Infraglottic aspect of canine vocal fold vibration: Effect of increase of mean airflow rate and lengthening of vocal fold

The mucosal upheaval (MU), where the mucosal wave starts and propagates upward, appears only when the vocal fold vibrates. The location of the MU histologically and the effect of changes in mean air flow rate (MFR) and vocal fold length on occurrence of the MU were studied in twelve excised canine larynges. The lower surface of the vocal fold was marked to serve as a landmark for subsequent study. Cricothyroid approximation was performed to lengthen the vocal fold. After taking high-speed pictures or recording stroboscopic images from the tracheal side, a small cut wound was made at the mark. This wound served to compare the position of the MU with the histologically identified location of the mark. The larynx was then sectioned in the frontal plane. Before lengthening the vocal fold, the MU occurred on the area where the lamina propria became thinner and where the muscular layer neared the epithelial layer. After lengthening the vocal fold, the MU actually shifted medially compared with its original position. The subglottic area surrounded by the bilateral MUs became longer and thinner. Whether or not complete glottal closure during a vibratory cycle was achieved did not alter these findings. In contrast, with a fixed vocal fold length the MU appeared more laterally as MFR increased, but, based on the relation with the mark, its location on the vocal fold did not change from its original position before increase of MFR.     

Comparison between thyroplasty type I andArytenoid rotation: a study of vocal fold vibration using excised human larynges

The purpose of this paper was to compare the vibration of the vocal fold submitted to Isshiki thyroplasty type I (TPI) to that of the contralateral one adducted by the arytenoid rotation (AR) technique. The vocal folds of ten human fresh excised larynges were medialized by TPI on one side and by rotation of the arytenoid on the contralateral side. Laryngeal vibration was artificially produced and was recorded by videostroboscopy. The images were subjectively and objectively analyzed. Subjective analysis included periodicity of vibratory cycles, features of the mucosal wave present on the TPI side, amplitude of vibration, and profile of free border of each vocal fold during the opening phase. Objective analyses were carried out on frame-by-frame digitalized images to determine amplitudes of vibrations and phase differences between the folds in three glottic regions (anterior, middle, and posterior). Subjective analysis revealed regular periodicity in 100% of the larynges, a decrease in the mucosal wave on the TPI side in 70%, reduction in amplitude in 30%, and a sigmoid profile of the free border on the TPI side in 80%. Objective analysis showed mean amplitude in the posterior glottic region on the TPI side significantly larger than that on the arytenoids rotation side and phase asymmetry in 90% of the larynges.     

Medial Surface Dynamics as a Function of Subglottal Pressure in a Canine Larynx Model

During vocal fold vibration, there may be a mucosal wave in the superior-inferior (vertical) direction, resulting in a convergent shape during opening and a divergent shape during closing. Most of our understanding of the converging/diverging shape of the glottis has come from studies in a hemilarynx model. Previous work has shown that vibratory patterns in the full excised larynx are different than the hemilarynx. This study characterized the dynamics of the medial glottal wall geometry during vibrations in the full excised canine larynx model. Using particle image velocimetry, the intraglottal geometry was measured at the midmembranous coronal plane in an excised canine larynx model. Measurements of the glottal area were taken simultaneously using high-speed imaging. The results show that skewing of the glottal area waveform occurs without the presence of a vocal tract and that the phase-lag of the superior edge relative to the inferior edge is smaller than reported and depends on the subglottal pressure. In addition, it shows that the glottal divergence angle during closing is proportional to the magnitude of the acoustic intensity and the intraglottal negative pressure. This preliminary data suggests that more studies are needed to determine the important mechanisms determining the relationship between intraglottal flow, intraglottal geometry, and acoustics.     

声带上表面振动黏膜波波速的激光测振估计方法

发声过程中声带组织振动的黏膜波测量对于声带组织力学特性和病理机制研究具有重要意义。本研究利用多普勒激光测振(Laser Doppler Vibrometer,LDV)和电声门图时间同步方法,对声带上表面的振动过程进行了重建,并基于该结果估计了黏膜波传播速度。通过离体犬喉发声实验,激光测振方法能够得到与高速光学方法相一致的黏膜波速度估计,并且能够重建不同时刻的声带上表面形态,证明了该方法应用于声带上表面振动特性研究的可行性和有效性。然而,由于单点测振的局限和时间同步的要求,稳态发声是保证该方法测量准确性的重要条件。     

Endoscopic microsuture repair of vocal fold defects

The presence of a nonvibratory segment of vocal folds after microlaryngeal surgery is often a cause of poor voice result. The etiology of a nonvibratory segment is due to full thickness epithelial defect followed by secondary wound closure and scar contracture. To reduce scar contracture and nonvibratory segment of the vocal folds, primary repair with a 6-0 chromic endo-knot suture technique was used to close defects and approximate microflaps of the vocal folds. This was done in 18 patients with epithelial defects after resection of benign vocal fold lesions. The pathologic findings included severe polypoid degeneration (n = 7), fusiform laryngeal polyps (n = 5), sulcus vocalis (n = 2), cyst (n = 2), and keratosis (n = 2). Voice was improved in all patients after surgery. Comparison of vocal fold vibration before and after surgery showed improvements in configuration, amplitude, and mucosal wave. Vocal folds that were sutured all had good vibratory characteristics; none had a nonvibrating segment at the site of suture placement. Voice and healing after microsuture technique were near normal by Day 10 and return of mucosal wave was often complete by Day 14. Endoscopic microsuture closure of microflaps of the vocal folds edge is safe and affords the surgeon an opportunity for primary repair with improved functional result.     

