Assessment of vocal function using simultaneous aerodynamic and calibrated videostroboscopic measures

Despite many attempts to model how vocal fold movements relate to the aerodynamic forces acting on them during phonation, there have been few simultaneous measurements of glottal area and transglottal air pressures and flows. A novel system is described that combines endoscopic measurement of glottal area with aerodynamic flow and pressure measures made during phonation. Results from bench top model tests and from one human subject are presented. For both tests, an aerodynamic model of airflow through a constriction was used to predict the area of the constriction (glottis), and these predictions were compared with endoscopic measurements. The results showed good correlation between predicted and observed areas; however, for small constrictions (<0.025 cm2), whether artificial or glottal, the errors in estimating areas with either optical or aerodynamic methods increase significantly. These results suggest that this measurement system has the potential to enhance the assessment of vocal function.     

Functional voice quality assessment in curative microsurgery of laryngeal malignancies. Postoperative voice rehabilitation based on the "laryngeal double valve function"

According to Negus and Pressman the sphincter systems of the vocal folds and the ventricular folds form a respiratory "laryngeal double valve function". Correspondingly, we found a physiological phonation system of the glottis and a pathological-compensatory one of the supraglottis. They appear to be regulated through an automatic phonatory control system with the glottal phonatory function evidently acting as sensor level. In order to confirm this hypothesis, objective voice analyses with glottal-relevant parameters of 26 voice-rehabilitated patients after minimally invasive laser surgery of glottal carcinomas are presented and integrated into a "hoarseness diagram" with the coordinates roughness and breathiness. Using statistically deliminated acoustic dusters, our data show a qualitative hierarchy of different postoperative phonation mechanisms. They demonstrate the influence of the vibratory capacity of glottal and supraglottal structures on the quality of the vibratory closure. Both functional parameters evidently determine the resulting voice quality in the sense of our hypothesis.     

Nucleotide sequencing analysis of the 146-kilobase segment around the IkBL and MICA genes at the centromeric end of the HLA class I region

The biomechanics of medialization laryngoplasty are not well understood. An excised canine larynx model was used to test the effects of various sized silicon implants. The vocal fold length, position, and tension were measured. Medialization laryngoplasty did not affect vocal fold length. At the mid-membranous vocal fold, larger shims resulted in greater medialization and tension. Medialization laryngoplasty neither medialized nor stiffened the vocal process to resist lateralizing forces. We conclude that medialization laryngoplasty provides bulk and support for defects of the membranous region of the vocal fold, but does not appear to close a posterior glottal gap. The selection of a surgical procedure to treat glottal incompetence should take into account the unique biomechanical properties of the anterior (membranous vocal folds) and posterior (cartilaginous portion) glottis.     

Vocal mechanics as the basis for phonosurgery

OBJECTIVE: A number of modifications in laryngoplastic phonosurgery have recently been proposed. This report is intended to clarify the concept on which the surgery should be based, vocal mechanics, for further rational development of the surgery. STUDY DESIGN: The results of various previous surgeries were compared. In an attempt to elucidate what makes the difference in the results, simulation of voice production was conducted with the use of excised larynges. METHODS: Excised larynges were mounted on a tube so as to be blown from below. Experimental variables in the model included the glottal area initially set, stiffness of the vocal folds, and subglottal pressure. The conditions under which the voice became hoarse were examined. RESULTS: The voice became hoarse under the following major conditions: 1) the initial glottal area exceeded a certain value, 2) stiffness was too high, and 3) the glottis was too tightly closed. Clinical representation for each condition was made, particularly for excessively tight glottal closure such as in spasmodic dysphonia. A new type of surgical treatment for spasmodic dysphonia, lateralization thyroplasty, was briefly reported, which restored the voice to normal without recurrence for 1 year at the time of this writing. CONCLUSIONS: A potential new type of laryngoplastic phonosurgery should be conformed to the mechanics of voice production. In treating dysphonia, it is often necessary to switch from etiologic or radical treatment, if infertile, to symptomatic treatment instead, at the level of mechanics.     

