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.

项目概要/摘要 据估计，美国有 2-800 万人患有原发性肌张力性发声障碍 (pMTD)—— 一种功能性嗓音障碍，对日常生活、职业生产力和生活质量产生不利影响 尽管 pMTD 会导致同样的结果，但由于缺勤导致每年损失 20 亿美元的生产力成本。 情感、社会、经济和职业困难，如器质性、结构性和神经性嗓音障碍， 人们对其病理生理学知之甚少，这些空白使得人们很难理解导致症状发生的原因。 抱怨声带疲劳、声道不适、发声困难以及长时间投射或说话困难 患者 pMTD 期间——尤其是在缺乏明显的喉部结构或神经异常的情况下 尽管喉部系统的肌肉紧张和功能亢进是最被提出的机制。 潜在的症状，它主要是理论性的并且基于轶事观察。 PI 实验室最近的研究使用经过严格审查和验证的生理指标来量化紧张和压力 喉（旁）肌功能亢进发现 pMTD 患者和 然而，患有 pMTD 的健康对照者一致报告说，他们的发声努力、发声能力明显更高。 这些研究中使用声音引起的疲劳和声道不适与自我报告的显着不同 这些发现表明感觉与内感受意识有关。 pMTD 患者的声音使用可能是简单肌肉症状的替代机制 紧张或功能亢进的运动输出。 我们测试了中心假设，即体感系统在 pMTD 体征和症状中发挥作用 在目标 1 中，我们将 pMTD 患者的喉部感觉与 pMTD 症状严重程度进行比较。 在目标 2 中，我们比较了喉部感觉测试和广泛性测试。 pMTD 患者和使用机械的对照组的肌肉骨骼感觉对 pMTD 症状严重程度的影响 压力和动态时间总和定量感官测试（QST）分析。 该提案的结果将阐明局部和中枢感觉机制在 pMTD 中的作用，并将 从而改善对这种使人衰弱的声音障碍的诊断和管理。