Multiparameter Analysis of Titanium Vocal Fold Medializing Implant in an Excised Larynx Model

Witt, Rachel E.; Hoffman, Matthew R.; Friedrich, Gerhard; Rieves, Adam L.; Schoepke, Benjamin J.; Jiang, Jack J.

doi:10.1177/000348941011900210

Cited by 12 publications

(12 citation statements)

References 39 publications

(73 reference statements)

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“…As observed previously, 10,14 PTF varied significantly across treatments while PTP did not. PTF is directly related to the cube of neutral glottal half-width 15 and is more sensitive than PTP to changes in glottal abduction.…”

Section: Discussionsupporting

confidence: 84%

“…Ex vivo canine larynges have been used extensively to study vocal fold paralysis. 10,12-14 There are several anatomical differences in the canine larynx relative to the human, including more angulated thyroid and cricoid cartilages, and the absence of a well-defined vocal ligament. 12 These differences did not affect the procedures performed in this study.…”

Section: Discussionmentioning

confidence: 99%

“…11 A metal pull clamp was used to stabilize the trachea to a tube connected to a pseudolung which served as a constant pressure source. Insertion of one 3-pronged micrometer in the arytenoid cartilage ipsilateral to the dissected thyroid cartilage allowed for adduction of one vocal fold, simulating UVFP in the unadducted vocal fold as in Czerwonka et al, 13 Witt et al, 14 and Hoffman et al 10 An additional 3-pronged micrometer was placed against the contralateral thyroid lamina for stability without providing vocal fold adduction. Methodological consistency was maintained by always adducting the contralateral arytenoid (simulated normal) to the midline.…”

Section: Methodsmentioning

confidence: 99%

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Optimal arytenoid adduction based on quantitative real‐time voice analysis

et al. 2011

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Hypothesis The optimal degree of arytenoid rotation for arytenoid adduction (AA) can be determined using quantitative real-time voice analysis. Study design Repeated measures with each larynx serving as its own control. Methods Unilateral vocal fold paralysis (VFP) was modeled in five excised canine larynges. Medialization laryngoplasty (ML) was performed, followed by AA. The optimal degree of arytenoid rotation was determined using real-time measurements of vocal efficiency (VE), percent jitter, and percent shimmer. After the optimal degree of rotation was determined, the arytenoid was hypo- and hyper-rotated 10±2% of the optimal angle to mimic hypoadducted and hyperadducted states. Aerodynamic, acoustic, and mucosal wave measurements were recorded. Results Mean optimal angle of arytenoid adduction was 151.4 ± 2.5°. VE differed significantly across experimental conditions (p = 0.003). Optimal AA produced the highest VE of any treatment, but this value did not reach that produced in the normal condition. Percent jitter (p < 0.001) and percent shimmer (p < 0.001) differed across groups and were lowest for optimal AA. Mucosal wave amplitude of the normal (p = 0.001) and paralyzed fold (p = 0.043) differed across treatments. Amplitude of both folds was highest for optimal AA. Conclusions VE and perturbation parameters were sensitive to the degree of arytenoid rotation. Using real-time voice analysis may aid surgeons in determining the optimal degree of arytenoid rotation when performing AA. Testing this method in patients and determining if optimal vocal outcomes are associated with optimal respiratory and swallowing outcomes will be essential to establishing clinical viability. Evidence based medicine level Not applicable – excised animal tissue study.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Optimal arytenoid adduction based on quantitative real‐time voice analysis

et al. 2011

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“…There are several limitations to the experimental design and implant that will be the subject of future investigations. Although the excised larynx setup is a valuable research tool and has been used frequently to study VFP,5, 16, 17, 19, 20 it cannot simulate all clinical concerns of thyroplasty such as physiological tissue response to implant insertion and long‐term effectiveness of the implant. Second, a round balloon was used in this study, which has the natural tendency to expand uniformly in all directions.…”

