Parameters quantifying dehydration in canine vocal fold lamina propria

Protein Substrate Alters Cell Physiology in Primary Culture of Vocal Fold Epithelial Cells

The basement membrane interacts directly with the vocal fold epithelium. Signaling between the basement membrane and the epithelium modulates gene regulation, differentiation, and proliferation. The purpose of this study was to identify an appropriate simple single-protein substrate for growth of rabbit vocal fold epithelial cells. Vocal folds from 3 New Zealand white rabbits (Oryctolagus cuniculus) were treated to isolate epithelial cells, and cells were seeded onto cell culture inserts coated with collagen I, collagen IV, laminin, or fibronectin. Transepithelial electrical resistance (TEER) was measured, and phase contrast microscopy, PanCK, CK14, and E-cadherin immunofluorescence were utilized to assess for epithelial cell-type characteristics. Further investigation via immunofluorescence labeling was conducted to assess proliferation (Ki67) and differentiation (Vimentin). There was a significant main effect of substrate on TEER, with collagen IV eliciting the highest, and laminin the lowest resistance. Assessment of relative TEER across cell lines identified a larger range of TEER in collagen I and laminin. Phase contrast imaging identified altered morphology in the laminin condition, but cell layer depth did not appear to be related to TEER, differentiation, or morphology. Ki67 staining additionally showed no significant difference in proliferation. All conditions had confluent epithelial cells and dispersed mesenchymal cells, with increased mesenchymal cell numbers over time; however, a higher proportion of mesenchymal cells was observed in the laminin condition. The results suggest collagen IV is a preferable basement membrane substrate for in vitro vocal fold epithelial primary cell culture, providing consistent TEER and characteristic cell morphology, and that laminin is an unsuitable substrate for vocal fold epithelial cells and may promote mesenchymal cell proliferation.

Study of spatiotemporal liquid dynamics in a vibrating vocal fold by using a self-oscillating poroelastic model

The main purpose of this study is to investigate the spatiotemporal interstitial fluid dynamics in a vibrating vocal fold. A self-oscillating poroelastic model is proposed to study the liquid dynamics in the vibrating vocal folds by treating the vocal fold tissue as a transversally isotropic, fluid-saturated, porous material. Rich spatiotemporal liquid dynamics have been found. Specifically, in the vertical direction, the liquid is transported from the inferior side to the superior side due to the propagation of the mucosal wave. In the longitudinal direction, the liquid accumulates at the anterior-posterior midpoint. However, the contact between the two vocal folds forces the accumulated liquid out laterally in a very short time span. These findings could be helpful for exploring etiology of some laryngeal pathologies, optimizing laryngeal disease treatment, and understanding hemodynamics in the vocal folds.

Magnetic resonance imaging quantification of dehydration and rehydration in vocal fold tissue layers

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.

Quantitative Study of the Effects of Dehydration on the Viscoelastic Parameters in the Vocal Fold Mucosa

OBJECTIVES

The goal of this study was to quantify the viscoelastic parameters of the vocal fold mucosa at varying dehydration levels.

STUDY DESIGN AND METHODS

Healthy canine larynges were obtained postmortem, and the samples were separated from the subglottal wall. The samples were dehydrated in a vacuum dryer. According to the total dehydration time per sample, dehydration levels were divided into four degrees: 0%, 40%, 60%, and 80%. The stepper was set to stretch the sample to a level of 35% strain at the same rate (0.5 mm/s). Data collection was repeated five times under each dehydration condition. The compression resilience, RC% = S'/S*100%, and the hysteresis area were measured according to the stress-strain curves. The varying properties of the samples under different dehydration levels were investigated by fitting the curves.

RESULTS

The area of the hysteresis loops observed in the stress-strain curves increased exponentially with dehydration levels, whereas the RC% decreased linearly. For all curves, low-strain stages can be explained by Hooke's law (σ = E₀*ε). With increasing levels of dehydration, E₀ was shown to increase, whereas the linear range was shortened. High-strain stages resembled exponential rather than the linear curves. And the nonlinear stage of the curve became increasingly apparent in the stress-strain curves of increased dehydration levels.

CONCLUSIONS

The quantitative results in this study not only provide a numerical reference for future experimental measurements, but also can be used to verify the biphasic model in future studies.

