Division of Phoniatrics and Pediatric Audiology, ENT Clinic, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Division of Phoniatrics and Pediatric Audiology, ENT Clinic, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
J Voice. 2019 Nov;33(6):851-859. doi: 10.1016/j.jvoice.2018.07.001. Epub 2018 Aug 22.
The pitch-shift reflex (PSR) is the adaptation of the fundamental frequency during phonation and speech and describes the auditory feedback control. Speakers without voice and speech disorders mostly show a compensation of the pitch change in the auditory feedback and adapt their fundamental frequency to the opposite direction. Dysphonic patients often display problems with the auditory perception and control of their voice during therapy. Our study focuses on the auditory and kinesthetic control mechanisms of patients with muscle tension dysphonia (MTD) and speakers without voice and speech problems. Main purpose of the study is the analysis of the functionality of the control mechanisms within phonation and speech between patients with MTD and normal speakers.
Sixty-one healthy subjects (17 male, 44 female) and 22 patients with MTD (7 male, 15 female) participated following two paradigms including a sustained phonation (vowel /a/) and speech (['mama]). Within both paradigms the fundamental frequency of the auditory feedback was increased synthetically. For the analysis of the PSR the electroencephalogram, electroglottography, the voice signal, and the high-speed endoscopy data were recorded simultaneously. The PSR in the electroencephalogram was detected via the N100 and the mismatch negativity. Statistical tests were applied for the detection of the PSR in the physiological response within the electroglottography, voice, and high-speed endoscopy signals. The results were compared between both groups.
No differences were found between the controls and patients with MTD regarding latency and magnitude of the perception of the pitch shift in both paradigms, but for the magnitude of the behavioral response. Differences also could be found for both groups between the "no pitch" and "pitch" condition of the two paradigms regarding vocal fold dynamics and voice quality. Patients with MTD showed more vibrational irregularities during the PSR than the controls, especially regarding the symmetry of vocal fold dynamics.
Patients with MTD seem to have a disturbed interaction between the auditory and kinesthetic feedback inducing the execution of an overriding behavioral response.
音高移位反射（PSR）是发声和言语过程中基频的适应，描述了听觉反馈控制。没有嗓音和言语障碍的说话者在听觉反馈中大多能补偿音高变化，并使基频适应相反的方向。患有发声障碍的患者在治疗过程中经常会出现听觉感知和嗓音控制问题。我们的研究侧重于肌肉紧张性发声障碍（MTD）患者和无嗓音和言语问题的说话者的听觉和运动觉控制机制。本研究的主要目的是分析 MTD 患者和正常说话者在发声和言语过程中控制机制的功能。
61 名健康受试者（17 名男性，44 名女性）和 22 名 MTD 患者（7 名男性，15 名女性）参与了两个包括持续发声（元音/a/）和言语（['mama]）的实验范式。在这两个实验范式中，听觉反馈的基频都被合成地增加。为了分析 PSR，同时记录了脑电图、声门图、语音信号和高速内窥镜数据。通过 N100 和失匹配负波检测 PSR 在脑电图中的反应。应用统计检验检测声门图、语音和高速内窥镜信号中生理反应的 PSR。将两组结果进行比较。
在两种实验范式中，MTD 患者与健康对照者在感知音高变化的潜伏期和幅度方面没有差异，但在行为反应的幅度方面有差异。对于两种范式的“无音高”和“音高”条件，两组之间也可以发现声带动力学和语音质量的差异。MTD 患者在 PSR 期间的振动不规则性比对照组更明显，尤其是在声带动力学的对称性方面。
MTD 患者似乎存在听觉和运动觉反馈之间的交互紊乱，导致执行过度的行为反应。
