Epiglottis - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

EPIGLOTTIS A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Epiglottis: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00411-9 1. Epiglottis-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on epiglottis. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON EPIGLOTTIS................................................................................................ 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Epiglottis....................................................................................... 4 The National Library of Medicine: PubMed ................................................................................ 10 CHAPTER 2. NUTRITION AND EPIGLOTTIS ...................................................................................... 29 Overview...................................................................................................................................... 29 Finding Nutrition Studies on Epiglottis...................................................................................... 29 Federal Resources on Nutrition ................................................................................................... 30 Additional Web Resources ........................................................................................................... 30 CHAPTER 3. ALTERNATIVE MEDICINE AND EPIGLOTTIS................................................................ 33 Overview...................................................................................................................................... 33 National Center for Complementary and Alternative Medicine.................................................. 33 Additional Web Resources ........................................................................................................... 34 General References ....................................................................................................................... 34 CHAPTER 4. PATENTS ON EPIGLOTTIS ............................................................................................ 35 Overview...................................................................................................................................... 35 Patents on Epiglottis.................................................................................................................... 35 Patent Applications on Epiglottis ................................................................................................ 56 Keeping Current .......................................................................................................................... 59 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 63 Overview...................................................................................................................................... 63 NIH Guidelines............................................................................................................................ 63 NIH Databases............................................................................................................................. 65 Other Commercial Databases....................................................................................................... 67 APPENDIX B. PATIENT RESOURCES ................................................................................................. 69 Overview...................................................................................................................................... 69 Patient Guideline Sources............................................................................................................ 69 Finding Associations.................................................................................................................... 71 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 73 Overview...................................................................................................................................... 73 Preparation................................................................................................................................... 73 Finding a Local Medical Library.................................................................................................. 73 Medical Libraries in the U.S. and Canada ................................................................................... 73 ONLINE GLOSSARIES.................................................................................................................. 79 Online Dictionary Directories ..................................................................................................... 79 EPIGLOTTIS DICTIONARY......................................................................................................... 81 INDEX .............................................................................................................................................. 111

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with epiglottis is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about epiglottis, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to epiglottis, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on epiglottis. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to epiglottis, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on epiglottis. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON EPIGLOTTIS Overview In this chapter, we will show you how to locate peer-reviewed references and studies on epiglottis.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and epiglottis, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “epiglottis” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Differential Diagnosis of Dysphagia in Children Source: Otolaryngologic Clinics of North America. 31(3): 435-451. June 1998. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887-4800. Summary: This article explores the differential diagnosis of dysphagia in children. Dysphagia is defined as any process that produces difficulty with active transport of food and liquid from mouth to stomach. The authors divide diagnostic pediatric dysphagia into categories including congenital, infectious or inflammatory, systemic, neoplastic, traumatic, and miscellaneous causes. In the first section, the authors discuss choanal atresia (complete nasal obstruction), congenital nasal masses, and cleft lip or cleft palate, laryngomalacia, vocal cord paralysis, laryngeal clefts, tracheoesophageal

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fistula or esophageal atresia, foregut malformations, and vascular rings. Infectious causes considered include acute pharyngitis, tonsillitis, peritonsillar abscess, retropharyngeal abscess, other deep neck abscesses, epiglottis, and esophagitis. Other causes covered are neurologic causes of dysphagia, central nervous system diseases, diseases of the neuromuscular junction, neoplastic causes of dysphagia (hemangioma, lymphangioma, papilloma, leiomyoma, neurofibroma), oral cavity and posterior pharyngeal injury, surgically related dysphagia, external trauma, caustic ingestion, gastroesophageal reflux, and foreign bodies of the upper aerodigestive tract. The authors caution that the diagnostic work up can be extremely difficult and exhaustive in many cases. Typical of any diagnostic dilemma, emphasis on history and physical examination remains paramount. Imaging studies can be extremely valuable in certain cases. Once a diagnosis has been established, treatment options are often less problematic. 4 figures. 1 table. 43 references. •

