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Dai YF, Tan JJ, Deng CQ, Liu X, Lv ZH, Li XP. Association of pepsin and DNA damage in laryngopharyngeal reflux-related vocal fold polyps. Am J Otolaryngol 2020; 41:102681. [PMID: 32889371 DOI: 10.1016/j.amjoto.2020.102681] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/25/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aimed to evaluate if laryngopharyngeal reflux (LPR) plays a role as a risk factor for vocal fold polyps (VFPs), and if pepsin is associated with higher oxidative DNA damage of VFPs in the presence of LPR. METHODS Thirty patients with VFPs were recruited between 2017 and 2018. Prior to surgery, a laryngoscopy was performed on all subjects to evaluate VFPs. Polyp tissue and saliva samples were obtained scrupulously. Hematoxylin-eosin staining was performed for pathologic analysis. Immunohistochemistry and ELISA were used to detect pepsin in tissue and saliva of VFP patients. 8-OHdG and p-H2AX expression was detected to measure oxidative DNA damage in tissue. DNA damage was investigated in human immortalized laryngeal epithelial cells exposed to pepsin. RESULTS The pepsin concentration in saliva was significantly higher (t = 2.38, P = .024) in the pepsin positive group. There was no significant difference in pepsin expression at different sites and pathological subtypes of VFPs. The levels of 8-OHdG and p-H2AX were significantly higher in the pepsin positive group and positively correlated with the tissue expression of pepsin. The concentration of pepsin in saliva also showed a significant correlation with 8-OHdG levels. Expression of 8-OHdG and p-H2AX, and tail moment of the comet assay were elevated in human immortalized laryngeal epithelial cells following treatment with pepsin. CONCLUSION Patients with VFPs have higher levels of oxidative DNA damage in the presence of pepsin reflux. Pepsin may induce DNA damage in laryngeal epithelial cells and participate in the pathogenesis of VFPs.
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Young VN, Yousef A, Zhao NW, Schneider SL. Voice and Stroboscopic Characteristics in Transgender Patients Seeking Gender-Affirming Voice Care. Laryngoscope 2020; 131:1071-1077. [PMID: 32750170 DOI: 10.1002/lary.28932] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/09/2020] [Accepted: 06/20/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Understanding transgender voice is in nascent stages. This study describes voice characteristics in treatment-seeking trans women by comparing two validated questionnaires-Voice Handicap Index-10 (VHI-10) and Transsexual Voice Questionnaire (TVQMtF )-and reports incidence of abnormal stroboscopy findings and acoustic characteristics. METHODS Retrospective review of transgender patients presenting to tertiary-care laryngology center between February 2018-February 2019. Mean VHI-10, TVQ, and Singing VHI-10 (SVHI-10) scores; audio-perceptual grade; acoustic measures; and stroboscopy findings were analyzed. VHI-10 and SVHI-10 vs TVQMtF were compared. RESULTS Sixty-one trans female patients (mean age: 32 ± 11 years) were analyzed. Mean duration since start of transition was 41.5 ± 61 months. Sixty-nine percent presented full-time female in all contexts. Pathologic stroboscopy findings were found in 5%. Mean questionnaire scores were 16 ± 10 (VHI-10), 19 ± 13 (SVHI-10), and 81 ± 22 (TVQMtF ). Correlation between VHI-10 and SVHI-10 versus TVQMtF was weak, R = 0.47 (P = .053) and R = 0.35 (P = .17), respectively. Mean audio-perceptual grade was 0.27 ± 0.15. Mean Cepstral Spectral Index of Dysphonia (CSID, sustained vowel) was 8.5 ± 21.9. Mean Cepstral Peak Prominence (CPP) Fo and CPP Fo SD in rainbow passage were 157.3 ± 16 and 59.4 ± 15.9, respectively. CONCLUSION Trans women report perceived voice handicap in speaking and singing, which appears separate from gender-related voice/communication concerns. This study is the first to report stroboscopy findings in transgender individuals, with 5% being abnormal. Stroboscopy is encouraged before initiating voice intervention in transgender patients. Preliminary evaluation suggests weak correlation between VHI-10 or SVHI-10 and TVQMtF but requires further investigation. TVQMtF may provide information which more specifically reflects voice concerns of trans women as compared to VHI-10 and SVHI-10. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1071-1077, 2021.
