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Measurement of the Maximum Frequency of Electroglottographic Fluctuations in the Expiration Phase of Volitional Cough as a Functional Test for Cough Efficiency

Abstract

The hypotheses of the present study were that the maximum frequency of fluctuation of electroglottographic (EGG) signals in the expiration phase of volitional cough (VC) reflects the cough efficiency and that this EGG parameter is affected by impaired laryngeal closure, expiratory effort strength, and gender. For 20 normal healthy adults and 20 patients diagnosed with unilateral vocal fold paralysis (UVFP), each participant was fitted with EGG electrodes on the neck, had a transnasal laryngo-fiberscope inserted, and was asked to perform weak/strong VC tasks while EGG signals and a high-speed digital image of the larynx were recorded. The maximum frequency was calculated in the EGG fluctuation region coinciding with vigorous vocal fold vibration in the laryngeal HSDIs. In addition, each participant underwent spirometry for measurement of three aerodynamic parameters, including peak expiratory air flow (PEAF), during weak/strong VC tasks. Significant differences were found for both maximum EGG frequency and PEAF between the healthy and UVFP groups and between the weak and strong VC tasks. Among the three cough aerodynamic parameters, PEAF showed the highest positive correlation with the maximum EGG frequency. The correlation coefficients between the maximum EGG frequency and PEAF recorded simultaneously were 0.574 for the whole group, and 0.782/0.717/0.823/0.688 for the male/female/male-healthy/male-UVFP subgroups, respectively. Consequently, the maximum EGG frequency measured in the expiration phase of VC was shown to reflect the velocity of expiratory airflow to some extent and was suggested to be affected by vocal fold physical properties, glottal closure condition, and the expiratory function.

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References

  1. 1.

    Von Leden H, Isshiki N. An analysis of cough at the level of the larynx. Arch Otolaryngol (Chicago, Ill: 1960). 1965;81:616–25.

  2. 2.

    Yanagihara N, Von Leden H, Werner-Kukuk E. The physical parameters of cough: the larynx in a normal single cough. Acta Otolaryngol. 1966;61(6):495–510.

  3. 3.

    Moore P, Von Leden H. Dynamic variations of the vibratory pattern in the normal larynx. Folia Phoniatr (Basel). 1958;10(4):205–38.

  4. 4.

    Pressman JJ. Sphincters of the larynx. AMA Arch Otolaryngol. 1954;59(2):221–36.

  5. 5.

    Leith DE. Cough. Phys Ther. 1968;48(5):439–47.

  6. 6.

    McCool FD, Leith DE. Pathophysiology of cough. Clin Chest Med. 1987;8(2):189–95.

  7. 7.

    Boitano LJ. Management of airway clearance in neuromuscular disease. Respir Care. 2006;51(8):913–22 discussion 922–914..

  8. 8.

    Ebihara S, Sekiya H, Miyagi M, Ebihara T, Okazaki T. Dysphagia, dystussia, and aspiration pneumonia in elderly people. J Thorac Dis. 2016;8(3):632–9. doi:10.21037/jtd.2016.02.60.

  9. 9.

    Heitmiller RF, Tseng E, Jones B. Prevalence of aspiration and laryngeal penetration in patients with unilateral vocal fold motion impairment. Dysphagia. 2000;15(4):184–7. doi:10.1007/s004550000026.

  10. 10.

    Doggett DL, Tappe KA, Mitchell MD, Chapell R, Coates V, Turkelson CM. Prevention of pneumonia in elderly stroke patients by systematic diagnosis and treatment of dysphagia: an evidence-based comprehensive analysis of the literature. Dysphagia. 2001;16(4):279–95. doi:10.1007/s00455-001-0087-3.

  11. 11.

    Smith Hammond CA, Goldstein LB, Zajac DJ, Gray L, Davenport PW, Bolser DC. Assessment of aspiration risk in stroke patients with quantification of voluntary cough. Neurology. 2001;56(4):502–6.

  12. 12.

    Pitts T, Bolser D, Rosenbek J, Troche M, Sapienza C. Voluntary cough production and swallow dysfunction in Parkinson’s disease. Dysphagia. 2008;23(3):297–301. doi:10.1007/s00455-007-9144-x.

  13. 13.

    Sancho J, Servera E, Diaz J, Marin J. Predictors of ineffective cough during a chest infection in patients with stable amyotrophic lateral sclerosis. Am J Respir Crit Care Med. 2007;175(12):1266–71. doi:10.1164/rccm.200612-1841OC.

  14. 14.

    Ruddy BH, Pitts TE, Lehman J, Spector B, Lewis V, Sapienza CM. Improved voluntary cough immediately following office-based vocal fold medialization injections. Laryngoscope. 2014;124(7):1645–7. doi:10.1002/lary.24529.

  15. 15.

    Smith Hammond CA, Goldstein LB, Horner RD, Ying J, Gray L, Gonzalez-Rothi L, Bolser DC. Predicting aspiration in patients with ischemic stroke: comparison of clinical signs and aerodynamic measures of voluntary cough. Chest. 2009;135(3):769–77. doi:10.1378/chest.08-1122.

  16. 16.

    Van Hirtum A, Berckmans D. Automated recognition of spontaneous versus voluntary cough. Med Eng Phys. 2002;24(7–8):541–5.

  17. 17.

    Addington WR, Stephens RE, Phelipa MM, Widdicombe JG, Ockey RR. Intra-abdominal pressures during voluntary and reflex cough. Cough. 2008;4:2. doi:10.1186/1745-9974-4-2.

