Objective Measures for Clinical Assessment of Voice Disorders

项目摘要： 喉内收肌张力障碍是一种以喉痉挛为特征的神经性发声障碍。一 次要症状是发声努力增加，可能与喉张力的代偿性增加有关。 声音症状显著影响心理健康和生活质量。金本位管理 需要将肉毒杆菌毒素（BTX）反复注射到喉肌中， 减少症状。长期治疗的新方法正在开发中，但只能是 如果使用发声功能的稳健结果进行评估，则可以将其转化为临床实践。可惜 缺乏对AdLD的声音症状足够敏感和特异的结果。事实上， 临床医生通常很难区分AdLD和肌肉紧张性发声障碍（MTD）， 一种由于两个声音同时发出而引起的喉张力增加而无喉痉挛的疾病， 障碍可以具有共同的认知-知觉特征。为了弥补这一差距，客观措施 需要反映AdLD的原发性和继发性声音症状。在我们上一个资助周期中， 我们验证了两种自动估计喉张力（AdLD的继发症状）：运动学 测量，运动刚度（KS），和声学测量，相对基频（RFF）。我们也 开发了一种新的，自动频谱声学测量，旨在捕捉喉痉挛在AdLD（一个 主要症状）。 结合HSPC和RFF测量，我们能够预测AdLD患者发声困难的总体严重程度， R2= 85%。虽然这些结果很有希望，但必须在更大的样本中进行验证。因此，我们提出一个 进行观测研究，以构建和验证初级和次级的自动运动学和声学测量， AdLD的继发症状我们将评估生理和判别效度，敏感性， 变化（治疗前/后），重测信度，以及这些措施的能力，以预测声音的严重性， AdLD。在目标1中，我们将比较AdLD的主要和次要症状的声学估计与 AdLD个体和MTD个体的运动学测量。结果将决定灵敏度 和特异性，并提供声学测量的生理验证。在目标2中 我们将评估声学和运动学测量对变化的敏感性和重测信度， 验证其在未来治疗功效评估中作为临床结果测量的用途。最后，在Aim 3中 我们将在一个大的队列中构建和评估发声障碍总体严重程度的统计声学模型， 演讲者Adl这些目标的完成将导致有效的，客观的和自动化的措施， AdLD特有的发声功能，有可能立即转化为临床实践。

Project Summary: Adductor laryngeal dystonia (AdLD) is a neurological voice disorder characterized by laryngeal spasms. A secondary symptom is increased vocal effort, likely related to compensatory increases in laryngeal tension. Voice symptoms significantly impact psychosocial well-being and quality of life. Gold-standard management requires repeated injections of botulinum toxin (BTX) into laryngeal muscles, each of which provides temporary reduction in symptoms. New approaches for long-lasting treatment are under development, but can only be translated to clinical practice if they are evaluated using robust outcomes of vocal function. Unfortunately, there is a dearth of outcomes that are sufficiently sensitive and specific to the voice symptoms of AdLD. In fact, clinicians often have difficulty differentiating AdLD from muscle tension dysphonia (MTD), a functional voice disorder in which there is increased global laryngeal tension without laryngeal spasms, since the two voice disorders can have shared auditory-perceptual characteristics. To address this gap, objective measures reflective of both the primary and secondary voice symptoms of AdLD are needed. In our previous grant cycle, we validated two automated estimates of laryngeal tension (a secondary symptom of AdLD): the kinematic measure, kinematic stiffness (KS), and the acoustic measure, relative fundamental frequency (RFF). We also developed a new, automated spectral acoustic measure designed to capture laryngeal spasms in AdLD (a primary symptom) via detection of pitch breaks (high-passed spectral power of the pitch contour; HSPC). Combining HSPC and RFF measures, we were able to predict the overall severity of dysphonia in AdLD with R2=85%. While these results are promising, they must be validated in a larger sample. Thus, we propose an observational study to construct and validate automated kinematic and acoustic measures of the primary and secondary symptoms in AdLD. We will assess the physiological and discriminant validity, sensitivity to change (pre/post treatment), test-retest reliability, and ability of these measures to predict voice severity in AdLD. In Aim 1 we will compare acoustic estimates of the primary and secondary symptoms of AdLD with kinematic measures in individuals with AdLD and individuals with MTD. Results will determine the sensitivity and specificity of these measures and provide the physiological validation of the acoustic measures. In Aim 2 we will assess the sensitivity to change and test-retest reliability of the acoustic and kinematic measures, validating their use as clinical outcome measures in future assessments of treatment efficacy. Finally, in Aim 3 we will construct and evaluate a statistical acoustic model of overall severity of dysphonia in a large cohort of speakers with AdLD. Completion of these aims will result in validated, objective, and automated measures of vocal function that are specific to AdLD, with the potential to be translated immediately to clinical practice.