Integrative Insights into the Myoelastic-Aerodynamic Theory and Acoustics of Phonation. Scientific Tribute to Donald G. Miller.

In this tribute article to D.G. Miller, we review some historical and recent contributions to understanding the myoelastic-aerodynamic (MEAD) theory of phonation and the related acoustic phenomena in subglottal and vocal tract. At the time of the formulation of MEAD by van den Berg in late 1950s, it was assumed that vocal fold oscillations are self-sustained thanks to increased subglottal pressure pushing the glottis to open and decreased subglottal pressure allowing the glottis to close. In vivo measurements of subglottal pressures during phonation invalidated these assumptions, however, and showed that at low fundamental frequencies subglottal pressure rather tends to reach a maximum value at the beginning of glottal closure and then exhibits damped oscillations. These events can be interpreted as transient acoustic resonance phenomena in the subglottal tract that are triggered by glottal closure. They are analogous to the transient acoustic phenomena seen in the vocal tract. Rather than subglottal pressure oscillations, a more efficient mechanism of transfer of aerodynamic energy to the vocal fold vibrations has been identified in the vertical phase differences (mucosal waves) making the glottal shape more convergent during glottis opening than during glottis closing. Along with other discoveries, these findings form the basis of our current understanding of MEAD.

Comparing Chalk With Cheese-The EGG Contact Quotient Is Only a Limited Surrogate of the Closed Quotient.

The electroglottographic (EGG) contact quotient (CQegg), an estimate of the relative duration of vocal fold contact per vibratory cycle, is the most commonly used quantitative analysis parameter in EGG. The purpose of this study is to quantify the CQegg's relation to the closed quotient, a measure more directly related to glottal width changes during vocal fold vibration and the respective sound generation events. Thirteen singers (six females) phonated in four extreme phonation types while independently varying the degree of breathiness and vocal register. EGG recordings were complemented by simultaneous videokymographic (VKG) endoscopy, which allows for calculation of the VKG closed quotient (CQvkg). The CQegg was computed with five different algorithms, all used in previous research. All CQegg algorithms produced CQegg values that clearly differed from the respective CQvkg, with standard deviations around 20% of cycle duration. The difference between CQvkg and CQegg was generally greater for phonations with lower CQvkg. The largest differences were found for low-quality EGG signals with a signal-to-noise ratio below 10 dB, typically stemming from phonations with incomplete glottal closure. Disregarding those low-quality signals, we found the best match between CQegg and CQvkg for a CQegg algorithm operating on the first derivative of the EGG signal. These results show that the terms "closed quotient" and "contact quotient" should not be used interchangeably. They relate to different physiological phenomena. Phonations with incomplete glottal closure having an EGG signal-to-noise ratio below 10 dB are not suited for CQegg analysis.

Interactive Augmentation of Voice Quality and Reduction of Breath Airflow in the Soprano Voice.

In 1985, at a conference sponsored by the National Institutes of Health, Martin Rothenberg first described a form of nonlinear source-tract acoustic interaction mechanism by which some sopranos, singing in their high range, can use to reduce the total airflow, to allow holding the note longer, and simultaneously enrich the quality of the voice, without straining the voice. (M. Rothenberg, "Source-Tract Acoustic Interaction in the Soprano Voice and Implications for Vocal Efficiency," Fourth International Conference on Vocal Fold Physiology, New Haven, Connecticut, June 3-6, 1985.) In this paper, we describe additional evidence for this type of nonlinear source-tract interaction in some soprano singing and describe an analogous interaction phenomenon in communication engineering. We also present some implications for voice research and pedagogy.

Kymographic imaging of laryngeal vibrations.

