Identifying physical and behavioral factors and mechanisms to improve detection and phenotyping of vocal hyperfunction

项目摘要/摘要 据估计，在美国，大约30%的成年人患有语音障碍。 在他们生命中的某个阶段，最常见的是与发声功能亢进有关的疾病。发音创伤性发声 声带功能亢进(PVH)与良性声带病变(如小结和息肉)的形成有关。 发声功能亢进也与发音困难有关，发音困难是在没有并发声带损伤的情况下发生的。 或其他结构/神经异常(例如，肌肉紧张性发音困难)，称为非 声带创伤性发声功能亢进(NPVH)。不幸的是，这些疾病的预防、诊断和治疗 功能亢进性发声障碍继续受到病因和疾病知识的限制。 在广泛的相关疾病范围内导致特定嗓音障碍的病理生理机制 有发声功能亢进症。 该项目继续阐明多个因素/机制，这些因素/机制被认为在 使用来自动态语音的数据组合来引起和维持功能亢进的语音障碍 监测和其他重要来源：反流状态、个性、声音对环境声级的反应性、 对语音治疗和非卧床生物反馈的反应，听觉运动障碍的评估，以及模型- 生成难以/不可能在临床上测量的发声生理参数的估计。 在第二个赠款周期内的研究将集中于进一步改进检测的相关目标 PVH和NPVH，并确定这两大类别中具有临床意义的亚组(表型)。 通过开发两种新的非卧床措施，能量耗散剂量(EDD)将改进检测，这两种措施 预计对轻度(早期)声音创伤和时间序列发声-静息比(VRR)更敏感 这将提供客观的见解，了解发声负荷和恢复之间的关系是如何与 声音创伤和发声疲劳。高级统计和机器学习方法的组合将是 应用于我们不断增长的综合/多维语音数据库，以优化PVH和 基于日常(非卧床)发声行为和发声客观测量差异的NPVH亚组 病理生理学。这些分组将通过反映更深层次洞察力的额外措施来进一步区分 转化为病理生理机制(例如，喉内肌激活水平、声带碰撞 压力等)以及潜在的诱因(如个性、反流等)。 实现本研究计划的目标将带来更好的预防、鉴别诊断等 集中有效地治疗这些高度流行的发音障碍。

Project Summary/Abstract Voice disorders have been estimated to affect approximately 30% of the adult population in the United States at some point in their lives with the most prevalent being associated with vocal hyperfunction. Phonotraumatic vocal hyperfunction (PVH) is associated with the formation of benign vocal fold lesions (e.g., nodules and polyps). Vocal hyperfunction is also associated with dysphonia that occurs in the absence of concurrent vocal fold trauma or other structural/neurological abnormalities (e.g., muscle tension dysphonia), which is referred to as non- phonotraumatic vocal hyperfunction (NPVH). Unfortunately, the prevention, diagnosis, and treatment of these hyperfunctional voice 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 vocal hyperfunction. This project continues to elucidate multiple factors/mechanisms that are assumed to play important roles in causing and maintaining hyperfunctional voice disorders using a combination of data from ambulatory voice monitoring and other important sources: reflux status, personality, vocal reactivity to environmental sound levels, responses to voice therapy and ambulatory biofeedback, assessment of auditory-motor deficits, and model- generated estimates of phonatory physiological parameters that are difficult/impossible to measure clinically. Research during this second grant cycle will focus on the interrelated goals of further improving the detection of PVH and NPVH and identifying clinically meaningful subgroups (phenotypes) within these two broad categories. Detection will be improved by developing two new ambulatory measures, energy dissipation dose (EDD), which is expected to be more sensitive to mild (early-stage) phonotrauma, and a time series voicing-resting ratio (VRR) that will provide objective insight into how the relationship between vocal load and recovery is associated with phonotrauma and vocal fatigue. A combination of advanced statistical and machine learning approaches will be applied to our growing comprehensive/multidimensional voice database to optimize the discovery of PVH and NPVH subgroups based on differences in objective measures of daily (ambulatory) vocal behavior and phonatory pathophysiology. The subgroups will be further differentiated by additional measures that reflect deeper insights into pathophysiological mechanisms (e.g., intrinsic laryngeal muscle activation levels, vocal fold collision pressure, etc.) and potential predisposing factors (e.g., personality, reflux, etc.). Achieving the goals of this research program will lead to improved prevention, differential diagnosis, and more focused and efficient treatment of these highly prevalent voice disorders.