Publications by authors named "Jack Jiang"

247 Publications

The Effect of Mandarin Vowels on Acoustic Analysis: A Prospective Observational Study.

J Voice 2022 May 1. Epub 2022 May 1.

Eye & ENT Hospital of Fudan University, Department of Otolaryngology Head & Neck Surgery, China; Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Objectives: Although vowels are of interest for acoustic analysis in clinics, there is no consensus regarding the effect of vowel selection on acoustic perturbation parameters. This study aimed to reveal the effects of Mandarin vowels on acoustic measurements.

Study Design: A prospective observational study.

Methods: This prospective observational study enrolled normal phonation Mandarin speakers at the Otolaryngology Department of the Eye & ENT Hospital affiliated with Fudan University from December 2020 to August 2021. This study recruited 107 normal-voiced Mandarin speakers (59 women and 49 men) with a median age of 26 (22, 33) years old. The objective measures included traditional acoustic parameters (fundamental frequency, harmonic-to-noise ratio, percent jitter, and percent shimmer) and cepstral analysis (smoothed cepstral peak prominence) of six Mandarin vowels (ɑ /a/, o /o/, e /ɤ/, i /i/, u /u/, ü /y/).

Results: The acoustic analysis revealed no significant differences in the fundamental frequency among vowels. The low vowel /a/ had the highest values for percent jitter and percent shimmer and the lowest harmonic-to-noise ratio value. The back vowel /u/ had the lowest cepstral measures (P < 0.05).

Conclusions: The acoustic analysis significantly varied across the different Mandarin vowels, and these differences must be considered for the effective clinical application of objective evaluations.
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http://dx.doi.org/10.1016/j.jvoice.2022.03.028DOI Listing
May 2022

Glottic Insufficiency in the Vertical Plane in Patients With Unknown-Source Unilateral Vocal Fold Hypomobility.

J Voice 2022 Apr 22. Epub 2022 Apr 22.

Department of Voice, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China. Electronic address:

Objective: To observe the laryngeal CT and strobe laryngoscopy signs of unilateral vocal fold hypomobility (UVFHM) in patients with well-closed glottises in the horizontal plane.

Methods: A retrospective analysis was performed on 18 subjects with well-closed glottises in the horizontal plane using strobe laryngoscopy, 9 patients diagnosed with unilateral vocal fold hypomobility with an unknown etiology were enrolled in the UVFHM group, and 9 healthy matched subjects with symmetrical bilateral vocal fold movement were enrolled in the control group. Vertical plane distances of bilateral vocal folds and three-dimensional structural parameters of vocal folds were measured through laryngeal CT. Glottic insufficiency in the vertical plane and reflux findings scores (RFS) were assessed under laryngeal CT and strobe laryngoscopy. Reflux symptom index (RSI) were collected. SPSS25.0 software was used for statistical analysis.

Results: The height differences in vertical plane and thicknesses of bilateral vocal folds in the UVFHM group were larger than those in the control (P < 0.05), while the length, width and subglottic convergence angle of the vocal folds were not statistically significant between the two groups (P > 0.05). In the UVFHM group, laryngeal CT showed that 77.78% of patients (7/9) had glottic insufficiency in the vertical plane, with height differences ranging from 0.3 to 1.9 mm and a mean of 0.76mm. However, strobe laryngoscopy showed that 33.33% (3/9) had glottic insufficiency in the vertical plane. The proportion of patients with glottic insufficiency in vertical plane in the UVFHM group was significantly higher than that in the control group (P < 0.05). RSI and RFS scores of the UVFHM group were higher than those of the control group (P < 0.05).

Conclusion: Glottic insufficiency in the vertical plane often occurred in patients with UVFHM with an unknown cause of hoarseness, so the presence of glottic insufficiency in the vertical plane should be considered when hoarseness is detected by clinicians. Laryngeal dynamic CT can enhance the diagnostic rate compared to strobe laryngoscopy. Unexplained UVFHM patients have higher RSI and RFS compared to control subjects, warranting further research about the relationship between UVFHM and laryngopharyngeal reflux.
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http://dx.doi.org/10.1016/j.jvoice.2022.03.025DOI Listing
April 2022

Chaos Behavior Analysis of Alaryngeal Voices Including Esophageal (SE) and Tracheoesophageal (TE) Voices.

Folia Phoniatr Logop 2022 Jan 20. Epub 2022 Jan 20.

Hypothesis/Objectives This study's objective was to develop a method to the evaluate the chaotic characteristic of alaryngeal speech. The proposed method will be capable of distinguishing between normal and alaryngeal voices, including esophageal (SE) and tracheoesophageal (TE) voices. It has been previously shown that alaryngeal voices exhibit chaotic characteristics due to the aperiodicity of their signals. The proposed method will be applied for future use to quantify both chaos behavior and the difference between SE and TE voices. Study Design A total of 74 voice recordings including 34 normal and 40 alaryngeal (26 esophageal (SE) and 14 tracheoesophageal (TE)) were used in the study. Voice samples were analyzed to distinguish alaryngeal voices from normal voices and investigate different chaotic characteristics of SE and TE speech. Methods A chaotic distribution detection-based method was used to investigate the chaos behavior of alaryngeal voices. This chaos behavior was used to detect the difference between SE and TE voice types. Quantification of the chaos behavior (CB) parameter was performed. Statistical analyses were used to compare the results of the CB analysis for both the SE and TE voices. Results Statistical analysis revealed that CB effectively differentiated between all normal and alaryngeal voice types (P<0.01). Subsequent multiclass receiver operating characteristic (ROC) analysis demonstrated that CB (area under the curve) possessed the greatest classification accuracy relative to Correlation dimension (D2). Conclusions The CB metric shows strong promise as an accurate, useful metric for objective differentiation between all normal and alaryngaeal, SE and TE voice types. The CB calculations showed expected results, as SE voices have significantly more chaos behavior than TE voices, constituting substantial improvement over previous methods and becoming the first SE and TE classification method. This metric can help clinicians obtain additional acoustical information when monitoring the efficacy of treatment for patients undergoing total laryngectomies.
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http://dx.doi.org/10.1159/000521222DOI Listing
January 2022

Anterior glottoplasty: the effect of inclusion of the vocal fold lamina propria to frequency elevation.

Acta Otolaryngol 2022 Jan 28;142(1):89-93. Epub 2021 Dec 28.

Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.

Background: Anterior glottoplasty is a commonly used treatment for voice feminization. But it remains in dispute over whether to suture of the ligament as part of the procedure.

Objectives: This study aimed to explore the effect of inclusion of the vocal lamina propia.

