Oral Breathing Increases Pth and Vocal Effort by Superficial Drying of Vocal Fold Mucosa

Oral breathing superficially dehydrates the airway lumen by decreasing the depth of the sol layer in humans and animals. Conversely, nasal breathing can increase the humidity of inspired air. We compared the effects of short-term oral and nasal breathing on P_th and perceived vocal effort in 20 female subjects randomly assigned to two groups: oral breathing (N = 10, age 21–32 years); nasal breathing (N = 10, age 20–36 years). We hypothesized that short-term oral breathing, but not nasal breathing, would increase P_th, and that subjects would perceive this change as an increase in vocal effort. Following 15 minutes of oral breathing, P_th increased at comfortable and low pitch (p < 0.01) with 6 of 10 subjects reporting increased vocal effort. Nasal breathing reduced P_th at all three pitches (p < 0.01), and 7 of 10 subjects reported decreased vocal effort. Over all subjects, 49% of the variance in treatment-induced change in P_th was accounted for by change in vocal effort (R = 0.70). We posit that obligatory oral breathing places healthy subjects at risk for symptoms of increased vocal effort. The facilitatory role of superficial hydration on vocal fold oscillation should be considered in biomechanical models of phonation and in the clinical prevention of laryngeal dryness.     

Vocal Warm-up Increases Phonation Threshold Pressure in Soprano Singers at High Pitch

Vocal warm-up is thought to optimize singing performance. We compared effects of short-term, submaximal, vocal warm-up exercise with those of vocal rest on the soprano voice (n = 10, ages 19-21 years). Dependent variables were the minimum subglottic air pressure required for vocal fold oscillation to occur (phonation threshold pressure, Pth), and the maximum and minimum phonation fundamental frequency. Warm-up increased Pth for high pitch phonation (p = 0.033), but not for comfortable (p = 0.297) or low (p = 0.087) pitch phonation. No significant difference in the maximum phonation frequency (p = 0.193) or minimum frequency (p = 0.222) was observed. An elevated Pth at controlled high pitch, but an unchanging maximum and minimum frequency production suggests that short-term vocal exercise may increase the viscosity of the vocal fold and thus serve to stabilize the high voice.     

Respiratory response to a decrease in velopharyngeal resistance

Individuals with congenital velopharyngeal impairment generally maintain adequate levels of intraoral pressures during consonant production by increasing respiratory effort. The purpose of the present study was to determine if normal individuals respond to a decrease in velopharyngeal resistance in a similar way. The velar mechanism was perturbed by having subjects voluntarily lower the soft palate during a series of words involving plosive consonants. The pressure-flow technique was used to measure oral pressures, calculate velopharyngeal orifice resistance, and estimate velopharyngeal orifice area. Inductive plethysmography was used to measure breathing volumes associated with the words. The data indicate that, in most instances, intraoral pressure remained at appropriate levels (greater than 3.0 cm H2O) after velar lowering. Speech breathing volume did not change during inspiration, but increased during speech expiration when the velopharyngeal port was open. The difference was statistically significant (p less than 0.01). Duration of the utterance did not change across conditions. A mechanical model was then used to determine how intraoral pressure would be affected by simulating the same conditions in a passive system. The modeling data revealed that pressure would drop threefold. It was concluded that increased respiratory volumes tend to stabilize intraoral pressure when vocal tract resistance is experimentally reduced.     

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

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

A virtual trajectory model predicts differences in vocal fold kinematics in individuals with vocal hyperfunction

A simple, one degree of freedom virtual trajectory model of vocal fold kinematics was developed to investigate whether kinematic features of vocal fold movement confirm increased muscle stiffness. Model simulations verified that increases in stiffness were associated with changes in kinematic parameters, suggesting that increases in gesture rate would affect kinematic features to a lesser degree in vocal hyperfunction patients given the increased levels of muscle tension they typically employ to phonate. This hypothesis was tested experimentally in individuals with muscle tension dysphonia (MTD; N = 10) and vocal nodules (N = 10) relative to controls with healthy normal voice (N = 10) who were examined with trans-nasal endoscopy during a simple vocal fold abductory-adductory task. Kinematic measures in MTD patients were less affected by increased gesture rate, consistent with the hypothesis that these individuals have elevated typical laryngeal muscle tension. Group comparisons of the difference between medium and fast gesture rates (Mann-Whitney, one-tailed) showed statistically significant differences between the control and MTD individuals on the two kinematic features examined (p<0.05). Results in nodules participants were mixed and are discussed independently. The findings support the potential use of vocal fold kinematics as an objective clinical assay of vocal hyperfunction.     

