声门上区肌肉张力在原发性肌肉紧张性发声障碍中的剪切波弹性成像研究。
Extrinsic Laryngeal Muscle Tension in Primary Muscle Tension Dysphonia with Shear Wave Elastography.
机构信息
Department of Otolaryngology-Head and Neck, Voice Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Speech, Language, and Hearing, School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, Texas, USA.
出版信息
Laryngoscope. 2023 Dec;133(12):3482-3491. doi: 10.1002/lary.30830. Epub 2023 Jun 19.
OBJECTIVES
It has been assumed that patients with primary muscle tension dysphonia (pMTD) have more extrinsic laryngeal muscle (ELM) tension, but tools to study this phenomenon lack. Shear wave elastography (SWE) is a potential method to address these shortcomings. The objectives of this study were to apply SWE to the ELMs, compare SWE measures to standard clinical metrics, and determine group differences in pMTD and typical voice users before and after vocal load.
METHODS
SWE measurements of the ELMs from ultrasound examinations of the anterior neck, supraglottic compression severities from laryngoscopic images, cepstral peak prominences (CPP) from voice recordings, and self-perceptual ratings of vocal effort and discomfort were obtained in voice users with (N = 30) and without (N = 35) pMTD, before and after a vocal load challenge.
RESULTS
ELM tension significantly increased from rest-to-voiced conditions in both groups. However, the groups were similar in their ELM stiffness levels at SWE at baseline, during vocalization, and post-vocal load. Levels of vocal effort and discomfort and supraglottic compression were significantly higher and CPP was significantly lower in the pMTD group. Vocal load had a significant effect on vocal effort and discomfort but not on laryngeal or acoustic patterns.
CONCLUSION
SWE can be used to quantify ELM tension with voicing. Although the pMTD group reported significantly higher levels of vocal effort and vocal tract discomfort and, on average, exhibited significantly more severe supraglottic compression and lower CPP values, there were no group differences in levels of ELM tension using SWE.
LEVEL OF EVIDENCE
2 Laryngoscope, 133:3482-3491, 2023.
目的
人们认为原发性肌肉紧张性发音障碍（pMTD）患者的外喉肌（ELM）张力更高，但缺乏研究这一现象的工具。剪切波弹性成像（SWE）是一种潜在的方法。本研究旨在将 SWE 应用于 ELM，比较 SWE 测量值与标准临床指标，并确定 pMTD 和典型嗓音使用者在发声负荷前后的组间差异。
方法
通过对颈前区的超声检查、喉镜图像上的声门上压缩严重程度、嗓音记录中的倒谱峰突出度（CPP）以及嗓音使用者对发声努力和不适的自我感知评分，获得了 pMTD 患者（N=30）和无 pMTD 患者（N=35）发声前和发声后的 SWE 测量值、ELM 张力、ELM 僵硬度、发声时和发声后的 SWE 测量值、发声时和发声后的 SWE 测量值。
结果
两组患者的 ELM 张力在休息到发声状态时均显著增加。然而，两组患者在 SWE 基线时、发声时和发声后负荷时的 ELM 僵硬度水平相似。pMTD 组的发声努力和不适程度以及声门上压缩程度显著较高，而 CPP 显著较低。发声负荷对发声努力和不适有显著影响，但对喉和声学模式没有影响。
结论
SWE 可用于量化发声时的 ELM 张力。尽管 pMTD 组报告的发声努力和发声道不适程度显著较高，平均声门上压缩程度显著较高，CPP 值显著较低，但使用 SWE 时，两组患者的 ELM 张力无差异。
证据水平
2 级喉镜检查，133：3482-3491，2023 年。
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