A computational study of the effect of false vocal folds on glottal flow and vocal fold vibration during phonation

Sensitivity of Phonation Onset Pressure to Vocal Fold Stiffness Distribution

Phonation onset is characterized by the unstable growth of vocal fold (VF) vibrations that ultimately results in self-sustained oscillation and the production of modal voice. Motivated by histological studies, much research has focused on the role of the layered structure of the vocal folds in influencing phonation onset, wherein the outer "cover" layer is relatively soft and the inner "body" layer is relatively stiff. Recent research, however, suggests that the body-cover (BC) structure over-simplifies actual stiffness distributions by neglecting important spatial variations, such as inferior-superior (IS) and anterior-posterior gradients and smooth transitions in stiffness from one histological layer to another. Herein, we explore sensitivity of phonation onset to stiffness gradients and smoothness. By assuming no a priori stiffness distribution and considering a second-order Taylor series sensitivity analysis of phonation onset pressure with respect to stiffness, we find two general smooth stiffness distributions most strongly influence onset pressure: a smooth stiffness containing aspects of BC differences and IS gradients in the cover, which plays a role in minimizing onset pressure, and uniform increases in stiffness, which raise onset pressure and frequency. While the smooth stiffness change contains aspects qualitatively similar to layered BC distributions used in computational studies, smooth transitions in stiffness result in higher sensitivity of onset pressure than discrete layering. These two general stiffness distributions also provide a simple, low-dimensional, interpretation of how complex variations in VF stiffness affect onset pressure, enabling refined exploration of the effects of stiffness distributions on phonation onset.

Synchronized and Desynchronized Dynamics Observed from Physical Models of the Vocal and Ventricular Folds

The ventricular folds, located superiorly to the vocal folds, do not usually vibrate during normal phonations. It has been shown, however, that they do vibrate together with the vocal folds under special circumstances such as voice pathology and singing voice. Towards understanding the effect of the ventricular fold oscillations on the vocal fold oscillations, the present study developed a synthetic model that takes into account anatomical features of the human ventricular folds. The synthetic model is made of flexible silicone compounds with material properties comparable to those of human ventricular fold tissues. In our experiment, an air-flow was injected into the vocal and ventricular fold models. As the distance between the left and right ventricular folds was reduced, the ventricular folds started to co-vibrate with the vocal folds. Depending upon the distance, various oscillation patterns of the vocal-ventricular folds were observed, e.g., synchronized dynamics with 1:1 or 1:2 frequency ratio and desynchronized chaotic dynamics. The observed chaotic dynamics might be related to voice pathology induced by the ventricular phonation. A computational model was further presented to elucidate the experimental findings.

An Integrated Experimental-Computational Study of Vocal Fold Vibration in Type I Thyroplasty

Subject-specific computational modeling of vocal fold (VF) vibration was integrated with an ex vivo animal experiment of type 1 thyroplasty to study the effect of the implant on the vocal fold vibration. In the experiment, a rabbit larynx was used to simulate type 1 thyroplasty, where one side of the vocal fold was medialized with a trans-muscular suture while the other side was medialized with a silastic implant. Vocal fold vibration was then achieved by flowing air through the larynx and was filmed with a high-speed camera. The three-dimensional computational model was built upon the pre-operative scan of the laryngeal anatomy. This subject-specific model was used to simulate the vocal fold medialization and then the fluid-structure interaction (FSI) of the vocal fold. Model validation was done by comparing the vocal fold displacement with postoperative scan (for medialization), and by comparing the vibratory characteristics with the high-speed images (for vibration). These comparisons showed the computational model successfully captured the effect of the implant and thus has the potential for presurgical planning.

Simulation of Multiple Source Vocalization in the Larynx: How True Folds, False Folds, and Aryepiglottic Folds May Interact

PURPOSE

This study was a modest beginning to determine dominance and entrainment between three soft tissues in the larynx that can be set into flow-induced oscillation and act as sound sources. The hypothesis was that they interact as coupled oscillators with observable bifurcations as energy is exchanged between them.

METHODOLOGY

The true vocal folds, the ventricular (false) folds, and the aryepiglottic folds were part of a soft-walled airway that produced airflow for sound production. The methodology was computational, based on a simplified Navier-Stokes solution of convective and compressible airflow in a variable-geometry airway.

RESULTS

Three serially connected sources could all produce flow-induced self-oscillation with soft wall tissue and small cross-sectional area. When the glottal cross-sectional areas were similar, bifurcations such as subharmonics, delayed voice onset, and aphonia occurred in the coupled oscillations.

CONCLUSIONS

Closely spaced sound sources in the larynx are highly interactive. They appear to entrain to the source that has the combined advantage of small cross-sectional glottal area and proximity to a downstream vocal tract that supports oscillation with acoustic inertance.

The influence of source-filter interaction on the voice source in a three-dimensional computational model of voice production

The goal of this computational study is to quantify global effects of vocal tract constriction at various locations (false vocal folds, aryepiglottic folds, pharynx, oral cavity, and lips) on the voice source across a large range of vocal fold conditions. The results showed that while inclusion of a uniform vocal tract had notable effects on the voice source, further constricting the vocal tract only had small effects except for conditions of extreme constriction, at which constrictions at any location along the vocal tract decreased the mean and peak-to-peak amplitude of the glottal flow waveform. Although narrowing in the epilarynx increased the normalized maximum flow declination rate, vocal tract constriction in general slightly reduced the source strength and high-frequency harmonic production at the glottis, except for a limited set of vocal fold conditions (e.g., soft, long vocal folds subject to relatively high pressure). This suggests that simultaneous laryngeal and vocal tract adjustments are required to maximize source-filter interaction. While vocal tract adjustments are often assumed to improve voice production, our results indicate that such improvements are mainly due to changes in vocal tract acoustic response rather than improved voice production at the glottis.

Towards modeling of phonation and its recovery in unilateral vocal fold paralysis by fluid-structure interaction

Introduction

Vocal folds are responsible for sound generation. In unilateral vocal fold paralysis (UVFP), the recurrent laryngeal nerve, which controls the vocal folds, is paralyzed. Medialization laryngoplasty is a surgery in which an implant is inserted to push the paralyzed vocal fold to the centerline to recover phonation.

Methods

Here, a numerical simulation is used to calculate flow-related parameters to give insight into what happens in healthy and treated(implanted) vocal folds and their enhancement. In the present work, airflow over vocal folds is modeled considering fluid-structure interaction (FSI) and varying inlet pressure. The governing equations are discretized for fluid and solid domains and solved using the Galerkin finite element method. The boundary conditions for healthy and unilaterally paralyzed vocal folds were imposed to agree with real cases behavior.

Results

The results showed the effectiveness of medialization laryngoplasty in treating unilateral vocal fold paralysis concerning healthy vocal folds.

