Characterization of the Medial Surface of the Vocal Folds

Simulated Laryngeal High-Speed Videos for the Study of Normal and Dysphonic Vocal Fold Vibration

PURPOSE

Laryngeal high-speed videoendoscopy (LHSV) has been recognized as a highly valuable modality for the scientific investigations of vocal fold (VF) vibrations. In contrast to stroboscopic imaging, LHSV enables visualizing aperiodic VF vibrations. However, the technique is less well established in the clinical care of disordered voices, partly because the properties of aperiodic vibration patterns are not yet described comprehensively. To address this, a computer model for simulation of VF vibration patterns observed in a variety of different phonation types is proposed.

METHOD

A previously published kinematic model of mucosal wave phenomena is generalized to be capable of left-right asymmetry and to simulate endoscopic videos instead of only kymograms of VF vibrations at single sagittal positions. The most influential control parameters are the glottal halfwidths, the oscillation frequencies, the amplitudes, and the phase delays.

RESULTS

The presented videos demonstrate zipper-like vibration, pressed voice, voice onset, constant and time-varying left-right and anterior-posterior phase differences, as well as left-right frequency differences of the VF vibration. Video frames, videokymograms, phonovibrograms, glottal area waveforms, and waveforms of VF contact area relating to electroglottograms are shown, as well as selected kinematic parameters.

CONCLUSION

The presented videos demonstrate the ability to produce vibration patterns that are similar to those typically seen in endoscopic videos obtained from vocally healthy and dysphonic speakers.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20151833.

Toward Development of a Vocal Fold Contact Pressure Probe: Bench-Top Validation of a Dual-Sensor Probe Using Excised Human Larynx Models

A critical element in understanding voice production mechanisms is the characterization of vocal fold collision, which is widely considered a primary etiological factor in the development of common phonotraumatic lesions such as nodules and polyps. This paper describes the development of a transoral, dual-sensor intraglottal/subglottal pressure probe for the simultaneous measurement of vocal fold collision and subglottal pressures during phonation using two miniature sensors positioned 7.6 mm apart at the distal end of a rigid cannula. Proof-of-concept testing was performed using excised whole-mount and hemilarynx human tissue aerodynamically driven into self-sustained oscillation, with systematic variation of the superior-inferior positioning of the vocal fold collision sensor. In the hemilarynx experiment, signals from the pressure sensors were synchronized with an acoustic microphone, a tracheal-surface accelerometer, and two high-speed video cameras recording at 4000 frames per second for top-down and en face imaging of the superior and medial vocal fold surfaces, respectively. As expected, the intraglottal pressure signal exhibited an impulse-like peak when vocal fold contact occurred, followed by a broader peak associated with intraglottal pressure build-up during the de-contacting phase. As subglottal pressure was increased, the peak amplitude of the collision pressure increased and typically reached a value below that of the average subglottal pressure. Results provide important baseline vocal fold collision pressure data with which computational models of voice production can be developed and in vivo measurements can be referenced.

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.

Quantification of Porcine Vocal Fold Geometry

OBJECTIVE

The aim of this study was to quantify porcine vocal fold medial surface geometry and three-dimensional geometric distortion induced by freezing the larynx, especially in the region of the vocal folds.

STUDY DESIGN

The medial surface geometries of five excised porcine larynges were quantified and reported.

METHODS

Five porcine larynges were imaged in a micro-CT scanner, frozen, and rescanned. Segmentations and three-dimensional reconstructions were used to quantify and characterize geometric features. Comparisons were made with geometry data previously obtained using canine and human vocal folds as well as geometries of selected synthetic vocal fold models.

RESULTS

Freezing induced an overall expansion of approximately 5% in the transverse plane and comparable levels of nonuniform distortion in sagittal and coronal planes. The medial surface of the porcine vocal folds was found to compare reasonably well with other geometries, although the compared geometries exhibited a notable discrepancy with one set of published human female vocal fold geometry.

CONCLUSIONS

Porcine vocal folds are qualitatively geometrically similar to data available for canine and human vocal folds, as well as commonly used models. Freezing of tissue in the larynx causes distortion of around 5%. The data can provide direction in estimating uncertainty due to bulk distortion of tissue caused by freezing, as well as quantitative geometric data that can be directly used in developing vocal fold models.

Effect of resection depth of early glottic cancer on vocal outcome: an optimized finite element simulation

OBJECTIVES/HYPOTHESIS

To test the hypothesis that subligamental cordectomy produces superior acoustic outcome than subepithelial cordectomy for early (T1-2) glottic cancer that requires complete removal of the superficial lamina propria but does not involve the vocal ligament.

STUDY DESIGN

Computer simulation.

METHODS

A computational tool for vocal fold surgical planning and simulation (the National Center for Voice and Speech Phonosurgery Optimizer-Simulator) was used to evaluate the acoustic output of alternative vocal fold morphologies. Four morphologies were simulated: normal, subepithelial cordectomy, subligamental cordectomy, and transligamental cordectomy (partial ligament resection). The primary outcome measure was the range of fundamental frequency (F0 ) and sound pressure level (SPL). A more restricted F0 -SPL range was considered less favorable because of reduced acoustic possibilities given the same range of driving subglottic pressure and identical vocal fold posturing.

