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Wu P, Scholp A, Cai J, Xu X, Huang L, Zhuang P. The Influence of Voice Training on Vocal Learners' Supraglottal Activities and Aerodynamic Evaluation. J Voice 2024; 38:711-716. [PMID: 35022152 DOI: 10.1016/j.jvoice.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Among music majors with only 18 months of training, supraglottal activities and aerodynamic parameters were studied to facilitate understanding of the influence of voice training on characteristics of voice production. METHODS Twenty-three students at the Xiamen Music School were examined over the course of 18 months of singing training. Only 17 students completed all data collection sessions. All students had no previous voice training and were confirmed to be without organic voice disorders by a laryngologist but did present with supraglottal compression. Strobolaryngoscopy and aerodynamic assessment were performed every 6 months. Using the laryngoscopic images, anterior-posterior (A-P) compression and medial-lateral compression were analyzed. Aerodynamic assessment was carried out to measure maximum phonation time, phonation threshold flow, glottal resistance, subglottal pressure, phonation threshold pressure, and vocal efficiency. From these measurements, the mean was calculated along with a measurement of reliability. One-way ANOVA with Bonferroni post hoc test was used to evaluate the results between subjects at different time points. Kendall's W test was completed to assure consistency between and within laryngologists. RESULTS Referring to the Strobolaryngoscopy Evaluation Rating Form, 4 of the 17 students had decreased A-P compression scores in the second measurement compared to the first (from 2.24 ± 0.20 to 2.12 ± 0.17, P = 0.100). After completion of the program, 6 of the 17 students' anterior-posterior compression scores further improved from the second measurement (from 2.12 ± 0.17 to 1.71 ± 0.17, P = 0.600). The A-P compression scores showed a gradual downward trend and was overall statistically significant (P = 0.004). In addition, there was an improvement of maximum phonation time (P = 0.016). CONCLUSION Professional voice training can improve the supraglottal activities and maximum phonation time. These parameters have potential to be used for voice training evaluation and screening.
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Affiliation(s)
- Pinhong Wu
- Department of Voice, Xiamen University Zhongshan Hospital, Xiamen, China; Barnard College of Columbia University, New York, New York
| | - Austin Scholp
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jie Cai
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xinlin Xu
- Department of Voice, Xiamen University Zhongshan Hospital, Xiamen, China
| | - Limin Huang
- Department of Singing, Xiamen Music School, Xiamen, China
| | - Peiyun Zhuang
- Department of Voice, Xiamen University Zhongshan Hospital, Xiamen, China.
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Cai J, Kim YJ, Xu X, Ma Y, Scholp A, Jiang JJ, Liu T, Zhuang P. To Explore the Changes and Differences of Microstructure of Vocal Fold in Vocal Fold Paralysis and Cricoarytenoid Joint Dislocation by Diffusion Tensor Imaging. J Voice 2023; 37:187-193. [PMID: 33388227 DOI: 10.1016/j.jvoice.2020.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The diffusion characteristics of water molecules were measured in the vocal folds of canines exhibiting unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation. These characteristics were used in conjunction with a histological examination of the microstructural changes of vocal fold muscle fibers to explore the feasibility of diffusion tensor imaging (DTI) in distinguishing unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation as well as evaluating microstructural changes. METHODS Ten beagles were randomly divided into three groups: four in the unilateral vocal fold paralysis group, four in the unilateral cricoarytenoid joint dislocation group, and two in the normal group. Unilateral recurrent laryngeal nerve resection was performed in the vocal fold paralysis group. Unilateral cricoarytenoid joint dislocation surgery was performed in the dislocation group. No intervention was performed in the normal group. Four months postintervention, the larynges were excised and put into a magnetic resonance imaging (MRI) system (9.4T BioSpec MRI, Bruker, German) for scanning, followed by an analysis of diffusion parameters among the different groups for statistical significance. After MRI scanning, the vocal folds were cut into sections, stained with hematoxylin and eosin, and scanned digitally. The mean cross-sectional area of muscle fibers, and the mean diameter of muscle fibers in the vocal folds were calculated by target detection and extraction technology. Mean values of each measurement were used to compare the differences among the three groups. Pearson correlation analysis was performed on the DTI parameters and the results from histological section extraction. RESULTS The paralysis group had significantly higher Fractional Anisotropy (FA) compared to the dislocation group and normal group (P = 0.004). The paralysis group also had a significantly lower Tensor Trace value compared to the dislocation group and normal group (P = 0.000). The average cross-sectional area of vocal fold muscle fibers in the paralysis group was significantly smaller than the dislocation group and normal group (P = 0.000). Pearson correlation analysis yielded values of, r = -0.785, P = 0.01 between the average cross-sectional area of vocal muscle fibers and FA, and values of r = 0.881, P = 0.00 between Tensor Trace and the average cross-sectional area of vocal muscle. CONCLUSION FA and Tensor Trace can be used as effective parameters to reflect the changes of microstructure in vocal fold paralysis and cricoarytenoid joint dislocation. DTI is an objective and quantitative method to effectively evaluate unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation, also capable of noninvasively evaluating vocal fold muscle fiber microstructure.
