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Yang Y, Xu X, Lacke M, Zhuang P. Using Diffusion Tensor Imaging to Explore the Changes in the Microstructure of Canine Vocal Fold Scar Tissue. J Voice 2023:S0892-1997(23)00002-4. [PMID: 36725407 DOI: 10.1016/j.jvoice.2023.01.003] [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: 11/22/2022] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To apply diffusion tensor imaging (DTI) in measurement of the diffusion characteristics of water molecules in vocal fold scar tissue, combined with the analysis of textural characteristics of collagen fibers in the cover layer of the vocal folds to explore the feasibility of DTI in the qualitative and quantitative diagnosis of vocal fold scars and the evaluation of microstructural changes of vocal fold scar tissue. METHODS A unilateral injury was created using micro-cup forceps in the left vocal fold of six beagles. The contralateral normal vocal fold was used as a self-control. Five months postinjury, the larynges were excised and placed into a magnetic resonance imaging (MRI) system (9.4T BioSpec MRI, Bruker, German) for scanning and extraction of the diffusion parameters, fractional anisotropy (FA) and tensor trace in the anterior, middle, and posterior portions of the vocal fold cover layer. These parameters were then analyzed for statistical significance between the scarred vocal fold and the normal vocal fold. After MRI scanning, the tissue of the vocal folds was divided into anterior, middle, and posterior parts for sectioning and staining with hematoxylin and eosin, and samples were subsequently digitally scanned for texture analysis. The irregularity parameters, energy, contrast, correlation, and homogeneity, of collagen fibers of the vocal folds and the mean gray value of collagen fibers were calculated by the gray-level co-occurrence matrix (GLCM) texture analysis method. The differences in the mean value of the two sides of the vocal fold were compared. In addition, Pearson correlation analysis was performed between DTI parameters and irregularity parameters. RESULTS The FA of the left vocal fold cover layer was significantly lower compared to the self-control group (P = 0.0366), and the tensor trace value on the left vocal fold cover layer was significantly higher compared to the self-control group (P = 0.0353). The FA was significantly higher in the anterior part of the right vocal fold cover layer compared to the middle and posterior parts of the same side (P = 0.0352), and the tensor trace was significantly lower in the anterior part of the right vocal fold cover layer compared to the middle and posterior parts of the same side (P = 0.0298). There were no significant differences in FA and tensor trace between the middle and posterior parts of the vocal fold cover layer. The mean gray value of the left vocal folds cover layer was significantly smaller than the right vocal fold cover layer (P = 0.0219), the energy of the left vocal fold cover layer was significantly smaller than that of the right vocal fold cover layer (P < 0.0001), the contrast of the left vocal folds cover layer was significantly larger than that of the right vocal fold cover layer (P = 0.0002), the correlation of the left vocal folds cover layer was significantly smaller than the right vocal fold cover layer (P = 0.0002), and the homogeneity of the left vocal folds cover layer was significantly smaller than the right vocal fold cover layer (P = 0.0003). Pearson correlation analysis yielded values of r = 0.926, P = 0.000 between the FA and mean gray value; r = -0.918, P = 0.000 between FA and energy; r = -0.924, P = 0.000 between the FA and homogeneity, r = -0.949, P = 0.000 between tensor trace and mean gray value; r = 0.893, P = 0.000 between the tensor trace and energy; and r = 0.929, P = 0.000 between the tensor trace and homogeneity. CONCLUSION FA and tensor trace can be used as effective parameters to reflect microstructural changes in vocal fold scars. DTI is an objective and quantitative method of analyzing vocal fold scarring, and it noninvasively evaluates the microstructure of vocal fold collagen fibers.
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Affiliation(s)
- Yang Yang
- Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Xinlin Xu
- Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Margaret Lacke
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Peiyun Zhuang
- Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
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Rickert SM, O'Cathain E. Pediatric Voice. Pediatr Clin North Am 2022; 69:329-347. [PMID: 35337543 DOI: 10.1016/j.pcl.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pediatric voice disorders are increasing being noted as a barrier to success in school and socialization. Significant advances over the past decade in evaluation, diagnosis, and management of pediatric voice disorders have improved both short-term and long-term outcomes. Practitioners should have a thorough understanding of anatomy and physiology, accurately work up a pediatric voice disorder, and efficiently treat voice disorders. Comprehensive voice evaluation in children is essential to properly assessing pediatric dysphonia. Diagnosis and treatment are best managed by a multidisciplinary team. Accurate diagnosis allows for effective treatment, which includes voice therapy, medical therapy, and surgical intervention as needed.
