1) range of fundamental frequency, (2) laryngeal muscle activation, (3) vocal fold length in relation to sarcomere length of the major laryngeal muscles, and (4) vocal fold morphological development. Results Limited data support the notion that speech tends to produce a contracture of the larynx. The morphological design of the human vocal folds, like that of primates and other mammals, is optimized for vocal communication over distances for which higher fundamental frequency, higher intensity, and fewer unvoiced segments are utilized than in conversational speech. Conclusion The positive message is that raising one’s voice to call, shout, or sing, or executing pitch glides to stretch the vocal folds, can counteract this trend toward a contracted state. PMID:27397113

Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis

PubMed Central

Zheng, Hongliang; Chen, Donghui; Zhu, Minhui; Wang, Wei; Liu, Fei; Zhang, Caiyun

2013-01-01

Objective To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. Methods Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. Results Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P < 0.05); most of the vocal function parameters were improved postoperatively compared with the preoperative parameters, albeit without a significant difference (P > 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. Conclusions Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity. PMID:24098581

Evaluation of the poly(lactic-co-glycolic acid)/pluronic F127 for injection laryngoplasty in rabbits.

PubMed

Lee, Jin Ho; Kim, Dong Wook; Kim, Eun Na; Park, Seok-Won; Kim, Hee-Bok; Oh, Se Heang; Kwon, Seong Keun

2014-11-01

Poly(lactic-co-glycolic acid) (PLGA) is an aliphatic polyester and one of the most commonly used synthetic biodegradable polymers for tissue engineering. The objectives of this study were to evaluate the biocompatibility of PLGA/Pluronic F127 in the vocal fold. A randomized, prospective, controlled animal study. University laboratory. We used 18 New Zealand white rabbits, which were divided into 5% PLGA solution (n = 9) and 10% PLGA solution (n = 9) groups. The PLGA/Pluronic F127 solutions were injected into the rabbit vocal fold. Laryngoscopic exams were performed at 1, 4, and 8 weeks after implantation; then larynx specimens were sampled. High-speed video camera examination was performed for functional analysis of vocal mucosa vibration at 8 weeks after implantation. Also, we evaluated the amplitude of the mucosal wave from the laryngeal midline on high-speed recording. Histologic study of larynx specimen was performed at 4 and 8 weeks. All animals survived until the scheduled period. Laryngoscopic analysis showed that both 5% and 10% PLGA/Pluronic F127 maintained after 8 weeks after injection without significant inflammatory response. On functional analysis, high-speed camera examination revealed regular and symmetric contact of vocal fold mucosa without a distorted movement by injected PLGA/Pluronic F127. Histologically, no significant inflammation was observed in the injected vocal fold. As a vocal fold injection material, PLGA/Pluronic F127 showed a good bio-compatibility without significant inflammatory response. Further experiment will follow to elucidate its role for drug or gene delivery into the vocal fold. © American Academy of Otolaryngology-Head and Neck Surgery Foundation 2014.

Standardized laryngeal videostroboscopic rating: differences between untrained and trained male and female subjects, and effects of varying sound intensity, fundamental frequency, and age.

PubMed

Sulter, A M; Schutte, H K; Miller, D G

1996-06-01

To determine the influence of the factors gender, vocal training, sound intensity, pitch, and aging on vocal function, videolaryngostroboscopic images of 214 subjects, subdivided according to gender and status of vocal training, were evaluated by three judges with standardized rating scales, comprising aspects of laryngeal appearance (larynx/pharynx ratio; epiglottal shape; asymmetry arytenoid region; compensatory adjustments; thickness, width, length, and elasticity of vocal folds) and glottal functioning (amplitudes of excursion; duration, percentage, and type of vocal fold closure; phase differences; location of glottal chink). The video registrations were made while the subjects performed a set of phonatory tasks, comprising the utterance of the vowel /i/ at three levels of both fundamental frequency and sound intensity. Analysis of the rating scales showed generally sufficient agreement among judges. With the exception of more frequently observed complete closure and lateral phase differences of vocal fold excursions in trained subjects, no further differences were established between untrained and trained subjects. With an alpha level of p = 0.005, men differed from women with respect to laryngeal appearance (larynx/pharynx ratio, compensatory adjustments, and the presence of omega and deviant-shaped epiglottises), and their vocal folds were rated thicker in the vertical dimension, smaller in the lateral dimension, longer, and more tense, with smaller amplitudes of excursion during vibration. Glottal closure in male subjects was rated more complete, but briefer in duration. Significant effects of the factors pitch, sound intensity, and age on vocal fold appearance and glottal functioning were ascertained. Awareness of the influence of these factors, as well as the factor gender, on the rated scales is essential for an adequate evaluation of laryngostroboscopic images.

An Immersed-Boundary Method for Fluid-Structure Interaction in the Human Larynx

NASA Astrophysics Data System (ADS)

Luo, Haoxiang; Zheng, Xudong; Mittal, Rajat; Bielamowicz, Steven

2006-11-01

We describe a novel and accurate computational methodology for modeling the airflow and vocal fold dynamics in human larynx. The model is useful in helping us gain deeper insight into the complicated bio-physics of phonation, and may have potential clinical application in design and placement of synthetic implant in vocal fold surgery. The numerical solution of the airflow employs a previously developed immersed-boundary solver. However, in order to incorporate the vocal fold into the model, we have developed a new immersed-boundary method that can simulate the dynamics of the multi-layered, viscoelastic solids. In this method, a finite-difference scheme is used to approximate the derivatives and ghost cells are defined near the boundary. To impose the traction boundary condition, a third-order polynomial is obtained using the weighted least squares fitting to approximate the function locally. Like its analogue for the flow solver, this immersed-boundary method for the solids has the advantage of simple grid generation, and may be easily implemented on parallel computers. In the talk, we will present the simulation results on both the specified vocal fold motion and the flow-induced vocal fold vibration. Supported by NIDCD Grant R01 DC007125-01A1.

Patient-Specific Computational Modeling of Human Phonation

NASA Astrophysics Data System (ADS)

Xue, Qian; Zheng, Xudong; University of Maine Team

2013-11-01

Phonation is a common biological process resulted from the complex nonlinear coupling between glottal aerodynamics and vocal fold vibrations. In the past, the simplified symmetric straight geometric models were commonly employed for experimental and computational studies. The shape of larynx lumen and vocal folds are highly three-dimensional indeed and the complex realistic geometry produces profound impacts on both glottal flow and vocal fold vibrations. To elucidate the effect of geometric complexity on voice production and improve the fundamental understanding of human phonation, a full flow-structure interaction simulation is carried out on a patient-specific larynx model. To the best of our knowledge, this is the first patient-specific flow-structure interaction study of human phonation. The simulation results are well compared to the established human data. The effects of realistic geometry on glottal flow and vocal fold dynamics are investigated. It is found that both glottal flow and vocal fold dynamics present a high level of difference from the previous simplified model. This study also paved the important step toward the development of computer model for voice disease diagnosis and surgical planning. The project described was supported by Grant Number ROlDC007125 from the National Institute on Deafness and Other Communication Disorders (NIDCD).

Insights into the role of elastin in vocal fold health and disease

PubMed Central

Moore, Jaime

2011-01-01

Elastic fibers are large, complex and surprisingly poorly understood extracellular matrix (ECM) macromolecules. The elastin fiber, generated from a single human gene - elastin (ELN), is a self assembling integral protein that endows critical mechanic proprieties to elastic tissues and organs such as the skin, lungs, and arteries. The biology of elastic fibers is complex because they have multiple components, a tightly regulated developmental deposition, a multi-step hierarchical assembly and unique biomechanical functions. Elastin is present in vocal folds, where it plays a pivotal role in the quality of phonation. This review article provides an overview of the genesis of elastin and its wide- ranging structure and function. Specific distribution within the vocal fold lamina propria across the lifespan in normal and pathological states and its contribution to vocal fold biomechanics will be examined. Elastin and elastin-derived molecules are increasingly investigated for their application in tissue engineering. The properties of various elastin– based materials will be discussed and their current and future applications evaluated. A new level of understanding of the biomechanical properties of vocal fold elastin composites and their molecular basis should lead to new strategies for elastic fiber repair and regeneration in aging and disease. PMID:21708449

Inpatient injection laryngoplasty for vocal fold immobility: When is it really necessary?

PubMed

Zuniga, Steven; Ebersole, Barbara; Jamal, Nausheen

To compare pulmonary and swallow outcomes of injection laryngoplasty when performed in the acute versus subacute setting in head & neck and thoracic cancer patients presenting with new onset unilateral vocal fold immobility. Case series with chart review at an academic cancer center over a 2year period. Based on swallow evaluation, patients diagnosed with vocal fold immobility were grouped into an unsafe swallow group, injected as inpatients, and a safe swallow group, for whom injection laryngoplasty was delayed to the outpatient setting or not performed. Rates of pneumonia, diet recommendations, and swallow outcomes were compared between groups. 24 patients with new-onset vocal fold immobility were evaluated. 7 underwent injection in the inpatient setting, 12 in the outpatient setting, and 5 did not undergo injection. There was no perceived difference in speech and swallow outcomes between the inpatient and outpatient injection groups. Injection laryngoplasty shows promise as an effective intervention for reducing aspiration risk and improving diet normalcy in patients with dysphagia as a result of unilateral vocal fold immobility. In patients determined to have a safe swallow, delay of injection laryngoplasty is not detrimental to swallow outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Measurements of vocal fold tissue viscoelasticity: Approaching the male phonatory frequency range

NASA Astrophysics Data System (ADS)

Chan, Roger W.

2004-06-01

Viscoelastic shear properties of human vocal fold tissues have been reported previously. However, data have only been obtained at very low frequencies (<=15 Hz). This necessitates data extrapolation to the frequency range of phonation based on constitutive modeling and time-temperature superposition. This study attempted to obtain empirical measurements at higher frequencies with the use of a controlled strain torsional rheometer, with a design of directly controlling input strain that introduced significantly smaller system inertial errors compared to controlled stress rheometry. Linear viscoelastic shear properties of the vocal fold mucosa (cover) from 17 canine larynges were quantified at frequencies of up to 50 Hz. Consistent with previous data, results showed that the elastic shear modulus (G'), viscous shear modulus (G''), and damping ratio (ζ) of the vocal fold mucosa were relatively constant across 0.016-50 Hz, whereas the dynamic viscosity (ɛ') decreased monotonically with frequency. Constitutive characterization of the empirical data by a quasilinear viscoelastic model and a statistical network model demonstrated trends of viscoelastic behavior at higher frequencies generally following those observed at lower frequencies. These findings supported the use of controlled strain rheometry for future investigations of the viscoelasticity of vocal fold tissues and phonosurgical biomaterials at phonatory frequencies.

Recurrent laryngeal nerve regeneration through a silicone tube produces reinnervation without vocal fold mobility in rats.

PubMed

Kumai, Yoshihiko; Aoyama, Takashi; Nishimoto, Kohei; Sanuki, Tetsuji; Minoda, Ryosei; Yumoto, Eiji

2013-01-01

We established an animal model of recurrent laryngeal nerve reinnervation with persistent vocal fold immobility following recurrent laryngeal nerve injury. In 36 rats, the left recurrent laryngeal nerve was transected and the stumps were abutted in a silicone tube with a 1-mm interspace, facilitating regeneration. The mobility of the vocal folds was examined endoscopically 5, 10, and 15 weeks later. Electromyography of the thyroarytenoid muscle was performed. Reinnervation was assessed by means of a quantitative immunohistologic evaluation with anti-neurofilament antibody in the nerve both proximal and distal to the silicone tube. The atrophy of the thyroarytenoid muscle was assessed histologically. We observed that all animals had a fixed left vocal fold throughout the study. The average neurofilament expression in the nerve both distal and proximal to the silicone tube, the muscle area, and the amplitude of the compound muscle action potential recorded from the thyroarytenoid muscle on the treated side increased significantly (p < 0.05) over time, demonstrating regeneration through the silicone tube. Recurrent laryngeal nerve regeneration through a silicone tube produced reinnervation without vocal fold mobility in rats. The efficacy of new laryngeal reinnervation treatments can be assessed with this model.

Cause of vocal fold scar.

PubMed

Allen, Jacqui

2010-12-01

The prolonged debilitation, loss of income, and decrement in quality of life caused by vocal fold scar is exacerbated by our inability to successfully treat this difficult problem. As technology focuses on developing innovative treatments, we need to fully appreciate and understand the mechanisms giving rise to glottal scar, on both a macroscopic and microscopic level. This review examines recent literature pertaining to the gross and molecular mechanisms which give rise to vocal fold scar. Mechanisms of vocal fold scar production have been examined in both macroscopic and microscopic detail. Trauma and injury involving any aspect of the lamina propria, particularly the deeper layers, may result in epithelial tethering and scar formation. At the molecular level, early inflammatory cytokines activate and recruit fibroblasts which then drive the fibrotic cascade. Transforming growth factor-β enhances fibrosis and is balanced by tissue matrix metalloproteinases and hepatocyte growth factor activity. Molecular signaling offers novel opportunities to intervene in scar formation. New work investigating the cause of vocal fold scar identifies complex molecular processes leading to fibrosis in the lamina propria. Improved mechanistic understanding offers insight into prevention strategies and possible targets for antifibrotic therapies that may help prevent or treat this debilitating condition.

Automatic and quantitative measurement of laryngeal video stroboscopic images.

PubMed

Kuo, Chung-Feng Jeffrey; Kuo, Joseph; Hsiao, Shang-Wun; Lee, Chi-Lung; Lee, Jih-Chin; Ke, Bo-Han

2017-01-01

The laryngeal video stroboscope is an important instrument for physicians to analyze abnormalities and diseases in the glottal area. Stroboscope has been widely used around the world. However, without quantized indices, physicians can only make subjective judgment on glottal images. We designed a new laser projection marking module and applied it onto the laryngeal video stroboscope to provide scale conversion reference parameters for glottal imaging and to convert the physiological parameters of glottis. Image processing technology was used to segment the important image regions of interest. Information of the glottis was quantified, and the vocal fold image segmentation system was completed to assist clinical diagnosis and increase accuracy. Regarding image processing, histogram equalization was used to enhance glottis image contrast. The center weighted median filters image noise while retaining the texture of the glottal image. Statistical threshold determination was used for automatic segmentation of a glottal image. As the glottis image contains saliva and light spots, which are classified as the noise of the image, noise was eliminated by erosion, expansion, disconnection, and closure techniques to highlight the vocal area. We also used image processing to automatically identify an image of vocal fold region in order to quantify information from the glottal image, such as glottal area, vocal fold perimeter, vocal fold length, glottal width, and vocal fold angle. The quantized glottis image database was created to assist physicians in diagnosing glottis diseases more objectively.

The shear modulus of the human vocal fold, preliminary results from 20 larynxes.

PubMed

Goodyer, Eric; Hemmerich, Sandra; Müller, Frank; Kobler, James B; Hess, Markus

2007-01-01

Quantification of the elastic properties of the human vocal fold provides invaluable data for researchers deriving mathematical models of phonation, developing tissue engineering therapies, and as normative data for comparison between healthy and scarred tissue. This study measured the shear modulus of excised cadaver vocal folds from 20 subjects. Twenty freshly excised human larynxes were evaluated less than four days post-mortem. They were split along the saggital plane and mounted without tension. Shear modulus was obtained by two different methods. For method 1 cyclical shear stress was applied transversely to the mid-membranous portion of the vocal fold, and shear modulus derived by applying a simple shear model. For method 2 the apparatus was configured as an indentometer, and shear modulus obtained from the stress/strain data by applying an established analytical technique. Method 1 shear model for male larynxes yielded a range from 246 to 3,356 Pa, with a mean value of 1,008 and SD of 380. The range for female larynxes was 286-3,332 Pa, with a mean value of 1,237 and SD of 768. Method 2 indentometer model for male larynxes yielded a range from 552 to 2,741 Pa, with a mean value of 1,000 and SD of 460. The range for female larynxes was 509-1,989 Pa, with a mean value of 1,332 and SD of 428. We have successfully demonstrated two methodologies that are capable of directly measuring the shear modulus of the human vocal fold, without dissecting out the vocal fold cover tissue. The sample size of nine female and 11 male larynxes is too small to validate a general conclusion. The high degree of variability in this small cohort of subjects indicates that factors such as age, health status, and post-mortem delay may be significant; and that there is range of 'normality' for vocal fold tissue.

Mechanism of and Threshold Biomechanical Conditions for Falsetto Voice Onset

PubMed Central

Deguchi, Shinji

2011-01-01

The sound source of a voice is produced by the self-excited oscillation of the vocal folds. In modal voice production, a drastic increase in transglottal pressure after vocal fold closure works as a driving force that develops self-excitation. Another type of vocal fold oscillation with less pronounced glottal closure observed in falsetto voice production has been accounted for by the mucosal wave theory. The classical theory assumes a quasi-steady flow, and the expected driving force onto the vocal folds under wavelike motion is derived from the Bernoulli effect. However, wavelike motion is not always observed during falsetto voice production. More importantly, the application of the quasi-steady assumption to a falsetto voice with a fundamental frequency of several hundred hertz is unsupported by experiments. These considerations suggested that the mechanism of falsetto voice onset may be essentially different from that explained by the mucosal wave theory. In this paper, an alternative mechanism is submitted that explains how self-excitation reminiscent of the falsetto voice could be produced independent of the glottal closure and wavelike motion. This new explanation is derived through analytical procedures by employing only general unsteady equations of motion for flow and solids. The analysis demonstrated that a convective acceleration of a flow induced by rapid wall movement functions as a negative damping force, leading to the self-excitation of the vocal folds. The critical subglottal pressure and volume flow are expressed as functions of vocal fold biomechanical properties, geometry, and voice fundamental frequency. The analytically derived conditions are qualitatively and quantitatively reasonable in view of reported measurement data of the thresholds required for falsetto voice onset. Understanding of the voice onset mechanism and the explicit mathematical descriptions of thresholds would be beneficial for the diagnosis and treatment of voice diseases and the development of artificial vocal folds. PMID:21408178

Inhibitory effects of hepatocyte growth factor and interleukin-6 on transforming growth factor-beta1 mediated vocal fold fibroblast-myofibroblast differentiation.

PubMed

Vyas, Bimal; Ishikawa, Keiko; Duflo, Suzy; Chen, Xia; Thibeault, Susan L

2010-05-01

The role of myofibroblasts in vocal fold scarring has not been extensively studied, partly because of the lack of a robust in vitro model. The objective of this investigation was to develop and characterize a myofibroblast in vitro model that could be utilized to investigate the molecular mechanism of myofibroblast differentiation and function in injured vocal fold tissue. Differentiation of human primary vocal fold fibroblasts (hVFFs) to myofibroblasts was stimulated with 5, 10, or 20 ng/mL of recombinant transforming growth factor-beta1 (TGF-beta1). Cultures were analyzed by immunofluorescence and Western blotting, with an alpha-smooth muscle actin (alpha-SMA) antibody used as a myofibroblast marker. Normal rabbit vocal folds were treated with 10 ng/mL of TGF-beta1 for 7 days for in vivo corroboration. The effects of interleukin-6 (IL-6) and hepatocyte growth factor (HGF) on myofibroblast differentiation were studied with Western blots. The hVFFs demonstrated positive alpha-SMA labeling in cells stimulated by 10 and 20 ng/mL TGF-beta1, indicating that hVFFs were capable of differentiation to myofibroblasts. Transforming growth factor-beta1 induced the largest increase in alpha-SMA at 10 ng/mL on day 5 of treatment. Both HGF and IL-6 suppressed the expression of TGF-beta1-induced alpha-SMA. Our work characterizes a useful in vitro model of TGF-beta1-mediated vocal fold fibroblast-myofibroblast differentiation. The extent of differentiation appears to be attenuated by HGF, suggesting a potential mechanism to support prior work indicating that HGF plays a protective role in reducing scar formation in vocal fold injuries. Paradoxically, IL-6, which has been shown to play a profibrotic role in dermal studies, also attenuated the TGF-beta1 response.

Permeability of canine vocal fold lamina propria.

PubMed

Meyer, Jacob P; Kvit, Anton A; Devine, Erin E; Jiang, Jack

2015-04-01

Determine the permeability of excised canine vocal fold lamina propria. Basic science. Vocal folds were excised from canine larynges and mounted within a device to measure the flow of 0.9% saline through the tissue over time. The resultant fluid volume displaced over time was then used in a variation of Darcy's law to calculate the permeability of the tissue. Permeability was found through each anatomical plane of the vocal fold, with five samples per plane. Permeability was also found for lamina propria stretched to 10%, 20%, and 30% of its initial length to determine the effects of tensile strain on permeability, with five samples per level of strain. Permeability was found to be 1.40 × 10(-13) m(3) s/kg through the sagittal plane, 1.00 × 10(-13) m(3) s/kg through the coronal plane, and 4.02 × 10(-13) m(3) s/kg through the axial plane. It was significantly greater through the axial plane than both the sagittal (P = .025) and coronal (P = .009) planes. Permeability under strain through the sagittal plane was found to be 1.94 × 10(-13) m(3) s/kg under 10% strain, 3.35 × 10(-13) m(3) s/kg under 20% strain, and 4.80 × 10(-13) m(3) s/kg under 30% strain. The permeability significantly increased after 20% strain (P < .05). Permeability in canine vocal fold lamina propria was found to be increased along the anterior-posterior axis, following the length of the vocal folds. This may influence fluid distribution within the lamina propria during and after vibration. Similarly, permeability increased after 20% strain was imposed on the lamina propria, and may influence vocal fold dynamics during certain phonation tasks. NA Laryngoscope, 125:941-945, 2015. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Psychogenic Respiratory Distress: A Case of Paradoxical Vocal Cord Dysfunction and Literature Review

PubMed Central

Leo, Raphael J.; Konakanchi, Ramesh

1999-01-01

Background: Pulmonary disease such as asthma is a psychosomatic disorder vulnerable to exacerbations precipitated by psychological factors. A case is described in which a patient thought to have treatment-refractory asthma was discovered to have a conversion reaction, specifically paradoxical vocal cord dysfunction (PVCD), characterized by abnormal vocal cord adduction during inspiration. Data Sources: Reports of PVCD were located using a MEDLINE search and review of bibliographies. MEDLINE (English language only) was searched from 1966 through December 1998 using the terms functional asthma, functional upper airway obstruction, laryngeal diseases, Munchausen's stridor, paradoxical vocal cord dysfunction, psychogenic stridor, respiratory stridor, vocal cord dysfunction, and vocal cord paralysis. A total of 170 cases of PVCD were reviewed. Study Findings: PVCD appears to be significantly more common among females. PVCD spans all age groups, including pediatric, adolescent, and adult patients. PVCD was most often misdiagnosed as asthma or upper airway disease. Because patients present with atypical and/or refractory symptoms, several diagnostic tests are employed to evaluate patients with PVCD; laryngoscopy is the most common. Direct visualization of abnormal vocal cord movement is the most definitive means of establishing the diagnosis of PVCD. A number of psychiatric disturbances are related to PVCD, including conversion and anxiety disorders. PVCD is associated with severe psychosocial stress and difficulties with modulation of intense emotional states. Conclusions: Psychogenic respiratory distress produced by PVCD can be easily misdiagnosed as severe or refractory asthma or other pulmonary disease states. Recognition of PVCD is important to avoid unnecessary medications and invasive treatments. Primary care physicians can detect cases of PVCD by attending to clinical symptoms, implementing appropriate laboratory investigations, and examining the psychological covariates of the disorder. Psychotherapy and speech therapy are effective in treating most cases of PVCD. PMID:15014694

Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery.

PubMed

Haerle, Stephan; Sidler, D; Linder, Th; Mueller, W

2008-12-01

The aims were to assess the technical feasibility of using a single electrode in the posterior arytenoid muscles (PAM) for intraoperative monitoring of the recurrent laryngeal nerve (RLN) in thyroid surgery, to validate the new method against the insertion of electrodes placed in the vocal cord muscle, and to report the results of the clinical application of the new concept. A total of 52 patients were enrolled. The handling and safety of RLN monitoring was tested by simultaneous registration of the EMG response from vocal fold electrodes and PAM electrodes. Acoustically and electromyographically we found nearly the same values for the arytenoid muscles as for the vocal folds, although the signals taken from the vocal folds were slightly stronger. PAM recording using a single bipolar electrode is technically feasible and as reliable compared to the standard vocal cord monitoring.

Development of laryngeal video stroboscope with laser marking module for dynamic glottis measurement.

PubMed

Kuo, Chung-Feng Jeffrey; Wang, Hsing-Won; Hsiao, Shang-Wun; Peng, Kai-Ching; Chou, Ying-Liang; Lai, Chun-Yu; Hsu, Chien-Tung Max

2014-01-01

Physicians clinically use laryngeal video stroboscope as an auxiliary instrument to test glottal diseases, and read vocal fold images and voice quality for diagnosis. As the position of vocal fold varies in each person, the proportion of the vocal fold size as presented in the vocal fold image is different, making it impossible to directly estimate relevant glottis physiological parameters, such as the length, area, perimeter, and opening angle of the glottis. Hence, this study designs an innovative laser projection marking module for the laryngeal video stroboscope to provide reference parameters for image scaling conversion. This innovative laser projection marking module to be installed on the laryngeal video stroboscope using laser beams to project onto the glottis plane, in order to provide reference parameters for scaling conversion of images of laryngeal video stroboscope. Copyright © 2013 Elsevier Ltd. All rights reserved.

Unsteady flow motions in the supraglottal region during phonation

NASA Astrophysics Data System (ADS)

Luo, Haoxiang; Dai, Hu

2008-11-01

The highly unsteady flow motions in the larynx are not only responsible for producing the fundamental frequency tone in phonation, but also have a significant contribution to the broadband noise in the human voice. In this work, the laryngeal flow is modeled either as an incompressible pulsatile jet confined in a two-dimensional channel, or a pressure-driven flow modulated by a pair of viscoelastic vocal folds through the flow--structure interaction. The flow in the supraglottal region is found to be dominated by large-scale vortices whose unsteady motions significantly deflect the glottal jet. In the flow--structure interaction, a hybrid model based on the immersed-boundary method is developed to simulate the flow-induced vocal fold vibration, which involves a three-dimensional vocal fold prototype and a two-dimensional viscous flow. Both the flow behavior and the vibratory characteristics of the vocal folds will be presented.

Functional reinnervation of vocal folds after selective laryngeal adductor denervation-reinnervation surgery for spasmodic dysphonia.

PubMed

DeConde, Adam S; Long, Jennifer L; Armin, Bob B; Berke, Gerald S

2012-09-01

Selective laryngeal adductor denervation-reinnervation surgery (SLAD-R) offers a viable surgical alternative for patients with adductor spasmodic dysphonia refractory to botulinum toxin injections. SLAD-R selectively denervates the symptomatic thyroarytenoid muscle by dividing the distal adductor branch of the recurrent laryngeal nerve (RLN), and preventing reinnervation, by the proximal RLN and maintaining vocal fold bulk and tone by reinnervating the distal RLN with the ansa cervicalis. We present a patient who had previously undergone successful SLAD-R but presented 10 years postoperatively with a new regional dystonia involving his strap muscles translocated to his reinnervated larynx by his previous ansa-RLN neurorraphy. The patient's symptomatic vocal fold adduction resolved completely on division of the ansa-RLN neurorraphy confirming successful selective functional reinnervation of vocal fold adductors by the ansa cervicalis. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Cyclooxygenase-2 expression and clinical parameters in laryngeal squamous cell carcinoma, vocal fold nodule, and laryngeal atypical hyperplasia.

PubMed

Sayar, Cağdaş; Sayar, Hamide; Özdemir, Süleyman; Selçuk, Tahsin; Görgülü, Orhan; Akbaş, Yücel; Kemal Olgun, Mustafa

2013-01-01

The diagnostic role of cyclooxygenase-2 (COX-2) expression in laryngeal atypical hyperplasia, vocal fold nodule, and laryngeal squamous cell carcinoma was examined. Specimens obtained from patients diagnosed with vocal fold nodule (n = 35), atypical hyperplasia (n = 35), laryngeal squamous cell carcinoma (n = 35), and clinical parameters were evaluated retrospectively. Although no staining was observed in patients with vocal fold nodules, staining was noted in laryngeal atypical hyperplasia and squamous cell carcinoma. The percentage of COX-2 staining was the highest in the carcinoma group. It was determined that COX-2 staining was significantly associated with laryngeal squamous cell carcinoma. It should be noted that overexpression of COX-2, a potentially important factor in the evolution of carcinogenesis in precancerous lesions, might be an indicator of the development of carcinoma. Copyright © 2012 Wiley Periodicals, Inc.

Hierarchical Diagnosis of Vocal Fold Disorders

NASA Astrophysics Data System (ADS)

Nikkhah-Bahrami, Mansour; Ahmadi-Noubari, Hossein; Seyed Aghazadeh, Babak; Khadivi Heris, Hossein

This paper explores the use of hierarchical structure for diagnosis of vocal fold disorders. The hierarchical structure is initially used to train different second-level classifiers. At the first level normal and pathological signals have been distinguished. Next, pathological signals have been classified into neurogenic and organic vocal fold disorders. At the final level, vocal fold nodules have been distinguished from polyps in organic disorders category. For feature selection at each level of hierarchy, the reconstructed signal at each wavelet packet decomposition sub-band in 5 levels of decomposition with mother wavelet of (db10) is used to extract the nonlinear features of self-similarity and approximate entropy. Also, wavelet packet coefficients are used to measure energy and Shannon entropy features at different spectral sub-bands. Davies-Bouldin criterion has been employed to find the most discriminant features. Finally, support vector machines have been adopted as classifiers at each level of hierarchy resulting in the diagnosis accuracy of 92%.