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Affiliation(s)
- Jie Cai
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Young Jin Kim
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Xinlin Xu
- Department of Voice, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Yanli Ma
- Department of Voice, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Austin Scholp
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Department of Surgery Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ting Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics & Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, Fujian, China.
| | - Peiyun Zhuang
- Department of Voice, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China.
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Yan P, Li S, Zhou Z, Liu Q, Wu J, Ren Q, Chen Q, Chen Z, Chen Z, Chen S, Scholp A, Jiang JJ, Kang J, Ge P. Automated detection of glottic laryngeal carcinoma in laryngoscopic images from a multicentre database using a convolutional neural network. Clin Otolaryngol 2023; 48:436-441. [PMID: 36624555 DOI: 10.1111/coa.14029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/22/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Little is known about the efficacy of using artificial intelligence (AI) to identify laryngeal carcinoma from images of vocal lesions taken in different hospitals with multiple laryngoscope systems. This multicentre study aimed to establish an AI system and provide a reliable auxiliary tool to screen for laryngeal carcinoma. STUDY DESIGN Multicentre case-control study. SETTING Six tertiary care centres. PARTICIPANTS Laryngoscopy images were collected from 2179 patients with vocal fold lesions. OUTCOME MEASURES An automatic detection system of laryngeal carcinoma was established and used to distinguish malignant and benign vocal lesions in 2179 laryngoscopy images acquired from 6 hospitals with 5 types of laryngoscopy systems. Pathological examination was the gold standard for identifying malignant and benign vocal lesions. RESULTS Out of 89 cases in the malignant group, the classifier was able to correctly identify laryngeal carcinoma in 66 patients (74.16%, sensitivity). Out of 640 cases in the benign group, the classifier was able to accurately assess the laryngeal lesion in 503 cases (78.59%, specificity). Furthermore, the region-based convolutional neural network (R-CNN) classifier achieved an overall accuracy of 78.05%, with a 95.63% negative predictive value and a 32.51% positive predictive value for the testing data set. CONCLUSION This automatic diagnostic system has the potential to assist clinical laryngeal carcinoma diagnosis which may improve and standardise the diagnostic capacity of laryngologists using different laryngoscopes.
