Sid Khosla

Validation of computational fluid dynamics methodology used for human upper airway flow simulations

An anatomically accurate human upper airway model was constructed from multiple magnetic resonance imaging axial scans. This model was used to conduct detailed Computational Fluid Dynamics (CFD) simulations during expiration, to investigate the fluid flow in the airway regions where obstruction could occur. An identical physical model of the same airway was built using stereo lithography. Pressure and velocity measurements were conducted in the physical model. Both simulations and experiments were performed at a peak expiratory flow rate of 200 L/min. Several different numerical approaches within the FLUENT commercial software framework were used in the simulations; unsteady Large Eddy Simulation (LES), steady Reynolds-Averaged Navier-Stokes (RANS) with two-equation turbulence models (i.e. k-epsilon, standard k-omega, and k-omega Shear Stress Transport (SST)) and with one-equation Spalart-Allmaras model. The CFD predictions of the average wall static pressures at different locations along the airway wall were favorably compared with the experimental data. Among all the approaches, standard k-omega turbulence model resulted in the best agreement with the static pressure measurements, with an average error of approximately 20% over all ports. The highest positive pressures were observed in the retroglossal regions below the epiglottis, while the lowest negative pressures were recorded in the retropalatal region. The latter is a result of the airflow acceleration in the narrow retropalatal region. The largest pressure drop was observed at the tip of the soft palate. This location has the smallest cross section of the airway. The good agreement between the computations and the experimental results suggest that CFD simulations can be used to accurately compute aerodynamic flow characteristics of the upper airway.

A multi-institutional analysis of tracheotomy complications.

To define the prevalence of tracheotomy tube complications and evaluate risk factors (RFs) associated with their occurrence.

Vortical Flow Field During Phonation in an Excised Canine Larynx Model

Objectives: To more fully understand the mechanisms of vocal fold vibration and sound production, we studied the velocity flow fields above the folds. Such velocity fields during phonation have not been reported in the literature. Methods: Using the particle image velocimetry method for 3 excised canine larynges, we obtained the velocity fields in the mid-membranous coronal plane during different phases of phonation. The velocity field was determined synchronously with the vocal fold motion recorded by high-speed videography. Results: The results show that vortices occur immediately above the vocal folds and that the location and shape of the vortices depend on the phase of the phonation cycle. Consistent vortical structures found included starting vortices, Kel-vin-Helmholtz vortices, entrainment vortices, and vortices directly above the folds during the divergent glottal stage. Conclusions: These vortical structures were consistently found during specific phases of the glottal cycle for 3 canine larynges that significantly varied in size. This consistent behavior suggests that the vortices may be important for both vibration and sound production; however, further study is needed to prove this. The clinical significance of these vortices is discussed.

Large Eddy Simulation and Reynolds-Averaged Navier-Stokes modeling of flow in a realistic pharyngeal airway model : An investigation of obstructive sleep apnea

Computational fluid dynamics techniques employing primarily steady Reynolds-Averaged Navier-Stokes (RANS) methodology have been recently used to characterize the transitional/turbulent flow field in human airways. The use of RANS implies that flow phenomena are averaged over time, the flow dynamics not being captured. Further, RANS uses two-equation turbulence models that are not adequate for predicting anisotropic flows, flows with high streamline curvature, or flows where separation occurs. A more accurate approach for such flow situations that occur in the human airway is Large Eddy Simulation (LES). The paper considers flow modeling in a pharyngeal airway model reconstructed from cross-sectional magnetic resonance scans of a patient with obstructive sleep apnea. The airway model is characterized by a maximum narrowing at the site of retropalatal pharynx. Two flow-modeling strategies are employed: steady RANS and the LES approach. In the RANS modeling framework both k-epsilon and k-omega turbulence models are used. The paper discusses the differences between the airflow characteristics obtained from the RANS and LES calculations. The largest discrepancies were found in the axial velocity distributions downstream of the minimum cross-sectional area. This region is characterized by flow separation and large radial velocity gradients across the developed shear layers. The largest difference in static pressure distributions on the airway walls was found between the LES and the k-epsilon data at the site of maximum narrowing in the retropalatal pharynx.

Unsteady laryngeal airflow simulations of the intra-glottal vortical structures

The intra-glottal vortical structures developed in a static divergent glottis with continuous flow entering the glottis are characterized. Laryngeal airflow calculations are performed using the Large Eddy Simulation approach. It has been shown that intra-glottal vortices are formed on the divergent wall of the glottis, immediately downstream of the separation point. Even with non-pulsatile flow entering the glottis, the vortices are intermittently shed, producing unsteady flow at the glottal exit. The vortical structures are characterized by significant negative static pressure relative to the ambient pressure. These vortices increase in size and strength as they are convected downstream by the flow due to the entrained air from the supra-glottal region. The negative static pressures associated with the intra-glottal vortical structures suggest that the closing phase during phonation may be accelerated by such vortices. The intra-glottal negative pressures can affect both vocal fold vibration and voice production.

