The biomechanics of the medialization laryngoplasty(thyroplasty type 1) in an ex vivo canine model

The biomechanics of medialization laryngoplasty are not well understood. An excised canine larynx model was used to test the effects of various sized silicon implants. The vocal fold length, position, and tension were measured. Medialization laryngoplasty did not affect vocal fold length. At the mid-membranous vocal fold, larger shims resulted in greater medialization and tension. Medialization laryngoplasty neither medialized nor stiffened the vocal process to resist lateralizing forces. We conclude that medialization laryngoplasty provides bulk and support for defects of the membranous region of the vocal fold, but does not appear to close a posterior glottal gap. The selection of a surgical procedure to treat glottal incompetence should take into account the unique biomechanical properties of the anterior (membranous vocal folds) and posterior (cartilaginous portion) glottis.     

Relationship among glottal area, static supraglottic compression, and laryngeal function studies in unilateral vocal fold paresis and paralysis

In this study, we evaluated the relationship between laryngeal function measures and glottal gap ratio and normalized measures of supraglottic behaviors in patients with unilateral vocal fold paresis (UVFP). Thirty-one patients were found to have unilateral vocal fold paresis by videoendoscopy and laryngeal electromyography, and 13 controls participated in this study. Patients with UVFP demonstrated significantly larger glottal gap ratios (p = 0.016) than control subjects. The nonparalyzed or contralateral vocal fold was associated with significantly more static false vocal fold compression (p = 0.03) compared with the paralyzed vocal fold or with the controls. Patients with unilateral vocal fold paresis were divided into subgroups: those with normal or abnormal maximum phonation time, flow, or pressure measures. Smaller glottal gap ratios were identified in patients with normal maximum phonation times and flow measures. Greater false vocal fold activity was identified in unilateral vocal fold paresis patients with normal laryngeal function measures than in unilateral vocal fold paresis patients with abnormal measures. These findings suggest that some patients with documented unilateral paresis and glottal incompetence can compensate for vocal fold weakness such that their acoustic and aerodynamic measures are normal.     

Vocal fold bulging effects on phonation using a biophysical computer model

Glottal adduction is a primary laryngeal variable that helps to determine glottal configuration and phonatory output. Greater adduction of the vocal folds can be produced by narrowing the gap between the vocal processes or by bulging the medial surface of the vocal folds. This study examined phonatory effects due to changing the degree of bulging using a computational model. Bulging was modeled as a quadratic surface and was related to active muscle stress. Results indicated that bulging had a significant effect on glottal flow resistance, maximum glottal width and area, and mean glottal volume velocity. The results are discussed relative to clinical issues of hyperfunction.     

Pressure-flow relationships during phonation as afunction of adduction

Pressure-flow relationships were obtained for five excised caninelarynges. Simultaneous recordings were made of average subglottal pressure, average air flow, and the electroglottograph at various levels of adduction and vocal fold lengths. The level of adduction was controlled by positioning the arytenoid cartilages via laterally imbedded three-prong attachments and by the use of intra-arytenoid shims. Adduction was quantified by measuring the vocal process gap. Results indicated a linear pressure-flow relationship within the experimental range of phonation for each level of adduction. Differential glottal resistance increased as the vocal process gap was reduced. A model is presented for the differential resistance as a hyperbolic function of vocal process gap. The pressure-flow relationship and the model can be used in computer simulations of speech production and for clinical insight into the aerodynamic function of the human larynx.     

Physiologic and acoustic differences between male and female voices

Comparison is drawn between male and female larynges on the basis of overall size, vocal fold membranous length, elastic properties of tissue, and prephonatory glottal shape. Two scale factors are proposed that are useful for explaining differences in fundamental frequency, sound power, mean airflow, and glottal efficiency. Fundamental frequency is scaled primarily according to the membranous length of the vocal folds (scale factor of 1.6), whereas mean airflow, sound power, glottal efficiency, and amplitude of vibration include another scale factor (1.2) that relates to overall larynx size. Some explanations are given for observed sex differences in glottographic waveforms. In particular, the simulated (computer-modeled) vocal fold contact area is used to infer male-female differences in the shape of the glottis. The female glottis appears to converge more linearly (from bottom to top) than the male glottis, primarily because of medial surface bulging of the male vocal folds.     

