Changes in Cough Airflow and Acoustics After Injection Laryngoplasty

Abstract

Objective/Hypothesis We explored the following hypotheses in a cohort of patients undergoing injection laryngoplasty: (1) glottic insufficiency affects voluntary cough airflow dynamics and restoring glottic competence may improve parameters of cough strength, (2) cough strength can be inferred from cough acoustic signal, and (3) glottic competence changes cough sounds and correlates with spectrogram morphology. Study Type/Design Prospective interventional study. Methods Subjects with glottic insufficiency secondary to unilateral vocal fold paresis, paralysis, or atrophy, and scheduled for injection laryngoplasty completed an instrumental assessment of voluntary cough airflow using a pneumotachometer and a protocolized voluntary cough sound recording. A Wilcoxon signed‐rank test was used to compare the differences between pre‐ and post‐injection laryngoplasty in airflow and acoustic measures. A Spearman rank‐order correlation was used to evaluate the association between airflow and acoustic cough measures. Results Twenty‐five patients (13F:12M, mean age 68.8) completed voluntary cough airflow measurements and 22 completed cough sound recordings. Following injection laryngoplasty, patients had a statistically significant decreased peak expiratory flow rise time (PEFRT) (mean change: −0.03 s, SD: 0.06, p = 0.04) and increased cough volume acceleration (mean change: 13.1 L/s2, SD: 33.9, p = 0.03), suggesting improved cough effectiveness. Correlation of cough acoustic measures with airflow measures showed a weak relationship between PEFRT and acoustic energy (coefficient: −0.31, p = 0.04) and peak power density (coefficient: −0.35, p = 0.02). Conclusions Our study thus indicates that injection laryngoplasty may help avert aspiration in patients with glottic insufficiency by improving cough effectiveness and that improved cough airflow measures may be tracked with cough sounds. Level of Evidence 3 Laryngoscope, 133:S1–S14, 2023

Should Injection Laryngoplasty Be Performed for Acute Unilateral Vocal Fold Paralysis to Improve Swallowing safety?

“…Rameau et al pursued a prospective interventional study to explore whether performing IL changed voluntary cough airflow dynamics in outpatients with glottic insufficiency of heterogeneous etiology. 5 They found that IL significantly decreased cough peak expiratory flow rise time and increased cough volume acceleration, suggesting an improvement in cough effectiveness. While targeting glottic competence with IL has long been presumed to improve cough function, this is the first study to quantify this benefit and provides a solid framework for future research.…”

“…However, swallowing dysfunction lies on a continuum and optimizing cough function to expel aspirated material can still decrease the risk of pneumonia. Rameau et al pursued a prospective interventional study to explore whether performing IL changed voluntary cough airflow dynamics in outpatients with glottic insufficiency of heterogeneous etiology 5 . They found that IL significantly decreased cough peak expiratory flow rise time and increased cough volume acceleration, suggesting an improvement in cough effectiveness.…”

Machine learning in the evaluation of voice and swallowing in the head and neck cancer patient

“…Methods for noninvasively assessing swallowing may help detect HNC patients at risk for functional disability. Several teams are investigating cough sounds and voice features as biomarkers of swallowing dysfunction using ML [70,71,72 ▪ ,73 ▪ ]. Others are studying high-resolution cervical auscultation (HRCA), which applies ML and time-series analysis to swallowing-induced acoustic and vibratory signals acquired from neck-attached sensors.…”