Toward Development of a Vocal Fold Contact Pressure Probe: Sensor Characterization and Validation Using Synthetic Vocal Fold Models

What kind of phonation causes the strongest vocal fold collision? - A hemi-larynx phonation contact pressure study

This paper presents a measurement setup which is able to measure the distribution of small scale pressure on an area of 15.2 mm × 30.4 mm with a sample rate up to 1.2 kHz. It was used to investigate the contact pressures of vocal folds during phonation. This was performed in ex vivo experiments of 11 porcine larynges. The contact pressure at the medial surface and other phonation parameters, as the glottal resistance and the closing velocity of the vocal fold, were measured at different adduction and elongation levels and air flow rates. A statistical analysis was carried out. It could be shown that the contact pressure rises, when the vocal fold is manipulated or when the flow rate is increased.

The influence of sensor size on experimental measurement accuracy of vocal fold contact pressure

The vocal folds experience repeated collision during phonation. The resulting contact pressure is often considered to play an important role in vocal fold injury, and has been the focus of many experimental studies. In this study, vocal fold contact pattern and contact pressure during phonation were numerically investigated. The results show that vocal fold contact in general occurs within a horizontal strip on the medial surface, first appearing at the inferior medial surface and propagating upward. Because of the localized and travelling nature of vocal fold contact, sensors of a finite size may significantly underestimate the peak vocal fold contact pressure, particularly for vocal folds of low transverse stiffness. This underestimation also makes it difficult to identify the contact pressure peak in the intraglottal pressure waveform. These results showed that the vocal fold contact pressure reported in previous experimental studies may have significantly underestimated the actual values. It is recommended that contact pressure sensors with a diameter no greater than 0.4 mm are used in future experiments to ensure adequate accuracy in measuring the peak vocal fold contact pressure during phonation.

Effect of Ligament Fibers on Dynamics of Synthetic, Self-Oscillating Vocal Folds in a Biomimetic Larynx Model

Synthetic silicone larynx models are essential for understanding the biomechanics of physiological and pathological vocal fold vibrations. The aim of this study is to investigate the effects of artificial ligament fibers on vocal fold vibrations in a synthetic larynx model, which is capable of replicating physiological laryngeal functions such as elongation, abduction, and adduction. A multi-layer silicone model with different mechanical properties for the musculus vocalis and the lamina propria consisting of ligament and mucosa was used. Ligament fibers of various diameters and break resistances were cast into the vocal folds and tested at different tension levels. An electromechanical setup was developed to mimic laryngeal physiology. The measurements included high-speed video recordings of vocal fold vibrations, subglottal pressure and acoustic. For the evaluation of the vibration characteristics, all measured values were evaluated and compared with parameters from ex and in vivo studies. The fundamental frequency of the synthetic larynx model was found to be approximately 200-520 Hz depending on integrated fiber types and tension levels. This range of the fundamental frequency corresponds to the reproduction of a female normal and singing voice range. The investigated voice parameters from vocal fold vibration, acoustics, and subglottal pressure were within normal value ranges from ex and in vivo studies. The integration of ligament fibers leads to an increase in the fundamental frequency with increasing airflow, while the tensioning of the ligament fibers remains constant. In addition, a tension increase in the fibers also generates a rise in the fundamental frequency delivering the physiological expectation of the dynamic behavior of vocal folds.

Examining the influence of epithelium layer modeling approaches on vocal fold kinematics and kinetics

Grouping the thin epithelium and thicker superficial lamina propria layers into a single cover layer has been widely adopted in finite element vocal fold models. Recent silicone vocal fold studies have suggested, however, that inclusion of a distinct epithelial layer leads to more physiologically representative motion. This study systematically explores the ramifications of incorporating an epithelial layer into a cover grouping for finite element vocal fold modeling. A membrane model for the epithelium is introduced to facilitate parametric investigation by reducing the mesh density requirement of the epithelium into a single infinitesimally thin layer. Excluding the epithelium entirely leads to increased energy in higher order modes and larger inferior-superior excursion of the folds. Integrating the epithelium into a cover layer with volume-weighted average stiffness results in similar kinematics to that of a model treating the epithelium as a distinct layer. However, the internal stress/strain and contact pressure during collision are higher, and viscous dissipation is lower, when the epithelium is integrated into the cover. Thus, careful treatment of the epithelium is recommended for finite element studies, particularly when employing the models for estimating measures dependent upon internal stress/strain and/or collision pressure, such as vocal dose.

