Sensory Mechanisms in Primary Muscle Tension Dysphonia

原发性肌紧张性发声障碍的感觉机制

• 批准号: 10778117
• 负责人: Adrianna Shembel
• 金额: $ 55.39万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-18 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10778117
• 关键词: Absenteeism; Acoustics; Address; Awareness; Biological Assay; Clinical; Communication; Control Groups; Diagnostic; Dysphonia; Emotional; Equipment and supply inventories; Esthesia; Exclusion; Fatigue; Functional disorder; Goals; Hand; Investigation; Laryngeal muscle structure; Laryngoscopy; Larynx; Leg; Literature; Location; Measures; Motion; Motor; Motor output; Muscle; Muscle Tension; Musculoskeletal; National Institute on Deafness and Other Communication Disorders; Neurologic; Neurologic Voice Disorder; Nociception; Occupational; Occupations; Optics; Outcome; Output; Patient Self-Report; Patients; Pattern; Persons; Physiological; Play; Productivity; Protocols documentation; Quality of life; Recording of previous events; Reporting; Role; Sensory; Severities; Signs and Symptoms; Somatoform Disorders; Stimulus; Symptoms; Syndrome; System; Tactile; Technology; Test Result; Testing; United States; Voice; Voice Disorders; Work; bodily sensation; central sensitization; comparison control; cost; diagnostic strategy; elastography; experience; improved; mechanical pressure; mechanical stimulus; response; sensory mechanism; sensory system; social; somatosensory; stem; tactile stimulation; theories; vocal cord

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 leads to the same emotional, social, financial, and occupational hardships as organic, structural, and neurological voice disorders, its pathophysiology is poorly understood. These gaps make it difficult to understand what causes symptom com- plaints of vocal fatigue, vocal tract discomfort, odynophonia, and difficulties projecting or speaking for prolonged periods in patients pMTD—especially in the context of a lack of overt structural or neurological laryngeal abnor- malities. Although muscle tension and hyperfunction in the laryngeal system is the most proposed mechanism underlying symptoms, it is largely theoretical and based on anecdotal observations. Recent studies from the PI’s lab using well-vetted and validated physiological metrics to quantify tension and hyperfunction in the (para)laryngeal muscles found no group differences between patients with pMTD and healthy controls. However, patients with pMTD consistently reported significantly higher vocal effort, vocal fa- tigue, and vocal tract discomfort with voice use across these studies and self-reported significantly different sensory experiences on measures of interoceptive awareness. These findings suggest altered sensations with voice use in patients with pMTD may be an alternative mechanism underlying symptomology to simply muscle tension or hyperfunctional motor output. We test the central hypothesis that the somatosensory system plays a role in pMTD signs and symptoms across two aims. In Aim 1, we compare laryngeal sensation to pMTD symptom severity in patients with pMTD and controls using laryngeal aesthesiometer sensory testing. In Aim 2, we compare paralaryngeal and widespread musculoskeletal sensation to pMTD symptom severity in patients with pMTD and controls using mechanical pressure and dynamic temporal summation quantitative sensory testing (QST) assays. Outcomes of this proposal will elucidate the role of localized and central sensory mechanisms in pMTD and will lead to improved diagnostics and management for this debilitating voice disorder.

项目摘要/摘要 美国估计有2-8万人与原发性肌肉紧张烦躁不安（PMTD）斗争 - 一种功能性语音障碍，会对日常生活，职业生产力和生活质量和生活质量产生不利影响 由于缺勤，导致20亿美元的年生产力成本损失。虽然PMTD导致相同 情感，社会，经济和占领的困难，例如有机，结构性和神经性语音障碍， 它的病理生理学知之甚少。这些差距使很难理解导致症状的原因 - 声带疲劳，声带不适，ododrophonia的平原以及长时间投射或说话的困难 PMTD患者的时期 - 尤其是在缺乏明显的结构或神经系统喉的情况下 尽管喉部系统中的肌肉张力和功能过高是提出的最多的机制 潜在的症状，它在很大程度上是理论上的，并且基于轶事观察。 PI实验室的最新研究使用经过验证和经过验证的身体指标来量化张力和 （Para）喉肌的功能过度发现PMTD患者和 健康控制。但是，PMTD患者始终报告的声音努力明显更高，声带FA- 在这些研究中的语音使用并自我报告明显不同的语音使用和声音不适 关于互感意识的衡量标准的感官经历。这些发现表明与 PMTD患者的语音使用可能是简单肌肉的替代机制 张力或功能过高的电动机输出。 我们测试了体感系统在PMTD符号和符号中起作用的中心假设 两个目标。在AIM 1中，我们将喉感觉与PMTD和PMTD症状严重程度进行比较 使用喉易度计的感觉测试对照。在AIM 2中，我们比较了抛学和宽度 PMTD患者的PMTD症状严重程度和使用机械对照的PMTD症状严重程度 压力和动态临时总和定量感觉测试（QST）测定。 该提案的结果将阐明局部和中央感官机制在PMTD中的作用，并将 导致这种使人衰弱的语音障碍改善诊断和管理。