The membranous contact quotient: A new phonatory measure of glottal competence

The membranous contact quotient (MCQ) is introduced as a measure of dynamic glottal competence. It is defined as the ratio of the membranous contact glottis (the anterior-posterior length of contact between the two membranous vocal folds) and the membranous vocal fold length. An elliptical approximation to the vocal fold contour during phonation was used to predict MCQ values as a function of vocal process gap (adduction), maximum glottal width, and membranous glottal length. MCQ is highly dependent on the vocal process gap and the maximum glottal width, but not on vocal fold length. Five excised larynges were used to obtain MCQ data for a wide range of vocal process gaps and maximum glottal widths. Predicted and measured MCQ values had a correlation of 0.93, with an average absolute difference of 9.6% (SD = 10.5%). The model is better at higher values of MCQ. The theory for MCQ is also expressed as a function of vocal process gap and subglottal pressure to suggest production control potential. The MCQ measure is obtainable with the use of stroboscopy and appears to be a potentially useful clinical measure.     

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.     

Changes in laryngeal airway resistance in young adult men and women as a function of vocal sound pressure level and syllable context

A noninvasive pressure-flow technique was used to assess laryngeal airway resistance (R_law) in eight young adult women and seven men. Syllable structures used were consonant-vowel (/pi/) and consonant-vowel-consonant (/bip/). The data were obtained from oscillographic records of intraoral air pressure and transglottal airflow over 2 consecutive days. Repetitions of each syllable context were produced at each subject's 25th, 50th, and 75th percentiles of vocal sound pressure level. No significant differences in R_law were found across days for the two groups. Women had significantly greater R_law than did men for the /pi/ and /bip/ contexts. Men showed a significantly greater average airflow rate than did women for both syllable contexts. Airflow, air pressure, and the ratio R_law increased as the sound pressure level of voice increased. The technique appears to be useful for characterizing certain features of laryngeal airway resistance for men and women.     

A three-dimensional model of vocal fold abduction/adduction

A three-dimensional biomechanical model of tissue deformation was developed to simulate dynamic vocal fold abduction and adduction. The model was made of 1721 nearly incompressible finite elements. The cricoarytenoid joint was modeled as a rocking-sliding motion, similar to two concentric cylinders. The vocal ligament and the thyroarytenoid muscle's fiber characteristics were implemented as a fiber-gel composite made of an isotropic ground substance imbedded with fibers. These fibers had contractile and/or passive nonlinear stress-strain characteristics. The verification of the model was made by comparing the range and speed of motion to published vocal fold kinematic data. The model simulated abduction to a maximum glottal angle of about 31 degrees. Using the posterior-cricoarytenoid muscle, the model produced an angular abduction speed of 405 degrees per second. The system mechanics seemed to favor abduction over adduction in both peak speed and response time, even when all intrinsic muscle properties were kept identical. The model also verified the notion that the vocalis and muscularis portions of the thyroarytenoid muscle play significantly different roles in posturing, with the muscularis portion having the larger effect on arytenoid movement. Other insights into the mechanisms of abduction/adduction were given.     

Measures of spectral slope using an excised larynx model

Spectral measures of the glottal source were investigated using an excised canine larynx (CL) model for various aerodynamic and phonatory conditions. These measures included spectral harmonic difference H1-H2 and spectral slope that are highly correlated with voice quality but not reported in a systematic manner using an excised larynx model. It was hypothesized that the acoustic spectra of the glottal source were significantly influenced by the subglottal pressure, glottal adduction, and vocal fold elongation, as well as the resulting vibration pattern. CLs were prepared, mounted on the bench with and without false vocal folds, and made to oscillate with a flow of heated and humidified air. Major control parameters were subglottal pressure, adduction, and elongation. Electroglottograph, subglottal pressure, flow rate, and audio signals were analyzed using custom software. Results suggest that an increase in subglottal pressure and glottal adduction may change the energy balance between harmonics by increasing the spectral energy of the first few harmonics in an unpredictable manner. It is suggested that changes in the dynamics of vocal fold motion may be responsible for different spectral patterns. The finding that the spectral harmonics do not conform to previous findings was demonstrated through various cases. Results of this study may shed light on phonatory spectral control when the larynx is part of a complete vocal tract system.     

Maintenance of intraoral pressure during speech after maxillary resection

Although structural defects such as cleft palate and severe anterior open bite alter vocal tract resistance, compensatory responses usually result in maintaining consonant pressures at an adequate level. The purpose of the present study was to determine if individuals with an acquired palatal defect spontaneously develop similar compensatory behaviors. The pressure-flow technique was used to measure aerodynamic variables associated with consonant production after surgery and obturation. Although intraoral pressures decreased considerably immediately after surgery, pressures were maintained at a mean level of 3.5-cm H2O. Respiratory volumes increased as much as fourfold without obturation and were normal with obturation. Voice-voiceless differences in air volumes among consonants were maintained even in the presence of the defect. These findings suggest that compensatory responses are directed toward maintaining an appropriate level of intraoral pressure for consonant production.     

