Contribution of Glottic Insufficiency to Perceived Breathiness in Classically Trained Singers

2016 ◽  
Vol 31 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Ellen Graham ◽  
Vrushali Angadi ◽  
Joanna Sloggy ◽  
Joseph Stemple
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Airflow Rate ◽  
Singing Voice ◽  
Glottic Insufficiency ◽  
Maximum Phonation Time ◽  
Breath Management ◽  
Subglottal Pressure ◽  
Glottal Insufficiency ◽  
Voice Students

Breathiness in the singing voice is problematic for classical singers. Voice students and singing teachers typically attribute breathiness to breath management issues and breathing technique. The present study sought to determine whether glottic insufficiency may also contribute to breathiness in a singer’s voice. Studies have revealed a relationship between insufficient vocal fold closure and inefficiency in the speaking voice. However, the effect of insufficient vocal fold closure on vocal efficiency in singers has yet to be determined. Two groups of voice students identified with and without breathiness issues underwent aerodynamic and acoustic voice assessment as well as laryngeal stroboscopy of the vocal folds to quantify the prevalence of insufficient vocal fold closure, also known as glottic insufficiency. These assessments revealed four groups: 1) those with glottic insufficiency and no perceived voice breathiness; 2) those with glottic sufficiency and perceived voice breathiness; 3) those with glottic insufficiency and perceived breathiness; and 4) those with glottic sufficiency and no perceived breathiness. Results suggest that previously undiscovered glottal insufficiency is common in young singers, particularly women, though the correlation with identified breathiness was not statistically significant. Acoustic and aerodynamic measures including noise-to-harmonics ratio, maximum phonation time, airflow rate, subglottal pressure, and laryngeal airway resistance were most sensitive to glottic insufficiency.

Laryngeal Electromyography-Guided Hyaluronic Acid Vocal Fold Injections for Glottic Insufficiency

2020 ◽  
Vol 129 (11) ◽  
pp. 1063-1070
Author(s):  
Alice Q. Liu ◽  
Joel Singer ◽  
Terry Lee ◽  
Amanda Hu
Keyword(s):  
Hyaluronic Acid ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
The Novel ◽  
Completion Rates ◽  
Laryngeal Electromyography ◽  
Glottic Insufficiency ◽  
Maximum Phonation Time ◽  
Novel Technique ◽  
Glottal Insufficiency

Objectives: To assess voice outcomes using the novel technique of in-office laryngeal electromyography-guided vocal fold injections (LEVFI) with hyaluronic acid to treat glottal insufficiency. Secondary objectives included determining the complication/completion rates and if any factors were associated with improved voice outcomes. Methods: Retrospective review of patients who received their first LEVFI from August 2017 to December 2018. Three- and six-month voice outcomes were assessed. Outcomes included voice handicap index-10 (VHI-10), maximum phonation time (MPT), perceptual analysis of voice (GRBAS), fundamental frequency, and stroboscopy. Results: Of the 121 eligible patients (55.4% male, age 63.7 years), 94 (77.7%) had complete 3-month data and 59 (48.8%) had complete 6-month data. VHI-10 was significantly improved from 25.7 ± 7.5 to 20.9 ± 10.9 at 3 months ( P < .001) and to 19.1 ± 11.5 at 6 months ( P < .001). MPT improved from 6.2 ± 5.4 seconds to 9.4 ± 7.1 seconds at 3 months ( P < .001) and to 11.3 ± 8.2 seconds at 6 months ( P < .001). GRBAS was improved in 74.8% of patients ([65.2, 82.8] 95% CI) at 3 months and 80.8% ([69.9, 89.1]) 95% CI) at 6 months. Stroboscopy showed a glottic gap improvement in 74.8% of patients ([65.8, 82.4] 95% CI) at 3 months and in 80.3% ([65.9, 88.5] 95% CI) at 6 months. Fundamental frequency was unchanged, as expected. Multivariate analysis reported that no factors were associated with better voice outcomes. Overall, 177/181 (97.8%) injections were completed. There were no complications. Conclusion: In-office LEVFI is an effective, novel technique to treat glottic insufficiency with improved voice outcomes, high completion rate, and no significant complications.

