Effect of tension, stiffness, and airflow on laryngeal resistance in the in vivo canine model

Regulation of laryngeal resistance and maximum power transfer with semi-occluded airway vocalization

Steady airflow resistances in semi-occluded airways as well as acoustic impedances in vocalization are quantified from the lungs to the lips. For clinical and voice training applications, the primary focus is on two airway conditions, an oral semi-occlusion and a semi-occlusion above the vocal folds. Laryngeal airflow resistance is divided into glottal airflow resistance and epilaryngeal airway resistance. Maximum aerodynamic power is transferred to the vocal tract if the glottal airflow resistance is reduced while the epilaryngeal airway resistance is increased. A semi-occlusion at the lips helps to set up this condition. For the acoustic power transfer, the epilaryngeal airway also serves to match the impedance of the source to the impedance of the vocal tract.

Effects of Voice Therapy for Dysphonia due to Tension Imbalance in Unilateral Vocal Fold Paralysis and Paresis

OBJECTIVES

Medialization procedures, such as type I thyroplasty, arytenoid adduction, and vocal fold injection, are popular treatments for dysphonia due to unilateral vocal fold paralysis (UVFP). However, dysphonia occasionally persists after medialization procedures owing to tension imbalance. This tension imbalance causes diplophonia, asymmetry and aperiodic vibrational flutter in travelling wave motion. Currently, there is no established treatment for tension imbalance. We herein report two cases with residual dysphonia due to tension imbalance following medialization for chronic UVFP, and another case presenting with dysphonia due to tension imbalance following chronic unilateral vocal fold paresis.

METHODS

Three patients underwent voice therapy using flow phonation to facilitate increased airflow management in speech as well as forward oral resonance by focusing on balanced airflow. Phonatory outcomes were evaluated using stroboscopic findings, aerodynamic and acoustic measures, as well as self-rating.

RESULTS

Aerodynamic assessments, acoustic findings and self-ratings improved in all three cases after voice therapy. Stroboscopic findings prior to voice therapy showed asymmetric vibration with glottic gap, which was improved after voice therapy. Fundamental frequency (F0) also increased post-therapy.

CONCLUSIONS

In a previous canine study, it was shown that enhanced breath support with expiratory airflow resulted in increased F0, suggesting that enhanced breath support could increase vocal fold tension. The increased F0 achieved in the present cases following voice therapy may increase vocal fold tension with breath support. Thus, voice therapy using flow phonation may be effective for supporting vocal fold tension and improving dysphonia due to tension imbalance following UVFP and paresis.

The Effects of Hyper- and Hypocapnia on Phonatory Laryngeal Airway Resistance in Women

PURPOSE

The larynx has a dual role in the regulation of gas flow into and out of the lungs while also establishing resistance required for vocal fold vibration. This study assessed reciprocal relations between phonatory functions-specifically, phonatory laryngeal airway resistance (Rlaw)-and respiratory homeostasis during states of ventilatory gas perturbations.

METHOD

Twenty-four healthy women performed phonatory tasks while exposed to induced hypercapnia (high CO2), hypocapnia (low CO2), and normal breathing (eupnea). Effects of gas perturbations on Rlaw were investigated as were the reciprocal effects of Rlaw modulations on respiratory homeostasis.

RESULTS

Rlaw remained stable despite manipulations of inspired gas concentrations. In contrast, end-tidal CO2 levels increased significantly during all phonatory tasks. Thus, for the conditions tested, Rlaw did not adjust to accommodate ventilatory needs as predicted. Rather, stable Rlaw was spontaneously accomplished at the cost of those needs.

CONCLUSIONS

Findings provide support for a theory of regulation wherein Rlaw may be a control parameter in phonation. Results also provide insight into the influence of phonation on respiration. The work sets the foundation for future studies on laryngeal function during phonation in individuals with lower airway disease and other patient populations.