Membranous and cartilaginous vocal fold adduction in singing

While vocal fold adduction is an important parameter in speech, relatively little has been known on the adjustment of the vocal fold adduction in singing. This study investigates the possibility of separate adjustments of cartilaginous and membranous vocal fold adduction in singing. Six female and seven male subjects, singers and non-singers, were asked to imitate an instructor in producing four phonation types: "aBducted falsetto" (FaB), "aDducted falsetto" (FaD), "aBducted Chest" (CaB), and "aDducted Chest" (CaD). The phonations were evaluated using videostroboscopy, videokymography (VKG), electroglottography (EGG), and audio recordings. All the subjects showed less posterior (cartilaginous) vocal fold adduction in phonation types FaB and CaB than in FaD and CaD, and less membranous vocal fold adduction (smaller closed quotient) in FaB and FaD than in CaB and CaD. The findings indicate that the exercises enabled the singers to separately manipulate (a) cartilaginous adduction and (b) membranous medialization of the glottis though vocal fold bulging. Membranous adduction (monitored via videokymographic closed quotient) was influenced by both membranous medialization and cartilaginous adduction. Individual control over these types of vocal fold adjustments allows singers to create different vocal timbres.     

On pressure-frequency relations in the excised larynx

The purpose of this study was to find relationships between subglottal pressure (P(s)) and fundamental frequency (F(0)) of phonation in excised larynx models. This included also the relation between F(0) and its rate of change with pressure (dFdP). Canine larynges were prepared and mounted over a tapered tube that supplied pressurized, heated, and humidified air. Glottal adduction was accomplished either by using two-pronged probes to press the arytenoids together or by passing a suture to simulate lateral cricoarytenoid muscle activation. The pressure-frequency relation was obtained through a series of pressure-flow sweep experiments that were conducted for eight excised canine larynges. It was found that, at set adduction and elongation levels, the pressure-frequency relation is nonlinear, and is highly influenced by the adduction and elongation. The results indicated that for the lower phonation mode, the average rate of change of frequency with pressure was 2.9+/-0.7 Hzcm H(2)O, and for the higher mode was 5.3+/-0.5 Hzcm H(2)O for adduction changes and 8.2+/-4.4 Hzcm H(2)O for elongation changes. The results suggest that during speech and singing, the dFdP relationships are taken into account.     

Laryngeal adduction in trillo

Acoustic, glottographic, and videolaryngoscopic analyses were made of trillo, a vocal ornament described as the rapid repetition of a single note. This vocal gesture, performed by a trained singer, was studied for variations in laryngeal adduction, fundamental frequency, and acoustic amplitude characteristics. Results suggested that trillo was produced with alternating abduction/adduction of the vocal folds, and fundamental frequency tended to be lower during the relatively more abducted portions of the utterance.     

Phonatory characteristics of excised pig, sheep, and cow larynges

The purpose of this study was to examine the phonatory characteristics of pig, sheep, and cow excised larynges and to find out which of these animal species is the best model for human phonation. Excised pig, sheep, and cow larynges were prepared and mounted over a tapered tube on the excised bench that supplied pressurized, heated, and humidified air in a manner similar to that for excised canine models. Each excised larynx was subjected to a series of pressure-flow experiments with adduction as major control parameter. The subglottal pressure, electroglottograph (EGG), mean flow rate, audio signal, and sound pressure level were recorded during each experiment. EGG signal was used to extract the fundamental frequency. It was found that pressure-frequency relations were nonlinear for these species with large rate of frequency changes for the pig. The average oscillation frequencies for these species were 220+/-57 Hz for the pig, 102+/-33 Hz for the sheep, and 73+/-10 Hz for the cow. The average phonation threshold pressure for the pig was 7.4+/-2.0 cm H(2)O, 6.9+/-2.9 cm H(2)O for the sheep, and 4.4+/-2.3 cm H(2)O for the cow.     

