Neuromuscular control of fundamental frequency and glottal posture at phonation onset

The laryngeal neuromuscular mechanisms for modulating glottal posture and fundamental frequency are of interest in understanding normal laryngeal physiology and treating vocal pathology. The intrinsic laryngeal muscles in an in vivo canine model were electrically activated in a graded fashion to investigate their effects on onset frequency, phonation onset pressure, vocal fold strain, and glottal distance at the vocal processes. Muscle activation plots for these laryngeal parameters were evaluated for the interaction of following pairs of muscle activation conditions: (1) cricothyroid (CT) versus all laryngeal adductors (TA/LCA/IA), (2) CT versus LCA/IA, (3) CT versus thyroarytenoid (TA) and, (4) TA versus LCA/IA (LCA: lateral cricoarytenoid muscle, IA: interarytenoid). Increases in onset frequency and strain were primarily affected by CT activation. Onset pressure correlated with activation of all adductors in activation condition 1, but primarily with CT activation in conditions 2 and 3. TA and CT were antagonistic for strain. LCA/IA activation primarily closed the cartilaginous glottis while TA activation closed the mid-membranous glottis.     

Simulated effects of cricothyroid and thyroarytenoid muscle activation on adult-male vocal fold vibration

Adjustments to cricothyroid and thyroarytenoid muscle activation are critical to the control of fundamental frequency and aerodynamic aspects of vocal fold vibration in humans. The aerodynamic and physical effects of these muscles are not well understood and are difficult to study in vivo. Knowledge of the contributions of these two muscles is essential to understanding both normal and disordered voice physiology. In this study, a three-mass model for voice simulation in adult males was used to produce systematic changes to cricothyroid and thyroarytenoid muscle activation levels. Predicted effects on fundamental frequency, aerodynamic quantities, and physical quantities of vocal fold vibration were assessed. Certain combinations of these muscle activations resulted in aerodynamic and physical characteristics of vibration that might increase the mechanical stress placed on the vocal fold tissue.     

Restraining mechanisms in regulating glottal closure during phonation

Recent experimental studies showed that isotropic vocal fold models were often blown wide apart and thus not able to maintain adductory position, resulting in voice production with noticeable breathy quality. This study showed that the capability of the vocal fold to resist deformation against airflow and maintain adductory position can be improved by stiffening the body-layer stiffness or increasing the anterior-posterior tension of the vocal folds, which presumably can be achieved through the contraction of the thyroarytenoid (TA) and cricothyroid (CT) muscles, respectively. Experiments in both physical models and excised larynges showed that, when these restraining mechanisms were activated, the vocal folds were better able to maintain effective adduction, resulting in voice production with much clearer quality and reduced breathiness. In humans, one or more restraining mechanisms may be activated at different levels to accommodate the varying degree of restraining required under different voice conditions.     

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

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.     

The effect of cricothyroid muscle action on the relation between subglottal pressure and fundamental frequency in an in vivo canine model.

The relation between subglottal pressure (Ps) and fundamental frequency (F0) in phonation was investigated with an in vivo canine model. Direct muscle stimulation was used in addition to brain stimulation. This allowed the Ps-F0 slope to be quantified in terms of cricothyroid muscle activity. Results showed that, for ranges of 0-2 mA constant current stimulation of the cricothyroid muscle, the Ps-F0 slope ranged from 10 Hz/kPa to 60 Hz/kPa. These results were compared to similar slopes obtained in a previous study on excised larynges in which the vocal fold length was varied instead of cricothyroid activation. A physical interpretation of the Ps-F0 slope is that the amplitude-to-length ratio of the vocal folds decreases with CT activity, resulting in a smaller time-varying stiffness. In other words, there is less dependence of F0 on amplitude of vibration when the vocal folds are long instead of short.     

The dynamics of length change in canine vocal folds

The time courses of vocal fold elongation and contraction have beenmeasured as a function of intrinsic laryngeal muscle activity. The superior and recurrent laryngeal nerves of anesthetized canines were stimulated supramaximally (on-off in all combinations) while the vocal folds were surgically exposed and illuminated for conventional and higher speed (300 frames per second) video recording. Microsutures were placed on various points on the vocal folds to measure elongation and contraction. Vocal fold strain, defined as elongation divided by rest length, ranged from −17% to +45%. The typical time constant for exponential increase or decrease in strain was about 30 ms. This reflects primarily the intrinsic muscle activation times rather than a passive (inertial or viscoelastic) response of cricothyroid joint rotation or translation.     