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Affiliation(s)
- Peikai Yan
- Department of Otolaryngology & Head Neck Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Shaohua Li
- Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, Guangdong, Zhongshan, Guangdong, China
| | - Zhou Zhou
- Department of Otolaryngology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Qian Liu
- Department of Otolaryngology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Jiahui Wu
- Department of Otolaryngology & Head Neck Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qingyi Ren
- Department of Otolaryngology & Head Neck Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qiuhuan Chen
- Department of Otolaryngology, Zhaoqing Gaoyao People's Hospital, Zhaoqing, China
| | - Zhipeng Chen
- Department of Otolaryngology, The Second People's Hospital of Longgang District, Shenzhen, China
| | - Ze Chen
- Department of Otolaryngology, Gaozhou People's Hospital, Gaozhou, China
| | - Shaohua Chen
- Department of Otolaryngology & Head Neck Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Austin Scholp
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health (A.S.), University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jack J Jiang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health (A.S.), University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jing Kang
- Department of Otolaryngology & Head Neck Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.,School of Medicine, South China University of Technology, Guangzhou, China
| | - Pingjiang Ge
- School of Medicine, South China University of Technology, Guangzhou, China
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Wu P, Klein L, Rozema Z, Haderlein N, Cai J, Scholp A, Xu X, Jiang JJ, Zhuang P. The Influence of Voice Training on Vocal Learner's Objective Acoustic Voice Components. J Voice 2021; 37:355-361. [PMID: 33653622 DOI: 10.1016/j.jvoice.2021.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Acoustic parameters of voice were studied in music majors throughout 18 months of training to understand the influence of voice training on voice. METHODS Twenty-three students from Xiamen Music School between 12 and 15 years old were enrolled. Acoustic examination was performed three times- every 6 months for 18 months. Various traditional acoustic parameters were measured, including dysphonia severity index (DSI), jitter, and D-value of vocal range. Nonlinear dynamic measures were also measured, including diffusive chaos to construct voice type component profiles (VTCPs), spectrum convergence ratio, and nonlinear energy difference ratio. The results were analyzed by multivariate analysis of variance. RESULTS Over the study duration, there was an improvement of DSI (P = 0.002), and D-value of vocal range (P = 0.000). Among nonlinear parameters, only voice type component data demonstrated significant changes during the study duration. Both Voice Type Component 1(VTC1) and VTC3 values differed from Time 1 to Time 2 as well as from Time 1 to Time 3. The proportion of VTC1 in samples generally decreased, while VTC3, representative of aperiodicity, increased. Both nonlinear energy difference ratio and spectrum convergence ratio exhibited no significant changes throughout the study. CONCLUSION Professional voice training can improve DSI and D-value of vocal range in singers' voices. These parameters have potential to be used for voice training evaluation and screening. Many nonlinear parameters did not detect differences in the healthy voices studied, but VTCPs created using intrinsic dimension present a valuable new method, visualizing increases in aperiodicity of the speaking voices after professional voice training.
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Affiliation(s)
- Pinhong Wu
- Barnard College of Columbia University, New York, NY, USA
| | - Logan Klein
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Zoe Rozema
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Nicole Haderlein
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jie Cai
- School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Austin Scholp
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Xinlin Xu
- Department of Voice, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - Jack J Jiang
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Peiyun Zhuang
- Department of Voice, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China.
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Scholp A, Jeddeloh C, Tao C, Liu X, Dailey SH, Jiang JJ. Study of spatiotemporal liquid dynamics in a vibrating vocal fold by using a self-oscillating poroelastic model. J Acoust Soc Am 2020; 148:2161. [PMID: 33138511 PMCID: PMC7575330 DOI: 10.1121/10.0002163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
The main purpose of this study is to investigate the spatiotemporal interstitial fluid dynamics in a vibrating vocal fold. A self-oscillating poroelastic model is proposed to study the liquid dynamics in the vibrating vocal folds by treating the vocal fold tissue as a transversally isotropic, fluid-saturated, porous material. Rich spatiotemporal liquid dynamics have been found. Specifically, in the vertical direction, the liquid is transported from the inferior side to the superior side due to the propagation of the mucosal wave. In the longitudinal direction, the liquid accumulates at the anterior-posterior midpoint. However, the contact between the two vocal folds forces the accumulated liquid out laterally in a very short time span. These findings could be helpful for exploring etiology of some laryngeal pathologies, optimizing laryngeal disease treatment, and understanding hemodynamics in the vocal folds.
