Pediatric dysphonia: Multidisciplinary advances to improve voice quality outcomes

摘要 儿童发声障碍会对沟通产生深远的影响，进而影响身体， 认知和情感发展。令许多人惊讶的是，儿童发声障碍的患病率很高， 然而，针对儿科嗓音评估的系统性床边研究严重缺乏。这 创新的建议旨在增进我们对儿童发音困难基本特征的了解，并 发展和改进量化儿科语音质量(VQ)的实验室方法和临床方案。这个 该提案涉及三个尚未得到回答的基本问题。首先，我们挑战心照不宣的 假设要评估、分析和跟踪的儿科VQ的主要维度是相同的 跨越年龄和振动源。这些假设尚未得到检验，尽管它们渗透到临床中。 实践和研究，尽管在发声解剖学和生理学方面存在显著差异 儿童与成人之间以及可影响VQ的振动源之间。为此，目标1涉及一个 建立与声门相关的主要嗓音质量的系统多维标度方法 儿童发音困难的声门上振动源。目标2探索音调知觉的潜在作用 告知我们有关儿童发音困难的情况，并更好地适应不同的振动源。虽然是标准的 VQ评估没有区分可能的振动源，专家们的轶事指出非常不同 来源依赖的VQ。在这样做的过程中，我们解决了非周期信号(例如，类型III)带来的困扰问题 通过引用最近开发的基于基音的测量，在具有声门上声源的儿童嗓音中 方法：研究方法。在目标3中，我们使用知觉的理论框架来量化主要维度上的VQ 支持：1)发现VQ的客观指数，2)发展VQ的稳健感知测量，以及3) 开发新的比率水平量表，作为诊断和结果测量的理想临床使用。这样的天平 增强临床对嗓音的知觉评估，支持治疗前、围手术期和住院期间的定量比较 治疗和治疗后的结果，以提供强有力的、基于证据的结果衡量标准。成功之路 这项提议得到了组建的唯一合格的专家小组的支持。该团队包括 合作者是儿科声音临床专家，由Alessandro De Alarcon医生领导，他是最重要的 儿科喉科医生，以及一个拥有多年使用创新方法调查声音的经验的小组 成人的质量，包括David Eddins博士、Rahul Shriastav博士、Supraja Anand博士和Erol Ozmeral博士， 在语音、语音、听力和信号处理方面的专业知识。总而言之，这支多学科团队拥有 知识、经验、专业知识和多站点资源，以高效有效地解决这些限制 如上所述。这种翻译前和翻译研究有望极大地推动 在儿科发声和发声保健领域，有可能导致正式的临床试验。

ABSTRACT Childhood voice disorders can have profound influences on communication that in turn impact physical, cognitive, and emotional development. Surprising to many, the prevalence of pediatric voice disorders is high, yet systematic bench-to-bedside research targeting pediatric voice assessment is severely lacking. This innovative proposal seeks to advance our knowledge of the basic properties of pediatric dysphonia and to develop and improve laboratory methods and clinical protocols for quantifying pediatric voice quality (VQ). The proposal addresses three fundamental issues as yet unanswered. First and foremost, we challenge the tacit assumption that the primary dimensions of pediatric VQ, to be assessed, analyzed, and tracked, are the same across age and vibratory source. These assumptions have yet to be tested, though they permeate clinical practice and research, despite the fact that there are marked differences in the vocal anatomy and physiology between children and adults and between vibratory sources that can impact VQ. To this end, Aim 1 involves a systematic multidimensional scaling approach to establish the dominant voice qualities associated with glottal and supraglottal vibratory sources in pediatric dysphonia. Aim 2 explores the potential role of pitch perception to inform us about pediatric dysphonia and to better accommodate different vibratory sources. While standard VQ assessments do not distinguish among possible vibratory sources, experts anecdotally note very different source-dependent VQ. In doing so, we address the vexing problem posed by aperiodic signals (e.g., Type III) in pediatric voices with supraglottal sources by invoking recently developed, pitch-based measurement methods. In Aim 3, we use a theoretical framework of perception to quantify VQ along primary dimensions to support: 1) discovery of objective indices of VQ, 2) development of robust perceptual measures of VQ, and 3) development of novel ratio-level scales ideal for clinical use as diagnostic and outcome measures. Such scales enhance clinical perceptual evaluation of voice to support quantitative comparisons among pre-treatment, peri- treatment, and post-treatment outcomes to provide robust, evidenced-based outcome measures. The success of this proposal is bolstered by the uniquely qualified expert team that has been assembled. The team includes collaborators that are expert pediatric voice clinicians, led by Dr. Alessandro de Alarcon who is a foremost pediatric laryngologist, and a group with years of experience using innovative methods to investigate voice quality in adults, including Drs. David Eddins, Rahul Shrivastav, Supraja Anand, and Erol Ozmeral, with expertise in voice, speech, hearing, and signal processing. Together, this multi-disciplinary team has the knowledge, experience, expertise, and multi-site resources to efficiently and effectively address the limitations noted above. This pre-translational and translational research has the promise to substantially advance the field of pediatric voice and vocal heath care with the potential to lead to formal clinical trials.