Videostrobolaryngoscopy of Mucus Layer during Vocal Fold Vibration in Patients with Laryngeal Tension-Fatigue Syndrome

The mucus layer on the vocal folds was examined by videostrobolaryngoscopy in patients with laryngeal tension-fatigue syndrome, a chronic functional dysphonia due to vocal abuse and misuse. Besides the findings in previous reports (such as abnormal glottal closure, phase or amplitude asymmetry, and the irregular mucosal wave), the vocal folds during vibration had an uneven mucus surface. The occurrence of an uneven mucus layer on vocal folds was significantly greater in subjects with this voice disorder (83% or 250 of 301 patients in this series) than in those without voice disorders (18.5% or 5 of 27). The increase of mucus viscosity, mucus aggregation, and the formation of rough surfaces on the vocal folds alter the mechanical properties that contribute to vibration of the cover of the vocal folds, and thereby worsen the symptoms of dysphonia in patients with laryngeal tension-fatigue syndrome.

Download Full-text

Reinke's Edema: Phonatory Mechanisms and Management Strategies

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949710600701 ◽

1997 ◽

Vol 106 (7) ◽

pp. 533-543 ◽

Cited By ~ 68

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.

Download Full-text

Effects of Voice Therapy as Objectively Evaluated by Digitized Laryngeal Stroboscopic Imaging

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940211101007 ◽

2002 ◽

Vol 111 (10) ◽

pp. 902-908 ◽

Cited By ~ 22

Author(s):

Renée Speyer ◽

Pieter A. Kempen ◽

George Wieneke ◽

Willem Kersing ◽

Elham Ghazi Hosseini ◽

...

Keyword(s):

Vocal Fold ◽

Vocal Folds ◽

Lesion Size ◽

Voice Therapy ◽

Benign Lesions ◽

Objective Measurements ◽

Significant Parameter ◽

Surface Areas ◽

Vocal Fold Vibration ◽

Maximal Opening

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.

Download Full-text

Presbylarynx, Functional Voice Disorders, Muscle Tension Dysphonia

10.2310/ot.7065 ◽

2021 ◽

Author(s):

Elizabeth Erickson-DiRenzo ◽

Christine M. Kim ◽

C. Kwang Sung Sung

Keyword(s):

Muscle Tension ◽

Voice Disorders ◽

Neuromuscular Control ◽

Vocal Folds ◽

Voice Therapy ◽

Type I ◽

Muscle Tension Dysphonia ◽

Functional Dysphonia ◽

Age Related ◽

Type I Thyroplasty

Presbylarynx refers to age-related structural changes of the vocal folds that include muscle atrophy, reduced neuromuscular control, loss of superficial lamina propria layer, and reduced pliability. The changes result in thin and bowed vocal folds, increased vocal effort requirements, breathy voice, change in habitual pitch, and strain. The primary treatment options are voice therapy focused on strengthening breath support and the intrinsic muscles of the larynx, and optimization of resonance; injection augmentation of the vocal folds; and type I thyroplasty. Functional dysphonia is defined as change in voice quality in the absence of structural or neurological abnormalities of the larynx. Muscle tension dysphonia (MTD) is a subtype of functional voice disorders and involves laryngeal muscle tension imbalance due to excessive or dysregulated activation resulting often in strained or breathy voice. MTD can be divided into primary (psychological etiology or vocal misuse) and secondary (compensatory for organic laryngeal pathology). The mainstay of treatment for MTD is voice therapy, along with medical or surgical treatment of the underlying vocal pathology in secondary MTD. Mutational falsetto, or puberphonia, is a functional voice disorder where a high-pitched, pre-adolescent voice fails to transition to the lower pitch of adulthood. This review contains 5 figures, 7 tables, 4 videos and 10 references Key Words: Presbylarynx, Injection augmentation, Type I thyroplasty, Primary muscle tension dysphonia, Secondary muscle tension dysphonia, Muscle tension patterns, Manual circumlaryngeal therapy, Functional dysphonia, Mutational falsetto

Download Full-text

Liquid-type non-thermal atmospheric plasma ameliorates vocal fold scarring by modulating vocal fold fibroblast

Experimental Biology and Medicine ◽

10.1177/1535370219850084 ◽

2019 ◽

Vol 244 (10) ◽

pp. 824-833 ◽

Cited By ~ 1

Author(s):

Ho-Ryun Won ◽

Eun Hye Song ◽

Jong Eun Won ◽

Hye Young Lee ◽

Sung Un Kang ◽

...