Parameterization of the voice source by combining spectral decay and amplitude features of the glottal flow

A new method is presented for the parameterization of glottal volume velocity waveforms that have been estimated by inverse filtering acoustic speech pressure signals. The new technique, Parameter for Spectral and Amplitude Features of the Glottal Flow (PSA), combines two features of voice production, the AC value and the spectral decay of the glottal flow, both of which contribute to changes in vocal loudness. PSA yields a single parameter that characterizes the glottal flow in different loudness conditions. By analyzing voices of 8 speakers it was shown that the new parameter correlates strongly with the sound pressure level of speech.     

Effect of the signal measured from the glottis on determination of the vocal tract shape

All-pole and pole-zero models for the vocal tract are developed. First an impulse train, then the pressure signal measured from the glottis, is used as the input in the models. The models for eight Turkish vowels produced by one male subject are studied to determine the effects of the presumed impulse train and the pressure signal measured from the glottis on the estimation of the vocal tract shape. The motion of the tongue is also examined for a whole word.     

Estimating phonation threshold pressure

Phonation threshold pressure (PTP) is the minimum subglottal pressure required to initiate vocal fold oscillation. Although potentially useful clinically, PTP is difficult to estimate noninvasively because of limitations to vocal motor control near the threshold of soft phonation. Previous investigators observed, for example, that trained subjects were unable to produce flat, consistent oral pressure peaks during/pae/syllable strings when they attempted to phonate as softly as possible (Verdolini-Marston, Titze, & Druker, 1990). The present study aimed to determine if nasal airflow or vowel context affected phonation threshold pressure as estimated from oral pressure (Smitheran & Hixon, 1981) in 5 untrained female speakers with normal velopharyngeal and voice function. Nasal airflow during /p/occlusion was observed for 3 of 5 participants when they attempted to phonate near threshold pressure. When the nose was occluded, nasal airflow was reduced or eliminated during /p/;however, individuals then evidenced compensatory changes in glottal adduction and/or respiratory effort that may be expected to alter PTP estimates. Results demonstrate the importance of monitoring nasal flow (or the flow zero point in undivided masks) when obtaining PTP measurements noninvasively. Results also highlight the need to pursue improved methods for noninvasive estimation of PTP.     

Behavioural topography in the striatum: differential effects of quinpirole and D-amphetamine microinjections

The structure of the nervous network and the distribution of tyrosine hydroxylase (TH)- and various neuropeptide-containing nerves were immunohistochemically studied in the glottis of the dog. The nervous network in the glottis revealed apparent regional differences in morphology. The nervous network in the cartilaginous vocal fold of the posterior glottis consisted of nerve bundles running parallel to the edge of the vocal fold. Only a small number of nerve bundles were observed in the anterior glottis, specifically in membranous vocal fold. In the subepithelial layer of the posterior glottis, a moderate number of galanin (GAL)-immunoreactive nerve fibers were observed, while only a few fibers were present in the anterior glottis. Numerous vasoactive intestinal peptide (VIP)-, GAL-, methionine-enkephalin (ENK)- and TH-immunoreactive nerve fibers were observed within and around the laryngeal submucosal seromucous gland. Many TH- and neuropeptide Y (NPY)-immunoreactive fibers were arranged around the blood vessels. In the epithelia, free nerve endings with immunoreactivity for substance P (SP) and calcitonin gene-related peptide (CGRP) was observed. Furthermore, nerve cell bodies with SP-, VIP-, GAL-, ENK-, and NPY-immunoreactivity were observed in the deep region of the submucosal layer. The results from the present study suggest that there is autonomic regulation of the glottis. Regional structural differences in the nervous network of the glottis may reflect functional differences.     

Financing changes of schistosomiasis control programmes in China 1980-1995: a case study in Songzi county

The biomechanics of arytenoid adduction surgery are not well understood. An excised canine larynx model was used to study the effects of variable suture tension on glottal configuration and on vocal fold tension (at the midfold and the vocal process). Arytenoid adduction both medializes the vocal fold and closes a posterior glottal chink. Vocal fold tension at the midfold did not vary significantly with suture tension. As suture tension increased to approximately 100 g, vocal fold tension at the vocal process also increased. Beyond 100 g of suture tension, vocal fold tension at the vocal process did not increase. We conclude that the effects of suture tension on the resistance to lateral movement are different at the midfold compared to the vocal process. Procedures for surgical rehabilitation of vocal fold paralysis should address the biomechanical subunits of the larynx individually in order to achieve optimum results.     