Material And Methods: Anterior webs were created in 8 excised canine larynges by sutures placed at 10%, 20%, and 30% of the vocal fold length, respectively. The suture depth was divided into two groups: epithelium layer (Shallow Suture, SS group) and deep layers of vocal fold lamina propia (Deep Suture, DS group).

Results: For anterior webs between 0% and 30%, the frequency elevation ranged from 3% to 151% of the pre-web fundamental frequency (fo) in SS group and from 13% to 222% in DS group. No significance was found between two groups at three different sutures ( = .486 for suture at 10% of vocal fold length, 0.686 for 20%, 0.886 for 30%, respectively).

Conclusions And Significance: The frequency in excised canine larynx increased continuously as the anterior glottic webs ranged from 0% to 30%. The inclusion of the vocal fold lamina propia does not affect the frequency elevation.
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http://dx.doi.org/10.1080/00016489.2021.2016953DOI Listing
January 2022

Phonosurgery: A review of current methodologies.

World J Otorhinolaryngol Head Neck Surg 2021 Oct 30;7(4):344-353. Epub 2020 Dec 30.

University of Wisconsin Madison School of Medicine and Public Health, United States.

Cold-steel has served as the gold standard modality of phonosurgery for most of its history. Surgical laser technology has revolutionized this field with its wide use of applications. Additional modalities have also been introduced such as coagulative lasers, photodynamic therapy, and cryotherapy. This review will compare the surgical modalities of cold steel, surgical lasers, phototherapy and cryotherapy. The mechanism of action, tissue effects and typical uses will be addressed for each modality.
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http://dx.doi.org/10.1016/j.wjorl.2020.09.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8486699PMC
October 2021

Asiatic Acid Improves Extracellular Matrix Remodeling in Vocal Fold Scarring Via SMAD7 Activation.

Laryngoscope 2022 Jun 30;132(6):1237-1244. Epub 2021 Sep 30.

ENT Institute and Otorhinolaryngology, Department of Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.

Objectives/hypothesis: Vocal fold (VF) fibroblasts are the central target for developing new strategies for the treatment of VF scarring and fibrosis. Asiatic acid (AA) is a triterpenoid derivate with antifibrotic properties. However, the effect of AA in VF scarring is poorly understood. The objective of this study was to investigate the potential application of AA as a therapeutic treatment in VF scarring.

Study Design: Xxxxx.

Methods: The functional expression of SMAD7 was knocked down with recombinant adenoviruses and adeno-associated viruses carrying shRNAs in the in vitro and in vivo models, which were constructed to investigate AA's antifibrotic function. The expression of collagens and SMADs in cultured human and rabbit cell lines and animal models was evaluated with quantitative reverse transcription polymerase chain reaction and immunohistochemistry labeling, respectively. Cell migration capacity and contraction in VF fibroblast cell lines were also evaluated.

Results: AA downregulated the downstream fibrotic activation in a dose-dependent manner. Meanwhile, AA attenuated VF scarring/fibrosis by reducing collagen deposition. Furthermore, the antifibrotic effects of AA were associated with the upregulation of SMAD7. In contrast, knockdown of SMAD7 inhibited the effect of AA on transforming growth factor-beta-1 (TGF-β1) stimulation, which suggests a central role for SMAD7 in AA-induced antifibrotic activities during VF fibrosis.

Conclusion: We concluded that AA, which is a novel therapeutic candidate for preventing VF scarring/fibrosis, might exert its antifibrotic effect via the TGF-β1/SMAD signaling pathway.

Level Of Evidence: NA Laryngoscope, 132:1237-1244, 2022.
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http://dx.doi.org/10.1002/lary.29884DOI Listing
June 2022

Effectiveness and Feasibility of Telepractice on Voice Therapy for Female Teachers in Elementary Schools with Self-Reported Voice Disorders.

J Voice 2021 Sep 25. Epub 2021 Sep 25.

University of Wisconsin-Madison.

Purpose: The purpose of this study is to explore the effectiveness of telepractice in voice intervention for female teachers in elementary schools with self-reported voice disorders.

Methods: Thirty-five female elementary school teachers with self-reported voice disorders volunteered to participate in the study. They were divided into a telepractice voice intervention group (experimental group N=18) and a face-to-face voice intervention group (control group N=17) based on their employment setting. The exact same treatment protocol was applied to both groups of subjects, except that the intervention group was seen through telepractice, and the control group was seen face-to-face. The treatment protocol includes vocal hygiene education and resonant voice therapy twice a week for a total of eight sessions. Auditory perceptual analysis, acoustic assessment, aerodynamic assessment and self-assessment protocol were conducted before the intervention and one week after the last intervention, and the differences before and after interventions within each group and between groups were compared.

Results: There was no significant difference in baseline data including age, working years, and voice symptoms between the two groups. Both groups showed significant improvement (P<0.05) in all voice assessment before and after the treatment sessions, except for the Voice Handicap Index-10 (VHI-10) assessment. No statistical difference was found in other pre- and post-intervention voice assessment changes between the two study groups. The control group presented higher improvement in the total score, and the two subdomain assessments of physiology and emotion.

Conclusions: Telepractice voice intervention can effectively improve the voice quality of female teachers in elementary schools, and telepractice therapy can be an effective alternative to face-to-face voice intervention.
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http://dx.doi.org/10.1016/j.jvoice.2021.07.015DOI Listing
September 2021

The integrity and barrier function of porcine vocal fold epithelium: its susceptibility to damage by deoxycholic acid compared with pepsin.

Eur Arch Otorhinolaryngol 2021 Dec 22;278(12):4893-4899. Epub 2021 Jul 22.

The Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.

Purpose: In this study, we aim to systematically evaluate the damaging role of gastric (pepsin and acid) and duodenal ingredients (bile acids) on vocal fold epithelium in excised porcine larynges.

Methods: Fresh ex vivo porcine larynges were exposed to one of five experimental conditions for 1 h. These conditions will be referred to as alkaline deoxycholic acid, acidic pepsin, acid pH3 only, acid pH5 only, and control, respectively. A Franz diffusing cell was used to evaluate the barrier function of vocal fold epithelium by measuring the permeability to fluorescein isothiocyanate dextran of 4 kDa. Histological changes were observed using transmission electron microscopy.

Results: After immersing the fresh porcine larynges in the five solution groups, we found that the vocal fold epithelium in the deoxycholic acid group had more permeability to FD4 than the pepsin group (P < 0.001). Fragmentation and desquamation of dead cell layers were observed in both the pepsin and deoxycholic acid groups, but were more severe in the deoxycholic acid group than the pepsin group. The thickness of the dead epithelial cell layer gradually increased with increasing acid concentration (P < 0.05). Additionally, the thickness of the dead epithelial cell layer in the deoxycholic acid group was significantly higher than that in the pepsin group (P < 0.01).