Linguistic models of F0 use, physiological models of F0 control, and the issue of "mean response time"

This paper evaluates "mean response time" (MRT), a method used in previous studies to relate physiological evidence (recordings of electromyographic activity in the cricothyroid and sternohyoid) to acoustic evidence (fundamental frequency). Rather than averaging over tokens before correlating these signals, we calculated the best response time (RT) for each token, and evaluated the pattern of variability across utterances. Furthermore, rather than correlating over whole utterances, we correlated electromyographic activity (EMG) to fundamental frequency (F0) only over intervals defined in terms of linguistically significant events in the F0 trace, identified using a linguistically motivated model of English intonation. Steep changes in the F0 tended to have better correlation coefficients than shallow ones, which we relate to the physiological model by noting the complex of components contributing to both signal types. Also, the distribution of lead times was easier to interpret when the two tones delimiting the analysis domain had some tight temporal relationship specified by the intonational phonology. Finally, lead times tended to vary as a function of what preceded the target rise or fall. In short, averaging over signals before analysis obscures patterns of variation in the data which may lead to new insights and to new directions for research.

Exit jet particle velocity in the in vivo canine laryngeal model with variable nerve stimulation

This study extends previous work on exit jet particle velocity in the in vivo canine model of phonation by measuring air particle velocity at multiple locations in the midline of the glottis and across multiple levels of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) stimulation. In a second experiment, exit jet particle velocity was measured at midline and offmidline positions with constant levels of RLN and SLN stimulation. In this study, peak particle velocity was higher at the anterior commissure than at the posterior commissure in the midline of the glottis, and peak particle velocity was higher at the midline than at offmidline positions. In addition, increasing levels of RLN stimulation resulted in increasing peak particle velocity; however, increasing levels of SLN stimulation failed to produce a uniform effect on peak particle velocity.

Long-term model of induced canine phonation

Experimental induced phonation in the dog has been used in short-term studies by several investigators and has proved quite useful in laryngeal research. In this study a long-term canine phonation model is described that uses permanently implanted electrodes on the superior and recurrent laryngeal nerves. A serial induced phonation model has not been previously reported and is needed for laryngeal research in which voice results are a primary end point. Inexpensive, reliable, nontoxic electrodes were designed and fabricated. The laryngeal nerves were found to be quite susceptible to injury, necessitating a series of changes in electrode design. Electrode durability and laryngeal nerve viability improved with each design modification; the final design gave a recurrent laryngeal nerve viability rate of 100% at 6 weeks, 83% at 9 weeks, and 73% at 12 weeks. Induced phonation was successfully produced on a repeated basis by stimulating the recurrent laryngeal nerves while passing air through the larynx, in 22 (95.6%) of 23 animals. Stimulation of the superior laryngeal nerves increased vocal fold length and tension but was not required for phonation. Technical aspects of chronic implantation and stimulation of the laryngeal nerves are discussed. The development and successful long-term implantation of electrodes on the laryngeal nerves and their use in repeated induced phonation have not been reported previously.

Pressure-flow relationships during phonation as a function of adduction

Pressure-flow relationships were obtained for five excised canine larynges. Simultaneous recordings were made of average subglottal pressure, average air flow, and the electroglottograph at various levels of adduction and vocal fold lengths. The level of adduction was controlled by positioning the arytenoid cartilages via laterally imbedded three-prong attachments and by the use of intra-arytenoid shims. Adduction was quantified by measuring the vocal process gap. Results indicated a linear pressure-flow relationship within the experimental range of phonation for each level of adduction. Differential glottal resistance increased as the vocal process gap was reduced. A model is presented for the differential resistance as a hyperbolic function of vocal process gap. The pressure-flow relationship and the model can be used in computer simulations of speech production and for clinical insight into the aerodynamic function of the human larynx.