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Affiliation(s)
- VyVy N Young
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Andrew Yousef
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Nina W Zhao
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Sarah L Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
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Abstract
This review provides a comprehensive compilation, from a digital image processing point of view of the most important techniques currently developed to characterize and quantify the vibration behaviour of the vocal folds, along with a detailed description of the laryngeal image modalities currently used in the clinic. The review presents an overview of the most significant glottal-gap segmentation and facilitative playbacks techniques used in the literature for the mentioned purpose, and shows the drawbacks and challenges that still remain unsolved to develop robust vocal folds vibration function analysis tools based on digital image processing.
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Joshi A, Watts CR, Hathway J. Phonation Quotient Using Three Aerodynamic Instruments in the Disordered Voice. J Voice 2020; 34:20-24. [DOI: 10.1016/j.jvoice.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/30/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022]
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Öcal B, Tatar EÇ, Toptaş G, Barmak E, Saylam G, Korkmaz MH. Evaluation of Voice Quality in Patients With Vocal Fold Polyps: The Size of a Polyp Matters or Does it? J Voice 2019; 34:294-299. [PMID: 31060763 DOI: 10.1016/j.jvoice.2019.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/12/2019] [Accepted: 04/16/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the correlation between morphological features of vocal fold polyps (VFPs) and subjective/objective voice parameters. METHODS Perceptual evaluations, aerodynamic and acoustic tests were performed on 47 patients with VFPs. Still images were captured from video and the morphological features associated with the size of VFP were quantified. To reveal the correlation between size-related morphological features (length of polyp base, the ratio of polyp base to vocal fold length, glottal gap area) and objective/subjective parameters of voice, Pearson's and Spearman's tests were carried out. RESULTS This cohort was composed of 30 (63.8 %) male and 17 (36.2%) female patients with the mean age of 45.2 years and 41.3 years, respectively. No correlation was found between the morphological features of VFPs and any of perceptual, aerodynamic and acoustic voice parameters. CONCLUSIONS Our findings indicated that controversies still exist regarding the role of vocal fold polyp morphology in clinical decision making.
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Affiliation(s)
- Bülent Öcal
- Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey.
| | - Emel Ç Tatar
- Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Gökhan Toptaş
- Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Elife Barmak
- Hearing-Speech-Balance Unit, Department of Otolaryngology and Head and Neck Surgery, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ministry of Health, Ankara, Turkey
| | - Güleser Saylam
- Department of Otolaryngology, Ministry of Health Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Mehmet H Korkmaz
- Department of Otolaryngology, Yıldırım Beyazıt University Medical School, Ankara, Turkey
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A Comparison of Indirect and Direct Methods for Estimating Transglottal Airflow Rate. J Voice 2017; 32:655-659. [PMID: 29108675 DOI: 10.1016/j.jvoice.2017.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this study was to compare indirect estimates of transglottal airflow rate using measures of phonation quotient with direct measures of mean airflow rate derived from a pneumotachograph. STUDY DESIGN This study used prospective, repeated measures design. METHODS Nineteen male and female participants, matched for age, completed tasks for maximum phonation time and vital capacity in addition to the comfortable sustained phonation protocol of the Phonatory Aerodynamic System (PAS), Model 6600. Phonation quotient was calculated from the vital capacity and phonation time measures, whereas actual transglottal airflow was obtained from the flow waveforms recorded on the PAS system. Statistical analyses compared transglottal airflow rate measures as a function of instrument and separately as a function of gender. RESULTS Statistically significant differences were present only as a function of gender on airflow measures but not as a function of the instrument. There were no interaction effects present between instrument and gender. CONCLUSIONS Phonation quotient can be used as an estimate of transglottal airflow in the absence of a pneumotachograph-based system.
