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Hirano S, Inufusa H, You F. The Effect of Oxidative Stress on the Human Voice. Int J Mol Sci 2024; 25:2604. [PMID: 38473848 DOI: 10.3390/ijms25052604] [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: 01/22/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
The vocal fold vibrates in high frequency to create voice sound. The vocal fold has a sophisticated histological "layered structure" that enables such vibration. As the vibration causes fricative damage to the mucosa, excessive voicing can cause inflammation or injury to the mucosa. Chronic inflammation or repeated injury to the vocal fold occasionally induces scar formation in the mucosa, which can result in severe dysphonia, which is difficult to treat. Oxidative stress has been proven to be an important factor in aggravating the injury, which can lead to scarring. It is important to avoid excessive oxidative stress during the wound healing period. Excessive accumulation of reactive oxygen species (ROS) has been found in the injured vocal folds of rats during the early phase of wound healing. Antioxidants proved to be useful in preventing the accumulation of ROS during the period with less scar formation in the long-term results. Oxidative stress is also revealed to contribute to aging of the vocal fold, in which the mucosa becomes thin and stiff with a reduction in vibratory capacity. The aged voice can be characterized as weak and breathy. It has been confirmed that ROS gradually increases in rat vocal fold mucosa with age, which may cause further damage to the vocal fold. Antioxidants have also proved effective in avoiding aging of the vocal fold in rat models. Recently, human trials have shown significant effects of the antioxidant Twendee X for maintaining the voice of professional opera singers. In conclusion, it is suggested that oxidative stress has a great impact on the damage or deterioration of the vocal folds, and the use of antioxidants is effective for preventing damage of the vocal fold and maintaining the voice.
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Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology Head and Neck Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Haruhiko Inufusa
- Division of Antioxidant Research, Gifu University, Gifu 501-1194, Japan
| | - Fukka You
- Division of Antioxidant Research, Gifu University, Gifu 501-1194, Japan
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2
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Tanner K, Robison HJ, Stevens ME, Merrill RM, Dromey C, Barkmeier-Kraemer J, Ben Christensen M. Corticosteroid-LABA inhalers increase phonation threshold pressure (PTP) and flow (PTF) in rabbits. Laryngoscope 2023; 133:2680-2686. [PMID: 36757019 PMCID: PMC10409873 DOI: 10.1002/lary.30585] [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: 08/07/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVES This study examined the effects of a combination corticosteroid plus long-acting beta2 -adrenergic agonist inhaler (IC) on rabbit phonation. METHODS White New Zealand male rabbits were assigned randomly to experimental and control groups (n = 11 per group). The experimental group received twice-daily doses of Advair HFA™ (fluticasone propionate 45 mcg and salmeterol 21 mcg) via a veterinary facemask with 1-way valve and spacer; the control group received aerosolized saline. After 8 weeks, animals were euthanized, larynges excised, frozen, and subsequently thawed and mounted on a standard bench apparatus. Phonation was elicited during 15 successive trials, and phonation threshold pressure (PTP; cmH2 O) and flow (PTF; L/min) were quantified. RESULTS Repeated measures analysis of variance indicated significant differences between the experimental and control groups (p < 0.05). Mean PTP and PTF values were higher (worse) for rabbits that received Advair HFA™. CONCLUSION Following 8-week exposure to ICs, rabbit larynges required greater air pressure and flow to initiate phonation. Because even modest phonation onset differences can have a meaningful clinical impact on voice function, these findings suggest that LABA ICs may put patients at risk for voice disorders. Furthermore, these voice disorders may occur within a relatively short timeframe. The results from this study have important clinical implications for voice care in those who use ICs. LEVEL OF EVIDENCE NA Laryngoscope, 133:2680-2686, 2023.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University
- Department of Surgery, Otolaryngology—Head & Neck Surgery, The University of Utah
| | | | - Maya Elena Stevens
- Department of Communication Sciences & Disorders, The University of Utah
| | | | | | - Julie Barkmeier-Kraemer
- Department of Surgery, Otolaryngology—Head & Neck Surgery, The University of Utah