Effect of nodule size and stiffness on phonation threshold and collision pressures in a synthetic hemilaryngeal vocal fold model

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.

Aerodynamic-induced Effects of Artificial Subglottic Stenosis on Vocal Fold Model Phonatory Response

OBJECTIVE

Subglottic stenosis (SGS) is characterized by a narrowing of the trachea near the cricotracheal junction and impairs breathing. SGS may also adversely affect voice quality, but for reasons that are not fully understood. The purpose of this study is to provide experiment-based data concerning the effects on phonation of airway obstruction due to SGS.

STUDY DESIGN

Basic science METHODS: A device simulating a SGS of adjustable severity ranging from 36% to 99.8% obstruction was created. Self-oscillating synthetic VF models were mounted downstream of the device and data were acquired to evaluate the effects of the obstruction on phonatory response.

RESULTS

Onset pressures were relatively insensitive to obstructions of up to approximately 80% to 90% reductions in subglottic airway area and sharply increased thereafter. Flow rate (under conditions of constant pressure), flow resistance, and fundamental frequency all exhibited similar degrees of sensitivity to SGS obstruction as onset pressure. High-frequency noise became significant by 80% obstruction. Glottal area appeared to be less sensitive, not being affected until approximately 90% obstruction.

CONCLUSIONS

Consistent with previous computational studies, this study found that aerodynamic, acoustic, and vibratory responses of self-oscillating VF models were largely unaffected by SGS until approximately 80% to 90% obstruction, and significantly affected at higher obstructions. This suggests that Grades I and II stenoses are unlikely to introduce subglottic airway aerodynamic disturbances that are sufficient in and of themselves to significantly alter phonatory output. The SGS model introduces a framework for future benchtop studies involving subglottic and supraglottic airway constrictions.

Lombard Effect in Individuals With Nonphonotraumatic Vocal Hyperfunction: Impact on Acoustic, Aerodynamic, and Vocal Fold Vibratory Parameters

PURPOSE

This exploratory study aims to investigate variations in voice production in the presence of background noise (Lombard effect) in individuals with nonphonotraumatic vocal hyperfunction (NPVH) and individuals with typical voices using acoustic, aerodynamic, and vocal fold vibratory measures of phonatory function.

METHOD

Nineteen participants with NPVH and 19 participants with typical voices produced simple vocal tasks in three sequential background conditions: baseline (in quiet), Lombard (in noise), and recovery (5 min after removing the noise). The Lombard condition consisted of speech-shaped noise at 80 dB SPL through audiometric headphones. Acoustic measures from a microphone, glottal aerodynamic parameters estimated from the oral airflow measured with a circumferentially vented pneumotachograph mask, and vocal fold vibratory parameters from high-speed videoendoscopy were analyzed.

RESULTS

During the Lombard condition, both groups exhibited a decrease in open quotient and increases in sound pressure level, peak-to-peak glottal airflow, maximum flow declination rate, and subglottal pressure. During the recovery condition, the acoustic and aerodynamic measures of individuals with typical voices returned to those of the baseline condition; however, recovery measures for individuals with NPVH did not return to baseline values.

CONCLUSIONS

As expected, individuals with NPVH and participants with typical voices exhibited a Lombard effect in the presence of elevated background noise levels. During the recovery condition, individuals with NPVH did not return to their baseline state, pointing to a persistence of the Lombard effect after noise removal. This behavior could be related to disruptions in laryngeal motor control and may play a role in the etiology of NPVH.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20415600.

Collision Pressure and Dissipated Power Dose in a Self-Oscillating Silicone Vocal Fold Model With a Posterior Glottal Opening

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.

Optimization of Synthetic Vocal Fold Models for Glottal Closure

Synthetic, self-oscillating models of the human vocal folds are used to study the complex and inter-related flow, structure, and acoustical aspects of voice production. The vocal folds typically collide during each cycle, thereby creating a brief period of glottal closure that has important implications for flow, acoustic, and motion-related outcomes. Many previous synthetic models, however, have been limited by incomplete glottal closure during vibration. In this study, a low-fidelity, two-dimensional, multilayer finite element model of vocal fold flow-induced vibration was coupled with a custom genetic algorithm optimization code to determine geometric and material characteristics that would be expected to yield physiologically-realistic frequency and closed quotient values. The optimization process yielded computational models that vibrated with favorable frequency and closed quotient characteristics. A tradeoff was observed between frequency and closed quotient. A synthetic, self-oscillating vocal fold model with geometric and material properties informed by the simulation outcomes was fabricated and tested for onset pressure, oscillation frequency, and closed quotient. The synthetic model successfully vibrated at a realistic frequency and exhibited a nonzero closed quotient. The methodology described in this study provides potential direction for fabricating synthetic models using isotropic silicone materials that can be designed to vibrate with physiologically-realistic frequencies and closed quotient values. The results also show the potential for a low-fidelity model optimization approach to be used to tune synthetic vocal fold model characteristics for specific vibratory outcomes.

