Van Stan Jarrad H, Ortiz Andrew J, Cortes Juan P, Marks Katherine L, Toles Laura E, Mehta Daryush D, Burns James A, Hron Tiffiny, Stadelman-Cohen Tara, Krusemark Carol, Muise Jason, Fox-Galalis Annie B, Nudelman Charles, Zeitels Steven, Hillman Robert E
Massachusetts General Hospital, Boston.
Harvard Medical School, Boston, MA.
J Speech Lang Hear Res. 2021 May 11;64(5):1457-1470. doi: 10.1044/2021_JSLHR-20-00538. Epub 2021 Apr 23.
Purpose The purpose of this study was to obtain a more comprehensive understanding of the pathophysiology and impact on daily voice use of nonphonotraumatic vocal hyperfunction (NPVH). Method An ambulatory voice monitor collected 1 week of data from 36 patients with NPVH and 36 vocally healthy matched controls. A subset of 11 patients with NPVH were monitored after voice therapy. Daily voice use measures included neck-skin acceleration magnitude, fundamental frequency ( ), cepstral peak prominence (CPP), and the difference between the first and second harmonic magnitudes (H1-H2). Additional comparisons included 118 patients with phonotraumatic vocal hyperfunction (PVH) and 89 additional vocally healthy controls. Results The NPVH group, compared to the matched control group, exhibited increased (Cohen's = 0.6), reduced CPP ( = -0.9), and less positive H1-H2 skewness ( = -1.1). Classifiers used CPP mean and H1-H2 mode to maximally differentiate the NPVH and matched control groups (area under the receiver operating characteristic curve of 0.78). Classifiers performed well on unseen data: the logit decreased in patients with NPVH after therapy; ≥ 85% of the control and PVH groups were identified as "normal" or "not NPVH," respectively. Conclusions The NPVH group's daily voice use is less periodic (CPP), is higher pitched ( ), and has less abrupt vocal fold closure (H1-H2 skew) compared to the matched control group. The combination of CPP mean and H1-H2 mode appears to reflect a pathophysiological continuum in NPVH patients of inefficient phonation with minimal potential for phonotrauma. Further validation of the classification model is needed to better understand potential clinical uses. Supplemental Material https://doi.org/10.23641/asha.14390771.
目的 本研究的目的是更全面地了解非发声创伤性嗓音功能亢进（NPVH）的病理生理学及其对日常嗓音使用的影响。方法 一个动态嗓音监测仪收集了36例NPVH患者和36例嗓音健康的匹配对照者1周的数据。11例NPVH患者在接受嗓音治疗后进行了监测。日常嗓音使用指标包括颈部皮肤加速度幅度、基频（ ）、谐波峰值突出度（CPP）以及第一和第二谐波幅度之差（H1-H2）。额外的比较包括118例发声创伤性嗓音功能亢进（PVH）患者和89例额外的嗓音健康对照者。结果 与匹配对照组相比，NPVH组表现出更高的 （科恩d = 0.6）、更低的CPP（ = -0.9）以及更小的正向H1-H2偏度（ = -1.1）。分类器使用CPP均值和H1-H2众数来最大程度地区分NPVH组和匹配对照组（受试者工作特征曲线下面积为0.78）。分类器在未见过的数据上表现良好：治疗后NPVH患者的逻辑回归值降低；对照组和PVH组中分别有≥85%被判定为“正常”或“非NPVH”。结论 与匹配对照组相比，NPVH组的日常嗓音使用周期性更低（CPP）、音调更高（ ）且声带闭合更不突然（H1-H2偏度）。CPP均值和H1-H2众数的组合似乎反映了NPVH患者发声效率低下且发声创伤可能性最小的病理生理连续体。需要对分类模型进行进一步验证，以更好地理解其潜在的临床用途。补充材料 https://doi.org/10.23641/asha.14390771 。