Conclusion: Deoxycholic acid in a weakly acidic condition is more likely than pepsin to induce apoptosis in ex vivo porcine vocal fold epithelium, destroy the link proteins between epithelial cells, and affect their integrity and barrier function.
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http://dx.doi.org/10.1007/s00405-021-06997-xDOI Listing
December 2021

Evaluating the Voice Type Component Distributions of Excised Larynx Phonations at Three Subglottal Pressures.

J Speech Lang Hear Res 2021 05 22;64(5):1447-1456. Epub 2021 Apr 22.

Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health.

Purpose The excised canine larynx provides an advantageous experimental framework in the study of voice physiology. In recent years, signal processing methods have been applied to analyze phonations in excised canine larynx experiments. However, phonations have a highly complex and nonstationary nature corresponding to different proportions of regular and chaotic signal elements. Current nonlinear dynamic methods that are used to assess the degree of irregularity in the voice fail to recognize the distribution of voice type components (VTCs). Method Based on measures of intrinsic dimension, this article presents a method to analyze the VTC distribution of phonations in excised canine larynx experiments. Thirty-nine phonation samples from 13 excised canine larynges at three different subglottal pressures were analyzed. Results Phonation produced with subglottal pressures above phonation instability pressure (PIP) and below phonation threshold pressure (PTP) resulted in high proportions of Voice Types 3 and 4, characterized by chaotic and noisy signals. Phonation produced with pressure between PTP and PIP contained mostly Type 1 voice, characterized by a regular and nearly periodic signal. Mean proportions of all VTCs varied significantly in comparisons of phonations produced with Sub-PTP and PTP as well as in comparisons of phonations produced with PTP and PIP. Conclusions Across all VTCs, the VTC profiles of normal and abnormal phonation differ significantly. Normal phonation is strongly associated with VTC (Voice Type Component 1), whereas abnormal phonation exhibits increased VTC (Voice Type Component 4). The study further demonstrates the ability of intrinsic dimension to successfully detect multiple voice types in an acoustic signal and highlights the need for expanded use of intrinsic dimension in human voice. Supplemental Material https://doi.org/10.23641/asha.14417585.
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http://dx.doi.org/10.1044/2021_JSLHR-20-00429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608150PMC
May 2021

Spectral arc length as a method to quantify pharyngeal high-resolution manometric curve smoothness.

Neurogastroenterol Motil 2021 10 20;33(10):e14122. Epub 2021 Apr 20.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Background: Pharyngeal high-resolution manometry (HRM) has emerged over the last decade as a valuable assessment tool for oropharyngeal dysphagia. Data analysis thus far has focused primarily on measures of pressure and duration within key anatomic regions. We apply spectral arc length (SPARC), a dimensionless metric for quantifying smoothness felt to indirectly reflect neuromuscular coordination, as a new method of describing manometric curves. We then use it to distinguish swallows from healthy subjects and those with dysphagia related to stroke.

Methods: Previously collected pharyngeal HRM data from eight subjects with history of stroke and eight age- and sex-matched controls were reviewed. Receiver operating characteristic (ROC) analysis was used to optimize SPARC inputs. SPARC was then computed for the velopharynx, tongue base, hypopharynx, and upper esophageal sphincter (UES), and the values were compared between the two subject groups.

Results: Optimized parameter settings yielded an ROC curve with area under the curve (AUC) of 0.953. Mean SPARC values differed between control and stroke subjects for the velopharynx (t = 3.25, p = 0.0058), tongue base (t = 4.77, p = 0.0003), and hypopharynx (t = 2.87, p = 0.0124). Values were similar for the UES (t = 0.43, p = 0.671).

Conclusions: In this preliminary study, SPARC analysis was applied to distinguish control from post-stroke subjects. Considering alternative methods of analyzing pharyngeal HRM data may provide additional insight into the pathophysiology of dysphagia beyond what can be gleaned from measures of pressure and duration alone.
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http://dx.doi.org/10.1111/nmo.14122DOI Listing
October 2021

The Influence of Voice Training on Vocal Learner's Objective Acoustic Voice Components.

J Voice 2021 Feb 27. Epub 2021 Feb 27.

Department of Voice, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China. Electronic address:

Objective: Acoustic parameters of voice were studied in music majors throughout 18 months of training to understand the influence of voice training on voice.

Methods: Twenty-three students from Xiamen Music School between 12 and 15 years old were enrolled. Acoustic examination was performed three times- every 6 months for 18 months. Various traditional acoustic parameters were measured, including dysphonia severity index (DSI), jitter, and D-value of vocal range. Nonlinear dynamic measures were also measured, including diffusive chaos to construct voice type component profiles (VTCPs), spectrum convergence ratio, and nonlinear energy difference ratio. The results were analyzed by multivariate analysis of variance.

Results: Over the study duration, there was an improvement of DSI (P = 0.002), and D-value of vocal range (P = 0.000). Among nonlinear parameters, only voice type component data demonstrated significant changes during the study duration. Both Voice Type Component 1(VTC1) and VTC3 values differed from Time 1 to Time 2 as well as from Time 1 to Time 3. The proportion of VTC1 in samples generally decreased, while VTC3, representative of aperiodicity, increased. Both nonlinear energy difference ratio and spectrum convergence ratio exhibited no significant changes throughout the study.

Conclusion: Professional voice training can improve DSI and D-value of vocal range in singers' voices. These parameters have potential to be used for voice training evaluation and screening. Many nonlinear parameters did not detect differences in the healthy voices studied, but VTCPs created using intrinsic dimension present a valuable new method, visualizing increases in aperiodicity of the speaking voices after professional voice training.
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http://dx.doi.org/10.1016/j.jvoice.2021.01.011DOI Listing
February 2021

Age and Sex Comparison of Aerodynamic Phonation Measurements Using Noninvasive Assessment.

J Speech Lang Hear Res 2021 03 19;64(3):776-791. Epub 2021 Feb 19.

Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison.