Changes in the Daily Phonotrauma Index Following the Use of Voice Therapy as the Sole Treatment for Phonotraumatic Vocal Hyperfunction in Females

Purpose The aim of this study was to use the Daily Phonotrauma Index (DPI) to quantify group-based changes in the daily voice use of patients with phonotraumatic vocal hyperfunction (PVH) after receiving voice therapy as the sole treatment. This is part of an ongoing effort to validate an updated theoretical framework for PVH. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and posttreatment data from 52 female patients with PVH. Normative weeklong data were also obtained from 52 matched controls. Each week was represented by the DPI, which is a combination of neck-surface acceleration magnitude skewness and the standard deviation of the difference between the first and second harmonic magnitudes. Results Compared to pretreatment, the DPI statistically decreased towards normal in the patient group after treatment (Cohen's d = -0.25). The posttreatment patient group's DPI was still significantly higher than the control group (d = 0.68). Conclusions The DPI showed the pattern of improved ambulatory voice use in a group of patients with PVH following voice therapy that was predicted by the updated theoretical framework. Per the prediction, voice therapy was associated with a decreased potential for phonotrauma in daily voice use, but the posttreatment patient group data were still significantly different from the normative control group data. This posttreatment difference is interpreted as reflecting the impact on voice use of the persistence of phonotrauma-induced structural changes to the vocal folds. Further validation of the DPI is needed to better understand its potential clinical use.

Direct measurement and modeling of intraglottal, subglottal, and vocal fold collision pressures during phonation in an individual with a hemilaryngectomy

The purpose of this paper is to report on the first in vivo application of a recently developed transoral, dual-sensor pressure probe that directly measures intraglottal, subglottal, and vocal fold collision pressures during phonation. Synchronous measurement of intraglottal and subglottal pressures was accomplished using two miniature pressure sensors mounted on the end of the probe and inserted transorally in a 78-year-old male who had previously undergone surgical removal of his right vocal fold for treatment of laryngeal cancer. The endoscopist used one hand to position the custom probe against the surgically medialized scar band that replaced the right vocal fold and used the other hand to position a transoral endoscope to record laryngeal high-speed videoendoscopy of the vibrating left vocal fold contacting the pressure probe. Visualization of the larynx during sustained phonation allowed the endoscopist to place the dual-sensor pressure probe such that the proximal sensor was positioned intraglottally and the distal sensor subglottally. The proximal pressure sensor was verified to be in the strike zone of vocal fold collision during phonation when the intraglottal pressure signal exhibited three characteristics: an impulsive peak at the start of the closed phase, rounded peak during the open phase, and minimum value around zero immediately preceding the impulsive peak of the subsequent phonatory cycle. Numerical voice production modeling was applied to validate model-based predictions of vocal fold collision pressure using kinematic vocal fold measures. The results successfully demonstrated feasibility of in vivo measurement of vocal fold collision pressure in an individual with a hemilaryngectomy, motivating ongoing data collection that is designed to aid in the development of vocal dose measures that incorporate vocal fold impact collision and stresses.

Vocal fold dynamics in a synthetic self-oscillating model: Intraglottal aerodynamic pressure and energy

Self-sustained oscillations of the vocal folds (VFs) during phonation are the result of the energy exchange between the airflow and VF tissue. Understanding this mechanism requires accurate investigation of the aerodynamic pressures acting on the VF surface during oscillation. A self-oscillating silicone VF model was used in a hemilaryngeal flow facility to measure the time-varying pressure distribution along the inferior-superior thickness of the VF and at four discrete locations in the anterior-posterior direction. It was found that the intraglottal pressures during the opening and closing phases of the glottis are highly dependent on three-dimensional and unsteady flow behaviors. The measured aerodynamic pressures and estimates of the medial surface velocity were used to compute the intraglottal energy transfer from the airflow to the VFs. The energy was greatest at the anterior-posterior midline and decreased significantly toward the anterior/posterior endpoints. The findings provide insight into the dynamics of the VF oscillation and potential causes of some VF disorders.