Glottal aerodynamics in compliant, life-sized vocal fold models

NASA Astrophysics Data System (ADS)

McPhail, Michael; Dowell, Grant; Krane, Michael

2013-11-01

This talk presents high-speed PIV measurements in compliant, life-sized models of the vocal folds. A clearer understanding of the fluid-structure interaction of voiced speech, how it produces sound, and how it varies with pathology is required to improve clinical diagnosis and treatment of vocal disorders. Physical models of the vocal folds can answer questions regarding the fundamental physics of speech, as well as the ability of clinical measures to detect the presence and extent of disorder. Flow fields were recorded in the supraglottal region of the models to estimate terms in the equations of fluid motion, and their relative importance. Experiments were conducted over a range of driving pressures with flow rates, given by a ball flowmeter, and subglottal pressures, given by a micro-manometer, reported for each case. Imaging of vocal fold motion, vector fields showing glottal jet behavior, and terms estimated by control volume analysis will be presented. The use of these results for a comparison with clinical measures, and for the estimation of aeroacoustic source strengths will be discussed. Acknowledge support from NIH R01 DC005642.

What can vortices tell us about vocal fold vibration and voice production.

PubMed

Khosla, Sid; Murugappan, Shanmugam; Gutmark, Ephraim

2008-06-01

Much clinical research on laryngeal airflow has assumed that airflow is unidirectional. This review will summarize what additional knowledge can be obtained about vocal fold vibration and voice production by studying rotational motion, or vortices, in laryngeal airflow. Recent work suggests two types of vortices that may strongly contribute to voice quality. The first kind forms just above the vocal folds during glottal closing, and is formed by flow separation in the glottis; these flow separation vortices significantly contribute to rapid closing of the glottis, and hence, to producing loudness and high frequency harmonics in the acoustic spectrum. The second is a group of highly three-dimensional and coherent supraglottal vortices, which can produce sound by interaction with structures in the vocal tract. Present work is also described that suggests that certain laryngeal pathologies, such as asymmetric vocal fold tension, will significantly modify both types of vortices, with adverse impact on sound production: decreased rate of glottal closure, increased broadband noise, and a decreased signal to noise ratio. Recent research supports the hypothesis that glottal airflow contains certain vortical structures that significantly contribute to voice quality.

[Case-control survey on risk factors of benign vocal fold lesions].

PubMed

Huang, Dong-Yan; Yang, Wei-Yan; Yu, Ping; He, Yao; Han, Dong-Yi

2008-02-01

To investigate the risk factors that may relate with benign vocal fold lesions including vocal fold nodule, vocal fold polyp, chronic laryngitis and Reinke's edema In present series, 321 cases who were performed laryngoscope were invited to participate the survey. Among them 168 cases with benign vocal fold lesions composed the case group. Another 153 cases with normal larynx composed the control group. Each case were undertook the same questionnaire. Logistic regression analysis was preformed to investigate the possible risk factors. The result demonstrated the occurring of benign vocal fold lesions positively correlated to five factors, including occupation, work or residence environment noise, alcohol-consuming, voice-using hours per day and abuse of voice. Occupations with intensive voice-use were more vulnerable to developing these disorders. Occurring risk of occupations type II with moderate voice-use was 1.934 times than that of occupations type I with lesser voice-use (OR = 1.934). And risk of occupations type III with upper voice-use was 2.633 times than that of type I. Risk raised 1.302 times with each more hour of voice use per day. OR of the following factors of voice abuse, environment noise, alcohol-consuming was 4.744, 2.115 and 2.177, respectively. The result suggested that people should abstain from alcohol, lowering the environment noise, prevent overuse and abuse of voice in order to decrease the prevalence of these disorders, which is especially important for the professional voice users, e. g. teachers or managers. The essential therapy for these disorders is to correct bad phonation habits.

Acute exposure to vibration is an apoptosis-inducing stimulus in the vocal fold epithelium.

PubMed

Novaleski, Carolyn K; Kimball, Emily E; Mizuta, Masanobu; Rousseau, Bernard

2016-10-01

Clinical voice disorders pose significant communication-related challenges to patients. The purpose of this study was to quantify the rate of apoptosis and tumor necrosis factor-alpha (TNF-α) signaling in vocal fold epithelial cells in response to increasing time-doses and cycle-doses of vibration. 20 New Zealand white breeder rabbits were randomized to three groups of time-doses of vibration exposure (30, 60, 120min) or a control group (120min of vocal fold adduction and abduction). Estimated cycle-doses of vocal fold vibration were extrapolated based on mean fundamental frequency. Laryngeal tissue specimens were evaluated for apoptosis and gene transcript and protein levels of TNF-α. Results revealed that terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was significantly higher after 120min of vibration compared to the control. Transmission electron microscopy (TEM) revealed no significant effect of time-dose on the mean area of epithelial cell nuclei. Extrapolated cycle-doses of vibration exposure were closely related to experimental time-dose conditions, although no significant correlations were observed with TUNEL staining or mean area of epithelial cell nuclei. TUNEL staining was positively correlated with TNF-α protein expression. Our findings suggest that apoptosis can be induced in the vocal fold epithelium after 120min of modal intensity phonation. In contrast, shorter durations of vibration exposure do not result in apoptosis signaling. However, morphological features of apoptosis are not observed using TEM. Future studies are necessary to examine the contribution of abnormal apoptosis to vocal fold diseases. Copyright © 2016 Elsevier Ltd. All rights reserved.

Amplitude of Glottal Mucosal Wave After Vocal Fold Microflap With or Without Fibrin Glue.

PubMed

González-Herranz, Ramón; Amarillo, Elizabeth; Hernández-García, Estefanía; Montojo Woodeson, José; Plaza-Mayor, Guillermo

2017-05-01

The vocal fold microflap technique is the ideal to remove benign vocal fold pathology. Our objective is to compare the amplitudes of the mucosal wave before and after the closure of microflap defect with fibrin glue, and when microflap is left to heal by secondary intention. The present study is a retrospective series, including 32 patients treated by intracordal phonosurgery, with closure of the microflap either with fibrin glue or by healing by secondary intention. They all had both preoperative and 6-month postoperative track records to allow voice analysis, a subjective Voice Handicap Index 10 (VHI-10), and a good image quality strobe. After selecting the patients was found that the mean overall preoperative VHI-10 was 26.6, and improved up to 10.5 after surgery, a statistical differences (P = 0.03). When comparing both groups, with or without fibrin glue, fibrin glue did not improved results in VHI-10. On the contrary, there was a significant difference in the improvement of the open glottal phase after surgery (P = 0.03), showing a much higher improvement when fibrin glue was used. The use of fibrin glue after a vocal fold microflap for advanced pathology, such as sulcus vocalis in pocket, vergeture, or vocal fold scar, increases the amplitude of the mucosal wave of the vocal folds, but does not improve the VHI-10 results in our cohort of female patients. So far, patient-reported outcome shows that healing by secondary intention continues to provide excellent voice results. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Acute Exposure to Vibration is an Apoptosis-Inducing Stimulus in the Vocal Fold Epithelium

PubMed Central

Novaleski, Carolyn K.; Kimball, Emily E.; Mizuta, Masanobu; Rousseau, Bernard

2016-01-01

Clinical voice disorders pose significant communication-related challenges to patients. The purpose of this study was to quantify the rate of apoptosis and tumor necrosis factor-alpha (TNF-α) signaling in vocal fold epithelial cells in response to increasing time-doses and cycle-doses of vibration. 20 New Zealand white breeder rabbits were randomized to three groups of time-doses of vibration exposure (30, 60, 120 minutes) or a control group (120 minutes of vocal fold adduction and abduction). Estimated cycle-doses of vocal fold vibration were extrapolated based on mean fundamental frequency. Laryngeal tissue specimens were evaluated for apoptosis and gene transcript and protein levels of TNF-α. Results revealed that terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was significantly higher after 120 minutes of vibration compared to the control. Transmission electron microscopy (TEM) revealed no significant effect of time-dose on the mean area of epithelial cell nuclei. Extrapolated cycle-doses of vibration exposure were closely related to experimental time-dose conditions, although no significant correlations were observed with TUNEL staining or mean area of epithelial cell nuclei. TUNEL staining was positively correlated with TNF-α protein expression. Our findings suggest that apoptosis can be induced in the vocal fold epithelium after 120 minutes of modal intensity phonation. In contrast, shorter durations of vibration exposure do not result in apoptosis signaling. However, morphological features of apoptosis are not observed using TEM. Future studies are necessary to examine the contribution of abnormal apoptosis to vocal fold diseases. PMID:27577014

Intraoperative laryngeal electromyography in children with vocal fold immobility: results of a multicenter longitudinal study.

PubMed

Maturo, Stephen C; Braun, Nicole; Brown, David J; Chong, Peter Siao Tick; Kerschner, Joseph E; Hartnick, Christopher J

2011-12-01

To determine whether laryngeal electromyography (LEMG) can predict recurrent laryngeal nerve function return in children and whether LEMG can aid in the management of vocal fold immobility (VFI). Prospective case series. Tertiary pediatric aerodigestive centers. Twenty-five children aged 14 days to 7 years at the time of first LEMG (mean age, 21.4 months) with VFI who underwent flexible fiberoptic laryngeal examination, intraoperative LEMG of the thyroarytenoid muscles, and 12-month follow-up. To compare results of LEMG with flexible fiberoptic laryngeal examination in children with vocal fold paresis and to determine if LEMG can predict vocal fold return. In children who had a patent ductus arteriosus ligation, the LEMG data suggest that if there is no activity 6 months after injury, then the nerve is unlikely to regain function. In 3 of 3 children with central causes of VFI, normal LEMG findings predicted return of nerve function 2 to 7 months before vocal fold movement on fiberoptic examination. Finally, in 3 of 3 children with idiopathic VFI, LEMG predicted return within 2 to 14 months of vocal folds with normal findings. Intraoperative LEMG is a safe, easy-to-use method for determining the likelihood of recurrent laryngeal nerve function return in children who have undergone patent ductus arteriosus ligation, in children with centrally correctable lesions, and in children with idiopathic VFI. More work is needed in the area of pediatric LEMG, but it is possible that LEMG data can be used to aid in management strategies and provide families with more information to make better informed decisions regarding their child's care.

Changes in Peak Airflow Measurement During Maximal Cough After Vocal Fold Augmentation in Patients With Glottic Insufficiency.

PubMed

Dion, Gregory R; Achlatis, Efstratios; Teng, Stephanie; Fang, Yixin; Persky, Michael; Branski, Ryan C; Amin, Milan R

2017-11-01

Compromised cough effectiveness is correlated with dysphagia and aspiration. Glottic insufficiency likely yields decreased cough strength and effectiveness. Although vocal fold augmentation favorably affects voice and likely improves cough strength, few data exist to support this hypothesis. To assess whether vocal fold augmentation improves peak airflow measurements during maximal-effort cough following augmentation. This case series study was conducted in a tertiary, academic laryngology clinic. Participants included 14 consecutive individuals with glottic insufficiency due to vocal fold paralysis, which was diagnosed via videostrobolaryngoscopy as a component of routine clinical examination. All participants who chose to proceed with augmentation were considered for the study whether office-based or operative augmentation was planned. Postaugmentation data were collected only at the first follow-up visit, which was targeted for 14 days after augmentation but varied on the basis of participant availability. Data were collected from June 5, 2014, to October 1, 2015. Data analysis took place between October 2, 2015, and March 3, 2017. Peak airflow during maximal volitional cough was quantified before and after vocal fold augmentation. Participants performed maximal coughs, and peak expiratory flow during the maximal cough was captured according to American Thoracic Society guidelines. Among the 14 participants (7 men and 7 women), the mean (SD) age was 62 (18) years. Three types of injectable material were used for vocal fold augmentation: carboxymethylcellulose in 5 patients, hyaluronic acid in 5, and calcium hydroxylapatite in 4. Following augmentation, cough strength increased in 11 participants and decreased cough strength was observed in 3. Peak airflow measurements during maximal cough varied from a decrease of 40 L/min to an increase of 150 L/min following augmentation. When preaugmentation and postaugmentation peak airflow measurements were compared, the median improvement was 50 L/min (95% CI, 10-75 L/min; P = .01). Immediate peak airflow measurements during cough collected within 30 minutes of augmentation varied when compared with measurements collected at follow-up (103-380 vs 160-390 L/min). Peak airflow during maximal cough may improve with vocal fold augmentation. Additional assessment and measurements are needed to further delineate which patients will benefit most regarding their cough from vocal fold augmentation.

Comprehensive Outcome Researches of Intralesional Steroid Injection on Benign Vocal Fold Lesions.

PubMed

Wang, Chi-Te; Lai, Mei-Shu; Hsiao, Tzu-Yu

2015-09-01

This study investigated multidimensional treatment outcomes, including prognostic factors and side effects of vocal fold steroid injection (VFSI). We recruited 126 consecutive patients, including patients with 49 nodules, 47 polyps, and 30 mucus retention cysts. All the patients received VFSI under local anesthesia in the office settings. Treatment outcomes were evaluated 1 and 2 months after the procedure, including endoscopic evaluation, perceptual voice quality (GRB scores), acoustic analysis, and 10-item Voice Handicap Index (VHI-10). More than 80% of the patients reported subjective improvements after VFSI. Objective measurements revealed significant improvements from baseline in most of the outcome parameters (P<0.05). Higher occupational vocal demands and fibrotic vocal nodules were significantly associated with poorer clinical responses as measured by the VHI-10 and GRB scores, respectively. For vocal polyps, dysphonia for more than 12 months were significantly associated with higher postoperative VHI-10 scores, whereas patients with laryngopharyngeal reflux (LPR) showed significantly poor postoperative voice quality as measured by GRB scores. Side effects after VFSI included hematoma (27%), triamcinolone deposits (4%), and vocal atrophy (1%), which resolved spontaneously within 1-2 months. Presentation with vocal fold ectasias/varicosities and higher vocal demands were significantly correlated with postoperative vocal hematoma. This study demonstrated significant improvements after VFSI in vocal nodules, polyps, and cysts. Occupational vocal demand and subtypes of vocal nodules are closely related to the treatment outcomes after VFSI, whereas symptom duration and LPR were significant prognostic factors for VFSI treatment outcomes in vocal polyps. Side effects after receiving VFSI were mostly self-limited without sequel, whereas the incidence rates might be varied by the injection approach and the timing for postoperative follow-up. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma.

PubMed

Arıkan, Akif Enes; Teksöz, Serkan; Bilgin, İsmail Ahmet; Tarhan, Özge; Özyeğin, Ateş

2017-01-01

Although vocal cord paralysis (VCP) following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis following thyroidectomy can be caused by a vocal cord hematoma with an incidence of 1.4% due to direct injury during orotracheal intubation. In this article, we present a case of VCP caused by vocal cord hematoma. A 32-year-old male patient who has been receiving propylthiouracil treatment for toxic multinodular goiter since 10 years was admitted to our hospital to be operated because of persisting complaints. The patient was hospitalized for sutureless thyroidectomy after he became euthyroid. Preoperative fiberoptic laryngoscopy performed by the ear, nose, and throat department revealed bilaterally motile vocal folds and a completely open airway. Patient underwent sutureless total thyroidectomy with a vessel sealing device (Ligasure TM LF1212, Covidien, CO), and a minivac drainage system was placed in the thyroid lodge. On the morning of the first postoperative day, 50 mL of serosanguinous fluid was drained. The patient's voice was normal, and there was no ecchymosis. Postoperative fiberoptic laryngoscopy revealed a hematoma near the right vocal fold and paralysis of the right vocal fold; however, the airway was open. It should be kept in mind that VCP is not solely due to surgery but can also result from intubation, as observed in this case.

A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma

PubMed Central

Arıkan, Akif Enes; Teksöz, Serkan; Bilgin, İsmail Ahmet; Tarhan, Özge; Özyeğin, Ateş

2017-01-01

Although vocal cord paralysis (VCP) following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis following thyroidectomy can be caused by a vocal cord hematoma with an incidence of 1.4% due to direct injury during orotracheal intubation. In this article, we present a case of VCP caused by vocal cord hematoma. A 32-year-old male patient who has been receiving propylthiouracil treatment for toxic multinodular goiter since 10 years was admitted to our hospital to be operated because of persisting complaints. The patient was hospitalized for sutureless thyroidectomy after he became euthyroid. Preoperative fiberoptic laryngoscopy performed by the ear, nose, and throat department revealed bilaterally motile vocal folds and a completely open airway. Patient underwent sutureless total thyroidectomy with a vessel sealing device (LigasureTM LF1212, Covidien, CO), and a minivac drainage system was placed in the thyroid lodge. On the morning of the first postoperative day, 50 mL of serosanguinous fluid was drained. The patient’s voice was normal, and there was no ecchymosis. Postoperative fiberoptic laryngoscopy revealed a hematoma near the right vocal fold and paralysis of the right vocal fold; however, the airway was open. It should be kept in mind that VCP is not solely due to surgery but can also result from intubation, as observed in this case. PMID:29260141

Vocal tract characteristics in Parkinson's disease.

PubMed

Gillivan-Murphy, Patricia; Carding, Paul; Miller, Nick

2016-06-01

Voice tremor is strongly linked to the Parkinson's disease speech-voice symptom complex. Little is known about the underlying anatomic source(s) of voice tremor when it occurs. We review recent literature addressing this issue. Additionally we report findings from a study we conducted employing rating of vocal tract structures viewed using nasolaryngoscopy during vocal and nonspeech tasks. In Parkinson's disease, using laryngeal electromyography, tremor has not been identified in muscles in the vocal folds even when perceived auditorily. Preliminary findings using nasolaryngoscopy suggest that Parkinson's disease voice tremor is not associated with the vocal folds and may involve the palate, the global larynx, and the arytenoids. Tremor in the vertical larynx on /a/, and tremor in the arytenoid cartilages on /s/ differentiated patients with Parkinson's disease from neurologically healthy controls. Visual reliable detection of tremor when it is absent or borderline present, is challenging. Parkinson's disease voice tremor is likely to be related to oscillatory movement in structures across the vocal tract rather than just the vocal folds. To progress clinical practice, more refined tools for the visual rating of tremor would be beneficial. How far voice tremor represents a functionally significant factor for speakers would also add to the literature.

Vocal exercise may attenuate acute vocal fold inflammation

PubMed Central

Abbott, Katherine Verdolini; Li, Nicole Y.K.; Branski, Ryan C.; Rosen, Clark A.; Grillo, Elizabeth; Steinhauer, Kimberly; Hebda, Patricia A.

2012-01-01

Objectives/Hypotheses The objective was to assess the utility of selected “resonant voice” exercises for the reduction of acute vocal fold inflammation. The hypothesis was that relatively large-amplitude, low-impact exercises associated with resonant voice would reduce inflammation more than spontaneous speech and possibly more than voice rest. Study Design The study design was prospective, randomized, double-blind. Methods Nine vocally healthy adults underwent a 1-hr vocal loading procedure, followed by randomization to (a) a spontaneous speech condition, (b) a vocal rest condition, or (c) a resonant voice exercise condition. Treatments were monitored in clinic for 4 hr, and continued extra-clinically until the next morning. At baseline, immediately following loading, after the 4-hr in-clinic treatment, and 24 hr post baseline, secretions were suctioned from the vocal folds bilaterally and submitted to enzyme-linked immunosorbent assay (ELISA) to estimate concentrations of key markers of tissue injury and inflammation: IL-1β, IL-6, IL-8, TNF-α, MMP-8, and IL-10. Results Complete data sets were obtained for 3 markers -- IL-1β, IL-6, and MMP-8 -- for one subject in each treatment condition. For those markers, results were poorest at 24-hr follow-up in the spontaneous speech condition, sharply improved in the voice rest condition, and best in the resonant voice condition. Average results for all markers, for all responsive subjects with normal baseline mediator concentrations, revealed an almost identical pattern. Conclusions Some forms of tissue mobilization may be useful to attenuate acute vocal fold inflammation. PMID:23177745

Taking Care of Your Voice

MedlinePlus

... open so that you can breathe. When it's time to speak, however, the brain orchestrates a series of events. The vocal folds snap together while ... Communication Disorders (NIDCD) supports research that includes laboratory ... other scientists design better treatments for conditions such as vocal fold ...

Dynamic viscosity of implantable autologous materials into the vocal fold.

PubMed

Wiikmann, Christian; da Silva, Marcelo Alves; Arêas, Elizabeth Pinheiro Gomes; Tsuji, Domingos Hiroshi; Sennes, Luiz Ubirajara

2012-07-01

To compare the dynamic viscosity (DV) of superficial layer of temporalis fascia (SLTF) with that of other biological tissues traditionally used for vocal fold implants to treat vocal fold rigidity. Experimental. Measurement of DV of samples of SLTF, deep layer of temporalis fascia (DLTF), and abdominal fat of 12 cadavers. DV values of the different samples were presented in the following increasing order: SLTF, DLTF, and abdominal fat. There was statistical difference between the samples. DV of SLTF is lower than of other tissues tested. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Paradigms and progress in vocal fold restoration.

PubMed

Ford, Charles N

2008-09-01

Science advances occur through orderly steps, puzzle-solving leaps, or divergences from the accepted disciplinary matrix that occasionally result in a revolutionary paradigm shift. Key advances must overcome bias, criticism, and rejection. Examples in biological science include use of embryonic stem cells, recognition of Helicobacter pylori in the etiology of ulcer disease, and the evolution of species. Our work in vocal fold restoration reflects these patterns. We progressed through phases of tissue replacement with fillers and biological implants, to current efforts at vocal fold regeneration through tissue engineering, and face challenges of a new "systems biology" paradigm embracing genomics and proteomics.

Office-based laryngeal injection of botulinum toxin for paradoxical vocal fold motion in a child.

PubMed

Montojo, José; González, Ramón; Hernández, Estefanía; Zafra, Miguel; Plaza, Guillermo

2015-07-01

We describe the case of a 13-year-old girl with paradoxical vocal fold motion (PVFM) who failed to improve with repeated medical treatment, speech therapy and psychotherapy, but was successfully treated with botulinum toxin A (BTX-A) injection to the vocal folds. For delivering the BTX-A we used a channeled fiber-optic laryngoscope under local anesthesia, in an office setting. The patient remained asymptomatic of PVFM for 5 months, was successfully treated again with the same method, and had no important side effects. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Kinematic measurements of the vocal-fold displacement waveform in typical children and adult populations: quantification of high-speed endoscopic videos.

PubMed

Patel, Rita; Donohue, Kevin D; Unnikrishnan, Harikrishnan; Kryscio, Richard J

2015-04-01

This article presents a quantitative method for assessing instantaneous and average lateral vocal-fold motion from high-speed digital imaging, with a focus on developmental changes in vocal-fold kinematics during childhood. Vocal-fold vibrations were analyzed for 28 children (aged 5-11 years) and 28 adults (aged 21-45 years) without voice disorders. The following kinematic features were analyzed from the vocal-fold displacement waveforms: relative velocity-based features (normalized average and peak opening and closing velocities), relative acceleration-based features (normalized peak opening and closing accelerations), speed quotient, and normalized peak displacement. Children exhibited significantly larger normalized peak displacements, normalized average and peak opening velocities, normalized average and peak closing velocities, peak opening and closing accelerations, and speed quotient compared to adult women. Values of normalized average closing velocity and speed quotient were higher in children compared to adult men. When compared to adult men, developing children typically have higher estimates of kinematic features related to normalized displacement and its derivatives. In most cases, the kinematic features of children are closer to those of adult men than adult women. Even though boys experience greater changes in glottal length and pitch as they mature, results indicate that girls experience greater changes in kinematic features compared to boys.

Pathogenesis of vocal fold nodules: new insights from a modelling approach.

PubMed

Dejonckere, Philippe H; Kob, Malte

2009-01-01

To give new insights into the pathogenesis of vocal fold nodules: (a) why the female/male ratio is so extreme, (b) how an hourglass-shaped vibration pattern - eliciting a localized microtrauma - originates, and (c) what the roles of muscular tension imbalance and of behavioral aspects are. Simulations with a 3-dimensional computer model of the vibrating vocal folds. (1) A slightly incomplete dorsal vocal fold adduction is a first condition for inducing an hourglass vibration pattern. (2) A limited collision zone is only possible with a small degree of curving of the rest position of the vocal fold edges in their ventral portion. This is an anatomical characteristic of the adult female larynx. Muscular fatigue and resulting hypotonia seem to enhance this curving. (3) If both these conditions are fulfilled, a sufficient vibration amplitude is required to achieve a localized impact. (4) This third condition can be obtained by an increased subglottal pressure and/or by a decrease in active stress of the tension forces between the neighboring vocalis masses. These last aspects incorporate muscular tension imbalance (dyskinesia) and behavioral aspects in the modelling process. Decrease in active stress is a possible effect of fatigue, and increase in subglottal pressure a result of effort compensation. Copyright 2009 S. Karger AG, Basel.

[Aetiology and treatment of vocal fold paralysis: retrospective study of 108 patients].

PubMed

Bothe, Carolina; López, Montserrat; Quer, Miquel; León, Xavier; García, Jacinto; Lop, Joan

2014-01-01

To review the aetiology and treatment of laryngeal paralysis diagnosed at our hospital and to describe the available therapeutic options. Retrospective review of medical records of 108 patients diagnosed with unilateral and bilateral vocal fold paralysis between 2000 and 2012, identifying the cause of paralysis and its treatment. Of the 108 cases analysed, 70% had unilateral vocal fold immobility and 30% bilateral immobility. The most frequent aetiology in both cases was trauma (represented mainly by surgical injury), followed by tumours in unilateral paralysis and medical causes in bilateral paralysis. Half of the patients with unilateral paralysis (38) were treated surgically, with medialization thyroplasty. In bilateral vocal fold immobility, the treatment consisted of tracheostomy in patients with threatened airway (40%). We planned to widen the air passage in 9 patients (27%), performing cordectomy in most of them. The aetiology observed in our patients is similar to that described in the literature. In cases of unilateral vocal fold paralysis, we believe thyroplasty is the procedure of choice. In bilateral paralysis, it is possible to perform cordectomy in selected patients once the airway has been secured. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

Laryngeal Electromyography for Prognosis of Vocal Fold Paralysis.

PubMed

Pardo-Maza, Adriana; García-Lopez, Isabel; Santiago-Pérez, Susana; Gavilán, Javier

2017-01-01

This study aimed to determine the value of laryngeal electromyography in the prognosis of vocal fold paralysis. This is a retrospective descriptive study. This study included 80 patients diagnosed with unilateral or bilateral vocal fold paralysis on flexible laryngoscopy between 2002 and 2014 in a tertiary medical center. Laryngeal electromyography using a standardized protocol was performed; the outcome measures were classified and analyzed into two groups according to the degree of injury. Group 1 included patients with mild to moderate injury, and group 2 included patients with severe to complete injury. Prognosis was correlated with vocal fold motion recovery status with a minimum of 6 months of follow-up since the symptoms onset using positive and negative predictive values. Sixty patients showed acute or chronic recurrent laryngeal neuropathy in laryngeal electromyography. Twelve of 41 patients included in group 1 recovered motion, and 30 of 35 patients included in group 2 did not recover, resulting in 88.2% of positive predictive value and 35.7% of negative predictive value. Our data confirm that laryngeal electromyography is a useful clinical tool in predicting poor recovery in patients with vocal fold paralysis. It allows identification of candidates for early intervention. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

[Vascular Lesions of Vocal Folds - Part 2: Perpendicular Vascular Lesions].

PubMed

Arens, C; Glanz, H; Voigt-Zimmermann, S

2015-11-01

The present work aims at a systematic pathogenetic description of perpendicular vascular changes in the vocal folds. Unlike longitudinal vascular changes, like ectasia and meander, perpendicular vascular changes can be observed in bening lesions. They predominantly occur as typical vascular loops in exophytic lesions, especially in recurrent respiratory papillomatosis (RRP), pre-cancerous and cancerous diseases of the larynx and vocal folds. Neoangiogenesis is caused by an epithelial growth stimulus in the early phase of cancerous genesis. In RRP the VVC impress by a single, long vessel loop with a narrow angle turning point in the each single papilla of the papilloma. In pre- and cancerous lesions the vascular loop is located directly underneath the epithelium. During progressive tumor growth, vascular loops develop an increasingly irregular, convoluted, spirally shape. The arrangement of the vascular loops is primarily still symmetrical. In the preliminary stage of tumor development occurs by neoangiogenesis to a microvascular compression. In advanced vocal fold carcinoma the regular vascular vocal fold structure is destroyed. The various stages of tumor growth are also characterized by typical primary epithelial and secondary connective tissue changes. The characteristic triad of vascular, epithelial and connective tissue changes therefore plays an important role in differential diagnosis. © Georg Thieme Verlag KG Stuttgart · New York.

