Decomposition of Vocal Cycle Length Perturbations into Vocal Jitter and Vocal Microtremor, and Comparison of Their Size in Normophonic Speakers

A statistical method that enables raw vocal cycle length perturbations to be decomposed into perturbations ascribed to vocal jitter and vocal tremor is presented, together with a comparison of the size of jitter and tremor. The method is based on a time series model that splits the vocal cycle length perturbations into uncorrelated cycle-to-cycle perturbations ascribed to vocal jitter and supra-cycle perturbations ascribed to vocal tremor. The corpus was composed of 114 vocal cycle length time series for sustained vowels [a], [i], and [u] produced by 22 male and 16 female normophonic speakers. The results were the following. First, 100 out of 114 time series were decomposed successfully by means of the time series model. Second, vocal perturbations ascribed to tremor were significantly larger than perturbations ascribed to jitter. Third, the correlation between vocal jitter and vocal tremor was moderate, but statistically significant. Fourth, small but statistically significant differences were observed among the three vowel timbres in the relative jitter and the arithmetic difference of jitter and tremor. Fifth, the differences between male and female speakers were not statistically significant in the relative raw perturbations, the relative jitter, or the modulation level owing to tremor.     

Muscle spindles are concentrated in the superior vocalis subcompartment of the human thyroarytenoid muscle

It is hypothesized that different parts of the thyroarytenoid muscle (TA) are functionally specialized. Specifically, the TA is divided into a lateral muscularis compartment and a medial vocalis compartment. This study examined the distribution of muscle spindles throughout the human TA as an indicator of these functional differences. Histological cross-sections from the anterior, middle, and posterior regions of five human membranous vocal folds were examined for the number and location of muscle spindles. There was an average of 6.1 muscle spindles in sections from each region with no significant variation between the different regions (p < .05). However, in sections from all three regions, the muscle spindles were always found to be concentrated in the superior medial quadrant of the TA (mean 85.9%, p < .01). The inferior medial, superior lateral, and inferior lateral quadrants of the TA contained 11.96%, 2.17%, and 0%, respectively, of the total muscle spindles. Within the superior medial quadrant, most of the muscle spindles were localized in the most superficial part of the muscle.The results of this study demonstrate that the majority of TA muscle spindlesare concentrated in its superior medial quadrant, an area we have termed the superior vocalis subcompartment (SC. This finding suggests that the superior vocalis SC is functionally distinct from the remainder of the TA. It is hypothesized that tension in the superior vocalis SC can be controlled independently from the remainder of the TA, and this capability is used to effect the biomechanics of vocal fold vibration during phonation.     

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.     

Symptomatology of adductor spasmodic dysphonia: A physiologic model

Vocal symptomatology of adductor spasmodic dysphonia (SD) is reviewed critically from historical, epidemiologic, and clinical perspectives. A model of symptomatology of this disorder based on a large patient population, and clinical and physiologic observations is advanced. The model incorporates crucial symptomatic and asymptomatic phonatory and nonphonatory physiologic parameters of laryngeal behavior in these patients. These parameters include vocal fold contact area, vocal fold collision force, glottic compression, and subglottic air pressure. Inappropriate efferent discharges from brain-stem basal ganglia are hypothesized as causing overadduction of the vocal folds in phonation, generating the basic and fundamental vocal symptom of adductor SD—strained, strangled, overpressured voice quality. Cortical loops are implicated as accountable for compensatory vocal behavior, not as the primary site of the disorder. Symptom occurrence, variability, magnitude, effects, and failure of treatment approaches, as well as recurrence of symptoms after ablative or invasive procedures, are explained by this model. The model also predicts that symptomatology of adductor spasmodic dysphonia is unique to this disorder and that symptoms are phonotopically organized. The minimal diagnostic battery based on the model is presented, and it is shown how this battery aids in the differential diagnosis of adductor SD and other phonatory disorders that closely mimic the vocal symptoms of adductor spasmodic dysphonia, including tremor.     

The effect of head position on glottic closure in patients with unilateral vocal fold paralysis

The present study was designed to assess the effect of head position on glottic closure as reflected in airflow rates (open quotient and maximum flow declination rate), in patients with unilateral vocal fold paralysis. Ten patients, 2 males and 8 females ranging in age from 40 to 75, with a mean age of 57.3, served as subjects. Airflow measures were taken during sustained phonation of two vowels (/i/ and /a/) in 3 head positions (center, right, left). Vowels /i/ and /a/ were produced at subject's comfortable pitch and loudness, with random ordering of both vowel order and head orientation. Subjects were trained to focus eye gaze on right and left markers (70-degree angle) and a central marker at eye level directly in front of the subject. Theoretically, if turning the head during phonation alters the laryngeal anatomic relationship by bringing the vocal folds in closer proximity to one another, then airflow rate should lessen. Our results indicate that head position does not improve glottic closure in these patients, which is in contrast to previously published research.(1) Our results question the utility and underlying theoretical construct for the use of head turning as a therapeutic technique for improvement of voice in patients with unilateral vocal fold paralysis.     