Reinke's Edema: Phonatory Mechanisms and Management Strategies

1997 ◽  
Vol 106 (7) ◽  
pp. 533-543 ◽  
Author(s):  
Steven M. Zeitels ◽  
Glenn W. Bunting ◽  
Robert E. Hillman ◽  
Traci Vaughn
Keyword(s):  
Lamina Propria ◽  
Fundamental Frequency ◽  
Vocal Fold ◽  
Management Strategies ◽  
Vocal Folds ◽  
Vocal Fold Vibration ◽  
Reinke’S Edema ◽  
Subglottal Pressure ◽  
Almost All ◽  
Superficial Lamina

Reinke's edema (RE) has been associated typically with smoking and sometimes with vocal abuse, but aspects of the pathophysiology of RE remain unclear. To gain new insights into phonatory mechanisms associated with RE pathophysiology, weused an integrated battery of objective vocal function tests to analyze 20 patients (19 women) who underwent phonomicrosurgical resection. Preoperative stroboscopic examinations demonstrated that the superficial lamina propria is distended primarily on the superior vocal fold surface. Acoustically, these individuals have an abnormally low average speaking fundamental frequency (123 Hz), and they generate abnormally high average subglottal pressures (9.7 cm H20). The presence of elevated aerodynamic driving pressures reflects difficulties in producing vocal fold vibration that are most likely the result of mass loading associated with RE, and possibly vocal hyperfunction. Furthermore, it is hypothesized that in the environment of chronic glottal mucositis secondary to smoking and reflux, the cephalad force on the vocal folds by the subglottal driving pressure contributes to the superior distention of the superficial lamina propria. Surgical reduction of the volume of the superficial lamina propria resulted in a significant elevation in fundamental frequency (154 Hz) and improvement in perturbation measures. In almost all instances, both the clinician and the patient perceived the voice as improved. However, these patients continued to generate elevated subglottal pressure (probably a sign of persistent hyperfunction) that was accompanied by visually observed supraglottal strain despite the normalsized vocal folds. This finding suggests that persistent hyperfunctional vocal behaviors may contribute to postsurgical RE recurrence if therapeutic strategies are not instituted to modify such behavior.

Nonlinear Vocal Fold Dynamics in a Two-Mass Model of Speech Arising From Asymmetric Intraglottal Flow

2011 ◽  
Author(s):  
Byron D. Erath ◽  
Matías Zañartu ◽  
Sean D. Peterson ◽  
Michael W. Plesniak
Keyword(s):  
Vocal Fold ◽  
Vocal Tract ◽  
Vocal Folds ◽  
Attractive Alternative ◽  
Nonlinear Phenomena ◽  
Mass Model ◽  
Sustained Oscillations ◽  
Voiced Speech ◽  
Subglottal Pressure ◽  
Vocal Fold Dynamics

Voiced speech is initiated as air is expelled from the lungs and passes through the vocal tract inciting self-sustained oscillations of the vocal folds. While various approaches exist for investigating both normal and pathological speech, the relative inaccessibility of the vocal folds make multi-mass speech models an attractive alternative. Their behavior has been benchmarked with excised larynx experiments, and they have been used as analysis tools for both normal and disordered speech, including investigations of paralysis, vocal tremor, and breathiness. However, during pathological speech, vocal fold motion is often unstructured, resulting in chaotic motion and a wealth of nonlinear phenomena. Unfortunately, current methodologies for multi-mass speech models are unable to replicate the nonlinear vocal fold behavior that often occurs in physiological diseased voice for realistic values of subglottal pressure.

scholarly journals Bayesian Inference of Vocal Fold Material Properties from Glottal Area Waveforms Using a 2D Finite Element Model

2019 ◽  
Vol 9 (13) ◽  
pp. 2735 ◽  
Author(s):  
Paul J. Hadwin ◽  
Mohsen Motie-Shirazi ◽  
Byron D. Erath ◽  
Sean D. Peterson
Keyword(s):  
Finite Element ◽  
Finite Element Model ◽  
Bayesian Estimation ◽  
Material Properties ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Element Model ◽  
Lumped Element ◽  
Subglottal Pressure ◽  
Contact Pressures

