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Thomson SL. Synthetic, self-oscillating vocal fold models for voice production researcha). THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2024; 156:1283-1308. [PMID: 39172710 PMCID: PMC11348498 DOI: 10.1121/10.0028267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/24/2024]
Abstract
Sound for the human voice is produced by vocal fold flow-induced vibration and involves a complex coupling between flow dynamics, tissue motion, and acoustics. Over the past three decades, synthetic, self-oscillating vocal fold models have played an increasingly important role in the study of these complex physical interactions. In particular, two types of models have been established: "membranous" vocal fold models, such as a water-filled latex tube, and "elastic solid" models, such as ultrasoft silicone formed into a vocal fold-like shape and in some cases with multiple layers of differing stiffness to mimic the human vocal fold tissue structure. In this review, the designs, capabilities, and limitations of these two types of models are presented. Considerations unique to the implementation of elastic solid models, including fabrication processes and materials, are discussed. Applications in which these models have been used to study the underlying mechanical principles that govern phonation are surveyed, and experimental techniques and configurations are reviewed. Finally, recommendations for continued development of these models for even more lifelike response and clinical relevance are summarized.
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Affiliation(s)
- Scott L Thomson
- Department of Mechanical and Civil Engineering, Brigham Young University-Idaho, Rexburg, Idaho 83460, USA
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Wu L, Zhang Z. Impact of the Paraglottic Space on Voice Production in an MRI-Based Vocal Fold Model. J Voice 2023; 37:633.e15-633.e23. [PMID: 33752927 PMCID: PMC8449798 DOI: 10.1016/j.jvoice.2021.02.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE While the vocal fold is in direct contact anteriorly with the thyroid cartilage, posteriorly the vocal fold connects to the thyroid cartilage through a soft tissue layer in the paraglottic space. Currently the paraglottic space is often neglected in computational models of phonation, in which a fixed boundary condition is often imposed on the lateral surface of the vocal fold. The goal of this study was to investigate the effect of the paraglottic space on voice production in an MRI-based vocal fold model, and how this effect may be counteracted by vocal fold stiffening due to laryngeal muscle activation. METHODS Parametric simulation study using an MRI-based computational vocal fold model. RESULTS The results showed that the presence of the paraglottic space increased the mean and amplitude of the glottal area waveform, decreased the phonation frequency and closed quotient. For the particular vocal fold geometry used in this study, the presence of the paraglottic space also reduced the occurrence of irregular vocal fold vibration. These effects of the paraglottic space became smaller with increasing paraglottic space stiffness and to a lesser degree with vocal fold stiffening. CONCLUSIONS The results suggest that the paraglottic space may be neglected in qualitative evaluations of normal phonation, but needs to be included in simulations of pathological phonation or vocal fold posturing.
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Affiliation(s)
- Liang Wu
- Department of Head and Neck Surgery, University of California, Los Angeles, California
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, University of California, Los Angeles, California.
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Motie-Shirazi M, Zañartu M, Peterson SD, Mehta DD, Hillman RE, Erath BD. Effect of nodule size and stiffness on phonation threshold and collision pressures in a synthetic hemilaryngeal vocal fold model. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 153:654. [PMID: 36732229 PMCID: PMC9884154 DOI: 10.1121/10.0016997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 12/19/2022] [Accepted: 01/06/2023] [Indexed: 06/18/2023]
Abstract
Synthetic vocal fold (VF) replicas were used to explore the role of nodule size and stiffness on kinematic, aerodynamic, and acoustic measures of voiced speech production. Emphasis was placed on determining how changes in collision pressure may contribute to the development of phonotrauma. This was performed by adding spherical beads with different sizes and moduli of elasticity at the middle of the medial surface of synthetic silicone VF models, representing nodules of varying size and stiffness. The VF models were incorporated into a hemilaryngeal flow facility. For each case, self-sustained oscillations were investigated at the phonation threshold pressure. It was found that increasing the nodule diameter increased the open quotient, phonation threshold pressure, and phonation threshold flow rate. However, these values did not change considerably as a function of the modulus of elasticity of the nodule. Nevertheless, the ratio of collision pressure to subglottal pressure increased significantly for both increasing nodule size and stiffness. This suggests that over time, both growth in size and fibrosis of nodules will lead to an increasing cycle of compensatory vocal hyperfunction that accelerates phonotrauma.