Studying vocal fold vibrations in Parkinson's disease with a nonlinear model

A nonlinear model is applied to study pathologic vocal vibratory characteristics and voice treatments of Parkinson's disease. We find that a number of pathologic vocal characteristics commonly observed in Parkinson's disease, including reduced vibratory intensity, incomplete vocal closure, increased phonation threshold pressure, glottal tremor, subharmonics, and chaotic vocal fold vibrations, can be studied with this nonlinear model. We also find that two kinds of clinical voice treatments for Parkinson's disease, including respiratory effort treatment and Lee Silverman voice treatment can be studied with this computer model. Results suggest that respiratory effort treatment, in which subglottal pressure is increased, might aid in enhancing vibratory intensity, improving glottal closure, and avoiding vibratory irregularity. However, the Lee Silverman voice treatment, in which both subglottal pressure and vocal fold adduction are increased, might be better than respiratory effort treatment. Increasing vocal fold thickness would be further helpful to improve these pathologic characteristics. The model studies show consistencies with clinical observations. Computer models may be of value in understanding the dynamic mechanism of disordered voices and studying voice treatment effects in Parkinson's disease.     

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.     

Laryngeal function and vocal fatigue after prolonged reading in individuals with unilateral vocal fold paralysis

The purpose of the present study was to examine the effect of prolonged loud reading, intended to induce fatigue, on vocal function in adults with unilateral vocal fold paralysis (UVFP). Subjects were 20 adults, 37–60 years old, with UVFP secondary to recurrent laryngeal nerve paralysis. Subjective ratings and instrumental measures of vocal function were obtained before and after reading. Statistical analysis revealed subjects rated their vocal quality and physical effort for voicing more severely following prolonged loud reading, whereas expert raters did not detect a significant perceptual difference in vocal quality. Reading fundamental frequency (Fo) was significantly increased following prolonged loud reading, as were mean airflow rates at all pitch conditions. Maximum phonation times for comfort and low pitches significantly decreased during posttests. Multiple regression analyses revealed significant associations between ratings of posttest physical effort and select posttest measures. Interpretation of results indicates the prolonged loud reading task was successful in vocally fatiguing most of the UVFP subjects. Key physiologic correlates of vocal fatigue, in individuals with UVFP, include further reduction of glottic efficiency, resulting in decreased regulation of glottic airflow and a temporary destabilization of speaking fundamental frequency.     

Effect of vocal effort on spectral properties of vowels.

The effects of variations in vocal effort corresponding to common conversation situations on spectral properties of vowels were investigated. A database in which three degrees of vocal effort were suggested to the speakers by varying the distance to their interlocutor in three steps (close--0.4 m, normal--1.5 m, and far--6 m) was recorded. The speech materials consisted of isolated French vowels, uttered by ten naive speakers in a quiet furnished room. Manual measurements of fundamental frequency F0, frequencies, and amplitudes of the first three formants (F1, F2, F3, A1, A2, and A3), and on total amplitude were carried out. The speech materials were perceptually validated in three respects: identity of the vowel, gender of the speaker, and vocal effort. Results indicated that the speech materials were appropriate for the study. Acoustic analysis showed that F0 and F1 were highly correlated with vocal effort and varied at rates close to 5 Hz/dB for F0 and 3.5 Hz/dB for F1. Statistically F2 and F3 did not vary significantly with vocal effort. Formant amplitudes A1, A2, and A3 increased significantly; The amplitudes in the high-frequency range increased more than those in the lower part of the spectrum, revealing a change in spectral tilt. On the average, when the overall amplitude is increased by 10 dB, A1, A2, and A3 are increased by 11, 12.4, and 13 dB, respectively. Using "auditory" dimensions, such as the F1-F0 difference, and a "spectral center of gravity" between adjacent formants for representing vowel features did not reveal a better constancy of these parameters with respect to the variations of vocal effort and speaker. Thus a global view is evoked, in which all of the aspects of the signal should be processed simultaneously.     

