False Vocal Folds Research Articles

Measures of Spectral Slope Using an Excised Larynx Model

Spectral measures of the glottal source were investigated using an excised canine larynx (CL) model for various aerodynamic and phonatory conditions. These measures included spectral harmonic difference H1-H2 and spectral slope that are highly correlated with voice quality but not reported in a systematic manner using an excised larynx model. It was hypothesized that the acoustic spectra of the glottal source were significantly influenced by the subglottal pressure, glottal adduction, and vocal fold elongation, as well as the resulting vibration pattern. CLs were prepared, mounted on the bench with and without false vocal folds, and made to oscillate with a flow of heated and humidified air. Major control parameters were subglottal pressure, adduction, and elongation. Electroglottograph, subglottal pressure, flow rate, and audio signals were analyzed using custom software. Results suggest that an increase in subglottal pressure and glottal adduction may change the energy balance between harmonics by increasing the spectral energy of the first few harmonics in an unpredictable manner. It is suggested that changes in the dynamics of vocal fold motion may be responsible for different spectral patterns. The finding that the spectral harmonics do not conform to previous findings was demonstrated through various cases. Results of this study may shed light on phonatory spectral control when the larynx is part of a complete vocal tract system.

Stimulating Swallowing: Essential Central and Peripheral Nervous System Targets

Stimulating Swallowing: Essential Central and Peripheral Nervous System Targets

Laryngeal schwannoma with extralaryngeal extension

Schwannomas of the larynx are rare. Furthermore, a laryngeal schwannoma extending to the neck region is extremely rare. The present case report describes a 37-year-old male patient with a history of hoarseness and cervical swelling on the left side for over 10 years. He presented with dyspnea on exertion. Fiberoptic laryngoscopy revealed a large submucosal mass in the left false and true vocal folds, and the left vocal fold was immobile. Magnetic resonance imaging revealed the presence of multiple tumors throughout the body, in addition to extension of the laryngeal tumor to the left neck region in a dumbbell shape. After analysis of the results of examinations including imaging tests and pathological examinations, a diagnosis of schwannomatosis was made. A tracheostomy was performed, along with resection of the laryngeal tumor. Following disarticulation of the cricothyroid joint and rotate ion of the thyroid cartilage, the intralaryngeal part of the tumor was smoothly removed without median or lateral thyrotomy. At the 3-month follow-up, the patient's vocal fold mobility was found to have recovered. Although uncommon, our procedure was very effective for the treatment of laryngeal schwannomas. By this approach, safe removal of the tumor was possible, without any injury to the laryngeal mucosa.

Pathology Quiz Case 1

A 15-YEAR-OLDBOYPRESENTEDWITHA1-MONTH history of hoarseness, shortness of breath with exertion, and a globus sensation. He denied any dysphagia, odynophagia, or localized pain. He was otherwise healthy and had no family history of childhood cancers or anemia. Fiberoptic laryngoscopyrevealeda2-cm,nonulcerated, submucosalsoft-tissuemassepicenteredintheanterior left false vocal fold (Figure 1). The results of the physical examination were otherwise unremarkable, with no palpable lymphadenopathy.Combinedpositronemission tomographyandcomputedtomographyrevealeda2.2 1.6-cmsofttissuemass in the left supraglottic larynxthatpartiallyobliterated the left piriform sinus (Figure 2). The mass had a maximal standard uptake variable of 14.2. The patient was taken to the operating room for direct laryngoscopyandabiopsy.Microscopicexaminationshowed sheetsofmonotonous,discohesivemedium-sizedcellswith highnuclear tocytoplasmicratios,vesicularchromatin,and prominent nucleoli in the submucosa. Frequent apoptotic debris, tingiblebodymacrophages,andmitotic figureswere present (Figure3). Immunostains were diffusely positive for CD20 (Figure 4), CD10, and CD45 and weakly positive forBCL-2 .Thetumorcellswerenegative forCD3,TdT, and CD34. A Ki-67 study showed a proliferative index of approximately80%.Fluorescenceinsituhybridization(FISH) showednorearrangements involving c-myc, bcl-2, or bcl-6. What is your diagnosis?

