Vocal Efficiency Measurements in Subjects with Vocal Polyps and Nodules: A Preliminary Report

Jiang, Jack J.; Stern, Jennifer I; Chen, Huijun; Solomon, Nancy Pearl

doi:10.1177/000348940411300404

Cited by 43 publications

(30 citation statements)

References 20 publications

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“…However, when the measurement is accurate and consistent, it can be used as part of the diagnostic process. High levels of subglottal pressure are often characteristic of vocal pathologies (22). A simple and reliable method of measuring P s could be used to screen patients for pathology or evaluate treatment efficacy.…”

Section: Discussionmentioning

confidence: 99%

Estimating Subglottal Pressure via Airflow Interruption with Auditory Masking

Hoffman

Jiang

2009

Journal of Voice

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Objective-Current noninvasive measurement of subglottal pressure using airflow interruption often produces inconsistent results due to the elicitation of audio-laryngeal reflexes. Auditory feedback could be considered as a means of ensuring measurement accuracy and precision. The purpose of this study was to determine if auditory masking could be used with the airflow interruption system to improve intrasubject consistency.Study Design-A prerecorded sample of subject phonation was played on a loop over headphones during the trials with auditory masking. This provided subjects with a target pitch and blocked out distracting ambient noise created by the airflow interrupter.Methods-Subglottal pressure was noninvasively measured using the airflow interruption system. Thirty subjects, divided into two equal groups, performed ten trials without auditory masking and ten trials with auditory masking. Group one performed the normal trials first, followed by the trials with auditory masking. Group two performed the auditory masking trials first, followed by the normal trials.Results-Intrasubject consistency was improved by adding auditory masking, resulting in a decrease in average intrasubject standard deviation from 0.93 ± 0.51 to 0.47 ± 0.22 cmH 2 O (p < . 001).Conclusions-Auditory masking can be used effectively to combat audio-laryngeal reflexes and aid subjects in maintaining constant glottal configuration and frequency, thereby increasing intrasubject consistency when measuring subglottal pressure. By considering auditory feedback, a more reliable method of measurement was developed. This method could be employed by clinicians, as reliable, immediately available values of subglottal pressure are useful in evaluating laryngeal health and monitoring treatment progress.

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Section: Discussionmentioning

confidence: 99%

Estimating Subglottal Pressure via Airflow Interruption with Auditory Masking

Hoffman

Jiang

2009

Journal of Voice

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“…Efficient performance can be accomplished by increasing coordination among working muscles, changing performance pace, providing different mechanical aids (e.g., toe clips and clothing that enhance aerodynamics in cycling), (Brooks, et al, 2005). In the voice domain, vocal efficiency (dB SPL/cm H2O x l/sec)-defined as a quantitative measure of the ability of the larynx to convert subglottal pressure to acoustic power (Jiang, Stern, Chen, & Solomon, 2004) -has been investigated in relation to the working muscles. For example, efficiency is known to vary with adjustments in glottal width (Slavit andMcCaffrey, 1991, Titze, 1992), contraction of cricothyroid muscle (Koike & Hirano, 1973, Titze, 1992, and contraction of vocalis muscle (Hirano, 1974, Berke et al, 1990.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Mechanisms of Vocal Fatigue

