Longitudinal Investigation of Factors Impacting the Development and Rehabilitation of Phonotrauma

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PROJECT SUMMARY / ABSTRACT Voice behavior in daily life is assumed to be a primary factor in the development and persistence of phonotrauma (e.g., vocal fold nodules, polyps, etc.), which is one of the most prevalent behavioral voice disorders. The shortage of prospective, longitudinal investigations into the ambulatory voice behaviors in high-risk individuals limits the differentiation between factors that are causative versus compensatory to phonotrauma, and therefore impacts optimal risk-assessment, mitigation, and therapeutic decision-making. Recent work has found that individuals with phonotrauma had higher levels of personality traits related to social dominance and impulsivity and higher speaking vocal doses and increased speaking vocal intensity during voice use in daily life. Individuals without current vocal pathology had strong relationships between those same personality traits and vocal behaviors, suggesting that personality traits and speaking voice use in daily life could be robust factors in the development of phonotrauma and could play a role in the prognosis for recovery. The primary objective of this project is to determine the enduring role that personality traits and daily voice use have on the development of phonotrauma, changes in vocal fold kinematics, and on the ability to change damaging vocal behavior using prospective, longitudinal methods. Aim 1 seeks to identify personality and vocal behavior factors involved in the development of phonotrauma. This will be achieved through initial assessment using a personality trait inventory, ambulatory voice monitoring, and laryngeal assessment via high-speed videoendoscopy of vocally asymptomatic singers who are freshmen in a college voice concentration music program. We will conduct these assessment procedures bi-annually, beginning in the singer’s freshman year and ending at the conclusion of their junior year. Aim 2 will assess which ambulatory and vocal fold kinematic parameters are the most predictive of phonotrauma. Aim 3 will investigate the impact that personality has on compliance with therapeutic/behavioral recommendations in daily life through personality assessment and ambulatory monitoring before and after participation in voice therapy. These studies will be the first to use ambulatory monitoring to (1) prospectively observe factors related to the development of phonotrauma and (2) measure the impact that personality traits have on the ability to change individual vocal behaviors. It will also be the first to use high-speed videoendoscopy to observe development of phonotrauma over time. This project will support advancement of the PI’s long-term career objective, which is to implement a program that uses psychosocial and behavioral factors to improve the prevention and treatment of phonotrauma in high-risk populations. This career objective can only be achieved with adequate training in longitudinal research methods, advanced statistical analyses, and acquisition and analysis of high-speed videoendoscopy. Results from this study will build a framework to ultimately improve early identification of phonotrauma risk, develop risk mitigation strategies, and inform treatment approaches.