The effects of respiratory-based treatment for muscle tension dysphonia: a randomized controlled trial

项目总结/摘要 原发性肌肉紧张性发声障碍是一种声音障碍，涉及过度和协调不良的肌肉 活动影响参与言语产生的多个子系统，在缺乏结构或 喉部的神经异常。原发性肌肉紧张性发声困难（MTD）是最常见的 这是一种常见的声音障碍形式，至少占在语音诊所就诊的患者的40%。从感官上讲， 声音嘶哑和紧张，降低响度和音高范围，和人与MTD发现说话非常 努力和疲劳。MTD的生理异常特征被认为是多因素的， 包括喉部及其周围肌肉的过度活动、喉部收缩模式和异常言语 呼吸模式然而，MTD的标准治疗方法主要针对喉功能， 包括重新定位喉结构，减少喉内肌和喉外肌的活动， 改变振动模式虽然这些治疗可能会改善声音，但许多患有MTD的人 在仅仅几个月后，声音问题就复发了，有些人在治疗后没有改善。这些 研究结果强调需要替代治疗，解决呼吸对MTD的贡献， 基于呼吸子系统的特定生理缺陷的训练目标， 影响发音系统。本项目的目标是确定基于药物治疗的效果 重点是改变MTD患者的肺容量水平，并将这些效果与对照组进行比较。一 将实施随机分组设计以确定每种条件的呼吸和声学效应， 以及嗓音变化与喉部生物力学之间的关系。我们将确定每一个的影响 在治疗完成后立即以及治疗完成后3个月和6个月评估短期和长期 治疗效果我们建议，改变语音呼吸开始和结束的水平（肺 音量启动和终止）将对相关的喉部行为产生积极影响， 声音拟议的项目有可能大大推进循证治疗方案， MTD，为减少这种疾病的衰弱作用迈出了重要的一步。

Project Summary/Abstract Primary muscle tension dysphonia is a voice disorder that involves excessive and poorly coordinated muscle activity affecting multiple subsystems that are involved in speech production, in the absence of structural or neurologic abnormalities of the larynx. Primary muscle tension dysphonia (MTD) is one of the most common forms of voice disorders, accounting for at least 40% of patients seen in voice clinics. Perceptually the voice sounds hoarse and strained, with reduced loudness and pitch range, and people with MTD find speaking very effortful and fatiguing. The physiological abnormalities that characterize MTD are considered multifactorial, and include over-activity of muscles in and around the larynx, laryngeal constriction patterns, and abnormal speech breathing patterns. However, standard treatment approaches for MTD primarily address laryngeal function, including repositioning of laryngeal structures, reducing activity in the intrinsic and extrinsic laryngeal muscles, and altering vibratory patterns. Although voice improvement may follow these treatments, many people with MTD show recurrence of voice problems after only a few months, and some do not improve with treatment. These findings highlight the need for alternative treatments that address the respiratory contributions to MTD, with training targets that are based on the specific physiologic deficits of the respiratory subsystem, which directly affect the phonatory system. The goal of this project is to determine the effects of respiratory-based treatment focused on altering lung volume levels in people with MTD, and compare those effects to a control condition. A randomized group design will be implemented to determine the respiratory and acoustic effects of each condition, and the association between voice change and laryngeal biomechanics. We will determine the effects of each condition immediately after and then 3 and 6 months after treatment completion to assess short- and long-term treatment effects. We propose that altering the levels at which speech breaths are initiated and ended (lung volume initiation and termination) while speaking will have a positive effect on related laryngeal behavior and voice. The proposed project has the potential to substantially advance the evidence-based treatment options for MTD, providing a vital step toward reducing the debilitating effects of this disorder.