Voice Therapy with Semi-Occluded Vocal Tracts

描述（由申请人提供）：本研究的中心目标是统一目前世界各地使用的各种声音治疗方法。它们有着不同的名称、不同的起源和不同的协议，乍一看似乎没有什么共同之处。然而，仔细观察发现，所有这些都利用半封闭声道的练习。这些半闭塞音的形式有浊摩擦音、唇音和舌颤音、鼻音辅音、紧元音/u/和/o/以及插入口中的阻流管。最近科学地证明了半封闭声道锻炼的好处。一个好处是稳定的声门上压力，以抵消过度内收或“压”声带的响度和口音的讲话的趋势。另一个好处是声门上方的声阻抗有利，发声阈值压力低，发音容易。“为了控制半闭塞的压力-流量特性，将研究一系列管道和非管道发音姿势，并优化治疗方案。具体目标是（1）描述和排序声道半闭塞（唇颤音、舌颤音、颤音、嗡嗡声、浊摩擦音、管发声），主要方法是口腔压力测压和电声门描记术（EGG），（2）确定具有不同直径和长度的所选管的稳态压力流特性和声输入阻抗，（3）评估混合登记的程度（具有适度的声带接触）是否可以用管发声实现，并且确定混合音域是否具有最低发声阈值压力;结果将通过将测量的EGG与计算机模拟的接触面积和到声道的最大功率传递进行比较来实现，（4）对选定的一组受试者进行磁共振成像（MRI），（5）在临床经济性和患者依从性方面，进行非言语半封闭练习（管发声）和渐进式Lessac-Madsen共振语音治疗（LMRVT）之间的优效性试验。

DESCRIPTION (provided by applicant): This study has a central goal of unifying a currently diverse group of voice therapy approaches used around the world. With different names, different origins, and different protocols, they appear at first glance to have little in common. Close scrutiny, however, reveals that all of them utilize exercises with a semi-occluded vocal tract. These semi-occlusions are in the form of voiced fricatives, lip and tongue trills, nasal consonants, tense vowels /u/ and /o/, and flow-resistant tubes inserted into the mouth. The benefits derived from exercising with a semi-occluded vocal tract have recently been demonstrated scientifically. One benefit is a steady supraglottal pressure to counteract a tendency to hyper-adduct or "press" the vocal folds for loudness and accent in speech. Another benefit is favorable acoustic impedance above the glottis for low phonation threshold pressure and "ease of phonation." To gain control over the pressure-flow characteristics of the semi- occlusions, a series of tubes and non-tube articulatory gestures will be studied and optimized for a therapy protocol. Specific aims are to (1) characterize and rank-order vocal tract semi-occlusions (lip trills, tongue, trills, humming, voiced fricatives, tube phonation) in terms of an ral pressure to subglottal pressure ratio, primary methodologies being oral pressure manometry and electroglottography (EGG), (2) to determine the steady pressure-flow characteristics and acoustic input impedance of selected tubes with different diameters and lengths, (3) to assess the degree to which mixed register (with moderate vocal fold contact) is achievable with tube phonation, and to determine if mixed register has the lowest phonation threshold pressure; results will be achieved by comparing measured EGG to computer simulated contact area and maximum power transfer to the vocal tract, (4) to quantify epilaryngeal changes as a function of oral semi-occlusion with the primary instrumentation being magnetic resonance imaging (MRI) with a select group of subjects, (5) to conduct a superiority trial between non-speech semi-occluded exercises (tube phonation) and progressive Lessac-Madsen Resonant Voice Therapy (LMRVT) in terms of clinical economy and patient adherence.