Novel approaches to the study of laryngeal muscle in functional voice disorders

研究功能性发声障碍中喉肌的新方法

• 批准号: 10599080
• 负责人: Adrianna Shembel
• 金额: $ 16.4万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-01 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10599080
• 关键词: Acoustics; Address; Air Movements; Anterior; Clinical; Clinical Assessment Tool; Clinical Management; Cluster Analysis; Contralateral; Coupling; Data; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Diagnostic Specificity; Differential Diagnosis; Disease; Dysphonia; Education; Electromyography; Enrollment; Exclusion; Exercise Therapy; Fatigue; Future; Goals; Heterogeneity; Hour; Impairment; Individual; Injury; Investigation; Laryngeal muscle structure; Laryngoscopy; Larynx; Limb structure; Literature; Massage; Measurement; Measures; Medical; Mental Health; Methodology; Methods; Motor; Muscle; Muscle Contraction; Muscle Fatigue; Muscle Tension; Muscle function; Musculoskeletal; Outcome; Outcome Measure; Outpatients; Pain; Palpation; Participant; Patients; Pattern; Physiological; Precision therapeutics; Quality of life; Radiation; Reproducibility; Resources; Respiratory Muscles; Respiratory System; Risk; Role; Severities; Signs and Symptoms; Skeletal Muscle; Specificity; Symptoms; System; Technology; Therapeutic; Time; Tissues; Treatment outcome; Ultrasonic Transducer; Visual; Visualization; Vocation; Voice; Voice Disorders; Work; analytical method; behavioral outcome; burden of illness; disability; elastography; experimental group; improved; muscle stiffness; muscular system; novel; novel strategies; pressure; profiles in patients; respiratory; therapeutic target; tool; ultrasound; voice therapy

PROJECT SUMMARY / ABSTRACT Vocal muscle hyperfunction, tension, and fatigue are considered ubiquitous to functional voice disorders. Alt- hough these voice disorders make up a large portion of cases on clinical caseloads in outpatient voice settings, diagnostic methods and appraisal of treatment approaches lack. This gap has led to a heavy emphasis on ex- clusionary diagnostics and clinical management steeped in trial and error. The long-term goal of this work is to address these methodological gaps and improve diagnostic specificity, therapeutic management, and treatment outcomes in functional voice disorders. As such, the overarching objectives of this proposal are twofold: The first goal (Aim 1) is to validate a novel method—ultrasound shear wave musculoskeletal elastography (SWE)—for the study of laryngeal muscle structure and function in patients with functional voice impairments and compare differences in the laryngeal muscles of individuals without vocal impairments pre- and post-vocal load. SWE uses acoustic radiation force impulse technology, where the acoustic beam generated by the ultrasound trans- ducer compresses the underlying tissue and induces a local shear wave; the higher the propagation velocity of the shear wave, the greater the muscle tension. Quantitative analysis using SWE has been shown to be objec- tive, reproducible, and can capture heterogeneity within motor units of skeletal muscle in the limbs. The second goal (Aim 2) is to identify clusters of laryngeal-respiratory clinical profiles in patients with functional voice disor- ders. This aim will be accomplished using cluster analytic methods of shear wave elastography and laryngo- scopic ratings of laryngeal muscle structure and function as well as aerodynamic measures of subglottal pres- sures and transglottal airflow. A total of 120 participants with (n = 60) and without (n = 60) functional voice impairments—will be enrolled in the study over the course of 3 years. Shear wave velocities of the hyolaryngeal extrinsic muscles—anterior digastric and sternohyoid—in patients with and without functional voice impairments will be conducted twice: the first time before a 1-hour vocally fatiguing task and the second time after vocal load. Shear wave velocities, hyolaryngeal muscle asymmetries, and intrinsic laryngeal muscle stability (% perturbations) will be calculated and used as outcome measures. Additionally, aerodynamic measures of subglottal pressures and transglottal airflow and VALDI ratings of supraglottic compression will be acquired for Aim 2. Anticipated results are improved methodological tools to study the impact of the laryngeal muscles in voice disorders and a better theoretical understanding of relationships between the laryngeal muscles and respiratory system. Outcomes of this proposal will provide a springboard into future investigations to improve mechanisti- cally-driven diagnostic paradigms and increased precision in therapeutic targets in individuals with functional voice disorders, thus reducing burdens of illness and disability.

