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Background Many authors have studied adult’s larynx modelization, but the mechanisms of newborn’s voice production have very rarely been investigated. After validating a numerical model with acoustic data, studies were performed on larynges of human fetuses in order to validate this model with aerodynamical experiments. Material and methods Anatomical measurements were performed and a simplified numerical model was built using Fluent ® with the vocal folds in phonatory position. The results obtained are in good agreement with those obtained by laser Doppler velocimetry (LDV) and high-frame rate particle image velocimetry (HFR-PIV), on an experimental bench with excised human fetus larynges. Results It appears that computing with first cry physiological parameters leads to a model which is close to those obtained in experiments with real organs.

Summary A new method of measuring the resonance properties of a vocal fold using electromagnetic excitation and laser optoreflectometry for response monitoring is described. Two resonance peaks were experimentally identified with one magnet stuck on the vocal fold at frequencies F0 1m =54.7Hz and F0′ 1m =35.8Hz. The addition of a second magnet allowed calculation of the actual viscoelastic properties of the vocal fold: F0=71.8Hz; quality factor Q =8.03; mass m =0.057g; stiffness k =11.6Nm; and damping ζ =0.0032Nm −1 . A numerical simulation of a two-layered model verified the experimental data.

Voice of patient with unilateral laryngeal paralysis (ULP) shows a nonlinear behaviour with sudden octave jumps, bifurcations and chaos. Such a behaviour may be due to an increased number of freedom degrees in the glottal system. We hypothesized that voice intensity (with increasing sub glottal pressure) could improve vocal signal stability with less freedom degrees in vibrating system, and then a decrease of nonlinearities. A prospective study of 32 consecutive voices of patients with ULP and severe dysphonia was conducted. Jitter and Lyapunov exponent from vocal signals were compared at comfortable and loud voicing with Wilcoxon’s test. In 23 out of 32 patients, jitter significantly decreased from 5 (median) in normal voice to 1.2 in loud voice (P < 10−3), Lyapunov exponent decreased from 1,495 bit/s (median) to 708 bit/s (P < 10−4). Two patients had paradoxical results regarding jitter (higher in loud voice) and 2 regarding Lyapunov exponent. From the 23 cases of voice improvement, 15 cases showing a marked improvement of the acoustic analysis supported our hypothesis (65%). Nonlinear phenomena detected in vocal signals of ULP with severe dysphonia may be reduced in loud voice.

This study describes a novel system allowing the noncontact measurement of vibration of each vocal fold. The system is based on reflectometry, i.e. measurement of light bouncing off a vibrating object. The system works in natural light and is sensitive, compact, and inexpensive. We have used this system for separate and simultaneous detection of the vibration of each vocal fold in excised porcine larynges. Normal conditions of vibration and asymmetry of tension leading to biphonations were studied. Analysis of each vibrating cycle reveals interaction between the vocal folds allowing synchronous vibration despite their physical asymmetry or episodes of period doubling.

The purpose was to determine the clinical value of a multiparametric objective voice evaluation protocol including acoustic and aerodynamic parameters measured mainly on a sustained /a/. This was done by comparison with perceptual analysis of continuous speech by a jury composed of 6 experienced listeners. Voice samples (continuous speech) from 63 male patients with dysphonia and 21 control subjects with normal voices were recorded and assesed by a jury of listeners. The jury was instructed to classify voice samples according to the G (overall dysphonia) component of the GRBAS score on a 4-point scale ranging from 0 for normal to 3 for severe dysphonia. Objective parameters were recorded on an EVA workstation. As usual with this type of system, parameters were measured mainly on a sustained /a/. Measured parameters included fundamental frequency (F0), intensity, jitter, shimmer, signal-to-noise ratio, Lyapunov coefficient (LC), oral airflow (OAF), maximum phonatory time (MPT), and vocal range (range). Estimated subglottic pressure (ESGP) was determined on a series of /pa/. Discriminant analysis was performed to detect correlation between jury classification and combinations of parameters. Results showed that a nonlinear combination of only six parameters (range, LC, ESGP, MPT, signal-to-noise ratio, and F0) allowed 86% concordance with jury classification. Discussion deals with the relative importance of the different objective parameters for discriminant analysis. Special emphasis is placed on two measurements rarely made in routine clinical workup, i.e., estimated subglottic pressure and Lyapunov coefficient.