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Affiliation(s)
- Austin Scholp
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin Medical School of Medicine and Public Health, Madison, Wisconsin 53792-7375, USA
| | - Caroline Jeddeloh
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin Medical School of Medicine and Public Health, Madison, Wisconsin 53792-7375, USA
| | - Chao Tao
- Shenzhen Research Institute of Nanjing University, Shenzhen 51800, China
| | - Xiaojun Liu
- MOE Key Laboratory of Modern Acoustics, Nanjing University, Nanjing 210093, China
| | - Seth H Dailey
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin Medical School of Medicine and Public Health, Madison, Wisconsin 53792-7375, USA
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin Medical School of Medicine and Public Health, Madison, Wisconsin 53792-7375, USA
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Kang J, Xue C, Lou Z, Scholp A, Zhang Y, Jiang JJ. The Therapeutic Effects of Straw Phonation on Vocal Fatigue. Laryngoscope 2020; 130:E674-E679. [PMID: 31971264 DOI: 10.1002/lary.28498] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/05/2019] [Accepted: 12/12/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Straw phonation has been investigated for its vocal warm-up effects on healthy populations and therapeutic effects on voice patients. The purpose of this article was to determine whether it is beneficial for vocal fatigue. STUDY DESIGN Prospective cohort study METHODS: Twenty-five healthy participants were recruited into 1-hour vocal loading tasks followed by 10-minute vocal rest or straw phonation on 2 different days. Various parameters including phonation threshold pressure (PTP), mean airflow, closed quotient (CQ), current speaking effort level (EFFT), and laryngeal discomfort (DISC) were acquired at baseline, after vocal load, and after the intervention. RESULTS Increased PTP, EFFT, and DISC were observed after vocal load. Decreased PTP, EFFT, and DISC were then acquired after both vocal rest or straw phonation. More significant improvements were obtained in straw phonation when compared with vocal rest. Additionally, significantly increased mean flow and decreased CQ were obtained after straw phonation when compared to vocal rest. CONCLUSIONS Straw phonation has the potential to adjust aerodynamics within the vocal tract leading to improved vocal efficiency, optimized vibration mode, and attenuated vocal fatigue. This study provided a promising treatment for vocal fatigue that could have wide clinical relevance to voice users with high voice demands. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E674-E679, 2020.
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Affiliation(s)
- Jing Kang
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
- Department of Otolaryngology-Head and Neck Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chao Xue
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Zhewei Lou
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Austin Scholp
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, U.S.A
| | - Yi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Jack J Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
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Cai J, Klein L, Wu P, Wilson A, Xu X, Scholp A, Bao H, Wang X, Jiang JJ, Liu T, Zhuang P. Evaluation of Diffusional Characteristics and Microstructure in Unilateral Vocal Fold Paralysis Using Diffusion Tensor Imaging. Ear Nose Throat J 2019; 100:NP177-NP184. [PMID: 31550925 DOI: 10.1177/0145561319874721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the value of diffusion tensor imaging (DTI) in the evaluation of vocal fold tissue microstructure after recurrent laryngeal nerve (RLN) injury. METHODS Six canines were divided into 2 groups: a unilateral vocal fold paralysis group (n = 4) and a control group (n = 2). The RLN was cut in the unilateral vocal fold paralysis group, and no intervention was applied in the control group. After 4 months, the canines' larynges were removed and placed in a small animal magnetic resonance imaging (MRI) system (9.4T BioSpec MRI; Bruker, Germany). After scanning, the vocal folds were isolated, sectioned, and stained. The slides were then analyzed for the cross-sectional area and muscle fiber density through feature extraction technology. Pearson correlation analysis was performed on the DTI scan and histological section extraction results. RESULTS In the vocal fold muscle layer, the fractional anisotropy (FA) of the unilateral RLN injury group was higher than that of the control group, and the Tensor Trace was lower than that of the control group. This difference was statistically significant, P < .05. In the lamina propria, the FA of the unilateral RLN injury group was lower than that of the control group, P > .05, and the Tensor Trace was lower than that of the control group, P < .05. The muscle fiber cross-sectional area of the RLN injury group was significantly smaller than the control group with statistical significance, P < .05, and the density of muscle fibers was lower, P < .05. The correlation coefficient between FA and the cross-sectional area was -0.838, P = .002, and .726; P = .017 between Tensor Trace and the cross-sectional area. CONCLUSION Diffusion tensor imaging is an effective method to assess the changes in the microstructure of atrophic vocal fold muscle tissue after RLN injury.
