Evidence of Long-Term Voice Therapy Effectiveness in Patients With Presbylarynges.

Evidence for long-term effectiveness of voice therapy (>2 years from previous clinic visit) is lacking from patients over 60 years who initially presented with voice complaints and subsequently demonstrated videostroboscopic signs of aging leading to voice therapy recommendations. Over the telephone, a certified speech-language pathologist enquired from those compliant and non-compliant, whether their voices were better, stable, or worse since their previous clinic visit, and asked them to rate Voice-Related Quality of Life, voice satisfaction, and Glottal Function Index to compare with their previous clinic visit ratings. Further questions focused on current voice satisfaction, and for those who were compliant, therapeutic experiences including home exercises.

Predicting Airflow from Measures Sensitive to Mid-cord Glottal Gap During the COVID-19 Pandemic.

Objectives: To determine if trans-laryngeal airflow, important in assessing vocal function in paresis/paralysis and presbylarynges patients with mid-cord glottal gaps, could be predicted by other measures sensitive to mid-cord glottal gap size but with smaller risks of spreading COVID-19, and if any patient factors need consideration.

Methods: Four populations were: unilateral vocal fold paresis/paralysis (UVFP, 148), aging and UVFP (UVFP plus aging, 22), bilateral vocal fold paresis/paralysis without airway obstruction (BVFP, 49), and presbylarynges (66). Five measures were selected from the initial clinic visit: mean airflow from repeated /pi/ syllables, longer of 2 /s/ and 2 /z/ productions, higher of 2 cepstral peak prominence smoothed for vowel /a/ (CPPSa), and Glottal Function Index (GFI).

Long-Term Voice Change in Presbylarynges Patients With and Without Intervention.

Purpose: To explore long-term patient experience of treated and untreated presbylarynges patients two or more years after their previous clinic visit by their responses to a probe about the changes in voice (better, stable, or worse) and standardized rating scales either by phone or from clinic records. Congruences of rating differences between visits and probe responses were assessed.

Methods: Thirty-seven participated prospectively and seven retrospectively.

Objective Laryngoscopic Measures From Older Patients With Voice Complaints and Signs of Aging.

Purpose: The purpose of this study was to use objective measures of glottal gap, bowing, and supraglottic compression from selected images of laryngoscopic examinations from adults over 60 years of age with voice complaints and signs of aging to test current hypotheses on whether degree of severity impacts treatment recommendations and potential follow-through with treatment.

Method: Records from 108 individuals 60 years or older with voice complaints and signs of aging were reviewed. Three objective measures (normalized glottal gap area [NGGA], total bowing index, and normalized true vocal fold width) were derived.

Surgical Management in Tracheobronchopathia Osteochondroplastica: A Case Study.

Tracheobronchopathia Osteochondroplastica is a benign condition characterized by osseous and cartilaginous submucosal growths of the tracheobronchial tree. This is a case report of an individual that was to undergo elective surgery using general anesthesia with endotracheal tube intubation. However, the anesthesiologist encountered a large osseous mass of the precricoid region and could not be intubated.

The Role of Choral Singing in Speaking Voice Preservation of Aging Adults.

Purpose This descriptive cohort pilot study, using a convenience sample, examined whether evidence from vocal function measures, auditory-perceptual ratings, and/or endoscopic signs of aging supported singing in senior chorales as a possible intervention to preserve the speaking voice in aging adults. Method Thirteen singers and five nonsinging controls, all over 65 years of age, participated. They were assessed at two visits, 15-20 months apart.

Unilateral versus bilateral botulinum toxin injections in adductor spasmodic dysphonia in a large cohort.

Objectives/hypothesis: The primary treatment of adductor spasmodic dysphonia is repeated injections of botulinum toxin type A (Botox) into the thyroarytenoid muscles. Dosing can be performed into either one or both thyroarytenoid muscles. The objective of this study was to evaluate the treatment effect and side effect profile across a large number of injections.

Treatment effectiveness for aging changes in the larynx.

Objectives: To compare the effectiveness of injection augmentation and bilateral thyroplasty surgery in managing age-related changes of the larynx.

Study Design: Retrospective chart review of patients treated with bilateral thyroplasty and/or injection augmentation.

Methods: We evaluated 22 patients before and after treatment using: 1) normalized glottal gap area and normalized true vocal fold width from endoscopic images; 2) patient self-rating questionnaires; and 3) acoustic and aerodynamic measures.

Medullary thyroid carcinoma presenting as a supraglottic mass.

We report a rare case of medullary thyroid carcinoma that presented as a metastasis to the supraglottic larynx. A 92-year-old man with a 3-month history of voice change and airway obstruction was diagnosed with medullary thyroid carcinoma metastatic to the supraglottis. Excision of the mass, total thyroidectomy, and elective neck dissection were recommended, but the patient declined because of his advanced age.

Computational study of effects of tension imbalance on phonation in a three-dimensional tubular larynx model.

Objectives: The present study explores the use of a continuum-based computational model to investigate the effect of left-right tension imbalance on vocal fold (VF) vibrations and glottal aerodynamics, as well as its implication on phonation. The study allows us to gain new insights into the underlying physical mechanism of irregularities induced by VF tension imbalance associated with unilateral cricothyroid muscle paralysis.

Methods: A three-dimensional simulation of glottal flow and VF dynamics in a tubular laryngeal model with tension imbalance was conducted by using a coupled flow-structure interaction computational model.

Subject-specific computational modeling of human phonation.

A direct numerical simulation of flow-structure interaction is carried out in a subject-specific larynx model to study human phonation under physiological conditions. The simulation results compare well to the established human data. The resulting glottal flow and waveform are found to be within the normal physiological ranges.

Perceived vocal fatigue and effort in relation to laryngeal functional measures in paresis patients.