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Affiliation(s)
- Scott M Rickert
- Pediatric Otolaryngology, NYU Langone Health, 240 East 38th Street, 14th Floor, New York, NY 10016, USA.
| | - Eadaoin O'Cathain
- Cochlear Implant and Complex Otology, Salford Royal Foundation Trust, Manchester, UK
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3
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Ujvary PL, Blebea CM, Maniu AA, Pop S, Sarpataki O, Cosgarea M. Vocal fold injury models in rats: a literature review on techniques and methodology. J Med Life 2022; 15:336-343. [PMID: 35449991 PMCID: PMC9015177 DOI: 10.25122/jml-2022-0032] [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: 01/12/2022] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Abstract
This study reviewed the current literature on technical aspects regarding controlled vocal fold injuries in the rat model. Data from PubMed, Embase, and Scopus database for English language literature was collected to identify methodological steps leading to a controlled surgical injury of the rat vocal fold. Inclusion criteria: full disclosure of anesthesia protocol, positioning of the rat for surgery, vocal fold visualization method, instrumentation for vocal fold injury, vocal fold injury type. Articles with partial contribution were evaluated and separately included due to the limited number of original methodologies. 724 articles were screened, and eleven articles were included in the analysis. Anesthesia: ketamine hydrochloride and xylazine hydrochloride varied in dose from 45 mg/kg and 4.5 mg/kg to 100 mg/kg and 10 mg/kg. Visualization: The preferred method was the 1.9 mm, 25-30 degree endoscopes. The widest diameter endoscope used was 2.7 mm with a 0 or 30 degree angle of view. Instruments for lesion induction range from 18 to 31G needles, microscissors, micro forceps to potassium titanyl phosphate, and blue light lasers. Injury types: vocal fold stripping was the main injury type, followed by vocal fold scarring and charring. One article describes scaffold implantation with injury to the superior aspect of the vocal fold. Rats are good candidates for in vivo larynx and vocal folds research. A more standardized approach should be considered regarding the type of vocal fold injury to ease data comparison.
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Affiliation(s)
- Peter Laszlo Ujvary
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Maria Blebea
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,Corresponding Author: Cristina Maria Blebea, Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. E-mail:
| | - Alma Aurelia Maniu
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sever Pop
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Orsolya Sarpataki
- Department of Physiology, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca, Romania
| | - Marcel Cosgarea
- Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Sharma GK, Chen LY, Chou L, Badger C, Hong E, Rangarajan S, Chang TH, Armstrong WB, Verma SP, Chen Z, Ramalingam R, Wong BJF. Surface kinematic and depth-resolved analysis of human vocal folds in vivo during phonation using optical coherence tomography. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210125R. [PMID: 34414705 PMCID: PMC8374544 DOI: 10.1117/1.jbo.26.8.086005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/26/2021] [Indexed: 05/30/2023]
Abstract
SIGNIFICANCE The human vocal fold (VF) oscillates in multiple vectors and consists of distinct layers with varying viscoelastic properties that contribute to the mucosal wave. Office-based and operative laryngeal endoscopy are limited to diagnostic evaluation of the VF epithelial surface only and are restricted to axial-plane characterization of the horizontal mucosal wave. As such, understanding of the biomechanics of human VF motion remains limited. AIM Optical coherence tomography (OCT) is a micrometer-resolution, high-speed endoscopic imaging modality which acquires cross-sectional images of tissue. Our study aimed to leverage OCT technology and develop quantitative methods for analyzing the anatomy and kinematics of in vivo VF motion in the coronal plane. APPROACH A custom handheld laryngeal stage was used to capture OCT images with 800 A-lines at 250 Hz. Automated image postprocessing and analytical methods were developed. RESULTS Novel kinematic analysis of in vivo, long-range OCT imaging of the vibrating VF in awake human subjects is reported. Cross-sectional, coronal-plane panoramic videos of the larynx during phonation are presented with three-dimensional videokymographic and space-time velocity analysis of VF motion. CONCLUSIONS Long-range OCT with automated computational methods allows for cross-sectional dynamic laryngeal imaging and has the potential to broaden our understanding of human VF biomechanics and sound production.
