Differences of respiratory kinematics in female and male singers – A comparative study using dynamic magnetic resonance imaging

Breath control is an important factor for singing voice production, but pedagogic descriptions of how a beneficial movement pattern should be performed vary widely and the underlying physiological processes are not understood in detail. Differences in respiratory movements during singing might be related to the sex of the singer. To study sex-related differences in respiratory kinematics during phonation, 12 singers (six male and six female) trained in the Western classical singing tradition were imaged with dynamic magnetic resonance imaging. Singers were asked to sustain phonation at five different pitches and loudness conditions, and cross-sectional images of the lung were acquired. In each dynamic image frame the distances between anatomical landmarks were measured to quantify the movements of the respiratory apparatus. No major difference between male and female singers was found for the general respiratory kinematics of the thorax and the diaphragm during sustained phonation. However when compared to sole breathing, male singers significantly increased their thoracic movements for singing. This behavior could not be observed in female singers. The presented data support the hypothesis that professional singers follow sex-specific breathing strategies. This finding may be important in a pedagogical context where the biological sex of singer and student differ and should be further investigated in a larger cohort

Differentiation of chronical rhinosinusitis with and without nasal polyposis on basis of symptomatology, course of disease, inflammatory mediators and comorbidity

Untersuchungen der letzten Jahre haben das Verständnis der Entzündungsreaktion der chronische Rhinosinusitis (CRS) erweitert, die Heterogenität dieser Erkrankung betont sowie die Notwendigkeit einer Untergliederung in die Subgruppen CRS-Patienten mit Polyposis nasi (CRSwNP) und ohne Polyposis nasi (CRSsNP) aufgezeigt. Ziel der vorliegenden Studie war es zu untersuchen, inwiefern sich CRSsNP- und CRSwNP-Patienten hinsichtlich Symptomatik, Lebensqualität, diagnostischer Befunde, Komorbiditäten und Krankheitsverlauf nach funktioneller endoskopischer Sinusoperation (FESS) und der beteiligten Entzündungsmediatoren untereinander und im Vergleich zu einer Kontrollgruppe unterscheiden. Weiterhin wurde untersucht ob es Beziehungen zwischen den oben genannten Parametern gibt und ob CRS-assoziierte Komorbiditäten wie Allergie, Asthma und Analgetika-Intoleranz für diese eine Rolle spielen. In die prospektive Studie wurden 48 CRS Patienten vor geplanter FESS eingeschlossen und den Gruppen CRSsNP (n=32) und CRSwNP (n=16) (nach EP3OS-Kriterien) zugeordnet. Als Kontrollgruppe dienten 23 Patienten ohne CRS, bei denen eine Septumplastik durchgeführt wurde. Alle Patienten und Kontrollen wurden präoperativ, die CRS Patienten auch 6 Monate postoperativ, bzgl. Symptomatik und Lebensqualität mittels RSOM-31, SF-36 sowie Visuellen Analogskalen befragt. Zusätzlich wurde ein Nasenendoskopie- und CT-Score erhoben. In der Nasenschleimhaut von CRS- und Kontroll-Patienten wurden die Proteinkonzentrationen von Eotaxin, PARC, TARC, Il-5, IgE, TGF-β und ENA-78 mittels ELISA bestimmt. Beide Subgruppen zeigten im Vergleich zur Kontrollgruppe eine signifikante Einschränkung der allgemeinen und gesundheitsbezogenen Lebensqualität. CRSwNP-Patienten wiesen im Vergleich zu CRSsNP-Patienten einen signifikant stärkeren Geruchsverlust, laufende Nase, das Bedürfnis sich die Nase zu schnauben, sowie eine ausgeprägtere Schleimhautschwellung im CT auf. Beide Subgruppen zeigten nach FESS einen signifikanten Rückgang der allgemeinen Beschwerdesymptomatik. In der CRSwNP- Patientengruppe wurden, verglichen mit CRSsNP-Patienten und der Kontrollgruppe, signifikant höhere Konzentrationen der Entzündungsmediatoren Il-5, IgE, PARC, TARC und Eotaxin festgestellt. Bei CRSsNP-Patienten hingegen war die TGF-β-Konzentration gegenüber CRSwNP-Patienten und der Kontrollgruppe signifikant erhöht. Zusätzlich zeigte sich eine signifikant erhöhte TARC- und Eotaxin-Konzentration bei CRSsNP-Patienten gegenüber der Kontrollgruppe. Präoperativ korrelierte bei CRSwNP-Patienten der CT-Score mit der Il-5- bzw. IgE-Konzentration in der Nasenschleimhaut. Für Il-5 zeigte sich ebenfalls präoperativ eine positive Korrelation mit den visuellen Analogskalen (VAS) für die Symptome Nasenatmungsbehinderung und Geruchsverlust. Der postoperative VAS-Score für Geruchsverlust korrelierte mit der intraoperativ bestimmten Konzentration von Eotaxin bei CRSwNP-Patienten positiv, mit der von TGF- β bei CRSsNP-Patienten dagegen negativ. CRSwNP-Patienten mit einem Poylposis-Rezidiv (n = 4) zeigten tendenziell höhere Konzentrationen von PARC, TARC und Eotaxin im Polypen-Gewebe. Im Vergleich zur Kontrollgruppe bestand in beiden CRS- Subgruppen häufiger Asthma bronchiale, keinen Unterschied gab es hinsichtlich Atopie, allergischer Rhinitis und Nahrungsmittelallergie. Ein signifikanter Zusammenhang zwischen bestehenden Komorbiditäten und diagnostischen Parametern oder Entzündungsmediatoren war nicht nachweisbar. Die Ergebnisse der Studie zeigen, dass die CRS in beiden Patientengruppen mit einer ausgeprägten sinusidalen Symptomatik und