Improved Airway Visualization during Direct Laryngoscopy Using Self‐retaining Laryngeal Retractors

To measure the degree to which the Lindholm laryngeal distending forceps improve visualization during direct laryngoscopy in selected pediatric patients. Case series with chart review. Pediatric hospital. Subjects included children undergoing direct laryngoscopy using the Lindholm laryngeal distending forceps. Intraoperative endoscopic photos with and without false cord retraction via the Lindholm laryngeal distending forceps were obtained from the Seattle Children's Hospital airway endoscopy photo library. Analysis was performed using imaging software. Comparisons of visible vocal cord and glottic opening areas as well as anterior commissure angles with and without the Lindholm laryngeal distending forceps were performed with a paired and unpaired Student t test. The use of the Lindholm laryngeal distending forceps increased the glottic opening by a mean of 359% (95% confidence interval [CI], 255%-463%) and increased visualized true vocal cord area by 337% (197%-477%). Angle at the anterior commissure increased from a mean of 24.9° to a mean of 71.5°, resulting in a net mean angle increase of 46.6° (95% CI, 40.2°-52.9°). All measured changes were statistically significant with P values <.01. When placed at the level of the false vocal folds, Lindholm laryngeal distending forceps will, at least in certain cases, greatly increase the visible area of the superior surface of the vocal folds, the anterior commissure, and, by increasing the glottic opening, the subglottic region. This improved visualization may enhance the surgeon's ability to diagnose and treat pathologies in these anatomic regions during direct laryngoscopy.

Complete resolution of laryngeal amyloidosis with radiation treatment

Localized amyloidosis of the larynx is a rare entity of unclear etiology. Surgical debulking is the primary treatment modality but often is not curative. A 41-year-old woman presenting with increasing hoarseness, dysphagia, dyspnea, and weight loss was found to have a submucosal mass in the left false vocal fold. Biopsy of the specimen revealed amyloid. After negative work-up for systemic disease, the patient underwent surgical debulking. Specimens revealed a population of clonal plasma cells demonstrating lambda restriction. The patient was treated with adjuvant external beam radiation to a dose of 45 Gy. At 11 months, the patient's voice, breathing, and swallowing have all improved substantially. Recent pathologic studies suggest that localized amyloidosis of the larynx is caused by a localized, nonmalignant plasma cell disorder. Because full resection is difficult, we recommend a combination of surgery and radiation therapy to cure this disease.

Stress relaxation in human true and false vocal folds.

Stress relaxation behavior of the human true and false vocal folds were measured in vitro and modeled for viscoelastic parameter determination. Vibrations of the vocal folds are greatly influenced by the elasticity and viscosity of its mucosal layer. When there is a change in the viscoelastic properties of vocal fold tissue due to disease or trauma such as scarring, voice change may occur. Voice simulation models are in need of viscoelastic properties of human vocal folds for more reliable results. Due to the shortage of human data, these properties have been extrapolated from animal data such as canine vocal fold tissues. In this study, samples are made from human larynges acquired from NDRI, which were snap frozen 24–48 h post mortem and stored in −82 °F. Samples were made from medial portion of true and false vocal folds without any muscle, with a piece cartilage at each end for mounting. Stepwise elongation of 20 and 30% stretch was applied the force response was measured with an ergometer and modeled with a quasi‐linear viscoelastic model. The preliminary results suggest the strong relaxation behavior in both true and false vocal folds are indicative of abundant collagen material. [Work supported by NIDCD Grant # DC00956.]

Coblation removal of laryngeal Teflon granulomas

AbstractLaryngoscope, 2010

Neck Surface Electromyography as a Measure of Vocal Hyperfunction before and after Injection Laryngoplasty

The goal of this preliminary study was to determine whether neck surface electromyography (sEMG) is sensitive to possible changes in vocal hyperfunction associated with injection laryngoplasty, particularly with respect to alterations in the degree of vocal hyperfunction. Thirteen individuals undergoing office-based injection laryngoplasty for glottal phonatory insufficiency were prospectively studied with a battery of acoustic, aerodynamic, endoscopic, and anterior neck sEMG assessments before the procedure and approximately 1 week afterward. Anterior neck sEMG values were not significantly reduced (p < 0.05) after the procedure; however, perceptual ratings of strain and false vocal fold compression were both significantly reduced, reflecting a decrease in vocal hyperfunction. The results do not support the use of anterior neck sEMG measures to assess vocal hyperfunction, and place into question the use of some other measures (estimates of anterior-posterior supraglottic compression, quantitative measures of anterior-posterior and false vocal fold supraglottic compression, and acoustic vowel rise times) that have been considered reflective of vocal hyperfunction.