Purpose The goal of this study was to present vocal aerodynamic measurements from pediatric and adult participant pools. There are a number of anatomical changes involving the larynx and vocal folds that occur as children age and become adults. Data were collected using two methods of noninvasive aerodynamic assessment: mechanical interruption and labial interruption. Method A total of 154 participants aged 4-24 years old took part in this study. Ten trials were performed for both methods of airway interruption. To perform mechanical interruption, participants phonated /α/ for 10 s trials while a balloon valve interrupted phonation 5 times. For labial interruption, participants said /pα/ 5 times at comfortable and quiet volumes. Aerodynamic measures included subglottal pressure, phonation threshold pressure, mean airflow, laryngeal resistance, and others. Results One hundred one participants (51 females) successfully completed testing with both methods. Eight out of 20 measurements were found to have a statistically significant effect of participant age on measurements. Sex alone had a significant effect on vocal efficiency for the labial quiet method. Conclusions The data discussed here can be used to view age and sex trends in vocal aerodynamic measurements. When using either method of mechanical or labial interruption, participant age needs to be taken into account to properly interpret several aerodynamic parameters. A participant's sex is not as important when using these methods.
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http://dx.doi.org/10.1044/2020_JSLHR-20-00501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8608227PMC
March 2021

Laryngopharyngeal Reflux and Inflammatory Responses in Mucosal Barrier Dysfunction of the Upper Aerodigestive Tract.

J Inflamm Res 2020 5;13:1291-1304. Epub 2021 Jan 5.

Otorhinolaryngology Department, ENT Institute, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, NHC Key Laboratory of Hearing Medicine Research, Fudan University, Shanghai 200032, People's Republic of China.

The upper aerodigestive tract (UAT) is the first line of defense against environmental stresses such as antigens, microbes, inhalants, foods, etc., and mucins, intracellular junctions, epithelial cells, and immune cells are the major constituents of this defensive mucosal barrier. Laryngopharyngeal reflux (LPR) is recognized as an independent risk factor for UAT mucosal disorders, and in this review, we describe the components and functions of the mucosal barrier and the results of LPR-induced mucosal inflammation in the UAT. We discuss the interactions between the refluxate and the mucosal components and the mechanisms through which these damaging events disrupt and alter the mucosal barriers. In addition, we discuss the dynamic alterations in the mucosal barrier that might be potential therapeutic targets for LPR-induced disorders.
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http://dx.doi.org/10.2147/JIR.S282809DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801919PMC
January 2021

To Explore the Changes and Differences of Microstructure of Vocal Fold in Vocal Fold Paralysis and Cricoarytenoid Joint Dislocation by Diffusion Tensor Imaging.

J Voice 2020 Dec 31. Epub 2020 Dec 31.

Department of Voice, Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China. Electronic address:

Objective: The diffusion characteristics of water molecules were measured in the vocal folds of canines exhibiting unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation. These characteristics were used in conjunction with a histological examination of the microstructural changes of vocal fold muscle fibers to explore the feasibility of diffusion tensor imaging (DTI) in distinguishing unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation as well as evaluating microstructural changes.

Methods: Ten beagles were randomly divided into three groups: four in the unilateral vocal fold paralysis group, four in the unilateral cricoarytenoid joint dislocation group, and two in the normal group. Unilateral recurrent laryngeal nerve resection was performed in the vocal fold paralysis group. Unilateral cricoarytenoid joint dislocation surgery was performed in the dislocation group. No intervention was performed in the normal group. Four months postintervention, the larynges were excised and put into a magnetic resonance imaging (MRI) system (9.4T BioSpec MRI, Bruker, German) for scanning, followed by an analysis of diffusion parameters among the different groups for statistical significance. After MRI scanning, the vocal folds were cut into sections, stained with hematoxylin and eosin, and scanned digitally. The mean cross-sectional area of muscle fibers, and the mean diameter of muscle fibers in the vocal folds were calculated by target detection and extraction technology. Mean values of each measurement were used to compare the differences among the three groups. Pearson correlation analysis was performed on the DTI parameters and the results from histological section extraction.

Results: The paralysis group had significantly higher Fractional Anisotropy (FA) compared to the dislocation group and normal group (P = 0.004). The paralysis group also had a significantly lower Tensor Trace value compared to the dislocation group and normal group (P = 0.000). The average cross-sectional area of vocal fold muscle fibers in the paralysis group was significantly smaller than the dislocation group and normal group (P = 0.000). Pearson correlation analysis yielded values of, r = -0.785, P = 0.01 between the average cross-sectional area of vocal muscle fibers and FA, and values of r = 0.881, P = 0.00 between Tensor Trace and the average cross-sectional area of vocal muscle.

Conclusion: FA and Tensor Trace can be used as effective parameters to reflect the changes of microstructure in vocal fold paralysis and cricoarytenoid joint dislocation. DTI is an objective and quantitative method to effectively evaluate unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation, also capable of noninvasively evaluating vocal fold muscle fiber microstructure.
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http://dx.doi.org/10.1016/j.jvoice.2020.12.016DOI Listing
December 2020

Nonadiabatic coupling of the dynamical structure to the superconductivity in YSrCuMoO and SrCuO.

Proc Natl Acad Sci U S A 2020 Dec 14;117(52):33099-33106. Epub 2020 Dec 14.

Department of Complex Matter, Jozef Stefan Institute, 1000 Ljubljana, Slovenia.

A crucial issue in cuprates is the extent and mechanism of the coupling of the lattice to the electrons and the superconductivity. Here we report Cu K edge extended X-ray absorption fine structure measurements elucidating the internal quantum tunneling polaron (iqtp) component of the dynamical structure in two heavily overdoped superconducting cuprate compounds, tetragonal YSrCuMoO with superconducting critical temperature, T = 84 K and hole density = 0.3 to 0.5 per planar Cu, and the tetragonal phase of SrCuO with T = 95 K and = 0.6. In YSrCuMoO changes in the Cu-apical O two-site distribution reflect a sequential renormalization of the double-well potential of this site beginning at T, with the energy difference between the two minima increasing by ∼6 meV between T and 52 K. SrCuO undergoes a radically larger transformation at T, >1-Å displacements of the apical O atoms. The principal feature of the dynamical structure underlying these transformations is the strongly anharmonic oscillation of the apical O atoms in a double-well potential that results in the observation of two distinct O sites whose Cu-O distances indicate different bonding modes and valence-charge distributions. The coupling of the superconductivity to the iqtp that originates in this nonadiabatic coupling between the electrons and lattice demonstrates an important role for the dynamical structure whereby pairing occurs even in a system where displacements of the atoms that are part of the transition are sufficiently large to alter the Fermi surface. The synchronization and dynamic coherence of the iqtps resulting from the strong interactions within a crystal would be expected to influence this process.
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http://dx.doi.org/10.1073/pnas.2018336117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7776783PMC
December 2020

Study of spatiotemporal liquid dynamics in a vibrating vocal fold by using a self-oscillating poroelastic model.

J Acoust Soc Am 2020 10;148(4):2161

Department of Surgery, Division of Otolaryngology - Head & Neck Surgery, University of Wisconsin Medical School of Medicine and Public Health, Madison, Wisconsin 53792-7375, USA.

