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

2002 ◽  
Vol 111 (10) ◽  
pp. 902-908 ◽  
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.

Accuracy of Measurements on Digital Videostroboscopic Images of the Vocal Folds

2005 ◽  
Vol 114 (6) ◽  
pp. 443-450 ◽  
Author(s):  
Renée Speyer ◽  
George H. Wieneke ◽  
Willem Kersing ◽  
Philippe H. Dejonckere
Keyword(s):  
Vocal Folds ◽  
The Real ◽  
Objective Measurements ◽  
Surface Areas ◽  
Accuracy Of Measurements ◽  
Magnification Ratio ◽  
Maximal Opening ◽  
Error Of Measurement ◽  
Boundary Correction

Objectives: The reliability of objective measurements on digital laryngeal images was investigated. Methods: The magnitude of the error of measurement of surface areas by visually tracing the outline was determined for three different areas: the area of the lesion and, during vibration, the glottal area on maximal opening of the vocal folds and the glottal area on maximal closing of the vocal folds. Results: The errors in these areas were 10% to 30%. The results suggest that the error is mainly due to the uncertainty of the real outline of areas with a vague boundary. Correction for differences in magnification between two images (posttherapy and pretherapy) is of importance in about 25% to 65% of cases, depending on the area measured. Conclusions: Only when the magnification ratio is small (less than about ±10% from 1.0) may a correction not be necessary.

Vibratory Characteristics of Teflon-Injected and Noninjected Paralyzed Vocal Folds

1990 ◽  
Vol 55 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Thomas Watterson ◽  
Stephen C. McFarlane ◽  
Andrea L. Menicucci
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Vocal Fold Paralysis ◽  
Voice Therapy ◽  
Head Turning ◽  
Glottal Closure ◽  
Vocal Fold Vibration ◽  
Digital Manipulation

This study compared the vibratory characteristics of normal vocal folds, Teflon-injected paralyzed vocal folds, and noninjected paralyzed vocal folds. Laryngeal videostroboscopy under eight phonatory conditions showed that the Teflon-injected vocal folds were adynamic. The noninjected vocal folds, however, vibrated during each of the phonatory conditions although not necessarily like a normal vocal fold. In terms of vocal fold physiology, it appeared that the noninjected paralyzed vocal folds were too compliant, whereas the Teflon-injected vocal folds were too stiff. Because vocal fold paralysis is often treated in voice therapy with "digital manipulation" and "head turning," the effect of these techniques on vocal fold vibration was also studied. The results showed that digital manipulation was superior to head turning for improving glottal closure but that neither technique appeared to influence the periodicity, amplitude, or extent of vocal fold vibration for either the injected or noninjected vocal folds.

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.

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

2002 ◽  
Vol 111 (6) ◽  
pp. 537-541 ◽  
Author(s):  
Tzu-Yu Hsiao ◽  
Chia-Ming Liu ◽  
Kai-Nan Lin
Keyword(s):  
Mechanical Properties ◽  
Vocal Fold ◽  
Rough Surfaces ◽  
Voice Disorders ◽  
Vocal Folds ◽  
Voice Disorder ◽  
Mucus Layer ◽  
Vocal Fold Vibration ◽  
Fatigue Syndrome ◽  
Functional Dysphonia

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.

Indirect Microsurgery of the Vocal Folds - Videostroboscopy vs. Microstroboscopy

1993 ◽  
Vol 72 (2) ◽  
pp. 134-141 ◽  
Author(s):  
Zoran Milutinović
Keyword(s):  
Laser Surgery ◽  
Vocal Fold ◽  
Vocal Folds ◽  
Surgical Approaches ◽  
Surgical Trauma ◽  
Benign Lesions ◽  
Functional Control ◽  
Microlaryngeal Surgery ◽  
Surgical Manipulation ◽  
Vocal Fold Surgery