The stabilometry signals involve irregular and unpredictable components. In order to identify the hidden dynamics that underlie the multi-link networks consisted of the multiple sensory systems, motor components and central integration, we applied a nonlinear analysis to these signals. We evaluated the postural control differences between eyes open and closed by means of the dynamical closeness between two states, known as similarity index, for the patients with vestibular disorders. We were able to demonstrate that some patients (eight of 21) showed a difference between the conventional and nonlinear measures. Especially, the similarity index tended to reflect the clinical course of the vestibular compensation and the findings in the patients with benign paroxysmal positional vertigo (BPPV) demonstrated that its vestibular function may include various pathologies besides canalithiasis. These results suggest that nonlinear analysis can elucidate the complex postural control networks and this procedure may also be able to provide the new findings of the stabilometry examinations.

We proposed to study and quantify the anteroposterior component, on top of the lateral one, of the body sway induced by different configurations of galvanic vestibular stimulation (GVS) in order to advance the understanding of the orientation of the response. Four stimulation configurations were used in two separate experiments: monaural, binaural, and opposite double monaural in the first experiment (11 subjects); monaural and double monaural in the second (13 subjects). The postural response of the subjects, standing with their eyes closed, to the stimulus (0.6 mA, 4 s) was assessed by measuring the displacement of the center of pressure (CoP) using a force platform. As usual, binaural GVS induced a strictly lateral deviation of the center of pressure. The opposite double monaural condition induced a similar lateral sway to that obtained in the binaural mode, although with a very different stimulation configuration. Monaural GVS induced an oblique, stereotyped deviation in each subject. The anteroposterior component comprised a forward deviation when the anode was on the forehead and a backward deviation when the anode was on the mastoid. The lateral component, directed towards the anode as in the binaural design, was twice as large in the binaural than in the monaural mode. The second experiment showed that double monaural stimulation elicited an anteroposterior deviation (backwards when the anode was on the mastoids and forwards when it was on the forehead) that was equivalent to the addition of two complementary monaural configurations. The present results show that monaural stimulation activates one side of the vestibular apparatus and induces reproducible, stereotyped deviations of the CoP in both the anteroposterior and lateral plane. Secondly, binaural GVS appears to result from the addition of two complementary monaural stimulations. Lateral components of the response to each stimulation, being in the same direction, are summed, whilst anteroposterior components, being in opposite directions, cancel each other out. The opposite happens when both labyrinths are polarized in the same way, as in the double monaural configuration. We suggest that the orientation of the response to GVS is a function of the imbalance between right and left vestibular polarization, rather than a function of the actual position of the electrodes.

Summary Coupling between the vocal folds is one of the nonlinear mechanisms allowing regulation and synchronization of mucosal vibration. The purpose of this study was to establish that modulations such as diplophonia and abnormalities observed in vocal signals that may be observed in some cases of laryngeal pathology can be considered as nonlinear behavior due to the persistence of some physical interaction (coupling). An experimental model using excised porcine larynx was designed to create tension asymmetry between the vocal folds and to obtain vocal signals with modulations. Signals were analyzed by spectral analysis and the phase portrait method. Results were compared with computer-generated synthetic signals corresponding to nonlinear combinations of sinusoid signals. Under these conditions, evidence of nonlinear behavior was detected in 85% of experimental signals. These findings were interpreted as a demonstration of vocal fold interaction. Based on these findings, the authors conclude that (1) coupling must be taken into account in physical models of laryngeal physiology, and that (2) methods of nonlinear dynamics may be used for objective voice analysis.

Objectives: One postural characteristic of increased vocal effort is stiffening of the whole body, which in turn induces some postural instability. The study of postural instability can shed some insight into behavior or causes associated with vocal hyperfunction. Patients and Methods: A posturography platform was used to measure the root mean square of the velocity of variation of the center of pressure (VCOP rms) of control subjects standing upright on the platform. Four conditions were analyzed: (1) standing with eyes open versus eyes closed (n: 9); (2) standing at rest versus holding a 3-kg weight (n: 15); (3) standing while reading a dialogue at normal voice level versus loud voice (n: 17), and (4) standing while reading a dialogue in a calm versus noisy (Lombard effect) ambiance (n: 19). Results: Conditions leading to a stiffening of the body (eyes closed and weight holding) were associated with an increased instability assessed by the VCOP rms. In phonatory conditions leading to vocal effort, the mean VCOP rms was significantly increased: in 19 subjects reading a dialogue in a calm ambiance the mean VCOP rms was at 11.19 mm/s, and the VCOP rms raised 16.69 mm/s with surrounding noise at 82 db (Lombard effect). Conclusion: Increased vocal effort is associated with increased VCOP rms in most subjects studied. The effects of VCOP rms as a postural index allowing noninvasive assessment of the voice in pathology warrants further study.