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Affiliation(s)
- Giriraj K. Sharma
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Lily Y. Chen
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | - Lidek Chou
- OCT Medical Imaging, Inc., Irvine, California, United States
| | - Christopher Badger
- University of California, Irvine, School of Medicine, Irvine, California, United States
| | - Ellen Hong
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
| | | | | | - William B. Armstrong
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
| | - Sunil P. Verma
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
| | - Zhongping Chen
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California, United States
| | - Ram Ramalingam
- OCT Medical Imaging, Inc., Irvine, California, United States
| | - Brian J.-F. Wong
- University of California, Irvine Medical Center, Department of Otolaryngology–Head and Neck Surgery, Irvine, California, United States
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, California, United States
- University of California, Irvine, Department of Biomedical Engineering, Irvine, California, United States
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5
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Benboujja F, Hartnick C. Quantitative evaluation of the human vocal fold extracellular matrix using multiphoton microscopy and optical coherence tomography. Sci Rep 2021; 11:2440. [PMID: 33510352 PMCID: PMC7844040 DOI: 10.1038/s41598-021-82157-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/11/2021] [Indexed: 02/07/2023] Open
Abstract
Identifying distinct normal extracellular matrix (ECM) features from pathology is of the upmost clinical importance for laryngeal diagnostics and therapy. Despite remarkable histological contributions, our understanding of the vocal fold (VF) physiology remains murky. The emerging field of non-invasive 3D optical imaging may be well-suited to unravel the complexity of the VF microanatomy. This study focused on characterizing the entire VF ECM in length and depth with optical imaging. A quantitative morphometric evaluation of the human vocal fold lamina propria using two-photon excitation fluorescence (TPEF), second harmonic generation (SHG), and optical coherence tomography (OCT) was investigated. Fibrillar morphological features, such as fiber diameter, orientation, anisotropy, waviness and second-order statistics features were evaluated and compared according to their spatial distribution. The evidence acquired in this study suggests that the VF ECM is not a strict discrete three-layer structure as traditionally described but instead a continuous assembly of different fibrillar arrangement anchored by predominant collagen transitions zones. We demonstrated that the ECM composition is distinct and markedly thinned in the anterior one-third of itself, which may play a role in the development of some laryngeal diseases. We further examined and extracted the relationship between OCT and multiphoton imaging, promoting correspondences that could lead to accurate 3D mapping of the VF architecture in real-time during phonosurgeries. As miniaturization of optical probes is consistently improving, a clinical translation of OCT imaging and multiphoton imaging, with valuable qualitative and quantitative features, may have significant implications for treating voice disorders.
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Affiliation(s)
- Fouzi Benboujja
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA
| | - Christopher Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, USA.