Bayesian estimation has been previously demonstrated as a viable method for developing subject-specific vocal fold models from observations of the glottal area waveform. These prior efforts, however, have been restricted to lumped-element fitting models and synthetic observation data. The indirect relationship between the lumped-element parameters and physical tissue properties renders extracting the latter from the former difficult. Herein we propose a finite element fitting model, which treats the vocal folds as a viscoelastic deformable body comprised of three layers. Using the glottal area waveforms generated by self-oscillating silicone vocal folds we directly estimate the elastic moduli, density, and other material properties of the silicone folds using a Bayesian importance sampling approach. Estimated material properties agree with the “ground truth” experimental values to within 3 % for most parameters. By considering cases with varying subglottal pressure and medial compression we demonstrate that the finite element model coupled with Bayesian estimation is sufficiently sensitive to distinguish between experimental configurations. Additional information not available experimentally, namely, contact pressures, are extracted from the developed finite element models. The contact pressures are found to increase with medial compression and subglottal pressure, in agreement with expectation.

S192 – 3D Diagnosis of Vocalizing Larynx Using Cone Beam CT

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P140-P140
Author(s):  
Koji Inagaki ◽  
Koichiro Saito ◽  
Hideki Naganishi ◽  
Takaoka Takuj ◽  
Momoshima Suketaka ◽  
...  
Keyword(s):  
Vocal Fold ◽  
3D Visualization ◽  
Cone Beam Ct ◽  
Vocal Folds ◽  
Cone Beam ◽  
3 Dimensional ◽  
Scanning Time ◽  
Informative Role ◽  
Glottal Insufficiency ◽  
The Impact

Objectives Cone beam computed tomography (CBCT) was developed for the office-based quick and precise 3D visualization of maxillofacial region. CBCT requires scanning time of less than 10 seconds and provides isotropic 3D image with high resolution. In this study, we examined the potential role of CBCT as a tool for 3-dimensional evaluation of the glottal insufficiency. Methods CBCT was performed in 2 normal controls and in 14 patients with unilateral vocal fold paralysis (13 cases) or paresis (1 case). Laryngeal CBCT images were taken in the resting state and during phonation. Furthermore, preoperative and postoperative images were evaluated to assess the impact of phonosurgeries in 5 cases. Results CBCT of the vocalizing vocal fold was successfully performed in all the cases, producing clear coronal images. During phonation, no remarkable differences in levels between the paralyzed and normal vocal folds were observed in 10 cases, proving the 2-dimensional glottal gap (2D cases). On the other hand, the levels of paralyzed vocal folds stayed higher during phonation compared to the normal side in 4 cases, proving the 3-dimensional glottal gap (3D cases). 4 of the 2D cases had injection laryngoplasty and 1 of the 3D cases had arytenoid adduction procedure to correct their glottal gaps. Postoperative CBCT images verified the successful correction of these gaps. Conclusions Our study proved the feasibility of CBCT for 3D evaluation of vocalizing larynx. This quick and easy system may have an informative role to suggest the proper phonosurgical procedure for glottic insufficiency.

Role of Injectable Collagen in the Treatment of Glottic Insufficiency: A Study of 119 Patients

1992 ◽  
Vol 101 (3) ◽  
pp. 237-247 ◽  
Author(s):  
Charles N. Ford ◽  
Diane M. Bless ◽  
Jean M. Loftus
Keyword(s):  
Vocal Fold ◽  
Acoustic Analysis ◽  
Objective Assessment ◽  
Vocal Folds ◽  
Science Center ◽  
Glottic Insufficiency ◽  
Study Objective ◽  
Bovine Collagen ◽  
Injectable Collagen ◽  
Self Assessments

