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 (P_s) 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 P_s-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 P_s-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 P_s-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 effect of laryngeal nerve stimulation on phonation: a glottographic study using an in vivo canine model

The present investigation was designed to examine the effect of change in vocal fold mass and stiffness on vocal fold vibration. To do this, the effect of variation in superior laryngeal nerve stimulation (SLNS) and recurrent laryngeal nerve stimulation (RLNS) was studied Photoglottography (PGG), electroglottography (EGG), and subglottic pressure (Psub) were measured in seven mongrel dogs using an in vivo canine model of phonation. The PGG, EGG, and Psub signals were examined at three frequencies (100, 130, and 160 Hz) for SLNS and RLNS, using a constant rate of air flow. Increasing SLNS, which caused a contraction of the cricothyroid muscle, produced a marked increase in F0, little change in Psub, an increase in open quotient (OQ), and a decrease in the closed quotient (CQ) of the glottal cycle. Increasing RLNS, which caused activation of the intrinsic laryngeal muscles, produced a modest increase in F0, a marked increase in Psub, no change in the OQ, and an increase in CQ. Phase quotient (Qp), which describes the interval between opening of the lower and upper fold margins, decreased with increasing RLNS and did not change significantly with increasing SLNS. Based upon changes in F0, Psub, OQ, CQ, and Qp, SLNS provides a physiologic correlate of the tension parameter Q, and RLNS provides a physiologic correlate of the parameter Psub in the Ishizaka and Flanagan two-mass model.     

The interrelationship of subglottic air pressure, fundamental frequency, and vocal intensity during speech

In this study we have simultaneously measured subglottic air pressure, airflow, and vocal intensity during speech in nine healthy subjects. Subglottic air pressure was measured directly by puncture of the cricothyroid membrane. The results show that the interaction between these aerodynamic properties is much more complex that previously believed. Certain trends were seen in most individuals, such as an increase in vocal intensity with increased subglottic air pressure. However, there was considerable variability in the overall aerodynamic properties between subjects and at different frequency and intensity ranges. At certain frequencies several subjects were able to generate significantly louder voices without a comparable increase in subglottic air pressure. We hypothesize that these increases in vocal efficiency are due to changes in vocal fold vibration properties. The relationship between fundamental frequency and subglottic pressure was also noted to vary depending on vocal intensity. Possible mechanisms for these behaviors are discussed.     

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.     

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 Fold Paralysis Following Radiotherapy for Nasopharyngeal Carcinoma: Laryngeal Electromyography Findings

Laryngeal electromyography was used to study the pattern of neurological injury in three patients with unilateral vocal fold paralysis following radiotherapy for nasopharyngeal carcinoma. The thyroarytenoid and cricothyroid muscles were assessed to give an indication of recurrent and superior laryngeal nerve function. Two patients demonstrated both recurrent and superior laryngeal neuropathy suggesting injury at the skull base. The other patient had only recurrent laryngeal neuropathy indicating more distal involvement. Subclinical neuropathic changes were seen in two cases on the side contralateral to the vocal fold paralysis. These patients may be at increased risk of developing bilateral vocal fold paralysis and potentially life-threatening airway obstruction. Long-term follow-up is recommended for such patients, especially if medialization thyroplasty is being considered. This is the first report describing the use of electromyography to determine the pattern of nerve injury in patients with vocal fold paralysis following head and neck radiotherapy.     

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

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.     

Cooperative Regulation of Vocal Fold Morphology and Stress by the Cricothyroid and Thyroarytenoid Muscles

Voice is produced by vibrations of vocal folds that consist of multiple layers. The portion of the vocal fold tissue that vibrates varies depending primarily on laryngeal muscle activity. The effective depth of tissue vibration should significantly influence the vibrational behavior of the tissue and resulting voice quality. However, thus far, the effect of the activation of individual muscles on the effective depth is not well understood. In this study, a three-dimensional finite element analysis is performed to investigate the effect of the activation of two major laryngeal muscles, the cricothyroid (CT) and thyroarytenoid (TA) muscles, on vocal fold morphology and stress distribution in the tissue. Because structures that bear less stress can easily be deformed and involved in vibration, information on the morphology and stress distribution may provide a useful estimate of the effective depth. The results of the analyses indicate that the two muscles perform distinct roles, which allow cooperative control of the morphology and stress. When the CT muscle is activated, the tip region of the vocal folds becomes thinner and curves upward, resulting in the elevation of the stress magnitude all over the tissue to a certain degree that depends on the stiffness of each layer. On the other hand, the TA muscle acts to suppress the morphological change and controls the stress magnitude in a position-dependent manner. Thus, the present analyses demonstrate quantitative relationships between the two muscles in their cooperative regulation of vocal fold morphology and stress.     

