Objective Measures for Clinical Assessment of Voice Disorders

项目总结： 内收性喉肌张力障碍(ADLD)是一种以喉痉挛为特征的神经性发声障碍。一个 次要症状是发声努力增加，可能与喉部张力的代偿性增加有关。 嗓音症状对心理社会健康和生活质量有显著影响。金本位管理 需要反复向喉部肌肉注射肉毒杆菌毒素(BTX)，每一次都能提供暂时的 症状减轻。长效治疗的新方法正在开发中，但只能 如果使用发声功能的稳健结果来评估它们，则将其转化为临床实践。不幸的是，在那里 缺乏对ADLD的嗓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和肌肉紧张性发音障碍(MTD)，MTD是一种功能性发音 无喉痉挛的全喉张力增加的一种疾病，因为两种声音 障碍可能具有共同的听觉-知觉特征。为解决这一差距，采取了客观措施 需要反映ADLD的主要和次要发音症状。在我们之前的赠款周期中， 我们验证了两种喉部张力(ADLD的次要症状)的自动评估：运动学 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化频谱声学测量，旨在捕捉AdLD(A)的喉部痉挛 主要症状)通过检测音调中断(音调轮廓的高通频谱功率；HSPC)。 结合HSPC和RFF测量，我们能够预测ADLD患者发音困难的总体严重程度 R2=85%。虽然这些结果很有希望，但它们必须在更大的样本中得到验证。因此，我们提出一种 构建和验证自动运动学和声学测量的观察性研究 ADLD的次要症状。我们将评估生理和区分效度，敏感性 这些测量的变化(治疗前/治疗后)、测试-重测可靠性以及预测发声严重程度的能力 阿德勒。在目标1中，我们将比较ADLD的主要和次要症状的声学评估与 ADLD患者和MTD患者的运动学测量。结果将决定敏感度 以及这些测量的特异性，并提供声学测量的生理学验证。在AIM 2 我们将评估声学和运动学测量对变化的敏感性和重新测试的可靠性， 在未来的治疗疗效评估中，验证它们作为临床结果指标的使用。最后，在目标3中 我们将在一个大的队列中构建和评估总体发音困难严重程度的统计声学模型 带AdLD的扬声器。完成这些目标将产生有效的、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.