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Zhang L, Fujiki RB, Brookes S, Calcagno H, Awonusi O, Kluender K, Berry K, Venkatraman A, Maulden A, Sivasankar MP, Voytik-Harbin S, Halum S. Eliciting and Characterizing Porcine Vocalizations: When Pigs Fly. J Voice 2024; 38:993-1001. [PMID: 35504794 PMCID: PMC9617810 DOI: 10.1016/j.jvoice.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES While voice-related therapeutic interventions are often researched preclinically in the porcine model, there are no well-established methods to induce porcine glottic phonation. Described approaches, such as training animals to phonate for positive reinforcement are time-consuming and plagued by inherent variability in the type of phonation produced and contamination of background noise. Thus, a reliable method of assessing glottic phonation in the porcine model is needed. METHODS In this study, we have created a novel pulley-based apparatus with harness for "pig-lifting" with surrounding acoustic insulation and high-directional microphone with digital recorder for recording phonation. Praat and Matlab were used to analyze all porcine vocalizations for fundamental frequency (F0), intensity, duration of phonation and cepstral peak prominence (CPP). Glottic phonation was detected using F0 (≥2000 hz), duration (≥3 seconds) and researcher perceptual judgment. Partial-glottic phonations were also analyzed. Reliability between researcher judgment and acoustic measures for glottic phonation detection was high. RESULTS Acoustic analysis demonstrated that glottic and partial-glottic phonation was consistently elicited, with no formal training of the minipigs required. Glottic vocalizations increased with multiple lifts. Glottic phonation continued to be elicited after multiple days but became less frequent. Glottic and partial-glottic phonations had similar CPP values over the 6 experimental days. CONCLUSION Our cost-effective, reliable method of inducing and recording glottic phonation in the porcine model may provide a cost effective, preclinical tool in voice research.
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Affiliation(s)
- Lujuan Zhang
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Robert Brinton Fujiki
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Sarah Brookes
- Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana
| | - Haley Calcagno
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Oluwaseyi Awonusi
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Keith Kluender
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Kevin Berry
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Anumitha Venkatraman
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Amanda Maulden
- Department of Animal Science, Purdue University, West Lafayette, Indiana
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Sherry Voytik-Harbin
- Department of Basic Medical Sciences, Purdue University, West Lafayette, Indiana; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Stacey Halum
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana.
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Duan C, Jimenez JM, Goergen C, Cox A, Sivasankar PM, Calve S. Hydration State and Hyaluronidase Treatment Significantly Affect Porcine Vocal Fold Biomechanics. J Voice 2023; 37:348-354. [PMID: 33541766 PMCID: PMC8325720 DOI: 10.1016/j.jvoice.2021.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The understanding of vocal fold hydration state, including dehydrated, euhydrated, rehydrated tissue, and how hydration affects vocal fold biomechanical properties is still evolving. Although clinical observations support the benefits of increasing vocal fold hydration after dehydrating events, more mechanistic information on the effects of vocal fold dehydration and the beneficial effects of rehydration are needed. Alterations to hyaluronic acid (HA), an important component of the vocal fold extracellular matrix, are likely to influence the biomechanical properties of vocal folds. In this study, we investigated the influence of hydration state and HA on vocal fold tissue stiffness via biomechanical testing. STUDY DESIGN Prospective, ex vivo study design. METHODS Fresh porcine vocal folds (N = 18) were examined following sequential immersion in hypertonic (dehydration) and isotonic solutions (rehydration). In a separate experiment, vocal folds were incubated in hyaluronidase (Hyal) to remove HA. Control tissues were not exposed to any challenges. A custom micromechanical system with a microforce sensing probe was used to measure the force-displacement response. Optical strain was calculated, and ultrasound imaging was used to measure tissue cross-sectional area to obtain stress-strain curves. RESULTS Significant increases (P ≤ 0.05) were found in tangent moduli between dehydrated and rehydrated vocal folds at strains of ε = 0.15. The tangent moduli of Hyal-digested tissues significantly increased at both ε = 0.15 and 0.3 (P ≤ 0.05). CONCLUSION Vocal fold dehydration increased tissue stiffness and rehydration reduced the stiffness. Loss of HA increased vocal fold stiffness, suggesting a potential mechanical role for HA in euhydrated vocal folds.
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Affiliation(s)
- Chenwei Duan
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana; Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Julian M Jimenez
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana; Department of Mechanical Engineering, University of Colorado-Boulder, Boulder, Colorado
| | - Craig Goergen
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana
| | - Preeti M Sivasankar
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana; Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Sarah Calve
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana; Department of Mechanical Engineering, University of Colorado-Boulder, Boulder, Colorado.
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Batıoğlu-Karaaltın A, Ugurlar M, Enver N, Erdur ZB, Yılmaz YZ, Bozkurt ER. Development of an Animal Model for Type II Sulcus (Sulcus Vergeture). J Voice 2023:S0892-1997(23)00001-2. [PMID: 36682999 DOI: 10.1016/j.jvoice.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/03/2023] [Accepted: 01/03/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To develop a reproducible experimental animal model for sulcus vergeture in rabbits. STUDY DESIGN Experimental animal study. MATERIAL METHOD We evaluated three methods of inducing sulcus in twelve New Zealand white rabbits to produce a sulcus model. Experimental groups comprised: group 1 (n = 4) underwent submucosal injury following endolaryngeal epithelial incision; group 2 (n = 4) received submucosal injury via thyrotomy; group 3 (n = 4) received submucosal injury via thyrotomy, followed with horizontal mucosal lateralization suture. Right vocal folds of the rabbits underwent surgery to produce sulcus vocalis and left vocal folds were used for the comparison. In the sixth week after the procedure, the rabbits were sacrificed and the larynxes were harvested and analyzed histopathologically. RESULTS No animals in group 1 or 2 developed sulcus vocalis. Sulcus formation was observed in all rabbits in group 3, under endoscopic examination and microscopic sulcus formation was demonstrated for the first, second, and third rabbits. An epithelial depression area was seen at the glandular ductal opening zone for the fourth rabbit, but it could also be accepted as a sulcus formation. CONCLUSION We successfully developed a reproducible survival model for sulcus using a submucosal injury via thyrotomy, followed with a horizontal mucosal lateralization suture. This model provides the groundwork for future research into the applicability of new approaches for sulcus management.
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Affiliation(s)
- Ayşegül Batıoğlu-Karaaltın
- Department of Otolaryngology-Head and Neck Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Muge Ugurlar
- Department of Otolaryngology-Head and Neck Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Necati Enver
- Department of Otolaryngology-Head and Neck Surgery, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Zulkuf Burak Erdur
- Department of Otolaryngology-Head and Neck Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yetkin Zeki Yılmaz
- Department of Otolaryngology-Head and Neck Surgery, Cerrahpasa Medicine Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Erol Rustu Bozkurt
- Department of Pathology, Istanbul Research and Training Hospital, Istanbul, Turkey
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Kollech HG, Chao MR, Stark AC, German RZ, Paniello RC, Christensen MB, Barkmeier-Kraemer JM, Vande Geest JP. Extracellular matrix deformations of the porcine recurrent laryngeal nerve in response to hydrostatic pressure. Acta Biomater 2022; 153:364-373. [PMID: 36152909 PMCID: PMC10627241 DOI: 10.1016/j.actbio.2022.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/22/2022] [Accepted: 09/15/2022] [Indexed: 11/25/2022]
Abstract
Damage to the recurrent laryngeal nerve (RLN) caused by supraphysiological compression or tension imposed by adjacent tissue structures, such as the aorta, may contribute to onset of idiopathic unilateral vocal fold paralysis (iUVP) resulting in difficulty speaking, breathing, and swallowing. We previously demonstrated in adolescent pigs that the right RLN epineurium exhibits uniform composition of adipose tissue, with larger quantities along its length within the neck region in contrast to the left RLN that shows greater collagen composition in the thoracic region and greater quantities of adipose tissue in the neck region. In contrast, the epineurium in piglets was primarily composed of collagen tissue that remained uniform along the length of the left and right RLNs. Tensile testing of the left and right RLN in piglets and pigs showed associated differences in strain by RLN side and segment by age. The goal of this study was to investigate how external hydrostatic compression of the RLN affects the nerve's connective tissue and microstructure. RLN segments were harvested from the distal (cervical/neck) regions and proximal (subclavian for the right RLN, thoracic for the left RLN) regions from eight adolescent pigs and nine piglets. RLN segments were isolated and assessed under fluid compression to test hypotheses regarding epineurium composition and response to applied forces. Second harmonic generation (SHG) imaging of epineurial collagen was conducted at 0, 40, and 80 mmHg of compression. The cartesian strain tensor, principal strain (Eps1), and principal direction of the RLN collagen fibers were determined at each pressure step. Significantly larger values of the 1st principal strain occurred in the proximal segments of the pig left RLN when compared to the same segment in piglets (p = 0.001, pig = 0.0287 [IQR = 0.0161 - 0.0428], piglet = 0.0061 [IQR = 0.0033 - 0.0156]). Additionally, the median transverse strain Eyy) for the second pressure increment was larger in the right proximal segment of pigs compared to piglets (p < 0.001, pig = 0.0122 [IQR = 0.0033 - 0.0171], piglet = 0.0013 [IQR = 0.00001 - 0.0028]). Eyy values were significantly larger in the right proximal RLN versus the left proximal RLNs in pigs but not in piglets (p < 0.001). In contrast to piglets, histological analysis of pig RLN demonstrated increased axial alignment of epineurial and endoneurial collagen in response to compressive pressure. These findings support the hypothesis that the biomechanical response of the RLN to compressive pressure changed from being similar to being different between the right and left RLNs during development in the porcine model. Further investigation of these findings associated with age-related onset of idiopathic UVP may illuminate underlying etiologic mechanisms. STATEMENT OF SIGNIFICANCE: Damage to the recurrent laryngeal nerve (RLN) caused by compression imposed by the aorta may contribute to the onset of left-sided idiopathic unilateral vocal fold paralysis resulting in difficulty speaking, breathing, and swallowing. The goal of this study was to investigate how compression affects the connective tissue and microstructure of the RLN. We quantified the pressure induced deformation of the RLN using multiphoton imaging as a function of both location (proximal versus distal) and age (piglets, adolescent pigs). Our results demonstrate that the biomechanical response of the RLN to compression changes in the right versus left RLN throughout development, providing further evidence that the the left RLN is exposed to increasing dynamic loads with age.
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Affiliation(s)
- Hirut G Kollech
- Computational Modeling and Simulation Program, University of Pittsburgh, Pittsburgh, PA, USA
| | - Melissa R Chao
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
| | - Amanda C Stark
- National Center for Voice and Speech, University of Utah, Salt Lake City, UT, USA
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University (NEOMED), Rootstown, OH, USA
| | - Randal C Paniello
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Julie M Barkmeier-Kraemer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Utah, UT, USA
| | - Jonathan P Vande Geest
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Mechanical Engineering and Material Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Berges AJ, Lina IA, Ospino R, Tsai HW, Ding D, Izzi JM, Hillel AT. Impact of Low-Volume, Low-Pressure Tracheostomy Cuffs on Acute Mucosal Injury in Swine. Otolaryngol Head Neck Surg 2022; 167:716-724. [PMID: 35998065 PMCID: PMC9891736 DOI: 10.1177/01945998221119160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/02/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Tapered low-volume, low-pressure (LVLP) cuffs have been introduced to improve sealing and reduce injury from tracheostomy and endotracheal intubation compared to traditional cylindrical high-volume, low-pressure (HVLP) cuffs. The objective of this study is to develop a swine model of tracheostomy injury and to compare live tissue response following LVLP and HVLP tracheostomy placement. STUDY DESIGN In vivo animal study. SETTING Academic institution. METHODS Swine underwent tracheostomy followed by placement of LVLP and HVLP tracheostomy cuffs at 30 cm H2O. After 24 and 48 hours, tracheal specimens underwent histopathological analysis including cilia, lamina propria and epithelial thickness, and mucosal injury score. RESULTS In all cuff contact areas, mean epithelial thickness for both tracheostomy cohorts was decreased compared to control epithelium at 24 and 48 hours (P < .01). HVLP proximal epithelium thickness was decreased at 24 and 48 hours relative to LVLP sections (P < .05). Lamina propria thickness in proximal LVLP sections was less than HVLP sections at 24 hours and 48 hours (P < .05). Mucosal injury score at areas of cuff contact was increased in tracheostomy cohorts relative to controls (P < .001), with HVLP injury score greater than LVLP at the proximal cuff (P < .05). CONCLUSION In a swine model, tracheostomy resulted in increased mucosal injury compared to normal tracheal mucosa. LVLP cuffs resulted in less injury than HVLP cuffs, with reduced mucosal inflammation and improved health of epithelium and lamina propria. The wider proximal LVLP cuff demonstrated improved mucosal health compared to the HVLP cylindrical cuff.
