hyolaryngeal excursion

Running EFFECTShead: OF EXERCISES ON SUBMENTAL … The mylohyoid and geniohyoid muscles attach to the body of the hyoid . Pharyngeal Swallowing Steps. Therefore, if reduced hyolaryngeal excursion is observed on videofluoroscopy, with resultant pyriform sinus residue, this technique is indicated. Measurement of Hyoid and Laryngeal Displacement in Video ... CTAR (Chin Tuck Against Resistance The exercise consists of You also can try Hyolaryngeal excursion as the physiological source of ... D C B Zoratto 1,2,3, T Chau 1,2,3,4 and C M Steele 1,2,3,4,5. Fingerprint Dive into the research topics of 'Correction to: Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy (Dysphagia, (2019), 34, 3, (298-307), 10.1007/s00455-018-9927-2)'. Isokinetic vs. Isometric. We recommend downloading the newest version of Flash here, but we support all versions 10 and above. ). By: Mary C. Ragland, Taeok Park, Gary McCullough, and Youngsun Kim. Penetration and aspiration may become apparent in more severe cases Kinematic effects of hyolaryngeal electrical stimulation therapy on hyoid excursion and laryngeal elevation Hyung Seok Nam , Jaewon Beom , Byung Mo Oh , … (immediately after the swallow the pt should cough to clear any residue) Of these, five The authors reported that 20 of 23 showed improve- were related to dysphagia as a consequence of stroke alone ment after a short period of “synchronized electrical [17–21], eight to dysphagia relating to other aetiologies, stimulation” aimed at improving hyolaryngeal excursion. The findings of maximal hyoid displacement varied among the investigations. Decreased labial stength. Impaired hyolaryngeal excursion underlies dysphagia in many treatment-seeking populations, including PD and post-stroke patients. (McCullough, 2012) Man kann es hyolaryngeale Exkursionen übersetzen, oder erläutern (Bewegungen von Zungenbein und Kehlkopf), je nach Zielgruppe Successful treatment for dysphagia facilitated increased hyolaryngeal excursion magnitude, duration and velocity. When an individual is sitting or standing, hyolaryngeal excursion must also act against another form of resistance – gravity. Inability to lateralize material with tongue. 1) Elevation and retraction of velum. Hyolaryngeal Excursion (HLE) 9. The laryngeal elevation tilts the epiglottis downward and closes the laryngeal vestibule. The laryngeal elevation extends the esophageal inlet, allowing the bolus to pass into the UES. Click to see full answer Beside this, what is laryngeal excursion? Meas. Swallowing dysfunction, or dysphagia, is a serious condition that can result from any structural or neurological impairment (such as stroke, neurodegenerative disease or brain injury) that affects the swallowing mechanism. If you know you have an injury to one side or the other, allow that to tailor your treatment. In the present study, every maximal excursions and maximal velocities of the hyolaryngeal complex increased in EFS, except the horizontal excursion and velocity of hyoid. They state that the hyoid excursion is dependent on the size of the person (size-of-the-system). SECTION 1 Overview of Instrumental Exam and The Role of Anatomy and Physiology 11 12. Selection criteria used for the images included clear visualization of the anterior– inferior edge of the hyoid bone (hyoid excursion), the 1. The Speed Of The Hyoid Excursion In Normal Swallowing. There are many factors to examine during hyolaryngeal excursion. If an exercise is not selected, do not attempt it … •Question: Does epiglottal retroflexion reflect hyolaryngeal excursion? Hyolaryngeal excursion (HE) is typically assessed via palpation during clinical swallowing exams (CSE) or visually during videofluoroscopy (VFSS). Decisions: Questions to Ask, Strategies and Definitions 10. tongue retraction, epiglottic inversion, vocal cord adduction with hyolaryngeal excursion, cricopharyngeal relaxation and minimal residuals Anatomy and Physiology Esophageal Stage: involves the cricopharyngeus, motility, lower esophageal sphincter, retrograde flow, reflux Expect to see: relaxation of the cricopharyngeus, timley peristaltic wave, hyolaryngeal excursion as compared to the sensory level group.59 - Park, 2012 – Post-stroke patients receiving motor level stimulation below the hyoid demonstrated a significantly better increase hyolaryngeal excursion and UES opening than patients in … CTAR vs Shaker: Both have a component of isometric versus isokinetic. (McCullough, 2012) maximal hyolaryngeal excursion (maximum excursion, P2). Motor: mouth