Monday, December 30, 2024
12/30/2024
PROJECT SUMMARY/ABSTRACT An estimated 2-8 million people in the United States struggle with primary muscle tension dysphonia (pMTD)— a functional voice disorder that adversely impacts daily living, occupational productivity, and quality of life and results in $2 billion in lost annual productivity costs due to absenteeism. Although pMTD results in the same emotional, social, financial, and occupational hardships as organic, structural, and neurological voice disorders, its pathophysiology is poorly understood. Excessive paralaryngeal muscle activity and altered phonatory breath- ing patterns have long been associated with vocal dysfunction in patients with pMTD. However, there is conflict- ing evidence for the role of paralaryngeal and respiratory movement patterns during phonation and the relation- ships between the paralaryngeal-respiratory vocal subsystems in patients with pMTD are largely hypothetical. Two key gaps make it challenging to study these vocal subsystem relationships. The first is physiological: any number of combinations of paralaryngeal and thoracoabdominal respiratory movements can result in similar vocal output profiles. The second is methodological: tools to quantify movement patterns on spatial and temporal scales across multiple degrees of freedom within and across the paralaryngeal-respiratory vocal subsystems are lacking. These gaps make it difficult to identify aberrant kinematic patterns that could cause symptom complaints of dysphonia, vocal effort and fatigue, and difficulties with increased vocal demands in patients with pMTD. Recent work from the PI’s lab found patients with pMTD had significantly increased movement variability in the paralaryngeal region closest to the larynx using motion capture (MoCap) technology compared to vocally healthy controls, especially with increased acute vocal demands. Spatiotemporal paralaryngeal variability in this region significantly correlated with standard clinical acoustic metrics of aberrant vocal quality. Using this MoCap tech- nology, we test the central hypothesis that an unstable paralaryngeal-respiratory vocal system is responsible for the symptoms of dysphonia, increased vocal effort, and vocal strain in pMTD across three aims. In Aim 1, we compare paralaryngeal-respiratory spatiotemporal coordination in patients with pMTD and vocally healthy con- trols. In Aim 2, we compare paralaryngeal-respiratory spatiotemporal coordination to standard voice metrics in patients with pMTD. In Aim 3, we characterize the effects of increased vocal demands with a vocal load challenge on pre-post load laryngeal-respiratory spatiotemporal pattern changes in patients with pMTD. The outcomes of this proposal will lead to improved physiological knowledge and methodological tools to under- stand the elusive voice disorder that is pMTD and can be applied to other common types of voice disorders in future investigations. These approaches are also critical for the development of interventions designed to en- hance and optimize vocal productions essential for communication and vocation.
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