PURPOSE OF REVIEW: Kymographic imaging is a modern method for displaying and evaluating vibratory behaviour of the vocal folds which is crucial for voice production. This review summarizes the state of the art of this method, and focuses on the progress in this area within the last 5 years. RECENT FINDINGS: Videokymography, using a special videocamera, offers high-speed (video)kymographic images in real time, which is advantageous in daily clinical practice. Two other methods use software to create kymograms retrospectively: digital kymography processes high-speed videolaryngoscopic recordings and offers numerous research possibilities, whereas strobovideokymography processes videostroboscopic recordings, and its use is limited to regular vibration patterns. Current studies reveal that high-speed kymographic images allow more reliable visual evaluation of vibrations than by watching video recordings. Image analysis procedures have been advanced to quantify the vibration properties of the vocal folds. New information has been obtained on asymmetry, mucosal waves, irregularities, phonation onset, and nonlinear dynamic phenomena in voice disorders, as well as in singing. SUMMARY: High-speed kymography visualizes vibratory features which are not simply observable via traditional methods. It shows large potential in better understanding the functional origin of hoarseness and unsteady phonatory states. Further research in this area is envisioned.

Membranous and cartilaginous vocal fold adduction in singing.

While vocal fold adduction is an important parameter in speech, relatively little has been known on the adjustment of the vocal fold adduction in singing. This study investigates the possibility of separate adjustments of cartilaginous and membranous vocal fold adduction in singing. Six female and seven male subjects, singers and non-singers, were asked to imitate an instructor in producing four phonation types: "aBducted falsetto" (FaB), "aDducted falsetto" (FaD), "aBducted Chest" (CaB), and "aDducted Chest" (CaD). The phonations were evaluated using videostroboscopy, videokymography (VKG), electroglottography (EGG), and audio recordings. All the subjects showed less posterior (cartilaginous) vocal fold adduction in phonation types FaB and CaB than in FaD and CaD, and less membranous vocal fold adduction (smaller closed quotient) in FaB and FaD than in CaB and CaD. The findings indicate that the exercises enabled the singers to separately manipulate (a) cartilaginous adduction and (b) membranous medialization of the glottis though vocal fold bulging. Membranous adduction (monitored via videokymographic closed quotient) was influenced by both membranous medialization and cartilaginous adduction. Individual control over these types of vocal fold adjustments allows singers to create different vocal timbres.

Depth-kymography of vocal fold vibrations: part II. Simulations and direct comparisons with 3D profile measurements.

We report novel direct quantitative comparisons between 3D profiling measurements and simulations of human vocal fold vibrations. Until now, in human vocal folds research, only imaging in a horizontal plane was possible. However, for the investigation of several diseases, depth information is needed, especially when the two folds act differently, e.g. in the case of tumour growth. Recently, with our novel depth-kymographic laryngoscope, we obtained calibrated data about the horizontal and vertical positions of the visible surface of the vibrating vocal folds. In order to find relations with physical parameters such as elasticity and damping constants, we numerically simulated the horizontal and vertical positions and movements of the human vocal folds while vibrating and investigated the effect of varying several parameters on the characteristics of the phonation: the masses and their dimensions, the respective forces and pressures, and the details of the vocal tract compartments. Direct one-to-one comparison with measured 3D positions presents-for the first time-a direct means of validation of these calculations. This may start a new field in vocal folds research.

Clinical evaluation of a membrane-based voice-producing element for laryngectomized women.

BACKGROUND: A newly developed artificial voice source was clinically evaluated in laryngectomized women for voice quality improvements. The prosthesis was placed in a commercially available, tracheoesophageal shunt valve. METHODS: In 17 subjects, voice-producing element (VPE) prototypes were compared with the subject's regular tracheo-esophageal shunt voice in a randomized cross-over trial. The evaluation was based on aeroacoustic measurements and perceptual analysis. RESULTS: Considerably higher fundamental frequencies were attained with the use of the VPE. The sound pressure level also increased for most subjects. The required driving pressures of the lung and air flow rates were altered, allowing significantly longer phonation times in 1 breath. Accumulation of mucus did not interfere with the proper functioning of the device during these tests. CONCLUSION: A VPE with sound-generating membranes is suitable for providing a substitute voice source for laryngectomized patients, especially patients suggestive of a severely hypotonic or atonic pharyngoesophageal segment who can benefit from a more melodious and louder voice.