Conclusion

This simulation provided a better insight into treatment results for patient-specific cases.

Examining the influence of epithelium layer modeling approaches on vocal fold kinematics and kinetics

Grouping the thin epithelium and thicker superficial lamina propria layers into a single cover layer has been widely adopted in finite element vocal fold models. Recent silicone vocal fold studies have suggested, however, that inclusion of a distinct epithelial layer leads to more physiologically representative motion. This study systematically explores the ramifications of incorporating an epithelial layer into a cover grouping for finite element vocal fold modeling. A membrane model for the epithelium is introduced to facilitate parametric investigation by reducing the mesh density requirement of the epithelium into a single infinitesimally thin layer. Excluding the epithelium entirely leads to increased energy in higher order modes and larger inferior-superior excursion of the folds. Integrating the epithelium into a cover layer with volume-weighted average stiffness results in similar kinematics to that of a model treating the epithelium as a distinct layer. However, the internal stress/strain and contact pressure during collision are higher, and viscous dissipation is lower, when the epithelium is integrated into the cover. Thus, careful treatment of the epithelium is recommended for finite element studies, particularly when employing the models for estimating measures dependent upon internal stress/strain and/or collision pressure, such as vocal dose.

Symptom Expression Across Voiced Speech Sounds in Adductor Laryngeal Dystonia

OBJECTIVES

Differential diagnosis for adductor laryngeal dystonia (AdLD) is often carried out by comparing symptom expression during sentences with either all voiced or voiced and voiceless consonants. However, empirical research examining the effects of phonetic context on symptoms is sparse. The purpose of this study was to examine whether symptom probabilities varied across voiced speech segments in an all-voiced sentence, and whether this variability was systematic with respect to phonetic features.

METHODS

Eighteen speakers with AdLD read aloud a sentence comprised entirely of voiced speech sounds. Speech segment boundaries and AdLD symptoms (phonatory breaks, frequency shifts, and creak) were labeled separately, and speech segments were coded as symptomatic or asymptomatic based on their temporal overlap. Generalized linear mixed effects models with a binomial outcome variable were used to compare the probability of symptom expression across: 1) all speech segments in the sentence, and 2) four speech sound classes (vowels, approximants, nasals, and obstruents).

RESULTS

Significant symptom variability was found across voiced speech segments in the sentence. Furthermore, the estimated probability of a symptom occurring on vowels and approximants was significantly greater than that of nasals and obstruents.

CONCLUSION

These results indicate that AdLD symptoms are not uniformly distributed across voiced speech segments with systematic variation across speech sound classes.To explain these findings, future work should investigate how the complex interactions between the vocal tract articulators and glottal configurations may influence symptom expression in this population.

Subject-Specific Computational Fluid-Structure Interaction Modeling of Rabbit Vocal Fold Vibration

A full three-dimensional (3D) fluid-structure interaction (FSI) study of subject-specific vocal fold vibration is carried out based on the previously reconstructed vocal fold models of rabbit larynges. Our primary focuses are the vibration characteristics of the vocal fold, the unsteady 3D flow field, and comparison with a recently developed 1D glottal flow model that incorporates machine learning. The 3D FSI model applies strong coupling between the finite-element model for the vocal fold tissue and the incompressible Navier-Stokes equation for the flow. Five different samples of the rabbit larynx, reconstructed from the magnetic resonance imaging (MRI) scans after the in vivo phonation experiments, are used in the FSI simulation. These samples have distinct geometries and a different inlet pressure measured in the experiment. Furthermore, the material properties of the vocal fold tissue were determined previously for each individual sample. The results demonstrate that the vibration and the intraglottal pressure from the 3D flow simulation agree well with those from the 1D flow model based simulation. Further 3D analyses show that the inferior and supraglottal geometries play significant roles in the FSI process. Similarity of the flow pattern with the human vocal fold is discussed. This study supports the effective usage of rabbit larynges to understand human phonation and will help guide our future computational studies that address vocal fold disorders.

Effect of Supraglottal Acoustics on Fluid-Structure Interaction During Human Voice Production

A hydrodynamic/acoustic splitting method was used to examine the effect of supraglottal acoustics on fluid-structure interactions during human voice production in a two-dimensional computational model. The accuracy of the method in simulating compressible flows in typical human airway conditions was verified by comparing it to full compressible flow simulations. The method was coupled with a three-mass model of vocal fold lateral motion to simulate fluid-structure interactions during human voice production. By separating the acoustic perturbation components of the airflow, the method allows isolation of the role of supraglottal acoustics in fluid-structure interactions. The results showed that an acoustic resonance between a higher harmonic of the sound source and the first formant of the supraglottal tract occurred during normal human phonation when the fundamental frequency was much lower than the formants. The resonance resulted in acoustic pressure perturbation at the glottis which was of the same order as the incompressible flow pressure and found to affect vocal fold vibrations and glottal flow rate waveform. Specifically, the acoustic perturbation delayed the opening of the glottis, reduced the vertical phase difference of vocal fold vibrations, decreased flow rate and maximum flow deceleration rate (MFDR) at the glottal exit; yet, they had little effect on glottal opening. The results imply that the sound generation in the glottis and acoustic resonance in the supraglottal tract are coupled processes during human voice production and computer modeling of vocal fold vibrations needs to include supraglottal acoustics for accurate predictions.

Experimental study of vocal-ventricular fold oscillations in voice production

Ventricular folds are located in the supraglottal region above the vocal folds. Although the ventricular folds do not vibrate under normal vocalizations, they vibrate under certain conditions, e.g., throat singing or ventricular fold dysphonia. In throat singing, the ventricular folds vibrate at the same frequency as (or at integer ratios of) the vocal fold vibration frequency. In ventricular fold dysphonia, on the other hand, the ventricular folds interfere with the vocal folds, giving rise to a hoarse voice. In the present study, the synthetic larynx model was utilized to examine the vocal-ventricular fold oscillations. Our experiments revealed that the vocal and ventricular folds can co-oscillate at the same frequency with an out-of-phase relation. Compared to the control condition, under which no ventricular folds exist, the phonation threshold pressure was increased in the presence of the ventricular folds. Acoustic analysis indicated that jitter was reduced and vocal efficiency was increased by the ventricular folds. Distance between the vocal and ventricular folds did not alter these oscillation properties. A computational model was further simulated to elucidate the mechanism underlying the observed vocal-ventricular fold oscillations. It has been suggested that out-of-phase oscillations of the vocal and ventricular folds are important for sustaining periodic laryngeal vibrations.