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Kang YA, Jo CW, Kim J, Chang JW. Aerodynamic Parameters and the Airflow Regression Slope (ARS) in Patients with Vocal Polyps before and after Laryngomicrosurgery according to Perceptual Judgment. ACTA ACUST UNITED AC 2017. [DOI: 10.21849/cacd.2017.00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Joshi A, Watts CR. Measurement Reliability of Phonation Quotient Derived From Three Aerodynamic Instruments. J Voice 2016; 30:773.e13-773.e19. [DOI: 10.1016/j.jvoice.2015.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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Joshi A, Watts CR. Phonation Quotient in Women: A Measure of Vocal Efficiency Using Three Aerodynamic Instruments. J Voice 2016; 31:161-167. [PMID: 27430861 DOI: 10.1016/j.jvoice.2016.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to examine measures of vital capacity and phonation quotient across three age groups in women using three different aerodynamic instruments representing low-tech and high-tech options. STUDY DESIGN This study has a prospective, repeated measures design. METHODS Fifteen women in each age group of 25-39 years, 40-59 years, and 60-79 years were assessed using maximum phonation time and vital capacity obtained from three aerodynamic instruments: a handheld analog windmill type spirometer, a handheld digital spirometer, and the Phonatory Aerodynamic System (PAS), Model 6600. Phonation quotient was calculated using vital capacity from each instrument. Analyses of variance were performed to test for main effects of the instruments and age on vital capacity and derived phonation quotient. Pearson product moment correlation was performed to assess measurement reliability (parallel forms) between the instruments. Regression equations, scatterplots, and coefficients of determination were also calculated. RESULTS Statistically significant differences were found in vital capacity measures for the digital spirometer compared with the windmill-type spirometer and PAS across age groups. Strong positive correlations were present between all three instruments for both vital capacity and derived phonation quotient measurements. CONCLUSIONS Measurement precision for the digital spirometer was lower than the windmill spirometer compared with the PAS. However, all three instruments had strong measurement reliability. Additionally, age did not have an effect on the measurement across instruments. These results are consistent with previous literature reporting data from male speakers and support the use of low-tech options for measurement of basic aerodynamic variables associated with voice production.
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Affiliation(s)
- Ashwini Joshi
- Department of Communication Sciences and Disorders, University of Houston, 4455 Cullen Blvd, Houston, Texas.
| | - Christopher R Watts
- Harris College of Nursing & Health Sciences, TCU Box 297450, Fort Worth, TX 76129
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Normative Values of Voice Analysis Parameters With Respect to Menstrual Cycle in Healthy Adult Turkish Women. J Voice 2016; 30:322-8. [DOI: 10.1016/j.jvoice.2015.04.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 04/21/2015] [Indexed: 11/18/2022]
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Aerodynamic measures of glottal function: what extra can they tell us and how do they guide management? Curr Opin Otolaryngol Head Neck Surg 2015; 22:450-4. [PMID: 25254405 DOI: 10.1097/moo.0000000000000107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article will define the major advances in laryngeal aerodynamics research from recent evidence-based literature. RECENT FINDINGS Recently published research focuses on new applications of aerodynamic parameters to improve patient diagnosis and outcomes, as well as further elucidating the mechanisms of phonation using computational modeling and excised larynges. SUMMARY Although there is an extensive amount of research on improving the diagnosis and treatment of voice disorders using aerodynamics, the majority of recent literature lacks any conclusive evidence on new methods for use in the clinic; further research in these is needed. The best practices for resonance tube phonation in water and semi-occluded voice therapy are being investigated, as is the exact mechanism by which glottal airflow interacts with vocal folds to produce phonation. It is recommended that clinicians evaluate patients with Parkinson's disease on the basis of airflow declination and lung volume expended per syllable to avoid dependence on an acoustic signal. In addition, advances in modeling laryngeal disorders and structures will contribute to future research into treatments and diagnosis. Now that the groundwork has been laid, it is crucial to begin evaluating such techniques in patient populations.