Analytic Representation of Volume Flow as a Function of Geometry and Pressure in a Static Physical Model of the Glottis

A static physical model of the larynx (model M5) was used to obtain a large set of volume flows as a function of symmetric glottal geometry and transglottal pressure. The measurements cover ranges of these variables relevant to human phonation. A generalized equation was created to accurately estimate the glottal volume flow given specific glottal geometries and transglottal pressures. Both the data and the generalized formula give insights into the flow behavior for different glottal geometries, especially the contrast between convergent and divergent glottal angles at different glottal diameters. The generalized equation produced a fit to the entire M5 dataset (267 points) with an average accuracy of 3.4%. The accuracy was about seven times better than that of the Ishizaka-Flanagan approach to glottal flow and about four times better than that of a pressure coefficient approach. Thus, for synthesis purposes, the generalized equation presented here should provide more realistic glottal flows (based on steady flow conditions) as suitable inputs to the vocal tract, for given values of transglottal pressure and glottal geometry. Applications of the generalized formula to pulses generated by vocal fold motions typical of those produced by the Ishizaka-Flanagan coupled-oscillator model and the more recent body-cover model of Story and Titze are also included.     

Analysis of Voice and Quantitative Measurement of Glottal Gap After Thyroplasty Type I in the Treatment of Unilateral Vocal Paralysis

Thyroplasty type I is one of several surgical treatments in which improving the voice of unilateral vocal fold paralysis is the ultimate objective. The goal of the surgery is the medialization of the paralyzed vocal fold. The purpose of this study is to evaluate the effectiveness of thyroplasty type I through acoustical analysis, aerodynamic measures, and quantitative videostroboscopic measurements. We report on 20 patients with unilateral vocal cord paralysis who underwent thyroplasty type I. We performed preoperative and postoperative video image analysis (normalized glottal gap area) and computer-assisted voice analysis (fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, mean phonation time, mean flow rate, mean subglottic pressure) in all patients. The glottal gap was significantly reduced after thyroplasty type I. Postoperative voice quality was characterized by an improved pitch and amplitude pertubation (jitter and shimmer), phonation time (mean phonation time), and subglottic pressure (mean subglottic pressure). Thyroplasty type I is an effective method for regaining glottal closure and vocal function.     

Optimal glottal configuration for ease of phonation

Recent experimental studies have shown the existence of optimalvalues of the glottal width and convergence angle, at which the phonation threshold pressure is minimum. These results indicate the existence of an optimal glottal configuration for ease of phonation, not predicted by the previous theory. In this paper, the origin of the optimal configuration is investigated using a low dimensional mathematical model of the vocal fold. Two phenomena of glottal aerodynamics are examined: pressure losses due to air viscosity, and air flow separation from a divergent glottis. The optimal glottal configuration seems to be a consequence of the combined effect of both factors. The results agree with the experimental data, showing that the phonation threshold pressure is minimum when the vocal folds are slightly separated in a near rectangular glottis.     

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

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 α 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.     

Approximations of open quotient and speed quotient from glottal airflow and egg waveforms : Effects of measurement criteria and sound pressure level

Noninvasive measures of vocal fold activity are useful for describingnormal and disordered voice production. Measures of open and speed quotient from glottal airflow and electroglottographic (EGG) waveforms have been used to describe timing events associated with vocal fold vibration. To date, there has been little consistency in the measurement criteria used to calculate quotient values. In this study, criteria of 20% and 50% were applied to the AC amplitude of glottal airflow and inverted EGG waveforms for measurement of open quotient. Criteria of 20%, 50%, and 80%, and a midslope criterion that segmented the waveform between 20% and 80% of the waveform amplitude, were used for the calculation of speed quotient. Subjects produced waveforms at sound pressure levels (SPL) of 70, 75, 80 and 85 dB. Results indicated that approximations of open quotient obtained from the glottal airflow waveform significantly decreased using both the 20% and 50% criteria as SPL increased from 80 to 85 dB. No significant changes were found in open quotient from the EGG waveform as a function of SPL. Results of speed quotient measures from the glottal airflow and EGG waveforms showed a generally increasing trend as SPL increased, although the differences were not statistically significant. The data suggest that the signal type, measurement criterion and SPL must be considered in interpreting quotient measures.     

Glottal opening in patients with vocal fold tissue changes

Synchronized videostroboscopy and electroglottography were applied to the measurement of anterior-to-posterior open glottal length in four groups of patients; two with no clinically significant voice disorder, one with vocal fold polyps, and one with vocal fold nodules. The data showed that the groups did not differ significantly when open glottal length was measured at the time of minimum glottal opening. The pathological groups had significantly lower open glottal length measurements, however, when measurements were obtained at the time that vocal fold contact was initiated during the glottal cycle. The findings are preliminary evidence that vocal fold neoplasms may not have the effect of reducing glottal closure, as previously suggested in the literature. The data also highlight the importance of examining differential effects of vocal fold neoplasms at various points throughout the glottal cycle.     

