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Involuntary Inspiratory Phonation

Involuntary inspiratory phonation is a vocal phenomenon in which an involuntary vocal sound is made when one breathes in. In other words, a vocal noise such as one might hear from a person who is startled, takes an inward breath, and “gasps.” Inspiratory phonation becomes involuntary (necessary or impossible to abolish) when two conditions are met:

  1. The vocal cords are unable to abduct (separate) normally during inspiration.
  2. The speed of inspiratory airflow is sufficient to in-draw the cords and set them vibrating.

Causes

Conditions that may be associated with this include glottic stenosis, bilateral vocal cord paralysis, chemical denervation of both posterior cricoarytenoid muscles after Botox injection for abductory spasmodic dysphonia.

How to Diagnose

In some cases, involuntary inspiratory phonation is heard only during the elicitations of the vocal capability battery, when the patient is asked to empty the lungs (breathe out fully) and then to fill them completely as rapidly and quietly as possible.

Audio Example

Other than when she speaks, the vocal sounds are while breathing in:

Progressive Radiation Fibrosis Effects on the Larynx and a Solution to some of It

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forty years after curative radiation for a vocal cord cancer

Forty years post-radiation (1 of 8)

This photo is taken forty years after curative radiation for a vocal cord cancer. Four decades of progressive radiation fibrosis (“leatherization”) has taken away arytenoid movement so that this is the maximum opening. The patient is exercise-intolerant and makes loud inspiratory breathing noises while sleeping. Her voice is also very poor.
mucosa indraws and vibrates

Involuntary inspiratory voice (2 of 8)

With sudden inspiration, the darker mucosa (at the arrows) indraws and vibrates, making an involuntary inspiratory voice.
small mucosa capable of vibration

Only capable of high pitch (3 of 8)

Other than a stage whisper, she can only make a very high pitch, because the only mucosa capable of vibration is the small segment indicated by the arrows.
vibrating mucosa in open phase

Open phase vibration (4 of 8)

Again under strobe light, this is the open phase of vibration, with arrows again indicating the short segment of mucosa that can oscillate.
cookie bites taken from posterior cords

One week post-commissuroplasty (5 of 8)

A week after posterior commissuroplasty, the patient’s breathing is much improved. Despite the distant view, the “cookie bites” taken from the posterior cords are visible.
posterior vocal cord divots

Rapid inhalation, closer view (6 of 8)

In a much closer view, the posterior vocal cord divots are seen well. The segment of flexible mucosa is indrawing here as the patient inhales rapidly (at arrows).
Vocal cords Three months post-surgery

Three months post-surgery (7 of 8)

Three months after the laser surgery, the patient continues to say the improvement of breathing is “large.” In this distant view the full reason why is not seen.
divots are smaller

Closer view, post-surgery (8 of 8)

In a closer view, as is always the case after complete healing, the divots are smaller than just after surgery.

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How Marginal Is this Airway?

In the video, the physician “shares” the patient’s airway with a flexible scope in order to determine the degree to which the airway is marginal. By “sharing” the airway, the patient concludes the following:

  1. That inspiratory noise is louder while sharing the airway.
  2. More importantly, that inspiration takes longer.
  3. That the patient’s airway is marginal but not dramatically so; emergency intervention is not needed.
  4. That what we have just seen/ heard correlates exactly with the patient’s description of degree of exercise intolerance.

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