Using Trial Vocal Fold Injection to Select Vocal Fold Scar Patients Who May Benefit From More Durable Augmentation.

PubMed

Carroll, Thomas L; Dezube, Aaron; Bauman, Laura A; Mallur, Pavan S

2018-02-01

Clinical indications for vocal fold injection augmentation (VFI) are expanding. Prior studies demonstrate the benefit of trial VFI for select causes of glottic insufficiency. No studies have examined trial VFI for glottic insufficiency resulting from true vocal fold (TVF) scar. Retrospective chart review of patients who underwent trial VFI for a dominant pathology of TVF scar causing dysphonia. Patients who subsequently underwent durable augmentation were identified. The primary study outcome was the difference in Voice Handicap Index-10 (VHI-10) score from pretrial VFI to post-durable augmentation. Twenty-eight patients underwent trial VFI for TVF scar, 22 of whom reported a positive response. Fifteen of 22 subjects who underwent durable augmentation had viable data for analysis. Mean VHI-10 improved from 26.9 to 18.6 ( P < .05), for a delta VHI-10 of 8.3, or 30.9% improvement. Twelve of the 15 (80%) showed a clinically significant improvement (delta VHI-10 >5). A trial VFI is a potentially useful, low-risk procedure that appears to help the patient and clinician identify when global augmentation might improve the voice when vocal fold scar is present. Patients who reported successful trial VFI often demonstrated significant improvement in their VHI-10 after subsequent durable augmentation.

Jugular vein phlebectasia in paediatric patients with vocal fold nodules.

PubMed

Liu, Xiang; Sun, Chang-zhi; Zou, Hua; Luo, Ren-zhong

2013-08-01

Jugular vein phlebectasia (JVP) may often be overlooked in clinical practice and the management for JVP include surgery and a conservative approach. We have studied the relationship between JVP and vocal fold nodules in paediatric patients as well as the effects of treatment. Twenty-three cases of paediatric vocal fold nodules with JVP were studied. All patients received voice therapy. After 6 months of treatment, hoarseness, neck appearance (subjective evaluation) and the degree of dilation of the jugular vein detected by Doppler ultrasonography were analysed. The follow-up period was 6 to 84 months. The hoarseness disappeared or lessened noticeably after treatment for 1-4 months. The neck masses also lessened (pre vs. post: 2.58 ± 0.40 vs. 1.60 ± 0.19) after treatment for 1-4 months. The visual analogue score of the post-treatment symptoms decreased significantly compared with pre-treatment (p <0.05). The degree of dilation of the post-treatment jugular vein also decreased significantly (p <0.05). Paediatric vocal fold nodules may be related to JVP. Voice changes may also be observed in cases of paediatric JVP. Voice therapy may offer another conservative treatment option for JVP accompanied by vocal fold nodules, and it may offer better results than simple observation of JVP.

Medialization thyroplasty in glottis insufficiency due to unilateral vocal fold paralysis and after laser cordectomies - preliminary report.

PubMed

Rzepakowska, Anna; Osuch-Wójcikiewicz, Ewa; Sielska-Badurek, Ewelina; Niemczyk, Kazimierz

2017-02-28

Medialization thyroplasty (type I) is surgical procedure performed on the thyroid cartilage. The major indication for this surgery is significant glottis insufficiency due to unilateral vocal fold paresis. However the proce¬dure is also performed after vocal fold resections during cordectomy. The evaluation of voice results in patients after medialisation throplasty. In Otolaryngology Department of Medical University of Warsaw there were performed so far 8 thyroplasty procedures under local anaesthesia with implantation of medical silicon protesis. 6 patients had unilat¬eral vocal fold paresis and the rest two underwent in the past laser cordectomy due to T1a vocal carcinoma. There were no complications during and post the surgery. The follow up examination in 1st , 3rd, 6th i 12th months postoperatively revealed for all patients significant improvement of glottal closure in laryngeal videostrobos¬copy. The voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shim¬mer, NHR) in both patients groups. However the rate of improvement was much more significant in group with uni¬lateral vocal fold paresis. In all patients the maximum phonation time (MPT) increased. The self-evaluation of voice quality with Voice Handicap Index questionnaire confirmed also individual improvement. The speech rehabilitations is not successful in each patient with glottis insufficiency. The medialisation thyroplasty remains the standard procedure for permanent improvement of voice quality in those cases.

Vocal fold hypomobility secondary to elective endotracheal intubation: a general surgeon's perspective.

PubMed

Sariego, Jack

2010-01-01

This study was performed retrospectively to evaluate the incidence of documented vocal fold injury as a result of elective endotracheal intubation during general surgical procedures. Medical record review was performed at a single institution and all surgical cases reviewed which required endotracheal intubation in the nonemergent setting between April 1, 2003 and August, 31, 2007. Cases with unexpected and documented vocal fold immobility postoperatively formed the study cohort, and data were gathered regarding diagnosis and procedures performed. Of 23,010 general surgery cases performed during the study period, only seven documented cases of vocal fold paralysis were discovered (0.03%). There were five women and two men in the group; all were adults. Only one patient had a primary diagnosis related to the head and neck. Comorbidities were recorded as well, but there were no statistically significant patterns discerned. Furthermore, during the study period, a total of 31 patients overall (both surgical and nonsurgical) were admitted who carried a primary diagnosis of vocal fold paralysis. Therefore, the study cohort therefore constituted 22.6% of this total. Finally, cohort patients spent a total of 150 days in hospital during the study period; this length of stay (an average of 16.7 hospital days per patient) was significantly longer than the average of 5.1 days, presumably at least in part related to the vocal paralysis. Copyright 2010 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

The effect of voice amplification on occupational vocal dose in elementary school teachers.

PubMed

Gaskill, Christopher S; O'Brien, Shenendoah G; Tinter, Sara R

2012-09-01

Two elementary school teachers, one with and one without a history of vocal complaints, wore a vocal dosimeter all day at school for a 3-week period. In the second week, each teacher wore a portable voice amplifier. Each teacher showed a reduction in vocal intensity during the week of amplification, with a larger effect for the teacher with vocal difficulties. This teacher also showed a decrease in hourly vocal fold distance dose as measured by the dosimeter despite incurring longer phonation times. Fundamental frequency and vocal fold cycle dose did not appear to be affected by the use of amplification during the teaching day. Both teachers showed evidence of a possible moderate effect of adjusting vocal intensity in the week after amplification, possibly as a means to recalibrate their perceived vocal loudness. This study demonstrates the usefulness of both vocal dosimetry and amplification in monitoring and modifying vocal dose in an occupational setting and reinforces previous data suggesting the effectiveness of amplification in reducing the vocal load in schoolteachers. Implications of the data for future research regarding prevention and treatment of occupational voice disorders are discussed. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Vocal warm-up increases phonation threshold pressure in soprano singers at high pitch.

PubMed

Motel, Tamara; Fisher, Kimberly V; Leydon, Ciara

2003-06-01

Vocal warm-up is thought to optimize singing performance. We compared effects of short-term, submaximal, vocal warm-up exercise with those of vocal rest on the soprano voice (n = 10, ages 19-21 years). Dependent variables were the minimum subglottic air pressure required for vocal fold oscillation to occur (phonation threshold pressure, Pth), and the maximum and minimum phonation fundamental frequency. Warm-up increased Pth for high pitch phonation (p = 0.033), but not for comfortable (p = 0.297) or low (p = 0.087) pitch phonation. No significant difference in the maximum phonation frequency (p = 0.193) or minimum frequency (p = 0.222) was observed. An elevated Pth at controlled high pitch, but an unchanging maximum and minimum frequency production suggests that short-term vocal exercise may increase the viscosity of the vocal fold and thus serve to stabilize the high voice.

Acoustic characteristics of phonation in "wet voice" conditions.

PubMed

Murugappan, Shanmugam; Boyce, Suzanne; Khosla, Sid; Kelchner, Lisa; Gutmark, Ephraim

2010-04-01

A perceptible change in phonation characteristics after a swallow has long been considered evidence that food and/or drink material has entered the laryngeal vestibule and is on the surface of the vocal folds as they vibrate. The current paper investigates the acoustic characteristics of phonation when liquid material is present on the vocal folds, using ex vivo porcine larynges as a model. Consistent with instrumental examinations of swallowing disorders or dysphagia in humans, three liquids of different Varibar viscosity ("thin liquid," "nectar," and "honey") were studied at constant volume. The presence of materials on the folds during phonation was generally found to suppress the higher frequency harmonics and generate intermittent additional frequencies in the low and high end of the acoustic spectrum. Perturbation measures showed a higher percentage of jitter and shimmer when liquid material was present on the folds during phonation, but they were unable to differentiate statistically between the three fluid conditions. The finite correlation dimension and positive Lyapunov exponent measures indicated that the presence of materials on the vocal folds excited a chaotic system. Further, these measures were able to reliably differentiate between the baseline and different types of liquid on the vocal folds.

Acoustic characteristics of phonation in “wet voice” conditions

PubMed Central

Murugappan, Shanmugam; Boyce, Suzanne; Khosla, Sid; Kelchner, Lisa; Gutmark, Ephraim

2010-01-01

A perceptible change in phonation characteristics after a swallow has long been considered evidence that food and∕or drink material has entered the laryngeal vestibule and is on the surface of the vocal folds as they vibrate. The current paper investigates the acoustic characteristics of phonation when liquid material is present on the vocal folds, using ex vivo porcine larynges as a model. Consistent with instrumental examinations of swallowing disorders or dysphagia in humans, three liquids of different Varibar viscosity (“thin liquid,” “nectar,” and “honey”) were studied at constant volume. The presence of materials on the folds during phonation was generally found to suppress the higher frequency harmonics and generate intermittent additional frequencies in the low and high end of the acoustic spectrum. Perturbation measures showed a higher percentage of jitter and shimmer when liquid material was present on the folds during phonation, but they were unable to differentiate statistically between the three fluid conditions. The finite correlation dimension and positive Lyapunov exponent measures indicated that the presence of materials on the vocal folds excited a chaotic system. Further, these measures were able to reliably differentiate between the baseline and different types of liquid on the vocal folds. PMID:20370039

Impact of Perioperative Voice Therapy on Outcomes in the Surgical Management of Vocal Fold Cysts.

PubMed

Tibbetts, Kathleen M; Dominguez, Laura M; Simpson, C Blake

2018-05-01

Vocal fold cysts are benign mid-membranous lesions of the true vocal fold, classified as mucus retention or epidermal inclusion cysts. Treatment is surgical excision with or without postoperative voice therapy. A retrospective review was performed of the demographics, treatment approach, and outcomes of patients treated for vocal fold cysts between 2009 and 2014. Voice Handicap Index (VHI)-10 scores before and after treatment were compared using the Wilcoxon Rank-Sum test and the two-tailed Student's t test. Videostroboscopy examinations were reviewed for posttreatment changes in vibratory characteristics of the vocal folds. Twenty-five patients were identified, and one was excluded for incomplete records. Mean age was 41.9 years (66.7% female), and mean follow-up time was 5.58 months. Microflap excision was pursued by 21/24 (87.5%) patients, with 14 patients (58.3%) undergoing perioperative voice therapy. One cyst recurred. Two patients elected for observation, and their cysts persisted. VHI-10 decreased from 23.8 to 6.6 (P < 0.001) overall. There was a statistically significant reduction in VHI-10 in patients undergoing surgery with and without postoperative voice therapy (P < 0.004 and 0.001), but there was no significant difference between these two groups. Mucosal wave was classified as normal or improved in the majority. Cysts were characterized as mucus retention cysts in 19/21 (90%) and as epidermal inclusion cysts in 2/21 (10%). Vocal fold cysts impact mucosal wave and glottic closure. Surgical excision resulted in low rates of recurrence, and in improvement in the mucosal wave and VHI-10. Perioperative voice therapy did not offer a significant benefit. Mucus retention cysts were the majority, in contrast to other published studies. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Dynamic Vibration Cooperates with Connective Tissue Growth Factor to Modulate Stem Cell Behaviors

PubMed Central

Tong, Zhixiang; Zerdoum, Aidan B.; Duncan, Randall L.

2014-01-01

Vocal fold disorders affect 3–9% of the U.S. population. Tissue engineering offers an alternative strategy for vocal fold repair. Successful engineering of vocal fold tissues requires a strategic combination of therapeutic cells, biomimetic scaffolds, and physiologically relevant mechanical and biochemical factors. Specifically, we aim to create a vocal fold-like microenvironment to coax stem cells to adopt the phenotype of vocal fold fibroblasts (VFFs). Herein, high frequency vibratory stimulations and soluble connective tissue growth factor (CTGF) were sequentially introduced to mesenchymal stem cells (MSCs) cultured on a poly(ɛ-caprolactone) (PCL)-derived microfibrous scaffold for a total of 6 days. The initial 3-day vibratory culture resulted in an increased production of hyaluronic acids (HA), tenascin-C (TNC), decorin (DCN), and matrix metalloproteinase-1 (MMP1). The subsequent 3-day CTGF treatment further enhanced the cellular production of TNC and DCN, whereas CTGF treatment alone without the vibratory preconditioning significantly promoted the synthesis of collagen I (Col 1) and sulfated glycosaminoglycans (sGAGs). The highest level of MMP1, TNC, Col III, and DCN production was found for cells being exposed to the combined vibration and CTGF treatment. Noteworthy, the vibration and CTGF elicited a differential stimulatory effect on elastin (ELN), HA synthase 1 (HAS1), and fibroblast-specific protein-1 (FSP-1). The mitogenic activity of CTGF was only elicited in naïve cells without the vibratory preconditioning. The combined treatment had profound, but opposite effects on mitogen-activated protein kinase (MAPK) pathways, Erk1/2 and p38, and the Erk1/2 pathway was critical for the observed mechano-biochemical responses. Collectively, vibratory stresses and CTGF signals cooperatively coaxed MSCs toward a VFF-like phenotype and accelerated the synthesis and remodeling of vocal fold matrices. PMID:24456068

High- and ultrahigh-field magnetic resonance imaging of naïve, injured and scarred vocal fold mucosae in rats.

PubMed

Kishimoto, Ayami Ohno; Kishimoto, Yo; Young, David L; Zhang, Jinjin; Rowland, Ian J; Welham, Nathan V

2016-11-01

Subepithelial changes to the vocal fold mucosa, such as fibrosis, are difficult to identify using visual assessment of the tissue surface. Moreover, without suspicion of neoplasm, mucosal biopsy is not a viable clinical option, as it carries its own risk of iatrogenic injury and scar formation. Given these challenges, we assessed the ability of high- (4.7 T) and ultrahigh-field (9.4 T) magnetic resonance imaging to resolve key vocal fold subepithelial tissue structures in the rat, an important and widely used preclinical model in vocal fold biology. We conducted serial in vivo and ex vivo imaging, evaluated an array of acquisition sequences and contrast agents, and successfully resolved key anatomic features of naïve, acutely injured, and chronically scarred vocal fold mucosae on the ex vivo scans. Naïve lamina propria was hyperintense on T1-weighted imaging with gadobenate dimeglumine contrast enhancement, whereas chronic scar was characterized by reduced lamina propria T1 signal intensity and mucosal volume. Acutely injured mucosa was hypointense on T2-weighted imaging; lesion volume steadily increased, peaked at 5 days post-injury, and then decreased - consistent with the physiology of acute, followed by subacute, hemorrhage and associated changes in the magnetic state of hemoglobin and its degradation products. Intravenous administration of superparamagnetic iron oxide conferred no T2 contrast enhancement during the acute injury period. These findings confirm that magnetic resonance imaging can resolve anatomic substructures within naïve vocal fold mucosa, qualitative and quantitative features of acute injury, and the presence of chronic scar. © 2016. Published by The Company of Biologists Ltd.

High- and ultrahigh-field magnetic resonance imaging of naïve, injured and scarred vocal fold mucosae in rats

PubMed Central

Kishimoto, Ayami Ohno; Kishimoto, Yo; Young, David L.; Zhang, Jinjin

2016-01-01

ABSTRACT Subepithelial changes to the vocal fold mucosa, such as fibrosis, are difficult to identify using visual assessment of the tissue surface. Moreover, without suspicion of neoplasm, mucosal biopsy is not a viable clinical option, as it carries its own risk of iatrogenic injury and scar formation. Given these challenges, we assessed the ability of high- (4.7 T) and ultrahigh-field (9.4 T) magnetic resonance imaging to resolve key vocal fold subepithelial tissue structures in the rat, an important and widely used preclinical model in vocal fold biology. We conducted serial in vivo and ex vivo imaging, evaluated an array of acquisition sequences and contrast agents, and successfully resolved key anatomic features of naïve, acutely injured, and chronically scarred vocal fold mucosae on the ex vivo scans. Naïve lamina propria was hyperintense on T1-weighted imaging with gadobenate dimeglumine contrast enhancement, whereas chronic scar was characterized by reduced lamina propria T1 signal intensity and mucosal volume. Acutely injured mucosa was hypointense on T2-weighted imaging; lesion volume steadily increased, peaked at 5 days post-injury, and then decreased – consistent with the physiology of acute, followed by subacute, hemorrhage and associated changes in the magnetic state of hemoglobin and its degradation products. Intravenous administration of superparamagnetic iron oxide conferred no T2 contrast enhancement during the acute injury period. These findings confirm that magnetic resonance imaging can resolve anatomic substructures within naïve vocal fold mucosa, qualitative and quantitative features of acute injury, and the presence of chronic scar. PMID:27638667

A portable high-speed camera system for vocal fold examinations.

PubMed

Hertegård, Stellan; Larsson, Hans

2014-11-01

In this article, we present a new portable low-cost system for high-speed examinations of the vocal folds. Analysis of glottal vibratory parameters from the high-speed recordings is compared with videostroboscopic recordings. The high-speed system is built around a Fastec 1 monochrome camera, which is used with newly developed software, High-Speed Studio (HSS). The HSS has options for video/image recording, contains a database, and has a set of analysis options. The Fastec/HSS system has been used clinically since 2011 in more than 2000 patient examinations and recordings. The Fastec 1 camera has sufficient time resolution (≥4000 frames/s) and light sensitivity (ISO 3200) to produce images for detailed analyses of parameters pertinent to vocal fold function. The camera can be used with both rigid and flexible endoscopes. The HSS software includes options for analyses of glottal vibrations, such as kymogram, phase asymmetry, glottal area variation, open and closed phase, and angle of vocal fold abduction. It can also be used for separate analysis of the left and vocal fold movements, including maximum speed during opening and closing, a parameter possibly related to vocal fold elasticity. A blinded analysis of 32 patients with various voice disorders examined with both the Fastec/HSS system and videostroboscopy showed that the high-speed recordings were significantly better for the analysis of glottal parameters (eg, mucosal wave and vibration asymmetry). The monochrome high-speed system can be used in daily clinical work within normal clinical time limits for patient examinations. A detailed analysis can be made of voice disorders and laryngeal pathology at a relatively low cost. Copyright © 2014 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Long-term follow-up of vocal fold movement impairment and feeding after neonatal cardiac surgery.

PubMed

Richter, Amy Li; Ongkasuwan, Julina; Ocampo, Elena C

2016-04-01

To determine the long-term prognosis of children with vocal fold mobility impairment (VFMI) after cardiac surgery, with respect to time to normal feeding and incidence of admissions for pneumonia and feeding difficulties. A retrospective chart review was conducted of all neonates who had otolaryngology exam after cardiac surgery at a tertiary children's hospital from May 2007 to May 2008. Charts were reviewed for demographics, type of cardiac surgery, vocal fold mobility, diet at time of discharge and at last follow-up, time to full oral feeding, and hospital admissions. There were a total of 94 patients included in the study, 17 of whom had VFMI. While significantly more patients with VFMI required modified diet at discharge, 48% compared to 19% of patients with normal vocal fold mobility; there was no statistically significant difference in time to regular diet on long-term follow-up, 0.8 years (VFMI) compared to 0.4 years (normal vocal fold mobility). Of the 25 patients with modified diet or gastrostomy tube at discharge, 52% returned to full feeds within a year. There was no difference in hospitalizations for pneumonia in patients with or without VFMI. However in patients with VFMI, 35% required readmission for feeding difficulty or poor weight gain compared to only 5% in the infants with normal vocal fold mobility. After neonatal cardiac surgery, there do not appear to be long-term effects of VFMI with regards to readmission for pneumonia. However, there is an increased risk for hospitalization with respect to feeding difficulties in those neonates with VFMI. The overall prognosis for time to oral feeding is good. Copyright © 2016. Published by Elsevier Ireland Ltd.

Ansa-RLN reinnervation for unilateral vocal fold paralysis in adolescents and young adults.

PubMed

Smith, Marshall E; Roy, Nelson; Stoddard, Kelly

2008-09-01

To assess the outcomes of management of unilateral vocal fold paralysis by ansa-RLN reinnervation in a series of patients ages 12-21. Clinical outcomes study. Six consecutive adolescents and young adults (ages 12-21 years) seeking treatment for unilateral vocal fold paralysis and glottal incompetence underwent ansa-RLN neurorraphy. Pre- and post-operative voice recordings acquired at least 1 year following surgery were submitted to acoustic and perceptual analysis. Patient-based measures were also taken. Mean perceptual visual analogue scale rating of dysphonia severity (0mm=profoundly abnormal voice, 100mm=completely normal voice) improved from 50mm pre-operatively to 82mm post-operatively. Mean maximum phonation time improved from 6.5s to 13.2s. Pitch and dynamic range were also observed to improve. Global self-ratings of voice function (0-100%) increased from 31.2% to 81.6% of normal. Ansa-RLN reinnervation is an effective treatment option for adolescents and young adults with unilateral vocal fold paralysis. The procedure has the potential to improve vocal function substantially, especially in those with isolated paralysis of the recurrent laryngeal nerve. The procedure alleviates the disadvantages associated with other surgical options for this age group.

Medial surface dynamics of the vocal folds in an in vivo canine model

NASA Astrophysics Data System (ADS)

Doellinger, Michael; Berke, Gerald S.; Chhetri, Dinesh K.; Berry, David A.

2004-05-01

Quantitative measurement of the medial surface dynamics of the vocal folds is important for understanding how sound is generated in the larynx. However, such data are hard to gather because of the inaccessibility of the vocal folds. Recent studies have applied hemi-larynx methodology to excised human larynges, to visualize these dynamics. The present study extends this methodology to obtain similar quantitative measurements using an in vivo canine hemi-larynx setup, with varying levels of stimulation to the recurrent laryngeal nerve. Use of an in vivo model allows us to examine effects of intrinsic muscle contraction on the medial surface of the vocal folds, to provide greater insight into mechanisms of vocal control. Data were collected using digital high-speed imaging with a sampling frequency of up to 4000 Hz, and a spatial resolution of up to 1024×1024 pixels. Three-dimensional motion will be extracted, computed, visualized, and contrasted as a function of the level of stimulation to the recurrent laryngeal nerve. Results will also be compared to patterns of vibration in excised larynges. Finally, commonly applied quantitative analyses will be performed to investigate the underlying modes of vibration. [Work supported by NIH/NIDCD.

Direct numerical simulation of human phonation

NASA Astrophysics Data System (ADS)

Bodony, Daniel; Saurabh, Shakti

2017-11-01

The generation and propagation of the human voice in three-dimensions is studied using direct numerical simulation. A full body domain is employed for the purpose of directly computing the sound in the region past the speaker's mouth. The air in the vocal tract is modeled as a compressible and viscous fluid interacting with the elastic vocal folds. The vocal fold tissue material properties are multi-layered, with varying stiffness, and a linear elastic transversely isotropic model is utilized and implemented in a quadratic finite element code. The fluid-solid domains are coupled through a boundary-fitted interface and utilize a Poisson equation-based mesh deformation method. A kinematic constraint based on a specified minimum gap between the vocal folds is applied to prevent collision during glottal closure. Both near VF flow dynamics and far-field acoustics have been studied. A comparison is drawn to current two-dimensional simulations as well as to data from the literature. Near field vocal fold dynamics and glottal flow results are studied and in good agreement with previous three-dimensional phonation studies. Far-field acoustic characteristics, when compared to their two-dimensional counterpart, are shown to be sensitive to the dimensionality. Supported by the National Science Foundation (CAREER Award Number 1150439).

Common diagnoses and treatments in professional voice users.

PubMed

Franco, Ramon A; Andrus, Jennifer G

2007-10-01

Common problems among all patients seen by the laryngologist are also common among professional voice users. These include laryngopharyngeal reflux, muscle tension dysphonia, fibrovascular vocal fold lesions (eg, nodules and polyps), cysts, vocal fold scarring, changes in vocal fold mobility, and age-related changes. Microvascular lesions and their associated sequelae of vocal fold hemorrhage and laryngitis due to voice overuse are more common among professional voice users. Much more common among professional voice users is the negative impact that voice problems have on their ability to work, on their overall sense of well-being, and sometimes on their very sense of self. This article reviews the diagnosis and treatment options for these and other problems among professional voice users, describing the relevant roles of medical treatment, voice therapy, and surgery. The common scenario of multiple concomitant entities contributing to a symptom complex is underscored. Emphasis is placed on gaining insight into the "whole" patient so that individualized management plans can be developed. Videos of select diagnoses accompany this content online.

A multiscale product approach for an automatic classification of voice disorders from endoscopic high-speed videos.

PubMed

Unger, Jakob; Schuster, Maria; Hecker, Dietmar J; Schick, Bernhard; Lohscheller, Joerg

2013-01-01

Direct observation of vocal fold vibration is indispensable for a clinical diagnosis of voice disorders. Among current imaging techniques, high-speed videoendoscopy constitutes a state-of-the-art method capturing several thousand frames per second of the vocal folds during phonation. Recently, a method for extracting descriptive features from phonovibrograms, a two-dimensional image containing the spatio-temporal pattern of vocal fold dynamics, was presented. The derived features are closely related to a clinically established protocol for functional assessment of pathologic voices. The discriminative power of these features for different pathologic findings and configurations has not been assessed yet. In the current study, a collective of 220 subjects is considered for two- and multi-class problems of healthy and pathologic findings. The performance of the proposed feature set is compared to conventional feature reduction routines and was found to clearly outperform these. As such, the proposed procedure shows great potential for diagnostical issues of vocal fold disorders.

Measurement of the viscoelastic properties of the vocal folds.

PubMed

Wiikmann, Christian; da Silva, Marcelo Alves; Arêas, Elizabeth Pinheiro Gomes; Tsuji, Domingos Hiroshi; Sennes, Luiz Ubirajara

2009-06-01

Studies of the viscoelastic properties of the vocal folds are normally performed with rheometers that use parallel plates whose interplate space is usually arbitrarily assigned a fixed value. In tissues subject to variation of thickness between samples, fixed gaps could result in different compressions, compromising the comparison among them. We performed an experimental study to determine whether different compressions can lead to different results in measurements of dynamic viscosity (DV) of vocal fold samples. We measured the DV of vocal fold samples of 10 larynges of cadavers under 3 different compression levels, corresponding to 0.2, 0.5, and 10 N on an 8-mm-diameter parallel-plate rheometer. The DV directly varied with compression. We observed statistically significant differences between the results of 0.2 and 10 N (p = 0.0396) and 0.5 and 10 N (p = 0.0442). The study demonstrated that the level of compression influences the DV measure and suggests that a defined compression level should be used in rheometric studies of biological tissues.

Linear Classifier with Reject Option for the Detection of Vocal Fold Paralysis and Vocal Fold Edema

NASA Astrophysics Data System (ADS)

Kotropoulos, Constantine; Arce, Gonzalo R.

2009-12-01

Two distinct two-class pattern recognition problems are studied, namely, the detection of male subjects who are diagnosed with vocal fold paralysis against male subjects who are diagnosed as normal and the detection of female subjects who are suffering from vocal fold edema against female subjects who do not suffer from any voice pathology. To do so, utterances of the sustained vowel "ah" are employed from the Massachusetts Eye and Ear Infirmary database of disordered speech. Linear prediction coefficients extracted from the aforementioned utterances are used as features. The receiver operating characteristic curve of the linear classifier, that stems from the Bayes classifier when Gaussian class conditional probability density functions with equal covariance matrices are assumed, is derived. The optimal operating point of the linear classifier is specified with and without reject option. First results using utterances of the "rainbow passage" are also reported for completeness. The reject option is shown to yield statistically significant improvements in the accuracy of detecting the voice pathologies under study.