RESULTS

Subligamental cordectomy generated solutions covering an F0 -SPL range 82% of normal for a rectangular vocal fold. In contrast, transligamental and subepithelial cordectomies produced significantly smaller F0 -SPL ranges, 57% and 19% of normal, respectively.

CONCLUSION

This study illustrates the use of the Phonosurgery Optimizer-Simulator to test a specific hypothesis regarding the merits of two surgical alternatives. These simulation results provide theoretical support for vocal ligament excision with maximum muscle preservation when superficial lamina propria resection is necessary but the vocal ligament can be spared on oncological grounds. The resection of more tissue may paradoxically allow the eventual recovery of a better speaking voice, assuming glottal width is restored. Application of this conclusion to surgical practice will require confirmatory clinical data.

LEVEL OF EVIDENCE

N/A.

Vibratory responses of synthetic, self-oscillating vocal fold models

The flow-induced responses of four self-oscillating synthetic vocal fold models are compared. All models were life-sized and fabricated using flexible silicone compounds with material properties comparable to those of human vocal fold tissue. Three of the models had two layers of different stiffness to represent the body-cover grouping of vocal fold tissue. Two of the two-layer models were based on the "M5" geometry [Scherer et al., J. Acoust. Soc. Am. 109, 1616-1630 (2001)], while the third was based on magnetic resonance imaging data. The fourth model included several layers, including a thin epithelial layer, an exceedingly flexible superficial lamina propria layer, a ligament layer that included an anteriorly-posteriorly oriented fiber to restrict vertical motion, and a body layer. Measurements were performed with these models in full larynx and hemilarynx configurations. Data included onset pressure, vibration frequency, glottal flow rate, maximum glottal width, and medial surface motion, the latter two of which were acquired using high-speed imaging techniques. The fourth, multi-layer model exhibited onset pressure, frequency, and medial surface motion traits that are comparable to published human vocal fold data. Importantly, the model featured an alternating convergent-divergent glottal profile and mucosal wave-like motion, characteristics which are important markers of human vocal fold vibration.

Modulating phonation through alteration of vocal fold medial surface contour

OBJECTIVES/HYPOTHESIS

1) To test whether alteration of the vocal fold medial surface contour can improve phonation and 2) to demonstrate that implant material properties affect vibration even when implantation is deep to the vocal fold lamina propria.

STUDY DESIGN

Induced phonation of excised human larynges.

METHODS

Thirteen larynges were harvested within 24 hours postmortem. Phonation threshold pressure (PTP) and flow (PTF) were measured before and after vocal fold injections using either calcium hydroxylapatite (CaHA) or hyaluronic acid (HA). Small-volume injections (median, 0.0625 mL) were targeted to the inferomedial aspect of the thyroarytenoid muscle. Implant locations were assessed histologically.

RESULTS

The effect of implantation on PTP was material dependent. CaHA tended to increase PTP, whereas HA tended to decrease PTP (Wilcoxon test, P = .00013 for onset). In contrast, the effect of implantation on PTF was similar, with both materials tending to decrease PTF (P = .16 for onset). Histology confirmed implant presence in the inferior half of the vocal fold vertical thickness.

CONCLUSIONS

Taken together, these data suggested the implants may have altered the vocal fold medial surface contour, potentially resulting in a less convergent or more rectangular glottal geometry as a means to improve phonation. An implant with a closer viscoelastic match to vocal fold cover is desirable for this purpose, as material properties can affect vibration even when the implant is not placed within the lamina propria. This result is consistent with theoretical predictions and implies greater need for surgical precision in implant placement and care in material selection.

Biomechanical modeling of the three-dimensional aspects of human vocal fold dynamics

Human voice originates from the three-dimensional (3D) oscillations of the vocal folds. In previous studies, biomechanical properties of vocal fold tissues have been predicted by optimizing the parameters of simple two-mass-models to fit its dynamics to the high-speed imaging data from the clinic. However, only lateral and longitudinal displacements of the vocal folds were considered. To extend previous studies, a 3D mass-spring, cover-model is developed, which predicts the 3D vibrations of the entire medial surface of the vocal fold. The model consists of five mass planes arranged in vertical direction. Each plane contains five longitudinal, mass-spring, coupled oscillators. Feasibility of the model is assessed using a large body of dynamical data previously obtained from excised human larynx experiments, in vivo canine larynx experiments, physical models, and numerical models. Typical model output was found to be similar to existing findings. The resulting model enables visualization of the 3D dynamics of the human vocal folds during phonation for both symmetric and asymmetric vibrations.

