Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.
School of Behavioral and Brain Sciences, Department of Speech, Language, and Hearing, University of Texas at Dallas, Dallas, Texas, U.S.A.
Laryngoscope. 2023 Dec;133(12):3449-3454. doi: 10.1002/lary.30814. Epub 2023 Jun 14.
BACKGROUND/OBJECTIVES: False 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.
Laryngoscopic 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.
At 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.
A 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.
3 Laryngoscope, 133:3449-3454, 2023.
背景/目的：发声时假声带（FVF）过度活动被认为是原发性肌肉紧张性发声障碍（pMTD）的诊断标志。然而，在典型说话者中也观察到了具有发声功能的过度活动模式。本研究通过 FVF 姿势的曲率（FVF）来测试以下假设，即在安静呼吸期间，FVF 的姿势可以区分 pMTD 患者和典型说话者。
前瞻性收集 30 例 pMTD 患者和 33 例典型说话者的喉镜图像。在安静呼吸的呼气末和最大吸气时、持续发/i/时以及大声发声前和发声后 30 分钟发声负荷任务时采集图像。使用新的曲率指数（CI，>0 表示过度活动/凸面，<0 表示“放松”/凹面）量化 FVF 曲率（凹度/凸度），并比较两组之间的差异。
在呼气末，pMTD 组采用凸面 FVF 轮廓，而对照组采用凹面 FVF 轮廓（平均 CI 0.123 [SEM 0.046] 与 -0.093 [SEM 0.030]，p=0.0002）。在最大吸气时，pMTD 组的 FVF 轮廓为中性/直线，而对照组的 FVF 轮廓为凹面（平均 CI 0.012 [SEM 0.038] 与 -0.155 [SEM 0.018]，p=0.0002）。在持续发声或大声发声的条件下，两组 FVF 曲率均无统计学差异。发声负荷并没有改变这些关系。
在安静呼吸时，特别是呼气末，FVF 呈现过度活动的姿势可能比发声时的声门上收缩更能提示存在过度活动的嗓音障碍。
3 级喉镜 133：3449-3454，2023 年。