Vocal fold dynamics in a synthetic self-oscillating model: Contact pressure and dissipated-energy dose

The energy dissipated during vocal fold (VF) contact is a predictor of phonotrauma. Difficulty measuring contact pressure has forced prior energy dissipation estimates to rely upon generalized approximations of the contact dynamics. To address this shortcoming, contact pressure was measured in a self-oscillating synthetic VF model with high spatiotemporal resolution using a hemilaryngeal configuration. The approach yields a temporal resolution of less than 0.26 ms and a spatial resolution of 0.254 mm in the inferior-superior direction. The average contact pressure was found to be 32% of the peak contact pressure, 60% higher than the ratio estimated in prior studies. It was found that 52% of the total power was dissipated due to collision. The power dissipated during contact was an order of magnitude higher than the power dissipated due to internal friction during the non-contact phase of oscillation. Both the contact pressure magnitude and dissipated power were found to be maximums at the mid anterior-posterior position, supporting the idea that collision is responsible for the formation of benign lesions, which normally appear at the middle third of the VF.

The influence of flow model selection on finite element model parameter estimation using Bayesian inference

Recently, Bayesian estimation coupled with finite element modeling has been demonstrated as a viable tool for estimating vocal fold material properties from kinematic information obtained via high-speed video recordings. In this article, the sensitivity of the parameter estimations to the employed fluid model is explored by considering Bernoulli and one-dimensional viscous fluid flow models. Simulation results indicate that prescribing an ad hoc separation location for the Bernoulli flow model can lead to large estimate biases, whereas including the separation location as an estimated parameter leads to results comparable to that of the viscous fluid flow model.

Investigating blunt force trauma to the larynx: The role of inferior-superior vocal fold displacement on phonation

Blunt force trauma to the larynx, which may result from motor vehicle collisions, sports activities, etc., can cause significant damage, often leading to displaced fractures of the laryngeal cartilages, thereby disrupting vocal function. Current surgical interventions primarily focus on airway restoration to stabilize the patient, with restoration of vocal function usually being a secondary consideration. Due to laryngeal fracture, asymmetric vertical misalignment of the left or right vocal fold (VF) in the inferior-superior direction often occurs. This affects VF closure and can lead to a weak, breathy voice requiring increased vocal effort. It is unclear, however, how much vertical VF misalignment can be tolerated before voice quality degrades significantly. To address this need, the influence of inferior-superior VF displacement on phonation is investigated in 1.0mm increments using synthetic, self-oscillating VF models in a physiologically-representative facility. Acoustic (SPL, frequency, H1-H2, jitter, and shimmer), kinematic (amplitude and phase differences), and aerodynamic parameters (flow rate and subglottal pressure) are investigated as a function of inferior-superior vertical displacement. Significant findings include that once the inferior-superior medial length of the VF is surpassed, sustained phonation degrades precipitously, becoming severely pathological. If laryngeal reconstruction approaches can ensure VF contact is maintained during phonation (i.e., vertical displacement doesn't surpass VF medial length), improved vocal outcomes are expected.

3D-FV-FE Aeroacoustic Larynx Model for Investigation of Functional Based Voice Disorders

For the clinical analysis of underlying mechanisms of voice disorders, we developed a numerical aeroacoustic larynx model, called simVoice, that mimics commonly observed functional laryngeal disorders as glottal insufficiency and vibrational left-right asymmetries. The model is a combination of the Finite Volume (FV) CFD solver Star-CCM+ and the Finite Element (FE) aeroacoustic solver CFS++. simVoice models turbulence using Large Eddy Simulations (LES) and the acoustic wave propagation with the perturbed convective wave equation (PCWE). Its geometry corresponds to a simplified larynx and a vocal tract model representing the vowel /a/. The oscillations of the vocal folds are externally driven. In total, 10 configurations with different degrees of functional-based disorders were simulated and analyzed. The energy transfer between the glottal airflow and the vocal folds decreases with an increasing glottal insufficiency and potentially reflects the higher effort during speech for patients being concerned. This loss of energy transfer may also have an essential influence on the quality of the sound signal as expressed by decreasing sound pressure level (SPL), Cepstral Peak Prominence (CPP), and Vocal Efficiency (VE). Asymmetry in the vocal fold oscillations also reduces the quality of the sound signal. However, simVoice confirmed previous clinical and experimental observations that a high level of glottal insufficiency worsens the acoustic signal quality more than oscillatory left-right asymmetry. Both symptoms in combination will further reduce the quality of the sound signal. In summary, simVoice allows for detailed analysis of the origins of disordered voice production and hence fosters the further understanding of laryngeal physiology, including occurring dependencies. A current walltime of 10 h/cycle is, with a prospective increase in computing power, auspicious for a future clinical use of simVoice.