Vocal Nodules and Laryngeal Morphology

Our purpose was to study the occurrence of vocal fold nodules under conditions of habitual vocal abuse associated with increased laryngeal muscle tension, to identify the existence of a relationship between vocal nodules and laryngeal morphology. We studied one group of 30 subjects with vocal nodules, 18 to 50 years old, who were compared with two control groups, one of females and one of males, consisting of 30 subjects each. The parameters evaluated were: type of vocal folds coaptation, glottic proportion (GP) and abduction angle (AA), obtained by videotelelaryngoscopy. In the nodules group, the larynges presented a mean value of GP similar to that of the female group, both of which were lower than the mean GP value of the male group. On the other hand, the mean AA was lower than the one in the female group, and closer to the one in the male group. We concluded that vocal nodules were present only in larynges with a predominantly young female morphology, with functional limitations of abduction.     

Unilateral cricothyroid contraction and glottic configuration

It is frequently stated that unilateral cricothyroid muscle (CT) paralysis can be diagnosed by physical examination, noting rotation of the glottis, and shortening and vertical displacement of the ipsilateral vocal fold. These signs, however, are inconsistently observed, and there is considerable controversy regarding the direction of glottic rotation. To determine the effects of CT contraction on three-dimensional glottic configuration, we performed computerized tomography on cadaver larynges before and after simulated CT contraction. Radiopaque makers were used to compute distances. Unilateral CT contraction equally increased the length of both membranous vocal folds, and rotated the posterior glottis less than 1 mm. CT contraction neither adducted the vocal processes, nor significantly their altered vertical level. These results suggest that unilateral CT paralysis cannot be diagnosed on the basis of any clinically apparent change in glottal configuration.     

The role of strap muscles in phonation—In vivo caninelaryngeal model

In spite of the presumed importance of the strap muscles on laryngealvalving and speech production, there is little research concerning the physiological role and the functional differences among the strap muscles. Generally, the strap muscles have been shown to cause a decrease in the fundamental frequency (F₀) of phonation during contraction. In this study, an in vivo canine laryngeal model was used to show the effects of strap muscles on the laryngeal function by measuring the F₀, subglottic pressure, vocal intensity, vocal fold length, cricothyroid distance, and vertical laryngeal movement. Results demonstrated that the contraction of sternohyoid and sternothyroid muscles corresponded to a rise in subglottic pressure, shortened cricothyroid distance, lengthened vocal fold, and raised F₀ and vocal intensity. The thyrohyoid muscle corresponded to lowered subglottic pressure, widened cricothyroid distance, shortened vocal fold, and lowered F₀ and vocal intensity. We postulate that the mechanism of altering F₀ and other variables after stimulation of the strap muscles is due to the effects of laryngotracheal pulling, upward or downward, and laryngotracheal forward bending, by the external forces during strap muscle contraction.     

Determination of superior surface strains and stresses, and vocal fold contact pressure in a synthetic larynx model using digital image correlation

Stresses and strains within the vocal fold tissue may play a critical role in voice fatigue, in tissue damage and resulting voice disorders, and in tissue healing. In this study, experiments were performed to determine mechanical fields on the superior surface of a self-oscillating physical model of the human vocal folds using a three-dimensional digital image correlation method. Digital images obtained using a high-speed camera together with a mirror system were used to measure displacement fields, from which strains, strain rates, and stresses on the superior surface of the model vocal folds were computed. The dependence of these variables on flow rate was established. A Hertzian impact model was used to estimate the contact pressure on the medial surface from superior surface strains. A tensile stress dominated state was observed on the superior surface, including during collision between the model folds. Collision between the model vocal folds limits the medial-lateral stress levels on the superior surface, in conjunction with compressive stress or contact pressure on the medial surface.     

Experimental study of the effects of surface mucus viscosity on the glottic cycle

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.     