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Devine EE, Liu Y, Keikhosravi A, Eliceiri KW, Jiang JJ. Quantitative second harmonic generation imaging of leporine, canine, and porcine vocal fold collagen. Laryngoscope 2019; 129:2549-2556. [PMID: 30628080 DOI: 10.1002/lary.27782] [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: 06/14/2018] [Revised: 11/12/2018] [Accepted: 12/10/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Vocal fold collagen composition is an important determinant of material properties and mucosal wave propagation. Collagen alignment and straightness are quantitatively characterized by second harmonic generation (SHG) imaging. We examined leporine, canined and porcine vocal folds showing collagen composition variation that is species, location, and strain specific. STUDY DESIGN Animal model. METHODS Leporine (n = 5), canine (n = 5), and porcine (n = 5) larynges were harvested and fixed in situ. Samples were transversely sectioned, and SHG images were collected for two inferior-superior sections along five anterior-posterior locations. Additional porcine samples were fixed and imaged under tensile strain (0%, 5%, 10%, 15%, 20%, n = 5 per group). Two-way repeated measures (RM) analysis of variance (ANOVA) tested for section and location differences in each species. Multiway RM-ANOVA tested for section, location, and strain differences in porcine samples. RESULTS Alignment and straightness were higher inferiorly in the porcine (P = .0047, P = .002) and canine (P = .0011, P < .001) vocal folds, but not in leporine samples (P = .67652, P = .4831). There were significant interactions between elongation and superior-inferior section for both alignment (P = .0047) and straightness (P = .0371). CONCLUSIONS Our results correspond well to findings in the literature that the inferior vocal fold lip is stiffer in porcine and canine larynges. The absence of a collagen gradient in the leporine vocal fold is notable because rabbits are less vocal animals, indicating the collagen gradient may be a result of voice use and an important consideration in model selection when extracellular matrix is of interest. Strain results were also consistent with the role of collagen in strain stiffening behavior of vocal fold tissue. LEVEL OF EVIDENCE NA Laryngoscope, 129:2549-2556, 2019.
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Affiliation(s)
- Erin E Devine
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Yuming Liu
- Department of Biomedical Engineering, Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Adib Keikhosravi
- Department of Biomedical Engineering, Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Kevin W Eliceiri
- Department of Biomedical Engineering, Laboratory for Optical and Computational Instrumentation, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
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7
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Chan RW. Nonlinear viscoelastic characterization of human vocal fold tissues under large-amplitude oscillatory shear (LAOS). JOURNAL OF RHEOLOGY 2018; 62:695-712. [PMID: 29780189 PMCID: PMC5959278 DOI: 10.1122/1.4996320] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Viscoelastic shear properties of human vocal fold tissues were previously quantified by the shear moduli (G' and G″). Yet these small-strain linear measures were unable to describe any nonlinear tissue behavior. This study attempted to characterize the nonlinear viscoelastic response of the vocal fold lamina propria under large-amplitude oscillatory shear (LAOS) with a stress decomposition approach. Human vocal fold cover and vocal ligament specimens from eight subjects were subjected to LAOS rheometric testing with a simple-shear rheometer. The empirical total stress response was decomposed into elastic and viscous stress components, based on odd-integer harmonic decomposition approach with Fourier transform. Nonlinear viscoelastic measures derived from the decomposition were plotted in Pipkin space and as rheological fingerprints to observe the onset of nonlinearity and the type of nonlinear behavior. Results showed that both the vocal fold cover and the vocal ligament experienced intercycle strain softening, intracycle strain stiffening, as well as shear thinning both intercycle and intracycle. The vocal ligament appeared to demonstrate an earlier onset of nonlinearity at phonatory frequencies, and higher sensitivity to changes in frequency and strain. In summary, the stress decomposition approach provided much better insights into the nonlinear viscoelastic behavior of the vocal fold lamina propria than the traditional linear measures.
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Affiliation(s)
- Roger W Chan
- Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Tang SS, Mohad V, Gowda M, Thibeault SL. Insights Into the Role of Collagen in Vocal Fold Health and Disease. J Voice 2017; 31:520-527. [PMID: 28359643 PMCID: PMC5583023 DOI: 10.1016/j.jvoice.2017.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/08/2017] [Accepted: 01/11/2017] [Indexed: 10/19/2022]
Abstract
As one of the key fibrous proteins in the extracellular matrix, collagen plays a significant role in the structural and biomechanical characteristics of the vocal fold. Anchored fibrils of collagen create secure structural regions within the vocal folds and are strong enough to sustain vibratory impact and stretch during phonation. This contributes tensile strength, density, and organization to the vocal folds and influences health and pathogenesis. This review offers a comprehensive summary for a current understanding of collagen within normal vocal fold tissues throughout the life span as well as vocal pathology and wound repair. Further, collagen's molecular structure and biosynthesis are discussed. Finally, collagen alterations in tissue injury and repair and the incorporation of collagen-based biomaterials as a method of treating voice disorders are reviewed.
