Journalof Voice

Vol. 8, No. 2, pp. 99-105

© 1994 Raven Press, Ltd., New York

Mechanical Stress in Phonation

Ingo R. Titze

Department of Speech Pathology and Audiology, National Center for Voice and Speech, University of Iowa, Iowa
City, Iowa, and Recording and Research Center, Denver Center for the Performing Arts, Denver, Colorado, U.S.A.

Summary: Mechanical stress is always encountered in phonation. This in-

cludes tensile stress, shear stress, impact stress during collision, maximum
active contractile stress in laryngeal muscles, inertial stress, and aerodynamic
stress (pressure). Order of magnitude calculations reveal that tensile stress can
reach the greatest value (near 1.0 MPa), contractile stress is next in size (near
100 kPa), and aerodynamic stress is relatively small (1-10 kPa). Inertial stress
and impact stress are greater than aerodynamic stress, but less than contractile
stress. Excessive collision and acceleration may be responsible for the greatest
tissue damage, even though they do not account tbr the greatest stresses. This
is because they act perpendicularly to the direction of tissue load-bearing fibers
and are applied directly to mucosal tissue. Key Words: Stress--Strain--
Injury--Vocal fold--Vibration--Damage--Vocal disorders.

This article was motivated by the lifelong inves-
tigations of voice disorders by Moore (1). Moore
convinced this author, and many others in the field,
that voice disorders and voice physiology are one
and the same topic. One cannot understand normal
vocal fold vibration with a disregard for abnormal
vibration patterns. This is becoming increasingly
more evident in light of modern views of nonlinear
dynamics. Chaotic behavior is part of a normal self-
oscillating vocal fold system, and "normal" vibra-
tion patterns can be seen when the vocal folds are
visually impaired.
Nowhere is this gray boundary between normal
function and dysfunction more evident than in the
assessment of mechanical stress in phonation. It is
generally assumed that excessive mechanical stress
can lead to organic disorders. But how much is ex-
cessive? Although repeated collision of the vocal
folds is likely to be the primary cause of vocal nod-
ules, we cannot produce much sound without col-
liding the vocal folds. So what is a tolerable
Accepted March 31, 1993.
Address correspondence and reprint requests to Dr. I. R.
Titze at Department of Speech Pathology and Audiology, Na-
tional Center for Voice and Speech, University of Iowa, Iowa
City, IA 52242, U.S.A.
amount? We also believe that persistent "pressing"
together of the arytenoid cartilages is a cause of
contact ulcers, and rubbing vocal fold tissue with
foreign objects (such as an endotracheal tube) is
known to cause granulomas, but, again, we have
no criteria for how much mechanical stress is abu-
sive.
Benign lesions are apparently a reaction to, and
ultimately a fortification against, mechanical insult
to vocal fold tissues. Little is known, however,
about the kind of stress that routinely occurs during
vocal fold vibration, and how that stress is distrib-
uted within the tissues. If the stress fields were
known for various phonation types, perhaps some
strategies for healthy, nonabusive voice production
would become clearer. Specifically, it would be de-
sirable to weigh phonation type and increases in
vocal loudness against increases in tissue stress to
obtain a cost/benefit ratio for certain vocal produc-
tions.
The present study is an extension of the summary
article on vocal strain written by Sonninen et al. (2),
who summarized the types of mechanical loads and
deformations found in the vocal folds. Twenty
years later, we can shed only a little additional light
on these critical questions: (a) What types of

