Novel approaches to the study of laryngeal muscle in functional voice disorders

研究功能性发声障碍中喉肌的新方法

• 批准号: 10359686
• 负责人: Adrianna Shembel
• 金额: $ 16.4万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-01 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10359686
• 关键词: Acoustics; Address; Air Movements; Anterior; Clinical; Clinical Assessment Tool; Clinical Management; Cluster Analysis; Contralateral; Coupling; Data; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Diagnostic Specificity; Differential Diagnosis; Disease; Dysphonia; Education; Electromyography; Enrollment; Exclusion; Exercise Therapy; Fatigue; Future; Goals; Heterogeneity; Hour; Impairment; Individual; Injury; Investigation; Laryngeal muscle structure; Laryngoscopes; Laryngoscopy; Larynx; Lead; Limb structure; Literature; Massage; Measurement; Measures; Medical; Mental Health; Methodology; Methods; Motor; Muscle; Muscle Contraction; Muscle Fatigue; Muscle Tension; Muscle function; Musculoskeletal; Outcome; Outcome Measure; Outpatients; Pain; Palpation; Participant; Patients; Pattern; Physiological; Precision therapeutics; Quality of life; Radiation; Reproducibility; Resources; Respiratory Muscles; Respiratory System; Risk; Role; Severities; Signs and Symptoms; Skeletal Muscle; Specificity; Suggestion; Symptoms; System; Technology; Therapeutic; Time; Tissues; Treatment outcome; Ultrasonic Transducer; Visual; Visualization; Vocation; Voice; Voice Disorders; Work; analytical method; base; behavioral outcome; burden of illness; disability; elastography; experimental group; improved; muscle stiffness; muscular system; novel; novel strategies; pressure; profiles in patients; respiratory; therapeutic target; tool; ultrasound; voice therapy

PROJECT SUMMARY / ABSTRACT Vocal muscle hyperfunction, tension, and fatigue are considered ubiquitous to functional voice disorders. Alt- hough these voice disorders make up a large portion of cases on clinical caseloads in outpatient voice settings, diagnostic methods and appraisal of treatment approaches lack. This gap has led to a heavy emphasis on ex- clusionary diagnostics and clinical management steeped in trial and error. The long-term goal of this work is to address these methodological gaps and improve diagnostic specificity, therapeutic management, and treatment outcomes in functional voice disorders. As such, the overarching objectives of this proposal are twofold: The first goal (Aim 1) is to validate a novel method—ultrasound shear wave musculoskeletal elastography (SWE)—for the study of laryngeal muscle structure and function in patients with functional voice impairments and compare differences in the laryngeal muscles of individuals without vocal impairments pre- and post-vocal load. SWE uses acoustic radiation force impulse technology, where the acoustic beam generated by the ultrasound trans- ducer compresses the underlying tissue and induces a local shear wave; the higher the propagation velocity of the shear wave, the greater the muscle tension. Quantitative analysis using SWE has been shown to be objec- tive, reproducible, and can capture heterogeneity within motor units of skeletal muscle in the limbs. The second goal (Aim 2) is to identify clusters of laryngeal-respiratory clinical profiles in patients with functional voice disor- ders. This aim will be accomplished using cluster analytic methods of shear wave elastography and laryngo- scopic ratings of laryngeal muscle structure and function as well as aerodynamic measures of subglottal pres- sures and transglottal airflow. A total of 120 participants with (n = 60) and without (n = 60) functional voice impairments—will be enrolled in the study over the course of 3 years. Shear wave velocities of the hyolaryngeal extrinsic muscles—anterior digastric and sternohyoid—in patients with and without functional voice impairments will be conducted twice: the first time before a 1-hour vocally fatiguing task and the second time after vocal load. Shear wave velocities, hyolaryngeal muscle asymmetries, and intrinsic laryngeal muscle stability (% perturbations) will be calculated and used as outcome measures. Additionally, aerodynamic measures of subglottal pressures and transglottal airflow and VALDI ratings of supraglottic compression will be acquired for Aim 2. Anticipated results are improved methodological tools to study the impact of the laryngeal muscles in voice disorders and a better theoretical understanding of relationships between the laryngeal muscles and respiratory system. Outcomes of this proposal will provide a springboard into future investigations to improve mechanisti- cally-driven diagnostic paradigms and increased precision in therapeutic targets in individuals with functional voice disorders, thus reducing burdens of illness and disability.

项目总结/摘要 发声肌功能亢进、紧张和疲劳被认为是功能性嗓音障碍中普遍存在的。替代- 尽管这些声音障碍在门诊语音环境中的临床病例中占很大一部分， 缺乏诊断方法和治疗方法的评价。这一差距导致了对前- 经验性诊断和临床管理都需要反复试验。这项工作的长期目标是 解决这些方法上的差距，提高诊断特异性、治疗管理和治疗 功能性嗓音障碍的结果。因此，本提案的总体目标有两个： 目的（Aim 1）是验证一种新的方法-超声剪切波肌肉骨骼弹性成像（SWE）-用于 功能性嗓音障碍患者喉肌结构与功能研究 没有声音损伤的个体在声音负荷前后的喉肌差异。SWE 采用声辐射力脉冲技术，超声波产生的声束经 换能器压缩下面的组织并引起局部剪切波; 剪切波越大，肌肉张力越大。使用SWE的定量分析已被证明是客观的， 有效的，可重复的，并且可以捕获四肢骨骼肌运动单位内的异质性。第二 目的（Aim 2）是识别功能性发声障碍患者的喉呼吸临床特征群， ders。这一目标将使用剪切波弹性成像和喉的聚类分析方法来实现。 喉肌结构和功能的镜下评级以及声门下压力的空气动力学测量， 和跨声门气流。 共有120名有（n = 60）和无（n = 60）功能性语音障碍的参与者将入组本研究。 在3年的时间里学习。舌喉外在肌-二腹肌前肌剪切波速度的研究 和胸骨舌骨-在有和没有功能性语音障碍的患者将进行两次：第一次 在1小时的声音疲劳任务之前和声音负荷之后的第二次。剪切波速度，咽喉 将计算肌肉不对称性和喉内肌稳定性（%扰动），并用作 结果测量。此外，声门下压力和跨声门下气流的空气动力学测量， 将获取Aim 2的VALDI声门上压迫评级。 预期的结果是改进的方法学工具，以研究喉肌肉的影响，在语音 疾病和更好的理论理解之间的关系喉肌肉和呼吸 系统这项建议的结果将为未来的研究提供一个跳板，以改善机制， 细胞驱动的诊断模式和增加的精确性，在个人的治疗目标， 语音障碍，从而减少疾病和残疾的负担。