einer Einschränkung der Lebensqualität verbunden war, wobei Patienten beider Subgruppen von der Operation profitieren. Neben den Unterschieden in der Ausprägung der Symptomatik und Befunde, stützen vor allem die Unterschiede im Profil der Entzündungsmediatoren bei CRS Patienten mit und ohne Polyposis nasi die Hypothese der Heterogenität der CRS. Die Zusammenhänge zwischen den Entzündungsmediatoren und der prä- und postoperativen Symptomausprägung weisen möglicherweise auf eine direkte Auswirkung dieser Mediatoren auf Klinik und Verlauf der Erkrankung hin. Zukünftige Studien mit größeren Patientenzahlen werden zur weiteren Differenzierung der CRS beitragen und über das individuelle Entzündungsmediator-Profil möglichweise eine gezieltere und effektivere Therapie ermöglichen.Recent cytokine and chemokine research has rapidly expanded our understanding of chronic rhinosinusitis (CRS) and underlined that it is necessary to divide this disease into subgroups. The objective of the present study was to investigate the differentiation of CRS patients with (CRSwNP) and without (CRSsNP) nasal polyposis on basis of symptomatology, course of disease, inflammatory mediators and comorbidity. Nasal Polyps (n=16), tissue samples taken from the paranasal sinuses (n=32) and turbinate tissue from 23 controls were obtained during endonasal surgery. Chemokine (Eotaxin, PARC, TARC, ENA-78) and cytokine (IL-5, IgE, TGF-β) protein content of tissue homogenates was measured by ELISA. Pre- and 6 month postoperative all patients and controls (controls only preoperative) were asked about their quality of life and the severity of their CRS symptoms. Additionally an allergy testing and an endoscopic examination of the nose were performed. The results were analyzed using the Mann-Whitney U test and Spearman test. The protein concentration of Eotaxin, PARC, TARC, IL-5 and IgE was significantly higher in CRSwNP patients than in CRSsNP patients, while the TGF-β levels were higher in CRSsNP patients. CRSwNP patients showed significantly higher loss of smell and a higher degree of mucosa swelling in the CT Score, while CRSsNP patients showed more postnasal dropping. Both groups improved after surgery. CRSwNP patients with an especially high content of Eotaxin in nasal polyps showed a particularly bad loss of smell postoperative, while the loss of smell in CRSsNP patients with especially high TGF-β levels exceedingly improved after the operation. The prevalence of asthma in patients with CRS (both subgroups) was significantly higher compared to controls (in contrast to allergic rhinitis, atopy or food allergy) but there was no relationship to symptomatology, course of disease or inflammatory mediators. CRSwNP and CRSsNP patients differ in symptomatology, CT-Score and inflammatory mediators. Relationships could be found between symptoms and inflammatory mediators. Probably CRSsNP and CRSwNP are two disease entities and do possibly have different pathomechanisms. An interindividual different treatment (e.g. based on cytokine and chemokine specific antibodies) might help to improve the outcome of CRS therapy

Weight-bearing MR imaging as an option in the study of gravitational effects on the vocal tract of untrained subjects in singing phonation.

Magnetic Resonance Imaging (MRI) of subjects in a supine position can be used to evaluate the configuration of the vocal tract during phonation. However, studies of speech phonation have shown that gravity can affect vocal tract shape and bias measurements. This is one of the reasons that MRI studies of singing phonation have used professionally trained singers as subjects, because they are generally considered to be less affected by the supine body position and environmental distractions. A study of untrained singers might not only contribute to the understanding of intuitive singing function and aid the evaluation of potential hazards for vocal health, but also provide insights into the effect of the supine position on singers in general. In the present study, an open configuration 0.25 T MRI system with a rotatable examination bed was used to study the effect of body position in 20 vocally untrained subjects. The subjects were asked to sing sustained tones in both supine and upright body positions on different pitches and in different register conditions. Morphometric measurements were taken from the acquired images of a sagittal slice depicting the vocal tract. The analysis concerning the vocal tract configuration in the two body positions revealed differences in 5 out of 10 measured articulatory parameters. In the upright position the jaw was less protruded, the uvula was elongated, the larynx more tilted and the tongue was positioned more to the front of the mouth than in the supine position. The findings presented are in agreement with several studies on gravitational effects in speech phonation, but contrast with the results of a previous study on professional singers of our group where only minor differences between upright and supine body posture were observed. The present study demonstrates that imaging of the vocal tract using weight-bearing MR imaging is a feasible tool for the study of sustained phonation in singing for vocally untrained subjects

Respiratory dynamics in phonation and breathing-A real-time MRI study.