  18. 18.

    Lee KK, Ward K, Rafferty GF, Moxham J, Birring SS. The intensity of voluntary, induced, and spontaneous cough. Chest. 2015;148(5):1259–67. doi:10.1378/chest.15-0138.

  19. 19.

    Britton D, Yorkston KM, Eadie T, Stepp CE, Ciol MA, Baylor C, Merati AL. Endoscopic assessment of vocal fold movements during cough. Ann Otol Rhinol Laryngol. 2012;121(1):21–7.

  20. 20.

    Britton D, Benditt JO, Merati AL, Miller RM, Stepp CE, Boitano L, Hu A, Ciol MA, Yorkston KM. Associations between laryngeal and cough dysfunction in motor neuron disease with bulbar involvement. Dysphagia. 2014;29(6):637–46. doi:10.1007/s00455-014-9554-5.

  21. 21.

    Iwahashi T, Ogawa M, Hosokawa K, Kato C, Inohara H. A detailed motion analysis of the angular velocity between the vocal folds during throat clearing using high-speed digital imaging. J Voice. 2016. doi:10.1016/j.jvoice.2015.11.004.

  22. 22.

    Baken RJ. Electroglottography. J Voice. 1992;6(2):98–110. doi:10.1016/S0892-1997(05)80123-7.

  23. 23.

    Haji T, Horiguchi S, Baer T, Gould WJ. Frequency and amplitude perturbation analysis of electroglottograph during sustained phonation. J Acoust Soc Am. 1986;80(1):58–62.

  24. 24.

    Rothenberg M, Mahshie JJ. Monitoring vocal fold abduction through vocal fold contact area. J Speech Hear Res. 1988;31(3):338–51.

  25. 25.

    Vlot C, Ogawa M, Hosokawa K, Iwahashi T, Kato C, Inohara H. Investigation of the immediate effects of humming on vocal fold vibration irregularity using electroglottography and high-speed laryngoscopy in patients with organic voice disorders. J Voice. 2016. doi:10.1016/j.jvoice.2016.03.010.

  26. 26.

    Sorin R, McClean MD, Ezerzer F, Meissner-Fishbein B. Electroglottographic evaluation of the swallow. Arch Phys Med Rehabil. 1987;68(4):232–5.

  27. 27.

    Perlman AL, Grayhack JP. Use of the electroglottograph for measurement of temporal aspects of the swallow: preliminary observations. Dysphagia. 1991;6(2):88–93.

  28. 28.

    Roubeau B, Moriniere S, Perie S, Martineau A, Falieres J, St Guily JL. Use of reaction time in the temporal analysis of normal swallowing. Dysphagia. 2008;23(2):102–9. doi:10.1007/s00455-007-9099-y.

  29. 29.

    Titze IR. Principles of voice production. Prentice Hall: Englewood Cliffs Inc.; 1994.

  30. 30.

    Titze IR. On the relation between subglottal pressure and fundamental frequency in phonation. J Acoust Soc Am. 1989;85(2):901–6.

  31. 31.

    Boersma P. PRAAT, a system for doing phonetics by computer. Glot Int. 2001;5:341–5.

  32. 32.

    Plowman EK, Watts SA, Robinson R, Tabor L, Dion C, Gaziano J, et al. Voluntary cough airfolw differentiates safe versus unsafe swallowing in amyotrophic lateral sclerosis. Dysphagia. 2016;31(3):383–90.

  33. 33.

    Kahane JC. A morphological study of the human prepubertal and pubertal larynx. Am J Anat. 1978;151(1):11–9. doi:10.1002/aja.1001510103.

  34. 34.

    Butler JE, Hammond TH, Gray SD. Gender-related differences of hyaluronic acid distribution in the humon vocal fold. Laryngoscope. 2001;111(5):907–11. doi:10.1097/00005537-200105000-00029.

  35. 35.

    Hong KH, Kim HK. Diplophonia in unilateral vocal fold paralysis and intracordal cyst. Otolaryngol Head Neck Surg. 1989;12(6):815–19.

  36. 36.

    Honjo I, Isshiki N. Laryngoscopic and voice characteristics of aged persons. Arch Otolaryngol. 1980;106(3):149–50.

  37. 37.

    Hirano M, Kurita S, Sakaguchi S. Ageing of the vibratory tissue of human vocal folds. Acta Otolaryngol. 2009;107(5–6):428–33. doi:10.3109/00016488909127535.

  38. 38.

    Martins RH, Benito Pessin AB, Nassib DJ, Branco A, Rodrigues SA, Matheus SM. Aging voice and the laryngeal muscle atrophy. Laryngoscope. 2015;125(11):2518–21. doi:10.1002/lary.25398.

  39. 39.

    Baken RJ, Orlikoff RF. Clinical measurement of speech and voice. 2nd ed. San Diego: Singular Publishing Group; 2000.

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Acknowledgement

This investigation was supported by JSPS KAKENHI Grant Number JP26462604.

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Correspondence to Makoto Ogawa.

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The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Iwahashi, T., Ogawa, M., Hosokawa, K. et al. Measurement of the Maximum Frequency of Electroglottographic Fluctuations in the Expiration Phase of Volitional Cough as a Functional Test for Cough Efficiency. Dysphagia 32, 691–702 (2017). https://doi.org/10.1007/s00455-017-9815-1

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Keywords

  • Cough efficiency
  • Electroglottography
  • Aerodynamic assessment
  • Peak expiratory air flow
  • Deglutition disorders