Quantification of Static and Dynamic Supraglottic Activity

Abstract

For estimating supraglottic compression in disordered voice production, categorical rating scales of true vocal fold coverage by supraglottic structures are the current standard. Quantification of change in the position of supraglottic structures compared to no supraglottic activity would be a better method for distinguishing between and within voice-disordered groups. This study developed a method for quantifying static supraglottic activity and extent of false vocal fold (FVF) motion during dynamic supraglottic activity. Twelve control participants and 12 individuals with voice disorders (6 with complaints of vocal fatigue and 6 with vocal fold nodules) were enrolled in the study. These individuals participated in a transnasal fiberoptic laryngeal examination in which various speech tasks were recorded. Single-frame images were selected to represent the positions of minimum and maximum supraglottic compression for each speech task. Two individuals rated these single-frame images using a categorical rating scale. Two other individuals measured the anterior-to-posterior (A-P) distance, vocal fold length, and vocal fold area. A-P and FVF compression were derived from these three measures. Reliability was demonstrated between judges for the ratings and between and within judges for the measures. Significant differences in normalized static supraglottic compression measures corresponded to the rating scale categories. Significant differences in normalized dynamic supraglottic compression measures corresponded to the differences in category ratings between minimum and maximum compression. Using the normalized measures, the voice-disordered groups demonstrated significantly greater static A-P compression (t test, p< .03) than did the control participants. These results suggest that static supraglottic activity may be diagnostic of voice disorder. Normalized dynamic FVF compression ratios were not significantly different between groups. This supports a previous hypothesis that dynamic supraglottic activity serves as an articulatory function at the level of the larynx and is part of the linguistic/phonemic system, rather than evidence of disordered laryngeal function.

Configuração das pregas vestibulares em laringes de pacientes com nódulo vocal

“…In view of this information, we could then suppose that in our group of vocal nodule, given that there was no participation of the vestibular folds, there was no effort at the supraglottic level. This finding is in agreement with what was observed by the group at the University of Washington in two different articles 16,17 which concluded the same as we did concerning lateral constriction using a different method with laryngeal measurements in pixels; conversely, these authors observed the existence of anterior-posterior supraglottic constriction, that is, approximation between the epiglottis cartilage and the arytenoids. In our study, this aspect was not considered, given that by our method, we would require the appropriate conditions to identify the anterior and posterior ends of the vestibular folds, which was not possible when the other type of supraglottic constriction happened.…”

“…Thus, practical applicability of the results of values of relative measurements of anterior-posterior and median compression may be questioned. [16][17][18] Vestibular folds have been recently classified according to their shape: concave, convex or linear, depending on the shape in studied subjects, presenting significant differences between the analyzed groups (normal voice and dysphonia), and such difference has also been observed when we compare male and female patients. 19 …”

Respiratory and Laryngeal Function During Spontaneous Speaking in Teachers With Voice Disorders

“…Videostroboscopic assessment has shown that both individuals who are experiencing vocal fatigue and individuals without voice complaints in whom vocal fatigue is induced show an increased frequency of anterior gap between the vocal folds (Eustace et al, 1996;Stemple et al, 1995). Supraglottic constriction has been consistently documented in individuals with voice disorders related to muscle misuse (Behrman, Dahl, Abramson, & Schutte, 2003;Stager et al, 2001;Stager, Bielamowicz, Regnell, Gupta, & Barkmeier, 2000). Different patterns of laryngeal muscle use, such as increased activation of the thyroarytenoid muscle (Eustace et al, 1996;McCue et al, 2001;Stemple et al, 1995) and increased extrinsic laryngeal muscle tension (Angsuwarangsee & Morrison, 2002;Morrison, 1997) have also been implicated in these voice disorders.…”

Relative Fundamental Frequency Distinguishes Between Phonotraumatic and Non-Phonotraumatic Vocal Hyperfunction

“…However, these techniques are subjective and prone to difficulties with reliability. For example, supraglottal compression is often attributed to individuals with VH; however, it is also present in individuals with healthy voices (Behrman, Dahl, Abramson, & Schutte, 2003;Pemberton et al, 1993;Sama, Carding, Price, Kelly, & Wilson, 2001;Stager et al, 2001;Stager, Bielamowicz, Regnell, Gupta, & Barkmeier, 2000;Stager, Neubert, Miller, Regnell, & Bielamowicz, 2003). Furthermore, even expert clinicians show weak interrater agreement for visual estimates of tension (Milstein, 1999;Stepp, Heaton, Jetté, Burns, & Hillman, 2010).…”