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Affiliation(s)
- Alexandra J. Berges
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Ioan A. Lina
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Rafael Ospino
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hsiu-Wen Tsai
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Dacheng Ding
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Jessica M. Izzi
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Alexander T. Hillel
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Abstract
A lack of reliable laryngeal thermal injury models precludes laryngeal burn wound healing studies and investigation of novel therapeutics. We hypothesize that a swine laryngeal burn model can allow for laryngeal burn evaluation over time. Twelve Yorkshire crossbreed swine underwent tracheostomy and endoscopically directed laryngeal burns using heated air (150-160°C). Swine larynges were evaluated and sectioned/stained at 12 hours, 1, 3, 7, 14, and 21 days. A board-certified veterinary pathologist assessed anatomic regions (left and right: epiglottis, true/false vocal folds, and subglottis) using a nine criteria histological injury scoring scale. Six swine were euthanized at scheduled endpoints, three prematurely (airway concerns), and three succumbed to airway complications after 16 to 36 hours. Endoscopic and gross examination from scheduled endpoints revealed massive supraglottic edema and tissue damage, particularly around the arytenoids, extending transglottically. Swine from premature endpoints had comparatively increased edema throughout. Microscopic evaluation documented an inverse relationship between injury severity score and time from injury. Inflammation severity decreased over time, nearly resolving by 14 days. Neutrophils predominated early with histiocytes appearing at 3 days. Granulation tissue appeared at 3 days, and early epiglottic and/or subglottic fibrosis appeared by 7 days and matured by 14 days. Edema, abundant initially, decreased by day 3 and resolved by day 7. This approach is the first to provide longitudinal analysis of laryngeal thermal injuries, reflecting some of the first temporal wound healing characteristic data in laryngeal thermal injuries and providing a platform for future therapeutic studies.
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Affiliation(s)
- Gregory R Dion
- Dental and Craniofacial Trauma Research Department, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas.,Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Christian S Pingree
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Pedro J Rico
- Clinical Investigation and Research Support, 59th Medical Wing, United States Air Force, JBSA-Lackland, Texas
| | - Christine L Christensen
- Clinical Investigation and Research Support, 59th Medical Wing, United States Air Force, JBSA-Lackland, Texas
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Zhao Y, Zhang D, Zhou L, Li S, Wang T, Li F, Han Y, Dionigi G, Sun H. Proprieties of adhesive surface arrays to thyroid cartilage for recurrent laryngeal nerve monitoring. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:690. [PMID: 33987388 PMCID: PMC8106000 DOI: 10.21037/atm-21-1229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background To investigate the optimal placement and size of adhesive thyroid cartilage electrodes (ATCEs) placed on the thyroid cartilage in porcine models for evaluating recurrent laryngeal nerve function compared with the other 3 recording electrode types. Methods Four Meishan piglets were used for this study. The electromyogram (EMG) signal stability was detected by intraoperative nerve monitoring (IONM). Best location and size of ATCEs were detected, and the EMG signals from each were compared. Latency data were tested by stimulating the different nerve points, and 6 manipulations of the trachea and endotracheal tube (ET) were applied to test the stability of EMG signals. ET electrodes, needle electrodes, and transcutaneous recording electrodes were simultaneously tested with comparison to ATCEs. Results The optimal placement locations and sizes of ATCEs were determined. The amplitudes and latencies recorded from the ATCEs were consistent with those of the ET electrodes. More anti-interference was observed with the ATCEs than with the ET electrodes in surgical manipulations. ATCEs could be used during intermittent and continuous monitoring in similar fashion to ET electrodes and needle electrodes. Conclusions ATCEs had consistent monitoring function with ET electrodes and needle electrodes. Feasibility, EMG stability, and optimal location and size of ATCEs for IONM were resolved. The EMG profiles from the ATCEs were more stable during surgical manipulations.
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Affiliation(s)
- Yishen Zhao
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Daqi Zhang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Le Zhou
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Shijie Li
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Tie Wang
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Fang Li
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Yujia Han
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "Gaetano Barresi", University Hospital G. Martino, University of Messina, Messina, Italy
| | - Hui Sun
- Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, China
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Smith SK, Burkhard TT, Phelps SM. A comparative characterization of laryngeal anatomy in the singing mouse. J Anat 2021; 238:308-320. [PMID: 32996145 PMCID: PMC7812124 DOI: 10.1111/joa.13315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 02/02/2023] Open
Abstract
Sexual displays are some of the most dramatic and varied behaviors that have been documented. The elaboration of such behaviors often relies on the modification of existing morphology. To understand how display elaboration arises, we analyzed the laryngeal anatomy of three species of mice that vary in the presence and complexity of their vocal displays. Mice and rats have a specialized larynx that enables them to produce both low-frequency "audible" sounds, perhaps using vocal fold vibration, as well as distinct mechanisms that are thought to enable higher frequency sounds, such as vocal membrane vibration and intralaryngeal whistles. These mechanisms rely on different structures within the larynx. Using histology, we characterized laryngeal anatomy in Alston's singing mouse (Scotinomys teguina), the northern pygmy mouse (Baiomys taylori), and the laboratory mouse (Mus musculus), which produce different types of vocalizations. We found evidence of a vocal membrane in all species, as well as species differences in vocal fold and ventral pouch size. Presence of a vocal membrane in these three species, which are not known to use vocal membrane vibration, suggests that this structure may be widespread among muroid rodents. An expanded ventral pouch in singing and pygmy mice suggests that these mice may use an intralaryngeal whistle to produce their advertisement songs, and that an expanded ventral pouch may enable lower frequencies than laboratory mouse whistle-produced sounds. Variation in the laryngeal anatomy of rodents fits into a larger pattern across terrestrial vertebrates, where the development and modification of vocal membranes and pouches, or air sacs, are common mechanisms by which vocalizations diversify. Understanding variation in the functional anatomy of relevant organs is the first step in understanding how morphological changes enable novel displays.
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Affiliation(s)
- Samantha K. Smith
- Department of Integrative BiologyUniversity of Texas at AustinAustinTXUSA
| | - Tracy T. Burkhard
- Department of Integrative BiologyUniversity of Texas at AustinAustinTXUSA
| | - Steven M. Phelps
- Department of Integrative BiologyUniversity of Texas at AustinAustinTXUSA
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Herbst CT, Nishimura T, Garcia M, Migimatsu K, Tokuda IT. Effect of Ventricular Folds on Vocalization Fundamental Frequency in Domestic Pigs (Sus scrofa domesticus). J Voice 2020; 35:805.e1-805.e15. [PMID: 33388229 DOI: 10.1016/j.jvoice.2020.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/10/2020] [Accepted: 01/16/2020] [Indexed: 10/22/2022]
Abstract
This study investigates the effect of the ventricular folds on fundamental frequency (fo) in the voice production of domestic pigs (Sus scrofa domesticus). The excised larynges of six subadult pigs were phonated in two preparation stages, with the ventricular folds present (PS1) and removed (PS2). Vocal fold resonances were tested with a laser vibrometer, and a four-mass computational model was created. Highly significant fo differences were found between PS1 and PS2 (means at 93.7 and 409.3 Hz, respectively). Two tissue resonances were found at 115 Hz and 250-290 Hz. The computational model had unique solutions for abducted and adducted ventricular folds at about 150 and 400 Hz, roughly matching the fo measured ex vivo for PS1 and PS2. The differing fo encountered across preparation stages PS1 and PS2 is explained by distinct activation of either a high or a low eigenfrequency mode, depending on the engagement of the ventricular folds. The inability of the investigated larynges to vibrate at frequencies below 250 Hz in PS2 suggests that in vivo low-frequency calls of domestic pigs (pre-eminently grunts) are likely produced with engaged ventricular folds. Allometric comparison suggests that the special, mechanically coupled "double oscillator" has evolved to prevent signaling disadvantages. Given these traits, the porcine larynx might - apart from special applications relating to the involvement of ventricular folds - not be an ideal candidate for emulating human voice production in excised larynx experimentation.
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Affiliation(s)
- Christian T Herbst
- Antonio Salieri Department of Vocal Studies and Vocal Research in Music Education, University of Music and Performing Arts Vienna, Vienna, Austria.
| | | | - Maxime Garcia
- ENES Lab, Université Lyon/Saint-Etienne, Neuro-PSI, CNRS UMR 9197, Saint-Etienne, France; Department of Evolutionary Biology and Environmental Studies, University of Zurich, Zürich, Switzerland
| | - Kishin Migimatsu
- Department of Mechanical Engineering, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Isao T Tokuda
- Department of Mechanical Engineering, Ritsumeikan University, Kusatsu, Shiga, Japan
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Gartling GJ, Sayce L, Kimball EE, Sueyoshi S, Rousseau B. A Comparison of the Localization of Integral Membrane Proteins in Human and Rabbit Vocal Folds. Laryngoscope 2020; 131:E1265-E1271. [PMID: 33155693 DOI: 10.1002/lary.29243] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES This study's objective was to identify and compare the localization of Aquaporin (AQP) 1, 4, 7, Na+/K + -ATPase, E-cadherin, zona occludin (ZO)-1, and occludin in human and rabbit vocal folds (VF)s to inform the design of future studies to explore the function of these proteins in the regulation of VF homeostasis. METHODS Four human larynges and five New Zealand white rabbit larynges were used. Samples were immunolabeled for primary antibodies against AQP1, AQP4, AQP7, the alpha subunit of Na+/K + -ATPase, E-cadherin, and ZO-1 and occludin and then captured digitally using a Nikon Eclipse 90i microscope and Hamamatsu C10600 Camera. Two raters familiar with human and rabbit VF histology identified positive labeling in tissue structures, including the apical epithelium, basal epithelium/basement membrane, and lamina propria (LP). RESULTS Samples from both species showed positive labeling for AQP1 in the basal epithelium/basement membrane, superficial LP, and deep/intermediate LP. Aquaporin 4, Aquaporin 7, Na+/K + -ATPase, and E-cadherin were primarily localized to the epithelium of both species. Zona occludin-1 was primarily localized apical epithelium and the superficial LP of both species. Occludin was primarily present in the apical epithelium in rabbit samples but not human. CONCLUSION These data provide evidence of the presence of key ion transport channels and cell adhesion proteins in human and rabbit VFs. Aquaporin 1, 4, 7, Na+/K + -ATPase, E-cadherin, and ZO-1 were similarly localized in both species. These findings will be useful to investigators interested in the exploration of VF homeostasis and barrier integrity in future studies. LEVEL OF EVIDENCE N/A Laryngoscope, 131:E1265-E1271, 2021.