- Department of Communication Sciences & Disorders, The University of Utah
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3
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Steffan B, Grossmann T, Grill M, Kirsch A, Groselj-Strele A, Gugatschka M. Comparing Effects of Short- and Long-Term Exposure of Cigarette Smoke Extract on Human Vocal Fold Fibroblasts. J Voice 2023:S0892-1997(23)00243-6. [PMID: 37696688 DOI: 10.1016/j.jvoice.2023.08.002] [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: 06/05/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVES To explore the effects of short- and long-term cigarette smoke extract (CSE) stimulation on the expression of extracellular matrix (ECM) components and inflammatory cytokines in an in vitro model for studying Reinke's edema using human vocal fold fibroblasts (hVFF). STUDY DESIGN Experimental pilot study using intervention with CSE in vitro. METHODS Immortalized hVFF were pretreated with 5% CSE or control medium over a period of 2 or 8 weeks, followed by a final 3-day incubation time. We evaluated cell proliferation and examined gene and protein expression of control- and CSE-treated cells using quantitative polymerase chain reaction, Western Blot and enzyme linked immunosorbent assay. RESULTS Cell numbers of CSE-treated hVFF strongly decreased after 8 weeks and limited the overall duration of the experiment. We observed significant upregulations in gene expression and protein levels of inflammatory markers (cyclooxygenase COX1, COX2) and ECM components (decorin, matrix metalloproteinase 1, transglutaminase 2, gremlin 2) induced by CSE after 2 and 8 weeks. Interleukin 1 receptor 1, prostaglandin I2 synthase, collagen- and hyaluronan-related gene expression showed minor upregulations. The majority of the observed genes were similarly regulated at both time points. However, the CSE-induced mRNA level of COX1 was ablated after 8 weeks. CONCLUSION Long-term treatment did not yield results significantly different from the short-term protocol. Therefore, we propose that prolonged CSE exposure is not superior to short-term settings, which save both time and materials.
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Affiliation(s)
- Barbara Steffan
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
| | - Tanja Grossmann
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria.
| | - Magdalena Grill
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
| | - Andrijana Kirsch
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
| | - Andrea Groselj-Strele
- Center for Medical Research, Computational Bioanalytics, Medical University of Graz, 8010 Graz, Austria
| | - Markus Gugatschka
- Department of Otorhinolaryngology, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
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4
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Sayce L, Zimmerman Z, Gartling G, Rousseau B, Branski RC. Epithelial response to vocal fold microflap injury in a preclinical model. Laryngoscope 2023; 133:350-356. [PMID: 35538915 PMCID: PMC11066888 DOI: 10.1002/lary.30169] [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: 12/17/2021] [Revised: 04/01/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Functional outcomes following microflap surgery for vocal fold pathology are favorable. Although the stratified squamous epithelium appears to heal rapidly, persistent physiologic tissue alterations are likely. We sought to elucidate key biochemical processes including recruitment of immune cells, regulation of cellular junction proteins, and long-term alterations to epithelial tissue permeability following microflap with an eye toward enhanced clinical outcomes. METHODS Forty New Zealand rabbits were assigned to eight groups (n = 5/group): no-injury control or bilateral microflap with survival for 0 h, 12 h, 1 day, 3 days, 7 days, 30 days, and 60 days post-microflap. The epithelium was dissected from one vocal fold and transepithelial resistance was quantified. The contralateral fold was subjected to transmission electron microscopy. Images were evaluated by a blinded rater and paracellular space dilation was quantified using ImageJ. Immune cell infiltration was evaluated and recorded qualitatively. RESULTS Increased innate immune response was observed 12 h as well as 7 and 30 days after microflap. At 60 days following injury, decreased epithelial resistance was observed. Paracellular spaces were dilated at all time-points following injury. CONCLUSIONS The vocal fold epithelium was significantly altered at 60 days following microflap. The implications for this tissue phenotype are unclear. However, compromised epithelial barrier function is implicated in various diseases and may increase the risk of subsequent injury. LEVEL OF EVIDENCE NA Laryngoscope, 133:350-356, 2023.