opening, mastication (chewing), hyolaryngeal excursion, tensing soft palate, facial expressions Sensory: sensation ant. Maximal excursion was defined as the point where no subsequent anterior or superior hyolaryngeal movement was noted during the swallow. Decreased hyolaryngeal excursion, incomplete airway closure at the level of the vocal cords, and pharyngeal residuals were again noted. Hitting the high note during the falsetto exercise has been widely practiced by Speech Pathologists for many years. I had planned to share this with that SLP directly…. Development of a New Objective Measurement Device to Evaluate Hyolaryngeal Excursion During Swallowing at the Bedside 6th European Society for Swallowing Disorders(ESSD) Congress 2016 October 14, 2016 Hyolaryngeal Excursion - Laryngeal extrinsics - Suprahyoid muscles - decreased hyolaryngeal excursion - penetration, aspiration - voice abnormalities - decreased UES opening - pooling, residuals 2b 1 3a good facilitation of geniohyoid, mylohyoid and thyrohyoid muscles facilitation supra- and infrahyoid muscles Fluoroand FEES; epiglottic Elevation of the larynx during swallowing plays two important roles: One is to protect the trachea. Starts when UES closes above. •Increased time of maximum hyolaryngeal excursion •Pharyngoesophageal: •Increased time for UES relaxation •Esophageal •Slower clear •Reaction time to sensory stimuli increases C. Brindo R. Maxbauer MSHA 2017 cbrindo@mbsenvision.com Tracey, Logemann 1989; Shaw et al, From here, the food or liquid passes through a long tube (esophagus) before entering your stomach. If you know the patient has an injury to one side or the other, allow that to tailor your treatment! 5) tongue base moves posteriorly to force bolus down. SECTION 1 Overview of Instrumental Exam and The Role of Anatomy and Physiology 11 12. In the pharyngeal stage, lingual propulsion and pharyngeal constriction push the bolus into the pharynx. Elevation of the hyolaryngeal complex is central to the intricate set of movements required to transfer a bolus from the oral cavity through the hypopharynx and into the esophagus. The hyolaryngeal complex consists of the hyoid muscle, the laryngeal cartilages, and the muscles intrinsic to the hyoid and larynx, including the thyrohyoid. • Gently touch the patient’s hyoid bone, ask them to swallow, and feel for hyolaryngeal elevation. NEURAL CONTROL OF SWALLOWING The brain communicates with muscles via upper motor neurons and lower motor neurons. Reduced hyolaryngeal excursion Unilateral vocal fold paresis/paralysis . Therefore, if reduced hyolaryngeal excursion is observed on videofluoroscopy, with resultant pyriform sinus residue, this technique is indicated. Surgical removal of tumors of the head and neck is a long-standing and well-established treatment modality which is still in wide use today [1,2].Swallow dysfunction is often observed after surgical excision of tumors in the head and neck; swallow disorders may occur in the oral … Coughing and declined hyolaryngeal excursion also raises concerns of potential penetration and/or aspiration. Interestingly, 5 of the 6 excursions exhibited no statistically significant difference between the EPG and the swallow. Laryngeal Dysfunction in Dysphagia Defective closure of the laryngeal vestibule occurs in 43 percent of patients with dysphagia (Ekberg, 1982). as hyolaryngeal excursion) secondary to activation in the hyolar-yngeal (mylohyoid, geniohyoid, anterior digastric, and thyro-hyoid) musculature.1-5 Reduced hyolaryngeal excursion is a common cause of aspiration in dysphagic patients.6,7 When hyolaryngeal excursion is restricted, the diminished superior and A decline in her hyolaryngeal excursion and a delay in pharyngeal swallow onset was also noted thorughout the assesment. In theory, NMES applied to the submandibular muscles when paired with swallowing exercises may have two different but complimentary effects for rehabilitating impaired hyolaryngeal function in swallowing. The Breather® is a respiratory trainer/exerciser that improves lung strength and capacity by improving oxygen uptake to vital organs. It was introduced by Dr.Jeri Logemann (1997) and described as an exercise for laryngeal elevation because of its presumed effect of lifting the larynx comparable to the swallow (p. 210) . The upper motor neurons (UMN) communicates signals from the brain to the lower motor neurons (LMN) which are the final neurons connecting to muscle fibers. Case Studies on Impaired Function 11. Palpating the swallow may not reliably evaluate delay or the extent of hyolaryngeal excursion, but we can note exhale versus inhale after the swallow. This site uses cookies. During this stage, the bolus enters the pharynx. 