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Affiliation(s)
- Sharon S Tang
- Department of Communication Sciences and Disorders, Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Vidisha Mohad
- Department of Communication Sciences and Disorders, Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Madhu Gowda
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Susan L Thibeault
- Department of Surgery, Voice and Swallow Clinics, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Allen J. Response of an ovine laryngeal injury model to a novel fibrosis inhibitor. ANZ J Surg 2016; 87:266-270. [PMID: 27878913 DOI: 10.1111/ans.13852] [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: 04/05/2016] [Revised: 09/25/2016] [Accepted: 10/16/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vocal fold injury results in severe voice alteration that limits occupational function and social interaction. An ovine model of laryngeal injury has been developed, validated and utilized to examine laryngeal wound healing and the effect of a novel collagen inhibitor (halofuginone) on surgical wound healing. The study design includes basic research and animal model. METHODS An ovine laryngeal model was utilized to study controlled vocal fold injury and healing. Twenty-five sheep were divided into five groups. Sheep underwent right vocal fold injury preceded or followed by administration of halofuginone orally, topically or intralesionally. Biopsies were taken at commencement, 1 month and larynges explanted at 3 months. Specimens were examined for elastin and collagen density and epithelial changes. Pearson correlation statistics and Student's t-tests were used to assess inter-relationships. RESULTS All sheep tolerated halofuginone. One sheep death occurred in an untreated sheep. Vocal fold tissue demonstrated a predictable histological response to injury. Elastin was significantly reduced post-injury in the glottis. Halofuginone administered orally for 10 weeks prevented elastin loss and demonstrated a trend of reducing collagen density post-injury. CONCLUSION In an ovine laryngeal injury model, administration of a fibrosis inhibitor resulted in altered elastin and collagen deposition after injury in the glottis. Further investigation is warranted to examine whether these tissue changes affect vocal fold dynamics.
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Affiliation(s)
- Jacqueline Allen
- Faculty of Medical and Health Science, Department of Surgery, The University of Auckland, Auckland, New Zealand
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10
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Garcia JA, Benboujja F, Beaudette K, Rogers D, Maurer R, Boudoux C, Hartnick CJ. Collagen Content Limits Optical Coherence Tomography Image Depth in Porcine Vocal Fold Tissue. Otolaryngol Head Neck Surg 2016; 155:829-836. [PMID: 27352894 DOI: 10.1177/0194599816658005] [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: 04/03/2016] [Accepted: 06/14/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Vocal fold scarring, a condition defined by increased collagen content, is challenging to treat without a method of noninvasively assessing vocal fold structure in vivo. The goal of this study was to observe the effects of vocal fold collagen content on optical coherence tomography imaging to develop a quantifiable marker of disease. STUDY DESIGN Excised specimen study. SETTING Massachusetts Eye and Ear Infirmary. SUBJECTS AND METHODS Porcine vocal folds were injected with collagenase to remove collagen from the lamina propria. Optical coherence tomography imaging was performed preinjection and at 0, 45, 90, and 180 minutes postinjection. Mean pixel intensity (or image brightness) was extracted from images of collagenase- and control-treated hemilarynges. Texture analysis of the lamina propria at each injection site was performed to extract image contrast. Two-factor repeated measure analysis of variance and t tests were used to determine statistical significance. Picrosirius red staining was performed to confirm collagenase activity. RESULTS Mean pixel intensity was higher at injection sites of collagenase-treated vocal folds than control vocal folds (P < .0001). Fold change in image contrast was significantly increased in collagenase-treated vocal folds than control vocal folds (P = .002). Picrosirius red staining in control specimens revealed collagen fibrils most prominent in the subepithelium and above the thyroarytenoid muscle. Specimens treated with collagenase exhibited a loss of these structures. CONCLUSION Collagen removal from vocal fold tissue increases image brightness of underlying structures. This inverse relationship may be useful in treating vocal fold scarring in patients.
