Effect of vocal fold implant placement on depth of vibration and vocal output

Simeon L. Smith, Ingo R. Titze, Claudio Storck, Ted Mau

Research output: Contribution to journalArticle

Abstract

Objective: Most type 1 thyroplasty implants and some common injectable materials are mechanically stiff. Placing them close to the supple vocal fold mucosa can potentially dampen vibration and adversely impact phonation, yet this effect has not been systematically investigated. This study aims to examine the effect of implant depth on vocal fold vibration and vocal output. Study Design: Computational simulation. Methods: Voice production was simulated with a fiber-gel finite element computational model that incorporates a three-layer vocal fold composition (superficial lamina propria, vocal ligament, thyroarytenoid muscle). Implants of various depths were simulated, with a “deeper” or more medial implant positioned closer to the vocal fold mucosa and replacing more muscle elements. Trajectories of surface and within-tissue nodal points during vibration were produced. Outcome measures were the trajectory radii, fundamental frequency (F0), sound pressure level (SPL), and smoothed cepstral peak prominence (CPPS) as a function of implant depth. Results: Amplitude of vibration at the vocal fold medial surface was reduced by an implant depth of as little as 14% of the total transverse vocal fold depth. Increase in F0 and decrease in CPPS were noted beyond 30% to 40% implant depth, and SPL decreased beyond 40% to 60% implant depth. Conclusions: Commonly used implants can dampen vibration “from a distance,” ie, even without being immediately adjacent to vocal fold mucosa. Since implants are typically placed at depths examined in this study, stiff implants likely have a negative vocal impact in a subset of patients. Softer materials may be preferable, especially in bilateral medialization procedures. Level of Evidence: N/A. Laryngoscope, 2019.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Vocal Cords
Vibration
Mucous Membrane
Laryngoplasty
Laryngeal Muscles
Laryngoscopes
Pressure
Phonation
Gels
Outcome Assessment (Health Care)
Muscles
Injections

Keywords

  • injection laryngoplasty
  • silastic implant
  • Thyroplasty
  • vocal fold injection
  • vocal fold paralysis

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Effect of vocal fold implant placement on depth of vibration and vocal output. / Smith, Simeon L.; Titze, Ingo R.; Storck, Claudio; Mau, Ted.

In: Laryngoscope, 01.01.2019.

Research output: Contribution to journalArticle

Smith, Simeon L. ; Titze, Ingo R. ; Storck, Claudio ; Mau, Ted. / Effect of vocal fold implant placement on depth of vibration and vocal output. In: Laryngoscope. 2019.
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abstract = "Objective: Most type 1 thyroplasty implants and some common injectable materials are mechanically stiff. Placing them close to the supple vocal fold mucosa can potentially dampen vibration and adversely impact phonation, yet this effect has not been systematically investigated. This study aims to examine the effect of implant depth on vocal fold vibration and vocal output. Study Design: Computational simulation. Methods: Voice production was simulated with a fiber-gel finite element computational model that incorporates a three-layer vocal fold composition (superficial lamina propria, vocal ligament, thyroarytenoid muscle). Implants of various depths were simulated, with a “deeper” or more medial implant positioned closer to the vocal fold mucosa and replacing more muscle elements. Trajectories of surface and within-tissue nodal points during vibration were produced. Outcome measures were the trajectory radii, fundamental frequency (F0), sound pressure level (SPL), and smoothed cepstral peak prominence (CPPS) as a function of implant depth. Results: Amplitude of vibration at the vocal fold medial surface was reduced by an implant depth of as little as 14{\%} of the total transverse vocal fold depth. Increase in F0 and decrease in CPPS were noted beyond 30{\%} to 40{\%} implant depth, and SPL decreased beyond 40{\%} to 60{\%} implant depth. Conclusions: Commonly used implants can dampen vibration “from a distance,” ie, even without being immediately adjacent to vocal fold mucosa. Since implants are typically placed at depths examined in this study, stiff implants likely have a negative vocal impact in a subset of patients. Softer materials may be preferable, especially in bilateral medialization procedures. Level of Evidence: N/A. Laryngoscope, 2019.",
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