Quantification of the Intraglottal Pressure Induced by Flow Separation Vortices Using Large Eddy Simulation

The greatest rate of change in the glottal flow rate during phonation is a rapid decrease that occurs during the latter part of the glottal closing. Previous works showed that intraglottal flow separation vortices form in a divergent glottis, produce negative gauge pressures (below atmospheric) during closing. It is hypothesized here that flow separation vortices contribute to the rapid closing mechanism of the true vocal folds during phonation. Four idealized static models (M5) of the human larynx were investigated using large eddy simulation: 2 models featured parallel folds that did not enable flow separation in the glottis and 2 models involved a divergent glottis. The influence of the ventricular gap (narrow/wide) is evaluated. An unsteady pressure inlet representing a voicing cycle was applied to the sub-glottal region to mimic the time-varying glottal flow. Intraglottal vortex structures formed downstream of the separation point in a divergent glottis. Their existence caused a higher closing force that was applied onto the vocal folds. A narrow ventricular gap strengthens this effect. Strength of the intraglottal vortices increased with the maximum flow declination rate. Therefore, a more divergent shape of the glottis during glottal closing will be one of the main contributors to the voice quality.

Effects of False Vocal Folds on Intraglottal Velocity Fields

Previous models have theorized that, during phonation, skewing of the glottal waveform (which is correlated with acoustic intensity) occurred because of inertance of the vocal tract. Later, we reported that skewing of the flow rate waveform can occur without the presence of a vocal tract in an excised canine larynx. We hypothesized that in the absence of a vocal tract, the skewing formed when dynamic pressures acted on the glottal wall during the closing phase; such pressures were greatly affected by formation of intraglottal vortices. In this study, we aim to identify how changes in false vocal folds constriction can affect the acoustics and intraglottal flow dynamics. The intraglottal flow measurements were made using particle image velocimetry in an excised canine larynx where a vocal tract model was placed above the larynx and the constriction between the false vocal folds was varied. Our results show that for similar values of subglottal pressures, the skewing of the glottal waveform, strength of the intraglottal vortices, and acoustic energy increased as the constriction between the false vocal folds was increased. These preliminary findings suggest that acoustic intensity during phonation can be increased by the addition of a vocal tract with false fold constriction.

Volume velocity in a canine larynx model using time‑resolved tomographic particle image velocimetry

In the classic source-filter theory, the source of sound is flow modulation. "Flow" is the flow rate (Q) and flow modulation is dQ/dt. Other investigators have argued, using theoretical, computational, and mechanical models of the larynx, that there are additional sources of sound. To determine the acoustic role of dQ/dt in a tissue model, Q needs to be accurately measured within a few millimeters of the glottal exit; however, no direct measures of Q currently exist. The goal of this study is to obtain this waveform in an excised canine larynx model using time-resolved tomographic particle image velocimetry. The flow rate data are captured simultaneously with acoustic measurements to determine relations with vocal characteristics. The results show that glottal waveform characteristics such as maximum flow declination rate are proportional to the subglottal pressure, fundamental frequency, and acoustic intensity. These findings are important as they use direct measurements of the volume flow at the glottal exit to validate some of the assumptions used in the source-filter theory. In addition, future work will address the accuracy of indirect clinical measurement techniques, such as the Rothenberg mask.

A computational study of the effects of vocal fold stiffness parameters on voice production

A three-dimensional flow-structure interaction model of voice production is used to investigate the effect of the stiffness parameters of vocal fold layers on voice production. The vocal fold is modeled as a three-layer structure consisting of the cover, ligament, and body layers. All the three layers are modeled as transversely isotropic materials for which the stiffness parameters include the transverse elastic modulus and longitudinal elastic modulus. The results show that, in addition to the obvious monotonic effects on the fundamental frequency, flow rate and glottis opening, the stiffness parameters also have significant and nonmonotonic effects on the divergent angle, open quotient, and closing velocity. It is further found that the longitudinal stiffness parameters generally have more significant impacts on glottal flows and vocal fold vibrations than the transverse stiffness parameters. The sensitivity analysis shows that, among all the stiffness parameters, the transverse and longitudinal stiffness of the ligament layer have the most dominant effect on most output measures.

Effect of Longitudinal Variation of Vocal Fold Inner Layer Thickness on Fluid-Structure Interaction During Voice Production

A three-dimensional fluid-structure interaction computational model was used to investigate the effect of the longitudinal variation of vocal fold inner layer thickness on voice production. The computational model coupled a finite element method based continuum vocal fold model and a Navier-Stokes equation based incompressible flow model. Four vocal fold models, one with constant layer thickness and the others with different degrees of layer thickness variation in the longitudinal direction, were studied. It was found that the varied thickness resulted in up to 24% stiffness reduction at the middle and up to 47% stiffness increase near the anterior and posterior ends of the vocal fold; however, the average stiffness was not affected. The fluid-structure interaction simulations on the four models showed that the thickness variation did not affect vibration amplitude, glottal flow rate, and the waveform related parameters. However, it increased glottal angles at the middle of the vocal fold, suggesting that vocal fold vibration amplitude was determined by the average stiffness of the vocal fold, while the glottal angle was determined by the local stiffness. The models with longitudinal variation of layer thickness consumed less energy during the vibrations compared with the constant layer thickness one.

Influence of vocal fold cover layer thickness on its vibratory dynamics during voice production

The influence of vocal fold cover layer thickness on the flow-induced vibration and voice production was studied by using a continuum-mechanics based computational model. The cover-body thickness ratio of a three-layer vocal fold was systematically varied. The effect on the vocal fold stiffness, eigenfrequencies and eigenmodes, fundamental frequencies, glottal flow rate, vocal fold vibratory dynamics, and synchronization of the eigenmodes were analyzed by using the structure eigen analysis and flow-structure interaction simulations. It was found that the cover-body layer thickness ratio significantly affected the strength and synchronization of the eigenmodes during flow-structure interactions, and ultimately affected the fundamental frequency and vibration pattern. With the increasing cover-body thickness ratio, the strength of the wave-type higher-eigenfrequency modes increased, and that resulted in a nonlinear bifurcation of the system in which the system evolved from a regular periodic vibration to a periodic doubling vibration and then back to a regular periodic vibration with increased fundamental frequencies. During the transition, the system vibrated chaotically. Because of the increased strength of the wave-type modes, the maximum divergent angle of the glottis was also increased with the increasing cover-body thickness ratio.

Aerodynamic impact of the ventricular folds in computational larynx models

Ventricular folds (VeFs) act as passive, non-moving structures during normal phonation. According to the literature, VeFs potentially aid the flow-driven oscillations of the vocal folds (VFs) that produce the primary sound of human phonation. In this study, large eddy simulations were performed to analyze this influence in a numerical model with imposed VF motion as measured experimentally from a synthetic silicone vocal fold model. Model configurations with and without VeFs were considered. Furthermore, configurations with rectangular and elliptical glottis shapes were simulated to investigate the effects of three-dimensional glottal jet evolutions. Results showed that VeFs increased flow rate and transglottal pressure difference by a decrease in the pressure level in the ventricles immediately downstream of the VFs. This led to an increase in the glottal flow resistance, increased energy transfer rate between the flow and VFs, and a simultaneous decrease in the laryngeal flow resistance, which shows a higher amount of kinetic energy in the glottal flow. This enhancement was more pronounced in the rectangular glottis and varied with the subglottal pressure and VeF gap size.