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Affiliation(s)
- Lea Sayce
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Zachary Zimmerman
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Gary Gartling
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, U.S.A
| | - Bernard Rousseau
- Communication Science and Disorders, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Ryan C Branski
- Rehabilitation Medicine, NYU Grossman School of Medicine, New York, U.S.A
- Otolaryngology-Head and Neck Surgery, NYU Grossman School of Medicine, New York, U.S.A
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5
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Martinez JD, Easwaran M, Ramirez D, Erickson-DiRenzo E. Effects of Electronic (E)-cigarette Vapor and Cigarette Smoke in Cultured Vocal Fold Fibroblasts. Laryngoscope 2023; 133:139-146. [PMID: 35213064 DOI: 10.1002/lary.30073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The public use of electronic-cigarettes (e-cigs) is rapidly growing. When heated, e-cigs produce a vapor that is inhaled. The vocal folds are among the first tissues exposed to this insult. However, the impact of e-cigs on vocal fold health is almost entirely unknown. Our objective was to evaluate the effects of e-cig vapor on cultured human vocal fold fibroblasts (hVFFs), the primary cell type of the lamina propria. We compared the cellular effects of e-cig vapor without and with nicotine and conventional cigarette smoke. STUDY DESIGN In vitro. METHODS E-cig vapor extract (EVE) and cigarette smoke extract (CSE) were created by bubbling vapor and smoke, respectively, into the cell culture medium. hVFFs were exposed to EVE without or with nicotine or CSE for 24 hours. Untreated cells were used as a control group. Cells were harvested, and cytotoxicity, extracellular matrix and inflammatory gene expression, and DNA damage were assessed. RESULTS Undiluted EVE without and with nicotine reduced the viability of hVFFs to a cytotoxic level. CSE reduced hVFFs viability to a greater extent than EVE and induced DNA damage as measured by DNA double-strand breaks. No changes in gene expression were observed following EVE or CSE exposure. CONCLUSION EVE induces cytotoxicity in hVFFs. However, cellular responses were greater following exposure to CSE, suggesting cigarette smoke may induce more harm, at least in the short term. Findings from this investigation improve our understanding of responses of hVFFs to e-cigs and form the basis for an in vitro methodology to study the vocal fold responses to these products. LEVEL OF EVIDENCE NA Laryngoscope, 133:139-146, 2023.
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Affiliation(s)
- Joshua D Martinez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Meena Easwaran
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Daniel Ramirez
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Elizabeth Erickson-DiRenzo
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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6
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Lins CVDM, Maciel Martins JR, Kobayashi EY, Korn GP, Park SW, Mororó WC, De Biase NG. Hyaluronic Acid Concentration in Female Vocal Folds With Reinke's Edema. Otolaryngol Head Neck Surg 2021; 166:337-342. [PMID: 34000904 DOI: 10.1177/01945998211008914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate hyaluronic acid (HA) concentrations in vocal folds among patients with Reinke's edema. STUDY DESIGN Prospective and experimental study. SETTING Single tertiary center. METHODS An HA binding protein isolated from bovine nasal cartilage was used to identify and isolate the HA from samples. Plates coated with biotin-conjugated binding protein and streptavidin-europium conjugate were sequentially incubated with 18 Reinke's edema samples and 11 female vocal fold cover samples from cadavers (the superficial layer of the lamina propria; control group). After the release of europium from streptavidin in enhancement solution, final fluorescence was measured in a fluorometer. RESULTS The mean HA concentration in Reinke's edema vocal folds was significantly higher than that in the control vocal folds (9.2 × 103 vs 0.9 × 103µg/g). CONCLUSION Vocal fold covers affected by Reinke's edema present a higher concentration of HA than do vocal fold covers with no edema.
