The long-range aim of this project is to improve our understanding of the role the intrinsic laryngeal muscles in phonation. More specifically, we plan to activate each laryngeal muscle in a graded fashion to predict the following: (1) the pre-phonatory posture (shape) of the vocal folds including (a) vocal fold length, (b) glottal width, (c) glottal convergence, and (d) medial surface bulging, (2) the resultant vibration pattern of the vocal folds using high-speed photography, and (3) the resultant phonation type (aphonic, falsetto-like, chest-like, fry-like, subharmonic, biphonic, aperiodic, etc.) which results from each pre-phonatory condition. In order to accomplish this objective, a full range of neuromuscular inputs will be studied systematically with respect to all five intrinsic laryngeal muscles on either side of the larynx (cricothyroid [CT], thyroarytenoid [TA], lateral cricoarytenoid [LCA], interarytenoid [IA], and posterior cricoarytenoid [PCA]), both individually and in combination. For conditions related to unilateral laryngeal paralysis and paresis of the recurrent laryngeal nerve (RLN), the same measurements will be repeated following variations of common surgical interventions for these vocal pathologies, including arytenoid adduction and medialization thyroplasty. A systematic study of this type is needed to resolve the complex interactions between both antagonistic and synergistic muscles over the intricate three-dimensional laryngeal structure, which ultimately enables the laryngeal tissues to couple with the glottal airflow, resulting in both vocal fold vibration and phonatory output. A better understanding of the phonatory impact of neuromuscular coordination of these intrinsic laryngeal muscles is important to both speech scientists and clinicians. For example, neuromuscular control of the vocal folds is known to influence vocal intensity, phonation onset pressure, fundamental frequency, and phonation type. Furthermore, hyper-stimulation of these laryngeal muscles is known to result in vocal pathologies, such as spasmodic dysphonia and muscle tension dysphonia. At the other extreme, hypo-stimulation of these muscles results in well-known vocal pathologies, such as laryngeal paralysis or paresis (both bilateral and unilateral) associated with either the recurrent laryngeal nerve (RLN) or the superior laryngeal nerve (SLN). Because no systematic study of neuromuscular input to this complete set of intrinsic laryngeal muscles has yet been conducted, our understanding of the phonatory impact of neuromuscular coordination is rudimentary and deficient. Thus, the proposed study of neuromuscular control of the larynx is extremely timely.

Public Health Relevance

Laryngeal paresis (weakness) and paralysis due to neuromuscular disease of the larynx are the most common illnesses leading to abnormal voice. At present, even for the neurologically intact larynx, speech scientists and clinicians do not understand how the five muscles on each side of the larynx interact to control vocal fold shape, voice production, control of airflow during speech, and vibratory patterns of the vocal folds, and current surgical treatments for these diseases have not yielded consistent results. This proposal will investigate the effect of each laryngeal muscle on vocal fold shape, voice, airflow, and vocal fold vibration, both in normal and pathologic conditions.

Agency
National Institute of Health (NIH)
Institute
National Institute on Deafness and Other Communication Disorders (NIDCD)
Type
Research Project (R01)
Project #
5R01DC011300-02
Application #
8248175
Study Section
Special Emphasis Panel (ZRG1-BBBP-E (06))
Program Officer
Shekim, Lana O
Project Start
2011-04-01
Project End
2016-03-31
Budget Start
2012-04-01
Budget End
2013-03-31
Support Year
2
Fiscal Year
2012
Total Cost
$597,140
Indirect Cost
$209,387
Name
University of California Los Angeles
Department
Surgery
Type
Schools of Medicine
DUNS #
092530369
City
Los Angeles
State
CA
Country
United States
Zip Code
90095
Zhang, Zhaoyan; Chhetri, Dinesh K; Bergeron, Jennifer L (2015) Effects of implant stiffness, shape, and medialization depth on the acoustic outcomes of medialization laryngoplasty. J Voice 29:230-5
Chen, Gang; Kreiman, Jody; Alwan, Abeer (2014) The glottaltopogram: a method of analyzing high-speed images of the vocal folds. Comput Speech Lang 28:1156-1169
Bergeron, Jennifer L; Chhetri, Dinesh K (2014) Indications and outcomes of endoscopic CO2 laser cricopharyngeal myotomy. Laryngoscope 124:950-4
Chhetri, Dinesh K; Jamal, Nausheen (2014) Percutaneous injection laryngoplasty. Laryngoscope 124:742-5
Chhetri, Dinesh K; Rafizadeh, Sassan (2014) Young's modulus of canine vocal fold cover layers. J Voice 28:406-10
Vorasubin, Nopawan; Vira, Darshni; Jamal, Nausheen et al. (2014) Airway management and endoscopic treatment of subglottic and tracheal stenosis: the laryngeal mask airway technique. Ann Otol Rhinol Laryngol 123:293-8
Bergeron, Jennifer L; Jamal, Nausheen; Erman, Andrew et al. (2014) Office-based tracheoesophageal puncture: updates in techniques and outcomes. Am J Otolaryngol 35:549-53
Chhetri, Dinesh K; Neubauer, Juergen; Sofer, Elazar et al. (2014) Influence and interactions of laryngeal adductors and cricothyroid muscles on fundamental frequency and glottal posture control. J Acoust Soc Am 135:2052-64
Jamal, Nausheen; Mundi, Jagmeet; Chhetri, Dinesh K (2014) Higher risk of superficial injection during injection laryngoplasty in women. Am J Otolaryngol 35:159-63
Chhetri, Dinesh K; Neubauer, Juergen; Sofer, Elazar (2014) Influence of asymmetric recurrent laryngeal nerve stimulation on vibration, acoustics, and aerodynamics. Laryngoscope 124:2544-50

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