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Affiliation(s)
- Mohsen Motie-Shirazi
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, New York 13699, USA
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Sean D Peterson
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Daryush D Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Robert E Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts 02114, USA
| | - Byron D Erath
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, New York 13699, USA
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Ng WC, Lokanathan Y, Baki MM, Fauzi MB, Zainuddin AA, Azman M. Tissue Engineering as a Promising Treatment for Glottic Insufficiency: A Review on Biomolecules and Cell-Laden Hydrogel. Biomedicines 2022; 10:3082. [PMID: 36551838 PMCID: PMC9775346 DOI: 10.3390/biomedicines10123082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/11/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Glottic insufficiency is widespread in the elderly population and occurs as a result of secondary damage or systemic disease. Tissue engineering is a viable treatment for glottic insufficiency since it aims to restore damaged nerve tissue and revitalize aging muscle. After injection into the biological system, injectable biomaterial delivers cost- and time-effectiveness while acting as a protective shield for cells and biomolecules. This article focuses on injectable biomaterials that transport cells and biomolecules in regenerated tissue, particularly adipose, muscle, and nerve tissue. We propose Wharton's Jelly mesenchymal stem cells (WJMSCs), induced pluripotent stem cells (IP-SCs), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), insulin growth factor-1 (IGF-1) and extracellular vesicle (EV) as potential cells and macromolecules to be included into biomaterials, with some particular testing to support them as a promising translational medicine for vocal fold regeneration.
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Affiliation(s)
- Wan-Chiew Ng
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Yogeswaran Lokanathan
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Marina Mat Baki
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mh Busra Fauzi
- Centre for Tissue Engineering and Regenerative Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Ani Amelia Zainuddin
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mawaddah Azman
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
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Motie-Shirazi M, Zañartu M, Peterson SD, Mehta DD, Hillman RE, Erath BD. Collision Pressure and Dissipated Power Dose in a Self-Oscillating Silicone Vocal Fold Model With a Posterior Glottal Opening. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:2829-2845. [PMID: 35914018 PMCID: PMC9911124 DOI: 10.1044/2022_jslhr-21-00471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/24/2022] [Accepted: 05/04/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The goal of this study was to experimentally evaluate how compensating for the adverse acoustic effects of a posterior glottal opening (PGO) by increasing subglottal pressure and changing supraglottal compression, as have been associated with vocal hyperfunction, influences the risk of vocal fold (VF) trauma. METHOD A self-oscillating synthetic silicone model of the VFs with an airflow bypass that modeled a PGO was investigated in a hemilaryngeal flow facility. The influence of compensatory mechanisms on collision pressure and dissipated collision power was investigated for different PGO areas and supraglottal compression. Compensatory behaviors were mimicked by increasing the subglottal pressure to achieve a target sound pressure level (SPL). RESULTS Increasing the subglottal pressure to compensate for decreased SPL due to a PGO produced higher values for both collision pressure and dissipated collision power. Whereas a 10-mm2 PGO area produced a 12% increase in the peak collision pressure, the dissipated collision power increased by 122%, mainly due to an increase in the magnitude of the collision velocity. This suggests that the value of peak collision pressure may not fully capture the mechanisms by which phonotrauma occurs. It was also found that an optimal value of supraglottal compression exists that maximizes the radiated SPL, indicating the potential utility of supraglottal compression as a compensatory mechanism. CONCLUSIONS Larger PGO areas are expected to increase the risk of phonotrauma due to the concomitant increase in dissipated collision power associated with maintaining SPL. Furthermore, the risk of VF damage may not be fully characterized by only the peak collision pressure.
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Affiliation(s)
- Mohsen Motie-Shirazi
- Department of Mechanical and Aeronautical Engineering, Clarkson University, Potsdam, NY
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Sean D. Peterson
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Ontario, Canada
| | - Daryush D. Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - Robert E. Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston
| | - Byron D. Erath
- Department of Mechanical and Aeronautical Engineering, Clarkson University, Potsdam, NY
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Jiang W, Farbos de Luzan C, Wang X, Oren L, Khosla SM, Xue Q, Zheng X. Computational Modeling of Voice Production Using Excised Canine Larynx. J Biomech Eng 2022; 144:1116031. [PMID: 34423809 PMCID: PMC8547019 DOI: 10.1115/1.4052226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Indexed: 02/03/2023]
Abstract
A combined experimental-numerical work was conducted to comprehensively validate a subject-specific continuum model of voice production in larynx using excised canine laryngeal experiments. The computational model is a coupling of the Navier-Stokes equations for glottal flow dynamics and a finite element model of vocal fold dynamics. The numerical simulations employed a cover-body vocal fold structure with the geometry reconstructed from magnetic resonance imaging scans and the material properties determined through an optimization-based inverse process of experimental indentation measurement. The results showed that the simulations predicted key features of the dynamics observed in the experiments, including the skewing of the glottal flow waveform, mucosal wave propagation, continuous increase of the divergent angle and intraglottal swirl strength during glottal closing, and flow recirculation between glottal jet and vocal fold. The simulations also predicted the increase of the divergent angle, glottal jet speed, and intraglottal flow swirl strength with the subglottal pressure, same as in the experiments. Quantitatively, the simulations over-predicted the frequency and jet speed and under-predicted the flow rate and divergent angle for the larynx under study. The limitations of the model and their implications were discussed.
