Biophysiological Mechanisms of 'Heightened Speech'

描述（由申请人提供）：广泛的目标是研究“大声”或“强化”语音的生物力学，并研究如何安全地训练有声音创伤的个体，他们的工作需要大声语音传统上被视为声音健康的诅咒。在本申请中，我们持有相反的观点，即专门的高声训练方法不仅可以防止伤害；有些方法在急慢性损伤的治疗中都具有一定的治疗价值。在这些研究中，我们关注的是教师，他们代表了美国最常见的职业。教师的声音问题几乎是流行病的比例，可追溯到工作中长时间大声讲话。这些问题的功能后果包括减少和失去工作，以及降低学生的认知功能。在美国，每年的社会成本似乎在数十亿美元之间，因此，对这一人群进行安全甚至治疗性大声说话的研究既重要又及时。我们通过研究影响声音响度的生物力学因素来启动我们的研究，这些因素被运作为辐射声音输出功率。具体目标#1通过测量辐射输出功率的变化作为喉部-声门横截面积比的函数，评估最近的大声语音产生的非线性模拟模型是否适用于人类受试者。我们使用单次快速自旋回波（SSFSE）磁共振成像（MRI）。我们期望复制理论研究结果，即阻抗匹配的发声条件——特别是那些涉及“共振声音”的中性耳咽部和声门区域的条件——将最大化输出功率，同时限制破坏性的声带冲击应力。具体目标#2评估“共振声音”练习对逆转急性声音创伤的效用。主要的因变量是喉部表面分泌物中炎症标志物的浓度，其次是空气动力学和知觉测量。最后，“具体目标#3”通过一项随机的前瞻性临床试验，检验了“共振声音”训练对慢性声音创伤教师的影响。我们将为有声创伤的教师提供标准化的共振语音治疗方案和对照治疗。主要的因变量是与声音相关的生活质量，用声音障碍指数来衡量。次要变量是空气动力学、喉部和声音质量测量。

DESCRIPTION (provided by applicant): The broad objectives are to study the biomechanics of "loud" or "heightened" speech, and to study how it can be safely trained in individuals with phonotrauma, who need it for their work Loud speech traditionally has been viewed as an anathema for vocal health. In this application we hold an opposing view that specialized approaches to loud voice training not only may prevent injury; some approaches actually may have therapeutic value in the treatment of both acute and chronic injury. In these studies, we focus on teachers, who represent the most common occupation in the United States. Teachers experience near epidemic proportions of voice problems, traceable prolonged, loud speech on the job. Functional consequences of such problems include reduction and loss of work, and reduced cognitive functioning for students. Societal costs appear to range in the billions of dollars annually in the U.S. Thus, a study of safe--and even therapeutic loud speech in this population is both critical and timely. We initiate our studies by investigating biomechanical factors that influence vocal loudness operationalized as radiated voice output power. Specific Aim #1 assesses whether recent, non-linear simulation models of loud speech production apply to human subjects, by measuring variations in radiated output power as a function of epilaryngeal-to-glottal cross-sectional area ratios. We use Single-Shot Fast Spin Echo (SSFSE) Magnetic Resonance Imaging (MRI). We expect to replicate theoretical findings that impedance-matched vocalization conditions--in particular those involving neutral epilaryngeal and glottal areas found with "resonant voice"--will maximize output power, while at the same time limiting damaging vocal fold impact stress. Specific Aim #2 assesses the utility of "resonant voice" exercises for the reversal of acute phonotrauma. The primary dependent variable is concentration of inflammatory markers from laryngeal surface secretions, and secondarily, aerodynamic and perceptual measures. Finally, Specific Aim #3 examines the effect of "resonant voice" training for teachers with chronic phonotrauma, using a randomized, prospective clinical trial. We will deliver a standardized resonant voice therapy program and a control treatment to teachers with phonotrauma. The primary dependent variable is quality of life in relation to voice, measured with the Voice Handicap Index. Secondary variables are aerodynamic, laryngeal, and vocal quality measures.