Vocal motor control and central auditory impairments in unilateral vocal fold paralysis

Naunheim, Molly; Yung, Katherine C.; Schneider, Sarah; Henderson‐Sabes, Jennifer; Kothare, Hardik; Mizuiri, Danielle; Klein, David J.; Houde, John F.; Nagarajan, Srikantan S.; Cheung, Steven W.

doi:10.1002/lary.27680

Cited by 18 publications

(25 citation statements)

References 49 publications

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“…Such reflexes are believed to be mediated by central processing mechanisms involving both auditory and motor brain areas 4 . Importantly, this reflexive vocal behavior has been shown to be dysfunctional in a variety of disorders affecting both voice and speech, including vocal cord paralysis, Parkinson's Disease, and cerebellar degeneration 5–8, 12, 21 …”

Section: Introductionmentioning

confidence: 99%

Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

2020

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Objectives/Hypothesis Hearing plays an important role in the maintenance of vocal control in normal individuals. In patients with spasmodic dysphonia (SD), however, the ability to maintain sustained control of phonation is impaired. The origins of SD are unknown, and it is unclear whether auditory feedback‐dependent vocal control is compromised in these patients. Study Design Prospective case‐control study. Methods We tested 15 SD patients and 11 age‐matched controls. Voice recordings were performed while subjects repeated the vowel /e/ and auditory feedback of their vocal sounds was altered in real‐time to introduce a pitch‐shift (±2 semitones), presented back to subjects using headphones. Recordings were analyzed to determine voice changes following the pitch‐shifted feedback. Results were further compared with patient demographics and subjective measures of dysphonia, including the Voice Handicap Index (VHI). Results Despite considerable pitch variability and vocal breaks, SD patients exhibited significantly higher average vocal pitch compensation than control subjects. SD patients also exhibited greater variability than controls. However, there were no significant correlations between vocal compensation and patient demographics, although there was a significant inverse correlation with VHI. Conclusions In this pilot study, patients with SD exhibited increased sensitivity to altered auditory feedback during sustained phonation. These results are consistent with recent theories of SD as a disorder of sensory‐motor feedback processing, and suggest possible avenues for future investigation. Level of Evidence 3 Laryngoscope, 131:2070–2075, 2021

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Section: Introductionmentioning

confidence: 99%

Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

2020

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“…Similar feedback manipulations have been extensively used in the study of vocal control in normal hearing healthy subjects 7,8,23 and select normal-hearing patient populations. [19][20][21] In the presence of pitch-shifted feedback, these subjects compensate for the shift by changing the pitch of their voice in the opposite direction. This behavior is thought to be reflexive and mediated by the central auditory system.…”

Section: Discussionmentioning

confidence: 99%

“…To better evaluate the use of CI auditory feedback in vocal control, we performed a pitch‐shift task. Similar feedback manipulations have been extensively used in the study of vocal control in normal hearing healthy subjects 7,8,23 and select normal‐hearing patient populations 19‐21 . In the presence of pitch‐shifted feedback, these subjects compensate for the shift by changing the pitch of their voice in the opposite direction.…”

Section: Discussionmentioning

confidence: 99%

“…Real‐time vocal control was measured using a pitch perturbation task, a commonly used method to assess feedback‐dependent vocal control 7,12,18‐21 . Subjects were instructed to hold a custom modified headphone (Sennheiser HD280PRO) over their implant speech processor, or both processors in bilateral implant recipients.…”

Section: Methodsmentioning

confidence: 99%

“…Real-time vocal control was measured using a pitch perturbation task, a commonly used method to assess feedback-dependent vocal control. 7,12,[18][19][20][21] Subjects were instructed to hold a custom modified headphone (Sennheiser HD280PRO) over their implant speech processor, or both processors in bilateral implant recipients. The headphone was carefully positioned to completely cover the microphones of the speech processor, and subjects queried that they could not…”

Section: Feedback Perturbationmentioning

confidence: 99%

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Real‐time feedback control of voice in cochlear implant recipients

Gautam

Brant

Ruckenstein

et al. 2020

Laryngoscope Investig Oto

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Objectives: To evaluate feedback-dependent vocal control in cochlear implant patients using pitch-shifted auditory feedback. Methods: Twenty-three CI recipients with at least 6 months of implant experience were enrolled. Vocal recordings were performed while subjects repeated the vowel /e/ and vocal signals were altered in real-time using a digital effects processor to introduce a pitch-shift, presented back to subjects using headphones. Recordings were analyzed to determine pitch changes following the pitch-shifted feedback, and results compared to the magnitude of the shift as well as patient demographics. Results: Consistent with previous results, CI patients' voices had higher pitches with their implant turned off, a change explainable by increases in vocal loudness without the CI. CI patients rapidly compensated for pitch-shifted feedback by changing their vocal pitch, but only for larger shifts. Considerable inter-subject variability was present, and weakly correlated with the duration of implant experience and implant sound thresholds. Conclusions: CI patients, like normal hearing individuals, are capable of real-time feedback-dependent control of their vocal pitch. However, CI patients are less sensitive to small feedback changes, possibly a result of courser CI frequency precision, and may explain poorer than normal vocal control in these patients.

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Cortical‐Basal Ganglia‐Cerebellar Networks in Unilateral Vocal Fold Paralysis: A Pilot Study

et al. 2019

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Objectives/Hypothesis To evaluate differences in cortical‐basal ganglia‐cerebellar functional connectivity between treated unilateral vocal fold paralysis (UVFP) and healthy control cohorts using resting‐state functional magnetic resonance imaging (RS‐fMRI). Study Design Cross‐sectional. Methods Ten UVFP study patients treated by type I thyroplasty and 12 control subjects underwent RS‐fMRI on a 3‐Tesla scanner to evaluate differences in functional connectivity of whole‐brain networks. Spontaneous RS‐fMRI data were collected using a gradient echo planar pulse sequence, preprocessed, and analyzed to compare seed‐to‐voxel maps between the two cohorts. Seeds were placed in the caudate, putamen, and globus pallidus divisions of the basal ganglia in both hemispheres. Group contrasts were tested for statistical significance using two‐tailed unpaired t tests corrected for multiple comparisons with a cluster false discovery rate threshold of P < .05. Results UVFP patients demonstrated increased connectivity between both caudate nuclei and the precuneus, a node of the default mode network, compared to healthy controls. Both caudate nuclei also showed decreased connectivity with the left cerebellar hemisphere. The putamen and globus pallidus divisions of the basal ganglia were not abnormally connected to other brain structures. Conclusions UVFP patients treated by type I thyroplasty exhibited long‐term alterations of cortical‐basal ganglia‐cerebellar networks thought to be important for self‐referential voice quality awareness and learning processes that compensate for changes to the paralyzed hemilarynx. This pilot study on relatively small cohorts adds to growing evidence for persistent central nervous system changes in treated UVFP. Replication studies with larger numbers of subjects will be essential to validate and extend findings. Level of Evidence 3b Laryngoscope, 130:460–464, 2020

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Vocal motor control and central auditory impairments in unilateral vocal fold paralysis

Cited by 18 publications

References 49 publications

Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

Auditory Feedback Control of Vocal Pitch in Spasmodic Dysphonia

Real‐time feedback control of voice in cochlear implant recipients

Cortical‐Basal Ganglia‐Cerebellar Networks in Unilateral Vocal Fold Paralysis: A Pilot Study

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