Pediatric dysphonia: Multidisciplinary advances to improve voice quality outcomes

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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.