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Affiliation(s)
- Cristiana Vanderlei de Melo Lins
- Department of Otorhinolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil
| | - João Roberto Maciel Martins
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil
| | - Elsa Yoko Kobayashi
- Laboratory of Molecular and Translational Endocrinology, Division of Endocrinology, Department of Medicine, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil
| | - Gustavo Polacow Korn
- Department of Otorhinolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil
| | - Sung Woo Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil
| | - Welber Chaves Mororó
- Department of Otorhinolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil.,Hospital Universitário da Universidade Federal do Maranhão, São Luís, Brazil
| | - Noemi Grigoletto De Biase
- Department of Otorhinolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil.,Pontifícia Universidade Católica de São Paulo, São Paulo, Brazil
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7
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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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Milovanovic J, Vukasinovic M, Jotic A, Vlajinac H, Milovanovic A, Pavlovic B, Banko B, Maksimovic J. Relationship between socio-demographic characteristics and vocal fold nodules, polyps and oedema. ACTA ACUST UNITED AC 2019; 38:424-430. [PMID: 30498270 PMCID: PMC6265663 DOI: 10.14639/0392-100x-1983] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 01/09/2018] [Indexed: 01/31/2023]
Abstract
The aim of our study was to compare socio-demographic characteristics of vocal fold nodules, polyps and oedema. The study included patients diagnosed for the first time with vocal fold nodules, polyps and oedema at the Communication Disorders Care Center of Clinic for Otorhinolaryngology and Maxillofacial Surgery in Clinical Center of Serbia, Belgrade. Diagnosis was made on the basis of symptoms, clinical otorhinolaryngological and phoniatric examination and endovideolaryngostroboscopic findings. A self-administered questionnaire was used to collect the following data: socio-demographic status, exposure to occupational noise and air pollution, occupational voice demands, health habits, symptoms of the present voice problems and voice problems in the family. By multivariate logistic regression analyses, nodules and oedema were more frequent in women than men in comparison with polyps (p < 0.001). Patients with nodules and polyps were younger than those with oedema (p < 0.001). Patients with nodules were more frequently lecturers, singers and actors compared with polyp patients (p = 0.006), had occupational voice demands more frequently than patients with oedema (p = 0.037) and were less frequently smokers than patients with polyps (p = 0.043) and those with oedema (p < 0.001). Patients with oedema were more frequently current smokers than patients with nodules and those with polyps (p < 0.001). Hoarseness as the main symptom was more frequent among patients with nodules than among patients with polyps (p = 0.040) and those with oedema (p = 0.001).Voice problems in the family was more frequently reported by oedema patients than by patients with polyps (p = 0.005). These findings are in agreement with majority of previous studies and may be of help in investigations on the aetiology of the disease.
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Affiliation(s)
- J Milovanovic
- Faculty of Medicine, University of Belgrade, Serbia.,Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - M Vukasinovic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - A Jotic
- Faculty of Medicine, University of Belgrade, Serbia.,Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - H Vlajinac
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia
| | - A Milovanovic
- Faculty of Medicine, University of Belgrade, Serbia.,Clinic for Physical Medicine and Rehabilitation, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Pavlovic
- Faculty of Medicine, University of Belgrade, Serbia.,Clinic for Otorhinolaryngology and Maxillofacial Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - B Banko
- Center for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia, Belgrade, Serbia
| | - J Maksimovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia
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Braut T, Krstulja M, Marijić B, Maržić D, Kujundžić M, Brumini G, Vučinić D, Oštarijaš E. Immunohistochemical analysis of vocal cord polyps applying markers of squamous cell carcinogenesis. Pathol Res Pract 2019; 215:144-150. [DOI: 10.1016/j.prp.2018.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/06/2018] [Indexed: 10/27/2022]
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10
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Suzuki R, Katsuno T, Kishimoto Y, Nakamura R, Mizuta M, Suehiro A, Yamashita M, Nakamura T, Tateya I, Omori K. Process of tight junction recovery in the injured vocal fold epithelium: Morphological and paracellular permeability analysis. Laryngoscope 2017; 128:E150-E156. [PMID: 29086429 DOI: 10.1002/lary.26959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/20/2017] [Accepted: 09/13/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES/HYPOTHESIS The vocal fold epithelium that includes tight junction (TJ)-based barrier function protects underlying connective tissues from external insults. TJs play an important role to control paracellular permeability of not only solutes but also ions, and preserve the vocal fold homeostasis. However, the distribution of TJs and paracellular diffusion barrier across the entire vocal fold epithelium are still unknown. The aim of this study was to identify the distribution of TJs in the vocal fold epithelium and to characterize the recovery process of TJ-based paracellular diffusion barrier in a rat model of vocal fold injury. STUDY DESIGN Animal experiments with controls. METHODS Normal and vocal fold-injured rats were used. Larynges were harvested for immunohistochemical examination of TJ proteins. For functional analysis, a tracer permeability assay was performed using EZ-Link Sulfo-NHS-LC-Biotin. RESULTS TJ proteins occludin and zonula occludens 1 signals were localized to the junctional regions of the most luminal cell layers of the vocal fold epithelium. The injured region had been recovered with epithelium at 5 days postinjury, but the paracellular diffusion barrier assays revealed that biotinylation reagents diffused into the lamina propria at 5 days postinjury, and were blocked at the epithelium at 14 and 28 days postinjury. CONCLUSIONS It was strongly suggested that TJs in the vocal fold epithelium exist at the junctional regions of the first layer of stratified squamous epithelium. TJ-based paracellular diffusion barrier following vocal fold injury is recovered by 14 days postinjury, and this period corresponds with the time course of structural changes in the regenerating epithelium layer. LEVEL OF EVIDENCE NA. Laryngoscope, 128:E150-E156, 2018.