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Affiliation(s)
- Gary J Gartling
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Lea Sayce
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Emily E Kimball
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee, U.S.A
| | - Shintaro Sueyoshi
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Bernard Rousseau
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
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Lee M, Ang C, Andreadis K, Shin J, Rameau A. An Open-Source Three-Dimensionally Printed Laryngeal Model for Injection Laryngoplasty Training. Laryngoscope 2020; 131:E890-E895. [PMID: 32750164 DOI: 10.1002/lary.28952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS A limited number of three-dimensionally (3D)-printed laryngeal simulators have been described in the literature, only one of which is specifically designed for percutaneous injection laryngoplasty (PIL) training and is currently of limited availability. This study describes the development and evaluation of a high-fidelity, open-source, low-cost 3D-printed simulator for PIL training, improving on existing models. STUDY DESIGN Simulator design and survey evaluation. METHODS Computed tomography scans of the upper airways were processed with 3D Slicer to generate a computer model of the endolarynx. Blender and Fusion 360 were used to refine the mucosal model and develop casts for silicone injection molding. The casted endolaryngeal structures were inserted into a modified version of a publicly available laryngeal cartilage model. The final models were evaluated by 10 expert laryngologists using a customized version of the Michigan Standard Simulation Experience Scale. Internal consistency and interrater reliability of the survey were evaluated using Cronbach's α and intraclass correlation, respectively. RESULTS Expert laryngologists highly rated the model for measures of fidelity, educational value, and overall quality (mean = 4.8, standard deviation = 0.5; 1 = strongly disagree, 5 = strongly agree). All reviewers rated the model as ready for use as is or with slight modifications. The filament needed for one cartilage model costs $0.96, whereas the silicone needed for one soft-tissue model costs $1.89. CONCLUSIONS Using 3D-printing technology, we successfully created the first open-source, low-cost, and anatomically accurate laryngeal model for injection laryngoplasty training. Our simulator is made freely available for download on Wikifactory with step-by-step tutorials for 3D printing, silicone molding, assembly, and use. LEVEL OF EVIDENCE NA Laryngoscope, 131:E890-E895, 2021.
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Affiliation(s)
- Mark Lee
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Chelston Ang
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - Katerina Andreadis
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
| | - James Shin
- Department of Radiology, Weill Cornell Medicine, New York, New York, U.S.A
| | - Anaïs Rameau
- Sean Parker Institute for the Voice, Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, New York, U.S.A
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12
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Whitten A, Key AP, Mefferd AS, Bodfish JW. Auditory event-related potentials index faster processing of natural speech but not synthetic speech over nonspeech analogs in children. BRAIN AND LANGUAGE 2020; 207:104825. [PMID: 32563764 DOI: 10.1016/j.bandl.2020.104825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
Given the crucial role of speech sounds in human language, it may be beneficial for speech to be supported by more efficient auditory and attentional neural processing mechanisms compared to nonspeech sounds. However, previous event-related potential (ERP) studies have found either no differences or slower auditory processing of speech than nonspeech, as well as inconsistent attentional processing. We hypothesized that this may be due to the use of synthetic stimuli in past experiments. The present study measured ERP responses during passive listening to both synthetic and natural speech and complexity-matched nonspeech analog sounds in 22 8-11-year-old children. We found that although children were more likely to show immature auditory ERP responses to the more complex natural stimuli, ERP latencies were significantly faster to natural speech compared to cow vocalizations, but were significantly slower to synthetic speech compared to tones. The attentional results indicated a P3a orienting response only to the cow sound, and we discuss potential methodological reasons for this. We conclude that our results support more efficient auditory processing of natural speech sounds in children, though more research with a wider array of stimuli will be necessary to confirm these results. Our results also highlight the importance of using natural stimuli in research investigating the neurobiology of language.
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Affiliation(s)
- Allison Whitten
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S., Nashville, TN, USA.
| | - Alexandra P Key
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S., Nashville, TN, USA; Department of Psychiatry and Behavioral Sciences, Vanderbilt Psychiatric Hospital, 1601 23rd Ave. S, Nashville, TN, USA; Vanderbilt Kennedy Center, 110 Magnolia Cir, Nashville, TN, USA
| | - Antje S Mefferd
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S., Nashville, TN, USA; Vanderbilt Kennedy Center, 110 Magnolia Cir, Nashville, TN, USA
| | - James W Bodfish
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S., Nashville, TN, USA; Department of Psychiatry and Behavioral Sciences, Vanderbilt Psychiatric Hospital, 1601 23rd Ave. S, Nashville, TN, USA; Vanderbilt Kennedy Center, 110 Magnolia Cir, Nashville, TN, USA; Vanderbilt Brain Institute, 6133 Medical Research Building III, 465 21st Avenue S., Nashville, TN, USA
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13
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Schild LR, Böhm F, Boos M, Kahrs LA, Coburger J, Greve J, Dürselen L, Hoffmann TK, Schuler PJ. Adding Flexible Instrumentation to a Curved Videolaryngoscope: A Novel Tool for Laryngeal Surgery. Laryngoscope 2020; 131:E561-E568. [PMID: 32585046 DOI: 10.1002/lary.28868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/05/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Transoral surgery of the larynx with rigid instruments is not always possible. This may result in insufficient therapy or in an increased need for open surgery. For these patients, alternative surgical systems are needed. Here, we demonstrate a curved prototype for laryngeal surgery equipped with flexible instruments. STUDY DESIGN Pre-clinical user study in an ex vivo porcine laryngeal model. METHODS The prototype was built from established medical devices, namely a hyperangulated videolaryngoscope and modified flexible instruments as well as three-dimensional printed parts. Feasibility of laryngeal manipulation was evaluated in a user study (n = 19) with a porcine ex vivo laryngeal model. Using three different visualization technologies, the participants performed various fine motor skills tasks and rated the usability of the system on a 5-point Likert scale. RESULTS Exposure, accessibility, and manipulation of important laryngeal structures were always possible using the new prototype. The participants needed considerably less time (mean, 96.4 seconds ± 6.4 seconds vs. 111.5 seconds ± 4.5 seconds, P = .18), reported significantly better general impression (mean score 3.0 vs. 3.8, P = .041) and significantly lower user head and neck strain (2.6 vs. 1.7, P = .022) using a 40-inch television screen as compared to a standard videolaryngoscope monitor. CONCLUSION The results indicate that our curved prototype and large monitor visualization may provide a cost-effective minimally invasive alternative for difficult laryngeal exposure. Its special advantages include avoiding the need for a straight line of sight and a simple and cost-effective construction. The system could be further improved through advances in camera chip technology and smaller instruments. Laryngoscope, 131:E561-E568, 2021.
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Affiliation(s)
- Leon R Schild
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany
| | - Felix Böhm
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany
| | - Marco Boos
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Lüder A Kahrs
- Department of Mathematical and Computational Sciences, University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Jan Coburger
- Department of Neurosurgery, Ulm University Medical Centre, Guenzburg, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Patrick J Schuler
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Centre, Ulm, Germany.,Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
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Liu X, Mustonen A, Zheng W, Sivasankar MP, Durkes AC. Cigarette Smoke Exposure to Pig Larynx in an Inhalation Chamber. J Voice 2019; 33:846-850. [PMID: 29983221 PMCID: PMC6320720 DOI: 10.1016/j.jvoice.2018.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/16/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study investigated the effects of cigarette smoke exposure on the pig larynx using an inhalation chamber. Specifically, we compared the effects of cigarette smoke exposure from either 3 cigarettes per day (3cd) or 15 cigarettes per day (15cd) for 20 days. STUDY DESIGN In vivo prospective design. METHODS Female pigs were exposed via an inhalation chamber to cigarette smoke (3R4F research cigarettes) from 3cd (n = 6) or 15cd (n = 6) for 20 days. Outcomes included histopathology of vocal fold and airway tissues; gene expression of interleukins, TNF-α, and VEGF; protein levels of TNF-α and IL-6; and number of coughs recorded in the chamber. RESULTS Pigs exposed to cigarette smoke from 15cd exhibited mild vocal fold edema as compared to the 3cd group on histopathological evaluation. There was also minimal inflammation of nasal and tracheal tissue characterized by presence of more granulocytes in the 15cd group compared to the 3cd group. Cough frequency was significantly greater for the 15cd group compared to the 3cd group. CONCLUSIONS A custom-designed large animal inhalation chamber successfully challenged pigs repeatedly, to varying levels of cigarette smoke. Future studies will combine such low levels of smoke exposure with other common challenges such as acid reflux to understand the multifactorial causation of laryngeal pathologies.
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Affiliation(s)
- Xinxin Liu
- School of Health Sciences, Purdue University, West Lafayette, Indiana; Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Allison Mustonen
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana
| | - Wei Zheng
- School of Health Sciences, Purdue University, West Lafayette, Indiana
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana
| | - Abigail C Durkes
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana.
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15
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Yu P, Luan J, Cui X, Li X, Hu X, Sun G. Development and Validation of a Low-Cost and Simple Simulator for Microlaryngeal Surgery. Clin Exp Otorhinolaryngol 2019; 13:58-63. [PMID: 31370389 PMCID: PMC7010492 DOI: 10.21053/ceo.2019.00556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/17/2019] [Indexed: 11/24/2022] Open
Abstract
Objectives. The simulation of microlaryngeal skills is rarely seen in surgical training, but it is particularly important in phonomicrosurgery. This study described and validated the laryngeal surgical simulator through surgical training. Methods. A simple and low-cost simulator was developed for the fixation of the suspension laryngoscope and porcine larynges. Twenty participants with work skills and experience did preparation before training, and performed suture and carbon dioxide (CO2) laser cordectomy for simulator evaluation. The results were proposed by the aspects of time taken for each procedure, the global rating scale, a procedure-specific assessment, and a post-simulation questionnaire. Results. All participants completed the preparation within 9 minutes and reached the conclusion that the microlaryngeal surgical simulator was helpful in improving their surgical skills. The performance of experts was superior to that of novices in both suture and CO2 laser cordectomy. Conclusion. This simulator could be easily assembled and was successfully validated by microlaryngeal surgical training both subjectively and objectively. It may be helpful to clinicians in microlaryngeal skills.
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Affiliation(s)
- Pengcheng Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia Luan
- Outpatient Department, Huashan Worldwide Medical Center, Shanghai, China
| | - Xidong Cui
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xumao Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xinqi Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Guangbin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
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16
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Tangney J, Scholp A, Kang J, Raj H, Jiang JJ. Effects of Varying Lengths and Diameters During Straw Phonation on an Excised Canine Model. J Voice 2019; 35:85-93. [PMID: 31353125 DOI: 10.1016/j.jvoice.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE/BACKGROUND Straw phonation, a well-established method of vocal exercise, started over 100 years ago. However, some of the most basic questions about best practices remain including the ideal extension length and the ideal restriction (semiocclusion) diameter. This study aims to help answer these questions by looking at both separately, with all other variables controlled. METHODS Four (4) straws with lengths of 5, 25, 50, and 75 centimeters and 4 restrictions with diameters of 3, 9, 15, and 21 mm were tested, separately. They were attached to the end of a simulated vocal tract which was then affixed to an excised canine larynx. Airflow was increased until the larynges achieved self-sustained phonation then aerodynamic, acoustic, and electroglottographic data were collected. RESULTS There was a significant decrease in the phonation threshold pressure using the 5 and 25 cm straw lengths and the 9 and 15 mm restrictions. The phonation threshold flow and contact quotient saw insignificant changes, except in the case of the 3 mm restriction. DISCUSSION It is theorized that the increased inertive reactance helps to decrease phonation threshold pressure. By controlling for all other variables, the effects of the length or diameter of the straw can be analyzed in isolation. These results narrow the significant range of lengths and diameters used in straw phonation.