Vortex dipolar structures in a rigid model of the larynx at flow onset

Starting jet airflow is investigated in a channel with a pair of consecutive slitted constrictions approximating the true and false vocal folds in the human larynx. The flow is visualized using the Schlieren optical technique and simulated by solving the Navier-Stokes equations for an incompressible two-dimensional viscous flow. Laboratory and numerical experiments show the spontaneous formation of three different classes of vortex dipolar structures in several regions of the laryngeal profile under conditions that may be assimilated to those of voice onset.

Respiratory complications after supracricoid partial laryngectomy

The objective of the study was to analyze the incidence, treatment, and prevention of early and late respiratory complications in a series of patients who had supracricoid partial laryngectomies with either cricohyoidoepiglottopexy or cricohyoidopexy. From medical charts, we retrospectively reviewed 101 patients who underwent supracricoid partial laryngectomies, from 1980 to 2006, for laryngeal squamous cell carcinoma, and recorded the various postoperative complications and the time of decannulation. The mortality rate was 3.96%. Early complications included broncho-pulmonary infections and laryngeal stenoses which occurred in 9.9%. Univariate analysis showed a statistically significant relationship between the pulmonary complications and neck dissections (p < 0.04). Later, they were due to laryngeal obstruction (neolaryngeal mucosal flap, residual false vocal cord fold or arytenoid edema). The median decannulation time was 8 days, and there was a significant relationship between the decannulation delay and the pulmonary complications. Only two patients had a later definitive tracheotomy. Respiratory complications after supracricoid partial laryngectomy are frequent, but can be easily managed in most cases. A preoperative pulmonary assessment is necessary to select patients. During surgery, a precise impaction of the hyoid bone with the cricoid cartilage and a repositioning of an arytenoid can avoid some postoperative stenoses.

Postsurgical dysphagia: evaluation and rehabilitation

Surgical resection of a malignant tumor in the head and neck regions quite often alters the complex act of swallowing. The goal of dysphagia rehabilitation is to return the patient’s swallowing to as near normal as possible. Although surgical procedures in the oral cavity, tongue, pharynx can affect preparation, control and transport of the bolus, functional disorders following laryngeal surgery are most common and severe. The larynx serves two critical functions during swallowing. First, it elevates anteriorly moving itself from the path of the bolus and contributing to the opening of the cricopharyngeal sphincter. Second, it protects the airways from inhaling acting as a three level valve -- the epiglottis, false vocal folds, and true vocal folds. Any surgical intervention affecting this closure will likely results in aspiration during the swallow. Patients undergoing total laryngectomy have few swallowing problems due to the separation of the airways from the esophagus. On the contrary both partial and reconstructive procedures can significantly affect both the respiratory and the alimentary function. Supraglottic laryngectomy can interfere with laryngeal elevation and sometimes with vocal fold adduction especially when the surgical procedure includes portions of the hyoid bone, base of tongue, aryepiglottic folds, or false vocal folds. Vertical laryngectomies reduce laryngeal closure. When the intervention is limited to one focal fold (cordectomy), the swallowing recovery is usually easily achieved. In frontolateral laringectomy the removal of tissues extends to the opposite vocal fold: in such cases swallowing recovery is still possible with a combination of increased effort and compensatory head posturing. In sub-total/reconstructive laryngectomies (Crico-Hyoido-Epiglotto-Pexy, CHEP and Crico-HyoidoPexy, CHP) the surgeon intends to create a neoglottis able to contracts during swallowing. In such cases critical factors in recovery of swallowing are considered the airway closure at the laryngeal entrance, the propulsive movement of the tongue base and its contact with the posterior pharyngeal wall. Two pernicious, life-threatening complications can slowly compromise the patient’s life aspiration, pneumonia and malnutrition. Diagnostic procedures of swallowing disorders are mainly represented by radiographic contrast examination and by fiberoptics endoscopic evaluation. Compensatory treatment strategies include postural changes, increasing sensory input, modifying volume, consistency and viscosity of foods. Rehabilitative procedures are designed to improve a range of movements of oral or pharyngo-laryngeal structures and increase their sensory-motor integration and timing. Exercises and manoeuvres designed to achieve such goals are considered in detail.

