Sensory Mechanisms in Primary Muscle Tension Dysphonia

项目摘要/摘要 据估计，美国有200万至800万人患有原发性肌肉紧张性发音障碍(PMTD)- 一种功能性发声障碍，对日常生活、职业生产力和生活质量产生不利影响 每年因旷工造成20亿美元的生产力损失。尽管pMTD导致了同样的 情感、社会、经济和职业困难，如器质性、结构性和神经性嗓音障碍， 人们对其病理生理学知之甚少。这些差距使我们很难理解是什么导致了症状。 抱怨发声疲劳，声道不适，发音困难，以及长时间投射或说话困难 PMTD患者的经期--特别是在缺乏明显的喉部结构或神经性异常的情况下- 男性化的。虽然喉系统的肌肉紧张和功能亢进是最被认为的机制 潜在的症状，这在很大程度上是理论上的，基于轶事观察。 来自PI实验室的最新研究使用经过良好审查和验证的生理指标来量化紧张和 在pMTD患者和pMTD患者之间，喉(旁)肌功能亢进没有差异 健康对照组。然而，pMTD患者始终报告显著更高的发声努力，发声发音。 TIGUE和声道不适与这些研究中使用的声音和自我报告的明显不同 关于内感知觉测量的感官体验。这些发现表明， PMTD患者的发声可能是单纯肌肉疾病的另一种潜在症状机制 张力或过度功能的运动输出。 我们检验了躯体感觉系统在pMTD体征和症状中起作用的中心假设。 两个目标。在目标1中，我们比较了pMTD和pMTD患者的喉部感觉和pMTD症状严重程度。 对照组采用喉感觉仪进行感觉测试。在目标2中，我们比较了咽旁和广泛性 机械治疗pMTD患者和对照组的肌肉骨骼感觉对pMTD症状严重程度的影响 压力和动态时间总和定量感觉测试(QST)分析。 这项建议的结果将阐明局部和中枢感觉机制在pMTD中的作用，并将 从而改善对这种令人衰弱的语音障碍的诊断和管理。

PROJECT SUMMARY/ABSTRACT An estimated 2-8 million people in the United States struggle with primary muscle tension dysphonia (pMTD)— a functional voice disorder that adversely impacts daily living, occupational productivity, and quality of life and results in $2 billion in lost annual productivity costs due to absenteeism. Although pMTD leads to the same emotional, social, financial, and occupational hardships as organic, structural, and neurological voice disorders, its pathophysiology is poorly understood. These gaps make it difficult to understand what causes symptom com- plaints of vocal fatigue, vocal tract discomfort, odynophonia, and difficulties projecting or speaking for prolonged periods in patients pMTD—especially in the context of a lack of overt structural or neurological laryngeal abnor- malities. Although muscle tension and hyperfunction in the laryngeal system is the most proposed mechanism underlying symptoms, it is largely theoretical and based on anecdotal observations. Recent studies from the PI’s lab using well-vetted and validated physiological metrics to quantify tension and hyperfunction in the (para)laryngeal muscles found no group differences between patients with pMTD and healthy controls. However, patients with pMTD consistently reported significantly higher vocal effort, vocal fa- tigue, and vocal tract discomfort with voice use across these studies and self-reported significantly different sensory experiences on measures of interoceptive awareness. These findings suggest altered sensations with voice use in patients with pMTD may be an alternative mechanism underlying symptomology to simply muscle tension or hyperfunctional motor output. We test the central hypothesis that the somatosensory system plays a role in pMTD signs and symptoms across two aims. In Aim 1, we compare laryngeal sensation to pMTD symptom severity in patients with pMTD and controls using laryngeal aesthesiometer sensory testing. In Aim 2, we compare paralaryngeal and widespread musculoskeletal sensation to pMTD symptom severity in patients with pMTD and controls using mechanical pressure and dynamic temporal summation quantitative sensory testing (QST) assays. Outcomes of this proposal will elucidate the role of localized and central sensory mechanisms in pMTD and will lead to improved diagnostics and management for this debilitating voice disorder.