99
100
stresses occur in vocal fold vibration, (b) How large
are they under normal and maximal-effort phona-
tion, and (c) Is there a likelihood that tissue damage
will occur from a specific type of stress?
TYPES OF MECHANICAL STRESS AND
RELATIVE MAGNITUDES
We begin by identifying the various types of me-
chanical stress encountered in vocal fold vibration,
with an attempt to estimate their magnitudes. It
should be understood that these estimates are or-
der-of-magnitude. In many cases, experiments are
yet to be done to verify the numbers.
Tensile stress
By far the greatest stress applied to vocal fold
tissues is a tensile stress (Fig. 1). This is applied
primarily to the longitudinal (anterior-posterior) fi-
bers of the vocal ligament by the cricothyroid mus-
cle. An estimate of the maximum tensile stress is
obtained by assuming that collagenous and elastic
fibers vibrate in a string-like fashion. Then
tr = 4L2F2p
where tr is the tensile stress L is the length of the
membranous vocal fold, F o is the fundamental fre-
quency, and p is the tissue density (1,040 kg/m3).
For a woman singing a high C (F o = 1,046 Hz) and
a membranous length of 0.01 m, the stress is
o- = 4(10 4)(1,046)2(1,040) ~ 500 kPa
For higher notes in the coloratura repertoire, fre-
quencies up to 1,500 Hz are possible, for which the
tensile stress would exceed 1.0 MPa. If the ligament
cross-section is - 1 mm × 1 mm, then the tension is
on the order of 1 N, or -¢2 lb.
For typical speech fundamental frequencies, es-
Cross section S I ~ F (cricothyroid force)
---I
Lo ~" AL ~ -
Tensile stress = cr = F / S
Tensile strain = e = AL/Lo
FIG. 1. Illustration of tensile stress and strain.
Journal of Voice, Vol. 8, No. 2, 1994
I . R . TITZE
16o-
12o-
................................
..... Maximum active
80
o
40-
$1 S
Passive ~ J
0 10 2~0 3'0 40
Strain (%)
FIG. 2. Maximum active contractile stress (dotted line) of the
thyroarytenoid muscle of canine larynges. The total stress (solid
line) is assumed to be the summation of the passive stress
(dashed line) and maximum active stress (after ref. 3).
pecially for men, the tensile stress is much lower.
At 100 Hz, for example, ~r is two orders of magni-
tude lower than at 1,000 Hz, giving a stress of - 5
kPa.
Maximum active contractile stress in muscles
(1) The maximum active contractile stress in the thy-
roarytenoid (TA) and cricothyroid (CT) muscles of
canines has been measured by Alipour-Haghighi et
al. (3,4). Results are shown in Fig. 2 for the TA and
in Fig. 3 for the CT. Note that these stresses vary
with vocal fold length (strain), but have a range of
values of -30-115 kPa. The TA muscle reaches a
maximum active stress of 100 kPa at 20% elonga-
(2)
tion, whereas the pars recta of the CT reaches the
same value at - 3 0 % elongation.
One might ask how the CT can produce a stress
of 1.0 MPa in the vocal ligament when its maximum
contractile stress is only - 100 kPa. The answer lies
in a transformation of cross-sectional area. The
force applied to the ligament equals the force pro-
duced by the CT muscle, but because the ligament
has a smaller cross-sectional area, the stress is mag-
nified by a factor of 10 or so.
Collision stress between vocal folds
The collision stress between the vocal folds can
be estimated from basic physical principles (Fig. 4).
Assuming the mass of a tissue element at the medial
surface to be
m = pAxAyAz (3)
.
where p is the tissue density given above and
2txAyAz is a small volume, then, from Newton's
 MECHANICAL STRESS IN PHONATION 101

This velocity is reduced to zero during the collision

Pars recta interval, such that
100 " maximumactivestress
• pars obl]qua
Av = v - 0 = 2rrFoA (7)