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Affiliation(s)
- Jie Cai
- School of Medicine, 12466Xiamen University, Xiamen, China
| | - Logan Klein
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 5232School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Pinhong Wu
- 5919Barnard College of Columbia University, Manhattan, NY, USA
| | - Azure Wilson
- Department of Communication Science and Disorders, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Xinlin Xu
- Department of ENT, Zhongshan Hospital, 12466Xiamen University, Xiamen, China
| | - Austin Scholp
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 5232School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Huijing Bao
- School of Medicine, 12466Xiamen University, Xiamen, China
| | - Xi Wang
- School of Medicine, 12466Xiamen University, Xiamen, China
| | - Jack J Jiang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, 5232School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Ting Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Center for Molecular Imaging and Translational Medicine, School of Public Health, Xiamen University, Xiamen, China
| | - Peiyun Zhuang
- Department of ENT, Zhongshan Hospital, 12466Xiamen University, Xiamen, China
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Tangney J, Scholp A, Kang J, Raj H, Jiang JJ. Effects of Varying Lengths and Diameters During Straw Phonation on an Excised Canine Model. J Voice 2019; 35:85-93. [PMID: 31353125 DOI: 10.1016/j.jvoice.2019.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE/BACKGROUND Straw phonation, a well-established method of vocal exercise, started over 100 years ago. However, some of the most basic questions about best practices remain including the ideal extension length and the ideal restriction (semiocclusion) diameter. This study aims to help answer these questions by looking at both separately, with all other variables controlled. METHODS Four (4) straws with lengths of 5, 25, 50, and 75 centimeters and 4 restrictions with diameters of 3, 9, 15, and 21 mm were tested, separately. They were attached to the end of a simulated vocal tract which was then affixed to an excised canine larynx. Airflow was increased until the larynges achieved self-sustained phonation then aerodynamic, acoustic, and electroglottographic data were collected. RESULTS There was a significant decrease in the phonation threshold pressure using the 5 and 25 cm straw lengths and the 9 and 15 mm restrictions. The phonation threshold flow and contact quotient saw insignificant changes, except in the case of the 3 mm restriction. DISCUSSION It is theorized that the increased inertive reactance helps to decrease phonation threshold pressure. By controlling for all other variables, the effects of the length or diameter of the straw can be analyzed in isolation. These results narrow the significant range of lengths and diameters used in straw phonation.
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Affiliation(s)
- Jacob Tangney
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Austin Scholp
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jing Kang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Hayley Raj
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jack J Jiang
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
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Kang J, Xue C, Chou A, Scholp A, Gong T, Zhang Y, Chen Z, Jiang JJ. Comparing the Exposure-Response Relationships of Physiological and Traditional Vocal Warm-ups on Aerodynamic and Acoustic Parameters in Untrained Singers. J Voice 2019; 33:420-428. [DOI: 10.1016/j.jvoice.2017.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/28/2017] [Indexed: 01/20/2023]
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Kang J, Scholp A, Tangney J, Jiang JJ. Effects of a simulated system of straw phonation on the complete phonatory range of excised canine larynges. Eur Arch Otorhinolaryngol 2019; 276:473-482. [PMID: 30631899 DOI: 10.1007/s00405-018-5247-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE This study investigated the effects of straw phonation therapy on the aerodynamic and acoustic parameters of the vocal folds at different levels of elongation and subglottal pressure. METHODS 20 excised canine larynges were used in both experimental (straw phonation therapy simulation) and control conditions. Aerodynamic parameters, including phonation threshold pressure (PTP), phonation instability pressure (PIP), phonation pressure range (PPR), phonation threshold flow (PTF), phonation instability flow (PIF), phonation flow range (PFR), were obtained at different levels of vocal fold elongation (0%, 10%, 20%). Acoustic parameters, including fundamental frequency (F0), jitter, shimmer, signal noise ratio (SNR) were detected at different levels of vocal fold elongation (0%, 10%, 20%) and subglottal pressure (15 cmH2O, 20 cmH2O, 25 cmH2O). RESULTS Significant decreases in PTP and PTF and significant increases in PIP, PIF, PPR, and PFR occurred in experimental condition at all levels of elongation when compared with control condition. However, no significant changes of acoustic parameters were obtained between conditions at all levels. CONCLUSION At different levels of vocal fold elongation, straw phonation not only lowered the onset of normal voice, but also elevated the onset of chaotic voice, indicating a better voice economy and voice control. Moreover, the improved phonatory range demonstrated that straw phonation had the potential to prevent voice users who have high voice demand from voice fatigue and vocal damage.