Spatiotemporal Quantification of Vocal Fold Vibration After Exposure to Superficial Laryngeal Dehydration: A Preliminary Study

OBJECTIVES

The aim of the study was to evaluate the effects of a superficial laryngeal dehydration challenge on vocal fold vibration in young healthy adults using high-speed video imaging.

SUBJECTS AND METHODS

In this prospective study, the effects of a 60-minute superficial laryngeal dehydration challenge on spatial (speed quotient, amplitude quotient) and temporal measures (jitter percentage, vibratory onset time) of vocal fold vibration and phonation threshold pressure (PTP) were evaluated in 10 (male = 4, female = 6) vocally normal adults (21-29 years). All measures except the vibratory onset time were measured at the 10 (low) and 80 (high) percent level of their pitch range. The vibratory onset time was obtained at habitual pitch and loudness level. Superficial laryngeal dehydration was induced by oral breathing in low ambient humidity. Prechallenge and postchallenge differences were statistically investigated using t tests with Bonferroni correction.

RESULTS

The speed quotient at low-pitch phonation significantly decreased after oral breathing of low ambient humidity. Other spatiotemporal measures and PTP at low and high pitch were not significant after challenge.

CONCLUSIONS

Results from this initial study have implications for the use of high-speed video imaging to detect and quantify the subtle changes in vocal fold vibrations after superficial dehydration in healthy individuals. Preliminary findings indicate that superficial dehydration in healthy individuals results in spatial deviations at low pitch. However, further studies are warranted to identify additional spatiotemporal changes in vocal fold vibration after superficial dehydration in normal and disordered populations.

Quantitative Study for the Surface Dehydration of Vocal Folds Based on High-Speed Imaging

OBJECTIVES

From the perspective of the glottal area and mucosal wave, quantitatively estimate the differences of vocal fold on laryngeal activity during phonation at three different dehydration levels.

STUDY DESIGN

Controlled three sets of tests.

METHODS

A dehydration experiment for 10 excised canine larynges was conducted at 16 cm H2O. According to the dehydration cycle time (H), dehydration levels were divided into three degrees (0% H, 50% H, 75% H). The glottal area and mucosal wave under three dehydration levels were extracted from high-speed images and digital videokymography (DKG) image sequences. Direct and non-direct amplitude components were derived from glottal areas. The amplitude and frequency of mucosal wave were calculated from DKG image sequences. These parameters in condition of three dehydration levels were compared for statistical analysis.

RESULTS AND DISCUSSIONS

The results showed a significant difference in direct (P = 0.001; P = 0.005) and non-direct (P = 0.005; P = 0.016) components of glottal areas between every two different dehydration levels. Considering the right-upper, right-lower, left-upper, and left-lower of vocal fold, the amplitudes of mucosal waves consistently decreased with increasing of dehydration levels. But, there was no significant difference in frequency.

CONCLUSIONS

Surface dehydration could give rise to complex variation of vocal fold on tissues and vibratory mechanism, which should need analyzing from multiple perspectives. The results suggested that the combination of glottal area and mucosal wave could be better to research the change of vocal fold at different dehydrations. It would become a better crucial research tool for the clinical treatment of dehydration-induced laryngeal pathologies.

Characterizing liquid redistribution in a biphasic vibrating vocal fold using finite element analysis

OBJECTIVES

Vocal fold tissue is biphasic and consists of a solid extracellular matrix skeleton swelled with interstitial fluid. Interactions between the liquid and solid impact the material properties and stress response of the tissue. The objective of this study was to model the movement of liquid during vocal fold vibration and to estimate the volume of liquid accumulation and stress experienced by the tissue near the anterior-posterior midline, where benign lesions are observed to form.

METHODS

A three-dimensional biphasic finite element model of a single vocal fold was built to solve for the liquid velocity, pore pressure, and von Mises stress during and just after vibration using the commercial finite element software COMSOL Multiphysics (Version 4.3a, 2013, Structural Mechanics and Subsurface Flow Modules). Vibration was induced by applying direct load pressures to the subglottal and intraglottal surfaces. Pressure ranges, frequency, and material parameters were chosen based on those reported in the literature. Postprocessing included liquid velocity, pore pressure, and von Mises stress calculations as well as the frequency-stress and amplitude-stress relationships.