Juvenile Ovine Ex Vivo Larynges: Phonatory, Histologic, and Micro CT Based Anatomic Analyses

It is well known that the phonatory process changes during the life span. However, detailed investigations on potential factors concerned are rare. To deal with this issue, we performed extended biomechanical, macro anatomical, and histological analyses of the contributing laryngeal structures in ex vivo juvenile sheep models. Altogether twelve juvenile sheep larynges were analyzed within the phonatory experiments. Three different elongation levels and 16 different flow levels were applied to achieve a large variety of phonatory conditions. Vocal fold dynamics and acoustical and subglottal signals could be analyzed for 431 experimental runs. Subsequently, for six juvenile larynges microcomputed tomography following virtual 3D reconstruction was performed. The remaining six juvenile larynges as well as six ex vivo larynges from old sheep were histologically and immunohistologically analyzed. Results for juveniles showed more consistent dynamical behavior compared to old sheep larynges due to vocal fold tissue alterations during the life span. The phonatory process in juvenile sheep seems to be more effective going along with a greater dynamic range. These findings are supported by the histologically detected higher amounts of elastin and hyaluronic acid in the lamina propria of the juvenile sheep. The 3D reconstructions of the thyro-arytenoid muscles (TAM) showed a symmetrical shape. Intraindividual volume and surface differences of the TAM were small and comparable to those of aged sheep. However, TAM dimensions were statistically significant smaller for juvenile larynges. Finally, topographical landmarks were introduced for later comparison with other individuals and species. This work resulted in detailed functional, immunohistological, and anatomical information that was not yet reported. This data will also provide reference information for therapeutic strategies regarding aging effects, e.g. laryngeal muscle treatment by functional electrical stimulation.

Clinical Characteristics and Management of Saccular Cysts: A Single Institute Experience

Objectives

A saccular cyst is defined as a dilated saccule of the larynx, filled with mucus, and is located between the false vocal cords and the thyroid cartilage. Although this uncommon laryngeal condition is benign in nature, it could lead to dyspnea, stridor, and airway obstruction, depending on its size and location. Furthermore, some saccular cysts have been associated with laryngeal carcinoma. This study aimed to characterize this rather uncommon laryngeal condition to aid in determining the proper management of this pathology.

Methods

Medical records were retrospectively reviewed of all patients with saccular cysts diagnosed and treated between 2006 and 2017 at a tertiary otolaryngologic care center.

Results

Seven patients with saccular cysts were identified (male:female=2:5; mean age, 34.1 years); two were pediatric patients. Surgical intervention was performed in all patients by laryngo-microsurgery using CO₂ laser. There was no recurrence after the initial surgical treatment.

Conclusion

Saccular cysts can be managed endoscopically using CO₂ laser, without requiring an external approach. Therefore, an endoscopic approach should be actively considered for an optimal treatment outcome.

Shear Wave Elastography to Assess False Vocal Folds in Healthy Adults: A Feasibility Study

OBJECTIVES

The aim of the study was to investigate the feasibility of using ultrasound shear wave elastography to quantify mechanical properties and movement symmetry of false vocal folds positioned in adduction and abduction.

METHODS

We prospectively measured the shear wave velocity (SWV) within the bilateral false vocal folds in 10 healthy adults using acoustic radiation force impulse imaging. From a transcutaneous approach at the level of thyroid cartilage, 5 SWV measurements were obtained within each side of the false vocal folds twice in adduction and again in abduction for each participant. Configuration-related differences in the SWV within false vocal folds were compared between adduction and abduction, in addition to differences between the right and left false vocal folds and between men and women, by a paired t test. We developed an SWV index [(SWV_greater - SWV_lesser )/SWV_greater ] to assess movement symmetry between the right and left false vocal folds. Intraobserver agreement on repeated measures was examined by the intraclass correlation coefficient.

RESULTS

The 10 participants included 5 men and 5 women. We observed that the SWV within false vocal folds was significantly higher in adduction than in abduction (P < .001). The SWV within false vocal folds in adduction was also significantly higher in women compared to men (P < .001). There was no significant difference in the SWV between the right and left false vocal folds in adduction or in abduction or between men and women in abduction (P > .05). The mean SWV index was 0.05 (range, 0.03-0.07). The intraclass correlation coefficient for intraobserver agreement was 0.89 (P < .001).

CONCLUSIONS

Shear wave elastography seems to be feasible to quantify mechanical properties and evaluate the symmetry of false vocal folds in healthy adults.

Ultrasound strain imaging in assessment of false vocal folds in adults: A feasibility study

PURPOSE

The aim of the study is to investigate the feasibility of ultrasound strain imaging (USI) in assessing magnitude and symmetry of false vocal folds (FVF) deformation as a quantitative marker for estimating FVF movement.

METHODS

From October 2016 to July 2017, we performed USI of FVF in 44 adults [33 healthy controls and 11 subjects with unilateral vocal fold motion impairment (VFMI), 17 men and 27 women, mean age 43 years]. Real time ultrasound data of FVF in different configuration (abduction and adduction) was acquired through transcutaneous anterior-mid neck. Peak to valley strain (strain magnitude of maximum to minimum) representing the largest FVF deformation was estimated using 2-D speckle tracking. We developed peak to valley strain index [(Peak to valley strain _right - Peak to valley strain _left)/Peak to valley strain _maximum] to assess the symmetry of FVF deformation.

RESULTS

The difference in peak to valley strain between left and right FVF was significant in subjects with VFMI, whereas it was not in healthy controls. The peak to valley strain index was small (≤0.25) in symmetric FVF deformation in healthy controls whereas it was large (≥0.53) in asymmetric FVF deformation in subjects with VFMI. The area under receiver operating characteristics for peak to valley strain index in the determining asymmetric FVF deformation was 1.

CONCLUSION

Our results suggest that USI seems feasible to quantify both magnitude and symmetry of FVF deformation in adults. Further validation of USI in assessing VFMI is warranted.