The main purpose of this study is to investigate the spatiotemporal interstitial fluid dynamics in a vibrating vocal fold. A self-oscillating poroelastic model is proposed to study the liquid dynamics in the vibrating vocal folds by treating the vocal fold tissue as a transversally isotropic, fluid-saturated, porous material. Rich spatiotemporal liquid dynamics have been found. Specifically, in the vertical direction, the liquid is transported from the inferior side to the superior side due to the propagation of the mucosal wave. In the longitudinal direction, the liquid accumulates at the anterior-posterior midpoint. However, the contact between the two vocal folds forces the accumulated liquid out laterally in a very short time span. These findings could be helpful for exploring etiology of some laryngeal pathologies, optimizing laryngeal disease treatment, and understanding hemodynamics in the vocal folds.
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http://dx.doi.org/10.1121/10.0002163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575330PMC
October 2020

Materializing rival ground states in the barlowite family of kagome magnets: quantum spin liquid, spin ordered, and valence bond crystal states.

NPJ Quantum Mater 2020 ;5(1)

Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, Menlo Park, CA 94025, USA.

The spin- kagome antiferromagnet is considered an ideal host for a quantum spin liquid (QSL) ground state. We find that when the bonds of the kagome lattice are modulated with a periodic pattern, new quantum ground states emerge. Newly synthesized crystalline barlowite (Cu(OH)FBr) and Zn-substituted barlowite demonstrate the delicate interplay between singlet states and spin order on the spin- kagome lattice. Comprehensive structural measurements demonstrate that our new variant of barlowite maintains hexagonal symmetry at low temperatures with an arrangement of distorted and undistorted kagome triangles, for which numerical simulations predict a pinwheel valence bond crystal (VBC) state instead of a QSL. The presence of interlayer spins eventually leads to an interesting pinwheel = 0 magnetic order. Partially Zn-substituted barlowite (CuZn(OH)FBr) has an ideal kagome lattice and shows QSL behavior, indicating a surprising robustness of the QSL against interlayer impurities. The magnetic susceptibility is similar to that of herbertsmithite, even though the Cu impurities are above the percolation threshold for the interlayer lattice and they couple more strongly to the nearest kagome moment. This system is a unique playground displaying QSL, VBC, and spin order, furthering our understanding of these highly competitive quantum states.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558222PMC
January 2020

Comparison Between Combination of Resonant Voice Therapy and Vocal Hygiene Education and Vocal Hygiene Education Only for Female Elementary School Teachers.

J Voice 2020 Oct 13. Epub 2020 Oct 13.

University of Wisconsin-Madison.

Objective: The study compares the rehabilitation outcome of two voice intervention methods for female elementary school teachers with self-reported voice disorders.

Methods: A total of 34 female teachers from two primary schools volunteered in the study. Participants from one school were assigned to the experimental group (16 teachers), who received the combination of vocal hygiene education and resonant voice therapy. Participants from the other school were assigned to the control group (18 teachers), who received vocal hygiene education only. Pre- and post-treatment data were compared.

Result: The total score of the Voice Handicap Index (VHI) decreased significantly from 12.19 ± 8.58 to 8.63 ± 7.27 (P < 0.05); the functional score of VHI significantly decreased from 5.38 ± 3.9 to 3.81 ± 3.62 (P < 0.05). No statistical significance was found in physiological and emotional scores of VHI. No statistical significance was found in the control group. In the experimental group, the maximum phonation time was increased from 14.34 ± 6.80s to 17.21 ± 6.06s (P < 0.05), Jitter decreased from 0.45% ± 0.13% to 0.26% ± 0.05% (P < 0.05), and Shimmer decreased from 0.21 ± 0.10. to 0.12 ± 0.03 (P < 0.05). Furthermore, the harmonic to noise ratio increased from 23.06 ± 2.99 to 25.23 ± 1.92 (P < 0.05), Spectrum Convergence Ratio increased from 0.53 ± 0.12 to 0.60 ± 0.11 (P < 0.05), yet no statistical significance was found in Nonlinear Energy Difference Ratio data for the experimental group. No statistical significance was found in the control group. In the auditory perception assessment (GRBAS), the G score decreased from 1.19 ± 0.54 to 0.81 ± 0.40 (P < 0.05), and the R score decreased from 1.19 ± 0.54 to 0.75 ± 0.45 (P < 0.05) in the experimental group. No statistical significance was found in the B, A, and S scores in the experimental group; moreover, none of the GRBAS scores in the control group demonstrated statistical significance. In the voice type component profile (VTC), the proportion of VTC1 of the experimental group increased significantly, while the proportions of VTC3 and VTC4 decreased significantly, indicating the improvement of voice quality was obvious after the intervention. The proportions of VTC of the control group did not demonstrate significant change.

Conclusion: The results of this study show that a combination of vocal hygiene education and resonant voice therapy can significantly improve the voice function of professional voice users and effectively improve their voice quality. In this study, the professional voice users receiving vocal hygiene education only did not show significant improvement of their voice quality.
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http://dx.doi.org/10.1016/j.jvoice.2020.09.028DOI Listing
October 2020

Biomarkers for Malignant Potential in Vocal Fold Leukoplakia: A State of the Art Review.

Otolaryngol Head Neck Surg 2021 04 29;164(4):751-758. Epub 2020 Sep 29.

Department of Otolaryngology, Geisinger Health System, Danville, Pennsylvania, USA.

Objective: To explore biomarkers that are candidates for understanding potential degeneration to malignancy of vocal fold leukoplakia (VFL), with the goal of guiding future diagnostic and treatment recommendations.

Data Sources: PubMed and Medline search engines.

Review Methods: A systematic review was conducted by searching the following key words: or , coupled with or , and combined with the term . We collated the biomarkers and their significance, followed by observing the power of their evidence by assessing the quality of the studies according to guidelines of tumor marker prognostic studies (REMARK).

Conclusions: Prognostic biomarkers in the 16 studies are generally divided into 3 categories according to their biological roles: proliferation (Ki-67, CK-1 RS14024 SNP), cell cycle control (P53, p16, cyclin D1, p57kip2, interleukin-10 [IL-10], miR-10a, and miR-34c), cell adhesion, and invasion (neutrophil-to-lymphocyte ratio, OPN/CD44v6 axis, MMP-1, vascular endothelial growth factor A, MMP-9, serpin peptidase inhibitor 1, plasminogen activator, CTNN/B1, β-catenin, NANOG, HERG1). The prognostic use of these biomarkers is limited due to the variable methodologies, study design, assay methods, and statistical analysis performed.