Effects of driving pressure and recurrent laryngeal nerve stimulation on glottic vibration in a constant pressure model

Glottic phonatory parameters have been studied in constant flow models; however, the lung-thorax system is better viewed as a constant pressure source. Adjusting the driving pressure and recurrent laryngeal nerve stimulation as independent variables, rather than as dependent variables, may provide a more physiologic understanding of laryngeal function and glottic parameters, including subglottic pressure, airflow, fundamental frequency, and glottic area. In three dogs subglottic pressure and airflow were measured in two separate conditions: with constant recurrent laryngeal nerve stimulation and varying driving pressure, and with constant driving pressure and varying recurrent laryngeal nerve stimulation. Videostroboscopic measures on four dogs assessed glottic areas with constant recurrent laryngeal nerve stimulation at different driving pressures. With constant recurrent laryngeal nerve stimulation, increasing driving pressure had no effect on glottic areas, whereas subglottic pressure, fundamental frequency, and airflow increased significantly. However, changes in subglottic pressure were minimal in comparison with changes in driving pressure. At constant driving pressure, increasing recurrent laryngeal nerve stimulation increased subglottic pressure and fundamental frequency and decreased airflow. These findings suggest that during phonation subglottic pressure is primarily dependent on recurrent laryngeal nerve stimulation and laryngeal muscular contraction, but not on lung driving pressure.

Characteristics of an in vivo canine model of phonation with a constant air pressure source

Many previous studies of laryngeal biomechanics using in vivo models have employed a constant air How source. Several authors have recently suggested that the lung-thorax system functions as a constant pressure source during phonation. This study describes an in vivo canine system designed to maintain a constant peak subglottic pressure (Psub) using a pressure-controlling mechanism. Increasing levels of recurrent laryngeal nerve (RLN) stimulation resulted in a significant rise in resistance followed by a plateau. For a given Psub, flow decreased significantly and precipitously with increasing stimulation and then quickly plateaued. Vocal intensity increased with increasing RLN stimulation until a peak was reached. After this peak, intensity dropped until a plateau was reached, corresponding to the flow minimum. At a given Psub, increasing levels of RLN stimulation resulted in a normal distribution of vocal efficiencies.

A pressure-regulated model of normal and pathologic phonation

Recent evidence suggests that the lung-thorax system functions as a constant pressure source during phonation. However, previous animal models used a constant flow source. This article describes an in vivo canine model that maintains a constant subglottic pressure during phonation to more closely simulate the pulmonary system. At any given subglottic pressure, increasing levels of recurrent laryngeal nerve stimulation resulted in a significant rise in resistance followed by a plateau. Increasing levels of superior laryngeal nerve stimulation, however, produced no significant change in glottal resistance. Three experimental conditions were studied: normal, unilateral recurrent laryngeal nerve paralysis, and paralysis followed by arytenoid adduction. In normal canines, maximal vocal efficiency values were the highest, indicating the best match between pressure and resistance. The vocal efficiency values were significantly lower in recurrent laryngeal nerve paralysis, indicating pressure-resistance mis-match. Arytenoid adduction increased the maximal vocal efficiency values and decreased the mismatch observed in the paralyzed state. These findings may provide insight into an understanding of normal and pathologic laryngeal behavior.

Effects of RLN and SLN stimulation on glottal area

In vivo canine experiments have demonstrated that vocal fold stiffness varies proportionately with changing levels of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) stimulation. This study evaluated the morphologic changes in the glottis at varying levels of nerve stimulation and the presumed effects on laryngeal air particle velocity. Stroboscopic data from the in vivo canine model of phonation were examined under varying conditions of RLN and SLN stimulation. Computerized analysis of stroboscopic images was used to reconstruct the glottal area vs. time waveforms. As RLN stimulation increased, glottal area per cycle decreased (p < 0.05). However, as SLN stimulation increased, glottal area per cycle increased (p < 0.05). However, as SLN stimulation increased, glottal area per cycle increased (p < 0.05). These results support the hypothesis that increasing RLN stimulation at similar levels of SLN stimulation produces an increase in air particle velocity, whereas an increase in SLN stimulation causes a decrease in air particle velocity.