Biomechanics of the soft-palate in sleep apnea patients with polycystic ovarian syndrome

Highly compliant tissue supporting the pharynx and low muscle tone enhance the possibility of upper airway occlusion in children with obstructive sleep apnea (OSA). The present study describes subject-specific computational modeling of flow-induced velopharyngeal narrowing in a female child with polycystic ovarian syndrome (PCOS) with OSA and a non-OSA control. Anatomically accurate three-dimensional geometries of the upper airway and soft-palate were reconstructed for both subjects using magnetic resonance (MR) images. A fluid-structure interaction (FSI) shape registration analysis was performed using subject-specific values of flow rate to iteratively compute the biomechanical properties of the soft-palate. The optimized shear modulus for the control was 38 percent higher than the corresponding value for the OSA patient. The proposed computational FSI model was then employed for planning surgical treatment for the apneic subject. A virtual surgery comprising of a combined adenoidectomy, palatoplasty and genioglossus advancement was performed to estimate the resulting post-operative patterns of airflow and tissue displacement. Maximum flow velocity and velopharyngeal resistance decreased by 80 percent and 66 percent respectively following surgery. Post-operative flow-induced forces on the anterior and posterior faces of the soft-palate were equilibrated and the resulting magnitude of tissue displacement was 63 percent lower compared to the pre-operative case. Results from this pilot study indicate that FSI computational modeling can be employed to characterize the mechanical properties of pharyngeal tissue and evaluate the effectiveness of various upper airway surgeries prior to their application.

Investigating the effects of laryngotracheal stenosis on upper airway aerodynamics

OBJECTIVE

Very little is known about the impact of laryngotracheal stenosis (LTS) on inspiratory airflow and resistance, especially in air hunger states. This study investigates the effect of LTS on airway resistance and volumetric flow across three different inspiratory pressures.

METHODS

Head-and-neck computed tomography scans of 11 subjects from 2010 to 2016 were collected. Three-dimensional reconstructions of the upper airway from the nostrils to carina, including the oral cavity, were created for one subject with a normal airway and for 10 patients with LTS. Airflow simulations were conducted using computational fluid dynamics modeling at three different inspiratory pressures (10, 25, 40 pascals [Pa]) for all subjects under two scenarios: 1) inspiration through nostrils only (MC), and 2) through both nostrils and mouth (MO).

RESULTS

Volumetric flows in the normal subject at the three inspiratory pressures were considerably higher (MC: 11.8-26.1 L/min; MO: 17.2-36.9 L/min) compared to those in LTS (MC: 2.86-6.75 L/min; MO: 4.11-9.00 L/min). Airway resistances in the normal subject were 0.051 to 0.092 pascal seconds per milliliter (Pa.s)/mL (MC) and 0.035-0.065 Pa.s/mL (MO), which were approximately tenfold lower than those of subjects with LTS: 0.39 to 0.89 Pa.s/mL (MC) and 0.45 to 0.84 Pa.s/mL (MO). Furthermore, subjects with glottic stenosis had the greatest resistance, whereas subjects with subglottic stenosis had the greatest variability in resistance. Subjects with tracheal stenosis had the lowest resistance.

CONCLUSION

This pilot study demonstrates that LTS increases resistance and decreases airflow. Mouth breathing significantly improved airflow and resistance but cannot completely compensate for the effects of stenosis. Furthermore, location of stenosis appears to modulate the effect of the stenosis on resistance differentially.

LEVEL OF EVIDENCE

NA. Laryngoscope, 128:E141-E149, 2018.

Computational Models of Laryngeal Aerodynamics: Potentials and Numerical Costs

Human phonation is based on the interaction between tracheal airflow and laryngeal dynamics. This fluid-structure interaction is based on the energy exchange between airflow and vocal folds. Major challenges in analyzing the phonatory process in-vivo are the small dimensions and the poor accessibility of the region of interest. For improved analysis of the phonatory process, numerical simulations of the airflow and the vocal fold dynamics have been suggested. Even though most of the models reproduced the phonatory process fairly well, development of comprehensive larynx models is still a subject of research. In the context of clinical application, physiological accuracy and computational model efficiency are of great interest. In this study, a simple numerical larynx model is introduced that incorporates the laryngeal fluid flow. It is based on a synthetic experimental model with silicone vocal folds. The degree of realism was successively increased in separate computational models and each model was simulated for 10 oscillation cycles. Results show that relevant features of the laryngeal flow field, such as glottal jet deflection, develop even when applying rather simple static models with oscillating flow rates. Including further phonatory components such as vocal fold motion, mucosal wave propagation, and ventricular folds, the simulations show phonatory key features like intraglottal flow separation and increased flow rate in presence of ventricular folds. The simulation time on 100 CPU cores ranged between 25 and 290 hours, currently restricting clinical application of these models. Nevertheless, results show high potential of numerical simulations for better understanding of phonatory process.

Phonation Analysis Combined with 3D Reconstruction of the Thyroarytenoid Muscle in Aged Ovine Ex Vivo Larynx Models

OBJECTIVE

The aim of the study was to establish a basic data set of combined functional and anatomical measures of aged sheep larynges using ex vivo models. Combining these two approaches in one and the same larynx is an unmet goal so far yet is important as newer treatment strategies aim to preserve the organ structure and new assessment tools are required. Ovine larynges were used as their dimensions, and muscle fiber type distribution highly resemble the human larynx.

STUDY DESIGN

Ex vivo animal study.

METHODS

Larynges of six sheep (~9 years of age) were subjected to ex vivo functional phonatory experiments. Phonatory characteristics were analyzed as a function of longitudinal vocal fold (VF) prestress. Anatomical measurements of the same larynges comprised micro-computed tomography scans followed by three-dimensional (3D) reconstructions. Using specially adapted radiological scan protocols with subsequent 3D reconstruction, muscle volumes, surface areas, and anatomical measurements were computed.

RESULTS

Increasing longitudinal prestress yielded higher subglottal pressure (P_S) for the same airflow. Quantitative differences to previous studies-such as the increased P_S and increased phonation threshold pressure-were detected. We achieved excellent visualization of the laryngeal muscles and framework, resulting in accurate 3D reconstructions for quantitative analysis. We found no significant intraindividual volume differences of the thyroarytenoid muscles.

CONCLUSION

The established protocol allows precise functional and anatomical measures. The data created provide a reference data set for upcoming therapeutic strategies (eg, growth factor therapy, functional electrical stimulation) that target essential structures of the VFs such as the laryngeal muscles and/or the VF mucosa.

Establishment and Analysis of False Vocal Folds Hypertrophy Model in Excised Canine Larynges

OBJECTIVE

This study aimed to investigate the role of false vocal folds (FVFs) medialization in phonation and the acoustic impact of ventricular hypertrophy by establishing an FVF hypertrophy model.

STUDY DESIGN

A prospective in vitro experiment was carried out.

SETTING

The study was carried out using a pseudolung platform with high-speed camera in a soundproof room.

MATERIALS AND METHODS

Control, degree I, and degree II FVFs hypertrophy were simulated in 10 excised larynges via fructose injection of 0.1 mL for degree I and 0.25 mL for degree II. Mean flow rate (MFR), fundamental frequencies (F0), formants, and sound pressure level were measured with a subglottal pressure of 1.5 kPa and 2.5 kPa, respectively.