Within the last 3 decades, microsurgery and stereotactic radiosurgery (SRS) have become well-established management options for vestibular schwannomas (VSs). Advancement in the management of VSs can be separated into three periods: the microsurgical pioneer period, the demonstration of SRS as a first-line therapy for small and medium-sized VSs, and currently, a period of SRS maturity based on a large worldwide patient accrual. The Marseille SRS experience includes 1,500 patients, with 1,000 patients having follow-up longer than 3 years. A long-term tumor control rate of 97%, transient facial palsy lower than 1%, and a probability of functional hearing preservation between 50 and 95% was achieved in this large series of patients treated with state-of-the-art SRS.

Summary Well-known multimass models of vocal folds are useful to describe main behavior observed in human voicing but their principle of functioning, based on harmonic oscillation, may appear complex. This work is designed to show that a simple one-mass model ruled by laws of relaxation oscillation can also depict main behavior of glottis dynamic. Theory of relaxation oscillation is detailed. A relaxation oscillation model is assessed through a numerical simulation using conventional values for tissue characteristics and subglottal pressure. As expected, raising the mass decreases the fundamental frequency and increases the amplitude of vocal fold vibration: for a mass ranging from 0.01 to 0.4 g, F 0 decreased from 297.5 to 42.5 Hz and vibrational amplitude increased from 1.26 to 3.25 mm (for stiffness k = 10 N m −1 , damping r = 0.015 N s m −1 , and subglottal pressure = 1 kPa). Stiffness value has the opposite effect. The subglottal pressure controls the fundamental frequency with a rate ranging from 20 to 50 Hz/kPa. The vibrational amplitude is also controlled linearly by subglottal pressure from 0.22 to 0.26 mm/kPa. The range of phonation threshold pressure (PTP) is close to the values currently proposed, that is, 0.1 to 1 kPa and varies with the fundamental frequency. The relaxation oscillator is a simple and useful tool for modeling vocal fold vibration.

International audience; Considering on the one hand the important histological differences that exist between newborn and adult vocal folds and on the other hand the specifical subglottal pressure at birth, the sound production in a newborn larynx is studied. The laryngotracheal airflow has been numerically modelled in order to evaluate its role in voice production by the larynx in newborn. The FFT spectrum of the pressure signal acquired just above the vocal folds was calculated and compared to the spectrum of a sound generated by an excised larynx. It can be determined that first, the computed pressure signal has a fundamental frequency close to that obtained experimentally with an excised larynx, and second the FFT spectra are qualitatively similar to one another. Third, the computed pressure fluctuation is strong enough to be detected by the human ear. The conclusion is that the airflow and the aerodynamical phenomena observed in a rigid geometry are, by themselves, able to produce a sound and consequently, are one of the several elements leading to sound production in the newborn larynx. #

Objective The aim of this study was to describe and analyze the vibratory pattern of vocal folds in an asymmetric situation. Study design and setting Cricothyroid muscle unilateral action was simulated on excised larynges on an experimental bench. Increasing airflow rates were applied to achieve vocal fold vibration. Electroglottography and an optoreflectometer device allowed analysis of separate and simultaneous vocal fold vibration. Spectra of the signals were obtained for each level of airflow variation. Results All experiments showed periodic vibration. A phase shift was noted between the two vocal folds. Subharmonics and biphonation were identified in all the experiments. Conclusion Lax vocal folds were more susceptible to spectral changes with increasing airflow. Significance Knowledge of the consequences of mass, tension, and position asymmetries of the vocal folds is crucial for diagnosis making and defining therapeutic strategies in dysphonic patients. This study may contribute to the understanding of physiology of vocal fold interaction and its compensatory mechanisms.

Summary Numerous clinical findings indicate that viscosity of laryngeal mucosa is a crucial factor in glottal perfomance. Experience using experimental test benches has shown the importance of humidifying air stream used to induce vibration in excised larynges. Nevertheless, there is a lack of knowledge particularly regarding the physicochemical properties of laryngeal mucus. The purpose of this study was to research vocal fold vibration in excised larynges using artificial mucus of precisely known viscosity. Eight freshly harvested porcine larynges were examined. Parameters measured were Fo and vocal fold contact time. Measurements were performed under three conditions: basal (no fluid application on vocal cord surface), after application of a fluid of 60cP viscosity (Visc60), and after application of a fluid of 100cP viscosity (Visc 100). Electroglottographic measurements were performed at two different times for each condition: 1 s after airflow onset (T1) and 6 seconds after airflow onset (T2). Statistical analysis consisted of comparing data obtained under each condition at T1 and T2. The results showed a significant decrease in Fo after application of Visc60 and Visc100 fluids and a decrease in Fo at T2. Closure time was significantly higher under Visc60 conditions and under Visc100 conditions than under basal conditions. Application of artificial mucus to the mucosa of the vocal folds lowered vibratory frequency and prolonged the contact phase. Our interpretation of this data is that the presence of mucus on the surface of the vocal folds generated superficial tension and caused adhesion, which is a source of nonlinearity in vocal vibration.