Measures of vocal function during changes in vocal effort level

The purpose of this article is to present the results of a controlled study of the day-to-day variabilities of three acoustic parameters (jitter, shimmer, and normalized noise energy), and two electroglottographic parameters (contact quotient and contact quotient perturbation) for vowels produced at three vocal efforts (low, normal, high). Data were obtained with use of a sophisticated bilinear interpolation pitch detection method. A repeated measures design required subjects to produce the vowels // and /a/ five times a day over 3 days at each vocal effort level. The jitter, shimmer, and normalized noise energy values from acoustic measures and contact quotient and contact quotient perturbation values varied significantly among the three vocal effort levels. The clinical implication of this finding is that vocal effort must be controlled in order to obtain consistent clinical measures. Furthermore, day-to-day variability must be taken into account if representative measures are to be obtained for clinical use.     

Development of vocal tract length during early childhood: a magnetic resonance imaging study

Speech development in children is predicated partly on the growth and anatomic restructuring of the vocal tract. This study examines the growth pattern of the various hard and soft tissue vocal tract structures as visualized by magnetic resonance imaging (MRI), and assesses their relational growth with vocal tract length (VTL). Measurements on lip thickness, hard- and soft-palate length, tongue length, naso-oro-pharyngeal length, mandibular length and depth, and distance of the hyoid bone and larynx from the posterior nasal spine were used from 63 pediatric cases (ages birth to 6 years and 9 months) and 12 adults. Results indicate (a) ongoing growth of all oral and pharyngeal vocal tract structures with no sexual dimorphism, and a period of accelerated growth between birth and 18 months; (b) vocal tract structure's region (oral/anterior versus pharyngeal/posterior) and orientation (horizontal versus vertical) determine its growth pattern; and (c) the relational growth of the different structures with VTL changes with development-while the increase in VTL throughout development is predominantly due to growth of pharyngeal/posterior structures, VTL is also substantially affected by the growth of oral/anterior structures during the first 18 months of life. Findings provide normative data that can be used for modeling the development of the vocal tract.     

An acoustic analysis of fluctuations in the voices of normal adult speakers across three times of day

The purpose of this study was to determine the amount of variation for several vocal parameters across three times of the day (morning, noon, and afternoon). Connected speech samples from normal adult males (N = 10) and females (N = 10) were recorded during morning, early afternoon, and late afternoon. Results showed that males produced a statistically significant increase in speaking fundamental frequency (SFF) from morning to afternoon. Females did not demonstrate a statistically significant change in SFF across the three time periods. Vocal amplitude did not change significantly for either group. The SFF variability was higher for the females than for the males. Analysis of individual data revealed that the patterns of vocal change across the three times of day were not consistent among the subjects.     

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.     

Perceived phonatory effort and phonation threshold pressure across a prolonged voice loading task: a study of vocal fatigue

Although the problem of vocal fatigue is not uncommon in people with voice disorders, research on objective quantifiable indicators of vocal fatigue is limited. It has been suggested that a speaker's perception of increased phonatory effort associated with periods of prolonged voice use is related to increased lung pressure required to initiate and sustain phonation. The purpose of this study was to examine the relationship among perceived phonatory effort (PPE), which was used as a subjective index of vocal fatigue, and phonation threshold pressure (PTP), a quantifiable measure defined as the minimal lung pressure required to initiate and sustain vocal fold oscillation. PTP and PPE were recorded before, during, and after five adult male and five adult female speakers engaged in a prolonged oral reading task designed to induce vocal fatigue. The results supported a direct, moderately strong relationship between PTP and PPE, particularly when PTP was measured during speech produced at comfortable and low-speaking pitch levels. No gender effects were found. PTP returned to baseline levels within 1 hour after the fatiguing task. PPE returned to baseline within 1 day. The data support the use of PTP as an objective index of vocal fatigue.     