Substituting Eqs. 3, 5, and 7 into 4 yields

~ 50
O3

pars obliqua
F = 207rAF2pAxAyAz (8)
Pars recta passive stress
~ = ~ O ~ p a esrtss s~~i~. v e If A y A z is taken to be the impact surface and Ax the
depth of the vibrating tissue, then the collision
o stress is
o t'o 2'0 3'0 40
Strain (%)
F
FIG. 3. Maximum active contractile stress of two components of ~r - AyA~ - 20"rrAFZpAx (9)
the CT muscle of canine larynges, The passive stress is also
shown (after ref. 4).
For an amplitude of vibration of 10 -3 m, a depth
second law, the average collision force over an im- of vibration of 10 -3 m, and an Fo of 200 Hz, this
pact interval At is stress is 2.6 kPa. Peak impact stresses on the order
of 0.5-5.0 kPa were measured by Jiang and Titze (5)
F = mAv/At (4) and are shown in Fig. 5 as a function of subglottal
pressure. Similar increases in contact stress were
where Av is the change in velocity during impact. obtained by Reed et al. (6) with a piezoelectric
Jiang and Titze (5) estimated the impact interval to transducer placed between the vocal folds of a hu-
be on the order of man subject.
Values of Fo in Fig. 5 were <200 Hz. For fre-
r0 quencies approaching 1,000 Hz, one would expect
At- 10 (5)
much higher impact stresses if the amplitude and
depth of vibration were to remain constant. Typi-
where To is the fundamental period. cally, however, both amplitude and depth of vibra-
The velocity change in Eq. 4 can be estimated by tion decrease with F0, making the exact stress un-
assuming sinusoidal motion with amplitude A and certain. One would expect that the impact stress
radian frequency o~ = 2¢rFo. The maximum veloc- could increase an order of magnitude, to - 5 0 kPa,
ity, which occurs near impact, is then for high F 0 and high subglottal pressure.
v = oJA = 2 w F o A (6)
5.0"

Collision
boundary Tissue element of 4.0
mass pAxAyAz &
3.0,

"5
2.0,

Q.
1.0,

J
11o 21o 31o 4.0
Av Subglottal pressure (kPa)
Impact stress = (pAx) ~ -
FIG. 5. Peak collision stress versus subglottal pressure in a ca-
FIG. 4. Illustration of impact stress. nine hemilarynx (after ref. 5).

