Novel approaches to the study of laryngeal muscle in functional voice disorders

研究功能性发声障碍中喉肌的新方法

• 批准号: 10359686
• 负责人: Adrianna Shembel
• 金额: $ 16.4万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-01 至 2024-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10359686
• 关键词: Acoustics; Address; Air Movements; Anterior; Clinical; Clinical Assessment Tool; Clinical Management; Cluster Analysis; Contralateral; Coupling; Data; Development; Diagnosis; Diagnostic; Diagnostic Procedure; Diagnostic Specificity; Differential Diagnosis; Disease; Dysphonia; Education; Electromyography; Enrollment; Exclusion; Exercise Therapy; Fatigue; Future; Goals; Heterogeneity; Hour; Impairment; Individual; Injury; Investigation; Laryngeal muscle structure; Laryngoscopes; Laryngoscopy; Larynx; Lead; Limb structure; Literature; Massage; Measurement; Measures; Medical; Mental Health; Methodology; Methods; Motor; Muscle; Muscle Contraction; Muscle Fatigue; Muscle Tension; Muscle function; Musculoskeletal; Outcome; Outcome Measure; Outpatients; Pain; Palpation; Participant; Patients; Pattern; Physiological; Precision therapeutics; Quality of life; Radiation; Reproducibility; Resources; Respiratory Muscles; Respiratory System; Risk; Role; Severities; Signs and Symptoms; Skeletal Muscle; Specificity; Suggestion; Symptoms; System; Technology; Therapeutic; Time; Tissues; Treatment outcome; Ultrasonic Transducer; Visual; Visualization; Vocation; Voice; Voice Disorders; Work; analytical method; base; behavioral outcome; burden of illness; disability; elastography; experimental group; improved; muscle stiffness; muscular system; novel; novel strategies; pressure; profiles in patients; respiratory; therapeutic target; tool; ultrasound; voice therapy

PROJECT SUMMARY / ABSTRACT Vocal muscle hyperfunction, tension, and fatigue are considered ubiquitous to functional voice disorders. Alt- hough these voice disorders make up a large portion of cases on clinical caseloads in outpatient voice settings, diagnostic methods and appraisal of treatment approaches lack. This gap has led to a heavy emphasis on ex- clusionary diagnostics and clinical management steeped in trial and error. The long-term goal of this work is to address these methodological gaps and improve diagnostic specificity, therapeutic management, and treatment outcomes in functional voice disorders. As such, the overarching objectives of this proposal are twofold: The first goal (Aim 1) is to validate a novel method—ultrasound shear wave musculoskeletal elastography (SWE)—for the study of laryngeal muscle structure and function in patients with functional voice impairments and compare differences in the laryngeal muscles of individuals without vocal impairments pre- and post-vocal load. SWE uses acoustic radiation force impulse technology, where the acoustic beam generated by the ultrasound trans- ducer compresses the underlying tissue and induces a local shear wave; the higher the propagation velocity of the shear wave, the greater the muscle tension. Quantitative analysis using SWE has been shown to be objec- tive, reproducible, and can capture heterogeneity within motor units of skeletal muscle in the limbs. The second goal (Aim 2) is to identify clusters of laryngeal-respiratory clinical profiles in patients with functional voice disor- ders. This aim will be accomplished using cluster analytic methods of shear wave elastography and laryngo- scopic ratings of laryngeal muscle structure and function as well as aerodynamic measures of subglottal pres- sures and transglottal airflow. A total of 120 participants with (n = 60) and without (n = 60) functional voice impairments—will be enrolled in the study over the course of 3 years. Shear wave velocities of the hyolaryngeal extrinsic muscles—anterior digastric and sternohyoid—in patients with and without functional voice impairments will be conducted twice: the first time before a 1-hour vocally fatiguing task and the second time after vocal load. Shear wave velocities, hyolaryngeal muscle asymmetries, and intrinsic laryngeal muscle stability (% perturbations) will be calculated and used as outcome measures. Additionally, aerodynamic measures of subglottal pressures and transglottal airflow and VALDI ratings of supraglottic compression will be acquired for Aim 2. Anticipated results are improved methodological tools to study the impact of the laryngeal muscles in voice disorders and a better theoretical understanding of relationships between the laryngeal muscles and respiratory system. Outcomes of this proposal will provide a springboard into future investigations to improve mechanisti- cally-driven diagnostic paradigms and increased precision in therapeutic targets in individuals with functional voice disorders, thus reducing burdens of illness and disability.

项目概要/摘要 声带肌肉功能亢进、紧张和疲劳被认为是功能性发声障碍的普遍现象。 尽管这些声音障碍在门诊声音环境中的临床病例中占很大一部分， 诊断方法和治疗方法评估的缺乏导致了对前治疗的高度重视。 这项工作的长期目标是不断尝试错误的结论诊断和临床管理。 解决这些方法上的差距并提高诊断特异性、治疗管理和治疗 因此，该提案的总体目标有两个：第一个。 目标（目标 1）是验证一种新方法——超声剪切波肌肉骨骼弹性成像 (SWE)—— 功能性发声障碍患者喉部肌肉结构和功能的研究及比较 没有声音障碍的个体在发声前和发声后的喉部肌肉的差异。 采用声辐射力脉冲技术，其中超声波传输产生的声束 减速器压缩下面的组织并诱发局部剪切波；传播速度越高； 剪切波越大，肌肉张力越大，使用 SWE 的定量分析已被证明是有问题的。 第二个是主动的、可重复的，并且可以捕获四肢骨骼肌运动单位内的异质性。 目标（目标 2）是识别功能性嗓音障碍患者的喉部呼吸临床特征簇。 这一目标将通过剪切波弹性成像和喉部的聚类分析方法来实现。 喉部肌肉结构和功能的镜下评级以及声门下压力的空气动力学测量 确保和经声门气流。 共有 120 名患有（n = 60）和没有（n = 60）功能性语音障碍的参与者 - 将参加该项目 舌喉外肌——二腹肌前部的剪切波速度研究。 和胸骨舌骨肌检查——对于有或没有功能性发声障碍的患者将进行两次：第一次 在 1 小时声音疲劳任务之前和第二次声音负载剪切波速度之后，舌喉。 肌肉不对称性和内在喉部肌肉稳定性（扰动百分比）将被计算并用作 此外，还包括声门下压力和经声门气流的空气动力学测量。 将为目标 2 获取声门上压缩的 VALDI 评级。 预期结果是改进的方法工具，用于研究喉部肌肉对发声的影响 疾病以及对喉部肌肉和呼吸之间关系的更好的理论理解 该提案的结果将为未来改进机制的研究提供一个跳板。 功能驱动的诊断范式和提高功能障碍个体治疗目标的精确度 声音障碍，从而减轻疾病和残疾的负担。