A comparison of the grade of laryngeal visualisation;--the McCoy compared with the Macintosh and the Miller blade in adults

Effectiveness in visualization of the vocal cord during orotracheal intubation with McCoy (McC) compared with Macintosh (Min) and Miller (Mil) blades were investigated. After an institutional review board approval, 117 patients for elective surgery under general anesthesia requiring tracheal intubation were investigated. Five board certified anesthesiologists tried to visualize the vocal cord of a patient three times with the three different types of laryngoscope. Total of 351 intubation attempts were studied. The view obtained at laryngoscopy with each of the three blades was recorded as follows. Grade 1. If most of the glottis is visible. Grade 2. If only the posterior extremity of the glottis is visible. Grade 3. If no part of the glottis can be seen. Grade 4. If not even the epiglottis can be exposed. Eight-two Grade 1 views were obtained with McC, 72 with Mil and 47 with Min, respectively. Thirty-three Grade 2 views were obtained with McC, 36 with Min and 24 with Mil. Two Grade 3 views with McC, 34 with Min and 14 with Mil were obtained. Seven Grade 4 views were obtained with Mil. The grades of laryngeal visualization with McC were significantly lower than those with Min and Mil.     

Correlation between vocal functions and glottal measurements in patients with unilateral vocal fold paralysis

Observations and analysis of glottal characteristics are critical in choosing the best modality for surgery in patients with unilateral vocal fold paralysis (UVP). This study suggests that multiple glottal characteristics influence the vocal product in patients with UVP. In addition to the horizontal position of the paralyzed vocal fold (deviation from the midline), the glottal area, degree of bowing of the paralyzed and contralateral vocal folds, maximum separation between vocal folds, compensatory glottal maneuvers, and the vertical glottic closure plane significantly influenced the quality of the voice. Clinicians should be aware of these observations to facilitate treatment planning and assessment of the results of surgical procedures used to improve voice quality in cases of UVP.     

Effects of lung volume on the glottal voice source

According to experience in voice therapy and singing pedagogy, breathing habits can be used to modify phonation, although this relationship has never been experimentally demonstrated. In the present investigation we examine if lung volume affects phonation. Twenty-four untrained subjects phonated at different pitches and degrees of vocal loudness at different lung volumes. Mean subglottal pressure was measured and voice source characteristics were analyzed by inverse filtering. The main results were that with decreasing lung volume, the closed quotient increased, while subglottal pressure, peak-to-peak flow amplitude, and glottal leakage tended to decrease. In addition, some estimates of the amount of the glottal adduction force component were examined. Possible explanations of the findings are discussed.     

Acoustic and mechanical properties of tympanic membrane transplants

BACKGROUND: The human tympanic membrane has reasonably good sound transmission properties and withstands high static pressure loads. Destruction of the tympanic membrane resulting from middle ear diseases or trauma may be repaired by different types of grafts. Middle ear surgery mostly uses autologous temporal fascia, cartilage, or cartilage perichondrium transplants which differ in their acoustical characteristics and mechanical strength. METHODS: We have investigated the acoustical and mechanical properties of these materials and compared them with human tympanic membranes by constructing an ear canal-tympanic membrane model. Fresh human tympanic membrane, fascia, perichondrium, and cartilage preparations were exposed to static pressures up to 4 kPa and white noise sound pressure levels of 70 dB. The vibrational amplitudes and displacements due to static pressure were measured by laser Doppler vibrometry. RESULTS: The temporal fascia and perichondrium show similar amplitude frequency responses compared to the tympanic membrane for dynamic excitation. The displacement of these materials at static pressures above 4 kPa indicates a higher compliance than the tympanic membrane. The acoustical and mechanical properties of cartilage transplants are determined by the thickness of the slices. Thin cartilage slices are less stable although their frequency response is comparable to the intact tympanic membrane. Layer thickness above 500 microns result in a decrease of vibration amplitudes. CONCLUSIONS: Cartilage is an excellent transplant material which provides a better prognosis than soft materials in cases of ventilation disorders with long-term middle ear pressure problems. Large cartilage slice transplants should not exceed layer thickness of 500 microns in order to minimize transmission loss.     

