Clinical measurement of vocal fold impact stress in children

描述(申请人提供)：在全国范围内，超过一百万或6-9%的儿童患有发音困难。发音困难对儿童的心理和学业都是有害的，因此早期识别和恢复最佳的发声健康是至关重要的。声带振动模式的直接可视化是声带病理正确诊断和治疗的基础。在儿科嗓音护理领域缺乏对声带生理学的客观评估，导致延误诊断和有效治疗的发展。这项拟议研究的长期目标是通过对导致声音障碍的不成熟声带功能建立适合年龄的定量测量，来改善治疗结果和早期识别声音嘶哑儿童。为了实现这一目标，有必要量化由于儿童与成人多层声带结构的差异而导致的声带振动。大多数儿童的嗓音问题被认为是由声带的机械损伤引起的，表现为高冲击应力，导致声带小结的发展。本项目的具体目标是确定声带层状结构的生长发育对声带生理的影响，以及这些因素与儿童声带小结发育的关系。本研究提出了1个里程碑驱动目标和2个假设驱动目标。因此，这项应用的具体目标是：1)优化我们实验室开发的两点激光投影系统的精确度，并计算预期测量变异性，以充分解释该系统在儿童中的使用；2)量化患有和不患有结节的儿童在发育过程中短声带长度与振动幅度增加之间的关系；以及3)量化儿童声带冲击应力随年龄和病理变化的时空特征。总共将招募80名儿童参加(年龄：5-12岁)，其中40名患有结节，40名不患有结节。40名成年人(21-45岁)将被招募来获得振动运动成熟的发育终点，因为成年人的声带具有明确的分层结构。使用一种新型的两点儿科激光高速数字成像系统，将测量声带振动的以下时空特征以识别冲击应力：中膜幅长比、声带峰值加速度(mm/s 2)、最大闭合速度(mm/s)、开商、振动刚度(最大速度与最大位移之比)和闭商。这项拟议的研究对于填补关于评估声音嘶哑儿童振动功能和识别诱因的最有效方法的知识空白具有重要意义。从这项工作中获得的振动功能的基本知识将直接转化为临床，产生有意义的发现和措施，可应用于儿科发声健康结果，从而减少儿童发声障碍造成的疾病和残疾负担。

DESCRIPTION (provided by applicant): Nationwide over one million or 6-9%1 of all children suffer from dysphonia. Dysphonia can be detrimental to children both psychologically and academically, hence early identification and restoration of optimal vocal health is critical. Direct visualization of vocal fold vibratory patterns is fundamental to appropriate diagnosis and treatment of vocal fold pathology. Objective assessments of vocal fold physiology are non-existent in the field of pediatric voice care, leading to delayed diagnosis and deferred development of effective treatments. The long term goal of the proposed research is to improve treatment outcomes and early identification in children with hoarseness by establishing age appropriate quantitative measurements of immature vocal fold function that contribute to voice disorders. To accomplish this goal, it is necessary to quantify vocal fold vibrations resulting from differences in the multilayered vocal fold structure of children compared with adults. Most voice problems in children are thought to be caused by mechanical trauma to the vocal folds manifested as high impact stress, leading to the development of vocal nodules. The specific goal of this project is to identify the impact of growth and development of the layered structure of the vocal folds on vocal physiology and the relationship of these factors to the development of vocal fold nodules in children. This research proposes 1 milestone-driven aim and 2 hypotheses-driven aims. Therefore, the specific aims of this application are: 1) to optimize a 2-point laser projection system developed in our laboratory for precision and to compute expected measurement variability to fully translate use of this system to children, 2) to quantify the relationship between short vocal fold length and increased vibratory amplitude during the developmental process in children with and without nodules, and 3) to quantify spatiotemporal features of vocal fold impact stress in children as a function of age and pathology. A total of 80 children will be recruited to participate (ages: 5-12), 40 with and 40 without nodules. Forty adults (21-45 years) will be recruited to obtain the developmental end point for maturation of vibratory motion because adults have a well-defined layered structure of the vocal folds. The following spatiotemporal features of vocal fold vibrations will be measured using a novel 2-point pediatric laser high speed digital imaging system to identify impact stress: mid membranous amplitude-to-length ratio, peak vocal fold acceleration(mm/sec2), peak closing velocity (mm/sec), open quotient, and vibratory stiffness (ratio of maximum velocity by maximum displacement) and closed quotient. The proposed research is significant in filling a gap in knowledge concerning the most effective methods for assessing vibratory function and identifying predisposing factors in children with hoarseness. The fundamental knowledge of vibratory function obtained from this work will directly translate to the clinic by producing meaningful findings and measures that can be applied to pediatric vocal health outcomes and will thus reduce the burden of illness and disability caused by voice disorders in children.