Cough in Reduced True Vocal Fold Mobility

Completed

Interventions: Other: cough airflow measure
Other: vocal tasks
Other: true vocal fold movement
Other: spirometry test
Other: maximum expiratory pressure (MEP)

Brief Summary: This project is a first attempt to assess cough airflow dynamics and true vocal fold (TVF) adduction and abduction angles during voluntary cough to examine the effects of changes in glottal closure due to reduced mobility of one true vocal fold. The hypothesis of this study is that the incomplete glottal closure due to reduced vocal fold mobility will result in changes in true vocal fold adductory and abductory angles during cough and will result in changes to voluntary cough airflow parameters. This study results will contribute to the existing knowledge of the laryngeal contribution to cough airflow dynamics.

Detailed Description: The study investigators will consecutively recruit 30 adults diagnosed with vocal fold insufficiency due to reduced mobility of one true vocal fold.

A questionnaire will be used to collect participants' information. Demographic information such as age, gender, race/ethnicity, height, weight, and a major complaint (dysphonia and/or dysphagia) and medical history information determining the eligibility for participation will be collected from the participant. Participant's medical and surgical history specifically related to the diagnosis and the etiology of reduced vocal fold mobility will be obtained from the participant's medical record.

Videolaryngoscopy will be performed as part of standard clinical care. Vocal fold image and cough airflow will be recorded simultaneously during voluntary cough production with the flexible endoscope in nasopharynx. A second part of the study will include spirometry and expiratory muscle strength assessments. Video images of the vocal fold movement during vowel phonation and cough production will be recorded and stored on a CD for later analysis. The cough airflow recordings will be displayed, stored, and analyzed using LabChart software for Windows.

Recruitment & Eligibility

Inclusion Criteria

Age between 40 and 75 years.
Glottal insufficiency secondary to reduced TVF mobility confirmed with the endoscopic evaluation performed by an otolaryngologist.
The ability to provide informed consent.
No history of chronic obstructive pulmonary disease, lung cancer, and/or lung transplant.
No history of neurodegenerative disease such as Parkinson's disease, multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or progressive supranuclear palsy (PSP), Alzheimer's disease, or dementia.

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Laryngeal function in cough	cough airflow measure	cough airflow measure, vocal tasks, true vocal fold movement, spirometry test, and maximum expiratory pressure (MEP) assessment will be performed in this group.
Laryngeal function in cough	true vocal fold movement	cough airflow measure, vocal tasks, true vocal fold movement, spirometry test, and maximum expiratory pressure (MEP) assessment will be performed in this group.
Laryngeal function in cough	spirometry test	cough airflow measure, vocal tasks, true vocal fold movement, spirometry test, and maximum expiratory pressure (MEP) assessment will be performed in this group.
Laryngeal function in cough	maximum expiratory pressure (MEP)	cough airflow measure, vocal tasks, true vocal fold movement, spirometry test, and maximum expiratory pressure (MEP) assessment will be performed in this group.
Laryngeal function in cough	vocal tasks	cough airflow measure, vocal tasks, true vocal fold movement, spirometry test, and maximum expiratory pressure (MEP) assessment will be performed in this group.

Primary Outcome Measures

Name	Time	Method
Peak expiratory flow rate (PEFR)	baseline	Maximum flow rate in expiratory phase, expressed in liters per second (L/s)
True vocal fold maximum abduction angles in inspiratory phase	baseline	The TVF maximum abduction angles during cough inspiratory phase of cough will be expressed in degrees.
True vocal fold maximum abduction angles in expiratory phase	baseline	True vocal fold maximum abduction angles in expiratory phase of cough will be expressed in degrees.
True vocal fold maximum adduction angles in compression phase	baseline	True vocal fold maximum adduction angles in compression phase of cough will be expressed in degrees.
Peak expiratory flow rise time (PEFRT)	baseline	Time to reach peak expiratory flow rate expressed in seconds
Cough volume acceleration (CVA)	baseline	A ratio of peak expiratory flow rate and peak expiratory flow rise time expressed in L/s/s
Expiratory phase duration	baseline	Duration of expiratory phase of cough expressed in seconds

Secondary Outcome Measures

Name	Time	Method
Peak expiratory flow	baseline	Maximum flow rate during forced exhalation expressed in L/s
Maximum expiratory pressure	baseline	Maximum expiratory pressure will be expressed in cmH2O.
Degree of glottal closure	baseline	The degree of glottal closure will be assessed during phonation using glottic closure rating scale 1-6, 1=complete closure, 6=incomplete closure all along the vocal folds (Södersten et al., 1990).
Forced vital capacity (FVC)	baseline	Maximum amount of air that can be exhaled with maximal speed and effort after maximum inhalation, expressed in L
Forced expired volume within 1 second (FEV1)	baseline	Maximum amount of air exhaled forcefully within 1 second, expressed in L.
The ratio FEV1/FVC	baseline	The percent (%) of forcefully exhaled air that can be exhaled during the first second of exhalation.

Locations (2): University of Florida ENT Clinic
🇺🇸
Gainesville, Florida, United States
University of Florida Speech and Hearing Center
🇺🇸
Gainesville, Florida, United States