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Affiliation(s)
- Jing Kang
- Department of Otolaryngology-Head and Neck Surgery, EENT Hospital of Fudan University, Shanghai, 200031, China
| | - Austin Scholp
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 1300 University Avenue, 2745 Medical Sciences Center, Madison, WI, 53706, USA
| | - Jacob Tangney
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 1300 University Avenue, 2745 Medical Sciences Center, Madison, WI, 53706, USA
| | - Jack J Jiang
- Department of Otolaryngology-Head and Neck Surgery, EENT Hospital of Fudan University, Shanghai, 200031, China. .,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 1300 University Avenue, 2745 Medical Sciences Center, Madison, WI, 53706, USA.
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Gong T, Zhang C, Kang J, Lou Z, Scholp A, Jiang JJ. The effects of cryotherapy on vocal fold healing in a rabbit model. Laryngoscope 2018; 129:E151-E157. [PMID: 30468242 DOI: 10.1002/lary.27629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES/HYPOTHESIS Cryotherapy has been shown to be a scarless treatment modality for dermal lesions; however, there are limited data addressing the effect of cryotherapy on vocal fold tissue. The aim of this study was to clarify the effectiveness of cryotherapy for prevention of postsurgical vocal fold scarring. STUDY DESIGN Prospective animal study in rabbits. METHODS The lamina propria of 20 rabbit vocal folds was bilaterally stripped, followed by randomized unilateral cryotherapy. Five larynges were harvested for real-time polymerase chain reaction (RT-PCR) analysis at 1 day, 3 days, and 7 days postinjury. The remaining five were harvested for histologic analysis at 3 months. Images of the healing phase were recorded by laryngoscopy. Analyses of RT-PCR for cyclooxygenase (COX)-2, interleukin (IL)-6, collagen I, collagen III, matrix metallopeptidase 1 (MMP1), transforming growth factor β (TGFβ1), α smooth muscle actin (α-SMA), and hyaluronan synthase 1 (HAS1) were completed. Histological samples were completed for collagen and hyaluronic acid analysis. RESULTS RT-PCR results revealed that higher expressions of HAS1 and MMP1 and lower expressions of COX-2, IL-6, collagen I, collagen III, TGFβ1, and α-SMA were observed, and histological examination showed significantly increased hyaluronic acid, decreased deposition, and more organized configuration of collagen in injury with the cryotherapy cohort compared with the injury cohort. CONCLUSIONS Cryotherapy can inhibit the inflammatory reaction and simulate a fetal healing environment in extracellular matrix synthesis to regenerate vocal fold tissue with less fibrosis. Histological results showed that cryotherapy achieves a mature healing result with less scar, which tends to return to normal. In summary, the findings of this study suggest that administration of cryotherapy at the time of injury has the potential to minimize vocal fold scarring. LEVEL OF EVIDENCE NA Laryngoscope, 129:E151-E157, 2019.