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Affiliation(s)
- Jacob Tangney
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Austin Scholp
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jing Kang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hayley Raj
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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17
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Pham TT, Chen L, Heidari AE, Chen JJ, Zhukhovitskaya A, Li Y, Patel U, Chen Z, Wong BJ. Computational analysis of six optical coherence tomography systems for vocal fold imaging: A comparison study. Lasers Surg Med 2019; 51:412-422. [PMID: 30681167 PMCID: PMC6658351 DOI: 10.1002/lsm.23060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES There have been many advancements in laryngeal imaging using optical coherence tomography (OCT), with varying system design and probes for use in research, office, and operating room settings. We evaluated the performance of six distinct OCT systems in imaging porcine vocal folds (cords) using computational image processing and segmentation. METHODS Porcine vocal folds were scanned using six OCT systems. Imaging system and probe performance were quantitatively assessed for signal penetration, layer differentiation, and epithelium (EP) measurement. Fitted exponential decay curves with corresponding α constant and intensity thresholding segmentation were utilized to quantify the aforementioned parameters. RESULTS The smallest average α constant and deepest signal penetration was of the SS-OCT 1700 nm 90 kHz microscope system (α = -1.74), followed by the SS-OCT 1310 nm 200 kHz VCSEL microscope system (α = -1.99), and SS-OCT 1310 nm 50 kHz rigid forward viewing endoscope system (α = -2.23). The EP was not readily visualized for three out of six systems, but was detected using automated segmentation. Average EP thickness (mean ± SD) was calculated as 55.79 ± 31.86 μm which agrees favorably with previous literature. CONCLUSION Comparisons of OCT systems are challenging, as they encompass different probe design, optical path, and lasers, depending on application. Practical evaluation of different systems using computer based quantitative image processing and segmentation revealed basic, constructive information, such as EP measurements. To further validate the comparisons of system performance with clinical usability, in vivo human laryngeal imaging will be conducted. Further development of automated image processing and segmentation can be useful in rapid analysis of information. Lasers Surg. Med. 51:412-422, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Tiffany T. Pham
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- School of Medicine, University of California—Irvine, Irvine, California 92617
| | - Lily Chen
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
| | - Andrew E. Heidari
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
| | - Jason J. Chen
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
| | - Alisa Zhukhovitskaya
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Otolaryngology—Head and Neck Surgery, University of California—Irvine, Orange, California 92868
| | - Yan Li
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
| | - Urja Patel
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
| | - Zhongping Chen
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
| | - Brian J.F. Wong
- Beckman Laser Institute & Medical Clinic, University of California—Irvine, Irvine, California 92612
- School of Medicine, University of California—Irvine, Irvine, California 92617
- Department of Biomedical Engineering, University of California—Irvine, Irvine, California 92697
- Department of Otolaryngology—Head and Neck Surgery, University of California—Irvine, Orange, California 92868
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Gómez P, Schützenberger A, Semmler M, Döllinger M. Laryngeal Pressure Estimation With a Recurrent Neural Network. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2018; 7:2000111. [PMID: 30680252 PMCID: PMC6331197 DOI: 10.1109/jtehm.2018.2886021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/24/2018] [Accepted: 11/30/2018] [Indexed: 11/24/2022]
Abstract
Quantifying the physical parameters of voice production is essential for understanding the process of phonation and can aid in voice research and diagnosis. As an alternative to invasive measurements, they can be estimated by formulating an inverse problem using a numerical forward model. However, high-fidelity numerical models are often computationally too expensive for this. This paper presents a novel approach to train a long short-term memory network to estimate the subglottal pressure in the larynx at massively reduced computational cost using solely synthetic training data. We train the network on synthetic data from a numerical two-mass model and validate it on experimental data from 288 high-speed ex vivo video recordings of porcine vocal folds from a previous study. The training requires significantly fewer model evaluations compared with the previous optimization approach. On the test set, we maintain a comparable performance of 21.2% versus previous 17.7% mean absolute percentage error in estimating the subglottal pressure. The evaluation of one sample requires a vanishingly small amount of computation time. The presented approach is able to maintain estimation accuracy of the subglottal pressure at significantly reduced computational cost. The methodology is likely transferable to estimate other parameters and training with other numerical models. This improvement should allow the adoption of more sophisticated, high-fidelity numerical models of the larynx. The vast speedup is a critical step to enable a future clinical application and knowledge of parameters such as the subglottal pressure will aid in diagnosis and treatment selection.
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Affiliation(s)
- Pablo Gómez
- Division of Phoniatrics and Pediatric AudiologyDepartment of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg91054ErlangenGermany
| | - Anne Schützenberger
- Division of Phoniatrics and Pediatric AudiologyDepartment of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg91054ErlangenGermany
| | - Marion Semmler
- Division of Phoniatrics and Pediatric AudiologyDepartment of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg91054ErlangenGermany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric AudiologyDepartment of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg91054ErlangenGermany
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19
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King RE, Steed K, Rivera AE, Wisco JJ, Thibeault SL. Magnetic resonance imaging quantification of dehydration and rehydration in vocal fold tissue layers. PLoS One 2018; 13:e0208763. [PMID: 30521642 PMCID: PMC6283588 DOI: 10.1371/journal.pone.0208763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/20/2018] [Indexed: 01/18/2023] Open
Abstract
Clinicians commonly recommend increased hydration to patients with voice disorders. However, effects on clinical voice outcome measures have been inconsistent. Hydration-induced change within different layers of vocal fold tissue is currently unknown. Magnetic Resonance Imaging (MRI) is a promising method of noninvasively measuring water content in vocal folds. We sought to image and quantify changes in water content within vocal fold mucosa and thyroarytenoid muscle after dehydration and rehydration. Excised porcine larynges were imaged using proton density (PD) weighted MRI (1) at baseline and (2) after immersion in one of five hypertonic, isotonic, or hypotonic solutions or in dry air. Larynges dehydrated in hypertonic solutions or dry air were rehydrated and imaged a third time. Scans revealed fluid-rich vocal fold mucosa that was distinct from muscle at baseline. Baseline normalized signal intensity in mucosa and muscle varied by left vs. right vocal fold (p < 0.01) and by anterior, middle, or posterior location (p < 0.0001). Intensity changes in the middle third of vocal fold mucosa differed by solution after immersion (p < 0.01). Hypertonic solutions dehydrated the middle third of mucosa by over 30% (p < 0.001). No difference from baseline was found in anterior or posterior mucosa or in muscle after immersion. No association was found between intensity change in mucosa and muscle after immersion. After rehydration, intensity did not differ by solution in any tissue, and was not different from baseline, but post-rehydration intensity was correlated with post-immersion intensity in both mucosa and muscle (p < 0.05), suggesting that degree of change in vocal fold water content induced by hypertonic solutions ex vivo persists after rehydration. These results indicate that PD-MRI can be used to visualize large mammalian vocal fold tissue layers and to quantify changes in water content within vocal fold mucosa and thyroarytenoid muscle independently.
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Affiliation(s)
- Renee E. King
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Kevin Steed
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah, United States of America
| | - Ana E. Rivera
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- School of Medicine, Ponce Health Sciences University, Ponce, Puerto Rico, United States of America
| | - Jonathan J. Wisco
- Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah, United States of America
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Neurobiology and Anatomy, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Susan L. Thibeault
- Division of Otolaryngology, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
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Deshpande N, Peretti G, Mora F, Guastini L, Lee J, Barresi G, Caldwell DG, Mattos LS. Design and Study of a Next-Generation Computer-Assisted System for Transoral Laser Microsurgery. OTO Open 2018; 2:2473974X18773327. [PMID: 30480214 PMCID: PMC6239143 DOI: 10.1177/2473974x18773327] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/30/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023] Open
Abstract
Objective To present a new computer-assisted system for improved usability, intuitiveness, efficiency, and controllability in transoral laser microsurgery (TLM). Study Design Pilot technology feasibility study. Setting A dedicated room with a simulated TLM surgical setup: surgical microscope, surgical laser system, instruments, ex vivo pig larynxes, and computer-assisted system. Subjects and Methods The computer-assisted laser microsurgery (CALM) system consists of a novel motorized laser micromanipulator and a tablet- and stylus-based control interface. The system setup includes the Leica 2 surgical microscope and the DEKA HiScan Surgical laser system. The system was validated through a first-of-its-kind observational study with 57 international surgeons with varied experience in TLM. The subjects performed real surgical tasks on ex vivo pig larynxes in a simulated TLM scenario. The qualitative aspects were established with a newly devised questionnaire assessing the usability, efficiency, and suitability of the system. Results The surgeons evaluated the CALM system with an average score of 6.29 (out of 7) in ease of use and ease of learning, while an average score of 5.96 was assigned for controllability and safety. A score of 1.51 indicated reduced workload for the subjects. Of 57 subjects, 41 stated that the CALM system allows better surgical quality than the existing TLM systems. Conclusions The CALM system augments the usability, controllability, and efficiency in TLM. It enhances the ergonomics and accuracy beyond the current state of the art, potentially improving the surgical safety and quality. The system offers the intraoperative automated scanning of customized long incisions achieving uniform resections at the surgical site.
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Affiliation(s)
- Nikhil Deshpande
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology, Università degli Studi di Genova, Genova, Italy
| | - Francesco Mora
- Department of Otorhinolaryngology, Università degli Studi di Genova, Genova, Italy
| | - Luca Guastini
- Department of Otorhinolaryngology, Università degli Studi di Genova, Genova, Italy
| | - Jinoh Lee
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Giacinto Barresi
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Darwin G Caldwell
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genova, Italy
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Chauhan M, Deshpande N, Pacchierotti C, Meli L, Prattichizzo D, Caldwell DG, Mattos LS. A robotic microsurgical forceps for transoral laser microsurgery. Int J Comput Assist Radiol Surg 2018; 14:321-333. [PMID: 30465304 DOI: 10.1007/s11548-018-1887-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/06/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE In transoral laser microsurgery (TLM), the close curved cylindrical structure of the laryngeal region offers functional challenges to surgeons who operate on its malignancies with rigid, single degree-of-freedom (DOF) forceps. These challenges include surgeon hand tremors, poor reachability, poor tissue surface perception, and reduced ergonomy in design. The integrated robotic microsurgical forceps presented here is capable of addressing the above challenges through tele-operated tissue manipulation in TLM. METHODS The proposed device is designed in compliance with the spatial constraints in TLM. It incorporates a novel 2-DOF motorized microsurgical forceps end-effector, which is integrated with a commercial 6-DOF serial robotic manipulator. The integrated device is tele-operated through the haptic master interface, Omega.7. The device is augmented with a force sensor to measure tissue gripping force. The device is called RMF-2F, i.e. robotic microsurgical forceps with 2-DOF end-effector and force sensing. RMF-2F is evaluated through validation trials and pick-n-place experiments with subjects. Furthermore, the device is trialled with expert surgeons through preliminary tasks in a simulated surgical scenario. RESULTS RMF-2F shows a motion tracking error of less than 400 μm. User trials demonstrate the device's accuracy in task completion and ease of manoeuvrability using the Omega.7 through improved trajectory following and execution times. The tissue gripping force shows better regulation with haptic feedback (1.624 N) than without haptic feedback (2.116 N). Surgeons positively evaluated the device with appreciation for improved access in the larynx and gripping force feedback. CONCLUSIONS RMF-2F offers an ergonomic and intuitive interface for intraoperative tissue manipulation in TLM. The device performance, usability, and haptic feedback capability were positively evaluated by users as well as expert surgeons. RMF-2F introduces the benefits of robotic teleoperation including, (i) overcoming hand tremors and wrist excursions, (ii) improved reachability and accuracy, and (iii) tissue gripping feedback for safe tissue manipulation.
