Pediatric dysphonia: Multidisciplinary advances to improve voice quality outcomes

儿科发声困难：改善语音质量结果的多学科进展

• 批准号: 10407454
• 负责人: Alessandro Dealarcon
• 金额: $ 45.51万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10407454
• 关键词: Address; Adult; Aftercare; Age; Anatomy; Area; Auditory Perception; Award; Basic Science; Behavioral; Caring; Child; Childhood; Clinical; Clinical Protocols; Clinical Research; Clinical Trials; Clinical assessments; Cognitive; Communication; Complement; Computing Methodologies; Data; Databases; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Dimensions; Disease; Dysphonia; Emotional; Ensure; Evaluation; Funding; Future; Health; Hearing; Height; High Prevalence; Human; Knowledge; Laboratories; Laboratory Study; Language; Lead; Leadership; Measurement; Measures; Medical center; Methods; Modeling; NIH Program Announcements; National Institute on Deafness and Other Communication Disorders; Outcome; Outcome Measure; Pathologist; Patients; Pediatric Hospitals; Perception; Periodicity; Phonation; Physiology; Pitch Perception; Population; Prevalence; Procedures; Process; Property; Protocols documentation; Rapid diagnostics; Reporter; Research; Research Methodology; Research Personnel; Resources; Role; Running; Science; Series; Severities; Signal Transduction; Site; Source; Speech; Stimulus; Strategic Planning; Targeted Research; Testing; Time; Translational Research; Treatment outcome; United States National Institutes of Health; Voice; Voice Disorders; Voice Quality; Weight; age related; base; bench to bedside; clinical decision-making; clinical practice; clinically relevant; cognitive neuroscience; design; evidence base; experience; guided inquiry; improved; improved outcome; indexing; innovation; knowledge base; meetings; multidisciplinary; novel; perceptual organization; personalized diagnostics; programs; signal processing; statistics; success

ABSTRACT Childhood voice disorders can have profound influences on communication that in turn impact physical, cognitive, and emotional development. Surprising to many, the prevalence of pediatric voice disorders is high, yet systematic bench-to-bedside research targeting pediatric voice assessment is severely lacking. This innovative proposal seeks to advance our knowledge of the basic properties of pediatric dysphonia and to develop and improve laboratory methods and clinical protocols for quantifying pediatric voice quality (VQ). The proposal addresses three fundamental issues as yet unanswered. First and foremost, we challenge the tacit assumption that the primary dimensions of pediatric VQ, to be assessed, analyzed, and tracked, are the same across age and vibratory source. These assumptions have yet to be tested, though they permeate clinical practice and research, despite the fact that there are marked differences in the vocal anatomy and physiology between children and adults and between vibratory sources that can impact VQ. To this end, Aim 1 involves a systematic multidimensional scaling approach to establish the dominant voice qualities associated with glottal and supraglottal vibratory sources in pediatric dysphonia. Aim 2 explores the potential role of pitch perception to inform us about pediatric dysphonia and to better accommodate different vibratory sources. While standard VQ assessments do not distinguish among possible vibratory sources, experts anecdotally note very different source-dependent VQ. In doing so, we address the vexing problem posed by aperiodic signals (e.g., Type III) in pediatric voices with supraglottal sources by invoking recently developed, pitch-based measurement methods. In Aim 3, we use a theoretical framework of perception to quantify VQ along primary dimensions to support: 1) discovery of objective indices of VQ, 2) development of robust perceptual measures of VQ, and 3) development of novel ratio-level scales ideal for clinical use as diagnostic and outcome measures. Such scales enhance clinical perceptual evaluation of voice to support quantitative comparisons among pre-treatment, peri- treatment, and post-treatment outcomes to provide robust, evidenced-based outcome measures. The success of this proposal is bolstered by the uniquely qualified expert team that has been assembled. The team includes collaborators that are expert pediatric voice clinicians, led by Dr. Alessandro de Alarcon who is a foremost pediatric laryngologist, and a group with years of experience using innovative methods to investigate voice quality in adults, including Drs. David Eddins, Rahul Shrivastav, Supraja Anand, and Erol Ozmeral, with expertise in voice, speech, hearing, and signal processing. Together, this multi-disciplinary team has the knowledge, experience, expertise, and multi-site resources to efficiently and effectively address the limitations noted above. This pre-translational and translational research has the promise to substantially advance the field of pediatric voice and vocal heath care with the potential to lead to formal clinical trials.

摘要 儿童嗓音障碍会对沟通产生深远的影响，进而影响身体， 认知和情感的发展令许多人惊讶的是，儿童嗓音障碍的患病率很高， 然而，严重缺乏针对儿科声音评估的系统的从实验室到床边的研究。这 一项创新的建议旨在提高我们对儿科发声障碍基本特征的认识， 开发和改进量化儿科语音质量（VQ）的实验室方法和临床方案。的 该提案涉及三个尚未得到答复的基本问题。首先，我们挑战的是 假设要评估、分析和跟踪的儿科VQ的主要维度相同 跨越年龄和振动源。这些假设还有待检验，尽管它们渗透到临床 尽管在发声解剖和生理上存在显著差异， 儿童和成人之间以及可能影响VQ的振动源之间的差异。为此，目标1涉及 系统的多维标度方法，以建立与声门相关的主要语音质量 和声门上振动源在小儿发音困难。目标2探讨音高知觉的潜在作用 以告知我们儿科发声障碍，并更好地适应不同的振动源。而标准 VQ评估并不区分可能的振动源，专家们注意到， 源相关矢量量化在这样做的过程中，我们解决了由非周期信号（例如，第三类） 通过调用最近开发的基于音高的测量， 方法.在目标3中，我们使用感知的理论框架来量化VQ的沿着主要维度， 支持：1）发现VQ的客观指标，2）开发VQ的鲁棒感知测量，以及3） 开发新的比率水平量表，作为诊断和结果测量的理想临床用途。这样的尺度 加强临床对声音的感知评估，以支持治疗前、治疗后和治疗后之间的定量比较。 治疗和治疗后结果，以提供稳健的、基于证据的结果指标。成功 这一建议得到了所组成的唯一合格的专家小组的支持。该团队包括 合作者都是专业的儿科语音临床医生，由最重要的Alessandro de Alarcon博士领导 儿科喉科医生和一个拥有多年经验的小组使用创新的方法来研究声音 成年人的质量，包括博士。大卫埃丁斯，拉胡尔Shrivastav，Supraja阿南德，和埃罗尔Ozmeral， 语音、语音、听觉和信号处理方面的专业知识。这个多学科团队共同拥有 知识、经验、专业知识和多站点资源，以高效和有效地解决限制 上面提到。这种翻译前和翻译研究有希望大大推进 儿科声音和声乐保健领域的潜力，导致正式的临床试验。