Closure of the larynx for intractable aspiration in neurologically impaired patients

We present three patients with intractable aspiration pneumonia in the setting of permanent neurologic impairment, who had received a tracheostomy and showed a juxtaposition of the innominate artery against the trachea. Neurologically impaired patients often show a juxtaposition or compression of the innominate artery against the trachea by chest deformity in the setting of severe scoliosis, which could result in a trachea-innominate artery fistula. For intractable aspiration, laryngotracheal separation is safely performed and effective in controlling aspiration, but is occasionally complicated by trachea-innominate artery fistula. As an alternative procedure, we performed a closure of the larynx in these three cases, using double flaps of the vocal folds and false vocal folds, as a treatment for intractable aspiration. After operation, the patients did well without complication or clinical evidence of recurrent aspiration.

Vocal cord schwannoma: A rare case report

Schwannomas of the larynx are rare benign tumors, most commonly involving aryepiglottic folds or false vocal folds. When a tumor involves vocal cord, it causes clinical symptoms like hoarseness of voice and foreign body sensation. We report the CT and magnetic resonance imaging findings in a 19-year-old male patient with vocal cord mass histologically diagnosed as a vocal cord schwannoma.

Treatment of Functional Ventricular Fold Phonation by Temporary Suture Lateralization

Ventricular fold phonation (VFP) is a phenomenon characterized by phonation using the false vocal folds. Besides a substitution voice due to loss of the true vocal folds-so called compensatory type-the noncompensatory types have a psychogenic, functional, or habitual background. Therapeutic options for these cases so far comprise voice therapy, pharmacological therapy (injection of anesthetics or botulinum toxin), and, in case of failure, surgical resection of the ventricular folds. Indication for aggressive surgical interventions is usually difficult, as there is always a risk of producing an irreversible state with an even worse situation. We present two cases of functional (psychogenic) VFP treatment refractory to conservative treatment. Lateralization of the ventricular folds by an endo-extralaryngeal temporary suture, similar to that used in bilateral vocal fold paralysis, was performed. Immediately after the procedure, a constant phonation at glottic level could be achieved in both cases. Sutures were removed 4 days after surgery, and phonation remained at the glottic level. Vocal fold phonation could be stabilized in the long run, and both patients recovered completely under additional voice therapy.

Differentiated Vocal Tract Control and the Reliability of Interpretations of Nasendoscopic Assessment

Training specific vocal techniques can be effective in treating nonorganic dysphonias. Evaluation of vocal function in these studies has included auditory-perceptual assessment, aerodynamic measurement, acoustic analysis, self-report, and visual inspection of the larynx. Reliability of judgments made using visual rating tools for nasendoscopic and videostroboscopic visualization of the larynx when diagnosing vocal function and disorder has been the focus of previous research. However, detailed analysis of factors that affect reliability and consistency of perceptual ratings of laryngoscopic footage has not been investigated in voice therapy outcome studies. This study evaluated clinicians' judgments of the effectiveness of training differentiated vocal tract control of false vocal fold activity (FVFA), true vocal fold mass (TVFM) and larynx height (LH). A within-subject, experimental design was used to assess participants' mastery in manipulating FVFA, TVFM, and LH assessed via laryngoscopic visualization of the larynx. Three experienced speech pathologists rated the nasendoscopy footage with accompanying acoustic recordings of 12 speakers. Intrajudge consistency, interjudge reliability, and interjudge agreement of perceptual ratings were investigated. Twelve vocally trained unimpaired speakers used differentiated biomechanical manipulation of various laryngeal muscles to produce eight specific vocal qualities each. These manipulated vocal qualities were rated by three experienced voice clinicians who demonstrated higher levels of intrajudge consistency and interjudge agreement when identifying rather than quantifying the degree of a voice quality based on their visual and auditory perceptions of the different vocal features. The findings suggest that unimpaired speakers can be trained successfully to manipulate and change individual biomechanical aspects of their vocal functions as demonstrated by the visual- and auditory-perceptual judgments of expert voice clinicians. These judgments are vulnerable to issues of reliability and suggests that judges used auditory-perceptual judgments when interpreting laryngoscopic footage, particularly when the view of laryngeal features is compromised.