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Affiliation(s)
- Manish Chauhan
- STORM Lab, School of Electronics and Electrical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - Nikhil Deshpande
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30, 16163, Genoa, Italy.
| | - Claudio Pacchierotti
- Centre National de la Recherche Scientifique (CNRS), Rainbow Team, Irisa and Inria Rennes Bretagne Atlantique, 35000, Rennes, France
| | - Leonardo Meli
- Department of Information Engineering and Mathematics, Università degli Studi di Siena, Via Roma 56, 53100, Siena, Italy
| | - Domenico Prattichizzo
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30, 16163, Genoa, Italy
- Department of Information Engineering and Mathematics, Università degli Studi di Siena, Via Roma 56, 53100, Siena, Italy
| | - Darwin G Caldwell
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30, 16163, Genoa, Italy
| | - Leonardo S Mattos
- Department of Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego 30, 16163, Genoa, Italy
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Langerman J, Doukas SG, Hasegawa H, Goodrich J, Lerner M, Sasaki C. In search of a longitudinal animal model of evoked swallow function. Laryngoscope Investig Otolaryngol 2018; 3:191-197. [PMID: 30062134 PMCID: PMC6057227 DOI: 10.1002/lio2.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 11/12/2022] Open
Abstract
Background A malfunction or impairment of swallow function can potentiate aspiration events and interfere with both quality of life and survival. Establishing an animal model for swallow research would provide a better understanding of its pathophysiology and would also allow for the development and validation of physiologically based clinical interventions to improve swallow function. Two requirements define the ideal model for longitudinal exploration: 1) identification of species similar to human in form and function; and 2) provision for reliable and reproducible evoked swallow under general anesthesia and one that would also support a longitudinal study design. Objective We hypothesize that an anesthetized porcine model under dexmedetomidine-based or ketamine-based anesthesia will support a reproducible and stable evoked swallow response. Methods Seven neutered male Yorkshire pigs were anesthetized using combinations of dexmedetomidine-based or ketamine-based anesthesia for induction and maintenance of anesthesia during the experimental portion of our study. Single stimulation of iSLN or vagus nerve, bilateral simultaneous single stimulation of iSLN or vagus nerve, and stimulus trains applied to afferent nerves were performed. Results None of the seven pigs demonstrated evoked swallow events, both during inhalational anesthesia (1.0 MAC) or during post-washout intravenous anesthesia (dexmedetomidine, ketamine/fentanyl or ketamine alone). Conclusion Our results support a high degree of organizational neurophysiologic complexity characterizing the swallow reflex and highlight the challenges and limitations of intraoperative study in survival models. Level of Evidence NA Laryngoscope, 2018.
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Affiliation(s)
- Jared Langerman
- Yale University School of Medicine New Haven Connecticut U.S.A
| | | | | | - James Goodrich
- Yale University School of Medicine New Haven Connecticut U.S.A
| | - Michael Lerner
- Yale University School of Medicine New Haven Connecticut U.S.A.,Albert Einstein College of Medicine Bronx New York U.S.A
| | - Clarence Sasaki
- Yale University School of Medicine New Haven Connecticut U.S.A
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Comparative Anatomy of Pig Arytenoid Cartilage and Human Arytenoid Cartilage. J Voice 2018; 33:620-626. [PMID: 30017432 DOI: 10.1016/j.jvoice.2018.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/20/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aims to investigate the feasibility of pig arytenoid cartilage as an animal model for simulating arytenoidectomy under microlaryngoscope by comparing the similarities and differences between pig arytenoid cartilage and human arytenoid cartilage. STUDY DESIGN This is a methodological study on the excised pig arytenoid cartilage and human arytenoid cartilage. METHODS Five excised human adult cadaver larynges and five adult excised porcine larynges were dissected and all the soft tissue and mucous membrane attached to the arytenoid and cricoarytenoid joint were removed. The anatomical structure and morphology of the arytenoid cartilage were observed and measured with a vernier caliper. Measurements included cricoarytenoid articular facet major and minor diameter, cricoarytenoid articular facet center distance, cricoarytenoid facet major and minor diameter, length of vocal process and muscular process, and distance between tip of vocal process, muscular process, and junction/apex of arytenoid cartilage. Data were then compared across these major anatomic markers using student t test. RESULTS The gross anatomy of the pig arytenoid cartilage was similar to the human. However, the size of the pig larynx arytenoid cartilage was obviously larger in total, and there was statistical significance for almost all measurements (P < 0.05), except the mean value of cricoarytenoid articular facet center distance, the cricoarytenoid facet minor diameter, and the length of vocal process of pig and human, without statistically significant difference (P > 0.05). Moreover, the biggest differences between the pig arytenoid cartilage and the human arytenoid cartilage were that the pig arytenoid cartilage apex had the angle winding structure toward the back, and that the posterior part of the bilateral arytenoid cartilages was partially connected. Whereas after the angle winding was removed from the junction, pig arytenoid cartilage and human arytenoid cartilage were shaped both like a triangular pyramid. CONCLUSION The data of this metric comparative study indicate that pig arytenoid, after resecting the angle winding structure and incising the interarytenoid cartilage, is similar to the human's. Therefore, pig larynx is an appropriate experimental model for endoscopic arytenoidectomy. In addition, regarding the pig laryngeal angle winding structure, we still require further basic and clinical research to clarify its physiological function and significance.
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Friedrich D, Modes V, Hoffmann T, Greve J, Schuler P, Burgner-Kahrs J. Teleoperated tubular continuum robots for transoral surgery - feasibility in a porcine larynx model. Int J Med Robot 2018; 14:e1928. [DOI: 10.1002/rcs.1928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 04/16/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Affiliation(s)
- D.T. Friedrich
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - V. Modes
- Laboratory for Continuum Robotics; Leibniz Universität Hannover; Hanover Germany
| | - T.K. Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - J. Greve
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - P.J. Schuler
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery; Ulm University Medical Center; Ulm Germany
| | - J. Burgner-Kahrs
- Laboratory for Continuum Robotics; Leibniz Universität Hannover; Hanover Germany
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Zhang C, Paddock K, Chou A, Scholp A, Gong T, Jiang JJ. Prolonged phonation impairs the integrity and barrier function of porcine vocal fold epithelium: a preliminary study. Eur Arch Otorhinolaryngol 2018; 275:1547-1556. [PMID: 29671091 DOI: 10.1007/s00405-018-4973-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/11/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Voice abuse is known to be a common risk factor of voice disorders and prolonged; high-intensity phonation has been shown to damage the vocal fold epithelium. We aim to evaluate the effects of phonation on the integrity and barrier function of vocal fold epithelium using a porcine laryngeal model. METHODS Ex vivo porcine larynges were phonated at low intensity or high intensity for 15, 30, or 60 min within 4 h after harvest. Vocal fold epithelium was visualized using transmission electron microscopy (TEM). The barrier function of vocal fold epithelium was evaluated by measuring the permeability to model molecules, fluorescein (376 Da), and fluorescein isothiocyanate (FITC)-dextrans of 4000 and 10,000 Da (FD4, FD10), in a Franz diffusing cell. RESULTS Cell death and dilated intercellular space after phonation were observed using TEM. Thickness of vocal fold epithelium was significantly reduced after low-intensity phonation for 30 and 60 min and high-intensity phonation for 15, 30, and 60 min. Epithelial permeability to fluorescein was significantly increased after low-intensity phonation for 30 and 60 min, and high-intensity phonation. Permeability to FD4 was significantly increased after high-intensity phonation for 30 and 60 min. Phonation did not alter the permeability to FD10 significantly. CONCLUSION Long-duration phonation destroys the integrity and barrier function of vocal fold epithelium. These effects likely make vocal folds more vulnerable to other environmental irritants, such as tobacco smoke, reflux components, allergens, and inhaled pollutants. Destroyed barrier function may be an important factor in the pathogenesis of voice lesions related to voice abuse.
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Affiliation(s)
- Chi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Kieran Paddock
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Adriana Chou
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Austin Scholp
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Ting Gong
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Jack J Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA.
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GARCIA MAXIME, HERBST CHRISTIANT. Excised larynx experimentation: history, current developments, and prospects for bioacoustic research. ANTHROPOL SCI 2018. [DOI: 10.1537/ase.171216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- MAXIME GARCIA
- ENES Lab, Université Lyon/Saint-Etienne, Neuro-PSI, CNRS UMR 9197, Saint-Etienne
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Gómez P, Schützenberger A, Kniesburges S, Bohr C, Döllinger M. Physical parameter estimation from porcine ex vivo vocal fold dynamics in an inverse problem framework. Biomech Model Mechanobiol 2017; 17:777-792. [DOI: 10.1007/s10237-017-0992-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 11/30/2017] [Indexed: 11/28/2022]
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Durkes A, Sivasankar MP. A Method to Administer Agents to the Larynx in an Awake Large Animal. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:3171-3176. [PMID: 29098280 PMCID: PMC5945077 DOI: 10.1044/2017_jslhr-s-17-0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/12/2017] [Accepted: 04/17/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE This research note describes an adapted experimental methodology to administer an exogenous agent to the larynx and upper airway of awake animals. The exogenous agent could be a perturbation. In the current study, the agent was isotonic saline. Isotonic saline was selected because it is safe, of similar composition to extracellular fluid, and used in voice studies. The described approach allowed large animals such as pigs to be comfortably restrained without chemical sedation or anesthesia for extended periods while receiving the agent. METHOD Six Sinclair pigs were successfully trained with positive reinforcement to voluntarily enter and then be restrained in a Panepinto Sling. Once restrained, the pigs accepted a nose cone that delivered nebulized isotonic saline. This procedure was repeated 3 times per day for 20 days. At the end of the study, the larynx and airway tissues were excised and examined using histology and transmission electron microscopy. RESULTS Pathology related to the procedure (i.e., nebulized inhaled isotonic saline or stress) was not identified in any examined tissues. CONCLUSIONS This methodology allowed for repeated application of exogenous agents to awake, unstressed animals. This method can be used repeatedly in the laboratory to test various therapeutics for safety, toxicity, and dosage. Future studies will specifically manipulate the type of agent to further our understanding of laryngeal pathobiology.
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Affiliation(s)
- Abigail Durkes
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN
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Xu CC, Chan RW, Sun H, Zhan X. A mixed-effects model approach for the statistical analysis of vocal fold viscoelastic shear properties. J Mech Behav Biomed Mater 2017; 75:477-485. [PMID: 28823902 PMCID: PMC6486179 DOI: 10.1016/j.jmbbm.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/25/2017] [Accepted: 08/03/2017] [Indexed: 11/26/2022]
Abstract
A mixed-effects model approach was introduced in this study for the statistical analysis of rheological data of vocal fold tissues, in order to account for the data correlation caused by multiple measurements of each tissue sample across the test frequency range. Such data correlation had often been overlooked in previous studies in the past decades. The viscoelastic shear properties of the vocal fold lamina propria of two commonly used laryngeal research animal species (i.e. rabbit, porcine) were measured by a linear, controlled-strain simple-shear rheometer. Along with published canine and human rheological data, the vocal fold viscoelastic shear moduli of these animal species were compared to those of human over a frequency range of 1-250Hz using the mixed-effects models. Our results indicated that tissues of the rabbit, canine and porcine vocal fold lamina propria were significantly stiffer and more viscous than those of human. Mixed-effects models were shown to be able to more accurately analyze rheological data generated from repeated measurements.
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Affiliation(s)
- Chet C Xu
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; Graduate Program in Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - Roger W Chan
- Department of Speech Language Pathology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Han Sun
- Department of Quantitative Health Sciences, the Cleveland Clinic Foundation, Cleveland, OH, 44195, USA; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Xiaowei Zhan
- Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
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Chávez KV, Barajas EM, Soroa F, Gamboa-Dominguez A, Ordóñez S, Pantoja JP, Sierra M, Velázquez-Fernández D, Herrera MF. Safety assessment of the use of ultrasonic energy in the proximity of the recurrent laryngeal nerve in a porcine model. Am J Surg 2017. [PMID: 28622836 DOI: 10.1016/j.amjsurg.2017.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Advanced bipolar and ultrasonic energy have demonstrated reduction of operating time and blood loss in thyroidectomy. However, these devices generate heat and thermal dispersion that may damage adjacent structures such as the recurrent laryngeal nerve (RLN). This study was designed to evaluate the safety profile of the Harmonic Focus+® (HF+) device through the evaluation of thermal injury to the RLN using different algorithms of distance and time with state of the art technology. METHODS 25 Vietnamese pigs underwent activation of HF+ in the proximity of their RLN. They were divided into 4 groups according to activation distance (3 mm, 2 mm, 1 mm and on the RLN). Time of activation, time between tones of the ultrasonic generator, changes in the electromyographic signal using continuous nerve neuromonitoring, vocal fold mobility assessed by direct laryngoscopy and histological thermal damaged were evaluated. RESULTS None of the pigs had loss of signal in the electromyography during the procedure; only one pig had isolated transient decrease in amplitude and one increase in latency. One pig had transient vocal fold paresis in the group with activation on the nerve. Evaluation of the nerves by histology and immunohistochemistry did not show significant changes attributed to thermal injury. CONCLUSIONS The use of ultrasonic energy close to the RLN is safe, provided that activation time does not exceed the necessary time to safely transect the tissue.