Section: Discussionmentioning

confidence: 99%

Preliminary investigation of adjustable balloon implant for type I thyroplasty

Hoffman¹,

Witt²,

McCulloch³

et al. 2011

The Laryngoscope

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Objective-We present the adjustable balloon implant (ABI), a novel implant to be used in type I thyroplasty for the treatment of vocal fold paralysis. The ABI offers the same medialization provided by other implants, but can easily be catered to individual patient anatomy as well as modified postoperatively without the need for a revision thyroplasty. Study design-Repeated measures with each larynx serving as its own control.Methods-Medialization thyroplasty (MT) with the ABI was performed on five excised canine larynges. Mucosal wave, aerodynamic, and acoustic parameters were measured for three conditions: normal; right vocal fold paralysis; and paralysis with the ABI.Results-Insertion of the ABI resulted in significant decreases in both phonation threshold pressure and phonation threshold flow. Perturbation parameters of percent jitter and percent shimmer were also significantly decreased and restored to normal levels. Signal-to-noise ratio was significantly increased to the normal level as well. The mucosal wave was preserved after implant insertion.Conclusions-This preliminary experiment showing significant improvements in aerodynamic and acoustic parameters demonstrates the potential of the ABI as a thyroplasty implant. Effective medialization and preservation of the mucosal wave combined with post-operative adjustability makes it a potentially valuable clinical device.

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“…[92], who evaluated the efficacy of a titanium vocal fold medializing implant (TVFMI) for the treatment of unilateral vocal fold paralysis on the basis of acoustic, aerodynamic, and mucosal wave measurements in eight excised canine larynges. The authors reported that the phonation threshold flow, phonation threshold power, jitter, and shimmer decreased significantly after medialization.…”

Section: Excised Human and Animal Larynx Experimentsmentioning

confidence: 99%

Experiments on Analysing Voice Production: Excised (Human, Animal) and In Vivo (Animal) Approaches

Döllinger¹,

Kobler²,

Berry³

et al. 2011

CBIO

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Experiments on human and on animal excised specimens as well as in vivo animal preparations are so far the most realistic approaches to simulate the in vivo process of human phonation. These experiments do not have the disadvantage of limited space within the neck and enable studies of the actual organ necessary for phonation, i.e., the larynx. The studies additionally allow the analysis of flow, vocal fold dynamics, and resulting acoustics in relation to well-defined laryngeal alterations. Purpose of Review This paper provides an overview of the applications and usefulness of excised (human/animal) specimen and in vivo animal experiments in voice research. These experiments have enabled visualization and analysis of dehydration effects, vocal fold scarring, bifurcation and chaotic vibrations, three-dimensional vibrations, aerodynamic effects, and mucosal wave propagation along the medial surface. Quantitative data will be shown to give an overview of measured laryngeal parameter values. As yet, a full understanding of all existing interactions in voice production has not been achieved, and thus, where possible, we try to indicate areas needing further study. Recent Findings A further motivation behind this review is to highlight recent findings and technologies related to the study of vocal fold dynamics and its applications. For example, studies of interactions between vocal tract airflow and generation of acoustics have recently shown that airflow superior to the glottis is governed by not only vocal fold dynamics but also by subglottal and supraglottal structures. In addition, promising new methods to investigate kinematics and dynamics have been reported recently, including dynamic optical coherence tomography, X-ray stroboscopy and three-dimensional reconstruction with laser projection systems. Finally, we touch on the relevance of vocal fold dynamics to clinical laryngology and to clinically-oriented research.

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Multiparameter Analysis of Titanium Vocal Fold Medializing Implant in an Excised Larynx Model

Cited by 12 publications

References 39 publications

Optimal arytenoid adduction based on quantitative real‐time voice analysis

Optimal arytenoid adduction based on quantitative real‐time voice analysis

Preliminary investigation of adjustable balloon implant for type I thyroplasty

Experiments on Analysing Voice Production: Excised (Human, Animal) and In Vivo (Animal) Approaches

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