Keyword(s):

Vocal Fold ◽

Therapeutic Agent ◽

Transforming Growth Factor ◽

Therapeutic Option ◽

Vocal Folds ◽

Atmospheric Plasma ◽

Matrix Metalloproteinase 2 ◽

Functional Improvement ◽

Voice Disorder ◽

Liquid Type

Injection laryngoplasty is a widely used therapeutic option for drug delivery into vocal folds (VFs). Efficient injectable materials are urgently needed for treating intractable VF disease. Liquid-type non-thermal atmospheric plasma (LTP) has been found to be useful for various biological applications, including in regenerative medicine. We evaluated the effects of LTP on VF regeneration. Migration and matrix metalloproteinase-2 expression of lipopolysaccharide (LPS)-treated human vocal fold-derived mesenchymal stem cells (VF-MSCs) were enhanced by LTP treatment. LTP treatment not only ameliorated nuclear factor-κB and interleukin-6 activation, induced by LPS treatment, but also the increased manifestation of α-smooth muscle actin and fibronectin, induced by transforming growth factor-ß. In a rabbit VF scarring animal model, histological analyses showed increased hyaluronic acid deposition and decreased collagen accumulation after LTP injection. Videokymographic analysis showed more improved vibrations in LTP-treated VF mucosa compared to those in non-treated group. In conclusion, LTP treatment enhanced the recruitment and activation of VF-MSCs. Regulated extracellular matrix (ECM) synthesis and eventual functional improvement of scarred VFs were observed upon LTP treatment. The results of this study suggest that LTP injection can enhance wound healing and improve functional remodeling following VF injury. Impact statement Voice disorder has a significant impact on life quality, and one of the major causes of this voice disorder is vocal fold scarring. Therefore, various approaches have been tried to treat for voice disorder. However, no method has satisfied all requirements until now. Plasma medicine, which involves the medical application of plasma, is a rapidly developing field. We have confirmed that liquid-type plasma improved vocal fold scarring by mobilizing and activating vocal fold fibroblast. In conclusion, liquid-type plasma is a potential therapeutic agent for promoting vocal fold scarring through simple injection and it may be an alternative therapeutic agent for the current situation to treat voice disorder.

Download Full-text

Personality and Voice Disorders

Journal of Speech Language and Hearing Research ◽

10.1044/jslhr.4303.749 ◽

2000 ◽

Vol 43 (3) ◽

pp. 749-768 ◽

Cited By ~ 64

Author(s):

Nelson Roy ◽

Diane M. Bless ◽

Dennis Heisey

Keyword(s):

Vocal Fold ◽

Voice Disorders ◽

Personality Factors ◽

Control Group ◽

Personality Variables ◽

Personality Differences ◽

Functional Dysphonia ◽

Vocal Nodules ◽

Personality Features ◽

And Control

To determine whether personality factors play causal, concomitant, or consequential roles in common voice disorders, a vocally normal control group and four groups with voice disorders—functional dysphonia (FD), vocal nodules (VN), spasmodic dysphonia (SD), and unilateral vocal fold paralysis (UVFP)—were compared on measures of personality and psychological adjustment. Superfactor group comparisons revealed that the majority of FD and VN subjects were classified as introverts and extraverts, respectively. Comparisons involving the SD, UVFP, and control subjects did not identify consistent personality differences. The disability hypothesis, which suggests that personality features and emotional maladjustment are solely a negative consequence of vocal disability, was not supported. Personality variables and their behavioral consequences may therefore contribute to FD and VN. Results are presented within the context of a dispositional theory offered by Roy and Bless (2000a).

