Vocal Tract Visualization and Imaging

LARYNGOSCOPY
Examination of the internal structures of the larynx, including the vocal folds, is called
laryngoscopy.

Laryngoscopy is of two types:

1) Indirect laryngoscopy
2) Direct laryngoscopy

Indirect Laryngoscopy
 The technique developed after Manuel Garcia visualised the intact larynx for the first
time in 1854 using a dental mirror.
 It derives its name from the technique of viewing the interior of the larynx indirectly via a
mirror or some other optical instrument rather than with naked eye.

 The physician faces the upright patient, wraps the tongue in gauze to protect the frenum
from the lower incisors, and, with thumb and middle finger, draws the tongue out of the
mouth.
 The mirror, slightly warmed and tested against the dorsum of the tongue, is introduced
into the mouth, the examiner carefully avoiding contact with the tongue.
 The mirror, guided posteriorly by pushing the uvula upward and backward, is positioned
in the oropharynx.
 Gagging can be inhibited by encouraging the patient to breathe through the mouth and to
keep the eyes open. Otherwise, a topical anesthetic agent is sprayed into the oropharynx.
 With the laryngeal mirror properly positioned, the clinician reflects a light beam off a
head mirror onto the laryngeal mirror to see the laryngeal interior.

 With the mirror, the laryngologist inspects the base of the tongue, the anterio anterior
surface of the epiglottis, the valleculae, the pharyngeal walls, the pyriform sinuses, the
posterior border of the epiglottis, the aryepiglottic folds, and the mucosa of the posterior
commissure.

 The vocal folds are viewed during quiet breathing and while the patient sustains the
vowel /e/ or /i/. The effort to produce these vowels causes the larynx to rise in the neck,
affording a clearer view of the vocal folds.
 The examiner searches for symmetry of glottal opening and closing, normalcy of color,
presence or absence of mass lesions, or inflammation.
Advantages Disadvantages

 Quick overview  Poorly tolerated

 No pain or trauma  If a gag reflex is present, this

procedure cannot be performed.

 Anatomical variations frequently

make it difficult to visualize the
larynx.
Direct laryngoscopy
1. Rigid laryngoscopy
2. Flexible Laryngoscopy

Rigid laryngoscopy

Instrumentation:

Rigid laryngoscope

Procedure:
 It is a non-flexible instrument.
 Superior to indirect laryngoscopy. It can be adopted for the photography and can be used
as an observation tube and can be connected to closed circuit television with video tape
recording.
 This examination provides the clearest magnified view of the larynx.
 The patient has to lie on the back during this procedure.
 The examiner then holds the patient's tongue while viewing the voice box.
 Images are usually recorded on video.
 It facilitates visualisation of the larynx, hypo pharynx, base of the tongue, nasopharynx,
and nasal surface of the palate.
Flexible fiberoptic laryngoscope/transnasal fiberoptic laryngoscopy
• First introduced by Swashima and Hirose, 1968.
• Fiberoptic scope/ nasopharyngoscope requires a powerful light source.
• A television monitor and recorder can be attached for viewing and videotaping
purposes.
• The curved part of the scope is a flexible fiberoptic cable that can be passed
through the nose and through the pharynx until it gives a view of the vocal folds.

The instrument shown above is a nasopharyngoscope. The curved part of the scope is a
flexible fiberoptic cable that can be passed through the nose and through the pharynx
until it gives a view of the vocal folds.

 The flexible scope causes very little gagging and is actually quite comfortable.
 Using this flexible endoscope, the larynx can be examined during normal speech.

Videostroboscopy
 Stroboscopy is a technique used to observe motion in cases where the movement is so
quick that the human visual system cannot capture and process the image.
 Stroboscopy is a special method used to visualize vocal fold vibration.. This "slow
motion picture" is an illusion, as the speed of actual vocal fold vibration is not changed
by stroboscopy.
 Principle:
 The light source of the stroboscope emits intermittent flashes of light which are
synchronous with the vibratory cycles.
 The source of the trigger signal for the light flashes is the waveform of the subject's
voice.