Fluid-Structure Interactions with Flexible and Rigid Bodies

NASA Astrophysics Data System (ADS)

Daily, David Jesse

Fluid structure interactions occur to some extent in nearly every type of fluid flow. Understanding how structures interact with fluids and visa-versa is of vital importance in many engineering applications. The purpose of this research is to explore how fluids interact with flexible and rigid structures. A computational model was used to model the fluid structure interactions of vibrating synthetic vocal folds. The model simulated the coupling of the fluid and solid domains using a fluid-structure interface boundary condition. The fluid domain used a slightly compressible flow solver to allow for the possibility of acoustic coupling with the subglottal geometry and vibration of the vocal fold model. As the subglottis lengthened, the frequency of vibration decreased until a new acoustic mode could form in the subglottis. Synthetic aperture particle image velocimetry (SAPIV) is a three-dimensional particle tracking technique. SAPIV was used to image the jet of air that emerges from vibrating human vocal folds (glottal jet) during phonation. The three-dimensional reconstruction of the glottal jet found faint evidence of flow characteristics seen in previous research, such as axis-switching, but did not have sufficient resolution to detect small features. SAPIV was further applied to reconstruct the smaller flow characteristics of the glottal jet of vibrating synthetic vocal folds. Two- and four-layer synthetic vocal fold models were used to determine how the glottal jet from the synthetic models compared to the glottal jet from excised human vocal folds. The two- and four-layer models clearly exhibited axis-switching which has been seen in other 3D analyses of the glottal jet. Cavitation in a quiescent fluid can break a rigid structure such as a glass bottle. A new cavitation number was derived to include acceleration and pressure head at cavitation onset. A cavitation stick was used to validate the cavitation number by filling it with different depths and hitting the stick to cause fluid cavitation. Acceleration was measured using an accelerometer and cavitation bubbles were detected using a high-speed camera. Cavitation in an accelerating fluid occurred at a cavitation number of 1. Keywords: Fluid structure interaction, vocal folds, acoustics, SAPIV, cavitation, slightly compressible

[Developing a canine vocal fold scar model by CO₂ laser and studying the LOX, HSP70 and HA expression in its extra celluar matrix].

PubMed

Liang, G T; Duan, B Y; Zhang, Y Y; Luo, S W; Lu, L; Yang, L P; Wang, B R

2017-01-20

Objective: Building a canine vocal fold scar model and analyzing the changes in morphology, histopathology and related factors of extra cellular matrix (ECM) of vocal cord healing at different time periods. Method: Five experimental dogs were randomly divided into the control group(one dog) and the experimental group (four dogs). No special treatment was done on the control group, and the experimental group was given CO₂ laser through laryngoscope with minimally invasive surgery on bilateral vocal cords. Observation of the morphological changes of injured vocal cords was made at five different time, pre-operation and 6 h, 3 w, 8 w and 12 w post-operation. HE staining, immunofluorescence, were used respectively to observe the histopathological and ultrastructural changes of each layer of vocal cord. Observation were made on the changing pattern of lysyl oxidase (LOX), heat shock proteins70 (HSP70), and the integrated optical density index (IOD) of Hyaluronic acid (HA) in vocal cord tissues. Result: ①Laryngoscope shows there were mild congestion and edema and inflammatory exudation on the wound surface of vocal cord 3w post-operation. On the wound surface of vocal cord 8 w post-operation, the congestion and edema disappear, the local contraction sink, and no adhesion and granulation form. 12 w post-operation, the surface of the vocal cord was smooth, there were local contractures, vocal fold scar form, and hoarseness in the bilateral vocal cords was obvious. ②HE staining shows 6 h post-operation there were a large number of inflammatory cell infiltration, red blood cell leakage, and cell congestion and edema on the wound surface of vocal cord. 3 w post-operation, there were fibroblast proliferation, angiogenesis, and a large number of fibrous tissues disorderly arranged on the wound surface of vocal cord. 8w post-operation, each layer of fibrous tissues were in hyperplasia and the blood vessels was thicken after on the wound surface of vocal cord, 12 w post-operation, a large number of collagens increases and were in group or fasciculation disorder. There were many irregular gaps in fibers, and blood vessels and glands become rare or disappear. ③The immunofluorescence showed LOX, HSP70 and HA were all localized in the cellular cytoplasm and nucleus. The expression levels were different at different postoperative time, and they were mainly relatively strong expressed in the inflammatory cells, vascular endothelial cells and the glands. ④The comparison of IOD values: The IOD values of LOX were different at different time periods ( P < 0.05). There were no significant differences in IOD of HSP70 between pre-operation and 12 w post-operation, but there are significant differences among other groups ( P < 0.05). There were no significant differences in IOD of HA between pre-operation and 12 w post-operation, but there were significant differences among other groups ( P < 0.01). ⑤The expression of LOX decreased 6h post-operation and increased 3-12 w post-operation. The expression of HSP70 post-operation reached the peak 6 h post-operation and decreased 3-12 w post-operation. The expression of HA decreased 6 h post-operation, increased to the peak 8 w post-operation, and decreased 8-12 w post-operation.⑥The transmission electron microscope showed 3 w to 8 w post-operation, in the intrinsic layer of the vocal cord, the fibroblasts were extremely active, the cells swelled, and the organelles were abundant.12 w post-operation, there were a small number of fibroblasts in the active state, and larger gaps between the fibers and fewer and thinner elastic fibers. Conclusion: CO₂ laser ablation of vocal cords under the Micro Post-Laryngoscope could establish reliable animal model of vocal fold scar, and 12 w reticular the vocal fold scars basically form. LOX, HSP70, HA play different roles at early, middle, and late stages in the vocal fold scar formation, and they can be used as a more sensitive index for vocal fold scar formation. Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.

Effect of resection depth of early glottic cancer on vocal outcome: An optimized finite element simulation

PubMed Central

Mau, Ted; Palaparthi, Anil; Riede, Tobias; Titze, Ingo R.

2015-01-01

Objectives/Hypothesis To test the hypothesis that subligamental cordectomy produces superior acoustic outcome than subepithelial cordectomy for early (T1-2) glottic cancer that requires complete removal of the superficial lamina propria but does not involve the vocal ligament. Study Design Computer simulation Methods A computational tool for vocal fold surgical planning and simulation (the National Center for Voice and Speech Phonosurgery Optimizer-Simulator) was used to evaluate the acoustic output of alternative vocal fold morphologies. Four morphologies were simulated: normal, subepithelial cordectomy, subligamental cordectomy, and transligamental cordectomy (partial ligament resection). The primary outcome measure was the range of fundamental frequency (F0) and sound pressure level (SPL). A more restricted F0-SPL range was considered less favorable because of reduced acoustic possibilities given the same range of driving subglottic pressure and identical vocal fold posturing. Results Subligamental cordectomy generated solutions covering an F0-SPL range 82% of normal for a rectangular vocal fold. In contrast, transligamental and subepithelial cordectomies produced significantly smaller F0-SPL ranges, 57% and 19% of normal, respectively. Conclusion This study illustrates the use of the Phonosurgery Optimizer-Simulator to test a specific hypothesis regarding the merits of two surgical alternatives. These simulation results provide theoretical support for vocal ligament excision with maximum muscle preservation when superficial lamina propria resection is necessary but the vocal ligament can be spared on oncological grounds. The resection of more tissue may paradoxically allow the eventual recovery of a better speaking voice, assuming glottal width is restored. Application of this conclusion to surgical practice will require confirmatory clinical data. PMID:26010240

[Objective study of the voice quality following partial laryngectomy].

PubMed

Remacle, M; Millet, B

1991-01-01

The high resolution frequency analyzer is used for the study of the vocal quality after partial laryngectomy. The post-operative plot after speech therapy is of good quality when respecting one vocal fold. On the contrary, the heard vocal sound does not correspond to the harmonics of the fundamental frequency but to intense noise from irregular vibrations of the residual laryngeal mucosa (ventricular folds, arytenoids). High resolution frequency analysis contributes to the follow-up of the partial laryngectomy.

Deciphering the complexity of acute inflammation using mathematical models.

PubMed

Vodovotz, Yoram

2006-01-01

Various stresses elicit an acute, complex inflammatory response, leading to healing but sometimes also to organ dysfunction and death. We constructed both equation-based models (EBM) and agent-based models (ABM) of various degrees of granularity--which encompass the dynamics of relevant cells, cytokines, and the resulting global tissue dysfunction--in order to begin to unravel these inflammatory interactions. The EBMs describe and predict various features of septic shock and trauma/hemorrhage (including the response to anthrax, preconditioning phenomena, and irreversible hemorrhage) and were used to simulate anti-inflammatory strategies in clinical trials. The ABMs that describe the interrelationship between inflammation and wound healing yielded insights into intestinal healing in necrotizing enterocolitis, vocal fold healing during phonotrauma, and skin healing in the setting of diabetic foot ulcers. Modeling may help in understanding the complex interactions among the components of inflammation and response to stress, and therefore aid in the development of novel therapies and diagnostics.

Effect of high-dose vocal fold injection of cidofovir and bevacizumab in a porcine model.

PubMed

Ahmed, Mostafa M; Connor, Matthew P; Palazzolo, Mitzi; Thompson, Michelle E; Lospinoso, Josh; O'Connor, Peter; Howard, N Scott; Maturo, Stephen C

2017-03-01

Perform a follow-up study to investigate the histologic impact of high-dose intralaryngeal cidofovir injections in porcine vocal cords, either alone or in combination with bevacizumab, and compared to saline controls. This was an in vivo study involving 24 pigs with blinded pathologist review of specimens. Six groups were created, with four subjects in each group. Each subject received 10 or 20 mg of either cidofovir or bevacizumab alone, or in combination, injected into the right vocal cord. The left vocal fold was used as a saline control. Three separate injections were made at 2-week intervals. Larynges were harvested at 8 and 12 weeks, stained with hematoxylin and eosin and trichrome stain, and reviewed for histologic changes by two blinded pathologists. Minimal inflammation, edema, and atypia were noted with all treatments. Increased glandular inflammation was noted with 10 mg bevacizumab (P < 0.05), which decreased when combined with 10 mg cidofovir (P < 0.05). No lamina propria or muscle fibrosis was observed. Drug duration had no statistically significant histologic impact. High-dose cidofovir and bevacizumab do not induce detrimental vocal fold changes. Combination cidofovir and bevacizumab do not cause vocal fold scarring. Further work is needed to assess systemic concentration with this high-dose combination in humans. N/A. Laryngoscope, 127:671-675, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Fluid-acoustic interactions and their impact on pathological voiced speech

NASA Astrophysics Data System (ADS)

Erath, Byron D.; Zanartu, Matias; Peterson, Sean D.; Plesniak, Michael W.

2011-11-01

Voiced speech is produced by vibration of the vocal fold structures. Vocal fold dynamics arise from aerodynamic pressure loadings, tissue properties, and acoustic modulation of the driving pressures. Recent speech science advancements have produced a physiologically-realistic fluid flow solver (BLEAP) capable of prescribing asymmetric intraglottal flow attachment that can be easily assimilated into reduced order models of speech. The BLEAP flow solver is extended to incorporate acoustic loading and sound propagation in the vocal tract by implementing a wave reflection analog approach for sound propagation based on the governing BLEAP equations. This enhanced physiological description of the physics of voiced speech is implemented into a two-mass model of speech. The impact of fluid-acoustic interactions on vocal fold dynamics is elucidated for both normal and pathological speech through linear and nonlinear analysis techniques. Supported by NSF Grant CBET-1036280.

Influence of collision on the flow through in-vitro rigid models of the vocal folds

NASA Astrophysics Data System (ADS)

Deverge, M.; Pelorson, X.; Vilain, C.; Lagrée, P.-Y.; Chentouf, F.; Willems, J.; Hirschberg, A.

2003-12-01

Measurements of pressure in oscillating rigid replicas of vocal folds are presented. The pressure upstream of the replica is used as input to various theoretical approximations to predict the pressure within the glottis. As the vocal folds collide the classical quasisteady boundary layer theory fails. It appears however that for physiologically reasonable shapes of the replicas, viscous effects are more important than the influence of the flow unsteadiness due to the wall movement. A simple model based on a quasisteady Bernoulli equation corrected for viscous effect, combined with a simple boundary layer separation model does globally predict the observed pressure behavior.

Asymmetric vibration in a two-layer vocal fold model with left-right stiffness asymmetry: Experiment and simulation

PubMed Central

Zhang, Zhaoyan; Hieu Luu, Trung

2012-01-01

Vibration characteristics of a self-oscillating two-layer vocal fold model with left-right asymmetry in body-layer stiffness were experimentally and numerically investigated. Two regimes of distinct vibratory pattern were identified as a function of left-right stiffness mismatch. In the first regime with extremely large left-right stiffness mismatch, phonation onset resulted from an eigenmode synchronization process that involved only eigenmodes of the soft fold. Vocal fold vibration in this regime was dominated by a large-amplitude vibration of the soft fold, and phonation frequency was determined by the properties of the soft fold alone. The stiff fold was only enslaved to vibrate at a much reduced amplitude. In the second regime with small left-right stiffness mismatch, eigenmodes of both folds actively participated in the eigenmode synchronization process. The two folds vibrated with comparable amplitude, but the stiff fold consistently led the soft fold in phase for all conditions. A qualitatively good agreement was obtained between experiment and simulation, although the simulations generally underestimated phonation threshold pressure and onset frequency. The clinical implications of the results of this study are also discussed. PMID:22978891

Asymmetric vibration in a two-layer vocal fold model with left-right stiffness asymmetry: experiment and simulation.

PubMed

Zhang, Zhaoyan; Luu, Trung Hieu

2012-09-01

Vibration characteristics of a self-oscillating two-layer vocal fold model with left-right asymmetry in body-layer stiffness were experimentally and numerically investigated. Two regimes of distinct vibratory pattern were identified as a function of left-right stiffness mismatch. In the first regime with extremely large left-right stiffness mismatch, phonation onset resulted from an eigenmode synchronization process that involved only eigenmodes of the soft fold. Vocal fold vibration in this regime was dominated by a large-amplitude vibration of the soft fold, and phonation frequency was determined by the properties of the soft fold alone. The stiff fold was only enslaved to vibrate at a much reduced amplitude. In the second regime with small left-right stiffness mismatch, eigenmodes of both folds actively participated in the eigenmode synchronization process. The two folds vibrated with comparable amplitude, but the stiff fold consistently led the soft fold in phase for all conditions. A qualitatively good agreement was obtained between experiment and simulation, although the simulations generally underestimated phonation threshold pressure and onset frequency. The clinical implications of the results of this study are also discussed.

Contribution of the supraglottic larynx to the vocal product: imaging and acoustic analysis

NASA Astrophysics Data System (ADS)

Gracco, L. Carol

1996-04-01

Horizontal supraglottic laryngectomy is a surgical procedure to remove a mass lesion located in the region of the pharynx superior to the true vocal folds. In contrast to full or partial laryngectomy, patients who undergo horizontal supraglottic laryngectomy often present with little or nor involvement to the true vocal folds. This population provides an opportunity to examine the acoustic consequences of altering the pharynx while sparing the laryngeal sound source. Acoustic and magnetic resonance imaging (MRI) data were acquired in a group of four patients before and after supraglottic laryngectomy. Acoustic measures included the identification of vocal tract resonances and the fundamental frequency of the vocal fold vibration. 3D reconstruction of the pharyngeal portion of each subjects' vocal tract were made from MRIs taken during phonation and volume measures were obtained. These measures reveal a variable, but often dramatic difference in the surgically-altered area of the pharynx and changes in the formant frequencies of the vowel/i/post surgically. In some cases the presence of the tumor created a deviation from the expected formant values pre-operatively with post-operative values approaching normal. Patients who also underwent radiation treatment post surgically tended to have greater constriction in the pharyngeal area of the vocal tract.

Spatiotemporal Quantification of Vocal Fold Vibration After Exposure to Superficial Laryngeal Dehydration: A Preliminary Study.

PubMed

Patel, Rita R; Walker, Reuben; Sivasankar, Preeti M

2016-07-01

The aim of the study was to evaluate the effects of a superficial laryngeal dehydration challenge on vocal fold vibration in young healthy adults using high-speed video imaging. In this prospective study, the effects of a 60-minute superficial laryngeal dehydration challenge on spatial (speed quotient, amplitude quotient) and temporal measures (jitter percentage, vibratory onset time) of vocal fold vibration and phonation threshold pressure (PTP) were evaluated in 10 (male = 4, female = 6) vocally normal adults (21-29 years). All measures except the vibratory onset time were measured at the 10 (low) and 80 (high) percent level of their pitch range. The vibratory onset time was obtained at habitual pitch and loudness level. Superficial laryngeal dehydration was induced by oral breathing in low ambient humidity. Prechallenge and postchallenge differences were statistically investigated using t tests with Bonferroni correction. The speed quotient at low-pitch phonation significantly decreased after oral breathing of low ambient humidity. Other spatiotemporal measures and PTP at low and high pitch were not significant after challenge. Results from this initial study have implications for the use of high-speed video imaging to detect and quantify the subtle changes in vocal fold vibrations after superficial dehydration in healthy individuals. Preliminary findings indicate that superficial dehydration in healthy individuals results in spatial deviations at low pitch. However, further studies are warranted to identify additional spatiotemporal changes in vocal fold vibration after superficial dehydration in normal and disordered populations. Published by Elsevier Inc.

Restructuring the vocal fold lamina propria with endoscopic microdissection.

PubMed

Bartlett, Rebecca S; Hoffman, Henry T; Dailey, Seth H; Bock, Jonathan M; Klemuk, Sarah A; Askeland, Ryan W; Ahlrichs-Hanson, Jan S; Heaford, Andrew C; Thibeault, Susan L

2013-11-01

The purposes of this preclinical study were to investigate histologic and rheologic outcomes of Microendoscopy of Reinke's space (MERS)-guided minithyrotomy and to assess its instrumentation. Human cadaveric and in vivo animal study. Three human cadaveric larynges were treated with MERS-guided placement of Radiesse VoiceGel and immediately evaluated histologically for biomaterial location. In the second part of this investigation, two scarred porcine larynges were treated with MERS-guided placement of HyStem-VF and rheologically evaluated 6 weeks later. Student t tests determined differences in viscoelastic properties of treated/untreated vocal folds. Sialendoscopes and microendoscopes were subjectively compared for their visualization capacity. MERS imaged the subepithelial area and vocal ligament, guiding both tissue dissection and biomaterial positioning. Sialendoscopes provided adequate visualization and feature incorporated working channels. Enhanced image clarity was created in a gas-filled rather than saline-filled environment, per rater judgment. Histological analysis revealed desirable biomaterial positioning with MERS. Per rheological analysis, viscoelastic properties of the MERS-treated porcine vocal folds compared to uninjured vocal folds 6 weeks following treatment did not statistically differ. MERS-guided laryngoplasty using sialendoscopes yielded satisfactory biomaterial positioning in the short-term and normalized rheologic tissue properties in the long-term, contributing to proof of concept for MERS in the treatment of scarring. Strengths of MERS include direct, real-time visualization of Reinke's space and an ability to manipulate surgical instruments parallel to the vocal fold edge while maintaining an intact epithelium. Future work will explore the clinical utility of MERS for addressing scarring, sulcus vocalis, and other intracordal processes. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Role of N-Methyl-D-Aspartate Receptors in Action-Based Predictive Coding Deficits in Schizophrenia.

PubMed

Kort, Naomi S; Ford, Judith M; Roach, Brian J; Gunduz-Bruce, Handan; Krystal, John H; Jaeger, Judith; Reinhart, Robert M G; Mathalon, Daniel H

2017-03-15

Recent theoretical models of schizophrenia posit that dysfunction of the neural mechanisms subserving predictive coding contributes to symptoms and cognitive deficits, and this dysfunction is further posited to result from N-methyl-D-aspartate glutamate receptor (NMDAR) hypofunction. Previously, by examining auditory cortical responses to self-generated speech sounds, we demonstrated that predictive coding during vocalization is disrupted in schizophrenia. To test the hypothesized contribution of NMDAR hypofunction to this disruption, we examined the effects of the NMDAR antagonist, ketamine, on predictive coding during vocalization in healthy volunteers and compared them with the effects of schizophrenia. In two separate studies, the N1 component of the event-related potential elicited by speech sounds during vocalization (talk) and passive playback (listen) were compared to assess the degree of N1 suppression during vocalization, a putative measure of auditory predictive coding. In the crossover study, 31 healthy volunteers completed two randomly ordered test days, a saline day and a ketamine day. Event-related potentials during the talk/listen task were obtained before infusion and during infusion on both days, and N1 amplitudes were compared across days. In the case-control study, N1 amplitudes from 34 schizophrenia patients and 33 healthy control volunteers were compared. N1 suppression to self-produced vocalizations was significantly and similarly diminished by ketamine (Cohen's d = 1.14) and schizophrenia (Cohen's d = .85). Disruption of NMDARs causes dysfunction in predictive coding during vocalization in a manner similar to the dysfunction observed in schizophrenia patients, consistent with the theorized contribution of NMDAR hypofunction to predictive coding deficits in schizophrenia. Copyright © 2016 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Determination of Strain Field on the Superior Surface of Excised Larynx Vocal Folds Using DIC

PubMed Central

Bakhshaee, Hani; Young, Jonathan; Yang, Justin C. W.; Mongeau, Luc; Miri, Amir K.

2013-01-01

Summary Objective/Hypothesis The objective of the present study was to quantify the mechanical strain and stress in excised porcine larynges during self-oscillation using digital image correlation (DIC) method. The use of DIC in the excised larynx setup may yield accurate measurements of the vocal fold displacement field. Study Design Ex vivo animal larynx. Methods Measurements were performed using excised porcine larynges on a humidified flow bench, equipped with two high-speed cameras and a commercially available DIC software. Surface deformations were calculated from digital images recorded at 3000 frames per second during continuous self-oscillation for four excised porcine larynges. Larynx preparation consisted of removing the supraglottal wall and the false folds. DIC yielded the deformation field on the superior visible surface of the vocal folds. Measurement data for adducted and freely suspended vocal folds were also used to estimate the distribution of the initial prephonatory strain field. An isotropic constitutive law, the polymer eight-chain model, was used to estimate the surface distributions of planar stresses from the strain data. Results The Lagrangian normal strain values were between ~16% and ~29% along the anterior-posterior direction. The motion of material points on the vocal fold surface described an elliptical trajectory during oscillation. A phase difference was observed between the anterior-posterior and the medial-lateral component of the displacement. The strain data and eight-chain model yielded a maximum stress of ~4 kPa along the medial-lateral direction on the superior surface. Conclusion DIC allowed the strain field over the superior surface of an excised porcine larynx to be quantified during self-oscillation. The approach allowed the determination of the trajectory of specific points on the vocal fold surface. The results for the excised larynx were found to be significantly different than previous results obtained using synthetic replicas. The present study provides suggestions for future studies in human subjects. PMID:24070590

Towards endoscopic ultrafast laser microsurgery of vocal folds

NASA Astrophysics Data System (ADS)

Hoy, Christopher L.; Everett, W. Neil; Yildirim, Murat; Kobler, James; Zeitels, Steven M.; Ben-Yakar, Adela

2012-03-01

Vocal fold scarring is a predominant cause of voice disorders yet lacks a reliable treatment method. The injection of soft biomaterials to improve mechanical compliance of the vocal folds has emerged as a promising treatment. Here, we study the use of precise femtosecond laser microsurgery to ablate subsurface voids, with a goal of eventually creating a plane in dense subepithelial scar tissue into which biomaterials can be injected for their improved localization. Specifically, we demonstrate the ablation of small subepithelial voids in porcine vocal fold tissue up to 120 µm below the surface such that larger voids in the active area of vocal fold mucosa (~3×10 mm2) can eventually be ablated in about 3 min. We use sub-µJ, 776-nm pulses from a compact femtosecond fiber laser system operating at a 500-kHz repetition rate. The use of relatively high repetition rates, with a small number of overlapping pulses, is critical to achieving ablation in a very short time while still avoiding significant heat deposition. Additionally, we use the same laser for nonlinear optical imaging to provide visual feedback of tissue structure and to confirm successful ablation. The ablation parameters, including pulse duration, pulse energy, spot size, and scanning speed, are comparable to the specifications in our recently developed miniaturized femtosecond laser surgery probes, illustrating the feasibility of developing an ultrafast laser surgical instrument.

Maximum imaging depth comparison in porcine vocal folds using 776-nm vs. 1552-nm excitation wavelengths

NASA Astrophysics Data System (ADS)

Yildirim, Murat; Ferhanoglu, Onur; Kobler, James B.; Zeitels, Steven M.; Ben-Yakar, Adela

2013-02-01

Vocal fold scarring is one of the major causes of voice disorders and may arise from overuse or post-surgical wound healing. One promising treatment utilizes the injection of soft biomaterials aimed at restoring viscoelasticity of the outermost vibratory layer of the vocal fold, superficial lamina propria (SLP). However, the density of the tissue and the required injection pressure impair proper localization of the injected biomaterial in SLP. To enhance treatment effectiveness, we are investigating a technique to image and ablate sub-epithelial planar voids in vocal folds using ultrafast laser pulses to better localize the injected biomaterial. It is challenging to optimize the excitation wavelength to perform imaging and ablation at depths suitable for clinical use. Here, we compare maximum imaging depth using two photon autofluorescence and second harmonic generation with third-harmonic generation imaging modalities for healthy porcine vocal folds. We used a home-built inverted nonlinear scanning microscope together with a high repetition rate (2 MHz) ultrafast fiber laser (Raydiance Inc.). We acquired both two-photon autofluorescence and second harmonic generation signals using 776 nm wavelength and third harmonic generation signals using 1552 nm excitation wavelength. We observed that maximum imaging depth with 776 nm wavelength is significantly improved from 114 μm to 205 μm when third harmonic generation is employed using 1552 nm wavelength, without any observable damage in the tissue.

Anatomical study of minor alterations in neonate vocal folds.

PubMed

Silva, Adriano Rezende; Machado, Almiro José; Crespo, Agrício Nubiato

2014-01-01

Minor structural alterations of the vocal fold cover are frequent causes of voice abnormalities. They may be difficult to diagnose, and are expressed in different manners. Cases of intracordal cysts, sulcus vocalis, mucosal bridge, and laryngeal micro-diaphragm form the group of minor structural alterations of the vocal fold cover investigated in the present study. The etiopathogenesis and epidemiology of these alterations are poorly known. To evaluate the existence and anatomical characterization of minor structural alterations in the vocal folds of newborns. 56 larynxes excised from neonates of both genders were studied. They were examined fresh, or defrosted after conservation via freezing, under a microscope at magnifications of 25× and 40×. The vocal folds were inspected and palpated by two examiners, with the aim of finding minor structural alterations similar to those described classically, and other undetermined minor structural alterations. Larynges presenting abnormalities were submitted to histological examination. Six cases of abnormalities were found in different larynges: one (1.79%) compatible with a sulcus vocalis and five (8.93%) compatible with a laryngeal micro-diaphragm. No cases of cysts or mucosal bridges were found. The observed abnormalities had characteristics similar to those described in other age groups. Abnormalities similar to sulcus vocalis or micro-diaphragm may be present at birth. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Kinematic Measurements of the Vocal-Fold Displacement Waveform in Typical Children and Adult Populations: Quantification of High-Speed Endoscopic Videos

PubMed Central

Donohue, Kevin D.; Unnikrishnan, Harikrishnan; Kryscio, Richard J.

2015-01-01

Purpose This article presents a quantitative method for assessing instantaneous and average lateral vocal-fold motion from high-speed digital imaging, with a focus on developmental changes in vocal-fold kinematics during childhood. Method Vocal-fold vibrations were analyzed for 28 children (aged 5–11 years) and 28 adults (aged 21–45 years) without voice disorders. The following kinematic features were analyzed from the vocal-fold displacement waveforms: relative velocity-based features (normalized average and peak opening and closing velocities), relative acceleration-based features (normalized peak opening and closing accelerations), speed quotient, and normalized peak displacement. Results Children exhibited significantly larger normalized peak displacements, normalized average and peak opening velocities, normalized average and peak closing velocities, peak opening and closing accelerations, and speed quotient compared to adult women. Values of normalized average closing velocity and speed quotient were higher in children compared to adult men. Conclusions When compared to adult men, developing children typically have higher estimates of kinematic features related to normalized displacement and its derivatives. In most cases, the kinematic features of children are closer to those of adult men than adult women. Even though boys experience greater changes in glottal length and pitch as they mature, results indicate that girls experience greater changes in kinematic features compared to boys. PMID:25652615

The Human Voice in Speech and Singing

NASA Astrophysics Data System (ADS)

Lindblom, Björn; Sundberg, Johan

This chapter speech describes various aspects of the human voice as a means of communication in speech and singing. From the point of view of function, vocal sounds can be regarded as the end result of a three stage process: (1) the compression of air in the respiratory system, which produces an exhalatory airstream, (2) the vibrating vocal folds' transformation of this air stream to an intermittent or pulsating air stream, which is a complex tone, referred to as the voice source, and (3) the filtering of this complex tone in the vocal tract resonator. The main function of the respiratory system is to generate an overpressure of air under the glottis, or a subglottal pressure. Section 16.1 describes different aspects of the respiratory system of significance to speech and singing, including lung volume ranges, subglottal pressures, and how this pressure is affected by the ever-varying recoil forces. The complex tone generated when the air stream from the lungs passes the vibrating vocal folds can be varied in at least three dimensions: fundamental frequency, amplitude and spectrum. Section 16.2 describes how these properties of the voice source are affected by the subglottal pressure, the length and stiffness of the vocal folds and how firmly the vocal folds are adducted. Section 16.3 gives an account of the vocal tract filter, how its form determines the frequencies of its resonances, and Sect. 16.4 gives an account for how these resonance frequencies or formants shape the vocal sounds by imposing spectrum peaks separated by spectrum valleys, and how the frequencies of these peaks determine vowel and voice qualities. The remaining sections of the chapter describe various aspects of the acoustic signals used for vocal communication in speech and singing. The syllable structure is discussed in Sect. 16.5, the closely related aspects of rhythmicity and timing in speech and singing is described in Sect. 16.6, and pitch and rhythm aspects in Sect. 16.7. The impressive control of all these acoustic characteristics of vocal signals is discussed in Sect. 16.8, while Sect. 16.9 considers expressive aspects of vocal communication.