Download Full-text

Low-Cost High-Speed Imaging System for Observing Vocal Fold Vibration in Voice Disorders

ORL ◽

10.1159/000341095 ◽

2012 ◽

Vol 74 (4) ◽

pp. 208-210 ◽

Cited By ~ 1

Author(s):

Kenichi Kaneko ◽

Koichi Sakaguchi ◽

Masato Inoue ◽

Haruo Takahashi

Keyword(s):

Vocal Fold ◽

High Speed ◽

Imaging System ◽

Low Cost ◽

Voice Disorders ◽

High Speed Imaging ◽

Vocal Fold Vibration

Download Full-text

Finite Element Modeling of Vocal Fold Vibration in Normal Phonation and Hyperfunctional Dysphonia: Implications for the Pathogenesis of Vocal Nodules

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700711 ◽

1998 ◽

Vol 107 (7) ◽

pp. 603-610 ◽

Cited By ~ 60

Author(s):

Jack J. Jiang ◽

Carlos E. Diaz ◽

David G. Hanson

Keyword(s):

Finite Element ◽

Finite Element Modeling ◽

Mechanical Stress ◽

Vocal Fold ◽

Vocal Folds ◽

Element Modeling ◽

Modeling Technology ◽

Vocal Fold Vibration ◽

Vocal Nodules ◽

High Mechanical Stress

A computer model of the vocal fold was developed using finite element modeling technology for studying mechanical stress distribution over vibrating vocal fold tissue. In a simulated normal phonation mode, mechanical stress was found to be lowest at the midpoint of the vocal fold and highest at tendon attachments. However, when other modes predominated, high mechanical stress could occur at the midpoint of the vocal folds. When a vocal fold mass was modeled, high shearing stress occurred at the base of the modeled vocal fold mass, suggesting that the presence of a vocal nodule or polyp is associated with high mechanical stress at the margins of the mass. This finding supports a hypothesis that mechanical intraepithelial stress plays an important role in the development of vocal nodules, polyps, and other lesions that are usually ascribed to hyperfunctional dysphonia.

Download Full-text

Empirical Eigenfunctions and Medial Surface Dynamics of a Human Vocal Fold

Methods of Information in Medicine ◽

10.1055/s-0038-1633981 ◽

2005 ◽

Vol 44 (03) ◽

pp. 384-391 ◽

Cited By ~ 30

Author(s):

N. Tayama ◽

D. A. Berry ◽

M. Döllinger

Keyword(s):

Vocal Fold ◽

High Speed ◽

Computational Models ◽

Imaging System ◽

Vocal Folds ◽

Sustained Oscillation ◽

Medial Surface ◽

Physical Mechanisms ◽

Vocal Fold Vibration ◽

Modes Of Vibration

Summary Objectives: The purpose of this investigation was to use an excised human larynx to substantiate physical mechanisms of sustained vocal fold oscillation over a variety of phonatory conditions. During sustained, flow-induced oscillation, dynamical data was collected from the medial surface of the vocal fold. The method of Empirical Eigenfunctions was used to analyze the data and to probe physical mechanisms of sustained oscillation. Methods: Thirty microsutures were mounted on the medial margin of a human vocal fold. Across five distinct phonatory conditions, the vocal fold was set into oscillation and imaged with a high-speed digital imaging system. The position coordinates of the sutures were extracted from the images and converted into physical coordinates. Empirical Eigenfunctions were computed from the time-varying physical coordinates, and mechanisms of sustained oscillation were explored. Results: Using the method of Empirical Eigenfunctions, physical mechanisms of sustained vocal fold oscillation were substantiated. In particular, the essential dynamics of vocal fold vibration were captured by two dominant Empirical Eigenfunctions. The largest Eigenfunction primarily captured the alternating convergent/ divergent shape of the medial surface of the vocal fold, while the second largest Eigenfunction primarily captured the lateral vibrations of the vocal fold. Conclusions: The hemi-larynx setup yielded a view of the medial surface of the vocal folds, revealing the tissue vibrations which produced sound. Through the use of Empirical Eigenfunctions, the underlying modes of vibration were computed, disclosing physical mechanisms of sustained vocal fold oscillation. The investigation substantiated previous theoretical analyses and yielded significant data to help evaluate and refine computational models of vocal fold vibration.

Download Full-text