Treatment of Apthous Ulcers in AIDS Patients Source: Laryngoscope. 104(5): 566-570. May 1994. Summary: This article reports on a study, from 1987 to 1992, of 240 AIDS patients with oral, laryngeal, and pharyngeal ulcers. In 180 patients, ulcers resolved in less than 2 weeks without treatment. Of the 60 patients whose ulcers persisted for more than 2 weeks, 24 were culture positive for herpes simplex virus, Cryptococcus organisms, cytomegalovirus, or Mycobacterium organisms and were treated accordingly. The remaining 36 patients were diagnosed as having major aphthous ulcers. The usual sites for these ulcers were the floor of the mouth, tonsillar fossa, and epiglottis. The most common symptoms were pain and weight loss. The patients were treated with intralesional injection with triamcinolone acetonide and examined weekly. Ulcers were reinjected biweekly as needed. Response to treatment was evaluated by pain relief, ulcer healing, and weight gain. All patients reported pain relief within 2 days of initial injection. Most had marked reduction in ulcer size and subsequent weight gain, and many experienced total resolution of symptoms and complete healing. 5 figures. 1 table. 21 references. (AA-M).

Federally Funded Research on Epiglottis The U.S. Government supports a variety of research studies relating to epiglottis. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to epiglottis. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use 2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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animals or simulated models to explore epiglottis. The following is typical of the type of information found when searching the CRISP database for epiglottis: •

