Examining the Links Among Motor Symptoms in Vocal Hyperfunction, Auditory Acuity, and Auditory-Motor Function

项目摘要 嗓音障碍很常见，在任何给定的时间都会影响多达9%的美国人口，而且大多数人 转诊到多学科发声诊所的患者患有功能亢进性发声障碍(HHD；例如声带 结节和肌肉紧张性发音困难)。临床上，HVDS的特征是发声疲劳、发音困难和 发声时肌肉活动失调。然而，人们对其病理生理学知之甚少。 在这些体征和症状下。阐明引起和维持人类免疫缺陷的机制是必要的。 指导有效治疗研究。最近的研究已经确定了听觉运动障碍，包括 发声基频的非典型听觉辨别和非典型适应性发声学习 对听觉反馈扰动的反应，在人类视觉缺陷患者的子集。带有HVDS的人显示 除了fo之外，跨多个语音参数的非典型语音，例如强度和语音质量。它是 这些行为可能与发声感觉运动控制的广泛听觉运动障碍有关。因此， 拟议中的研究将通过检查听觉来解决人类视觉系统缺陷中听觉运动障碍的特异性。 发声感觉运动控制的两个重要参数的敏锐度和自适应发声学习：Fo和 强度。除了了解HVDS的听觉运动障碍的程度外，还可以确定 这些损害与这些疾病的临床特征之间的关系对于指导 临床研究。到目前为止，听觉运动障碍和肌肉调节失调之间存在直接关系 发声时的激活是人类免疫缺陷的一个标志，但尚未确定。对侧咽周联合收缩 当说话者增加发声努力时，肌肉就会出现，被认为是在HVDS患者发声时发生的。在……里面 关于伸展运动的研究，协同收缩发生在肢体对反馈扰动的反应中 以稳定运动，并随着参与者适应扰动而减少。至关重要的是，肢体的研究 感觉运动控制也表明，感觉敏锐度较差会降低适应性。因此，我们建议 咽周联合收缩可响应于听觉反馈扰动而发生，以稳定喉部 喉部，并将随着适应性发声学习而减少。此外，一些演讲者的听觉敏锐度受损 伴有发声障碍的患者可能与非典型适应性发声学习和持续性咽周协同发声有关 与没有使用高压减震器的扬声器相比，这是一种收缩。因此，目标1将比较适应性发声学习和 个体咽周协同收缩对fo和听觉反馈强度扰动的反应 合并(n=26)和不合并(n=26)HVDS。目标2将评估发声的非典型听敏度的患病率 同一组演讲者的音量和强度。在目标3中，听觉敏锐度、自适应发声之间的关系 学习和咽周联合收缩将被检查。这项工作将是第一次对喉部进行检查 在听觉反馈扰动后的稳定反应，并可能识别潜在的机制 人类发声障碍患者发声过程中听觉运动障碍与肌肉激活失调之间的联系。

Project Summary Voice disorders are common, affecting up to 9% of the U.S. population at any given time, and the majority of patients referred to multidisciplinary voice clinics have hyperfunctional voice disorders (HVDs; e.g., vocal fold nodules and muscle tension dysphonia). Clinically, HVDs are characterized by vocal fatigue, dysphonia, and dysregulated muscle activation during voicing. Yet, relatively little is understood about the pathophysiology underlying these signs and symptoms. Elucidating the mechanisms that cause and sustain HVDs is necessary to guide impactful treatment research. Recent studies have identified auditory-motor impairments, including atypical auditory discrimination of voice fundamental frequency (fo) and atypical adaptive vocal learning in response to fo auditory feedback perturbations, in a subset of individuals with HVDs. People with HVDs display atypical voicing across multiple parameters of voice, such as intensity and voice quality, in addition to fo. It is possible that these behaviors relate to a broad auditory-motor impairment for vocal sensorimotor control. Thus, the proposed studies will address the specificity of auditory-motor impairment in HVDs by examining auditory acuity and adaptive vocal learning across two important parameters for vocal sensorimotor control: fo and intensity. In addition to understanding the extent of auditory-motor impairment in HVDs, determining the relationship between such impairments and the clinical characteristics of these disorders is critical to guide clinical research. To date, a direct relationship between auditory-motor impairment and dysregulated muscle activation during voicing, a hallmark of HVDs, has not been established. Co-contraction of opposing perilaryngeal muscles occurs when speakers increase their vocal effort, and is thought to occur during voicing in HVDs. In studies of reaching movements, co-contraction occurs in the limbs in response to feedback perturbations in order to stabilize movements, and decreases as participants adapt to the perturbations. Crucially, studies of limb sensorimotor control also suggest that worse sensory acuity reduces adaptation. Thus, we propose that perilaryngeal co-contraction may occur in response to auditory feedback perturbations in order to stabilize the larynx, and will decrease with adaptive vocal learning. Furthermore, impaired auditory acuity in some speakers with HVDs may be associated with both atypical adaptive vocal learning and persistent perilaryngeal co- contraction compared to speakers without HVDs. Therefore, Aim 1 will compare adaptive vocal learning and perilaryngeal co-contraction in response to perturbations of fo and intensity of auditory feedback in individuals with (n = 26) and without (n = 26) HVDs. Aim 2 will evaluate the prevalence of atypical auditory acuity for vocal fo and intensity in the same groups of speakers. In Aim 3, relationships among auditory acuity, adaptive vocal learning, and perilaryngeal co-contraction will be examined. This work will be the first to examine laryngeal stabilization responses following auditory feedback perturbations, and may identify a potential mechanistic connection between auditory-motor impairment and dysregulated muscle activation during voicing in HVDs.