The respiratory system is a central part of voice production, but for phonation neither the underlying functional relations between diaphragm (DPH) and rib cage (RC), nor differences to normal breathing are yet understood. This study aims to compare respiratory dynamics in phonation and breathing via dynamic MRI of the lung. Images of the breathing apparatus of 6 professional singers were captured in a 1.5T MRI system in supine position during vital capacity breathing and maximal long sustained phonation at 3 different pitches and loudness conditions. In a dynamic series of cross-sectional images of the lung, distances between characteristic anatomical landmarks were measured. During exhalation in normal breathing the diaphragm and rib cage moved synchronously to reduce lung volume, but during phonation different functional units could be identified, which support phonation by facilitating the control of subglottic pressure

Regional ventilation during phonation in professional male and female singers.

The respiratory system is a central part of voice production, but details in breath control during phonation are not yet fully understood. This study therefore aims to investigate regional ventilation of the lungs during phonation. It was analyzed in 11 professional singers using electrical impedance tomography during breathing and phonation with maximum phonation time. Our results show differences in impedance changes between phonation and exhalation in the courses of time and amplitude normalized curves. Furthermore, differences related to gender and professionalism were found in the temporal and spatial profiles of regional ventilation. For female singers (sopranos and mezzo-sopranos) the anterior region participated less at the start of ventilation, and was more stable at the midpoint compared to male singers (tenors). This might be an expression of a smaller relative movement in rib cage and anterior diaphragm, primarily in early phonation

The influence of water resistance therapy on vocal fold vibration: a high speed digital imaging study

Purpose: This study investigated the influence of tube phonation into water on vocal fold vibration. Method: Eight participants were analyzed via high-speed digital imaging while phonating into a silicon tube with the free end submerged into water. Two test sequences were studied: (1) phonation pre, during, and post tube submerged 5cm into water; and (2) phonation into tube submerged 5cm, 10cm, and 18cm into water. Several glottal area parameters were calculated using phonovibrograms. Results: The results showed individual differences. However, certain trends were possible to identify based on similar results found for the majority of participants. Amplitude-to-length ratio, harmonic-to-noise ratio, and spectral flatness (derived from glottal area) decreased for all tube immersion depths, while glottal closing quotient increased for 10cm immersion and contact quotient for 18cm immersion. Closed quotient decreased during phonation into the tube at 5cm depth, and jitter decreased during and after it. Conclusion: Results suggest that the depth of tube submersion appears to have an effect on phonation. Shallow immersion seems to promote smoother and more stable phonation, while deeper immersion may involve increased respiratory and glottal effort to compensate for the increased supraglottal resistance. This disparity, which is dependent upon the degree of flow resistance, should be considered when choosing treatment exercises for patients with various diagnoses, namely hyperfunctional or hypofunctional dysphonia.Deutsche Forschungsgemeinschaft Ec 409/1-1 Ri 1050/4-1 Finnish Academy of Sciences 112809

Morphometric Differences of Vocal Tract Articulators in Different Loudness Conditions in Singing

<div><p>Introduction</p><p>Dynamic MRI analysis of phonation has gathered interest in voice and speech physiology. However, there are limited data addressing the extent to which articulation is dependent on loudness.</p><p>Material and Methods</p><p>12 professional singer subjects of different voice classifications were analysed concerning the vocal tract profiles recorded with dynamic real-time MRI with 25fps in different pitch and loudness conditions. The subjects were asked to sing ascending scales on the vowel /a/ in three loudness conditions (comfortable = mf, very soft = pp, very loud = ff, respectively). Furthermore, fundamental frequency and sound pressure level were analysed from the simultaneously recorded optical audio signal after noise cancellation.</p><p>Results</p><p>The data show articulatory differences with respect to changes of both pitch and loudness. Here, lip opening and pharynx width were increased. While the vertical larynx position was rising with pitch it was lower for greater loudness. Especially, the lip opening and pharynx width were more strongly correlated with the sound pressure level than with pitch.</p><p>Conclusion</p><p>For the vowel /a/ loudness has an effect on articulation during singing which should be considered when articulatory vocal tract data are interpreted.</p></div

Two Positions of a Participant in the G-Scan.

<p>The upright (a) and supine (b) positions of a subject in the G-Scan during measurements are depicted. The head is located in the isocentre of the magnet, in a dedicated 2-channel phased array neck coil. The upper half of the system, containing parts of the permanent magnet and gradient system, is located in front of the head. The individual in this figure gave written informed consent (as outlined in PLOS consent form) to publish these case details.</p