The effects of respiratory-based treatment for muscle tension dysphonia: a randomized controlled trial

项目摘要/摘要 原发性肌肉紧张性发音障碍是一种声音障碍，涉及肌肉过度和协调不良。 影响涉及言语产生的多个子系统的活动，在没有结构性或非结构性的情况下 喉部的神经学异常。原发性肌肉紧张性发音障碍(MTD)是最常见的 各种发声障碍，至少占发声诊所就诊患者的40%。从感觉上看，这个声音 声音沙哑和紧张，声音响度和音域降低，患有MTD的人发现说话非常困难 吃力和疲惫。MTD的生理异常被认为是多因素的，并且 包括喉内和喉周围肌肉过度活动，喉部收缩模式，以及言语异常 呼吸模式。然而，MTD的标准治疗方法主要涉及喉功能， 包括重新定位喉部结构，减少喉部内外肌肉的活动， 以及改变振动模式。尽管这些治疗可能会改善声音，但许多患有MTD的人 仅在几个月后就会表现出嗓音问题的复发，有些人在治疗后没有改善。这些 研究结果强调了替代疗法的必要性，以解决呼吸对MTD的贡献， 训练目标是基于呼吸子系统的特定生理缺陷，这直接 影响发声系统。这个项目的目标是确定以呼吸为基础的治疗的效果 重点是改变MTD患者的肺容量水平，并将这些影响与控制条件进行比较。一个 将实施随机分组设计，以确定每种情况下的呼吸和声学效应， 以及嗓音变化与喉部生物力学之间的关系。我们将确定每一种方法的影响 在治疗结束后立即以及3个月和6个月后评估短期和长期情况 治疗效果。我们建议改变言语呼吸的开始和结束水平(肺 音量开始和结束)时说话会对相关的喉部行为产生积极影响 声音。拟议的项目有可能大幅推进以证据为基础的治疗方案 MTD，为减少这种疾病的衰弱效应迈出了至关重要的一步。

Project Summary/Abstract Primary muscle tension dysphonia is a voice disorder that involves excessive and poorly coordinated muscle activity affecting multiple subsystems that are involved in speech production, in the absence of structural or neurologic abnormalities of the larynx. Primary muscle tension dysphonia (MTD) is one of the most common forms of voice disorders, accounting for at least 40% of patients seen in voice clinics. Perceptually the voice sounds hoarse and strained, with reduced loudness and pitch range, and people with MTD find speaking very effortful and fatiguing. The physiological abnormalities that characterize MTD are considered multifactorial, and include over-activity of muscles in and around the larynx, laryngeal constriction patterns, and abnormal speech breathing patterns. However, standard treatment approaches for MTD primarily address laryngeal function, including repositioning of laryngeal structures, reducing activity in the intrinsic and extrinsic laryngeal muscles, and altering vibratory patterns. Although voice improvement may follow these treatments, many people with MTD show recurrence of voice problems after only a few months, and some do not improve with treatment. These findings highlight the need for alternative treatments that address the respiratory contributions to MTD, with training targets that are based on the specific physiologic deficits of the respiratory subsystem, which directly affect the phonatory system. The goal of this project is to determine the effects of respiratory-based treatment focused on altering lung volume levels in people with MTD, and compare those effects to a control condition. A randomized group design will be implemented to determine the respiratory and acoustic effects of each condition, and the association between voice change and laryngeal biomechanics. We will determine the effects of each condition immediately after and then 3 and 6 months after treatment completion to assess short- and long-term treatment effects. We propose that altering the levels at which speech breaths are initiated and ended (lung volume initiation and termination) while speaking will have a positive effect on related laryngeal behavior and voice. The proposed project has the potential to substantially advance the evidence-based treatment options for MTD, providing a vital step toward reducing the debilitating effects of this disorder.