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Affiliation(s)
- Ting Gong
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Chi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Jing Kang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Zhewei Lou
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Austin Scholp
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Jack J Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
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Lou Z, Zhang C, Gong T, Xue C, Scholp A, Jiang JJ. Wound-healing effects of 635-nm low-level laser therapy on primary human vocal fold epithelial cells: an in vitro study. Lasers Med Sci 2018; 34:547-554. [PMID: 30244401 DOI: 10.1007/s10103-018-2628-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/27/2018] [Indexed: 11/28/2022]
Abstract
Low-level laser therapy (LLLT) has been promoted for its beneficial effects on tissue healing and pain relief for skin and oral applications. However, there is no corresponding literature reporting on vocal fold wound healing. Our purpose was to assess the potential wound-healing effects of LLLT on primary human vocal fold epithelial cells (VFECs). In this study, normal vocal fold tissue was obtained from a 58-year-old male patient who was diagnosed with postcricoid carcinoma without involvement of the vocal folds and underwent total laryngectomy. Primary VFECs were then cultured. Cells were irradiated at a wavelength of 635 nm with fluences of 1, 4, 8, 12, 16, and 20 J/cm2 (50 mW/cm2), which correspond to irradiation times of 20, 80, 160, 240, 320, and 400 s, respectively. Cell viability of VFECs in response to varying doses of LLLT was investigated by the Cell Counting Kit-8 (CCK-8) method. The most effective irradiation dose was selected to evaluate the cell migration capacity by using the scratch wound-healing assay. Real-time polymerase chain reaction (RT-PCR) was used to detect the gene expression of TGF-β1, TGF-β3, EGF, IL-6, and IL-10. Irradiation with doses of 8 J/cm2 resulted in 4% increases in cell proliferation differing significantly from the control group (p < 0.05). With subsequent doses at 48 and 72 h after irradiation, the differences between the experimental and the control groups became greater, up to 9.8% (p < 0.001) and 19.5% (p < 0.001), respectively. It also increased cell migration and the expression of some genes, such as EGF, TGF-β1, TGF-β3, and IL-10, involved in the tissue healing process. This study concludes that LLLT at the preset parameters was capable of stimulating the proliferation and migration of human vocal fold epithelial cells in culture as well as increase the expression of some genes involved in tissue healing process. Additionally, successive laser treatments at 24 h intervals have an additive beneficial effect on the healing of injured tissues.
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Affiliation(s)
- Zhewei Lou
- The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200030, China
| | - Chi Zhang
- The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200030, China
| | - Ting Gong
- The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200030, China
| | - Chao Xue
- The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200030, China
| | - Austin Scholp
- The Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Jack J Jiang
- The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200030, China.
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Zhang C, Paddock K, Chou A, Scholp A, Gong T, Jiang JJ. Prolonged phonation impairs the integrity and barrier function of porcine vocal fold epithelium: a preliminary study. Eur Arch Otorhinolaryngol 2018; 275:1547-1556. [PMID: 29671091 DOI: 10.1007/s00405-018-4973-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/11/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Voice abuse is known to be a common risk factor of voice disorders and prolonged; high-intensity phonation has been shown to damage the vocal fold epithelium. We aim to evaluate the effects of phonation on the integrity and barrier function of vocal fold epithelium using a porcine laryngeal model. METHODS Ex vivo porcine larynges were phonated at low intensity or high intensity for 15, 30, or 60 min within 4 h after harvest. Vocal fold epithelium was visualized using transmission electron microscopy (TEM). The barrier function of vocal fold epithelium was evaluated by measuring the permeability to model molecules, fluorescein (376 Da), and fluorescein isothiocyanate (FITC)-dextrans of 4000 and 10,000 Da (FD4, FD10), in a Franz diffusing cell. RESULTS Cell death and dilated intercellular space after phonation were observed using TEM. Thickness of vocal fold epithelium was significantly reduced after low-intensity phonation for 30 and 60 min and high-intensity phonation for 15, 30, and 60 min. Epithelial permeability to fluorescein was significantly increased after low-intensity phonation for 30 and 60 min, and high-intensity phonation. Permeability to FD4 was significantly increased after high-intensity phonation for 30 and 60 min. Phonation did not alter the permeability to FD10 significantly. CONCLUSION Long-duration phonation destroys the integrity and barrier function of vocal fold epithelium. These effects likely make vocal folds more vulnerable to other environmental irritants, such as tobacco smoke, reflux components, allergens, and inhaled pollutants. Destroyed barrier function may be an important factor in the pathogenesis of voice lesions related to voice abuse.