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.     

Combination thyroplasty and the “twisted larynx:” combined type IV and type I thyroplasty for superior laryngeal nerve weakness

Vocal cord medialization through Isshiki type I thyroplasty is part of the standard approach for patients with unilateral vocal cord immobility secondary to recurrent laryngeal nerve paralysis. However, several other modalities have been used to treat the symptomatic “twisted” larynx caused by unilateral superior laryngeal nerve weakness. The Isshiki type IV thyroplasty (cricothyroid approximation) specifically addresses cricothyroid muscle weakness, but, canine studies at the Mayo Clinic demonstrated a trend toward decreased acoustic power and sound intensity with simulated cricothyroid activity. Thus it is reasoned that addition of an ipsilateral type I thyroplasty should help compensate for this power loss.Using videostroboscopic and acoustic analysis, 9 patients with unilateral superor laryngeal nerve weakness were treated with combination type IV and type I thyroplasty. Subjective dysphonia and objective visual and acoustic measurements revealed postoperative improvement in most patients. The combination type IV and type I thyroplasty is recommended for surgical treatment of patients with superior laryngeal nerve weakness, because it addresses cricothyroid muscle weakness without compromising vocal power.     

Direct measurement of subglottic pressure and laryngealresistance in normal subjects and in spasmodic dysphonia

This study tested the accuracy of indirect methods of measurementof laryngeal airway resistance in normal subjects and in spasmodic dysphonia (SD). The indirect method assumes that subglottic air pressure remains constant during the voiced segment of a syllable. In this study subglottic air pressure was directly measured via puncture of the cricothyroid membrane in seven normal subjects and seven subjects with SD. The true laryngeal airway resistance was calculated and compared with airway resistance measured using indirect techniques based on intraoral air pressure. In five of the seven normal subjects, subglottic air pressure did not remain constant during the voiced segment. As a result, the error produced using indirect method of calculating average laryngeal resistance for the normal subjects varied from −44% to +50%. For SD subjects the error ranged from −49% to +22%. In general, the indirect technique over-estimated laryngeal airway resistance in normal subjects and underestimated the resistance in subjects with SD.     

Changes in Vocal Fold Morphology During Singing Over Two Octaves

ObjectiveVocal folds are widely assumed to only elongate to raise vocal pitch. However, the mechanisms seem to be more complex and involve both elongation and tensioning of the vocal folds in series. The aim of the present study was to show that changes in vocal fold morphology depend on vocal fold elongation and tensioning during singing.Study designThis was a prospective study.MethodsForty-nine professional female singers (25 sopranos, 24 altos) were recruited and three-dimensional laryngeal images analyzed in a coronal view derived from high-resolution computed tomography scans obtained at the mean speaking fundamental frequency (ƒ₀) and one (2ƒ₀) and two octaves (4ƒ₀) above ƒ₀.ResultsThe vocal fold angle, defined by a tangent above and below the vocal folds, was 58° at ƒ₀, 47° at 2ƒ₀, and 59° at 4ƒ₀.ConclusionThe decreased caudomedial angle of the vocal fold from ƒ₀ to 2ƒ₀ (change in muscle belly from “;fat” to “thin”) and increased angle from 2ƒ₀ to 4ƒ₀ (from “thin” to “fat”) strongly supports the hypothesis that the vocal folds elongate and then tension when singing from ƒ₀ to 4ƒ₀. This is the first study to show this relationship in vivo.     

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.     