Project Title: AERODYNAMIC AND ACOUSTIC MODELS OF PHONATION Principal Investigator & Institution: Scherer, Ronald C.; Professor; Communication Disorders; Bowling Green State Univ Bowling Green 220 Mcfall Ctr Bowling Green, Oh 43403 Timing: Fiscal Year 2002; Project Start 01-JAN-1998; Project End 30-JUN-2006 Summary: (provided by applicant): Phonation is a component of speech communication with a highly complex interplay of physiological and physical properties. Phonation is the vibratory system in the larynx that changes air flow from the lungs into sound in the throat. The process of vocal fold vibration and the conversion of air flow into sound is insufficiently understood for the purposes of making precise diagnostic decisions in the voice clinic, targeting optimal intervention strategies for voice problems, and achieving high quality articulatory speech synthesis. The long-range goal of this research program is to develop an efficient and highly effective computer model of phonation that takes into account the tissue and flow-acoustic dynamics for both normal and pathological laryngeal conditions. This continuation application focuses on the details of the basic physics dealing with the flow-acoustic interactions and driving intraglottal pressures by using various physical, computational, and tissue models of phonation. The aims are to 1) extend phonatory modeling to three dimensions with greater geometric complexity, 2) gain a thorough understanding of the aerodynamics and aeroacoustics for steady and pulsatile flows in rigid and moving-wall laryngeal airways, 3) develop detailed predictive models to explain the flow physics of phonation, in parallel with simpler models that are computationally efficient and clinically applicable, and 4) determine the effects of glottal jet flow for normal and pathological conditions of the glottis using an in-vivo canine model. The three types of models (physical, computational, and tissue) are used to cross-validate new information that bridges between basic modeling and real larynx phonation. This research program is a collaboration among laboratories at Bowling Green State University, Purdue University, the University of Toledo, and Washington University in Saint Louis. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: AIRWAY PROTECTION DURING VOMITING Principal Investigator & Institution: Lang, Ivan M.; Medical College of Wisconsin Po Box26509 Milwaukee, Wi 532260509 Timing: Fiscal Year 2002 Summary: Vomiting is a complex motor behavior that requires the coordinated action of musculature within the gastrointestinal and aerodigestive tracts. The mechanisms of airway protection during vomiting have not been studied and are presently unknown. This is in contrast to an extensive body of literature providing information on airway protective mechanisms operational during swallowing. Acute and chronic animal models will be utilized to study the role of the laryngeal, pharyngeal and hyoid muscles during vomiting. Investigation of the associated movements of the tongue base, hyoid bone, cricoid and thyroid cartilage, and epiglottis will also be studied. The action of these aerodigestive muscles will be temporally correlated with the action of the esophagus and gastrointestinal tract, and lower respiratory musculature. Finally, the relative contribution of peripheral reflexes and direct central nervous system control over the motor events that comprise vomiting will be studied.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: ANATOMICAL SPECIALIZATIONS OF THE HUMAN PHARYNX Principal Investigator & Institution: Mu, Liancai; Otolaryngology; Mount Sinai School of Medicine of Nyu of New York University New York, Ny 10029 Timing: Fiscal Year 2002; Project Start 01-FEB-2001; Project End 31-JAN-2005 Summary: (Applicant's abstract): What variables in the neuromuscular properties of the human pharynx make some patients more susceptible to aspiration, obstructive sleep apnea (OSA), acid reflux, cricopharyngeal spasm and other disorders of the pharyngeal region? In most mammals (and neonatal humans) the respiratory system is protected by overlapping the epiglottis and soft palate, however with separation of these structures the human at risk of aspiration, and this is often the cause of death in the elderly and neurologically impaired. At present the basic neuromuscular specializations of the human pharynx are poorly understood. In preliminary work numerous novel observations were made, one example is that of the human cricopharyngeus (CP) muscle; That the CP receives its innervation from multiple nerves, each of which supplies a distinct region within the muscle, and that it contains specialized muscle fibers. One of these, slow tonic muscle fibers (STMF) has a unique physiology. STMF are extremely rare in mammals but preliminary work has shown that they are widespread in human upper airway structures including the tongue and larynx. Moreover the particular distribution of these fiber suggests that they are directly related to distinct biomechanics. The proposed work will focus on clarifying the peripheral organization patterns of the human pharyngeal plexus and characterizing the intrinsic properties of the CP and the muscles surrounding the pharynx to answer the questions: what anatomic specializations are present that appear specific to humans and possibly speech and swallowing related? What variations in these specializations correlate with certain ethnic (black males OSA), genders (males reflux, OSA) and especially geriatric (CP spasm and aspiration) susceptibility to specific disorders? All studies will be done in human post-mortem tissue. The motor and sensory nerve supply to the pharyngeal region will be studied using Sihler's stain. An additional hypothesis to be tested is that the human glossopharyngeal nerve (IX) provides motor innervation not only to the traditionally described stylopharyngeus, but also to the CP and pharyngeal constrictor muscles as demonstrated by our preliminary studies. This will be studied by triple approaches: Sihler's stain whole-mount acetylcholinesterase (AChE) and silver stain, and Karnovsky-Roots' method. Another hypothesis to be tested is that most swallowingrelated muscles are specialized and composed of neuromuscular compartments (NMC) as functional requirements. Our preliminary studies provided evidence for the existence of the NMC within the human CP inferior constrictor and geniohyoid muscles. In addition, the human CP appears to be a specialized skeletal muscle as it contains slow tonic and a-cardiac myosin heavy chain isoforms that are not normally present in limb muscles. The muscular specializations of the upper esophageal sphincter, pharyngeal constrictor and suprahyoid muscles will be explored using a wide variety of histochemical, immunohistochemical, electrophoretic and immunoblotting techniques The muscle fiber architecture, distribution of the fiber types and the major and unusual myosin heavy chain isoforms will be studied. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: DIFFERENCES IN SWALLOW MECHANICS IN INFANTS Principal Investigator & Institution: German, Rebecca Z.; Professor; Biological Sciences; University of Cincinnati 2624 Clifton Ave Cincinnati, Oh 45221