RESULTS

When the subglottal pressure was controlled at both at 1.5 kPa and at 2.5 kPa, the degree of FVF hypertrophy significantly influenced the distribution of the formants, F0, and MFR in excised canine larynges. Increasing the degree of hypertrophy was associated with a decrease in F0 and an increase in MFR. In degree II FVF hypertrophy models, the sound pressure level and the first formant were significantly higher (P < 0.05) than in normal models.

CONCLUSION

Hypertrophy of the FVFs has a significant influence on the distribution of sound energy and is associated with changes in sound quality.

Fully-coupled aeroelastic simulation with fluid compressibility - For application to vocal fold vibration

In this study, a fully-coupled fluid-structure interaction model is developed for studying dynamic interactions between compressible fluid and aeroelastic structures. The technique is built based on the modified Immersed Finite Element Method (mIFEM), a robust numerical technique to simulate fluid-structure interactions that has capabilities to simulate high Reynolds number flows and handles large density disparities between the fluid and the solid. For accurate assessment of this intricate dynamic process between compressible fluid, such as air and aeroelastic structures, we included in the model the fluid compressibility in an isentropic process and a solid contact model. The accuracy of the compressible fluid solver is verified by examining acoustic wave propagations in a closed and an open duct, respectively. The fully-coupled fluid-structure interaction model is then used to simulate and analyze vocal folds vibrations using compressible air interacting with vocal folds that are represented as layered viscoelastic structures. Using physiological geometric and parametric setup, we are able to obtain a self-sustained vocal fold vibration with a constant inflow pressure. Parametric studies are also performed to study the effects of lung pressure and vocal fold tissue stiffness in vocal folds vibrations. All the case studies produce expected airflow behavior and a sustained vibration, which provide verification and confidence in our future studies of realistic acoustical studies of the phonation process.

Effect of the ventricular folds in a synthetic larynx model

Within the human larynx, the ventricular folds serve primarily as a protecting valve during swallowing. They are located directly above the sound-generating vocal folds. During normal phonation, the ventricular folds are passive structures that are not excited to periodical oscillations. However, the impact of the ventricular folds on the phonation process has not yet been finally clarified. An experimental synthetic human larynx model was used to investigate the effect of the ventricular folds on the phonation process. The model includes self-oscillating vocal fold models and allows the comparison of the pressure distribution at multiple locations in the larynx for configurations with and without ventricular folds. The results indicate that the ventricular folds increase the efficiency of the phonation process by reducing the phonation threshold level of the pressure below the vocal folds. Two effects caused by the ventricular folds could be identified as reasons: (1) a decrease in the mean pressure level in the region between vocal and ventricular folds (ventricles) and (2) an increase in the glottal flow resistance. The reason for the first effect is a reduction of the pressure level in the ventricles due to the jet entrainment and the low static pressure in the glottal jet. The second effect results from an increase in the glottal flow resistance that enhances the aerodynamic energy transfer into the vocal folds. This effect reduces the onset threshold of the pressure difference across the glottis.

Computational Modeling of Fluid-Structure-Acoustics Interaction during Voice Production

The paper presented a three-dimensional, first-principle based fluid-structure-acoustics interaction computer model of voice production, which employed a more realistic human laryngeal and vocal tract geometries. Self-sustained vibrations, important convergent-divergent vibration pattern of the vocal folds, and entrainment of the two dominant vibratory modes were captured. Voice quality-associated parameters including the frequency, open quotient, skewness quotient, and flow rate of the glottal flow waveform were found to be well within the normal physiological ranges. The analogy between the vocal tract and a quarter-wave resonator was demonstrated. The acoustic perturbed flux and pressure inside the glottis were found to be at the same order with their incompressible counterparts, suggesting strong source-filter interactions during voice production. Such high fidelity computational model will be useful for investigating a variety of pathological conditions that involve complex vibrations, such as vocal fold paralysis, vocal nodules, and vocal polyps. The model is also an important step toward a patient-specific surgical planning tool that can serve as a no-risk trial and error platform for different procedures, such as injection of biomaterials and thyroplastic medialization.

Evaluation of aerodynamic characteristics of a coupled fluid-structure system using generalized Bernoulli's principle: An application to vocal folds vibration

In this work we explore the aerodynamics flow characteristics of a coupled fluid-structure interaction system using a generalized Bernoulli equation derived directly from the Cauchy momentum equations. Unlike the conventional Bernoulli equation where incompressible, inviscid, and steady flow conditions are assumed, this generalized Bernoulli equation includes the contributions from compressibility, viscous, and unsteadiness, which could be essential in defining aerodynamic characteristics. The application of the derived Bernoulli's principle is on a fully-coupled fluid-structure interaction simulation of the vocal folds vibration. The coupled system is simulated using the immersed finite element method where compressible Navier-Stokes equations are used to describe the air and an elastic pliable structure to describe the vocal fold. The vibration of the vocal fold works to open and close the glottal flow. The aerodynamics flow characteristics are evaluated using the derived Bernoulli's principles for a vibration cycle in a carefully partitioned control volume based on the moving structure. The results agree very well to experimental observations, which validate the strategy and its use in other types of flow characteristics that involve coupled fluid-structure interactions.

Mechanics of human voice production and control

As the primary means of communication, voice plays an important role in daily life. Voice also conveys personal information such as social status, personal traits, and the emotional state of the speaker. Mechanically, voice production involves complex fluid-structure interaction within the glottis and its control by laryngeal muscle activation. An important goal of voice research is to establish a causal theory linking voice physiology and biomechanics to how speakers use and control voice to communicate meaning and personal information. Establishing such a causal theory has important implications for clinical voice management, voice training, and many speech technology applications. This paper provides a review of voice physiology and biomechanics, the physics of vocal fold vibration and sound production, and laryngeal muscular control of the fundamental frequency of voice, vocal intensity, and voice quality. Current efforts to develop mechanical and computational models of voice production are also critically reviewed. Finally, issues and future challenges in developing a causal theory of voice production and perception are discussed.

The Effect of False Vocal Folds on Laryngeal Flow Resistance in a Tubular Three-dimensional Computational Laryngeal Model

OBJECTIVE

The current study used a three-dimensional (3D) computational laryngeal model to investigate the effect of false vocal folds (FVFs) on laryngeal flow resistance.

METHOD

A 3D, tubular shaped computational laryngeal model was designed with a high level of realism with respect to the human laryngeal anatomy. Two cases, one with the FVFs and the other without the FVFs, were created in the numerical simulation to compare the laryngeal flow behaviors.