5) tongue base moves posteriorly to force bolus down. The maximum hyoid displacement was associated with such events as onset of bolus transit, upper esophageal sphincter (UES) widest opening, UES closure, laryngeal closure, maximum laryngeal closure, and laryngeal opening [13]. Hyolaryngeal Excursion (HLE) 9. Hyolaryngeal Excursion - Laryngeal extrinsics - Suprahyoid muscles - decreased hyolaryngeal excursion - penetration, aspiration - voice abnormalities - decreased UES opening - pooling, residuals 2b 1 3a good facilitation of geniohyoid, mylohyoid and thyrohyoid muscles facilitation supra- and infrahyoid muscles Based on these results, dysphagia was classified as: 1) problems on timing of hyolaryngeal excursion (PT), and 2) problems on range of hyolaryngeal excursion (PR). 6) contraction of pharyngeal sphincters from top to bottom. Our aim was to be able to describe the effects of EMST on swallowing both at a functional level (i.e., measures of swallowing safety and efficiency) and at a mechanistic level (i.e., other measures of swallow-ing physiology visible on videofluoroscopy), in order to Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy Clinicians appeared to be able to differentiate peak anterior hyoid movement but not superior or hypotenuse movement on palpation. 3)Closure of Larynx at all three levels. Starts when UES closes above. Isokinetic vs. Isometric. Yawning: Helps upward movement of the larynx (voice box) and the opening of the esophagus. Selection criteria used for the images included clear visualization of the anterior– inferior edge of the hyoid bone (hyoid excursion), the 3)Closure of Larynx at all three levels. 2. SWALLOWING FUNCTION AFTER SURGERY FOR CANCER OF THE HEAD AND NECK. Treatment Decisions Many of these key factors have to be viewed during MBSS using frame by frame imaging to determine amount of hyolaryngeal excursion. Neruomuscular and Anatomic Disorders of Swallowing. - This study found that 20 treatments incorporating 30 to 40 Mendelsohn maneuvers seemed to have a rehabilitative effect. Clinical Symptom. Esophageal Stage. Epiglottis needs full hyoid and laryngeal excursion to retroflex/downfold completely –study on larynges in cadavers and MBS studies •Current study underway with simult. 4) Opening of UES. Some of these cookies are essential to the operation of the site, while others help to improve your experience by providing insights into how the site is being used. Decreased hyolaryngeal excursion, weakening pharyngeal constriction, and poor coordination of laryngeal and UES function all tend to present early in the progression of the disease process. The esophageal phase appears to be within functional limits. Reduced hyolaryngeal excursion Unilateral vocal fold paresis/paralysis . Hyolaryngeal excursion as the physiological source of swallowing accelerometry signals. The JoVE video player is compatible with HTML5 and Adobe Flash. hyolaryngeal excursion / elevation hyoid & larynx move up & forward for airway protection and opening stomach other terms for UES--Upper Esophageal Sphincter Cricopharyngus (CP), Pharyngo-Esophogeal Segment (PES) in hyolaryngeal excursion, the elevation causes... the epiglottis to go down to protect the airway It could mean a deficit in the oral phase with poor mastication, oral transfer with poor stabilization of the floor of the mouth, AND/OR the pharyngeal phase with decreased hyolaryngeal excursion (which we know is a huge predictor in dysphagia)! Mit hyolaryngeal ist der Bereich von Zungenbein (Os hyoideus) und Kehlkopf (Larynx) gemeint. How to assess airway patency? Biofeedback therapy to increase hyolaryngeal excursion was initiated on May 6, 1996. It could mean a deficit in the oral phase with poor mastication, oral transfer with poor stabilization of the floor of the mouth, AND/OR the pharyngeal phase with decreased hyolaryngeal excursion (which we know is a huge predictor in dysphagia)! A few months ago, an SLP emailed looking for some information and video examples of hyolaryngeal elevation. Food falling from the mouth. Oropharyngeal dysphagia (OD) is very prevalent among poststroke patients, causing severe complications but lacking specific neurorehabilitation treatment. Validated on adults; may be appropriate for older children with adequate cognitive and communicative abilities to follow instructions. On a fiberoptic exam, one might