The Inspiratory Maneuver: A Simple Method to Assess the Superficial Lamina Propria During Endoscopy

High-Speed Videoendoscopic and Acoustic Characteristics of Inspiratory Phonation

PURPOSE

Given the importance of inspiratory phonation for assessment of vocal fold structure, the aim of this investigation was to evaluate and describe the vocal fold vibratory characteristics of inspiratory phonation using high-speed videoendoscopy in healthy volunteers. The study also examined the empirical relationship between cepstral peak prominence (CPP) and glottal area waveform measurements derived from simultaneous high-speed videoendoscopy and audio recordings.

METHOD

Vocally healthy adults (33 women, 28 men) volunteered for this investigation and completed high-speed videoendoscopic assessment of vocal fold function for two trials of an expiratory/inspiratory phonation task at normal pitch and normal loudness. Twelve glottal area waveform measures and acoustic CPP values were extracted for analyses.

RESULTS

Inspiratory phonation resulted in shorter closing time, longer duration of the opening phase, and faster closing phase velocity compared to expiratory phonation. Sex differences were elucidated. CPP changes for inspiratory phonation were predicted by changes in the glottal area index and waveform symmetry index, whereas changes in CPP during expiratory phonation were predicted by changes in asymmetry quotient, glottal area index, and amplitude periodicity.

CONCLUSIONS

Vocal fold vibratory differences were identified for inspiratory phonation when compared to expiratory phonation, the latter of which has been studied more extensively. This investigation provides important basic inspiratory phonation data to better understand laryngeal physiology in vivo and provides a basic model from which to further study inspiratory phonation in a larger population representing a broader age range.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22223812.

High-Speed Characterization of Vocal Fold Vibrations in Normally Cycling and Postmenopausal Women: Randomized Double-Blind Analyses

Purpose The aim of this study was to examine the influence of menstrual cycle phases (follicular, ovulatory, luteal, and ischemic) and hormone levels (estradiol, testosterone, progesterone, and neuropeptide Y) on vocal fold vibrations in reproductive and postmenopausal women. Method Glottal area waveforms were extracted from high-speed videoendoscopy during sustained phonation, inhalation phonation, and voice onset/offset in the reproductive (n = 15) and postmenopausal (n = 13) groups. Linear mixed-model analysis was conducted to evaluate hormone levels and high-speed videoendoscopy outcome variables between the reproductive and postmenopausal groups. In the reproductive group, simple linear regression and multiple regression were conducted to determine the effects of hormones on the dependent variables. Results Group differences between reproductive and postmenopausal women were identified for stiffness index, oscillatory onset time, and oscillatory offset time. Neuropeptide Y hormone in the ischemic phase significantly predicted changes in the reproductive group for some dependent variables; however, the relationship varied for sustained phonation and inhalation phonation. Conclusion These findings provide preliminary evidence that vocal fold vibrations in the reproductive group are different predominantly in the ischemic phase due to neuropeptide Y changes.

The Importance of Inspiratory Maneuver for Benign Laryngeal Lesions

Introduction  Inspiratory maneuver corresponds to a simple method used during videolaryngoscopy to increase characterizations of laryngeal findings, through the movement of the vocal fold cover and exposure of the ligament, facilitating its evaluation.

Objective  To evaluate the increase in diagnosis of benign laryngeal lesions from the usage of inspiratory maneuvers during videolaryngoscopy in patients with or without vocal complaints.

Methods  A cross-sectional study performed from March 1 to July 1, 2018, in the Laryngology sector of a tertiary hospital. The age of the patients varied from 18 to 60 years old. They were divided into two groups, symptomatic and asymptomatic vocals, and evaluated through videolaryngoscopy together with inspiratory maneuvers. The exams were recorded and later evaluated by three trained laryngologists who determined the laryngeal lesions before and after the inspiratory maneuver.

Results  There were 60 patients in this sample, 41 of which were vocal symptomatic and 19 asymptomatic. The majority was female and the main complaint was about dysphonia. Before the inspiratory maneuver, the most observed lesions in both groups were chronic laryngitis, followed by vascular dysgenesis. After the inspiratory maneuver, sulcus vocalis was the most frequent additional finding.

Conclusion  With the inspiratory maneuver, it was possible to increase the identification of structural lesions in the vocal fold, and the most frequent lesion in patients with or without vocal complaints was sulcus vocalis.

Interarticulator timing control during inspiratory phonation

OBJECTIVE

The ability of Cantonese speakers in producing aspirated and unaspirated stops and stops at different places of articulation using expiratory phonation (EP) and inspiratory phonation (IP) was compared. Interarticulator timing during stop production using EP and IP was examined. Voice onset time (VOT) associated with EP and IP stops was compared with stop identification scores by naïve listeners.

