Effect of deficits in laryngeal sensation on laryngeal muscle biochemistry

Assessment of Laryngeal Sensory Function using a Tactile Aesthesiometer in Healthy Adults

INTRODUCTION

Laryngeal sensory function in healthy adults was assessed through the delivery of tactile stimuli using Cheung-Bearelly monofilaments.

METHODS

37 healthy adults were recruited with 340 tactile stimuli analyzed. Four calibrated tactile stimuli were delivered to three laryngeal sites: false vocal fold (FVF), aryepiglottic fold (AEF), and lateral pyriform sinus (LPS). Primary outcome was the elicitation of laryngeal adductor reflex (LAR). Secondary outcomes were gag, patient-reported laryngeal sensation (PRLS), and perceptual strength. Analysis was performed with mixed effects logistic regression modeling.

RESULTS

Positive LAR was observed in 35.7%, 70.2%, and 91.2% of stimuli at LPS, AEF, and FVF respectively. LAR rates were significantly associated with laryngopharyngeal subsite (p < 0.001), tactile force (p = 0.001), age (p = 0.022) and sex (p = 0.022). LAR, gag, PRLS, and perceptual strength significantly increased as a more medial laryngeal subsite was stimulated and as stimulus force increased. Each of the ten years of age increase was associated with 19% reduction in odds of LAR (aOR = 0.81, 95% CI [0.68, 0.97]; p = 0.022). Male gender was associated with a 55% reduction in odds of LAR (aOR = 0.45, 95% CI [0.23, 0.89]; p = 0.022).

CONCLUSION

LAR elicitation capability decreases in the male gender, aging, and a more lateral subsite. This study provides insight into the pathophysiology of hypo- and hyper-sensitive laryngeal disorders and is paramount to making accurate diagnostic assessments and finding novel treatment options for various laryngological disorders. Laryngoscope, 133:2525-2532, 2023.

The effects of treadmill running on aging laryngeal muscle structure

OBJECTIVES/HYPOTHESIS

Age-related changes in laryngeal muscle structure and function may contribute to deficits in voice and swallowing observed in elderly people. We hypothesized that treadmill running, an exercise that increases respiratory drive to upper airway muscles, would induce changes in thyroarytenoid muscle myosin heavy chain (MHC) isoforms that are consistent with a fast-to-slow transformation in muscle fiber type.

STUDY DESIGN

Randomized parallel group controlled trial.

METHODS

Fifteen young adult and 14 old Fischer 344/Brown Norway rats received either treadmill running or no exercise (5 days/week/8 weeks). Myosin heavy chain isoform composition in the thyroarytenoid muscle was examined at the end of 8 weeks.

RESULTS

Significant age and treatment effects were found. The young adult group had the greatest proportion of superfast-contracting MHCIIL isoform. The treadmill running group had the lowest proportion of MHCIIL and the greatest proportion of MHCIIx isoforms.

CONCLUSION

Thyroarytenoid muscle structure was affected both by age and treadmill running in a fast-to-slow transition that is characteristic of exercise manipulations in other skeletal muscles.

LEVEL OF EVIDENCE

NA. Laryngoscope, 126:672-677, 2016.

Laryngeal somatosensory deficits in Parkinson's disease: implications for speech respiratory and phonatory control

Parkinson's disease (PD) is often associated with substantial impairment of speech respiratory and phonatory control. However, the degree to which these impairments are related to abnormal laryngeal sensory function is unknown. This study examined whether individuals with PD exhibited abnormal and more asymmetric laryngeal somatosensory function compared with healthy controls, and whether these deficits were associated with disease and voice severity. Nineteen PD participants were tested and compared with 18 healthy controls. Testing included endoscopic assessment of laryngeal somatosensory function, with aerodynamic and acoustic assessment of respiratory and phonatory control, and clinical ratings of voice and disease severity. PD participants exhibited significantly abnormal and asymmetric laryngeal somatosensory function compared with healthy controls. Sensory deficits were significantly associated with timing of phonatory onset, voice intensity, respiratory driving pressure, laryngeal resistance, lung volume expended per syllable, disease severity, and voice severity. These results suggest that respiratory and phonatory control are influenced by laryngeal somatosensory function, that speech-related deficits in PD are related to abnormal laryngeal somatosensory function, and that this function may degrade as a function of disease severity. Thus, PD may represent a model of airway sensorimotor disintegration, highlighting the important role of the basal ganglia and related neural networks in the integration of laryngeal sensory input for speech-related motor control.