What can vortices tell us about vocal fold vibration and voice production.

Purpose of reviewMuch clinical research on laryngeal airflow has assumed that airflow is unidirectional. This review will summarize what additional knowledge can be obtained about vocal fold vibration and voice production by studying rotational motion, or vortices, in laryngeal airflow. Recent findingsRecent work suggests two types of vortices that may strongly contribute to voice quality. The first kind forms just above the vocal folds during glottal closing, and is formed by flow separation in the glottis; these flow separation vortices significantly contribute to rapid closing of the glottis, and hence, to producing loudness and high frequency harmonics in the acoustic spectrum. The second is a group of highly three-dimensional and coherent supraglottal vortices, which can produce sound by interaction with structures in the vocal tract. Present work is also described that suggests that certain laryngeal pathologies, such as asymmetric vocal fold tension, will significantly modify both types of vortices, with adverse impact on sound production: decreased rate of glottal closure, increased broadband noise, and a decreased signal to noise ratio. SummaryRecent research supports the hypothesis that glottal airflow contains certain vortical structures that significantly contribute to voice quality.

Using Particle Imaging Velocimetry to Measure Anterior-Posterior Velocity Gradients in the Excised Canine Larynx Model

Objectives To quantify the anterior-posterior velocity gradient, we studied the velocity flow fields above the vocal folds in both the midcoronal and midsagittal planes. It was also our purpose to use these fields to deduce the mechanisms that cause the anterior-posterior gradient and to determine whether the vortical structures are highly 3-dimensional. Methods Using the particle imaging velocimetry method for 5 excised canine larynges, we obtained phase-averaged velocity fields in the midcoronal and midsagittal planes for 30 phases of phonation. The velocity fields were determined synchronously with the vocal fold motion recorded by high-speed videography. Results The results show that immediately above the folds, there is no significant anterior-posterior velocity gradient. However, as the flow travels downstream, the laryngeal jet tends to narrow in width and skew toward the anterior commissure. Vortices are seen at the anterior and posterior edges of the flow. Conclusions The downstream narrowing in the midsagittal plane is consistent with and is probably due to a phenomenon known as axis switching. Axis switching also involves vortices in the sagittal and coronal planes bending in the axial plane. This results in highly 3-dimensional, complex vortical structures. However, there is remarkable cyclic repeatability of these vortices during a phonation cycle.

Role of vortices in voice production: normal versus asymmetric tension.

Decreasing the closing speed of the vocal folds can reduce loudness and energy in the higher frequency harmonics, resulting in reduced voice quality. Our aim was to study the correlation between higher frequencies and the intraglottal vorticity (which contributes to rapid closing by producing transient negative intraglottal pressures).

Gender and age in benign vocal fold lesions.

Certain lesions appear to occur predominantly in one gender or in younger or older patients. We examined a large sample from a treatment‐seeking population to describe gender and age associations of an array of benign vocal fold lesions.

Flow Fields and Acoustics in a Unilateral Scarred Vocal Fold Model

Objectives: From prior work in an excised canine larynx model, it has been shown that intraglottal vortices form between the vocal folds during the latter part of closing. It has also been shown that the vortices generate a negative pressure between the folds, producing a suction force that causes sudden, rapid closing of the folds. This rapid closing will produce increased loudness and increased higher harmonics. We used a unilateral scarred excised canine larynx model to determine whether the intraglottal vortices and resulting acoustics were changed, compared to those of normal larynges. Methods: Acoustic, flow field, and high-speed imaging measurements from 5 normal and 5 unilaterally scarred canine larynges are presented in this report. Scarring was produced by complete resection of the vocal fold mucosa and superficial layer of the lamina propria on the right vocal fold only. Two months later, these dogs were painlessly sacrificed, and testing was done on the excised larynges during phonation. High-speed video imaging was then used to measure vocal fold displacement during different phases. Particle image velocimetry and acoustic measurements were used to describe possible acoustic effects of the vortices. Results: A higher phonation threshold was required to excite the motion of the vocal fold in scarred larynges. As the subglottal pressure increased, the strength of the vortices and the higher harmonics both consistently increased. However, it was seen that increasing the maximum displacement of the scarred fold did not consistently increase the higher harmonics. The improvements that result from increasing subglottal pressure may be due to a combination of increasing the strength of the intraglottal vortices and increasing the maximum displacement of the vocal fold; however, the data in this study suggest that the vortices play a much more important role. Conclusions: The current study indicates that higher subglottal pressures may excite higher harmonics and improve loudness for patients with unilateral vocal fold scarring. This finding implies that therapies that raise the subglottal pressure may be helpful in improving voice quality.