In spite of the great significance of direct microlaryngeal surgery (DML), the inadequacies of this technique are evident. In order to avoid surgical trauma and introduce functional control during surgery, indirect microstroboscopic (IMS) and indirect videostroboscopic surgery (IVS) of the vocal folds are advocated. Both of these meet most criteria for surgical work in this field. The aim of this work was to make a comparative study of these techniques. The study is based on 603 operations conducted for benign lesions of the vocal folds. We are of the opinion that indirect vocal fold surgery for small benign lesions has significant advantages when compared with the conventional microlaryngoscopy, including laser surgery, which was proven elsewhere. When comparing these two indirect surgical approaches, the principal advantages of IVS surgery over the IMS method are easier surgical manipulation and better view. With respect to other areas of comparison, these techniques are quite similar. As complementary methods to conventional microlaryngoscopy, we believe that both IVS and IMS surgery should be used in practice.

Benign Lesions of the Vocal Folds: Histopathology and Phonotrauma

1995 ◽  
Vol 104 (9) ◽  
pp. 698-703 ◽  
Author(s):  
Frederik G. Dikkers ◽  
Peter G. J. Nikkels
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Histopathologic Examination ◽  
Benign Lesions ◽  
Ultrastructural Examination ◽  
Abnormal Increase ◽  
Reinke Edema ◽  
Histopathologic Findings ◽  
Single Blind ◽  
Vocal Fold Nodules

Benign lesions of the vocal folds have various appearances. Histopathologic examination might provide the true diagnosis. Therefore, histologic slides of 74 patients (92 vocal folds) with clinically well-defined diagnoses were single-blind examined by a pathologist. Single histologic features did not differentiate between different clinical entities, but combinations make some diagnoses more likely than others. Ultrastructural examination of submucosal vessels in the three most common clinical entities (polyps, Reinke edema, and vocal fold nodules) showed an entity-unique pattern of abnormal increase of layers of basement membrane—like material. A potential pathogenetic model of benign lesions of the vocal folds is presented, employing a combination of histopathologic findings and their possible relations with various forms of trauma inducing and maintaining these lesions.

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

1998 ◽  
Vol 107 (7) ◽  
pp. 603-610 ◽  
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.

Empirical Eigenfunctions and Medial Surface Dynamics of a Human Vocal Fold

2005 ◽  
Vol 44 (03) ◽  
pp. 384-391 ◽  
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.

Nonlinear behavior of vocal fold vibration: The role of coupling between the vocal folds

1999 ◽  
Vol 13 (4) ◽  
pp. 465-476 ◽  
Author(s):  
Antoine Giovanni ◽  
Maurice Ouaknine ◽  
Bruno Guelfucci ◽  
Ping Yu ◽  
Michel Zanaret ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Nonlinear Behavior ◽  
Vocal Folds ◽  
Vocal Fold Vibration

A Study of Vocal Fold Vibration Using a Slightly Compressible Fluid Domain

2009 ◽  
Author(s):  
D. J. Daily ◽  
S. L. Thomson
Keyword(s):  
Boundary Conditions ◽  
Incompressible Fluid ◽  
Compressible Fluid ◽  
Vocal Fold ◽  
Computational Models ◽  
Fluid Model ◽  
Vocal Folds ◽  
Moving Wall ◽  
Slightly Compressible ◽  
Vocal Fold Vibration

During human voice production, air forced from the lungs through the larynx induces vibration of the vocal folds. Computational models of this coupled fluid-solid system have traditionally utilized an incompressible fluid domain. However, studies have shown that coupling of tracheal acoustics with vocal fold dynamics is significant. Further, in the absence of compressibility, some models fail to achieve self-sustained vibration. This presentation discusses a slightly compressible airflow model, fully coupled with a vocal fold tissue model, as a possible substitute for the traditional incompressible approach. The derivation and justification of the slightly compressible fluid model are discussed. Results are reported of a study of the nature of the coupling between the fluid and vocal fold regions for both slightly compressible and incompressible fluid domains using a commercial fluid-solid finite element package. Three different types of inlet boundary conditions, including constant pressure, constant velocity, and moving wall, are explored. The incompressible and slightly compressible models with the three boundary conditions are compared with each other and with experimental data obtained using synthetic self-oscillating vocal fold models. The results are used to validate the slightly compressible flow model as well as to explore candidate boundary conditions for vocal fold vibration simulations.

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