Spontaneous perforation of cervical oesophagus: a rare variant of Boerhaave's syndrome

A 29-year-old man presented with sudden onset of severe pain in his throat, difficulty breathing and a hoarse voice, following an episode of vomiting. Initial laboratory tests were normal. The patient underwent fibre-optic nasendoscopy, which demonstrated a haematoma in the piriform fossa. Lateral neck radiography and subsequent computed tomography scanning confirmed a 2 cm, loculated, gas-containing collection at the level of the vallecula in the right posterolateral wall, extending to the false vocal folds and communicating between the right parapharyngeal space and the right carotid sheath. Water-soluble contrast swallow confirmed the diagnosis. Contained oesophageal perforation. Conservative treatment was adopted involving nil orally, intravenous antibiotics and nasogastric feeding. The patient made an uneventful recovery.

Congenital Saccular Cyst of the Larynx

Congenital Saccular Cyst of the Larynx

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. In this study, a high fidelity, two-dimensional computational model, which combines an immersed boundary method for the airflow and a continuum, finite-element method for the vocal folds, is used to examine the effect of the false vocal folds on flow-induced vibration (FIV) of the true vocal folds and the dynamics of the glottal jet. The model is notionally based on a laryngeal CT scan and employs realistic flow conditions and tissue properties. Results show that the false vocal folds potentially have a significant impact on phonation. The false vocal folds reduce the glottal flow impedance and increase the amplitude as well as the mean glottal jet velocity. The false vocal folds also enhance the intensity of the monopole acoustic sources in the glottis. A mechanism for reduction in flow impedance due to the false vocal folds is proposed.

Endoscopic Repair of Anterior Glottic Web Using a False Vocal Fold Microflap as a Biological Keel

The LaryngoscopeVolume 119, Issue S3 p. S266-S266 Triological Society 2009 Annual Meeting Poster Session Endoscopic Repair of Anterior Glottic Web Using a False Vocal Fold Microflap as a Biological Keel Murtaza T. Ghadiali MD, Murtaza T. Ghadiali MD UCLA Voice Center, Los Angeles, CaliforniaSearch for more papers by this authorRonen Nazarian MD, Ronen Nazarian MD UCLA Voice Center, Los Angeles, CaliforniaSearch for more papers by this authorDinesh K. Chhetri MD, Dinesh K. Chhetri MD UCLA Voice Center, Los Angeles, CaliforniaSearch for more papers by this authorGerald S. Berke MD, Gerald S. Berke MD UCLA Voice Center, Los Angeles, CaliforniaSearch for more papers by this author Murtaza T. Ghadiali MD, Murtaza T. Ghadiali MD UCLA Voice Center, Los Angeles, CaliforniaSearch for more papers by this authorRonen Nazarian MD, Ronen Nazarian MD UCLA Voice Center, Los Angeles, CaliforniaSearch for more papers by this authorDinesh K. Chhetri MD, Dinesh K. Chhetri MD UCLA Voice Center, Los Angeles, CaliforniaSearch for more papers by this authorGerald S. Berke MD, Gerald S. Berke MD UCLA Voice Center, Los Angeles, CaliforniaSearch for more papers by this author First published: 11 January 2011 https://doi.org/10.1002/lary.21524Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume119, IssueS3Supplement: Triological Society 2009 Annual Meeting Poster Session2009Pages S266-S266 RelatedInformation