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Objective Measures of Laryngeal Imaging: What Have We Learned Since Dr. Paul Moore. J Voice 2014; 28:69-81. [DOI: 10.1016/j.jvoice.2013.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 02/06/2013] [Indexed: 11/19/2022]
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Correlation Between the Basic Video Laryngostroboscopic Parameters and Multidimensional Voice Measurements. J Voice 2013; 27:744-52. [DOI: 10.1016/j.jvoice.2013.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 06/12/2013] [Indexed: 11/19/2022]
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Wang CC, Chang MH, Wang CP, Liu SA, Liang KL, Wu SH, Jiang RS, Huang HT, Lai HC. Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis--preliminary results. J Voice 2011; 26:506-14. [PMID: 21816569 DOI: 10.1016/j.jvoice.2011.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 04/11/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study is to investigate the feasibility of using an injectable needle electrode to guide hyaluronic acid (HA) vocal fold injection (VFI) during laryngeal electromyography (LEMG) for unilateral vocal fold paralysis (UVFP). STUDY DESIGN Prospective study. METHODS From March to June 2010, 20 UVFP patients received LEMG examination at our clinic. Before completion of LEMG, 1.0 cc of HA (Restylane Perlane(®); Q-Med, Uppsala, Sweden) was injected via a 26-gauge monopolar injectable needle electrode into paralyzed thyroarytenoid muscle. After injection, 20 patients completed 3-months follow-up and 16 patients completed 6-months follow-up. The data before, 1 week, 3 months, and 6 months after injection, including the normalized glottal gap area (NGGA) from videostroboscopy, maximal phonation time (MPT), mean airflow rate (MAFR), phonation quotient (PQ), perceptual evaluation of voice (grade, roughness, breathiness, asthenia, strain [GRBAS] scale), Voice Handicap Index (VHI), and self-grading of choking (grade 1-7), were analyzed by the Wilcoxon signed rank test. RESULTS All of the patients completed the procedure without complications. After injection, mean NGGA was significantly reduced from 8.28 units to 0.52 units (1 week), 1.79 units (3 months), and 1.36 units (6 months). The mean MPT was prolonged from 5.66 seconds to 11.73, 11.25, and 11.93 seconds, respectively. VHI was reduced from 76.05 to 38.10, 37.40 and 35.00, respectively. Other analyzed data (PQ, MAFR, GRBAS scale, and choking severity) also showed statistically significant improvement. CONCLUSION LEMG-guided HA VFI provides UVFP patients with neuromuscular function evaluation and treatment in one step. This clinical technique is feasible, and the short-term results are satisfactory.
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Affiliation(s)
- Chen-Chi Wang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Classification of functional voice disorders based on phonovibrograms. Artif Intell Med 2010; 49:51-9. [DOI: 10.1016/j.artmed.2010.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 08/20/2009] [Accepted: 01/10/2010] [Indexed: 11/17/2022]
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Eckley CA, Swensson J, Duprat ADC, Donati F, Costa HO. [Incidence of structural vocal fold abnormalities associated with vocal fold polyps. Braz J Otorhinolaryngol 2009; 74:508-11. [PMID: 18852975 PMCID: PMC9442099 DOI: 10.1016/s1808-8694(15)30596-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Accepted: 03/05/2007] [Indexed: 11/16/2022] Open
Abstract
Phonotrauma is considered the main cause of vocal fold polyps (VFP). However, the authors believe that an underlying anatomical deviation could render the vocal folds more susceptible to such trauma. Aim To prove this hypothesis a retrospective chart review was carried out to correlate the surgical findings of patients with VFP. Material and Methods The charts of thirty-three patients who underwent surgery for excision of VFP were reviewed: 21 had right VFP, 10 had left VFP and 2 had bilateral lesions. Results Associated lesions were reported in 27 patients (14 lesions on the opposite VF and 13 on the ipsilateral VF): 10 opposite nodules, 12 sulcus vocalis, 3 cysts, and 2 capillary engorgement. Discussion and Conclusions The high incidence of associated anatomical lesions to the VF (63%) suggests that patients with these minor underlying anatomical deviations are more vulnerable to vocal abuse, probably because they present abnormal glottic closure and an irregular vibratory margin.
