The Bases Of Normal And Disordered Laryngeal And Speech

正常和紊乱的喉部和言语的基础

• 批准号: 6508703
• 负责人: Christy Leslie Ludlow
• 金额: --
• 依托单位: NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/6508703
• 关键词: adolescence (12-20); behavioral /social science research tag; botulinum toxins; brain stem; child (0-11); clinical research; disease /disorder proneness /risk; dystonia; endoscopy; family genetics; genetic screening; human subject; larynx disorder; larynx muscle; motor neurons; nervous system disorder; nervous system prosthesis; neuromuscular function; sensorimotor system; sensory mechanism; speech; stuttering; swallowing; vocal cords; vocalization; voice

The Laryngeal and Speech Section investigates the control of laryngeal functioning in normal and disordered voice, speech and swallowing. The long-term goal of the Section is to identify the factors and mechanisms involved in the pathogenesis of two idiopathic speech and voice disorders, spasmodic dysphonia and stuttering. Both are considered neurological disorders and involve involuntary disruptions in speech. Currently the Section is addressing: 1) the underlying mechanisms involved in normal and disordered laryngeal control for voice and swallowing; 2) risk factors involved in familial laryngeal and speech disorders; and, 3) the use neuromuscular stimulation to provide integrative control of laryngeal function in voice and swallowing. Significant advances made during the last year include the following. 1) Pathophysiology of Voice, Speech and Swallowing. Studies published this year were aimed at improved understanding of the abnormalities underlying symptoms in abductor spasmodic dysphonia. It has long been assumed that voice breaks in this disorder are secondary to spasmodic bursts in the posterior cricoarytenoid muscle. A cross-over study evaluated the effects of endoscopic and percutaneous botulinum toxin injections into the posterior cricoarytenoid muscle on symptoms. Blinded counts of symptom frequency were conducted before and after each treatment. No significant reductions in symptoms were found with either injection type, although the expected reductions in movement occurred. The results differed from previous unblinded studies and suggested that symptom generation may involve other control abnormalities in this disorder. In subsequent study we compared activity in multiple intrinsic laryngeal muscles on both side of the larynx during symptom generation with normal speakers. We found that patients with abductor spasmodic dysphonia had asymmetries in thyroarytenoid and cricothyroid activation between the right and left sides of the larynx. Some patients had higher levels of muscle activation on the right side. The results suggest that these patients may have unilateral muscle tone abnormalities similar to those found on both sides of the larynx in patients with adductor spasmodic dysphonia. A further investigation of this hypothesis is now underway. 2) Familial Laryngeal Disorders. Over the last 3 years the Section has been investigating familial vocal fold paralysis, a rare but life-threatening disease. Detailed examinations of the different phenotypes indicate various disease types can be involved: some are isolated to motor control of the larynx and diaphragm; others are a polyneuropathy affecting both motor and sensory axons; while another form may involve both spinal and brain stem motor neurons. Collaboration with the Neurogenetics Branch is ongoing to examine candidate genes as well as conducting a whole genome wide screen. 3) Development of a Laryngeal Neuroprosthesis for Voice and Swallowing. Reduced extent and abnormal timing of laryngeal elevation occur in patients at risk for aspiration following stroke. We determined whether extrinsic laryngeal muscle stimulation could be used to elevate the larynx in humans. Combined stimulation of the thyrohyoid and mylohyoid muscles produced fifty percent of the laryngeal elevation that occurs during normal swallowing. Obstructive sleep apnea can be due to collapse of the tongue into the pharynx. We examined whether stimulation of the geniohyoid might bring the base of the tongue forward to produce pharyngeal opening. Measurement of nasoendoscopic recordings was used to quantify the diameter before and during geniohyoid stimulation. Rapid and sustained pharynx widening occurred with 30 Hz stimulation, demonstrating a potential new method for management of this common life-threatening disorder.

喉和语音部分研究了喉部功能的控制，以正常和无序的声音，言语和吞咽。本节的长期目标是确定两种特发性言语和语音疾病，痉挛性烦躁和口吃的发病机理所涉及的因素和机制。两者都被认为是神经系统疾病，并且涉及语音的非自愿中断。目前，该部分正在解决：1）正常和无序的喉部控制涉及声音和吞咽的基本机制； 2）涉及家族性喉和言语障碍的危险因素； 3）使用神经肌肉刺激以在语音和吞咽中对喉功能的整合控制。去年取得的重大进展包括以下内容。 1）声音，言语和吞咽的病理生理学。今年发表的研究旨在提高对绑扎痉挛性刺激性刺激性肌电症的异常症状的理解。长期以来，人们一直认为，这种疾病中的声音断裂是后粒肌肌肉肌痉挛性爆发的继发性。一项跨界研究评估了内窥镜和经皮肉毒杆菌毒素注射到后cricarytenoid肌肉对症状的影响。每次治疗前后都进行了症状频率盲的计数。两种注射类型尚未发现症状的显着降低，尽管发生了预期的运动减少。结果与以前的未盲研究不同，并表明症状产生可能涉及该疾病中其他控制异常。在随后的研究中，我们比较了正常扬声器的症状产生喉部两侧的多个内在喉部肌肉的活性。我们发现，绑扎子痉挛性吞咽困难的患者在喉的甲状腺甲状腺素和甲状腺功能亢进症患者的右侧和左侧之间存在不对称性。一些患者在右侧具有较高水平的肌肉激活。结果表明，这些患者的肌肉张张异常可能与内收痉挛性吞咽困难患者的喉部两侧相似。现在正在对该假设进行进一步研究。 2）家族性喉部疾病。在过去的三年中，该部分一直在研究家族性的声带瘫痪，这是一种罕见但威胁生命的疾病。对不同表型的详细检查表明可能涉及各种疾病类型：有些是分离出来的喉部和隔膜的运动控制；其他是影响运动轴突和感觉轴突的多发性神经病。而另一种形式可能涉及脊柱和脑干运动神经元。与神经遗传学分支的合作正在进行检查候选基因以及进行整个基因组宽筛查。 3）开发用于声音和吞咽的喉神经假体。中风后有吸入风险的患者发生喉升高的程度和异常时间。我们确定了外在的喉肌肉刺激是否可以用于抬高人类的喉。甲基类和肌羟基肌肉的联合刺激产生了正常吞咽期间发生的喉升高的百分之五十。阻塞性睡眠呼吸暂停可能是由于舌头塌陷到咽中。我们检查了刺激基因舌体是否可能使舌的底部向前产生咽部开口。使用鼻镜记录的测量来量化基因舌刺激之前和期间的直径。 30 Hz刺激发生了快速和持续的咽部扩张，这表明了一种潜在的管理这种威胁生命的疾病的新方法。