Geometry of human vocal folds and glottal channel for mathematical and biomechanical modeling of voice production

Current models of the vocal folds derive their shape from approximate information rather than from exactly measured data. The objective of this study was to obtain detailed measurements on the geometry of human vocal folds and the glottal channel in phonatory position. A non-destructive casting methodology was developed to capture the vocal fold shape from excised human larynges on both medial and superior surfaces. Two female larynges, each in two different phonatory configurations corresponding to low and high fundamental frequency of the vocal fold vibrations, were measured. A coordinate measuring machine was used to digitize the casts yielding 3D computer models of the vocal fold shape. The coronal sections were located in the models, extracted and fitted by piecewise-defined cubic functions allowing a mathematical expression of the 2D shape of the glottal channel. Left-right differences between the cross-sectional shapes of the vocal folds were found in both the larynges.

Viscoelastic measurements of vocal folds using the linear skin rheometer

As the number of interventions for vocal fold scar grows and with the advancement of mathematical modeling, greater accuracy and precision in the measurement of vocal fold pliability will become essential. Although indirect pliability measures have been used successfully, direct measurement of tissue pliability is essential. Indirect measurement with parallel plate technology has limitations; it requires the tissue to be removed from the surrounding framework, allows no site specificity, and offers no future for in vivo use in animals or humans. We tested the linear skin rheometer (LSR) in the evaluation of vocal fold pliability. We measured site-specific rheology of vocal folds thereby creating "pliability maps" in human, dog, and rat cadaveric larynges under conditions of altered stiffness; the canine vocal folds possessed sulci, the rat vocal fold was stiff secondary to controlled biopsy, and the human vocal fold was injected with trichloroacetic acid. Histology was performed to confirm the site and type of canine sulci. We found that the LSR reliably detected stiffness in the vocal folds of all species and created "pliability maps" consistent with previous data and clinical observations. The LSR should prove useful in the evaluation of vocal fold pliability for ex vivo and ultimately for in vivo applications.

Visualization and Quantification of the Medial Surface Dynamics of an Excised Human Vocal Fold During Phonation

SUMMARY

The purpose of this investigation was to investigate physical mechanisms of vocal fold vibration during normal phonation through quantification of the medial surface dynamics of the fold. An excised hemilarynx setup was used. The dynamics of 30 microsutures mounted on the medial surface of a human vocal fold were analyzed across 18 phonatory conditions. The vibrations were recorded with a digital high-speed camera at a frequency of 4,000 Hz. The positions of the sutures were extracted and converted to three-dimensional coordinates using a linear approximation technique. The data were reduced to principal eigenfuctions, which captured over 90% of the variance of the data, and suggested mechanisms of sustained vocal fold oscillation. The vibrations were imaged as the following phonatory conditions were manipulated: glottal airflow, an adductory force applied to the muscular process, and an elongation force applied to the thyroid cartilage. Over the range of variables studied, only the variation in glottal airflow yielded significant changes in subglottal pressure and fundamental frequency. All recordings showed high correlation for the distribution of the dynamics across the medial surface of the vocal fold. The distribution of the different displacement directions and velocities showed the highest variations around the superior region of the medial surface. Although the computed vibration patterns of the two largest empirical eigenfunctions were consistent with previous experimental observations, the relative prominence of the two eigenfunctions changed as a function of glottal airflow, impacting theories of vocal efficiency and vocal economy.

A Quantitative Study of the Medial Surface Dynamics of an In Vivo Canine Vocal Fold during Phonation

OBJECTIVES/HYPOTHESIS

The purpose of this study was to measure the medial surface dynamics of a canine vocal fold during phonation. In particular, displacements, velocities, accelerations, and relative phase velocities of vocal fold fleshpoints were reported across the entire medial surface. Although the medial surface dynamics have a profound influence on voice production, such data are rare because of the inaccessibility of the vocal folds.

STUDY DESIGN

Medial surface dynamics were investigated during both normal and fry-like phonation as a function of innervation to the recurrent laryngeal nerve for conditions of constant glottal airflow.

METHODS

An in vivo canine model was used. The larynx was dissected similar to methods described in previous excised hemilarynx experiments. Phonation was induced with artificial airflow and innervation to the recurrent laryngeal nerve. The recordings were obtained using a high-speed digital imaging system. Three dimensional coordinates were computed for fleshpoints along the entire medial surface. The trajectories of the fleshpoints were preprocessed using the method of Empirical Eigenfunctions.

RESULTS

Although considerable variability existed within the data, in general, the medial-lateral displacements and vertical displacements of the vocal fold fleshpoints were large compared with anterior-posterior displacements. For both normal and fry-like phonation, the largest displacements and velocities were concentrated in the upper medial portion. During normal phonation, the mucosal wave propagated primarily in a vertical direction. Above a certain threshold of subglottal pressure (or stimulation to the recurrent laryngeal nerve), an abrupt transition from chest-like to fry-like phonation was observed.

CONCLUSIONS

The study reports unique, quantitative data regarding the medial surface dynamics of an in vivo canine vocal fold during phonation, capturing both chest-like and fry-like vibration patterns. These data quantify a complex set of dynamics. The mathematical modeling of such complexity is still in its infancy and requires quantitative data of this nature for development, validation, and testing.