Biophysiological Mechanisms of 'Heightened Speech'

描述(申请人提供)：主要目标是研究“大声”或“增强”发音的生物力学，并研究如何安全地对患有声音创伤的人进行训练，因为他们的工作需要大声发声传统上被视为对嗓音健康的诅咒。在本申请中，我们持有相反的观点，即专门的大声发声训练方法不仅可以预防损伤；一些方法实际上可能在治疗急性和慢性损伤方面具有治疗价值。在这些研究中，我们把重点放在教师身上，他们代表了美国最常见的职业。教师在工作中经历了几乎流行的嗓音问题，可追踪到长时间的大声讲话。这些问题的功能后果包括减少和失去工作，以及学生的认知功能下降。在美国，每年的社会成本似乎高达数十亿美元。因此，对这一人群中安全的、甚至是治疗性的大声讲话进行研究，既关键又及时。我们通过研究影响声音响度的生物力学因素开始我们的研究，这些因素被操作为辐射的声音输出功率。具体目标#1通过测量辐射输出功率随咽喉和声门横截面面积比的变化，评估最近的非线性大声语音产生模拟模型是否适用于人类受试者。我们使用单次激发快速自旋回波(SSFSE)磁共振成像(MRI)。我们希望复制理论发现，阻抗匹配的发声条件--特别是那些涉及中性喉部和声门区域的发声条件--将最大限度地提高输出功率，同时限制破坏性的声带冲击应力。具体目标#2评估“共鸣”练习对于扭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性标志物的浓度，其次是空气动力学和感知指标。最后，《特定目标#3》采用随机前瞻性临床试验的方法，考察了对患有慢性声带损伤的教师进行“共鸣”训练的效果。我们将为患有声音创伤的教师提供标准化的共鸣声音治疗方案和对照治疗。主要的因变量是与语音相关的生活质量，用语音残疾指数衡量。次要变量是空气动力学、喉咙和发声质量指标。

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.