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Affiliation(s)
- Karla V Chávez
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Elpidio M Barajas
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Francisco Soroa
- Service of Otolaryngology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Armando Gamboa-Dominguez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Samuel Ordóñez
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan P Pantoja
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mauricio Sierra
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - David Velázquez-Fernández
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Miguel F Herrera
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Mills RD, Dodd K, Ablavsky A, Devine E, Jiang JJ. Parameters From the Complete Phonatory Range of an Excised Rabbit Larynx. J Voice 2017; 31:517.e9-517.e17. [PMID: 28108153 DOI: 10.1016/j.jvoice.2016.12.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/24/2016] [Accepted: 12/28/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aims to collect data throughout the complete phonatory range using rabbit larynges. STUDY DESIGN This is a methodological excised rabbit larynx study. METHODS Seven rabbit larynges were dissected and mounted on a modified excised laryngeal apparatus. Phonation was initiated at phonation threshold pressure (PTP) and airflow was increased by consistent increments until phonation instability pressure (PIP) was reached. At each airflow level, aerodynamic measurements, acoustic recordings, and high-speed videos were recorded. This procedure was repeated at multiple elongation conditions to further explore the parameters. Data were then compared across subjects and elongation conditions. RESULTS At PTP, subglottal pressure, fundamental frequency, and sound pressure level were found to increase significantly as elongation was increased. As elongation was increased at PIP, airflow was found to significantly decrease, whereas fundamental frequency was found to significantly increase. Vibratory amplitude decreased at both PTP and PIP as elongation increased. Also, as elongation increased, the range of all parameters was found to decrease significantly. CONCLUSIONS The results obtained, combined with the similarities of the histologic structure of the vocal fold lamina propria between rabbits and humans, validate the rabbit larynx as an effective and reliable model for tissue inflammation studies.
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Affiliation(s)
- Randal D Mills
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Keith Dodd
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Alex Ablavsky
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Erin Devine
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.
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Dion GR, Coelho PG, Teng S, Janal MN, Amin MR, Branski RC. Dynamic nanomechanical analysis of the vocal fold structure in excised larynges. Laryngoscope 2016; 127:E225-E230. [PMID: 27873325 DOI: 10.1002/lary.26410] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/27/2016] [Accepted: 10/10/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Quantification of clinical outcomes after vocal fold (VF) interventions is challenging with current technology. High-speed digital imaging and optical coherence tomography (OCT) of excised larynges assess intact laryngeal function, but do not provide critical biomechanical information. We developed a protocol to quantify tissue properties in intact, excised VFs using dynamic nanomechanical analysis (nano-DMA) to obtain precise biomechanical properties in the micrometer scale. STUDY DESIGN Experimental animal study. METHODS Three pig larynges were bisected in the sagittal plane, maintaining an intact anterior commissure, and subjected to nano-DMA at nine locations with a 250-μm flat-tip punch and frequency sweep load profile (10-105 Hz, 1,000 μN peak force) across the free edge of the VF and inferiorly along the conus elasticus. RESULTS Storage, loss, and complex moduli increased inferiorly from the free edge. Storage moduli increased from a mean of 32.3 kPa (range, 6.5-55.38 kPa) at the free edge to 46.3kPa (range, 7.4-71.6) 5 mm below the free edge, and 71.4 kPa (range, 33.7-112 kPa) 1 cm below the free edge. Comparable values were 11.6 kPa (range, 5.0-20.0 kPa), 16.7 kPa (range, 5.7-26.8 kPa), and 22.6 kPa (range, 9.7-38.0 kPa) for loss modulus, and 35.7 kPa (range, 14.4-56.4 kPa), 50.1 kPa (range, 18.7-72.8 kPa), and 75.4 kPa (range, 42.0-116.0 kPa) for complex modulus. Another larynx repeatedly frozen and thawed during technique development had similarly increased storage, loss, and complex modulus trends across locations. CONCLUSIONS Nano-DMA of the intact hemilarynx provides a platform for quantification of biomechanical responses to a myriad of therapeutic interventions to complement data from high-speed imaging and OCT. LEVEL OF EVIDENCE NA Laryngoscope, 127:E225-E230, 2017.
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Affiliation(s)
- Gregory R Dion
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, New York, U.S.A
| | - Stephanie Teng
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Malvin N Janal
- Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, New York, U.S.A
| | - Milan R Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
| | - Ryan C Branski
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, New York, U.S.A
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Wu CW, Randolph GW, Lu IC, Chang PY, Chen YT, Hun PC, Lin YC, Dionigi G, Chiang FY. Intraoperative neural monitoring in thyroid surgery: lessons learned from animal studies. Gland Surg 2016; 5:473-480. [PMID: 27867861 PMCID: PMC5106378 DOI: 10.21037/gs.2016.09.06] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/09/2016] [Indexed: 12/31/2022]
Abstract
Recurrent laryngeal nerve (RLN) injury remains a significant morbidity associated with thyroid and parathyroid surgery. In the past decade, surgeons have increasingly used intraoperative neural monitoring (IONM) as an adjunct technique for localizing and identifying the RLN, detecting RLN injury, and predicting the outcome of vocal cord function. In recent years, many animal studies have investigated common pitfalls and new applications of IONM. For example, the use of IONM technology in animal models has proven valuable in studies of the electrophysiology of RLN injury. The advent of animal studies has substantially improved understanding of IONM technology. Lessons learned from animal studies have immediate clinical applications in establishing reliable strategies for preventing intraoperative RLN injury. This article gives an overview of the research progress on IONM-relevant animal models.
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Affiliation(s)
- Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Laryngology and Otology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA
| | - I-Cheng Lu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pi-Ying Chang
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Ting Chen
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pao-Chu Hun
- Laboratory Animal Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Chu Lin
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gianlorenzo Dionigi
- 1 Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Autologous fat injection therapy including a high concentration of adipose-derived regenerative cells in a vocal fold paralysis model: animal pilot study. The Journal of Laryngology & Otology 2016; 130:914-922. [PMID: 27604559 DOI: 10.1017/s0022215116008707] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To verify the effectiveness and safety of the addition of adipose-derived regenerative cells to autologous fat injection therapy. METHODS Unilateral vocal fold paralysis models were made by cutting the right recurrent laryngeal nerve in two pigs. At day 30, 0.5 ml adipose-derived regenerative cells mixed with 1 ml autologous fat was injected into the right vocal fold of one pig, with the other receiving 0.5 ml Ringer's solution mixed with 1 ml autologous fat. At day 120, fibrescopy, laser Doppler flowmeter, computed tomography, vocal function evaluation and histological assessment were conducted. RESULTS Although histological assessment revealed atrophy of the thyroarytenoid muscle fibre in both pigs, there was remarkable hypertrophy of the thyroarytenoid muscle fibre in the area surrounding the adipose-derived regenerative cells injection site. CONCLUSION The addition of a high concentration of adipose-derived regenerative cells to autologous fat injection therapy has the potential to improve the treatment outcome for unilateral vocal fold paralysis.
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Mattioli F, Presutti L, Caversaccio M, Bonali M, Anschuetz L. Novel Dissection Station for Endolaryngeal Microsurgery and Laser Surgery: Development and Dissection Course Experience. Otolaryngol Head Neck Surg 2016; 156:1136-1141. [DOI: 10.1177/0194599816668324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective We aimed to develop and validate an ex vivo dissection station for endolaryngeal surgery suitable for different kinds of laryngeal specimen and any type of operating technique (CO2 laser, cold instruments by endoscopic or microscopic techniques). Study Design Experimental construction and validation of a highly specialized dissection station. Setting Laboratory and international dissection course. Methods We designed a lightweight dissection station made of polycarbonate resin approved for use with a CO2 laser. The cylindrical box hosts an articulated laryngeal support. The laryngoscope is positioned on an articulated arm, which is fixed on the construction’s footplate. Validation of the larynx box was performed during an international dissection course on laryngeal surgery held in January 2016. Results We assessed the suitability of our novel dissection station among specialized laryngologists with a mean experience of 14 years. Feedback from the participants was very positive, with a mean general impression of 9.5 (out of 10 points) and a recommendation score of 9.6 for further use. Its utility in transforming the taught surgical steps into daily practice has been highly recognized, with a score of 9.5. Conclusion The lightweight and transparent larynx box is suitable for any kind of laryngeal specimen, and any surgical intervention can be taught at reasonable cost. It is safe and suitable for use with CO2 lasers. Validation among experienced surgeons revealed its suitability in the teaching of endolaryngeal microsurgery and laser surgery.
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Affiliation(s)
- Francesco Mattioli
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Marco Caversaccio
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Marco Bonali
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Modena, Modena, Italy
| | - Lukas Anschuetz
- Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Modena, Modena, Italy
- Department of Otorhinolaryngology–Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
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Ahmed MM, Connor MP, Palazzolo M, Thompson ME, Lospinoso J, O'Connor P, Howard NS, Maturo SC. Effect of high-dose vocal fold injection of cidofovir and bevacizumab in a porcine model. Laryngoscope 2016; 127:671-675. [DOI: 10.1002/lary.26185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 05/16/2016] [Accepted: 06/23/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Mostafa. M. Ahmed
- San Antonio Military Medical Center; Fort Sam Houston; San Antonio Texas U.S.A
| | - Matthew. P. Connor
- San Antonio Military Medical Center; Fort Sam Houston; San Antonio Texas U.S.A
| | - Mitzi Palazzolo
- San Antonio Military Medical Center; Fort Sam Houston; San Antonio Texas U.S.A
| | - Michelle E. Thompson
- Wilford Hall USAF Medical Center; Lackland Air Force Base; San Antonio Texas U.S.A
| | - Josh Lospinoso
- Portia Statistical Consulting LLC; San Antonio Texas U.S.A
| | - Peter O'Connor
- San Antonio Military Medical Center; Fort Sam Houston; San Antonio Texas U.S.A
| | - N. Scott Howard
- San Antonio Military Medical Center; Fort Sam Houston; San Antonio Texas U.S.A
| | - Stephen. C. Maturo
- San Antonio Military Medical Center; Fort Sam Houston; San Antonio Texas U.S.A
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Woo JH, King SN, Hoffman H, Dailey S, Wang S, Christensen MB, Thibeault SL. MERS versus Standard Surgical Approaches for Porcine Vocal Fold Scarring with Adipose Stem Cell Constructs. Otolaryngol Head Neck Surg 2016; 155:612-23. [PMID: 27165681 DOI: 10.1177/0194599816645772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cells, scaffold, and surgical approaches are important for regeneration of the lamina propria of the scarred vocal fold (VF). Microendoscopy of Reinke's space (MERS) is a surgical approach used to access the lamina propria. The present study evaluated MERS in the treatment of VF scarring as compared with standardized approaches for the treatment of VF scarring with adipose stem cell constructs. STUDY DESIGN Animal study. SETTING Academic center. SUBJECTS AND METHODS VF injury was performed bilaterally to induce scarring in 20 pigs. Eight weeks after injury, pigs were classified into no treatment, minithyrotomy, VF injection, VF incision/dissection, and MERS. All groups (except control) were implanted with adipose stem cell and hyaluronan. Four weeks after treatment, histology for collagen, hyaluronan, and fibronectin; mRNA expression for α-smooth muscle actin, tumor growth factor β1, collagen 1α1, collagen 3α1, matrix metalloproteinase 2, basic fibroblast growth factor, and hepatocyte growth factor; and tissue rheology were evaluated. RESULTS Differences were measured among surgical approaches for protein levels of collagen, hyaluronan, and fibronectin (P = .0133, P < .0001, and P = .0025, respectively). Fibroblast growth factor, collagen 1α1, and matrix metalloproteinase 2 transcript levels were different among treatment groups (P = .003, P = .0086, and P = .014, respectively), while no differences were measured for α-smooth muscle actin, tumor growth factor β1, hepatocyte growth factor, and collagen 3α1. Rheologically, significant differences were not measured between groups. CONCLUSION MERS is a promising surgical approach for the treatment of VF scarring, optimizing the placement of implanted biomaterials.