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Affiliation(s)
- Ryo Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Katsuno
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Nakamura
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Suehiro
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masaru Yamashita
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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11
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Liu X, Zheng W, Sivasankar MP. Acute Acrolein Exposure Induces Impairment of Vocal Fold Epithelial Barrier Function. PLoS One 2016; 11:e0163237. [PMID: 27643990 PMCID: PMC5028054 DOI: 10.1371/journal.pone.0163237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/06/2016] [Indexed: 01/07/2023] Open
Abstract
Acrolein is a ubiquitous pollutant abundant in cigarette smoke, mobile exhaust, and industrial waste. There is limited literature on the effects of acrolein on vocal fold tissue, although there are clinical reports of voice changes after pollutant exposures. Vocal folds are responsible for voice production. The overall objective of this study was to investigate the effects of acrolein exposure on viable, excised vocal fold epithelial tissue and to characterize the mechanism underlying acrolein toxicity. Vocal fold epithelia were studied because they form the outermost layer of the vocal folds and are a primary recipient of inhaled pollutants. Porcine vocal fold epithelia were exposed to 0, 50, 100, 500, 900 or 1300 μM of acrolein for 3 hours; the metabolic activity, epithelial resistance, epithelial permeability, tight junction protein (occludin and claudin 3) expression, cell membrane integrity and lipid peroxidation were investigated. The data demonstrated that acrolein exposure at 500 μM significantly reduced vocal fold epithelial metabolic activity by 27.2% (p≤0.001). Incubation with 100 μM acrolein caused a marked increase in epithelial permeability by 130.5% (p<0.05) and a reduction in transepithelial electrical resistance (TEER) by 180.0% (p<0.001). While the expression of tight junctional protein did not change in acrolein-treated samples, the cell membrane integrity was significantly damaged with a 45.6% increase of lipid peroxidation as compared to controls (p<0.05). Taken together, these data provide evidence that acute acrolein exposure impairs vocal fold epithelial barrier integrity. Lipid peroxidation-induced cell membrane damage may play an important role in reducing the barrier function of the epithelium.
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Affiliation(s)
- Xinxin Liu
- School of Health Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Wei Zheng
- School of Health Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - M. Preeti Sivasankar
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, United States of America
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, United States of America
- * E-mail:
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Tanner K, Nissen SL, Merrill RM, Miner A, Channell RW, Miller KL, Elstad M, Kendall KA, Roy N. Nebulized isotonic saline improves voice production in Sjögren's syndrome. Laryngoscope 2015; 125:2333-40. [PMID: 25781583 DOI: 10.1002/lary.25239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/12/2015] [Accepted: 02/09/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This study examined the effects of a topical vocal fold hydration treatment on voice production over time. STUDY DESIGN Prospective, longitudinal, within-subjects A (baseline), B (treatment), A (withdrawal/reversal), B (treatment) experimental design. METHODS Eight individuals with primary Sjögren's syndrome (SS), an autoimmune disease causing laryngeal dryness, completed an 8-week A-B-A-B experiment. Participants performed twice-daily audio recordings of connected speech and sustained vowels and then rated vocal effort, mouth dryness, and throat dryness. Two-week treatment phases introduced twice-daily 9-mL doses of nebulized isotonic saline (0.9% Na(+)Cl(-)). Voice handicap and patient-based measures of SS disease severity were collected before and after each 2-week phase. Connected speech and sustained vowels were analyzed using the Cepstral Spectral Index of Dysphonia (CSID). Acoustic and patient-based ratings during each baseline and treatment phase were analyzed and compared. RESULTS Baseline CSID and patient-based ratings were in the mild-to-moderate range. CSID measures of voice severity improved by approximately 20% with nebulized saline treatment and worsened during treatment withdrawal. Posttreatment CSID values fell within the normal-to-mild range. Similar patterns were observed in patient-based ratings of vocal effort and dryness. CSID values and patient-based ratings correlated significantly (P < .05). CONCLUSION Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity. Future work should optimize topical vocal fold hydration treatment formulations, dose, and delivery methodologies for various patient populations. This study lays the groundwork for future topical vocal fold hydration treatment development to manage and possibly prevent dehydration-related voice disorders. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Kristine Tanner
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Shawn L Nissen
