The entire glottis has mostly been the focus in the tracking of the vocal folds, both manually and automatically. From a treatment point of view, the various regions of the glottis are of specific interest. The aim of the study was to test if it was possible to supplement an existing convolutional neural network (CNN) with post-network calculations for the localization and quantification of posterior glottal gaps during phonation, usable for vocal fold function analysis of e.g. laryngopharyngeal reflux findings. 30 subjects/videos with insufficient closure in the rear glottal area and 20 normal subjects/videos were selected from our database, recorded with a commercial high-speed video setup (HSV with 4000 frames per second), and segmented with an open-source CNN for validating voice function. We made post-network calculations to localize and quantify the 10% and 50% distance lines from the rear part of the glottis. The results showed a significant difference using the algorithm at the 10% line distance between the two groups of p < 0.0001 and no difference at 50%. These novel results show that it is possible to use post-network calculations on CNNs for the localization and quantification of posterior glottal gaps.

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Quantitative voice analysis for clinical use has been focused upon for many years. The aim was to test if Glottal Analysis Tools (GAT) could be used, based on High-Speed Video (HSV) to quantify distances between the vocal folds at any place on the vocal folds. The software includes a reproduced computed film of the vocal fold movements online. 20 normal HSV and 30 with insufficient closure in the rear part of the vocal folds (rear glottal gap) were compared in a case-control study. The distance of trajectories was chosen at 50% and 10% from the rear part of the glottis and maximum and minimum distances between the vocal folds were defined during phonation in the 2 groups. It was possible to calculate the absolute data of insufficiency of closure of the vocal folds compared to normal HSV with a statistical difference of p<0,0001. An interesting result was in this material also that functional closure was found in all images in the middle of the vocal folds. In the future quantification of voice disorders should include specific parts of the Glottal Area Waveform (GAW) analyses based on HSV for better differentiation of function and pathology of the vocal folds.

Adolescence is a challenging time of change in voicing, normally and in pathology. An increased focus on voice production in relation to genetics can expand our knowledge of the onset of puberty and voice change. Our aim with this review was to connect research of genetics to voice production in adolescence. We need further understanding of the developmental background of voice in childhood and adolescence, because many genetic multi handicaps include voice production. Genetic development related to voice production was the focus in a search made by the Royal English Society of Medicine, with only a few results. We supplemented with references to genetic studies of adults and animals as well as adjacent areas of voice production. The genetic development of voice production is steered from the hypothala-mus probably related to growth hormone. The genetic voice production in adults form the basis for understanding development. Some research results were found related to the pubertal steps. The findings are important in the future, using advanced voice analysis and artificial intelligence methods in patients with Multi handicaps.