Design of a new somatosensory stimulus delivery device for measuring laryngeal mechanosensory detection thresholds in humans

Laryngeal control is essential for airway protection, breathing, deglutition, speech, and voice. Unfortunately, integration of laryngeal sensory assessment in research and clinical practice is limited by technical and practical limitations of commercially available technology. A commercial device is available, but reported limitations include procedural complexity requiring two or three individuals to operate, limited stimulus dynamic range, device generated noise, and questionable stimulus reproducibility. The objective of this study was to design a new laryngeal somatosensory stimulus delivery device that provides direct, reliable control over the timing, duration, and dynamic range of stimulus presentation, and test the device in individuals who may manifest a laryngeal sensory deficit. The new device operates silently and has more than four times greater stimulus dynamic range than the commercial device. Testing with the new device revealed laryngeal mechanosensory detection thresholds in an individual with Parkinson's disease that were seven times higher than those of healthy controls. These data would have otherwise gone undetected due to limited stimulus dynamic range in the commercial device. The new design resulted in a new assessment instrument that is simple to use for routine clinical assessment, yet sufficiently versatile for integration within rigorous clinical research protocols.

Effect of aging on blood flow in rat larynx

OBJECTIVE/HYPOTHESIS

Age-associated muscular changes and fatigue have been shown to affect phonatory function. Reductions in blood flow with aging could translate to reductions in oxidative capacity within laryngeal muscles and increased fatigability. We tested the hypothesis that there would be increased capillary red blood cell (RBC) velocity and a reduction of capillary density in the thyroarytenoid (TA) muscle of senescent rats.

STUDY DESIGN/METHODS

Ten male Fisher 344/Brown Norway rats in two age groups were used: young adult (9 mo) and old (28-30 mo). Sixteen additional young and old rats were used in a fluorescent microsphere experiment that examined blood flow rates before and after a surgical manipulation. With use of a specially equipped intravital microscope, in vivo measurements of capillary geometry and flow were obtained, including RBC velocity, capillary density, tortuosity, and number of branch points.

RESULTS

There was an age-related reduction in capillary surface area as evidenced by reduced lineal density of capillaries. In addition, reduced RBC transit time was suggested by the reduction in branch points found with age. There was no change in RBC velocity with aging. The surgical method used to expose the TA muscle for blood flow recordings did not significantly affect resultant blood flow measurements.

CONCLUSIONS

We developed a method to evaluate in vivo laryngeal microvasculature. We found age-related changes in microvascular geometry within the TA muscle of the rat that could affect blood flow to this critical muscle of phonation and airway protection. These microvascular changes could contribute to age-related laryngeal dysfunction.

Contractile dysfunction and altered metabolic profile of the aging rat thyroarytenoid muscle

The larynx and its muscles are important for ventilation, coughing, sneezing, swallowing, Valsalva's maneuver, and phonation. Because of their functional demands, the intrinsic laryngeal muscles have a unique phenotype: very small and fast fibers with high mitochondrial content. How aging affects their function is largely unknown. In this study, we tested the hypothesis that an intrinsic laryngeal muscle (thyroarytenoid muscle, a vocal fold adductor) would become weaker, slower, and fatigable with age. Muscles from Fischer 344 x Brown Norway F1 hybrid rats (6, 18, and 30 mo of age) were used for in vitro contractile function and histology. Thyroarytenoid muscles generated significantly lower twitch and tetanic forces at 30 mo vs. 6 and 18 mo. Maximal shortening velocity decreased by 20% at 30 mo (vs. 6 mo), and velocity of unloaded shortening was slower at 18 and 30 mo by 19 and 27% vs. 6 mo. There was no histochemical evidence of altered myosin ATPase activity at 18 or 30 mo of age. Fatigue resistance was significantly decreased at 18 and 30 mo. We also found abundant mitochondrial clusters and ragged red fibers in the muscles of 30-mo-old rats, and there was an age-related increase in glycogen-positive fibers. We conclude that rat thyroarytenoid muscles become weaker, slower, and more fatigable with age. These functional changes are not due to alterations in myosin ATPase activity, but a switch in the expression of myosin isoforms remains a possibility. Finally, the alterations in mitochondrial and glycogen content indicate a shift in the metabolic characteristics of these muscles with age.