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Ray M Merrill
- Department of Health Science, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Alison Miner
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Ron W Channell
- Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Karla L Miller
- Department of Health Science, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A
| | - Mark Elstad
- Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Salt Lake City, Utah, U.S.A.,George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, U.S.A
| | - Katherine A Kendall
- Division of Otolaryngology, Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Nelson Roy
- Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, U.S.A
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Erickson-DiRenzo E, Sivasankar MP, Thibeault SL. Utility of cell viability assays for use with ex vivo vocal fold epithelial tissue. Laryngoscope 2014; 125:E180-5. [PMID: 25511412 DOI: 10.1002/lary.25100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Ex vivo models are routinely used to investigate the barrier function of the vocal fold epithelium. However, there are limited reports on assays that can be used to investigate the effect of clinically relevant challenges on vocal fold epithelial tissue viability. Our objective was to determine the utility of two assays routinely used in cell culture-a cellular metabolic activity assay and a cell membrane integrity assay-to investigate the viability of ex vivo porcine vocal fold epithelium. STUDY DESIGN Prospective, ex vivo animal study. METHODS Porcine vocal folds were exposed to acrolein, hydrochloric acid, or hydrogen peroxide challenge. An untreated, sham challenge was included as a control. Assays including metabolic activity, cell membrane integrity, and histology were used to determine whether challenges reduced epithelial viability as compared to sham. RESULTS Cell membrane integrity and metabolic activity assays detected reductions in viability following hydrochloric acid and hydrogen peroxide challenges but not acrolein challenge as compared to sham. No challenge produced significant changes in epithelial appearance as evidenced by light microscopy. CONCLUSIONS Metabolic activity and cell membrane integrity assays are valuable tools that can be used to evaluate the viability of ex vivo vocal fold epithelial tissue following clinically relevant challenges. As viability is reduced, the ability of epithelial tissue to maintain its barrier function is compromised. Accurate assessment of viability may provide us clues into understanding mechanisms underlying vocal fold epithelial injury and disease. LEVEL OF EVIDENCE NA Laryngoscope, 125:E180-E185, 2015.
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Affiliation(s)
- Elizabeth Erickson-DiRenzo
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin
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14
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Zhang H, Wang Y, Bai X, Lv Z, Zou J, Xu W, Wang H. Cyclic tensile strain on vocal fold fibroblasts inhibits cigarette smoke-induced inflammation: implications for Reinke edema. J Voice 2014; 29:13-21. [PMID: 25439508 DOI: 10.1016/j.jvoice.2014.06.001] [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: 02/06/2014] [Accepted: 06/04/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate whether patients with Reinke edema are more extrovertive than patients with carcinoma and, whether cyclic tensile strain (CTS) attenuates cigarette smoke condensate (CSC)-induced inflammation in human vocal fold fibroblasts (HVFF). STUDY DESIGN In vitro and ex vivo study. METHODS Clinical investigation and Eysenck personality questionnaire were performed to evaluate the personality and smoking status in individuals among groups. 3-(4,5)-dimethylthiahiazo (-z-y1)-3,5-di-phenytetrazoliumromide (MTT) assay was applied to test the viabilities of cultured HVFF exposed to CSC and/or CTS. The messenger RNA (mRNA) and protein expressions of cluster of differentiation 44 (CD44), cyclooxygenase-2 (COX-2), and matrix metalloproteinase-9 (MMP-9) in tissues from Reinke edema, paracancerous site, normal vocal fold, and in HVFF with different treatments were measured by reverse transcriptase polymerase chain reaction or western blot, respectively. RESULTS Patients with either Reinke edema or carcinoma were moderate/heavy smokers; the extraversion score, however, was higher in Reinke edema patients than that in carcinoma patients. CD44 mRNA and protein expressions were significantly higher, whereas, COX-2 and MMP-9 expressions were significantly lower in Reinke edema tissues than those in paracancerous tissues. Treatment of HVFF with CSC led to the decrease in cell viability, the reduction in CD44 expression, but, the increase in COX-2 and MMP-9 expressions and, moreover, administration of CTS inhibited such effects of CSC on HVFF. CONCLUSIONS Our results demonstrate that Reinke edema patients have more extrovert personality characteristics in comparison to carcinoma patients and, importantly, CTS attenuates CSC-induced inflammation in HVFF. Phonatory vibration may be a mechanism for lower expression of proinflammatory mediators in Reinke edema tissues in spite of cigarette smoke exposure.
