Multiparameter comparison of injection laryngoplasty, medialization laryngoplasty, and arytenoid adduction in an excised larynx model

Hoffman, Matthew R.; Witt, Rachel E.; Chapin, William; McCulloch, Timothy M.; Jiang, Jack J.

doi:10.1002/lary.20830

Cited by 41 publications

(36 citation statements)

References 44 publications

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“…In addition to perceived quality, acoustic measures are often used to demonstrate change with treatment. A common finding in treatment studies is that some of these measures signal improvement while others do not (Kotby et al, 1991; Chen et al, 2007; Hoffman et al, 2010; Little, Costello, & Harries, 2011; Colton et al, 2011). This is likely because voice quality results from auditory decoding of the acoustic signal radiated at the lips, and the radiated acoustic signal is the product of the anatomical structure, kinematic characteristics, and aeroacoustic interactions of the larynx and vocal tract.…”

Section: Introductionmentioning

confidence: 99%

Relation of Perceived Breathiness to Laryngeal Kinematics and Acoustic Measures Based on Computational Modeling

Samlan

Story

Bunton

2013

J Speech Lang Hear Res

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Purpose To determine 1) how specific vocal fold structural and vibratory features relate to breathy voice quality and 2) the relation of perceived breathiness to four acoustic correlates of breathiness. Method A computational, kinematic model of the vocal fold medial surfaces was used to specify features of vocal fold structure and vibration in a manner consistent with breathy voice. Four model parameters were altered: vocal process separation, surface bulging, vibratory nodal point, and epilaryngeal constriction. Twelve naïve listeners rated breathiness of 364 samples relative to a reference. The degree of breathiness was then compared to 1) the underlying kinematic profile and 2) four acoustic measures: cepstral peak prominence (CPP), harmonics-to-noise ratio, and two measures of spectral slope. Results Vocal process separation alone accounted for 61.4% of the variance in perceptual rating. Adding nodal point ratio and bulging to the equation increased the explained variance to 88.7%. The acoustic measure CPP accounted for 86.7% of the variance in perceived breathiness, and explained variance increased to 92.6% with the addition of one spectral slope measure. Conclusions Breathiness ratings were best explained kinematically by the degree of vocal process separation and acoustically by CPP.

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Section: Introductionmentioning

confidence: 99%

Relation of Perceived Breathiness to Laryngeal Kinematics and Acoustic Measures Based on Computational Modeling

Samlan

Story

Bunton

2013

J Speech Lang Hear Res

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“…A incompetência glótica causada pela paralisia de prega vocal provoca impacto não somente no sinal vocal, mas no sinal de fala como um todo 16 , verificando-se soprosidade, devido ao escape glótico e rouquidão, devido à vibração irregular das pregas vocais 10 . Muitas são as informações na literatura relacionadas aos procedimentos cirúrgicos 3,8,11,17 , porém informações relacionadas ao efeito da terapia vocal para paralisia unilateral de prega vocal ainda são escassos. Torna-se, portanto, necessária a avaliação dos benefícios da terapia fonoaudiológica sobre os aspectos vocais relacionados às características perceptivo-auditivas e espectográficas.…”

Section: Introductionunclassified

Alteração de mobilidade de prega vocal unilateral: avaliação subjetiva e objetiva da voz nos momentos pré e pós-fonoterapia

et al. 2010

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RESUMOObjetivo: avaliar de forma subjetiva e objetiva a voz de pacientes com paralisia unilateral de prega vocal nos momentos pré-tratamento e pós-tratamento. Método: trata-se de um estudo retrospectivo por meio de revisão de prontuário, que analisou as gravações de vozes de 12 indivíduos com diagnóstico otorrinolaringológico de paralisia unilateral de prega vocal. O material de voz colhido foi a emissão sustentada da vogal /a/, seguida de fala encadeada. As vozes pré e pós-terapia foram analisadas por meio da escala GRBASI, análise espectrográfica e medida do tempo máximo de fonação (TMF). Os parâmetros para análise espectrográfica foram: forma do traçado, grau de escurecimento dos harmônicos, continuidade do traçado, presença de ruídos, presença de sub-harmônicos e harmônicos definidos. A medida do TMF da vogal /a/ representou a maior de três emissões. Os dados obtidos foram submetidos a análise descritiva de tendência central e dispersão, e ao Teste Wilcoxon. Resultados: na análise perceptivo-auditiva, o parâmetro que mais se modificou no momento pós-tratamento foi o de soprosidade (B) (p=0,003), seguido do grau da disfonia (G) (p=0,004) e astenia (A) (p=0,01), sendo que estes resultados foram estatisticamente significantes. Com relação ao espectrograma, houve melhora do traçado em 91% dos pacientes, e os parâmetros que mais se modificaram foram: aumento do número de harmônicos (32%) e diminuição do ruído (24%). A medida do TMF da vogal /a/ apresentou-se significantemente maior no momento pós-fonoterapia (p=0,003%). Conclusão: pacientes com paralisia de prega vocal que foram submetidos ao tratamento fonoaudiológico apresentaram melhora dos dados perceptivo-auditivos, espectrográfico e do TMF.

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“…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%

“…Due to the increased morbidity associated with AA, some authors question whether the procedure is warranted; 9 however, the added improvement of AA after ML provides support for its use. 10 Developing an objective, quantitative evaluation may allow surgeons to more efficiently and accurately evaluate the degree of adduction, maximizing procedural benefit and reducing risk. We employed real-time measures of percent jitter, percent shimmer, and vocal efficiency (V E ) to determine the optimal degree of arytenoid rotation in an excised larynx setup.…”

Section: Introductionmentioning

confidence: 99%

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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Multiparameter comparison of injection laryngoplasty, medialization laryngoplasty, and arytenoid adduction in an excised larynx model

Cited by 41 publications

References 44 publications

Relation of Perceived Breathiness to Laryngeal Kinematics and Acoustic Measures Based on Computational Modeling

Relation of Perceived Breathiness to Laryngeal Kinematics and Acoustic Measures Based on Computational Modeling

Alteração de mobilidade de prega vocal unilateral: avaliação subjetiva e objetiva da voz nos momentos pré e pós-fonoterapia

Optimal arytenoid adduction based on quantitative real‐time voice analysis

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