Implications For Practice: Prognostic factors in vocal fold leukoplakia have important clinical implications regarding the potential for malignant degeneration. Although further study is needed, the currently available evidence suggests that p53, p16, cyclin D1, IL-10, NLR, OPN and CD44v6, CTNNB1, and CTTN and FAK might be of particular interest in determining prognosis of VFL as related to malignancy. Future, large, well-designed, prospective studies are expected to determine the prognostic power of these biomarkers before their implementation in routine clinical practice.
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http://dx.doi.org/10.1177/0194599820957251DOI Listing
April 2021

Simulation of Pediatric Endoscopic Cricoid Reduction and Expansion.

OTO Open 2020 Jul-Sep;4(3):2473974X20946268. Epub 2020 Jul 31.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.

Endoscopic cricoid expansion and reduction are newer approaches to the management of pediatric bilateral vocal fold immobility and postlaryngotracheal reconstruction glottic insufficiency, respectively. These procedures offer a less invasive, endoscopic alternative to procedures that typically required open management with a more prolonged recovery. These technically demanding procedures are currently performed only in select centers, and there is no currently described training model for practicing them. We present a modification to a laryngeal dissection station that allows for simulation of endoscopic cricoid reduction and expansion with excised larynges. The model allows trainees to practice endoscopic posterior cricoid exposure, incision of the cricoid cartilage, placement of a simulated costal cartilage graft for expansion, and endoscopic suturing for reduction. Development of simulators for procedures that are infrequently performed have the potential to help trainees reach surgical competency faster and more safely.
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http://dx.doi.org/10.1177/2473974X20946268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416139PMC
July 2020

Probability-Based Best Sample Selection for Acoustic Analysis of Normal and Disordered Voices.

J Voice 2022 Jan 29;36(1):21-26. Epub 2020 May 29.

University of Wisconsin-Madison School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin. Electronic address:

Purpose: Acoustic analysis is a commonly used method for quantitatively measuring vocal fold function. The accuracy of acoustic analysis depends upon the operator selecting a stable segment of the voice sample to analyze. This paper proposes a novel method to more accurately and reliably select a stable voice segment.

Study Design: Four selection methods were implemented to evaluate each raw audio signal and determine the most stable segment of each signal: The proposed modal periodogram method, the moving window method, the midvowel method, and the whole vowel method. Acoustic parameters of interest-namely perturbation (jitter), correlation dimension (D2), and spectrum convergence ratio (SCR)-were calculated for 48 phonation samples to evaluate each method.

Methods: The proposed modal periodogram method utilizes a minimum mean-square error based approach to calculate a stable modal periodogram and obtain the most stable segment. The Wilcoxon Signed-Rank test was used to compare jitter, D2, and SCR values acquired using the modal periodogram method against the current standard segment selection methods.

Results: The modal periodogram method yielded significantly lower D2 values, and a significantly higher SCR for both normal and disordered voice samples (P < 0.01). This indicates that the modal periodogram method is more apt for selecting a stable audio segment than the other selection methods.
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http://dx.doi.org/10.1016/j.jvoice.2020.03.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704568PMC
January 2022

Retest Reliability for Complete Airway Interruption Systems of Aerodynamic Measurement.

J Voice 2022 Jan 4;36(1):27-33. Epub 2020 Apr 4.

University of Wisconsin School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin. Electronic address:

Introduction: Measures of subglottal pressure (Ps), phonation threshold pressure (PTP), and laryngeal resistance (LR) can be used as indicators of vocal cord disorders. The gold standard non-invasive measurement uses labial interruption, which has been shown to have reliability inconsistencies. Mechanical interruption methods have demonstrated promise in measurement reliability. The goal of the present study is to compare retest reliability of labial and mechanical interruption methods.

Methods: 55 subjects aged 18-69 participated. Ten trials were performed for each method. For labial interruption, subjects produced five labial plosives at comfortable and quiet volumes. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times. Thirty subjects completed a second study visit identical to the first approximately two weeks (15 days ± 3.76) after the first visit. Ps, PTP, mean airflow rate, and LR were determined for each subject and retest reliability for each was analyzed.

Results: The percent difference in measurement results for test-retest of Ps were 12.88% ± 10.15 for mechanical interruption and 27.56% ± 17.14 for labial interruption (P = 0.0003). The percent difference for PTP measurements were 21.46% ± 16.01 for mechanical and 17.04% ± 14.62 (P = 0.3372) for labial. Intra-subject coefficients of variation of Ps were 0.086 ± 0.046 for mechanical and 0.161 ± 0.078 for labial (P < 0.0001). For PTP, the coefficients were 0.177 ± 0.083 for mechanical and 0.186 ± 0.091 for labial (P = 0.5402). Lastly, for LR (Ps divided by mean airflow rate) the percent differences were 14.33% ± 10.06 for mechanical and 53.87% ± 43.19 for labial (P < 0.0001) with intra-subject variability of 0.115 ± 0.050 for mechanical and 0.287 ± 0.222 for labial (P < 0.0001).

Conclusions: Ps and LR measured using mechanical interruption showed more consistency for both retesting across separate study visits and intra-subject variability. PTP was similar in retesting and intra-subject variability. Continued work to improve mechanical interruption techniques is warranted as these methods offer higher reliability and consistency than the labial interruption methods.
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http://dx.doi.org/10.1016/j.jvoice.2020.02.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7541393PMC
January 2022

Local lattice distortions and dynamics in extremely overdoped superconducting YSrCuMoO.

Proc Natl Acad Sci U S A 2020 03 18;117(9):4559-4564. Epub 2020 Feb 18.

Center of Excellence on Nanoscience and Nanotechnology Nanocenter, 1000 Ljubljana, Slovenia.

A common characteristic of many "overdoped" cuprates prepared with high-pressure oxygen is values ≥ 50 K that often exceed that of optimally doped parent compounds, despite O stoichiometries that place the materials at the edge or outside of the conventional boundary between superconducting and normal Fermi liquid states. X-ray absorption fine-structure (XAFS) measurements at 52 K on samples of high-pressure oxygen (HPO) YSrCuMoO, = 84 K show that the Mo is in the (VI) valence in an unusually undistorted octahedral geometry with predominantly Mo neighbors that is consistent with its assigned substitution for Cu in the chain sites of the structure. Perturbations of the Cu environments are minimal, although the Cu X-ray absorption near-edge structure (XANES) differs from that in other cuprates. The primary deviation from the crystal structure is therefore nanophase separation into Mo- and Cu-enriched domains. There are, however, indications that the dynamical attributes of the structure are altered relative to YBaCuO, including a shift of the Cu-apical O two-site distribution from the chain to the plane Cu sites. Another effect that would influence is the possibility of multiple bands at the Fermi surface caused by the presence of the second phase and the lowering of the Fermi level.
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http://dx.doi.org/10.1073/pnas.1918704117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060693PMC
March 2020

Local structure of SrCuO, a 95 K cuprate superconductor without CuO planes.