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Affiliation(s)
- Joo Hyun Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Suzanne N King
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Henry Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Seth Dailey
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sarah Wang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Dion GR, Jeswani S, Roof S, Fritz M, Coelho PG, Sobieraj M, Amin MR, Branski RC. Functional assessment of the ex vivo vocal folds through biomechanical testing: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 64:444-453. [PMID: 27127075 DOI: 10.1016/j.msec.2016.04.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 03/21/2016] [Accepted: 04/06/2016] [Indexed: 11/25/2022]
Abstract
The human vocal folds are complex structures made up of distinct layers that vary in cellular and extracellular composition. The mechanical properties of vocal fold tissue are fundamental to the study of both the acoustics and biomechanics of voice production. To date, quantitative methods have been applied to characterize the vocal fold tissue in both normal and pathologic conditions. This review describes, summarizes, and discusses the most commonly employed methods for vocal fold biomechanical testing. Force-elongation, torsional parallel plate rheometry, simple-shear parallel plate rheometry, linear skin rheometry, and indentation are the most frequently employed biomechanical tests for vocal fold tissues and each provide material properties data that can be used to compare native tissue to diseased or treated tissue. Force-elongation testing is clinically useful, as it allows for functional unit testing, while rheometry provides physiologically relevant shear data, and nanoindentation permits micrometer scale testing across different areas of the vocal fold as well as whole organ testing. Thoughtful selection of the testing technique during experimental design to evaluate a hypothesis is critical to optimize biomechanical testing of vocal fold tissues.
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Affiliation(s)
- Gregory R Dion
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Seema Jeswani
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Scott Roof
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Mark Fritz
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States
| | - Michael Sobieraj
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, United States
| | - Milan R Amin
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States
| | - Ryan C Branski
- NYU Voice Center, Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, United States.
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Chan CY, Lau DPC. Simulators and models for laryngeal laser surgery and laser myringotomy. Laryngoscope 2015; 126:2089-91. [PMID: 26690962 DOI: 10.1002/lary.25817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Ching Yee Chan
- Department of Otolaryngology, Singapore General Hospital, Singapore
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Hughes OR, Ayling SM, Birchall MA. Innate Immune Response of the Pig Laryngeal Mucosa to Endotracheal Intubation. Otolaryngol Head Neck Surg 2015; 154:138-43. [PMID: 26567047 DOI: 10.1177/0194599815617125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/23/2015] [Indexed: 12/17/2022]
Abstract
Objective The aim of this study was to measure the effects of endotracheal intubation on innate immune response within the pig laryngeal mucosa. Study Design Prospective controlled basic science study. Setting The animal experiments and analyses were conducted at the University of Bristol. Samples and Methods Eighteen pigs, matched at the major histocompatibility complex (MHC), were used in the study. The pigs were divided into 9 pairs. One of each pair (9 pigs in total) was intubated with an endotracheal tube under general anesthesia for 90 minutes. Two days later, pinch biopsies were taken from the supraglottis (specifically the false cords) and subglottis of both pigs. The experiment was repeated 8 more times. Based on quantitative immunohistochemistry, percentage areas of positive staining for CD172a, CD163, MHC class II, CD14, and CD16 were calculated separately for the epithelium and lamina propria of each biopsy. Results Total areas of laryngeal mucosa (epithelium and lamina propria) expressing CD172a and coexpressing CD163 and CD172a were significantly reduced at 2 days following endotracheal intubation ( P = .039 and P = .037, respectively). MHC class II expression and MHC class II coexpression with CD172a were similarly reduced following intubation ( P = .003 and P = .005, respectively). In the supraglottis, MHC class II coexpression with CD16 and CD14 was also reduced following endotracheal intubation ( P = .037). Conclusions Our results indicate that endotracheal intubation reduces the number of innate immune cells within the upper airway mucosa. This may be an important first step in a cascade leading to chronic wound and scar formation causing airway stenosis.
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Affiliation(s)
- Owain R. Hughes
- Molecular Immunology Unit, Institute of Child Health, University College London, London, UK
| | - Sarah M. Ayling
- Department of Geography and Environmental Management, University of the West of England, Bristol, UK
| | - Martin A. Birchall
- Department of Otorhinolaryngology–Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, and University College London, London, UK
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Stevens KA, Thomson SL, Jetté ME, Thibeault SL. Quantification of Porcine Vocal Fold Geometry. J Voice 2015; 30:416-26. [PMID: 26292797 DOI: 10.1016/j.jvoice.2015.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/18/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to quantify porcine vocal fold medial surface geometry and three-dimensional geometric distortion induced by freezing the larynx, especially in the region of the vocal folds. STUDY DESIGN The medial surface geometries of five excised porcine larynges were quantified and reported. METHODS Five porcine larynges were imaged in a micro-CT scanner, frozen, and rescanned. Segmentations and three-dimensional reconstructions were used to quantify and characterize geometric features. Comparisons were made with geometry data previously obtained using canine and human vocal folds as well as geometries of selected synthetic vocal fold models. RESULTS Freezing induced an overall expansion of approximately 5% in the transverse plane and comparable levels of nonuniform distortion in sagittal and coronal planes. The medial surface of the porcine vocal folds was found to compare reasonably well with other geometries, although the compared geometries exhibited a notable discrepancy with one set of published human female vocal fold geometry. CONCLUSIONS Porcine vocal folds are qualitatively geometrically similar to data available for canine and human vocal folds, as well as commonly used models. Freezing of tissue in the larynx causes distortion of around 5%. The data can provide direction in estimating uncertainty due to bulk distortion of tissue caused by freezing, as well as quantitative geometric data that can be directly used in developing vocal fold models.
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Affiliation(s)
- Kimberly A Stevens
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah
| | - Scott L Thomson
- Department of Mechanical Engineering, Brigham Young University, Provo, Utah.
| | - Marie E Jetté
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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Durkes A, Sivasankar MP. In vivo investigation of acidified pepsin exposure to porcine vocal fold epithelia. Laryngoscope 2015; 126:E12-7. [PMID: 26153224 DOI: 10.1002/lary.25478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/07/2015] [Accepted: 06/08/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVES/HYPOTHESIS The study objective was to investigate epithelial changes in response to direct, repeated, acidified pepsin exposures in an in vivo porcine model. We hypothesized that 12 acidified pepsin applications to simulate reflux would elicit a vocal fold response characterized by inflammation, epithelial proliferation, and increased intercellular space, as well as changes in the gene expression of epithelial junctional proteins, ion transporter proteins, and proinflammatory cytokines. STUDY DESIGN Prospective, in vivo study. METHODS Pigs received acidified pepsin (pH = 4) or saline (sham) applied directly to vocal folds. Larynges were collected following three exposures per week for 4 weeks. Vocal fold tissue morphology, collagen, and elastin were evaluated histologically. Gene expression of E-cadherin, zona occludens-1, cystic fibrosis transmembrane conductance regulator, epithelial sodium channel, interleukin-1β, tumor necrosis factor-α, and interferon-γ were measured. Ultrastructural alterations, epithelial intercellular space diameter, and microridge height were measured using transmission electron microscopy. RESULTS There were no significant differences in histology, gene transcripts, epithelial ultrastructure, intercellular space, and microridge height after acidified pepsin exposure. CONCLUSIONS Twelve simulated reflux challenges were insufficient to elicit epithelial changes, demonstrating the resistance of healthy vocal folds to direct, repeated acidified pepsin exposures. These data increase our understanding of healthy vocal fold defenses and lay the groundwork for a prospective, uninjured, nonsurgical, laryngopharyngeal reflux model where pigs can be exposed directly to acidified pepsin.
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Affiliation(s)
- Abigail Durkes
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, U.S.A
| | - M Preeti Sivasankar
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, U.S.A
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Lang A, Koch R, Rohn K, Gasse H. The histological components of the phoniatrical body-cover model in minipigs of different ages. PLoS One 2015; 10:e0128085. [PMID: 26018404 PMCID: PMC4446030 DOI: 10.1371/journal.pone.0128085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/22/2015] [Indexed: 12/02/2022] Open
Abstract
Pigs are models in human phoniatry. However, features of maturation and ageing have not been considered with regard to the so-called body-cover model in this species. Therefore, the glottis of “young” (2–3 months; n = 6) and “old” (4–7 years; n = 6) minipigs was investigated. Their cranial (CraF) and caudal (CauF) vocal folds were histomorphometrically and stratigraphically analysed with emphasis on their amounts of collagen structures and elastic fibres. A dense subepithelial layer (SEL) was a distinct feature of CraF and CauF of both age groups; it was spread upon the underlying loose, flexible “cover” like a fibro-elastic membrane. The “cover” was characterised by the so-called superficial layer (SL), which was distinctly loose in the “young” minipigs, but had a much denser texture in the “old” minipigs. Here, the SL was dominated by elastic fibres in the CraF, but was of mixed qualities (collagenous and elastic) in the CauF. The structural requirements for the SL’s function as a loose “cover” were thus met only in the “young” animals. A clearly demarcated intermediate layer (IL)—characterised by high amounts of elastic fibres (as in humans)—was only found in the CraF of the “young” animals. In the “old” animals, it had lost its demarcation. In the depth of the CraF of the “old” animals, many thick collagen fibre bundles were detected in a location equivalent to that of the vocal muscle in the CauF. The development of their large diameters was interpreted as part of the maturation process, thereby supporting the hypothesis of their functional importance as a component of the “body.” In the CauF, the amounts of collagen structures increased throughout the entire lamina propria, resulting in a loss of demarcated stratigraphical subdivisions in the “old” minipigs. This situation resembled that described in the vocal fold of geriatric humans.
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Affiliation(s)
- Anja Lang
- Institute of Anatomy, University of Veterinary Medicine Hannover, Hanover, Germany
- * E-mail:
| | - Rüdiger Koch
- Institute of Anatomy, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Karl Rohn
- Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Hanover, Germany
| | - Hagen Gasse
- Institute of Anatomy, University of Veterinary Medicine Hannover, Hanover, Germany
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Lang A, Koch R, Rohn K, Gasse H. Histomorphometric analysis of collagen and elastic fibres in the cranial and caudal fold of the porcine glottis. Anat Histol Embryol 2014; 44:186-99. [PMID: 24995486 DOI: 10.1111/ahe.12125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 05/05/2014] [Indexed: 11/28/2022]
Abstract
The porcine glottis differs from the human glottis in its cranial and caudal vocal folds (CraF, CauF). The fibre apparatus of these folds was studied histomorphometrically in adult minipigs. For object definition and quantification, the colour-selection tools of the Adobe-Photoshop program were used. Another key feature was the subdivision of the cross-sections of the folds into proportional subunits. This allowed a statistical analysis irrespective of differences in thickness of the folds. Both folds had a distinct, dense subepithelial layer equivalent to the basement membrane zone in humans. The subsequent, loose layer was interpreted - in principle - as being equivalent to Reinke's space of the human vocal fold. The next two layers were not clearly separated. Due to this, the concept of a true vocal ligament did not appear applicable to neither CauF nor CraF. Instead, the body-cover model was emphasized by our findings. The missing vocalis muscle in the CraF is substituted by large collagen fibre bundles in a proportional depth corresponding to the position of the muscle of the CauF. The distribution of elastic fibres made the CraF rather than the CauF more similar to the human vocal fold. We suggest that these data are useful for those wishing to use the porcine glottis as a model for studying oscillatory properties during phonation.