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Affiliation(s)
- Haiyan Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China; Shandong Provincial Key Laboratory of Otology, Jinan, P.R. China; Institute of Eye and ENT, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China
| | - Yawei Wang
- Department of Chemotherapy, Cancer Center, Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Xiaohui Bai
- Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China; Shandong Provincial Key Laboratory of Otology, Jinan, P.R. China; Institute of Eye and ENT, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China
| | - Zhenghua Lv
- Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China; Shandong Provincial Key Laboratory of Otology, Jinan, P.R. China; Institute of Eye and ENT, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China
| | - Jidong Zou
- Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China; Shandong Provincial Key Laboratory of Otology, Jinan, P.R. China; Institute of Eye and ENT, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China
| | - Wei Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China; Shandong Provincial Key Laboratory of Otology, Jinan, P.R. China; Institute of Eye and ENT, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China
| | - Haibo Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China; Shandong Provincial Key Laboratory of Otology, Jinan, P.R. China; Institute of Eye and ENT, Provincial Hospital affiliated to Shandong University, Jinan, P.R. China.
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15
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Levendoski EE, Leydon C, Thibeault SL. Vocal fold epithelial barrier in health and injury: a research review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2014; 57:1679-91. [PMID: 24686981 PMCID: PMC4557797 DOI: 10.1044/2014_jslhr-s-13-0283] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 03/04/2014] [Indexed: 05/07/2023]
Abstract
PURPOSE Vocal fold epithelium is composed of layers of individual epithelial cells joined by junctional complexes constituting a unique interface with the external environment. This barrier provides structural stability to the vocal folds and protects underlying connective tissue from injury while being nearly continuously exposed to potentially hazardous insults, including environmental or systemic-based irritants such as pollutants and reflux, surgical procedures, and vibratory trauma. Small disruptions in the epithelial barrier may have a large impact on susceptibility to injury and overall vocal health. The purpose of this article is to provide a broad-based review of current knowledge of the vocal fold epithelial barrier. METHOD A comprehensive review of the literature was conducted. Details of the structure of the vocal fold epithelial barrier are presented and evaluated in the context of function in injury and pathology. The importance of the epithelial-associated vocal fold mucus barrier is also introduced. RESULTS/CONCLUSIONS Information presented in this review is valuable for clinicians and researchers as it highlights the importance of this understudied portion of the vocal folds to overall vocal health and disease. Prevention and treatment of injury to the epithelial barrier is a significant area awaiting further investigation.