RESULTS AND CONCLUSION

The results were discussed in a comparative manner with the previous two-dimensional (2D) computational model. On the one hand, the results demonstrated the similar mechanism as observed in the 2D model that the presence of the FVFs suppressed the deflection of the glottal jet and in doing so, reduced the mixing-related minor loss in the supraglottal region. On the other hand, the 3D flow was more stable and straighter, so the effect of FVFs on suppressing the jet deflection in the 3D model was not as prominent as in the 2D model. Furthermore, the presence of the FVFs also increased the friction-related major loss due to the increased velocity gradient in the restricted flow channel. Therefore, it was hypothesized that the final effect of the FVFs on flow resistance is the combined effect of the reduced mixing-related minor loss and increased friction-related major loss, both of which are highly related to the gap between the FVFs.

Dynamic vocal fold parameters with changing adduction in ex-vivo hemilarynx experiments

Ex-vivo hemilarynx experiments allow the visualization and quantification of three-dimensional dynamics of the medial vocal fold surface. For three excised human male larynges, the vibrational output, the glottal flow resistance, and the sound pressure during sustained phonation were analyzed as a function of vocal fold adduction for varying subglottal pressure. Empirical eigenfunctions, displacements, and velocities were investigated along the vocal fold surface. For two larynges, an increase of adduction level resulted in an increase of the glottal flow resistance at equal subglottal pressures. This caused an increase of lateral and vertical oscillation amplitudes and velocity indicating an improved energy transfer from the airflow to the vocal folds. In contrast, the third larynx exhibited an amplitude decrease for rising adduction accompanying reduction of the flow resistance. By evaluating the empirical eigenfunctions, this reduced flow resistance was assigned to an unbalanced oscillation pattern with predominantly lateral amplitudes. The results suggest that adduction facilitates the phonatory process by increasing the glottal flow resistance and enhancing the vibrational amplitudes. However, this interrelation only holds for a maintained balanced ratio between vertical and lateral displacements. Indeed, a balanced vertical-lateral oscillation pattern may be more beneficial to phonation than strong periodicity with predominantly lateral vibrations.

[The size of the vocal folds in the children during the first years of life]

The objective of the present study was to determine the size of the vocal folds in the children during the first several years of life. The study included 137 children at the age from the birth up to 3 years who were referred to our clinic for the pre-planned surgical intervention with the use of endotracheal intubation. The length and the width of the vocal folds from the muscle tubercle to the anterior commissure in abduction were measured using a probe specially designed and adapted for this purpose. In all the cases, the endoscope was positioned at the same distance from the vocal folds. The fold length (ab) and width (cd) were expressed in millimeters. These parameters were measured in the following age groups of the patients: from the birth to 1 month 29 days (group 1), from 12 mo to 23 mo 29 d (group 2), from 24 mo to 35 mo 29 d (group 3), and above 36 months (group 4). The length and the width of the vocal folds varied from 2.6 mm to 7.8 mm and from 1.3 mm to 3.2 mm respectively. The length of the vocal folds increased at a rate of 1.025 mm per year showing marked variations within each age group, from the maximum value of 1.79 mm during the second year of life to the minimum of 0.48 mm during the fourth year. The authors conclude that these data may be of use for the improvement of the quality of the surgical treatment and subsequent rehabilitation of the respiratory and voice-generating functions of the larynx.

Time-Dependent Pressure and Flow Behavior of a Self-oscillating Laryngeal Model With Ventricular Folds

OBJECTIVE

The purpose of the study was to better understand the pressure-flow behavior of a self-oscillating vocal fold model at various stages of the glottal cycle.

METHODS

An established self-oscillating vocal fold model was extended to include the false vocal folds (FVFs) and was used to study time-dependent pressure and velocity distributions through the larynx (including the true vocal folds [TVFs] and FVFs). Vocal fold vibration was modeled with a finite element method, laryngeal flow was simulated with the solution of unsteady Navier-Stokes equations, and the acoustics of the vocal tract was modeled with a wave reflection method.

RESULTS

The results demonstrate realistic phonatory behaviors and therefore may be considered as a pedagogical tool for showing detailed aerodynamic, kinematic, and acoustic characteristics. The TVFs self-oscillated regularly with reasonable amplitude and mucosal waves. There were large pressure gradients in the glottal region. The centerline velocity was highest during glottal closing and sharply dropped near the center of the flow vortex. The average centerline velocity was about 25 m/second in the glottal region. The transglottal pressure was higher during glottal closing when the glottal shape was divergent and pressure recovery was present within the glottis. The centerline velocity increased as expected throughout the convergent glottis, tended to decrease throughout the divergent glottis, and decreased past the TVFs within the ventricle-FVF region.

CONCLUSIONS

This model produces realistic results and demonstrates interactions among phonation variables of a highly instructive nature, including the influence of the FVFs.

Computational modeling of vibration-induced systemic hydration of vocal folds over a range of phonation conditions

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.

Ventricular-fold dynamics in human phonation

PURPOSE

In this study, the authors aimed (a) to provide a classification of the ventricular-fold dynamics during voicing, (b) to study the aerodynamic impact of these motions on vocal-fold vibrations, and (c) to assess whether ventricular-fold oscillations could be sustained by aerodynamic coupling with the vocal folds.

METHOD

A 72-sample database of vocal gestures accompanying different acoustical events comprised high-speed cinematographic, audio, and electroglottographic recordings of 5 subjects. Combining the physiological correlates with a theoretical model of phonation, the vocal-ventricular aerodynamic interactions were investigated.

RESULTS

A ventricular-fold motion is found during (de)crescendos, shout, throat singing, yodel, growls, and glides with transitions between registers. Three main types of dynamics are identified: slow nonoscillatory motion and fast oscillatory motion with aperiodical or periodical vibrations. These patterns accompany a change in voice quality, pitch, and/or intensity. Alterations of glottal-oscillatory amplitude, frequency, and contact were predicted. It is shown that a ventricular oscillation can be initiated and sustained by aerodynamic coupling with the vocal folds.

CONCLUSIONS

Vocal-ventricular aerodynamic interactions can alter, enhance, or suppress vocal-fold vibrations or leave them unchanged, depending on the ventricular-fold dynamics involved. Depending on its variation in time, a similar level of ventricular-fold adduction impacts the glottal vibratory magnitude and contact much differently.