Changes in a Daily Phonotrauma Index After Laryngeal Surgery and Voice Therapy: Implications for the Role of Daily Voice Use in the Etiology and Pathophysiology of Phonotraumatic Vocal Hyperfunction

Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls. Each week was represented by the DPI, standard deviation of the difference between the first and second harmonic amplitudes (H1-H2). Results Compared to pretreatment, the DPI significantly decreased in the patient group after surgery (Cohen's d effect size = -0.86) and voice therapy (d = -1.06). The patient group DPI only normalized after voice therapy. Conclusions The DPI produced the expected pattern of improved ambulatory voice use across laryngeal surgery and postsurgical voice therapy in a group of patients with PVH. The results were interpreted as providing new objective information about the role of daily voice use in the etiology and pathophysiology of PVH. The DPI is viewed as an estimate of potential vocal fold trauma that relies on combining the long-term distributional characteristics of two parameters representing the magnitude of phonatory forces (neck-surface acceleration magnitude) and vocal fold closure dynamics (H1-H2). Further validation of the DPI is needed to better understand its potential clinical use.

3D-Printed Synthetic Vocal Fold Models

OBJECTIVE

Synthetic vocal fold (VF) models used for studying the physics of voice production are comprised of silicone and fabricated using traditional casting processes. The purpose of this study was to develop and demonstrate a new method of creating synthetic VF models through 3D printing in order to reduce model fabrication time, increase yield, and lay the foundation for future models with more life-like geometric, material, and vibratory properties.

STUDY DESIGN

Basic science.

METHODS

A 3D printing technique based on embedding a UV-curable liquid silicone into a gel-like medium was selected and refined. Cubes were printed and subjected to tensile testing to characterize their material properties. Self-oscillating VF models were then printed, coated with a thin layer of silicone representing the epithelium, and used in phonation tests to gather onset pressure, frequency, and amplitude data.

RESULTS

The cubes were found to be anisotropic, exhibiting different modulus values depending on the orientation of the printed layers. The VF models self-oscillated and withstood the strains induced by phonation. Print parameters were found to affect model vibration frequency and onset pressure. Primarily due to the design of the VF models, their onset pressures were higher than what is found in human VFs. However, their frequencies were within a comparable range.

CONCLUSION

The results demonstrate the ability to 3D print synthetic, self-oscillating VF models. It is anticipated that this method will be further refined and used in future studies exploring flow-induced vibratory characteristics of phonation.

Aerodynamically driven phonation of individual vocal folds under general anesthesia in canines

OBJECTIVES/HYPOTHESIS

We previously developed an instrument called the Aerodynamic Vocal Fold Driver (AVFD) for intraoperative magnified assessment of vocal fold (VF) vibration during microlaryngoscopy under general anesthesia. Excised larynx testing showed that the AVFD could provide useful information about the vibratory characteristics of each VF independently. The present investigation expands those findings by testing new iterations of the AVFD during microlaryngoscopy in the canine model.

STUDY DESIGN

Animal model.

METHODS

The AVFD is a handheld instrument that is positioned to contact the phonatory mucosa of either VF during microlaryngoscopy. Airflow delivered through the AVFD shaft to the subglottis drives the VF into phonation-like vibration, which enables magnified observation of mucosal-wave function with stroboscopy or high-speed video. AVFD-driven phonation was tested intraoperatively (n = 26 VFs) using either the original instrument design or smaller and larger versions three-dimensionally printed from a medical grade polymer. A high-fidelity pressure sensor embedded within the AVFD measured VF contact pressure. Characteristics of individual VF phonation were compared with typical two-fold phonation and compared for VFs scarred by electrocautery (n = 4) versus controls (n = 22).

RESULTS

Phonation was successful in all 26 VFs, even when scar prevented conventional bilateral phonation. The 15-mm-wide AVFD fits best within the anteroposterior dimension of the musculo-membranous VF, and VF contact pressure correlated with acoustic output, driving pressures, and visible modes of vibration.

CONCLUSIONS

The AVFD can reveal magnified vibratory characteristics of individual VFs during microlaryngoscopy (e.g., without needing patient participation), potentially providing information that is not apparent or available during conventional awake phonation, which might facilitate phonosurgical decision making.

LEVEL OF EVIDENCE

NA Laryngoscope, 130: 1980-1988, 2020.

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.