Depth-kymography: high-speed calibrated 3D imaging of human vocal fold vibration dynamics.

We designed and developed a laser line-triangulation endoscope compatible with any standard high-speed camera for a complete three-dimensional profiling of human vocal fold vibration dynamics. With this novel device we are able to measure absolute values of vertical and horizontal vibration amplitudes, length and width of vocal folds as well as the opening and closing velocities from a single in vivo measurement. We have studied, for the first time, the generation and propagation of mucosal waves by locating the position of its maximum vertical position and the propagation velocity. Precise knowledge about the absolute dimensions of human vocal folds and their vibration parameters has significant importance in clinical diagnosis and treatment as well as in fundamental research in voice. The new device can be used to investigate different kinds of pathological conditions including periodic or aperiodic vibrations. Consequently, the new device has significant importance in investigating vocal fold paralysis and in phonosurgical applications.

New laryngoscope for quantitative high-speed imaging of human vocal folds vibration in the horizontal and vertical direction.

We report the design of a novel laser line-triangulation laryngoscope for the quantitative visualization of the three-dimensional movements of human vocal folds during phonation. This is the first successful in vivo recording of the three-dimensional movements of human vocal folds in absolute values. Triangulation images of the vocal folds are recorded at the rate of 4000 fps with a resolution of 256x256 pixels. A special image-processing algorithm is developed to precisely follow the subpixel movements of the laser line image. Vibration profiles in both horizontal and vertical directions are calibrated and measured in absolute SI units with a resolution of +/-50 microm. We also present a movie showing the vocal folds dynamics in vertical cross section.

Real-time kymographic imaging for visualizing human vocal-fold vibratory function.

A stand-alone kymographic system for visualizing human vocal-fold vibration in real time is presented. By using a dual charge-coupled-device construction, the system not only provides kymographic images but also simultaneously presents structural images for navigating the endoscope to a desired position. With a temporal resolution of 7200 lines/s, the kymographic imaging produces a sufficient speed to investigate most types of vocal-fold vibrations. Moreover, by buffering the kymographic images during the vertical blanking periods, the system can retrieve an uninterrupted kymographic image sequence even though the television standard is used. The results from preliminary clinical evaluation present evidence that the real-time kymographic imaging substantially reduces the time required for functional evaluation of the vocal-fold vibrations.

Videokymography in voice disorders: what to look for?

OBJECTIVES: Kymographic imaging through videokymography has been recognized as a convenient, novel way to display laryngeal behavior, yet little systematic research has been done to map the relevant features displayed in such images. Here we have aimed at specification of these features to enable systematic visual characterization and categorization of vocal fold vibratory patterns in voice disorders. METHODS: A cross-sectional, descriptive design was used. We selected 45 subjects and extracted 100 videokymographic images from the archive of more than 7,000 videokymographic examinations of subjects with a wide range of voice disorders. The images showed a large variety of vocal fold vibratory behaviors during sustained phonations. We visually identified the prominent features that distinguished the vibration patterns across the images. RESULTS: We divided the findings into 10 feature categories. They included refined traditional features (eg, mucosal waves), as well as additional features that are obscured in strobolaryngoscopy (eg, different types of irregularities, left-right frequency differences, shapes of lateral and medial peaks, cycle aberrations). CONCLUSIONS: The variations in the identified features reveal different behavioral origins of voice disorders. The findings open new possibilities for objective documentation and for monitoring vocal fold behavior in clinical practice through kymographic imaging.

The Saanen goat as an animal model for post-laryngectomy research: practical implications.

