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Artificial Manipulation of Voice in the Human by an Implanted Stimulator

Authors

  • Michael Broniatowski MD, FACS,

    Corresponding author
    1. Division of Otolaryngology–Head and Neck Surgery, St Vincent Charity Hospital, University Hospitals Health System Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
    • Michael Broniatowski, MD, 2351 East 22nd Street, Cleveland, OH 44115
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  • Sharon Grundfest-Broniatowski MD, FACS,

    1. Department of General Surgery, The Cleveland Clinic Foundation/The Lerner College of Medicine at Case Western Reserve University Cleveland, Ohio, U.S.A.
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  • Nina S. Zobenica MSE, JMS,

    1. Department of Biomedical Engineering, Case Western Reserve University Cleveland, Ohio, U.S.A.
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  • Dustin J. Tyler PhD

    1. Department of Biomedical Engineering, Case Western Reserve University Cleveland, Ohio, U.S.A.
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Abstract

Objectives/Hypothesis: Traditional approaches influencing voice quality (e.g., anatomical and chemical denervation for spasmodic dysphonia, surgical medialization for paralysis) have ignored the dynamic nature of the larynx.

Study Design: We report here the first attempt to manipulate voice using an implanted stimulator to systematically control vocal fold adduction.

Methods: Devices placed for aspiration in three subjects retaining speech after stroke, cerebral palsy, and multiple sclerosis were used to stimulate recurrent laryngeal nerves with 42 Hz, 52 to 200 microsecond pulses of incremental amplitudes during phonation with the tracheostomy tube occluded. Vocal fold adduction increased with stimulation strength (P < .05). Speech was analyzed with the Vox Metria program.

Results: We found highly significant differences for fundamental frequency (P < .007), jitter (P < .004), and shimmer (P < .005), between natural and stimulated voice (aah and eeh) when using higher charges.

Conclusions: Dynamic vocal fold manipulation seems promising in terms of versatility lacking with static approaches to voice control.

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