Intravascular pressure likely rises significantly during vocal fold vibration and may lead to the type of injury seen in benign vocal fold lesions. The results support voice therapy aimed at reducing vibratory amplitude. More vibratory amplitude measurements need to be performed in a wider range of subjects before the full range of human vocal fold vascular pressures can be estimated.

In this study, a biphasic theory is applied to investigate the viscoelastic behaviors of vocal fold lamina propria during stress relaxation. The vocal fold lamina propria tissue is described as a biphasic material composed of a solid phase and an interstitial fluid phase. The biphasic theory reveals the interaction between the solid and the fluid. For the one-dimensional case, the analytical solutions of solid displacement, fluid velocity, and stress are derived. The biphasic theory predicts the stress relaxation of the vocal fold lamina propria. The quasilinear viscoelastic model as well as its higher-order elastic parameters can be derived from this biphasic theory. Furthermore, the fluid is found to support the majority of the stress at the early stage of stress relaxation; however, when the time becomes sufficiently large, the solid eventually bears all the stress. The early fluid stress support is much higher than the eventual solid support and may be important for understanding the effects of dehydration on tissue damage. By considering the solid-fluid structure of the vocal fold lamina propria, the biphasic theory allows for a more physical theory of tissue viscoelasticity than a single phase solid description and may provide a valuable physical mechanism for the observed vocal fold rheologic behaviors.

The human vocal fold is treated as a continuous, transversally isotropic, porous solid saturated with liquid. A set of mathematical equations, based on the theory of fluid-saturated porous solids, is developed to formulate the vibration of the vocal fold tissue. As the fluid-saturated porous tissue model degenerates to the continuous elastic tissue model when the relative movement of liquid in the porous tissue is ignored, it can be considered a more general description of vocal fold tissue than the continuous, elastic model. Using the fluid-saturated porous tissue model, the vibration of a bunch of one-dimensional fibers in the vocal fold is analytically solved based on the small amplitude assumption. It is found that the vibration of the tissue will lead to the accumulation of excess liquid in the midmembranous vocal fold. The degree of liquid accumulation is positively proportional to the vibratory amplitude and frequency. The correspondence between the liquid distribution predicted by the porous tissue theory and the location of vocal nodules observed in clinical practice, provides theoretical evidence for the liquid accumulation hypothesis of vocal nodule formation (Jiang, Ph. D., dissertation, 1991, University of Iowa).

Hypothesis Posterior positioning of medialization thyroplasty provides the best acoustic and aerodynamic outcomes. Study Design Ex vivo excised canine larynx. Methods Unilateral thyroplasty windows were cut in the thyroid cartilages of 10 excised canine larynges. Each larynx was mounted on an artificial lung and the vocal fold opposite the thyroid window was adducted by medializing its arytenoid cartilage. Then, medialization thyroplasty was simulated with a probe placed anterior, central, and posterior in the thyroid window. The glottal area, airway reduction, medialization force, phonation threshold pressure and flow, aerodynamic power, intensity, efficiency, jitter, shimmer, and signal-to-noise ratio (SNR) were measured at each medialization position. Results Posterior medialization probe placement minimized the glottal area, provided the best voice as determined by perturbation measures and SNR, reduced the work of phonation, and increased efficiency. Anterior and middle probe placement minimized the work of phonation but provided only modest gains in sound quality and decreased sound intensity. Medializing the vocal fold with posterior probe placement required twice as much force as central and anterior probe placement. Conclusions The results suggest that posterior medialization provides the greatest improvement in acoustic parameters and efficiency in patients who can tolerate the airway reduction. Middle and anterior medialization can decrease work of phonation, but in this experiment objective improvement in sound quality was limited. Subtle changes in displacement shim contour, especially in middle and anterior locations, have a substantial impact on voice outcome, affirming the value of intraoperative voice assessment.

A CBCT offers marginally improved sensitivity at the cost of reduced specificity for assessment of bone invasion compared to CT.