Procedure
 The microphone is attached to the subject's neck near the thyroid cartilage with an elastic
band to make contact with the larynx.
 The camera is attached to a fiber-optic endoscope that is used to view the VFs.
 Instead of viewing the larynx under steady light, this procedure uses rapid flashes of light
to view vocal folds.
 These light flashes are synchronous with the vibratory cycles.
 When the subject phonates, the fundamental frequency of phonation is determined and
the stroboscope light is pulsed at approximately the same frequency.
 When the frequency of flash coincides exactly with frequency of vibration of the vocal
fold (synchronisation), the vocal fold seems motionless.
 When a rapidly moving object (represented by the high frequency waveform) is strobed
by flashes at a lower frequency, the rapidly moving object appears to move more slowly

There are the following general tendencies:

 As the fundamental frequency increases, the amplitude of vibration and the mucosal
wave decrease and the closed phase becomes relatively shorter, assuming that the vocal
effort is roughly constant.
 As the vocal intensity increases, the amplitude and the mucosal wave increase and the
closed phase becomes relatively longer.
 In falsetto, the amplitude is small, the mucosal wave is hardly found, and the glottis is not
completely closed.

Advantages Disadvantages
 extensive body of information  patient discomfort related to the
relative to the effect of pathology use of FFN or RFOE
 on the process of voicing

 image restricted to isolated vowel

production when the strobe light is
 potential for providing information used
about the neuromuscular and
physiological integrity of the vocal  highly subjective (Roy et al.,
folds and supraglottic structures 2013)

Aerodynamic:
INTRODUCTION
Aerodynamic in voice production refers to the study of how air flows and interacts with the vocal
folds and other structures involved in producing sound.

Aerodynamic measures:

 Lung volumes and capacities

 Air pressure
 Airflow

Volume and capacity:

 Volume is the quantity of three dimensional space enclosed by some closed

boundary.
 Capacity is the maximum amount that can be held, absorbed or produced.
TIDAL VOLUME: (VT)
 It is the volume of air entering and leaving the nose or mouth per breath.
 It is determined by the activity of the respiratory control centers in the brain as they effect
the respiratory muscles and by the mechanics of the lung & the chest wall.
 Tidal volume is one of the components of lung volumes and capacities, which are the
measurements of the different aspects of lung function

INSPIRATORY RESERVE VOLUME: (IRV)

• It is the volume of air that is inhaled into the lungs during a maximal forced inspiration,
starting at the end of a normal tidal inspiration.
• It is determined by the strength of contraction of the inspiratory muscles, the inward
elastic recoil of the lung and the chest wall.
• The IRV of a normal 70 kg adult is about 2.5lt.

EXPIRATORY RESERVE VOLUME: (ERV)

 It is the volume of air that is expelled from the lungs during a maximal forced expiration
that starts at the end of a normal tidal expiration.
 It is therefore determined by the difference between the FRC and the RV.
 ERV is one of the four lung volumes that are measured by spirometry, a test that
evaluates how well your lungs work.

RESIDUAL VOLUME: (RV)

 It is the volume of gas left in the lungs after a maximal forced expiration.
  It is determined by the force generated by the muscles of expiration and the inward
elastic recoil of the lungs as they oppose the outward elastic recoil of the chest wall.
 The RV of a healthy 70kg adult is about 1.5 Lt.

SPIROMETER
Spirometry (spy-ROM-uh-tree) is a common office test used to assess how well your lungs work
by measuring how much air you inhale, how much you exhale and how quickly you exhale.

Types
There are two types of spirometer they are:

 Wet spirometer.
 Dry spirometer

Wet spirometer
 The classic instrument for the evaluation of air volumes is the wet spirometer which is an
extremely simple device.
 It consists of an air collecting “bell” inverted in a vessel of water.
 At the start of the test, water fills the bell but air from the patient is channeled into it and
the water is displaced.
 This causes the bell to float so that its height is directly proportional to the amount of air
in it.
 A pointer linked to bell indicates the volume of air.

Dry spirometer
 Hand held or dry spirometers are compact and portable device that does not depend on
the displacement of water from a bell.

 Dry spirometers measure the volume of air expired by the lungs and the volume of air in
the lungs.
 Dry spirometers can be used to perform basic pulmonary function tests (PFTs), such as
measuring the forced vital capacity (FVC) and the forced expiratory volume in one
second (FEV1).
 Dry spirometers have an indicator that moves along a scale as the air is exhaled, showing
the amount of air in milliliters or liters.