Botulinum toxin injection in the treatment of vocal fold paralysis associated with multiple sclerosis: A case report

Botulinum toxin has been demonstrated clinically to be an effective treatment for a variety of laryngeal problems, most notably spasmodic dysphonia. As in other movement disorders, the theory behind the injection of this substance in the larynx has been a weakening of the vocal fold musculature to relieve uncoordinated and spasmodic movement of the vocal folds, presumably rebalancing the forces within the intralaryngeal musculature. Recently, this concept was applied to help reposition the arytenoid cartilage in acute and longstanding anteromedial cricoarytenoid dislocations. This same concept may apply to the paralyzed vocal fold. In support of this idea, a number of investigators have shown that immobile, clinically paralyzed vocal folds may still have partial voluntary motor unit activity. This voluntary activation may not produce clinically evident movement but may be sufficient to produce tone within the fold. If the voluntary motor units in the abductor musculature of the paralyzed fold are weakened with botulinum toxin, the continued pull of the functioning adductor musculature may be sufficient to medialize the paralyzed fold. This idea has been supported by animal experiments, which have shown that botulinum toxin may affect the ability of the fold to rebalance itself. With this evidence in mind, a patient with fold immobility secondary to multiple sclerosis was treated in an attempt at laryngeal rebalancing, using botulinum toxin to medialize the fold. However, instead of simply having the fold return fixed to the midline, the patient regained normal laryngeal mobility and voice. While it is unclear whether the botulinum toxin alone was responsible, the coincidence of this occurrence certainly requires reporting. This paper is a report of the first successful treatment of vocal fold paralysis using botulinum toxin to treat vocal fold fixation in a patient with multiple sclerosis.     

Vocal fold and ventricular fold vibration in period-doubling phonation: physiological description and aerodynamic modeling

Occurrences of period-doubling are found in human phonation, in particular for pathological and some singing phonations such as Sardinian A Tenore Bassu vocal performance. The combined vibration of the vocal folds and the ventricular folds has been observed during the production of such low pitch bass-type sound. The present study aims to characterize the physiological correlates of this acoustical production and to provide a better understanding of the physical interaction between ventricular fold vibration and vocal fold self-sustained oscillation. The vibratory properties of the vocal folds and the ventricular folds during phonation produced by a professional singer are analyzed by means of acoustical and electroglottographic signals and by synchronized glottal images obtained by high-speed cinematography. The periodic variation in glottal cycle duration and the effect of ventricular fold closing on glottal closing time are demonstrated. Using the detected glottal and ventricular areas, the aerodynamic behavior of the laryngeal system is simulated using a simplified physical modeling previously validated in vitro using a larynx replica. An estimate of the ventricular aperture extracted from the in vivo data allows a theoretical prediction of the glottal aperture. The in vivo measurements of the glottal aperture are then compared to the simulated estimations.     

A two-dimensional biomechanical model of vocal fold posturing

The forces and torques governing effective two-dimensional (2D) translation and rotation of the laryngeal cartilages (cricoid, thyroid, and arytenoids) are quantified on the basis of more complex three-dimensional movement. The motions between these cartilages define the elongation and adduction (collectively referred to as posturing) of the vocal folds. Activations of the five intrinsic laryngeal muscles, the cricothyroid, thyroarytenoid, lateral cricoarytenoid, posterior cricoarytenoid, and interarytenoid are programmed as inputs, in isolation and in combination, to produce the dynamics of 2D posturing. Parameters for the muscles are maximum active stress, passive stress, activation time, contraction time, and maximum shortening velocity. The model accepts measured electromyographic signals as inputs. A repeated adductory-abductory gesture in the form /hi-hi-hi-hi-hi/ is modeled with electromyographic inputs. Movement and acoustic outputs are compared between simulation and measurement.     

A model for vocal fold vibratory motion, contact area, and the electroglottogram

The electroglottogram (EGG) has been conjectured to be related to the area of contact between the vocal folds. This hypothesis has been substantiated only partially via direct and indirect observations. In this paper, a simple model of vocal fold vibratory motion is used to estimate the vocal fold contact area as a function of time. This model employs a limited number of vocal fold vibratory features extracted from ultra high-speed laryngeal films. These characteristics include the opening and closing vocal fold angles and the lag (phase difference) between the upper and lower vocal fold margins. The electroglottogram is simulated using the contact area, and the EGG waveforms are compared to measured EGGs for normal male voices producing both modal and pulse register tones. The model also predicts EGG waveforms for vocal fold vibration associated with a nodule or polyp.     