The Human Voice in Speech and Singing

NASA Astrophysics Data System (ADS)

Lindblom, Björn; Sundberg, Johan

This chapter describes various aspects of the human voice as a means of communication in speech and singing. From the point of view of function, vocal sounds can be regarded as the end result of a three stage process: (1) the compression of air in the respiratory system, which produces an exhalatory airstream, (2) the vibrating vocal folds' transformation of this air stream to an intermittent or pulsating air stream, which is a complex tone, referred to as the voice source, and (3) the filtering of this complex tone in the vocal tract resonator. The main function of the respiratory system is to generate an overpressure of air under the glottis, or a subglottal pressure. Section 16.1 describes different aspects of the respiratory system of significance to speech and singing, including lung volume ranges, subglottal pressures, and how this pressure is affected by the ever-varying recoil forces. The complex tone generated when the air stream from the lungs passes the vibrating vocal folds can be varied in at least three dimensions: fundamental frequency, amplitude and spectrum. Section 16.2 describes how these properties of the voice source are affected by the subglottal pressure, the length and stiffness of the vocal folds and how firmly the vocal folds are adducted. Section 16.3 gives an account of the vocal tract filter, how its form determines the frequencies of its resonances, and Sect. 16.4 gives an account for how these resonance frequencies or formants shape the vocal sounds by imposing spectrum peaks separated by spectrum valleys, and how the frequencies of these peaks determine vowel and voice qualities. The remaining sections of the chapter describe various aspects of the acoustic signals used for vocal communication in speech and singing. The syllable structure is discussed in Sect. 16.5, the closely related aspects of rhythmicity and timing in speech and singing is described in Sect. 16.6, and pitch and rhythm aspects in Sect. 16.7. The impressive control of all these acoustic characteristics of vocal signals is discussed in Sect. 16.8, while Sect. 16.9 considers expressive aspects of vocal communication.

Relation of perceived breathiness to laryngeal kinematics and acoustic measures based on computational modeling

PubMed Central

Samlan, Robin A.; Story, Brad H.; Bunton, Kate

2014-01-01

Purpose To determine 1) how specific vocal fold structural and vibratory features relate to breathy voice quality and 2) the relation of perceived breathiness to four acoustic correlates of breathiness. Method A computational, kinematic model of the vocal fold medial surfaces was used to specify features of vocal fold structure and vibration in a manner consistent with breathy voice. Four model parameters were altered: vocal process separation, surface bulging, vibratory nodal point, and epilaryngeal constriction. Twelve naïve listeners rated breathiness of 364 samples relative to a reference. The degree of breathiness was then compared to 1) the underlying kinematic profile and 2) four acoustic measures: cepstral peak prominence (CPP), harmonics-to-noise ratio, and two measures of spectral slope. Results Vocal process separation alone accounted for 61.4% of the variance in perceptual rating. Adding nodal point ratio and bulging to the equation increased the explained variance to 88.7%. The acoustic measure CPP accounted for 86.7% of the variance in perceived breathiness, and explained variance increased to 92.6% with the addition of one spectral slope measure. Conclusions Breathiness ratings were best explained kinematically by the degree of vocal process separation and acoustically by CPP. PMID:23785184

Artificially lengthened and constricted vocal tract in vocal training methods.

PubMed

Bele, Irene Velsvik

2005-01-01

It is common practice in vocal training to make use of vocal exercise techniques that involve partial occlusion of the vocal tract. Various techniques are used; some of them form an occlusion within the front part of the oral cavity or at the lips. Another vocal exercise technique involves lengthening the vocal tract; for example, the method of phonation into small tubes. This essay presents some studies made on the effects of various vocal training methods that involve an artificially lengthened and constricted vocal tract. The influence of sufficient acoustic impedance on vocal fold vibration and economical voice production is presented.

Spontaneous resolution of hemorrhagic polyps of the true vocal fold.

PubMed

Klein, Adam M; Lehmann, Marcus; Hapner, Edie R; Johns, Michael M

2009-01-01

Hemorrhagic polyps are the most common benign lesions surgically removed from the vocal folds. Although this modality does offer satisfactory results in most of the cases, there is a subset of polyps that seems to resolve with conservative therapy. This study was performed to examine this subset of polyps. Thirty-four consecutive subjects diagnosed with hemorrhagic polyps of the true vocal fold were retrospectively reviewed to determine the incidence of spontaneous resolution of the lesions with nonsurgical therapy. Sixteen subjects began conservative therapy, consisting of voice therapy and proper vocal hygiene, often while awaiting an optimal personal time for surgical intervention. Of these subjects, nine (56.3%) experienced a resolution of their lesion and symptoms without undergoing surgical therapy. Surgical removal of hemorrhagic polyps is often considered the standard of treatment for these benign lesions. However, these observations support a regimen of voice therapy and observation in select cases.

Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis

PubMed Central

Daniero, James J.; Garrett, C. Gaelyn; Francis, David O.

2014-01-01

Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes. PMID:24883239

Benign Rolandic epilepsy presenting like paradoxical vocal fold motion.

PubMed

Gross, Jennifer H; Bertrand, Mary; Hirose, Keiko

2017-11-01

Paradoxical vocal fold motion (PVFM) is characterized by vocal fold adduction during respiration. Benign Rolandic epilepsy (BRE) is the most common childhood epilepsy and can cause oropharyngolaryngeal or facial manifestations. A 9-year-old male presented with intermittent apnea lasting 30-60 seconds and presumed PVFM. The patient's physical and fiberoptic exam were normal. He was admitted and found to have episodes of oxygen desaturation, neck twitching, and tongue burning. An EEG revealed focal epilepsy. After starting anti-epileptic medications, he had resolution of symptoms. Our patient was eventually diagnosed with BRE, a focal onset epilepsy that can mimic primary otolaryngologic disease. Copyright © 2017 Elsevier B.V. All rights reserved.

Vibration stimulates vocal mucosa-like matrix expression by hydrogel-encapsulated fibroblasts.

PubMed

Kutty, Jaishankar K; Webb, Ken

2010-01-01

The composition and organization of the vocal fold extracellular matrix (ECM) provide the viscoelastic mechanical properties that are required to sustain high-frequency vibration during voice production. Although vocal injury and pathology are known to produce alterations in matrix physiology, the mechanisms responsible for the development and maintenance of vocal fold ECM are poorly understood. The objective of this study was to investigate the effect of physiologically relevant vibratory stimulation on ECM gene expression and synthesis by fibroblasts encapsulated within hyaluronic acid hydrogels that approximate the viscoelastic properties of vocal mucosa. Relative to static controls, samples exposed to vibration exhibited significant increases in mRNA expression levels of HA synthase 2, decorin, fibromodulin and MMP-1, while collagen and elastin expression were relatively unchanged. Expression levels exhibited a temporal response, with maximum increases observed after 3 and 5 days of vibratory stimulation and significant downregulation observed at 10 days. Quantitative assays of matrix accumulation confirmed significant increases in sulphated glycosaminoglycans and significant decreases in collagen after 5 and 10 days of vibratory culture, relative to static controls. Cellular remodelling and hydrogel viscosity were affected by vibratory stimulation and were influenced by varying the encapsulated cell density. These results indicate that vibration is a critical epigenetic factor regulating vocal fold ECM and suggest that rapid restoration of the phonatory microenvironment may provide a basis for reducing vocal scarring, restoring native matrix composition and improving vocal quality. 2009 John Wiley & Sons, Ltd.

Contribution of Glottic Insufficiency to Perceived Breathiness in Classically Trained Singers.

PubMed

Graham, Ellen; Angadi, Vrushali; Sloggy, Joanna; Stemple, Joseph

2016-09-01

Breathiness in the singing voice is problematic for classical singers. Voice students and singing teachers typically attribute breathiness to breath management issues and breathing technique. The present study sought to determine whether glottic insufficiency may also contribute to breathiness in a singer's voice. Studies have revealed a relationship between insufficient vocal fold closure and inefficiency in the speaking voice. However, the effect of insufficient vocal fold closure on vocal efficiency in singers has yet to be determined. Two groups of voice students identified with and without breathiness issues underwent aerodynamic and acoustic voice assessment as well as laryngeal stroboscopy of the vocal folds to quantify the prevalence of insufficient vocal fold closure, also known as glottic insufficiency. These assessments revealed four groups: 1) those with glottic insufficiency and no perceived voice breathiness; 2) those with glottic sufficiency and perceived voice breathiness; 3) those with glottic insufficiency and perceived breathiness; and 4) those with glottic sufficiency and no perceived breathiness. Results suggest that previously undiscovered glottal insufficiency is common in young singers, particularly women, though the correlation with identified breathiness was not statistically significant. Acoustic and aerodynamic measures including noise-to-harmonics ratio, maximum phonation time, airflow rate, subglottal pressure, and laryngeal airway resistance were most sensitive to glottic insufficiency.

The Effects of Size and Type of Vocal Fold Polyp on Some Acoustic Voice Parameters.

PubMed

Akbari, Elaheh; Seifpanahi, Sadegh; Ghorbani, Ali; Izadi, Farzad; Torabinezhad, Farhad

2018-03-01

Vocal abuse and misuse would result in vocal fold polyp. Certain features define the extent of vocal folds polyp effects on voice acoustic parameters. The present study aimed to define the effects of polyp size on acoustic voice parameters, and compare these parameters in hemorrhagic and non-hemorrhagic polyps. In the present retrospective study, 28 individuals with hemorrhagic or non-hemorrhagic polyps of the true vocal folds were recruited to investigate acoustic voice parameters of vowel/ æ/ computed by the Praat software. The data were analyzed using the SPSS software, version 17.0. According to the type and size of polyps, mean acoustic differences and correlations were analyzed by the statistical t test and Pearson correlation test, respectively; with significance level below 0.05. The results indicated that jitter and the harmonics-to-noise ratio had a significant positive and negative correlation with the polyp size (P=0.01), respectively. In addition, both mentioned parameters were significantly different between the two types of the investigated polyps. Both the type and size of polyps have effects on acoustic voice characteristics. In the present study, a novel method to measure polyp size was introduced. Further confirmation of this method as a tool to compare polyp sizes requires additional investigations.

The Effects of Size and Type of Vocal Fold Polyp on Some Acoustic Voice Parameters

PubMed Central

Akbari, Elaheh; Seifpanahi, Sadegh; Ghorbani, Ali; Izadi, Farzad; Torabinezhad, Farhad

2018-01-01

Background Vocal abuse and misuse would result in vocal fold polyp. Certain features define the extent of vocal folds polyp effects on voice acoustic parameters. The present study aimed to define the effects of polyp size on acoustic voice parameters, and compare these parameters in hemorrhagic and non-hemorrhagic polyps. Methods In the present retrospective study, 28 individuals with hemorrhagic or non-hemorrhagic polyps of the true vocal folds were recruited to investigate acoustic voice parameters of vowel/ æ/ computed by the Praat software. The data were analyzed using the SPSS software, version 17.0. According to the type and size of polyps, mean acoustic differences and correlations were analyzed by the statistical t test and Pearson correlation test, respectively; with significance level below 0.05. Results The results indicated that jitter and the harmonics-to-noise ratio had a significant positive and negative correlation with the polyp size (P=0.01), respectively. In addition, both mentioned parameters were significantly different between the two types of the investigated polyps. Conclusion Both the type and size of polyps have effects on acoustic voice characteristics. In the present study, a novel method to measure polyp size was introduced. Further confirmation of this method as a tool to compare polyp sizes requires additional investigations. PMID:29749984

Factors associated with voice therapy outcomes in the treatment of presbyphonia.

PubMed

Mau, Ted; Jacobson, Barbara H; Garrett, C Gaelyn

2010-06-01

Age, vocal fold atrophy, glottic closure pattern, and the burden of medical problems are associated with voice therapy outcomes for presbyphonia. Retrospective. Records of patients seen over a 3-year period at a voice center were screened. Inclusion criteria consisted of age over 55 years, primary complaint of hoarseness, presence of vocal fold atrophy on examination, and absence of laryngeal or neurological pathology. Videostroboscopic examinations on initial presentation were reviewed. Voice therapy outcomes were assessed with the American Speech-Language-Hearing Association National Outcomes Measurement System scale. Statistical analysis was performed with Spearman rank correlation and chi(2) tests. Sixty-seven patients were included in the study. Of the patients, 85% demonstrated improvement with voice therapy. The most common type of glottic closure consisted of a slit gap. Gender or age had no effect on voice therapy outcomes. Larger glottic gaps on initial stroboscopy examination and more pronounced vocal fold atrophy were weakly correlated with less improvement from voice therapy. A weak correlation was also found between the number of chronic medical conditions and poorer outcomes from voice therapy. The degree of clinician-determined improvement in vocal function from voice therapy is independent of patient age but is influenced by the degree of vocal fold atrophy, glottic closure pattern, and the patient's burden of medical problems.

Laryngopharyngeal Reflux and Children

MedlinePlus

... with the voice box (larynx) and causes the vocal cords to close to prevent aspiration of the material ... as a narrowing of the area below the vocal cords (subglottic stenosis), hoarseness, and possibly eustachian tube dysfunction ...

Optimal Duration for Voice Rest After Vocal Fold Surgery: Randomized Controlled Clinical Study.

PubMed

Kaneko, Mami; Shiromoto, Osamu; Fujiu-Kurachi, Masako; Kishimoto, Yo; Tateya, Ichiro; Hirano, Shigeru

2017-01-01

Voice rest is commonly recommended after phonomicrosurgery to prevent worsening of vocal fold injuries. However, the most effective duration of voice rest is unknown. Recently, early vocal stimulation was recommended as a means to improve wound healing. The purpose of this study is to examine the optimal duration of voice rest after phonomicrosurgery. Randomized controlled clinical study. Patients undergoing phonomicrosurgery for leukoplakia, carcinoma in situ, vocal fold polyp, Reinke's edema, and cyst were chosen. Participants were randomly assigned to voice rest for 3 or 7 postoperative days. Voice therapy was administered to both groups after voice rest. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 (VHI-10) were performed pre- and postoperatively at 1, 3, and 6 months. Stroboscopic examination evaluated normalized mucosal wave amplitude (NMWA). Parameters were compared between both groups. Thirty-one patients were analyzed (3-day group, n = 16; 7-day group, n = 15). Jitter, shimmer, and VHI-10 were significantly better in the 3-day group at 1 month post operation. GRBAS was significantly better in the 3-day group at 1 and 3 months post operation, and NMWA was significantly better in the 3-day group at 1, 3, and 6 months post operation compared to the 7-day group. The data suggest that 3 days of voice rest followed by voice therapy may lead to better wound healing of the vocal fold compared to 7 days of voice rest. Appropriate mechanical stimulation during early stages of vocal fold wound healing may lead to favorable functional recovery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

The role of allergy in the etiology of Reinke's edema on vocal folds.

PubMed

Kravos, Alenka; Zupevc, Avgust; Cizmarevic, Bogdan; Hocevar-Boltezar, Irena

2010-05-01

To identify the role of allergy in the occurrence of Reinke's edema on vocal folds. This was a prospective study in patients with Reinke's edema on vocal folds (n = 80) and a control group of patients without Reinke's edema (n = 80). All the patients were examined by the same ENT specialist at an ENT outpatient center in the period 2001-2003. The control group comprised 80 successive patients from the same clinic who were willing to cooperate in the study and were not already being treated for allergic disease by any specialist other than an ENT specialist. Patients from both groups were examined by rigid laryngoscope, skin prick allergic testing (type I allergy) and laboratory determination of serum thyroid-stimulating hormone level. The prevalence of allergy was not significantly different between the two groups: 20.0% in the patients with Reinke's edema and 23.8% in the control group (P = 0.576). No significant difference was detected in the prevalence of allergy when comparing patients with recurrent Reinke's edema after previous surgical treatment (n = 10) with patients with a first occurrence (n = 70) (P = 1.000). However, we found significantly more type I allergy in the patients with Reinke's edema and chronic hyperplastic rhinitis than in the patients with Reinke's edema without chronic hyperplastic rhinitis. All other risk factors (reflux of gastric content to the larynx, vocal abuse or misuse, unfavorable microclimate conditions at work, thyroid diseases) appeared significantly more often in the group with Reinke's edema on vocal folds than in the control group. Type I allergy is not a crucial factor in the pathogenesis of Reinke's edema on vocal folds or in recurrence of the disease after surgical treatment.

Effects of the epilarynx area on vocal fold dynamics and the primary voice signal.

PubMed

Döllinger, Michael; Berry, David A; Luegmair, Georg; Hüttner, Björn; Bohr, Christopher

2012-05-01

For the analysis of vocal fold dynamics, sub- and supraglottal influences must be taken into account, as recent studies have shown. In this work, we analyze the influence of changes in the epilaryngeal area on vocal fold dynamics. We investigate two excised female larynges in a hemilarynx setup combined with a synthetic vocal tract consisting of hard plastic and simulating the vowel /a/. Eigenmodes, amplitudes, and velocities of the oscillations, the subglottal pressures (P(sub)), and sound pressure levels (SPLs) of the generated signal are investigated as a function of three distinctive epilaryngeal areas (28.4 mm(2), 71.0 mm(2), and 205.9 mm(2)). The results showed that the SPL is independent of the epilarynx cross section and exhibits a nonlinear relation to the insufflated airflow. The P(sub) decreased with an increase in the epilaryngeal area and displayed linear relations to the airflow. The principal eigenfunctions (EEFs) from the vocal fold dynamics exhibited lateral movement for the first EEF and rotational motion for the second EEF. In total, the first two EEFs covered a minimum of 60% of the energy, with an average of more than 50% for the first EEF. Correlations to the epilarynx areas were not found. Maximal values for amplitudes (up to 2.5 mm) and velocities (up to 1.57 mm/ms) changed with varying epilaryngeal area but did not show consistent behavior for both larynges. We conclude that the size of the epilaryngeal area has significant influence on vocal fold dynamics but does not significantly affect the resultant SPL. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Experiments on Analysing Voice Production: Excised (Human, Animal) and In Vivo (Animal) Approaches

PubMed Central

Döllinger, Michael; Kobler, James; Berry, David A.; Mehta, Daryush D.; Luegmair, Georg; Bohr, Christopher

2015-01-01

Experiments on human and on animal excised specimens as well as in vivo animal preparations are so far the most realistic approaches to simulate the in vivo process of human phonation. These experiments do not have the disadvantage of limited space within the neck and enable studies of the actual organ necessary for phonation, i.e., the larynx. The studies additionally allow the analysis of flow, vocal fold dynamics, and resulting acoustics in relation to well-defined laryngeal alterations. Purpose of Review This paper provides an overview of the applications and usefulness of excised (human/animal) specimen and in vivo animal experiments in voice research. These experiments have enabled visualization and analysis of dehydration effects, vocal fold scarring, bifurcation and chaotic vibrations, three-dimensional vibrations, aerodynamic effects, and mucosal wave propagation along the medial surface. Quantitative data will be shown to give an overview of measured laryngeal parameter values. As yet, a full understanding of all existing interactions in voice production has not been achieved, and thus, where possible, we try to indicate areas needing further study. Recent Findings A further motivation behind this review is to highlight recent findings and technologies related to the study of vocal fold dynamics and its applications. For example, studies of interactions between vocal tract airflow and generation of acoustics have recently shown that airflow superior to the glottis is governed by not only vocal fold dynamics but also by subglottal and supraglottal structures. In addition, promising new methods to investigate kinematics and dynamics have been reported recently, including dynamic optical coherence tomography, X-ray stroboscopy and three-dimensional reconstruction with laser projection systems. Finally, we touch on the relevance of vocal fold dynamics to clinical laryngology and to clinically-oriented research. PMID:26581597

Oral and vocal fold diadochokinesis in dysphonic women.

PubMed

Louzada, Talita; Beraldinelle, Roberta; Berretin-Felix, Giédre; Brasolotto, Alcione Ghedini

2011-01-01

The evaluation of oral and vocal fold diadochokinesis (DDK) in individuals with voice disorders may contribute to the understanding of factors that affect the balanced vocal production. Scientific studies that make use of this assessment tool support the knowledge advance of this area, reflecting the development of more appropriate therapeutic planning. To compare the results of oral and vocal fold DDK in dysphonic women and in women without vocal disorders. For this study, 28 voice recordings of women from 19 to 54 years old, diagnosed with dysphonia and submitted to a voice assessment from speech pathologist and otorhinolaryngologist, were used. The control group included 30 nondysphonic women evaluated in prior research from normal adults. The analysis parameters like number and duration of emissions, as well as the regularity of the repetition of syllables "pa", "ta", "ka" and the vowels "a" and "i," were provided by the Advanced Motor Speech Profile program (MSP) Model-5141, version-2.5.2 (KayPentax). The DDK sequence "pataka" was analyzed quantitatively through the Sound Forge 7.0 program, as well as manually with the audio-visual help of sound waves. Average values of oral and vocal fold DDK dysphonic and nondysphonic women were compared using the "t Student" test and were considered significant when p<0.05. The findings showed no significant differences between populations; however, the coefficient of variation of period (CvP) and jitter of period (JittP) average of the "ka," "a" and "i" emissions, respectively, were higher in dysphonic women (CvP=10.42%, 12.79%, 12.05%; JittP=2.05%, 6.05%, 3.63%) compared to the control group (CvP=8.86%; 10.95%, 11.20%; JittP=1.82%, 2.98%, 3.15%). Although the results do not indicate any difficulties in oral and laryngeal motor control in the dysphonic group, the largest instability in vocal fold DDK in the experimental group should be considered, and studies of this ability in individuals with communication disorders must be intensified.

Vocal Fold Phase Asymmetries in Patients with Voice Disorders: A Study across Visualization Techniques

ERIC Educational Resources Information Center

Bonilha, Heather Shaw; Deliyski, Dimitar D.; Whiteside, Joanna Piasecki; Gerlach, Terri Treman

2012-01-01

Purpose: To examine differences in vocal fold vibratory phase asymmetry judged from stroboscopy, high-speed videoendoscopy (HSV), and the HSV-derived playbacks of mucosal wave kymography, digital kymography, and a static medial digital kymography image of persons with hypofunctional and hyperfunctional voice disorders. Differences between the…

Frequency Response of Synthetic Vocal Fold Models with Linear and Nonlinear Material Properties

ERIC Educational Resources Information Center

Shaw, Stephanie M.; Thomson, Scott L.; Dromey, Christopher; Smith, Simeon

2012-01-01

Purpose: The purpose of this study was to create synthetic vocal fold models with nonlinear stress-strain properties and to investigate the effect of linear versus nonlinear material properties on fundamental frequency (F[subscript 0]) during anterior-posterior stretching. Method: Three materially linear and 3 materially nonlinear models were…

Vocal Fold Epithelial Response to Luminal Osmotic Perturbation

ERIC Educational Resources Information Center

Sivasankar, Mahalakshmi; Fisher, Kimberly V.

2007-01-01

Purpose: Dry-air challenges increase the osmolarity of fluid lining the luminal surface of the proximal airway. The homeostasis of surface fluid is thought to be essential for voice production and laryngeal defense. Therefore, the authors hypothesized that viable vocal fold epithelium would generate a water flux to reduce an osmotic challenge (150…

Voice rest after vocal fold surgery: current practice and evidence.

PubMed

Coombs, A C; Carswell, A J; Tierney, P A

2013-08-01

Voice rest is commonly recommended after vocal fold surgery, but there is a lack of evidence base and no standard protocol. The aim of this study was to establish common practice regarding voice rest following vocal fold surgery. An online survey was circulated via e-mail invitation to members of the ENT UK Expert Panel between October and November 2011. The survey revealed that 86.5 per cent of respondents agreed that 'complete voice rest' means no sound production at all, but there was variability in how 'relative voice rest' was defined. There was no dominant type of voice rest routinely recommended after surgery for laryngeal papillomatosis or intermediate pathologies. There was considerable variability in the duration of voice rest recommended, with no statistically significant, most popular response (except for malignant lesions). Surgeons with less than 10 years of experience were more likely to recommend fewer days of voice rest. There is a lack of consistency in advice given to patients after vocal fold surgery, in terms of both type and length of voice rest. This may arise from an absence of robust evidence on which to base practice.

Nanoscale Viscoelasticity of Extracellular Matrix Proteins in Soft Tissues: a Multiscale Approach

PubMed Central

Miri, Amir K.; Heris, Hossein K.; Mongeau, Luc; Javid, Farhad

2013-01-01

We propose that the bulk viscoelasticity of soft tissues results from two length-scale-dependent mechanisms: the time-dependent response of extracellular matrix proteins (ECM) at the nanometer scale and the biophysical interactions between the ECM solid structure and interstitial fluid at the micrometer scale. The latter was modeled using the poroelasticity theory with an assumption of free motion of the interstitial fluid within the porous ECM structure. Following a recent study (Heris, H.K., Miri, A.K., Tripathy, U., Barthelat, F., Mongeau, L., 2013. Journal of the Mechanical Behavior of Biomedical Materials), atomic force microscopy was used to perform creep loading and 50-nm sinusoidal oscillations on porcine vocal folds. The proposed model was calibrated by a finite element model to accurately predict the nanoscale viscoelastic moduli of ECM. A linear correlation was observed between the in-depth distribution of the viscoelastic moduli and that of hyaluronic acids in the vocal fold tissue. We conclude that hyaluronic acids may regulate the vocal fold viscoelasticity at nanoscale. The proposed methodology offers a characterization tool for biomaterials used in vocal fold augmentations. PMID:24317493

Frequency Response of Synthetic Vocal Fold Models with Linear and Nonlinear Material Properties

PubMed Central

Shaw, Stephanie M.; Thomson, Scott L.; Dromey, Christopher; Smith, Simeon

2014-01-01

Purpose The purpose of this study was to create synthetic vocal fold models with nonlinear stress-strain properties and to investigate the effect of linear versus nonlinear material properties on fundamental frequency during anterior-posterior stretching. Method Three materially linear and three materially nonlinear models were created and stretched up to 10 mm in 1 mm increments. Phonation onset pressure (Pon) and fundamental frequency (F0) at Pon were recorded for each length. Measurements were repeated as the models were relaxed in 1 mm increments back to their resting lengths, and tensile tests were conducted to determine the stress-strain responses of linear versus nonlinear models. Results Nonlinear models demonstrated a more substantial frequency response than did linear models and a more predictable pattern of F0 increase with respect to increasing length (although range was inconsistent across models). Pon generally increased with increasing vocal fold length for nonlinear models, whereas for linear models, Pon decreased with increasing length. Conclusions Nonlinear synthetic models appear to more accurately represent the human vocal folds than linear models, especially with respect to F0 response. PMID:22271874

An immersed-boundary method for flow–structure interaction in biological systems with application to phonation

PubMed Central

Luo, Haoxiang; Mittal, Rajat; Zheng, Xudong; Bielamowicz, Steven A.; Walsh, Raymond J.; Hahn, James K.

2008-01-01

A new numerical approach for modeling a class of flow–structure interaction problems typically encountered in biological systems is presented. In this approach, a previously developed, sharp-interface, immersed-boundary method for incompressible flows is used to model the fluid flow and a new, sharp-interface Cartesian grid, immersed boundary method is devised to solve the equations of linear viscoelasticity that governs the solid. The two solvers are coupled to model flow–structure interaction. This coupled solver has the advantage of simple grid generation and efficient computation on simple, single-block structured grids. The accuracy of the solid-mechanics solver is examined by applying it to a canonical problem. The solution methodology is then applied to the problem of laryngeal aerodynamics and vocal fold vibration during human phonation. This includes a three-dimensional eigen analysis for a multi-layered vocal fold prototype as well as two-dimensional, flow-induced vocal fold vibration in a modeled larynx. Several salient features of the aerodynamics as well as vocal-fold dynamics are presented. PMID:19936017

Modeling viscous dissipation during vocal fold contact: the influence of tissue viscosity and thickness with implications for hydration.

PubMed

Erath, Byron D; Zañartu, Matías; Peterson, Sean D

2017-06-01

The mechanics of vocal fold contact during phonation is known to play a crucial role in both normal and pathological speech production, though the underlying physics is not well understood. Herein, a viscoelastic model of the stresses during vocal fold contact is developed. This model assumes the cover to be a poroelastic structure wherein interstitial fluid translocates in response to mechanical squeezing. The maximum interstitial fluid pressure is found to generally increase with decreasing viscous dissipation and/or decreasing tissue elasticity. A global minimum in the total contact stress, comprising interstitial fluid pressure and elastic stress in the tissue, is observed over the studied dimensionless parameter range. Interestingly, physiologically reasonable estimates for the governing parameters fall within this global minimum region. The model is validated against prior experimental and computational work, wherein the predicted contact stress magnitude and impact duration agree well with published results. Lastly, observations of the potential relationship between vocal fold hydration and increased risk of tissue damage are discussed based upon model predictions of stress as functions of cover layer thickness and viscosity.

Frequency response of synthetic vocal fold models with linear and nonlinear material properties.