conclude from viewing pyriform residue that the patient is not getting good excursion. Methods: Temporal and biomechanical measurements of hyolaryngeal excursion were calculated Minimal evidence exists to support the use of these perceptual methods for judging HE. Methods: Temporal and biomechanical measurements of hyolaryngeal excursion were calculated using videofluoroscopic swallowing examinations (VFSEs) of 37 healthy individuals. Hyolaryngeal excursion amplitude, duration, and velocity of movement during swallowing were measured via VFSS. measures of hyolaryngeal excursion, and measures of bolus clearance and residue. Recap 10. The Evidence hyolaryngeal excursion, they could overcome the effects of aging on pharyngeal bolus transit and decrease the chance of consequent laryngeal penetration and/or aspiration. Excursion velocities were calculated from excursion magnitude and duration measures. If the respiratory rate is >30, the patient may inhale after the swallow, placing him at a higher aspiration risk (per Coyle at What's Wrong With My Patient? They also observed substantial increase in hyolaryngeal elevation and excursion during swallow. Interventions 12. Esophageal Stage. - This study found that 20 treatments incorporating 30 to 40 Mendelsohn maneuvers seemed to have a rehabilitative effect. Instruct pt to continue to hold breath lightly while swallowing. (McCullough, 2012) 3/8/19 4 CASE STUDIES The mechanism of swallowing is extremely complex and not fully understood; however, impaired hyolaryngeal excursion and subsequent inadequate opening of the upper esophageal sphincter are most commonly attributed to postradiation therapy dysphagia (2). as hyolaryngeal excursion) secondary to activation in the hyolar-yngeal (mylohyoid, geniohyoid, anterior digastric, and thyro-hyoid) musculature.1-5 Reduced hyolaryngeal excursion is a common cause of aspiration in dysphagic patients.6,7 When hyolaryngeal excursion is restricted, the diminished superior and Assessment of labial seal and anterior spillage, and evidence of oral control, including mastication and transit, manipulation of the bolus, presence of hyolaryngeal excursion as observed externally or to palpation, and time required to complete the swallow sequence and then I inadvertently deleted the email contact and cleaned out my deleted emails without realizing it. Hyolaryngeal excursion at rest: Submental/throat regions: decreasing hyolaryngeal excursion Submental: increasing anterior excursion of the hyolaryngeal structures: Park et al. 3. Case-series: 16: Healthy: Throat: Hyolaryngeal excursion during swallowing: Increasing superior hyoid excursion: Nam et al. However, velocity of hyolaryngeal excursion has received limited attention in the literature on normal or abnormal swallowing. Treatment Decisions Shaker: Place PMV to restore pressure, do not lay patient completely flat, ensure trach does not displace or … Results support the need for further investigations to determine whether the CtC exercise has a positive effect as a rehabilitative exercise for clinical populations with dysphagia secondary to upper esophageal sphincter dysfunction where hyolaryngeal excursion is a physiological impairment. •VanDaele, (1995) = our best study to date. Page 1 of 1 These exercises help strengthen swallowing muscles. Recap 10. When a patient has a tracheostomy tube, several options exist for evaluating airway patency. Hyoid “burst”, superior and anterior excursion of the hyolaryngeal complex. labial seal, anterior spillage and evidence of oral control, including mastication and transit, manipulation of the bolus, presence of hyolaryngeal excursion as observed externally or to palpation, and time required to complete the swallow sequence; • The pharyngeal phase with decreased hyolaryngeal excursion (big predictor of dysphagia!) VFS examination was conducted and an 8-point scale was used for assessing the severity of dysphagia. (immediately after the swallow the pt should cough to clear any residue) Although progressive loads cannot be applied in this context, the duration of contraction against the resistance can be increased progressively throughout an exercise protocol. As the patient swallows, the SLP “feels” the hyolaryngeal movement and judges the speech of elevation. What in the Heck is Hyolaryngeal ExWhatsion? There are many factors to examine during hyolaryngeal excursion. Hyoid “burst”, superior and anterior excursion of the hyolaryngeal complex. The laryngeal elevation extends the esophageal inlet, allowing the … Swallowing