Assessment of local vocal fold deformation characteristics in an in vitro static tensile test

Voice quality is strongly dependent on vocal fold dynamics, which in turn are dependent on lung pressure and vocal fold biomechanics. Numerical and physical models are often used to investigate the interactions of these different subsystems. However, the utility of numerical and physical models is limited unless appropriately validated with data from physiological models. Hence a method that enables analysis of local vocal fold deformations along the entire surface is presented. In static tensile tests, forces are applied to distinctive working points being located in cover and muscle, respectively, so that specific layer properties can be investigated. The forces are directed vertically upward and are applied along or above the vocal fold edge. The resulting deformations are analyzed using multiple perspectives and three-dimensional reconstruction. Deformation characteristics of four human vocal folds were investigated. Preliminary results showed two phases of deformation: a range with a small slope for small deformations fading into a significant nonlinear deformation trend with a high slope. An increase of tissue stiffness from posterior to anterior was detected. This trend is more significant for muscle and in the mid-anterior half of the vocal fold.     

Length-tension relationship of the feline thyroarytenoid muscle

Vocal fold tension during phonation is generated by coordinated contraction of the intrinsic laryngeal muscles. The thyroarytenoid muscle has been found to have increased stiffness at various levels of strain when compared with other intrinsic laryngeal muscles. The objective here is to test the hypothesis that the thyroarytenoid muscle exhibits high passive tension during maximal isometric tetanic force generation, and to test the hypothesis that the thyroarytenoid maintains the ability to generate contractile force at high levels of strain more effectively than other skeletal muscle. The thyroarytenoid muscles (n=9) and digastric muscle strips (n=7) were removed from adult random-bred cats. Maximal isometric tension and passive tension at optimum length were measured from each muscle in vitro. Active and passive length-tension curves were constructed for each muscle. The contractile properties of the thyroarytenoid group were compared with those of the digastric muscle group. The thyroarytenoid muscle group required on average 140 mN of passive tension to generate maximal isometric tetanic tension. This represented 39% of the average maximal isometric tetanic tension generated by the muscles. These results were significantly higher than the digastric muscle group, which required on average 28 mN of passive tension (9% of maximal isometric tetanic tension, p<0.05). At 110% of optimum length, the thyroarytenoid muscle maintained 89.8% of maximal isometric tetanic force, whereas the digastric muscle group maintained 67.7% of maximal isometric tetanic force (p<0.05). The thyroarytenoid muscle exhibits higher passive tension when generating maximal isometric tension than the digastric muscle control group. The thyroarytenoid muscle maintains higher levels of active tension at high strain than the digastric muscle control group. We conclude that these findings are related to the ability of the thyroarytenoid muscle to function as a fine tensor of the vocal fold in a high strain environment.     

Muscle spindles are concentrated in the superior vocalis subcompartment of the human thyroarytenoid muscle

It is hypothesized that different parts of the thyroarytenoid muscle (TA) are functionally specialized. Specifically, the TA is divided into a lateral muscularis compartment and a medial vocalis compartment. This study examined the distribution of muscle spindles throughout the human TA as an indicator of these functional differences. Histological cross-sections from the anterior, middle, and posterior regions of five human membranous vocal folds were examined for the number and location of muscle spindles. There was an average of 6.1 muscle spindles in sections from each region with no significant variation between the different regions (p < .05). However, in sections from all three regions, the muscle spindles were always found to be concentrated in the superior medial quadrant of the TA (mean 85.9%, p < .01). The inferior medial, superior lateral, and inferior lateral quadrants of the TA contained 11.96%, 2.17%, and 0%, respectively, of the total muscle spindles. Within the superior medial quadrant, most of the muscle spindles were localized in the most superficial part of the muscle.The results of this study demonstrate that the majority of TA muscle spindlesare concentrated in its superior medial quadrant, an area we have termed the superior vocalis subcompartment (SC. This finding suggests that the superior vocalis SC is functionally distinct from the remainder of the TA. It is hypothesized that tension in the superior vocalis SC can be controlled independently from the remainder of the TA, and this capability is used to effect the biomechanics of vocal fold vibration during phonation.