Clinical Characteristics and Effects of Vocal Demands in Occupational Voice Users With and Without Primary Muscle Tension Dysphonia

McDowell, Sarah E.; Morrison, Robert; Mau, Ted; Shembel, Adrianna C.

doi:10.1016/j.jvoice.2022.10.005

Cited by 13 publications

(20 citation statements)

References 25 publications

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“…Vocal hyperfunction (VH) is defined as excessive perilaryngeal muscle activation during phonation [1] and is associated with some of the most prevalent voice disorders [2], [3]. VH is considered the primary manifestation of primary muscle tension dysphonia (pMTD) [4]- [6]. In addition, VH contributes to the formation of vocal fold nodules [7], [8] and often emerges as a compensatory behavior in response to global insufficiency (e.g.…”

Section: Introductionmentioning

confidence: 99%

Perilaryngeal Functional Muscle Network in Patients with Vocal Hyperfunction - A Case Study

O'Keeffe¹,

Shirazi²,

Mehrdad³

et al. 2023

Preprint

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Patients with both phonotraumatic and non-phonotraumatic dysphonia commonly present with vocal hyperfunction, defined as excessive perilaryngeal muscle activity and characterized by muscular pain and strain in the neck, increased vocal effort, and vocal fatigue. The inability to reliably measure vocal hyperfunction is a barrier to adequate evaluation and treatment of hyperfunctional voice disorders. We have recently demonstrated that the perilaryngeal functional muscle network can be a novel sensitive neurophysiological window to vocal performance in vocally healthy subjects. In this paper, for the first time, we evaluate the performance and symmetry of functional perilaryngeal muscle networks in three patients with voice disorders. Surface electromyography signals were recorded from twelve sensors (six on each side of the neck) using the wireless Trigno sEMG system (Delsys Inc., Natick, MA). Patient 1 was diagnosed with primary muscle tension dysphonia, Patient 2 was diagnosed with unilateral vocal fold paresis, and Patient 3 was diagnosed with age-related glottal insufficiency. This paper reports altered functional connectivity and asymmetric muscle network scan behavior in all three patients when compared with a cohort of eight healthy subjects. Our approach quantifies synergistic network activity to interrogate coordination of perilaryngeal and surrounding muscles during voicing and potential discoordination of the muscle network for dysphonic conditions. Asymmetry in muscle networks is proposed here as a biomarker for monitoring vocal hyperfunction.

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Section: Introductionmentioning

confidence: 99%

Perilaryngeal Functional Muscle Network in Patients with Vocal Hyperfunction - A Case Study

O'Keeffe¹,

Shirazi²,

Mehrdad³

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…26 At the same time, however, the MTD patients reported significantly higher levels of vocal effort and vocal tract discomfort. 12 It is tempting to connect the higher vocal tract discomfort with the laryngoscopic finding of FVF hyperfunction during quiet respiration. It is possible that such baseline (non-phonatory) hyperfunction contributes to the sensation of higher vocal tract discomfort.…”

Section: Discussionmentioning

confidence: 99%

“…Laryngoscopy was performed as part of an experimental protocol that also included voicing and vocal loading for other studies with different end points. 12 Laryngoscopy was performed both before and after a 30-min vocal loading task, after both nasal cavities had been sprayed with topical lidocaine/nasal decongestant. An Olympus ENF-VH flexible laryngoscope was used in combination with a continuous xenon light source, with videos recorded in MPEG-4 format.…”

Section: Laryngoscopymentioning

confidence: 99%

“…11 Our group's recent findings are consistent with those from the prior reports, with medio-lateral FVF hyperfunction present in 23.0% in a pMTD group vs. 13.3% of controls prior to vocal loading, and 10.0% in pMTD vs. 6.7% in controls after vocal loading. 12 Collectively, these studies challenge the common clinical practice of citing the sign of medio-lateral FVF hyperfunction during phonation as diagnostic for pMTD.…”