SUBJECTS AND METHODS

Aspirated and unaspirated voiceless stops (/p(h), t(h), k(h), p, t, k/) followed by the vowel /a/ were produced by 15 male and 15 female Cantonese speakers using EP and IP. VOT values were measured and isolated speech samples of stop productions were identified by 10 naïve listeners. Percent correct identification of stops was obtained from the 10 listeners.

RESULTS

Perceptual data showed that production of IP stops were associated with reduced accuracy in stop identification, with predominant errors in aspiration perception. Acoustic analysis showed that IP stops were generally produced with significantly shorter VOT than their EP counterparts. In addition, effect of place of articulation on VOT was also found for both IP and EP stops, notably with velar stops being associated with significantly longer VOT values than bilabial and alveolar stops.

CONCLUSIONS

The findings that IP stops were produced with shorter VOT as compared with EP stops imply that the articulatory-phonatory coordination during IP was not the same as that during EP, causing a discrepancy in the timing control between articulators.

Modificações vocais acústicas espectrográficas produzidas pela fonação reversa

OBJETIVO: conhecer os efeitos da técnica de fonação reversa, realizando análise da sua eficácia sobre vozes femininas normais, por meio da espectrografia acústica de banda larga e de banda estreita. MÉTODOS: 32 mulheres adultas jovens, que assinaram o Termo de Consentimento Livre e Esclarecido da pesquisa, submeteram-se à avaliação otorrinolaringológica e triagem fonoaudiológica a fim de eliminar possíveis alterações que pudessem interferir nos resultados da pesquisa. Tiveram amostras vocais coletadas antes e após realizar três séries de 15 repetições de fonação reversa em tempo máximo de fonação com tom e intensidade habituais, com 30 segundos de repouso passivo entre cada série. Utilizou-se o software Real Time Spectrogram (Kay Elemetrics Corp.) para gerar espectrogramas de banda larga e de banda estreita. Os dados obtidos foram analisados por meio de porcentagem simples e do teste do Qui-Quadrado, com nível de significância de 5%. RESULTADOS: houve tendência percentual ao aumento da definição de harmônicos, da regularidade do traçado, da intensidade e da definição dos Formantes 3 e 4, da intensidade das altas frequências e em todo o espectro; e aumento significante da definição do Formante 1. CONCLUSÃO: acredita-se que a técnica favoreça o alongamento e a vibração das pregas vocais com possível homogeneização e modificações ocorridas na mucosa, e conseqüente melhoria do sinal vocal, com maior regularidade de vibração e melhora de ressonância.

Aspectos fisiológicos e clínicos da técnica fonoterapêutica de fonação reversa

A fonação reversa é a produção de voz durante a inspiração, realizada espontaneamente em situações como o suspiro. OBJETIVO: Realizar uma revisão da literatura, descrevendo achados relacionados à utilização da fonação reversa na prática clínica, à anatomofisiologia de sua produção e seus efeitos no trato vocal, e às indicações e contra-indicações da técnica para os distúrbios e para o aperfeiçoamento da voz. RESULTADOS: Foram encontrados relatos de mudanças significativas no trato vocal durante a produção da fonação reversa, como o relaxamento dos ventrículos, o afastamento das pregas ventriculares, o aumento da freqüência fundamental, o movimento inverso da onda mucosa, além da facilitação do estudo dinâmico da laringe, quando associada à endoscopia, o que possibilita melhor definição da localização das lesões nas camadas da lâmina própria da mucosa das pregas vocais. CONCLUSÃO: Existem poucos estudos que descrevem o comportamento laríngeo durante a fonação reversa e, para que essa técnica utilizada de forma mais precisa e objetiva, acredita-se que ainda devem ser realizados estudos que visem a comprovar sua eficácia na prática clínica.

Reverse phonation -physiologic and clinical aspects of this speech voice therapy modality

Reverse phonation is the voice production during inspiration, accomplished spontaneously in situations such as when a person sighs.

AIM

to do a literature review, describing discoveries related to the use of the reverse phonation in the clinical practice, the anatomy and physiology of its production and its effects in vocal treatments; and moreover, indications and problems of the technique for speech disorders treatment and voice enhancement.

RESULTS

there were reports of significant changes in vocal treatment during with the use of reverse phonation: ventricular distention, ventricular folds separation, increase in the fundamental frequency, mucous wave inverse movement; and it also facilitates the dynamic study of the larynx when associated with endoscopy, making it possible to have a better definition of lesion localization in vocal folds superficial lamina propria layers.

CONCLUSION

There are few studies describing larynx behavior during reverse phonation and, for this technique to be used in a more precise and objective way, more studies are necessary in order to prove its effectiveness in practical matters.