Proc Natl Acad Sci U S A 2020 Mar 14;117(9):4565-4570. Epub 2020 Feb 14.

Stanford Synchrotron Radiation Lightsource, SLAC National Accelerator Laboratory, Menlo Park, CA 94025.

The local structure of the highly "overdoped" 95 K superconductor SrCuO determined by Cu K X-ray absorption fine structure (XAFS) at 62 K in magnetically oriented samples shows that 1) the magnetization is perpendicular to the axis; 2) at these levels of precision the Cu sublattice is tetragonal in agreement with the crystal structure; the O sublattice has 3) continuous -Cu-O- chains that orient perpendicular to an applied magnetic field; 4) approximately half-filled -Cu-O- chains that orient parallel to this field; 5) a substantial number of apical O vacancies; 6) O ions at some apical positions with expanded Cu-O distances; and 7) interstitial positions that imply highly displaced Sr ions. These results contradict the universally accepted features of cuprates that require intact CuO planes, magnetization along the axis, and a termination of the superconductivity when the excess charge on the CuO Cu ions exceeds 0.27. These radical differences in charge and structure demonstrate that this compound constitutes a separate class of Cu-O-based superconductors in which the superconductivity originates in a different, more complicated structural unit than CuO planes while retaining exceptionally high transition temperatures.
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http://dx.doi.org/10.1073/pnas.1918890117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060713PMC
March 2020

The Therapeutic Effects of Straw Phonation on Vocal Fatigue.

Laryngoscope 2020 11 23;130(11):E674-E679. Epub 2020 Jan 23.

Department of Otolaryngology-Head and Neck Surgery, Eye and Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China.

Objectives: Straw phonation has been investigated for its vocal warm-up effects on healthy populations and therapeutic effects on voice patients. The purpose of this article was to determine whether it is beneficial for vocal fatigue.

Study Design: Prospective cohort study METHODS: Twenty-five healthy participants were recruited into 1-hour vocal loading tasks followed by 10-minute vocal rest or straw phonation on 2 different days. Various parameters including phonation threshold pressure (PTP), mean airflow, closed quotient (CQ), current speaking effort level (EFFT), and laryngeal discomfort (DISC) were acquired at baseline, after vocal load, and after the intervention.

Results: Increased PTP, EFFT, and DISC were observed after vocal load. Decreased PTP, EFFT, and DISC were then acquired after both vocal rest or straw phonation. More significant improvements were obtained in straw phonation when compared with vocal rest. Additionally, significantly increased mean flow and decreased CQ were obtained after straw phonation when compared to vocal rest.

Conclusions: Straw phonation has the potential to adjust aerodynamics within the vocal tract leading to improved vocal efficiency, optimized vibration mode, and attenuated vocal fatigue. This study provided a promising treatment for vocal fatigue that could have wide clinical relevance to voice users with high voice demands.

Level Of Evidence: 4 Laryngoscope, 130:E674-E679, 2020.
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http://dx.doi.org/10.1002/lary.28498DOI Listing
November 2020

Site-Specific Structure at Multiple Length Scales in Kagome Quantum Spin Liquid Candidates.

Phys Rev Mater 2020 ;4(12)

Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA.

Realizing a quantum spin liquid (QSL) ground state in a real material is a leading issue in condensed matter physics research. In this pursuit, it is crucial to fully characterize the structure and influence of defects, as these can significantly affect the fragile QSL physics. Here, we perform a variety of cutting-edge synchrotron X-ray scattering and spectroscopy techniques, and we advance new methodologies for site-specific diffraction and L-edge Zn absorption spectroscopy. The experimental results along with our first-principles calculations address outstanding questions about the local and long-range structures of the two leading kagome QSL candidates, Zn-substituted barlowite (CuZn Cu (OH)FBr) and herbertsmithite (CuZn(OH)Cl). On all length scales probed, there is no evidence that Zn substitutes onto the kagome layers, thereby preserving the QSL physics of the kagome lattice. Our calculations show that antisite disorder is not energetically favorable and is even less favorable in Zn-barlowite compared to herbertsmithite. Site-specific X-ray diffraction measurements of Zn-barlowite reveal that Cu and Zn selectively occupy distinct interlayer sites, in contrast to herbertsmithite. Using the first measured Zn L-edge inelastic X-ray absorption spectra combined with calculations, we discover a systematic correlation between the loss of inversion symmetry from pseudo-octahedral (herbertsmithite) to trigonal prismatic coordination (Zn-barlowite) with the emergence of a new peak. Overall, our measurements suggest that Zn-barlowite has structural advantages over herbertsmithite that make its magnetic properties closer to an ideal QSL candidate: its kagome layers are highly resistant to nonmagnetic defects while the interlayers can accommodate a higher amount of Zn substitution.
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http://dx.doi.org/10.1103/physrevmaterials.4.124406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174140PMC
January 2020

Spatial Motion of Arytenoid Cartilage Using Dynamic Computed Tomography Combined with Euler Angles.

Laryngoscope 2020 11 24;130(11):E646-E653. Epub 2019 Dec 24.

Department of Physics, Xiamen University, Xiamen, Fujian, China.

Objective: To investigate the feasibility of dynamic computed tomography in recording and describing the spatial motion characteristics of the arytenoid cartilage.

Methods: Dynamic computed tomography recorded the real-time motion trajectory of the arytenoid cartilage during inspiration and phonation. A stationary coordinate system was established with the cricoid cartilage as a reference and a motion coordinate system was established using the movement of the arytenoid cartilage. The Euler angles of the arytenoid cartilage movement were calculated by transformation of the two coordinate systems, and the spatial motion characteristics of the arytenoid cartilage were quantitatively studied.

Results: Displacement of the cricoid cartilage was primarily inferior during inspiration. During phonation, the displacement was mainly superior. When the glottis closed, the superior displacement was about 5-8 mm within 0.56 s. During inspiration, the arytenoid cartilage was displaced superiorly approximately 1-2 mm each 0.56 s. The rotation angle was subtle with slight rotation around the XYZ axis, with a range of 5-10 degrees. During phonation, the displacement of the arytenoid cartilage was mainly inferior (about 4-6 mm), anterior (about 2-4 mm) and medial (about 1-2 mm). The motion of the arytenoid cartilage mainly consisted of medial rolling, and there was an alternating movement of anterior-posterior tilting. The arytenoid cartilage rolled medially (about 20-40 degrees within 0.56 s), accompanied by anterior-posterior tilting (about 15-20 degrees within 0.56 s).

