Effects of Driving Pressure and Recurrent Laryngeal Nerve Stimulation on Glottic Vibration in a Constant Pressure Model

Abstract

Glottic phonatory parameters have been studied in constant flow models; however, the lung-thorax system is better viewed as a constant pressure source. Adjusting the driving pressure and recurrent laryngeal nerve stimulation as independent variables, rather than as dependent variables, may provide a more physiologic understanding of laryngeal function and glottic parameters, including subglottic pressure, airflow, fundamental frequency, and glottic area. In three dogs subglottic pressure and airflow were measured in two separate conditions: with constant recurrent laryngeal nerve stimulation and varying driving pressure, and with constant driving pressure and varying recurrent laryngeal nerve stimulation. Videostroboscopic measures on four dogs assessed glottic areas with constant recurrent laryngeal nerve stimulation at different driving pressures. With constant recurrent laryngeal nerve stimulation, increasing driving pressure had no effect on glottic areas, whereas subglottic pressure, fundamental frequency, and airflow increased significantly. However, changes in subglottic pressure were minimal in comparison with changes in driving pressure. At constant driving pressure, increasing recurrent laryngeal nerve stimulation increased subglottic pressure and fundamental frequency and decreased airflow. These findings suggest that during phonation subglottic pressure is primarily dependent on recurrent laryngeal nerve stimulation and laryngeal muscular contraction, but not on lung driving pressure.