Vocal stability in functional dysphonic versus healthy voices at different times of voice loading

Functional (nonorganic) dysphonia is often characterized by vocal instability. The purpose of the prospective study was to examine whether there is a difference in vocal instability of functional dysphonic voices compared with healthy ones, this means whether electroglottographic perturbation values differ (1) between healthy and dysphonic voices and (2) between two subgroups of the dysphponic voices (hpertonic and hypotonic dysphonic voices). Twenty-three patients with hypertonic functional dysphonia, 9 with hypotonic functional dysphonia and 31 healthy nonsmokers, were each examined electroglottographically before (Ex 1), immediately after (Ex 2), and 1 hour after (Ex 3) voice loading. Perturbations of frequency, amplitude, quasi-open-quotient, and contact-index were calculated from the EGG signal. At all three times of examination, hypertonic dysphonic voices showed higher perturbations than healthy voices, and they had higher perturbations than hypotonic dysphonic voices before and 1 hour after voice loading. Hypotonic dysphonic voices showed higher perturbations than healthy voices only 1 hour after voice loading. Voice loading induced different reactions in dysphonic voices: Some voices showed increased perturbations, and others exhibited normal or even decreased perturbation immediately after voice loading. Examination of electroglottographic-derived perturbations immediately after voice loading seems not to be useful. Differentiation of hypertonic and hypotonic dysphonic voices was possible with an estimated sensitivity of 88.9% and a specificity of 87.0% by using the sum of the amplitude-perturbation and the quasi-open-quotient-perturbation measured before voice loading.     

Decision problems in the space of Dehn fillings

Normal surface theory is used to study Dehn fillings of a knot-manifold. We use that any triangulation of a knot-manifold may be modified to a triangulation having just one vertex in the boundary. In this situation, it is shown that there is a finite computable set of slopes on the boundary of the knot-manifold, which come from boundary slopes of normal or almost normal surfaces. This is combined with existence theorems for normal and almost normal surfaces to construct algorithms to determine precisely those manifolds obtained by Dehn filling of a given knot-manifold that: (1) are reducible, (2) contain two-sided incompressible surfaces, (3) are Haken, (4) fiber over S¹, (5) are the 3-sphere, and (6) are a lens space. Each of these algorithms is a finite computation.Moreover, in the case of essential surfaces, we show that the topology of each filled manifold is strongly reflected in the combinatorial properties of a triangulation of the knot-manifold with just one vertex in the boundary. If a filled manifold contains an essential surface then the knot-manifold contains an essential normal vertex solution which caps off to an essential surface of the same type in the filled manifold. (Normal vertex solutions are the premier class of normal surface and are computable.)     

Singular Points Near an X_0-breaking Double Singular Fold Point in Z_2-symmetric Nonlinear Equations

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Visible surgery, four-dimensionals-cobordisms and related questions in geometric topology

The visible surgery theory of M. Weiss is used to complete the topological classification of four-dimensionals-cobordisms between three-dimensional spherical spaceforms. Applications to various questions concerning pseudo-isotopies of 3-manifolds, computations of the simple Wall groups of finite periodic groups, and inductive detection of self-homeomorphisms of manifolds are also discussed.The first named author was partially supported by a grant from the Louisiana Board of Regents and National Science Foundation Grants DMS 89-01583 and 91-01575, and the second named author was partially supported by National Science Foundation Grants DMS 86-02543, 89-02622 and 91-02711.     

Mild Vocal Fold Paresis: Understanding Clinical Presentation and Electromyographic Findings

The implications of mild vocal fold hypomobility are incompletely understood. This study describes the clinical, electromyographic, and probable etiologic findings in patients who presented with complaints of dysphonia and whose physical examination revealed vocal fold paresis as a factor possibly contributing to their voice complaints. A retrospective chart review of all patients who presented to a tertiary laryngology referral center over a 13-month period, who had a clinical diagnosis of mild vocal fold hypomobility and who underwent laryngeal electromyography, were included in the study. A total of 22 patients completed the medical evaluation of their voice complaint. Of these patients, 19 (86.4%) were found to have evidence of neuropathy on laryngeal electromyography. The clinical picture indicated the following probable origins for the vocal fold paresis: goiter/thyroiditis (7/22 or 31.8%), idiopathic (4/22 or 18.2%), viral neuritis (4/22 or 18.2%), trauma (3/22 or 13.6%), and Lyme's disease (1/22 or 4.5%). This article describes the clinical entity of mild vocal fold hypomobility and associated flexible laryngoscopic, rigid strobovideolaryngoscopic, and laryngeal electromyographic findings.