The Effect of Subglottic Stenosis Severity on Vocal Fold Vibration and Voice Production in Realistic Laryngeal and Airway Geometries Using Fluid-Structure-Acoustics Interaction Simulation.

Abstract

This study investigates the impact of subglottic stenosis (SGS) on voice production using a subject-specific laryngeal and airway model. Direct numerical simulations of fluid-structure-acoustic interaction were employed to analyze glottal flow dynamics, vocal fold vibration, and acoustics under realistic conditions. The model accurately captured key physiological parameters, including the glottal flow rate, vocal fold vibration patterns, and the first four formant frequencies. Simulations of varying SGS severity revealed that up to 75% stenosis, vocal function remains largely unaffected. However, at 90% severity, significant changes in glottal flow and acoustics were observed, with vocal fold vibration remaining stable. At 96%, severe reductions in glottal flow and acoustics, along with marked changes in vocal fold dynamics, were detected. Flow resistance, the ratio of glottal to stenosis area, and pressure drop across the vocal folds were identified as critical factors influencing these changes. The use of anatomically realistic airway and vocal fold geometries revealed that while anatomical variations minimally affect voice production at lower stenosis grades, they become critical at severe stenosis levels (>90%), particularly in capturing distinct anterior-posterior opening patterns and focused jet effects that alter glottal dynamics. These findings suggest that while simplified models suffice for analyzing mild to moderate stenosis, patient-specific geometric details are essential for accurate prediction of vocal fold dynamics in severe cases.