PubMed

Shaw, Stephanie M; Thomson, Scott L; Dromey, Christopher; Smith, Simeon

2012-10-01

The purpose of this study was to create synthetic vocal fold models with nonlinear stress-strain properties and to investigate the effect of linear versus nonlinear material properties on fundamental frequency (F0) during anterior-posterior stretching. Three materially linear and 3 materially nonlinear models were created and stretched up to 10 mm in 1-mm increments. Phonation onset pressure (Pon) and F0 at Pon were recorded for each length. Measurements were repeated as the models were relaxed in 1-mm increments back to their resting lengths, and tensile tests were conducted to determine the stress-strain responses of linear versus nonlinear models. Nonlinear models demonstrated a more substantial frequency response than did linear models and a more predictable pattern of F0 increase with respect to increasing length (although range was inconsistent across models). Pon generally increased with increasing vocal fold length for nonlinear models, whereas for linear models, Pon decreased with increasing length. Nonlinear synthetic models appear to more accurately represent the human vocal folds than do linear models, especially with respect to F0 response.

Voice Rest versus Exercise: A Review of the Literature

PubMed Central

Ishikawa, Keiko; Thibeault, Susan

2010-01-01

Voice rest is commonly prescribed after vocal fold surgery to promote wound healing of the vocal fold. Currently, there is no standard protocol that is established based on biological evidence. In orthopedic rehabilitation, long-term rest is found to be less effective for connective tissue healing than exercise. Connective tissue healing is also an important factor for successful voice rehabilitation; however, whether this concept can be extrapolated to voice rehabilitation is unknown. The purpose of this article is to review current clinical and basic science literature to examine the effect of voice rest in post-surgical rehabilitation. First, we present a summary of clinical literature that pertains to voice rest. Second, description of connective tissue that are involved in orthopedic and voice rehabilitation, specifically, ligament and lamina propria, respectively, and their wound healing process are offered. Third, a summary of the literature from orthopedic research on the effect of rest versus exercise is presented. Lastly, it summarizes in vitro and in vivo studies that examined the effect of mechanical stress on vocal fold tissue. Current literature suggests that there is a lack of clinical evidence that supports a specific type and duration of voice rest, and extrapolation of the findings from orthopedic research may be unreasonable due to the morphological and biochemical difference between the tissues. In order to determine the effect of voice rest, further elucidation of vocal fold wound healing process and the effect of mechanical stress on vocal fold tissue remodeling are needed. PMID:19660903

Evidence-based practice: evaluation and management of unilateral vocal fold paralysis.

PubMed

Misono, Stephanie; Merati, Albert L

2012-10-01

This article discusses the causes and symptoms, evaluation, and management of unilateral vocal fold paralysis (UVFP). Cross-sectional imaging is appropriate in the work-up of idiopathic UVFP, but the routine use of serology is not well supported. The usefulness of laryngeal electromyography has remained controversial. Predictors of poor prognosis for functionally meaningful recovery include fibrillation potentials, positive sharp waves, and absent/reduced voluntary motor unit potentials. Voice therapy may be helpful. Injection and laryngeal framework surgery (medialization thyroplasty) improve vocal quality. The vocal impact of laryngeal reinnervation is comparable with that of medialization. Some patients may benefit from multiple procedures. Copyright © 2012 Elsevier Inc. All rights reserved.

High-Performance Agent-Based Modeling Applied to Vocal Fold Inflammation and Repair.

PubMed

Seekhao, Nuttiiya; Shung, Caroline; JaJa, Joseph; Mongeau, Luc; Li-Jessen, Nicole Y K

2018-01-01

Fast and accurate computational biology models offer the prospect of accelerating the development of personalized medicine. A tool capable of estimating treatment success can help prevent unnecessary and costly treatments and potential harmful side effects. A novel high-performance Agent-Based Model (ABM) was adopted to simulate and visualize multi-scale complex biological processes arising in vocal fold inflammation and repair. The computational scheme was designed to organize the 3D ABM sub-tasks to fully utilize the resources available on current heterogeneous platforms consisting of multi-core CPUs and many-core GPUs. Subtasks are further parallelized and convolution-based diffusion is used to enhance the performance of the ABM simulation. The scheme was implemented using a client-server protocol allowing the results of each iteration to be analyzed and visualized on the server (i.e., in-situ ) while the simulation is running on the same server. The resulting simulation and visualization software enables users to interact with and steer the course of the simulation in real-time as needed. This high-resolution 3D ABM framework was used for a case study of surgical vocal fold injury and repair. The new framework is capable of completing the simulation, visualization and remote result delivery in under 7 s per iteration, where each iteration of the simulation represents 30 min in the real world. The case study model was simulated at the physiological scale of a human vocal fold. This simulation tracks 17 million biological cells as well as a total of 1.7 billion signaling chemical and structural protein data points. The visualization component processes and renders all simulated biological cells and 154 million signaling chemical data points. The proposed high-performance 3D ABM was verified through comparisons with empirical vocal fold data. Representative trends of biomarker predictions in surgically injured vocal folds were observed.

Modulating the Behaviors of Mesenchymal Stem Cells Via the Combination of High-Frequency Vibratory Stimulations and Fibrous Scaffolds

PubMed Central

Tong, Zhixiang; Duncan, Randall L.

2013-01-01

We are interested in the in vitro engineering of artificial vocal fold tissues via the strategic combination of multipotent mesenchymal stem cells (MSCs), physiologically relevant mechanical stimulations, and biomimetic artificial matrices. We have constructed a vocal fold bioreactor that is capable of imposing vibratory stimulations on the cultured cells at human phonation frequencies. Separately, fibrous poly (ɛ-caprolactone) (PCL) scaffolds emulating the ligamentous structure of the vocal fold were prepared by electrospinning, were incorporated in the vocal fold bioreactor, and were driven into a wave-like motion in an axisymmetrical fashion by the oscillating air. MSC-laden PCL scaffolds were subjected to vibrations at 200 Hz with a normal center displacement of ∼40 μm for a total of 7 days. A continuous (CT) or a 1 h-on-1 h-off (OF) regime with a total dynamic culture time of 12 h per day was applied. The dynamic loading did not cause any physiological trauma to the cells. Immunohistotochemical staining revealed the reinforcement of the actin filament and the enhancement of α5β1 integrin expression under selected dynamic culture conditions. Cellular expression of essential vocal fold extracellular matrix components, such as elastin, hyaluronic acid, and matrix metalloproteinase-1, was significantly elevated as compared with the static controls, and the OF regime is more conducive to matrix production than the CT vibration mode. Analyses of genes of typical fibroblast hallmarks (tenascin-C, collagen III, and procollagen I) as well as markers for MSC differentiation into nonfibroblastic lineages confirmed MSCs' adaptation of fibroblastic behaviors. Overall, the high-frequency vibratory stimulation, when combined with a synthetic fibrous scaffold, serves as a potent modulator of MSC functions. The novel bioreactor system presented here, as a versatile, yet well-controlled model, offers an in vitro platform for understanding vibration-induced mechanotransduction and for engineering of functional vocal fold tissues. PMID:23516973

High-Performance Agent-Based Modeling Applied to Vocal Fold Inflammation and Repair

PubMed Central

Seekhao, Nuttiiya; Shung, Caroline; JaJa, Joseph; Mongeau, Luc; Li-Jessen, Nicole Y. K.

2018-01-01

Fast and accurate computational biology models offer the prospect of accelerating the development of personalized medicine. A tool capable of estimating treatment success can help prevent unnecessary and costly treatments and potential harmful side effects. A novel high-performance Agent-Based Model (ABM) was adopted to simulate and visualize multi-scale complex biological processes arising in vocal fold inflammation and repair. The computational scheme was designed to organize the 3D ABM sub-tasks to fully utilize the resources available on current heterogeneous platforms consisting of multi-core CPUs and many-core GPUs. Subtasks are further parallelized and convolution-based diffusion is used to enhance the performance of the ABM simulation. The scheme was implemented using a client-server protocol allowing the results of each iteration to be analyzed and visualized on the server (i.e., in-situ) while the simulation is running on the same server. The resulting simulation and visualization software enables users to interact with and steer the course of the simulation in real-time as needed. This high-resolution 3D ABM framework was used for a case study of surgical vocal fold injury and repair. The new framework is capable of completing the simulation, visualization and remote result delivery in under 7 s per iteration, where each iteration of the simulation represents 30 min in the real world. The case study model was simulated at the physiological scale of a human vocal fold. This simulation tracks 17 million biological cells as well as a total of 1.7 billion signaling chemical and structural protein data points. The visualization component processes and renders all simulated biological cells and 154 million signaling chemical data points. The proposed high-performance 3D ABM was verified through comparisons with empirical vocal fold data. Representative trends of biomarker predictions in surgically injured vocal folds were observed. PMID:29706894

A three-dimensional study of the glottal jet

NASA Astrophysics Data System (ADS)

Krebs, F.; Silva, F.; Sciamarella, D.; Artana, G.

2012-05-01

This work builds upon the efforts to characterize the three-dimensional features of the glottal jet during vocal fold vibration. The study uses a Stereoscopic Particle Image Velocimetry setup on a self-oscillating physical model of the vocal folds with a uniform vocal tract. Time averages are documented and analyzed within the framework given by observations reported for jets exiting elongated nozzles. Phase averages are locked to the audio signal and used to obtain a volumetric reconstruction of the jet. From this reconstruction, the intra-cycle dynamics of the jet axis switching is disclosed.

Vocal power and pressure–flow relationships in excised tiger larynges

PubMed Central

Titze, Ingo R.; Fitch, W. Tecumseh; Hunter, Eric J.; Alipour, Fariborz; Montequin, Douglas; Armstrong, Douglas L.; McGee, JoAnn; Walsh, Edward J.

2010-01-01

Despite the functional importance of loud, low-pitched vocalizations in big cats of the genus Panthera, little is known about the physics and physiology of the mechanisms producing such calls. We investigated laryngeal sound production in the laboratory using an excised-larynx setup combined with sound-level measurements and pressure–flow instrumentation. The larynges of five tigers (three Siberian or Amur, one generic non-pedigreed tiger with Bengal ancestry and one Sumatran), which had died of natural causes, were provided by Omaha's Henry Doorly Zoo over a five-year period. Anatomical investigation indicated the presence of both a rigid cartilaginous plate in the arytenoid portion of the glottis, and a vocal fold fused with a ventricular fold. Both of these features have been confusingly termed ‘vocal pads’ in the previous literature. We successfully induced phonation in all of these larynges. Our results showed that aerodynamic power in the glottis was of the order of 1.0 W for all specimens, acoustic power radiated (without a vocal tract) was of the order of 0.1 mW, and fundamental frequency ranged between 20 and 100 Hz when a lung pressure in the range of 0–2.0 kPa was applied. The mean glottal airflow increased to the order of 1.0 l s–1 per 1.0 kPa of pressure, which is predictable from scaling human and canine larynges by glottal length and vibrational amplitude. Phonation threshold pressure was remarkably low, on the order of 0.3 kPa, which is lower than for human and canine larynges phonated without a vocal tract. Our results indicate that a vocal fold length approximately three times greater than that of humans is predictive of the low fundamental frequency, and the extraordinarily flat and broad medial surface of the vocal folds is predictive of the low phonation threshold pressure. PMID:21037066

Vocal power and pressure-flow relationships in excised tiger larynges.

PubMed

Titze, Ingo R; Fitch, W Tecumseh; Hunter, Eric J; Alipour, Fariborz; Montequin, Douglas; Armstrong, Douglas L; McGee, Joann; Walsh, Edward J

2010-11-15

Despite the functional importance of loud, low-pitched vocalizations in big cats of the genus Panthera, little is known about the physics and physiology of the mechanisms producing such calls. We investigated laryngeal sound production in the laboratory using an excised-larynx setup combined with sound-level measurements and pressure-flow instrumentation. The larynges of five tigers (three Siberian or Amur, one generic non-pedigreed tiger with Bengal ancestry and one Sumatran), which had died of natural causes, were provided by Omaha's Henry Doorly Zoo over a five-year period. Anatomical investigation indicated the presence of both a rigid cartilaginous plate in the arytenoid portion of the glottis, and a vocal fold fused with a ventricular fold. Both of these features have been confusingly termed 'vocal pads' in the previous literature. We successfully induced phonation in all of these larynges. Our results showed that aerodynamic power in the glottis was of the order of 1.0 W for all specimens, acoustic power radiated (without a vocal tract) was of the order of 0.1 mW, and fundamental frequency ranged between 20 and 100 Hz when a lung pressure in the range of 0-2.0 kPa was applied. The mean glottal airflow increased to the order of 1.0 l s(-1) per 1.0 kPa of pressure, which is predictable from scaling human and canine larynges by glottal length and vibrational amplitude. Phonation threshold pressure was remarkably low, on the order of 0.3 kPa, which is lower than for human and canine larynges phonated without a vocal tract. Our results indicate that a vocal fold length approximately three times greater than that of humans is predictive of the low fundamental frequency, and the extraordinarily flat and broad medial surface of the vocal folds is predictive of the low phonation threshold pressure.

Biofeedback Treatment of Paradoxical Vocal Fold Motion and Respiratory Distress in an Adolescent Girl

ERIC Educational Resources Information Center

Warnes, Emily; Allen, Keith D.

2005-01-01

In this investigation, we evaluated the effectiveness of surface electromyography (EMG) biofeedback to treat paradoxical vocal fold motion in a 16-year-old girl. EMG biofeedback training occurred once per week over the course of 10 weeks. In a changing criterion design, muscle tension showed systematic changes that corresponded with changes in the…

Localization of Label-Retaining Cells in Murine Vocal Fold Epithelium

ERIC Educational Resources Information Center

Leydon, Ciara; Bartlett, Rebecca S.; Roenneburg, Drew A.; Thibeault, Susan L.

2011-01-01

Purpose: Epithelial homeostasis is critical for vocal fold health, yet little is known about the cells that support epithelial self-renewal. As a known characteristic of stem cells is that they are slow-cycling in vivo, the purpose of this prospective controlled study was to identify and quantify slow-cycling cells or putative stem cells in murine…

Preliminary experiments to quantify liquid movement under mimetic vocal fold vibrational forces.

PubMed

Titze, Ingo R; Klemuk, Sarah; Lu, Xiaoying

2014-07-01

Hydration of vocal fold tissues is essential for self-sustained oscillation. Normal regulatory processes of liquid transport to and from the vocal folds would be expected through the autonomic systems, but the possibility exists that liquid movement may occur locally due to vibrational pressures. Such movement may cause regions of lower or higher concentrations of liquid viscosity and therewith changes in phonation threshold pressure. Hyaluronic acid, a glycosaminoglycan that attracts large quantities of free water, may be a key molecule for transporting or localizing liquids. Some preliminary experiments are reported in which attempts were made to move low-concentration HA liquids with vibration. None of the experiments was conclusive, but collectively they lay some groundwork for future explorations.

Dynamics of coherent flow structures of a pulsating unsteady glottal jet in human phonation.

NASA Astrophysics Data System (ADS)

Neubauer, Juergen; Miraghaie, Reza; Berry, David

2004-11-01

The primary sound source for human voice is oscillation of the vocal folds in the larynx. Phonation is the self-sustained oscillation of the viscoelastic vocal fold tissue driven by the air flow from the lung. It is due to the flow-induced Hopf instability of the biomechanical-aerodynamic system of vocal folds coupled to the aeroacoustic driving air flow. The aim of this study is to provide insight to the aero-acoustic part of the primary sound source of human voice. A physical rubber model of vocal folds with air flow conditions typical for human phonation was used. This model exhibits self-sustained oscillations similar to those in human phonation. The oscillating physical model can be regarded as a dynamic slit-like orifice that discharges a pulsating unsteady jet. A left-right flapping of the glottal jet axis was detected using hotwire anemometer measurements of the unsteady glottal jet. Flow visualization experiments revealed the detachment of the glottal jet from the physical model folds during the accelerating and decelerating phase of the jet pulsation. Roll-up of large-scale vortex rings as well as secondary vortex shedding in the form of Von Karman street due to shear layer instability were found downstream of the physical model.

Consensus statement: Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis.

PubMed

Munin, Michael C; Heman-Ackah, Yolanda D; Rosen, Clark A; Sulica, Lucian; Maronian, Nicole; Mandel, Steven; Carey, Bridget T; Craig, Earl; Gronseth, Gary

2016-06-01

The purpose of this study was to develop an evidence-based consensus statement regarding use of laryngeal electromyography (LEMG) for diagnosis and treatment of vocal fold paralysis after recurrent laryngeal neuropathy (RLN). Two questions regarding LEMG were analyzed: (1) Does LEMG predict recovery in patients with acute unilateral or bilateral vocal fold paralysis? (2) Do LEMG findings change clinical management in these individuals? A systematic review was performed using American Academy of Neurology criteria for rating of diagnostic accuracy. Active voluntary motor unit potential recruitment and presence of polyphasic motor unit potentials within the first 6 months after lesion onset predicted recovery. Positive sharp waves and/or fibrillation potentials did not predict outcome. The presence of electrical synkinesis may decrease the likelihood of recovery, based on 1 published study. LEMG altered clinical management by changing the initial diagnosis from RLN in 48% of cases. Cricoarytenoid fixation and superior laryngeal neuropathy were the most common other diagnoses observed. If prognostic information is required in a patient with vocal fold paralysis that is more than 4 weeks and less than 6 months in duration, then LEMG should be performed. LEMG may be performed to clarify treatment decisions for vocal fold immobility that is presumed to be caused by RLN. Muscle Nerve 53: 850-855, 2016. © 2016 Wiley Periodicals, Inc.

Laryngeal Reinnervation Using Ansa Cervicalis for Thyroid Surgery-Related Unilateral Vocal Fold Paralysis: A Long-Term Outcome Analysis of 237 Cases

PubMed Central

Li, Ding; Li, Meng; Xia, Siwen; Zheng, Hongliang

2011-01-01

Objective To evaluate the long-term efficacy of delayed laryngeal reinnervation using the main branch of the ansa cervicalis in treatment of unilateral vocal fold paralysis (UVFP) caused by thyroid surgery. Summary of Background Data UVFP remains a serious complication of thyroid surgery. Up to now, a completely satisfactory surgical treatment of UVFP has been elusive. Methods From Jan. 1996 to Jan. 2008, a total of 237 UVFP patients who underwent ansa cervicalis main branch-to-recurrent laryngeal nerve (RLN) anastomosis were enrolled as UVFP group; another 237 age- and gender-matched normal subjects served as control group. Videostroboscopy, vocal function assessment (acoustic analysis, perceptual evaluation and maximum phonation time), and electromyography were performed preoperatively and postoperatively. The mean follow-up period was 5.2±2.7 years, ranging from 2 to 12 years. Results Analysis of videostroboscopic findings indicated that the glottic closure, vocal fold edge, vocal fold position, phase symmetry and regularity were significantly improved in the UVFP group (P<0.001, postoperative vs. preoperative). The postoperative parameters of vocal function were also significantly improved in the UVFP group (P<0.001) and showed no statistical differences compared to the control group (P>0.05, respectively). Postoperative laryngeal electromyography confirmed successful reinnervation of laryngeal muscle. Conclusions Delayed laryngeal reinnervation with the main branch of ansa cervicalis is a feasible and effective approach for treatment of thyroid surgery-related UVFP; it can restore the physiological laryngeal phonatory function to the normal or a nearly normal voice quality. PMID:21559458

Experimental study of the effects of surface mucus viscosity on the glottic cycle.

PubMed

Ayache, Stéphane; Ouaknine, Maurice; Dejonkere, Philippe; Prindere, Pierre; Giovanni, Antoine

2004-03-01

Numerous clinical findings indicate that viscosity of laryngeal mucosa is a crucial factor in glottal perfomance. Experience using experimental test benches has shown the importance of humidifying air stream used to induce vibration in excised larynges. Nevertheless, there is a lack of knowledge particularly regarding the physicochemical properties of laryngeal mucus. The purpose of this study was to research vocal fold vibration in excised larynges using artificial mucus of precisely known viscosity. Eight freshly harvested porcine larynges were examined. Parameters measured were Fo and vocal fold contact time. Measurements were performed under three conditions: basal (no fluid application on vocal cord surface), after application of a fluid of 60cP viscosity (Visc60), and after application of a fluid of 100cP viscosity (Visc100). Electroglottographic measurements were performed at two different times for each condition: 1 s after airflow onset (T1) and 6 seconds after airflow onset (T2). Statistical analysis consisted of comparing data obtained under each condition at T1 and T2. The results showed a significant decrease in Fo after application of Visc60 and Visc100 fluids and a decrease in Fo at T2. Closure time was significantly higher under Visc60 conditions and under Visc100 conditions than under basal conditions. Application of artificial mucus to the mucosa of the vocal folds lowered vibratory frequency and prolonged the contact phase. Our interpretation of this data is that the presence of mucus on the surface of the vocal folds generated superficial tension and caused adhesion, which is a source of nonlinearity in vocal vibration.

ANALYSIS OF FLOW-STRUCTURE COUPLING IN A MECHANICAL MODEL OF THE VOCAL FOLDS AND THE SUBGLOTTAL SYSTEM.

PubMed

Howe, M S; McGowan, R S

2009-11-01

An analysis is made of the nonlinear interactions between flow in the subglottal vocal tract and glottis, sound waves in the subglottal system and a mechanical model of the vocal folds. The mean flow through the system is produced by a nominally steady contraction of the lungs, and mechanical experiments frequently involve a 'lung cavity' coupled to an experimental subglottal tube of arbitrary or ill-defined effective length L, on the basis that the actual value of L has little or no influence on excitation of the vocal folds. A simple, self-exciting single mass mathematical model of the vocal folds is used to investigate the sound generated within the subglottal domain and the unsteady volume flux from the glottis for experiments where it is required to suppress feedback of sound from the supraglottal vocal tract. In experiments where the assumed absorption of sound within the sponge-like interior of the lungs is small, the influence of changes in L can be very significant: when the subglottal tube behaves as an open-ended resonator (when L is as large as half the acoustic wavelength) there is predicted to be a mild increase in volume flux magnitude and a small change in waveform. However, the strong appearance of second harmonics of the acoustic field is predicted at intermediate lengths, when L is roughly one quarter of the acoustic wavelength. In cases of large lung damping, however, only modest changes in the volume flux are predicted to occur with variations in L.

Oral breathing challenge in participants with vocal attrition.

PubMed

Sivasankar, Mahalakshmi; Fisher, Kimberly V

2003-12-01

Vocal folds undergo osmotic challenge by mouth breathing during singing, exercising, and loud speaking. Just 15 min of obligatory oral breathing, to dry the vocal folds, increases phonation threshold pressure (Pth) and expiratory vocal effort in healthy speakers (M. Sivasankar & K. Fisher, 2002). We questioned whether oral breathing is more detrimental to phonation in healthy participants with a history of temporary vocal attrition. The effects of a 15-min oral or nasal breathing challenge on Pth and perceived expiratory vocal effort were compared for participants reporting symptoms of vocal attrition (N = 18, ages 19-38 years) and normal controls (N = 20, ages 19-33 years). Post-challenge-prechallenge differences in Pth (deltaPth) and effort (deltaEffort) revealed that oral breathing, but not nasal breathing, increased Pth (p < .001 ) and effort (p < .001) at low, comfortable, and high pitch. deltaPth was significantly greater in participants with vocal attrition than in normal controls (p < .001). Nasal breathing reduced Pth for all controls but not for all participants reporting vocal attrition. deltaPth was significantly and linearly correlated with deltaEffort (rvocal attrition = .81, p < .001; rcontrol = .84, p < .001). We speculate that the greater increases in Pth in participants reporting vocal attrition may result from delayed or inadequate compensatory response to superficial laryngeal dehydration. Obligatory oral breathing may place voice users at risk for exacerbating vocal attrition. That sol layer depletion by obligatory oral breathing increased Pth and vocal effort provides support for the role of superficial hydration in maintaining ease of phonation.

How low can you go? Physical production mechanism of elephant infrasonic vocalizations.

PubMed

Herbst, Christian T; Stoeger, Angela S; Frey, Roland; Lohscheller, Jörg; Titze, Ingo R; Gumpenberger, Michaela; Fitch, W Tecumseh

2012-08-03

Elephants can communicate using sounds below the range of human hearing ("infrasounds" below 20 hertz). It is commonly speculated that these vocalizations are produced in the larynx, either by neurally controlled muscle twitching (as in cat purring) or by flow-induced self-sustained vibrations of the vocal folds (as in human speech and song). We used direct high-speed video observations of an excised elephant larynx to demonstrate flow-induced self-sustained vocal fold vibration in the absence of any neural signals, thus excluding the need for any "purring" mechanism. The observed physical principles of voice production apply to a wide variety of mammals, extending across a remarkably large range of fundamental frequencies and body sizes, spanning more than five orders of magnitude.

The effects of physiological adjustments on the perceptual and acoustical characteristics of simulated laryngeal vocal tremor

PubMed Central

Lester, Rosemary A.; Story, Brad H.

2015-01-01

The purpose of this study was to determine if adjustments to the voice source [i.e., fundamental frequency (F0), degree of vocal fold adduction] or vocal tract filter (i.e., vocal tract shape for vowels) reduce the perception of simulated laryngeal vocal tremor and to determine if listener perception could be explained by characteristics of the acoustical modulations. This research was carried out using a computational model of speech production that allowed for precise control and manipulation of the glottal and vocal tract configurations. Forty-two healthy adults participated in a perceptual study involving pair-comparisons of the magnitude of “shakiness” with simulated samples of laryngeal vocal tremor. Results revealed that listeners perceived a higher magnitude of voice modulation when simulated samples had a higher mean F0, greater degree of vocal fold adduction, and vocal tract shape for /i/ vs /ɑ/. However, the effect of F0 was significant only when glottal noise was not present in the acoustic signal. Acoustical analyses were performed with the simulated samples to determine the features that affected listeners' judgments. Based on regression analyses, listeners' judgments were predicted to some extent by modulation information present in both low and high frequency bands. PMID:26328711

Assessment of Fine Needle Aspiration Feasibility and Specimen Adequacy for Molecular Diagnostics of Benign Vocal Fold Lesions

PubMed Central

Li, Nicole Y. K.; Dailey, Seth; Thibeault, Susan L.

2014-01-01

Objectives/Hypothesis The use of molecular testing is becoming more significant for the diagnosis and classification of disease. The application of fine-needle aspiration (FNA) biopsy as the means of sampling lesions in union with molecular testing could be a powerful combination in laryngology. The objectives of this study were to investigate 1) if FNA was feasible to sample benign vocal fold lesions; 2) if FNA samples provided sufficient RNA quality for molecular analysis; and 3) if gene expression of FNA samples matched paired surgical excised specimens. Study Design Prospective cross-sectional. Methods Fifteen vocal fold specimens were obtained from adult patients undergoing routine surgical removal for benign vocal fold lesions using FNA and surgical excision. Comparisons were made between FNA and excision biopsies for RNA quality. Correlative analysis was completed for RNA expression of nine genes, including decorin (DCN), connective tissue growth factor (CTGF), vascular endothelial growth factor (VEGF), collagen type VI alpha 3 (COL6A3), superoxide dismutase 1 (SOD1), glutathione S-transferase (GST2), collagen type I alpha 2 (COL1A2), ATP binding cassette (ABC), and procollagen I alpha 1 (COL1A1). Results FNA and excision samples demonstrated similar RNA quality (P > 0.05). Per gene expression, four out of nine genes were moderately correlated between the paired samples (P < 0.05). Conclusions FNA of the vocal fold lamina propria is technically feasible to perform. Further improvement in the FNA technology is desirable to optimize RNA quality for reliable gene expression analysis. PMID:23404571

Analysis of high-pitched phonation using three-dimensional computed tomography.

PubMed

Hiramatsu, Hiroyuki; Tokashiki, Ryoji; Nakamura, Hirokazu; Motohashi, Ray; Sakurai, Eriko; Nomoto, Masaki; Toyomura, Fumimasa; Suzuki, Mamoru

2012-09-01

Our aim was to use three-dimensional computed tomography (3DCT) to examine arytenoid cartilage movement during a high-pitched tone task. This was a prospective study. This study included 14 patients with male-to-female gender identity disorder who had undergone 3DCT imaging for surgical simulation between January 2007 and May 2008. First, to prove that the phonation condition was indeed one of the high-pitched phonation, we confirmed the rotational movement of the thyroid cartilage, horizontal gliding movement of the inferior horn, and vocal fold elongation on a high-pitched tone task. Next, we detected the arytenoid cartilage positions of the joint during a comparison of comfortable and high-pitched phonations. We measured the movement direction and movement distance of the arytenoid cartilage. In all cases, the cricothyroid space became narrower (rotation movement), and we observed anterior gliding movement of the inferior horn. In all cases, elongation of the vocal folds by the high-pitched phonation was confirmed and the arytenoid cartilages were displaced both anteriorly and caudally from the position during comfortable phonation by the high-pitched tone task. The arytenoid cartilages did not move posteriorly to elongate the vocal folds during high-pitched phonation. The arytenoid cartilages were pulled anteriorly and moved caudally because of tension associated with vocal fold elongation because of the task of high-pitched phonation. These results suggest that there are no movements at the cricoarytenoid joint that directly control the length of the vocal folds in accordance with pitch. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Magnetic Resonance Imaging of the Vocal Folds in Women with Congenital Adrenal Hyperplasia and Virilized Voices

ERIC Educational Resources Information Center

Nygren, Ulrika; Isberg, Bengt; Arver, Stefan; Hertegård, Stellan; Södersten, Maria; Nordenskjöld, Agneta

2016-01-01

Purpose: Women with congenital adrenal hyperplasia (CAH) may develop a virilized voice due to late diagnosis or suboptimal suppression of adrenal androgens. Changes in the vocal folds due to virilization have not been studied in vivo. The purpose was to investigate if the thyroarytenoid (TA) muscle is affected by virilization and correlate…

Arytenoid and posterior vocal fold surgery for bilateral vocal fold immobility.