Section: Introductionmentioning

confidence: 99%

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Quantification of False Vocal Fold Hyperfunction During Quiet Breathing in Muscle Tension Dysphonia

et al. 2023

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Background/ObjectivesFalse vocal fold (FVF) hyperfunction during phonation is thought to be a diagnostic sign of primary muscle tension dysphonia (pMTD). However, hyperfunctional patterns with phonation are also observed in typical speakers. This study tested the hypothesis that FVF posturing during quiet breathing, as measured by the curvature of FVF, could differentiate patients with pMTD from typical speakers.MethodsLaryngoscopic images were collected prospectively in 30 subjects with pMTD and 33 typical speakers. Images were acquired at the end of expiration and maximal inspiration during quiet breathing, during sustained /i/, and during loud phonation before and after a 30‐min vocal loading task. The FVF curvature (degree of concavity/convexity) was quantified using a novel curvature index (CI, >0 for hyperfunctional/convex, <0 for “relaxed”/concave) and compared between the two groups.ResultsAt end‐expiration, the pMTD group adopted a convex FVF contour, whereas the control group adopted a concave FVF contour (mean CI 0.123 [SEM 0.046] vs. −0.093 [SEM 0.030], p = 0.0002) before vocal loading. At maximal inspiration, the pMTD group had a neutral/straight FVF contour, whereas the control group had a concave FVF contour (mean CI 0.012 [SEM 0.038] vs. −0.155 [SEM 0.018], p = 0.0002). There were no statistically significant differences in FVF curvature between groups in either the sustained voiced or loud conditions. Vocal loading did not change any of these relationships.ConclusionsA hyperfunctional posture of the FVFs during quiet breathing especially at end‐expiration may be more indicative of a hyperfunctional voice disorder than supraglottic constriction during voicing.Level of Evidence3 Laryngoscope, 2023

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“…Subjects in the control group had no voice issues within the last 6 months, defined by auditory‐perceptual and acoustic analysis within normal limits, and needed to score less than 5 on the VHI‐10 (see Table I). We did not include standard voice output metrics (auditory‐perceptual or acoustic analysis) as part of our inclusion criteria for the pMTD group because not everyone with pMTD has complaints of aberrant vocal quality 9 and it is not uncommon for patients with pMTD to exhibit acoustic characteristics within normal limits 10,29 . However, we did include a table with demographics and also included cepstral peak prominence on sustained vowel /a/—an acoustic correlate of vocal perturbations that has been shown to account for 65% of computational and statistical models in its ability to define and distinguish voice characteristics in patients with pMTD (Table I).…”

Section: Methodsmentioning

confidence: 99%

Use of Motion Capture Technology to Study Extrinsic Laryngeal Muscle Tension and Hyperfunction

et al. 2023

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ObjectivesPatients with primary muscle tension dysphonia (pMTD) commonly report paralaryngeal pain and discomfort, and extrinsic laryngeal muscle (ELM) tension and hyperfunction are commonly implicated. However, quantitative physiological metrics to study ELM movement patterns for the characterization of pMTD diagnosis and monitoring of treatment progress are lacking. The objectives of this study were to validate motion capture (MoCap) technology to study ELM kinematics, determine whether MoCap could distinguish ELM tension and hyperfunction between individuals with and without pMTD, and investigate relationships between common clinical voice metrics and ELM kinematics.MethodsThirty subjects (15 with pMTD and 15 controls) were recruited for the study. Sixteen markers were placed on different anatomical landmarks on the chin and anterior neck. Movements across these regions were tracked during four voice and speech tasks using two three‐dimensional cameras. Movement displacement and variability were determined based on 16 key‐points and 53 edges.ResultsIntraclass correlation coefficients demonstrated high intra‐ and inter‐rater reliability (p's < 0.001). Other than greater movement displacements around the thyrohyoid space during longer phrasing (reading passage, 30‐s diadochokinetics) and more movement variability in patients with pMTD, kinematic patterns between groups were similar across the 53 edges for the four voice and speech tasks. There were also no significant correlations between ELM kinematics and standard voice metrics.ConclusionResults demonstrate the feasibility and reliability of MoCap for the study of ELM kinematics.Level of Evidence3 Laryngoscope, 2023

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Clinical Characteristics and Effects of Vocal Demands in Occupational Voice Users With and Without Primary Muscle Tension Dysphonia

Cited by 13 publications

References 25 publications

Perilaryngeal Functional Muscle Network in Patients with Vocal Hyperfunction - A Case Study

Perilaryngeal Functional Muscle Network in Patients with Vocal Hyperfunction - A Case Study

Quantification of False Vocal Fold Hyperfunction During Quiet Breathing in Muscle Tension Dysphonia

Use of Motion Capture Technology to Study Extrinsic Laryngeal Muscle Tension and Hyperfunction

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