Journal of Voice, Vol. 8, No. 2, 1994

102 I.R.
Inertial stress
The inertial stress is similar to the impact stress,
except that acceleration and deceleration occur
without collision. Assuming again that the tissue
moves sinusoidally with amplitude A, i.e.,
x = Asintot (10)
then the maximum acceleration is to2A. The maxi-
mum inertial stress is mass (pAxAyAz) times accel-
eration (4~r2F~A) divided by the surface area (AyAz),
which simplifies to
cr = 47r2AF02pAx (1 1)
This stress is approximately half of the impact
stress, on the order of 1-2 kPa for normal phona-
tion.
A e r o d y n a m i c stress
The mean aerodynamic driving stress is the mean
intraglottal pressure, which has been estimated as
in the open phase (6). Here P,. is the input pressure
to the vocal tract (supraglottal pressure), al is the
glottal entry area, a2 is the glottal exit area, and P=
is the subglottal pressure. The greatest pressure oc-
curs for a highly convergent glottis, where az/al "~
0, in which case Pg ~ P="
In high-effort phonation, P~ can be as high as 5-6
kPa, and occasionally reaches 10 kPa (8). This can
be taken as the upper limit on aerodynamic stress.
A r y t e n o i d contact stress
Maximum contact stress between the arytenoid
cartilages has been estimated by Rethi (9) and
Kakeshita (10) to be on the order of 50-100 kPa in
animals who had the adductor muscles fully con-
tracted. This range would tend to agree with the
maximum active stresses measured in the CT and
TA muscles of canines. Adduction stress for normal
phonation is much lower than that, however, even
for so-called "pressed voice." Values reported by
Scherer et al. (11) were on the order of 1-5 kPa.
Shear stress at anterior and posterior macula flava
The shear stress in the ligament increases with
the amplitude of vibration. If the ligament is pinned
at the endpoints (anterior and posterior macula
flava), then the shear stress -r can be written as
"r = Ixsin0 (13)
Journal of Voice, Vol. 8, No. 2, 1994
TITZE
where Ix is the shear modulus and 0 is the shear
angle at the endpoints (Fig. 6). The shear angle can
be expressed in terms of the vibrational amplitude
and the membranous length of the vocal folds.
Thus, if
x = Asin~ry/L (14)
is the displacement of a lowest-string mode in the
anterior-posterior (y) direction, A is the amplitude
(at the center) and L is the membranous length, then
dx -rrA
- tan0 -~ sin0 (15)
dy y=O,L L
For an amplitude of 0.2 mm and a length of 10 mm,
sin 0 = 0.6.
The shear modulus tx of the collagen fibers in the
macula flavae is not known to this author, which
makes it impossible to estimate the absolute value
of the shear stress. All one can say is that it in-
creases with amplitude of vibration and decreases
with vocal fold length. The A / L ratio is a key vari-
able for dynamic shear stress.
Summary of relative magnitudes of stresses
A summary chart of the relative magnitudes of
the various mechanical stresses is given in Fig. 7.
Estimates are made for conditions of normal pho-
nation (clear bars) and maximum stress (cross-
hatched bars). Note the large maximum tensile
stresses relative to all other stresses. Note also the
relatively small aerodynamic stresses. Active con-
tractile, arytenoid contact, impact, and inertial
stresses are intermediate in size.
Anteriorboundary
7///S,
I~O~ Vocalligament
i
Shear stress =/.tsinO
FIG. 6. Illustration of shear stress in the vocal ligament.
 M E C H A N I C A L STR E SS I N P H O N A T I O N
~" ~',
//i
100- ~,~ Max
//1
S~
//1
Tensile '~ Aryienoid Impact lnertial
stress Contractile contact stress stress
muscle stress
stress
FIG. 7. Summary of the relative magnitudes of various mechan-
ical stresses in vocal fold tissues.
DAMAGE CRITERIA
Damage to vocal fold tissue may occur from any
of the mechanical stresses described. Based on the
relative size of the tensile stress in relation to other
stresses, one would reason that the vocal ligament
would be at the highest risk of damage, particularly
at high pitches. Excessive tension would appear to
rupture the tissue fibers. If the vocal ligament has
comparable strength to other ligaments in the body,
however, it is well protected against this type of
rupture. The following discussion will clarify this
point.
Rupture due to tensile stress
As an analogy with other body tissues, consider
the anterior cruciate ligament of the knee, which
has been studied extensively by Noyes and Grood
(12). This ligament is larger than the vocal ligament.
The authors report an average length of 27 mm and
an average cross-sectional area of 44 mm 2. This is
approximately twice the length of the vocal liga-
ment and approximately 10 times the cross-section.
Nevertheless, because stress and strain are essen-
tially independent of sample size, the comparison is
useful.
Figure 8 shows the mechanical response of the
anterior cruciate ligament under tensile stress.
Strain was applied at a rate of 100% per second. The
attempt was to simulate conditions in sports, where
extension, flexion, and torsion occur quite rapidly.
Tissue age was a parameter in the study. One group
of subjects was in the 16-26-year age bracket,
whereas another was in the 48-86-year bracket.
Note that the older group displayed a lower maxi-
103
mum stress (13.3 MPa as compared with 37.8 MPa
for the younger group). Furthermore, this maxi-
mum stress occurred at a lower strain (30 instead of
44%). Thus, not only could the younger ligament
support more tensile stress, but it could support this
Normal stress at a greater elongation.
Failure of the ligament occurred differently in the
two age groups. For the younger group, collagen
fibers were ruptured throughout the length of the
ligament. This caused the stress to decrease rapidly
as shown. For the older group, failure was primarily
due to bone avulsion. This took place more gradu-
Aerodynamic
ally and is probably the cause of earlier failure with
increased strain.
It is important to contemplate the overall stress
magnitude that this k n e e ligament can support. In
the "linear" range, stresses can be 10-20 MPa. This
is 40-80 times the stress we estimated for a soprano
singing a high C. If the vocal fold ligament is made
up of the same type and density of collagen fibers as
this knee ligament, one would conclude that there is
little chance of failure of the vocal ligament by ex-
cessive CT contraction.
The vocal ligament probably serves to protect
other tissues in the vocal fold from rupture. If we
can assume that 30% is a strain limit on the vocal
folds, which tends to agree with the estimates of
van den Berg (13), then the mucosa and the TA
muscle will not be elongated to their yield points.
Figures 9 and 10 show stress-strain curves for the
canine TA muscle and vocal fold cover, respec-
tively. These curves were obtained by cyclic
stretch-release methods at a rate of 1 Hz (similar to
50-
Max stress
40-
~ 20-
(~ M~,x stress
- ,~aJLure
10" ",,.
~, ,, " Linear limit
0 • ~ • i , i , i , i
10 20 30 40 50 6'0 70
Strain (%)
FIG. 8. Stress-strain curve for the anterior cruciate ligament in
humans (after ref. 12). Solid line is for the younger specimen
(16-26 years) and dashed line for the older specimen (48-86
years).
Journal of Voice, Vol. 8, No. 2, 1994
104 I . R . TITZE