Analysis of Vocal-fold Vibrations from High-Speed Laryngeal Images Using a Hilbert Transform-Based Methodology

This paper presents a Hilbert transform-based approach to analyze vocal fold vibrations in human subjects exhibiting normal and abnormal voice productions. This new approach is applied to the analysis of glottal area waveform (GAW) and is capable of providing useful information on the vocal fold vibration. The GAW is extracted from high-speed laryngeal images by delineating the glottal edge for each image frame. An analytic signal is generated through the Hilbert transform of the GAW, which yields a recognizable pattern of the vocal fold vibration in the analytic phase plane. The vibratory pattern is comprehensive and can be correlated with specific voice conditions. Quantitative measures of the glottal perturbation are introduced using the analytic amplitude and instantaneous frequency obtained from the analysis. Examples of clinical voice recordings are used to evaluate and test the effectiveness of this approach in providing qualitative representation and quantitative characteristics of vocal fold vibratory behavior. The results demonstrate the potential of using this new analytical tool incorporated with the high-speed laryngeal imaging modality for clinical voice assessment.     

Simulation of vocal fold impact pressures with a self-oscillating finite-element model

Vocal fold impact pressures were studied using a self-oscillating finite-element model capable of simulating vocal fold vibration and airflow. The calculated airflow pressure is applied on the vocal fold as the driving force. The airflow region is then adjusted according to the calculated vocal fold displacement. The interaction between airflow and the vocal folds produces a self-oscillating solution. Lung pressures between 0.2 and 2.5 kPa were used to drive this self-oscillating model. The spatial distribution of the impact pressure was studied. Studies revealed that the tissue collision during phonation produces a very large impact pressure which correlates with the lung pressure and glottal width. Larger lung pressure and a narrower glottal width increase the impact pressure. The impact pressure was found to be roughly the square root of lung pressure. In the inferior-superior direction, the maximum impact pressure is related to the narrowest glottis. In the anterior-posteriorfirection, the greatest impact pressure appears at the midpoint of the vocal fold. The match between our numerical simulations and clinical observations suggests that this self-oscillating finite-element model might be valuable for predicting mechanical trauma of the vocal folds.     

Influence of glottal closure configuration on vocal efficacy in young normal-speaking women

Posterior closure insufficiency of the glottis is often mentioned in connection with permanent voice disorders. Recently published studies have revealed that an incomplete closure of the glottis can be found also in normal-speaking voices, especially in women. However, the effect of glottal closure configuration on vocal efficacy is not sufficiently clarified. The purpose of this study was to determine the effect of glottal closure configuration on singing and speaking voice characteristics. Overall, 520 young female normal-speaking subjects were examined by videostroboscopy for different phonation conditions in the combination of soft, loud, low, and/or high phonation and by voice range profile measurements. According to the videostroboscopic analysis, the subjects were subdivided into four groups: complete closure of the vocal folds already in soft phonation (group 1), closure of the vocal fold with increasing intensity (group 2), persistent closure insufficiencies despite increasing intensity (group 3), and hourglass-shaped closure in subjects with vocal nodules (group 4). Subjects in which the glottal closure could not be evaluated sufficiently were subclassified into group 5 (missing values).

Selected criteria of the singing and speaking voice were evaluated and statistically processed according to the mentioned subclassification. Group 1 reached significantly the highest sound pressure levels (SPL_max) for the singing voice as well as for the shouting voice. Group 3 showed a limited capacity to increase the intensity of the singing and speaking voice. The results gathered in this study objectify the relationship of insufficient glottal closure and reduced vocal capabilities. As long as no conclusive data on long-term consequences of insufficient glottal closure are available, a prophylactic improvement of the laryngeal situation especially in female professional voice users by voice therapy should be recommended.     

A preliminary study of particle velocity during phonation in an in vivo canine model

The particle velocity across the glottis was measured with simultaneous electroglottography, photoglottography, and subglottic pressure in an in vivo canine model of phonation. A constant temperature anemometer measured flow velocity at five midline anterior to posterior glottal positions. Tracheal input air flow was varied in five steps from 175 to 500 cc/s, while vocal fold approximation was achieved by constant electrical stimulation of the laryngeal nerves. For all levels of air flow, a decreasing peak velocity gradient was observed from the anterior commissure to the arytenoids. Time-varying features of the flow velocity are discussed in relation to glottal vibratory events and aerodynamics.     