Injectable bovine collagen has been used for treatment of glottic insufficiency at the University of Wisconsin Clinical Science Center since 1983. This report reviews our experience in treating 119 patients with a variety of vocal fold disorders manifested by glottic insufficiency. Many of the patients were referred because of prior treatment failures or problems that were impossible to treat with other modalities. Results were assessed by comprehensive voice evaluations using subjective patient self-assessments, perceptual judgments made by a panel of experts who had no prior knowledge of the study, objective assessments, and videostroboscopy. Objective assessment included vocal function measures and acoustic analysis. Results indicate that collagen not only is comparable to other injection filler substances but also has unique advantages as a bioimplant. Collagen injection seems uniquely suited for treatment of several problems, including vocal fold atrophy, focal defects, minimal glottic insufficiency, and scarred vocal folds that are not managed optimally with Teflon injection. Overall there were no serious complications and treatment was effective for a broad spectrum of problems. In most instances the correction persisted, and in those instances in which injected collagen seemed improperly distributed, the vocal fold was recontoured or the implant removed without appreciable damage to the surrounding tissues. Injectable collagen has been extensively studied and deserves to be included in the armamentarium of the laryngeal surgeon.

scholarly journals Methods of sparing surgical treatment of chronic edematous-polypous laryngitis, edema Reinke

2021 ◽  
pp. 184-191
Author(s):  
B. Z. Abdullaev ◽  
I. I. Nazhmudinov ◽  
Kh. Sh. Davudov ◽  
T. I. Garashchenko ◽  
I. Kh. Guseynov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Mucous Membrane ◽  
Vocal Fold ◽  
Carbon Dioxide Laser ◽  
General Structure ◽  
Vocal Folds ◽  
Endoscopic Examination ◽  
Upper Respiratory Tract ◽  
Maximum Phonation Time ◽  
The Voice

Introduction. Laryngeal pathology occupies a leading place in the general structure of diseases of the upper respiratory tract, chronic edematous-polypous laryngitis, Reinke-Gayek edema accounts for 5.5% of all benign diseases of the vocal folds. The main method of treating Reinke-Gayek's disease is surgical treatment, which consists in removing excess mucosa, or “stripping” - tearing a strip of mucosa with forceps from the vocal fold. One of the main principles of laryngeal surgery is the maximum preservation of the structures of the vocal fold, obtaining a flexible vibration of the muscular-membranous part and the mucous membrane of the vocal fold.Purpose. The purpose of our work is to improve the effectiveness of treatment of chronic edematous-polypous laryngitis using a CO2 laser.Tasks. To develop a differentiated approach to the surgical treatment of chronic edematous-polypous laryngitis using a carbon dioxide laser.Materials and Methods. We treated 46 patients with Reinke-Gayek disease, including 35 women and 11 men. The age of the patients ranged from 40 to 67 years. Preoperative examination included endoscopic examination, laryngostroboscopy. The type was determined according to the classification of H. Yonekawa, for the choice of further surgical tactics. In type II, an incision of the mucosa, aspiration of gelatinous matter from the Reinke space, and laying of the mucosa were performed. With type III, it is made by forming M-shaped flap to close the defect.Results. All patients in the preoperative period were surveyed with the VOICE HANDICAP INDEX(VHI-30) questionnaire, laryn-gostroboscopy, and maximum phonation time. In the postoperative period, the examination was performed twice, 1 month after the operation and 3 months after the operation. There is a significant increase in indicators, an increase in the maximum phonation time, a decrease in VHI-30 points.Conclusion. The use of this technique allowed to significantly accelerate the recovery of the voice, reduce the time spent in the hospital, minimally damaging the structure of the mucous membrane of the vocal folds.

Frequency and Intensity Effects upon Temporal and Aerodynamic Aspects of Vocal Fold Diadochokinesis

1991 ◽  
Vol 73 (3) ◽  
pp. 880-882 ◽  
Author(s):  
Herbert A. Leeper ◽  
Elizabeth Jones
Keyword(s):  
Young Adult ◽  
Repetition Rate ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Clinical Applications ◽  
Airflow Rate ◽  
Adult Women ◽  
Young Adult Women

The present study of vocal fold diadochokinesis in 18 young adult women yielded statistically significant differences in intensity (at percentiles 25%, 50%, 75% of range) of production for vowel /⁁/ repetition rate. In addition, there were statistically significant differences for vocal frequency and intensity effects for airflow rate through the vocal folds at the 25th, 50th, and 75th percentile points within the functional vocal range. Clinical applications of the data axe suggested.