On the relation between subglottal pressure and fundamental frequency in phonation

The change in fundamental frequency with subglottal pressure in phonation is quantified on the basis of the ratio between vibrational amplitude and vocal fold length. This ratio is typically very small in stringed instruments, but becomes quite appreciable in vocal fold vibration. Tension in vocal fold tissues is, therefore, not constant over the vibratory cycle, and a dynamic tension gives rise to amplitude-frequency dependence. It is shown that the typical 2-6 Hz/cm H2O rise in fundamental frequency with subglottal pressure observed in human and canine larynges is a direct and predictable consequence of this amplitude-frequency dependence. Results are presently limited to phonation in the chest register.     

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

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

Autologous fat implantation for vocal fold scar: A preliminary report

New insights into the anatomy and physiology of phonation, along with technological advances in voice assessment and quantification, have led to dramatic improvements in medical voice care. Techniques to prevent vocal fold scar have been among the most important, especially scarring and hoarseness associated with voice surgery. Nevertheless, dysphonia due to vocal fold scar is still encountered all too frequently. Although it is not generally possible to restore such injured voices to normal, patients with scar-induced dysphonia can usually be helped. Voice improvement is optimized through a team approach. Treatment may include sophisticated voice therapy and vocal fold surgery. Although experience with collagen injection has been encouraging in selected cases (particularly in those involving limited areas of vocal fold scar), there is no consistently successful surgical technique. Attempts to treat massive vocal fold scar, such as may be seen following vocal fold stripping, have been particularly unsuccessful. This paper reports preliminary experience with the implantation of autologous fat into the vibratory margin of the vocal fold of patients with severe, extensive scarring. Using this technique, it appears possible to recreate a mucosal wave and improve voice quality. Additional research is needed.     

Treatment of sulcus vocalis: Auditory perceptual and acoustical analysis of the slicing mucosa surgical technique

Sulcus vocalis is a furrow in the mucosa of the vocal folds that causes glottic insufficiency, irregular vibrations, and a distinctive dysphonia of variable severity. Treatment of sulcus vocalis needs to achieve anatomical and functional improvements that satisfy the behavior of the larynx and vocal quality. We suggest a combined approach, which includes vocal fold mucosal surgery through a technique called slicing mucosa, followed by intensive vocal rehabilitation. The aim of the surgery is to detach the mucosa of the sulcus and to interrupt the longitudinal fibrotic tension lines. The results of this procedure in 10 patients were analyzed through visual, auditory, and acoustical methods, and the data lead us to conclude that the treatment proposed offered a good anatomical result, a better vibratory pattern, and an improvement in overall vocal quality.     

Management of Vocal Fold Scar with Autologous Fat Implantation: Perceptual Results

Vocal fold scar disrupts the mucosal wave and interferes with glottic closure. Treatment involves a multidisciplinary approach that includes voice therapy, medical management, and sometimes surgery. We reviewed the records of the first eight patients who underwent autologous fat implantation for vocal fold scar. Information on the etiology of scar, physical findings, and prior interventions were collected. Videotapes of videostroboscopic findings and perceptual voice ratings [Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS)] were randomized and analyzed independently by four blinded observers. Etiology of scar included mass excision (7), vocal fold stripping (3), congenital sulcus (2), and hemorrhage (1). Prior surgical procedures performed included thyroplasty (1), autologous fat injection (9), excision of scar (2), and lysis of adhesions (2). Strobovideolaryngoscopy: Statistically significant improvement was found in glottic closure, mucosal wave, and stiffness (P = 0.05). Perceptual ratings (GRBAS): Statistically significant improvement was found in all five parameters, including overall Grade, Roughness, Breathiness, Asthenia, and Strain (P = 0.05). Patients appear to have improved vocal fold function and quality of voice after autologous fat implantation in the vocal fold. Autologous fat implantation is an important adjunctive procedure in the management of vocal fold scar, and a useful addition to the armamentarium of the experienced phonomicrosurgeon.     