is a complex function that requires elevation and anterior excursion of the hyolaryngeal complex in the pharyngeal phase, which aids laryngeal vestibule closure and serves to prevent aspiration into the respiratory tract [1]. Is a speaking valve an option that will assist with restoring subglottic pressure, sensation, hyolaryngeal excursion and other functions impacting swallowing (for a more detailed review, see the article by Barrow, 2020)? Electrical stimulation. Hyolaryngeal excursion is a key movement feature of normal swallowing function which is known to change with age and other extrinsic variables such … Case-series: 16: Healthy: Throat: Hyolaryngeal excursion during swallowing: Increasing superior hyoid excursion: Nam et al. 2)Hyolaryngeal Excursion. • Hyolaryngeal Displacement: - After two weeks of intensive therapy using only the Mendelsohn maneuver both hyolaryngeal elevation and hyolaryngeal excursion increased. 6) contraction of pharyngeal sphincters from top to bottom. Used to reduce hyolaryngeal excursion (reduced airway closure) INSTRUCTIONS Ask pt to inhale and hold their breath very tightly, bearing down. (That’s what I get for trying to get better about email inbox cleanliness, oof.) The results concur with previous studies, implicating hyolaryngeal excursion as the primary physiological source of swallowing accelerometry signals, with … maximal hyolaryngeal excursion (maximum excursion, P2). This movement requires a series of actions from the muscles in these areas. Titel: Hyolaryngeal excursion as the physiological source of swallowing accelerometry signals. Nine coordinates, mapping the cranial base, mandible, vertebrae and elements of the hyolaryngeal complex, were recorded at the frames of … Radiographic Symptom. 31 843 Perhaps a head turn, or head rotation to the weak side will allow for the unaffected, stronger side to lead the way. Hyolaryngeal excursion as the physiological source of swallowing accelerometry signals. –Positively affectsdisplacement and duration of the hyoid movement. Therefore, if reduced hyolaryngeal excursion is observed on videofluoroscopy, with resultant pyriform sinus residue, this technique is indicated. Purpose: Hyolaryngeal excursion (HE) is typically assessed via palpation during clinical swallowing exams (CSE) or visually during videofluoroscopy (VFSS). 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Esophageal phase appears to be more related to upper esophageal sphincter opening,, study... Were calculated using videofluoroscopic swallowing examinations ( VFSEs ) of 37 Healthy.! Perhaps a head turn, or head hyolaryngeal excursion to the body of the tongue, pain sensation. That’S what I get for trying to get better about email inbox cleanliness,.. Minute with a minute rest x 3 repetitions in these areas during normal swallowing using by! Elevation tilts the epiglottis downward and closes the laryngeal vestibule might conclude from viewing pyriform residue the... Laryngeal excursion and Parkinson’s Disease < /a > Reduced hyolaryngeal excursion literature on or... Und Kehlkopf ( Larynx ) gemeint hyolaryngeal excursion, superior and anterior excursion the!, Taeok Park, Gary McCullough, and Youngsun Kim, several options exist for evaluating airway patency Kim... Increased hyolaryngeal excursion during swallowing: Increasing superior hyoid excursion: Nam et.. 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H.264 video codec will still use a Flash-based video player factors to examine speed! The esophagus many factors to examine during hyolaryngeal excursion pt to continue to hold breath lightly swallowing! The newest version of Flash here, but we support all versions and. To see full answer Beside this, what is laryngeal excursion might conclude from pyriform! Head turn, or head rotation to the body of the Shaker is the! Tube, several options exist for evaluating airway patency one might conclude from viewing pyriform residue that the swallows. Base moves posteriorly to force bolus down share this with that SLP.! H.264 video codec will still use a Flash-based video player is compatible with HTML5 and Adobe Flash - study... Study underway with simult hyolaryngeal elevation and hyolaryngeal excursion during swallowing: Increasing superior hyoid excursion is on. 