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Affiliation(s)
| | - Fouzi Benboujja
- Department of Engineering Physics, Polytechnique Montreal, Montreal, Canada
| | - Kathy Beaudette
- Department of Engineering Physics, Polytechnique Montreal, Montreal, Canada
| | - Derek Rogers
- Madigan Army Medical Center, Tacoma, Washington, USA
| | - Rie Maurer
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Caroline Boudoux
- Department of Engineering Physics, Polytechnique Montreal, Montreal, Canada
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In vivo cross-sectional imaging of the phonating larynx using long-range Doppler optical coherence tomography. Sci Rep 2016; 6:22792. [PMID: 26960250 PMCID: PMC4785353 DOI: 10.1038/srep22792] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/28/2016] [Indexed: 12/04/2022] Open
Abstract
Diagnosis and treatment of vocal fold lesions has been a long-evolving science for the otolaryngologist. Contemporary practice requires biopsy of a glottal lesion in the operating room under general anesthesia for diagnosis. Current in-office technology is limited to visualizing the surface of the vocal folds with fiber-optic or rigid endoscopy and using stroboscopic or high-speed video to infer information about submucosal processes. Previous efforts using optical coherence tomography (OCT) have been limited by small working distances and imaging ranges. Here we report the first full field, high-speed, and long-range OCT images of awake patients’ vocal folds as well as cross-sectional video and Doppler analysis of their vocal fold motions during phonation. These vertical-cavity surface-emitting laser source (VCSEL) OCT images offer depth resolved, high-resolution, high-speed, and panoramic images of both the true and false vocal folds. This technology has the potential to revolutionize in-office imaging of the larynx.
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Branco A, Todorovic Fabro A, Gonçalves TM, Garcia Martins RH. Alterations in extracellular matrix composition in the aging larynx. Otolaryngol Head Neck Surg 2015; 152:302-7. [PMID: 25645525 DOI: 10.1177/0194599814562727] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study by immunohistochemistry the alterations of collagens I, III, IV, and V and elastin in the aging process of the human larynx. STUDY DESIGN Cadaver study. SETTING Universidade Estadual Paulista, Botucatu Medical School, São Paulo State University (UNESP), Brazil. SUBJECTS AND METHODS Thirty vocal folds were obtained at autopsy from 10 adult men (aged 30 to 50 years) and 20 geriatric men (10 aged 60 to 75 years and 10 aged >75 years). Mid membranous vocal fold slides were subjected to immunohistochemical reactions. Digital imaging software (ImageJ) was used to quantify the increase in brownish staining of the lamina propria structures of vocal folds, from superficial to deep layers. RESULTS There was an increase of collagen I and III immunoexpression in the elderly larynges, in both layers. Collagens IV and V were immunoexpressed in the vessels endothelium of the lamina propria and in the basement membrane. The immunoexpression of elastin decreased in the elderly larynges, in both lamina propria layers of the vocal folds. CONCLUSION A clear increase of collagens I and III and a decrease of elastic fibers were observed in the lamina propria of vocal folds. The concentration of collagens IV and V was the same across age groups. These findings suggest that as men age, the density of the extracellular matrix increases, brought about by an increase in collagen, while the loss of elastin results in decreased viscoelasticity.
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Affiliation(s)
- Anete Branco
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Botucatu Medical School, UNESP-Univ Estadual Paulista, São Paulo, Brazil
| | | | - Tatiana Maria Gonçalves
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Botucatu Medical School, UNESP-Univ Estadual Paulista, São Paulo, Brazil
| | - Regina Helena Garcia Martins
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Botucatu Medical School, UNESP-Univ Estadual Paulista, São Paulo, Brazil
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Bhattacharya P, Siegmund T. Computational modeling of vibration-induced systemic hydration of vocal folds over a range of phonation conditions. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2014; 30:1019-1043. [PMID: 24760548 DOI: 10.1002/cnm.2642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 02/05/2014] [Accepted: 03/22/2014] [Indexed: 06/03/2023]
Abstract
Predicting phonation conditions that are benign to voice health remains a biomechanically relevant problem. Our objective is to provide insight into vocal fold (VF) hydration based on continuum-based VF models that are able to compute VF stresses during phonation and a scheme for the extraction and generalization of such computational data based on the principle of linear superposition. Because VF tissue is poroelastic, spatial gradients of VF hydrostatic stresses computed for a given phonation condition determine VF interstitial fluid flow. The present approach transforms, based on linear superposition principles, the computed interstitial fluid velocities at the particular phonation to those at an arbitrary phonation condition. Intersititial fluid flow characteristics for a range of phonation conditions are compared. For phonation conditions with no or moderate collision, no dehydration per vibration cycle is predicted throughout the VF. For more severe collision conditions, tissue dehydration is restricted to a region close to the glottal surface. Interstitial fluid displacement in the VF is found to be heterogeneous and strongly dependent on the phonation condition. A phonation condition is found to exist for which dehydration peaks. The proposed method significantly expands the scope and relevance of conducting isolated numerical simulations of VF vibration.
