A Comparison of Indirect and Direct Methods for Estimating Transglottal Airflow Rate

Published:November 03, 2017DOI:https://doi.org/10.1016/j.jvoice.2017.09.020



      The purpose of this study was to compare indirect estimates of transglottal airflow rate using measures of phonation quotient with direct measures of mean airflow rate derived from a pneumotachograph.

      Study design

      This study used prospective, repeated measures design.


      Nineteen male and female participants, matched for age, completed tasks for maximum phonation time and vital capacity in addition to the comfortable sustained phonation protocol of the Phonatory Aerodynamic System (PAS), Model 6600. Phonation quotient was calculated from the vital capacity and phonation time measures, whereas actual transglottal airflow was obtained from the flow waveforms recorded on the PAS system. Statistical analyses compared transglottal airflow rate measures as a function of instrument and separately as a function of gender.


      Statistically significant differences were present only as a function of gender on airflow measures but not as a function of the instrument. There were no interaction effects present between instrument and gender.


      Phonation quotient can be used as an estimate of transglottal airflow in the absence of a pneumotachograph-based system.

      Key Words

      To read this article in full you will need to make a payment


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Remacle M.
        • Eckel H.E.
        • Dejonckere P.H.
        Assessment of voice and respiratory function.
        in: Surgery of Larynx and Trachea. Springer-Verlag, Berlin, Heidelberg2010
        • Stemple J.C.
        • Roy N.
        • Klaben B.G.
        Clinical Voice Pathology: Theory and Management.
        5th ed. Plural Publishing, San Diego, CA2014
        • Baken R.
        • Orlikoff R.
        Clinical Measurement of Speech and Voice.
        2nd ed. Thompson Learning, Clifton Park, NJ2000
        • Dejonckere P.H.
        • Bradley P.
        • Clemente P.
        • et al.
        A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques.
        Eur Arch Otorhinolaryngol. 2001; 258: 77-82
        • Awan S.
        • Barkmeier-Kraemer J.
        • Courey M.
        • et al.
        Standard clinical protocols for endoscopic, acoustic and aerodynamic voice assessment: Recommendations from ASHA expert committee seminar.
        (The American Speech-Language-Hearing Association Annual Convention)2014 (Orlando, FL)
        • Shin J.N.S.
        • Yoo S.
        • Kimn S.
        Analysis of voice and quantitative measurement of glottal gap after thyroplasty type I in the treatment of unilateral vocal paralysis.
        J Voice. 2002; 16: 136-152
        • Dastolfo C.
        • Gartner-Schmidt J.
        • Yu L.
        • et al.
        Aerodynamic outcomes of four common voice disorders: moving toward disorder-specific assessment.
        J Voice. 2016; 30: 301-307
        • Hartl D.M.
        • Hans S.
        • Vaissiere J.
        • et al.
        Laryngeal aerodynamics after vocal fold augmentation with autologous fat vs thyroplasty in the same patient.
        Arch Otolaryngol Head Neck Surg. 2005; 131: 696-700
        • Liang F.Y.
        • Yang J.S.
        • Mei X.S.
        • et al.
        The vocal aerodynamic change in female patients with muscular tension dysphonia after voice training.
        J Voice. 2014; 28 (e397-310): 393
        • Zheng Y.-Q.
        • Zhang B.-R.
        • Su W.-Y.
        • et al.
        Laryngeal aerodynamic analysis in assisting with the diagnosis of muscle tension dysphonia.
        J Voice. 2012; 26: 177-181
        • Awan S.N.
        • Novaleski C.K.
        • Yingling J.R.
        Test-retest reliability for aerodynamic measures of voice.
        J Voice. 2013; 27: 674-684
        • Holmberg E.B.
        • Hillman R.E.
        • Perkell J.S.
        Glottal airflow and transglottal air pressure measurements for male and female speakers in soft, normal, and loud voice.
        J Acoust Soc Am. 1988; 84: 511-529
        • Schutte H.K.
        Integrated aerodynamic measurements.
        J Voice. 1992; 6: 127-134
        • Södersten M.
        • Hertegård S.
        • Hammarberg B.
        Glottal closure, transglottal airflow, and voice quality in healthy middle-aged women.
        J Voice. 1995; 9: 182-197
        • Stager S.V.
        • Bielamowicz S.A.
        Evidence of return of function in patients with vocal fold paresis.
        J Voice. 2010; 24: 614-622
        • Zraick R.I.
        • Smith-Olinde L.
        • Shotts L.L.
        Adult normative data for the KayPENTAX phonatory aerodynamic system model 6600.
        J Voice. 2012; 26: 164-176
        • Hirano M.
        • Koike Y.
        • von Leden H.
        Maximum phonation time and air usage during phonation.
        Folia Phoniatr Logop. 1968; 20: 185-201
        • Yumoto E.
        Aerodynamics, voice quality, and laryngeal image analysis of normal and pathologic voices.
        Curr Opin Otolaryngol Head Neck Surg. 2004; 12: 166-173
        • Rau D.
        • Beckett R.L.
        Aerodynamic assessment of vocal function using hand-held spirometers.
        J Speech Hear Disord. 1984; 49: 183-188
        • Wang C.-C.
        • Chang M.-H.
        • Jiang R.-S.
        • et al.
        Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis a prospective long-term follow-up outcome report.
        JAMA Otolaryngol Head Neck Surg. 2015; 141: 264-271
        • De Virgilio A.
        • Chang M.H.
        • Jiang R.S.
        • et al.
        Influence of superior laryngeal nerve injury on glottal configuration/function of thyroidectomy-induced unilateral vocal fold paralysis.
        Otolaryngol Head Neck Surg. 2014; 151: 996-1002
        • Kao Y.C.
        • Chen S.H.
        • Wang Y.T.
        • et al.
        Efficacy of voice therapy for patients with early unilateral adductor vocal fold paralysis.
        J Voice. 2017; https://doi.org/10.1016/j.jvoice.2017.01.007
        • Aghajanzadeh M.
        • Darouie A.
        • Dabirmoghaddam P.
        • et al.
        The relationship between the aerodynamic parameters of voice and perceptual evaluation in the Iranian population with or without voice disorders.
        J Voice. 2017; 31 (250.e259–250.e215)
        • Joshi A.
        • Watts C.R.
        Measurement reliability of phonation quotient derived from three aerodynamic instruments.
        J Voice. 2016; 30: 773.e713-773.e719
        • Joshi A.
        • Watts C.R.
        Phonation quotient in women: a measure of vocal efficiency using three aerodynamic instruments.
        J Voice. 2017; 31: 161-167
      1. KayPENTAX Corp LP, NJ. Instruction Manual, 2009, Phonatory Aerodynamic System (PAS), Model 6600.

      2. IBM SPSS Statistics for Windows [computer program]. Version 22.0. Armonk, NY: IBM Corp; 2013.

        • Goozée J.V.
        • Murdoch B.E.
        • Theodoros D.G.
        • et al.
        The effects of age and gender on laryngeal aerodynamics.
        Int J Lang Commun Disord. 1998; 33: 221-238
        • van den Berg J.
        Modern research in experimental phoniatrics.
        Folia Phoniatr Logop. 1962; 14: 81-149