Pressure-flow relationships during phonation in the canine larynx

Measurements of air pressure and flow were made using an in vivo canine model of the larynx. Subglottic pressures at varying flow rates were taken during phonation induced by laryngeal nerve stimulation. Results showed that during constant vocal fold stiffness, subglottic pressure rose slightly with increased air flow. The larynx in the in vivo canine model exhibited a flow-dependent decrease in laryngeal airway resistance. Increasing flow rate was associated with an increase in frequency of phonation and open quotient, as measured glottographically. Results from this experiment were compared with a theoretical two-mass model of the larynx and other theoretical models of phonation. The influence of aerodynamic forces on glottal vibration is explained by increased lateral excursion of the vocal folds during the open interval and shortening of the closed interval during the glottal cycle.     

Respiratory and glottal efficiency measures in normal classically trained singers

Respiratory and glottal efficiency measures were collected from a pool of 40 classically trained singers with normal larynges. All singers had ?3 years of formal classical voice training and were active professional solo classical singers. Mean flow rates were obtained from all subjects to assess glottal efficiency. Additionally, maximum phonation times and phonation quotients were obtained from a subset of the singers. Pulmonary function test data on forced expiratory volume, forced vital capacity, and forced expiratory flow were obtained for all subjects. Results were compared with published normal values, not specifically derived from trained singers, used commonly in voice laboratoires. Differences were found, suggesting the need for separate normative data to be used for evaluation of the vocal athlete.     

Phonation Threshold Power in Ex Vivo Laryngeal Models

This study hypothesized that phonation threshold power is measureable and sensitive to changes in the biomechanical properties of the vocal folds. Phonation threshold power was measured in three sample populations of 10 excised canine larynges treated with variable posterior glottal gap, variable bilateral vocal fold elongation, and variable vocal fold lesioning. Posterior glottal gap varied from 0 to 4 mm in 0.5 mm intervals. Bilateral vocal fold elongation varied from 0% to 20% in 5% intervals. Vocal fold lesion treatments included unilateral and bilateral vocal fold lesion groups. Each treatment was investigated independently in a sample population of 10 excised canine larynges. Linear regression analysis indicated that phonation threshold power was sensitive to posterior glottal gap (R² = 0.298, P < 0.001) and weakly to vocal fold elongation (R² = 0.052, P = 0.003). A one-way repeated measures analysis of variance indicated that phonation threshold power was sensitive to the presence of lesions (P < 0.001). Theoretical and experimental evidence presented here suggests that phonation threshold power could be used as a broad screening parameter sensitive to certain changes in the biomechanical properties of the larynx. It has not yet been measured in humans, but because it has the potential to represent the airflow-tissue energy transfer more completely than the phonation threshold pressure or flow alone, it may be a more useful parameter than these and could be used to indicate that laryngeal health is likely abnormal.     

Strobophotoglottographic transillumination as a method for the analysis of vocal fold vibration patterns

The purpose of this exploratory study was to determine if laryngeal transillumination in combination with stroboscopy (strobophotoglottography; SPGG) is useful for (1) the visualization of vocal fold vibration (VFV) opening patterns, (2) the localization of initial vocal fold opening in horizontal glottal thirds (anterior, midmembranous, and posterior), (3) determination of the temporal correspondence of the so-called electroglottography (EGG)-knee and initial vocal fold separation, and, finally, (4) automatized quantitative measurements of glottal area function within endoscopic images. With stroboscopic transillumination, initial inferior vocal fold separation was detectable during the "closed" phase, where the vocal folds were still closed in the upper portion and therefore initial inferior vocal fold separation could not be visualized with usual laryngoscopy techniques. In the horizontal plane within similar fundamental frequencies in modal voice registers in two male subjects, localization of initial glottal opening depended on the voice types used (soft, normal, or pressed phonation). We found zipperlike posterior-to-anterior openings, initial midmembranous openings, initial anterior openings, as well as simultaneous initial opening of all three portions in the two healthy male adults examined. This technique proved to add temporal and spatial information to vocal fold opening patterns and extends our examination techniques to the very beginning of vocal fold opening at the inferior portion. Simultaneous electroglottogram tracking and comparison with bidirectionally illuminated stroboscopic images revealed a time-locked correspondence of the EGG-knee with the aforementioned initial inferior vocal fold separation. Bidirectional illumination combined with digital color extraction techniques allowed for image separation of subglottally and supraglottally illuminated structures. This facilitated vocal fold contour detection and automatized image processing, for example, for determination of glottal area function, and is considered to be a further step to objective automatized quantitative measurements within endoscopic images.