Summary It has been shown that voice signal abnormalities, particularly in unilateral laryngeal paralysis (ULP), are not always randomly distributed and that "statistical" indexes of regularity, such as jitter and shimmer, may be unreliable in these cases. The techniques of nonlinear dynamics, particularly phase portraits, have been used to demonstrate that some of the abnormalities observed were the consequence of nonlinearity of glottic function. From a theoretical point of view, determination of Lyapunov exponents allows quantification of the complexity of the phase portraits. The authors studied vocal signals recorded in 12 normal subjects and 26 patients with ULP and calculated the largest Lyapunov exponent (LLE). In normal subjects, LLE mean value was 0.380 (SD = 0.182). In patients with ULP, LLE mean value was 0.570 (SD = 0.337). The difference is significant at P = 0.031. Determination of LLE was compared to more "classical" indexes such as jitter and oral airflow during phonation. A principal component analysis showed that information contained in LLE was not redundant but complementary to the other parameters.

We investigated the possibility of obtaining an anteroposterior body response to galvanic vestibular stimulation (GVS) by applying an equivalent stimulus to both sides of the vestibular apparatus. An original ‘double fronto-mastoidal’ stimulation was used on eight subjects standing with their head facing forwards. Both the onset and the cut-off of the current did induce an anteroposterior body tilt, without any lateral component. The amplitude of the tilt increased as a function of stimulus intensity. GVS evokes anteroposterior or lateral sway of similar spatio-temporal features according to the stimulation configuration. We suggest that the central nervous system makes use of the discrepancy between the left and right vestibular activity to orientate the response: equivalent afferent flows would result in an anteroposterior body response whereas lateral sway is obtained with discrepant ones. © 1998 Elsevier Science Ireland Ltd.

Recovery of head postural control after unilateral vestibular neurectomy was investigated in the alert cat by chronically recording the spontaneous neck muscle EMG activity from splenius capitis on both sides and the vestibulocollic reflexes evoked during roll and pitch tilts. Neuronal correlates occurring within the lateral (Deiters) vestibular nuclei (LVN) were also recorded during the time-course of recovery. During the acute phase (1-2 weeks), the cats exhibited strong imbalance in spontaneous neck muscle activity, characterized by increased muscular tone in the ipsilateral splenius capitis muscle and hypoactivity in the contralateral one. At the same time, the mean resting activity of Deiters' neurons strongly decreased on the deafferented side, while a slight but significant decrease was observed on the intact side. Vestibulocollic reflexes were totally lacking during the acute phase, whatever the direction and the amplitude of tilt. Recovery developed in the following weeks, leading to complete rebalance of spontaneous EMG activity as well as near to normal static vestibulocollic reflexes 5 weeks after the lesion. However, compensation remained sub-normal during roll tilts while overcompensation was found during pitch tilts, suggesting that the intact labyrinth would play a leader role in the recovery process but that bilateral cooperation of the two labyrinths is required for proper head postural control. Five weeks are also needed for a partial rebalancing of resting activity between both LVN. These results indicate that changes in neck muscle activity observed in the acute cats and that recovery found in the compensated animals could result from modifications in neural networks controlling neck musculature, such as the LVN.

Objectives: In previous work, we showed that a rigid larynx-like geometry can generate a sound by itself. However, very little is known about the exact mechanisms and control of the larynx during the first cry of life. The goal of this work was to understand how the very first cry is generated. Methods: Simultaneous high-speed imaging and sound recording on 2 excised 38-week term human fetus larynges were performed. The behaviors of the vocal folds and the false vocal folds were studied separately. The behavior of the vocal folds after resection of the supraglottic structures was also analyzed. A comparative acoustic analysis of the first cry and of the sound generated by the excised organs was performed. Results: Our data showed that the vocal folds in a larynx with the pressure conditions of the first cry do not generate sound themselves, but induce aerodynamic conditions leading to vibrations of other parts of the larynx. Conclusions: The similarities between the sound generated by an excised larynx and the first cry suggest a lack of neurologic control of the larynx during production of the first cry. A model-algorithm is proposed.