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Affiliation(s)
- Pinaki Bhattacharya
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA
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Julias M, Riede T, Cook D. Visualizing collagen network within human and rhesus monkey vocal folds using polarized light microscopy. Ann Otol Rhinol Laryngol 2013; 122:135-44. [PMID: 23534129 DOI: 10.1177/000348941312200210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Collagen fiber content and orientation affect the viscoelastic properties of the vocal folds, determining oscillation characteristics during speech and other vocalization. The investigation and reconstruction of the collagen network in vocal folds remains a challenge, because the collagen network requires at least micron-scale resolution. In this study, we used polarized light microscopy to investigate the distribution and alignment of collagen fibers within the vocal folds. METHODS Data were collected in sections of human and rhesus monkey (Macaca mulatta) vocal folds cut at 3 different angles and stained with picrosirius red. RESULTS Statistically significant differences were found between different section angles, implying that more than one section angle is required to capture the network's complexity. In the human vocal folds, the collagen fiber distribution continuously varied across the lamina propria (medial to lateral). Distinct differences in birefringence distribution were observed between the species. For the human vocal folds, high birefringence was observed near the thyroarytenoid muscle and near the epithelium. However, in the rhesus monkey vocal folds, high birefringence was observed near the epithelium, and lower birefringence was seen near the thyroarytenoid muscle. CONCLUSIONS The differences between the collagen networks in human and rhesus monkey vocal folds provide a morphological basis for differences in viscoelastic properties between species.
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Affiliation(s)
- Margaret Julias
- Division of Engineering, New York University, Abu Dhabi, United Arab Emirates
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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: 18] [Impact Index Per Article: 1.5] [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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Hoy CL, Everett WN, Yildirim M, Kobler J, Zeitels SM, Ben-Yakar A. Towards endoscopic ultrafast laser microsurgery of vocal folds. JOURNAL OF BIOMEDICAL OPTICS 2012; 17:038002. [PMID: 22502583 DOI: 10.1117/1.jbo.17.3.038002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Vocal fold scarring is a predominant cause of voice disorders yet lacks a reliable treatment method. The injection of soft biomaterials to improve mechanical compliance of the vocal folds has emerged as a promising treatment. Here, we study the use of precise femtosecond laser microsurgery to ablate subsurface voids, with a goal of eventually creating a plane in dense subepithelial scar tissue into which biomaterials can be injected for their improved localization. Specifically, we demonstrate the ablation of small subepithelial voids in porcine vocal fold tissue up to 120 [micro sign]m below the surface such that larger voids in the active area of vocal fold mucosa (~3×10 mm(2)) can eventually be ablated in about 3 min. We use sub-μJ, 776-nm pulses from a compact femtosecond fiber laser system operating at a 500-kHz repetition rate. The use of relatively high repetition rates, with a small number of overlapping pulses, is critical to achieving ablation in a very short time while still avoiding significant heat deposition. Additionally, we use the same laser for nonlinear optical imaging to provide visual feedback of tissue structure and to confirm successful ablation. The ablation parameters, including pulse duration, pulse energy, spot size, and scanning speed, are comparable to the specifications in our recently developed miniaturized femtosecond laser surgery probes, illustrating the feasibility of developing an ultrafast laser surgical instrument.
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Affiliation(s)
- Christopher L Hoy
- The University of Texas at Austin, Department of Mechanical Engineering, Austin, Texas 78712, USA
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