title: Artificial manipulation of voice in the human by an implanted stimulator.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, St Vincent Charity Hospital, University Hospitals Health System, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA. michael.broniatowski@case.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Broniatowski
authors.forename: Sharon
authors.initials: S
authors.lastname: Grundfest-Broniatowski
authors.forename: Nina S
authors.initials: NS
authors.lastname: Zobenica
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Tyler