Phonetographic profiles and F0-SPL characteristics of untrained versus trained vocal groups

The phonetogram has been recommended as an international tool for voice analysis. However, the capability of this technique to distinguish between different vocal groups has not been clearly established. The purpose of this study was to examine untrained versus trained vocalists using the phonetogram and the fundamental frequency by intensity (F₀/SPL) information derived through that method. In this study, “musical” or “controlled” ranges of phonation were stressed rather than “physiological” ranges. Results indicated that (a) characteristic phonetographic profiles may be established for untrained versus trained vocalists, and (b) trained vocalists show significantly increased capability in terms of F₀ range and maximum, minimum, and comfortable SPL production. Elicitation of “controlled” phonations may be the key to revealing the underlying vocal capabilities of seemingly different vocal groups.     

Laryngeal electromyographic responses to perturbations in voice pitch auditory feedback

The present study was conducted to test the hypothesis that intrinsic laryngeal muscles are involved in producing voice fundamental frequency (F(0)) responses to perturbations in voice pitch auditory feedback. Electromyography (EMG) recordings of the cricothyroid and thyroarytenoid muscles were made with hooked-wire electrodes, while subjects sustained vowel phonations at three different voice F(0) levels (conversational, high pitch in head register, and falsetto register) and received randomized pitch shifts (±100 or ±300 cents) in their voice auditory feedback. The median latencies from stimulus onset to the peak in the EMG and voice F(0) responses were 167 and 224 ms, respectively. Among the three different F(0) levels, the falsetto register produced compensatory EMG responses that occurred prior to vocal responses and increased along with rising voice F(0) responses and decreased for falling F(0) responses. For the conversational and high voice levels, the EMG response timing was more variable than in the falsetto voice, and changes in EMG activity with relevance to the vocal responses did not follow the consistent trend observed in the falsetto condition. The data from the falsetto condition suggest that both the cricothyroid and thyroarytenoid muscles are involved in generating the compensatory vocal responses to pitch-shifted voice feedback.     

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.     

Combination thyroplasty and the "twisted larynx:" combined type IV and type I thyroplasty for superior laryngeal nerve weakness.

Vocal cord medialization through Isshiki type I thyroplasty is part of the standard approach for patients with unilateral vocal cord immobility secondary to recurrent laryngeal nerve paralysis. However, several other modalities have been used to treat the symptomatic "twisted" larynx caused by unilateral superior laryngeal nerve weakness. The Isshiki type IV thyroplasty (cricothyroid approximation) specifically addresses cricothyroid muscle weakness, but, canine studies at the Mayo Clinic demonstrated a trend toward decreased acoustic power and sound intensity with simulated cricothyroid activity. Thus it is reasoned that addition of an ipsilateral type I thyroplasty should help compensate for this power loss. Using videostroboscopic and acoustic analysis, 9 patients with unilateral superor laryngeal nerve weakness were treated with combination type IV and type I thyroplasty. Subjective dysphonia and objective visual and acoustic measurements revealed postoperative improvement in most patients. The combination type IV and type I thyroplasty is recommended for surgical treatment of patients with superior laryngeal nerve weakness, because it addresses cricothyroid muscle weakness without compromising vocal power.     

Acoustic analysis of the speaking voice after thyroidectomy

Voices of 47 female patients were analyzed before and after thyroidectomy, with preservation of the recurrent and superior laryngeal nerves and normal vocal fold motility during the observation period. A mean decrease of the speaking fundamental frequency (SFF) of 12 Hz was found on day 4; in 8 patients the postoperative vocal pitch was more than 2 semitones lower. The distance between the highest and lowest F₀ during speaking was diminished (speech was more monotone) and the vocal jitter was elevated. In the frequency spectrum, there was a diminished prominence of the harmonics. The other spectral parameters (as the slope of the spectrum and the H1/H2 ratio) were unchanged. All changes had disappeared the fifteenth day, except for a lower SFF (>2 semitones) in 2 cases. It is concluded that after normal dissection of the laryngeal nerves, and in the absence of vocal fold paresis, other reasons for voice changes immediately after thyroidectomy remain: alterations in the neck muscles, in the laryngeal mucosa, and in the patient's general condition. Although the effects seem limited and of short duration, knowledge of them is helpful when informing the patient before thyroid surgery.     

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.     

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.