Laryngeal airway resistance in teacherswith vocal fatigue: A preliminary study

A noninvasive pressure-flow technique was used to compare laryngealairway resistances in nine female classroom teachers with symptoms of vocal fatigue and seven teachers without symptoms of vocal fatigue. Data were collected two times per day on the Monday, Wednesday, and Friday of a typical work-week. No significant between-group differences were found, but two within-group differences were notable. Airflow in the fatigued subjects decreased across the sampling period (p = .0009). In the controls, air pressure increased across the sampling period (p = .021). These findings suggest that both groups may have reacted to vocal demands during the week by employing two different strategies to maintain habitual laryngeal airway resistance: laryngeal adjustments alone or laryngeal adjustments plus increased respiratory drive. The first strategy, employed by the fatigued subjects, may have been less efficient, thereby provoking conditions associated with their vocal fatigue.     

Electroglottographic tracking of phonatory response to Botox.

Botox injection into the thyroarytenoid muscle is thought to alter the glottal competence and laryngeal adduction of patients with adductor spasmodic dysphonia (ADSD). Hypofunctional responses to treatment have been rated subjectively and inferred from postinjection breathy voice, aphonia, midline glottal gap, or subclinical aspiration. Clinical experience suggests that temporary hypofunction varies in duration and severity among patients. This study used electroglottographic measures to examine changes over time in glottal competence during the relatively stable phonation produced by 5 patients with ADSD. Hierarchical linear modeling was used to test 3 hypotheses: (a) that reduced laryngeal adduction would occur during the first 3 weeks postinjection, followed by a reversal; (b) that patients' hypofunctional response curves would differ one from another; and (c) that changes in adduction, if present, would be related to changes in severity ratings of ADSD symptoms. For 3 participants, significant hypoadduction occurred after injection and reversed toward preinjection level over an 8-week period. Two participants demonstrated a flat or increasing vocal fold contact response curve during the early postinjection period. Observations were consistent with the previously reported differences and possibly complex relation between the resolution of breathy hypofunction and ultimate return of ADSD symptoms.     

Electroglottographic tracking of phonatory response to botox™

Botox injection into the thyroarytenoid muscle is thought to alter the glottal competence and laryngeal adduction of patients with adductor spasmodic dysphonia (ADSD). Hypofunctional responses to treatment have been rated subjectively and inferred from postinjection breathy voice, aphonia, midline glottal gap, or subclinical aspiration. Clinical experience suggests that temporary hypofunction varies in duration and severity among patients. This study used electroglottographic measures to examine changes over time in glottal competence during the relatively stable phonation produced by 5 patients with ADSD. Hierarchical linear modeling was used to test 3 hypotheses: (a) that reduced laryngeal adduction would occur during the first 3 weeks postinjection, followed by a reversal; (b) that patients' hypofunctional response curves would differ one from another; and (c) that changes in adduction, if present, would be related to changes in severity ratings of ADSD symptoms. For 3 participants, significant hypoadduction occurred after injection and reversed toward preinjection level over an 8-week period. Two participants demonstrated a flat or increasing vocal fold contact response curve during the early postinjection period. Observations were consistent with the previously reported differences and possibly complex relation between the resolution of breathy hypofunction and ultimate return of ADSD symptoms.     

A comparison of type I thyroplasty and arytenoid adduction

Glottal incompetence is a common laryngeal disorder causing impaired swallowing and phonation. The resultant voice has been characterized as weak and breathy with a restricted pitch range. Currently, medialization thyroplasty and arytenoid adduction are two of the surgical treatments for patients with glottal incompetence. However, few studies have evaluated the changes in objective measures of speech with type I thyroplasty and arytenoid adduction. In this study, 59 patients with glottal incompetence underwent either type I thyroplasty or arytenoid adduction. Acoustic (jitter, shimmer, and harmonics-to-noise ratio) and aerodynamic (airflow, subglottic pressure, and glottal resistance) measures were obtained both pre- and postoperatively. No significant differences were found among acoustic or aerodynamic measures for operation type. However, a significant pre/postsurgery effect was observed for translaryngeal airflow. In addition, no significant differences were found among the measures for patients with traditional compared with nontraditional operative indications. Patients who developed glottal insufficiency due to previous laryngeal surgery (e.g., vocal fold stripping) demonstrated no statistically significant improvement in acoustic or aerodynamic measures following thyroplasty or arytenoid adduction.     

Ventricular pressures in phonating excised larynges

Pressure in the laryngeal ventricle was measured with a beveled needle connected to a pressure transducer in excised canine larynges. Air pressures within the ventricle were obtained for different adduction levels of the true vocal folds (TVFs), false vocal folds (FVFs), and subglottal pressures (Ps). Results indicated that the air pressures in the ventricle appear to be strongly related to the motion of the FVFs rather than to the effects of TVF vibration. Both dc and ac pressures depend on FVF adduction, amplitude of motion of the FVFs, and whether the FVFs touch each other during the vibratory cycle. Mean and peak-to-peak pressures in the ventricle were as high as 65% of the mean and peak-to-peak Ps, respectively, when the FVFs vibrated with large amplitude and contact each cycle. If the glottis was not closed, a medial movement of the FVFs appeared to create a positive pressure pulse on the Ps signal due to an increase in the laryngeal flow resistance. The electroglottograph signal showed evidence of tissue contact for both the TVFs and the FVFs. The study suggests that the laryngeal ventricle acts as a relatively independent aero-acoustic chamber that depends primarily upon the motion of the FVFs.     