30- The primary symptom of a vascular disorder is

"white finger," which is basically the symptom of
reduced circulation. Circulation is impeded by rapid
acceleration and deceleration of the tissue. Esti-
20"
mates of maximum acceleration of vocal fold tis-
sues within the vibratory cycle were implicit in
Eq. 1,
N lO-
a = toZA = 4~rZF~A (16)

For a fundamental frequency of 200 Hz and a vibra-

o
o 1'o 2'0
Strain (%)
FIG. 9. Stress-strain curve for the thyroarytenoid muscle of ca-
nines during cyclic stretch and release.
the rate of the knee ligament elongation). Note that
30-40% elongation was possible without tissue
damage. Thus, the presence of a vocal ligament
would tend to keep strains in the "safe" range for
muscle and mucosal tissue.
Excessive vibration
In his H a n d b o o k o f H u m a n Vibration, Griffin
(14) lists five disorders associated with hand-
transmitted vibration: (a) vascular disorders, (b)
bone and joint disorders, (c) peripheral neurologic
disorders, (d) muscle disorders, and (e) other (e.g.,
central nervous system). These disorders are usu-
ally associated with tool use. They may not apply at
all to vocal fold vibration, but it is worthwhile to
make a few comparisons. Parameters for consider-
ation are vibrational magnitude, frequency, and du-
ration.
4O
tional amplitude of 0.001 m, there is a peak accel-
a'0 40 eration of 1,600 m/s 2, with a root mean squared
value of 1,100 m/s 2. If such a vibration were to oc-
cur continuously for 30 min, it would fall well into
the unacceptable region of exposure according to
International Standards Organization (ISO) stan-
dards (ref. 14, p. 647). As shown in Fig. 11, accel-
erations of even one-tenth this value would be un-
acceptable (see data point in relation to the line of
safety). Phonation is never continuous, of course,
for 30 rain. This makes the dosage criterion difficult
to assess, but it cannot be ruled out that excessive
vibration could lead to some vascular disorders in
the larynx.
Impact stress
Assessment of safe limits of impact stress is also
difficult. We do not have well-controlled experi-
ments that show the tissue damage as a direct result
of collision. The studies by Gray et al. (15) and Gray
and Titze (16) are beginnings. Continuous phona-
tion was maintained (by an artificial air supply) for
several hours at high intensity in anesthetized ca-
nines. Electron-microscopic examination showed
10000

1000,

30 ¸ E
100-
UnbaccePt
ratiotunabl
vimagni e4A~~ep~le
des
&
20 ¸
10-
_/ vibration

8
10. 1

0
0 i , i , o 1'o 16o lC;OO 10000
lO 20 3'0 4'0 so
Frequency (Hz)
Strain (%) ;.
FIG. 11. 1SO standard for hand-transmitted vibration (after ref.
FIG. 10. S t r e s s - s t r a i n curve for the vocal fold cover of canines 14). Data point suggests that vocal fold vibration could exceed
during cyclic stretch and release. the m a x i m u m r e c o m m e n d e d dose.