2017

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Vocal fatigue is among the most debilitating conditions affecting individuals with voice disorders. Impressions about mechanisms potentially underlying vocal fatigue have varied depending on how fatigue is defined, participants studied, and measures made, thereby impacting the selection of treatment strategies that may alleviate the condition. However, little is currently known about actual metabolic mechanisms of vocal fatigue. The current study aimed to address this issue by investigating the hypothesis that neuromuscular inefficiency, cardiovascular recovery deficits, or both, may play a role in fatigue. The approach replicated well-vetted approaches in exercise physiology.Metabolic profiles of subjects with vocal fatigue were assessed using gas exchange measures in comparison to two non-fatigue groups: vocally healthy and cardiovascular trained individuals, recruited based on results from a newly vetted questionnaire, the Vocal Fatigue Index (VFI) and laryngeal examination. Participants read out loud at two different loudness levels for a duration of 5 minutes for each task with periods of rest between tasks. Metabolic cost for and recovery time from reading were same across all groups. Oxygen uptake and recovery kinetics (EPOC), ratings of perceived exertion revealed interesting patterns in individuals with vocal fatigue compared to cardiovascular trained individuals in particular.Specifically, slow oxygen uptake kinetics in the vocal fatigue compared to the cardiovascular iv trained group pointed to utilization of anaerobic energy source to meet the demands of the reading task in the vocal fatigue group, suggesting neuromuscular inefficiency. In contrast, rapid oxygen uptake kinetics in the cardiovascular trained group pointed to utilization of aerobic energy sources and greater neuromuscular efficiency. Similarly, a greater number of individuals in vocal fatigue and vocally healthy groups showed an increase in oxygen consumption post reading (EPOC) compared to the cardiovascular trained group, indicating possible cardiovascular recovery deficits in the former groups.In addition to uncovering potential mechanisms underlying vocal fatigue, including neuromuscular inefficiency and cardiovascular recovery deficits, results from the present study highlight the potential importance of aerobic training to generate aerobic energy required for vocal task demands for both ease of task performance and recovery from it. In sharp contrast to the situation for voice, fatigue as a common physical phenomenon more generally has received extensive attention in the physical therapy, sports medicine, and exercise physiology literature. Three broad schools of thought identify mechanisms pertaining to the origins of physical fatigue: (1) peripheral mechanisms (Allen, Lamb, & Westerblad, 2008;Asmussen, 1979;Edwards, 1981;Fitts, 1994;Westerblad, Allen, & Lannergren, 2002;Westerblad, Lee, Lannergren, & Allen, 1991), (2) The next pages and chapters provide pertinent background information on vocal fatigue, fatigue as understood ...

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“…It was not used before because the most challenging aspect of calculating vocal efficiency was determining subglottal pressure [22].…”

Section: Discussionmentioning

confidence: 99%

Objective measurement of real time subglottic pressure during medialization thyroplasty: a feasibility study

Matar

Remacle

Bachy

et al. 2011

Eur Arch Otorhinolaryngol

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It is hypothesized that real time objective measurement of the subglottic pressure could contribute to the choice of the implant's size (IS) in medialization thyroplasty (MT). A prospective study was conducted with patients with glottal insufficiency. Patients had a MT using a Montgomery implant(®) (Boston medical, Boston, USA). Peak direct subglottic pressure (PDSGP) was measured intraoperatively using a catheter inserted in the cricothyroid membrane. The implant's choice was based on the results of PDSGP measured prior and after placement of the implant and was compared to the surgeon's and patient's perception and fiber optic estimation of the glottis aperture. Six patients were included in the first part of the study. The PDSGP could be measured in all the patients without increasing the surgical time or patients' discomfort. The mean PDSGP before and after the placement of the implant was 15.2 (SD = 5) and 10.6 (SD = 4) cmH(2)O, respectively. In the second part of the study, five patients were included. The PDSGP varied with the size of the implant and the implant with the lowest pressure was chosen in 4/5 patients. Peroperative measurement of PDSGP is easy, feasible and might allow a more objective choice of the IS in MT. Level of evidence 2c.

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Vocal Efficiency Measurements in Subjects with Vocal Polyps and Nodules: A Preliminary Report

Cited by 43 publications

References 20 publications

Estimating Subglottal Pressure via Airflow Interruption with Auditory Masking

Estimating Subglottal Pressure via Airflow Interruption with Auditory Masking

Metabolic Mechanisms of Vocal Fatigue

Objective measurement of real time subglottic pressure during medialization thyroplasty: a feasibility study

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