A modern way of voice rehabilitation after total laryngectomy includes the use of shunt valves and tracheostoma valves. Problems of fixation to the surrounding tissue are a major drawback in the use of the shunt valve, heat and moisture exchange (HME) filters and, especially, the tracheostoma valve. To solve these problems different tissue connectors were developed. The main objective was to test the feasibility of these prototypes in a new animal model. Here we discuss the results, problems and complications of the selected Saanen goat model. In this prospective laboratory study, 19 healthy adult female Saanen goats (Capra hircus) were used and observed post-surgically for 12 weeks. Selection criteria such as comparable anatomy to humans and easy handling were used for animal model development. Also a literature search using the Medline and the ISI Web of Science databases was performed. The anatomy of the Saanen goat was investigated in a separate postmortem study. Surgery consisted of a laryngotracheal separation and implantation of a tracheo-oesophageal and tracheostoma tissue connector with fibrin tissue glue. Postoperative care consisted of frequent stoma care, monitoring appetite, weight, vital signs and administration of antibiotics, analgesics and mucolytic agents. All animals survived the surgical procedure. However, postoperative care was extensive, labour intensive and was accompanied by several complications. Eleven animals died spontaneously before the end of the experiment. The tracheostoma tissue connector caused signs of local infection in all cases. There was no evidence of infection around the tracheo-oesophageal tissue connector in 18 cases. It was concluded that the use of goats in this tracheostoma model was associated with major complications and should, therefore, only be used for short-term experiments with intensive care. Additional research is needed to see if clinical application of the tissue connectors is possible in the future.

In vivo experiments with tracheostoma tissue connector prototypes.

In cancer patients who have undergone total surgical removal of the larynx, ideally voice rehabilitation should be performed using a shunt valve (placed in a fistula of the tracheo-esophageal wall) and a tracheostoma valve (TSV) to enable hands-free tracheo-esophageal speech. A tracheostoma is created by suturing the trachea into the lower anterior part of the neck, and a TSV is a device that can be placed at the stoma. Unfortunately, many patients are unable to use a TSV, mainly due to fixation difficulties. To improve the fixation of the TSV, tracheostoma tissue connector (TS-TC) prototypes have been designed. Prototype 1 consisted of a titanium ring, inner diameter 30 mm, with a circular polypropylene mesh glued to it with silicone adhesive. Four holes had been drilled into the ring for the insertion of sub- and percutaneous screws. Prototype 2 consisted of a silicone rubber ring, inner diameter 30 mm, combined with polypropylene mesh and four titanium inserts that functioned as a base plate for the insertion of sub- and percutaneous screws. In adult female goats a tracheostoma was created and the prototypes were implanted. After 6 weeks of subcutaneous implantation, percutaneous screws were inserted. After twelve weeks, the experiment was terminated and the implants with the surrounding tissues were processed and examined histologically. The clinical appearance during weeks 7-12 varied from very poor to relatively good. Histologically, the implants showed a uniform inflammatory response. We found that all the tissue surrounding the screws showed signs of epithelial down growth. It was concluded that the two-stage implantation procedure of our prototype TS-TCs in this animal model was unsuccessful. Additional research efforts are necessary to improve tissue immobilization and to devise reliable fixation systems for TSVs.

A new generation videokymography for routine clinical vocal fold examination.

OBJECTIVE: This study aims to introduce a new-generation videokymographic system, which provides simultaneous laryngoscopic and kymographic image, for routine clinical vocal fold examination. STUDY DESIGN: The authors explored a new imaging method for diagnosis and evaluation of voice disorders. METHODS: The new-generation videokymographic system includes two charge-coupled device image sensors, a color area image sensor, and a monochromic high-speed line-scan image sensor. The high-speed line-scan image sensor is used to capture the kymogram, and the color area image sensor is used to obtain the laryngoscopic image. The two images can be displayed simultaneously on a video monitor or stored in a standard video recorder. Three subjects with nonpathologic voice were investigated in detail with the new videokymographic system. RESULTS: The high-quality laryngoscopic image and kymogram can be used directly for clinical purposes with no further postprocessing. The scan position of the kymogram is always indicated in the laryngoscopic image, which provides feedback for the operator to easily locate the expected scanning position. All varieties of vocal fold vibration, including irregular vibrations, phonation onset and offset, can be observed with the presented method. The continuous kymogram of the vocal fold vibration can be retrieved from a kymographic image sequence for quantitative analysis. CONCLUSIONS: The new-generation videokymography provides a simple, quick means to investigate vocal fold vibration, especially for voice disorders. It can emerge as an important tool for routine clinical vocal fold examination.