项目摘要 /摘要 人声肌肉过度功能，张力和疲劳被认为是功能性语音疾病的普遍存在。 alt 这些语音障碍构成了门诊临床案件的大部分病例， 缺乏治疗方法的诊断方法和评估。这一差距导致了人们的重点 包括诊断和临床管理陷入了试验和错误。这项工作的长期目标是 解决这些方法上的差距并改善诊断特异性，治疗管理和治疗 功能性语音障碍的结果。因此，该提案的总体目标是双重的：第一个 目标（AIM 1）是验证一种新方法 - 拆卸剪切波肌骨骼弹性（SWE） - 对功能性语音障碍患者的喉肌结构和功能的研究，并比较 没有人声障碍的个体喉部肌肉的差异。 SWE 使用声学辐射冲动技术，其中超声反式射击产生 ducer压缩下面的组织并诱导局部剪切波；传播速度越高 剪切波，肌肉张力越大。使用SWE的定量分析已显示为OBJEC- tive，可重现，并且可以捕获四肢骨骼肌运动单元内的异质性。第二个 目标（AIM 2）是确定功能性语音失误患者的喉呼吸临床特征的簇 der。将使用剪切波弹性图和Laryngo-的群集分析方法来实现此目标。 喉部肌肉结构和功能的范围等级以及肿瘤下pres的空气动力学测量值 确保并经过通风气流。 共有120名参与者（n = 60）和没有（n = 60）功能性语音障碍 - 将招募 在3年的过程中学习。肢体外部肌肉的剪切波速度 - 前数字 和胸骨类 - 在有和没有功能性语音障碍的患者中，将进行两次：第一次 在1小时的声音疲劳任务和声带载荷后的第二次之前。剪切波速度，hyolaryngeal 肌肉不对称和内在的喉肌稳定性（％扰动）将被计算并用作 结果措施。此外，跨球压力和跨磁气流的空气动力学测量 AIM 2将获得valdi上压缩压缩的评级。 预期的结果是改进的方法学工具来研究语音中喉肌的影响 疾病和对喉部肌肉与呼吸系统之间关系的更好理论理解 系统。该提案的成果将为未来的投资提供一个跳板，以改善机械师 呼叫驱动的诊断范例和功能性患者的治疗靶标的精度提高 语音疾病，从而减少了疾病和残疾的伯恩斯。

项目成果

Clinical Characteristics and Effects of Vocal Demands in Occupational Voice Users With and Without Primary Muscle Tension Dysphonia.

患有和不患有原发性肌紧张性发声困难的职业语音使用者的声音需求的临床特征和影响。

• DOI: 10.1016/j.jvoice.2022.10.005
• 发表时间: 2022
• 期刊: Journal of voice : official journal of the Voice Foundation
• 作者: McDowell,Sarah;Morrison,Robert;Mau,Ted;Shembel,AdriannaC
• 通讯作者: Shembel,AdriannaC

Relationships Between Laryngoscopic Analysis Metrics of Supraglottic Compression and Vocal Effort in Primary Muscle Tension Dysphonia.

原发性肌紧张性发声困难的声门上压缩和发声力度的喉镜分析指标之间的关系。

• DOI: 10.1016/j.jvoice.2023.06.011
• 发表时间: 2023
• 期刊: Journal of voice : official journal of the Voice Foundation
• 作者: Shembel,AdriannaC;Morrison,RobertA;McDowell,Sarah;Smeltzer,JuliannaC;Crocker,Caroline;Bell,Crystal;Mau,Ted
• 通讯作者: Mau,Ted

Interoception, Voice Symptom Reporting, and Voice Disorders.

内感受、声音症状报告和声音障碍。

• DOI: 10.1016/j.jvoice.2023.03.002
• 发表时间: 2023
• 期刊: Journal of voice : official journal of the Voice Foundation
• 作者: Smeltzer,JuliannaComstock;Chiou,SyHan;Shembel,AdriannaC
• 通讯作者: Shembel,AdriannaC

Extrinsic Laryngeal Muscle Tension in Primary Muscle Tension Dysphonia with Shear Wave Elastography.

用剪切波弹性成像研究原发性肌张力性发声障碍中的外在喉肌张力。

• DOI: 10.1002/lary.30830
• 发表时间: 2023
• 期刊: The Laryngoscope
• 作者: Shembel,AdriannaC;Morrison,RobertA;Fetzer,DavidT;Patterson-Lachowicz,Amber;McDowell,Sarah;ComstockSmeltzer,JuliannaC;Mau,Ted
• 通讯作者: Mau,Ted

Characterization of Primary Muscle Tension Dysphonia Using Acoustic and Aerodynamic Voice Metrics.

• DOI: 10.1016/j.jvoice.2021.05.019
• 发表时间: 2023-11
• 期刊: JOURNAL OF VOICE
• 影响因子: 2.2
• 作者: Shembel, Adrianna C.;Lee, Jeon;Sacher, Joshua R.;Johnson, Aaron M.
• 通讯作者: Johnson, Aaron M.