The role of glottal surface adhesion on vocal folds biomechanics

The airway surface liquid (ASL) is a very thin mucus layer and covers the vocal fold (VF) surface. Adhesion mediated by the ASL occurs during phonation as the VFs separate after collision. Such adhesion is hypothesized to determine voice quality and health. However, biomechanical insights into the adhesive processes during VF oscillation are lacking. Here, a computational study is reported on self-sustained VF vibration involving contact and adhesion. The VF structural model and the glottal airflow are considered fully three-dimensional. The mechanical behavior of the ASL is described through a constitutive traction-separation law where mucosal cohesive strength, cohesive energy, and rupture length enter. Cohesive energy values considered are bound below by the cohesive energy of water at standard temperature and pressure. Cohesive strength values considered are bound above by prior reported data on the adhesive strength of mucosal surface of rat small intestine. This model introduces a mechanical length scale into the analysis. The sensitivity of various aspects of VF dynamics such as flow-declination rate, VF separation under adhesive condition, and formation of multiple local fluid bridges is determined in relation to specific ASL adhesive properties. It is found that for the ASL considered here, the characteristics of the VF separation process are of debond type. Instabilities lead to the breakup of the bond area into several smaller bond patches. Such finding is consistent with in vivo observations.

Validation of a flow-structure-interaction computation model of phonation

Computational models of vocal fold (VF) vibration are becoming increasingly sophisticated, their utility currently transiting from exploratory research to predictive research. However, validation of such models has remained largely qualitative, raising questions over their applicability to interpret clinical situations. In this paper, a computational model with a segregated implementation is detailed. The model is used to predict the fluid-structure interaction (FSI) observed in a physical replica of the VFs when it is excited by airflow. Detailed quantitative comparisons are provided between the computational model and the corresponding experiment. First, the flow model is separately validated in the absence of VF motion. Then, in the presence of flow-induced VF motion, comparisons are made of the flow pressure on the VF walls and of the resulting VF displacements. Self-similarity of spatial distributions of flow pressure and VF displacements is highlighted. The self-similarity leads to normalized pressure and displacement profiles. It is shown that by using linear superposition of average and fluctuation components of normalized computed displacements, it is possible to determine displacements in the physical VF replica over a range of VF vibration conditions. Mechanical stresses in the VF interior are related to the VF displacements, thereby the computational model can also determine VF stresses over a range of phonation conditions.

A numerical and experimental investigation of the effect of false vocal fold geometry on glottal flow

The false vocal folds are hypothesized to affect the laryngeal flow during phonation. This hypothesis is tested both computationally and experimentally using rigid models of the human larynges. The computations are performed using an incompressible Navier-Stokes solver with a second order, sharp, immersed-boundary formulation, while the experiments are carried out in a wind tunnel with physiologic speeds and dimensions. The computational flow structures are compared with available glottal flow visualizations and are employed to study the vortex dynamics of the glottal flow. Furthermore, pressure data are collected on the surface of the laryngeal models experimentally and computationally. The investigation focuses on three geometric features: the size of the false vocal fold gap; the height between the true and false vocal folds; and the width of the laryngeal ventricle. It is shown that the false vocal fold gap has a significant effect on glottal flow aerodynamics, whereas the second and the third geometric parameters are of lesser importance. The link between pressure distribution on the surface of the larynx and false vocal fold geometry is discussed in the context of vortex evolution in the supraglottal region. It was found that the formation of the starting vortex considerably affects the pressure distribution on the surface of the larynx. The interaction of this vortex structure with false vocal folds creates rebound vortices in the laryngeal ventricle. In the cases of small false vocal fold gap, these rebound vortices are able to reach the true vocal folds during a time period comparable with one cycle of the phonation. Moreover, they can create complex vorticity patterns, which result in significant pressure fluctuations on the surface of the larynx.

Computational study of effects of tension imbalance on phonation in a three-dimensional tubular larynx model

OBJECTIVES

The present study explores the use of a continuum-based computational model to investigate the effect of left-right tension imbalance on vocal fold (VF) vibrations and glottal aerodynamics, as well as its implication on phonation. The study allows us to gain new insights into the underlying physical mechanism of irregularities induced by VF tension imbalance associated with unilateral cricothyroid muscle paralysis.

METHODS

A three-dimensional simulation of glottal flow and VF dynamics in a tubular laryngeal model with tension imbalance was conducted by using a coupled flow-structure interaction computational model. Tension imbalance was modeled by reducing by 20% the Young's modulus of one of the VFs, while holding VF length constant. Effects of tension imbalance on vibratory characteristic of the VFs and on the time-varying properties of glottal airflow as well as the aerodynamic energy transfer are comprehensively analyzed.

RESULTS AND CONCLUSIONS

The analysis demonstrates that the continuum-based biomechanical model can provide a good description of phonatory dynamics in tension imbalance conditions. It is found that although 20% tension imbalance does not have noticeable effects on the fundamental frequency, it does lead to a larger glottal flow leakage and asymmetric vibrations of the two VFs. A detailed analysis of the energy transfer suggests that the majority of the energy is consumed by the lateral motion of the VFs and the net energy transferred to the softer fold is less than the one transferred to the normal fold.

Subject-specific computational modeling of human phonation

A direct numerical simulation of flow-structure interaction is carried out in a subject-specific larynx model to study human phonation under physiological conditions. The simulation results compare well to the established human data. The resulting glottal flow and waveform are found to be within the normal physiological ranges. The effects of realistic geometry on the vocal fold dynamics and the glottal flow are extensively examined. It is found that the asymmetric anterior-posterior laryngeal configuration produces strong anterior-posterior asymmetries in both vocal fold vibration and glottal flow which has not been captured in the simplified models. It needs to be pointed out that the observations from the current numerical simulation are only valid for the flow conditions investigated. The limitations of the study are also discussed.

Influence of numerical model decisions on the flow-induced vibration of a computational vocal fold model

Computational vocal fold models are often used to study the physics of voice production. In this paper the sensitivity of predicted vocal fold flow-induced vibration and resulting airflow patterns to several modeling selections is explored. The location of contact lines used to prevent mesh collapse and assumptions of symmetry were found to influence airflow patterns. However, these variables had relatively little effect on the vibratory response of the vocal fold model itself. Model motion was very sensitive to Poisson's ratio. The importance of these parameter sensitivities in the context of vocal fold modeling is discussed.

On the acoustic effects of the supraglottic structures in excised larynges

The acoustic effects of the supraglottic laryngeal structures (SGSs), including the false vocal folds (FVFs) laryngeal ventricle, and the epiglottis were investigated in an excised canine larynx model with and without these anatomical structures. The purpose of this study was to better understand the acoustic contributions of these structures to phonation. Canine larynges were prepared and mounted over a 3/4 in. tube, which supplied pressurized, heated, and humidified air. Glottal adduction was accomplished by rotating the arytenoids with a suture passed behind the vocal folds to simulate the lateral cricoarytenoid muscle action. The SGSs were kept intact in the first part of the experiment and were removed in the second part. Results indicated that when the FVFs vibrated, a low frequency component was observed in the spectral data. The excised larynx with a SGS had a limited range of frequency with subglottal pressure, while the larynx without a SGS had a larger frequency range. The excised canine larynx with a SGS oscillated with a higher phonation threshold pressure and significantly louder.