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Affiliation(s)
- A Lang
- Institute of Anatomy, University of Veterinary Medicine Hannover, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - R Koch
- Institute of Anatomy, University of Veterinary Medicine Hannover, Bischofsholer Damm 15, 30173 Hannover, Germany
| | - K Rohn
- Department of Biometry, Epidemiology and Information Processing, University of Veterinary Medicine Hannover, Bünteweg 2, 30559 Hannover, Germany
| | - H Gasse
- Institute of Anatomy, University of Veterinary Medicine Hannover, Bischofsholer Damm 15, 30173 Hannover, Germany
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Awan SN, Novaleski CK, Rousseau B. Nonlinear analyses of elicited modal, raised, and pressed rabbit phonation. J Voice 2014; 28:538-47. [PMID: 24836360 DOI: 10.1016/j.jvoice.2014.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 01/28/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to use nonlinear dynamic analysis methods such as phase space portraits and correlation dimension (D2) as well as descriptive spectrographic analyses to characterize acoustic signals produced during evoked rabbit phonation. METHODS Seventeen New Zealand white breeder rabbits were used to perform the study. A Grass S-88 stimulator (SA Instrumentation, Encinitas, CA) and constant current isolation unit (Grass Telefactor, model PSIU6; West Warwick, RI) were used to provide electrical stimulation to laryngeal musculature, and transglottal airflow rate and stimulation current (mA) were manipulated to elicit modal, raised intensity, and pressed phonations. Central 1 second portions of the most stable portion of the acoustic waveform for modal, raised intensity, and pressed phonations were edited and then analyzed via phase space portraits, Poincaré sections, and the estimation of the D2. In an attempt to limit the effects of the highly variable and nonstationary characteristics of some of the signals being analyzed, D2 analysis was also performed on the most stable central 200-millisecond portion of the acoustic waveform. Descriptive analysis of each phonation was also conducted using sound spectrograms. RESULTS Results showed that the complexity of phonation and the subsequent acoustic waveform is increased as transglottal airflow rate and degree of glottal adduction are manipulated in the evoked rabbit phonation model. In particular, phonatory complexity, as quantified via D2 analyses and demonstrated via spectrographic characteristics, increases from "modal" (ie, phonation elicited at just above the phonation threshold pressure) to raised intensity (phonation elicited by increasing transglottal airflow rate) to pressed (phonation elicited by increasing the stimulation current delivered to the larynx). Variations in a single dynamic dimension (airflow rate or adductory force) resulted in significantly increased productions of nonlinear phenomenon, including bifurcations from periodicity to regions of subharmonic content, fundamental frequency, and harmonic jumps, and evidence of periodicity within aperiodic regions ("chaos"). CONCLUSIONS The evoked rabbit phonation model described in this study allows for the elicitation of various types of phonations under controlled conditions and, therefore, has the potential to provide insight regarding important variables that may elicit examples of nonlinear phenomena such as subharmonics and deterministic chaos.
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Affiliation(s)
- Shaheen N Awan
- Department of Audiology and Speech Pathology, Bloomsburg University of Pennsylvania, Bloomsburg, Pennsylvania.
| | - Carolyn K Novaleski
- Department of Hearing and Speech Sciences, Vanderbilt University, Nashville, Tennessee
| | - Bernard Rousseau
- Department of Otolaryngology, Hearing and Speech Sciences, and Mechanical Engineering, Vanderbilt University School of Medicine, Nashville, Tennessee
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Chhetri DK, Rafizadeh S. Young's modulus of canine vocal fold cover layers. J Voice 2014; 28:406-10. [PMID: 24491497 DOI: 10.1016/j.jvoice.2013.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 12/04/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The objective of this study was to measure the elastic modulus (Young's modulus) of canine vocal fold cover layers. STUDY DESIGN Basic science study. METHODS Cover layers from vocal folds of eight canine larynges were dissected. Cover layer samples from the mid-membranous, medial vocal fold surface area were used to measure material stiffness using a previously validated indentation method. Cover layers from two human larynges were also measured as control references. Superior and inferior medial cover layers were measured separately. A total of 15 superior medial surface and 17 inferior medial surface specimens from the canine and two and four specimens, respectively, from the human were tested. RESULTS In the canine larynges, the mean Young's modulus of the superior medial surface was 4.2 kPa (range, 3.0-5.4 kPa; standard deviation [SD], 0.6 kPa) and of the inferior medial surface was 6.8 kPa (range, 5.4-8.5 kPa; SD, 0.8 kPa). Measurements on human cover samples were 5.0 kPa (range, 4.7-5.4 kPa; SD, 0.5 kPa) and 7.0 kPa (range, 6.7-7.3 kPa; SD, 0.3 kPa) for the superior medial and inferior medial surface, respectively. Human measurements were similar to the previously validated measurements. There was no difference between the stiffness measurements in the human and canine cover layer samples (P>0.05). CONCLUSIONS The elastic stiffness (Young's modulus) of the canine and human vocal fold cover layers is similar. Findings support the use of canine larynx as an externally valid model to study voice production.
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Affiliation(s)
- Dinesh K Chhetri
- Laryngeal Physiology Laboratory, Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Sassan Rafizadeh
- Laryngeal Physiology Laboratory, Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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Campbell EO, Samlan RA, McMullen NT, Cook S, Smiley-Jewell S, Barkmeier-Kraemer J. Developmental changes in the connective tissues of the porcine recurrent laryngeal nerve. J Anat 2013; 222:625-33. [PMID: 23590663 DOI: 10.1111/joa.12046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/26/2022] Open
Abstract
The recurrent laryngeal nerve (RLN) branches from the vagus cranial nerve to innervate structures important for voicing and swallowing. Damage to this nerve, commonly associated with surgery or idiopathic etiologies that largely occur with aging, results in impaired voicing and swallowing (Myssiorek, 2004). Sunderland proposed a model of peripheral nerve damage whereby a nerve's ability to resist damage from stretch and compression is determined by the quantity and composition of its epineurial connective tissues (Sunderland, 1951). Thus, it would be expected that epineurium differs depending upon the forces imposed on a nerve within its anatomical setting. The purpose of this study was to investigate RLN epineurium quantity and composition with development. A porcine model (piglet vs. juvenile) was used because of the similarity between porcine and human laryngeal innervation, anatomy and function. The entire RLN was excised bilaterally, and stereological methods were used to quantify the composition of epineurial connective tissues. Compared with the piglet, the juvenile pig RLN was double the diameter. While the piglet had no differences in the percentage of epineurial collagen and adipose between proximal and distal segments of both sides of the RLN, the juvenile pig had a greater percentage of collagen in the proximal segment of both sides of the RLN and a greater percentage of adipose in the distal segment of the left RLN compared with the proximal segment. In addition, unlike the piglet, the juvenile pig had a greater number of fascicles in the proximal than distal segment of the RLN, regardless of nerve side. These findings are consistent with predicted patterns associated with the different anatomical settings of the left and right RLN, show that the RLN changes with age, and support Sunderland's model.
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Affiliation(s)
- Ellen O Campbell
- Department of Speech, Language, Hearing, University of Arizona, Tucson, AZ, USA
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Maytag AL, Robitaille MJ, Rieves AL, Madsen J, Smith BL, Jiang JJ. Use of the rabbit larynx in an excised larynx setup. J Voice 2012; 27:24-8. [PMID: 23159025 DOI: 10.1016/j.jvoice.2012.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 08/03/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To modify the excised larynx bench apparatus to accommodate experiments with rabbit larynges. STUDY DESIGN Methodological study using ex vivo rabbit larynges. METHODS Rabbit larynges (n=5) were dissected and mounted on a custom-made phonatory apparatus. The arytenoids were adducted by rods, and humidified air was passed through the larynx to elicit vocal fold vibration. Acoustic, aerodynamic, electroglottographic (EGG), and videokymographic data were collected for each larynx. The same data were collected for five canine larynges for the purpose of comparison, and coefficients of variation were calculated for each parameter in both models. RESULTS Reliable phonation was achieved in each larynx. Acoustic fundamental frequency (F(0)), percent jitter, percent shimmer, signal-to-noise ratio, pressure and flow at phonation onset and offset; and F(0), closed quotient, speed quotient, jitter, shimmer, and contact quotient, as recorded by EGG; and mucosal wave amplitude and phase difference are reported for rabbit larynges. Coefficients of variation for each parameter are similar in magnitude between the two models. CONCLUSION We developed a method for recording reliable acoustic, aerodynamic, videokymographic, and EGG data from rabbit larynges. When data obtained from leporine larynges were compared with data from canine larynges, the intralarynx variability of rabbit larynges was found to be similar to that of canine larynges.
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Affiliation(s)
- Allison L Maytag
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Teller SS, Farran AJE, Xiao L, Jiao T, Duncan RL, Clifton RJ, Jia X. High-frequency viscoelastic shear properties of vocal fold tissues: implications for vocal fold tissue engineering. Tissue Eng Part A 2012; 18:2008-19. [PMID: 22741523 DOI: 10.1089/ten.tea.2012.0023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The biomechanical function of the vocal folds (VFs) depends on their viscoelastic properties. Many conditions can lead to VF scarring that compromises voice function and quality. To identify candidate replacement materials, the structure, composition, and mechanical properties of native tissues need to be understood at phonation frequencies. Previously, the authors developed the torsional wave experiment (TWE), a stress-wave-based experiment to determine the linear viscoelastic shear properties of small, soft samples. Here, the viscoelastic properties of porcine and human VFs were measured over a frequency range of 10-200 Hz. The TWE utilizes resonance phenomena to determine viscoelastic properties; therefore, the specimen test frequency is determined by the sample size and material properties. Viscoelastic moduli are reported at resonance frequencies. Structure and composition of the tissues were determined by histology and immunochemistry. Porcine data from the TWE are separated into two groups: a young group, consisting of fetal and newborn pigs, and an adult group, consisting of 6-9-month olds and 2+-year olds. Adult tissues had an average storage modulus of 2309±1394 Pa and a loss tangent of 0.38±0.10 at frequencies of 36-200 Hz. The VFs of young pigs were significantly more compliant, with a storage modulus of 394±142 Pa and a loss tangent of 0.40±0.14 between 14 and 30 Hz. No gender dependence was observed. Histological staining showed that adult porcine tissues had a more organized, layered structure than the fetal tissues, with a thicker epithelium and a more structured lamina propria. Elastin fibers in fetal VF tissues were immature compared to those in adult tissues. Together, these structural changes in the tissues most likely contributed to the change in viscoelastic properties. Adult human VF tissues, recovered postmortem from adult patients with a history of smoking or disease, had an average storage modulus of 756±439 Pa and a loss tangent of 0.42±0.10. Contrary to the results of some other investigators, no significant frequency dependence was observed. This lack of observable frequency dependence may be due to the modest frequency range of the experiments and the wide range of stiffnesses observed within nominally similar sample types.
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Affiliation(s)
- Sean S Teller
- School of Engineering, Brown University, Providence, RI 02912, USA
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Lau DP, Chng CB, Choo JQ, Teo N, Bunte RM, Chui CK. Development of a microclip for laryngeal microsurgery: Initial animal studies. Laryngoscope 2012; 122:1809-14. [DOI: 10.1002/lary.23280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 01/20/2012] [Accepted: 02/10/2012] [Indexed: 11/11/2022]
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