Conclusion: Dynamic computed tomography recordings of arytenoid cartilage movement can be combined with Euler transformations as a tool to study the spatial characteristics of laryngeal structures during phonation.

Level Of Evidence: 4 Laryngoscope, 130:E646-E653, 2020.
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http://dx.doi.org/10.1002/lary.28468DOI Listing
November 2020

Compensatory Movement of Contralateral Vocal Folds in Patients With Unilateral Vocal Fold Paralysis.

J Voice 2021 Mar 22;35(2):328.e23-328.e28. Epub 2019 Oct 22.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin.

Objectives: Previous studies of subjects with unilateral vocal fold paralysis (UVFP) as observed in a positron emission tomography-computed tomography (PET-CT) examination have demonstrated false positive results in the contralateral cricoarytenoid, in which the metabolism may be higher. This area may also be the site of contralateral compensatory movement in these patients. In this study, we compared the adduction speed of the contralateral vocal folds in patients with UVFP and in healthy subjects as measured by the stroboscopic laryngoscope frame rate. This study aimed to explore the contralateral compensatory movement of the vocal folds in subjects with UVFP.

Methods: (1) We collected visual data from 14 patients with UVFP and 14 healthy subjects through a stroboscopic laryngoscope. These subjects were divided into a vocal fold paralysis group and a control group, and we analyzed the excessive adduction of the contralateral vocal folds in the vocal fold paralysis group by examining vocal fold movement speed (pixels/s) as featured in a stroboscopic laryngoscope video. (2) We analyzed the uptake of 18-FDG in the posterior vocal fold from positron emission tomography-computed tomography imaging from four subjects with UVFP and 12 healthy subjects. An independent sample t test and a χ test were used to compare data.

Results: Four subjects with UVFP had a higher metabolic rate in the contralateral cricoarytenoid joints, with a significant difference between the two groups, P < 0.05. Fifty percent of the cases of contralateral adduction of the vocal folds in the subjects with UVFP adducted past the midline, with a significant difference between the two groups, P < 0.05. The contralateral adduction of the vocal folds in subjects with UVFP had shorter video frames and higher adduction speed than the control group, and the difference was statistically significant, P < 0.05. There were fewer vocal fold abduction video frames and higher abduction speed of the healthy side of the vocal fold in subjects with UVFP than the control group, but there was no statistically significant difference, P > 0.05.

Conclusion: Subjects with UVFP exhibited faster adduction compensation in the contralateral vocal folds, and the contralateral cricoarytenoid joint's metabolism in subjects with UVFP was higher. These data may help clarify the diagnostic criteria for laryngeal nerve damage.
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http://dx.doi.org/10.1016/j.jvoice.2019.09.010DOI Listing
March 2021

Evaluation of Diffusional Characteristics and Microstructure in Unilateral Vocal Fold Paralysis Using Diffusion Tensor Imaging.

Ear Nose Throat J 2021 May 24;100(4):NP177-NP184. Epub 2019 Sep 24.

Department of ENT, Zhongshan Hospital, 12466Xiamen University, Xiamen, China.

Objective: To investigate the value of diffusion tensor imaging (DTI) in the evaluation of vocal fold tissue microstructure after recurrent laryngeal nerve (RLN) injury.

Methods: Six canines were divided into 2 groups: a unilateral vocal fold paralysis group (n = 4) and a control group (n 2). The RLN was cut in the unilateral vocal fold paralysis group, and no intervention was applied in the control group. After 4 months, the canines' larynges were removed and placed in a small animal magnetic resonance imaging (MRI) system (9.4T BioSpec MRI; Bruker, Germany). After scanning, the vocal folds were isolated, sectioned, and stained. The slides were then analyzed for the cross-sectional area and muscle fiber density through feature extraction technology. Pearson correlation analysis was performed on the DTI scan and histological section extraction results.

Results: In the vocal fold muscle layer, the fractional anisotropy (FA) of the unilateral RLN injury group was higher than that of the control group, and the Tensor Trace was lower than that of the control group. This difference was statistically significant, < .05. In the lamina propria, the FA of the unilateral RLN injury group was lower than that of the control group, > .05, and the Tensor Trace was lower than that of the control group, < .05. The muscle fiber cross-sectional area of the RLN injury group was significantly smaller than the control group with statistical significance, < .05, and the density of muscle fibers was lower, < .05. The correlation coefficient between FA and the cross-sectional area was -0.838, = .002, and .726; = .017 between Tensor Trace and the cross-sectional area.

Conclusion: Diffusion tensor imaging is an effective method to assess the changes in the microstructure of atrophic vocal fold muscle tissue after RLN injury.
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http://dx.doi.org/10.1177/0145561319874721DOI Listing
May 2021

Dynamically Monitoring Vocal Fatigue and Recovery Using Aerodynamic, Acoustic, and Subjective Self-Rating Measurements.

J Voice 2019 Sep 29;33(5):809.e11-809.e18. Epub 2018 Jun 29.

Department of Otolaryngology-Head and Neck Surgery, EENT Hospital of Fudan University, Shanghai, China. Electronic address:

Objectives: This study aimed to quantify the effects of vocal loading and vocal rest using aerodynamic, acoustic, and self-rating measurements.

Methods: Ten participants were recruited to perform vocal loading tasks lasting 60 minutes, followed by 30 minutes of vocal rest. Objective parameters (phonation threshold pressure, fundamental frequency, jitter, shimmer, and noise-to-harmonics ratio) and subjective parameters (current speaking effort level and laryngeal discomfort) were taken at different time intervals: before vocal loading (baseline), after 15 minutes (L15), 30 minutes (L30), 45 minutes (L45), and 60 minutes (L60) of vocal loading, as well as after 5 minutes (R5), 10 minutes (R10), 20 minutes (R20), and 30 minutes (R30) of vocal rest.

Results: Phonation threshold pressure was found to increase significantly within the first 15 minutes of the vocal loading task (P = 0.032), followed by a relatively gentle increase in the subsequent 45 minutes. Subjective self-ratings increased significantly after 30 minutes of loud reading (P < 0.05). Phonation threshold pressure recovered faster than subjective parameters after the vocal loading activity had finished. Fundamental frequency was found to consistently increase during vocal loading but return to baseline rapidly within 5 minutes of vocal rest. However, no significant changes in jitter, shimmer, and noise-to-harmonics ratio were observed after vocal loading.

Conclusions: Phonation threshold pressure and self-ratings may have the potential to track vocal fatigue and recovery. Furthermore, a dynamic monitor of vocal fatigue was presented, which may further provide a guide for appropriate voice use.
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http://dx.doi.org/10.1016/j.jvoice.2018.03.014DOI Listing
September 2019
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