Journal of Voice, Vol. 8, No. 2, 1994

 M E C H A N I C A L STRESS I N P H O N A T I O N
destruction of surface microvillae, of squamous ep-
ithelial cells, and of the basement membrane zone.
Future investigations should quantify this type of
destruction in terms of measured impact stress. It
would also be extremely valuable to know the time
course and degree of the healing process.
CONCLUSION
The largest mechanical stresses in vocal fold vi-
bration are the tensile stresses required for pitch
increase. Estimates are that they may reach values
on the order of 1 MPa. This would be excessive for
epithelial or muscular tissue, but seems to be nor-
mal for ligamental tissue. We assume, therefore,
that a well-developed and healthy vocal ligament
provides a "safety-valve" for other, perhaps more
injury-prone, tissues in the vocal folds. The liga-
ment limits elongation and assumes most of the ten-
sile stress at high pitches.
The ligament cannot protect as well against vocal
fold collision, however, where the stress is trans-
verse to the fibers. Here the softer tissues of the
lamina propria are exposed and do absorb most of
the impact stress. Some evidence of destruction has
been reported, and the fact that vocal fold nodules
occur bilaterally at the point of maximum impact
stress (5) attest to this.
The possibility that safe limits of tissue accelera-
tion are exceeded in prolonged phonation needs fur-
ther exploration. Exposure durations are shorter
than what is typically reported for hand-transmitted
vibration with power tools, but acceleration magni-
tudes are comparably larger. This leaves the inte-
grated dosage uncertain.
Finally, shear stresses and aerodynamic stresses
were discussed briefly, but no damage estimates
could be made in this preliminary study. Aerody-
namic stresses are very small in comparison to ten-
sile stresses and maximum contractile stresses of
the laryngeal muscles, which leads one to speculate
105
that aerodynamic stresses of themselves do not
pose a damage risk.
Acknowledgment: This study was supported by grant
no. P60 DC00976 from the National Institute on Deafness
and Other Communication Disorders. I thank Julie
Lemke for manuscript preparation and Mark Peters for
graphic support.
REFERENCES
1. Moore P. Organic voice disorders. Englewood Cliffs, New
Jersey: Prentice-Hall, 1991.
2. Sonninen A, Damst6 PH, Jol J, Fokkens J. On vocal strain.
Folia Phoniatr (Basel) 1972;24:321-36.
3. Alipour-Haghighi F, Titze IR, Perlman A. Tetanic contrac-
tion in vocal fold muscle. J Speech Hear Res 1989;32:226-
31.
4. Alipour-Haghighi F, Titze IR, Perlman A. Tetanic response
of the cricothyroid muscle. Ann Otol Rhinol Laryngol 1991;
100:626-31.
5. Jiang JJ, Titze IR. Measurement of vocal fold intraglottal
pressure and impact stress. J Voice 1994;8:132-44.
6. Reed CG, Doherty ET, Shipp T. Direct measurement of vo-
cal fold medial forces. ASHA 1992;34:131(A).
7. Titze IR. The physics of small-amplitude oscillation of the
vocal folds. J Acoust Soc A m 1988;83:1536-52.
8. Schutte H. The efficiency o f voice production. Groningen:
Kemper, 1980.
9. Rethi L. Die stimmbandspannung, experimentell gepr~ft.
Sitzgsber Akadem Wissenschaft Wien Math Naturwissen-
shaft Kl III 1897;106:244.
10. Kakeshita T. Uber eine neue methode zur messung der beim
stimubrandverschluss winkende krafte. I Mitt Pflugers Arek
far die Gesamunte Physiol 1927;215:19.
11. Scherer RC, Cooper DS, Alipour-Haghighi F, Titze IR. Con-
tact pressure between the vocal processes of an excised bo-
vine larynx. In: Titze J, Scherer R, eds. Vocal fold physiol-
ogy: biomechanics, acoustics, and phonatory control. Den-
ver: Denver Center for the Performing Arts, 1985:292-303.
12. Noyes FR, Grood ES. The strength of the anterior cruciate
ligament in humans and rhesus monkeys. J Bone Joint Surg
A m 1976;58:1074-82.
13. van den Berg J. Myoelastic-aerodynamic theory of voice
production. J Speech Hear Res 1958;1:227-44.
14. Griffin MJ. Handbook o f human vibration. New York: Ac-
ademic Press, 1990.
15. Gray SD, Titze IR, Lusk RP. Electron microscopy of hyper-
phonated vocal cords. J Voice 1987;1:109-15.
16. Gray S, Titze IR. Histologic investigation of hyper-phonated
canine vocal cords. Ann Otol Rhinol Laryngol 1988;97:
381-8.
Journal of Voice, Vol. 8, No. 2, 1994