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Affiliation(s)
- Chi Zhang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Kieran Paddock
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Adriana Chou
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Austin Scholp
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA
| | - Ting Gong
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Jack J Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, 53792, USA.
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Thompson JD, Hoffman MR, Scholp A, Devine EE, Jiang JJ, McCulloch TM. Excised larynx evaluation of subthyroid cartilage approach to medialization thyroplasty. Laryngoscope 2017; 128:675-681. [PMID: 28891238 DOI: 10.1002/lary.26852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/24/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe an alternative approach to medialization thyroplasty involving dissection underneath the thyroid cartilage with placement of a Gore-Tex implant, and to evaluate its effect on a range of phonatory measures using an excised canine larynx model. STUDY DESIGN Animal model. METHODS On each of eight excised canine larynges, the conditions of normal, paralysis, medialization thyroplasty by standard transthyroid cartilage approach, and medialization thyroplasty by experimental subthyroid cartilage approach were performed. Aerodynamic, acoustic, and mucosal wave parameters were measured for each condition. RESULTS Compared to the vocal fold paralysis state, both the transthyroid and subthyroid approaches for Gore-Tex insertion resulted in significant decreases in phonation threshold pressure and phonation threshold flow. Both approaches also significantly decreased percent jitter, decreased percent shimmer, and improved signal-to-noise ratio. The mucosal wave was preserved after insertion of the Gore-Tex implant for both approaches. For all the phonatory measures except phonation threshold flow, there were no significant differences between the transthyroid and subthyroid approaches. CONCLUSIONS Gore-Tex implantation via a subthyroid approach in an excised canine larynx model can produce effective medialization, preserve the mucosal wave, and significantly improve aerodynamic and acoustic parameters without meaningful difference compared to a traditional transthyroid approach. The subthyroid approach does not require creation of a thyroid cartilage window and could be a potentially valuable alternative method of performing medialization thyroplasty. LEVEL OF EVIDENCE NA. Laryngoscope, 128:675-681, 2018.
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Affiliation(s)
- James D Thompson
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Matthew R Hoffman
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Austin Scholp
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Erin E Devine
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Jack J Jiang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Timothy M McCulloch
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
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Kang J, Scholp A, Jiang JJ. A Review of the Physiological Effects and Mechanisms of Singing. J Voice 2017; 32:390-395. [PMID: 28826978 DOI: 10.1016/j.jvoice.2017.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/13/2017] [Accepted: 07/17/2017] [Indexed: 01/26/2023]
Abstract
Daily experience suggests that singing can energize us and even provide a physical workout. A growing amount of evidence has been presented to support anecdotal claims of the benefits of singing on health and well-being. Singing has been shown to be related to numerous physiological changes. The cardiorespiratory system is utilized during persistent singing training, resulting in enhanced respiratory muscles and an optimized breathing mode. In addition, singing can also cause changes in neurotransmitters and hormones, including the upregulation of oxytocin, immunoglobulin A, and endorphins, which improves immune function and increases feelings of happiness. This review is organized by respiratory, circulatory, and hormonal changes that are collectively a part of singing in a healthy population. The various studies are discussed with the intention of helping researchers and clinicians realize the potential benefit of singing and provide a clinical option as an adjunct therapy for a given situation. Better understanding of physiological mechanisms will lay a solid theoretical foundation for singing activities and will present important implications for further study. Evaluations of existing research and recommendations for future research are given to promote the scale and duration to better demonstrate the effectiveness of singing before it can be recommended in clinical guidelines and satisfy criteria for funding by commissioners of health and social care.
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Affiliation(s)
- Jing Kang
- EENT Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China
| | - Austin Scholp
- University of Wisconsin-Madison, School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin
| | - Jack J Jiang
- EENT Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China; University of Wisconsin-Madison, School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin.
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