Experimental results of the tracheoesophageal tissue connector for improved fixation of shunt valves in laryngectomized patients.

BACKGROUND: After total laryngectomy and voice rehabilitation using a tracheoesophageal shunt valve, patients often have valve-related complications such as leakage. To solve these problems, a tracheoesophageal tissue connector (TE-TC) was devised to serve as an interface between the patient's tissue (trachea and esophagus) and the shunt valve. METHODS: The TE-TC is a permucosal connection constructed from a titanium ring (filled with a silicon rubber plug) combined with polypropylene or titanium mesh. After implantation in adult goats for 12 weeks the implants were submitted to histologic investigation. RESULTS: Firm implant fixation was achieved. In nearly all (18/19), no signs of infection of the implant were seen; 11 of 19 animals died before the end of the experiment owing to complications not related to the implant. CONCLUSIONS: The TE-TC is a new device with potential in the solution for fixation-related problems in tracheoesophageal voice rehabilitation.

An in-vitro test set-up for evaluation of a voice-producing element under physiologic acoustic conditions.

To improve the voice quality of laryngectomised patients, a voice-producing element has been developed. Prior to in vivo testing we constructed and validated an in-vitro test set-up, consisting of a physical model of the subglottal tract and three physical models of the vocal tract, for the vowels /a/, /i/ and /u/ to evaluate the voice-producing element under physiologic acoustic conditions. To meet acoustic conditions described in the literature, we determined the appropriate dimensions of these physical models, using a numerical model of the pressure perturbation in rigid tubes. The numerical model showed that an acoustic equivalent of the subglottal tract could be obtained with a three-tube system and an end impedance. Vocal tract models could be constructed using two- and four-resonator tubes. The physical models were built and successfully validated according to the human acoustic properties. The developed in-vitro set-up can now be applied to test voice-producing elements or vocal fold models under physiologic acoustic conditions.

'Mixing' the registers: glottal source or vocal tract?

Electroglottograph and microphone signals are examined of scale passages crossing the boundary between chest and middle registers in the female singing voice. From a protocol executed by professional classical singers, the examples are selected to illustrate differing approaches to the chest-middle transition, as well as to illuminate varying theories on the female middle register, specifically the question of 'mixing' the primary registers, chest and falsetto. The results suggest that the skillful tuning of the resonances of the vocal tract contributes more toward the pedagogical goal of smoothing the register transition than does a presumed mixing of the registers at the glottal source.

Resonance strategies revealed in recorded tenor high notes.

With careers that depend to a large extent on the amplitude and sonorous beauty of their voices, opera singers must pay special attention to high notes, where the wide spacing of the harmonics of the voice source intensifies the critical importance of the tuning of the resonances of the vocal tract. This study uses spectrum analysis to examine a large number of recordings of a particularly challenging high note for tenors, the final sustained B4-flat of the aria 'Celeste Aida' from Verdi's opera Aida. The resonance strategy most frequently found uses a markedly displaced second formant to create a dominant resonance at the frequency of the third harmonic, about 1,400 Hz. Other strategies and combinations of strategies are examined as well. Arguments concerning the validity of drawing conclusions from the acoustic signals available in commercial recordings are considered, and it is concluded that such recordings can contain valuable information on resonance strategies for those who aspire to sing similar high notes.