Clinical Research Center for the Improved Prevention, Diagnosis, and Treatment of Vocal Hyperfunction

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Project Summary/Abstract Vocal hyperfunction (VH) is associated with the most frequently occurring types of voice disorders. These include benign vocal folds lesions (e.g., nodules and polyps) and dysphonia that occurs in the absence of concurrent pathology (e.g., muscle tension dysphonia). Effective prevention and clinical management of these disorders continue to be hampered by limited knowledge of the etiological and pathophysiological mechanisms that underlie specific voice disorders within the broad range of those associated with VH. To address this need, this Clinical Research Center brings together a multidisciplinary team of experienced investigators to pursue a comprehensive program of research focused on hyperfunctional voice disorders. The central theme of the Center is that the clinical management of hyperfunctional voice disorders can be significantly improved by attaining a better understanding of the etiology and pathophysiology of these disorders and then translating this knowledge into new, more effective methods for prevention, diagnosis, and treatment. A central premise of this work is that multiple factors contribute and interact in different ways to cause and maintain the various disorders linked to VH, with the most important being associated with behavioral, sensorimotor, environmental, psychological/emotional, physiological, and biomechanical mechanisms. The interdisciplinary research program will focus on attaining a comprehensive understanding of the fundamental relationships between these factors and the different manifestations of VH. Research at the Center will be guided and coordinated by a new comprehensive theoretical framework for VH that clearly illustrates the key hypotheses that will be assessed in a combined effort by the three major Research Projects and Scientific Core that comprise the Center. The Center’s Projects will employ an innovative combination of laboratory studies of sensorimotor and physiologic mechanisms; neural network modeling of voice motor control; computational and physical modeling of phonatory mechanisms; and the use of ambulatory biosensors to investigate the potential differential impact on vocal function of daily voice use, psychological stress, and environmental sound level in patients with VH and well-matched normal controls. Use of ambulatory biofeedback as a treatment strategy will also be assessed. A significant strength of the Center will be the centralized recruitment and clinical management of all participants through the Scientific Core, which will greatly facilitate the integration of results across the projects and magnify the impact of the Center well beyond the sum of its parts. This program of research in hyperfunctional voice disorders is unprecedented in terms of its scope, integration of information across multiple domains, number of innovative concepts and methods that are being simultaneously developed and tested, and its potential to significantly improve the clinical management of these disorders. Achieving the goals of this research program will lead to improved prevention, differential diagnosis, and more focused and efficient treatment of these very prevalent conditions.