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Incomplete glottal closure is a laryngeal configuration wherein the glottis is not fully obstructed prior to phonation. In this work, we introduce an Euler-Bernoulli composite beam vocal fold (VF) model that produces qualitatively similar incomplete glottal closure patterns as those observed in experimental and high-fidelity numerical studies, thus offering insights in to the potential underlying physical mechanisms. Refined physiological insights are pursued by incorporating the beam model into a VF posturing model that embeds the five intrinsic laryngeal muscles. Analysis of the combined model shows that co-activating the lateral cricoarytenoid (LCA) and interarytenoid (IA) muscles without activating the thyroarytenoid (TA) muscle results in a bowed (convex) VF geometry with closure at the posterior margin only; this is primarily attributed to the reactive moments at the anterior VF margin. This bowed pattern can also arise during VF compression (due to extrinsic laryngeal muscle activation for example), wherein the internal moment induced passively by the TA muscle tissue is the predominant mechanism. On the other hand, activating the TA muscle without incorporating other adductory muscles results in anterior and mid-membranous glottal closure, a concave VF geometry, and a posterior glottal opening driven by internal moments induced by TA muscle activation. In the case of initial full glottal closure, the posterior cricoarytenoid (PCA) muscle activation cancels the adductory effects of the LCA and IA muscles, resulting in a concave VF geometry and posterior glottal opening. Furthermore, certain maneuvers involving co-activation of all adductory muscles result in an hourglass glottal shape due to a reactive moment at the anterior VF margin and moderate internal moment induced by TA muscle activation.
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Folia Phoniatr Logop
August 2025
Objectives: Type I medialization thyroplasty (MT) is one of the standard procedures in patients having permanent unilateral vocal fold paralysis (UVFP) with insufficient glottal closure. The objective of this study was to evaluate the clinical outcome in patients with UVFP 7 weeks post implantation using the novel APrevent® VOIS (VOIS) implant with its adjustable balloon.
Methods: The VOIS implant was applied in 32 Patients with UVFP during MT.
Laryngoscope Investig Otolaryngol
August 2025
Department of Otolaryngology Head and Neck Surgery University of Wisconsin Madison USA.
Objective: Injection augmentation (or injection laryngoplasty) is a common treatment for presbyphonia. As current injection materials are temporary, it is anticipated that patients injected for presbyphonia will either need a repeat injection or framework surgery to maintain glottal competence (or sufficient glottal closure). Despite the expected temporary nature of these injections, patients report variable durability of effect, and some do not require a repeat injection.
View Article and Find Full Text PDFIEEE Trans Audio Speech Lang Process (2025)
December 2024
Institute for Research and Development on Bioengineering and Bioinformatics, CONICET-UNER, Oro Verde, Entre Ríos, Argentina.
Voice inverse filtering methods aim at noninvasively estimating the glottal source information from the voice signal. These inverse filtering strategies typically rely on parametric models and variants of linear prediction for tuning the vocal tract filter. Weighted linear prediction schemes have proved to be the best performing for inverse filtering applications.
View Article and Find Full Text PDFBioengineering (Basel)
June 2025
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA.
Unilateral vocal fold paralysis (UVFP) can lead to significant dysphonia. Medialization thyroplasty type 1 (TT1) is a common surgical intervention aiming at improving vocal quality by optimally positioning the paralyzed fold to generate the necessary vibrations for phonation. Implants are generally placed through the thyroid cartilage in a sedated patient and positioned either underneath the level of the vocal folds (infraglottal medialization or IM) or at the level of the vocal folds (glottal medialization or GM).
View Article and Find Full Text PDFJ Voice
May 2025
Complex Operative Unit of Otolaryngology, Department of Aging, Neurological, Orthopedic and Head and Neck Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Section of Otolaryngology, University Department of Head-Neck and Sense Organs, Catholic University of the Sacred H
Objectives: Aim of this study was to verify the effects of early management through non-phonatory exercises aimed at improving glottic closure in patients affected by iatrogenic unilateral vocal fold paralysis.
Study Design: randomized clinical trial.
Methods: Between February 2024 and September 2024, 20 patients (15 F, 5 M; mean age 46.