Aerodynamic and acoustic characteristics of the adult African American voice

Laryngeal aerodynamic and acoustic characteristics of African American voice production were examined from vowel samples produced by ten adult female and ten adult male speakers. The data were compared with that for a control group consisting of ten adult female and ten adult male White speakers, matched for age, height, and weight. All measures were analyzed using Cspeech 4.0. Aerodynamic measurements, extracted from a glottal airflow waveform, included maximum flow declination rate, alternating glottal airflow, minimum glottal airflow, and airflow open quotient. Acoustic measures included fundamental frequency and sound pressure level. No significant mean differences between the African American and White speakers were found, except for maximum-flow declination rate. The White speakers produced significantly higher declination rates than the African American speakers. The factor of sex for the African American speakers was statistically significant for the measures of maximum-flow declination rate, alternating glottal airflow, open quotient, and fundamental frequency, consistent with the functioning of the White speakers. The results suggest that during vowel production, where the vocal tract is in a fairly static position, acoustic and aerodynamic characteristics for African American and White Speakers are comparable.     

Comments on the myoelastic - aerodynamic theory of phonation

The myoelastic-aerodynamic theory of phonation has been quantified and tested with mathematical models. The models suggest that vocal fold oscillation is produced as a result of asymmetric forcing functions over closing and opening portions of the glottal cycle. For nearly uniform tissue displacements, as in falsetto voice, the asymmetry in the driving forces can result from the inertia of the air moving through the glottis. This inertia can in turn be enhanced or suppressed by supraglottal or subglottal vocal tract coupling. More obvious and pronounced asymmetries in the driving forces are associated with non-uniform vocal fold tissue displacements. These are combinations of normal tissue modes, and can result in vertical and horizontal phase differences along the surfaces, as observed in chest voice. The ranges of oscillation increase among various models as more freedom in the simulated tissue movement is incorporated. Of particular significance in initiating and maintaining oscillation are the vertical motions that facilitate coupling of aerodynamic energy into the tissues and allow tissue deformations under conditions of incompressibility. Vertical displacements also can have a significant on vocal tract excitation. Control of fundamental frequency of oscillation (FO) is basically myoelastic, partially as a result of deliberate or reflex adjustments of laryngeal muscles, and partially as a result of nonlinear tissue strain over the vibrational cycle. This places limits on the control of FO by subglottal pressure, and forces such control to be inseparably connected with vibrational amplitude, or less directly, with vocal intensity.     

Analysis of pathological vocal fold vibrations using high-speed digital imaging

There have been various methods devised to monitor vocal fold vibration. Stroboscopy provides clinically-celevant information concerning pathology of the vocal folds. However, slow motion observation is based on the regularity of the vibration, and this ignores the role of irregularity of the vocal fold vibration in pathological cases. In order to know more about the nature of the vocal fold vibratory pattern, it is essential to monitor the vibration on a cycle by cycle basis. We analysed vocal fold vibrations of 22 pathological larynges using a computer-assisted high-speed digital imaging technique. Observed items included symmetry, regularity, phase difference, glottal closure, amplitude, mucosal wave and periodicity difference. Vibratory patterns were classified by location of lesion, severity of disease, expiratory pressure and laryngeal modulation. Analyses of pathological vocal fold vibrations using high-speed digital imaging techniques are providing the theoretical support for voice therapy and elucidating the causes of hoarseness.     

Medialization laryngoplasty

Medialization laryngoplasty was performed in 25 patients between 1993 and 1997. The underlying pathology resulting in glottal incompetence was vocal cord paralysis in 22 patients and vocal cord bowing in 3 patients. Two types of implants were used: self-carved Proplast in 19 patients and prefabricated hydroxyapatite prostheses in 6 patients. Preoperative and postoperative results were compared in terms of dysphagia, vocal quality as graded by three experienced voice specialists, and computer measurements of the glottal gap. All patients showed improvement both subjectively and on the objective measurements used. Swallowing returned to normal in all patients who had isolated recurrent laryngeal nerve paralysis. The voice improved in all patients but was rarely judged as entirely normal.     