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16
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Malpass GE, Arimilli S, Prasad GL, Howlett AC. Regulation of gene expression by tobacco product preparations in cultured human dermal fibroblasts. Toxicol Appl Pharmacol 2014; 279:211-9. [PMID: 24927667 DOI: 10.1016/j.taap.2014.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/06/2014] [Accepted: 06/03/2014] [Indexed: 12/23/2022]
Abstract
Skin fibroblasts comprise the first barrier of defense against wounds, and tobacco products directly contact the oral cavity. Cultured human dermal fibroblasts were exposed to smokeless tobacco extract (STE), total particulate matter (TPM) from tobacco smoke, or nicotine at concentrations comparable to those found in these extracts for 1h or 5h. Differences were identified in pathway-specific genes between treatments and vehicle using qRT-PCR. At 1h, IL1α was suppressed significantly by TPM and less significantly by STE. Neither FOS nor JUN was suppressed at 1h by tobacco products. IL8, TNFα, VCAM1, and NFκB1 were suppressed after 5h with STE, whereas only TNFα and NFκB1 were suppressed by TPM. At 1h with TPM, secreted levels of IL10 and TNFα were increased. Potentially confounding effects of nicotine were exemplified by genes such as ATF3 (5h), which was increased by nicotine but suppressed by other components of STE. Within 2h, TPM stimulated nitric oxide production, and both STE and TPM increased reactive oxygen species. The biological significance of these findings and utilization of the gene expression changes reported herein regarding effects of the tobacco product preparations on dermal fibroblasts will require additional research.
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Affiliation(s)
- Gloria E Malpass
- Department of Physiology and Pharmacology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA.
| | - Subhashini Arimilli
- Department of Microbiology and Immunology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA.
| | - G L Prasad
- R&D Department, R.J. Reynolds Tobacco Company, Winston-Salem, NC 27102, USA.
| | - Allyn C Howlett
- Department of Physiology and Pharmacology, Wake Forest University Health Sciences, Winston-Salem, NC 27157, USA.
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Levendoski EE, Sivasankar MP. Vocal fold ion transport and mucin expression following acrolein exposure. J Membr Biol 2014; 247:441-50. [PMID: 24648011 PMCID: PMC4306594 DOI: 10.1007/s00232-014-9651-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/06/2014] [Indexed: 11/30/2022]
Abstract
The vocal fold epithelium is exposed to inhaled particulates including pollutants during breathing in everyday environments. Yet, our understanding of the effects of pollutants on vocal fold epithelial function is extremely limited. The objective of this study was to investigate the effect of the pollutant acrolein on two vocal fold epithelial mechanisms: ion transport and mucin (MUC) synthesis. These mechanisms were chosen as each plays a critical role in vocal defense and in maintaining surface hydration which is necessary for optimal voice production. Healthy, native porcine vocal folds (N = 85) were excised and exposed to an acrolein or sham challenge. A 60-min acrolein, but not sham challenge significantly reduced ion transport and inhibited cyclic adenosine monophosphate-dependent, increases in ion transport. Decreases in ion transport were associated with reduced sodium absorption. Within the same timeline, no significant acrolein-induced changes in MUC gene or protein expression were observed. These results improve our understanding of the effects of acrolein on key vocal fold epithelial functions and inform the development of future investigations that seek to elucidate the impact of a wide range of pollutant exposures on vocal fold health.
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Kelleher JE, Siegmund T, Chan RW. Could spatial heterogeneity in human vocal fold elastic properties improve the quality of phonation? Ann Biomed Eng 2012; 40:2708-18. [PMID: 22707177 DOI: 10.1007/s10439-012-0609-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/08/2012] [Indexed: 11/24/2022]
Abstract
The physical mechanisms leading to the acoustic and perceptual qualities of voice are not well understood. This study examines the spatial distribution of biomechanical properties in human vocal folds and explores the consequences of these properties on phonation. Vocal fold lamina propria specimens isolated from nine excised human male larynges were tested in uniaxial tension (six from non-smokers, three from smokers). An optical method was employed to determine the local stretch, from which the elastic modulus of three segments in the anterior-posterior direction was calculated. Several specimens exhibited a significant heterogeneity in the modulus with the middle segment stiffer than the other segments. It was concluded that such modulus gradients are stronger in specimens from non-smokers than smokers. To understand the functional implications of a modulus gradient, the first eigenmode of vibration was calculated with a finite element model. With a modulus gradient, the vocal fold's eigenmode deflection was spread along the anterior-posterior length, whereas for a homogeneous modulus distribution, the deflection was more focused around the mid-coronal plane. Consequently, the strong modulus gradient may enable more complete glottal closure, which is important for normal phonation, while a more homogeneous modulus may be responsible for poor glottal closure and a perceived "breathy" voice.
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Affiliation(s)
- Jordan E Kelleher
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907, USA
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