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Abstract
Endovideolaryngostroboscopy is the obliged evaluation tool in our everyday practice. Standardized protocol in management of broad spectrum of vocal pathology is useful in clinical, scientific and educational evaluation of patient from the first interview till the end of the treatment. Using of contemporary computerised multidimensional analysis of stroboscopic image we are approaching to optimum evaluation of any kind of interpersonal communication disorder. There were 66 patients in prospective clinical study of correlation between suspect endovideolaryngostroboscopic findings and histo-pathology verification of glottis carcinoma. Asymmetric and irregular vibrations with absent mucosal wave or absent vibrations of one part or of the whole vocal fold was improved as carcinoma in 85% of patients. The most frequent diagnosis was Ca planocellularae invasivum G2 NG 2, with subsequent open chordectomy. In every case of hoarseness longer more than 14 days, endovideolaryngostroboscopy is the golden standard for evaluating the need for microlaryngoscopy and biopsy.
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Eckley CA, Swensson J, Duprat ADC, Donati F, Costa HO. Incidência de alterações estruturais das pregas vocais associadas ao pólipo de prega vocal. ACTA ACUST UNITED AC 2008. [DOI: 10.1590/s0034-72992008000400005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A etiologia mais aceita para pólipos de pregas vocais é o fonotrauma. Imaginamos que possa existir alguma alteração anatômica prévia nas pregas vocais que predisponha indivíduos a apresentarem lesões fonotraumáticas. OBJETIVO: O presente estudo retrospectivo procura encontrar correlação entre os pólipos de prega vocal e alterações estruturais da prega vocais. MATERIAL E MÉTODO: Foi realizado trabalho retrospectivo a partir da descrição cirúrgica de 33 pacientes submetidos a exérese de pólipo de prega vocal no período de três anos em hospital universitário. RESULTADOS: Trinta e um pacientes apresentaram pólipos unilaterais e 2 bilaterais. Foram encontradas 27 lesões associadas: 10 lesões reacionais, 12 sulcos, 3 cistos e 2 ectasia capilars. Foram 14 lesões contralaterais e 13 ipsilaterais. DISCUSSÃO E CONCLUSÕES: Encontrou-se uma forte correlação entre a presença de uma lesão de base influindo como co-fator de fragilização da prega vocal ao fonotrauma, pois das 27 lesões encontradas 17 foram consideradas pré-existentes (63%). As lesões poderiam interferir na coaptação das pregas vocais, gerando uma onda mucosa irregular durante a fonação, expondo o espaço de Reinke a uma agressão estrutural. Apesar do caráter preliminar do trabalho os achados sugerem íntima correlação entre o pólipo e lesões estruturais mínimas das pregas vocais.
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Dynamic MRI of larynx and vocal fold vibrations in normal phonation. J Voice 2007; 23:235-9. [PMID: 18082366 DOI: 10.1016/j.jvoice.2007.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 08/28/2007] [Indexed: 11/21/2022]
Abstract
Dynamic magnetic resonance imaging (MRI) of the larynx and vocal folds during phonation was used for measuring the vertical laryngeal movements and the glottal angle of the vocal folds opening and closing in dynamic phase. The data used in this analysis were taken on 10 healthy volunteers during maximal inspiration and the prolonged phonation of the vowels [i] (as in key), [a] (as in car), [u] (as in loop), and the consonant [sh] (as in ship). The results of our MRI data have demonstrated the difference of the vocal folds movement in relation to the vowel and consonant sounds, with a large glottal opening for [sh] and a narrow opening for [i] and [u], and the difference of the laryngeal position in relation to the vowels, with [a] and [u] having a lower larynx position than [i]. Imaging the larynx's positions and the vocal folds' vibrations is possible using dynamic MRI. This technique permits measurements of laryngeal structures and glottal parameters in dynamic function with multiplanar high-resolution imaging. Analysis of laryngeal activity and vocal folds' vibration may be helpful for the evaluation of the phonation function and for the understanding of the physiology of vocal production and voice modulation.
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