Research Article|Articles in Press

High-Speed Image Analysis Comparing Loading of Vocal Folds During Coughing and Phonation: A Case Study



      Coughing is related to voice problems, since it involves firm glottal closure, fast glottal opening, and high subglottic pressure and flow rate. In this study, the glottal area variation and movements of laryngeal structures during coughing and phonation are compared.


      High-speed laryngoscopy recordings were made of a normophonic male participant with a healthy larynx producing a neutral vowel and coughing. Oral air pressure was registered in a mouthpiece, through which an endoscope was inserted into the pharynx. Electroglottography, acoustic, and pressure signals were recorded simultaneously. The glottal width variation at the membranous and cartilaginous parts of the glottis was derived from the high-speed images, and the strong vibration of the false vocal folds was also registered.


      In coughing, compared to ordinary vowel phonation in nearly the same sound pressure level (93–94 dB6cm), the glottal width was 25% larger at the middle of the vocal folds, the maximum glottal opening velocity was 39% higher, and the maximum glottal width declination rate during glottal closing was up to three times higher. The maximum acceleration was 40% higher, and the maximum deceleration was 47% higher. Fundamental frequency f0 was the highest (ca. 400 Hz) at the beginning of the first phase of a typical coughing process. During the last part of the coughing process, f0 decreased from ca. 250 Hz to ca. 85 Hz at the phonation offset.


      The remarkable increase in maximum glottal width declination rate implies much higher vocal fold loading in coughing compared to phonation.

      Key Words

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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


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


        • Shaha M
        • Hoffman MR
        • Hapner ER
        • et al.
        Membranous vocal fold lesions in patients with chronic cough: A case series.
        J Voice. 2023; (Available online 11 March 2023)
        • Pan Y
        • Li J
        • Wang X
        • et al.
        Prognosis of patients with laryngeal contact granuloma: development and validation of RCGSG score.
        Laryngoscope Investig Otolaryngol. 2022; 7: 1973-1978
        • LaTour D
        • Crawley B
        • Krishna P
        • et al.
        Effects of cough suppression therapy on voice disorder severity.
        The Laryngoscope. 2021; 131: 2747-2751
        • Martinez-Paredes JF
        • Alfakir R
        • Thompson CC
        Effect of chronic cough on voice measures in patients with dysphonia.
        J Voice. 2021;
        • Comroe JH
        Physiology of respiration.
        2nd ed. Year Book Medical Publishers Inc., Chicago1974
        • Irwin RS
        • Rosen MJ
        • Braman SS
        Cough: a comprehensive review.
        Arch Intern Med. 1977; 137: 1181-1191
        • Korpáš J
        • Sadloňová J
        • Vrabec M
        Analysis of the cough sound: an overview.
        Pulm Pharmacol. 1996; 9: 261-268
        • Ross BB
        • Gromiak R
        • Rahn H
        Physical dynamics of the cough mechanism.
        J App Physiol. 1955; 8: 264-268
        • Evans JN
        • Jaeger MJ
        Mechanical aspects of coughing.
        Pneumonologie. 1975; 152: 253-257
        • Hirano M
        Clinical examination of voice.
        in: Arnold GE Winckel F Wyke BD Disorders of human communication 5. Springer-Verlag, Wien1981
        • Baken RJ
        • Orlikoff R
        Clinical measurement of speech and voice.
        2nd edn. Singular Publishing Group, San Diego, USA2000
        • Kwon SB
        • Park J
        • Jang J
        • et al.
        Study on the initial velocity distribution of exhaled air from coughing and speaking.
        Chemosphere. 2012; 87: 1260-1264
        • Wani MK
        • Woodson GE
        Laryngeal contact granuloma.
        The Laryngoscope. 1999; 109: 1589-1593
        • Titze IR
        Mechanical stress in phonation.
        J Voice. 1994; 8: 99-105
        • Jiang J
        • Titze I
        Measurement of vocal fold intraglottal stress and impact stress.
        J Voice. 1994; 8: 132-144
        • Titze IR
        Theoretical analysis of maximum flow declination rate versus maximum area declination rate in phonation.
        J Speech Lang Hear Res. 2006; 49: 439-447
        • Titze IR
        • Laukkanen AM
        Can vocal economy in phonation be increased with an artificially lengthened vocal tract? a computer modeling study.
        Logoped Phoniatr Vocol. 2007; 32: 147-156
        • Laukkanen AM
        • Geneid A
        • Bula V
        • et al.
        How much loading does water resistance voice therapy impose on the vocal folds? An experimental human study.
        J Voice. 2020; 34: 387-397
        • Horáček J
        • Radolf V
        • Bula V
        • et al.
        Experimental modelling and human data of glottal area declination rate for vowel and semi-occluded vocal tract phonation.
        Biomed Signal Process Control. 2021; 66102432
        • Švec JG
        • Šram F
        • Schutte HK
        Videokymography in voice disorders: What to look for?.
        Ann Otol Rhinol Laryngol. 2007; 116: 172-180
        • Horáček J
        • Radolf V
        • Laukkanen AM
        Experimental and computational modeling of the effects of voice therapy using tubes.
        J Speech Lang Hear Res. 2019; 62: 2227-2244
        • Horáček J
        • Radolf V
        • Laukkanen AM
        Impact stress in water resistance voice therapy: a physical modeling study.
        J Voice. 2019; 33: 490-496
        • Yanagihara N
        • Leden H
        • Werner-Kukuk E
        The physical parameters of cough: the larynx in a normal single cough.
        Acta Oto-Laryng. 1966; 61: 495-509
      1. Horáček J, Laukkanen AM, Šidlof P,et al. (2009) Comparison of acceleration and impact stress as possible loading factors in phonation: a computer modeling study. Folia Phoniatr Logop 61:137-145.

        • Patel RR
        • Sundberg J
        • Gill B
        • et al.
        Glottal airflow and glottal area waveform characteristics of flow phonation in untrained vocally healthy adults.
        J Voice. 2020; 36 (0892-1997): 140.e1-140.e21
        • Titze IR
        Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings.
        J Speech Lang Hear Res. 2006; 49: 448-459
        • Zwitman DH
        • Calcaterra TC
        The “silent cough” method for vocal hyperfunction.
        J Speech Hear Disord. 1973; 38: 119-125