Objectives/hypothesis: To determine if differences in objective measures of laryngeal function can meaningfully explain different levels of self-perceptions of effort or fatigue in patients with vocal fold paresis.

Study Design: A retrospective chart review of 72 patients with vocal fold paresis diagnosed using laryngeal electromyography, who had either been observed (n=21), treated only by injection (n=24), or treated only by surgery (n=27).

Methods: Before and after treatment/observation, patients' subjective ratings of severity of vocal effort and fatigue were assessed using the Glottal Function Index.

Computational modeling of phonatory dynamics in a tubular three-dimensional model of the human larynx.

Simulation of the phonatory flow-structure interaction has been conducted in a three-dimensional, tubular shaped laryngeal model that has been designed with a high level of realism with respect to the human laryngeal anatomy. A non-linear spring-based contact force model is also implemented for the purpose of representing contact in more general conditions, especially those associated with three-dimensional modeling of phonation in the presence of vocal fold pathologies. The model is used to study the effects of a moderate (20%) vocal-fold tension imbalance on the phonatory dynamics.

Sensitivity of vocal fold vibratory modes to their three-layer structure: implications for computational modeling of phonation.

The sensitivity of the eigenmodes and eigenfrequencies of the human vocal fold to its three-layer structure is studied using finite-element modeling. The study covers a variety of three-dimensional vocal fold models ranging from an idealized, longitudinally uniform structure to a physiologically more realistic, longitudinally varying structure. Geometric parameters including the thickness of the ligament and cover layers as well as the ligament length are varied systematically.

Direct-numerical simulation of the glottal jet and vocal-fold dynamics in a three-dimensional laryngeal model.

An immersed-boundary method based flow solver coupled with a finite-element solid dynamics solver is employed in order to conduct direct-numerical simulations of phonatory dynamics in a three-dimensional model of the human larynx. The computed features of the glottal flow including mean and peak flow rates, and the open and skewness quotients are found to be within the normal physiological range. The flow-induced vibration pattern shows the classical "convergent-divergent" glottal shape, and the vibration amplitude is also found to be typical for human phonation.

Toward a simulation-based tool for the treatment of vocal fold paralysis.

Advances in high-performance computing are enabling a new generation of software tools that employ computational modeling for surgical planning. Surgical management of laryngeal paralysis is one area where such computational tools could have a significant impact. The current paper describes a comprehensive effort to develop a software tool for planning medialization laryngoplasty where a prosthetic implant is inserted into the larynx in order to medialize the paralyzed vocal fold (VF).

A computational study of asymmetric glottal jet deflection during phonation.

Two-dimensional numerical simulations are used to explore the mechanism for asymmetric deflection of the glottal jet during phonation. The model employs the full Navier-Stokes equations for the flow but a simple laryngeal geometry and vocal-fold motion. The study focuses on the effect of Reynolds number and glottal opening angle with a particular emphasis on examining the importance of the so-called "Coanda effect" in jet deflection.

Primary care perceptions of otolaryngology.

Objective: To identify diseases of the head and neck for which primary care physicians may underappreciate the role of the otolaryngologist.

Study Design: Cross-sectional analysis.

Setting: With increasing subspecialization in the world of medicine, there is the potential for confusion about the scope of practice for different specialties by primary care physicians.

A computational study of the effect of vocal-fold asymmetry on phonation.

Unilateral laryngeal paralysis leads to tension imbalance and hence to asynchronous movements between the two vocal folds during phonation. In the current study, a computational model of phonation that couples a two-mass model of the vocal folds with a Navier-Stokes model of the glottal airflow, has been used to examine the dynamics of vocal fold configurations with tension imbalance and its implications for phonation. The simulations show that tension imbalance influences phonation onset, intensity as well as the fundamental phonation frequency.

Using laryngeal electromyography to differentiate presbylarynges from paresis.

Purpose: Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from previous studies with presbylarynges and significantly different from those of patients with abnormal LEMG.

An immersed-boundary method for flow-structure interaction in biological systems with application to phonation.

A new numerical approach for modeling a class of flow-structure interaction problems typically encountered in biological systems is presented. In this approach, a previously developed, sharp-interface, immersed-boundary method for incompressible flows is used to model the fluid flow and a new, sharp-interface Cartesian grid, immersed boundary method is devised to solve the equations of linear viscoelasticity that governs the solid. The two solvers are coupled to model flow-structure interaction.

Evidence of return of function in patients with vocal fold paresis.

Unilateral vocal fold paresis (UVFP) patients were examined over time for achievement of partial or full functional return or no functional return in the extent of arytenoid movement, clarity of laryngeal articulation, maximum phonation time (MPT), and flow. Effects of treatment type and initial laryngeal electromyography (EMG) results were examined. A retrospective chart review was completed for patients a year or less after onset evaluated between April 1999 and December 2005 and treated between 2 and 20 months after onset.

Analysis of flow-structure interaction in the larynx during phonation using an immersed-boundary method.

A recently developed immersed-boundary method is used to model the flow-structure interaction associated with the human phonation. The glottal airflow is modeled as a two-dimensional incompressible flow driven by a constant subglottal pressure, and the vocal folds are modeled as a pair of three-layered, two-dimensional, viscoelastic structures. Both the fluid dynamics and viscoelasticity are solved on fixed Cartesian grids using a sharp-interface immersed boundary method.

A computational study of the effect of false vocal folds on glottal flow and vocal fold vibration during phonation.

The false vocal folds are believed to be components of the acoustic filter that is responsible for shaping the voice. However, the effects of false vocal folds on the vocal fold vibration and the glottal aerodynamic during phonation remain unclear. This effect has implications for computational modeling of phonation as well as for understanding laryngeal pathologies such as glottal incompetence resulting from unilateral vocal fold paralysis.