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Affiliation(s)
- Weili Jiang
- Department of Mechanical Engineering, University of Maine, 204 Crosby Hall, Orono, ME 04473,e-mail:
| | - Charles Farbos de Luzan
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45256,e-mail:
| | - Xiaojian Wang
- Department of Mechanical Engineering, University of Maine, 204 Crosby Hall, Orono, ME 04473,e-mail:
| | - Liran Oren
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45256,e-mail:
| | - Sid M. Khosla
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH 45256,e-mail:
| | - Qian Xue
- Department of Mechanical Engineering, University of Maine, Room 213, Boardman Hall, Orono, ME 04473,e-mail:
| | - Xudong Zheng
- Department of Mechanical Engineering, University of Maine, Room 213 A, Boardman Hall, Orono, ME 04473,e-mail:
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Movahhedi M, Geng B, Xue Q, Zheng X. Effects of cricothyroid and thyroarytenoid interaction on voice control: Muscle activity, vocal fold biomechanics, flow, and acoustics. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:29. [PMID: 34340476 DOI: 10.1121/10.0005275] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/21/2021] [Indexed: 06/13/2023]
Abstract
An MRI-based three-dimensional computer model of a canine larynx was used to investigate the effect of cricothyroid (CT) and thyroarytenoid (TA) muscle activity on vocal fold pre-phonatory posturing and glottic dynamics during voice production. Static vocal fold posturing in the full activation space of CT and TA muscles was first simulated using a laryngeal muscle mechanics model; dynamic flow-structure-acoustics interaction (FSAI) simulations were then performed to predict glottal flow and voice acoustics. The results revealed that TA activation decreased the length and increased the bulging, height, and contact area of the vocal fold. CT activation increased the length and contact area and decreased the height of the vocal fold. Both CT and TA activations increased the vocal fold stress, stiffness, and closure quotient; and only slightly affected the flow rate and voice intensity. Furthermore, CT and TA showed a complex control mechanism on the fundamental frequency pattern, which highly correlated with a combination of the stress, stiffness, and stretch of the vocal fold.
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Affiliation(s)
| | - Biao Geng
- Department of Mechanical Engineering, University of Maine, Orono, Maine 04473, USA
| | - Qian Xue
- Department of Mechanical Engineering, University of Maine, Orono, Maine 04473, USA
| | - Xudong Zheng
- Department of Mechanical Engineering, University of Maine, Orono, Maine 04473, USA
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Calvache C, Solaque L, Velasco A, Peñuela L. Biomechanical Models to Represent Vocal Physiology: A Systematic Review. J Voice 2021; 37:465.e1-465.e18. [PMID: 33678534 DOI: 10.1016/j.jvoice.2021.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
Biomechanical modeling allows obtaining information on physical phenomena that cannot be directly observed. This study aims to review models that represent voice production. A systematic review of the literature was conducted using PubMed/Medline, SCOPUS, and IEEE Xplore databases. To select the papers, we used the protocol PRISMA Statement. A total of 53 publications were included in this review. This article considers a taxonomic classification of models found in the literature. We propose four categories in the taxonomy: (1) Models representing the Source (Vocal folds); (2) Models representing the Filter (Vocal Tract); (3) Models representing the Source - Filter Interaction; and (4) Models representing the Airflow - Source Interaction. We include a bibliographic analysis with the evolution of the publications per category. We provide an analysis of the number as well of publications in journals per year. Moreover, we present an analysis of the term occurrence and its frequency of usage, as found in the literature. In each category, different types of vocal production models are mentioned and analyzed. The models account for the analysis of evidence about aerodynamic, biomechanical, and acoustic phenomena and their correlation with the physiological processes involved in the production of the human voice. This review gives an insight into the state of the art related to the mathematical modeling of voice production, analyzed from the viewpoint of vocal physiology.