PubMed

Young, VyVy N; Rosen, Clark A

2011-12-01

Many procedures exist to address the airway restriction often seen with bilateral vocal fold immobility. We review the most recent studies involving arytenoid and/or posterior vocal fold surgery to provide an update on the issues related to these procedures. Specific focus is placed on selection of the surgical approach and operative side, use of adjunctive therapies, and outcome measures including decannulation rate, revision and complication rate, and postoperative results. Ten studies were identified between 2004 and 2011. Modifications to the orginal transverse cordotomy and medial arytenoidectomy techniques continue to be investigated to seek improvement in dyspnea symptoms with minimal decline in voice and/or swallowing function. Decannulation rates for these approaches are high. Postoperative dysphagia appears to be less commonly observed but requires continued study. The use of mitomycin-C in these procedures has been poorly studied to date. Both transverse cordotomy and medial arytenoidectomy procedures result in high success rates. However, many questions related to these procedures remain unanswered, particularly with respect to preoperative and postoperative evaluations of voice quality, swallowing function, and pulmonary status. There is need for rigorous prospective clinical studies to address these many issues further.

Evaluation of aerodynamic characteristics of a coupled fluid-structure system using generalized Bernoulli’s principle: An application to vocal folds vibration

PubMed Central

Zhang, Lucy T.; Yang, Jubiao

2017-01-01

In this work we explore the aerodynamics flow characteristics of a coupled fluid-structure interaction system using a generalized Bernoulli equation derived directly from the Cauchy momentum equations. Unlike the conventional Bernoulli equation where incompressible, inviscid, and steady flow conditions are assumed, this generalized Bernoulli equation includes the contributions from compressibility, viscous, and unsteadiness, which could be essential in defining aerodynamic characteristics. The application of the derived Bernoulli’s principle is on a fully-coupled fluid-structure interaction simulation of the vocal folds vibration. The coupled system is simulated using the immersed finite element method where compressible Navier-Stokes equations are used to describe the air and an elastic pliable structure to describe the vocal fold. The vibration of the vocal fold works to open and close the glottal flow. The aerodynamics flow characteristics are evaluated using the derived Bernoulli’s principles for a vibration cycle in a carefully partitioned control volume based on the moving structure. The results agree very well to experimental observations, which validate the strategy and its use in other types of flow characteristics that involve coupled fluid-structure interactions. PMID:29527541

Diagnostic and prognostic contribution of laryngeal electromyography in unilateral vocal-fold immobility in adults.

PubMed

Focquet, A; Péréon, Y; Ségura, S; Ferron, C; Malard, O; Espitalier, F

2017-02-01

To study the diagnostic and prognostic contribution of laryngeal electromyography in unilateral vocal-fold immobility in adults. A retrospective study included patients with unilateral vocal-fold immobility undergoing laryngeal electromyography between 2007 and 2015. Neurogenic, normal or myogenic findings were compared to the clinical aspect. Prognosis for recovery was assessed from motor unit potentials on laryngeal electromyography, and compared to subsequent progress on laryngoscopy. Sixty-three patients (mean age, 59 years) were initially included; 2 were subsequently excluded from analysis. Mean time from onset of immobility to laryngeal electromyography was 7 months. 85% of the 61 patients showed neurogenic findings, indicating neural lesion; 13% showed normal electromyography, indicating cricoarytenoid joint ankylosis; and 1 patient showed a myogenic pattern. Neurogenic cases were usually secondary to cervical surgery. Thirty-eight patients were followed up. In total, 75% of patients showing reinnervation potentials recovered. The positive predictive value of laryngeal electromyography was 69.2%. Laryngeal electromyography is effective in specifying the origin of unilateral vocal-fold immobility in adults. It also has a prognostic role, lack of reinnervation potentials being a possible indication for early medialization surgery. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Effects of mucosal loading on vocal fold vibration.

PubMed

Tao, Chao; Jiang, Jack J

2009-06-01

A chain model was proposed in this study to examine the effects of mucosal loading on vocal fold vibration. Mucosal loading was defined as the loading caused by the interaction between the vocal folds and the surrounding tissue. In the proposed model, the vocal folds and the surrounding tissue were represented by a series of oscillators connected by a coupling spring. The lumped masses, springs, and dampers of the oscillators modeled the tissue properties of mass, stiffness, and viscosity, respectively. The coupling spring exemplified the tissue interactions. By numerically solving this chain model, the effects of mucosal loading on the phonation threshold pressure, phonation instability pressure, and energy distribution in a voice production system were studied. It was found that when mucosal loading is small, phonation threshold pressure increases with the damping constant R(r), the mass constant R(m), and the coupling constant R(mu) of mucosal loading but decreases with the stiffness constant R(k). Phonation instability pressure is also related to mucosal loading. It was found that phonation instability pressure increases with the coupling constant R(mu) but decreases with the stiffness constant R(k) of mucosal loading. Therefore, it was concluded that mucosal loading directly affects voice production.

Effects of mucosal loading on vocal fold vibration

NASA Astrophysics Data System (ADS)

Tao, Chao; Jiang, Jack J.

2009-06-01

A chain model was proposed in this study to examine the effects of mucosal loading on vocal fold vibration. Mucosal loading was defined as the loading caused by the interaction between the vocal folds and the surrounding tissue. In the proposed model, the vocal folds and the surrounding tissue were represented by a series of oscillators connected by a coupling spring. The lumped masses, springs, and dampers of the oscillators modeled the tissue properties of mass, stiffness, and viscosity, respectively. The coupling spring exemplified the tissue interactions. By numerically solving this chain model, the effects of mucosal loading on the phonation threshold pressure, phonation instability pressure, and energy distribution in a voice production system were studied. It was found that when mucosal loading is small, phonation threshold pressure increases with the damping constant Rr, the mass constant Rm, and the coupling constant Rμ of mucosal loading but decreases with the stiffness constant Rk. Phonation instability pressure is also related to mucosal loading. It was found that phonation instability pressure increases with the coupling constant Rμ but decreases with the stiffness constant Rk of mucosal loading. Therefore, it was concluded that mucosal loading directly affects voice production.

Nanoscale viscoelasticity of extracellular matrix proteins in soft tissues: A multiscale approach.

PubMed

Miri, Amir K; Heris, Hossein K; Mongeau, Luc; Javid, Farhad

2014-02-01

It is hypothesized that the bulk viscoelasticity of soft tissues is determined by two length-scale-dependent mechanisms: the time-dependent response of the extracellular matrix (ECM) proteins at the nanometer scale and the biophysical interactions between the ECM solid structure and interstitial fluid at the micrometer scale. The latter is governed by poroelasticity theory assuming free motion of the interstitial fluid within the porous ECM structure. In a recent study (Heris, H.K., Miri, A.K., Tripathy, U., Barthelat, F., Mongeau, L., 2013. J. Mech. Behav. Biomed. Mater.), atomic force microscopy was used to measure the response of porcine vocal folds to a creep loading and a 50-nm sinusoidal oscillation. A constitutive model was calibrated and verified using a finite element model to accurately predict the nanoscale viscoelastic moduli of ECM. A generally good correlation was obtained between the predicted variation of the viscoelastic moduli with depth and that of hyaluronic acids in vocal fold tissue. We conclude that hyaluronic acids may regulate vocal fold viscoelasticity. The proposed methodology offers a characterization tool for biomaterials used in vocal fold augmentations. © 2013 Elsevier Ltd. All rights reserved.

Evaluation of aerodynamic characteristics of a coupled fluid-structure system using generalized Bernoulli's principle: An application to vocal folds vibration.

PubMed

Zhang, Lucy T; Yang, Jubiao

2016-12-01

In this work we explore the aerodynamics flow characteristics of a coupled fluid-structure interaction system using a generalized Bernoulli equation derived directly from the Cauchy momentum equations. Unlike the conventional Bernoulli equation where incompressible, inviscid, and steady flow conditions are assumed, this generalized Bernoulli equation includes the contributions from compressibility, viscous, and unsteadiness, which could be essential in defining aerodynamic characteristics. The application of the derived Bernoulli's principle is on a fully-coupled fluid-structure interaction simulation of the vocal folds vibration. The coupled system is simulated using the immersed finite element method where compressible Navier-Stokes equations are used to describe the air and an elastic pliable structure to describe the vocal fold. The vibration of the vocal fold works to open and close the glottal flow. The aerodynamics flow characteristics are evaluated using the derived Bernoulli's principles for a vibration cycle in a carefully partitioned control volume based on the moving structure. The results agree very well to experimental observations, which validate the strategy and its use in other types of flow characteristics that involve coupled fluid-structure interactions.

War, politics, and voice: the vocal fold paralysis of George Orwell.

PubMed

Sulica, Lucian

2007-02-01

In 1936, like many individuals who felt the menace of fascism, George Orwell traveled to Spain to lend his support to the cause of the Republic, battling a right-wing coup. Spain, during its Civil War, was an eye-opening experience for him, yielding insights that allowed, and even compelled him to write Animal Farm and 1984. Spain was also a close brush with death. In May of 1937, in a trench on a windswept ridge near Huesca, Orwell was shot through the neck by a sniper, leaving him with a paralyzed vocal fold. A thorough review of firsthand accounts of Orwell's injury and subsequent care was made. These are presented in the context of current knowledge of ballistics, penetrating neck trauma, and vocal fold paralysis. Orwell survived largely because of the nature of his wounding with a high-velocity jacketed military round. His recovery followed a course in many ways typical for patients with vocal fold paralysis. His writings leave us a unique and extraordinary account of the experience of being shot, of the medical care of the day, of the handicap of paralytic dysphonia, and of survival and heroism under extraordinary circumstances.

Paediatric vocal fold paralysis.

PubMed

Garcia-Lopez, Isabel; Peñorrocha-Teres, Julio; Perez-Ortin, Magdalena; Cerpa, Mauricio; Rabanal, Ignacio; Gavilan, Javier

2013-01-01

Vocal fold paralysis (VFP) is a relatively common cause of stridor and dysphonia in the paediatric population. This report summarises our experience with VFP in the paediatric age group. All patients presenting with vocal fold paralysis over a 12-month period were included. Medical charts were revised retrospectively. The diagnosis was performed by flexible endoscopic examination. The cases were evaluated with respect to aetiology of the paralysis, presenting symptoms, delay in diagnosis, affected side, vocal fold position, need for surgical treatment and outcome. The presenting symptoms were stridor and dysphonia. Iatrogenic causes formed the largest group, followed by idiopathic, neurological and obstetric VFP. Unilateral paralysis was found in most cases. The median value for delay in diagnosis was 1 month and it was significantly higher in the iatrogenic group. Surgical treatment was not necessary in most part of cases. The diagnosis of VFP may be suspected based on the patient's symptoms and confirmed by flexible endoscopy. Infants who develop stridor or dysphonia following a surgical procedure have to be examined without delay. The surgeon has to keep in mind that there is a possibility of late spontaneous recovery or compensation. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Asthma and Vocal Cord Dysfunction: Can You Tell the Difference?

PubMed

Corjulo, Michael; Schoessler, Sally

2016-11-01

School nurses care for students with asthma on a daily basis, but what happens when the asthma medication is administered and symptoms persist? As a part of care coordination, the school nurse provides ongoing assessment and care for students with asthma. When symptoms persist despite treatment, school nurses need to consider other issues such as Vocal Cord Dysfunction (VCD). The purpose of this article is to highlight the similarities and differences in the pathophysiology and treatment of both asthma and VCD.

Learning to detect vocal hyperfunction from ambulatory neck-surface acceleration features: initial results for vocal fold nodules.

PubMed

Ghassemi, Marzyeh; Van Stan, Jarrad H; Mehta, Daryush D; Zañartu, Matías; Cheyne, Harold A; Hillman, Robert E; Guttag, John V

2014-06-01

Voice disorders are medical conditions that often result from vocal abuse/misuse which is referred to generically as vocal hyperfunction. Standard voice assessment approaches cannot accurately determine the actual nature, prevalence, and pathological impact of hyperfunctional vocal behaviors because such behaviors can vary greatly across the course of an individual's typical day and may not be clearly demonstrated during a brief clinical encounter. Thus, it would be clinically valuable to develop noninvasive ambulatory measures that can reliably differentiate vocal hyperfunction from normal patterns of vocal behavior. As an initial step toward this goal we used an accelerometer taped to the neck surface to provide a continuous, noninvasive acceleration signal designed to capture some aspects of vocal behavior related to vocal cord nodules, a common manifestation of vocal hyperfunction. We gathered data from 12 female adult patients diagnosed with vocal fold nodules and 12 control speakers matched for age and occupation. We derived features from weeklong neck-surface acceleration recordings by using distributions of sound pressure level and fundamental frequency over 5-min windows of the acceleration signal and normalized these features so that intersubject comparisons were meaningful. We then used supervised machine learning to show that the two groups exhibit distinct vocal behaviors that can be detected using the acceleration signal. We were able to correctly classify 22 of the 24 subjects, suggesting that in the future measures of the acceleration signal could be used to detect patients with the types of aberrant vocal behaviors that are associated with hyperfunctional voice disorders.

Vocal Hygiene Education, Voice Production Therapy, and the Role of Patient Adherence: A Treatment Effectiveness Study in Women with Phonotrauma

ERIC Educational Resources Information Center

Behrman, Alison; Rutledge, John; Hembree, Amanda; Sheridan, Sarah

2008-01-01

Purpose: To assess the effectiveness of vocal hygiene education (VHE) and voice production therapy (VP) in altering patient perception of vocal handicap in adult women with benign, bilateral phonotraumatic vocal fold lesions and the role of adherence in that perception. Method: Sixty-two women were randomly assigned to 6 weeks of VP (n = 31) or…

Feasibility and Associated Limitations of Office-Based Laryngeal Surgery Using Carbon Dioxide Lasers.

PubMed

Hu, Hao-Chun; Lin, Shu-Yi; Hung, Yi-Ting; Chang, Shyue-Yih

2017-05-01

There are few reports evaluating awake, office-based carbon dioxide (CO2) laser surgery for laryngeal lesions. To date, this study was the largest reported case series of office-based laryngeal surgery by fiber delivery CO2 laser. Office-based laryngeal surgical procedures have become increasingly popular. Technical problems and treatment outcomes associated with the use of a CO2 laser for office-based laryngeal surgery have yet to be fully addressed. To discuss a single institution's clinical experience with office-based CO2 laser laryngeal surgery and the feasibility and limitations associated with this procedure. This retrospective study evaluated 49 laryngeal surgical procedures performed using a CO2 laser in 40 consecutive adult patients at a single institution in Taiwan from July 1, 2014, through September 30, 2015. Laryngeal lesions treated included vocal fold leukoplakia (n = 13), benign vocal fold lesions (n = 10), Reinke edema (n = 4), recurrent respiratory papillomatosis (n = 6), and lesions outside the vocal folds (n = 7). Office-based laryngeal surgery performed using a CO2 laser under topical anesthesia. Videolaryngoscopy was performed on all patients at each follow-up point. Among patients with benign vocal lesions and Reinke edema, videolaryngostroboscopy, voice laboratory measurements, perceptual measurements of vocal quality, and subjective evaluations were conducted before and after surgery. Among the 40 patients included in this study (28 men [70%] and 12 women [30%]; median [range] age, 56 [29-83] years), median follow-up time was 6.5 months (range, 1-21 months). Among the 49 procedures, 2 (4%) could not be tolerated by patients owing to severe gag reflex and laryngeal hypersensitivity, 6 (12%) could not completely evaporate lesions owing to an inadequate surgical field or laryngeal instability, and 1 (2%) led to a complication (ie, mild vocal fold wound stiffness). In addition, 2 patients with premalignant vocal fold leukoplakia showed lesion recurrence in the subglottic area. Among patients with benign vocal lesions and Reinke edema, postoperative phonatory function showed large improvements in jitter (effect size, 0.61; median difference, -0.98%; 95% CI, -1.57% to -0.11%), noise to harmonic ratio (effect size, 0.63; median difference, -0.02; 95% CI, -0.07 to -0.01), maximal phonation time (effect size, 0.61; median difference, 3.6 seconds; 95% CI, 1.9 to 8.8 seconds), and Voice Handicap Index-10 score (effect size, 0.60; median difference, -7; 95% CI, -12 to -2). Office-based laryngeal surgery performed using a CO2 laser was shown to be a feasible treatment option for various types of vocal lesions. However, patients should not undergo this procedure if they have multiple bulky lesions or lesions involving the subglottic area, the laryngeal ventricle, or (in cases of inadequate laryngeal stability) the free edge of a vocal fold.

Oral and vocal fold diadochokinesis in dysphonic women

PubMed Central

LOUZADA, Talita; BERALDINELLE, Roberta; BERRETIN-FELIX, Giédre; BRASOLOTTO, Alcione Ghedini

2011-01-01

The evaluation of oral and vocal fold diadochokinesis (DDK) in individuals with voice disorders may contribute to the understanding of factors that affect the balanced vocal production. Scientific studies that make use of this assessment tool support the knowledge advance of this area, reflecting the development of more appropriate therapeutic planning. Objective To compare the results of oral and vocal fold DDK in dysphonic women and in women without vocal disorders. Material and methods For this study, 28 voice recordings of women from 19 to 54 years old, diagnosed with dysphonia and submitted to a voice assessment from speech pathologist and otorhinolaryngologist, were used. The control group included 30 nondysphonic women evaluated in prior research from normal adults. The analysis parameters like number and duration of emissions, as well as the regularity of the repetition of syllables "pa", "ta", "ka" and the vowels "a" and "i," were provided by the Advanced Motor Speech Profile program (MSP) Model-5141, version-2.5.2 (KayPentax). The DDK sequence "pataka" was analyzed quantitatively through the Sound Forge 7.0 program, as well as manually with the audio-visual help of sound waves. Average values of oral and vocal fold DDK dysphonic and nondysphonic women were compared using the "t Student" test and were considered significant when p<0.05. Results The findings showed no significant differences between populations; however, the coefficient of variation of period (CvP) and jitter of period (JittP) average of the "ka," "a" and "i" emissions, respectively, were higher in dysphonic women (CvP=10.42%, 12.79%, 12.05%; JittP=2.05%, 6.05%, 3.63%) compared to the control group (CvP=8.86%; 10.95%, 11.20%; JittP=1.82%, 2.98%, 3.15%). Conclusion Although the results do not indicate any difficulties in oral and laryngeal motor control in the dysphonic group, the largest instability in vocal fold DDK in the experimental group should be considered, and studies of this ability in individuals with communication disorders must be intensified. PMID:22230989

Long-term Surveillance Following Intralesional Steroid Injection for Benign Vocal Fold Lesions.

PubMed

Wang, Chi-Te; Lai, Mei-Shu; Cheng, Po-Wen

2017-06-01

The short-term outcomes of vocal fold steroid injection (VFSI) are well documented. However, few studies have reported the long-term outcomes following VFSI. To investigate the incidence rates of symptom recurrence and secondary interventions following VFSI for benign vocal fold lesions. This prospective cohort study was conducted at a tertiary referral medical center in Taipei, Taiwan. The cohort included 189 patients with vocal fold lesions who had received VFSI as the primary treatment between August 2011 and September 2013. All participants underwent VFSI. Long-term surveillance was conducted through structured telephonic interviews and by reviewing medical charts every 6 months over a 2-year period. We assessed the 10-item voice handicap index, dysphonic symptoms, and whether the patients had received any additional interventions after the initial VFSI. The 189 participants (32 men and 157 women; mean [SD] age, 39 [10] years [range, 20-74 years] included patients who had undergone VFSI for vocal fold nodules (n = 72), polyps (n = 72), or mucus-retention cysts (n = 45). Following VFSI, 141 patients (74.6%; 23 men and 118 women; mean age, 39 years [range, 20-70 years]) showed positive response (ie, clinically significant symptom resolution without the need for additional procedures) and received long-term surveillance. The median follow-up period was 19.4 months, and 2 patients were lost to follow-up postoperatively within 1 year. The cumulative failure rates (subjective symptom recurrence plus secondary treatments) at 6, 12, 18, and 24 months after VFSI were 12%, 17%, 24%, and 32%, respectively. When the initial response rate to VFSI (141 of 189, 74.6%) was considered altogether, VFSI remained effective after 2 years in 50% of the initially recruited 189 patients. The highest rate of long-term effectiveness of VFSI occurred in vocal polyps (54%), followed by nodules (49%) and cysts (43%). This study demonstrates that VFSI can be beneficial in managing benign vocal lesions, especially when first-line treatments are unsuitable. However, the long-term results of this study clarify that a substantial number of patients experience symptom recurrence or receive subsequent interventions within 2 years after VFSI; this should be considered in medical decision making.

The Physiological Basis of Chinese Höömii Generation.

PubMed

Li, Gelin; Hou, Qian

2017-01-01

The study aimed to investigate the physiological basis of vibration mode of sound source of a variety of Mongolian höömii forms of singing in China. The participant is a Mongolian höömii performing artist who was recommended by the Chinese Medical Association of Art. He used three types of höömii, namely vibration höömii, whistle höömii, and overtone höömii, which were compared with general comfortable pronunciation of /i:/ as control. Phonation was observed during /i:/. A laryngostroboscope (Storz) was used to determine vibration source-mucosal wave in the throat. For vibration höömii, bilateral ventricular folds approximated to the midline and made contact at the midline during pronunciation. Ventricular and vocal folds oscillated together as a single unit to form a composite vibration (double oscillator) sound source. For whistle höömii, ventricular folds approximated to the midline to cover part of vocal folds, but did not contact each other. It did not produce mucosal wave. The vocal folds produced mucosal wave to form a single vibration sound source. For overtone höömii, the anterior two-thirds of ventricular folds touched each other during pronunciation. The last one-third produced the mucosal wave. The vocal folds produced mucosal wave at the same time, which was a composite vibration (double oscillator) sound source mode. The Höömii form of singing, including mixed voices and multivoice, was related to the presence of dual vibration sound sources. Its high overtone form of singing (whistle höömii) was related to stenosis at the resonance chambers' initiation site (ventricular folds level). Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Dysphonia and dysphagia after anterior cervical decompression.

PubMed

Tervonen, Hanna; Niemelä, Mika; Lauri, Eija-Riitta; Back, Leif; Juvas, Anja; Räsänen, Pirjo; Roine, Risto P; Sintonen, Harri; Salmi, Tapani; Vilkman, S Erkki; Aaltonen, Leena-Maija

2007-08-01

In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function. The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology-Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography. Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome. Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD. Recurrent laryngeal nerve damage detected by EMG is not rare. Pre-and postoperative laryngeal examination of ACD patients should be considered.

A Longitudinal Study of Voice before and after Phonosurgery for Removal of a Polyp

ERIC Educational Resources Information Center

Stajner-Katusic, Smiljka; Horga, Damir; Zrinski, Karolina Vrban

2008-01-01

The aim of the present investigation was to evaluate the acoustic parameters, perceptual estimation, and self-estimation of voice before, 1 month after, and 6 years after surgical removal of a vocal fold polyp. Subjects were five male patients who came to the Phoniatric Clinic because of breathiness. For all patients, a polyp of one vocal fold was…

Microscopie non-lineaire pour l'imagerie des cordes vocales

NASA Astrophysics Data System (ADS)

Deterre, Romain

The vocal cords are two folds of epithelial tissues located in the larynx and are involved in production of the human voice. Despite their apparent simplicity, their internal structure is complex. Each fold can be divided into several layers with different mechanical properties. The gold standard for studying their structure - histology - has the inconvenience of being very invasive. Non-linear microscopy is an optical imaging technique which allows images to be taken in depth within samples in a non invasive manner. It also offers intrinsic contrasts, allowing the identification of certain fibrous proteins - elastin and collagen - which are responsible for the mechanical properties of epithelious tissues. The main goal of this research project was to assess nonlinear microscopy's performances for vocal fold imaging. The study has been broken down in two separate tasks. The first one was to evaluate the nonlinear modalities contrast against histology. For that purpose, we chose to first take images of thin samples and compare them to the corresponding histological slides. The second task was to make tests to transcribe the results obtained to in vivo imaging. A custom-built nonlinear imaging system was used for these experiments. It was developed to allow acquisition of wide-field images. A C++ based software was developped to control the microscope and allow treatment and visualization of the images. After being built, the system was further tested to check its performances in comparison with the theoretical limit as described in the literature. Thin slices of vocal folds were obtained from the team of Pr Christopher J. Hartnick from Massachusetts Eye and Ear Infirmary, Harvard Medical School. Specialists from his team analysed the histological samples to extract structural data from the vocal folds. A good correlation was measured between histological and nonlinear data. A first step in evaluating the possibility for translating these results towards in vivo imaging was performed during this project. A swine's larynx was obtained, and vocal folds were extracted for imaging purposes. This experiment showed that it is indeed possible to localize various macrostructures of the tissues with nonlinear microscopy.

Laryngeal evidence for the first and second passaggio in professionally trained sopranos

PubMed Central

Burk, Fabian; Köberlein, Marie; Selamtzis, Andreas; Döllinger, Michael; Burdumy, Michael; Richter, Bernhard

2017-01-01

Introduction Due to a lack of empirical data, the current understanding of the laryngeal mechanics in the passaggio regions (i.e., the fundamental frequency ranges where vocal registration events usually occur) of the female singing voice is still limited. Material and methods In this study the first and second passaggio regions of 10 professionally trained female classical soprano singers were analyzed. The sopranos performed pitch glides from A3 (ƒo = 220 Hz) to A4 (ƒo = 440 Hz) and from A4 (ƒo = 440 Hz) to A5 (ƒo = 880 Hz) on the vowel [iː]. Vocal fold vibration was assessed with trans-nasal high speed videoendoscopy at 20,000 fps, complemented by simultaneous electroglottographic (EGG) and acoustic recordings. Register breaks were perceptually rated by 12 voice experts. Voice stability was documented with the EGG-based sample entropy. Glottal opening and closing patterns during the passaggi were analyzed, supplemented with open quotient data extracted from the glottal area waveform. Results In both the first and the second passaggio, variations of vocal fold vibration patterns were found. Four distinct patterns emerged: smooth transitions with either increasing or decreasing durations of glottal closure, abrupt register transitions, and intermediate loss of vocal fold contact. Audible register transitions (in both the first and second passaggi) generally coincided with higher sample entropy values and higher open quotient variance through the respective passaggi. Conclusions Noteworthy vocal fold oscillatory registration events occur in both the first and the second passaggio even in professional sopranos. The respective transitions are hypothesized to be caused by either (a) a change of laryngeal biomechanical properties; or by (b) vocal tract resonance effects, constituting level 2 source-filter interactions. PMID:28467509

Lamina propria of the human vocal fold: histomorphometric study of collagen fibers.

PubMed

Prades, Jean-Michel; Dumollard, Jean Marc; Duband, Sébastien; Timoshenko, Andrei; Richard, Céline; Dubois, Marie Dominique; Martin, Christian; Peoc'h, Michel

2010-04-01

Since the seminal work of M. Hirano, which defined the three-layered lamina propria of the human vocal fold, there has been confusion in the labeling of each layer. Recent studies described the composition of fibers and interstitial molecules within the lamina propria leading to various biomechanical properties. However, collagen fibers appear as the most important structure component. We used an optical analysis and the picrosirius-polarization method to describe collagen fibers from six adult and two fetal human larynges fixed in formalin and frontally sectioned in the middle part of the vocal fold. The deep layer of the lamina propria is the most densely organized band of collagen fibers penetrating the superficial muscle bundles of the vocal muscle. The mean thickness of this layer is about 36% of the lamina propria and shows a network of strongly birefringent fibers (collagen type I and III). The superficial layer of the lamina propria is a narrow band of collagen fibers immediately below the basement membrane of the epithelium. The mean thickness of this layer is about 13% of the lamina propria and shows strong birefringent fibers. The intermediate layer is the less densely organized band between the deep and superficial layers. The mean thickness of this layer is about 51% of the lamina propria and shows clear, green weakly birefringent fibers characterized as collagen type III. The fetal lamina propria contains only a monolayer distribution of loose collagen fibers between the epithelium and the vocal muscle. These results help describe the distribution of collagen fibers within the lamina propria of the human vocal fold and have implications to understand the cover-body theory of voice production both in the adult and newborn.

Laryngeal Aerodynamics in Healthy Older Adults and Adults With Parkinson's Disease.

