McDowell Sarah, Morrison Robert, Mau Ted, Shembel Adrianna C
School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas.
Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, Texas.
J Voice. 2025 Mar;39(2):448-456. doi: 10.1016/j.jvoice.2022.10.005. Epub 2022 Nov 3.
The objectives of this study were to (1) compare laryngeal configuration patterns in occupational voice users with and without primary muscle tension dysphonia (pMTD), (2) characterize laryngeal configurations in relation to other clinical metrics (acoustic, perceptual), and (3) determine the effects of vocal demands (load) on these clinical parameters.
Thirty subjects (15 pMTD, 15 control) were recruited for the study. Laryngoscopic examinations and voice samples for sustained /i/ were obtained before and after a half hour vocal load task. Subjects rated their vocal effort and discomfort before and after the vocal load. Laryngeal configurations were analyzed subjectively with dichotomous and categorical rating scales and hyper function severity quantified (endolaryngeal area outlets). Overall dysphonia severity and vocal instability of each voice sample was rated on 100mm visual analog scales and cepstral peak prominence (CPP) extracted from each voice sample.
Laryngeal configurations between groups or vocal load condition were not distinguishable with any of the dichotomous, categorical, or quantitative laryngeal metrics. Vocal effort and discomfort ratings were significantly higher in the pMTD group compared to the control group. Vocal load also had significant effects across groups on vocal effort and vocal tract discomfort ratings. Although CPP values fell within the normal range in both groups, CPP was significantly lower in the pMTD group at both pre-load and post-load time points. Auditory-perceptual ratings were also significantly worse in the pMTD group. Vocal load did not have a significant effect on acoustic or auditory-perceptual measures.
Similar laryngeal configurations between groups at both pre- and post-vocal load suggests classic patterns of laryngeal "hyperadduction" may occur variably in occupational voice users and may not be indicative of pMTD pathophysiology. Greater vocal effort, discomfort, instability, and perturbation within the vocal system may better define pMTD than laryngeal configuration in occupational voice users with pMTD.
本研究的目的是：（1）比较有和没有原发性肌肉紧张性发声障碍（pMTD）的职业用嗓者的喉部结构模式；（2）根据其他临床指标（声学、感知）描述喉部结构；（3）确定发声需求（负荷）对这些临床参数的影响。
招募30名受试者（15名pMTD患者，15名对照者）参与本研究。在半小时发声负荷任务前后，进行喉镜检查并采集持续发/i/音的语音样本。受试者在发声负荷前后对其发声努力程度和不适感进行评分。使用二分法和分类评分量表对喉部结构进行主观分析，并对喉功能亢进严重程度进行量化（喉内区域出口）。对每个语音样本的总体发声障碍严重程度和发声不稳定性在100毫米视觉模拟量表上进行评分，并从每个语音样本中提取谐波峰值突出度（CPP）。
在任何二分法、分类或定量喉部指标中，各组之间或发声负荷条件下的喉部结构均无明显差异。与对照组相比，pMTD组的发声努力程度和不适感评分显著更高。发声负荷对各组的发声努力程度和声道不适感评分也有显著影响。尽管两组的CPP值均在正常范围内，但在负荷前和负荷后时间点，pMTD组的CPP均显著更低。pMTD组的听觉感知评分也显著更差。发声负荷对声学或听觉感知指标没有显著影响。
发声负荷前后各组喉部结构相似，提示职业用嗓者中经典的喉部“过度内收”模式可能存在差异，可能并不指示pMTD的病理生理学。在患有pMTD的职业用嗓者中，发声系统内更大的发声努力、不适感、不稳定性和扰动可能比喉部结构更能明确pMTD。