A nonlinear operator-based speech feature analysis method with application to vocal fold pathology assessment

Traditional speech processing methods for laryngeal pathology assessment assume linear speech production with measures derived from an estimated glottal flow waveform. They normally require the speaker to achieve complete glottal closure, which for many vocal fold pathologies cannot be accomplished. To address this issue, a nonlinear signal processing approach is proposed which does not require direct glottal flow waveform estimation. This technique is motivated by earlier studies of airflow characterization for human speech production. The proposed nonlinear approach employs a differential Teager energy operator and the energy separation algorithm to obtain formant AM and FM modulations from filtered speech recordings. A new speech measure is proposed based on parameterization of the autocorrelation envelope of the AM response. This approach is shown to achieve impressive detection performance for a set of muscular tension dysphonias. Unlike flow characterization using numerical solutions of Navier-Stokes equations, this method is extremely computationally attractive, requiring only a small time window of speech samples. The new noninvasive method shows that a fast, effective digital speech processing technique can be developed for vocal fold pathology assessment without the need for direct glottal flow estimation or complete glottal closure by the speaker. The proposed method also confirms that alternative nonlinear methods can begin to address the limitations of previous linear approaches for speech pathology assessment.     

Study of MgO-Based Desulfurizer in Hot Metal Desulfurization

This paper has investigated a new desulfurizer for iron and steel industry to make up the lackness of magnesium-based desulfurizer. In order to explore the desulfurization process of hot metal by the new desulfurizer, both the thermodynamics and experiments have been studied.. The results of thermodynamics indicated that, under the standard condition,the lowest reaction temperatures of MgO + C and MgO +Si were 1846℃ and 2132℃ and the pressure of Mg vapor at the hot metal temperature were 0.2-0.5kPa and 0.005-0.01kPa, respectively. In the case of reaction between MgO and Al, the calculated starting reaction temperature under standard condition was 1475 ℃, and the pressure of Mg vapor was distributed from 27 kPa to 45kPa at the hot metal temperature, showing that it was easy to happen the reaction of MgO+Al. The experimental results displayed that the desulfurization efficiency was only 42.31% by the desulfurizer of MgO and C, while the effect of MgO+ Al and MgO+ Al-Si was good, since the desulfurization efficiencies were above 85%, and the lowest sulfur content was below 40×10-6.     

Critical review of phonosurgical methods in the treatment of sulcus vocalis

INTRODUCTION: Sulcus vocalis is an epithelial invagination along the free edge of the membranous vocal fold. It interferes with the glottic closure and vibration pattern. Sulcus vocalis provokes voice fatigue, hoarseness and breathiness, and it usually appears in association with hyperkinetic phonatory pattern. Hyperkinesis develops secondarily, due to the compensatory effort to overcome the deficiency in glottic closure. The treatment of sulcus vocalis is very difficult. Phonosurgery is used, and is followed by postoperative voice therapy. PHONOSURGICAL OPERATIONS: Various surgical techniques are used in the therapy of sulcus vocalis. Over a 10-year period we have operated on 1550 patients with benign lesion of the vocal folds, of whom only 11 had sulcus vocalis (0.7%). We carried out various surgical techniques. a) Excision of sulcus A longitudinal incision of mucosa is performed along the upper surface of the vocal fold, distant of the free edge. Mucosa is undermined caudally, and sulcus is detached from its base. Sulcus is then removed by surgical scissors. With this technique we could not provide physiological phonation and vibration pattern, in spite of an apparent improvement in the voice. b) "Slicing mucosa" technique This procedure was suggested by Pontes, and it also begins with a longitudinal incision followed by creation of inferiorly based slices of mucosa. c) Excision plus rhyroplasty Excision of sulcus is combined with thyroplasty type I in order to achieve medialization of the vocal fold. It can be used in cases with severe glottal gap in order to improve the results of excision. d) Implants Various materials were used in order to enlarge the mass of the vocal fold. In our patients, the results of this procedure were inferior as related to excision surgery. DISCUSSION: The surgical procedure which is safe and accepted by the majority of surgeons has not yet been at our disposal. The treatment of sulcus vocalis should start with voice therapy, which lasts as long as the patient shows a progress. Only then the surgical procedure can be discussed. We obtained the best results with the combination of excision and voice therapy. However, the surgeon and the patient must be aware that the treatment is demanding and long-lasting.