Pediatric dysphonia: Multidisciplinary advances to improve voice quality outcomes

儿科发声困难：改善语音质量结果的多学科进展

• 批准号: 10624847
• 负责人: Alessandro Dealarcon
• 金额: $ 6.55万
• 依托单位: UNIVERSITY OF SOUTH FLORIDA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10624847
• 关键词: Address; Adult; Aftercare; Age; Anatomy; Area; Auditory Perception; Award; Basic Science; Behavioral; Child; Childhood; Clinical; Clinical Protocols; Clinical Research; Clinical Trials; Clinical assessments; Cognitive; Communication; Complement; Computing Methodologies; Data; Databases; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Dimensions; Disease; Dryness; Dysphonia; Emotional; Ensure; Evaluation; Funding; Future; Health; Healthcare; Hearing; Height; High Prevalence; Human; Knowledge; Laboratories; Laboratory Study; Language; Leadership; Measurement; Measures; Medical center; Methods; Modeling; NIH Program Announcements; National Institute on Deafness and Other Communication Disorders; Outcome; Outcome Measure; Pathologist; Patients; Pediatric Hospitals; Perception; Periodicity; Phonation; Physiology; Pitch Perception; Population; Prevalence; Procedures; Process; Property; Protocols documentation; Qualifying; Rapid diagnostics; Reporter; Research; Research Methodology; Research Personnel; Resources; Role; Running; Science; Series; Severities; Signal Transduction; Site; Source; Speech; Stimulus; Strategic Planning; Targeted Research; Testing; Time; Translational Research; Treatment outcome; United States National Institutes of Health; Voice; Voice Disorders; Voice Quality; age related; bench to bedside; clinical decision-making; clinical practice; clinically relevant; cognitive neuroscience; design; evidence base; experience; guided inquiry; improved; improved outcome; indexing; innovation; knowledge base; meetings; multidisciplinary; novel; perceptual organization; personalized diagnostics; programs; signal processing; statistics; success

ABSTRACT Childhood voice disorders can have profound influences on communication that in turn impact physical, cognitive, and emotional development. Surprising to many, the prevalence of pediatric voice disorders is high, yet systematic bench-to-bedside research targeting pediatric voice assessment is severely lacking. This innovative proposal seeks to advance our knowledge of the basic properties of pediatric dysphonia and to develop and improve laboratory methods and clinical protocols for quantifying pediatric voice quality (VQ). The proposal addresses three fundamental issues as yet unanswered. First and foremost, we challenge the tacit assumption that the primary dimensions of pediatric VQ, to be assessed, analyzed, and tracked, are the same across age and vibratory source. These assumptions have yet to be tested, though they permeate clinical practice and research, despite the fact that there are marked differences in the vocal anatomy and physiology between children and adults and between vibratory sources that can impact VQ. To this end, Aim 1 involves a systematic multidimensional scaling approach to establish the dominant voice qualities associated with glottal and supraglottal vibratory sources in pediatric dysphonia. Aim 2 explores the potential role of pitch perception to inform us about pediatric dysphonia and to better accommodate different vibratory sources. While standard VQ assessments do not distinguish among possible vibratory sources, experts anecdotally note very different source-dependent VQ. In doing so, we address the vexing problem posed by aperiodic signals (e.g., Type III) in pediatric voices with supraglottal sources by invoking recently developed, pitch-based measurement methods. In Aim 3, we use a theoretical framework of perception to quantify VQ along primary dimensions to support: 1) discovery of objective indices of VQ, 2) development of robust perceptual measures of VQ, and 3) development of novel ratio-level scales ideal for clinical use as diagnostic and outcome measures. Such scales enhance clinical perceptual evaluation of voice to support quantitative comparisons among pre-treatment, peri- treatment, and post-treatment outcomes to provide robust, evidenced-based outcome measures. The success of this proposal is bolstered by the uniquely qualified expert team that has been assembled. The team includes collaborators that are expert pediatric voice clinicians, led by Dr. Alessandro de Alarcon who is a foremost pediatric laryngologist, and a group with years of experience using innovative methods to investigate voice quality in adults, including Drs. David Eddins, Rahul Shrivastav, Supraja Anand, and Erol Ozmeral, with expertise in voice, speech, hearing, and signal processing. Together, this multi-disciplinary team has the knowledge, experience, expertise, and multi-site resources to efficiently and effectively address the limitations noted above. This pre-translational and translational research has the promise to substantially advance the field of pediatric voice and vocal heath care with the potential to lead to formal clinical trials.

抽象的 儿童嗓音障碍会对沟通产生深远的影响，进而影响身体、 认知和情感发展。令许多人惊讶的是，儿童嗓音障碍的患病率很高， 然而，针对儿科声音评估的系统性临床研究却严重缺乏。这 创新提案旨在增进我们对儿科发声障碍基本特性的了解，并 开发和改进量化儿科语音质量 (VQ) 的实验室方法和临床方案。这 该提案解决了尚未得到解答的三个基本问题。首先，我们挑战默契 假设要评估、分析和跟踪的儿童 VQ 的主要维度是相同的 跨越年龄和振动源。这些假设尚未得到检验，尽管它们渗透到临床中 尽管声带解剖学和生理学存在显着差异，但实践和研究 儿童和成人之间以及可能影响 VQ 的振动源之间。为此，目标 1 涉及 系统的多维尺度方法来建立与声门相关的主要语音质量 和儿科发声困难的声门上振动源。目标 2 探索音高感知的潜在作用 让我们了解小儿发声困难并更好地适应不同的振动源。虽然标准 专家指出，VQ 评估不区分可能的振动源，差异很大 源相关的 VQ。在此过程中，我们解决了非周期信号（例如，Type III）带来的棘手问题 通过调用最近开发的基于音调的测量，在具有声门上源的儿科声音中 方法。在目标 3 中，我们使用感知的理论框架来量化沿主要维度的 VQ，以 支持：1) 发现 VQ 的客观指标，2) 开发稳健的 VQ 感知测量，以及 3) 开发新型比率水平量表，非常适合临床用作诊断和结果测量。这样的秤 加强声音的临床感知评估，以支持治疗前、治疗期间之间的定量比较 治疗和治疗后结果，以提供强有力的、基于证据的结果测量。成功 该提案得到了已组建的独特合格专家团队的支持。该团队包括 合作者是儿科声音临床专家，由 Alessandro de Alarcon 博士领导，他是最重要的 儿科喉科医生和一群拥有多年使用创新方法研究声音的经验的团队 成人的质量，包括博士。 David Eddins、Rahul Shrivastav、Supraja Anand 和 Erol Ozmeral 以及 语音、言语、听力和信号处理方面的专业知识。这个多学科团队共同拥有 知识、经验、专业知识和多站点资源，以高效、有效地解决局限性 如上所述。这项翻译前和翻译研究有望大幅推进 儿科声音和声乐健康护理领域，有可能进行正式的临床试验。