Analysis of spasmodic dysphonia by aerodynamic and laryngostroboscopic measurements

Sequential assessment of laryngeal function using laryngostroboscopy and phonatory air flow assessment was carried out in 18 patients with spasmodic dysphonia (SD). Comparison was made between findings in patients before treatment (n = 18), after unilateral recurrent nerve block by lidocaine (n = 6), after bilateral injections of botulinum toxin (Botox) (n = 13), and prior to Botox reinjection (n = 3). Unilateral nerve block resulted in higher mean phonatory airflows than after bilateral Botox injections. Both unilateral nerve block and Botox injections increased fluctuant or alternating flow source (AC); however, unilateral nerve block resulted in more unmodulated airflow leakage. Phonation time on a single breath was longer than with Botox injection. Bilateral Botox injections resulted in better glottal closure, fewer instances of vocal fold level differences, and, better vocal fold vibrations with phase symmetry, as determined by laryngostroboscopy. Partial bilateral denervation using Botox resulted in laryngeal function, which appeared to be intermediate between that of tightly squeezed pretreatment status and a breathy voice with incomplete adduction after unilateral nerve block. Of all treatments assessed, bilateral partial denervation by Botox appeared to be the most physiologic in restoring normal vocal fold vibratory function and airflow.     

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.     

The abduction quotient related to vocal quality

The abduction quotient, a measure of effective glottal width, was obtained for electroglottographic recordings from a professional operatic baritone singer. The subject produced repeated tokens of the voice qualities breathy, normal, and pressed (or constricted) in both a speech and a singing manner. In the singing manner, the subject produced the three vocal qualities at three pitch levels and three loudness levels. The abduction quotient decreased from breathy to pressed voice, suggesting that the measure corresponds to effective glottal width. The measure was found to be consistently low during all conditions of singing, suggesting that the subject produced all singing tokens with relatively strong laryngeal adduction at the vocal process level. Although the results of this study support the validity and usefulness of the abduction quotient, further verification is needed.     

Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: Functional results

We report vocal and respiratory results following endoscopic CO₂ laser therapy for bilateral vocal fold immobility in adduction. Two techniques were used: posterior cordectomy (PC) and subtotal arytenoidectomy (SA). Respiratory improvement was demonstrated by the peak expiratory flow/peak inspiratory flow ratio (PEF/PIF, normal = 1), which was less than 2 for 83% of patients following PC and for 81% following SA. As for vocal results, there were no significant quantitative differences between the two techniques. Mean maximum phonation time (/a/) was 6.8 ± 2.6 s after SA and 7.8 ± 1.6 s following PC. The phonation quotient was 288 ± 116 ml/s after SA and 304 ± 92 ml/s after PC. Mean vocal intensity was 62 ± 4 dB after SA and 59 ± 3 dB after PC. Vocal quality was measured by high-resolution vocal frequency analysis, as represented by a histogram. Peaks corresponding to fundamental frequency and first harmonics were preserved in more than 60% of patients in the two groups. Vocal preservation is better when the paralyzed folds are in the paramedian position, with the possibility of adduction (Gerhardt syndrome). SA is performed in our procedure, though it is longer and more difficult to perform than PC. PC often requires two procedures to achieve satisfactory results.     

Thyroplasty as primary and adjunctive treatment of glottic insufficiency

This study addresses the role of medialization thyroplasty in a variety of vocal fold pathological conditions manifested by glottic insufficiency. In this series, most patients had preceding or concurrent phonosurgical procedures. Success of surgery was determined by subjective, audioperceptual judgments, acoustic analysis, and vocal function measures. Vocal fold pathology played a greater role in determining success than did the presence or absence of adjunctive surgical procedures. Thyroplasty Type I was effective in treating glottic insufficiency in patients previously treated with various augmentation procedures as well as in those undergoing simultaneous reinnervation and arytenoid adduction. Technical factors predisposing to complications included violation of inner thyroid cartilage perichondrium, small shim size, sacrifice of cartilagenous window, and mucosal penetration. Thyroplasty should be considered as a primary or adjunctive treatment of patients with glottic insufficiency, especially when preservation of membranous vocal fold structure is of primary importance.