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. 2024 May;281(5):2523-2529.
doi: 10.1007/s00405-024-08519-x. Epub 2024 Feb 29.

Acoustics and aerodynamic effects following glottal and infraglottal medialization in an excised larynx model

Liran Oren  1 , Alexandra Maddox  2 , Charles Farbos de Luzan  3 , Changchun Xie  4 , Rebecca Howell  3 , Gregory Dion  3 , Ephraim Gutmark  2 , Sid Khosla  3
Affiliations

Acoustics and aerodynamic effects following glottal and infraglottal medialization in an excised larynx model

Liran Oren et al. Eur Arch Otorhinolaryngol. 2024 May.

Abstract

Objective: This study aimed to investigate the impact of the implant's vertical location during Type 1 Thyroplasty (T1T) on acoustics and glottal aerodynamics using excised canine larynx model, providing insights into the optimal technique for treating unilateral vocal fold paralysis (UVFP).

Methods: Measurements were conducted in six excised canine larynges using Silastic implants. Two implant locations, glottal and infraglottal, were tested for each larynx at low and high subglottal pressure levels. Acoustic and intraglottal flow velocity field measurements were taken to assess vocal efficiency (VE), cepstral peak prominence (CPP), and the development of intraglottal vortices.

Results: The results indicated that the implant's vertical location significantly influenced vocal efficiency (p = 0.045), with the infraglottal implant generally yielding higher VE values. The effect on CPP was not statistically significant (p = 0.234). Intraglottal velocity field measurements demonstrated larger glottal divergence angles and stronger vortices with the infraglottal implant.

Conclusion: The findings suggest that medializing the paralyzed fold at the infraglottal level rather than the glottal level can lead to improved vocal efficiency. The observed larger divergence angles and stronger intraglottal vortices with infraglottal medialization may enhance voice outcomes in UVFP patients. These findings have important implications for optimizing T1T procedures and improving voice quality in individuals with UVFP. Further research is warranted to validate these results in clinical settings.

Keywords: Implant location; Intraglottal flow; Medialization laryngoplasty; Unilateral vocal fold paralysis; Vocal efficiency.

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Conflict of interest statement

The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Schematic showing the implants’ approximate location. a Coronal plane. b Glottal. c Infraglottal
Fig. 2
Fig. 2
Change in a vocal efficiency (VE) and b cepstral peak prominence (CPP) based on implant location. The low- and high-subglottal pressure data from each larynx are averaged together
Fig. 3
Fig. 3
The vocal efficiency of a glottal implant, infraglottal implant, baseline, and phonation with UVFP over their full range of phonation. Aerodynamic power = Psg x Qmean
Fig. 4
Fig. 4
Intraglottal PIV velocity fields from one larynx (L4). Implants were placed in the left fold for all four cases. Infraglottal implant velocity fields (top row) show phase with maximum circulation strength. Glottal implant flow fields show phase with maximum divergence angle since circulation strength was always zero
See this image and copyright information in PMC

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