RESULTS

Resulting time-averaged velocity vectors during vibration indicated liquid movement toward the midline of the fold, as well as upward movement in the inferior-superior direction. Pore pressure and von Misses stresses were higher in this region just after vibration. A linear relationship was found between the amplitude and pore pressure, whereas a nonlinear relationship was found between the frequency and pore pressure.

CONCLUSIONS

Although this study had certain computational simplifications, it is the first biphasic finite element model to use a realistic geometry and demonstrate the ability to characterize liquid movement due to vibration. Results indicate that there is a significant amount of liquid that accumulates at the midline; however, the role of this accumulation still requires investigation. Further investigation of these mechanical factors may lend insight into the mechanism of benign lesion formation.

Systemic hydration: relating science to clinical practice in vocal health

OBJECTIVES

To examine the current state of the science regarding the role of systemic hydration in vocal function and health.

STUDY DESIGN

Literature review.

METHODS

Literature search spanning multiple disciplines, including speech-language pathology, nutrition and dietetics, medicine, sports and exercise science, physiology, and biomechanics.

RESULTS

The relationship between hydration and physical function is an area of common interest among multiple professions. Each discipline provides valuable insight into the connection between performance and water balance, as well as complimentary methods of investigation. Existing voice literature suggests a relationship between hydration and voice production; however, the underlying mechanisms are not yet defined and a treatment effect for systemic hydration remains to be demonstrated. Literature from other disciplines sheds light on methodological shortcomings and, in some cases, offers an alternative explanation for observed phenomena.

CONCLUSIONS

A growing body of literature in the field of voice science is documenting a relationship between hydration and vocal function; however, greater understanding is required to guide best practice in the maintenance of vocal health and management of voice disorders. Integration of knowledge and technical expertise from multiple disciplines facilitates analysis of existing literature and provides guidance as to future research.

A computational study of systemic hydration in vocal fold collision

Mechanical stresses develop within vocal fold (VF) soft tissues due to phonation-associated vibration and collision. These stresses in turn affect the hydration of VF tissue and thus influence voice health. In this paper, high-fidelity numerical computations are described, taking into account fully 3D geometry, realistic tissue and air properties, and high-amplitude vibration and collision. A segregated solver approach is employed, using sophisticated commercial solvers for both the VF tissue and glottal airflow domains. The tissue viscoelastic properties were derived from a biphasic formulation. Two cases were considered, whereby the tissue viscoelastic properties corresponded to two different volume fractions of the fluid phase of the VF tissue. For each case, hydrostatic stresses occurring as a result of vibration and collision were investigated. Assuming the VF tissue to be poroelastic, interstitial fluid movement within VF tissue was estimated from the hydrostatic stress gradient. Computed measures of overall VF dynamics (peak airflow velocity, magnitude of VF deformation, frequency of vibration and contact pressure) were well within the range of experimentally observed values. The VF motion leading to mechanical stresses within the VFs and their effect on the interstitial fluid flux is detailed. It is found that average deformation and vibration of VFs tend to increase the state of hydration of the VF tissue, whereas VF collision works to reduce hydration.

Effects of surface dehydration on mucosal wave amplitude and frequency in excised canine larynges

OBJECTIVE

Evaluate the effect of vocal fold surface dehydration on mucosal wave amplitude and frequency.

STUDY DESIGN

Controlled test-retest.

SETTING

Larynges were mounted on an excised larynx phonation system and attached to a pseudolung in a triple-walled sound-attenuated room that eliminated background noise and maintained a stabilized room temperature and humidity level.

SUBJECTS AND METHODS

High-speed video was recorded for 8 excised canine larynges during exposure to dehumidified air at 20 cm H(2)O. Control trials consisted of high-speed videos recorded for 2 excised canine larynges during exposure to humidified air at the same pressure.

RESULTS

In the majority of larynges, increased levels of dehydration were correlated with decreased amplitude and frequency. The slope of the linear regression fitted to the change in amplitude (P = .003) and the percent change (P < .001) between the initial and final trials were significantly decreased in dehydrated larynges. These measurements with respect to the change in frequency were also significantly decreased in dehydrated larynges (P < .001; P = .027).

CONCLUSION

Vocal fold surface dehydration caused a decrease in mucosal wave amplitude and frequency. This study provides objective, quantitative support for the mechanism of voice deterioration observed after extreme surface dehydration.