PubMed

Matheron, Deborah; Stathopoulos, Elaine T; Huber, Jessica E; Sussman, Joan E

2017-03-01

The present study compared laryngeal aerodynamic function of healthy older adults (HOA) to adults with Parkinson's disease (PD) while speaking at a comfortable and increased vocal intensity. Laryngeal aerodynamic measures (subglottal pressure, peak-to-peak flow, minimum flow, and open quotient [OQ]) were compared between HOAs and individuals with PD who had a diagnosis of hypophonia. Increased vocal intensity was elicited via monaurally presented multitalker background noise. At a comfortable speaking intensity, HOAs and individuals with PD produced comparable vocal intensity, rates of vocal fold closure, and minimum flow. HOAs used smaller OQs, higher subglottal pressure, and lower peak-to-peak flow than individuals with PD. Both groups increased speaking intensity when speaking in noise to the same degree. However, HOAs produced increased intensity with greater driving pressure, faster vocal fold closure rates, and smaller OQs than individuals with PD. Monaural background noise elicited equivalent vocal intensity increases in HOAs and individuals with PD. Although both groups used laryngeal mechanisms as expected to increase sound pressure level, they used these mechanisms to different degrees. The HOAs appeared to have better control of the laryngeal mechanism to make changes to their vocal intensity.

Postoperative vocal fold palsy in patients undergoing thyroid surgery with continuous or intermittent nerve monitoring.

PubMed

Schneider, R; Sekulla, C; Machens, A; Lorenz, K; Nguyen Thanh, P; Dralle, H

2015-10-01

Continuous monitoring of electromyographic (EMG) amplitudes of the vocal muscles detects impending injury of the recurrent laryngeal nerve (RLN) during thyroid operations earlier than intermittent EMG monitoring. This may alert the surgeon to stop a manoeuvre causing stretching or pressure on the RLN, with better recovery of nerve function. Patients with intact preoperative RLN function who underwent thyroid surgery for benign disease between January 2011 and September 2014 under continuous intraoperative nerve monitoring (CIONM) or intermittent intraoperative nerve monitoring (IIONM) were included in this observational study conducted at a tertiary surgical centre. For CIONM, combined EMG events indicative of imminent nerve injury were defined as an EMG amplitude decrease of 50 per cent or more and a latency increase of 10 per cent relative to baseline values. The rates of early and permanent palsy for the two groups of patients were compared. There were 1526 patients, 788 of whom (1314 nerves at risk) underwent thyroid surgery using CIONM and 738 (965 nerves at risk) had IIONM. With the use of CIONM, 63 (82 per cent) of 77 combined events were reversible during the operation. No permanent vocal fold palsy occurred with CIONM, whereas four unilateral permanent vocal fold palsies (0·4 per cent) were diagnosed after IIONM (P = 0·019). Operation with CIONM resulted in fewer permanent vocal fold palsies compared with IIONM after thyroid surgery in patients with benign disease. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Unusually high-pitched neonate distress calls of the open-habitat Mongolian gazelle ( Procapra gutturosa) and their anatomical and hormonal predictors

NASA Astrophysics Data System (ADS)

Volodin, Ilya A.; Volodina, Elena V.; Frey, Roland; Kirilyuk, Vadim E.; Naidenko, Sergey V.

2017-06-01

In neonate ruminants, the acoustic structure of vocalizations may depend on sex, vocal anatomy, hormonal profiles and body mass and on environmental factors. In neonate wild-living Mongolian gazelles Procapra gutturosa, hand-captured during biomedical monitoring in the Daurian steppes at the Russian-Mongolian border, we spectrographically analysed distress calls and measured body mass of 22 individuals (6 males, 16 females). For 20 (5 male, 15 female) of these individuals, serum testosterone levels were also analysed. In addition, we measured relevant dimensions of the vocal apparatus (larynx, vocal folds, vocal tract) in one stillborn male Mongolian gazelle specimen. Neonate distress calls of either sex were high in maximum fundamental frequency (800-900 Hz), but the beginning and minimum fundamental frequencies were significantly lower in males than in females. Body mass was larger in males than in females. The levels of serum testosterone were marginally higher in males. No correlations were found between either body mass or serum testosterone values and any acoustic variable for males and females analysed together or separately. We discuss that the high-frequency calls of neonate Mongolian gazelles are more typical for closed-habitat neonate ruminants, whereas other open-habitat neonate ruminants (goitred gazelle Gazella subgutturosa, saiga antelope Saiga tatarica and reindeer Rangifer tarandus) produce low-frequency (<200 Hz) distress calls. Proximate cause for the high fundamental frequency of distress calls of neonate Mongolian gazelles is their very short, atypical vocal folds (4 mm) compared to the 7-mm vocal folds of neonate goitred gazelles, producing distress calls as low as 120 Hz.

Relationship between patient-perceived vocal handicap and clinician-rated level of vocal dysfunction.

PubMed

Childs, Lesley F; Bielinski, Clifford; Toles, Laura; Hamilton, Amy; Deane, Janis; Mau, Ted

2015-01-01

The relationship between patient-reported vocal handicap and clinician-rated measures of vocal dysfunction is not understood. This study aimed to determine if a correlation exists between the Voice Handicap Index-10 (VHI-10) and the Voice Functional Communication Measure rating in the National Outcomes Measurement System (NOMS). Retrospective case series. Four hundred and nine voice evaluations over 12 months at a tertiary voice center were reviewed. The VHI-10 and NOMS scores, diagnoses, and potential comorbid factors were collected and analyzed. For the study population as a whole, there was a moderate negative correlation between the NOMS rating and the VHI-10 (Pearson r = -0.57). However, for a given NOMS level, there could be considerable spread in the VHI-10. In addition, as the NOMS decreased stepwise below level 4, there was a corresponding increase in the VHI-10. However, a similar trend in VHI-10 was not observed for NOMS above level 4, indicating the NOMS versus VHI-10 correlation was not linear. Among diagnostic groups, the strongest correlation was found for subjects with functional dysphonia. The NOMS versus VHI-10 correlation was not affected by gender or the coexistence of a psychiatric diagnosis. A simple relationship between VHI-10 and NOMS rating does not exist. Patients with mild vocal dysfunction have a less direct relationship between their NOMS ratings and the VHI-10. These findings provide insight into the interpretation of patient-perceived and clinician-rated measures of vocal function and may allow for better management of expectations and patient counseling in the treatment of voice disorders. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery.

PubMed

Puccinelli, Cassandra; Modzeski, Mara C; Orbelo, Diana; Ekbom, Dale C

Unilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility. Retrospective case series at single tertiary referral center between 2002 and 2015. 141 patients were included who underwent laryngology interventions (micronized acellular dermis injection laryngoplasty and/or type 1 thyroplasty) to treat symptomatic UVFP diagnosed subsequent to cardiothoracic surgery. Pulmonary procedures were most often associated with UVFP (n=50/141; 35.5%). 87.2% had left-sided paralysis (n=123/141). Median time to diagnosis was 42days (x¯=114±348). Over time, UVFP was diagnosed progressively earlier after cardiothoracic surgery. 63.4% of patients (n=95/141) underwent injection laryngoplasty as their initial intervention with median time from diagnosis to injection of 11days (x¯=29.6±54). 41.1% (n=58/141) ultimately underwent type 1 thyroplasty at a median of 232.5days (x¯=367±510.2) after cardiothoracic surgery. 10.2% (n=9/88) of those with adequate follow-up recovered full vocal fold mobility. Many cardiothoracic procedures are associated with symptomatic UVFP, predominantly left-sided. Our data showed poor recovery of vocal fold mobility relative to other studies. Early diagnosis and potential surgical medialization is important in the care of these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Biochemical basis of vocal fold mobilization after microflap surgery in a rabbit model.

PubMed

Mitchell, Joshua R; Kojima, Tsuyoshi; Wu, Hongmei; Garrett, C Gaelyn; Rousseau, Bernard

2014-02-01

To investigate phonation-related extracellular matrix (ECM) changes in the vocal fold lamina propria after microflap surgery using an in vivo rabbit phonation model. Prospective animal study. Twenty-four New Zealand White rabbits were used in this study. Quantitative polymerase chain reaction and immunohistochemistry were used to investigate alterations in vocal fold ECM proinflammatory and profibrotic gene, and protein expression from a control group of animals receiving a microflap without phonation and a separate group of animals receiving experimentally induced phonation on postmicroflap days 0, 3, and 7. IHC demonstrated the highest concentration of CD45 in vocal folds on postoperative day 0. Staining for CD45 was absent by postoperative day 7, with no differences in CD45 staining between groups. Fibronectin gene expression increased significantly on postoperative day 3 in the control and experimentally induced phonation groups, with maximal staining of fibronectin around the microflap incision on postoperative day 7. No alterations in cyclooxygenase-2, interleukin-1β, and transforming growth factor-β1 gene expression were observed between groups. Results of the present study revealed an acute inflammatory response in the vocal fold at the time of microflap (day 0) and up to 3 days post-microflap. By post-operative day 3, staining of CD45 positive cells decreased, with essentially no evidence of inflammation by post-operative day 7. With the end of the acute inflammatory response occurring around day 3, these data may provide support for mobilizing tissue after inflammation has subsided and the process of active tissue remodeling has ensued (days 3-7). N/A. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Practice variations in voice treatment selection following vocal fold mucosal resection.

PubMed

Moore, Jaime E; Rathouz, Paul J; Havlena, Jeffrey A; Zhao, Qianqian; Dailey, Seth H; Smith, Maureen A; Greenberg, Caprice C; Welham, Nathan V

2016-11-01

To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population. Retrospective analysis of a large, nationally representative Medicare claims database. Patients with > 12 months of continuous Medicare coverage who underwent a leukoplakia- or cancer-related vocal fold mucosal resection (index) procedure during calendar years 2004 to 2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each postindex treatment type, treating the other treatment types as competing risks, and further evaluated postindex treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex, and Medicaid eligibility were used as predictors. A total of 2,041 patients underwent 2,427 index procedures during the study period. In 14% of cases, an initial voice treatment event was identified. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65 to 75 years, the likelihood of undergoing surgical treatment increased significantly with each 5-year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy. The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age, and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care. 2c. Laryngoscope, 126:2505-2512, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Practice variations in voice treatment selection following vocal fold mucosal resection

PubMed Central

Moore, Jaime E.; Rathouz, Paul J.; Havlena, Jeffrey A.; Zhao, Qianqian; Dailey, Seth H.; Smith, Maureen A.; Greenberg, Caprice C.; Welham, Nathan V.

2016-01-01

Objective To characterize initial voice treatment selection following vocal fold mucosal resection in a Medicare population. Study Design Retrospective analysis of a large, nationally-representative Medicare claims database. Methods Patients with >12 months of continuous Medicare coverage who underwent a leukoplakia- or cancer-related vocal fold mucosal resection (index) procedure during calendar years 2004–2009 were studied. The primary outcome of interest was receipt of initial voice treatment (thyroplasty, vocal fold injection, or speech therapy) following the index procedure. We evaluated the cumulative incidence of each post-index treatment type treating the other treatment types as competing risks, and further evaluated post-index treatment utilization using the proportional hazards model for the subdistribution of a competing risk. Patient age, sex and Medicaid eligibility were used as predictors. Results 2041 patients underwent 2427 index procedures during the study period. An initial voice treatment event was identified in 14% of cases. Women were significantly less likely to receive surgical or behavioral treatment compared to men. From age 65–75 years, the likelihood of undergoing surgical treatment increased significantly with each 5-year age increase; after age 75 years, the likelihood of undergoing either surgical or behavioral treatment decreased significantly every 5 years. Patients with low socioeconomic status were significantly less likely to undergo speech therapy. Conclusions The majority of Medicare patients do not undergo voice treatment following vocal fold mucosal resection. Further, the treatments analyzed here appear disproportionally utilized based on patient sex, age and socioeconomic status. Additional research is needed to determine whether these observations reflect clinically explainable differences or disparities in care. Level of Evidence 2c PMID:26972900

Quantitative Study for the Surface Dehydration of Vocal Folds Based on High-Speed Imaging.

PubMed

Li, Lin; Zhang, Yu; Maytag, Allison L; Jiang, Jack J

2015-07-01

From the perspective of the glottal area and mucosal wave, quantitatively estimate the differences of vocal fold on laryngeal activity during phonation at three different dehydration levels. Controlled three sets of tests. A dehydration experiment for 10 excised canine larynges was conducted at 16 cm H2O. According to the dehydration cycle time (H), dehydration levels were divided into three degrees (0% H, 50% H, 75% H). The glottal area and mucosal wave under three dehydration levels were extracted from high-speed images and digital videokymography (DKG) image sequences. Direct and non-direct amplitude components were derived from glottal areas. The amplitude and frequency of mucosal wave were calculated from DKG image sequences. These parameters in condition of three dehydration levels were compared for statistical analysis. The results showed a significant difference in direct (P = 0.001; P = 0.005) and non-direct (P = 0.005; P = 0.016) components of glottal areas between every two different dehydration levels. Considering the right-upper, right-lower, left-upper, and left-lower of vocal fold, the amplitudes of mucosal waves consistently decreased with increasing of dehydration levels. But, there was no significant difference in frequency. Surface dehydration could give rise to complex variation of vocal fold on tissues and vibratory mechanism, which should need analyzing from multiple perspectives. The results suggested that the combination of glottal area and mucosal wave could be better to research the change of vocal fold at different dehydrations. It would become a better crucial research tool for the clinical treatment of dehydration-induced laryngeal pathologies. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Effect of intralaryngeal muscle synkinesis on perception of voice handicap in patients with unilateral vocal fold paralysis.

PubMed

Lin, R Jun; Munin, Michael C; Rosen, Clark A; Smith, Libby J

2017-07-01

Intralaryngeal muscle synkinesis associated with unilateral vocal fold paralysis (UVFP) is thought to preserve thyroarytenoid-lateral cricoarytenoid muscle complex tone, resulting in a better voice despite the presence of vocal fold paralysis (VFP). This study compares voice handicap in patients with unilateral VFP (UVFP) with and without evidence of adductory synkinesis on laryngeal electromyography (LEMG). Retrospective review of LEMG data and Voice Handicap Index-10 (VHI-10) scores of patients diagnosed with permanent UVFP. LEMG was performed within 1 to 6 months post onset of UVFP. Patients were stratified into two groups: 1) recurrent laryngeal nerve (RLN) neuropathy with synkinesis and 2) RLN neuropathy without synkinesis. Synkinesis was diagnosed when the sniff to phonation maximum amplitude ratio was ≥0.65. VHI-10 scores at 6-month follow-up were recorded. Four hundred forty-nine patients with UVFP and who had an LEMG were reviewed. Eighty-three patients met the inclusion criteria, with 16 in group 1 and 67 in group 2. There was no significant difference between the groups with regard to age, timing of LEMG from onset of VFP, number of patients undergoing temporary vocal fold injection or use of off-label nimodipine. Average VHI-10 scores at 6 months post onset of VFP were 14.4 ± 10.6 for patients with LEMG-identified synkinesis (group 1) and 21.0 ± 10.1 for patients with no LEMG evidence of synkinesis (group 2). This was statistically significant (P = .02). Patients with unilateral vocal fold paralysis and LEMG evidence of laryngeal synkinesis are more likely to have less perceived voice handicap than those without synkinesis. 4. Laryngoscope, 127:1628-1632, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

The anisotropic nature of the human vocal fold: an ex vivo study.

PubMed

Rohlfs, Anna-Katharina; Goodyer, Eric; Clauditz, Till; Hess, Markus; Kob, Malte; Koops, Susan; Püschel, Klaus; Roemer, Frank W; Müller, Frank

2013-05-01

The purpose of this study was to measure the relationship between the shear elastic properties of vocal fold with respect to the direction of applied stress. There is extensive published material that quantifies the shear viscoelastic properties of the vocal fold, but as much of these data were obtained using rotating parallel plate rheometers, which are unable to resolve out difference of the shear elastic behaviour with respect to direction, there is very little data that indicates anisotropic behaviour. To overcome this gap in knowledge, the team devised an apparatus that is capable of applying a shear stress in a known direction. A series of measurements were taken at the mid-membranous position, in the transverse and longitudinal directions. Point-specific measurements were performed using fourteen human cadaver excised larynges, which were hemi-sectioned to expose the vocal fold. An extremely low sinusoidal shear force of 1 g was applied tangentially to the membrane surface in both the longitudinal and transverse direction, and the resultant shear strain was measured. With the probe applied to the intact vocal fold, the average ratio of the elasticity in the transverse with respect to the longitudinal direction was 0.55. Further investigation using histological staining of collagens in the lamina propria indicates that there is a visible difference in the general alignment of collagen fibres when comparing the coronal and the sagittal sections. Our conclusion is that there is a quantifiable difference between the shear elastic response of the lamina propria in the longitudinal and transverse directions, and that this could be explained by the difference in alignment of collagen fibres within the lamina propria.

Vocal Fold Mucus Aggregation in Persons with Voice Disorders

PubMed Central

Bonilha, Heather Shaw; White, Lisa; Kuckhahn, Kelsey; Gerlach, Terri Treman; Deliyski, Dimitar D.

2012-01-01

Mucus aggregation on the vocal folds is a common finding from laryngeal endoscopy. Patients with voice disorders report the presence of mucus aggregation. Patients also report that mucus aggregation causes them to clear their throat, a behavior believed to be harmful to vocal fold mucosa. Even though clinicians and patients report and discuss mucus aggregation, we have a limited understanding of mucus aggregation in persons with voice disorders. The primary goal of this study was to provide an initial assessment of the presence and features of mucus aggregation in persons with voice disorders. The secondary goal of this study was to determine if there are differences in mucus aggregation between persons with and without voice disorders. To address these goals, four features of mucus aggregation were judged from laryngeal endoscopy recordings from 54 speakers with voice disorders and compared to judgments of these same features in persons without voice disorders. The results from this study showed: (1) 100% of dysphonic speakers had visible mucus aggregation on their vocal folds. (2) Persons with hyperfunctional voice disorders had different mucus characteristics than persons with hypofunctional voice disorders (p=0.002). (3) Dysphonic speakers did not differ in frequency of mucus identified on the vocal folds than non-dysphonic speakers. However, the two groups had different mucus characteristics (p=0.001). Future studies are warranted to determine if these differences in mucus aggregation between persons with and without voice disorders relate to specific aspects of laryngeal pathology or patient characteristics, such as age and gender. Once we understand these relationships, we may be able to use this information to improve our diagnosis and treatment of patients with atypical laryngeal mucus aggregation. PMID:22510352

Effects of matrix composition, microstructure, and viscoelasticity on the behaviors of vocal fold fibroblasts cultured in three-dimensional hydrogel networks.

PubMed

Farran, Alexandra J E; Teller, Sean S; Jha, Amit K; Jiao, Tong; Hule, Rohan A; Clifton, Rodney J; Pochan, Darrin P; Duncan, Randall L; Jia, Xinqiao

2010-04-01

Vocal fold diseases and disorders are difficult to treat surgically or therapeutically. Tissue engineering offers an alternative strategy for the restoration of functional vocal folds. As a first step toward vocal fold tissue engineering, we investigated the responses of primary vocal fold fibroblasts (PVFFs) to two types of collagen and hyaluronic acid (HA)-based hydrogels that are compositionally similar, but structurally variable and mechanically different. Type A hydrogels were composed of mature collagen fibers reinforced by oxidized HA, whereas type B hydrogels contained immature collagen fibrils interpenetrated in an amorphous, covalently cross-linked HA matrix. PVFFs encapsulated in either matrix adopted a fibroblastic morphology and expressed genes related to important extracellular matrix proteins. DNA analysis indicated a linear growth profile for cells encapsulated in type B gels from day 0 to 21, in contrast to an initial dormant, nonproliferative period from day 0 to 3 experienced by cells in type A gels. At the end of the culture, similar DNA content was detected in both types of constructs. A reduction in collagen content was observed for both types of constructs after 28 days of culture, with type A constructs generally retaining higher amounts of collagen than type B constructs. The HA content in the constructs decreased steadily throughout the culture, with type A constructs consistently exhibiting less HA than type B constructs. Using the torsional wave analysis, we found that the elastic moduli for type A constructs decreased sharply during the first week of culture, followed by 2 weeks of matrix stabilization without significant changes in matrix stiffness. Conversely, the elastic modulus for type B constructs increased moderately over time. It is postulated that PVFFs residing in gels alter the matrix organization, chemical compositions, and viscoelasticity through cell-mediated remodeling processes.

An In Vivo Study of Composite Microgels Based on Hyaluronic Acid and Gelatin for the Reconstruction of Surgically Injured Rat Vocal Folds

PubMed Central

Coppoolse, Jiska M. S.; Van Kooten, T. G.; Heris, Hossein K.; Mongeau, Luc; Li, Nicole Y. K.; Thibeault, Susan L.; Pitaro, Jacob; Akinpelu, Olubunmi; Daniel, Sam J.

2016-01-01

Purpose The objective of this study was to investigate local injection with a hierarchically microstructured hyaluronic acid–gelatin (HA-Ge) hydrogel for the treatment of acute vocal fold injury using a rat model. Method Vocal fold stripping was performed unilaterally in 108 Sprague-Dawley rats. A volume of 25 ml saline (placebo controls), HA-bulk, or HA-Ge hydrogel was injected into the lamina propria (LP) 5 days after surgery. The vocal folds were harvested at 3, 14, and 28 days after injection and analyzed using hematoxylin and eosin staining and immunohistochemistry staining for macrophages, myofibroblasts, elastin, collagen type I, and collagen type III. Results The macrophage count was statistically significantly lower in the HA-Ge group than in the saline group (p < .05) at Day 28. Results suggested that the HA-Ge injection did not induce inflammatory or rejection response. Myofibroblast counts and elastin were statistically insignificant across treatment groups at all time points. Increased elastin deposition was qualitatively observed in both HA groups from Day 3 to Day 28, and not in the saline group. Significantly more elastin was observed in the HA-bulk group than in the uninjured group at Day 28. Significantly more collagen type I was observed in the HA-bulk and HA-Ge groups than in the saline group (p < .05) at Day 28. The collagen type I concentration in the HA-Ge and saline groups was found to be comparable to that in the uninjured controls at Day 28. The concentration of collagen type III in all treatment groups was similar to that in uninjured controls at Day 28. Conclusion Local HA-Ge and HA-bulk injections for acute injured vocal folds were biocompatible and did not induce adverse response. PMID:24687141

Quantitative high-speed laryngoscopic analysis of vocal fold vibration in fatigued voice of young karaoke singers.

PubMed

Yiu, Edwin M-L; Wang, Gaowu; Lo, Andy C Y; Chan, Karen M-K; Ma, Estella P-M; Kong, Jiangping; Barrett, Elizabeth Ann

2013-11-01

The present study aimed to determine whether there were physiological differences in the vocal fold vibration between nonfatigued and fatigued voices using high-speed laryngoscopic imaging and quantitative analysis. Twenty participants aged from 18 to 23 years (mean, 21.2 years; standard deviation, 1.3 years) with normal voice were recruited to participate in an extended singing task. Vocal fatigue was induced using a singing task. High-speed laryngoscopic image recordings of /i/ phonation were taken before and after the singing task. The laryngoscopic images were semiautomatically analyzed with the quantitative high-speed video processing program to extract indices related to the anteroposterior dimension (length), transverse dimension (width), and the speed of opening and closing. Significant reduction in the glottal length-to-width ratio index was found after vocal fatigue. Physiologically, this indicated either a significantly shorter (anteroposteriorly) or a wider (transversely) glottis after vocal fatigue. The high-speed imaging technique using quantitative analysis has the potential for early identification of vocally fatigued voice. Copyright © 2013 The Voice Foundation. All rights reserved.

Computational Modeling of Fluid–Structure–Acoustics Interaction during Voice Production

PubMed Central

Jiang, Weili; Zheng, Xudong; Xue, Qian

2017-01-01

The paper presented a three-dimensional, first-principle based fluid–structure–acoustics interaction computer model of voice production, which employed a more realistic human laryngeal and vocal tract geometries. Self-sustained vibrations, important convergent–divergent vibration pattern of the vocal folds, and entrainment of the two dominant vibratory modes were captured. Voice quality-associated parameters including the frequency, open quotient, skewness quotient, and flow rate of the glottal flow waveform were found to be well within the normal physiological ranges. The analogy between the vocal tract and a quarter-wave resonator was demonstrated. The acoustic perturbed flux and pressure inside the glottis were found to be at the same order with their incompressible counterparts, suggesting strong source–filter interactions during voice production. Such high fidelity computational model will be useful for investigating a variety of pathological conditions that involve complex vibrations, such as vocal fold paralysis, vocal nodules, and vocal polyps. The model is also an important step toward a patient-specific surgical planning tool that can serve as a no-risk trial and error platform for different procedures, such as injection of biomaterials and thyroplastic medialization. PMID:28243588

Effect of pneumotach on measurement of vocal function

NASA Astrophysics Data System (ADS)

Walters, Gage; McPhail, Michael; Krane, Michael

2017-11-01

Aerodynamic and acoustic measurements of vocal function were performed in a physical model of the human airway with and without a pneumotach (Rothenberg mask), used by clinicians to measure vocal volume flow. The purpose of these experiments was to assess whether the device alters acoustic and aerodynamic conditions sufficiently to change phonation behavior. The airway model, which mimics acoustic behavior of an adult human airway from trachea to mouth, consists of a 31.5cm long straight duct with a 2.54cm square cross section. Model vocal folds comprised of molded silicone rubber were set into vibration by introducing airflow from a compressed air source. Measurements included transglottal pressure difference, mean volume flow, vocal fold vibratory motion, and sound pressure measured at the mouth. The experiments show that while the pneumotach imparted measurable aerodynamic and acoustic loads on the system, measurement of mean glottal resistance was not affected. Acoustic pressure levels were attenuated, however, suggesting clinical acoustic measurements of vocal function need correction when performed in conjunction with a pneumotach Acknowledge support from NIH DC R01005642-11.

Vocal cysts: clinical, endoscopic, and surgical aspects.

PubMed

Martins, Regina Helena Garcia; Santana, Marcela Ferreira; Tavares, Elaine Lara Mendes

2011-01-01

Vocal cysts are benign laryngeal lesions, which affect children and adults. They can be classified as epidermic or mucous-retention cyst. The objective was to study the clinical, endoscopic, and surgical aspects of vocal cysts. We reviewed the medical charts of 72 patients with vocal cysts, considering age, gender, occupation, time of vocal symptoms, nasosinusal and gastroesophageal symptoms, vocal abuse, tabagism, alcoholism, associated lesions, treatment, and histological details. Of the 72 cases, 46 were adults (36 females and 10 male) and 26 were children (eight girls and 18 boys). As far as occupation is concerned, there was a higher incidence of students and teachers. All the patients had symptoms of chronic hoarseness. Nasosinusal (27.77%) and gastroesophageal (32%) symptoms were not relevant. Vocal abuse was reported by 45.83%, smoking by 18%, and alcoholism by 8.4% of the patients. Unilateral cysts were seen in 93% of the cases, 22 patients had associated lesions, such as bridge, sulcus vocalis, and microweb. Surgical treatment was performed in 46 cases. Histological analysis of the epidermic cysts revealed a cavity with caseous content, covered by stratified squamous epithelium, often keratinized. Mucous cysts presented mucous content, and the walls were coated by a cylindrical ciliated epithelium. Vocal cysts are benign vocal fold lesions that affect children and adults, being often associated with vocal overuse, which frequently affects people who use their voices professionally. Vocal symptoms are chronic in course, often times since childhood, and the treatment of choice is surgical removal. A careful examination of the vocal folds is necessary during surgery, because other laryngeal lesions may be associated with vocal cysts. Copyright © 2011 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

A lumped mucosal wave model of the vocal folds revisited: Recent extensions and oscillation hysteresis

PubMed Central

Lucero, Jorge C.; Koenig, Laura L.; Lourenço, Kelem G.; Ruty, Nicolas; Pelorson, Xavier

2011-01-01

This paper examines an updated version of a lumped mucosal wave model of the vocal fold oscillation during phonation. Threshold values of the subglottal pressure and the mean (DC) glottal airflow for the oscillation onset are determined. Depending on the nonlinear characteristics of the model, an oscillation hysteresis phenomenon may occur, with different values for the oscillation onset and offset threshold. The threshold values depend on the oscillation frequency, but the occurrence of the hysteresis is independent of it. The results are tested against pressure data collected from a mechanical replica of the vocal folds, and oral airflow data collected from speakers producing intervocalic ∕h∕. In the human speech data, observed differences between voice onset and offset may be attributed to variations in voice pitch, with a very small or inexistent hysteresis phenomenon. PMID:21428520

Laryngeal and vocal alterations after thyroidectomy.

PubMed

Iyomasa, Renata Mizusaki; Tagliarini, José Vicente; Rodrigues, Sérgio Augusto; Tavares, Elaine Lara Mendes; Martins, Regina Helena Garcia

2017-09-21

Dysphonia is a common symptom after thyroidectomy. To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy n=40, total thyroidectomy n=88, thyroidectomy+lymph node dissection n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy+isthmectomy n=6; total thyroidectomy n=17; thyroidectomy+lymph node dissection n=9) and 2 superior laryngeal nerve (lobectomy+isthmectomy n=1; Total thyroidectomy+lymph node dissection n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21). Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.