Sensory Mechanisms in Primary Muscle Tension Dysphonia

原发性肌紧张性发声障碍的感觉机制

• 批准号: 10778117
• 负责人: Adrianna Shembel
• 金额: $ 55.39万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-18 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10778117
• 关键词: Absenteeism; Acoustics; Address; Awareness; Biological Assay; Clinical; Communication; Control Groups; Diagnostic; Dysphonia; Emotional; Equipment and supply inventories; Esthesia; Exclusion; Fatigue; Functional disorder; Goals; Hand; Investigation; Laryngeal muscle structure; Laryngoscopy; Larynx; Leg; Literature; Location; Measures; Motion; Motor; Motor output; Muscle; Muscle Tension; Musculoskeletal; National Institute on Deafness and Other Communication Disorders; Neurologic; Neurologic Voice Disorder; Nociception; Occupational; Occupations; Optics; Outcome; Output; Patient Self-Report; Patients; Pattern; Persons; Physiological; Play; Productivity; Protocols documentation; Quality of life; Recording of previous events; Reporting; Role; Sensory; Severities; Signs and Symptoms; Somatoform Disorders; Stimulus; Symptoms; Syndrome; System; Tactile; Technology; Test Result; Testing; United States; Voice; Voice Disorders; Work; bodily sensation; central sensitization; comparison control; cost; diagnostic strategy; elastography; experience; improved; mechanical pressure; mechanical stimulus; response; sensory mechanism; sensory system; social; somatosensory; stem; tactile stimulation; theories; vocal cord

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.

项目总结/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困难（pMTD）。 功能性嗓音障碍，对日常生活、职业生产力和生活质量产生不利影响， 每年因缺勤造成的生产力损失高达20亿美元。虽然pMTD导致相同的 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， 其病理生理学知之甚少。这些差距使人们很难理解是什么原因导致症状COM- 主诉发声疲劳、声道不适、发音困难和长时间发音或说话困难 在pMTD患者中，尤其是在缺乏明显的结构或神经性喉异常的情况下， 恶意虽然喉系统的肌肉紧张和功能亢进是最被提出的机制 它主要是理论上的，并基于轶事观察。 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程度， （帕拉）喉肌功能亢进的患者之间没有发现组间差异pMTD和 健康对照然而，pMTD患者一致报告了显著更高的发声努力，发声频率， 在这些研究中，与自我报告的显著不同， 感官体验对内感受性意识的影响。这些发现表明， pMTD患者的语音使用可能是一种替代机制，其基础是简单的肌肉 紧张或机能亢进的运动输出。 我们测试了中心假设，即躯体感觉系统在pMTD体征和症状中发挥作用， 两个目标。在目标1中，我们比较了pMTD患者的喉感觉与pMTD症状严重程度， 对照组采用喉感觉测试仪进行感觉测试。在目标2中，我们比较了咽喉和广泛的 肌肉骨骼感觉与pMTD症状严重程度的关系，pMTD患者和对照组使用机械 压力和动态时间总和定量感觉测试（QST）测定。 该建议的结果将阐明局部和中枢感觉机制在pMTD中的作用， 从而改善对这种使人衰弱的声音障碍的诊断和管理。