Abstract

The purpose of this paper is to report on the first in vivo application of a recently developed transoral, dual-sensor pressure probe that directly measures intraglottal, subglottal, and vocal fold collision pressures during phonation. Synchronous measurement of intraglottal and subglottal pressures was accomplished using two miniature pressure sensors mounted on the end of the probe and inserted transorally in a 78-year-old male who had previously undergone surgical removal of his right vocal fold for treatment of laryngeal cancer. The endoscopist used one hand to position the custom probe against the surgically medialized scar band that replaced the right vocal fold and used the other hand to position a transoral endoscope to record laryngeal high-speed videoendoscopy of the vibrating left vocal fold contacting the pressure probe. Visualization of the larynx during sustained phonation allowed the endoscopist to place the dual-sensor pressure probe such that the proximal sensor was positioned intraglottally and the distal sensor subglottally. The proximal pressure sensor was verified to be in the strike zone of vocal fold collision during phonation when the intraglottal pressure signal exhibited three characteristics: an impulsive peak at the start of the closed phase, rounded peak during the open phase, and minimum value around zero immediately preceding the impulsive peak of the subsequent phonatory cycle. Numerical voice production modeling was applied to validate model-based predictions of vocal fold collision pressure using kinematic vocal fold measures. The results successfully demonstrated feasibility of in vivo measurement of vocal fold collision pressure in an individual with a hemilaryngectomy, motivating ongoing data collection that is designed to aid in the development of vocal dose measures that incorporate vocal fold impact collision and stresses.

Highlights

  • Voice disorders have been estimated to affect approximately 30% of the adult population in the United States at some point in their lives, with up to 7.6% of individuals affected at any given point in time [1,2]

  • The intraglottal pressure sensor was deemed to be positioned as desired in the phonatory strike zone by comparing the intraglottal pressure sensor waveform with that of the subglottal pressure sensor

  • The waveform of the intraglottal pressure sensor was further investigated to determine if the expected waveshape characteristics, per the literature, were observed

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Summary

Introduction

Voice disorders have been estimated to affect approximately 30% of the adult population in the United States at some point in their lives, with up to 7.6% of individuals affected at any given point in time [1,2]. The etiology of phonotraumatic lesions has classically centered on the role of vocal fold impact stress (in the direction of tissue motion at contact) and shear stress (along the tissue surface) during phonation [4]. Insight into the role of collision pressures in the generation of vocal fold lesions is important for any quantification or modeling of phonotrauma since phonotraumatic lesions are widely considered to form due to repetitive stress on the mid-membranous portion of the vocal folds at the location of maximal tissue contact [5,6,7]. The direct measurement of vocal fold collision pressure is challenging to carry out in vivo, and only two published studies have attempted to gather data from sensors placed intraglottally during phonation [8,9]. Verdolini et al [9,10] developed a piezoresistive pressure sensor with a flat frequency response up to 50 kHz and a linear sensing range of

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