Simulation and analysis of nasalized vowels based on magnetic resonance imaging data

In this study, vocal tract area functions for one American English speaker, recorded using magnetic resonance imaging, were used to simulate and analyze the acoustics of vowel nasalization. Computer vocal tract models and susceptance plots were used to study the three most important sources of acoustic variability involved in the production of nasalized vowels: velar coupling area, asymmetry of nasal passages, and the sinus cavities. Analysis of the susceptance plots of the pharyngeal and oral cavities, -(B(p)+B(o)), and the nasal cavity, B(n), helped in understanding the movement of poles and zeros with varying coupling areas. Simulations using two nasal passages clearly showed the introduction of extra pole-zero pairs due to the asymmetry between the passages. Simulations with the inclusion of maxillary and sphenoidal sinuses showed that each sinus can potentially introduce one pole-zero pair in the spectrum. Further, the right maxillary sinus introduced a pole-zero pair at the lowest frequency. The effective frequencies of these poles and zeros due to the sinuses in the sum of the oral and nasal cavity outputs changes with a change in the configuration of the oral cavity, which may happen due to a change in the coupling area, or in the vowel being articulated.     

Effects on the glottal voice source of vocal loudness variation in untrained female and male voices

Subglottal pressure is one of the main voice control factors, controlling vocal loudness. In this investigation the effects of subglottal pressure variation on the voice source in untrained female and male voices phonating at a low, a middle, and a high fundamental frequency are analyzed. The subjects produced a series of /pae/ syllables at varied degrees of vocal loudness, attempting to keep pitch constant. Subglottal pressure was estimated from the oral pressure during the /p/ occlusion. Ten subglottal pressure values, approximately equidistantly spaced within the pressure range used, were identified, and the voice source of the vowels following these pressure values was analyzed by inverse filtering the airflow signal as captured by a Rothenberg mask. The maximum flow declination rate (MFDR) was found to increase linearly with subglottal pressure, but a given subglottal pressure produced lower values for female than for male voices. The closed quotient increased quickly with subglottal pressure at low pressures and slowly at high pressures, such that the relationship can be approximated by a power function. For a given subglottal pressure value, female voices reached lower values of closed quotient than male voices.     

Preliminary report on hormone receptors in the human vocal fold

There has been an ongoing effort to describe the physiologic factors associated with perceived and/or measured human voice changes that occur with age. In our study we focused on possible endocrine involvement on voice by using immunohistochemical staining to observe hormone receptor presence in vocal folds from 42 deceased subjects (fresh cadavers), male and female, ranging in age from 2 months to 82 years (average 37.7 years). On statistical analysis, age and gender were found to be associated with progesterone receptor staining of the glandular nuclei (young>old P = 0.013; male>female, P = 0.060). Gender was associated with androgen receptor staining in glandular cytoplasm (male>female, P = 0.014) and progesterone receptor staining in the epithelial cytoplasm (male>female, P = 0.039). No statistical significance was noted in other categories. CONCLUSION: Hormone receptors are found in the nucleus and cytoplasm of cells in the vocal fold with statistically significant differences in age and gender distribution.     

Task complexity effect on vocal reaction time in aged speakers

The aged population is at risk for impaired speech communication due to the increased likelihood of deterioration of central nervous system (CNS) processes that underlie cognition, language, and/or speech motor control. Vocal reaction time (RT) may provide a means of quantifying the efficiency of CNS processes that underlie speech production. The present study used a simple RT paradigm to investigate effects of the complexity of the required task on vocal RT in normal young and aged speakers. Task complexity was represented by two levels: a single word and a short sentence. Only the aged subjects showed a significant task complexity effect on vocal RT. Furthermore, the between-group RT difference increased as a function of task complexity. Specific causes for the increase in vocal RT for the aged subjects are presently unknown, but likely reside in altered respiratory biomechanics and reduced efficiency of CNS motor processing.     

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.     

Paradoxical vocal fold movement: A case report

We present a case of one patient with respiratory stridor that was resolved by speech therapy. Paradoxical vocal fold movements were observed by flexible fiberoptic videolaryngoscopy in this patient during episodes of wheezing and dyspnea. Otherwise, normal vocal fold movement was observed in normal conditions of breathing (out of the crisis) and during phonation. Many different terms have been used to describe this entity in the literature, and it is crucial that clinicians recognize the subtle signs of functional stridor. Paradoxical vocal fold motion has to be considered as an important cause of respiratory disease. Its recognition and treatment are discussed in this report.