Computational fluid dynamics of upper airway aerodynamics for exercise-induced laryngeal obstruction: A feasibility study

Michael Döllinger, Bernhard Jakubaß, Hu Cheng, Stephen J Carter, Stefan Kniesburges, Bea Aidoo, Chi Hwan Lee, Claudio Milstein, Rita R Patel, Michael Döllinger, Bernhard Jakubaß, Hu Cheng, Stephen J Carter, Stefan Kniesburges, Bea Aidoo, Chi Hwan Lee, Claudio Milstein, Rita R Patel

Abstract

Objective: Use of computational fluid dynamic (CFD) simulations to measure the changes in upper airway geometry and aerodynamics during (a) an episode of Exercise-Induced Laryngeal Obstruction (EILO) and (b) speech therapy exercises commonly employed for patients with EILO.

Methods: Magnetic resonance imaging stills of the upper airway including the nasal and oral cavities from an adult female were used to re-construct three-dimensional geometries of the upper airway. The CFD simulations were used to compute the maximum volume flow rate (l/s), pressure (Pa), airflow velocity (m/s) and area of cross-section opening in eight planes along the vocal tract, separately for inhalation and exhalation.

Results: Numerical predictions from three-dimensional geometrical modeling of the upper airway suggest that the technique of nose breathing for inhalation and pursed lip breathing for exhalation show most promising pressure conditions and cross-sectional diameters for rescue breathing exercises. Also, if EILO is due to the constriction at the vocal fold level, then a quick sniff may also be a proper rescue inhalation exercise. EILO affects both the inspiratory and the expiratory phases of breathing.

Conclusions: A prior knowledge of the supraglottal aerodynamics and the corresponding upper airway geometry from CFD analysis has the potential to assist the clinician in choosing the most effective rescue breathing technique for optimal functional outcome of speech therapy intervention in patients with EILO and in understanding the pathophysiology of EILO on a case-by-case basis with future studies.

Level of evidence: 4.

Keywords: computational fluid dynamics (CFD); exercise‐induced laryngeal obstruction (EILO); paradoxical vocal fold motion; speech therapy; voice therapy.

Conflict of interest statement

The authors declare no conflicts of interest.

© 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.

Figures

FIGURE 1
FIGURE 1
Reconstructed three‐dimensional geometry of the upper airway depicting the planes where parameters were computed.
FIGURE 2
FIGURE 2
Area (mm2) across the six different anatomical planes for the six experimental conditions: tasks: nose breathing (NB), deep mouth breathing (DMB), pursed lip breathing (PLB), simulated exercise‐induced laryngeal obstruction with stridor (EILO‐S), quick sniff (QS), and deep nose breathing (DNB).
FIGURE 3
FIGURE 3
Pressure in midsagittal plane during inspiration (I) and expiration (II) at time‐step for maximum inhalation/exhalation flow for the six experimental tasks: nose breathing (NB), deep mouth breathing (DMB), pursed lip breathing (PLB), simulated exercise‐induced laryngeal obstruction with stridor (EILO‐S), quick sniff (QS), and deep nose breathing (DNB).
FIGURE 4
FIGURE 4
Velocity (m/s) in midsagittal plane during inspiration (I) and expiration (II) for the six experimental tasks: nose breathing (NB), deep mouth breathing (DMB), pursed lip breathing (PLB), simulated exercise‐induced laryngeal obstruction with stridor (EILO‐S), quick sniff (QS), and deep nose breathing (DNB). The glottal jet above (expiration) and below (inspiration) the vocal folds are also visible.
FIGURE 5
FIGURE 5
The 3D view of upper airway. The pressure on the walls of the upper airway during inspiration for the six experimental tasks: nose breathing (NB), deep mouth breathing (DMB), pursed lip breathing (PLB), simulated exercise‐induced laryngeal obstruction with stridor (EILO‐S), quick sniff (QS), and deep nose breathing (DNB).

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