Mucosal Wave: A Normophonic Study Across Visualization Techniques

Visualization of vocal fold vibration is essential for accurate diagnoses and optimal treatment of persons with voice disorders. Recently, scientific and anecdotal reports have evidenced an increased amount of variation in the diagnostically relevant features of extent and symmetry of mucosal wave magnitude in normophonic speakers. The objectives of this study were to preliminarily ascertain the variation in mucosal wave magnitude and symmetry for normophonic speakers as assessed via standard and novel techniques, and compare findings across modal and pressed phonations. A correlational design with a multiple baseline across visualization methods approach was used. Mucosal wave presence, magnitude, and symmetry from 52 normophonic speakers were judged via stroboscopy, high-speed videoendoscopy (HSV) playback, mucosal wave playback, and mucosal wave kymography playback. Results demonstrate a prevalence of atypical magnitude and symmetry of mucosal wave during modal and pressed phonations by normophonic persons, differences across techniques, and a relationship between judgments and habitual fundamental frequency. Given the prevalence of mucosal wave magnitude and symmetry variations in the normophonic population, overdiagnosis may be possible without caution. The various visualization techniques provided unique information suggesting that it may be beneficial to use both full view and kymographic visualization techniques in combination. A major restriction of the current commercial HSV systems is the frame rate, typically limited to 2000 frames per second, which appears insufficient for most female habitual phonations.     

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.     

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.     

Investigating acoustic correlates of human vocal fold vibratory phase asymmetry through modeling and laryngeal high-speed videoendoscopy

Vocal fold vibratory asymmetry is often associated with inefficient sound production through its impact on source spectral tilt. This association is investigated in both a computational voice production model and a group of 47 human subjects. The model provides indirect control over the degree of left-right phase asymmetry within a nonlinear source-filter framework, and high-speed videoendoscopy provides in vivo measures of vocal fold vibratory asymmetry. Source spectral tilt measures are estimated from the inverse-filtered spectrum of the simulated and recorded radiated acoustic pressure. As expected, model simulations indicate that increasing left-right phase asymmetry induces steeper spectral tilt. Subject data, however, reveal that none of the vibratory asymmetry measures correlates with spectral tilt measures. Probing further into physiological correlates of spectral tilt that might be affected by asymmetry, the glottal area waveform is parameterized to obtain measures of the open phase (open/plateau quotient) and closing phase (speed/closing quotient). Subjects' left-right phase asymmetry exhibits low, but statistically significant, correlations with speed quotient (r=0.45) and closing quotient (r=-0.39). Results call for future studies into the effect of asymmetric vocal fold vibration on glottal airflow and the associated impact on voice source spectral properties and vocal efficiency.     

高速摄影成像分析声带振动发声的前后不对称性

高速摄影成像直接观察到声带振动的前后不对称性。将11个离体狗喉声带进行发声实验,设置3组声门下压分别为10 cm H₂O,20 cm H₂O和30 cm H₂O,利用高速摄像仪和传声器,分别记录不同声门下压的声带振动图像和声信号.对高速摄影成像与同步采集的声信号基频进行定量分析和比较,基频均随声门下压的增大而增加。此外,对两种测量方法得到的基频进行相关分析比较,得到在同一声门下压下两种方法的基频相关系数均大于0.9,表明高速摄影成像得到的基频与声信号的基频具有高度相关性。高速摄影成像能直观地测量声带振动行为,对研究声带振动发声机理提供了有价值的测量手段。高速摄影获得的声带线性结构上25%,50%,75%位置处的振动幅度,显示了声带前后振动不对称且声门下压较低时振动不对称较明显。     

Observation of perturbations in a lumped-element model of the vocal folds with application to some pathological cases

In this paper a mass-spring model is developed that is a hybrid of the two-mass and the longitudinal string models, proposed by Ishizaka and Flanagan [Bell Sys. Tech. J. 51, 1233-1268 (1972)] and Titze [Phonetica 28, 129-170 (1973)], respectively. The model is used to simulate the vibratory motion of both the normal and asymmetric vocal folds. Mouth-output pressure, lateral tissue displacement, phase plots, and energy diagrams are presented to demonstrate the interaction between vocal fold tissue and the aerodynamic flow between the folds. The results of the study suggest that this interaction is necessary for sustained large amplitude oscillation because the flow supplies the energy lost by the tissue damping. Tissue mass and stiffness were varied locally or uniformly. Decreased stress in the longitudinal string tension produced subharmonic and chaotic vibrations in the displacement, velocity and acceleration phase diagrams. Similar vibratory characteristics also appeared in pathological speech data analyzed using time domain jitter and shimmer measures and a harmonics-to-noise ratio metric. The subharmonics create an effect that has been perceptually described as diplophonia.     

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.     

Spatial arrangement of the structural elements ofvocal fold layers: An adjustment to the vibration process

It is well established that the multilayered structure of the vocal fold is highly adjusted to the requirements of the vibration process during phonation. There is also some partial data indicating that the spatial arrangement of each vocal fold layer corresponds to the functional requirements, and thus facilitate the phonation process. Nevertheless, all reports on the spatial arrangement of the vocal fold structures deal only with an individual element of the vocal fold histologic structure. The present study encompasses the spatial histologic analysis of all major elements of the vocal fold layers. It was demonstrated that the vocal fold epithelial cells, the connective and muscle fibers, and even the blood vessels run parallel to the vocal fold free edge, which indicates a high adjustment to the phonation requirements and the vibration process.