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Timing: Fiscal Year 2002; Project Start 01-JUL-1998; Project End 31-JUL-2006 Summary: (provided by applicant): Swallowing requires the coordination of a large number of muscles; this complexity arises partly from the need for airway protection. In the previous funding period, we added to the understanding of muscle activity and oropharyngeal kinematics in infant deglutition. However, the role of the majority of muscles during emptying of the valleculae and in the transport of the bolus past the laryngeal opening or the natural stimuli that initiate the emptying of the valleculae over maturation is not well understood. Our preliminary data suggest that two distinct pathways of bolus movement exist, either around the epiglottis/laryngeal opening (in the newborn) or over it (by the age of weaning). However the timing of the transition, from one path to the other and the associated changes in the kinematics or motor patterns, are unknown. The decerebrate pig is an excellent model for studying vallecular emptying because this phase of the swallow can be isolated experimentally. We propose to apply our existing techniques both to this model and to intact animals, in order to answer the following questions. What natural stimuli initiate vallecular emptying, and do they change during maturation? What is the pattern of muscle activity during vallecular emptying in terms of the order and amplitude of muscle activation? Does change in the consistency of the bolus alter the motor pattern during vallecular emptying, and does this change over developmental time? Does epiglottal movement result from: (i) direct muscle contraction; (ii) indirect movement of the rest of the larynx, (iii) the mechanical action of food on the epiglottis, or a combination of all three? Current studies of human dysphagia and rehabilitation rely heavily on several older studies of oral function in adult man and animal; these studies did not have the means to examine the ontogeny of vallecular function in detail. The proposed study of the maturation of motor patterns will provide an important baseline for treatment strategies aimed at human infant dysphagia. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: FLOW VISUALIZATION IN THE CANINE LARYNX DURING PHONATION Principal Investigator & Institution: Khosla, Siddarth M.; Otolaryngology; Medical College of Ohio at Toledo Research & Grants Admin. Toledo, Oh 436145804 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The primary purpose of this grant is to train the candidate to be able to independently derive computational and theoretical models of laryngeal diseases, to verify these models by experiments in animals, and to use the results of theoretical and animal models to design new medical and surgical therapies for diseases of the larynx. Coursework in fluid mechanics, computational flow dynamics, vibrations, and acoustics will give the candidate the necessary knowledge to derive new theoretical models for laryngeal diseases. In addition the candidate will develop his own computational model of airflow in the canine larynx during phonation. The coursework will be supplemented by tutorials in speech science given by the candidate?s mentor, Dr. Ron Scherer. Experience in verifying theory in animal experiments will be obtained in the research part of this proposal. For his research, the candidate will use the flow visualization method he has already developed to determine the patterns of airflow in the larynx during phonation. The pattern of airflow in the larynx is important because flow produces forces that drive vocal fold (cord) vibrations, and certain airflow patterns may also produce sound by mechanisms other than vocal fold vibration. Current computational and theoretical models make assumptions about the flow patterns that have not yet been experimentally verified. The investigator will

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use flow visualization and the particle image velocimetry method to determine whether flow separation occurs in the glottis, whether vortices occur above the glottis, and whether the flow directly above the glottis is laminar. The candidate will then compare his experimental findings with current theoretical and computational models and with his computational model. Training in recognizing clinical applications of the work will be fostered by consultations with two prominent laryngologists, Dr. Gerald Berke and Dr. Randal Paniello. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: GLOTTAL JET AERODYNAMICS Principal Investigator & Institution: Krane, Michael H.; None; Rutgers the St Univ of Nj New Brunswick Asb Iii New Brunswick, Nj 08901 Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2005 Summary: (provided by applicant): The proposed research will address unresolved issues regarding the airflow involved in human voice production, focusing on the formation and evolution of jet flows in the glottal and pharyngeal regions. The glottal jet is hypothesized to play a key role in the flow-induced vibration of the vocal folds and in the production of voiced sound, as well as a central role in determining both voice efficiency (through turbulent dissipation) and voice quality (through producing perturbations and fluctuations in voiced sound output). This hypothesis rests on the well-established instability of jet flows, which may lead to variations in the formation and evolution of the jet across vocal fold vibration cycles. A central consideration to the proposed work is, then, to what extent glottal aerodynamics may be considered quasisteady. The degree to which the glottal jet manifests these effects has not yet been directly addressed, in part because what experimental data exists concerning glottal jet behavior was obtained using invasive point measurement techniques. These methods preclude systematic study of cycle-to-cycle variations in both the spatial and temporal structure of the jet. In addition, previous modeling of glottal flow has considered the effect of the jet in a limited manner. The proposed research will address these issues directly, making use of recent advances in computational and experimental fluid dynamics techniques, which have not yet been applied to speech science. In vitro experiments in which the instantaneous particle velocity and acceleration fields of a water flow through a moving vocal fold wall model are successively measured in real time using video Particle Image Velocimetry/Accelerometry (PIV/A). In order to assure spatial and temporal resolution, the glottal model is scaled up and the appropriate Reynolds number and Strouhal number ranges (500