Effect of Superior Laryngeal Nerve on Vocal Fold Function: An in Vivo Canine Model

1991 ◽  
Vol 105 (6) ◽  
pp. 857-863 ◽  
Author(s):  
David H. Slavit ◽  
Thomas V. Mccaffrey ◽  
Eriko Yanagi
Keyword(s):  
Vocal Fold ◽  
Superior Laryngeal Nerve ◽  
Vocal Folds ◽  
Canine Model ◽  
Electrical Signal ◽  
Laryngeal Nerve ◽  
Airflow Rate ◽  
Cricothyroid Muscle

Assessment of laryngeal framework surgery requires an awareness of the effect of vocal fold mass, stiffness, and position on voice production. The vibratory pattern of the vocal folds during phonation depends on the subglottic pressure as well as the mass and stiffness of the folds. To assess the effect of variations in vocal fold tension with contraction of the cricothyroid muscle on phonation, eight mongrel dog larynges were studied in vivo. Photoglottography, electroglottography, and subglottic pressure were simultaneously recorded as airflow rate and superior laryngeal nerve (SLN) stimulation were varied. Stimulation of the SLN was modified by varying the frequency and voltage of the stimulating electrical signal. Multiple regression analysis of the data revealed a direct relationship between the voltage of SLN stimulation and frequency of vibration (P < 0.001) at constant subglottic pressure. Increases in the stimulating voltage to the SLN also led to an increase in open quotient (p < 0.001), but no statistically significant change in speed quotient, subglottic pressure, or sound intensity. Changing the frequency of SLN stimulation had only a modest effect on the frequency of vibration. These results are consistent with the reported findings of an increase in frequency and open quotient with increased tension in an in vitro canine model. The glottographic measurement open quotient appears to be an estimator of cricothyroid contraction and longitudinal vocal fold tension, and may be clinically applicable to the assessment of superior laryngeal nerve injuries and laryngeal framework procedures.

scholarly journals Outcomes versus complications in patients undergoing different modalities of injection laryngoplasty

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Mohamed E. Darweesh ◽  
Aml F. Y. El-Gazzar ◽  
Shaimaa M. Sarag ◽  
Ayat-Allah Raouf Sheikhany
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Vocal Fold ◽  
Voice Quality ◽  
Vocal Folds ◽  
Complication Rates ◽  
Injection Laryngoplasty ◽  
Vocal Fold Injection ◽  
Glottal Insufficiency ◽  
Sulcus Vocalis

Abstract Background Glottal insufficiency results in glottal gap between the two vocal folds, which in turn might cause dysphonia, dysphagia, and breathing problems. Vocal fold injection is considered a safe, reliable, and highly effective method of treatment. The purpose of the present study was to assess voice outcomes and complication rates in patients with glottal insufficiency undergoing injection laryngoplasty (IL) under local versus general anesthesia before, 1 week then 1 month after IL. Results Examined patients were 13 males and 12 females, suffering from dysphonia due to glottal insufficiency with mean age 43.68 ± SD 14.55. Unilateral vocal fold paralysis (UVFP) was diagnosed in seventeen cases, vocal fold scarring in six cases, presbylarynx in one case, and sulcus vocalis in one case. IL was performed in 18 cases under local anesthesia, and 7 under general anesthesia. Hyaluronic acid was injection material in 23 cases and calcium hydroxylapatite in two cases. IL by either local or general anesthesia has improved the patients’ auditory perceptual analysis of voice quality as assessed by “GRBAS” scale and Voice Handicap Index (VHI). There were four (16% of all injections) minor and self-limited complications (12% under local and 4% under general anesthesia). Conclusion Injection laryngoplasty performed under local and general anesthesia offers similar voice outcomes, but with slightly higher self-limited complications in IL under local anesthesia.

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