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Affiliation(s)
- Carlos Calvache
- Vocology Center, Bogotá, Colombia; Department of Mechatronics Engineering, Universidad Militar Nueva Granada, Bogotá, Colombia.
| | - Leonardo Solaque
- Department of Mechatronics Engineering, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Alexandra Velasco
- Department of Mechatronics Engineering, Universidad Militar Nueva Granada, Bogotá, Colombia
| | - Lina Peñuela
- Department of Mechatronics Engineering, Universidad Militar Nueva Granada, Bogotá, Colombia
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Geng B, Pham N, Xue Q, Zheng X. A three-dimensional vocal fold posturing model based on muscle mechanics and magnetic resonance imaging of a canine larynx. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 147:2597. [PMID: 32359330 DOI: 10.1121/10.0001093] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
In this work, a high-fidelity three-dimensional continuum model of the canine laryngeal framework was developed for simulating laryngeal posturing. By building each muscle and cartilage from magnetic resonance imaging (MRI), the model is highly realistic in anatomy. The muscle mechanics is modeled using the finite-element method. The model was tested by simulating vocal fold postures under systematic activations of individual as well as groups of laryngeal muscles, and it accurately predicted vocal fold posturing parameters reported from in vivo canine larynges. As a demonstration of its application, the model was then used to investigate muscle controls of arytenoid movements, medial surface morphology, and vocal fold abduction. The results show that the traditionally categorized adductor and abductor muscles can have opposite effects on vocal fold posturing, making highly complex laryngeal adjustments in speech and singing possible. These results demonstrate that a realistic comprehensive larynx model is feasible, which is a critical step toward a causal physics-based model of voice production.
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Affiliation(s)
- Biao Geng
- Department of Mechanical Engineering, University of Maine, Orono, Maine 04473, USA
| | - Ngoc Pham
- Department of Mechanical Engineering, University of Maine, Orono, Maine 04473, USA
| | - Qian Xue
- Department of Mechanical Engineering, University of Maine, Orono, Maine 04473, USA
| | - Xudong Zheng
- Department of Mechanical Engineering, University of Maine, Orono, Maine 04473, USA
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Motie-Shirazi M, Zañartu M, Peterson SD, Mehta DD, Kobler JB, Hillman RE, Erath BD. Toward Development of a Vocal Fold Contact Pressure Probe: Sensor Characterization and Validation Using Synthetic Vocal Fold Models. APPLIED SCIENCES-BASEL 2019; 9. [PMID: 32377408 PMCID: PMC7202565 DOI: 10.3390/app9153002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Excessive vocal fold collision pressures during phonation are considered to play a primary role in the formation of benign vocal fold lesions, such as nodules. The ability to accurately and reliably acquire intraglottal pressure has the potential to provide unique insights into the pathophysiology of phonotrauma. Difficulties arise, however, in directly measuring vocal fold contact pressures due to physical intrusion from the sensor that may disrupt the contact mechanics, as well as difficulty in determining probe/sensor position relative to the contact location. These issues are quantified and addressed through the implementation of a novel approach for identifying the timing and location of vocal fold contact, and measuring intraglottal and vocal fold contact pressures via a pressure probe embedded in the wall of a hemi-laryngeal flow facility. The accuracy and sensitivity of the pressure measurements are validated against ground truth values. Application to in vivo approaches are assessed by acquiring intraglottal and VF contact pressures using a synthetic, self-oscillating vocal fold model in a hemi-laryngeal configuration, where the sensitivity of the measured intraglottal and vocal fold contact pressure relative to the sensor position is explored.
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Affiliation(s)
- Mohsen Motie-Shirazi
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY 13699, USA
| | - Matías Zañartu
- Department of Electronic Engineering, Universidad Técnica Federico Santa María, Valparaíso 2390123, Chile
| | - Sean D. Peterson
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Daryush D. Mehta
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
| | - James B. Kobler
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Robert E. Hillman
- Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Byron D. Erath
- Department of Mechanical & Aeronautical Engineering, Clarkson University, Potsdam, NY 13699, USA
- Correspondence:
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Wu L, Zhang Z. A parametric vocal fold model based on magnetic resonance imaging. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2016; 140:EL159. [PMID: 27586774 PMCID: PMC5397093 DOI: 10.1121/1.4959599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This paper introduces a parametric three-dimensional body-cover vocal fold model based on magnetic resonance imaging (MRI) of the human larynx. Major geometric features that are observed in the MRI images but missing in current vocal fold models are discussed, and their influence on vocal fold vibration is evaluated using eigenmode analysis. Proper boundary conditions for the model are also discussed. Based on control parameters corresponding to anatomic landmarks that can be easily measured, this model can be adapted toward a subject-specific vocal fold model for voice production research and clinical applications.
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Affiliation(s)
- Liang Wu
- Department of Head and Neck Surgery, University of California, Los Angeles, 31-24 Rehabilitation Center, 1000 Veteran Avenue, Los Angeles, California 90095-1794, USA ,
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, University of California, Los Angeles, 31-24 Rehabilitation Center, 1000 Veteran Avenue, Los Angeles, California 90095-1794, USA ,
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