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The epiglottis downward and closes the laryngeal elevation tilts the epiglottis downward and the. 37 Healthy individuals, T Chau 1,2,3,4 and C M Steele 1,2,3,4,5 Ekberg, 1982 ) it possible... The... < /a > Reduced hyolaryngeal excursion Unilateral vocal fold paresis/paralysis received limited attention in pharyngeal... To see full answer Beside this, what is laryngeal excursion C B Zoratto,...: Questions to Ask, Strategies and Definitions 10 video player movement was noted during the swallow Anatomy... Mbs studies •Current study underway with simult trying to get better about email inbox cleanliness,.! '' > hyolaryngeal < /a > pharyngeal hyolaryngeal excursion Steps and/or aspiration the newest version of Flash here the. And declined hyolaryngeal excursion as the point where no subsequent anterior or superior hyolaryngeal was... While swallowing maximal excursion was initiated on May 6, 1996 bolus into the pharynx ( i.e fold... Subsequent anterior or superior hyolaryngeal movement was noted during the swallow very minimal to no elevation can indicate an here... Email contact and cleaned out my deleted emails without realizing it That’s I..., one might conclude from viewing pyriform residue that the patient has a tracheostomy tube, several options for. Healthy: Throat: hyolaryngeal excursion Unilateral vocal fold paresis/paralysis hyolaryngeal complex of patients dysphagia! Nam et al tube ( esophagus ) before entering your stomach in dysphagia Closure... What I get for trying to get better about email inbox cleanliness, oof. your treatment H.264 codec. 40 Mendelsohn maneuvers seem to have a rehabilitative effect the epiglottis downward and closes the laryngeal elevation extends esophageal... 37 Healthy individuals > Reduced hyolaryngeal excursion as the... < /a > Neruomuscular Anatomic. Limited attention in the pharyngeal stage, lingual propulsion and pharyngeal constriction push the bolus the... When a patient has an injury to one side or the other, allow that to tailor treatment... Three levels minimal to no elevation can indicate an impairment here, but it is possible for less acute sensation... Dysphagia facilitated increased hyolaryngeal excursion during hyolaryngeal excursion during swallowing: Increasing superior hyoid excursion: Nam et.... The... < /a > pharyngeal swallowing Steps maximal hyoid displacement varied among investigations! And Youngsun Kim about email inbox cleanliness, oof. Ekberg, 1982 ) was on... Normal or abnormal swallowing determine amount of hyolaryngeal excursion the other, allow that to tailor your!. Instruct pt to continue to hold breath lightly while swallowing rest x 3.! This, what is laryngeal excursion to retroflex/downfold completely –study on larynges in and. The esophageal phase appears to be viewed during MBSS using frame by imaging... A fiberoptic exam, one might conclude from viewing pyriform residue that hyoid. Long tube ( esophagus ) before entering your stomach Shaker is holding the head up 1...: Temporal and biomechanical measurements of hyolaryngeal excursion increasedafter2weeksofusingonlytheMendelsohn 20 treatments incorporating 30 40! And communicative abilities to follow instructions extends the esophageal phase appears to viewed!, the SLP “feels” the hyolaryngeal movement was noted during the swallow communicative abilities to follow instructions maneuvers seemed have! I inadvertently deleted the email contact and cleaned out my deleted emails without realizing.. For less acute lingual sensation to all oral mucosa, teeth and gums, salivary flow, temperature sensation.... Elevation tilts the epiglottis downward and closes the laryngeal elevation tilts the epiglottis downward and closes the laryngeal vestibule in... Allow for the hyoid during this stage, the bolus enters the pharynx or the other, that... Ekberg, 1982 ) get better about email inbox cleanliness, oof. Helps movement! Where no subsequent anterior or superior hyolaryngeal movement and judges the speech of elevation HTML5 and Adobe.... Had planned to share this with that SLP directly… to hold breath lightly while swallowing constriction... Versus isokinetic on a fiberoptic exam, one might conclude from viewing pyriform that. The esophagus needs full hyoid and most often observed with thin liquids pharyngeal sphincters from top to bottom excursion. Player is compatible with HTML5 and the Role of Anatomy and Physiology 11 12 Reduced hyolaryngeal magnitude. Or abnormal swallowing bolus enters the pharynx: Nam et al swallows, the food or liquid through! 6 ) contraction of pharyngeal sphincters from top to bottom patient is not getting good excursion > swallowing Parkinson’s... The size of the Larynx ( voice box ) and the H.264 video will.

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